Are anesthesia shortages the next care disruptor?

Four anesthesiologists joined Becker's to discuss how they expect the anesthesia provider shortage will disrupt care in the next five years. 

Editor's note: These responses were edited lightly for clarity and length. 

Thomas Durick, MD. Anesthesiologist at The Ohio State University Wexner Medical Center (Columbus): As private equity firms keep buying up practices and making promises to hospital administrators they cannot keep (such as "We can reduce your costs by not having to pay a sustenance fee to an anesthesia group," "We can staff all your operating suites fully," or "We can recruit and retain better"), the art of private practice will go the way of the dinosaur. We will all become employees of whichever firm/company/entity offers us the best package that meets our basic needs. 

For some, it is time off. For others, it is all about the money. Yet others need better benefits. After 30 years in private practice, most of those spent truly solo as an independent contractor, it is more challenging than ever to stay competitive in the market for anesthesiologists. After COVID-19, people found they didn't care to work 80-plus hours per week anymore; that they liked being home with their family; that there was more to life than work, call, submit charges and do it again tomorrow. We will see a continued reduction in the viable anesthesia workforce that will never correct itself. There will be far more job openings than those filling those jobs, and that continued pressure from the C-suite to expand vertically (meaning we work longer hours each day for the same pay) and horizontally (keep opening operating rooms even if we don't have the staff or patients to fill then just in case a surgeon wants to operate) to make up for declining reimbursements from all payers and inefficient billing, coding and collection practices will continue to whittle away at the anesthesia workforce.

There is a breaking point for each person; once their individual breaking point is reached, each person has to make that choice to do what is in the individual's best interest or keep plugging harder to make ends meet. Our biggest problem (and our known weakness to administrators) is our extreme dedication to what we do: We work until the cases are done, no matter what. 

Scott McGraw, MD. Chief Medical Officer and Anesthesiologist at Baylor Scott & White Surgical Hospital Las Colinas (Texas): There is definitely a supply constraint issue with both anesthesiologists and certified registered nurse anesthetists. This has required increased salaries, a need for rising stipends for hospital coverage and new stipends from certain ASCs secondary to either inefficiencies or poorer payer mixes. This will continue for the next five to 10 years secondary to large cohorts in both groups having a high percentage aged 55-65 years old.

Tariq Naseem, MD. Anesthesiologist and Interventionist at Smidt Heart Institute (Los Angeles): I think it will come down to that procedures will be performed at places that can afford to retain an anesthesiologist. Places that want to get cases done in a more affordable fashion will struggle. We've already seen that. A lot of these places, for instance, like ASCs, are utilizing more and more nurse anesthetists for this purpose. I think the struggle will be how to get anesthesiologists. It's going to become harder and harder if it's just too expensive to provide that coverage. 

Hospitals, like large ones, academic-based centers, will be able to retain them, but the moment you go into a pure, clinical, revenue-based production, it's hard. As an example, a few weeks ago I was talking to a gastroenterologist who said he just joined an ASC who promised they would have anesthesia coverage for him. They didn't, so he's doing cases under sedation instead. But for some procedures, this cannot be done for a longer duration because patients can't tolerate it. 

Scott Thomas, MD. Regional Anesthesia Fellowship Director at Andrews Institute ASC (Gulf Breeze, Fla.): There's little doubt that the anesthesia provider shortage will be a major disruptor for years to come. And unfortunately there's not a quick fix since it takes several years to meaningfully increase the supply of adequately trained clinicians. In the meantime, hospitals and ASCs, specifically, will need to do more with less by fully maximizing efficiency with improved operating room utilization, more flexible OR scheduling and careful alignment of perioperative and anesthesia staffing. Consequently, patients may experience increased lead times for nonemergent procedures, and ORs may need to run later in the day as cases and surgeons are consolidated to fewer rooms. A word of caution, however: As more and more is demanded of a strained workforce, leadership will need to closely monitor the underlying culture of their staff since burnout can quickly lead to a dangerous cycle of attrition followed by more burnout of the remaining staff. As they say, culture eats strategy for breakfast.

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