Job shortages in anesthesia: a pro or con?
Over the last 30 years, cyclical changes have occurred in Canada with respect to matching the number of graduate residents to the number of available staff anesthesiologist positions. Despite previous models and predictions to the contrary, the current landscape appears to be one of 'job market' restriction. While this is a major and immediate problem for graduates, as well as for training programs, there are important potential impacts positive and negative on the profession. In this editorial perspective, we briefly review the key problems resulting from this mismatch but also explore some potentially important benefits. Although many of the principles in this discussion may relate to the profession in any province (or country) our perspective primarily concerns the work of anesthesiologists in Ontario. Health human resource planning is difficult because it requires accurate forecasts of supply and demand in health economics using factors that are constantly evolving. On the supply side, the key elements are the stock (i.e. the count of available qualified physicians) and its flow (i.e. the additions to, and the losses from, the stock) In addition, evolution in practice (e.g. development of the anesthesia care team, more efficient approaches to care, change in the required ratio of anesthesiologists to operating rooms) may mean that fewer specialists are needed to provide equivalent care for a given patient population. The demand side may also be difficult to predict because of the influence of economic, legislative, and competitive pressures, as well as population changes (e.g. aging, chronic illnesses) or changing expectations of care (e.g. shorter wait times or enhanced access to care) A reduction in healthcare spending, such as during economic restraint, can bear a semblance to apparent lower demand and clinician surplus.
Canadian Journal of Anesthesia/Journal canadien d'anesthesie