Recently, an ASC in Niagara Falls, N.Y., lost its anesthesiology group, moved to a CRNA-based model and gave up Fridays and pediatric cases to make the math work. With CRNA pay up 59% since 2019 and reimbursement lagging, utilization targets and schedule design are changing what CRNA jobs look like.
Note: the NP/PA pillar page (/nurse-practitioner-physician-assistant/) did not load, so the opening links the Physician & Advanced Practice Jobs pillar instead.
This analysis synthesizes 5 sources published the week ending Oct 17, 2026. Editorial analysis by the PhysEmp Editorial Team.
An outpatient surgery center in Niagara Falls, N.Y., now runs four days a week instead of five, no longer operates on children, and has its surgeons supervising anesthesia they were never trained to give. None of that was a strategic choice. It is what the anesthesia shortage looks like once it reaches a center too small to bid for scarce clinicians, and it says more about the CRNA side of Physician & Advanced Practice Jobs than any salary table does.
The Ambulatory Surgery Center of Niagara lost its anesthesiology group roughly two years ago, after payer reimbursement stopped making the contract worthwhile. Administrator Kimberly Fullone told Becker’s that no local group would replace it: low-paying eye cases cannot compete with hospital work or larger surgical cases, and groups short on staff have become choosy. “They don’t have the manpower to pick up other centers,” she said. The center moved to a CRNA-based group that bills payers directly, and its case volume fell.
The schedule bends before the payroll does
The detail that matters most for job seekers sits in a companion piece on how the center made CRNA economics work. It closed Fridays and packed cases into four full days. Surgeons who used to run half days or leave block time empty were told to fill their blocks or lose them. “If you only have a half day, we can’t run the room,” Fullone said.
That is a labor-cost decision dressed as a scheduling one. The same article cites Marit Health and AANA figures showing CRNA salaries rose 59% from 2019 to 2026, from $181,000 to $288,000, while a Veralon report put anesthesiologist pay growth at 29% over the same stretch. Fullone’s summary of the reimbursement side was blunt: “What the insurance is reimbursing does not even cover what they need to pay their CRNAs.” When a center cannot raise revenue per case, the only lever left is making sure every paid anesthesia hour has a patient in it.
Hospitals are hearing the same message from consultants. A white paper from Surgical Directions and Ventra Health, covered by Becker’s under the headline “Anesthesia’s hidden $4M cost,” recommends an adjusted OR utilization target of about 75%, against the 50% to 65% it says many hospitals run. Its example: 23 operating rooms carrying about $2,300 a day in fixed anesthesia overhead per staffed room, which it estimates leaves $4 million a year in unused anesthesia capacity. One of its recommendations is to match OR, non-OR and after-hours coverage to actual demand before adding premium labor.
Most coverage of the anesthesia shortage counts missing clinicians. The quieter cost shows up as missing days and missing case types. A center that drops Fridays and pediatric cases does not post a vacancy, so the shortage never registers in the job-posting data many analysts watch.
What the CRNA-only job actually looks like
For CRNAs, the shift has an obvious upside. More ASCs are moving to CRNA-only models as anesthesiologist coverage thins, and at least some administrators describe it as permanent. Dan Zahumensky, who runs Proliance Surgeons’ ENT service line in the Seattle area, switched after his provider could not cover the summer for lack of anesthesiologists. “I don’t see a reason to abandon CRNAs and restart recruitment of anesthesiologists only,” he said.
The role that results is different from a care-team job in a hospital, and candidates should evaluate it that way. At Niagara, surgeons supervising CRNAs must hold ACLS certification, most nurses now do too, the center hired three ICU nurses, rebuilt its code cart with dosing for every emergency drug, and ran mock codes with an outside trainer. That is a center trying to back up its anesthetists. It also means the CRNA’s practical scope is set by the surgeons’ comfort level, not only by state law. The center stopped pediatric surgery because its strabismus surgeon was not comfortable supervising outpatient pediatric anesthesia. Fullone was explicit that the issue was surgeon readiness, not CRNA skill: “We love CRNAs.”
So the questions worth asking in an ASC interview are concrete. Who supervises, and how do they feel about it? Which case types have already been dropped, and which might be next? Is the schedule four long days, and are surgeons held to full blocks? A compressed week can be a draw for some clinicians; a half-empty one is a warning sign about the center’s finances.
The paycheck headlines point in two directions at once. CRNA pay is up 59% since 2019, yet PhysEmp reported Oct. 12 that nonacademic starting offers fell nearly 18% in a year. Both can be true when employers stop paying scarcity premiums and start redesigning the work instead.
That second figure comes from our earlier look at regional pay, and it fits this week’s reporting. If reimbursement cannot cover rising salaries, employers will push on utilization and schedule design first, and on starting offers next. CRNAs comparing offers should weigh total annual hours and case mix alongside base pay.
The pipeline answers are small and slow
The Niagara story cites projections of a shortage of roughly 12,500 CRNAs by 2033 and 6,300 anesthesiologists by 2036, with nearly 57% of practicing anesthesiologists 55 or older. This week’s supply-side news does not touch numbers like that. Florida International University and Baptist Health South Florida announced a four-year anesthesiology residency whose first class starts in July 2027, meaning its graduates reach the market around 2031. On the CRNA side, a Chicago coaching company, The Mindful CRNA, is launching a three-call “bootcamp” on Oct. 21 to help applicants and students handle the pressure of nurse anesthesia training. Founder Amanda Kay says she has mentored more than 700 aspiring nurse anesthetists; the company has no affiliation with any program.
Retention help for students has value, since every resident who finishes is one more clinician. But neither announcement changes what a small ASC can hire in 2027, which is why the operational fixes are arriving first.
The number to watch is utilization. If the 75% OR target becomes the standard that hospitals and ASCs manage anesthesia against, expect more CRNA postings built around four-day, full-block schedules and fewer built around flexible half days, and expect lower-paying specialties such as ophthalmology to keep losing anesthesia coverage first. Pediatric outpatient cases are the access gap to track: Niagara was one of only two local sites doing pediatric strabismus surgery before it stopped.
Sources
Why this ASC closed Fridays to make CRNA math work – Becker’s ASC Review
Why this New York ASC had to drop cases following an anesthesia exit – Becker’s ASC Review
Anesthesia’s hidden $4M cost – Becker’s ASC Review
FIU, Baptist Health launch anesthesiology residency program – Becker’s ASC Review
CRNA ‘bootcamp’ targets pressure of nurse anesthesia school – Becker’s ASC Review