In 2025, ASC leaders grappled with mounting anesthesia provider shortages, reimbursement headwinds and the growing expectation to pay stipends to secure coverage, pressures that are reshaping staffing models and threatening access in some markets.
Now, as volumes climb and more complex cases continue shifting to outpatient settings, leaders say the next year could bring even sharper disruption.
Three leaders joined Becker’s to discuss the anesthesia challenges they are preparing for in 2026.
Editor’s note: Responses were edited lightly for clarity and length.
Question: What anesthesia-related issue do you expect to be the most disruptive in 2026?
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia (Los Angeles): The biggest disruption will be the growing mismatch between anesthesia workforce capacity and procedural demand, amplified by flat reimbursement and increasingly restrictive payer policies. As volumes rise across ASCs, gastroenterology, catheterization labs and OB-GYN, there is little tolerance left for inefficiency or excess coverage, placing pressure on staffing models and clinician sustainability.
Emma Gimmel, BSN, RN. Director of Nursing at Manhattan Endoscopy Center (New York City): As we continue finding the Zen moment post [the] pandemic’s anesthesia “seizures,” finding available anesthesiologists to join us and support from payers policies may be the watch focus. Models are difficult to modify without running into other changes that would require further changes to complicate life as we know it, but if we need to change our model, we will.
Kristen Richards. Vice President of Ambulatory Care at Cardiovascular Logistics (Lafayette, La.):. For cardiovascular ASCs, the need for anesthesia coverage will be needed due to the newly approved CMS ruling for cardiac ablations in the ASC setting. The challenge is going to be finding available anesthesia services to provide coverage for these EP procedures. We are currently seeing a national shortage of anesthesiologists and CRNAs. Cardiovascular ASCs should already be pursuing anesthesia coverage for their facility in preparation for cardiac ablations along with acquiring the appropriate anesthesia equipment, EP mapping equipment, developing anesthesia protocols and revising their patient selection criteria to ensure the right patient, for the right procedure at the right facility.
