The anesthesia shortage isn’t a future problem, and, according to one anesthesia expert, most ASCs aren’t ready for it.
Jeff Tieder, MSN, CRNA, clinical assistant professor at the University of Tennessee at Chattanooga, said centers that treat anesthesia as a cost line item rather than a strategic asset are setting themselves up for serious disruption.
He joined Becker’s to discuss what ASC leaders are missing, which facility types face the greatest risk, and why the lowest bid may turn out to be the most expensive decision they make.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Looking at the anesthesiologist shortage — is it hitting yet, or are we still moving toward it?
Jeff Tieder: What I’m seeing is that some ASCs are preparing for it, but the market itself is not yet prepared. I think they’re underestimating what it’s going to look like and the potential for a real structural shift.
ASCs aren’t in a vacuum — they’re not isolated. When the physician shortage hits, the bigger need for physicians is obviously always going to be at the hospital level. That’s going to become the big vacuum that draws anesthesiologists to hospitals, which is going to leave even more vacancies in ASCs. So three to five, maybe seven years down the road, we could start seeing that kind of draw away from anesthesiologists even being available to work in ASCs.
Some of these models are going to be shifting very, very quickly. We are seeing that shift — CRNA-only models, CRNA-driven and CRNA-centric models are getting more and more traction. But I think those centers that aren’t prepared are really going to be left with a bigger disruption issue.
Q: What does ‘underestimating it’ look like? How could an ASC leader know whether they’re correctly preparing?
JT: The biggest mistake is treating anesthesia as a cost line item only — not integrating anesthesia into the entire operation of the ASC. Salaries are high. Anesthesia costs today are high. Everybody’s paying a stipend. I understand the thought process where surgeons or ASC directors are like, “I just need a warm body, so we can do the cases.” But as everything becomes more ASC-centric, we’re getting sicker and sicker patients in the ASC. And all of a sudden ASCs need quality anesthesia providers, and the lowest bid may not be the best option.
You really have to look beyond just the cost and invest in the service itself. Because that’s what we are — we are a service. Yes, we’re expensive. I’m sorry, it’s just the nature of where things are right now. Reimbursement is down, the number of anesthesia providers is limited — simple supply and demand economics. Salaries are going to be high.
So look past that initial cost and ask: as long as we have good quality anesthesia, regardless of degree, are we getting the stability and the quality that our ASC needs? Because if you have a surgeon — maybe they own part of the ASC, maybe they don’t — and they don’t have reliable, high-quality anesthesia staff, they’re going to stop coming. They’re going to find somewhere else. And now you’re looking at three days on the schedule instead of four, four instead of five. You can’t staff it, you’re laying people off, and it just becomes a struggle.
It’s very easy to fall into that short-term thinking because the margins ASCs are looking at are really tight. Gone are the days when ASCs just printed money left and right. They have to look deeper. They have to look beyond just the cost.
Q: Is there a specific type of ASC that will struggle with this more than others?JT: Single-specialty ASCs are going to have it really hard, unless it’s orthopedic. If you’ve got a single-specialty orthopedic practice with decent anesthesia, you’re probably doing just fine. Gastroenterology does okay because you can increase volume pretty well, and most GI centers have gone CRNA-only, or at least a lot of them have. But some of these other single specialties — ophthalmology, for example — I know some of those clinics were already struggling to get anesthesia staff. They’re paying top dollar for it. It’s a real struggle for them.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.