Friday, July 27, 2001

Anesthesiologists in short supply

Hospitals say some leave for more money

By Tim Bonfield
The Cincinnati Enquirer

        Children's Hospital Medical Center — the nation's second-busiest pediatric medical center — has closed two of its 16 operating rooms because the hospital can't hire enough anesthesiologists to staff them.

        Mercy Health Partners has resorted to hiring temporary specialists to keep up with growing surgery demand at its five Tristate hospitals.

[photo] Anesthesiologist Dr. Theodore Striker monitors Tyler Espinosa during a procedure at Children's Hospital. Resident Alex Stanziola assists.
(Glenn Hartong photo)
| ZOOM |
        Meanwhile, several groups of anesthesiologists report that their members are leaving town for better paying jobs elsewhere — all part of a national shortage of anesthesiologists plaguing hospitals since the mid-90s.

        If the problem continues, doctors say, Cincinnati will notice increased delays for elective surgery, more cutbacks at hospitals that lose operating-room income, and less access to top-quality doctors.

        “In the last three years, we have lost three young, excellent anesthesiologists who left town for Indianapolis, Milwaukee and Chicago, purely for economic reasons,” said Dr. Anthony Cionni, director of anesthesiology at Good Samaritan Hospital. “We're down to the point where we've had to shut down one room (of 18) on some days.”

        The median base salary of an anesthesiologist is $174,699 nationwide and the top half of earners are paid on average $251,000, according to national salary surveys.

        Operating rooms are key profit centers for hospitals. But if nobody can provide anesthesia, surgery can't happen.

        “People are feeling double-stressed. As (anesthesiologists) leave town, the people who stay are working harder for less,” Dr. Cionni said.

        Surgical cases that took two to four weeks to schedule last year are taking as long as six weeks to schedule now at Children's. Emergency cases are still being treated immediately, however.

        “This is a national problem. Every children's hospital in the country is looking for pediatric anesthesiologists,” said Dr. Theodore Striker, the hospital's director of anesthesiology.

        Children's doubled its nurse anesthetists from three to six and is pushing its 21 anesthesiologists to work longer hours, Dr. Striker said .

        The national problem stems from a 1994 report for the American Society of Anesthesiologists that predicted a possible oversupply of anesthesiologists.

        Medicare cut rates for anesthesia services, and many specialists-in-training opted for other fields. The number of anesthesiologists graduating from U.S. residency programs plummeted 87 percenteven though surgical procedures continued to grow.

        Now, as competition for anesthesiologists intensifies, Cincinnati's lower-than-average payment rates make it harder to recruit.

        “We're losing recruits to neighboring cities and states where reimbursement rates can be 30 percent to 50 percent higher,” Dr. John Davren, chief medical officer of Mercy Health Partners, which hasn't closed any operating rooms yet.

        “There are people in town who think this will be a crisis in a couple of years.” he said.

        Surgeons are already starting to voice concerns. At University Hospital — the area's top trauma center — a sudden gunshot wound or car crash wreaks havoc on OR schedules.

        “Not a night goes by lately without our people being up half the night dealing with a gunshot case,” said Dr. Phillip Bridenbaugh, chairman of UC's anesthesiology department. “Then we have surgeons coming to work thinking they can start their (elective) cases at 7:30 a.m. .. only to find out their cases have to wait.”

        And arguments are increasing over what constitutes an urgent case, said breast cancer surgeon Dr. Elizabeth Shaughnessy.

        “It has become more difficult to get patients into the OR,” she said, recounting how a woman diagnosed with an enlarged lymph node was initially not considered an emergency case. But this lymph node had grown big enough to threaten to cut off blood flow to an artery. It still took two days to find an OR, where surgery was then performed at 11:30 p.m., she said.


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