Anesthesia staffing shortage: what hospital leaders need to know

The anesthesia staffing shortage is not a post-pandemic blip. Federal projections show the anesthesiologist workforce shrinking while demand grows, and the cost of that gap lands on hospital budgets.

Leaders who know the numbers, and who have their own coverage model, negotiate from a stronger position than those who wait for the next subsidy request.

How big is the anesthesia staffing shortage?

Start with anesthesiologists. The Health Resources and Services Administration (HRSA) projects national supply falling from 55,750 full-time equivalents in 2023 to 50,560 in 2038. Over the same period, demand rises to 61,220.¹ That is a projected anesthesiologist shortage of 10,660 by 2038.

Training more residents helps, but not enough. HRSA's "more graduates" scenario still puts 2038 supply at only 52,980. If anesthesiologists retire earlier than expected, supply drops to 48,490.¹

The CRNA shortage is more uneven. HRSA projects national nurse anesthetist supply growing faster than demand over the next decade. Metropolitan areas are short today, though: 53,030 nurse anesthetists against demand for 56,170 in 2026. HRSA's model does not close that metro gap until 2034.¹

One more point on the HRSA figures. They start 2023 with supply and demand in balance. Facilities did not feel balanced. In an American Society of Anesthesiologists (ASA) analysis, the share of facilities reporting an anesthesia staffing shortage rose from 35% in early 2020 to 78% in late 2022.²

Why demand for anesthesia keeps rising

Three forces push demand up.

An older population. The Census Bureau projects that the share of Americans 65 and older will surpass the share under 18 in 2029.³ ASA lists an aging patient population and growing procedural complexity among the drivers of demand.²

Anesthesia outside the operating room. Endoscopy suites, cath labs and interventional radiology all need anesthesia coverage, and they draw on the same clinicians as the OR. In national registry data, the share of anesthesia cases performed outside the operating room rose from 28.3% in 2010 to 35.9% in 2014.⁴ Every new procedural site competes for the same people.

Steady job growth. The Bureau of Labor Statistics projects nurse anesthetist employment to grow 10% from 2025 to 2035, from 54,500 jobs to 59,800.⁵

Why supply is slow to respond

Anesthesia clinicians take years to train, and the CRNA pipeline has lengthened.

Since January 1, 2022, every student entering an accredited nurse anesthesia program must be enrolled in a doctoral program.⁶ Accreditation standards require at least one year of full-time critical care nursing experience before admission, then a minimum of three years of full-time study.⁷ A student who starts this fall will not be ready to practice for at least three years.

Meanwhile, burnout is thinning the current workforce. In a November 2022 survey of ASA attending members, 67.7% of anesthesiologists were at high risk for burnout, and 78.4% had recently experienced staffing shortages. The factor most strongly linked to burnout was perceived lack of support at work.⁸

People who burn out tend to leave. In AMA survey data for 2025, 42.2% of anesthesiologists reported at least a moderate likelihood of leaving their organization within two years. That was the second-highest rate of any specialty. The average across all physicians was 31.1%.⁹

ASA describes the result as a spiral: heavier workloads drive stress and retirements, which make the workload heavier for those who stay.²

What the shortage costs hospitals

Scarcity shows up in pay first. BLS data put mean annual pay for nurse anesthetists at $181,040 in May 2019¹⁰ and $248,320 in May 2025.¹¹

That cost does not stay with the anesthesia group. When a group's billing revenue does not cover the cost of staffing the rooms a hospital asks for, the difference comes back as a subsidy request.

When permanent staff cannot be found, locum tenens coverage fills the gap at a premium, and that premium tends to show up in the next contract conversation.

The shortage also shifts negotiating leverage. A group that can credibly say it cannot recruit holds a strong hand when it asks for more money or fewer covered locations. A hospital with no alternative plan holds a weak one.

How hospital leaders can respond

Hospitals cannot fix the national pipeline. They can control how efficiently they use the clinicians they have.

Design the anesthesia care team model on purpose. Under Medicare rules, an anesthesiologist can medically direct two, three or four concurrent cases staffed by CRNAs, anesthesiologist assistants or residents. Beyond four, payment falls to the lower medically supervised rate.¹² The ratio drives cost. In a 10-room suite, 1:2 medical direction takes five anesthesiologists, 1:3 takes four, and 1:4 takes three. The right ratio depends on case mix and acuity. Set it with your clinical leaders instead of inheriting it.

Consider anesthesiologist assistants where state law allows. Certified anesthesiologist assistants (CAAs) work within the anesthesia care team under the supervision of physician anesthesiologists.¹³ Counts differ by source; the ASA lists 24 jurisdictions where CAAs may practice.¹⁴ Our explainer on care team ratios has the current picture. Supervision ratios vary by state, so confirm current law before you plan around them.¹³

Match coverage to actual demand. Staff the rooms you actually run, by hour and by day, rather than the rooms on the block schedule. If rooms staffed until 5 p.m. routinely finish at 2, you are paying for idle coverage.

Consolidate low-volume sites and hours. Every anesthetizing location you ask a group to staff carries a cost, whether it runs cases or not. Where volume is thin, consolidating sites or trimming late-day and weekend room commitments can save more than a rate negotiation.

Treat retention as a shared job. Burnout research points to support at work as the strongest factor.⁸ A survey of rural nurse anesthetists found salary was the top retention factor, but guaranteed time off, feeling valued and colleague morale also mattered.¹⁵ Predictable schedules and a workplace where clinicians feel supported are levers hospitals and groups can pull together.

Have your own model before the group's letter arrives

Many hospitals learn about their anesthesia economics when a letter arrives asking for a higher subsidy or fewer covered rooms. By then the group has done its analysis, and the hospital has not.

Build yours first. Know your case volume by site and hour. Know what your current care-team ratio costs, and what the alternatives would cost. Know the true cost of each staffed location and how much coverage you actually need. With that in hand, a request becomes a negotiation instead of an ultimatum.

Sources

1. Health Resources and Services Administration, National Center for Health Workforce Analysis, "Workforce Projections (FY2025 full data download, 2023–2038)," HRSA Data Warehouse, December 2025. https://data.hrsa.gov/topics/health-workforce/nchwa/workforce-projections ↩ ↩² ↩³

2. American Society of Anesthesiologists, "Anesthesia Workforce Shortage Poses Threat to Health Care," ASA News Release, June 2024. https://www.asahq.org/about-asa/newsroom/news-releases/2024/06/anesthesia-workforce-shortage-poses-threat-to-health-care ↩ ↩² ↩³

3. U.S. Census Bureau, "U.S. Population Projected to Begin Declining in Second Half of Century," Census Bureau Press Release, November 2023. https://www.census.gov/newsroom/press-releases/2023/population-projections.html ↩

4. Nagrebetsky A, Gabriel RA, Dutton RP, Urman RD, "Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis," Anesthesia & Analgesia, April 2017. https://pubmed.ncbi.nlm.nih.gov/27918331/ ↩

5. U.S. Bureau of Labor Statistics, "Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners," Occupational Outlook Handbook, August 2026. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm ↩

6. Council on Accreditation of Nurse Anesthesia Educational Programs, "Position Statements," COA, undated. https://www.coacrna.org/about-coa/position-statements/ ↩

7. Council on Accreditation of Nurse Anesthesia Educational Programs, "Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate," COA, May 2025. https://www.coacrna.org/wp-content/uploads/2025/08/Standards-for-Accreditation-of-Nurse-Anesthesia-Programs-Practice-Doctorate-May-2025-Effective-Date-January-2026-1.pdf ↩

8. Afonso AM, Cadwell JB, Staffa SJ, Sinskey JL, Vinson AE, "U.S. Attending Anesthesiologist Burnout in the Postpandemic Era," Anesthesiology, January 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10751072/ ↩ ↩²

9. Sara Berg, American Medical Association, "Physicians in These 10 Specialties Are Less Likely to Quit," AMA, May 2026. https://www.ama-assn.org/practice-management/physician-health/physicians-these-10-specialties-are-less-likely-quit ↩

10. U.S. Bureau of Labor Statistics, "Occupational Employment and Wages, May 2019: 29-1151 Nurse Anesthetists," Occupational Employment and Wage Statistics, May 2019 estimates. https://www.bls.gov/oes/2019/may/oes291151.htm ↩

11. U.S. Bureau of Labor Statistics, "Nurse Anesthetists, Annual Mean Wage, National (Series OEUN000000000000029115104)," BLS Public Data API, May 2025 estimates. https://api.bls.gov/publicAPI/v2/timeseries/data/OEUN000000000000029115104 ↩

12. Centers for Medicare & Medicaid Services, "Medicare Claims Processing Manual, Chapter 12, Section 50: Payment for Anesthesiology Services," CMS Internet-Only Manual (Rev. 13316), July 2025. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf ↩

13. American Society of Anesthesiologists, "Statement on Certified Anesthesiologist Assistants (CAAs): Description and Practice," ASA Standards and Practice Parameters, October 2022. https://www.asahq.org/standards-and-practice-parameters/statement-on-certified-anesthesiologist-assistants-description-and-practice ↩ ↩²

14. American Society of Anesthesiologists, "Certified Anesthesiologist Assistants," ASA Advocacy, September 2025. https://www.asahq.org/advocating-for-you/anesthesiologist-assistants ↩

15. Wilbanks BA, Effinger B, "Workforce Assessment of Nurse Anesthetists to Mitigate Intent to Leave and Improve Labor Participation," Journal of Nursing Administration, March 2025. https://pubmed.ncbi.nlm.nih.gov/39970027/ ↩