The anesthesia workforce shortage is nothing new in healthcare — especially not for ASC leaders, who have cited the ongoing crisis as one of their top concerns in the year ahead.
There are, however, new data, technology, clinical and policy developments that are shaping the shortage in 2026 — and how leaders will approach it.
The staffing shortage in anesthesia is generally understood to be a supply-and-demand issue, with surgical demand across the U.S. rising faster than new medical students can replace retiring physicians.
Here’s a breakdown of the statistics, laws and finances behind the shortage and how its changing strategies to address the problem in the year ahead:
The numbers
- The projected shortage of anesthesiologists by 2036 will hit 6,300, according to a 2025 Medicus Healthcare Solutions white paper.
- Fifty-nine percent of practicing anesthesiologists are 55 or older, with 17% nearing retirement age.
- Anesthesiologists have the highest desire to leave their roles out of all physician specialists, with 40.6% expressing an interest in leaving their current jobs within the next two years, according to a June 2025 report from the American Medical Association.
- Around 50% of anesthesiologists report feeling burned out and depressed, according to the Medicus white paper, while 61% would take less pay for a better work-life balance and 51% attribute burnout to too many hours at work.
- More than 3,000 students applied to 1,805 anesthesiology residency training programs in the 2025 Match, resulting in 40% of applicants going unmatched.
- Between 2019 and 2023, there was a 45% decline in anesthesia-based applicants to pain medicine fellowships, according to a study published in the January 2025 edition of Pain Practice.
- Certified-registered nurse anesthetists also represent a significant portion of the anesthesia workforce, especially in rural areas, where 75% of CRNAs report practicing independently.
- By 2033, the U.S. is projected to face a shortage of about 12,500 CRNAs, nearly 22% of the current workforce. However, demand remains high, with the Bureau of Labor Statistics projecting 38% growth in the field by 2032, making a CRNA one of the fastest-growing healthcare roles.
The compounding factors
Several legislative, payer-related and regulatory developments have worsened the shortage by cutting reimbursements and straining operational margins, making it more difficult for ASCs to meet salary expectations for anesthesia providers.
The average anesthesia reimbursement rate in 2023 was $21.88 per unit, a 5.5% decline from 2019, according to medical billing servicer Coronis Health. Similarly, Medicare reimbursement fell from $22.27 per unit in 2019 to $21.12 in 2023, a trend highlighted in a VMG Health report.
Over the past 23 years, inflation-adjusted Medicare reimbursement for select pain management procedures has decreased an average of 2.81% annually, according to the American Association of Physician Leadership.
“At the same time, Medicare patients are often older, sicker and more resource-intensive, which increases clinical complexity while reimbursement moves in the opposite direction,” Michael Bernard, MD, an anesthesiologist and chief medical officer of Ambulatory Anesthesia Solutions in West Bloomfield Township, Mich., told Becker’s. “This widening mismatch is a major driver behind the surge in anesthesia stipend requests from ASC-based anesthesia groups, especially as more procedures become eligible for the ambulatory setting.”
Commercial payers have also tried to cut certain anesthesia reimbursements, notably those allocated to CRNAs. In October, UnitedHealthcare reduced reimbursement for QZ-billed CRNA services by 15% in selected states and removed payments tied to several add-on and qualifying-circumstance codes.
“Continued decrease in reimbursement certainly puts a strain on anesthesia practices at a time when overhead continues to increase,” Jason Habeck, MD, assistant professor of anesthesiology at the Minneapolis-based University of Minnesota, told Becker’s.
Payers are also becoming more aggressive in denying or clawing back payments.
“Insurers are getting more aggressive, and more creative, in avoiding payment,” Katy Dean, CRNA, chief nurse anesthetist at Newport News, Va.-based TKMAnesthesia, told Becker’s. “We’re seeing more denials for time discrepancies, claims being reprocessed months later with money pulled back, and even outright rejections for technicalities like modifier confusion (the codes that show who provided care).”
The shortage is also compounded by some “manufactured” elements, Vijay Sudheendra, MD, president of Providence, R.I.-based Narragansett Bay Anesthesia, told Becker’s.
“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.”
Even at facilities that are fully staffed, volatile procedure demand is creating inefficiencies that diminish access, drive up costs and contribute to a heightened sense of strain in the workforce.
“One thing that we are seeing — even as facilities are staffed — is a temporal and site-level mismatch. Procedural demand has become a lot more volatile and front-loaded, particularly across GI, catheterization labs and other nonoperating room anesthesia [NORA] locations,” Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia Consultants, told Becker’s. Anesthesia staffing models are still built around six daily blocks and historical averages, but we see consistent surges early in the day and then late add-ons and short-notice case stacking, especially in these NORA areas, that outstrip scheduled anesthesia coverage. That’s followed by midday lulls where providers are staffed but underutilized.”
The No Surprises Act
The federal No Surprises Act went into effect in 2022 with the goal of preventing surprise billing by implementing an independent dispute resolution process for payment disputes between payers and out-of-network providers.
However, the legislation has been at the center of controversy between anesthesia providers and payers. Physicians and provider groups claim that insurance companies take advantage of flaws and loopholes in the IDR process by creating significant delays in payment and, pushing physicians out-of-network and utilizing third-party companies during the dispute process to drive physician payment rates down.
A study published in August 2025 in Health Affairs found that the IDR process has generated at least $5 billion in costs since 2022. The costs are largely due to high dispute volumes and providers winning the majority of disputes from 2022 to 2024. Administrative costs accounted for more than half of the overall amount, at $2.8 billion. In 2024, providers won 85% of disputes. Median payment determinations were 459% of QPA in the fourth quarter of 2024, up from 327% in 2023. Some organizations, such as HaloMD, won awards at 934% of QPA. There have since been numerous lawsuits between payers and provider groups regarding the IDR process and award amounts.
In July 2025, the American College of Radiology, American College of Emergency Physicians and American Society of Anesthesiologists expressed support for the No Surprises Enforcement Act. The legislation would impose a penalty three times the difference between the insurer’s initial payment and the IDR arbiter’s ruling per claim, which would also be subject to interest.
“Insurance companies taking advantage of flaws in the NSA system jeopardizes the sustainability of anesthesia practices, threatening access to care,” said ASA President Donald Arnold, MD. “This legislation would hold big insurance companies accountable and shows a continued bipartisan interest in improving the No Surprises Act system.
Stipends
Provider shortages and coverage gaps are forcing many ASCs to pay anesthesia stipends. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report released Oct. 9. Additionally, 67% of respondents cited anesthesia coverage to be in their top three financial challenges for 2026.
“Anesthesia is now a cost for many ASCs that previously did not have to subsidize their providers,” Traci Albers, CEO of Sioux Falls, S.D.-based Surgical Management Professionals, told Becker’s. “With increasing anesthesia shortages, increasing salaries and stagnant reimbursement, ASCs are now subsidizing anesthesia.”
Christina Menor, MD, president of the California Society of Anesthesiologists, told Becker’s improving scheduling efficiency is one of the few levers ASCs can pull to offset rising costs. Even if anesthesia shortages disappeared, declining payment rates and payer tactics would still make the current setup difficult to sustain.
“In the past, ASCs bent over backwards to accommodate surgeons, because they wanted them to bring their business,” she said. “Now we’re seeing centers push back because of scheduling and access to safe, quality anesthesia services, which with the shortage will continue to be challenging.”
Recruitment, retention and scheduling
With many elements of the anesthesia staffing crisis out of ASC leaders’ direct control, recruitment and retention is one thing they can exercise some influence.
Chris Glover, MD, associate chief of anesthesiology at Texas Children’s Hospital in Houston told Becker’s that it’s “not always about the money” when it comes to preventing anesthesia turnover and burnout.
“Scheduling flexibility is one [thing]. When you talk about long-term sustainable strategy, and how you retain folks when they’re burnt out, it’s giving them their ‘why’ — and you try to build that into your culture, ensuring that there’s a call structure equity and a workforce equity, where everybody feels like there’s a there’s a collective pull when it comes to the work being done,” he said.
Some ASCs are improving anesthesia coverage by consolidating scheduling and staffing into a single pool of providers across their networks.
This approach reduces idle time, improves first-case, on-time starts and lowers reliance on costly locums. By managing anesthesia providers as a shared resource, centers gain flexibility without overextending their teams.
“By consolidating scheduling across all of our facilities, we created a single pool of providers that we can deploy flexibly based on case volume and acuity,” Joe Martin, CEO of Fresno, Calif.-based Valley Regional Anesthesia Associates told Becker’s.
New strategies emerge
ASCs are experimenting with new strategies that lean on technology, collaboration and workforce flexibility to stabilize coverage amid ongoing shortages.
1. AI-driven predictive staffing and operating room coordination. ASCs are beginning to use predictive analytics to anticipate anesthesia staffing needs before shortages occur. These platforms pull data on surgical case volume, case complexity and provider availability to align coverage with demand.
“AI models can also anticipate retirement patterns, burnout risks, and regional gaps in coverage, enabling more proactive recruitment and resource deployment,” Allyn Miller, CRNA, regional director of Franklin, Tenn.- based Anesthesia Operations at Community Health Systems, told Becker’s. “These insights can guide policy and operational decisions at the facility, system, and national levels.”
2. Integrated AI to optimize workflow. Beyond staffing, AI is transforming anesthesia workflow inside the OR.
3. Centralized scheduling and staffing models. Some ASCs are improving anesthesia coverage by consolidating scheduling and staffing into a single pool of providers across their networks. This approach reduces idle time, improves first-case, on-time starts and lowers reliance on costly locums.
4. Collaborative efficiency models. ASCs are improving anesthesia coverage not by adding staff, but by engaging anesthesia leaders directly in operational decisions around throughput, block times and case-mix.
5. Flexible employment tracks to attract and retain staff. Compensation structure is emerging as a key factor in anesthesia staffing and retention. Some CRNAs prefer the autonomy and higher pay of 1099 work, while others value the stability of traditional, W-2 employment.
“I think if anesthesia practices offered both 1099 and W-2 models, they could keep employees while also reducing turnover,” Andrew Hicks, CRNA. Advanced Practice Providers for Cardiothoracic Division of the Ohio State University College of Medicine in Columbus, told Becker’s. “There are CRNAs that want the higher pay of a 1099, but there are also CRNAs that want the security of a W-2. If groups could offer both, I think turnover would be less.”
6. CRNA-only models: As CRNAs gain broader legal authority to practice independently in many states, many leaders are seeing ASCs adopting CRNA-only anesthesia models.
“Most of the ASCs in my area are also becoming CRNA-only,” Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker’s. “This helps keep costs down for anesthesia services.”
In Mr. Johnson’s market, most ASCs are for-profit and physician-owned, meaning they often lack additional staff to assist with complex cases.
Jeff Tieder, MSN, CRNA, clinical assistant professor in the nurse anesthesia program at the University of Tennessee at Chattanooga, echoed this shift. He said many ASCs are moving away from the traditional physician-supervised model. According to Mr. Tieder, CRNA-only models demand “streamlined workflows, cost-effective care and rapid patient turnover without compromising safety.”
7. New approaches to stipends. In 2024, the Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., flipped the traditional anesthesia payment model on its head. Instead of the facility paying anesthesia stipends, surgeons are now required to pay a fee if they fail to meet the minimum number of cases for their assigned operating block.
Bruce Feldman, former administrator of the center and now head of his own ASC consulting firm, told Becker’s the change became a “win-win” for the surgery center and the anesthesia group, even motivating surgeons to find creative ways to improve operating room efficiency.
Initially, the anesthesia group approached the center requesting stipends because operating rooms were not being fully utilized.
“They were providing anesthesiologists, but ORs were sitting empty — so they weren’t making enough revenue to justify coverage,” Mr. Feldman said.
According to Mr. Feldman, this solved two problems. It compensated anesthesia providers fairly while pushing surgeons to maximize their operating time, because leaving block time unused now came with a direct cost.
8. Bringing anesthesia in-house: Some ASCs are taking another approach, bringing anesthesia services under their own roof. Alex Andrade, COO of Medical Associates in Dubuque, Iowa, told Becker’s that what began as a defensive strategy has turned into a strategic opportunity to enhance throughput and efficiency.
“Our goal is to leverage our anesthesia team to drive operating efficiencies and increase throughput as part of one end-to-end process,” he said.
9. Offering leadership positions at ASCs. Christina Menor, MD, president-elect at California Society of Anesthesiologists, told Becker’s that ASCs can be a place where anesthesiologists step into leadership roles, sometimes better suited than surgeons because of their cross-cutting role in perioperative care.
“Anesthesiologists — by virtue of our involvement in all aspects of perioperative care and workflow — are uniquely positioned to serve as ASC medical directors, often better suited to the role than surgeons,” she said. “Partnering closely with our surgical colleagues, we can lead innovations that enhance efficiency, safety and patient outcomes.”
She also stressed that anesthesiologists can lead in EHR adoption, pre-op assessment design, supply chain oversight, and revenue cycle optimization, opportunities that are not typically available in hospital settings where they’re often siloed.
10. Creating new training pipelines: Dr. Sudheendra and his practice run their 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.
With access to a more consistent pool of potential hires, Dr. Sudheendra’s practice is able to be more nimble and flexible in their partnerships with ASCs.
“We are still struggling with our staffing, both in the hospital and ASC, but what we have found is the ASCs would like to partner with us because we are also in the hospitals,” he said. “So our recruitment pool is a lot better than if you’re just doing ASCs with one or two, or three or four rooms, it’s not easy because then you’re also sitting on their [profit and loss]. For us, it’s very easy because we flex our staff.”
Narragansett Bay Anesthesia also utilizes a regional coordination model in Rhode Island, which allows Dr. Sudheendra to adjust his staffing to meet the needs of partner facilities on any given day.
What’s at stake
1. Surgeries delayed, backlogs grow
Prolonged shortages could mirror the COVID-19 pandemic, Antonio Conte, MD, told Becker’s, with elective cases pushed out for months, larger surgical backlogs and patients arriving sicker with higher complication risk and worse outcomes.
2. Capacity shrinks as demand rises
Don Harmeyer, CRNA at Burlington-based University of Vermont Medical Center, pointed to a “perfect storm” of more retirees and fewer full-time clinicians as demand climbs with an aging population. He said the mismatch is already showing up as longer wait times and operating room closures, and could intensify quickly as older clinicians cut hours or exit the workforce.
3. Rural access breaks first
Rural and community access will be the first to break, leaders told Beckers. Jason Manella, MD, director of anesthesia operations at Chicago-based Endeavor Health, warned shortages force hospitals to prioritize only the most acute cases, delaying other care and limiting procedure access. Rural facilities relying on one or two anesthesia providers can lose surgical services altogether, according to Allyn Miller, CRNA, regional director of anesthesia services at Community Health Systems. This will push patients to travel farther or forgo care and threaten hospital viability.
4. Equity gaps widen
Delays hit vulnerable patients hardest, those with lower income, limited transportation or rural residence, worsening chronic disease and preventable complications and making it harder for people to return to work, Mr. Miller added.
5. Burnout rises, safety risks climb
Persistent gaps mean longer hours and heavier workloads for remaining clinicians, driving burnout and fatigue. Mark Zapp, MD, anesthesiologist at Fleming Island (Fla.) Surgery Center, said that burnout could lead to reduced attention to detail, less reliable emergency coverage and higher overall patient risk.
6. Financial pressure could close sites, cut service lines
Wage inflation, plus declining reimbursement, is straining anesthesia groups and facilities, with stipends fueling an unsustainable “arms race,” according to Mo Azam, MD, head of innovation at Orlando, Fla.-based US Anesthesia Partners. Facilities may reduce low-margin services, limit OR time or close when coverage can’t be secured.
7. Care models could permanently shift
Rachel Charney, MD, managing associate and senior client partner of DSG Global, flagged leadership pipeline erosion as staffing crunches discourage junior clinicians from taking on roles beyond day-to-day coverage. Additionally, staffing models will keep shifting (more independent CRNA teams and more cases moving to ASCs), as hospitals and surgery centers adapt to maintain volume.
