Beyond survival mode: Best practices and creative ideas for coping with the shortages in anesthesiology

The labor shortage has been an ongoing challenge for healthcare systems, and anesthesiology is no exception. This specialty is being squeezed on both the demand and supply sides as health systems search for ways to address the shortfall.

At Becker's Hospital Review's 13th Annual Meeting, North American Partners in Anesthesia (NAPA) sponsored an executive roundtable focused on strategies for addressing the labor shortages in anesthesia. NAPA is the leading anesthesia services providers in the US. Two of NAPA's leaders —Rafael Cartagena, MD, Chief Executive Officer, and Peter Doerner, Executive Vice President and Chief Development Officer — discussed the challenges in the anesthesia labor market and strategies for hospitals and health systems to address these challenges.

Five key takeaways were:

  1. The shortage of anesthesiologists is due to both demand and supply issues. According to Dr. Cartagena, there is a 75 percent increase in the number of open job postings for anesthesiologists. "Health systems have an insatiable appetite for anesthesiologists," he said. "On the demand side, we're spreading them out over more geographic areas, throughout more buildings and to more areas within the buildings. Every time you spread any resource out, you drop efficiency."

    "On the supply side, we are not training any more people than we used to," he said. "A significant portion of anesthesiologists are 55 years of age or older, and then we had a real slump in the number of people going into this specialty. Professionals under 40 are looking for a different type of work-life balance than the baby boomers they're replacing. The mismatch in supply and demand means compensation is going up dramatically, but as pay increases, more professionals are choosing to just work less. We cannot solve this just by throwing money at it."

  1. There are effective practices for addressing these challenges. The leaders from NAPA shared best practices:
    • Recognize the world has changed. Build clinical staffing models with flexible work-life balance and a focus on clinicians' well-being. Create the right work environment to attract and retain these sought-after clinicians.
    • Leverage scale to offer flexibility. By having a larger footprint it is possible to create flexible opportunities for clinicians to work in different environments and shift between tertiary, ambulatory and office environments
    • Invest in leadership development. Build programs to give clinicians the education and skills they need to thrive. Provide mentors and meaningful evaluations to nurture talent.
    • Support the fight on a national level. Advocate on behalf of anesthesia providers.
    • Select the right clinical leaders. Find leaders who foster great cultures and can support their hospital’s business goals.
    • Have the right provider partnerships. Work with partners who are aligned, have collaborative cultures and support healthy recruiting and retention environments.

  1. Health systems need to think outside the box and be creative and disruptive. A participant from a Midwest orthopedic surgery hospital suggested the idea of a virtual operating room. "If we're paying anesthesiologists 50 percent more, let's have them earn their keep," he said. "Let's have that anesthesiologist run three operating rooms virtually, like air traffic control, with state-of-the-art technology using CRNAs in each room."

  2. Train both existing and new professionals to recruit and retain talent. Two participants emphasized the importance of "growing your own," both in terms of staff and leadership. "It's important to give [new anesthesiologists] opportunities, create that internal career path," Mr. Doerner said. "Surround yourself with great people and grow them. Yes, bring others in, but certainly nurture the ones you have."

  3. Ongoing consolidation will be needed to reduce service line expenses. "Last year, NAPA worked with a very large health system of 11 hospitals, and they had five different anesthesia solutions," Mr. Doerner "They had an insourced model at some locations, and then they had four individual anesthesia groups serving other locations. Why pay for five overhead structures, duplicative leadership structures, etc. ? It is a great opportunity to innovate as well as consolidate, and I think we're going to see more of that in this post-COVID world. We need to think about our health systems as a market-based system with uniformity."

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