Anesthesia coverage has become one of the tightest constraints on ASC growth. The U.S. is projected to face a shortage of 6,300 anesthesiologists by 2036, and more than half of practicing anesthesiologists are older than 55.
Private equity has reshaped the market at the same time, and nowhere more visibly than in Texas. The FTC sued Dallas-based US Anesthesia Partners and private equity firm Welsh Carson in 2023, alleging an anticompetitive scheme to consolidate anesthesiology practices in the state. USAP reached an agreement in principle with the FTC in April, and on Oct. 30, it disclosed settlements in principle in two proposed class actions alleging it overcharged Texas patients and health plans.
The same day, two anesthesiologists who lead ASC anesthesia programs discussed what consolidation and the locums market have meant for coverage during a panel at Becker’s 32nd Annual Business and Operations of ASCs conference in Chicago.
Maggie Jeffries, MD, owns Houston-based Avanti Anesthesia and is medical director of Memorial Hermann Surgery Center Kirby Glen in Houston.
“We’re literally taking each other’s employees on a round robin game,” Dr. Jeffries said of the Houston market. “I find the shortage to be a little bit of a falsely elevated one. And when I say that, I think it has a lot to do with the burnout and the locums market.”
Locums assignments typically pay premium rates for short-term coverage, and Dr. Jeffries described who has been taking them.
“A lot of the people coming out of training were doing that as well, which I’m not a huge fan of because they should be at a stable place with supervision and help from older colleagues,” Dr. Jeffries said. “But they jumped on that bandwagon too. So I think we falsely lost a lot of providers to the burnout. Production pressures, chronic understaffing, longer hours, sicker patients. We really have to think about how we can get people to take stable long-term positions.”
This is why ASC leaders should prioritize local hiring and a stable labor pool over short-term coverage whenever possible, she added.
“Why don’t they want to work at the ASC in their neighborhood? Those are the people that you really want to recruit,” Dr. Jeffries said. “And if you have an anesthesia group that is local to your area, trust me, they want to stay. Even when they act like they don’t. The burnout is real.”
Adamina Podraza, MD, an anesthesiologist with Anesthesia Consultants of Morris and medical director of Deerpath Ambulatory Surgical Center in Morris, Ill., agreed.
“I feel that if you can have a stable anesthesia group working with the surgeons, your efficiency is improved because they know your surgeons, they know the center,” Dr. Podraza said. “Bringing in a locum slows everything down, and it’s very cost ineffective.”
Asked how ASC leaders are pushing back on private equity consolidation and what partnership structures are working, Dr. Jeffries started with her home state of Texas.
“Having struggled through all of it, I think pushback is long overdue,” she said. “I think small groups need to come together and find ways to stay small groups. There’s nothing wrong with a group that only services one center. I don’t know when that became such a problem.”
She said ASC leaders should also be held accountable for working with their anesthesia group to find scheduling solutions rather than jumping from group to group.
“So if you open another room tomorrow, they may not have somebody. They’re a small group, they can’t float someone from another facility. But I will challenge you to think that that should be an acceptable response, can we move things around? Could we start early? How can we work together to find this rather than, well, we’ll find another group that can,” Dr. Jeffries said.
Those relationships and discussions will be crucial in returning anesthesia to a more stable and independent state, she added.
“And that has been the mantra for a very long time in the Texas market. If you say no, as an anesthesiologist, you have that real significant fear of tomorrow, you’re being replaced,” she said. “And that is exactly what happened with the PE groups in our area. They very easily took contracts, they have better rates and they had the ability to float staff. And some of them even own their own staffing agencies so they can throw in their own locums.”
In Texas, Becker’s has reported that commercial anesthesia prices rose nearly 30% within two years of USAP’s acquisitions in Houston and Dallas.
Dr. Podraza described the effect in her own market.
“I find in our community, the private equity is just a turnover of staff. Consistently, somebody’s just going for a higher amount. So you don’t have that consistency,” Dr. Podraza said. “And once you don’t have the consistency in staff, you slow things down, which actually costs even more. So you’re paying more for your overhead, you’re paying more for your staff, and now you’re slowing down your surgery center because of turnover. The people are inconsistent and you’re losing money. I mean, that’s my personal opinion against private equity. …In some places it works very well, but I think the overall cost is very expensive.”
Dr. Jeffries closed her answer with a direct appeal to administrators.
“I’d love to see ‘Support local anesthesia’ T-shirts because I think while private equity can be helpful in certain scenarios and in thoughtful places, if you’re trying to develop a long-term relationship with your anesthesia providers, PE should not be the first thing that you go to,” she said. “You can find that support, you can find a way to make it work.”
“I know a lot of administrators out there suffer with also the merry-go-round of anesthesia groups. The grass is just really not greener,” Dr. Jeffries added. “So, unless there’s a real significant problem, I challenge people to work through it.”
Dr. Podraza closed on the broader care team.
“Making somebody feel valued in your community, whether it’s a nurse or an anesthesiologist or a CRNA. I think involving them strategically in the growth of your center is important because they feel more vested, and they’re more likely to stay,” she said.
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.
