Time to Pivot: Reengineering the Pipeline for the Next Generation of Subspecialists and Physician Scientists in Anesthesiology

Megan Rolfzen, MD

A Sunday, May 3 morning session at the 2026 Annual Meeting, presented by IARS and SOCCA, was delivered by a panel of distinguished anesthesiologists invested in the education and mentoring of the next generation of both clinical and research-oriented anesthesiologists. They note that the field is at a crossroads; interest in subspecialty training, the academic mission, and research inquiry is diminishing. While residency positions are competitive, the subsequent pipeline for subspecialty fellowships is beginning to dwindle. This session, “Subspecialty Training in Anesthesia: A Stress Test and an Opportunity for Reconditioning,” co-sponsored by the Society of Academic Associations of Anesthesiology and Perioperative Medicine (SAAAPM), and moderated by Babar Fiza, MD, an associate professor of anesthesiology and critical care medicine and program director for the Critical Care Medicine Fellowship at Emory University School of Medicine, provided a sobering analysis of the financial, cultural, and organizational barriers to further specialization, while offering a roadmap for “reconditioning” the academic infrastructure.

Allison Dalton, MD, an associate professor in the Department of Anesthesia & Critical Care at the University of Chicago and vice chair for education and director of the Anesthesia Critical Care Fellowship, opened the session by quantifying the vacancy crisis. Across the “Big Six” Accreditation Council for Graduate Medical Education (ACGME)-accredited subspecialties, adult cardiothoracic, critical care, obstetric, pain, pediatric, and regional, nearly 1,250 positions are available annually. To fill these spots, approximately 65-75% of all graduating anesthesiology residents would need to pursue fellowships. While adult cardiothoracic programs have remained relatively resilient, pain medicine has seen a concerning decline in applications from anesthesia-trained individuals from 2019 to 2024, accompanied by a widening gender disparity. The barriers are primarily, though not exclusively, financial. Dr. Dalton noted that the average medical school student now accumulates $250,000 in debt. In the current environment, where the average signing bonus for an anesthesiologist is $46,502 and earnings potential ranks 15^th out of 52 medical specialties, some see an extra year of training as an opportunity cost. Retention ideas include “bridging” the fellowship salary gap, offering more flexible training models such as non-ACGME pathways and senior-level supervisory rotations that provide autonomy, and highlighting the long-term benefits of subspecialization through targeted mentorship.

Peter Allan Klock, MD, the chair of the Department of Anesthesia and Critical Care at the University of Chicago, highlighted the erosion of the physician-scientist track. Preliminary insights from a National Survey on the impact of the 2025 change in federal funding priorities on academic anesthesiologists described worsening job satisfaction, loss of research staff, and growing pressure to shift toward clinically driven or industry-based work. One in five respondents (members of the American Society of Anesthesiologists [ASA] as well as the Association of University of Anesthesiologists [AUA]) planned to reduce or exit research altogether. The value of early investment is clear: a 2015 study found that 79% of Foundation for Anesthesia Education and Research (FAER) grant recipients remained in academic anesthesia and collectively secured over $448 million in National Institutes of Health (NIH) funding (n=397). However, that funding is increasingly concentrated. In 2025, five institutes captured 41% of the roughly $250 million awarded to US anesthesia departments. Dr. Klock argued that academic departments might consider embedding research infrastructure, such as dedicated biostatisticians, seed grant programs, and physician-scientist training directly into residency through programs like Duke’s Academic Career Enrichment Scholars (ACES) or Washington University’s Academic Scholars Advancement Program (ASAP).

Closing the session, Jeffrey Berger, MD, MBA, the Seymour Alpert chair and professor of Anesthesiology at George Washington University and co-Editor-in-Chief of The Journal of Education in Perioperative Medicine, provided strategies to optimize subspecialty staffing. He reframed the current shortage as a systematic issue decades in the making. He pointed to the 1997 graduate medical education cap and lingering impacts of the mid-1990’s policies that discouraged specialization. Furthermore, new administrative burdens and H1B visa costs have hindered international recruitment. Dr. Berger warned that the “commoditization” of physicians in employment models, coupled with large student debts, has fundamentally changed how residents view their career options.

The final takeaway message was one of pragmatism: inaction accelerates the spiral, and the research mission is a fight worth having to ensure that the specialty of anesthesiology continues to provide nuanced, evidence-based care. Reconditioning the pipeline will require more than just enticements; it will require fundamental cultural, structural, and organizational reforms that protect time, recognize scholarship, and reward those who choose the path of specialization.