Anesthesia professionals are currently experiencing workforce shortages, which are projected to only worsen across the United States. Many of us experience this reality daily in our private and academic practices, with shortages resulting in anesthesiologists experiencing longer work hours, more calls, and difficulty obtaining desired days off and vacations. This increased workload has accelerated the exodus from the workforce due to “burnout.” To understand how this problem can potentially be addressed, it is critical to fully understand how the health care industry arrived at this point. The etiology of the workforce shortages affecting our hospital organizations is multifactorial.

The COVID-19 pandemic has created a state of disruption in the workplace. Approximately 38 million workers quit their jobs during “The Great Resignation,” and retirement among baby boomers doubled. There was an increased need to stay home and render family care. It is apparent that the general shift to remote work and virtual meetings is here to stay. Remote work, coupled with generational differences in expected work-life balance, has led to a shortage of health care workers. Anesthesiology has not escaped this supply-and-demand imbalance. Training additional providers is a long-term supply solution but does not address our immediate needs.

An old adage states that culture will eat strategy for breakfast, lunch, and dinner. Hence, any potential solution must be anchored in a solid and nurturing work culture. In the past, anesthesia business models were based on efficiency, safety, and sound economic principles. Our present need to recruit and retain staff in an environment that incentivizes leaving the workforce requires that we focus on culture. To resonate with today’s anesthesiologists, employers must align their work environment with an acceptable balance between work and external life. A core principle that must underlie any solution to this new paradox requires anesthesiology groups to think creatively and to fully utilize the workforce potential in nontraditional ways. These new paradigms should be aligned with staff’s personal and cultural needs.

Anesthesiology practices need to redeploy and reimagine talent. In creating a method of change, groups should endeavor to encourage staff to own any change introduced and ensure that the group believes in the newly created mission. We must focus on the creative process and ensure belief in radical ideas if engagement is the goal. Moreover, beyond engagement, practices should seek a corollary of improvements in the ability to recruit and retain.

Leaders of anesthesia practices must recognize that there may be a generational difference between themselves and the younger members of their groups. It is a fact that millennials will make up around 50% of the workforce by the year 2050. These millennials are revolutionizing work culture. We must acknowledge and embrace their workstyles. Leaders frequently struggle with millennials wanting flexible work schedules and work-life balance, not because of a lack of agreement but mostly because of the difficulty in meeting the requests while fulfilling anesthesia service needs. Millennials value meaningful motivation. They may be categorized as being driven by novel work, sharing their gifts, and making positive contributions in their communities. They need to see meaning in their work. Oftentimes, these intrinsic motivators can be seen in a millennial’s approach to their careers. Anesthesia groups may help to settle this concern with millennials by plainly delineating the purpose and impact of their professional roles.

The cohort born between 1980 and 1994, commonly known as Generation Y, came of age during a severe financial crisis. Members of Generation Y have been the pioneers (and guinea pigs) of technological change. Having been plugged into the global network for much of their lives, this group is working differently than their predecessors. Now that they’re in the workforce, it should be no surprise they are working differently, too. Those differences may be interpreted by employers as stereotypically lazy. In fact, nothing could be further from the truth. Generation Y works to live rather than lives to work. The employer’s challenge is to find patterns of working that align with their cultural imperatives. Generation Y has a lot to offer the specialty, so attracting and retaining members of this group will bring long-term benefits to anesthesiology.

One way to improve recruitment and retention is for groups to examine their clinical schedule and identify and implement alternative work schedules to match provider life-work integration expectations, all the while meeting practice and community needs. One tactic is the flexible shift. Henry Ford Health System introduced several shift patterns to align with the needs of the workforce. A night float with compensatory days off addressed the needs of the physicians as well as the relative shortages of providers by not requiring a pre-and-post call day off. Another popular model brought staff into work late morning (11 a.m.), with a definitive end of the day at 9 p.m. This model was very popular among young parents who wanted to be around in the morning to take their kids to school and then possibly take care of personal needs.

Another solution may be for practices to recognize that the demand for service does not necessarily have to be filled with a team of anesthesiologists working a full schedule. The U.S. health care system has lagged somewhat behind Europe in adopting the concept of “job sharing.” Team members, such as new mothers, are conflicted by their professional and domestic responsibilities. The variance can be easily resolved by offering a fractionated FTE that could be shared by a colleague.

Another important priority for the present workforce is transparency. An important question to ask is, “What is the culture and governance of your group?” A shared, well-communicated mission, vision, and values statement is essential to ensure that all members are aligned. It is not enough to simply make these statements – rather, the leadership within the group must walk the talk. What type of governance structure is present? Consensus? Autocracy? Or something in between? Is it time to contemplate a variation in your governance structure?

While it is important to acknowledge differences among us, this is an opportune time to implement the principles of diversity, equity, and inclusion, or DEI. Diversity is having differences within a setting, equity is ensuring that processes are fair and impartial, and inclusion is ensuring that all have a sense of belonging. When you subscribe to these principles, you create a safe environment. And with diversity of opinion, one will come to the best possible solution.

It may be time to query your providers:

  • What skills do they have (regional, cardiac, OB, peds, etc.)?
  • What is their preference as far as utilizing these skills?
  • What type of work/life balance are they seeking and at what price?
    • How many hours a week do they want to work (ideal, acceptable, unacceptable)?
    • How much call are they willing to take and at what price?

Assess how much workforce you need and try to align these questions. Unless you ask the questions and listen, you may be missing a win-win opportunity.

ASA is looking at short-term and long-term solutions to the imbalance of supply and demand. The solutions will be multifactorial, addressing the supply and demand sides of the issues. For example, on the supply side, a long-term solution to the supply issue would be to increase the number of residency positions. One possible short-term solution is to have flexible work schedules to minimize attrition/retirement of valued colleagues. Patients’ needs drive demand, and, historically, scheduling is based on surgeon/proceduralist requests. Hospital organizations are going to need to evaluate their cultures to identify specific opportunities to address the demand side of the equation. There are many possibilities to consider. Health care leaders need to balance the wants of the surgeons and proceduralists with the realities of anesthesia and nurse staffing. In a time of limited resources, we can’t afford to have gaps in schedules or horizontal schedules (everyone wanting a 7:30 a.m. start but not working the whole day) unless they can be aligned with other needed resources. Through collaborative efforts among professional organizations and health care leaders, the solutions will become apparent.