The rapid expansion of ASCs is bumping up against a critical constraint: anesthesia staffing.
As ASCs take on more complex procedures, anesthesia coverage is becoming a key chokepoint — and for many centers, the inability to reliably staff anesthesiologists or certified registered nurse anesthetists is threatening schedules, margins and growth.
Anesthesia has become increasingly consolidated in recent years as private equity-backed anesthesia groups have expanded their presence across hospital outpatient departments and ASCs — often leading to higher costs for centers already facing margin pressure.
A JAMA study published in April 2022 found that anesthesia prices increased an average of 26% when private equity-backed companies took over anesthesia services compared with independent practices. The study also found that about 20% of anesthesia practices were involved in private equity buyouts and about one-third of anesthesiologists became part of such transactions.
“The lack of anesthesia providers for ASCs in many markets will continue and anesthesia compensation will continue to rise,” Adam Spiegel, CEO of Irving, Texas-based NorthStar Anesthesia, told Becker’s. “These two dynamics are at odds: fewer providers and more access needed.”
In many markets, ASCs are pivoting to CRNA-only or hybrid anesthesia models to maintain operations. Burnout, demand for flexible scheduling and competition from hospitals and locum agencies compound the problem, making anesthesia one of the toughest staffing challenges for ASC leaders.
“Today’s shortage of anesthesia providers has been compounding for years and has turned into an incredible challenge for all,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s.
More than 40% of anesthesia professionals are considering leaving their roles within two years, citing workload and pay pressures. Some centers have closed rooms or canceled cases due to lack of coverage.
ASCs expanding into spine, orthopedic and cardiovascular lines are adapting to new outpatient realities as complexity rises. Advancements in robotics and navigation systems are making high-acuity cases more feasible outside the hospital, but growth depends on infrastructure, reimbursement alignment and coordinated anesthesia support
In smaller markets, centers are exploring new ways to secure anesthesia coverage — from expanding training pipelines and adjusting reimbursement strategies to strengthening relationships with anesthesia partners.
Anesthesia costs have become one of the fastest-rising budget pressures for ASCs as workforce shortages, burnout and reimbursement cuts converge.
Amid these pressures, ASCs and anesthesia groups are rethinking how they align. Many centers are exploring closer partnerships with their anesthesia providers — through in-house employment, dedicated contracting or management service agreements — to stabilize coverage and improve collaboration.
Independent anesthesia groups, meanwhile, are looking for ways to maintain autonomy as consolidation and private equity ownership reshape the market. Some groups are restructuring their agreements with ASCs to maintain independence while balancing staffing and reimbursement needs.
As staffing challenges persist, anesthesia alignment will likely remain a top strategic priority for ASC leaders. Closer collaboration — whether through new contracting structures, shared governance or integrated care models — could help stabilize coverage and protect access to outpatient surgery as case volumes and complexity continue to rise.
