ASC leaders have had to adapt to a variety of shifts in the anesthesia labor market as traditional group coverage models become more difficult to sustain and declining reimbursement rates continue to eat away at ASC margins.
Four ASC leaders recently joined Becker’s to discuss their predictions for how anesthesia models will change over the next four years and how their facilities are adapting to market shifts.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What models or methods for anesthesia procurement and team management do you think will be the most highly-utilized over the next five years?
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): In my opinion, we need to move toward a model that is focused more on alignment rather than coverage.
Today’s model, unintentionally creates competing incentives:
| Stakeholder | Primary Incentive |
| ASC | Maximize OR utilization and complete the schedule efficiently. |
| Surgeon | Perform as many appropriate cases as possible while maintaining quality. |
| Anesthesia | Compensation is largely unchanged regardless of case volume or day length. |
This is not to say that anesthesia providers are unwilling to work hard, but it does illustrate that the compensation structure often fails to reward the additional effort required to accommodate higher volume, or longer operating days.
Over the next five years, I believe the industry may be forced to move away from “contracting coverage” toward models that better align incentives among surgery centers, surgeons, and anesthesia providers.
This means, instead of relying exclusively on independent anesthesia groups, more physician groups, health systems, and ASC ownership entities may need to directly employ anesthesiologists and CRNAs.
This approach will offer greater control over recruitment, scheduling, costs, and provider retention while reducing the disruption caused by frequent contract turnover.
Julie Jackson, NP. Chief Administrative Officer of GI Associates (Milwaukee) Over the next five years, I expect ASCs to rely more heavily on flexible, partnership-based anesthesia models rather than a single traditional staffing approach. The anesthesia market continues to be challenged by workforce shortages, rising compensation expectations, increased malpractice and operating costs, and the need to safely manage higher-acuity patients in outpatient settings. For many ASCs, the most sustainable model will likely be a hybrid structure that combines a stable core anesthesia team with flexible coverage options for volume fluctuations, expansion, or higher-complexity cases. Strong anesthesia partnerships will also be defined by operational alignment: shared scheduling goals, efficient block utilization, clear patient selection criteria, quality oversight, and regular communication between anesthesia leadership, surgeons, administrators, and nursing teams. We are integrating our anesthesiologist into our practice to create a sense of belonging. ASCs that treat anesthesia as a strategic partner — not simply a contracted service — will be better positioned to preserve access, control costs, maintain quality, and support growth as more procedures shift to the outpatient environment.
Raghu Reddy. Member of the Ambulatory Surgery Center Association’s Education and Quality Committees, Chief Administrative Officer MiOrtho Surgery Center (Southfield, Mich.): Over the next five years, many ASCs will likely rely on hybrid anesthesia teams, with anesthesiologists supervising CRNAs and per diem or locum support for peak demand. Dedicated core teams will remain important because consistency improves efficiency, communication and patient safety. As reimbursement pressure grows, more contracts may include stipends, management fees, or minimum revenue guarantees, creating a significant risk to ASC profitability.
Where specialty mix and state regulations permit, some centers may also consider CRNA-only models to control costs. These agreements should include clear expectations for coverage, on-time starts, utilization, quality and patient satisfaction, supported by technology and AI for scheduling, preoperative screening, documentation, and staffing forecasts. For MiOrtho, the best approach would be a consistent hybrid team with flexible backup and a performance-based contract that balances quality, access and cost.
Scott Shapiro, MD. Cardiologist at AMS Cardiology (Horsham, Pa.): The U.S. anesthesia workforce is shrinking — HRSA projects an 8,450-provider shortfall by 2037 — just as procedure volume keeps migrating from hospitals to ASCs, where over 60% of surgeries are now performed. The answer isn’t simply hiring more anesthesiologists; it’s acuity-matched staffing. Because ASCs treat lower-risk, well-screened patients, a large share of cases are appropriate for moderate (conscious) sedation delivered by trained non-anesthesia personnel under protocol-driven, accreditation-compliant guardrails — freeing scarce anesthesiologist and CRNA time for the higher-acuity cases that genuinely need it. For higher-volume or higher-acuity ASCs, especially those expanding into cardiovascular service lines, that increasingly means directly employing anesthesiologists or CRNAs sized to a leaner, acuity-appropriate caseload rather than competing for locum coverage — giving predictable capacity, medical direction over sedation protocols, and room to grow without full dependence on a tightening labor market.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.