Anesthesia Workforce Supply and Demand Imbalance: Comment

To the Editor: We read with interest the recent article by Abouleish et al. discussing the anesthesia workforce supply-demand crisis.1 The authors did an admirable job highlighting much of the nature and severity of the issue, as well as potential solutions. We agree the imbalance between workforce supply and demand is a crisis requiring deliberate and proactive engagement to successfully navigate the challenges ahead and, while the article mentions the status of burnout and well-being within our workforce, we write to emphasize that addressing burnout and cultivating cultures of well-being are fundamental to fostering a sustained and optimally engaged workforce. It is foundational to all other solutions. Said clearly: we believe that a commitment to enhancing workforce well-being must be centrally integrated into every aspect of our path forward if we are to successfully arrive at a more enduring pairing of workforce supply and demand. At this moment, burnout is epidemic in the anesthesiology community2 and its consequences are profound. In the postpandemic era, multiple datasets demonstrate a striking intention to leave as well as marked strain attributed to staffing shortages, setting up a difficult challenge on the horizon. Indeed, recent data reveal that greater than 45% of academic anesthesiologists express a moderate-to-high intention to leave their current institution within two years,3 the highest measurable intent to leave among all academic physician specialties in medicine.3 While we applaud that this important data was cited by Abouleish et al., we want to emphasize that this data is perhaps best seen through a lens of burnout and dissatisfaction: in this impressive study from Ligibel et al.,3 burnout and lack of professional fulfillment were among the factors most associated with intention to leave. Similarly, in the most recent study of U.S. Attending Anesthesiologist American Society of Anesthesiologists (ASA; Schaumburg, Illinois) members, intention to leave was positively associated with burnout. Among those identified as being at high risk for burnout, more than two-thirds of respondents expressed a high to very high likelihood of leaving their current practice within two years.2 Successfully navigating the workforce imbalance will require seeing investments in well-being as fundamental investments in both the sustainability and engagement of the workforce. Put simply, we need to create workplace cultures where anesthesiologists want to stay. As we look to increase efficiency and productivity and maintain the quality of care we provide, neglecting to center healthcare professional experience and sustainability may impede durable progress. Inherent in the present crisis is the fact that our healthcare professionals are a precious, limited, and strained resource. Centering our healthcare professionals’ career sustainability in the problem-solving process may align incentives in a powerful way, unlocking potential virtuous cycle momentum and yielding progress across necessary practice solutions to address the supply-demand imbalance. In summary, prioritizing well-being improvement and burnout reduction as guiding principles is essential to ensuring a stable future. This can primarily be achieved by improving our systems to be more aligned with the needs and values of us as healthcare professionals within anesthesiology striving to do our best (see table 1 for future directions). By embracing this ethos, we can cultivate cultures of well-being, support, and belonging within anesthesiology and build a compassionate workforce better aligned with our systems and more responsive to the needs of the patients we serve. Indeed, this is the driving focus of the ASA’s Committee on Physician Well-Being, of which all authors are affiliated. Consequently, our workforce will become more resilient to future challenges and better protected against factors that threaten our engagement and retention, ultimately improving the supply-demand balance in favor of all stakeholders, including anesthesiologists, patients, and healthcare systems. Table 1. - Future Directions Domain* Example Future Directions and Opportunities Develop positive work and learning environments and culture Prioritize cultivating and developing those cultural factors known to attenuate burnout:Wellness-centered leadership,5 perceived social support, shared decision making, perceptions of belonging, work-schedule flexibility and predictability,2 and other influencers of professional fulfillment and career sustainability Promote cultures that intrinsically understand that as job demands increase, we must introduce system-based resource categories that have been proven to offset burnout6 Prioritize and promote human-centered design, involving experts in this problem-solving technique, to address issues such as workforce imbalances Support mental health and reduce stigma Develop standards for peer support in anesthesiology and resource them for success (e.g., centralized process for training people to be effective peer supporters within anesthesiology) Build bridges to mental healthcare that align with the busy work lives of anesthesia personnel Continue to develop the work the ASA Committee on Physician Well-Being is doing in this realm (e.g., project SafeHaven access, focus on suicide prevention, and more). Invest in the development and deployment of rigorous perioperative well-being measurement and assessment strategies Develop perioperative medicine-specific assessment tools on professional fulfillment allowing tracking of provider fulfillment along with change initiatives Recruit and retain a diverse and inclusive workforce Foster a sense of belonging for all: continue to develop mentorship programs and support affinity groups to support enhancing the sense of inclusion for a diverse workforce Encourage the local development of workplace support systems that foster supportive, inclusive, and respectful team cultures for everyone. Address compliance, regulatory, and policy barriers for daily work Advocate for continued progress with medical licensing boards to support physicians who seek mental health care or substance-use rehabilitation Engage effective technology tools Leverage AI and machine learning to enhance departments’ ability to provide work-scheduling flexibility and predictability Institutionalize well-being as a long-term value Continue to advance the ASA Committee on Physician Well-Being and integrate its efforts across critical ASA missions. Champion and facilitate all departments developing local well-being improvement science expertise Champion professional development opportunities to support the arrival of wellness-centered leaders across anesthesiology5 *Domains adapted from the 7 Priority Areas in the National Academy of Medicine’s National Plan for Health Workforce Well-Being4.ASA, American Society of Anesthesiologists Competing Interests The authors declare no competing interests.