Anesthesia workforce shortages aren’t easing, and raising compensation alone isn’t the fix. Across the country, anesthesia leaders say retention hinges less on headline pay and more on culture, schedule control and operational sustainability.
Making employees feel valued, not interchangeable, is what ultimately keeps teams stable, industry leaders told Becker’s. From predictable staffing models and equitable call structures to meaningful autonomy and visible appreciation, these are the biggest determinants of retention in today’s workforce.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What single change would most improve anesthesia workforce retention?
Rita Agarwal, MD. Clinical Professor of Anesthesiology at Stanford (Calif.) University: The thing that would improve workforce retention in anesthesia is figuring out what your anesthesiologists want. All of us want to feel valued and not like just interchangeable parts. For most, some degree of control over their schedule is a huge bonus and one way to indicate that individuals are valued and important. That may include flexibility in work hours, shift coverage, call trades, availability of part-time or job share options and the ability to get time off when we want it, within reason. I find that I am much happier covering an extra shift/call/colleague if I had the opportunity to volunteer, or refuse, that particular assignment, than if I was forced to take it.
Moeed Azam, MD. Head of Innovation at U.S. Anesthesia Partners (Dallas): In one word: Culture. Attention to overall culture would greatly improve retention in clinical settings. That sounds like common sense, but remarkably, it isn’t common practice to truly focus on culture. I’d like to give a shout-out to my partner, Kelly LeBlanc, MD, who has led a national culture initiative across our partner practices.
She created a culture committee in Houston that has subsequently rolled out across the country. They provided a platform for CRNA, CAA, physician partner, associate physicians and business staff input. It is a venue to listen to feedback in a safe space. And very intentional, to use that input and implement changes to further improve the clinician experience.
Brian Cohen, MD. Administrative Chief of Miami Anesthesia Services: The single change that would most improve anesthesia workforce retention is allowing greater customization of individual scheduling models. While compensation should remain at fair-market value, the current supply–demand imbalance gives clinicians leverage to prioritize work-life balance and schedule control. Groups that structure customizable work-hour packages aligned with individual clinician needs will build greater loyalty and retention than those competing primarily on pay or forcing an all-or-nothing employment package.
Neal Cohen, MD. Professor Emeritus of Anesthesia and Perioperative Care and Medicine at the University of California San Francisco: Anesthesia practices and health systems cannot continue to treat anesthesiologists as commodities. Each department should ensure that it functions as a “community” that supports the anesthesiologists, considers and balances the needs of the clinicians as well as patients and the health systems. Whether a full-time physician, locums or part-time anesthesiologists, each should be respected, acknowledged and provided support to ensure that they can practice at the highest level. As their professional life and needs evolve, they should also be provided professional development opportunities that meet their changing professional and personal goals.
Katy Dean, CRNA. TKMAnesthesia (Newport News, Va.): The single change most likely to improve anesthesia workforce retention is increasing workforce flexibility through autonomy and scheduling control. Providing CRNAs with greater practice autonomy, including the ability to work at full scope, while offering flexible scheduling and competitive compensation, creates a more sustainable and satisfying practice environment. This integrated approach supports professional fulfillment, reduces burnout and improves work–life balance, which are key drivers of long-term retention. Empowering clinicians with both independence and flexibility ultimately strengthens staffing stability while maintaining high-quality patient care.
Aristeidie Diveris, MD. President of Polykarpos Anesthesia (Pleasant Prairie, Wis.): Subsidies are necessary due to the unfortunate inconsistency in surgical case volumes.
Christopher Hoeman. CEO of ICON Anesthesia of New England (Middleton, Mass.): Provider price stabilization to reduce and minimize the ever-growing mercenary population. The mercenary market is creating flak and distraction in the marketplace. It creates what I am going to call, the FOMO Effect. Providers hear and see the outrageous rates that some centers are willing to pay to get people and it becomes the unrealistic norm of expectation. Despite getting fair and respectable wages, they fear they are missing out. This only distracts from those facilities that are creating a great culture and environment with solid pay. Price becomes the determinant of value and not relationships; the next shiny thing, money, becomes the thing they are missing out on.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s: The most significant change would be implementing flexible, predictable staffing models that give anesthesiologists meaningful control over their schedules and workload, while recognizing them as essential perioperative leaders.
Structured flexibility across career stages from early-career growth to late-career sustainability allows physicians to remain engaged as their professional and personal needs evolve. At Phoenix Children’s, we have prioritized inclusive scheduling, equitable call structures and physician input into operational decisions, which has strengthened engagement and workforce stability. When anesthesiologists have autonomy and a voice in shaping their practice, burnout declines and long-term retention becomes far more sustainable.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): Appreciation is the best way to retain people. We all like recognition for our contributions, and will stay where it is given, and even work twice as hard. Everyone values being part of a team and doing something important. Institutional and group leaders can recognize people by putting their pictures in a newsletter or on a bulletin board, listing their achievements in a group email, or simply saying, ‘Thank you for what you did today, you were a big help.’
David LaGuardia. Vice President of Clinical Operations at Sentry-Northstar Anesthesia (Newnan, Ga.): The greatest advancement in improving anesthesia retention lies in empowering CRNAs to practice independently to the fullest extent of their licensure. By granting CRNAs the autonomy to make clinical decisions, healthcare facilities can enhance satisfaction, efficiency and patient outcomes. Most importantly, they can reduce facility anesthesia financial supplement cost. This independence not only acknowledges their expertise, but also fosters a more collaborative healthcare environment, ultimately benefiting both providers and patients alike.
Evan Lebovitz, MD. Anesthesiologist in Alexandria (Va.): In anesthesiology, staffing to average demand is a false economy. Surgical schedules fluctuate, emergencies are inevitable and clinician absences are predictable, even if modeled as anomalies. Any system run consistently at maximal utilization is not efficient; it is brittle. High-reliability industries recognize the necessity of slack capacity: deliberate, protected excess staffing that absorbs variability and prevents cascading delays, burnout and compromised patient care. What may appear as “bloat” on paper is, in reality, the margin that preserves patient safety, case throughput and provider stability. Anesthesia services cannot be optimized to the mean; they must be built to withstand variability.
Penny Liu, MD. Vice Chair for Clinical Affairs and Director of Neuroanesthesia at Tufts Medical Center (Boston): If I could make one change to improve workforce retention, it would be to intentionally invest in the steady, mission-driven clinicians who consistently deliver excellent care without fanfare. These “quiet high performers” are the cultural backbone of our departments. They create psychological safety, model professionalism and carry operational reliability.
Creating formal pathways for mentorship, leadership development and recognition for these steady contributors sends a powerful signal as to how we truly define excellence. When organizations recognize and develop these individuals, they reinforce that integrity, consistency and patient-centered mastery truly matter. Organizations that recognize quiet excellence don’t just retain talent, they build resilient cultures.
Rick Middleton, MSN, CRNA. Director of Anesthesia Services at UNC Wayne (Goldsboro, N.C.): The one thing that would immediately improve anesthesia workforce retention would be the advent of routine retention bonuses. Since the loss of pensions for retirement savings, facility commitment has all but disappeared. The advent of the 1099 and locum CRNA prevents CRNAs from building a true commitment to their local facility or place of employment. True multiyear performance-based retention bonuses would go a long way to help to secure facility CRNA employment commitment and also help to establish local workforce commitment.
Michael Nurok, MD, PhD. Professor and Co-Chair in the Department of Anesthesiology at Cedars-Sinai Medical Center (Los Angeles): Too often, the anesthesia workforce are treated as interchangeable and nameless bodies at the head of the OR table. Retention requires institutional culture and leadership that truly value their anesthesiologists, foster purpose-driven work and provide meaningful opportunities for professional growth and development.
Michelle Reilly, DNP, CRNA. Chief CRNA, Anesthesia Co.-Frederick Division at Frederick (Md.) Health: The most impactful change would be building anesthesia staffing models that prioritize operational sustainability, not just minimum daily coverage. In many perioperative settings, teams are structured to meet scheduled case volume, not the predictable variability of add-ons, prolonged cases, trauma activations, ICU transfers and PACU support. When there is no margin for surge, providers absorb the strain through missed breaks, late relief, heavier call intensity and schedule volatility.
Retention improves when organizations staff to expected variability, distribute call burden equitably, align coverage with acuity and service line growth and include anesthesia leadership in block time and throughput planning. Anesthesia workforce retention ultimately depends on designing sustainable practice models that utilize providers efficiently, deploy them to the top of their training and balance productivity with long-term operational resilience.
Gregory Rendelman, CRNA. Department of Veterans Affairs (Lancaster, Pa.): When I was a kid, we had “camper counselor day,” where the kids got to be counselors, and the counselors were kids, just for a day! It was a fantastic way to see things from another angle. Imagine if those who make big decisions took a little nap with propofol, along with a full set of anesthesia drugs and breathing equipment for that patient. We could call it “Anesthesia / Administrator Day” or “Surgeon/Anesthetist Day.” We’d be there as their safety net, ready to fix any problems instantly.
Steven Schaefer, MD. Anesthesiologist at Legacy Mount Hood Medical Center (Gresham, Ore.): The single most impactful change to improve anesthesia workforce retention would be providing individuals with greater agency over their time. This means ensuring predictable, regular hours and the ability to schedule time off effectively to achieve a satisfying work-life balance.
Nick Schiavoni, MD. Locum Anesthesiologist: The single change that would most improve anesthesia workforce retention is giving clinicians predictable control over their schedules. Attrition is often driven by unpredictable call burden, last-minute schedule changes and cumulative workload creep. Until departments redesign staffing structures around schedule transparency and autonomy, instability will persist regardless of pay increases.
Samuel Smith, MSN. CRNA at Richmond (Va.) VA Medical Center: Effective leadership is the cornerstone of workforce retention in the anesthesia field. Retaining providers is significantly improved by cultivating a supportive workplace culture that makes them feel appreciated and provides access to professional development and mentorship. Furthermore, addressing the need for better work-life balance through flexible scheduling is a consistent strategy shown in labor force statistics to reduce turnover intentions and combat burnout across various practice environments.
The most successful retention strategies identified in the literature share several key characteristics: they empower providers with autonomy and control over their schedules, utilize technology for efficient supply-and-demand matching, systematically integrate individual preferences and strategically balance the simultaneous needs for both flexibility and predictability.
Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas): A greater emphasis and development of clinical leadership would have the largest impact on workforce retention. Knowing how to balance and navigate the complex demands and unpredictable schedules of the operating room allows strong clinical leaders to cultivate trust and cohesion across the team. With this foundation, leaders can empower administrators and clinicians to advance their skills and expertise, while maintaining an appropriate workload balance.
Ruth Waterman, MD. Chair of the Department of Anesthesiology at UC San Diego Health: The single change that would most improve anesthesia workforce retention is creating a culture of genuine respect, backed by operational support, from colleagues and hospital administration. Respect must be visible in daily practice: involving anesthesia in scheduling and throughput decisions, acknowledging clinical judgment without pushback and treating anesthesiologists as essential perioperative leaders rather than interchangeable service providers.
Operationally, this means fixing call burden, the single greatest driver of burnout, with protected post-call relief, equitable distribution and realistic staffing models. It also means recognizing that covering multiple sites, especially with medically complex or unstable patients, significantly increases cognitive load and stress, and staffing accordingly. The care team model is important. CRNAs and AAs are integral to that model, and mutual respect and accountability are essential for strong collaboration. Retention improves when clinicians feel valued, heard and protected, not stretched thin and blamed for system strain.
Kristin Winterer, CRNA. Co-Founder of AVEA CRNA (Niceville, Fla.): Culture retains CRNAs. Facilities need to shift their focus to value and appreciation. Including CRNAs in decision-making processes with higher levels of administration allows them to work to the top level of their practice and gives them full autonomy. Compensation should be based on fair market value but include qualifiers and bonuses based on teamwork, helping others, providing quality care, willingness to do any and all cases and mutual support. Doing this will foster a strong, cohesive team. A cohesive team that cares for each other and is appreciated by the hospital and staff will have little desire to chase the high-paying locum market. That is just my opinion, but if these things had been at my last hospital, I wouldn’t have left!
