Anesthesia stipends continue to skyrocket, with the share of ASCs expecting to pay stipends jumping from 28% in 2024 to 44% in 2025, according to a VMG Health report, a 57% increase in a single year.
Additionally, 60% of ASC leaders ranked anesthesia coverage among their top three financial challenges for 2026, according to the same VMG Health survey, making it the most commonly cited operational concern heading into the year.
Sean Gipson, an ASC administrator in the Dallas-Fort Worth area with a background in hospital administration, told Becker’s he didn’t believe it at first. Mr. Gipson had spent months asking the certified registered nurse anesthetists and anesthesiologists he works with what was pulling them toward hospital shifts instead of ASC cases. The answer, once he got someone to show him, came in the form of a canceled check.
“They’re paying them like a $4,000 stipend just to walk in the door,” Mr. Gipson said.
He said the number sounded implausible until a provider “pulled out a check that showed the stipend right there.”
“ASCs increasingly must offer anesthesia subsidies just to keep coverage intact due to workforce shortages and declining anesthesia reimbursement,” Scott Kulstad, CEO of St. Paul (Minn.) Eye Clinic, told Becker’s. “These subsidies were rare a few years ago but are now becoming material operating expenses that commercial contracts do not account for.”
Traci Albers, CEO of Sioux Falls, S.D.-based Surgical Management Professionals, said that subsidy burden is landing on centers that never budgeted for it.
“Anesthesia is now a cost for many ASCs that previously did not have to subsidize their providers,” she told Becker’s. “With increasing anesthesia shortages, increasing salaries and stagnant reimbursement, ASCs are now subsidizing anesthesia.”
These stipends, however, are sustainable within hospital margins, not ASC margins. According to Mr. Gipson, hospitals are outbidding ASCs for a shrinking pool of anesthesia providers because they can absorb costs that ASCs can’t.
“That’s more than twice of what we were paying anesthesia providers even three years ago,” he said of the group he now employs.
The gap, he said, comes down to what each site can afford to lose.
“I wasn’t going to be able to afford that, nor would any other ASC, when you’re working on the margins that we work on versus what a hospital works on,” he said.
Mr. Gipson points to a mismatch between falling anesthesia reimbursement and rising stipend costs, leaving hospitals and ASCs both stuck absorbing the difference because neither can run cases without anesthesia coverage.
“If you look at the reimbursements for anesthesia, they’re going down,” he said. “We’re the ones taking the squeeze, because the hospitals or the ASCs are the ones that have to have anesthesia there — we can’t do surgery without them.”
Average professional anesthesia reimbursement has fallen 5.5% since 2019, dropping from $22.27 per unit to $21.88 per unit in 2023.
Mr. Gipson ties the stipend conundrum directly to a shrinking anesthesia workforce. He estimated the field will see an additional 20% shrinkage over the next five years as older providers retire, compounded by low enrollment in anesthesia training programs in recent years.
Rather than keep competing for stipend-driven coverage, Mr. Gipson bought an anesthesia group outright.
He credits the purchase with letting him redirect some of that same anesthesia capacity back toward hospital cases at the now-inflated market rate, rather than only absorbing the higher cost.
“To be quite honest, I’ll throw them over in hospital cases because we’re making those stipends now,” he said. “We pay our guys well, but it’s an exorbitant [amount] — more than twice of what we were paying anesthesia providers even three years ago.”
Not every ASC has the capital or scale to acquire an anesthesia group outright, which is where Mr. Gipson’s story becomes a warning rather than a playbook. Smaller, independent centers without that option are left negotiating from a weaker position against the same hospital stipends squeezing the market.
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.
