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
Thankful for Anesthesia providers, but we need MORE!
In this Thanksgiving episode, we break down why operating rooms are closing, why anesthesia staffing fell behind demand, and what hospitals can do now to keep cases moving.
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This is going under Anesthesia Answered with Dr. Brian Schmutzler on Bahid Sodter's Hide. We're brought to you by the Butterfly Network. We are.
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SPEAKER_01:I think they do.
SPEAKER_00:Check it out at ButterflyNetwork.com.
SPEAKER_01:And we link it below. Butterfly Network, appreciate you sponsoring this podcast. And this podcast is not exactly the happiest one in the world. We're Debbie Downer today for sure. Well, I mean, we've brought this up before and to scale, but we and maybe you didn't think it was going to happen this quickly. Um so government reopens. Yeah. Yay. Yeah. But now, if you've been noticing, there's hospital staffing shortages and not just any hospital staffing shortages, particular to your uh specialty. Specialty, sir.
SPEAKER_00:What what is up with this? So uh there's been a bunch of reports that have come out in the last like four to six weeks about how uh how understaffed we are in anesthesia overall. Um, and so there's there's three big articles that came out, and then actually there was a another sort of white paper by one of the anesthesia companies or locum's companies. But so the first one was in Becker's Healthcare, says the existential crisis facing anesthesia. And so in that article, basically what they're talking about is there are now ORs being shut down, like permanently shut down because we don't have enough anesthesia providers. So that you know, you go to your local hospital, and the local hospital used to do a hundred cases a day, and now they're only doing 70 because they don't have enough anesthesia providers, and so and with with essentially no plan to reopen, right? I mean, you anesthesia groups and hospitals go through phases where they have more and less anesthesia, more and less anesthesia. Okay, okay. I mean, that happens, but this is something like permanent. Just we're not we're not even gonna try to restaff this. It used to be 15 rooms a day, now we're doing five or whatever. Um, so it's bad. Um, and there was one that happened in North Carolina about a year and a half ago, two years ago, where they went from like 30 ORs to four. Just because of anesthesia. Yeah, because there's not enough anesthesia providers, yeah.
SPEAKER_01:And and anesthesia providers is a general term for anesthesiologists. C RNAs and AAs, yeah. And what about anesthesia? Locums, or are those just the type of jobs that people have?
SPEAKER_00:Locums are either anesthesiologists, CRNAs, or AAs, but they're locums means that you're not tied to that place. You just you find an agency and you go and it's like temp work. AA's, though, you have to have an anesthesiologist, yeah, medically directing, correct.
SPEAKER_01:So if there's not so let's back this up though. Um, you know, last year we were kind of giving out stats on this. If you want to see that podcast, I'll link it below. Yeah. Shameless plug. Shameless plug. But I'll link it below if you can hear if you want to hear that one and then come back to this one. But essentially you were saying in a couple of years it could be a huge problem.
SPEAKER_00:Well, it yeah, and it was a big problem coming out of COVID. And I thought we had kind of stabilized it. Um, and that, you know, maybe it was just a slow drift into this, and we'd have a little time to figure out, you know, what do we do about operating rooms? How do we move things around? How do we get more anesthesia providers, whether that's CRNAs or anesthesiologists? What's what's the process? How do we do this and how do we make it not fall off a cliff? Well, I think we're right at the edge of the cliff now.
SPEAKER_01:What what is the problem? I mean, we talked about this before, but let's let's go back. Is it the chicken or the egg or like what what is the problem? There's so many.
SPEAKER_00:Is it that they're not allowing more into medical schools and not medical medical school is not the bottleneck, residency is the bottleneck. Remember, residencies are supported by CMS, Centers for Medicare and Medicaid Services. And they have a limited number that they're willing to pay for because they pay for it. They pay for the provider, the uh the anesthesia resident, and then they also pay the hospital money to help train the anesthesiologist. But why aren't other specialties problems? They are many are, yeah, many are, but not like anesthesia. So so I'll give you the again the culmination of how this all happened. So we were already having, we had a an older population than a lot of other specialties. Lots of baby boomers, older people, anesthesiologists, and CRNAs who were kind of on the verge of retiring anyway, but were hanging on because you know, maybe they had a job in an ASC or something easy. COVID hits, right? And COVID was a complete turnaround for anesthesia. Um, so many people retired, many, many people got sick and or died during COVID, um, and many lost their jobs and just said, uh, forget this. Like, I'm just gonna retire or I'm gonna go do something else. Or I'm gonna just do locums and I'm not gonna come back because they didn't have any loyalty to me when they fired me during COVID because they didn't have any cases. So that that started things. And then coming out of COVID, there was a huge increase in demand. They just because everybody who didn't get surgery during the first year and a half of COVID wants surgery now. And so now you're expanding to other departments. Um, you're they're doing more, anesthesia is doing more and more and more places. So, you know, the GI lab uh surgery centers are opening, especially in states where there's not a certificate of need. You've got um EP or cardiology, like the anesthesia is all over the hospital now when it wasn't necessarily in the past. So that that's been huge. Um, so increased increased demand, decreased supply. And again, I thought you know that there's a lot of new CRNA schools opening, there's some AA schools opening. Um, they have added a few uh private anesthesiology residencies. So, like there's one in Indianapolis that's just funded by the group. So they're they're you know training anesthesiologists, but it seems like it's not enough. So you've got that headline, you've got the um you got the the existential crisis facing anesthesia, then you've got um anesthesia leaders biggest concerns for 2026, and every single one of them staffing, staffing, staffing, staffing.
SPEAKER_01:So this is interesting. You actually own a staffing company. Correct, yes. What could you say is are you having problems bringing on people? Or what are you finding? So you're not having issues finding staffing. No. So what where's the next step here? What you know what I mean? Like if you're a staffing company and you bring on people like cRNAs and AAs and anesthesiologists, what's the next step to making sure these ORs are back open and fully staffed?
SPEAKER_00:Well, I only staff in a small region of the country, number one. Um number two, um uh I think that hospitals are overextending themselves and then don't want to pay for the additional services.
SPEAKER_01:Yeah, correct. How could you not pay for anesthesiologist or anesthesia in general? I mean, are they hoping that a magic like wand comes? I mean, I think you're you're standing at a cliff that I don't foresee how do you turn that around quickly. You can't.
SPEAKER_00:You can't, and they don't understand that, right? So most hospital administrators don't understand that you just go ahead and pay for the anesthesia because there's so there's so much downstream revenue from the cases in the operating room, right? And we'll talk about reimbursements later on. I don't bring money, uh not enough to cover my salary. Anesthesia doesn't bring enough money in to cover their cost. But the hospital makes a lot of money on facility fees from the procedure, and then they make money for the patient sitting on the floor, and they make money for the MRI and the lab and all the other stuff. There's a lot of downstream revenue that comes from that patient having surgery, and they can't have surgery without anesthesia. So I don't understand like what their issue is. But we look we look we're looked at as a cost center, right? Because they look at us and they say, Well, it costs this much to bring you guys on, and you only collect this much, so you know why would I pay all that money for you?
SPEAKER_01:What but what what I think I'm not understanding w and maybe I speak for some folks out there who are getting cases canceled and stuff like that. What are they hoping for then? Are they hoping that surgeons can all of a sudden just provide anesthesia? No. I mean, like if they want to make money off of surgery, yeah, you have to have somebody that performs anesthesia.
SPEAKER_00:They just are stacking cases. So instead of saying, okay, there's 10 rooms today, you say there's eight, and those other two rooms just get to slip in behind everybody else. So you've got you've got OR rooms going four, five, six, eight hours longer than normal.
SPEAKER_01:So there's a and I'm looking at this right now, this data. Yeah. There's a shortage of minus twelve thousand five hundred anesthesia providers. Yeah. To fully come back from that, how long would it take for staffing? 12,500.
SPEAKER_00:So I think there's I don't know what the numbers are. There's not there's nowhere near that being being trained every year. It's a lot. And don't forget, every year a certain percentage retires as well, or leaves, or dies, or whatever. I I think it takes, I mean, at the current rate, we never catch up. We continue to decline.
SPEAKER_01:Yeah. So I guess I'm just kind of confused.
SPEAKER_00:Yeah. So the answer is either train a whole bunch more anesthesia providers, okay. Anesthesiologists, C RNAs, AAs, or reduce the number of sites of service. So do we need a do we need a surgery center on every corner of of every shopping mall, right? You look, you drive over towards northeast Indiana. There's surgery centers all over the place. Northwest Indiana surgery centers are all over the place. Indy. Indy surgery centers all over the place. So maybe there's a contraction of sites of service.
SPEAKER_01:But that's not good for anesthesia. I mean, look at the current amount of students. Yeah. That are not even close. That no, no, no, I mean that are going into the practice.
SPEAKER_00:Yeah, but it's not even close to even if you shut down all those surgery centers, every every one of those um extraneous surgery centers in Indiana, you still don't have enough anesthesia providers to cover everything. Is this bad for somebody who's looking to get into anesthesia? This is good. Yeah, because there's a lot of demand and not enough supply. So that's why anesthesia compensation is going through the roof.
SPEAKER_01:So compensation is going through the roof, but again, if there are not enough surgery anesthesia providers for surgery centers, is what I'm saying.
SPEAKER_00:Well, there's not enough anesthesia providers at work in a surgery center, you could go work in a surgery center, you can pretty much tell them this is what I want.
SPEAKER_01:It's just crazy to me that that is the really the one thing that you can't, you know, you cannot lack. Yeah, you know, you cannot do surgery without an anesthesia anesthesia provider. Yep. So I don't really understand, you know, where the kind of chain link is broken there, you know. I mean it's for you who's in the profession, right? You understand fully. Uh-huh. You know, but for outsiders, yeah. And for, you know, a lay person who is a patient, I don't I don't understand why they just, you know, why there isn't enough funding for anesthesia providers. Why there isn't enough money.
SPEAKER_00:Lack of foresight by both the government and hospital administrators. They wanted to cut yeah, cut costs. Yeah. You know, so so but but why now, right? So the next time why now? Why is this happening now? Why in 2025? We talked a little bit about. So baby boomers are retiring. Yep, right? We've talked about this many times, mostly anesthesiologists, but also CRNAs and AAs. Training programs are either at capacity or there aren't enough of them, and we can't produce enough providers. Again, orthopedics, excuse me, is is driving a lot of this demand, right? So you've got a lot of these baby boomers who are retiring now with their hips and knees and shoulders done, right? Okay, so that's a big thing. Bariatric surgeries. We talked about this at ASMBS, right? Tons of bariatric surgeries happening now. It's getting better and better and more and more approved by insurance. And then more complex patients mean longer cases. So that's another big thing because we're getting fatter as a population, we're getting sicker as a population. So surgeries take longer. So your whole day takes longer.
SPEAKER_01:So hearing you say all this, my mind kind of shifts to what's going on in in Canada with surgery. Okay, surgery is now we have different structures of medical systems, right? Health insurance. But it it almost seems to me that like if we go this route of cutting surgery centers, yeah, having a more condensed, if I need surgery, you're gonna be scheduling four or five, six months out.
SPEAKER_00:Yeah. Yep. Let me let me let me put one more thing on your radar here. So the reason we're not just because otherwise, you know, let's say I wanted to have surgery, they're like, nah, you know, we're too busy. I can't really get you in. Guess what's really pushing things now? The government shutdown was over the Obamacare subsidies, right? So people are looking at their insurance for next year and looking at how little it's going to cover or how expensive it's gonna be. Everything changes in January 1, 2026. So we're even seeing this locally. They're trying to schedule more surgeries than I've ever seen in really uh-huh ever since the government shutdown, because people are looking now at what insurance is gonna cost and what a surgery is gonna cost. They're covering less and less. So that's adding to it as well. Wow. Yep.
SPEAKER_01:So really the ripple effect, you're seeing it live in person. Oh, yeah. Even on our local level.
SPEAKER_00:Within a couple of weeks of when it was pretty clear that the shutdown was gonna be over.
SPEAKER_01:What are you seeing in terms of, you know, in the OR yourself, in terms of this kind of backlog of not having enough providers?
SPEAKER_00:We're busier than we've ever been, I think. So I mean that's part of it. Um, you know I work at a location that isn't typically open on weekends or you know holiday-ish days, and they're starting to do cases on weekends and holiday-ish days because there's so much demand. Wow. Yeah.
SPEAKER_01:I mean, it's a good problem to have, right? I'm not, but it's a good problem to have if you're a provider, right?
SPEAKER_00:If you're a for now, but eventually we're and we've talked about this before.
SPEAKER_01:Provider, obviously, if you're in anesthesia.
SPEAKER_00:Yeah, we're gonna break the system, right? I mean, it's just it's there is only so much money in the system. And if you're if all of the margin of these hospitals or surgery centers is going to pay for anesthesia, at some point they're going to shut down. And then it's bad for everybody. Because if you only have if you have half the number of ORs you have now, then it's a problem, right? We're not we're not half if if I if half the ORs shut down, there are too many OR or too many anesthesia providers for the number of ORs at that point.
SPEAKER_01:What do you think hospitals and ACS? Yeah. What what what do you think ASCs, what do you think they should do?
SPEAKER_00:What do you think the the I So I think there can be some consolidation? Um again, I think that there are a lot of surgery centers that don't do that many cases and are only open either because of legacy or because a couple of guys are making some some dividends off that surgery center. So combining surgery centers I think is big. Um I think there are a lot of um what I would call unnecessary surgeries. Not that they're not that they're wrongly done, but they're surgeries that probably don't need to happen, right? So like not everybody needs a cataract just because they're over the age of 65. Like some some people don't actually need that. Um you know, not everybody needs both hips, both knees, and both shoulders done. Um so I I think there's some of that. Um I think, you know, um, I think cutting down the number of rooms in some degree to some degree would help. Um I don't know though. There's not a good there's not a good solution. I mean, i if if the government would just fund more anesthesiology spots, that would help. If the CRNA schools would pump out providers a little bit more quickly, that would help. I mean, you you gotta fight it on both sides, right? You gotta fight the supply side and the demand side. So you gotta decrease demand some and you've got to increase supply. The other thing that a lot of people are talking about, and I'm I love my parents, I love the boomers, clearly, uh but they're coming towards the end of their lives. And when that happens, there's gonna be much less utilization of the healthcare system. So as the baby boomers die out and it's supposed to be over the next like ten years, there'll probably be less demand that way as well. Now, I will we catch up? I don't know, but there certainly won't be that the amount of demand that we have right now.
SPEAKER_01:A couple of questions to take us out. What A uh one A, where do you see where do you see this going in the next three to five years? And B where do you see it going for companies like yours, staffing providers? What where do you see that going?
SPEAKER_00:Okay, so where are things going in general for the next three to five years? Like I said, consolidation keeps happening, right? It's it has to. Um consolidating rooms, but also consolidating systems, right? So if you look at these these hospital systems are buying up surgery centers or buying up smaller hospitals, so there's going to be consolidation. Sure. Demand will stay high. I think until the until the baby boomer generation is not utilizing the healthcare system anymore, I think the dem the CRNA demand will will go way up. I think the anesthesiologist demand will go up too, but we we have such a limited number, um, you know, and we're not making any more. Um so again, uh consolidation, not just consolidation of hospitals or surgery centers, but consolidation of groups. Um, and this is something that you know we've been a part of as well. You know, we've acquired groups in the past, but I think that's gonna continue. Um I I think you know, there's a lot of stuff about algorithms and AI and all that kind of stuff. That that's probably gonna help quite a bit to optimize operating rooms. Um it probably at some point will get good enough where it will be running the cases in the operating rooms. So that that's you know, I don't know. I I'm bad at these predictions, but let's say 20 years down the line, you've got AI just doing the cases and you've got an anesthesia provider watching six or seven rooms of AI doing the cases. Um but then I I mean I think it I think it all comes down to forward-thinking leadership, right? So within the group, within the hospital, you have to work together. The hospital leadership has to work with the anesthesia department leadership to figure out how they go together instead of being adversarial, which has been which has been the way it has been in the past. Again, the the the worst thing that a hospital administrator can do is say, look, anesthesia is a cost center for us, they don't generate enough revenue to cover their costs, don't even worry about them, just schedule the cases, we'll figure it out. And some of them do that. So I think you have to have a really, really strong partnership.
SPEAKER_01:And what is the rate of attrition compared to the rate of growth?
SPEAKER_00:Uh in terms of anesthesia providers? Right.
SPEAKER_01:So, like I don't know. You know, so like people are retiring, you know, you have the older population that that, you know, um I think we're still not keeping up with the overall loss of providers.
SPEAKER_00:So we're already so short, and then everybody let's say we even are a one-to-one replacement. The number of providers trained each year is the same as the number of providers leaving each year. We're gonna constantly be in this deficit, and then the demand just keeps going up. So again, you're less and less providers for more and more demand. And so for me, I do think this is doom and gloom. And I'll I'll say so, so I and I'll say personally, so so we went through a period when we used to talk to hospitals when they were asking for new anesthesia services where all they cared about was staffing coming out of COVID, right? Do you have the staff? I don't even care if they're good. Just do you have somebody who can sit on a stool and deliver anesthesia? And then about 18 months ago to two years ago, they started going, Well, all right, I trust you have staff. What's your quality? How do you measure your quality? How do you, you know, how do you make sure that your providers are great? And then just in the last probably three months, it's gone back to We need somebody to staff. Yeah. Do you have staff? Yeah, that quality's great. Okay, fine, but do you have staff? So I think it's I think it actually I think what happened was that we got to a point where we were somewhat stable in terms of staffing and those and the compensation wasn't skyrocketing. And hospital administrators did it what hospital administrators do, and they're like, Great, more cases. Let's go. Increase the number of rooms, build an ASC, did the worst thing you could possibly do when we were just on the edge of of stabilization.
SPEAKER_01:Well, we walked out of here last week and and I was asking about Dr. Cian. Yeah. And you're like, oh yeah, he had 12 cases today. Yeah. Or whatever. Yeah. I'm like, what? Yeah. Yeah. Yeah, he won't be here for a while. He had a bunch of cases today. Yeah. Wow. Yeah. I'm just, I, you know, it is baffling to me. Again, hopefully it's not all doom and gloom at this point.
SPEAKER_00:I I don't have a lot of I don't have a lot of positive things to say right now. I mean, even so, so if you look, and I'm just going back to the article here, two of the five articles that we looked at are from locums companies talking about how scary it is. You know, in the locums company, so locums companies make money off of storage shortages. They're whole thing. Right. And they're even saying this is a problem. So that that really, those two articles. Yeah. So coming to a hospital near you, oh, I'm sorry, your surgery's canceled today because you don't have anesthesia. Yeah.
SPEAKER_01:Knock on wood. Knock on wood. Knock on wood. Um one thing that I would love to do with you, in particular on what on your social channels, is do like a QA. Yeah. Because I think we could do that. I think, you know, obviously your expertise in this matter, and also, you know, your audience, right? I mean, on social media, if you've been to Dr. Schmutzler's social media profiles, really a lot of the content is geared towards medical students coming out of school, coming out of residency, getting those jobs. I think we we're gonna have some success with QA's. And if you have a question for Dr. Brian Schmutzer, put it below because he will answer those questions. Yeah, let us know. For sure. Um, all right, is the doom and gloom it? Are we I mean uh ready for Happy Thanksgiving, everybody?
SPEAKER_00:Happy Thanksgiving. Happy days. We still so to to be to be fair, yeah, we still have the best healthcare system in the world, right? Not not that it's necessarily perfect and there are a lot of things that need change, but if you get sick, you want to be in the United States. That's my that's my plug.
SPEAKER_01:We'll we'll leave it at that. Uh very positive, positive outlook. Yeah. Happy Thanksgiving, my friend. Happy Thanksgiving.
SPEAKER_00:And to everybody, happy Thanksgiving.
SPEAKER_01:Happy Thanksgiving as we start the holiday season. We've got so much more to come here on Going Under Anesthesia Answered the rest of the year. We're gonna take you up till December 31st, by the way. And then we've got a nice 12-part series starting in January. Immediately in January. So don't go anywhere. If you want a stocking stuffer, well, there you go. Buckle up. That's it. That's it. Tell your loved ones. All right, for Dr. Brian Schmutzer, I'm Vahid Sadrzadi. This has been going under brought to you, anesthesia answered brought to you by the Butterfly Network. I was waiting for you.
SPEAKER_00:As always, but brought to you by the Butterfly Network. See you in the next one. See you in the next one. See you in the next one.
