As ASCs confront an escalating shortage of anesthesia providers, many leaders feel the conversation has too often fixated on surface-level symptoms — labor costs, physician vacancies and training bottlenecks — while overlooking deeper, structural contributors to the crisis.
Eleven anesthesia leaders joined Becker’s to shed light on what’s missing in today’s discourse.
Question: What’s missing in conversations around anesthesia workforce shortages and reimbursement challenges?
Editor’s note: Responses have been lightly edited for clarity and length.
George Anatsein, MD. Director of Anesthesiology at White Plains (N.Y.) Hospital: While anesthesia labor costs are readily available, there is little transparency on how that fits into the overall surgical services budget. The shortage of anesthesia clinicians has brought to the forefront the critical role we play in determining how many elective surgeries and procedures can be performed at healthcare facilities.
Robert Evener, DO. Anesthesiologist in Jacksonville, Fla.: As far as anesthesiologists are concerned, residency positions have not increased with demand over the years. It is one of the highest placed specialties on residency match day, so both the demand and interest is there … just a bottleneck with training programs which are rigorous.
Megan Friedman, DO. Director of Pacific Coast Anesthesia Consultants (Los Angeles): Reimbursement challenges! Medicare has undervalued anesthesia services for decades. Physicians in general but especially anesthesiology regarding government payers. The specialty has relied on commercial payers, but now commercial payers are aggressive about delaying and outright denying legitimate reimbursement.
What’s missing is the recognition that anesthesiologists should be the “captain of the ship” when it comes to OR and procedural efficiency. We’re one of the few specialties that operate across all service lines — from the OR to non-OR areas like imaging, cath lab, bronchoscopy and labor and delivery. Anesthesia isn’t just a service — it’s a 24/7 specialty that hospitals rely on across departments.
What benefits hospitals and surgery centers — efficient throughput, optimized utilization and the right case and payer mix — also benefits the anesthesia service line. Our goals are aligned. Instead of focusing solely on cost-cutting, hospitals should leverage anesthesiologists’ unique position to drive efficiencies, reduce bottlenecks and improve patient flow across all areas of care.
Dewey Galeas, CRNA. Forensic Anesthesia Auditor and Chairman of Columbia County (Ga.) Hospital Authority: We are an aging and not totally renewable resource. The high stress and long hours of anesthesia practice exact a toll on the profession. Employers and facilities fail to count personnel and rooms correctly. Five rooms do not require five anesthesia providers — six or more is suitable to avoid provider fatigue and burnout. When any skilled workforce feels overused, it votes with its feet. I retired in January, and, no, not even the new high pay rates will bring me back to the machine. Because the landscape never changes.
In terms of reimbursement, the dollars need to be placed in the hands of the people who produced the billables. We are now savvy enough to understand that our long hours too often support layers of non-providers in their gated communities and lifestyles. Thirty-five years ago, I learned to work for myself and never looked back. And if the billables fall short of the pay, remember that the billables are zero if a provider is not there. Adjust the pay and improve the conditions, or have a dark room.
Antonio Hernandez-Conte, MD. Immediate Past President of California Society of Anesthesiologists (Sacramento): Many practices are facing both anesthesiologist and nurse anesthetist workforce challenges. These challenges are particularly serious in areas where practices must manage insufficient revenue caused by unreasonably low payment rates. Geographic areas with high Medicare and Medicaid populations and where insurers have taken particularly aggressive postures to lower payments to anesthesia practices exacerbate workforce issues, causing financial instability. Furthermore, hospitals are now bearing the responsibility to provide additional revenue enhancements/subsidies to sustain anesthesiology practices so that operating rooms can be staffed and remain open. Practices need sufficient revenue to attract and retain necessary clinical staff and to remain sustainable over the long term.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s Hospital: What’s missing: The conversation often overlooks the maldistribution of anesthesia providers — urban centers are saturated, while rural and underserved areas face critical gaps. There’s also a critical shortage of pediatric anesthesiologists, which jeopardizes safe care for children needing surgery. Additionally, the impact of burnout, poor work-life balance and lack of pipeline development (e.g., mentorship and early exposure for diverse trainees) are underdiscussed root causes that worsen both shortages and reimbursement struggles.
Bob Johnstone, MD. Professor and Chair for the Department of Anesthesiology at West Virginia University (Morgantown): We have more anesthesia capacity than ever. The perceived anesthesia supply shortage is actually due to increased demand for anaesthesia care. Formerly, all anesthetics were administered in surgical suites. Now we deliver anesthetics in radiology suites, bronchoscopy labs, psychiatry centers, orthopedic offices, plastic surgery offices, etc. It requires more anesthesia workforce to cover the same number of cases when they are dispersed. Concentrating anesthetic care in fewer areas would reduce costs.
Daniel King, CRNA. Board Director of the American Association of Nurse Anesthesiology (Rosemont, Ill.): We must empower CRNAs to do the work they are educated and prepared to do, and we must rectify discriminatory reimbursement policies that undervalue their contributions. CRNAs are the most cost-effective and widely distributed anesthesia professionals — especially in rural and underserved communities where access to care is most fragile.
The data are clear: CRNAs provide safe, high-quality care and are a proven solution to workforce shortages. Yet outdated reimbursement structures and unnecessary practice restrictions — neither supported by evidence, but perpetuated by certain interest groups for financial gain — continue to hold us back.
If we are serious about improving patient access, increasing system efficiency and reducing healthcare costs, it’s time to fully leverage the capabilities of all anesthesia providers delivering direct care. Clinging to legacy hierarchies doesn’t serve patients — it delays progress and wastes resources.
Robert Lerma. Administrator of Upper Valley Dialysis Access Surgery Center (Mission, Texas): A discussion on how the facility and anesthesiologists can develop a collaborative partnership.
Rick Middleton, CRNA. Director of Anesthesia Services at UNC Wayne (Goldsboro, N.C.): There are multiple issues here to discuss. Most current CRNAs do not understand anesthesia billing, cost, revenue, reimbursement — different than revenue — and how all of that relates to payor mix, bad debt, bundled charging, etc. All these issues come into play when accounting for anesthesia revenue and salaries.
Multiple financial efforts to retain CRNAs need to be explored. These include substantial yearly retention bonuses, true salary market adjustments, tuition reimbursement, options for employing 1099 vs locums, true ACT collaboration and respectful work environments. Patients are getting sicker and attention to excellent care, rather than focusing on turnover times, plays a role as well.
Jeff Tieder, CRNA. Clinical Assistant Professor of the Nurse Anesthesia Concentration at the University of Tennessee at Chattanooga: While much of the national conversation centers on physician shortages, certified registered nurse anesthetists have long provided safe, efficient and high-quality anesthesia care — often independently. Yet, many workforce discussions continue to overlook CRNAs as fully qualified, primary anesthesia providers.
In nearly every national conversation about the anesthesia workforce, one phrase keeps resurfacing: “the looming physician shortage.” It’s cited as the main threat to patient access and the reason we must urgently train more anesthesiologists. But this narrow narrative ignores the thousands of CRNAs who are already bridging the gap — safely and cost-effectively.
Despite caring for millions across diverse practice settings, CRNA voices are frequently excluded from workforce planning, policy development and legislative testimony. Meanwhile, national strategies focus on filling workforce gaps without seriously addressing the regulatory and reimbursement barriers that limit the potential of CRNAs — despite decades of data showing our outcomes are equivalent to or better than traditional models. CRNAs are not a future backup plan. We are already the solution.
Despite delivering equivalent care, CRNAs are often reimbursed at only 85% of physician rates. While the Affordable Care Act includes a nondiscrimination clause meant to protect providers practicing within their licensed scope, it has not been meaningfully enforced to address disparities in how CRNA services are valued and paid. This inequality not only undervalues our profession — it directly limits patient access to safe, cost-effective anesthesia services.
We urge a shift in the national conversation toward expanding the most efficient and scalable models of anesthesia care — collaborative and CRNA-only practices. These aren’t theoretical models. They are already operating successfully in hospitals, critical access facilities and surgery centers across the country.
During the COVID-19 pandemic, CRNAs stepped up to lead ICU teams and provided frontline care to overwhelmed communities, practicing at the full extent of their training. Now, with a prolonged and worsening anesthesia provider shortage, those same flexibilities should not only be reinstated — they should be made permanent. If we’re serious about solving the anesthesia workforce crisis, it’s time to fully recognize, support and invest in the CRNAs who are already meeting the moment.
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