When ASC leaders blame inefficiencies on a workforce shortage they are dodging the root cause of the problem.
In the majority of cases, facilities are dealing with a failure in workplace utilization, not a lack of providers. ASCs have to find ways to become more efficient with the providers and resources that they do have in order to improve productivity.
These four physicians and executives discussed the importance of efficiency in the anesthesia space at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago.
Note: Responses were lightly edited for clarity and length.
Question: What doesn’t get enough attention right now around fixing or addressing the anesthesiology shortage?
Megan Friedman, DO. Chief, Anesthesiology, Adventist Health Southern California & Pacific Coast Anesthesia (Los Angeles): I think we’re spending too much time talking about workforce supply and not workforce utilization. Many facilities still function in the same ways as they did before COVID. A center might open a room just for one case. At that point the anesthesia provider or the anesthesia group takes the hit on that. You sit around all day, you do one case. Now with the shortage and many facilities providing subsidies, that’s just not sustainable. Centers are now realizing that they need to start looking at operational efficiency and schedule integrity. There needs to be a lot more focus on that because you can get more providers, but you’re ultimately not gonna fix the root cause and problem. There are many reasons why people leave the field, but feeling like your time and expertise are not respected is definitely a leading cause of burnout.
David Mackey, MD. Professor of UT MD Anderson Cancer Center (Houston): I do not believe we have an anesthesiologist shortage. I believe we have a maldistribution of it. It all depends on working conditions, jobs, security, salary and benefits. There obviously are places that can’t find anesthesiologists, can’t find nurse anesthetists. There are other places where you’ve got a long line of people, including my place. There’s probably several dozen anesthesiologists that want to come and work at my place at any given time. At one time there were over 100 people standing in line. So it really depends.
Brett Maxfield. Director, Surgical and Anesthesia Services of Madison Avenue Surgery Center (Idaho Falls, Idaho): My thought is that we’re not addressing the root cause. We talk about the problem, but we very rarely talk about the cause. We’ve got a maldistribution and we’ve got people in places where they could be better utilized. Ever since the pandemic, we’ve had an exodus from the hospital with surgeons and anesthesia providers, and there are unintended consequences. I also think it’s maldistribution when you have seven surgeons that all want a 7 a.m. start, but this one’s done at 10 a.m., this one’s done at 11 a.m., this one’s done at 1 p.m. and this one’s done at 3 p.m. That’s a waste of resources. If you have talented providers that could be in a chair doing that and instead they’re, you know, maybe doing preoperative testing or something like that, take that provider and move them back into a chair where they are needed.
Mira Yaache. Administrator, Anesthesiology and Critical Care Medicine Department of Johns Hopkins Bayview Medical Center (Baltimore): I have two thoughts on the distribution of anesthesia providers. The first is that there is a golden value proposition that some employers have figured out, and the rest of us are still trying to adapt. The golden proposition value is more money for a more desirable schedule and more time off. That’s what the new generations coming into the workforce are asking for and desiring. There might be people looking for work on the market, but they’re going to these employers and not to the traditional, more archaic, in a way, employers that have not quite adapted those models. The other thing is nursing skill sets and where do we really have to evaluate that and try to upskill our nursing colleagues to be able to fill some of the gaps. In nursing sedation, we have seen that there’s been a drift away from that. I think that’s a part of this shortage equation that we should be looking at.