By 2036, the U.S. is expected to face a shortage of 6,300 anesthesiologists, a crisis poised to reshape procedural care delivery.
Becker’s spoke with six anesthesia leaders to explore the long-term consequences of this growing shortage and how it could impact surgical access, care quality and healthcare system sustainability in the next five years.
Question: If the anesthesia shortage persists, what long-term effects are you most concerned about for the healthcare system over the next 5 years?
Editor’s note: These interviews were edited lightly for clarity and length.
Mo Azam, MD. Head of Innovation at US Anesthesia Partners (Orlando, Fla.): Clinician headcount and case volumes have been tightly matched for many years. The burnout, turnover and recruiting cycle have hit all sectors of the healthcare workforce. Health system margins are strained because of workforce costs and declining reimbursements, and anesthesia practices are encountering even more magnified effects, because of much more severe cuts in reimbursement and much higher wage inflation. In the desperate effort to retain or grow procedural volume, which is high-margin for facilities, health systems willingly sacrificed efficiency. The core issue is certainly NOT a labor shortage in anesthesia services. It’s structural inefficiency of procedural care. Most facilities run at less than 65% utilization. So they have to pay for clinical teams, who are not productive for nearly one-third of the day. Facilities paying stipends have created an arms race between each other, and are doing so to keep grossly inefficient systems in place and compete with each other to attract cases. The long term effect will be some winners and many losers. Those losers will be facilities that can not compete — rural, those that are already strained financials, and some ASCs. As well as many anesthesia practices that can not successfully negotiate for fair reimbursement in this context. The winners will figure out how to work together with shared alignment.
Andrew Briggs CRNA. Clinical Education Coordinator at UCHealth Anesthesia Southern Region (Colorado Springs, Colo.): The shortage of providers combined with daily financial needs rising in recent years has led to increased compensation for anesthesia providers. While provider pay is trending in a more “stable” direction since the surges in compensation during COVID-19, demand for consistent staffing has still driven an appropriately increased pay scale. The unknowns related to government funding in addition to provider shortages make this a very unique time in anesthesia. In the past, compensation demands for providers have had a linear relationship with funding. In the wake of declining anesthesia reimbursements, I’ve noticed many hospital systems bracing for financial crisis.
The greater numbers of our aging population and increases to healthcare access in the last decade (since Obama-era) have created a need for surgical services in all geographical areas. Rural hospital systems may face significant financial strain related to anesthesia compensation needs meeting decreases in funding. Should recent legislation validate these fears, rural systems especially face a great danger of losing anesthesia services in the wake of progressively declining reimbursement trends. These communities face massive challenges in areas where recruiting providers is already difficult. The staffing and presence of multiple specialties required to designate hospitals as a “higher level of care” leaves people with fewer options for complex services. These (already overwhelmed) hospital systems will face a greater workload if peripheral locations close and are unable to offset the needs of their community.
Recent trends have shown hospitals and anesthesia providers being forced into unfavorable financial agreements for hospital employed providers and private groups alike. Since 2024, institutions have already seen a 17% increase in the use of expensive temporary providers with another 5% increase expected for 2025. These arrangements are unfavorable to hospital systems, and the surges in compensation are not likely sustainable in the long term. Overall, funding and staffing shortages will eventually cause less access to healthcare, delays in care (leading to less healthy and more complex patient populations), and greater costs passed on to our patients from hospital systems already absorbing unreasonable portions of care. With this, it seems possible that anesthesia becomes a less desirable specialty for physicians and advanced practice providers alike.
Rachel Charney, MD. Adjunct Professor of Saint Louis (Mo._ University: I wear two hats, as a long-term pediatric emergency physician with a focus in disaster management and response (which I have mostly stepped away from), as well as in my current role in healthcare leadership recruitment. For the former, my concerns often focus around shortages and lean staffing models that make it hard for hospitals to respond to large scale disasters, and thus require more thoughtful planning ahead of events. With the significant challenges and issues in front of leaders, this planning is often underdeveloped and thus places patients at potential risk in a mass casualty event.
From the perspective of healthcare executive recruitment, a shortage in any field leads to several challenges. First, it reduces motivation for more junior faculty to take on leadership roles, due to increased pressure for much needed patient care. This diminishes our pipeline of strong leaders. Similarly, research can also be harder to take on and lead to a narrowing of scientific discoveries and advancements in anesthesiology just when those innovations might be most helpful to manage bottlenecks. In addition, fiscal impact of limited ability to schedule elective procedures may have negative impacts on healthcare systems across the board. As a consultant in healthcare executive search, our goal would be to partner with healthcare systems more closely to ensure rapid replacement of leaders and top scientists in an increasingly difficult recruitment space.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): Anesthesia shortages create production pressures for facilities trying to complete all scheduled cases. This pressure is a cause of clinician burnout. Anesthesia shortages also compromise quality by forcing surgeries into a few multi-purpose areas, rather than providing surgeons and proceduralists with specialty work areas where they can perform their tasks more effectively. I also worry that anesthesia shortages may lead to higher costs for patients and less access to care due to facility consolidation.
Rick Snyder, MD. President of HeartPlace (Dallas): If the anesthesia shortage persists, it will negatively impact access to necessary procedures in all healthcare settings, especially as the demand continues to grow with the ever continuing expansion of the baby-boomer, over-65 population. This negative impact is especially true in the ASC setting as CMS is transitioning more and more procedures to this cost efficient site of service so as to try and preserve the solvency of Medicare and Medicaid.
Jake Yellen, CRNA. Owner of United Sedation (Albany, N.Y.): I don’t see the anesthesia shortage improving significantly over the next five years. The main concern for the healthcare system will be finding ways to maintain surgical volume, as the system cannot afford a drop in revenue. Inpatient hospitals will increasingly be forced to pay stipends to outside groups to offset the rising costs of competitive compensation for anesthesia providers. If a hospital chooses not to pay a stipend, it often ends up paying premium rates for locum providers instead. In many cases, it makes more financial and operational sense for a hospital to retain its credentialed staff; who are already familiar with the system, even if it requires paying a stipend. The alternative often involves onboarding locums, credentialing them and managing orientation, which can result in similar or higher costs.
We’ll also see a rise in independent CRNA-only teams and more use of medical supervision or QZ billing models, even when both MDs and CRNAs are on-site. The traditional 4:1 medical direction staffing ratio will likely become outdated and impractical due to workforce shortages. Some hospitals may adopt models where a sole “rescueologist” oversees care while CRNAs practice to the full extent of their licenses. CAAs will have a more limited role in addressing the shortage, as they require direct physician supervision, further straining MDA capacity.
Meanwhile, more elective surgeries will shift to outpatient ASCs. These centers will have an easier time attracting anesthesia providers due to improved work-life balance, but will still face challenges with premium wages and guaranteed hours until supply catches up with demand. I also expect to see more private ASCs move toward directly hiring their own anesthesia teams instead of paying stipends to outside groups.
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