While the projected shortage of 6,300 anesthesiologists by 2036 may seem far off, its impact is already emerging.
Financial pressures, staffing challenges and shifting care models are reshaping how surgical care is delivered, and anesthesia leaders warn that the next five years could bring significant and lasting change. Here are five long-term consequences they see ahead.
1. Financial strain and operational inefficiency
Workforce costs and declining reimbursements are hitting anesthesia practices harder than most specialties, driven by steep wage inflation, said Mo Azam, MD, head of innovation at Orlando, Fla.-based US Anesthesia Partners. Many facilities, he noted, operate at less than 65% utilization, meaning they pay for anesthesia teams who are idle for large portions of the day.
“Facilities paying stipends have created an arms race between each other, and are doing so to keep grossly inefficient systems in place,” Dr. Azam said. “The long-term effect will be some winners and many losers… rural, financially strained facilities and some ASCs may not survive.”
2. Reduced rural access
The shortage is driving compensation higher even as reimbursements decline — a particularly dangerous combination for rural hospitals, said Andrew Briggs, CRNA, clinical education coordinator at UCHealth Anesthesia Southern Region in Colorado Springs, Colo.
“Rural systems especially face a great danger of losing anesthesia services,” Mr. Briggs said. “These communities face massive challenges in areas where recruiting providers is already difficult.”
He noted that hospitals are increasingly relying on costly temporary providers, with usage up 17% since 2024 and projected to rise another 5% in 2025. Funding shortfalls, he warned, could lead to care delays and sicker, more complex patient populations.
CRNAs deliver more than 80% of anesthesia services in rural counties, according to the American Association of Nurse Anesthesiology. Yet shortages are widening: facilities reporting anesthesia staffing gaps grew from 35% in 2020 to 78% by late 2022, and nearly 22% of anesthesia providers are expected to leave the workforce by 2033. Insurer policies are adding pressure — for example, UnitedHealthcare’s July 1 update will cut CRNA reimbursement by 15% starting Oct. 1, limiting payments to 85% of physician rates.
3. Leadership pipeline erosion
Staffing shortages don’t just affect patient care, they also threaten the leadership pipeline, said Rachel Charney, MD, managing associate and senior client partner of DSG Global.
“A shortage in any field reduces motivation for junior faculty to take on leadership roles,” Dr. Charney said. “This diminishes our pipeline of strong leaders and narrows scientific discoveries and advancements in anesthesiology.”
She added that lean staffing models can weaken hospitals’ disaster readiness, as planning for mass casualty events is often deprioritized amid day-to-day operational pressures.
4. Compromised care quality
Shortages force facilities to consolidate surgical cases into fewer, less-specialized areas, a shift that can undermine efficiency and outcomes, said Robert Johnstone, MD, professor of anesthesiology at West Virginia University.
“Anesthesia shortages also compromise quality by forcing surgeries into a few multi-purpose areas,” Dr. Johnstone said.
He warned that these pressures contribute to clinician burnout and could accelerate facility consolidation.
5. Shifts in staffing models
Hospitals will increasingly rely on stipends or premium locum rates to maintain surgical volume, and staffing models will evolve to adapt, predicted Jake Yellen, CRNA, owner of United Sedation in Albany, N.Y.
“The traditional 4:1 medical direction staffing ratio will likely become outdated,” Mr. Yellen said. “We’ll see more independent CRNA-only teams, more QZ billing models and more outpatient surgeries shifting to ASCs.”
Mr. Yellen added that some ASCs may begin directly hiring anesthesia teams to control costs and ensure stability.
