Causes of the Crisis
Most observers agree there are at least three factors that have resulted in the current situation. The first is the migration of cases from traditional inpatient venues to outpatient facilities and surgicenters, the net impact of which has been a material increase in the number of anesthetizing locations. Then, there was the long-term impact of the pandemic. Ultimately, the nature of anesthesia practice has evolved considerably. An objective assessment of the current market indicates that although training programs continue to increase the number of providers, the growth in the supply of anesthesiologists and CRNAs is out of balance with the growth in anesthetizing locations and coverage requirements.
The most significant transformation of the anesthesia market had been the dramatic increase in outpatient surgical volume. Most practices now provide care in a variety of venues including outpatient hospital facilities, free-standing ambulatory surgery centers, colonoscopy centers and doctors’ offices. The reality is that each new venue typically requires additional staffing, even though overall operating room productivity has tended to decline.
Greener Grass
Given the very competitive environment for hospitals, many are constantly exploring new lines of business to attract more customers. A common example is the development of stroke centers which typically require additional anesthesia providers to ensure the level of service desired. Neonatlogy is another new line of business that may require additional staffing.
While it is true that the pandemic has pretty much faded into the past, the implications of its dramatic impact on elective surgery scheduling has had significant impact on most anesthesia practices. Because the reduction in case volumes was so precipitous and so profound in 2021, many providers decided it was time to either retire or find new practices. Given the aging of many providers, the pandemic was the last straw. Having so many providers retire only exacerbated the problem.
Morphing Models
Meanwhile, the market for anesthesia services has been undergoing another significant change that has impacted anesthesia income and workload. There was a time when professional fee-for-service payments would cover the cost of the services provided. This is no longer the case. Most practices now require significant financial subsidies to balance their books. The impact of this change is that practices are now more focused on the cost of providing care and the revenue potential. For many practices, that has resulted in new staffing models.
The ASA has been recommending that training programs expand their rosters to accommodate the new reality. Considering the complicated nature of the current environment, a perfect solution may prove elusive. Market forces are at work, and it is impossible to predict how long the current situation will last.