When Ohio State University Wexner Medical Center in Columbus opened its Eye and Ear Institute surgery center over a decade ago, most of the anesthesia residency training still happened on the main campus. That model worked well enough, until a familiar pattern started playing out: cases migrated, and the program didn’t follow them.
Jarrett Heard, MD, associate professor of clinical anesthesiology and medical director of perioperative services at Ohio State University Wexner Medical Center, said the gap became clear through feedback from residents themselves.
“We quickly found that once the cases left EEI, our first surgery center, they started sharing things like, ‘I’ve never done a sitting shoulder case,’” Dr. Heard said. “And even though that’s not necessarily an ACGME requirement, we felt that was very, very wrong.”
Ohio State has since opened five ASCs and two additional HOPDs. Regional cases, hand cases and shoulder cases that once lived on the main campus floor have moved steadily to those sites. The residency program has had to move with them.
The fix, Dr. Heard said, started with the program director looking at the residency class schedule and identifying how many months they could place two residents on the ambulatory rotation simultaneously. When they could, one of those residents would be assigned to one of the newer surgery centers, specifically to get the procedural exposure that wasn’t available on main campus anymore.
From there, the restructuring expanded. Ohio State embedded ambulatory exposure across multiple training years, rather than concentrating it in the traditional CA-3 rotation. By the end of the CA-1 year and again in the CA-2 year, residents now rotate through the same-day surgery center. A regional anesthesia rotation places two residents at a community hospital and builds in time for them to work at a surgery center on regional blocks. By the CA-3 year, residents rotate to all of the health system’s ambulatory sites, with the exception of two sites staffed by community-based anesthesiologists.
The Ohio State Wexner Medical Center also launched a student registered nurse anesthetist program, and Dr. Heard said he has been working with leadership to integrate the program into ambulatory settings as well — part of the same logic that if the labor force is going to work in surgery centers after training, the surgery center experience needs to be built into the training itself.
“You can’t say, ‘Hey, this is all 100% for profit and just cranking out cases, and we don’t have time to teach,’” Dr. Heard said. “You’re going to have to figure out how to get them involved in these cases, so that they’re ready to go out and become the next wave of the labor force as we get older and retire.”
The curriculum at the ambulatory sites includes a lecture series running throughout the rotation that covers market conditions, staffing challenges and the economics of outpatient surgery. Dr. Heard said the goal is to move residents out of the academic hospital mindset and into the operational reality of a busy community surgery center.
“The success of them performing in this role is to get into the mindset of being in a community-based practice and being at a very busy surgery center,” he said.
The program also applies efficiency standards that reflect ASC norms rather than academic hospital norms. Teaching time ends at 2 p.m., after which the attending surgeon or proceduralist is expected to be scrubbed and actively participating. Residents are given less independent latitude as the day progresses, in part to keep cases from running past scheduled hours — an expectation Dr. Heard said is set explicitly at the start of each rotation.
The structural changes at Ohio State reflect a broader shift Dr. Heard said academic anesthesia programs cannot afford to ignore. As ASC market share grows and inpatient surgical volume continues declining in many regions, programs that train residents exclusively in hospital environments are producing graduates who are underprepared for the settings where most of their careers will actually take place.
“We know we’ve seen an increase in market share of ASCs, especially relative to HOPDs, and we see an increase in outpatient surgery,” Dr. Heard said. “So that was our solution to getting them out there with respect to how we can try to mitigate operational inefficiencies when it comes to procedural work.”
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.