Becker's ASC Review

5 ASC MANAGEMENT The retention breakthrough anesthesia needs By Sophie Eydis A nesthesia workforce shortages aren't easing, and raising compensation alone isn't the fix. Across the country, anesthesia leaders say retention hinges less on headline pay and more on culture, schedule control and operational sustainability. Making employees feel valued, not interchangeable, is what ultimately keeps teams stable, industry leaders told Becker's. From predictable staffing models and equitable call structures to meaningful autonomy and visible appreciation, these are the biggest determinants of retention in today's workforce. Editor's note: Responses have been lightly edited for clarity and length. Question: What single change would most improve anes- thesia workforce retention? Rita Agarwal, MD. Clinical Professor of Anesthesiology at Stanford (Calif.) University: e thing that would improve workforce retention in anesthesia is figuring out what your anesthesiologists want. All of us want to feel valued and not like just interchangeable parts. For most, some degree of control over their schedule is a huge bonus and one way to indicate that individuals are valued and important. at may include flexibility in work hours, shi coverage, call trades, availability of part-time or job share options and the ability to get time off when we want it, within reason. I find that I am much happier covering an extra shi/call/colleague if I had the opportunity to volunteer, or refuse, that particular assignment, than if I was forced to take it. Moeed Azam, MD. Head of Innovation at U.S. Anesthesia Partners (Dallas): In one word: Culture. Attention to overall culture would greatly improve retention in clinical settings. at sounds like common sense, but remarkably, it isn't common practice to truly focus on culture. I'd like to give a shout-out to my partner, Kelly LeBlanc, MD, who has led a national culture initiative across our partner practices. She created a culture committee in Houston that has subsequently rolled out across the country. ey provided a platform for CRNA, CAA, physician partner, associate physicians and business staff input. It is a venue to listen to feedback in a safe space. And very intentional, to use that input and implement changes to further improve the clinician experience. Brian Cohen, MD. Administrative Chief of Miami Anesthesia Services: e single change that would most improve anesthesia workforce retention is allowing greater customization of individual scheduling models. While compensation should remain at fair-market value, the current supply–demand imbalance gives clinicians leverage to prioritize work-life balance and schedule control. Groups that structure customizable work-hour packages aligned with individual clinician needs will build greater loyalty and retention than those competing primarily on pay or forcing an all-or-nothing employment package. Neal Cohen, MD. Professor Emeritus of Anesthesia and Perioperative Care and Medicine at the University of California San Francisco: Anesthesia practices and health systems cannot continue to treat anesthesiologists as commodities. Each department should ensure that it functions as a "community" that supports the anesthesiologists, considers and balances the needs of the clinicians as well as patients and the health systems. Whether a full-time physician, locums or part-time anesthesiologists, each should be respected, acknowledged and provided support to ensure that they can practice at the highest level. As their professional life and needs evolve, they should also be provided professional development opportunities that meet their changing professional and personal goals. Katy Dean, CRNA. TKMAnesthesia (Newport News, Va.): e single change most likely to improve anesthesia workforce retention is increasing workforce flexibility through autonomy and scheduling control. Providing CRNAs with greater practice autonomy, including the ability to work at full scope, while offering flexible scheduling and competitive compensation, creates a more sustainable and satisfying practice environment. is integrated approach supports professional fulfillment, reduces burnout and improves work–life balance, which are key drivers of long-term retention. Empowering clinicians with both independence and flexibility ultimately strengthens staffing stability while maintaining high-quality patient care. Aristeidie Diveris, MD. President of Polykarpos Anesthesia (Pleasant Prairie, Wis.): Subsidies are necessary due to the unfortunate inconsistency in surgical case volumes. Christopher Hoeman. CEO of ICON Anesthesia of New England (Middleton, Mass.): Provider price stabilization to reduce and minimize the ever-growing mercenary population. e mercenary market is creating flak and distraction in the marketplace. It creates what I am going to call, the FOMO Effect. Providers hear and see the outrageous rates that some centers are willing to pay to get people and it becomes the unrealistic norm of expectation. Despite getting fair and respectable wages, they fear they are missing out. is only distracts from those facilities that are creating a great culture and environment with solid pay. Price becomes the determinant of value and not relationships; the next shiny thing, money, becomes the thing they are missing out on. Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children's: e most significant change would be implementing flexible, predictable staffing models that give anesthesiologists meaningful control over their schedules and workload, while recognizing them as essential perioperative leaders. Structured flexibility across career stages from early-career growth to late-career sustainability allows physicians to remain engaged as their professional and personal needs evolve. At Phoenix Children's, we have prioritized inclusive scheduling, equitable call structures and physician input into operational decisions, which has strengthened engagement and workforce stability. When anesthesiologists have autonomy and a voice in shaping their practice, burnout declines and long-term retention becomes far more sustainable. Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): Appreciation is the best way to retain people. We all like recognition for our contributions, and will stay where it is given, and even work twice as hard. Everyone values being part of a team and doing something important. Institutional and group leaders can recognize people by putting their pictures in a newsletter or on a bulletin board, listing their achievements in a group email, or simply saying, 'ank you for what you did today, you were a big help.' David LaGuardia. Vice President of Clinical Operations at Sentry- Northstar Anesthesia (Newnan, Ga.): e greatest advancement in improving anesthesia retention lies in empowering CRNAs to practice

• Cover