Full text of DOI:10.1007/BF03017442

GENERAL ANESTHESIA
663
A physician workforce planning model applied to
Canadian anesthesiology: assessment of needs
[Un modèle de planification des effectifs médicaux appliqué à l’anesthésiologie
canadienne : évaluation des besoins]
Robert J. Byrick MD FRCPC,* Douglas Craig MD FRCPC,† Franco Carli MD MPHIL FRCA‡
Purpose: A human resource planning model for anesthesiology is
described.
services d’anesthésie est calculée comme le produit des dépenses “par
habitant” et des projections de population à une date ultérieure. La
demande future a été convertie en dispensateurs nécessaires en
équivalent temps plein (ETP) en divisant par les “unités de service”
annuelles fournies de façon optimale par l’ETP d’un anesthésiologiste.
Le modèle de consommation de services d’anesthésie selon l’âge/le
sexe (données démographiques) au Québec a été comparé aux don-
nées provenant d’Ontario afin de valider son utilisation dans un mo-
dèle de planification. Le modèle a été ensuite appliqué à toutes les
provinces et territoires.
Résultats : Les dépenses “par habitant” des services d’anesthésie au
Québec et en Ontario affichent une forme régulière. Avec ce modèle,
la demande d’anesthésiologistes en ETP au Québec est estimée à 546
pour 1999 et à 669 pour 2016. Quand nous ajoutons les demandes
non cliniques, nous estimons que la demande totale du Québec va
augmenter à 730 ETP environ en 2016. Des estimations semblables
ont été faites pour toutes les provinces. L’accroissement de la popula-
tion prévu est de 17,9 %, mais celui de la demande en ETP au
Canada est de 30,9 %.
Methods: The model uses ‘per capita’ expenditure for anesthesi-
ologists in Quebec, as a measure of clinical services provided to dif-
ferent age/gender groups. The future demand for anesthesia
services is calculated as the product of ‘per capita’ expenditure and
the population projections to a future date. Future demand was
converted into full-time equivalent (FTE) providers required, by
dividing by the annual ‘units of service’ optimally delivered by one
FTE anesthesiologist. The pattern of age/gender (demographic)
consumption of anesthesia services in Quebec was compared with
data from Ontario to validate its use in a planning model. The
model was then applied to all provinces and territories.
Results: The ‘per capita’ expenditures on anesthesia services in
Quebec and Ontario showed a regular pattern. Using the model,
the estimated 1999 demand for FTE anesthesiologists to provide
clinical services in Quebec is 546 and 669 for 2016. When non-
clinical demands were included, we estimated that Quebec’s total
demand will increase to approximately 730 FTEs in 2016. Similar
estimates are made for all provinces. The population increase antic-
ipated is 17.9% but the increase in FTE demand in Canada is
30.9%.
Conclusion : Le modèle a montré que la cause de l’augmentation
de la demande en ETP pour les anesthésiologistes est une combinai-
son de l’accroissement de la population et de sa composition démo-
graphique. L’impact relatif de chacun de ces facteurs varie d’une
province à l’autre. Les modèles de planification efficaces, spécifiques à
une spécialité, peuvent être élaborés, mais exigent l’utilisation maxi-
male de ressources permanentes et de personnes engagées.
Conclusion: The model showed that the cause of the increased
FTE demand for anesthesiologists is a combination of increased pop-
ulation and its demographic composition. The relative impact of each
of these factors varies in different provinces. Effective specialty-specif-
ic planning models can be designed but they need ongoing commit-
ted resources and personnel for their usefulness to be maximized.
URING the last decade several western
countries, including Canada, reported
shortages of physicians delivering anesthe-
Objectif : Décrire un modèle de planification des ressources
humaines pour l’anesthésiologie.
Méthode : Le modèle utilise les dépenses “par habitant” pour les
anesthésiologistes du Québec comme mesure des services cliniques
fournis aux groupes d’âge et de sexe différents. La demande de futurs
sia services.1–3 In Canada, the shortage has
D
been addressed both nationally and provincially on an ad
hoc, interim basis. The Association of Canadian
From the Departments of Anaesthesia, University of Toronto,* University of Manitoba,† and McGill University‡
Address correspondence to: Dr. Robert J. Byrick, Department of Anaesthesia, University of Toronto, Room 132, FitzGerald Building,
150 College Street, Toronto, Ontario M5S 3E2, Canada. Phone: 416-978-4306; Fax: 416-978-2408; E-mail: robert.byrick@utoronto.ca
Accepted for publication March 28, 2002.
Revision accepted May 30, 2002.
CAN J ANESTH 2002 / 49: 7 / pp 663–670

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CANADIAN JOURNAL OF ANESTHESIA
University Departments of Anesthesia (ACUDA) com-
missioned a study to assess future requirements, with suf-
ficient lead-time to adopt policies directed towards
ensuring an adequate future supply of anesthesiologists.A
This report is the first of two publications derived
from the comprehensive human resource planning
(HRP) model designed specifically for the specialty of
anesthesia.4 This HRP model uses an innovative
methodology that includes a means of quantifying the
‘units of service’ delivered. The full report is available at
the ACUDA website (http://www.anesthesia.org
/acuda/en/ryten.html). Unlike other HRP mod-
els,1–3,5 this methodology includes population demo-
graphics (e.g., age and gender) in the calculation of the
required number of full-time equivalent (FTE) anesthe-
siologists. It is widely recognized that consumption of
health care resources varies with patient age and gender,
yet, most planning models do not include the influence
of these factors in quantifying the future demand for
anesthesia providers.1,3,5
performed it and demographic data on the patient to
whom the service was delivered. It is the inclusion of
the patient demography along with the other infor-
mation that makes RAMQ a valuable data source for
health services research. The RAMQ research depart-
ment prepared statistics under contract to describe
what services anesthesiologists provide, billings for
these services and the demographic characteristics of
the patients served. These data covered all anesthesia
services delivered over an entire year (1998–99). All
services were included even if non-anesthesiologists
delivered them. From the database, members of the
Association des Anesthésiologistes du Québec (AAQ)
classified more than 2,000 anesthesia services into
analytically useful groupings. The classification was
designed to enable a detailed measurement of the
work of anesthesiologists and thus, distinguish
between the surgical and non-surgical activities. This
permitted an analysis of changing rates of utilization
for specific services. Total expenditures on these anes-
thesia services for patients in each of 18 age/gender
categories were used as a proxy for the ‘units of ser-
vice’ provided for each group. The validity of using
dollar values as a measure of ‘units of service’ is only
possible if the time spent in providing equivalent ser-
vices is comparable. Because time is an essential ele-
ment of the “resources” used for anesthesia billings,
this seemed warranted.
The HRP model was based on an analysis of billing
data from Quebec, which was used to estimate the
‘per capita’ consumption of anesthesia services by each
demographic group. In this article, we provide an
overview of the model and use data derived from the
report4 to illustrate its use to estimate the future
demand for anesthesiologists in each province.
Methods
Rationale and description of model
Statistics Canada provided population estimates for
each province. These population estimates projected
the age and gender (demographic) characteristics of the
population for 2016. The Statistics Canada projectionsB
assumed general rates of immigration, emigration,
internal migration between provinces, birth and death.
These projections included four potential population
scenarios for each province: a low, medium and two
high growth scenarios. Analyses based on all projections
are available in the full report,4 however in this article,
we detail only one growth scenario for the year 2016
(termed the “high 2” projection in full report). This
scenario was chosen as it seems representative of rea-
sonable growth-rate projection, although all projections
may be unreasonably low. Interested readers are
referred to the full report for other scenario options.4
The underlying rationale for this HRP model, devel-
oped by E. Ryten,4 differs from general physician
workforce models in that the variables included specif-
ically deal with the demand for health care services
delivered almost exclusively by anesthesiologists. The
model consists of two major segments, one that calcu-
lates the future demand for anesthesia services and
another that anticipates future supply under a variety
of conditions. This article deals with segment 1, the
future demand for anesthesia services in Canada.
Data sources
The billing agency of the province of Quebec, the
Régie de l’assurance maladie du Québec, (RAMQ)
maintains a data system that records all acts/health
care services for which a fee is paid. The record
includes the specific medical act that was performed,
the dollar value paid for the act, the physician who
Validation of the model
Comprehensive billing data were also obtained from
the database of the Ontario Health Insurance Plan
A
Anesthesiologist refers to a physician who has Royal
B
College of Physicians and Surgeons of Canada (RCPSC) certifi-
cation in anesthesiology or is recognized as a specialist in
his/her own province.
Statistics Canada. Estimates: vital statistics and popu-
lation estimates, demography division. Projections: population
projections section, demography division, September 1999.

Byrick et al.: PLANNING THE ANESTHESIA WORKFORCE
665
(OHIP) through the assistance of the Ontario
Medical Association. The analysis of OHIP billing
data (1998–99) was undertaken to establish total
expenditures on anesthesia services by physicians who
were recognized as specialists. The Ontario data,
therefore, includes only specialist anesthesiologist
billings, whereas the RAMQ data reports expenditures
for all anesthesia services in Quebec. For both Ontario
and Quebec (1998–99), the ‘per capita’ expenditure
on anesthesia services for each age/gender group was
calculated by dividing the total annual expenditure for
that age/gender group by the total number of people
in the group. If the pattern of ‘per capita’ expenditure
by age and gender groups was similar in these two
provinces, we reasoned that a regular pattern of uti-
lization had been established and the model could be
generally applicable to other provinces.
FIGURE Cost of anesthesia services by sex and age for Ontario
and Quebec 1998–1999.
Calculation of ‘demand’ for anesthesia services
We calculate the future ‘demand’ for anesthesia ser-
vices by using the ‘per capita’ utilization of anesthesia
services, derived from 1999 RAMQ data. This ‘per
capita’ expenditure reflects the average consumption
of clinical anesthesia services by persons in each
age/gender category. By multiplying the average ‘per
capita’ expenditure on anesthesia services by the esti-
mated number of people in each age/gender cohort at
a future date (e.g., 2016), we calculate a “demand”
for anesthesia services at that time. It is important to
emphasize that these projections do not estimate the
future costs for anesthesia services, which may vary
with many factors. For the purposes of this HRP
model, the expenditures on anesthesia services repre-
sent the ‘units of service’ provided for each demo-
graphic group.
The estimated ‘demand’ for anesthesia services in
2016 is calculated for each age/gender group in each
province by multiplying the ‘per capita’ units of service
(1998–99) by the number of people projected to be in
each demographic group using the demographic esti-
mates obtained from Statistics Canada.B The sum of the
calculated ‘units of demand’ for all age/gender groups
estimates the total for 2016. This ‘demand’ for anes-
thesia services may be met by providers in that province
or by anesthesiologists elsewhere in the region. Also,
these age/gender ‘per capita’ expenditures include only
services delivered under the terms of the fee-for-service
billing system. Services delivered outside this system
would be in addition. One assumption in the model is
that the proportion of services delivered outside the
provincial health care system will remain stable.
Number of FTE anesthesiologists required
After calculating the total annual ‘units of demand’ for
anesthesia services required by the population of each
province in 1999 and 2016, it was necessary to con-
vert this calculated value into the number of FTE
anesthesiologists required to provide the service. If
the ‘units of service’ (expenditures) are considered a
‘proxy’ measurement for the total time spent provid-
ing clinical anesthesia services, the number of anesthe-
siologists needed to deliver these services can be
estimated. Discussions with the AAQ provided infor-
mation that was used to equate one FTE anesthesiol-
ogist’s workload with a defined amount of billings in
1998–99. It should be emphasized that this number is
based on the tariffs prevailing in Quebec in 1998–99.
Only if we use the ‘per capita’ expenditures on anes-
thesia services from Quebec can we use this conver-
sion factor elsewhere. The definition of one FTE was
based on a consensus established by the consultant
(E.R.) after discussions with one of the authors (F.C.)
that an income around the 75th percentile of all anes-
thesiologists in Quebec would provide sufficient
workload for a full and varied practice, but not so
much work that overwork would lead to professional
dissatisfaction. After discussions with the executive of
the AAQ, a consensus was reached that this represent-
ed the billings of an anesthesiologist working approx-
imately 180–200 days per year (1999). Therefore, to
estimate the FTE equivalent for all provinces, we
applied the rate of conversion (one full-time, full-year
anesthesiologist = 175,000 units of demand) for esti-
mating the FTE equivalent for all provinces.

666
CANADIAN JOURNAL OF ANESTHESIA
The number of FTE anesthesiologists required for
vices (termed units of demand ‘per capita’ in 1999),
the population of Quebec and the estimated demand
for anesthesia services in both 1999 and 2016. From
these data (Table I), we calculate the number of FTE
anesthesiologists required to provide clinical service in
Quebec. In 1999, the total expenditure on anesthesia
services was $95,540,084. Therefore, the number of
clinical service in each province was calculated by
dividing the total ‘units of demand’ for each province
by the conversion rate for one FTE anesthesiologist
(175,000 units/year). This was done for 1998–99 and
2016. These estimates calculate the number of FTE
anesthesiologists required for provision of clinical ser-
vice and ignore the number required for administra-
tive and academic roles.
FTE
anesthesiologists
needed
was
546
(95,540,084/175,000).
Estimation of non-clinical requirements
Utilization of anesthesia services in Ontario and Quebec
The Figure also shows the annual ‘per capita’ expen-
diture on anesthesia services (1998–99) calculated
from the Ontario (OHIP) health care records, as well
as the ‘per capita’ expenditure from Quebec. The low-
est ‘per capita’ expenditures on anesthesia services in
Ontario was found for boys and girls (aged 10–14). In
both provinces, the same bi-modal pattern of ‘per
capita’ expenditures for women was demonstrated. By
age 55–59, males in both provinces increased ‘per
capita’ expenditure on anesthesia services to values
greater than females. From these data, family physi-
cians accounted for 8.8% of the 1998–99 anesthesia
billings in Ontario, compared with an estimated 4%
for family practitioners in Quebec.
In the absence of direct current data, the results from
the 1995 Royal College of Physicians and Surgeons of
Canada (RCPSC) Specialty Physician Workforce
StudyC were re-examined to estimate the number of
anesthesiologists involved in non-clinical activities.
Adjustments were made to account for non-respon-
ders. Of the 2,119 anesthesia certificants who received
a questionnaire, 1,558 (73.5%) provided analysable
responses. Since 15.2% of the non-responders were
believed to be professionally inactive in Canada, they
were eliminated from the analysis, producing an
adjusted response rate of 76.6%. Hours of work data
provided by 1,395 responders were used to estimate
the hours of work for all active certificants.
Adjustments were made to the 1995 study data to
match the 1999 and 2016 service volume data (see
results for details).
Projected demand for clinical anesthesia services
(2016) for Quebec
We applied 1998–99 ‘per capita’ expenditure on anes-
thesia services (Figure, Table I) to estimate the uti-
lization for the projected population of Quebec in
2016. Table I shows the population distribution in
1998–99 and one projection for the year 2016. Table
I also shows the calculated demand for anesthesia ser-
vices consumed by each age and gender group in
1998–99 and 2016 using the model. These data show
the aging population and the impact of differential
rates of consumption of services by age. Assuming that
one FTE anesthesiologist’s workload is equivalent to
175,000 units of service per year, we estimate that the
need for clinical anesthesiologists for 2016 will be 669
FTEs (117,053,573/175,000).
Results
Quebec utilization of anesthesia services: by age and by
sex
The RAMQ billing data was used to calculate the ‘per
capita’ expenditure on anesthesia services in Quebec.
The ‘per capita’ expenditure varied substantially for
different age and gender components of the popula-
tion in 1998–99 (Figure). Boys and girls aged 10–14
yr had the lowest utilization of anesthesia services,
$2.90 ‘per capita’ for girls and $3.56 for boys. The
highest utilization was by men aged 75–79, for whom
the ‘per capita’ cost was $42.52. For women, the
childbearing years were associated with an increase in
the use of anesthesia services in conjunction with sur-
gical and non-surgical childbirth, abortion, steriliza-
tion and reproductive healthcare services. Among the
older age groups, the consumption was higher on
average for men than for women (Figure). Table I
shows the ‘per capita’ expenditure on anesthesia ser-
Canada’s projected demand for clinical anesthesia ser-
vices in 2016
Since the ‘per capita’ expenditure on anesthesia ser-
vices in Ontario revealed a pattern essentially similar to
that in Quebec (Figure), we applied the model to cal-
culate future demand in each of the other provinces
and the territories. Quebec (RAMQ) data were cho-
sen since these estimates were lower than Ontario’s
and represented total expenditure on anesthesia ser-
vices (including family practitioners). For each
C
1995 RCPSC Specialty Physician Workforce Study.
Royal College of Physicians and Surgeons of Canada. Ottawa,
Ontario. May, 1996.

Byrick et al.: PLANNING THE ANESTHESIA WORKFORCE
667
TABLE I Population and estimated demand for anesthesia services in 1999 and 2016
Male population
Age
(yr)
‘per capita’
units of demand
Quebec population Quebec population
Estimated ‘units of
demand’ (1999)
Estimated ‘units of
demand’ (2016)
projection (1999)
projection (2016)
0–4
5–9
8.06
5.01
3.56
5.27
5.95
5.71
6.31
6.97
210,178
246,120
228,769
249,568
254,468
242,813
279,159
331,798
323,276
282,915
249,768
195,353
151,225
136,114
107,920
73,627
212,318
211,115
210,811
218,340
256,335
259,008
262,809
280,392
265,480
269,878
316,981
315,359
270,968
223,801
163,573
104,546
67,343
1,694,035
1,233,061
814,418
1,711,283
1,057,686
750,487
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85
1,315,223
1,514,085
1,386,462
1,761,493
2,312,632
2,612,070
2,860,271
3,444,301
3,789,848
3,949,997
4,494,484
4,340,542
3,130,620
1,380,108
724,489
1,150,652
1,525,193
1,478,936
1,658,325
1,954,332
2,145,078
2,728,467
4,371,168
6,117,965
7,077,684
7,389,909
6,578,906
4,445,296
2,402,125
1,574,333
56,117,825
8.08
10.11
13.79
19.40
26.12
33.02
40.22
42.52
35.67
29.53
38,691
24,534
3,626,296
53,313
3,962,370
Total
42,758,139
Female population
Age
(yr)
‘per capita’
units of demand
Population
projection (1999)
Population projection
(2016)
Estimated ‘units of
demand’ (1999)
Estimated ‘units of
demand’ (2016)
0–4
5–9
5.30
3.63
2.90
7.54
202,010
235,736
218,153
236,469
242,668
232,589
267,437
321,786
319,795
284,398
255,530
202,084
162,327
155,494
139,520
112,530
73,753
203,056
202,551
201,619
207,872
245,603
249,684
252,880
269,692
255,052
259,069
305,517
314,993
279,587
242,146
187,721
131,743
101,346
136,954
4,047,085
7,506,950
1,070,653
855,722
632,644
1,076,197
735,260
584,695
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85
1,782,976
3,795,328
5,651,913
5,586,759
4,440,647
3,511,349
3,208,009
3,222,233
2,918,093
2,769,299
3,335,346
3,564,736
3,130,585
1,865,213
1,440,441
52,781,945
95,540,084
1,567,355
3,841,231
6,067,321
5,282,663
3,721,750
2,800,471
2,922,298
3,852,569
4,548,499
4,769,754
5,194,032
4,796,272
3,665,090
2,563,040
2,947,250
60,935,748
117,053,573
15.64
24.30
20.89
13.80
10.98
11.28
12.61
14.44
17.06
21.45
25.55
27.82
25.29
21.52
66,935
3,729,214
7,355,510
Total
Canadian
total
Population estimates are taken from Statistics Canada data and the ‘per capita’ units of demand are calculated from RAMQ data (Figure)
and used to calculate the projected demand for anesthesia services.
province, the projections were made separately for
males and females in each of 18 age groups as shown
for Quebec (Table I). A detailed description and data
for the calculations of total ‘units of demand’ in each
province are available in the full report.4
services in each province (1999 and 2016). These esti-
mates were calculated from the sum of the ‘units of
demand’ for anesthesia services for all age/gender cate-
gories (from Statistics Canada) divided by the conversion
factor for one FTE provider (175,000 units per FTE).
Table II summarizes the estimated number of FTE
anesthesiologists that will be required to provide clinical

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CANADIAN JOURNAL OF ANESTHESIA
TABLE II Calculated full-time equivalent (FTE) anesthesiologists for each province and the territories of Canada for both 1999 and 2016
Province
1999
1999
Total
2016
Adjusted *
2016
2016 total
clinical
FTEs
non-clinical
FTEs
FTEs needed in clinical FTEs no. clinical
non-clinical estimated *
1999
FTEs
FTEs
FTEs
Newfoundland
PEI
40
10
4
0
44
10
41
12
43
12
6
1
49
13
Nova Scotia
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
Territories
Canada
70
56
546
852
85
10
3
60
108
11
7
22
21
0
80
59
606
960
96
81
63
81
63
650
1,155
97
14
4
80
150
14
9
31
30
1
95
67
669
1,164
100
88
272
426
9
730
1,305
111
94
325
466
10
76
83
85
207
301
6
229
322
6
294
436
9
2,249
246
2,495
2,925
2,925
340
3,265
*Denotes the “best estimate” of provincial requirements when considering the current inflows and outflows from clinical practice. These
values are used for starting assessment of future supply of anesthesiologists (see reference 8).
Non-clinical anesthesiologists required (2016)
total 3,265, increased from 2,495 in 1999. The per-
centage increase in population and in the estimated
demand for anesthesia services between 1999–2016 is
shown for each province in Table III. The expected
change in demand for anesthesia services can be sepa-
rated into two components: that due to population
growth and that due to demographic shifts. The com-
ponent due to age/gender demographic changes is
also shown in Table III. In Canada, population
growth (using this Statistics Canada estimate) will
increase by 17.9%, whereas total demand for anesthe-
sia services will increase by 29.1%. The difference
(11.2%) is due to demographic changes.
Based on the RCPSC survey, Table II summarizes the
allocation of the 246 estimated non-clinical FTE anes-
thesiologists required in 1999.6 This estimate was
made by extending these data to include all active cer-
tificants in the 1995 study and assuming a 50-hr work
week. This led to an estimated need (in 1995) for
Canada of 131 FTEs for academic activities and 96
FTEs for non-academic administrative activities. The
total for 1995 (227) was adjusted to match increased
clinical activities between 1995 and 1999 (assuming
equivalent increase in non-clinical component) to pro-
duce the estimate of 246 FTEs for Canada. This total
was then allocated by province. The academic compo-
nent allocation was based on the number of anesthesi-
ology residency positions and the 1998–99 research
expenditures in anesthesiology (data from the
Association of Canadian Medical Colleges).C The
non- academic administrative component was based
on the volume of clinical services in each province.
The 2016 estimate of non-clinical FTEs (Table II) is
340, a 30% increase from 1999, matching the project-
ed increase in clinical volumes.
Discussion
Canada has a shortage of anesthesiologists.1,6,7
Recently the shortage has resulted in operating room
closures and a negative impact on the care of patients
in need of surgery. This has given a sense of urgency
to plan for future requirements. This article presents a
unique approach to calculating the need for FTE anes-
thesiologists required to provide anesthesia services.
The data identified the need for 3,265 FTE anesthesi-
ologists. To complete a HRP model, these data need
to be linked to an estimate of the future ‘stock’ of
providers that will be available. This more compre-
hensive planning exercise is given in the second of the
articles from the ACUDA study.4,8
Projected need for anesthesiologists (1999–2016)
In the report,4 Ryten made minor adjustments to the
provincial distribution of the estimated FTEs required
for clinical services in 2016. These are shown in Table
II as “adjusted number of clinical FTEs” and can be
considered the “best estimate of requirements for
2016”. These FTE estimates are used as the starting
point for reflection on future demand to examine
whether current inflows into and outflows from prac-
tice are sufficient. The predicted FTE needs for 2016
The strengths of this planning model are: it quan-
tifies relevant factors, such as the demography of the
population; it measures the specific professional activ-
ities provided by the anesthesiologists; and it consid-
ers the demographics of specialty providers and the
repercussions of changes in clinical practice norms.

Byrick et al.: PLANNING THE ANESTHESIA WORKFORCE
669
different age/gender groups (Figure). Importantly,
this study shows that there is an underlying regularity
in the pattern of ‘per capita’ expenditures between
provinces (Figure). If there was no regularity shown,
the use of ‘per capita’ expenditure as a measure of
future ‘demand’ for anesthesia services would be use-
less. The Figure demonstrates that this approach is
possible, yet more experience will be required to assess
its validity in all regions. For accurate projection of
‘demand’, it would be preferable to establish the ‘per
capita’ expenditure on anesthesia services for each
region independently. At present, complete data from
other provinces are not available.
TABLE III Percentage change in demand for clinical anesthesia
services (based on projections using the human resource planning
model) for each province is shown as demand. The change in
demand due to projected population change (based on one
Statistics Canada model) and that due to the changing demo-
graphic composition of population (Dem Comp) are also shown.
Province
Reason for change
% increase
Newfoundland
Population
Demand
-12.6%
+4.3%
Dem. comp.
+16.9%
Prince
Edward Island
Population
Demand
Dem. comp.
+1.2%
+14.4%
+13.2%
We chose to apply the Quebec ‘per capita’ expendi-
ture on anesthesia services to other provinces because
the RAMQ data collected all anesthesia services deliv-
ered in the province. Ontario’s ‘per capita’ expendi-
ture (Figure) represents only expenditures for services
delivered by specialist anesthesiologists. It is notable
that these are slightly higher than in Quebec and our
projections for other provinces (Table II) may be a
conservative estimate. The cause of this difference may
be increased availability of anesthesia services in
Ontario and/or increased remuneration for profes-
sional services. For the purpose of planning the work-
force, inclusion of the work performed by all providers
(e.g., family practitioner anesthesiologist) and non-
clinical service is essential.
Some regional variation in the number of FTE
anesthesiologists among the provinces is expected due
to the fact that segments of the population with high-
er than average consumption of anesthesia services
(Figure) are growing faster than segments that are
lower users of anesthesia services. For example, in
Newfoundland, the anticipated change in population
is a decrease of 12.6% between 1999 and 2016, how-
ever the calculations suggest an increase of 4.3% in
‘demand’ for anesthesia services (Table III). If
demand parallelled population, the demand would be
expected to decrease by 12.6%. By inference, the dif-
ference between these two numbers (16.9%) must be
due to demographic (age/gender) composition. The
need for regional planning is emphasized by the wide
variations in the ‘demand’ shown between provinces
(Table III). In provinces expected to experience rapid
population growth (e.g., British Columbia and
Ontario), the increases in ‘demand’ will be a result of
both population growth and demographic change.
Using this model, although some provinces will expe-
rience heavy population growth and some very little,
all provinces will be faced with providing substantial
increases in anesthesia services due to demographic
change, largely aging of the population.
Nova Scotia
Population
Demand
Dem. comp.
+1.3%
+15.6%
+14.3%
New
Brunswick
Population
Demand
Dem. comp.
-2.6%
+12.3%
+14.9%
Quebec
Population
Demand
Dem. comp.
+8.9%
+22.5%
+13.6%
Ontario
Population
Demand
Dem. comp.
+26.4%
+36.6%
+10.2%
Manitoba
Saskatchewan
Alberta
Population
Demand
Dem.comp.
+8.3%
+18.1%
+9.8%
Population
Demand
Dem.comp.
+5.7%
+15.3%
+9.6%
Population
Demand
Dem. comp.
+15.8%
+31.7%
+15.9%
British Columbia
Territories
Canada
Population
Demand
Dem. comp.
+26.6%
+41.5%
+11.9%
Population
Demand
Dem. comp.
+30.8%
+50.7%
+19.9%
Population
Demand
Dem.comp.
+17.9%
+29.1%
+11.2%
The Figure shows age/gender differential rates of
utilization of anesthesia services and illustrates the
extent to which the aging population will determine
the need for anesthesia services. Large variations in the
‘per capita’ expenditure on anesthesia services exist for

670
CANADIAN JOURNAL OF ANESTHESIA
The proposed methodology provides for changes in
Medical Colleges – retired) for the Management
Committee of the Association of Canadian University
Departments of Anesthesia (Chairs of all 16 Canadian
University Departments). ACUDA and the Anesthesia
Section of the Ontario Medical Association provided
generous financial support for the project. We are
grateful to the staff of the Department of Anesthesia
of the Montreal Children’s Hospital, and particularly
to Ms. Victoria Kompogiannis for the review and
analysis of billing codes in the development of the
classification of anesthesia services by field of practice.
In addition, our thanks go to the staff of the Service
de Statistiques, Régie de l’assurance maladie du
Québec, and in particular to Mme D. Labrie-Pelletier
and Mr. J Barry, chef de service.
medical services utilized based on what anesthesiolo-
gists actually do. This flexibility can be accomplished
through an ongoing analysis of the codes billed for
services delivered and how amounts vary over time.
This is possible because provincial Health Care sys-
tems have comprehensive billings data arising out of
fee-for service payments. They provide Canada with
an almost unique research tool compared with coun-
tries with multiple payer or salary systems. Another
aspect of the flexibility of the model is its built-in pro-
vision for regular monitoring and updating of the data
as they become available or when policy changes
occur, such as a change in immigration targets.
As in all HRP planning, several assumptions were
made. One major assumption in the model is that
Quebec delivered all the anesthetic services required
by the population in the base year (1998–99).
Another assumption is the calculation of FTE equiva-
lent, based on the Quebec data. We also made
assumptions in calculating the non-clinical FTEs
required (Table II). Recognizing these assumptions
and limitations, it is important to emphasize that any
HRP model is meant to “shape the future, not predict
it”. The calculations need to be repeated at intervals,
and compared with current experience. This would
provide for ongoing planning in a rational fashion.
Repeating the calculations over time, would also allow
for the refinement of predictions to account for new
technologies and practice patterns. When Chairs of
University Departments (ACUDA) examined the
1999 estimates of FTE providers (Table II), these
were in accordance with the perceived need.
These data on the need for anesthesiologists form the
basis of another report, which will focus on examining
whether current inflows and outflows from practice are
sufficient to ensure an adequate supply of anesthesiolo-
gists in the future.8 One of the most important conclu-
sions of this study, is the feasibility of conducting
specialty specific workforce planning in anesthesiology.
The negative impact of planning from misguided HRP
models is well-documented.2,9 The methods and model
can be adapted for use by other specialties, and thus con-
tribute to the quality of work done in physician work-
force planning beyond the specialty of anesthesia. For
this goal to be realized, the work must continue.
Operating and implementing a physician workforce-
planning model implies a long-term commitment, with
dedicated resources and qualified personnel.
References
1 Donen N, King F, Reid D, Blackstock D. Canadian
anesthesia physician resources: 1996 and beyond. Can
J Anesth 1999; 46; 962–9.
2 Schubert A, Eckhout G, Cooperider T, Kuhel A.
Evidence of a current and lasting national anesthesia
personnel shortfall: scope and implications. Mayo Clin
Proc 2001; 76: 995–1010.
3 Australian Institute of Health and Welfare. The anaes-
thetic workforce in Australia: supply, requirements and
projections 1995–2006. Australian Medical Workforce
Advisory Committee. January 1996.
4 Ryten E. A physician workforce planning model for the
specialty of anesthesia: theoretical and practical consid-
erations.
http://www.anesthesia.org/acuda/en/ryten.html
5 Abt Associates Inc. Prepared for the American Society
of Anesthesiologists. Estimation of physician workforce
requirements in anesthesiology. September 16, 1994.
6 Duncan PG. Anesthesia human resources in Canada
(Editorial). Can J Anesth 2000; 47: 99–104.
7 Yang H, Byrick R, Donen N. Analysis of anesthesia
physician resources: projected Ontario deficit in 2005.
Can J Anesth 2000; 47: 179–84.
8 Craig DB, Byrick RJ, Carli F. A physician workorce
planning model applied to Canadian anesthesiology:
planning the future supply of anesthesiologists. Can J
Anesth 2002; 49: 671–77.
9 Byrick RJ, Craig DB. Consequences of inadequate
Canadian physician resource planning (Editorial). Can
J Anesth 1999; 46: 913–8.
Acknowledgements
The ACUDA study was conducted by Ms. Eva Ryten
(former Director of Research, Association of Canadian