Anesthesia Shortages Are Reshaping ASC Operations

Erik Sunset: [00:00:00] Hey everybody. Hello and welcome back. I’m Erik, your host of the DocBuddy Journal. After a short hiatus, we are returning with the 2026 season of the show. Really happy to be back. Um, this is actually gonna be episode number 113 that we’re recording on January 22nd, 2026. So it’s a little bit late into January to wish you all out there in the audience a happy new year, but we’re gonna do it anyway.

We wanna wish all of our clients, our colleagues, our partners, and otherwise friends of DocBuddy. And of course, you are valued listeners, a happy, healthy, and profitable 2026. Um, on a, on a DocBuddy corporate note. Uh, wanted to share the note that we just returned from our 2026 kickoff meetings in Denver.

And this team is so fired up from sales, marketing, ops [00:01:00] product, our account management team, um, development. Everybody. I’m sure I’m leaving somebody out, some department out. Uh, but the entirety of the DocBuddy team, every single one of the doc buddies is more fired up than I’ve ever seen ’em, and I’ve known a lot of this group for a, a number of years now, quite some time.

And, uh, this group has never been more fired up, I don’t think, uh, since even entering the ASC space in 2022, uh, we’ve been growing like a weed. We’ve been growing like crazy. Uh, from our client list and our, our users to our own headcount and our staff. Uh, we have had a lot of fun, uh, getting to this point with DocBuddy.

You are absolutely not going to believe what we have in store for 2026. So be sure you’re subscribed on Apple Pods, Spotify, YouTube, uh, be sure you’re following us on LinkedIn as always to get the latest news and announcements from DocBuddy.

All right, so [00:02:00] let’s roll into the first topic of the day. Um, and I guess as a quick programming note, before we do, um, we want to be delivering a really concentrated piece of value out, uh, to you, our listeners. So we’ll wanna kind get in, get out of these podcasts for a solo show, uh, relatively quickly. And where we have guests, we wanna provide a little bit more of an expanded run sheet, a little bit richer experience.

We wanna do a better job in 2026 of sort of balancing the two. Uh, so, uh, you know, keep up with us across your favorite podcast listeners across YouTube, and then obviously on LinkedIn you get all of our newest stuff. Um, so thank you for humoring me there on the programming note. Um, to get into the first topic of 2026.

Oh gosh. It’s one that I’ve been beating the drum on for a long time. Years and years and years. Uh, we’re talking about anesthesia shortages. Once again, this issue is persistent. [00:03:00] It’s not gonna go away, it’s not gonna fix itself. Um, and then sort of lagging this anesthesia. Shortage and even anesthetic shortage if we’re talking about supplies, but anesthesiology, uh, care teams, CRNAs, anesthesiologists, in addition to the lack of drugs of anesthetics.

Uh, is just ahead of the curve, uh, for what’s happening with the physician shortage and hate to start off 2026 on such a dower note, but wanted to share a couple of insights and a couple of learnings from a very new article posted, published, rather by our friends over at Becker’s ASC. Uh, this is under their anesthesia heading, how Anes, excuse me.

How anesthesia shortages are reshaping or schedules or operating room schedules. So I’ll, uh, I’ll cop to it. I had a very good understanding that through COVID, like Heart of the Pandemic, [00:04:00] uh, supply shortages were all over the place, you know, hard to get any type of supply that you needed. We’ve heard about the, the saline shortage that’s, you know, 18, 24 months old.

At this point, I wasn’t aware that there was a persistent anesthetic shortage that was disrupting, uh, scheduling and forcing workflow changes. So the actual anesthetic. Uh, supplies and some of the fixes that health systems are, are putting into place and that ASCs are putting into place, uh, to lessen disruption is they’re adjusting EHR order sets to steer clinicians towards alternatives, while others are diversifying suppliers.

Um, so that’s a little bit scary, uh, to quote Erin Fox here. She’s a PharmD Senior Director of Drug Information and Support Services at the University of Utah Health. Said that the most common shortages involve cheap, generic injectable medications that have been used at hospitals for a long time, [00:05:00] including lidocaine and saline.

So that’s obviously a huge drag, uh, you know, to still be dealing with these supply chain issues for surgery and potentially busting up block times and destroying, uh, an ASCs, uh, schedule for the day or week. Uh, the next item to call out is that anesthesia workforce shortages are increasing day of surgery disruption, including delayed or canceled procedures.

And this is never a shot at, at Becker’s, obviously, but that’s, that’s not anything new. You know, that’s, that’s not news. It’s still happening. It’s persistent, just like the shortage of the anesthetic medications themselves. Um, with fewer anesthesiologists and CRNAs available. ASC leaders are saying staffing shortages are driving up labor costs, while also creating direct operational instability, including room closures, delayed procedures, and canceled cases when coverage falls short.

ASC leaders are telling Becker’s that anesthesia subsidies and contract coverage, [00:06:00] including for locums, are among their most significant and growing costs. And I wanna flash back to Healthx last year in Nashville. Uh, Healthx, if you’re not familiar, it’s a week long event. Uh, you know, that talks about all of these things that are, are, are pressure on the US healthcare system.

One of the top five largest ASC management companies shared their anesthesia subsidy for 2025, and it was expected to cost them every bit and more, even of $30 million just in anesthesia subsidies. It’s a lot of money. It’s a lot of money, but that’s what you have to do to guarantee coverage. And I’ve said it before and it’s a very bad tongue in cheek joke, but I’m not going into the or if, if I’m not certain that I’m gonna have anesthesia for my procedure, you’re not cutting me open, uh, while I’m awake.

[00:07:00] So, to quote, uh, one of the, uh, contributors to this, to this article, Tina Driggers, administrator of DSC Day Surgery Center in Winter Haven, Florida. Okay. Uh, said that the biggest challenge she faces with anesthesia is the nationwide shortage of anesthesia staff. This leads to room closure and canceling of cases, which in turn ends up with economic stresses to the surgery center.

Yeah, I mean, Tina, when you’re right, you’re right. Um, this makes the orchestration of your block times, excuse me, just one moment. I’ll be right back. Ooh, sorry about that. We’re back. Uh, I was just saying that Tina, when you’re right, you’re right. Being able to orchestrate anesthesia coverage against, against block times and uh, being sure that everything comes off that hitch.

Is a huge challenge when there’s just simply not enough anesthesiologists or CRNAs to go around to provide coverage for all the cases that everybody needs [00:08:00] coverage for that, which is actually a really nice way to take us to our next point. Anesthesia staffing shortages are becoming a scheduling choke point as ASCs take on more complex cases.

The surgery centers expand into higher acuity and more complex procedures. Leaders say anesthesia coverage is becoming a critical constraint and unreliable access to anesthesiologists and CRNAs as threatening schedules, margins, and long-term growth plans. The lack of anesthesia providers for ASCs in many markets will continue and anesthesia comp will continue to rise.

Adam Spiegel, CEO of North Star Anesthesia told Becker’s. Yeah. I mean, Adam, once again, man, you’re right. When you’re right, you’re right. If there’s not enough anesthesia staff to go around, the staffing and the coverage that is available is gonna cost more. I mean, simple supply and demand. And Adam, I, I know there’s a lot more context to your statement.

I’m just making a [00:09:00] commentary on this, uh, on this article here. But yeah, what we really need to solve for is to inject a ton a. Literal ton of anesthesiologists and CRNAs into our healthcare system, and we need to do it fast. Um, otherwise, this is a, this problem’s not gonna get any better. It’s just gonna get worse.

And especially with our, our baby boomer generation here in America, getting older and needing more and more care, and presumably more and more surgical procedures. We need more anesthesiologists. We need more CRNAs now. Uh, so to continue in many markets, ASEs are pivoting obviously to CRNA, only your hybrid coverage models to maintain ops, while others are experimenting with in-house anesthesia teams, contracting through temp agencies and reworking perioperative workflows to make demands leaner.

ASC are already pretty lean. ASEs are pretty lean. We’re gonna get to [00:10:00] a point towards the end. Uh, you’ll get to hear me talk about technology and really the need for technology to run as lean as possible, but I, I just can’t help myself but make the comment here, you know, ASEs don’t have a, an army of people just sitting around looking for something to do.

Uh, so all of that to say though, moving on, reliance on temp anesthesia coverage is rising, increasing schedule, volatility, and cost pressure as anesthesia workforce shortages persist. Surgery centers are leaning more heavily on temp providers to maintain coverage, but leaders say the shift is driving up costs and making day-to-day ops less stable when coverage gaps emerge.

Facilities are increasingly relying on costly temporary anesthesia providers with locum tens usage up almost 20%, so up 70% since 2024, and this is projected to climb another 5% in 2025. Uh. [00:11:00] Several ASC leaders have shared that anesthesia subsidies and contract coverage, including locums, are among their most significant and growing costs, squeezing already non-existent margins and causing room closures or cancel cases when coverage isn’t available.

Ugh, it’s not really the surgery center’s fault that there’s not enough anesthesia coverage going around. Certainly not. Any, necessarily any provider organization’s fault that there’s not anes enough anesthesia coverage going around. But for all of the things that, um, that you’d want the government to have a tab on, it would be ensuring.

That there’s enough doctors in the country, whatever incentives need to be put in place. Obviously you can’t compel people to become anesthesiologists or, or physicians of any sort or providers of any sort. You catch my drift. Can’t make people do it. [00:12:00] But there should really be some great incentives in place to be sure that we’re not a country that’s waiting a year for a primary care visit and.

Having a, a surgery priority list where only the most critical of cases, you know, life or death, trauma type cases get anesthesia coverage. Just, it should, shouldn’t be this way. Had a lot of smart people on the show to, uh, talk about why that might be and, and even we’re referencing the, uh, the owner of the outlet whose article we’re citing today.

We’ve even had Scott Becker on get a lot of great thoughts. I think that was December 24. Uh, quite a long ways back, you’ll have to do a search in our catalog to find out exactly which episode that was, but very nuanced take how to get more folks interested in medicine when today’s crop of physicians, by and large, is advising their kids not to go into medicine at all.

Okay. All right. Coming down the home stretch here, ASCs are redesigning scheduling and anesthesia alignment to [00:13:00] protect throughput and coverage stability as anesthesia shortages persist. ASC leaders say sustaining or efficiency increasingly depends on tighter alignment with anesthesia teams and more intentional scheduling strategies to maximize limited coverage.

Yep. But you’ve had to do that. Look, surgery centers have had to do that for years and years and years. Uh, anesthesia subsidies are, have been a part of the game for a long time. Uh, so that’s not really anything new. And again, I’m certainly not picking on the article, the author or any of the contributors here, just, you know, clearing the air.

Uh, Alex Andrade, COO at Dubuque, Iowa based medical associates told Becker’s that after insourcing anesthesia, the goal was to leverage the team to drive operating efficiencies and increase throughput as part of an end process. End. End process. Excuse me. Nathan Garner, director of area Ops at Sacramento, California based Sutter Surgery Center division also told Becker’s that [00:14:00] ASCs have had to scramble for coverage sometimes using costly locum tenants or minimum guarantees, and that uncertainty around coverage and new costs have strained relationships among ASCs, anesthesia groups and surgeons.

Man, what a luxury it is to have in-house anesthesia. I’ve talked about that with, uh, several guests over, over a period of years. And if you can get it, man, that’s great. That’s, uh, that’s the way to go. Uh, simplifies so many things, but obviously different, different, uh, different set of hurdles to hiring them.

Retaining them, and. You know, making that a core part of your business. Um, one of the things that’s curious to me, uh, through all of this commentary is around driving, operating efficiencies, increasing throughput and coverage stability. Like, yeah, you obviously, you obviously need those things, but with a dwindling supply, or, let me hang on.

You need and [00:15:00] want those things. You’re gonna do what you can to achieve those ends. That’s how I would’ve wanted to say it the first time. But the reality is that you are competing in a zero sum game for anesthesia coverage. And I’m sure there’s a game theory vocab term for this, but like the zero sum game is getting smaller, the pie is smaller like that.

And for those who aren’t familiar with zero sum game would be like I have a pumpkin pie, which is my favorite type of pie. By the way, there’s only so much pie. So if I give you a slice. That means I can’t have that same slice like I am effectively left with less pie if I give you some, so zero sum game, right?

The supply of anesthesiologists and CRNAs is going down. So for, for some indeterminate amount of time, you will be able to outcompete other surgery centers for that [00:16:00] same anesthesia coverage that they would want, like in your same market if you don’t employ them. But what happens when there’s just not enough anesthesiologists?

That’s the problem to solve here, isn’t it? Same with physicians. Nobody’s really talking about the physician shortage yet. We will be soon. We will be soon. I mean, certain outlets cover it. Some of you are aware of it. If you listen to the show regularly, you’re aware of it. ’cause I can’t stop talking about it.

You know, it’s a huge concern of mine personally and uh, you know, just wanting folks to have good healthcare in the us. Um, but let’s, let’s come off that rather, uh, depressing point. Hopefully there’s a lot smarter people than me working on that problem of, uh, physician supply and access to them safer anesthesiologists.

But to come back to the point around needing to drive efficiency and increase, uh, procedure throughput, right now there’s really only one way. That a surgery center can do that and a hospital system for that matter. But [00:17:00] there’s really only one way for a surgery center to do that. Earlier I, I, uh, spun the phrase that surgery centers don’t have an army of people just sitting around looking for something to do.

In fact, the opposite is often the case, especially, uh, uh, when you’re thinking about all of the. All of the alignment that needs that, that does and needs to take place for a surgery center to be as effective as it is. You can’t have bloat like the mar. The point I’m trying to spit out is that margins are really thin and you, you just can’t afford to have extra staff on retainer, like sitting in the breaker and looking for something to do.

So it’s a long walk for the short drink of water. That software, my dear listener software, is how you’re going to drive operating efficiencies and increase, increase procedure throughput as part of an end-to-end process, as well as stabilize your anesthesia coverage for hopefully given week and a month or a calendar quarter at a time.

You cannot throw this problem at [00:18:00] people to maximize block time utilization and think about all the different stakeholders here. You have the facility, the surgeon, you have the anesthesia team. If they’re external, the patient. Like we, I think orchestration’s a really good word here. Uh, and I don’t always feel that way about the word just because it’s so overused in like business jargon.

Uh, but orchestration really is what needs to happen. Software is how you do it. DocBuddy is a software that can help you with that, by the way, it’s called Surgery Workflow. You can go to DocBuddy.com and go to our solutions tab and find surgery workflow right there. This is an orchestration tool to help surgery centers maximize block time utilization, maximize anesthesia coverage, maximize, uh, effectively revenue, uh, to the facility revenue and patient care.

The two things go hand in hand, of course. So with that, let’s cut it. We, uh, started this episode saying we want to give you more [00:19:00] concentrated value. I think I’m gonna come in just under the 20 minute mark for everybody out there listening, I would love your thoughts for, uh, the right length of time, the right amount of commentary.

Do we want more? Commentary. You wanna hear my voice longer during an episode? Less during an episode. Do you want me to give you sort of like the, the scoop? Should we be doing broader content, uh, topics throughout each individual show? Uh, that is all up for you to tell me what to do. I would recommend to share your feedback to go to DocBuddy.com, go to our contact page and then submit the form to let us know what you think.

And in between now and the next time we publish. I’m your host Erik. Want to thank you for listening. Be sure you get yourself subscribed and we will talk to you very soon. On the next episode of the DocBuddy journal, take care I.