ASCs are rethinking who staffs their operating rooms and how much it costs them to do it as the anesthesia workforce continues to face pressures on both the supply and demand side of the equation.
As certified registered nurse anesthetists gain broader authority to practice without physician supervision in more states, and as anesthesiologist and CRNA recruiting costs keep climbing, ASC leaders are weighing employment, contracting and hybrid staffing models against a workforce shortage that is not expected to peak for years.
Here are six recent developments shaping that conversation.
1. CRNA pipeline expands on three fronts. Nurse anesthesia training has seen a boost as new education programs roll out in high-demand areas. Saint Mary’s University of Minnesota and St. Cloud, Minn.-based CentraCare partnered to open a new nurse anesthesiology program location aimed at rural workforce needs, Peoria, Ill.-based Methodist College moved to launch its own CRNA program, and the University of Toledo earned full accreditation for a doctor of nursing practice program in nurse anesthesia that will continue training previously offered at Sylvania, Ohio-based Lourdes University, which closed its program at the end of the 2025-26 academic year.
2. A 27th state drops the supervision mandate. Vermont and Ohio became the 26th and 27th states to opt out of the federal Medicare requirement that CRNAs practice under physician supervision.
3. Two staffing paths, no easy button. ASCs choosing between employing their own anesthesia providers and contracting with a third-party group are finding neither route simple, said Brian Cohen, MD, administrative chief of Miami Anesthesia Services. Direct employment means committing to salaries without the flexibility to scale costs down on slower days, plus payer contracting and credentialing work many ASC operators don’t already have in place.
“Strong commercial contracts are what make the employment math work,” Dr. Cohen said.
Third-party contracting shifts that risk elsewhere, but Dr. Cohen said it only works with transparency on both sides.
“You need to hand over accurate historical data, and they need to hand back honest projections, not a pro forma built to win the deal,” he said.
4. Sign-on bonuses reflect the price of scarcity. Anesthesiologists pulled in average sign-on bonuses of $59,583 in 2024-2025 — more than 50% above the $38,215 average across all physician specialties — as anesthesiology became the third most-requested physician search nationally, according to AMN Healthcare’s 2025 review of physician and advanced practitioner recruiting incentives.
Average starting anesthesiologist salaries reached $485,000, up 5.5% year over year, while new-graduate CRNAs were offered average sign-on bonuses of $40,000 plus a $5,000 relocation bonus. Overall, 80% of CRNAs received a sign-on bonus offer, averaging around $20,000, according to the American Association of Nurse Anesthesiology.
5. AANA’s president frames it as an access problem. Tracy Young, CRNA, co-founder and COO of Essential Anesthesia Management and president of the American Association of Nurse Anesthesiology, said the workforce fight comes down to one thing.
“The common denominator is access. Do patients have access to anesthesia professionals?” he said.
Mr. Young pointed to UnitedHealthcare’s 15% cut to CRNA reimbursement, which he said gets passed on to hospitals, as a sustainability threat, and said he wants to bring a “big tent mentality” to a profession he sees as at risk of fragmenting over differing priorities.
“I want to unify the profession under this big tent and keep us focused on the mission,” he said.
6. The numbers gap keeps widening. The national anesthesiologist shortfall is projected to more than double, from 3,720 full-time-equivalent positions in 2026 to 8,140 by 2031, according to Medicus Healthcare Solutions’ “The State of Anesthesia Care Delivery” report. More than 42% of anesthesiologists said they are likely to leave their current organization within two years, and nearly two-thirds of anesthesia positions used locum tenens staffing in 2025 — the highest reliance on temporary coverage of any physician specialty. More than 80% of rural U.S. counties have no anesthesiologist at all, leaving CRNAs to deliver an estimated 80% of rural anesthesia care where it exists.
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.
