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DP09: ANESTHESIA FELLOWSHIP IN THE POST-COVID ERA: NATIONAL TRENDS AND ACADEMIC IMPLICATIONS
Kendall M Jenkins, MD1; Kiana Foster, BS2; Cynthia Garvan, PhD1; Nikolaus Gravenstein, MD1; Emuejevoke Chuba, MD1
1University of Florida; 2FIU Herbert Wertheim College of Medicine
The recent COVID-19 pandemic significantly disrupted the anesthesiology workforce, leading to a reduction in clinical capacity, increased burnout, and interruptions in graduate medical education (1,2,3). These disruptions may have long term implications on the participation and interest in anesthesiology subspecialty training possibly leading to downstream effects on anesthesiology resident and fellow education.
This study analyzed data from the ACGME and NRMP databases from 2014 to 2024, focusing on trends in demographics and anesthesiology fellowship applications across anesthesia residency programs and anesthesia subspecialty programs in the pre-COVID-19 era (2014 - 2019) compared to the post-COVID-19 era (2019 - 2024). The relationship between two categorical variables was analyzed using chi-square tests. The relationship between two numeric variables was analyzed using Spearman correlation. Multiple regression modeling was used to examine the relationship between number of anesthesiologists and field (general anesthesia, pediatrics, and pain), year, and the interaction term of field by year. SAS software version 9.4 (Cary, NC) was used for all analyses. The level of significance was set at .05.
In the pre-COVID years, the correlations between year and both number of residents and number of programs were perfectly correlated (r = 1.0; p <.0001); post-COVID the correlation between year and number of programs dropped to .90 (p <.0001). The relative proportion of male and female fellows differed significantly in years examined (p < .0001) such that the proportion of female fellows dipped during peak COVID years and rebounded following COVID (% female 2014-2019 = 34.91%, 2020-2022 = 33.35%, 2023-2024 = 36.03%, Table I). The proportion of fellows in subspecialities changed significantly pre- to post-COVID (p <.0001) with a notable decrease in pediatric subspecialty decreasing from 20.94% pre-COVID to 16.85% post-COVID (Table II). In the multiple regression analysis, we found that field (p <.0001), year (p <.0001), and the year by field interaction term (p <.0001) were significantly related to total count; correlations differed between count and year by field (general anesthesia, r = .95; pain, r = .94, pediatrics, r = .66).
The tempered rise in enrollment in anesthesiology subspecialty programs such as critical care medicine and pain could possibly be explained by the enrollment of fellows from multiple different residency backgrounds (emergency medicine, neurology, physical medicine and rehabilitation, internal medicine and surgery) instead of solely anesthesiology. The decrease in enrollment for pediatrics indicates possible future workforce shortages, potentially leading to complications in patient care and disruption of education for future anesthesiologists interested in subspeciality training. Further research should be done to assess variables that could have influenced the change in anesthesiology fellowship trends within specific subspecialities and ways to mitigate these problems.
1. Abouleish AE, Pomerantz P, et al. Closing the Chasm: Understanding and Addressing the Anesthesia Workforce Supply and Demand Imbalance. Anesthesiology. 2024 Aug 1;141(2):238-249.
2. Afonso AM, Cadwell JB, et al. Burnout Rate and Risk Factors among Anesthesiologists in the US. Anesthesiology. 2021 May 1;134(5):683-696.
3. Rajan S, Bebawy J, et al. The Impact of the Global SARS-CoV-2 (COVID-19) Pandemic on Neuroanesthesiology Fellowship Programs Worldwide. J Neurosurg Anesthesiol. 2021 Jan;33(1):82-86.