Baby boom or bust … is 64 the new 57?

W E read with interest the article published in this issue of ANESTHESIOL-OGY by Orkin et al. 1 reporting on factors influencing retirement decisions by American anesthesiologists. The study employed a cross-sectional survey of anesthesiologists aged 50–79 yr, using a survey design to evaluate the decision matrix of retirement. Significant findings included: (1) retirement age has increased; (2) part-time work increased with age; and (3) modifiable factors such as health, professional satisfaction , and on-call responsibilities were drivers of retirement. The issues presented by Orkin et al. provide the framework for a broader discussion relating to the baby-boomer generation of anesthesiologists who are redefining the choice architecture of retirement. Since the devastating impact of inaccurate estimates on demand for anesthesia services by the Abt survey, ‡ which precipitated a shortage of anesthesiologists, our profession has made increasingly more sophisticated estimates of both the labor supply and demand for anesthesia services, as can be seen in the 2010 RAND Corporation's Technical Report: An Analysis of the Labor Markets for Anesthesiology § cited by Orkin et al. The proclamations based on the Abt survey have been a " lesson learned " about the limitations of any workforce survey and how the assumptions inherent to the model and their functional relationship to empirical reality can quickly lose relevancy. The rationale for the Orkin study was set in the context of a predicted shortage of anesthesiologists by RAND and a brief summary of RAND and how the landscape has changed has merit. The RAND study modeled a range of growth in demand for anesthesia services (proxied by the demand for surgery) from a baseline of 1.6–3% per year and predicted a nationwide shortage of anesthesiologists unless the rate of physicians entering the workforce exceeded their supply–demand break-even point of 2.76%. Table 1 summarizes selected factors that have changed, or are likely to change, since RAND was performed. It is reasonable to surmise that RAND, based on 2006–2007 data, may lack relevance in 2012 and that the precision of their projections may be suspect. This premise is supported by a number of " soft-signs " indicative of a constriction in the shortage of anesthesiologists (e.g., decreased demand for anesthesiologists by recruiting agencies), which may represent simple variation or are indeed precursors of a fundamental shift in the workforce. The matrix for retirement decisions is complex and dynamic, as evidenced by the seemingly innumerable theories attempting …