Anesthesia leaders say the specialty is facing a convergence of financial, workforce and operational pressures that threaten hospital stability nationwide. Stagnant Medicare rates, aggressive payer tactics and reimbursement cuts are colliding with workforce shortages, rising demand and growing reliance on locum tenens staffing.
At the same time, restrictions on scope of practice, rigid employment models and attempts to treat anesthesia as a case-by-case service, rather than core clinical infrastructure, are widening staffing gaps and driving burnout. The result, leaders told Becker’s, is not just departmental strain but a broader risk to surgical access, hospital margins and long-term system resilience.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What emerging trend poses the greatest threat to anesthesia stability today?
Mo Azam, MD. Head of Innovation at US Anesthesia Partners (Dallas): The biggest threats to anesthesia stability are similar to the rest of healthcare: appropriate reimbursement and support of the future workforce. On the reimbursement side, it is a well-worn refrain: unreimbursed clinical services or reimbursements that can be lower than the actual costs of providing care.
Medicare is stuck where it was 30 years ago, on an inflation-adjusted basis. On the workforce side, the threat is the lack of clinical training sites, stagnant slots and funding for graduate medical education. My practice has approached this dilemma by implementing innovative solutions to train residents, CRNAs and CAAs. These include bold new collaborations with academic institutions and the formation of several of our own residency programs.
Adam Chaucer, CRNA. Owner of Trident Anesthesia (Dallas-Forth Worth, Texas): A continuing threat to anesthesia stability is restricting access to care by not allowing all anesthesia providers, regardless of title, to practice to their full scope. Demand for anesthesia services is rising due to factors such as an aging population, increased surgical volume and growth in outpatient procedures.
At the same time, workforce shortages are expected as many providers near retirement, potentially creating a shortfall of thousands within the next five to 10 years. This combination could widen staffing gaps, delay surgeries and reduce available services. Restricting a major workforce segment, such as CRNAs, is structurally destabilizing, and unnecessary policies and bylaws should be revisited to focus on value rather than politics. No studies show significant differences in safety outcomes between CRNA-only, MD-only or collaborative staffing models. It’s time to move beyond legacy policies toward solutions that support workforce capacity, access to care and financial sustainability.
Antonio Hernandez Conte, MD. Past-President of the California Society of Anesthesiologists: The escalating aggressive behavior by health insurance carriers to place profits over patient care is a serious threat to access. Currently, the latest tactic is to financially penalize hospitals and ASCs that do not use physicians who participate on “in-network” panels. This tactic is designed to force physicians to sign “in-network” contracts that are meant to lower physician reimbursement. The resultant effect for anesthesia practices is that hospitals will be forced to provide additional revenue to anesthesiologists to make up for the deteriorating third-party payer reimbursement, which does not match market costs for anesthesia services.
Garo Derparseghian, MD. Anesthesiologist in Montebello, Calif.: The greatest threat to anesthesia stability is the thought that you can use software to dictate anesthesia staffing needs, based on what cases are scheduled, in advance. This reinforces the broken idea that anesthesia is an à la carte service. Anesthesia requires continuous staffing and standby readiness, not case-by-case deployment. Combined with a permanent shift toward workforce predictability, underestimating the cost of reliable coverage leads to burnout, turnover and rising subsidy pressure.
Stephen Dorman, MD. Chief Compliance Officer at CCI Anesthesia (Pensacola, Fla.): Key challenges include reduced third-party reimbursement for CRNA services (though some states have prohibited this), increasing difficulty recruiting anesthesiologists and CRNAs as demand grows and reluctance in some states to grant independent CRNA status despite workforce shortages in rural and even some metropolitan areas. Additionally, high locum tenens pay pulls providers away from permanent roles, driving up contract anesthesia costs, while hospitals’ limited control over OR schedules leads to long workdays, burnout, greater time-off needs and increased staffing demands.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s: The greatest emerging threat to anesthesia stability today is the market-driven commoditization of the specialty amid unprecedented workforce mobility. Demand for anesthesiologists has never been higher, and the rapid growth of the locum tenens market, coupled with health systems adjusting compensation packages to recruit and retain talent, has created intense competition for clinicians. When physicians do not feel valued, aligned or supported within a system, they have abundant alternative opportunities, often at higher compensation.
This dynamic drives contract instability, supervision strain and workforce fragility. Stability depends not just on filling positions, but on creating environments where clinicians feel respected, appropriately supported and invested in the institution’s mission. Without that alignment, even fully staffed departments can become operationally unstable.
Julie Staczek-Marx, CRNA. President-elect of the Michigan Association of Nurse Anesthetists: Underutilization of the collaborative anesthesia model is destabilizing facilities in Michigan. Following the 2021 Opt-Out and Public Health Code 53, hospitals were given flexibility to choose anesthesia models that best fit their community and budget. While rural regions like the Thumb and Upper Peninsula are seeing success, other areas show costly duplication, such as in Grand Rapids running 1:1 CRNA-to-anesthesiologist staffing and in metro Detroit ASC sites where there is excessive provider scheduling relative to points of service.
This inefficiency threatens financial solvency and OR productivity. Implementing flexible, collaborative models that allow all providers to practice to the full scope of their training is essential to improving efficiency, reducing costs and stabilizing staffing.
Ryan McDonald, MSN, CRNA. Director of Anesthesia at Prosser (Wash.) Memorial Hospital: The most recent emerging threat in anesthesia stability is influential United Healthcare, unacceptably and illegally, electing to reduce reimbursement for anesthesia services performed by a CRNA in the independent, also known as QZ, billing environment. The change is unreasonably discriminatory in practice as it is damaging to already-stressed health economics. If such operations can go unchallenged, it is easy to see the slippery-slope.
Amit Prabhakar, MD. Chief of Anesthesiology at Emory University Hospital Midtown and Winship at Emory Midtown (Atlanta): The most significant emerging threat to anesthesia stability is the structural fragility within the care delivery model. Growing procedural demand and rising case complexity are converging with workforce contraction, evolving employment structures and reimbursement compression. This is resulting in systemic instability rather than isolated shortages.
As higher acuity care shifts into resource-constrained outpatient settings, the margin for error narrows, while staffing flexibility declines. The risk is fundamentally economic and organizational, undermining resilience across the anesthesia ecosystem.
Nanette Schwann, MD. Professor and Vice Chair in the Research Department of Anesthesiology at Lehigh Valley Health Network (Allentown, Pa.): More and more, people are realizing that anesthesia isn’t just about filling shifts; it’s a core part of a hospital’s clinical backbone. When organizations treat anesthesia as a true clinical infrastructure, everything works better. Surgical and ambulatory expansions actually take off, patients move through the system more smoothly and access expands in a predictable and safe manner.
AI will only make this stronger when it’s guided by clinicians instead of being dropped in as a standalone tool. When anesthesia is invited into the design of throughput, safety and reliability, health systems end up with steadier operations, happier patients and more room to grow. The places that embrace anesthesia as integral to their architecture stay resilient; the ones that view it as just staffing coverage tend to feel the strain.
Jacob Schaff, MD. Division Chief of Cardiac Anesthesiology at White Plains (N.Y.) Hospital: Declining payments and rising costs, but that’s a macro-problem every specialty faces. More immediately solvable: The greatest threat to anesthesia stability is that we’re managing diverse provider preferences with one-size-fits-all employment structures. Many clinicians would willingly trade compensation for flexibility and protected time off; others want to maximize earnings and are happy to work more shifts. These aren’t competing interests; they’re symbiotic.
In theory, departments could pair them deliberately: Flex-track providers covering fewer shifts at lower total compensation, revenue-focused providers picking up additional shifts at premium rates. But rigid W-2 models rarely allow for this differentiation, so both groups increasingly leave for locums or 1099 arrangements where they can self-select.
Departments that build differentiated employment tracks will retain talent. Those that don’t will continue losing providers to contract work, regardless of how high their baseline compensation is.
Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas): Surgeons are performing procedures on more medically complex patients in ASCs, leading to more variability in coverage requirements and a greater demand for clinicians who can manage acute care needs.
Even modest increases in acuity can create outsized operational challenges, including greater need for comprehensive pre-admission testing, increased demands on anesthesia teams, higher cancellation rates, longer recovery times and extended case duration. These shifts can also affect financial performance, particularly in ASCs with limited payer mix flexibility. The industry is already under strain as payers continue to reduce reimbursement for anesthesia services, effectively undervaluing the expertise and clinical risk management that anesthesiologists provide.