Anesthesia leaders told Becker’s the specialty is approaching a period of structural instability as financial pressure, workforce shortages and operational strain converge across hospitals and ASCs.
Declining reimbursement, aggressive payer tactics and rigid employment models are colliding with rising surgical demand and growing reliance on locum tenens staffing. Those forces combined, leaders said, agitate a “perfect storm” for anesthesia staffing and financial stability.
Reimbursement stagnation and workforce pipeline constraints
“The biggest threats to anesthesia stability are similar to the rest of healthcare: appropriate reimbursement and support of the future workforce,” Mo Azam, MD, head of innovation at US Anesthesia Partners in Dallas, told Becker’s.
Medicare payments for anesthesia have effectively remained flat for decades when adjusted for inflation, leaving many practices providing services below the cost of care. At the same time, limited clinical training sites and stagnant graduate medical education funding restrict the number of new clinicians entering the field.
Some organizations are responding by expanding collaborations with academic institutions and launching new residency programs to increase training capacity, Dr. Azam said.
Restrictions on scope of practice and its consequences
Workforce pressures are amplified by policy and staffing decisions that limit how anesthesia teams can operate, according to Adam Chaucer, CRNA, owner of Trident Anesthesia in Dallas-Fort Worth, Texas.
Demand for anesthesia services is rising due to an aging population, increased surgical volume and growth in outpatient procedures, while many clinicians are approaching retirement.
“Restricting a major workforce segment, such as CRNAs, is structurally destabilizing,” he said, adding that policies limiting providers from practicing to the full scope of their training could widen staffing gaps and delay procedures.
Payer pressure and rising subsidies
Financial pressure from insurers is also intensifying: Some health plans are using network participation policies to push anesthesia groups toward lower reimbursement contracts, Antonio Hernandez Conte, MD, past president of the California Society of Anesthesiologists, told Becker’s.
The tactic can leave hospitals and ASCs subsidizing anesthesia services to maintain coverage.
“The resultant effect for anesthesia practices is that hospitals will be forced to provide additional revenue to anesthesiologists to make up for the deteriorating third-party payer reimbursement,” he said.
Operational strain and workforce mobility
Internal operational decisions within health systems can compound the external instabilities.
Garo Derparseghian, MD, an anesthesiologist in Montebello, Calif., said some hospitals are attempting to determine anesthesia staffing based strictly on scheduled surgical cases — treating the specialty as a variable service rather than core clinical infrastructure.
“Anesthesia requires continuous staffing and standby readiness, not case-by-case deployment,” he said.
Meanwhile, the rapid growth of the locum tenens market is reshaping the workforce, Narasimhan Jagannathan, MD, division chief of anesthesiology at Phoenix Children’s, said.
Demand for anesthesiologists has never been higher, which can fuel workforce churn : “When physicians do not feel valued, aligned or supported within a system, they have abundant alternative opportunities,” he said.
A fragile care delivery model
Procedural demand, patient complexity, workforce contraction and reimbursement compression are creating “structural fragility” within the anesthesia care delivery model, Amit Prabhakar, MD, chief of anesthesiology at Emory University Hospital Midtown in Atlanta.
As more complex procedures shift into outpatient settings, staffing flexibility declines while the margin for operational error narrows.
“The risk is fundamentally economic and organizational,” Dr. Prabhakar said.
Treating anesthesia as core infrastructure
By and large, leaders concur on one point: anesthesia can no longer be treated simply as staffing coverage.
Nanette Schwann, MD, vice chair of research in the department of anesthesiology at Lehigh Valley Health Network in Allentown, Pa., said organizations that treat anesthesia as core clinical infrastructure tend to run more stable surgical operations.
“When organizations treat anesthesia as a true clinical backbone, everything works better,” she said.
Hospitals that integrate anesthesia teams into decisions about throughput, safety and operational design will be better positioned to expand surgical capacity and maintain patient access.
