This is the second part of a two-part series. The first part appeared in the August issue of
The Ophthalmic ASC.
Skilled MD anesthesiologists (MDAs) and certified registered nurse anesthetists (CRNAs) play a crucial role in patient safety and the success of ophthalmic ambulatory surgery centers (ASCs). Indeed, their expertise directly impacts patient safety and satisfaction, as well as a center’s efficiency and reputation in the community.
A critical shortage of these professionals that began with the COVID-19 pandemic and shows signs of only getting worse, however, is making recruiting and retaining top talent challenging for ASCs throughout the United States. It is vital for ASCs to pull out every tool at their disposal to compete for and retain top-notch anesthesia providers.
“Anesthesia is in a crisis,” says Regina Boore, executive vice president, Progressive Surgical Solutions, a division of VMG Health. “This shortage is impacting pretty much everybody at this point, especially ophthalmic [ASCs] in non-urban areas and secondary and tertiary markets. They're really struggling.”
Roots of the Shortage
The current dearth of anesthesiology providers has its roots in the COVID pandemic, when many ophthalmic ASCs were forced to close their doors temporarily as cataract, LASIK and other elective procedures were put on hold. Many MDAs and CRNAs found new opportunities at hospitals being flooded with COVID patients.
“CRNAs are airway management specialists, so the hospitals brought them in and they started working on the sickest of the sick,” says Cassie Syme, a consultant with Progressive Surgical Solutions, a division of VMG Health. One consequence of that development, she explains, is that many MDAs and CRNAs suffered burnout under the stress of caring for COVID patients.
“A lot of the older ones said, ‘This is not what I want to do. I'm dealing with these sick patients, people are dying,’” she says. “They left the market … because of the pressure of having to work in the hospitals. That’s what has caused this drought we're having.”
Another factor that has contributed to the shortage is the lack of new MDA CRNA graduates entering the market, Ms. Syme adds. “The doctorate programs aren’t set up to facilitate the volume of people that need to go through them,” she says. “The number of CRNAs that are missing from the market today is immense.”
Dan Chambers, CEO of Key-Whitman Eye Center in Dallas, Texas, agrees, observing that during the pandemic, MDAs and CRNAs “basically moved away from the anesthesia profession without a new wave of personnel coming in.”
He adds that business issues also factored into the shortage, with private equity consolidating small anesthesia provider groups into larger companies. The result: greater competition for MDAs and CRNAs across both hospitals and ASCs.
“Hospital systems realized that they couldn’t function, since the majority of their business comes from surgical activity,” he explains. “They captured the anesthesia providers and guaranteed them even more money as long as their first priority was the hospital. As a result, it became somewhat of a bidding war for personnel.”
The current nationwide shortage of anesthetists is expected to worsen. A 2021 American Association of Medical Colleges report estimated that the number of MDAs will fall short of demand by 12,500 by 2033, while the shortage of CRNAs could reach 7,800 by 2028.1
Recruitment: Show Them the Money (and Benefits)
Given the severity of the drought and the relatively bleak future, ASCs must up their game with respect to recruiting and retaining staff MDAs and CRNAs. At the top of the list for recruitment is developing a competitive compensation package.
ASCs should be conducting regular market analysis to ensure their compensation package is competitive within the industry and their specific region. The package includes not just base salary but also bonuses and comprehensive benefits packages that consist of health insurance, retirement plans, paid time off, continuing education allowances, and malpractice insurance.
Although it’s still considered taboo in many circles to discuss one’s salary with others, Ms. Syme says, many of today’s CRNAs are abandoning that practice. Fully aware of the strength of their bargaining position, many share the details of their compensation packages with colleagues at other practices. This puts pressure on ASCs to offer the same or better benefits packages to compete for top talent.
According to the MGMA 2023 Provider Compensation and Production Survey Report, anesthesiologist pay increased 15%, and CRNA pay increased 4.4% from 2021 to 2022. As a result, average anesthesiologist compensation is now nearly $500,000 per year, while CRNAs are commanding an average of $214,200 in 2023, up from $181,040 in 2019.2 In some cases, CRNAs are commanding anywhere from $250,000 to $300,000, depending on market, says Cassie Syme, a consultant with Progressive Surgical Solutions, a division of VMG Health.2
“You absolutely have to be competitive financially,” Mr. Chambers says, noting that ASCs may even have to guarantee their providers a full day’s salary even if the caseload isn’t there — which can be a challenge for smaller ASCs. “The way we function, we have some pretty good margin for paying our CRNAs well, and because we don't use general anesthesia they don’t have to go into the OR with the cataract surgeon.”
Key-Whitman employs four part-time CRNAs.
Retention: Leverage the Power of Positivity — and Flexibility
Creating a positive work environment is essential for retaining anesthetists. Strategies include fostering a supportive and collaborative culture where they feel valued and respected. Encouraging open communication and providing them with opportunities to voice their concerns and suggestions is particularly effective, says Ms. Syme.
To this end, involve providers in decision-making processes related to the practice, policies, and other relevant areas. This inclusion promotes a sense of ownership and investment in the ASC’s success.
“Include them on figuring out the best way to provide anesthesia services in that facility,” Ms. Syme says. “The way that it's all set up, the way pre-op should go. Does all that land on the head of the CRNA, or are other staff involved? It’s about making them feel like they are a cohesive unit with the ASC.”
Promoting a healthy work-life balance by offering flexible schedules and manageable workloads is another effective way to recruit and retain anesthetists.
“Be as supportive as possible and offer a flexible work environment, because a lot of CRNAs appreciate that,” Ms. Syme says. “I have found that that a flexible work schedule is key. I've worked with a lot of women CRNAs who have families, and they want to be able to take their kids to baseball practice or attend their child’s school play. So that flexibility where they can share schedules is huge.”
It’s also important to avoid overburdening anesthetists with excessive workloads. Burnout and stress are significant challenges in the healthcare industry, particularly for anesthesia providers. ASC leaders should provide access to mental health resources, such as counseling services, stress management programs, and wellness initiatives.
Flexibility is also important with respect to employment itself. According to Ms. Syme, some anesthetists prefer to work as 1099 contractors, while others want to be part- or full-time employees. There are benefits for both.
“With 1099 contractors, it’s their own business. They can write things off — mileage, clothing. There’s a lot they can do. And then you have the other side of the coin, CRNAs who want to be employed because of the benefits package, the insurance. It’s important to look at what they would like, and how they want to be employed. That’s another piece of the puzzle.”
Conclusion
Recruiting and retaining skilled anesthesia providers in ophthalmic ASCs requires a multifaceted approach. By offering competitive compensation, a positive work environment, and flexible working conditions, ASC leaders can up their chances of attracting and retaining top anesthetist talent. These strategies not only enhance the center’s operational efficiency, but also ensure the delivery of high-quality, patient-centered care. OASC
References:
1. Kaplan KC, Polanco K. Where Have All the Anesthesia Specialists Gone? Insights for Healthcare Leaders. Posted October 12, 2023. https://www.veralon.com/where-have-all-the-anesthesia-specialists-gone-insights-for-healthcare-leaders. Accessed June 11, 2024.
2. Wallace C. 7 CRNA updates in 2024. Becker’s ASC. Posted June 12th, 2024. https://www.beckersasc.com/anesthesia/7-crna-updates-in-2024.html?utm_campaign=asc&utm_source=website&utm_content=latestarticles. Accessed June 12, 2024.
