Tired of underwriting outside anesthesia groups, a growing number of ASCs are cutting out the middleman and putting providers on payroll.
While a 2025 survey from VMG Health found that only 9% of ASC leaders said they plan to staff anesthesia through a traditional employment agreement, more leaders are beginning to consider it as an alternative, particularly as share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025.
Paul Lynch, MD, founder and CEO of US Pain Care, told Becker’s that employment the answer to a problem that has only worsened since the pandemic.
“With anesthesia in lower supply every year since COVID, I think bringing it in-house is the answer — full-time employment with your own CRNAs or anesthesiologists rather than subsidizing an outside group,” Dr. Lynch said.
But the switch doesn’t come without burdens.
“Base salary with a productivity bonus is a great way to set these up,” he said. “And if you go this route, make sure your billing company has real experience billing anesthesia — it’s tricky, and that’s where a lot of centers get burned.”
Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, said his practice moved to direct employment more than two years ago and expects others to follow.
“Another major issue is the CRNA wage inflation, if this doesn’t cool off some, you’ll see more ASCs/practices explore W-2 employment like our practice did well over 2 years ago,” Mr. Lovewell said.
CRNA salaries grew 59% from 2019 to 2026, rising from $181,000 to $288,000, according to Marit Health and AANA data, which is nearly twice the 29% growth rate for anesthesiologists over the same period, according to a report from healthcare consulting firm Veralon.
However, Aaron Hayes, administrative director of North Pointe Surgery Center in Lancaster, Pa., directly employs the center’s anesthesiologist and CRNAs said the model relocates the cost rather than eliminating it.
“That model has given us a high degree of control over who provides care, how many ORs we can reliably cover each day, and, to some extent, the cost structure of the anesthesia department. However, it does not make anesthesia inexpensive,” Mr. Hayes said. “While we are not paying a stipend to an outside anesthesia group, we are still carrying wages, benefits, CME, malpractice, recruitment risk and the operational burden of maintaining coverage.”
The deeper problem, Mr. Hayes said, is structural.
“ASCs need anesthesia to generate facility revenue, but the anesthesia service line itself may not be financially self-sustaining,” he said.
Bruce Feldman, administrator of Bronx Ambulatory Surgery Center in New York City, sees ownership, not employment, as where the model ultimately lands.
“ASCs need to begin viewing anesthesiology no longer as a service line/commodity but rather as a partner no different than how they view their surgeon investors,” Mr. Feldman said. “Having equity arrangements instead of paying stipends will become the norm.”
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.