Anesthesia workforce challenges are often framed as a simple staffing shortage, but leaders across the field say that narrative often misses the mark. From inefficient care models and misaligned incentives to burnout and growing clinical complexity, the real issue is how anesthesia services are structured, deployed and valued. Anesthesia leaders nationwide say solving the problem will require system redesign, not just more providers.
Question: What do you think is the biggest misconception about today’s anesthesia workforce challenge?
Editor’s note: Responses have been lightly edited for clarity and length.
George Anastasian, MD. Chief of Anesthesiology at White Plains (N.Y.) Hospital: Staffing needs, such as the procedures that currently require anesthesia clinicians to be present, will remain the same. If labor costs remain high, the reality is large hospital systems will utilize AI tools to stratify what procedures truly need an anesthesiologist, CRNA or AA versus a sedation nurse supervised by the physician doing the procedure. This will likely apply to the cath lab, ophthalmology, interventional radiology and endoscopy.
Kelli Camp, DNP, CRNA. President of the Washington Association of Nurse Anesthesiology (Spokane): The biggest misconception about the anesthesia workforce is that access problems in the United States are being driven primarily by an absolute shortage of providers. In reality, we have a deployment and utilization problem, not a shortage of providers. With more than 117,000 CRNAs and physician anesthesiologists (approximately 35 per 100,000), the U.S. meets and exceeds the World Federation of Societies of Anaesthesiologists’ workforce benchmarks.
In Washington, CRNAs can legally practice independently. Yet some facilities maintain unnecessarily restrictive staffing models claiming physician-led care is safer, a claim unproven and without evidence after over 150 years of practice. These duplicative models often require two anesthesia providers for routine cases like a colonoscopy that one fully qualified provider could safely manage, leaving other facilities and communities struggling to staff even basic services. The result is not improved safety but rather a misallocation of a finite workforce driven by structure rather than patient need.
This kind of inefficiency doesn’t just limit access. It costs our healthcare system trillions every year and wastes scarce clinical resources. Whether the goal is to improve access, control costs or stabilize the workforce, the answer isn’t more providers. The answer is to remove unnecessary barriers, making full use of the 117,000 anesthesia professionals we already have.
Daniel Cole, MD. Vice Chair of the Department of Anesthesiology at the University of California Los Angeles: A persistent misconception is the anesthesiology workforce challenge is merely a pipeline problem, solvable by a single lever such as producing more clinicians. In truth, this is a complex adaptive systems issue, not a linear supply shortfall. It will not be resolved through traditional strategies that rely on linear plans, dashboards or discrete metrics.
What’s required is [a] high-leverage system redesign that aligns change across people, processes, technology and incentives. Expanding headcount without redesigning the system simply redistributes strain; it does not restore capacity or improve quality and safety. Healthcare is attempting to meet the access and quality needs of the American population using a care model built for a different era, one that does not adequately support the seismic change in patient complexity, the increasing technical demands of modern procedures and the human performance and vitality needs of today’s clinicians. Until system design evolves alongside clinical demand, workforce expansion alone will remain an incomplete solution.
Katy Dean, CRNA. TKMAnesthesia (Newport News, Va.): The biggest misconception about today’s anesthesia workforce challenge is the belief that all anesthesia care models must be led by an anesthesiologist to ensure safety.
Multiple rigorous studies have demonstrated that CRNAs practicing independently provide anesthesia care with outcomes equivalent to those of physician anesthesiologists across a wide range of procedures and settings. In response to access and workforce shortages, several states have removed outdated and restrictive supervision requirements without evidence of increased patient risk, particularly in rural and underserved areas. These policy changes reflect an evidence-based understanding that anesthesia safety is driven by provider competence, case complexity and system resources, not mandatory physician leadership. Persisting in supervision-mandated models risks worsening access gaps and inefficiencies at a time when the healthcare system requires flexible, team-based and data-supported solutions.
Garo Derparseghian, MD. Anesthesiologist in Montebello (Calif.): The misconception is treating anesthesia like a transactional service instead of core infrastructure. You simply can’t staff anesthesia only when a case starts, coverage requires clinicians to be present, flexible and ready to redeploy at a moment’s notice. That operational reality is why fee-for-service alone no longer works and why the workforce issue is really about alignment between staffing models, operations and payment.
Don Harmeyer, CRNA. Staff Nurse Anesthetist at University of Vermont Medical Center (Burlington): I see the current anesthesia workforce challenge having two main misconceptions. The first is that the current shortage is anything like what we have seen historically with the supply and demand of anesthesia providers. Never in our country’s history have we been faced with this aging anesthesia provider demographic. Furthermore, our country has never seen an exponential growth in the aging population as we are just beginning to experience. Some will argue that the supply and demand of our profession is cyclical, but this time it is much different.
The second major misconception is that we can continue to cling to practice models such as 2-to-1 medical direction and meet the needs of the future. It is simply not possible with the current advanced age of providers, the impending provider retirements and the expected growth in surgical volume from an aging American population. The American Society of Anesthesiologists and the American Association of Nurse Anesthesiology must work together to find solutions to work in parallel to avoid the rationing of care to Americans.
Narasimhan Jagannathan, MD. Professor and Chief of Anesthesiology at Phoenix Children’s: The biggest misconception is that the anesthesia workforce challenge is simply a numbers problem, recruiting more providers or throwing money at the problem, is not the solution. My perspective from a large pediatric health care system is that the strain starts in the training pipeline, with growing difficulty attracting well-prepared physicians into pediatric and other advanced fellowships after residency. These subspecialty roles require experience and judgment that cannot be quickly replaced, and they are essential to delivering complex pediatric care.
Retention is just as critical. Many clinicians are leaving not because they lack commitment, but because of how the work is structured, rigid schedules, call burden, moral distress and outdated care models that amplify strain rather than absorb it. At the same time, today’s physicians expect a sense of belonging, purpose, flexibility, transparency and equity, and systems that do not meet these expectations struggle to sustain their workforce.
Ultimately, these issues require redesigning training pathways, work and financial models and workplace culture to support how modern anesthesiologists want to practice
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): The anesthesia workforce is not that short. If you add together anesthesiologists, nurse anesthetists and anesthesiologist assistants, we have more than 100,000 anesthesia clinicians.
The “workforce shortage” is due, in part, to institutions’ desire for anesthesia groups to provide care in so many places. Institutions often recruit surgeons and proceduralists by telling them they can have their own suites, with anesthesia available whenever they want it. Providing anesthesia in these independent sites is inefficient. It requires more anesthesia clinicians for the same number of anesthetics because anesthesia groups can’t cross-cover distant sites, provide concurrent anesthetics, turn cases over quickly or tightly schedule independent suites. At one time, most anesthetics were provided in single-, multi-specialty surgical suites. Groups must now often provide anesthesia at myriad out-of-operating-room sites, more than in the main surgical suite.
David LaGuardia. Vice President of Clinical Operations at Sentry-Northstar Anesthesia (Newnan, Ga.): The biggest misconception about the anesthesia staffing shortage in America is that it is solely due to a lack of qualified anesthesiologists or nurse anesthetists. While there is indeed a shortage of these professionals, the issue is also compounded by factors such as increasing demand for surgical procedures, a growing aging population and a lack of resources for training new anesthesiologists and CRNAs. Additionally, burnout and job dissatisfaction among existing practitioners have led to early retirements, with around 30% of current anesthesiologists expected to retire or be over 60 by 2026.
To address this multifaceted issue, several systemic changes are necessary. First, increasing training opportunities by expanding residency and training programs for anesthesiologists and nurse anesthetists can generate a larger workforce. Enhancing work conditions and promoting better work-life balance can help retain current staff and attract new professionals. Implementing anesthesia care teams, which involve anesthesiologists working alongside a certified registered nurse anesthetist, can boost efficiency and expand capacity.
Additionally, leveraging telemedicine for preoperative assessments and remote monitoring can alleviate some burdens on anesthesiologists. Offering incentives for service in underserved areas, such as loan forgiveness or salary incentives, can draw more professionals to these regions. Advocating for regulatory changes that expand the scope of practice for nurse anesthetists can also improve access to care. Lastly, raising public awareness about the importance of anesthesia providers and advocating for supportive policies can lead to sustainable workforce solutions.
By understanding the complexity of the anesthesia staffing shortage and implementing these changes, the healthcare system can better manage demand and enhance the delivery of anesthesia care.
Michael Nurok, MD, PhD. Professor and Co-Chair in the Department of Anesthesiology at Cedars-Sinai Medical Center (Los Angeles): We tend to look at anesthesia workforce challenges through a lens of absolute scarcity. While it is accurate that the global demand for anesthesia services exceeds the total supply of caregivers, we don’t know what the true gap between supply and demand would look like if we more efficiently and thoughtfully deployed our workforce. This would require consistently matching patient and procedural needs to caregiver training and skill as we are trying to do at Cedars-Sinai. Such an approach can meaningfully narrow the workforce gap and have tangible benefits for healthcare in general.
Peter Panzica, MD. Director of Anesthesiology at Westchester Medical Center and Chair of the Department of Anesthesiology at New York Medical College (Valhalla): The biggest misconception about today’s anesthesia workforce challenge is the belief that it can be solved using outdated employment models. We can no longer assume anesthesiologists will pursue linear careers, joining a practice, working toward partnership or entering academic departments with the expectation of promotion and leadership over time.
A growing segment of the workforce now views employment as episodic or “gig-based,” with locum work often representing a deliberate lifestyle choice rather than a temporary stopgap.
Lifestyle considerations play an increasingly central role: anesthesiologists can earn strong incomes without taking calls or managing high-acuity cases at tertiary centers. As a result, health systems must be open to nontraditional staffing models, additional vacation, 1099 arrangements, premium pay for call, night-float structures with protected recovery time and accepting higher mobility driven by serial sign-on incentives.
An unintended consequence of this shift is a shrinking pipeline of early-career physicians willing to invest in leadership development and long-term institutional roles. It is a great time to be an anesthesiologist, at least for now, but not so great to be responsible for staffing to the current demand.
Amit Prabhakar, MD. Chief of Anesthesiology at Emory University Hospital Midtown and Winship at Emory Midtown (Atlanta): This is not simply a staffing shortage. The current anesthesia workforce challenge reflects systemic issues that include provider burnout, geographic maldistribution, increasing patient and procedural complexity, and care models that have not evolved with clinical and operational demands. Sustainable solutions will require redesigning how anesthesia services are structured, supported and retained, rather than relying on recruitment alone.
Michelle Reilly, DNP, CRNA. Chief CRNA, Anesthesia Co.-Frederick Division at Frederick (Md.) Health: One of the biggest misconceptions about today’s anesthesia workforce challenge is the belief that modern access and efficiency demands can be met using legacy staffing models. We are facing a model-of-care mismatch. Sustainable solutions require collaborative practices that fully utilize every provider to deliver anesthesia care — physician anesthesiologists and CRNAs practicing anesthesia, with CRNAs supported to practice at the top of their license without unnecessary restrictions and [certified anesthesia assistants], where licensed, deployed within the medical directive framework for which their profession is designed. Data increasingly show that aligning scope of practice with care delivery improves operating room efficiency and workforce sustainability. The opportunity ahead is to modernize care team design to meet today’s clinical and operational realities.
Brent Sacks, DNP, CRNA. Sleep Tight Anesthesia (Los Angeles): The most persistent misconception about the anesthesia workforce challenge is that the answer must be physician-driven. In many facilities, CRNAs are underutilized or restricted from practicing at the top of their training, despite providing the same anesthesia care with equivalent safety outcomes. As a CRNA working in independent practice, I routinely manage the full scope of anesthesia care from pre-op to post-op without the need for a physician anesthesiologist. When surgery centers insist on utilizing an anesthesia care team model or hiring only physician anesthesiologists to perform identical services, it not only worsens the perception of a staffing crisis, but it also drives up healthcare costs for hospitals, insurers and ultimately patients. Empowering CRNAs to practice to the fullest extent of their education is one of the most immediate and cost-effective solutions to expanding access to anesthesia services nationwide.
Nick Schiavoni, MD. Locum Anesthesiologist: One of the biggest misconceptions about today’s anesthesia workforce challenge is that locums should be avoided at all costs and used only as a last resort. In reality, locums can be a very practical and strategic tool. They can help manage seasonal volume fluctuations, bridge gaps while recruiting permanent hires and allow staff to take needed time off. When used this way, locums help protect core teams from burnout and support efficient operations.
Mont Stern, MD. Program Director of Adult Cardiac Anesthesia at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo (N.Y.): The biggest misconception about the workforce challenge is surging demand outside the OR and inefficient utilization of existing staff. Just about every surgeon is “entitled” to two anesthesia teams to insulate them for how inefficient OR turnovers have become. We are the “canary in the coal mine” for the level of the inefficiency of surgical services.
Doug Tortella, DNP, CRNA. Rancocas Anesthesiology (Cinnaminson, N.J.): The biggest misconception is that anesthesiologists must lead an anesthesia care team. In addition, if a care team model is employed, supervising in a 1-to-2, 1-to-3 or 1-to-4 ratio is a colossal waste of money and staffing. It has been proven in multiple peer reviewed studies that anesthesia is safe regardless of whether a CRNA is practicing independently or in a care team model. If every anesthesiologist and CRNA did their own independent anesthetics allowing CRNAs to practice to the full extent of their training, we would double the workforce, solve staffing shortage and slow the continual salary inflation.
Lee Weiss, MD. Cardiac Anesthesiologist at Marietta (Ohio) Memorial Hospital: The biggest misconception about today’s anesthesia workforce challenge is that it is simply a shortage of clinicians. The real problem is how anesthesiologists are being deployed. Across the country, physicians are increasingly expected to supervise a growing number of high acuity cases simultaneously, often across different locations and services. These expectations assume anesthesia care is infinitely scalable, when in reality it depends on proximity, judgment and the ability to respond immediately when conditions change. Clinicians are not leaving medicine. They are leaving systems built on assumptions that no longer match clinical reality.
Matthew Zinder, DNAP, CRNA. Owner of Zinder Anesthesia (Baltimore): One of the biggest misconceptions about the anesthesia workforce shortage is that it’s just a temporary numbers issue, that it will resolve once more providers graduate. While provider volume is a factor, this shortage has been predicted for over 15 years due to the retirement of baby boomers outpacing graduation rates. Additional contributors include longer training timelines, early retirements driven by COVID-19, rising patient acuity and demand and high burnout among younger clinicians, much of it tied to a culture of poor self-care.
Financial pressures also play a major role. Declining reimbursement from insurers, despite rising provider costs, has driven many anesthesiologists to leave permanent roles for higher-paying 1099 or locum assignments. This shift has increased costs for hospitals, which must pay more to maintain OR staffing. Without policy changes to align reimbursement with care costs, staffing gaps will persist and patient care will suffer.