Perioperative leaders are navigating a cost equation that’s getting harder to balance. Becker’s asked surgical and anesthesia executives which cost pressures concern them most and the answers converge overwhelmingly on labor: rising wages, staffing shortages and growing reliance on premium pay are straining margins faster than reimbursement can keep up, while supply and implant costs climb right alongside them. The result is an environment where even small inefficiencies — a delayed first case, underused block time and a same-day cancellation — carry outsized financial weight in a space defined by fixed costs.
Beyond labor and supply costs, leaders are rethinking how perioperative services fit into the broader organization. Some are pushing for standardized supplies and procedures to cut costly variation, while others warn that trimming staff too aggressively can backfire — breeding burnout and turnover that cost more than the premium pay it avoided. A few go further, arguing perioperative services should be seen as strategic assets that drive growth, not just costs to be managed. Below, eight leaders share what’s shaping their priorities.
The leaders featured below are speaking at Becker’s Perioperative Summit, set for Sept. 14-15 at the Hilton Chicago.
If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What cost pressures worry you most?
Aaron Kalin, DO. Vice Chair of Surgery Department, Medical Director and Chief of Anesthesiology, and Hospital Board Member for Adventist Health (Roseville, Calif.): The greatest cost pressure facing health systems today is workforce sustainability. Labor costs continue to rise across clinical specialties while reimbursement has failed to keep pace, creating a widening financial gap. In perioperative services, inadequate staffing not only increases expenses but also limits surgical capacity, delays care and reduces revenue. The organizations that will succeed are those that view anesthesia and perioperative services as strategic enterprise assets rather than simply cost centers.
Courtney M. Pearson. Assistant Vice President of Operations, Perioperative Service Line for MedStar Health (Columbia, Maryland): The cost pressures that concern me most in perioperative services are labor expenses, supply and implant costs, and the increasing investment required to support technology, equipment, and growth initiatives. While these challenges are significant, I believe our teams have done an excellent job managing resources responsibly and maintaining a strong focus on quality and patient outcomes. Going forward, one of our greatest opportunities is to continue standardizing practices and reducing unwarranted variation across sites, providers, and procedures. By leveraging system-wide best practices, aligning on supply utilization, and creating more consistent workflows, we can improve efficiency, control costs, and ensure we are delivering the highest value care across the organization.
Neil Tanna, MD. Senior Vice President of System Perioperative Services and Strategy for Northwell Health (New Hyde Park, N.Y.): The cost pressures that are most concerning center around three interconnected challenges: escalating supply chain costs, workforce expenses and utilization inefficiencies. Supply costs, particularly for implants, surgical technology and innovation, continue to rise, often without corresponding reimbursement increases. Physician preference and autonomy have to be balanced with standardization goals. Simultaneously, there are unprecedented workforce costs driven by staffing shortages. These rising costs unfortunately have to be managed coincidentally with operating room inefficiencies, such as block time underutilization, same day cancellations and first-case delays. The pressure to do more with less has never been greater.
Jared Bement. Vice President of Perioperative, Endoscopy and Women’s Health for St. Elizabeth Healthcare (Edgewood, Ky): Labor, supply, length of stay and payer mix remain at the forefront of our discussions. Over the past six months, however, we have placed a heightened focus on supply expense planning. This has included leveraging our GPOs contract spend, increasing compliance to fully realize those agreements, and engaging physicians to identify high-quality, standardized products. This remains an ongoing priority with periods of intensified focus.
Nadine Simmons-Ziegler, RN. Vice President of Perioperative Services for South Shore University Hospital (Bay Shore, N.Y.): Rising labor costs and persistent workforce shortages remain one of the most significant pressures, particularly in specialized perioperative roles where reliance on premium labor impacts efficiency and sustainability. At times, this includes increased dependence on agency staffing.
At the same time, the cost of surgical supplies, implants and technology continues to outpace reimbursement, creating ongoing margin strain. I am also concerned about underutilized OR capacity, where inefficiencies translate into lost revenue in a fixed-cost environment. Ultimately, navigating these pressures will require balancing cost discipline with a steadfast commitment to safe, equitable, and high-quality patient care.
Adam Kopelan, MD, Chief of General Surgical Services North for RWJBarnabas Health (West Orange, N.J.): Labor is our largest cost in our operating rooms and is growing faster than reimbursement. We have continued shortages in nursing and key physician specialties, which means we will likely see cost increases that outpace reimbursement. Vendor pricing power affects our already expensive OR implants; supply costs are sensitive to inflationary pressures; and we continue to see drug price increases associated with shortages. The cost of necessary capital purchases, which ensure a modern and healthy operating room, continues to place strain on our bottom line. All of this is wrapped up into uneven surgical growth areas and possible decreases in reimbursement with the Big Beautiful Bill in 2027. Much of our efforts are now vested in improving efficiency in our workforce, supply chain decisions, and capital investments to combat the current cost pressures.
Stephen Estime, MD. Associate Chair of Anesthesiology and Critical Care for UChicago Medicine: As growth demands push more work into nights and weekends, premium pay becomes necessary for the groups that keep after-hours work safe and efficient, including anesthesia, nursing, technicians, and support personnel like sterile processing teams and environmental services. Some organizations try to sidestep that cost by asking staff to absorb the extra hours as part of their expected role, without additional pay. Others keep staffing lean yet demand more from them. While it looks like savings on paper, it can breed resentment, burnout, and eventually attrition, all of which cost far more in the long run. With these issues in mind, it’s critical to create and maintain a system of accurate accounting of where premium and off-hours work is actually happening and who is working it. And while that provides stronger data points and insights into costs, it may not be enough to convince decision makers to slow down growth. My concern is that without better workforce accounting data, the costs incurred to support procedural growth end up eating into the very margin gains the growth was supposed to deliver.
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