The 'catch 22' of solving the anesthesia shortage

Anesthesia provider shortages are plaguing the industry, forcing ASCs and hospitals, particularly in rural areas, to rethink their strategies.

Mark Thoma, MD, chair of anesthesia with San Francisco-based The Permanente Medical Group, joined Becker's to discuss how the shifting healthcare industry has accelerated the anesthesia provider shortage, and what could be done to mitigate it. 

Editor's note: This interview was edited lightly for clarity and length. 

Question: How are the anesthesia shortages affecting rural hospitals?

Dr. Mark Thoma: You're starting with a smaller pool. If you're thinking about medicine, the hospital is dying, in part because of the ASC. It's clear now that you can do a lot more work in the ASC, which has shifted the way care is delivered. It's an explosion. The hard part is now you have spread your industry's workforce – your nursing and your tech — horizontally, instead of vertically. 

When it comes to anesthesia, you need more butts in chairs. 

Now, you're not just running 12 operating rooms, you're running 12 operating rooms and six rooms over at that ASC. Maybe you need at least 18 people in the morning instead of 12 people, and where are those people coming in? Whether it's an anesthesia practice or whether it's an anesthesia care team with CRNAs, you just need those bodies. Within the hospital, we're seeing the horizontal explosion of non-OR anesthesia – so catheterization labs, gastroenterology, interventional radiology, etc. 

It's totally awesome that we're doing all of these. We're doing things to prevent people from having to go to the operating room. But the problem is, it's requiring higher levels of anesthesia care. 

Q: What strategies are there to turn that horizontal care more vertical or to 'get more butts in chairs'?   

MT: The first thing you start with is more outreach earlier. You get people to return to the field and you develop your pipeline that way. We are limited in the number of training programs that we have. In this year's match, there were hundreds of people that applied for anesthesia that there was no spot for. So there's interest in the anesthesia, there just aren't spots. They're just no training positions. 

It's a bit of a catch 22. Historically, the federal government supported residency training programs through Medicare reimbursements. And not to say that it's profitable, but you're taking time for training, you're probably gonna run more lab tests, it's all of those things that slow down and then affect efficiency. The federal government will give some money to make up for the fact that institutions are doing training, but they haven't really increased the numbers of positions that they'll fund for the last 25 years. There's been some small increases here and there, but it's not enough. So if you want to have more training programs, it's going to largely come out of pocket, and there are big startup costs for doing that. 

Also, historically, we've always had it that universities are the only place that you can train. I don't totally agree with that being the best option. There's institutions like Kaiser Permanente and Geisinger, and other large private systems, where you do have that opportunity to give the trainees a great experience, an educational experience. Overall, we need more trainees. 

Another issue is that historically a large majority of a hospital's revenue comes from doing procedures, which is even higher in an ASC. I think there's a way to look at supply and demands and schedule your day differently. It's not always trying to make more resources available, it's making sure you use your resources efficiently and make sure people aren't sitting around idle.

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