Fewer anesthesiology residents applying to US pain medicine fellowships

By Hugo Francisco de SouzaReviewed by Danielle Ellis, B.Sc.Jan 28 2025

Applications have dropped 45% since 2019, raising concerns about future workforce shortages and patient care challenges

In a recent study published in Pain Practise, researchers analyzed data from publicly available reports to establish trends in pain medicine fellowship applications. Their findings from 2019 to 2023 revealed substantial declines in pain medicine applicants, suggesting that today’s anesthesiology trainees prefer general, potentially tenens offering or part-time employment over subspecialization.

The paper further elucidates significant gender disparities in pain medicine applications, with less than 1/3^rd of applicants identifying as female. Alarmingly, the discrepancy between the numbers of male and female applications continues to widen each year.

Background

Anesthesiology is the medical specialty involved in providing care to patients during the perioperative period. Pain is a subspeciality under the anesthesiology umbrella involved in short—or long-term follow-up with patients.

Unlike general anesthesiologists, pain medicine practitioners require considerable training in nerve agents, anti-inflammatory agents, and muscle relaxants, as well as knowledge of local regulations, laws, and accurate dosages to suppress patients’ pain without dependency or addiction risk.

The market demand for anesthesiologists has witnessed an unprecedented surge, particularly in the post-COVID-19 era. Driven by changing demographics, healthcare targeting an aging population, and advancements in medical (mainly surgical) procedures, opportunities for anesthesiologists have burgeoned, reflected by substantial increases in pay scales offered to professionals in recent years.

Unfortunately, colloquial reports, including the Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship programs report (2023), suggest an alarming trend – a large proportion of anesthesiologist residents are opting out of subspecialization fellowships (such as pain medicine) in favor of general practice, possibly due to a shift towards flexibility (part-time employment and flexible locum tenens offerings) in the field.

Study findings

The present study reveals several trends in pain medicine medical programs. Firstly, pain medicine programs witnessed an almost 50% decline in just five years—from 351 applicants in 2019 to just 193 applicants in 2023 (45%).

Notably, anesthesiology witnessed a 14.2% decline in applications over the same period (529 in 2019 to 446 in 2023), suggesting that fewer prospective doctors are applying to the field despite substantially higher pay grades than other medical professions.

Secondly, substantial gender and race/ethnicity disparities were observed in pain medicine applications – Most pain medical applicants were White (43% in 2019) and male (74.9% in 2019).

While racial disparities reduced over the five years under study (White applicants comprised 40% of all applications in 2023), gender disparities widened—only 21.3% of pain medicine applicants in 2023 were female. Female applications declined 27.5% over the five years under study compared to male applications (-9.8%).

Future outlook and conclusions

The year 2023 marked a turning point in pain medicine fellow recruitment – fewer medical fellows applied to pain medicine programs than in memorable history, resulting in an unprecedented number of unfilled programs and drawing the attention of academic faculty and program directors. 024 AAMC applicant data reveal no slowing of this decline, with only 410 applicants until April 14 (-8.1% reduction over 2023 and -21.2% over 2019).

Future research should unravel the drivers behind these declines and educate program directors and medical educators on the steps required to reverse these trends, lest society’s evolving healthcare needs remain unmet in years to come.