As anesthesia departments face mounting pressures from labor shortages, case demand variability, and increasing complexity across OR and non-OR locations, forward-thinking leaders are adopting new strategies and tools to stay ahead. In this Q&A, Northwell Health leaders Sabatino Leffe, DO, Eastern Region Operations Director of Anesthesiology, and Attila Kett, MD, MBA, FASA, Chair of the Department of Anesthesiology at Northern Westchester Hospital discuss the operational realities of running large-scale anesthesia services, their evolving staffing models, and how technology can alleviate the burden.
Question: Can you give us a sense of the scale and complexity of Northwell Health’s anesthesia operations?
Dr. Leffe: Northwell is New York’s largest healthcare provider, and the breadth of our anesthesia services reflects that. We have 30 hospitals, nearly 100 ambulatory sites, and oversee roughly 600 anesthesiologists and 300 CRNAs. These providers support a full spectrum of services—ORs, NORA (non-OR anesthesia), ASCs, OB, peds, cardiac, you name it. Our team includes full-time, part-time, per diem, and locum clinicians. Just coordinating this workforce day-to-day is a massive undertaking, let alone ensuring consistent coverage and quality across so many settings.
Q: What are the biggest challenges you face in ensuring adequate anesthesia coverage?
Dr. Kett: The most significant challenge is a fundamental mismatch between supply and demand. There are more locations needing anesthesia care than there are providers available, and that gap is widening. The COVID-19 pandemic exacerbated these issues, and we haven’t bounced back. Provider retirements are accelerating—55 percent of anesthesiologists today are over age 55. At the same time, procedural demand continues to rise with our aging population.
Dr. Leffe: And unlike traditional ORs, NORA and ASC environments are much harder to predict. One day a location needs four anesthesiologists, the next day two. We often don’t get final room counts until the night before. That lack of visibility puts us in a constant position of either over- or understaffing. We try to use historical utilization to anticipate patterns, but there’s still a tremendous amount of variability.
Q: How has your approach to recruitment evolved given this environment?
Dr. Leffe: We’ve had to become more aggressive and creative. Previously, we might review our compensation benchmarks annually. Now it’s every quarter. The market is shifting that quickly. We’re also investing heavily in training pipelines. That includes a new anesthesiology residency at my hospital and a CRNA program designed to grow talent from within. Long-term, we need to build sustainability into our workforce model.
Dr. Kett: The other big shift is around expectations. Younger anesthesiologists are often looking for roles with no call, more flexibility, and better work-life balance. We’re adapting to that by adjusting call structures, offering meaningful pay differentials, and designing staffing models that accommodate both early- and late-career needs. But it’s not easy. Balancing provider preferences with operational requirements is a constant tension.
Q: How do you manage daily scheduling across so many varied sites and settings?
Dr. Leffe: In my region alone, I manage six hospitals and 14 ambulatory centers. I consolidate those ambulatory sites into one “mega-pool” and use historical patterns to forecast demand across them. We build quarterly staffing grids with expected room counts per day and compare that against the available providers. That gives us a daily delta to work from when building out the actual schedule.
Dr. Kett: But even with that level of effort, it’s still very manual. We’re cobbling together spreadsheets, emails, and phone calls. Our current scheduling platform doesn’t interface with systems that handle bookings or case loads. So we’re matching supply and demand by gut and experience, not data. That limits how proactive we can be.
Q: How do you handle last-minute changes and sick calls?
Dr. Leffe: That’s what I call the “last mile” problem. We plan ahead as best we can, but on the day before or the day of, we’re often thrown curveballs—urgent add-ons, sick calls, cancellations. That’s where flex staff becomes essential. I rely on strong relationships with per diems, retirees, and part-timers who can step in on short notice. But there’s no system to help us manage that process. It’s just texting and calling people manually.
Dr. Kett: We do use tiered coverage models to create some flexibility. For example, adjusting CRNA supervision ratios or calling in evening shift providers early if needed. But there’s only so far you can stretch a team. When you’re already operating lean, even one sick call can destabilize the day.
Q: What happens when there are intraday changes, like case add-ons or cancellations?
Dr. Leffe: Right now, every hospital has a site coordinator—a human being—who’s juggling these changes in real time. They decide who floats, who gets reassigned, what room gets bumped. It’s incredibly complex, especially when you’re dealing with sub-specialty needs or surgeon preferences. There’s no automation for this. It’s experience and intuition.
Dr. Kett: Some hospitals keep an open OR specifically for add-ons or urgent cases, which helps. But smaller sites often don’t have that luxury. They try to fit in cases around breaks or after electives wrap. Having tools that could help us reallocate in real-time—with visibility across all sites—would be transformative.
Q: Where do you see the biggest opportunity for AI-powered technology to help?
Dr. Leffe: We need tools that bring together demand forecasting and staff assignment. Right now, those two functions live in totally different systems, and they don’t talk to each other. That makes proactive planning nearly impossible. If we could better predict our room needs and align staffing accordingly, it would reduce burnout, improve patient access, and save money.
Dr. Kett: And there’s huge potential in real-time operations. Imagine an app that lets surgeons, anesthesiologists, and coordinators see updates instantly—room changes, late add-ons, break assignments. Other industries, like airlines and hotels, are already doing this. Healthcare needs to catch up.
Dr. Leffe and Dr. Kett spoke on this topic at Transform Hospital Operations Virtual Summit this June. Don’t miss the next Transform Virtual Summit slated for September 16 and 17, 2025 for more great insights like these. Register here.
