The anesthesia workforce shortage has become a fixture in healthcare at large as hospitals, health systems and ASCs figure out how to balance high surgical demand with a lack of providers.
Three leaders in anesthesia recently joined Becker’s to share the trends they’re observing in how ASCs and other organizations adapt to the shortage.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What adjustments has your practice made in the last year to keep operations flowing smoothly and safety amid this challenge? Or what trends have you observed in other facilities?
Adam Chauncer, CRNA. Owner of Trident Anesthesia (Dallas-Forth Worth, Texas): Most of the facilities that we cover are smaller facilities where it is unnecessary and unsustainable to have multiple anesthesia providers working in an anesthesia care team, where some providers are present in the facility but not generating revenue by doing their own cases. Over the past several years, more and more of these facilities have explored different staffing models. Facilities that used to request physician anesthesiologist-only coverage have been open to other models for coverage, including CRNA-only coverage, the aforementioned physician anesthesiologist-only coverage, or a blended collaborative approach where CRNAs and physician anesthesiologists are utilized in similar roles, allowing each to utilize their full scope of practice. A collaborative anesthesia approach utilizes providers based on the needs of the facility, the availability of the anesthesia providers, the skills and experience of each anesthesia provider, and the desires of the surgeons and/or facilities. By not imposing unnecessary restrictions in their policies, procedures, and bylaws that may be “legacy” policies that have been in effect for years, these facilities now have multiple options for consistent coverage by a group of anesthesia providers working independently and collaborating with the facility, with a focus on value and not politics.
Xi Luo, MD. Clinical Associate Professor in the Department of Anesthesiology & Pain Management at UT Southwestern (Dallas): The anesthesia workforce continues to experience instability, and one of the most effective levers individual anesthesia divisions can deploy is the intentional creation and maintenance of a strong culture of safety. Importantly, this includes not only patient safety, but psychological safety for all members of the care team.
In practice, this means maintaining professionalism in all interactions, fostering collaborative case planning, and ensuring that team members feel respected even during periods of strain. A psychologically safe environment stabilizes the existing workforce and can become a meaningful recruiting differentiator in a competitive market.
During day-to-day staffing shortages, transparency is essential. Clearly communicating staffing challenges and distributing additional workload equitably helps preserve trust, prevent resentment, and reduce burnout. When teams understand how decisions are made and feel the burden is shared fairly, operational performance and clinical outcomes remain strong even during understaffed periods.
From a broader facility perspective, several trends are emerging. Many organizations are strategically deploying mid-level providers and selectively incorporating locum tenens coverage. Mid-levels, such as nurse practitioners, can add substantial value in the perioperative space when appropriately trained—particularly in preoperative evaluation, risk stratification, and case planning. The key is structured onboarding and a clear emphasis on anesthetic risk recognition and escalation pathways.
Similarly, thoughtful integration of locums can protect the core workforce from burnout. When accompanied by a clear cultural reset and expectations, locum utilization can also serve as a recruitment pipeline, with opportunities to convert high-performing locums into permanent staff.
Mark Vojtko, APRN, CRNA. Delta Wave Anesthesia (Exeter, N.H.): I don’t really see an anesthesia staffing shortage on the scale that many think. What I do see is a failure within anesthesia departments to utilize personnel efficiently. In my opinion, the Anesthesia Care Team/Medical Direction (ACT) model is the biggest threat to anesthesia services and continues to be a contributor to the problem.
There is no shortage of evidence to prove that no practice model is superior to another, be it solo physician anesthesiologist, nurse anesthesiologist, or ACT. First and foremost, we have to both understand and admit that the ACT model is a billing model and not a standard of care. If you are board-certified in anesthesia, you should be in an operating room delivering anesthesia and not supervising others doing the work. Regardless of what initials you have after your name, there is no reason whatsoever that a nurse anesthesiologist can’t be doing pre-ops, making assignments, being the helping hands for emergencies and complex cases, or doing blocks while a physician anesthesiologist is in an operating room. The care team model, by design, creates a hierarchy that is not conducive to all anesthesia personnel practicing to the full extent of their licensure and training. Furthermore, the ACT hierarchy creates clinical and educational limitations, job dissatisfaction and burnout. The endpoint is overworked, unhappy employees, leading to turnover, which is very expensive.
As a full-time independent contractor, I have seen a more relaxed approach to practice models, with more emphasis on independent practice for nurse anesthesiologists, more use of “collaborative” models, more physician anesthesiologists in the OR doing cases and more AA and QZ-only billing. With the increasing needs of patients, all providers have a professional responsibility to expand their education and skill set to meet the demands of “doing more with what we have” vs. “doing more with less”.
Everyone wants work-life balance. Nobody really wants to spend their weekends being on-call, and money doesn’t fix problems. We need to start getting creative with schedules: half days, later starts, early release, weekend-only schedules that maximize OR utilization and minimize the need to compensate for inactivity. We also need to understand that flexibility comes with a financial shortfall—you can’t have it both ways.
