Although the public health emergency is over, the effects of COVID-19 linger as hospitals and health systems deal with supply and demand challenges, from a shortage of healthcare professionals (many of whom suffer from burnout) to a backlog of — and increased demand for — surgeries and advanced medical procedures.
Community hospital chief executive officers cited these workforce challenges as their top concern in 2022, according to the American College of Healthcare Executives’ annual survey.
And no hospital, big or small, is immune. As American Medical Association President Dr. Jesse Ehrenfeld recently noted, “the physician shortage we have long feared — and warned was on the horizon — is here. It’s an urgent crisis, hitting every corner of this country.”
Each institution may face different issues, but all must implement solutions to ensure they meet current and future patient surgical and procedural demand, maintain quality outcomes and generate revenue so they can continue to care for their communities.
While there is no quick fix, anesthesiologists, who are perioperative leaders in coordinating safe and efficient surgical and procedural services — the major revenue “engine” for healthcare institutions — are identifying short- and long-term solutions to help hospitals improve efficiency and bolster the anesthesiology workforce. Their education, training and clinical experience brings versatility, collaboration and innovation to hospitals and health systems and helps bridge medical and surgical specialties.
Anesthesiologists also align with the interests of healthcare executives to effectively manage the perioperative process and focus on the collective interests of the hospital and the best use of restrained resources.
Short-term solutions
To begin developing short-term solutions, hospital executives should identify physician leaders, ideally anesthesiologists, who can work with surgeons, other proceduralists and hospital administrators to create a plan based on the hospital’s strategic priorities and resources.
Once developed, the plan must be communicated to all involved, underscoring that hospital leadership has empowered the group and supports its actions.
The plan should focus on improving:
- Efficiency: Ease surgical backlogs by ensuring surgeons and other proceduralists release their unfilled operating room block times with sufficient lead time so others can book surgeries and prevent unfilled blocks that are costly and inefficient.
- Scheduling: Create a process focused on efficient scheduling of surgeries in the OR and of procedures in non-OR anesthesia (NORA) sites, and ensure the rules are followed and enforced whether in an OR or NORA.
As a caveat, it’s vital to factor some level of “slack” into the scheduling system to plan for unexpected delays. For example, anesthetizing locations should be scheduled at roughly 80% of their capacity to account for procedures taking longer than anticipated, patients arriving late, emergency cases occurring, etc. Scheduling these sites at more than 80% capacity can lead to staff dissatisfaction and burnout, risking the loss of valuable staff. It also creates dissatisfaction among patients scheduled later in the day when their procedure is delayed.
- Predictability: Determine scheduling based on hospital priorities for different surgeries and procedures. For example, some hospitals may provide trauma care, which may necessitate staffing a frequently underutilized “open” OR dedicated to traumas and other emergent cases, versus “bumping” elective or non-emergent cases in a regularly booked site. Or many hospitals will have more unfilled schedules for general, orthopedic and neurosurgery to support trauma programs. In light of the current state of frequent OR staffing challenges, scheduling models such as ‘flip rooms’ in which a surgeon switches between two ORs may need to be reduced or eliminated, as such models often create underutilization of scarce OR resources.
Long-term solutions
Long-term solutions also are necessary to ensure workforce challenges are solved, not just patched. Anesthesiologists are working with healthcare executives, policymakers and other leaders toward possible remedies such as:
- Expanding residency programs through Medicare graduate medical education (GME) and private payors (hospitals self-funding over the GME cap)
- Reforming Medicare payment for anesthesia services
- Increasing the anesthesia advanced practice provider workforce through expanding the states in which Certified Anesthesiologist Assistants are licensed to practice.
Anesthesiologists are poised to partner and develop alternatives that creatively challenge the status quo while providing safe and effective alternatives for the provision of care. Learn more about how healthcare executives can partner with anesthesiologists by visiting: https://www.asahq.org/madeforthismoment/health-care-executives/
About the authors
Mary Dale Peterson, MD, is past president of the American Society of Anesthesiologists, as well as chief operating officer and executive vice president of Driscoll Health System.
Ronald L. Harter, MD, is president of the American Society of Anesthesiologists. He is also a professor in the department of anesthesiology at The Ohio State University Wexner Medical Center.
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