How the anesthesia shortage is impacting orthopedics


The anesthesiologist shortage is affecting every area of healthcare, and orthopedics is no exception.  

Three orthopedic surgeons connected with Becker's to answer, "How has the anesthesia shortage impacted the orthopedic industry?"

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: Is consolidation a threat to orthopedic practices?

Please send responses to Riz Hatton at by 5 p.m. CST Thursday, Feb. 22.

Note: These responses have been lightly edited for length and clarity.

Matthew Levine, MD. Orthopedic Physician at the Centers for Advanced Orthopaedics (Bethesda, Md.): The anesthesia shortage has had an impact on orthopedics in several ways.  

First, the anesthesia shortage creates difficulty when scheduling cases at multiple facilities, including hospitals and ambulatory surgical centers. If physicians can’t schedule cases, it is harder to manage trauma and acute injuries through hospital systems, and patient care is delayed.

Due to the shortage, hospitals and ambulatory centers bring in anesthesiologists or other advanced practitioners through anesthesia staffing services. Working with an unfamiliar team can result in weaker outcomes or difficulties in the operating room.  

In addition to trouble in administration and the operating room, the anesthesia shortage impacts surgery centers financially. Without enough anesthesia, physicians will have to cancel procedures. This means fewer patients get the care they need, and the surgery center generates less income.

Hooman Melamed, MD. Orthopedic Spine Surgeon at the Spine Pro (Beverly Hills, Calif.): I don't think we have an anesthesia problem. The issue is reimbursements. So many hospitals have cut down on anesthesia pay, and I know many good experienced anesthesiologists who have gone into freelancing and doing surgery center work instead. They literally are getting paid twice as much as if they were to work for a hospital if the hospitals will reimburse.

A lot of these experienced anesthesiologists would be happy to come back if, and only if they are reimbursed more appropriately. They cannot be getting paid the same as a nurse anesthetist, and expect them to do the same work.

Brett Shore, MD. Orthopedic Surgeon at DISC Sports & Spine Center (Marina del Rey, Calif.): As a practicing orthopedic surgeon who is married to an anesthesiologist (who is also the medical director of DISC Sports & Spine Center in Marina del Rey), I have unique insight into this topic. Thanks to advancements in pain management and regional anesthesia, a large percentage of orthopedic surgery is performed on an outpatient basis, much of it in ambulatory surgery centers throughout the country. ASCs function safely and efficiently when there are close internal working relationships between surgeons and anesthesiologists. An internal anesthesia group that is well-versed in protocols surrounding outpatient orthopedic surgery, and that is able to provide consistent, reliable regional anesthesia, is critical to running a successful ASC.

One of the challenges in operating an ASC is variability in case volume throughout the year (and even through the week). Because of the shortage of anesthesiologists nationwide, it can be difficult to fully staff these ASCs on a consistent basis, resulting in both unused operating rooms and delays in patient care.

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