For years, ASC staffing shortages were treated as a cost-line headache. Now, leaders increasingly describe workforce scarcity as something closer to a ceiling on what an ASC can safely do at all.
“ASCs are particularly dealing with shortages in skilled nursing, scrub techs and anesthesiologists,” Sean Gipson, CEO and ASC division president of Remedy Surgery Center in Houston, told Becker’s. “As we find our ASCs doing higher acuity procedures, we also find that we need higher skilled nurses such as cath-lab nurses. Scrub technologists are also lean in the sense of needing a scrub tech that is skilled in a vast array of surgeries over the course of their day at a multispecialty center. In the past year, ASCs have felt a shortage of anesthesia providers as well. Hospitals are paying stipends due to a highly competitive market, and ASCs are also having to compete with similar models to meet the need in our facilities for anesthesia care.”
The numbers behind that shortage are stark, and they’re a supply problem, not just a pay problem. The U.S. is projected to be short 6,300 anesthesiologists by 2036 and 12,500 CRNAs by 2033, nearly 22% of the current CRNA workforce. The existing supply is aging out fast: 59% of practicing anesthesiologists are 55 or older, and 17% are near retirement age.
On the other end of the pipeline, 40.6% of anesthesiologists say they’re interested in leaving the field within two years, the highest rate among any specialty, with roughly half reporting burnout or depression. Meanwhile the training bottleneck isn’t loosening. More than 3,000 applicants competed for just 1,805 anesthesiology residency positions in the most recent cycle, leaving 40% unmatched.
The financial response to that scarcity is showing up fast on ASC balance sheets. The share of ASCs paying anesthesia stipends jumped from 28% in 2024 to 44% in 2025, and 67% of ASC leaders now name anesthesia coverage among their top three financial challenges heading into 2026.
Jack Dillon, CEO of Grand Rapids, Mich.-based Anesthesia Practice Consultants, connects that cost pressure directly to the volume-versus-margin problem playing out across the industry.
“Many centers are focused on filling operating rooms, but in today’s environment — where labor, anesthesia and supply costs are rising faster than reimbursement — more cases do not necessarily mean better margins,” he said. “The critical question is no longer ‘How do we stay full?’ but rather, ‘Do we have the right cases and the right surgeons in our market to achieve our financial and operational goals?'”
That question is inseparable from staffing capacity, according to Peter Bravos, MD, chief medical officer of Sacramento, Calif.-based Sutter Health Surgery Center Division. As cases get more complex, he said, anesthesia coverage stops being a line item and becomes part of the clinical infrastructure that determines what a center can responsibly take on.
“The winners won’t just be the centers that capture volume,” Dr. Bravos said, “they’ll be the ones built to safely absorb it through disciplined patient selection, sophisticated anesthesia coverage, and deeper clinical competency.”
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.
