Authors: Johnstone R E et al.
Source: Anesthesiology Open, Volume 1, Issue 1, January 2026,
Summary:
This article examines the origins, passage, and long-term consequences of the Medicare Anesthesiology Teaching Funding Restoration Act of 2007, landmark legislation that reversed a financially devastating Medicare policy affecting anesthesiology residency training. In 1995, the Centers for Medicare and Medicaid Services (CMS) reduced reimbursement by 50% for anesthesiologists supervising two residents concurrently. Unlike teaching surgeons and internists, anesthesiologists were uniquely penalized, resulting in annual losses averaging $400,000 per residency program and prompting widespread program closures.
After repeated unsuccessful regulatory appeals to CMS, leaders of the American Society of Anesthesiologists (ASA) concluded that legislative action was necessary. Beginning in 2003, ASA launched a coordinated advocacy campaign involving physician education, grassroots congressional engagement, and bipartisan legislative sponsorship. The resulting Senate and House bills were incorporated into the Medicare Improvements for Patients and Providers Act of 2008 and enacted after Congress overrode a presidential veto.
CMS implemented the restored payment policy in 2010, allowing full reimbursement for anesthesiologists teaching two residents concurrently. From 2010 through 2024, Medicare paid approximately $1.26 billion for 2.8 million resident-administered anesthetics. The authors estimate that this represented $442 million to $568 million in additional Medicare payments compared with what would have occurred without the legislation. During this period, anesthesiology residency programs increased from 131 to 167, and the number of graduating residents nearly doubled.
The article highlights how the funding restoration stabilized training programs, reversed a decade-long decline, and protected the future physician anesthesiology workforce. It also emphasizes broader lessons learned, including the limits of regulatory advocacy, the necessity of congressional engagement to change Medicare policy, and the effectiveness of persistent, physician-led, bipartisan advocacy. The authors frame the legislation as a defining political, financial, and educational victory for anesthesiology, demonstrating the specialty’s ability to protect residency training through organized national action.
Key Points:
• Medicare’s 1995 payment cut led to widespread anesthesiology residency program closures
• Regulatory appeals failed, necessitating direct congressional intervention
• Bipartisan advocacy resulted in passage of the Teaching Funding Restoration Act
• Full teaching payments were restored beginning in 2010
• An estimated $442–568 million in additional Medicare funding was secured
• Residency programs and graduating anesthesiology residents expanded substantially
• The Act established a durable model for future specialty advocacy efforts
Thank you to Anesthesiology Open for allowing us to summarize and discuss this important article.