Question: How do you envision the anesthesia workforce evolving over the next five years?
Editor’s note: Responses were edited lightly for clarity and length.
Aaron Chyfetz, MD. Assistant Professor Of Medicine at Montefiore Health System (New York City): All anesthesiologists will be employed by hospital networks and there will be universal standard health coverage where healthcare teams collaborate for optimal health care delivery and patient results.
Corey Collins, DO. Medical Director at Anesthesia Consults of Massachusetts (Boston): I believe anesthesia services will suffer a sudden systemic shift to an ICU model, where physicians are relegated to American Society of Anesthesiologists class 3 or 4 patients and CRNAs provide all routine ASA [class] 1 to 3 care. Sedation services will be returned to sedation RNs for routine short ASC cases. Mark Warner, MD, has described this since the early 2000s at the Mayo Clinic, and I think he was right.
Robert Fabich, CRNA at SSM Healthcare of Oklahoma (Edmond): An overall increase in the anesthesia provider shortage related to the aging workforce as well as decreasing reimbursements amongst other things. I also see a push for anesthesiologist assistants as a bandaid to the problem, albeit not a viable or fiscally responsible long-term solution. It will also be interesting to see how the growth of emerging technologies such as AI will impact the anesthesia workforce. Bottom line, I for see a time of chaotic change.
Marco Fernandez, MD. Anesthesiologist at Chicago Anesthesia Leaders. The pandemic and healthcare consolidation has created unique problems in the medical profession or, as our organizations like to think about things, it has created unique opportunities. My No. 1 priority as the president of Midwest Anesthesia Partners and the Association for Independent Medicine is to take good care of our physicians, CRNAs and CAAs. Our biggest asset is our members, and the high demand for, and low supply of, our services gives us an opportunity to stay independent and collaborate with all of our stakeholders. We will continue to struggle as a specialty because some of the focus is on the differences between the MDs, CRNAs and certified anesthesiologist assistants, instead of the threads that can unite us. This anesthesia demand and supply shock is an opportunity to think outside the box on how to address our workforce issues. The easy answer is to increase the number of spots for anesthesia residencies, CRNAs and CAAs, including using foreign graduates. Increasing the number of spots requires investment, something that may not be feasible in the economic model of profit extraction.
Chris Hackney, MD. Anesthesiologist at Emory Specialty Associates Anesthesia (Johns Creek, Ga.): For the next five years, I see expansion of independent CRNA practice in private outpatient surgery centers. Anesthesiologists will be more specialized to care for patients in hospitals and the surgery centers associated with hospitals. Healthcare systems will look for more ways to reduce the costs by conducting more procedures such as outpatient surgery, perhaps even creating more hybrid centers that can provide extended 23-hour postoperative care.
Matthew Hulse, MD. Chief of the Division of Critical Care Medicine at Medical University of South Carolina (Charleston): Anesthesia providers are uniquely positioned to be both leaders and disruptors in healthcare, balancing clinical expertise with innovation, efficiency and entrepreneurial thinking in care delivery. The next five years will bring key transformations:
- Smarter technology, smarter care: AI and automation won’t replace anesthesiologists, but they will become essential tools for optimizing perioperative decision-making. Predictive analytics will refine hemodynamic management, while AI-driven workflow efficiencies will help us do more with less — without compromising patient care. The real challenge will be integrating these tools seamlessly without adding cognitive overload.
- Anesthesia without walls: The days of anesthesia being confined to the OR are fading. As complex procedures shift into ASCs, office-based settings and other non-traditional environments, anesthesiologists will need to think like operational strategists — balancing efficiency, safety and logistics in ways we haven’t before. Those who embrace this shift and develop scalable systems to support it will thrive.
- Scaling expertise, not just manpower: With ongoing workforce shortages, the traditional anesthesiologist-to-patient ratio isn’t sustainable. We’ll see more structured care team models where anesthesiologists take on expanded supervisory roles, leveraging CRNAs and AAs to maintain quality and oversight at scale. The real innovation will come in dynamically structuring teams based on case complexity rather than rigid staffing ratios.
- Fixing the workforce equation: Burnout remains one of the greatest threats to the specialty and the medical workforce as a whole. The solution isn’t just better staffing — it’s rethinking how and where we work. Flexible scheduling models, telemedicine for preop/postop assessments, and AI-assisted charting could reduce non-clinical burdens. The groups that successfully balance workforce engagement with high-quality care will have a serious competitive advantage.
Christopher Hoeman. CEO of ICON Anesthesia of New England (Middleton, Mass.): It is difficult to make a global prediction on the state of anesthesia. Each region is unique in the state laws, providers and reimbursements. Overall, it is obvious there is a push toward outpatient facilities managed by larger hospital groups/PE. If the smaller entities want to survive they must band together. Eventually, the mercenary mentality will have to subside due to unsustainability. Ultimately, everyone will need to share in the compromise of what profit margins mean. Centers are and will be forced to streamline case scheduling while focusing on procedures that maintain a higher profitability for the centers to properly support their anesthesia partners and themselves. In turn, anesthesia groups will need to become more transparent if they are going to ask for the necessary subsidization. We are and will be more symbiotic with the centers to ensure viability. The utilization of non-physician providers in independent or collaborative roles will be more the norm to minimize costs while providing quality care. Ultimately, the trend will continue to be directed towards a lifestyle where [a] 7:00 to 3:30 [workday] with decent pay and time off are the biggest draw. This will continue to push the allure of the 1099/locums provider to obtain control and flexibility in their lives.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s: Over the next five years, the anesthesia workforce will adapt to meet increasing demand through:
- Expanded roles for non-physician providers: Certified registered nurse anesthetists and certified anesthesiologist assistants will take on more responsibilities, especially in underserved areas.
- Integration of non-anesthesia physicians: To address provider shortages, non-anesthesiologist physicians are increasingly administering sedation for procedures outside the operating room, necessitating robust training and credentialing to ensure patient safety.
- Adoption of AI: AI platforms will optimize the match between anesthesia provider availability and surgical demand, enhancing operational efficiency and reducing costs.
- Focus on data-driven decision making: Utilization of data analytics will enhance patient outcomes and operational efficiency, guiding clinical decisions and resource allocation.
Cory Koenig, DO. Vice President of Operations at Providence Anesthesiology Associates (Charlotte, N.C.): I certainly want to remain optimistic that things will improve. However, I just don’t think the workforce can continue to be asked to do more for less. The financial pressures on the specialty must be fixed because the supply and demand are in such misalignment already. I think one of the most demoralizing things was when our government and CMS attempts to label us health care heroes for being on the front lines during COVID and then immediately decrease reimbursements year after show goes to show you what they really think of us. If things do not change, I believe the staffing shortages will continue and the specialty will become less desirable. I simply can’t wrap my head around the fact that almost all other payments by CMS are being adjusted somewhat for inflation but anesthesia reimbursements are down 20% over the last 20 years.
John Kezele. CRNA at Franklin County Medical Center (Preston, Idaho): Value-based anesthesia providers will move to the front of the line. The others will wind up working for value based care provider wages or will find a way to move towards chief medical officers, or what the ASA called the peri-operative surgical home, pushed a decade ago. The problem is that CMS and insurance companies are now reducing pay for non physician providers. Somewhere the system will break down. Payments and wages are not keeping up with inflation. Anesthesia service should follow the same safety guidelines as the airline industry. Most of us are working longer hours to achieve the same income. All may become the perfect storm in the near future.
Julie Staczek-Marx, CRNA. Federal Political Director Michigan Association Of Nurse Anesthetists: Over the next five years, anesthesia staffing models must evolve and adapt in response to economic pressures and workforce shortages due to attrition. Financial realities will drive hospitals and healthcare systems to adopt the most cost-effective, sustainable anesthesia delivery models, particularly in states that have opted out of federal supervision requirements. These forward-thinking states have given hospitals the flexibility to choose anesthesia care models that best align with their financial and operational needs, ensuring continued access to high-quality anesthesia services.
Here in Michigan, we have five doctorate-level CRNA programs, graduating over 123 CRNAs annually, with more than 95% remaining in the state. These highly trained professionals are filling critical gaps in anesthesia care, from urban level 1 trauma centers to rural hospitals in the Upper Peninsula.
The growing interest in the CRNA profession is evident at Oakland University-Beaumont’s [Graduate Program of Nurse Anesthesia], applications surged to over 873 in 2024, more than double the number in 2020. While the pipeline of future CRNAs is expanding, securing adequate clinical rotations for hands-on anesthesia training remains a challenge.
One of the primary barriers is competition with physician residents for case numbers. Unlike physician residency programs, there is less financial incentive for supervising CRNAs in training, making some clinical sites hesitant to accommodate them. Without adaptation in training models and funding structures, some programs may be forced to limit student admissions, ultimately constraining the growth of the CRNA workforce at a time when demand is rising.
To ensure a resilient, adaptable and patient-centered anesthesia workforce, healthcare systems must embrace innovative staffing models, expand clinical training opportunities and advocate for equitable reimbursement structures that support the evolving role of CRNAs. The next five years present both challenges and opportunities in our ability to adapt will determine the future of anesthesia care.
Samuel Smith. CRNA at Richmond (Va.) VA Medical Center: The APRN model has been under attack for decades, but CRNAs have been at the forefront of anesthesia practice for 150 years. That is a message that the public needs to hear. We have been serving quietly on the frontlines, providing safe and solo anesthesia care to every branch of the military, since the Civil War. No other anesthesia specialty has that feather in their cap. To that end, with continually contracting reimbursements, CRNAs must be seen as the safe and cost-efficient anesthesia provider of choice. I would love to see the model of OB-GYN and midwifery collaboration extend into the anesthesia profession to finally end the constant bickering between the experts in anesthesia, CRNAs and anesthesiologists, but unfortunately, the model of physician-extenders has been the choice for anesthesiologists, rather than them “sitting the chair,” which will continue to drive costs in the wrong direction.
Ron Tharp. CRNA at Akron (Ohio) Children’s Hospital: I think cost containment while maintaining high quality of care will be a huge challenge. Integration of AI into anesthesia practice will make anesthesia safer for all patients.
Jeff Tieder. MSN, CRNA. Clinical Assistant Professor at the University of Tennessee at Chattanooga: The U.S. is facing a significant anesthesiologist shortage, projected to reach 12,000 physician anesthesia providers by 2030. This shortage is driving a shift in practice models, particularly in states requiring supervision, where anesthesiologist assistants are unable to practice independently. The key question is, “How will anesthesia care teams adapt when there aren’t enough physician anesthesiologists to supervise?” In response, we may see a growing reliance on CRNA-led models, as CRNAs in most states can practice independently or under the supervision of a surgeon, whereas AAs cannot. Traditional anesthesia care team models, where one anesthesiologist supervises multiple cases, may become less sustainable as demand increases. Some hospitals and surgery centers have already experienced OR closures, as seen with Emory and Grady in Atlanta, due to a lack of available anesthesia providers.
At the same time, economic pressures are forcing a reassessment of supervision models. While anesthesia care team structures have long been the norm in many facilities, the cost-effectiveness of physician anesthesiologists primarily supervising rather than directly providing care is being questioned. With reimbursement rates remaining equal regardless of provider type under the Affordable Care Act, some insurers still reimburse CRNAs at lower rates due to the lack of a final rule from the executive branch. These financial and workforce constraints could push anesthesia models toward a future where physician anesthesiologists function more like hospitalists or intensivists — providing consultation and additional resources in some cases, rather than directly supervising every anesthetic.
As the anesthesia workforce continues to evolve, efficiency and adaptability will be critical. Facilities may need to rethink how they structure anesthesia services to ensure both access to care and financial sustainability in the years ahead.
Reuben Wechsler, MD. Anesthesiology at Wellstar MCG Health (Kennesaw, Ga.): The workforce is aging, and the inability to fill the shortfall created by COVID-19, because we don’t graduate enough anesthesiologists per year, makes it difficult to envision how we can evolve. Literature recommends older practitioners should cut back if they wish to keep working, but in the real world, are rarely allowed to, which forces them to retire because of the stress created, and for safety’s sake. This of course adds to the shortage. A true Catch-22.
