A growing anesthesia provider shortage is forcing ASCs to rethink long-standing business models.
Across the country, anesthesia groups are shifting from traditional fee-for-service arrangements to hourly or salaried models, according to Megan Friedman, DO, chair and medical director of Los Angeles-based Pacific Coast Anesthesia Consultants, and many centers are struggling to adapt.
By 2037, the U.S. is expected to be facing a shortage of 8,450 anesthesiologists nationwide, according to a white paper from Medicus Healthcare Solutions.
Dr. Friedman told Becker’s that for many ASCs, the shift has been abrupt. Before the shortage, the market was oversaturated and ASCs had no problem finding providers.
Historically, anesthesia groups operated on a fee-for-service model, anesthesiologists billed per case, and ASCs rarely needed to subsidize coverage. That model has unraveled.
“It used to be all fee-for-service, but anesthesiologists have realized they should function more like ER staffing — you have physicians and [other] providers available to handle whatever comes in,” she said. “Anesthesia is similar: anesthesiologists and CRNAs don’t schedule their own cases or choose patients based on insurance. They’re at the mercy of the surgeons and the center.”
Now, many facilities are paying anesthesia providers hourly to ensure consistent coverage. Facilities need anesthesia available as a constant resource, whereas “in the past, you could get an anesthesiologist to do a case, wait a few hours, then do another,” she said.
“In ASCs, with declining reimbursements and inefficient scheduling, CRNAs just aren’t taking those cases anymore,” she said. “That’s why so many centers are relying on subsidies or switching to hourly models.”
According to an October VMG Health report, 67% of leaders ranked anesthesia coverage as a top concern for 2026, and expectations to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025.
That shift has been difficult for many administrators and physician-owners, Dr. Friedman noted.
“A lot of centers are relying on subsidies or switching to hourly models,” she said. “But that’s been hard for some administrators and joint venture partners to accept — they want to go back to how things were 10 years ago.”
Small and independent ASCs are feeling the strain most acutely, because they don’t have “hospital-level resources,” she said.
To offset rising anesthesia costs, Dr. Friedman said centers need to tighten operations and reduce downtime.
“They need to get stricter about what’s happening in their ORs,” she said. “For example, you can’t have one surgeon operating in the morning and another who doesn’t want to start until noon — you can’t have staff sitting around for hours. That’s not efficient use of resources.”
Analyzing case profitability is another key step. For instance, if an ENT is only doing tonsillectomies, maybe they can start bringing sinus cases that pay better.
Scheduling optimization is also critical. Dr. Friedman recommends keeping a sharp eye on data — including cost-per-case, overall and comparing among surgeons, and all aspects of anesthesia billing time units.
“You can’t have downtime,” she said. If you’re paying anesthesiologists hourly, you want to maximize billing and collections to make that worthwhile.”
In some cases, consolidation might be critical.
“ASCs might need to consolidate,” Dr. Friedman said. “While surgeons might not like it at first, they can’t argue with data. No one can really argue with data.”
