Some trained and certified anesthesiologists choose to apply their anesthesiology expertise in other professions, including as researchers, medical or pharmaceutical consultants, hospital administrators, and health technology experts. At the same time, practicing anesthesiologists may assume non-clinical responsibilities. In fact, some of these responsibilities may be increasing. This increase is a subject of active debate within the profession, and there are strong arguments in favor of and against anesthesiologists assuming non-clinical responsibilities.

One non-clinical role that appeals to some anesthesiologists is that of basic science researcher. Though it is hard to estimate what percentage of practicing anesthesiologists have experience with or are currently involved in basic research—which does not have an immediate or obvious medical application—many medical schools with anesthesiology labs host basic science research projects. Columbia University’s Department of Anesthesiology, for example, lists lung biology, neuroscience and pain, neurotoxicity, organ protection, and vascular biology among its basic science research areas.¹ By studying fundamental principles of biology in this capacity, anesthesiologists may be better suited to advance the field of anesthesiology. Compared with other physician-researchers, anesthesiologists may be especially well positioned to catalyze research advances because they have expertise in a wide range of medical areas.²

OR management may be one of the non-clinical responsibilities that anesthesiologists assume, which involves case scheduling, budget management, overseeing compliance with regulations, and optimizing for patient safety and outcomes.³ OR directors oversee these tasks and ensure that personnel, equipment, and supplies are available for all surgeries. One study showed that 52% of OR directors are anesthesiologists, and nearly all surveyed anesthesiologists reported that they believe anesthesiologists have the skills for the job.³ As medical generalists, anesthesiologists, according to many, should serve in OR management roles.

There are, however, strong arguments to be made against anesthesiologists taking on non-clinical responsibilities, which can typically be distilled to one primary concern: by doing so, anesthesiologists will inevitably have less time and attention for patients, contributing to an already dire anesthesiologist shortage and introducing risk for the surgeries they participate in.

As the population ages, there will be an even greater demand for anesthesiologists, yet the lack of graduate medical education and the aging and retiring workforce in the United States will only exacerbate this shortage, according to a study from last year.⁴ Additionally, the rates of anesthesiologist burnout have also been higher than historical levels ever since the Covid-19 pandemic.⁵ As such, some argue that anesthesiologists should prioritize their clinical work.

It has also been documented that the more patients that anesthesiologists must oversee simultaneously, the greater the risk of morbidity and mortality in those patients.⁶ This may suggest that anesthesiologists that juggle multiple responsibilities may be less capable to exercise their clinical duties to the highest degree, though this claim would need to be further investigated in separate studies. Given the compelling reasoning on both sides, it will be interesting to see how anesthesiologists approach this question in the coming years.

References

1. Basic Science Research Areas. Department of Anesthesiology https://www.anesthesiology.cuimc.columbia.edu/basic-science-research-areas (2017).
2. Griffiths, K. K., Gerber, A. & Whittington, R. A. The Anesthesiologist as Translational Scientist. J. Neurosurg. Anesthesiol. 34, 113–115 (2022), DOI: 10.1097/ANA.0000000000000807

3. Boggs, S. Anesthesiologists as Operating Room Directors: Results of a Survey. International Journal of Anesthetics and Anesthesiology. (2016), DOI: 10.23937/2377-4630/3/1/1041
4. Menezes, J. & Zahalka, C. Anesthesiologist shortage in the United States: A call for action. J. Med. Surg. Public Health 2, 100048 (2024), https://doi.org/10.1016/j.glmedi.2024.100048
5. Afonso, A. M., Cadwell, J. B., Staffa, S. J., Sinskey, J. L. & Vinson, A. E. U.S. Attending Anesthesiologist Burnout in the Post-Pandemic Era. Anesthesiology 140, 38–51 (2024), DOI: 10.1097/ALN.0000000000004784
6. Burns, M. L. et al. Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality. JAMA Surg. 157, 807–815 (2022), DOI:10.1001/jamasurg.2022.2804