How CMOs Can Battle the Anesthesia Staff Shortage

After the pandemic, 78% of healthcare facilities report anesthesia staff shortages. Here's how to fix it.

The country is grappling with a critical shortage of anesthesia staff and several steps need to be taken to address the problem.

A recent article published in the journal Anesthesiology detailed the extent of the anesthesia staff shortage and offered solutions to rise to the challenge. According to the article, before the coronavirus pandemic, 35% of healthcare facilities reported an anesthesia staff shortage. Two years after the pandemic, the percentage of healthcare facilities reporting an anesthesia staff shortage rose to 78%, the article says.

"For me, the biggest challenge of the anesthesiologist shortage is patient safety," says Gulshan Sharma, MD, MPH, senior vice president and chief medical and innovation officer at The University of Texas Medical Branch at Galveston. "It's a different ballgame when you are putting a patient under anesthesia. You want to make sure you have a talented team of anesthesia professionals who can help manage the patient."

There are three primary strategies to address the anesthesia staff shortage, according to Sharma.

"One strategy is to make sure that anesthesiologists are paid fairly based on the market, which is one thing we have done to improve recruitment and retention," Sharma says. "A second strategy is to support anesthesiologist well-being, which is something we are working on. A third strategy is to staff low-risk areas with outside agencies. We have pursued all three of these strategies at UTMB over the past couple of years."

Tackling the problem

There are no short-term solutions, but several steps need to be taken to address the shortage of anesthesia staff, the lead author of the Anesthesiology article says.

A critical step is increasing the number of training positions for anesthesiologists, says Amr Abouleish, MD, MBA, professor of anesthesiology at UTMB.

"One approach is to increase the number of training positions in existing programs, which is my preference," Abouleish says. "The challenge is funding those positions—they are not free positions and residents need to be paid."

At this point, the Centers for Medicare & Medicaid Services does not pay for these positions, so hospitals must pay for them, according to Abouleish. The good news is that with anesthesiology staffing tight, CMOs and other healthcare leaders can make a good argument that funding resident positions actually saves money for hospitals because they don't have to hire costly locum tenens staff.

"Another approach is starting brand new training programs," according to Abouleish. "A lot of the new programs are partners in a nontraditional sense. We have a paradigm shift, where facilities such as HCA Healthcare hospitals and companies such as North American Partners in Anesthesia are partnering to create residency programs."

This is a paradigm change because residency programs have traditionally been at academic institutions or private practices.

Healthcare organizations need to promote retention of anesthesiologists and certified registered nurse anesthetists (CRNAs), Abouleish says.

"One of the things we must do is reduce burnout," according to Abouleish. "We are short people. And when we hire locum tenens anesthesiologists, they usually are not on call. In 2021, my department's anesthesiologists averaged five to six in-house calls per month. That was tolerable, but it contributed to burnout."

According to Abouleish, burnout is a hard problem because until hospitals recruit new anesthesiologists, existing clinicians are taking on too much call.

"UTMB has been addressing burnout—we have increased compensation to make our positions more attractive to boost recruitment, which makes us less stretched thin," Abouleish says.

Another retention strategy is to increase opportunities for anesthesiologists and CRNAs to have flexible schedules or part-time hours, Abouleish says.

As young anesthesiologists grow their families, healthcare organizations need to promote work-life balance as well as have flexible and part-time positions available to them, according to Abouleish, who added that when female anesthesiologists have a baby, they should be allowed to come back and work part-time.

Part-time positions are also important for anesthesiologists and CRNAs who are close to retirement, Abouleish says, adding that part-time positions can be the difference between anesthesia professionals leaving for retirement or staying at a reduced capacity for several years.

Hospitals need to effectively manage Non-Operating Room Anesthesia (NORA) sites and place them close to operating rooms, according to Abouleish. NORA sites include cardiac catheterization labs, gastrointestinal and endoscopy suites, and interventional radiology suites.

"At a freestanding children's hospital, NORA sites are almost 50% of the anesthetizing sites required," Abouleish says. "At UTMB, NORA sites are almost 30% of the anesthetizing sites. There has been an explosion of NORA sites."

Geographic isolation of anesthesia sites challenges understaffed anesthesiology teams, according to Abouleish.

"If I were to build a new hospital today, I would have all interventional patients on the same floor," Abouleish says, "the pulmonary lab, the gastrointestinal lab, the cath lab, interventional radiology, and operating rooms all on the same floor."