By 2036, the U.S. is expected to face a shortage of 6,300 anesthesiologists, a crisis poised to reshape procedural care delivery.
Gavin Baker, CRNA, CEO of New Orleans-based Krewe Anesthesia, said that scheduling is one driver of the shortage that ASCs and other facilities can hone in on to relieve some pressure on anesthesia services.
“We started the anesthesia staffing business because I saw the way things were going at the hospitals where I was working, how they were utilizing staffing companies. I felt like there was a better way,” he said. Mr. Baker, who has previously served in leadership roles at academic health centers, said there was often a misalignment between the needs of the center and the expectations of the anesthesia providers — often due to a lack of insight into the granular, yet important details of anesthesia services.
“For example, we would have needs at our facility and credentialing would take too long, or the companies that we were using would send us the wrong type of CRNA that didn’t have the right skill set to fit our needs, or didn’t want to do the schedule that would fit our needs,” he said. “The CRNAs weren’t told or didn’t understand what they were getting into when they came into a level 1 trauma center or a large teaching institution. So I think there was a mismatch of provider to job. I thought that if there was a provider leading these things, it would be different, because we would set the expectations and be able to get with the facility that had the need and really understand the need at the level that only another anesthesia provider can really understand.”
This mismatch often exacerbated the existing burnout among providers, as responsibilities and schedules would shift around to compensate for a misalignment of needs and practitioners.
“When you bring in the wrong type of person for a staffing assignment, it can actually lead to more people quitting and leaving the job,” Mr. Baker said. “Because you’re going to bring them in and let them do the easy cases and the best schedule, when you need to find people that’ll do the things that are causing burnout, causing the shortage to begin with.”
He said that, particularly in ASCs, scheduling methods do not always center anesthesia utilization, often leading to higher anesthesia costs.
“Everybody, especially the surgeons, want to do as many cases as they can. Some surgeons want two to three rooms that they can bounce back and forth,” Mr. Baker said. “If you can be efficient with that, that’s great, but a lot of times that ends up costing decreased utilization in regards to anesthesia time. If you do the calculation and it makes sense to increase procedure count, you have to realize that may be an inefficient use of anesthesia, [even though] it is an efficient use of the surgeon’s time to give them multiple rooms.”
His practice works with facilities to align their financial needs with their anesthesia time utilization — a practice that involves thinking outside the box and finding a certain balance between the needs of the facility, providers and patients.
“There’s give-and-take there, because you’re going to have time where the anesthesia is now actually billing minutes when the surgeon is being more efficient. Sometimes that leads to less efficient anesthesia,” he said. “And as long as that give-and-take is upfront and calculated then, that’s fine. But I think sometimes they forget that just because the surgeon’s time is more efficient, doing it that way with multiple rooms, it may not necessarily be the case with anesthesia.”
Mr. Baker said that it’s important to center transparency in these conversations as the economic factors surrounding anesthesia have changed in recent years.
“If we have input, we can decrease anesthesia costs, but it may be at the expense of either surgeon preference or the workflow that you’re accustomed to,” he said. “Years ago, you could run inefficient models and still be okay, but as anesthesia costs go up, that piece of the pie gets bigger, and it’s more important to figure out: Am I really utilizing anesthesia to its max efficiency? So just letting them know that the way ASCs have done it in the past, may need to change a little bit. It may not be the same way just because of the rising cost of anesthesia.”
He also added that more transparent and well-coordinated collaboration among ASCs and hospitals within a given geographic region could go a long way towards improving the efficiency and utilization of a limited number of anesthesia providers.
“It’s hard, because everybody is kind of fighting for the same talent pool. The ASCs are pulling talent from the hospitals, and hospitals are trying to pull it back from the ASCs. I think that the ability for these groups to use all the providers to the most efficient use in terms of scheduling [will be important],” he said. “At the end of the day, it’s being creative and being able to put the puzzle pieces together.”
