Workforce shortages, reimbursement declines and costly inefficiencies were some of the biggest anesthesia-related issues for ASC leaders in 2025. While many of these issues will persist into 2026, here are the wins that ASC leaders shared with Becker’s throughout the last year:
Staffing shortages
The projected shortage of anesthesiologists by 2036, according to a 2025 Medicus Healthcare Solutions white paper. The shortage is being driven by rising surgical demand alongside a training bottleneck, with residency positions failing to expand enough to meet workforce needs.
The shortage also extends to certified registered nurse anesthetists, who make up more than 80% of anesthesia providers in rural counties. By 2033, the U.S. is projected to face a shortage of about 12,500 CRNAs, nearly 22% of the current workforce.
The shortage may also look different across geographies, which is why successful ASCs emphasize being nimble and responsive to industry shifts.
“Because individual markets are unique, a one-size-fits-all approach to staffing is ineffective,” Brian Evans, COO of Opti Health System in Savannah, Ga., told Becker’s. “Anesthesia groups must be flexible, adapting to the available workforce to find the right mix of full-time, part-time and independent contractor staff. This strategy meets facility demands while minimizing the use of locums.”
Vijay Sudheendra, MD, president of Providence, R.I.-based Narragansett Bay Anesthesia, told Becker’s that his practice runs its own anesthesia school through a hospital and academic medical center partnership, where it trains providers with the hopes of keeping as many as possible retained.
As a smaller private practice, Dr. Suhdeendra said that it’s not always possible to meet prevailing compensation demands — a problem that many facilities are facing.
“With that being said, there’s also some amount of manufactured crisis in anesthesia. There are people who go to 1099, per diem, people who only want to work for 24, 30, 32 hours [per week], yet want to make the same as 40 hours,” he said. “There is a real crisis, and I get it, but there’s also some manufactured crisis because people are taking advantage of the situation.”
Reimbursement and cost issues
CMS finalized a 2.83% cut to the anesthesia conversion factor for 2025, adding financial strain at a time when labor costs for anesthesiologists and CRNAs continue to rise. Leaders say the squeeze is especially difficult for hospitals and ASCs already facing subsidy growth and staffing shortages.
ASC leaders managing anesthesia face a difficult set of decisions as they find ways to make up for rising costs without interfering with patient care.
“Over 90% of anesthesia costs are clinician salaries, limiting opportunities for significant cuts in today’s competitive market,” Brian Cohen, MD, administrative chief of Miami Anesthesia Services told Becker’s. “The key to high-quality, lower-cost care is optimizing team deployment — collaborating with surgical departments on case scheduling, consolidating service locations and reducing downtime. As anesthesia costs increasingly shift to hospitals and ASCs, leaders must balance staffing ‘needs’ versus ‘wants.’ At no point should anesthesia quality be compromised — the stakes are too high.”
Operating room inefficiencies
OR scheduling and turnover times are some of the biggest challenges for ASC and anesthesia leaders, as the operating room minute represents one of the most expensive units of time in medicine.
Leaders are thinking about both large scale and team-level changes that can make a significant difference in OR efficiency.
“In 2025, I learned that small workflow adjustments can significantly improve throughput, and that most delays can be prevented with early, clear communication among anesthesia, nursing and scheduling,” Peter Bravos, MD, chief medical officer of Sutter Health Surgery Division in Sacramento, Calif., told Becker’s. “Strong block-utilization planning, while making sure block time is used efficiently and adjusted proactively, has proven equally important in reducing idle time and preventing downstream delays.”
Alejandro Badia, MD, an orthopedic surgeon and founder of Miami-based OrthoNOW, told Becker’s that efficiency in the OR looks very different than it did even a few years ago.
“Due to the decreasing margins at most ASCs, OR efficiency can not be discussed without including OR utilization. In collaboration with our partners at Miami Anesthesia Services, the surgeon partners have decreased the gaps in our horizontal schedule to run more vertically,” he said. “This requires teamwork across all stakeholders, as we strive to fill the days from 7 a.m to 5 p.m. We have also embraced a more customized approach to anesthesia staffing models tailored to the specific cases scheduled that day. This allows for a more efficient workflow that begins in the preop area and extends through discharge.”
