Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
Don't forget to send your questions to Dr. Brian Schmutzler on social media and his website at www.drbrianschmutzler.com.
Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Money Matters: Navigating the Financial Future of Anesthesia Providers
The economics of anesthesia is approaching a breaking point. In this eye-opening episode of Going Under, Dr. Brian Schmutzer and Vahid Sadrzadeh reveal the unsustainable trajectory of anesthesia provider compensation against a backdrop of critical shortages that threaten to fundamentally alter surgical care delivery nationwide.
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This is going under Anesthesia Answered with Dr. Brian Schmutzer. I'm your host, Fahid Sadersade. We're brought to you as always by the Butterfly Network.
SPEAKER_00:Alright, I'm gonna let you in on a little secret. Something that's completely changed the way I practice. I've been using Butterfly probes for years. It's a portable ultrasound that plugs right into my smartphone or tablet, and it allows me to start scanning immediately. If you've used the older versions or even if you're new to the handheld ultrasound game, let me tell you why the IQ3 is a game changer and really impressive. First off, having an ultrasound literally that fits in my pocket means I can move faster. Whether it's vascular access, procedural guidance, or just getting real-time insights from my patients. And the tech inside this tiny device is pretty incredible. It's got biplane imaging, which allows me to see short and long access views simultaneously, which is huge for procedural guidance and honestly for learners. The new needle out of plane preset even shifts the scan plane digitally so you can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ3 holds up against some of the high-end cart systems I've used. That's impressive for a ultrasound probe that's this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the latest IQ three. Go to ButterflyNetwork.com to check it out.
SPEAKER_01:Link is below, as always. Thank you, Butterfly Network. And today we are kind of talking about a subject we talked about last season on the podcast. Very popular. Very popular. Um are are you going to change your answer at all to give us a little insight or so we're we're talking about money again.
SPEAKER_00:Money, money, money, money. But we are going to talk about the changes in compensation for anesthesia providers, and then we're going to talk a little bit about shortages as well and kind of what we see coming down the pike.
SPEAKER_01:So let's just do a quick rehash. How much is the range? Range, yes. When you come out of college, and how does it compare to other medical residency? A residency. How does it compare to other uh specialties and stuff like that?
SPEAKER_00:So probably top 25%, 25, 30 percent. Um, so anesthesiologists are paid well, um, as are CRNAs, obviously. Um the range for anesthesiologists is probably 250,000 to 1.5 million, depending on how much you work, where you're practicing, that sort of stuff. CRNAs are probably in the range of 200,000 to maybe 700,000, 800,000, give or take. Okay. Again, depending on practice type and location and all that sort of stuff.
SPEAKER_01:Sure. So uh and you know, last time we talked, let's just kind of rehash that conversation. You know, we're just talking about, you know, as anesthesiologists maybe aren't as prevalent as they used to be, it's more of a scarce. Yeah, supply and demand for sure. Yeah.
SPEAKER_00:The pay is going up. Correct, correct. So we've seen a huge increase in the last 15 and maybe 10 years, um, which really culminated in uh right after COVID, right? So there was a huge amount of anesthesiologists, CRNAs, who either retired or died during the COVID um, you know, I guess crisis you could call it. Um so I think uh, you know, everybody who was close to retirement, particularly anesthesiologists, were just like, I'm out, I'm done, I'm not gonna practice anymore. This is too scary. Um, not to mention, you know, you've got an aging population anyway, and then you've got the baby boomers, so you've got way more sites of service, right? So there's tons and tons and tons of surgery centers opening, GI centers, offices even need anesthesia for dental and podiatry and GYN and plastics, and then you've got um just even more outside of the OR locations in the hospital, so GI suites and cath lab and all that sort of stuff. So you've got an aging population, you've got a bunch of people retiring, you got a bunch of people who like I said, there's a lot of anesthesia providers who died during COVID, who got COVID and died because they were older anyway.
SPEAKER_01:And so you've got was that that was scaring? You said you just said they're they were kind of scared them away.
SPEAKER_00:Yeah, yeah. I I mean I think especially at the front end of COVID, you know, anesthesiologists were right in the airway. Sure. You know, so doing procedures on patients. So we we didn't do any elective procedures for depending where you were, six weeks to six months. So you were doing all sick patients who may or may not have had COVID, at least in the front end, and I think a lot of people got scared away from that. So if they were sort of at the border of retiring or not, they just said, forget it. I'm not gonna deal with this, I'm gonna retire. So um, I think back, you know, three, four years ago, whenever it was we talked about this, I think the prediction was, or the current the current was that there's like three to five thousand too few anesthesiologists. Um, probably about that same range of CRNAs, but I don't know the data as well currently on that.
SPEAKER_01:How many CRNAs and anesthesiologists are there in the country? Okay.
SPEAKER_00:So and about five thousand give or take um AA's.
SPEAKER_01:I would I would think that's way less of a number than family care docs or you know, yeah, yeah.
SPEAKER_00:I don't know the answer to that. I don't know how many family practice docs there are. I think probably more would be my guess. I'm not totally sure. Um definitely more than 60,000 family practice docs when you compare to anesthesiologist. I don't know if there's more than 120,000 family practice docs or not. You'd assume there are, right? Right. Yeah, I mean and a population of 350 million, you'd assume even if it's like one to fifty or one to a hundred, I don't I don't know. I don't know what the exact numbers are there, but so um so currently three to five thousand too few both CRNAs and docs. So let's combine that together. Let's say on the high end, 10,000 too few. The prediction is that by 2035 that there's gonna be a a shortage of fifteen to twenty thousand anesthesiologists and probably still some shortage of CRNAs as well. So I don't know what we're gonna do, right? You're gonna have to reduce the sites of service, or you're gonna have to figure out a way to produce more anesthesia providers. The CRNAs can do that because they can open a school, right, and then send people through. It still takes time and it's gonna be slow, but it takes it it can happen. The problem with anesthesiologists is residencies are capped, they're funded by by CMS, by Medicare Medicaid services. So we can't make any more unless the federal government pays for it. They pass an amendment to pay for more anesthesia slots. There are a few go ahead, yeah. Well, how do you replace the ones that you're losing?
SPEAKER_01:That's a great question. You can't. Because you're talking about extra slots, right? So like if you're is that what you're talking about? So if the the Medicare and Medicaid Medicaid, they approve to create new spots or just even the ones the ones that are currently got it. They pay for all of them. Not even the extras. You're talking about the ones who are would replace the ones that retire and have died.
SPEAKER_00:Right. So we're we are not replacing, we're not even getting close. We're getting way worse in replacing. Then why aren't they replacing money's running out? Money. I mean, the uh like I always say, the answer is money. Now what's the question, right? Medicare doesn't want to pay any more money for for docs. So CRNAs are are already prevalent, but are probably going to become more prevalent in the anesthesia world just because, again, they can be be you you can train more of them. You're able to open a CRNA school if you've got the funding for it, whether it's federal or or uh private, right? And you can charge the students to go to a CRNA school so they can just kind of self-fund. There are a few programs, there's actually one in Indiana that's self-funding four slots, four anesthesiologist slots in a residency, but again, that's four slots out of 15 or 20,000 that were short, right? There's just not enough money going around to train anesthesiologists. So now that's a problem for supply, but the demand hasn't changed. So what does that mean, right? It's it's economics, the the compensation is going way up. I mean, way up. So we looked at this recently. Um if you look at it's I think it's called the CPI for medical or whatever, there's a CPI for medical anesthesia specific. And what we've seen from everything I can gather, and there's huge ranges, right? But from everything I can gather, it's around so so CRNA's compensation went up in, and we'll just start at 23 because that's when I started looking at it. From January 2023 through July of 2025, went up like seven and a half percent per year. Wow. Exactly. Yeah. So and and the um the locums market, which is the PRN, people who don't have a full-time job, they're not saying, hey, I want that full-time job, and here's how much you're gonna pay me. It's you're gonna pay me, you know, temp, basically temp work. You're gonna pay me X amount per day or whatever, went up even more than that, maybe nine or ten percent. Um, anesthesiologists were a slower increase, about three and a half or four percent. Um, but the locums were going up about five, six, maybe seven percent. So yeah, it's great short term for people who do a lot of locums work and even people looking for a job, right? You can make a lot of money. The problem is we're destroying the system. You know, there's not enough money to pay for all this. And so I guess what I would caution people, and I don't want to be too preachy here, but I'm going to anyway. I would caution people, you know, get what you're worth, but don't be a mercenary. Don't go out there and say, oh, I can I can gouge this place for, you know, way more money. Don't do that because all you're doing is ruining the system. All you're doing is the system's gonna come down more quickly. So, you know, we've got to figure out a way to not either not pay as much or to get more providers or to find a way that the federal government will pitch in more and the insurance companies will pitch in more or something like that, right? Because otherwise we're gonna break anesthesia itself is gonna break the system because of cost.
SPEAKER_01:So what I mean I'm not gonna ask ask that question. You should ask it. Well, I mean, like, what is the answer? So, I mean, okay, so either you you you take a pay cut, I'm not talking about you personally, I'm just saying in general.
SPEAKER_00:Or you take less of a pay increase. I'm not I'm not advocating for people to say, like, oh yeah, pay me less money. I'm advocating for anesthesia providers to look and say, yeah, I could probably gouge that hospital for another hundred thousand dollars, but maybe I'll take fifteen or twenty instead and make it a long-term thing instead of you know, how can I make as much money as I possibly can as quickly as I can?
SPEAKER_01:So who's to blame here? Well, I mean, I'd always like to blame the government, right? You know, the the okay, so if you're a up-and-coming student and you're choosing a profession, you're choosing a specialty, you know you want to go into medicine. Do you are you thinking, hey, you know, I don't know what's happening in the anesthesia world. So maybe uh many students are not choosing to be anesthesia.
SPEAKER_00:Anesthesia is always full. Popular. Oh, yeah, very, very. Because because again, the the benefits of anesthesia we've talked about before. You you take call, but you're not at home where the a patient's going to call you, right? It's kind of shift work. You show up, you do your job. Um, it's very, you don't have your own patient load, right? So you're not following somebody forever. It's very um, it's very immediate gratification, right? So you do something and the patient's blood pressure changes right away. So I a lot of people like anesthesia, and a lot of people see that the market keeps going like this, so you can make a lot of money. So there are there are more people who apply for anesthesia than there are anesthesia slots, and there are very few, if any, every year that don't go filled. So it's it's not a problem of people not wanting to do anesthesia. There's not enough enough medical, there's not enough residency slots in anesthesia. You could probably, I bet, it's maybe a little bit offhand, but I bet you could add 50% more spots and still fill them.
SPEAKER_01:Wow. Yep. So I I do have a question, and this relates back to kind of your work that you do with your companies. Yeah. Um and it's and it's bringing people on, it's staffing, it's management, all that stuff. Yeah. Does that change the future or the game for anesthesia? Maybe not residents, but does it change the game for how people go about the profession? Like, does it Yeah, maybe that's a very general question, so I apologize. No, I know what you're saying.
SPEAKER_00:Is it is it do they correlate or does it help or you know, so I I would say we saw a niche and filled it, right? Especially locally. We had a lot of people who wanted to work and we had a lot of connections with places, we put them together. I would say we're reasonable in our in our rates on both sides, right? So if a if an anesthesia provider comes to me and asks for something way outside the norm, we say no. And if uh, you know, when we sign a contract with a location, we try to keep the rates reasonable, right? Reasonable and customary, right? Try to keep it where, you know, everybody needs to make money to work. You don't work for free, otherwise we'd be in sub-Saharan Africa doing free anesthesia. So I get it, right? I you've got to make money, but you don't have to gouge on both sides, right? So we don't gouge the facilities and we don't allow the providers to gouge us. Now, what we do see is a is a cultural um generational thing, right? Okay, huge, huge difference between even baby boomers and Gen X than late millennials and Gen Z, right? So we we kind of joke that a lot of younger providers want a lot of what they call work-life balance. Sometimes we say life life balance, where they get to not work very much and make a lot of money. I mean, of course, that's everybody's dream, but you have to work to make money. And so, so we're finding generationally that a lot of people are looking for, hey, I want to work three 12-hour shifts a week. I want to work 26 weeks a year, and that's all I want to do. I don't really care that much about more money. Now I want to get paid really well when I'm there, but I don't care about making that much more money. I want all that time off to go do what I want to do, as opposed to boomers and Gen Xers who were who were like, hey, I want to work seven days a week, 50 weeks a year, I'll take two weeks of vacation, I want to make as much money as I can, and you know, they feel that that duty to work a lot. So we we find that we have a lot of of those late millennials and and Gen Z who are just really just want to do straight up eight hours of shift work and that's it, go home. So I'm not, I mean, there's other podcasts where I've made judgments on whether that's right or wrong. I won't judge it in the in this particular podcast. If you would like to listen to that, go back and listen to the other ones. But yeah, so so I mean, I think um, you know, it's it's causing an issue as well because you got a lot of part-time people, right? So so then you've got somebody that you've fully trained who might only be working 0.3 FTE. So that means you've got to have three people to make up for that one spot that you would have covered in the past. So there's a lot of factors that go in here. Um it's it's frustrating in some ways. Um, and it's also so so who do we blame? I think there's a lot of people to blame. Um, I think we as anesthesia providers, and I'll throw myself in this as well, uh, probably aren't um we're asking for too much money and we're not working to our full potential. I also think, though, that reimbursements from Medicare and from the insurers, particularly for anesthesia, are atrociously bad, right? So if you would shift some of that cost burden from the hospitals and the ASCs and the facilities back to the insurance companies who are making billions and billions of dollars a year, I think that fixes some of the issue as well. Um, but also, I mean, on us, right, I think we're being greedy as anesthesia providers. And it is what it is. I mean, you know, I again get paid what you're worth, but all you're doing is driving the system closer to collapse. And if the system collapses, none of us have a job. So you're not gonna make that egregious amount of money, you're gonna make zero. Um, or you know, if they have to if somebody has to make a decision and you're the guy that's the most expensive, who's getting let go first? The guy that's most expensive, right? Not the guy who was reasonable and said, Hey, yeah, I know I could get more money out of you, but I'm not gonna do that.
SPEAKER_01:At what point are they? Boy, I don't want to say it like that. Just say it.
SPEAKER_00:Well, no, I mean, you know, let's be controversial.
SPEAKER_01:Just say it. I don't want to be controversial in the fact that listen, we know a lot of great CRNAs, a lot of great AAs, a lot of great anesthesiologists, yep. A lot of great anesthesiologists in general. What at what point are they you know what? We're gonna we're gonna go, you know, hospital systems, everybody. At what point do they go, we're gonna go the AA and the CRNA route instead of anesthesiologists because it's less expensive. Less expensive.
SPEAKER_00:It's a cost-saving route. Yeah. So a lot have already done that. Um I mean, and and it's sheer numbers, too, right? Again, you've got AAs, I mean, no offense to AAs, but they don't play a huge uh role in this because there's so few of them, right? So so let's take them out of the equation. Um, if you look at CRNAs versus anesthesiologists, there are there will be so many more CRNAs than anesthesiologists that you're gonna have to go that route. And I've talked to multiple facilities where they're like, yeah, we would love to have an all anesthesiologist practice or even a, you know, but they just can't afford it. But we we can't afford it and we can't find anybody, especially in a rural area. I mean, there's counties, and we've talked about this before, there's counties in Indiana where I'm the only anesthesiologist credentialed at the hospital. Only one, right? Not certainly not Indianapolis, Fort Wayne, South Bend proper, Evansville. But you go outside those main five or six cities in Indiana, there's a lot of places that don't have any anesthesiologists. It's only CRNAs. So uh, I mean, it's gonna keep moving that direction. And I think as an anesthesiologist, the the role of an anesthesiologist is gonna change and already has, but I think it's gonna change even more, where it's going to be more of a consultative supervisory type role as opposed to actually doing your own cases. And that I mean that's been moving that way for probably 20 years, but uh it's just gonna have to move that way because there's just not there's just not enough anesthesiologists, and it makes more sense to have an anesthesiologist available to do a lot or or side by side, right? Where you're just you're doing some cases here and there and the CRNAs are doing cases here and there. We've got facilities that do that too. But it's just not it just you you can't have a heavy MD practice anymore in most places because there's not enough of them.
SPEAKER_01:And again, you can't afford it. Worry some for patients, I can tell you that much. I mean, like to hear that as a patient that we don't have enough anesthesia providers, yeah, absolutely.
SPEAKER_00:Yeah, I mean of course, yeah.
SPEAKER_01:So I mean, then what? What are they just gonna train regular surgeons to do anesthesia? So you do you know the history?
SPEAKER_00:You know the history of anesthesia? It used to be the medical students who did the anesthesia for back, you know, way back when before there was before the so the medical student they just tell the medical student, like, give some ether, and the medical student would do it while they were doing surgery, and a lot of people die, right, obviously. Um probably not because long-term practices that yeah, that's not great. Yeah, so there's actually an interesting story that I just read in um in a book about um the mob. Um I can't remember who it was. Um one of the mobsters from the 30s went to like some you know illegal doctor, and the his like butler or something did the anesthesia got puked all over himself. Anyway, so um no, so uh I mean I think there's some AI things coming down the pike. I know we talked about this a little bit, but I think there's some AI stuff coming down the pike that um and there this has been published too, where some of the lower acuity stuff, um, you know, cataracts, uh, endoscopy, that sort of stuff can be done potentially by an AI facilitated computer program type thing. Jeez. Where you've got a nurse kind of monitoring and an anesthesia provider then monitoring maybe 10 suites or something like that. So that's probably gonna come down the pike. I mean, you we're gonna have to do something, right? The other thing is you're gonna have to start reducing the anesthesia locations and start stacking things, which means that you might have otherwise done 20 ORs from 7 a.m. to 3 p.m. Now you're gonna do two from 7 a.m. to 1 a.m. So that's not super a super great solution either, but that may be the way things have to go.
SPEAKER_01:I just I I I don't want to do this comparison, but I always do. Um I'm gonna do it anyway. I'm gonna do it anyway. It's like the bubble bursting in the housing market. It really dot-com bubble. Yeah, I mean, it's like, you know, I mean, when it becomes so disparaging, it just bursts. Yep. And it's like almost the government is hoping it bursts. And you know what I mean?
SPEAKER_00:And they can put everybody under Medicare and drive salaries or drive compensation themselves, maybe. I mean, that's nefarious, but maybe that's what they're trying to do.
SPEAKER_01:You know, I don't I again, I don't know if that's gonna happen or what's gonna happen, but it sounds like a problem. Uh-huh. Yep.
SPEAKER_00:Yep. And I and I don't think we as anesthesia providers, we we are hastening this collapse. That's what I want to try to really point out here. So, like, uh, you know, we're we're not gonna share the exact compensation, but it is going up, so we want to talk about that. But I would like to really impress upon anesthesia providers who listen to this podcast to I I get it, you want to make a lot of money, but don't hasten the collapse of the system out of greed. I really, I mean, I you just you can't. There are so many, and I see them day after day after day, who are so greedy about how much money they expect to do the work. Um, maybe not understanding or not caring that they're gonna make the system collapse. So that that's I guess if anything in this podcast, that's what I want to say is don't hasten the collapse of our of our anesthesia and medical system because of your greed.
SPEAKER_01:And and if you've got a comment too, comment below or email us. I mean, you have uh you guys out there that listen to the podcast that watch it on YouTube, you have access to send in a question and and uh send us a note. And uh we always love hearing from you. Yeah.
SPEAKER_00:Um and I would love to hear somebody else's opinion about, and maybe we bring somebody else on, somebody else's opinion about what the solution is. Because I I've been trying to figure this out, you know, for a long time. Now I will tell you what we're seeing now. More people are taking full-time positions because they've gotten burned out on the working all the time and traveling around. And hospitals and surgery centers are cutting down the number of rooms they're running. That's that's what's happening now. And they're just saying, hey, listen, I'm sorry, surgeons, it's less convenient for you, and you might have to come at 3 p.m. instead of 7 a.m. But we're only running five rooms, not 10, because our OR efficiency is so poor. You don't get to just decide to open a room for a couple of cases and bring another anesthesia provider in. So that's going to continue for sure. And that's not necessarily a bad thing. I think that we've overburdened the number of operating rooms we have, probably unnecessarily for convenience. And again, I'll I'll give a little dig to the surgeons, but I get it that a surgeon wants to operate whenever the surgeon wants to operate. But when you're paying not only anesthesia, but your entire OR staff, your entire, you know, front office staff and everybody at the surgery center or the hospital a bunch of money so that you can show up whenever you want and operate, that's going to break the system too. I mean, that's just as bad as the anesthesia providers demanding more money. So I think, you know, consolidation of services into less rooms is it is the probably the first and immediate step. And that's why the rate of increase of compensation of anesthesia providers has actually kind of leveled out. And we we for three years were doing this, right? At this super high trajectory. Now we're kind of maybe more like this, right? So I think that's part of the reason why hospitals are finally getting smart and saying we can't just dump as much money as as possible into anesthesia. We've got to think about this and be smarter. So that's step one. We've got to create more supply for sure. But I would love to hear anybody else's kind of take on this and what they think the solution is, because I I don't have a great solution.
SPEAKER_01:It just seems like we're kind of destroying our own medical system. We are for greed. Yep.
SPEAKER_00:On a lot of ends. I mean, not just anesthesia, right? Insurance companies. Yeah, there's we could talk about that.
SPEAKER_01:We see how from afar I think maybe we took this for granted in in the eighties and nineties and the early 2000s, we see how other countries do things. Yeah. And it's like, oh, we'll never be those other countries. And maybe we won't be exactly, but it definitely is not how it was 20 years ago in this country.
SPEAKER_00:Yeah. I mean, especially 40 or 50 years ago. I I mean, so, and we've talked about this before, but you had a bunch of business guys who looked at the medical system and said, wow, that's like 30% of our GDP. I want some of that. So you got a lot of hands in the pot. You got private equity, you've got government, which is taking some of the money out. You've definitely got the insurance companies who we are no fan of, um, who don't provide anything. You've got pharmaceutical companies who are taking a bunch of money out of the system, medical device companies who are taking a bunch of money out of the system. And again, I'm not as not as hard on them because at least they're creating something that I can use, but you've got all these people with their hand in the pot, and it's just it's not sustainable. At some point, we've got to stop. So, and I don't I don't advocate for socialized medicine either. I don't think that's necessarily the right way to go where the government runs the whole thing. You know, you see places there are some places where it works, where it's a real homogeneous population. It doesn't work great in Canada, it doesn't work great in the UK, right? The National Health Service is shutting down. We talked to uh Dr. Lassiter about that. So, you know, is that the right answer? No. Is there is the right answer what we're doing? No. There's got to be something in between, right? Well, we're gonna leave it at that. All right. And well, we're gonna And I still haven't told you how much money I make. That is the ultimate question. That is the ultimate question.
SPEAKER_01:Some things are okay. Better better left unsaid. Better left unsaid. That's right. Well, we appreciate all you do, and uh we know that whatever it is, it's well worth it. So uh you've done a great job. So uh again, if you have a question for Dr. Brian Schmutzer, leave it in the comments below or uh on YouTube and or on our uh Spotify feed, whatever platform you listen. Yeah. So drop it below and love to hear from you. And we've heard from a few of you over the past couple of weeks, which is which is great.
SPEAKER_00:So somebody somebody send me the solution so that I can take credit for it and implement it, all right? Storyboarded. Storyboarded. No, no. I want I want to I want a like a four-paragraph. You want a FOIA, basically, yeah. I want a FOIA so that I can that I can fix the system and take credit for it.
SPEAKER_01:This is going under with Dr. Anesthesia answered with Dr. Brian Schmutzler. I'm Vahid Sadur Sade. We're brought to you by the Butterfly Network. We'll see you in the next one, my friend. See ya.
