Eight physicians joined Becker’s to discuss the challenges that hit hardest this year, including staffing shortages, administrative burdens, payer dysfunction and a growing distrust of medicine.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: In 2025, what challenge most impacted your ability to do your job or care for patients?
James Cain, MD. Chair and Professor of the Department of Anesthesiology at University of Florida (Jacksonville): In 2025, the most significant challenge was the convergence of rising demand for anesthesia services, a growing shortage of anesthesia providers and the structural undervaluation of anesthesiology by public payers. The U.S. is experiencing a demographic shift. As the population age 65 and older grows by more than 40% in the coming decades, demand for anesthesia services is increasing, particularly for complex and high-acuity cases.
At the same time, a substantial portion of the anesthesia workforce — physicians, nurse anesthetists and anesthesiologist assistants — is nearing retirement. Yet the supply of newly trained anesthesiologists, CRNAs and CAAs has not kept pace. While interest in the specialty is exceptionally strong, with approximately 50% more applicants than residency positions available each year, leaving close to 1,000 qualified graduates unable to match into anesthesiology despite choosing it as their intended career. Longstanding limits on federally supported graduate medical education have created a structural ceiling on workforce growth at a time of rising national need. There is similarly strong interest in becoming a CRNA or CAA, but the number of training opportunities has not kept pace, leaving many aspiring providers without a pathway into the specialty.
Compounding this pressure is the financial model for anesthesia care. Public-payer reimbursement for anesthesiology is disproportionately low when compared with other medical specialties. For many fields — including primary care, dermatology, OB-GYN, psychiatry and several surgical specialties — public payers typically reimburse 70% to 90% of what commercial insurers reimburse for comparable services. In anesthesiology, however, public reimbursement often amounts to less than 30% of commercial reimbursement for the same essential care — a uniquely steep reduction not seen in the rest of medicine. The complexity and safety-critical nature of anesthesia do not change according to insurance type, yet the resources required to recruit, retain and support anesthesia teams are markedly underfunded when serving publicly insured patients.
This combination — rising demand, constrained training capacity and deeply misaligned reimbursement — places disproportionate strain on safety-net and academic hospitals, which serve a high proportion of Medicare and Medicaid patients and must absorb the financial gap while maintaining 24/7 coverage for trauma, obstetrics, emergency surgery and critical care. These challenges directly affect patient access, workforce sustainability and the long-term viability of essential perioperative services in the communities that rely on them most.
Marsha Haley, MD. Clinical Associate Professor of Radiation Oncology at University of Pittsburgh School of Medicine: 2025 has been a challenging year for me and my physician colleagues due to the “middleman” and the layers of unnecessary administration inherent in our healthcare system. For example, as an oncologist, most of my patients require prior authorization for even routine cancer treatments. Prior authorization causes delays, which add to patient anxiety and can sometimes worsen outcomes. Pharmacy benefit managers often implement administrative barriers to medication access and markup the costs of cancer medication, making it more difficult for patients to receive care. My colleagues in independent practices are beleaguered by payment practices that favor large integrated health systems. To improve our healthcare system, we need to bring medicine back to the foundation of the physician-patient relationship.
Ahad Mahootchi, MD. Cataract Surgeon at the Eye Clinic of Florida (Zephyrhills): The Consumer Assessment of Healthcare Providers and Systems threatened us because we can’t do any other surveys.
Mary Meyer, MD. Emergency Medicine at Kaiser Permanente Westside Medical Center (Hillsboro, Ore.): One of the biggest challenges I encountered in 2025 was increasing questioning or even frank distrust of modern medicine and healthcare among my patients. I found this to be true in my work as a frontline physician, in my research and in my writing. It was challenging because, in the beginning, it wasn’t something I was expecting. I practice in a healthcare organization that often treats patients for most of their lifespan, and we have historically had a lot of trust with our patient population. But in 2025, I often found myself pausing more to explain the logic or evidence behind some of my recommendations and to answer questions about information on tik tok or in public debates. This requires spending more time and having a thoughtful conversation with my patients, which is ultimately more rewarding, but also requires additional bandwidth at a time when physician bandwidth is stretched fairly thin.
Udaya Padakandla, MD. Past President of the Texas Society of Anesthesiologists: It was not one [factor], but a combination of
- Physician burnout and early exits leading to workforce shortages from workforce consolidation
- An enormous administrative burden — namely documentation and the pressure to stay in compliance with government mandates just to earn the basic compensation from Medicare/Medicaid or risk receiving a pay cut
- An ever-widening gap in payments between primary care physicians and specialist groups
- Inability on physicians’ part to own hospitals and surgery centers
- Systemic barriers for patient access to physicians because of the aforementioned factors.
Aparna Padiyar, MD. University Hospitals (Cleveland): Many practices navigated resource constraints and shifting care models while working to maintain access, reliability and patient continuity.
Amit Singh, MD. Cardiologist at Cayuga Health (Lansing, N.Y.): Switching to a new EHR in 2025 without proper support.
Prince Singh, MD. Nephrologist at Allina Health Faribault (Minn.) Clinic: Lack of autonomy and pressure to meet some numbers.
