As hospitals and ASCs grapple with persistent anesthesia workforce shortages, issues with “wasted coverage” are emerging alongside them, according to Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia Consultants.
Dr. Friedman joined Becker’s to discuss how even in facilities that are technically fully staffed, volatile procedure demand is creating inefficiencies that strain access, drive up costs and fuel clinician burnout.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Where are you seeing the biggest gaps today between anesthesia staffing and procedure demand?
Megan Friedman: Our group is fortunate right now that we’re fully staffed. A lot of sites, a lot of hospitals, are still having coverage issues. One thing that we are seeing — even as facilities are staffed — is a temporal and site-level mismatch. Procedural demand has become a lot more volatile and front-loaded, particularly across GI, catheterization labs and other non-operating room anesthesia [NORA] locations. 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. That’s followed by midday lulls where providers are staffed but underutilized.
This mismatch creates access bottlenecks for patients at the beginning and ends of the day, and inefficiencies for hospitals and anesthesia groups. With more and more NORA locations requiring anesthesia coverage, this is only going to accelerate. These cases are not always electively scheduled, which makes static staffing models increasingly misaligned with real-world procedural demand.
With technology getting more advanced, you’re seeing more and more things done outside the OR, and that’s contributing to this problem.
Q: What would you say is the best strategy to combat this imbalance?
MF: It starts with changing your mindset from a scheduling standpoint — moving away from “we’re going to staff this room” and instead recognizing that early-day demand, late add-ons and short-notice cases, especially in NORA locations, are going to happen.
You also need your schedulers, whether at an ASC or hospital, to be well aware of this and working in tandem. A lot of facilities have IR scheduling separately, and no one communicates. If you have more centralized scheduling, you can fill provider gaps during those midday lulls. Ultimately, you start the day with a certain number of providers, and you need to use them efficiently. Whether that means better sequencing of cases or coordinating across service lines, centralized scheduling with anesthesia at the core would help.
Q: What does “wasted coverage” look like in practice, and how much of a cost driver is it?
MF: Wasted coverage shows up in a few ways. Number one is fully staffed rooms with no cases due to poor block management. Blocks aren’t released in time by surgeons or proceduralists, or on the flip side, they’re not filled by schedulers. Schedulers need to be aggressive about calling offices and filling time. Some facilities are very aggressive, and others aren’t, and you see a big difference in volume and gaps in the day.
Another issue is anesthesia teams being held for delayed or canceled cases. For example, an anesthesiologist who should have gone home at 3 p.m. ends up waiting for a GI doctor who shows up two hours late, or doesn’t show up, and then the case is canceled. That’s a huge waste in coverage.
We also see providers sitting idle at one site while another site is overloaded with add-ons. Financially, this is a major hidden cost. Hospitals often perceive this as overstaffing, but historically, anesthesia groups absorbed it as uncompensated standby time, which contributed to workforce attrition and the shift toward hourly compensation models.
When you multiply even 30 to 60 minutes of idle time per room across multiple rooms, sites, and days, the cost becomes material very quickly — often reaching six or seven figures annually. More importantly, it erodes clinician morale. Nothing contributes to burnout faster than being held to inefficient schedules when demand exists elsewhere.
In our group, we credential physicians across all sites and dynamically redeploy anesthesiologists as volume shifts. That preserves productivity and morale by ensuring meaningful work for the day. Long term, physicians aren’t going to stay in environments where their days are routinely wasted or cut short.
