The anesthesia shortage is easing for ASCs, but not evenly. Small centers and those staffed only by anesthesiologists report the strongest access, while large centers and those using the industry’s most common staffing model still trail.
Of the 307 surgery centers across 44 states that responded to the Ambulatory Surgery Center Association’s third-quarter 2026 60-Second Survey, published Oct. 16, 76% reported adequate access to anesthesia providers. That is the highest share in ASCA’s four anesthesia surveys since 2022, up from 70% in 2024, 64% in 2023 and 56% in 2022.
Small centers lead
Size is the clearest dividing line in the survey. Among ASCs with one or two operating or procedure rooms, 85% reported adequate anesthesia access. Among large ASCs with five or more rooms, 70% did.
Large centers are also more likely to pay for coverage. Forty-three percent of large ASCs offer financial assistance in their anesthesia contracts, compared with 31% of all respondents. The survey does not break out why size matters.
Anesthesiologist-only centers report the best access and are least likely to pay for coverage
The staffing model is the second dividing line. Of ASCs staffed only by anesthesiologists, 88% reported adequate access, the highest share of any group ASCA reported. Among centers where anesthesiologists supervise CRNAs or certified anesthesiologist assistants, 72% did.
Anesthesiologist-only centers are also the least likely to pay for coverage. Just 17% offer financial incentives in their anesthesia contracts, compared with 31% overall.
Those centers are a minority. The supervised care team model is the most common arrangement, used by 36.2% of respondents. CRNA-only staffing followed at 30.9%, and anesthesiologist-only staffing at 21.5%. Another 11.4% use some other arrangement. The survey does not show whether the staffing model itself drives better access.
Physician-owned centers are less likely to pay, too
Facilities owned only by physicians were also less likely to offer anesthesia incentives, at 23%. Overall, 31% of ASCs offer financial assistance to anesthesia providers or groups, roughly flat from 30% in 2024.
The form of that assistance is shifting. Stipend contracts remain the most common form, at 51%, followed by collections guarantees at 29%. Flat subsidies dropped to 15% in 2026 from 21% in 2024 and 27% in 2023.
Most centers still buy coverage from outside groups. Eighty-two percent of respondents contract for anesthesia services rather than employing providers, unchanged from 2024 and down from 86% in 2023.
Other industry data points to rising pressure on stipends. A VMG Health survey found the share of ASCs expecting to pay anesthesia stipends rose to 44% in 2025 from 28% in 2024.
How centers are adapting
ASC leaders who have held on to coverage describe trade-offs, not easy fixes.
Shifting the cost to surgeons. Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., charges surgeons $300 per unused block hour, paid to the anesthesia group. Surgeons began trading block time to avoid the charge.
“It became a win-win,” Bruce Feldman, the center’s former administrator, told Becker’s in November 2025. He said the model works best in multispecialty centers with flexible case mixes.
Moving to CRNA-only coverage. An ENT center in Proliance Surgeons’ network switched to a CRNA-only group after its anesthesiologist group struggled to staff it starting around July 2024 and declined to renew its contract. The center pays a relatively low daily stipend that varies with scheduled hours.
Dan Zahumensky, administrator of Proliance’s ENT service line, told Becker’s in September 2025 that “we were forced into a decision.” He added, “I do see it as a long-term solution.”
Cutting days to fill the ones left. Ambulatory Surgery Center of Niagara in Niagara Falls, N.Y., moved to a CRNA group after its anesthesiology group left and no local group would take the center. It now closes Fridays and runs four full days.
“If you only have a half day, we can’t run the room,” administrator Kimberly Fullone told Becker’s on Oct. 13. The center also stopped pediatric cases and hired three ICU nurses.
Who is still squeezed
Nearly one in four ASCs still lacks adequate access. Respondents most often cited limited availability of anesthesia providers (81%) and high cost (66%) as barriers to maintaining anesthesia services. They also named low reimbursement tied to a high share of government payers and competition with local hospitals.
The effect on volume has not improved. Among centers that reported difficulty keeping anesthesia providers, 75% said the problem affected procedure volume, unchanged from 2024.
Cost pressure can hit even centers that have changed models. Advanced Ambulatory Surgery Center in Redlands, Calif., has cycled through four anesthesia arrangements, from free hospital coverage about 12 years ago to a hybrid model today. One group it worked with lost $350,000 in a single year despite the center’s stipend.
“Our current CRNA group has roughly doubled their pricing over the past year,” administrator Suzi Cunningham told Becker’s in May.
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.
