The field of anesthesiology has experienced significant growth and transformation in recent years. Medical advancements have redefined the healthcare landscape, and patient safety is at the forefront of current efforts toward continuing progress. Moreover, the changing landscape of healthcare financing has posed financial challenges for ambulatory surgery centers and hospitals (1). Within these trends and others, such as debates around scope-of-practice, anesthesiology is also evolving.
Anesthesiologists’ roles have expanded beyond the operating room, extending into the broader postoperative care continuum. Anesthesiologists now play an essential role in preoperative patient assessment, intraoperative management, and postoperative pain control (2). This trend in anesthesiology has significant benefits for continuity of care and patient safety. In particular, the impact of investing more time and resources in preoperative patient assessment cannot be understated. Effective preoperative assessment and prehabilitation of high-risk patients before surgery help ensure safe and successful surgeries, reducing healthcare costs and hospital readmissions (2).
In a similar vein, anesthesiologists have become increasingly more involved with chronic care, pain management, and critical care in addition to their roles in acute surgical care (3). As a result, finding new models of healthcare payment that enable anesthesiologists to fully participate in the continuum of perioperative care is important for optimizing patient outcomes (3). For example, a value-based model may be able to give anesthesiologists more freedom to engage with preoperative assessments, postoperative pain management, and chronic care without needing to be directly compensated for every task (3).
Expanding anesthesiologists’ roles beyond the operating room goes hand-in-hand with increasing collaboration between anesthesiologists, other specialties, and nurse anesthetists. One of the broader medical trends that affects anesthesiology is increasing coordination in perioperative care, with the goal of reducing patient mortality and morbidity due to the physiological trauma of surgery (3). For example, ensuring a seamless transition of care between different providers can help reduce morbidity and mortality due to handoffs (2).
Finally, financial challenges and staffing shortages at healthcare facilities are influencing trends in the field of anesthesiology (5). Staffing shortages remain a major challenge since the start of the COVID-19 pandemic (5). Consequently, facilities are incentivized to provide competitive salaries and benefits to attract and retain nurses, surgical techs, and anesthesiologists (5). Meanwhile, an aging domestic population has resulted in an upward trend in the portion of procedures that are covered by public payers such as Medicare and Medicaid (1). The reality is that governmental payers are typically insufficient on their own to fund the operational costs involved with running an ambulatory service center, including enough coverage, staff stipends, and necessary healthcare equipment (1). Simultaneously, hospitals and partners of ASCs may devalue the services provided by anesthesiologists, since the specialty doesn’t provide revenue-boosting patient referrals (1).
In response to these financial trends, many ambulatory surgery centers are being acquired by private equity groups or subsidized by healthcare systems, reducing the percentage of ASCs that are physician-owned (5). Payers and employers may be tempted to shift anesthesiologists’ responsibilities to emerging automated technologies in order to cut costs, putting pressure on members of the field to adapt to new technologies (4).
In conclusion, as the field of anesthesiology evolves, anesthesiologists are assuming expanded roles in perioperative care, contributing to improved patient outcomes. However, external pressures from financial concerns, existing payment models, and changing ownership models are putting pressure on ASCs and anesthesiologists. Those working in anesthesiology can adapt to trends in the field by taking on leadership positions within perioperative care, learning to work with emerging technologies, and focusing on making high-quality anesthetic care available to patients of diverse identities.
References
1. Deutch, Zachary. “The Current and Future State of Anesthesiology: Good, Bad, or Indifferent?” ASA Monitor, July 2023, doi.org/10.1097/01.ASM.0000945076.05386.b8
2. Evers, Alex S. and Jeanine P. Weiner-Kronish. “Rolls for Anesthesiologists in the Future of Medicine in the United States.” Anesthesia & Analgesia, vol. 134, no. 2, pp. 231-233. doi: 10.1213/ANE.0000000000005852
3. Kain, Zeev N. et al. “Future of Anesthesiology is Perioperative Medicine: A Call for Action.” Anesthesiology, 2015, vol. 122, pp. 1192-1195. doi: 10.1097/ALN.0000000000000680
4. Rothman, et al. “Anesthesiology 2030: What is the Future?” ASA Monitor, Oct 2021, vol. 85, pp. 8-10. anesthesiaexperts.com/uncategorized/anesthesiology-2030-future/
5. “The Top Trends in Surgery Today.” Outpatient Surgery, AORN, 7 Dec 2022, www.aorn.org/outpatient-surgery/article/the-top-trends-in-surgery-today