Anesthesia teams are under pressure as surgical demand rises, staffing tightens and financial strains mount. Yet the specialty is entering a pivotal year of change, and the decisions made now will shape its future, leaders told Becker’s.
Question: What is the one change you expect will most shape the future of anesthesia in the year ahead, and why?
Editor’s note: These responses have been lightly edited for clarity and length.
Rita Agarwal, MD. Clinical Professor of Anesthesiology at Stanford (Calif.) University: The federal funding cuts have the potential to have a huge impact on healthcare in general, but an outsized effect on rural and pediatric care, including surgery and anesthesia. As a pediatric anesthesiologist who works at a children’s hospital, I am very concerned about the impact these cuts will have on kids. I worry that we will be taking care of sicker patients with more life-threatening or limiting conditions.
George Anastasian, MD. Chief of Anesthesiology at White Plains (N.Y.) Hospital: Optimized scheduling. Facilities, especially those with employed surgeons, will shift away from scheduling based on surgeon availability to scheduling based on anesthesia and OR staffing and availability. AI will be used to optimize efficiency based on historical data and projections. Further, anesthesia groups will offer more flexible work hours based on the preference of their clinicians in order to motivate greater engagement at their particular site. Larger groups will develop in-house locum teams to decrease costs and provide better flexibility when serving multiple locations.
Matt Bell, MSN, CRNA. Self-employed CRNA (Morganton, N.C.): Clinically? I’m hoping that real clinician decision support via AI will finally find its way into now, data entry only, electronic health records. That epoch in anesthesia care can’t come fast enough. Future clinician supply? The cessation of Grad PLUS loans for SRNAs has the potential to put a dent in supply at a time when we can ill afford it.
Katy Dean, CRNA. Chief Nurse Anesthetist at TKM Anesthesia (Newport News, Va.): The shift toward multimodal, regional-first anesthesia as the default standard of care, particularly in the outpatient setting. As ASCs take on higher-acuity cases, anesthesia models that reduce opioid use, shorten PACU stays and deliver predictable recoveries will be essential for safety and efficiency. This is the model I utilize at the Independent CRNA ASC, and it reflects where anesthesia is headed, moving from task-based coverage to a value-driven role that directly supports throughput, case complexity and patient satisfaction.
Steve Dorman, MD. Chief Compliance Officer at CCI Anesthesia (Pensacola, Fla.): Reimbursements will go down, and hospital expenses for anesthesia services will therefore go up in this extremely competitive market for providers.
Antonio Hernandez Conte, MD. Past-president of the California Society of Anesthesiologists: Anesthesia practices will face significant financial challenges due to the triple threat of reduced Medicaid funding (via H.R.1), increased uninsured patients due to loss of ACA subsidies and continued pressure to move to undercompensated remuneration with in-network contracts with insurance companies. A practice’s fiscal and operational viability will be determined by its ability to demonstrate value coupled with efficiencies of scale, while maintaining safe, high-quality anesthesia care.
Cory Koenig, DO. Vice President of Operations at Providence Anesthesiology Associates (Charlotte, N.C.): Anesthesia will, unfortunately, continue to see downward pressures from payers for reimbursement. This is playing out in many ways and with different strategies by government and private payers. Simply said, the vast majority of anesthesia being provided is not generating the revenue to pay for the expenses. When you add a national staffing shortage, the result will be a continued domino effect. Hospitals, HOPDs, ASCs and surgical partners will continue to see increased stipends, income guarantees and other forms of financial asks for uncompensated services. Block scheduling, OR utilization, efficiencies, payor and case mix, flip and staggered room guidelines will all continue to be major topics of discussion and ways to partner with anesthesia to control costs.
Yassine Moussali, MD. CEO & Anesthesiologist at Hoopcare (New York City): Take full ownership of the preoperative evaluation process. Preoperative care remains highly fragmented, manual and expensive—yet it governs surgical throughput and operating room efficiency. The shift underway moves from basic risk assessment to personalized optimization aimed at reducing complications. Digital tools and AI are now mature enough to help solve this complex workflow—transforming preoperative evaluation from a cost center into a strategic lever for quality, scheduling and financial performance.
Emily Mycyk. President-elect of the American Academy of Anesthesiologist Assistants: The most consequential change shaping the future of anesthesia in the year ahead will be the acceleration of team-based workforce redesign to address nationwide anesthesia care shortages while protecting quality and safety. Hospitals and health systems are increasingly recognizing that sustainable anesthesia delivery depends on modernizing staffing models, not relying on costly, temporary coverage.
Certified anesthesiologist assistants are a critical part of this evolution. As more states expand CAA practice pathways and more systems integrate CAAs into their anesthesia care teams, we will see improved operating room efficiency, better staffing stability and strengthened physician-led team care. This shift reflects a broader movement toward evidence-based workforce models that preserve high-quality anesthesia services while supporting long-term financial and operational resilience.
Michael Nurok, MD, PhD. Professor and Co-Chair in the Department of Anesthesiology at Cedars-Sinai Medical Center (Los Angeles): We have an opportunity to be more thoughtful about deploying physician anesthesiologists, CRNAs and nurses in procedural settings by aligning caregiver expertise with patient needs. Clearly, physician anesthesiologists are critical to leading care for complex patients. On the other end of the spectrum, many less invasive procedures can now be performed safely by a nurse administering sedation aided by sophisticated drugs and monitors. Given the challenges facing hospitals—including shortages of physician anesthesiologists and CRNAs, rising healthcare costs and access to care— it’s important for institutions to deploy resources strategically and safely for the benefit of patients and the broader healthcare system.
Amit Prabhakar, MD. Chief of Anesthesiology at Emory University Hospital Midtown and Winship at Emory Midtown (Atlanta): Next year, AI decision support won’t just be another pilot project—it’ll actually start showing up in everyday clinical work. It’s not here to replace clinical judgment, but it can boost quality, safety and consistency and help teams handle staffing more smoothly as health systems keep changing. We still need to keep anesthesia care led by physicians, and that means building creative, team-based models and making sure the current workforce feels supported. Burnout and people leaving the field are real problems. If we face expected staffing gaps head-on, our specialty can keep up with whatever the future throws at perioperative care.
Jacob Schaff, MD. Division Chief of Cardiac Anesthesiology at White Plains (N.Y.) Hospital: Staffing will be the biggest factor shaping anesthesia next year as we approach a critical supply-demand tipping point. Meeting this challenge will require inventive staffing models paired with AI-driven perioperative workflows — from intelligent scheduling to predictive analytics. The goal isn’t more work for clinicians, but smarter, more effective allocation of resources to optimize care and anticipate complications.
Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas): Within the ASC setting, the most significant change will be the continually increasing complexity of cases, combined with rising procedure volume. ASCs play a vital role in delivering care to patients, often in settings that differ substantially from hospital environments and require anesthesia providers to operate efficiently in faster-paced models, with increasing patient acuity. As this trend accelerates, anesthesia providers will need to adapt by offering innovative care models to serve these patients in more distributed, smaller and faster paced sites.
Jeff Tieder, MSN, CRNA. Clinical Assistant Professor of the Nurse Anesthesia Concentration at the University of Tennessee at Chattanooga: Expect the unexpected. While the industry broadly understands the macro trend, rising anesthesia utilization driven by procedural growth and an aging population, paired with continued reimbursement pressure, the pace and interaction of these forces remain unpredictable.
Utilization will continue to rise, but margins will tighten. This will push health systems and ambulatory surgery centers to reassess staffing models, efficiency and case selection in real time, rather than through long-term planning cycles.
Meanwhile, workforce dynamics will evolve unevenly. Although CRNA program expansions may modestly increase supply, this will be offset by a growing anesthesiologist shortage projected to peak around 2036. Regional variability will remain significant, with some markets seeing continued salary growth while others stabilize. The net effect will be an accelerating shift toward flexible, CRNA-led or hybrid anesthesia models as organizations adapt to uncertainty rather than wait for clarity that may never fully arrive.
Mark Vojtko, APRN, CRNA. Delta Wave Anesthesia: Increased use of AI. While I don’t see AI being able to direct anesthesia care from start to finish and manage all the variables, I do see it being incorporated into projecting outcomes based on physical status scores, comorbidities, surgical procedure, surgeon and facility. I also foresee it as a gatekeeper for medication administration, preferred anesthesia type and location for common surgical procedures.
Staffing models will have to adapt and all those trained in anesthesia delivery will have to take on more cases, not just supervise them. The ACT [anesthesia care team] model of medical direction in and of itself has a long-standing history of poor compliance (i,e., billing fraud) and therefore should be abandoned once and for all. It is the hierarchy created by the ACT model that contributes significantly to job dissatisfaction, staff turnover and burnout. Once autonomous MDs, autonomous CRNAs and collaborative practice models (which bill under the AA or QZ modifiers only) become the norm, billing will become more simplified and more anesthesia providers will become available for improved patient flow.
Increased use of regional anesthesia and opioid- free and sparing anesthesia is gaining rapid acceptance for both the surgical and the anesthesia teams. As more procedures move to the outpatient setting, rapid recovery from anesthesia will be essential to maintain patient flows and optimal outcomes. For example, a hemorrhoidectomy with short-duration spinal anesthesia and sedation will yield both higher satisfaction scores and outcomes than those performed with general anesthesia. The industry needs to get on board with more efficient techniques that allow for optimal surgical conditions, faster recovery and improved postoperative pain scores and patient satisfaction.