ASC leaders have told Becker’s in recent months that dependable anesthesia coverage now decides how many cases a center can take on, and at some facilities, anesthesia access has become the primary rate-limiting factor, ahead of staffing costs or supply chain pressures.
The pressure is not confined to one service line. Gastroenterology, cardiology and orthopedics are all expanding in the ambulatory setting —, and each is leaning on the same pool of anesthesiologists and certified registered nurse anesthetists.
The supply side is not on track to catch up. The U.S. is projected to face a shortage of 6,300 anesthesiologists by 2036 and roughly 12,500 CRNAs by 2033, and nearly 57% of practicing anesthesiologists are 55 or older.
ASCs are paying to close the gap in the meantime. The share of ASCs expecting to pay anesthesia stipends to secure coverage jumped from 28% in 2024 to 44% in 2025, according to VMG Health data, and 67% of ASC leaders rank anesthesia coverage among their top three financial challenges heading into 2026.
Gastroenterology may feel it most directly. The colorectal cancer screening age dropped to 45 from 50, expanding the screening-eligible population by about 19 million people and pushing colonoscopy volume higher. Seth Gross, MD, clinical chief of gastroenterology and hepatology at New York City-based NYU Langone Health, told Becker’s shortages of both CRNAs and anesthesiologists are restricting patient access, while anesthesia reimbursement has not kept pace with rising costs.
Amy Oxentenko, MD, vice dean of practice and chief patient experience officer at Rochester, Minn.-based Mayo Clinic and a past president of the American College of Gastroenterology, said GI built much of that exposure itself.
“We’ve created a very strong dependency on another specialty that has its own workforce challenges, and so that is going to perpetually limit what our opportunities are if we continue that dependency,” Dr. Oxentenko told Becker’s.
When Dr. Oxentenko trained, gastroenterologists sedated most of their own patients using moderate sedation. Anesthesia-supported sedation expanded as procedures and patients grew more complex, which she said was legitimate. But the practice spread well beyond those cases.
“Now, that has become almost reflexive, where it’s just easier to just have someone else do the anesthesia rather than us holding ourselves accountable to do it,” she said.
Even where coverage exists, it often does not line up with how GI cases arrive. Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia Consultants, said demand in GI suites and other non-operating room anesthesia settings has become front-loaded and unpredictable.
“Anesthesia staffing models are still built around six daily blocks and historical averages, but we see consistent surges early in the day and then late add-ons and short-notice case stacking, especially in these NORA areas, that outstrip scheduled anesthesia coverage,” Dr. Friedman said.
An ACG task force convened by Dr. Oxentenko has proposed that GI loosen the dependency from its own side. Its recommendations include making sure fellows leave training competent in moderate sedation and exploring whether gastroenterologists and nurses could be trained and legally permitted to administer propofol-based sedation, with safety guardrails in place. That would require state legislative changes and buy-in from anesthesia professionals. Hiring more anesthesia clinicians alone will not close the gap, Dr. Oxentenko said.
“We’re not going to train and recruit our way out of this issue,” she said.
Outpatient cardiology is also facing an anesthesia bottleneck. CMS added electrophysiology ablation to the ASC covered procedures list, and the number of single-specialty cardiology ASCs grew from 55 to 221 between 2018 and 2023. Many of those centers built their cardiovascular programs around moderate sedation, adding EP ablation means adding anesthesia.
Kristen Richards, vice president of ambulatory care at Lafayette, La.-based Cardiovascular Logistics, told Becker’s that anesthesia coverage is quickly becoming one of the key operational hurdles, particularly for EP procedures.
“We are currently seeing a national shortage of anesthesiologists and CRNAs,” she said. “Cardiovascular ASCs should already be pursuing anesthesia coverage for their facility in preparation for cardiac ablations, along with acquiring the appropriate anesthesia equipment, EP mapping equipment, developing anesthesia protocols and revising their patient selection criteria to ensure the right patient, for the right procedure at the right facility.”
Anesthesia providers are seeing the same shift. Mr. Kuz said his center is also moving cardiac cases out of the hospital, which puts cardiology in line for the same anesthesiologists and CRNAs that GI centers are already struggling to schedule.
In orthopedics, the issue is less about getting coverage at all and more about keeping it consistent as ASCs take on total joints and other higher-acuity cases. Raghu Reddy, chief administrative officer of Southfield, Mich.-based MiOrtho Surgery Center, said continuity is what keeps high-volume orthopedic rooms moving.
“Consistent providers who know our surgeons, workflows and standards help avoid day-to-day inefficiencies and improve overall performance,” Mr. Reddy said.
For multispecialty operators, those pressures add up. Peter Bravos, MD, chief medical officer of Sutter Surgery Center Division in Sacramento, Calif., told Becker’s guaranteed, dependable coverage is his nonnegotiable anesthesia strategy for 2026.
“Variability in anesthesia coverage creates risks that far exceed any short-term cost benefit,” Dr. Bravos said.
Dr. Oxentenko was speaking about GI when she warned against waiting for the workforce to catch up. But the warning applies to every specialty now lining up for the same anesthesia workforce.
“We need to be thinking outside our current paradigm because this will continue to get worse before it gets better unless we put clear mechanisms in place,” she said.
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.
