Factors influencing the availability of anesthesiologists: a scoping review

Access to safe surgery and anesthesia remains a pressing global challenge, particularly in low- and middle-income countries (LMICs). This study examines the factors influencing the worldwide availability of anesthesiologists, a critical determinant of effective surgical care.

We performed a scoping review based on the five-stage Arksey and O'Malley framework. Relevant studies were identified through systematic searches of scientific and grey literature databases, including PubMed, Scopus, Web of Science, and Google Scholar, as well as anesthesia-specific websites and journals. The review encompassed publications from May 2015 to November 2023. A multidisciplinary team conducted data extraction and thematic coding using the STEEP(Social, Technological, Economic, Environmental, Political) model, resolving discrepancies through consensus.

Of the 925 screened articles, 63 met the inclusion criteria. The analysis identified 68 distinct factors organized into five STEEP areas. The most frequently cited issues in each category are as follows: (1) Political Factors: These emerged as the most frequently cited, with national and international institutional support for workforce planning identified as a cornerstone issue. (2) Social Factors: Key challenges included limited opportunities for professional development and skills evaluation, compounded by poor work-life balance. (3) Economic Factors: Financial disincentives and excessive workloads stood out as the primary barriers to anesthesiologist availability. (4) Technological Factors: Restricted access to medical training opportunities posed a significant obstacle. (5) Environmental Factors: Though less prominent, these were recognized for their potential to enhance geographical equity and resource access in anesthesia education and service delivery. High-income countries focused on optimizing performance, improving workplace quality, and strengthening retention strategies, while LMICs contended with structural challenges such as resource shortages, workforce migration, and inadequate infrastructure. Across all countries, social issues such as job burnout and work-life imbalance, alongside economic challenges like financial incentives and workload were recurring themes.

These findings illuminate the complex, multifaceted nature of factors affecting anesthesiologist availability. They underscore the necessity for comprehensive strategies that promote collaboration at local, national, and global levels. Addressing the political, economic, social, technological, and environmental dimensions is imperative to ensure safe and effective anesthesia care worldwide.