Policy Brief: The Anesthesiologist Shortage and Its Impact on ASCs

May 2025 

Ambulatory Surgical Centers (ASCs), including those operated by LUGPA practices, are facing growing difficulties in securing consistent anesthesia coverage. A combination of declining reimbursements and a worsening anesthesiologist shortage has forced many ASCs to offer unsustainable financial incentives, such as stipends or revenue guarantees, to attract providers. Without intervention, these pressures will undermine access, increase costs, and threaten the quality of care in outpatient surgical settings.

Key Challenges

1. A Shrinking Workforce

• Of the 51,492 active anesthesiologists in the U.S., 56.9% are age 55 or older, and more than 17% are near retirement.
• Without targeted interventions, retirements will significantly shrink the workforce in the coming years.

2. Insufficient Training Pipeline

• In 2024, only 1,695 anesthesiology residency slots were available nationwide.
• Nearly 44% of applicants did not match into a residency, reflecting a major bottleneck in training new anesthesiologists.

3. Rising Demand

• Demand for surgical procedures is expected to grow 2–3% annually over the next decade, increasing pressure on a limited workforce.

4. Burnout and Attrition

• 50% of anesthesiologists report burnout, and 61% would accept lower pay for improved work-life balance.
• High stress, long hours, and administrative burden are accelerating attrition rates.

Why ASCs Are Offering Subsidies

To maintain surgical capacity, many ASCs are offering financial incentives to secure anesthesia coverage. This is driven by:

• Declining reimbursements from Medicare and commercial payers, which often fail to cover the cost of anesthesia services.
• Rising competition for providers, with large staffing firms limiting the bargaining power of independent ASCs.
• Market complexity, including care team models, payer mix, and fluctuating case volumes that challenge financial viability.

Consequences of the Current Model

• Regulatory Scrutiny: Subsidy arrangements are increasingly reviewed by federal and state regulators, raising compliance risks.
• Escalating Costs: Subsidies drive up ASC operating expenses, often impacting margins or being passed on to patients.
• Operational Disruptions: Gaps in anesthesia coverage result in delayed procedures, reduced scheduling flexibility, and lower patient satisfaction.

Implications for LUGPA Members

Independent urology practices depend on ASCs to provide efficient, high-quality care. The anesthesiologist shortage threatens this model and may:

• Limit patient access to outpatient procedures;
• Force practices into financially unsustainable subsidy agreements;
• Drive up costs for both patients and providers.

Policy Recommendations

LUGPA supports the following policy actions:

• Expand Training Capacity: Increase anesthesiology residency slots and offer incentives for medical students to enter the specialty; this applies to most specialties as well.
• Promote Workforce Retention: Back initiatives to reduce burnout, encourage flexible work models, and improve job satisfaction.
• Advocate for Fair Reimbursement: Push for payment reforms that reflect the true cost of delivering anesthesia services, especially in ASCs.
• Clarify Regulatory Guidelines: Work with policymakers to ensure compliance rules support rather than penalize ASCs maintaining access through subsidies.

The anesthesiologist shortage is already disrupting care delivery in ASCs. For LUGPA members, this trend threatens the sustainability of independent practice. Lawmakers must prioritize reforms for long-term workforce solutions, equitable reimbursement, and regulatory clarity to ensure continued access to high-quality urologic care in outpatient settings.