Anesthesia coverage is no longer just a staffing issue; it is central to surgical growth, ASC stability and financial sustainability.
Rising procedural demand, persistent workforce shortages, flat reimbursement and shifting clinician expectations are reshaping how hospitals and ASCs secure anesthesia services. For many operators, the difference between expansion and stalled capacity may come down to whether they can stabilize coverage and modernize their care models.
Here are five forces shaping the industry in 2026:
1) Workforce scarcity — not case volume — is the growth limiter: Anesthesiology faces a projected shortage of 6,300 anesthesiologists by 2036, with 56.9% of current physicians age 55 or older and more than 17% nearing retirement.
Burnout and attrition are accelerating the strain: 40.6% plan to leave their current roles within two years, and 56% of CRNAs report burnout. Access in rural areas is especially fragile, with 78% of rural facilities reporting CRNA staffing gaps, up from 35% in 2020.
2) Volume growth and flat reimbursement strain ASC anesthesia models:
In 2025, ASC leaders faced mounting anesthesia shortages, reimbursement headwinds and growing expectations to pay stipends to secure coverage. Leaders expect disruption to intensify through 2026 as volumes rise and more complex cases shift outpatient.
“The biggest disruption will be the growing mismatch between anesthesia workforce capacity and procedural demand, amplified by flat reimbursement and increasingly restrictive payer policies,” Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia, told Becker’s.
Cardiovascular ASCs are also preparing for increased anesthesia demand following CMS approval of cardiac ablations in ASCs, adding pressure to secure coverage and update protocols.
3) Anesthesia stipends are becoming the norm — and exposing financial strain: More ASCs are being forced to subsidize anesthesia coverage as staffing shortages deepen and reimbursement stagnates. From 2024 to 2025, the share of centers expecting to pay stipends rose from 28% to 44%.
Leaders say the issue extends beyond workforce gaps. Average anesthesia reimbursement fell by 5.5% from 2019 to 2023, Medicare rates have declined, and payers are becoming more aggressive with denials and clawbacks.
Some leaders warn that the growing reliance on stipends reflects deeper structural inefficiencies in the traditional ASC model, particularly around scheduling and surgeon-driven operations, raising concerns about long-term sustainability for financially vulnerable centers.
4) Staffing models shift as clinician preferences evolve: Anesthesia workforce dynamics are changing structurally, prompting hospitals and ASCs to rethink recruitment and coverage strategies. The 2025 Somnia Labor Market Study found that more clinicians are seeking 1099 arrangements for flexibility and autonomy, while others continue to prefer the stability of traditional W-2 employment.
In response, organizations are adopting hybrid staffing models that blend employment security with lifestyle-aligned scheduling, now a key differentiator in recruitment and retention. The report also noted a renewed preference for hospital-based practice, the growing importance of leadership effectiveness in retention and increased openness among early-career clinicians to team-based care models.
5) AI emerges as a force multiplier for anesthesia teams: AI is being integrated into anesthesia care for everything from real-time OR decision support to predictive pre-op risk modeling and AI-assisted ultrasound for regional blocks and vascular access.Leaders told Becker’s they view the technology as a tool to improve precision, consistency and efficiency, particularly amid workforce shortages and reimbursement pressure. Rather than replacing clinicians, AI is being deployed to streamline monitoring, documentation and workflow, allowing anesthesia teams to focus on higher-acuity decision-making and patient care.
