The vicious cycle of workforce challenges in anesthesiology

PN126 – Managing Anesthesia Services in Turbulent Times: Expert Advice for Success
2:45-3:45 p.m. | Saturday, October 19
Room 116

Anesthesiologists who are used to taking the pulse of patients are now actively encouraged to take the pulse of their own workforce in a constantly changing landscape.

Challenged by issues of staffing and academic growth as well as the quest for diversity and inclusion, panelists will tackle topics and solutions for change during Saturday’s session, “Managing Anesthesia Services in Turbulent Times: Expert Advice for Success.”

“The session underscores the importance of cultural change in driving better outcomes in both organizational performance and career advancement,” said Elizabeth Rebello, MD, FACHE, FASA, CPPS, CMQ, Executive Director of Anesthesiology, Critical Care, and Pain Medicine at the University of Texas MD Anderson Cancer Center in Houston. “Negotiation and leadership strategies should incorporate principles to effectively address systemic inequalities in the workforce. The focus on sponsorship, allyship, and tailored negotiation training presents actionable pathways for creating a more inclusive and profitable work environment for all​.”

According to Dr. Rebello, promoting an environment where different perspectives are included enhances organizational performance and the bottom line. For example, she said hospitals with women CEOs often have a higher percentage of women in senior leadership, which is associated with improved margins and organizational outcomes.

“Women make up almost 75% of hospital employees but only represent 19% of hospital CEOs and less than 24% of C-suite executives.​ The lack of representation, especially in leadership roles, reflects broader systemic issues within health care where women and people of color are underrepresented despite being a significant part of the workforce,” she said.

To address these challenges, Dr. Rebello offered several solutions:

• Sponsorship: Creating sponsorship opportunities where senior leaders advocate for candidates to ensure their advancement in leadership roles.
• Negotiation training: Offering negotiation training specifically tailored to bridge the existing disparities in power and influence. 
• Organizational change: Implementing structural changes, such as regular auditing of succession plans, to ensure a culture that actively promotes equity and inclusion.

Academic and nonacademic centers alike are scrambling to address workforce issues in general, said fellow panelist Santhanam Suresh, MD, MBA, FASA, Professor of Anesthesiology and Pediatrics at Rush University Medical Center in Chicago. Part of the problem is that a significant number of anesthesiologists exited the field earlier than planned around the time of COVID-19, he said.

“Once COVID happened, many people thought that it was time for them to hang up their hats and leave,” Dr. Suresh said. “So, we have a lot more attrition going on in terms of people in their 60s who are leaving the workforce as opposed to the number of people who are actually coming into the field.”

One strategy he suggested that might help is to offer potential retirees part-time opportunities.

“I mean these are experienced people who have worked for decades. Give them an opportunity to take calls in a limited capacity,” Dr. Suresh said. “Reduce their work burden, but at the same time keep them engaged because you know they bring a lot of experience to the workforce.”

Addressing physician burnout is another key factor. Dr. Suresh said one strategy might be as simple as letting anesthesiologists work from home to handle most administrative tasks.

Essentially, today’s workforce challenges in anesthesiology come down to “supply and demand.” The demand has grown steadily in some areas, particularly with increases in both surgical and procedural volume, while the supply of anesthesiologists has dropped dramatically in other areas, according to James P. Rathmell, MD, MBA, Professor of Anaesthesia at Harvard Medical School in Boston and Editor-in-Chief of Anesthesiology.

According to Dr. Rathmell, the health care workforce is “susceptible to disequilibrium,” and forecasting is difficult.

“A lot of anesthesia professionals, CRNAs, and anesthesiologists have left the workforce for reasons that aren't clear,” he said. “So, we’ve had a decrease in the number of available people to do the work. At the same time, we’ve had an increase in the amount of work that needs to be done, particularly because there are new procedures that require deep sedation to be able to conduct them, mostly outside the OR.”

In academic settings, he said, workforce supply challenges are often more difficult due to lower salaries compared to private practice. Training, education, and research take people away from the OR and don’t generate revenue to support those important activities.

Still, Dr. Rathmell said workforce issues are not unique to anesthesiology. The challenge topped the American College of Healthcare Executives’ 2023 survey of issues confronting hospitals for a second year in a row. In short, physician shortages were noted by 71% of survey respondents; nursing and technician shortages were reported by 86% of respondents, and labor costs are expected to double the rate of inflation.

“Reliable anesthesia staffing is essential to providing high-quality, safe, and timely procedural care, representing a major financial driver for health systems,” Dr. Rathmell said. “Anesthesia coverage agreements are costly, and contracts are frequently sent for competitive bids, looking for immediate savings without fully appreciating adverse downstream consequences of accepting the lowest bid.”

His solutions for tackling workforce challenges in anesthesiology include increasing the number of anesthesiology residency training positions, increasing staffing ratios to reduce costs and increase anesthesia coverage, and determining whether many nonoperating room anesthesia, or NORA, sites need an anesthesia team at all.

As for the academic setting, Dr. Rathmell said leaders in academic medical centers have the same pressure as private institutions. They just have broader missions, having to meet both education and research goals.

“The pressure to meet the clinical demand pulls people away from the things that would drive innovation. And that's really frightening,” Dr. Rathmell said. “It's a vicious cycle. The more you pull them away, the more you pay them, the more they want to do the clinical work and neglect the innovation part. The more we neglect innovation, the more stagnant we become as a specialty.”