Table 2 Overview of anesthesiology fellows’ and direct-entry anesthesiologists’ perceived challenges to the practice of anesthesiology
Category | Brief definition of category | Count (%) of all responses (n = 1011) | Count (%) of Anesthesiology Fellows’ responses (n = 547) | Count (%) of Direct-Entry Anesthesiologists’ responses (n = 464) |
|---|---|---|---|---|
Theme 1: Workforce Competition and Challenges | 772 (76.4) | 439 (80.3) | 333 (71.8) | |
Competition from non-physician providers | Non-physician anesthesia providers (such as CRNAs or AAs) encroaching on job security | 536 (53.0) | 308 (56.3) | 228 (49.1)* |
External perception of anesthesiologist value | Lack of recognition of anesthesiologist importance and/or lack of advocacy for the profession | 335 (33.1) | 189 (34.6) | 146 (31.5) |
Apathy from anesthesiologist colleagues | Challenges related to other anesthesiologists; concerns relating to peer performance or attitudes | 44 (4.4) | 23 (4.2) | 21 (4.5) |
Role of anesthesiologists | Lack of defined anesthesiologist roles in the perioperative surgical home | 32 (3.2) | 19 (3.5) | 13 (2.8) |
Theme 2: Healthcare System Changes | 340 (33.6) | 164 (30.0) | 176 (37.9) | |
Compensation | Negative changes to reimbursement or payment models | 160 (15.8) | 81 (14.8) | 79 (17.0) |
Uncertainty of changes in the healthcare system | Uncertainty due to general or political changes to the overall healthcare system | 91 (9.0) | 47 (8.6) | 44 (9.5) |
Threats to patient care | Increase in patient acuity; insufficient resources to address patient needs; patient safety and production pressure | 85 (8.4) | 37 (6.8) | 48 (10.3) |
Corporationized management | Large anesthesia management corporations | 78 (7.7) | 33 (6.0) | 45 (9.7) |
Theme 3: Personal Challenges | 76 (7.5) | 35 (6.4) | 41 (8.8) | |
Psychological pressures | Psychological pressures including burnout, depression, and family-related pressures | 55 (5.4) | 24 (4.4) | 31 (6.7) |
Meeting the standards | Contention about ACGME standards, or ABA certifying exams | 22 (2.2) | 13 (2.4) | 9 (1.9) |