Many anesthesia departments and ASCs facing staffing shortages have turned toward cheaper labor as a solution. Jarrett Heard, MD, associate professor of clinical anesthesiology and medical director of perioperative services at Ohio State University Wexner Medical Center in Columbus, thinks that framing misses the actual lever available to the specialty.
“I really think that’s the first thing you really want to look at, where the demand is, and you want to match your anesthesia staffing with that demand,” Dr. Heard told Becker’s. He said that instead of looking to recruit more labor, leaders should be analyzing utilization.
“What is the best way to operationalize them, to realize them, and actually maximize revenue? I don’t know that those things are always discussed,” he continued. “Typically, they’re just discussed in the form of, well, I see if I can get a cheaper anesthesiologist to provide the same service.”
That mismatch between where anesthesia coverage is needed and where it’s actually deployed has been compounded by market pressure on the specialty itself, including insurers that have at times pushed back on anesthesia billing practices for procedures and surgical overruns. Dr. Heard said anesthesia, as a discipline, including advanced practice providers, needs to better identify where its services are most critical rather than ceding that argument by default.
The fix he’s built at Ohio State is using the EMR as a real-time staffing tool rather than the retrospective research database it was originally designed to be.
“Leveraging predictive algorithms and electronic records to show us where it’s best to staff and to schedule anesthesiologists — I think that’s the key to solving that mismatch,” he said.
Dr. Heard described a same-day example of what that looks like in practice. One of the health system’s surgery centers was running four operating rooms instead of its usual six because of low patient volume tied to the academic calendar, with an outgoing resident class and an incoming class not yet ready for the OR. Knowing the day’s surgeon schedules, vacation calendars and case volume in advance allowed leadership to consolidate rooms before the day began, rather than scrambling once it was underway.
“Why aren’t we leveraging the EMR and people’s schedules and finding out with a pretty informed decision what things are going to look like a week or two in advance, when we know we have pain points with anesthesia staffing?” Dr. Heard said. “So that we can deploy people to where they’re truly needed, and we can consolidate where it’s needed.”
Without that kind of system, he said, the default approach falls to pavilion leaders manually checking in with managers, room by room, asking staff to hold off opening a room unless a surgeon specifically requests it — a reactive process built on relationships and instinct rather than data.
Ohio State has already deployed a predictive triage tool to determine whether patients need a virtual or in-person preoperative visit, and Dr. Heard said the system is close to finishing a broader surgical pavilion predictive tool.
For Dr. Heard, the payoff of getting that data infrastructure right extends beyond internal scheduling efficiency. He sees it as the foundation for a different kind of conversation with payers, particularly for independent ASCs already under pressure in contract negotiations.
“If I can assure you your patient’s going to get to surgery on time, and I’m going to be mindful of cost, I’ve got something to come to the table with,” he said. “I have some leverage now.”
That, he said, is the lens the specialty needs going forward: not how to produce more anesthesiologists, but how to prove — with data — where the ones already on staff are most needed.