Original article
Vol. 151 No. 3334 (2021)
Physician anaesthesia providers in Switzerland today and tomorrow: results of the National Anaesthesia Workforce Study (NAWOS)
- Guy Haller
- Christoph Heim
- Kaspar Meier
- Nicola Clerici
- Christophe Combescure
- Michael T. Ganter
- Jürg Schliessbach
- Christoph Kindler
- Urs Eichenberger
- Christian Kern
Summary
AIMS OF THE STUDY: The Swiss healthcare system is highly ranked, given its unrestricted access to specialised care and short waiting lists for surgery. However, the need for anaesthetic and surgical care is escalating owing to the increasing size and ageing of the Swiss population. In addition, to address the persistent and recurrent SARS-CoV-2 pandemic crisis, the speciality of anaesthesia is under tremendous pressure to maintain an effective workforce in order to address population needs. The current number, characteristics and future evolution of the physician anaesthesia workforce in Switzerland are currently unknown. The purpose of this study was to assess the size and professional and sociodemographic characteristics of the current anaesthesia workforce in Switzerland and to forecast its development up to 2034.
METHODS: We performed a cross-sectional study using a 150-item questionnaire prepared by the National Anaesthesia Workforce Study Group (NAWOS). We included all physicians (trainees and certified) practising anaesthesia in Switzerland. We collected demographic and professional information, such as the current position, hospital characteristics, workload, number of shifts and future life plans. We built a computer-based Markov model with Monte Carlo simulations to project both supply and demand for physician anaesthesia provider positions.
RESULTS: Of the 2661 distributed questionnaires, 1985 (74.2%) were completed and returned. We found that the average age of anaesthesiologists practising in Switzerland was 45.2 years, with 44.3% of them being women and 76.9% holding a Swiss specialist title. Only 59.6% of respondents worked full time. The forecasting model showed a steady increase in the number of anaesthesiologists retiring by 2034, with 27% of full-time equivalent jobs being lost in the next 8 years. Even if existing full-time equivalent training positions are all filled, a gradual deficit of anaesthesiologists is to be expected after 2022, and the deficit should culminate in 2034 with a deficit ratio of 0.87.
CONCLUSIONS: Due to the upcoming high retirement rate of anaesthesiologists, Switzerland is likely to face a shortage of anaesthesiologists in the near future. To compensate for the shortage, the country will likely increase its reliance on medical staff trained abroad. Southern and eastern cantons of Switzerland are particularly at risk, given that they already heavily rely on foreign anaesthesia workforce. This reliance should be considered a national priority because anaesthesiologists are heavily involved in both the treatment of patients with respiratory complications of SARS-CoV2 infection and the care of surgical patients, the number of which is expected to rise steadily in upcoming years.
References
- GBD 2015 Healthcare Access and Quality Collaborators. Electronic address: cjlm@uw.edu GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet. 2017 Jul;390(10091):231–66. https://doi.org/10.1016/S0140-6736(17)30818-8
- Björnberg A, Yung Phang A. Euro Health Consumer Index 2018. Available at https://healthpowerhouse.com/publications/#200118 Accessed 2 February 2020).
- Agency for Healthcare Research and Quality R. MD. Elements of Access to Health Care 2018 [cited December 2019]. Available from: https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/access/elements.html
- De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, et al. Switzerland: Health System Review. Health Syst Transit. 2015;17(4):1-288, xix. Epub 2016/01/15. PubMed PMID: 26766626
- Hübner M, Zingg T, Martin D, Eckert P, Demartines N. Surgery for non-Covid-19 patients during the pandemic. PLoS One. 2020 Oct;15(10):e0241331. https://doi.org/10.1371/journal.pone.0241331
- Office fédéral de la statistique. Bilan de la population résidante permanente, 1861-2018. Available at https://www.bfs.admin.ch/bfs/fr/home/statistiques/population/effectifevolution.assetdetail.9486047.html Accessed 12 February 2020
- Office fédéral de la statistique. Les scénarios de l’évolution de la population de la Suisse 2015–2045. Available at https://www.bfs.admin.ch/bfs/fr/home/statistiques/catalogues-banques-donnees/publications.assetdetail.350327.html Accessed 12 February 2020
- Hänsgen K.-D., Spicher B. Numerus clausus: le «test d’aptitudes pour les études de médecine» (AMS) permet-il de trouver les personnes les plus aptes? Bulletin des médecins suisses 2002;83: Nr 47
- Fédération des médecins suisse.Statistique Médicale de la FMH.Enquête sur la démographie médicale dans les établissements de formation IFSM. Mai 2018. Available at https://www.fmh.ch/fr/prestations/statistique/indicateurs.cfm Accessed 5 January 2020
- Fédération des médecins suisse.Statistique Médicale de la FMH. Outil de recherche interactif. Available at https://aerztestatistik.myfmh2.fmh.ch/ Accessed 5 January 2020
- Kerr EA, Hays RD, Mittman BS, Siu AL, Leake B, Brook RH. Primary care physicians’ satisfaction with quality of care in California capitated medical groups. JAMA. 1997 Jul;278(4):308–12. https://doi.org/10.1001/jama.1997.03550040064039
- Maslach C, Jackson SE. The Measurement of Experienced Burnout. J Occup Behav. 1981;2(2):99-113. http://doi: DOI https://doi.org/10.1002/job.4030020205
- McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, et al.; SGIM Career Satisfaction Study Group. Physician job satisfaction : developing a model using qualitative data. J Gen Intern Med. 1997 Nov;12(11):711–4. https://doi.org/10.1046/j.1525-1497.1997.07145.x
- Roberfroid D, Leonard C, Stordeur S. Physician supply forecast: better than peering in a crystal ball? Hum Resour Health. 2009;7:10. Epub 2009/02/17. http://doi: https://doi.org/1478-4491-7-10 [pii]https://doi.org/10.1186/1478-4491-7-10
- European Commission. EU level Collaboration on Forecasting Health Workforce Needs, Workforce Planning and Health Workforce Trends – A Feasibility Study. http://ec.europa.eu/health/workforce/key_documents/study_2012/index_en.htm
- Deal CL, Hooker R, Harrington T, Birnbaum N, Hogan P, Bouchery E, et al. The United States rheumatology workforce: supply and demand, 2005-2025. Arthritis Rheum. 2007 Mar;56(3):722–9. https://doi.org/10.1002/art.22437
- Lagarde M, Cairns J. Modelling human resources policies with Markov models: an illustration with the South African nursing labour market. Health Care Manage Sci. 2012 Sep;15(3):270–82. https://doi.org/10.1007/s10729-011-9184-5
- Jovic E, Wallace JE, Lemaire J. The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians. BMC Health Serv Res. 2006 May;6(1):55. https://doi.org/10.1186/1472-6963-6-55
- Sheahan P. Generation Y: thriving and surviving with Generation Y at work Grant H, editor. Prahran, Victoria: Hardy Grant; 2005. 274 p.
- Mamie C, Clergue F, Zocatelli D, Haller G. Swiss healthcare cost containment policies and their impact on anaesthetists’ density and satisfaction. Swiss Med Wkly. 2011 Oct;141:w13251. https://doi.org/10.4414/smw.2011.13251
- Kempthorne P, Morriss WW, Mellin-Olsen J, Gore-Booth J. The WFSA Global Anesthesia Workforce Survey. Anesth Analg. 2017 Sep;125(3):981–90. https://doi.org/10.1213/ANE.0000000000002258
- US bureau of labor statistics. Nurse anaesthetists, nurse midwives, and nurse practitionners. Available at https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm. Accessed 20 February 2021.
- Meeusen V, van Zundert A, Hoekman J, Kumar C, Rawal N, Knape H. Composition of the anaesthesia team: a European survey. Eur J Anaesthesiol. 2010 Sep;27(9):773–9. https://doi.org/10.1097/EJA.0b013e32833d925b
- Vonlanthen R, Lodge P, Barkun JS, Farges O, Rogiers X, Soreide K, et al. Toward a Consensus on Centralization in Surgery. Ann Surg. 2018 Nov;268(5):712–24. https://doi.org/10.1097/SLA.0000000000002965
- Cheneval F, Ferrin M. Switzerland: A Future Model for the EuropeanUnion? Similarities and Differences. 2017. Brussel.European commission https://doi.org/https://doi.org/10.5167/uzh-136069
- Mullan F. The metrics of the physician brain drain. N Engl J Med.2005;353(17):1810-8. Epub 2005/10/28.http://doi: https://doi.org/353/17/1810 [pii]https://doi.org/10.1056/NEJMsa050004. PubMed PMID: 16251537.
- International Organization for Migration. Managing Labour Mobility in the Evolving Global Economy.Geneva; 2008
- Buchan J. How can the migration of health professionals be managed so as to reduce any negative effects on supply.Policy Brief Series World Health Organization 2008 and World Health Organization, on behalf of the European Observatory on Health Systems and Policies 2008 Available at https://www.euro.who.int/data/assets/pdf_file/0006/75453/E93414.pdf
- Kirigia JM, Gbary AR, Muthuri LK, Nyoni J, Seddoh A. The cost of health professionals' brain drain in Kenya. BMC Health Serv Res. 2006;6:89. Epub 2006/07/19. http://doi: https://doi.org/1472-6963-6-89 [pii]https://doi.org/10.1186/1472-6963-6-89
- Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011 Nov;343 nov23 3:d7031. https://doi.org/10.1136/bmj.d7031
- Cohen JJ. Our compact with tomorrow’s doctors. Acad Med. 2002 Jun;77(6):475–80. https://doi.org/10.1097/00001888-200206000-00002
- Waurick R, Weber T, Bröking K, Van Aken H. The European Working Time Directive: effect on education and clinical care. Curr Opin Anaesthesiol. 2007 Dec;20(6):576–9. https://doi.org/10.1097/ACO.0b013e3282f0ef6100001503-200712000-00016 https://doi.org/10.1097/ACO.0b013e3282f0ef61
- Clergue F. Time to consider nonphysician anaesthesia providers in Europe? Eur J Anaesthesiol. 2010 Sep;27(9):761–2. https://doi.org/10.1097/EJA.0b013e32833c1bb3
- Lange M, Prien T, Brussel T, Van Aken H. The anaesthetist makes a difference: the bottom line matters! Eur J Anaesthesiol. 2011;28(4):306; author reply -7. Epub 2010/11/23.http://doi: https://doi.org/10.1097/EJA.0b013e3283414cd2.
- World Health Organization on behalf of the European Observatory on Health Systems and Policies. Health Professional Mobility and Health Systems.Evidence from 17 European countries Edited by Wismar M, Maier C, Glinos I, Dussault G, Figueras J. Copenhagen: WHO 2011. https://www.euro.who.int/__data/assets/pdf_file/0017/152324/Health-Professional-Mobility-Health-Systems.pdf
- Bloor K, Maynard A. The productivity of health care. Health Econ. 2006 Dec;15(12):1257–9. https://doi.org/10.1002/hec.1183
- Organisation for Economic Co-Operation and Development. OECD Health Data 2017. Available at http://www.oecd-ilibrary.org/. Accessed 5 January 2020
- Goodman DC, Fisher ES, Little GA, Stukel TA, Chang CH. Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns. Pediatrics. 2001 Aug;108(2):426–31. https://doi.org/10.1542/peds.108.2.426
- Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals [pii]. N Engl J Med. 2002 May;346(22):1715–22. https://doi.org/10.1056/NEJMsa012247346/22/1715 https://doi.org/10.1056/NEJMsa012247
- Bixenstine PJ, Shore AD, Mehtsun WT, Ibrahim AM, Freischlag JA, Makary MA. Catastrophic medical malpractice payouts in the United States. J Healthc Qual. 2014 Jul-Aug;36(4):43–53. https://doi.org/10.1111/jhq.12011
- Campbell G, Rollin AM, Smith AF. Cases relating to anaesthetists handled by the UK General Medical Council in 2009: methodological approach and patterns of referral. Anaesthesia. 2013 May;68(5):453–60. https://doi.org/10.1111/anae.12117
- Staender S, Schaer H, Clergue F, Gerber H, Pasch T, Skarvan K, et al. A Swiss anaesthesiology closed claims analysis: report of events in the years 1987-2008. Eur J Anaesthesiol. 2011 Feb;28(2):85–91. https://doi.org/10.1097/EJA.0b013e3283414fea