Anesthesiologist age and workforce geography during the United States COVID-19 pandemic

Coronavirus, herein referred to as COVID-19, has emerged as a global pandemic of unprecedented scale. While the virus has infected populations of all demographics, studies from several nations have indicated a strong relationship between increasing age and poor disease prognosis [1]. The Centers for Disease Control and Prevention has recently published data indicating the heightened risk experienced by healthcare workers. As of April 9, 2020, of the 49,370 cases with complete data pertaining to occupation, 19% were healthcare personnel [2].

Given the need for advanced airway management, sedation, and hemodynamic management for acutely ill COVID-19 patients, anesthesiologists are among the frontline healthcare workforce managing the present crisis [3]. Since many aerosol-generating procedures (AGPs) such as airway suction, bronchoscopy, and endotracheal intubation have been shown to increase the risk of nosocomial transmission, a host of safety guidelines have been proposed regarding workforce management, protective equipment, and triage.

Following the initial peak of the pandemic, the recent reopening of elective surgery in may place the anesthesiology workforce at increased risk in the coming months. Caution should be exercised among practices assuming normal operations, particularly for personnel with advanced age or comorbidities increasing their susceptibility to the virus. While several studies have explored the geography of such risks among various members of the healthcare workforce, to date no state has analyzed the age-related COVID-19 risk among practicing anesthesiologists across the United States (U.S.) [4]. The present study aimed to describe the geographic distribution of active anesthesiologists above the age of 60, in comparison to the cumulative distribution of COVID-19 cases, in order to further inform safety guidelines and workforce planning throughout the duration of the pandemic.

Using the State Physician Workforce Reports by the American Association of Medical Colleges (AAMC), the number and percentage of anesthesiologists above the age of 60 were extracted for each U.S. state [5]. COVID-19 coordinate data (as of July 20, 2020) were obtained from the Environmental Systems Research Institute and merged with the state-level demographics using the QGIS geospatial mapping software (version 3.12.1). States were grouped into color-coordinated quintiles, based on their relative proportion of anesthesiologists above 60 years old. Confirmed COVID-19 case volumes were adjusted using a logarithmic scale to make proportionally sized data points for each coordinate with a confirmed case. Due to the use of publicly available deidentified information, this study was considered IRB exempt by the Case Western Reserve University Institutional Review Board.

There were 41,715 practicing anesthesiologists in 2018, 15,139 (36.8%) of which were older than 60 years old [5]. The proportion of older anesthesiologists ranged from 45.9% in New Mexico to 26.3% in North Dakota. The states considered to have been at highest risk for older anesthesiologists, as defined by highest volumes of COVID-19 cases per older anesthesiologists as an index for case burden seen by an anesthesiologist, were Mississippi, Louisiana, Idaho, Arizona, and South Carolina The states with the lowest ratio of confirmed cases to older anesthesiologists were Hawaii, Vermont, Maine, Montana, and Oregon (Fig. 1 ).

Fig. 1.

Geographic distribution of older anesthesiologists and COVID-19 confirmed case numbers.

The present geospatial analysis highlights that certain states with prolific COVID-19 case volumes may overlap with states where nearly third of the anesthesiologist workforce is over the age of 60. These states, including but not limited to Mississippi, Louisiana, Idaho, Arizona, and South Carolina, should proceed with reopening protocol with caution and engage in workforce planning and management discussions anticipating a potential second wave of the pandemic. Given the massive revenue losses and increased costs associated with the pandemic, the economic pressure to resume elective surgeries has been building and, while valid, should be contextualized with the health and safety of the anesthesiologist workforce, among other factors.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

None.