From delayed surgeries to increased patient complications, the stakes of the anesthesia shortage could not be more clear. To address these stakes, nine leaders joined Becker’s to discuss the effects and consequences of the anesthesia shortage.
Question: What are the potential consequences if the current anesthesia shortage goes unaddressed?
Editor’s note: Responses have been lightly edited for clarity and length.
Chris Campanotta, CRNA at Anesthesiologists Associated (Birmingham, Ala.): I think it is slowly being addressed, but it does seem that a lot of the players like to keep the conditions the way that they are — with the shortages. CRNAs want to be paid market rate, anesthesiologists seem to dance around this, depending on their current practice model, [be it] private group, academic, urban, rural. Insurance companies seem to be doing just fine the way things are, but they really should embrace a shifting practice model. Hospitals are entering into relationships with providers on multiple fronts that have them playing both sides of the field — i.e. partnering with a GI group for a CRNA-only practice peeling CRNAs off the main hospital for the cherry-picked patients — knowing these CRNAs are paid a base much higher than the hospital-based ones that are employed by the group. They have a stipend contract where the admin is limiting locum increases, but then asking the CRNAs in that group to do anesthesia for blocks and they are billing QZ modifier — sends multiple mixed messages. I think the simple answer to your question, though, is all the people profiting off the current arrangement are playing checkers and no one seems interested in chess. Playing checkers is going to force hospitals to limit the OR starts and eventually affect access. Facilities are trying to do the same amount of work with less staff already and it is already forcing providers to job hop because conditions get so stretched thin and folks are getting burned out running all over the place, just so hospitals and anesthesia groups do not have to actually tackle the big issues and get everyone to the table to form a strategic vision.
Angie Edwards, MD. Associate Professor of Anesthesiology and Section Head for Perioperative Medicine at Wake Forest University School of Medicine in (Winston Salem, N.C.): One of the most profound consequences of the current anesthesia staffing shortage will be the exponential impact on patient safety. As anesthesiologists are spread thin and expected to staff more operating rooms and satellite sites than may be appropriate, there is a risk for diminished direct supervision of nurse anesthetists. Nurse anesthetists cannot replace physician anesthesiologists. Yet, CRNA programs are graduating more students than ever and faster, since it takes only two to three years of training to work as a certified nurse anesthetist. Further, this risks having newly minted certified nurse anesthetists with merely two to three years of training in positions where they are not as safe or comfortable taking care of more complex patients. Or they may be asked to care for complex patients when they may not be prepared to do so. Feeling pressured by another supervising physician. This imbalance has a tremendous impact on patient safety which may not be as readily apparent to the general population of patients.
Antonio Hernandez Conte, MD. Former President of the California Society of Anesthesiologists: In many ways, if the anesthesia workforce shortage continues, we will see many of the same issues that occurred during the COVID-19 pandemic. Elective surgeries will get delayed and surgical backlogs will increase significantly by three to six months, maybe even more. As surgical care gets delayed, when patients do finally arrive to have their procedures/operations, their conditions may have worsened, possibly leading to higher complications and nonoptimal surgical outcomes. For example, an elective total hip replacement that gets delayed can begin to negatively impact a patient, including further deterioration of the hip joint, possible hip fracture, as well as deteriorating functional status and lower back problems. Additionally, oftentimes, patients have a narrow window of time in which their pre-existing medical conditions (i.e. high blood pressure, cardiac conditions) can be optimized or medications can be stopped. Therefore, unpredictable surgical scheduling due to anesthesia shortage will impact patients in serious ways. Finally, anesthesia practitioners having to work additional hours to cover the staffing shortages will eventually experience burn out and health issues themselves, and that is not acceptable for maintaining our anesthesia workforce for the long term.
Don Harmeyer CRNA. Staff Nurse Anesthetist at the University of Vermont Medical Center (Burlington, Vt.): By 2033, the nurse anesthetist workforce is expected to experience a shortage of approximately 12,500 providers, representing nearly 22% of the current staff. The market for CRNA will grow nearly 38% by 2032, according to a new report by the U.S. Bureau of Labor Statistics, making it one of the most in-demand subfields of the healthcare industry.
The most recent data that I am familiar with for anesthesiologists is no less concerning. In 2020, the average age of an anesthesiologist was 53, with 45% of all anesthesiologists being over the age of 55. For most providers, once they reach the age of 55, most are interested in working less hours, further adding to the issue. In a mere 10 years, a large portion of the current supply could simply retire or semi-retire. At the age of 59, I too am part of this aging demographic of providers. Additionally, the newest generation of providers is more concerned with a balanced lifestyle than with working too many hours.
The effects of an aging demographic of providers combined with an aging population is the perfect storm. Increasing demand for surgical services will continue to rise by 2% to 3% per year over the next decade fueled by population growth. By 2030, the number of U.S. residents aged 65 and older is expected to increase by 55%, and the number of people aged 75 and older will grow by 73%. This older population will need more procedures requiring anesthesia services. The consequences of this are already being realized with increased surgical wait times and operating room closures. This will intensify and institutions that fail to position themselves will find themselves needing to limit surgical procedures, hire expensive temporary providers or both. This will most certainly result in an increase in morbidity and mortality within the American population and impact the institution’s strongest revenue generating area, the operating room.
Jason Manella, MD. Director of Anesthesia Operations at Endeavor Health (Chicago): Anesthesia is a critical element for many operations and procedures performed across the healthcare system. If the anesthesia staffing shortage goes unaddressed, we could start seeing delayed patient care due to acuity prioritization, increased burnout of anesthesia providers, a decrease in access to certain procedures in rural communities and a decrease in revenue for healthcare systems overall.
Allyn Miller, CRNA. Regional Director of Anesthesia Operations of Community Health Systems (Franklin, Tenn.): Social determinants of health and overall population health are increasingly impacted by the growing anesthesia workforce crisis, not due to a decline in total provider numbers, but because of rising procedural demand and a shrinking pool of full-time clinical anesthesia professionals. Delays in accessing surgical and procedural care disproportionately affect vulnerable populations, particularly those with lower income, limited transportation, or who live in rural communities. These delays can exacerbate chronic conditions, lead to preventable complications, and hinder patients’ ability to return to work, further entrenching cycles of poverty, poor health and limited access to care.
As anesthesia coverage becomes more difficult to secure, particularly in underserved regions, health equity erodes and communities face widening gaps in healthcare delivery. Several workforce trends compound this challenge. Although the number of licensed anesthesiologists and CRNAs has remained stable or grown slightly, full-time workforce participation is decreasing. Many providers opt for part-time roles, flexible schedules or nonclinical work due to burnout, lifestyle preferences or retirement planning.
At the same time, the demand for anesthesia services is rapidly rising due to an aging population, increased surgical volumes and the expansion of outpatient procedural settings. The result is a functional shortage, where the number of available [full-time equivalents] falls short of the coverage required to meet clinical needs. This mismatch is especially critical in rural healthcare settings. Rural hospitals often depend on just one or two anesthesia providers to keep their surgical services operational. If those providers cut hours or leave, it can result in temporary or permanent loss of surgical capabilities, forcing patients to travel long distances for care or forgo needed procedures altogether. These closures also put the entire hospital’s financial sustainability at risk, contributing to rural hospital closures and health system consolidation.
To adapt, many health systems make strategic decisions about which surgical and procedural services to maintain, often driven by financial margins and anesthesia availability. Low-volume or low-margin services are increasingly being reduced or eliminated, and facilities without consistent anesthesia coverage may close.
As these trends continue, the number of care sites decreases, particularly in community and rural settings, further limiting access to timely surgical care. Addressing the anesthesia workforce crisis requires more than increasing training pipelines; it calls for targeted support for rural facilities, investment in retention strategies, and flexible staffing models that align with evolving workforce expectations and growing healthcare demands.
Jeffrey Winacoo. CRNA at UMass Memorial Health (Worcester, Mass.): One consequence of the current anesthesia workforce shortage that I foresee is the end of anesthesiology’s monopoly on propofol sedation. Any nurse who is currently administering fentanyl/midazolam sedation can give propofol. Yes, propofol can dramatically depress respiration and blood pressure but so can fentanyl and/or midazolam and procedural nurses should be trained and competent to treat both, no matter which drug is the cause.
Mark Zapp, MD. Anesthesiologist at Fleming Island (Fla.) Surgery Center: Consequences of an anesthesia shortage:
- Delay in having surgeries performed.
- Decreased efficiency of performing surgeries.
- Less availability of qualified professionals in emergencies.
- Continued shift toward physician extenders in areas some are not comfortable with.
- Decreased care for lower reimbursed procedures or insurances including government insurances.
- Provider burnout.
- Longer hours with decreased attention to detail with longer shifts.
- Decreased profitability or outright losses for anesthesia companies/hospitals to keep up with market forces.
- Facility closures on times when anesthesia providers are not available.
- Increased patient risk based on all of the above information.
Erin Pukenas, MD. Vice Chair and Associate Professor of the Department of Anesthesiology at Cooper University Health Care (Camden, N.J.): The anesthesia workforce shortage is not just a staffing issue — it’s a critical patient safety and access to care crisis. Without urgent, coordinated responses — including retention strategies, innovative care delivery models and better workforce planning — the shortage could deeply impact the delivery and quality of surgical, obstetric and procedural care in the U.S.
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