The anesthesia workforce crisis isn’t just about headcount. Rising costs, payer dynamics that reward size over quality, overstuffed clinics and a growing debate over care delivery models are straining the system from multiple directions.
Five leaders spoke with Becker’s to discuss what’s breaking down — and where the field goes from here.
Note: Responses were lightly edited for clarity and length.
Jason Acevedo, MD. President of Elm Place Ambulatory Surgery Center and Otolaryngologist at West Texas Ear, Nose & Throat (Abilene): Regarding anesthesia coverage models at my ASC, I do not anticipate significant changes over the next five years. We have operated successfully as a CRNA-staffed facility and have consistently maintained high standards of quality and safety without the added financial pressures associated with MD anesthesia. Unless compensation structures shift meaningfully, I expect most ambulatory surgery centers to continue moving toward CRNA-driven models.
With rising inflationary pressures and flat reimbursements, every ASC must evaluate its cost centers and determine how to allocate resources most effectively. Whether sedation is administered by an RN, or anesthesia is provided by CRNAs or MD anesthesiologists, each role must add value to the center. To remain financially viable, we must all focus on delivering safe, high-quality care at the best possible cost.
Brendan Coughlin. Section Administrator, Anesthesia and Critical Care Department of University of Chicago Medicine: Access to care. At this point, all of our clinics are stuffed and overstuffed. Every day I get messages from the clinical support that they’re feeling overwhelmed or overworked. We have excellent physicians that have 150% staffing of patients for their clinics, which is excellent. But at the end of the day, we need support staff. And when we’re told, especially in academic medicine by those in the C-suite that we can’t approve certain positions, so on and so forth, that should never be a stopgap for us providing the appropriate care for a patient. We need to be fully staffed, whether it’s from a coordinator to a nurse, to make our practices run smoothly.
Megan Friedman, DO. Chief of Anesthesiology of Adventist Health Southern California & Pacific Coast Anesthesia (Los Angeles): I think we’re spending too much time talking about workforce supply and not workforce utilization. Many facilities still function in the same ways as they did before COVID. A center might open a room just for one case. At that point the anesthesia provider or the anesthesia group takes the hit on that. You sit around all day, you do one case. Now with the shortage and many facilities providing subsidies, that’s just not sustainable. Centers are now realizing that they need to start looking at operational efficiency and schedule integrity. There needs to be a lot more focus on that because you can get more providers, but you’re ultimately not going to fix the root cause and problem. There are many reasons why people leave the field, but feeling like your time and expertise are not respected is definitely a leading cause of burnout.
Jarrett Heard, MD. Associate Professor of Clinical Anesthesiology and Medical Director of Perioperative Services at Ohio State University Wexner Medical Center (Columbus): I think that’s the first thing you want to look at, where the demand is, and you want to match your anesthesia staffing with that demand. What is the best way to operationalize them, to realize them, and actually maximize revenue? I don’t know that those things are always discussed. Typically, they’re just discussed in the form of, well, I see if I can get a cheaper anesthesiologist to provide the same service.
Leveraging predictive algorithms and electronic records to show us where it’s best to staff and to schedule anesthesiologists — I think that’s the key to solving that mismatch. Why aren’t we leveraging the EMR and people’s schedules and finding out with a pretty informed decision what things are going to look like a week or two in advance, when we know we have pain points with anesthesia staffing?
Nick Schiavoni, MD. Anesthesiologist and CEO of Calder Health Laguna Beach, Calif.): The most disruptive payer tactic isn’t a denial code. It’s how the rates get set in the first place. Payers negotiate on leverage, and that rewards scale. The bigger the group, the better the rate, so it comes down to your size, not your quality. And that’s slowly pushing traditional insurance-based private practice out of the picture.
When the best clinicians are building careers that go around you, it’s time to start paying attention. If payers want quality and continuity of care, they have to break the link between leverage and rates, and give private and independent practice a viable path again. One that rewards outcomes, not just size.
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.