Staff retention and turnover — especially due to burnout — is becoming a “silent” force undermining ASCs’ financial performance, Benjamin Stein, MD, president and CEO of Capital Orthopaedic Surgery Center in Germantown, Md., told Becker’s.
The turnover results in “a two-pronged hit of reliance on more costly staffing agencies and the resultant decreased efficiencies of unfamiliar staff that lead to decreased revenues,” Dr. Stein said.
This challenge is especially pronounced in competitive healthcare markets, where ASCs must go head-to-head with hospitals that can often provide significantly higher salaries and broader benefits. This disparity puts many centers at a disadvantage when trying to attract and retain staff.
Healthcare staffing costs are climbing across the board, straining ASC budgets. In 2023, 43% of ASCs reported operating budgets of $3 million or more, up from 32% in 2022, according to a survey from OR Manager. A substantial portion of that increase is tied to escalating labor expenses.
“As a nurse who’s worked in one of the larger hospitals in the area, I understand the challenge,” Jennifer Robinson, RN, is director of Norfolk, Va.-based Center for Special Surgery, currently in development, told Becker’s. “Hospitals have the lion’s share of the healthcare workforce, and like everywhere else, there’s a nursing shortage.”
Despite advantages like more predictable hours and better work-life balance, Ms. Robinson acknowledged that even small wage differences can make retention difficult.
“The draw for ASCs is still there, but if competitors offer a couple of dollars more per hour, it’s going to be hard to compete,” Mr. Robinson said. “We’ll have to navigate that when the time comes, especially since I want good staffing ratios and to prioritize patient safety. We don’t have the same benefits as larger companies, but the work-life balance and set hours are huge draws.”
ASCs also face mounting recruitment challenges in specialties grappling with provider shortages, such as gastroenterology.
“For the long term, practices need to develop retention plans for senior physicians and also expand and retain ancillary providers into the practice,” Stephen Amann, MD, gastroenterologist at Digestive Health Specialists in Tupelo, Miss., told Becker’s last year. “Recruitment of new GI doctors will also be critical for patient service and support and will be on the minds of all practices.”
Compounding the issue is a broader shift in the healthcare employment landscape. About 77% of physicians have moved away from independent settings, opting for employment by hospitals or health systems — a trend that further limits the pool of independent surgeons typically affiliated with ASCs.
“This shift has led to these hospital employed surgeons performing their surgeries at the hospitals instead of surgery centers and there can be an unwritten pressure from the hospital for these doctors to do so,” Patrick McEneaney, DP, owner and CEO of Crystal Lake-based Northern Illinois Foot & Ankle Specialists, told Becker’s. “Because of this, recruiting is having to focus on the remaining independent surgeons. Additionally, we are seeing our patients sicker than previous years with more medical comorbidities. This has led to more of the patients having to be brought to the hospital for surgery because they are too high risk for the ASC.”
While ASCs may not always match the salaries and benefits of large health systems, they can still be competitive by fostering a strong workplace culture. Offering professional development, clinical autonomy, and ongoing education can enhance job satisfaction and support long-term retention.
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