Hospitals and health systems across the country continue to face anesthesiologist shortages, with little relief in sight. Research suggests the United States could see a shortfall of 8,450 anesthesiologists by 2037. As demand for anesthesia services rises and the pipeline of new anesthesiologists continues to fall short of market needs, many healthcare leaders are turning their attention to stabilizing and sustaining their anesthesia programs.
During a Becker’s Healthcare virtual anesthesia conference, Shannon Peterson, Senior Vice President, Head of Delivery at Medicus Healthcare Solutions, moderated a panel discussion with three anesthesia healthcare leaders. The conversation centered on the current landscape and practical strategies for program stability. The panelists included:
- Dr. Matthew Boles, Executive Vice President of Surgical Services and Vice President of Medical Affairs at Salem Health
- Dr. Daniel Fagin, Medical Director, Department of Anesthesiology at Endeavor Health
- Dr. Daniel Roke, Chair, Department of Anesthesiology and Critical Care at Saint Louis University
Here are four key takeaways from their conversation:
- Anesthesia market disruptions are reducing patient access to care.
Staff shortages in anesthesia have been exacerbated by consolidation in the healthcare sector and changes in care delivery models. Dr. Fagin explained that when large hospitals and health systems buy smaller hospitals, private practice anesthesia groups are sometimes displaced.
In many cases, these shortages challenge healthcare organizations’ ability to provide acute care. Dr. Boles noted that in Oregon, some health systems have cut about 50% of their procedural volume due to anesthesia shortages. “The patients are the ones who suffer,” he said. “These aren’t elective cases. Many are malignancies and other serious conditions. Then those patients end up in our EDs.”
According to Dr. Roke, organizations in rural areas and those that serve populations with limited access to healthcare have the hardest time recruiting and retaining anesthesiologists. “I definitely see this as a long-term disruption that we all have to cope with,” he said. - Care team models are an effective solution for anesthesiologist shortages.
Many healthcare organizations are adopting care team models for anesthesia. In addition to anesthesiologists, these teams include certified registered nurse anesthetists (CRNAs), student registered nurse anesthetists (SRNAs) and anesthesiologist assistants (AAs).
“The care team model means working with AAs, CRNAs and residents and treating them as the partners they are,” Dr. Roke said. “Organizations must recognize that they have a lot of expertise and training that they can bring to bear.”
To support the talent pipeline for anesthesia care teams, Endeavor Health has developed an SRNA training program and Saint Louis University has created an AA program. - To overcome resistance to change in anesthesiology, intentional change management is essential.
It can take time for hospitals and health systems to accept care team models for anesthesiology. Dr. Fagin observed that skepticism is common in the operative environment. “Surgeons, pre-operative nurses, PACU nurses and others think they’re getting an inferior product because staff don’t have an MD after their name,” he said. “They don’t realize that it’s a care team providing care for a patient and there are a lot of benefits to that.”
Communication, education and cultivating administration support are key to change management. Endeavor Health and Salem Health both held a series of town halls to slowly introduce the anesthesiology care team model to the broader organization.
Dr. Boles emphasized how critical it is to go slow in order to then go fast. When Salem Health brought on CRNAs, the organization did so very slowly. The team literally started with one, then added more, one at a time. “We really wanted to take the time to introduce them to our culture,” he said.
Patience is absolutely necessary for effective change management, according to Dr. Fagin. “In the end, a lot of it has do with some sort of cultural component. You must recognize that culture doesn’t change in a day, a week or even a year. It could be a couple of years before you can implement a new culture,” he said. - As organizations address the anesthesia crisis, the importance of culture can’t be underestimated.
Leading hospitals and health systems recognize that culture plays a central role in hiring and retaining anesthesiologists — whether they are employees or locums providers.
Salem Health, for example, invited its newly formed employee group to participate in a mission- and vision-setting exercise. “This really grounded us with our North Star and our world-class vision,” Dr. Boles said. “It resonated with our locums and helped bring on new recruits that want to be a part of something special.”
The panelists also underscored the importance of creating a culture based on respect and dignity. To attract anesthesiologists, Salem Health has capped the number of hours worked per week and publicizes its commitment to life-work balance.
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