Can Community Hospitals Be the Saviors of Anesthesiology? ~ By Joseph F. Answine, MD, FASA

I was reading about a study out of University of Pittsburgh which was presented at Advance 2023 entitled “Additional anesthesiology residency positions may help hospitals save costs, address projected workforce shortages of anesthesia care professionals”.  The findings were impressive. The study showed that expanding residency positions at university hospitals can be cost-effective when compared to paying CRNAs overtime and locums rates. The savings are substantial even though the institutions have reached their cap for federal funding for residency positions.

The Accreditation Council for Graduate Medical Education (ACGME) may grant the extra positions, but we cannot forget that residents are not interchangeable with CRNAs. CRNAs have completed their education, however, the residents are trainees. Trainees require training. They require their own education.  

Many of the university-based training programs are pushing the limit for allowable resident work hours. Furthermore, they are commonly not making didactics mandatory for residents, I assume to avoid burnout.  I have witnessed personally and heard of after-hours journal clubs, guest speaker presentations, and local conferences with few or no residents in attendance. I hope that the chair of my department during residency, Dr. Julien Biebuyck, does not hear about this trend. I imagine he may feel compelled to come out of his much-deserved retirement at 90 to re-establish order.

The programs must have educators willing to spend quality time in the operating rooms (ORs) passing on their years of anesthesia wisdom. More residents mean more educators that also happen to be in short supply.

But is it possible that expanding the already maxed-out university programs is not the only answer? Many of us with careers beginning prior to the mid-1990s can remember the community-based training programs, both allopathic and osteopathic. When the dramatic lack of interest in anesthesiology as a specialty occurred at that time, most residency spots were left unfilled. The community programs closed having to rely on other models to keep their ORs running. The university programs survived with creative maneuvers such as putting interns in the ORs by combining the clinical base and CA1 years as well as increasing the CRNA workforce.

Due to the current overwhelming interest in anesthesiology, community-based programs are making a comeback. But many of the younger anesthesiologists are concerned with this trend. Can community hospitals train anesthesiologists as well as the universities can?

The answer is “yes” but the education is different as I will explain...

For additional reading, check out this article from the ASA Monitor