This analysis synthesizes 4 sources published the week ending Oct 23, 2026. Editorial analysis by the PhysEmp Editorial Team.
Three in four surgery centers now report adequate access to anesthesia providers, the best reading in four years of industry surveys. In the same weeks, trade coverage described centers ending contracts with physician anesthesia groups and hiring CRNA-only groups to hold costs down. Both are true at once. Together they show a hiring market inside ambulatory surgery that is being reorganized rather than relieved, and for anyone tracking Physician & Advanced Practice Jobs, the useful question is who gets hired into which model, and on whose terms.
An access score that improved while the complaints stayed put
The Ambulatory Surgery Center Association’s third-quarter survey, which drew 307 centers in 44 states, found that 76% reported adequate access to anesthesia providers. That compares with 70% in 2024, 64% in 2023 and 56% in 2022. Nearly one center in four still falls short.
The same respondents named limited provider availability (81%) and high cost (66%) as the leading barriers to keeping anesthesia in place. Among centers struggling to retain providers, 75% said it affected procedure volume, unchanged from 2024. Better access and the same complaints can coexist when centers are finding clinicians by paying for them, and the money is changing form. Flat subsidies fell to 15% of assistance arrangements from 27% in 2023, while stipend contracts (51%) and collections guarantees (29%) held roughly steady, and 31% of centers offer some financial assistance at all.
A rising access score and a persistent availability complaint fit together once cost is counted. The survey measures whether coverage exists, not what the center pays for it or which kind of clinician ends up providing it.
Headlines about the survey tend to read 76% as a shortage easing. That reading skips the cost side entirely, and the cost side is where hiring decisions are actually being made.
The model with the best access is the one fewest centers use
Centers staffed only by anesthesiologists reported adequate access 88% of the time, against 72% where anesthesiologists supervise CRNAs or anesthesiologist assistants. Yet only 21.5% of respondents use the anesthesiologist-only model. Supervised care teams account for 36.2%, CRNA-only groups for 30.9%, and other arrangements for 11.4%.
The survey does not show that the model produces the access. Anesthesiologist-only centers were also the least likely to offer financial incentives, at 17% against 31% overall, which hints that they may be the sites where recruiting is easy to begin with. Size cuts the same way: 85% of centers with one or two rooms reported adequate access, versus 70% of those with five or more, and 43% of the large centers offer assistance. Bigger sites pay more and still report less comfort.
CRNA-only groups arrive after someone leaves
Becker’s reporting on ASCs moving to CRNA-only models gives the pattern a human shape. A Seattle-area ENT group, Proliance Surgeons, switched in late 2024 after its physician anesthesia group could not staff the centers consistently and declined to renew; other physician groups had asked for billing rights and daily stipends. In Niagara Falls, New York, the anesthesiology group left and no local group would take the center. The center now closes Fridays, runs four full days, has stopped pediatric cases and hired three ICU nurses. Its surgeons supervise the CRNAs, a role their administrator said they did not initially want.
In both examples the CRNA-only model followed a physician group’s departure rather than a menu choice. Part of today’s CRNA hiring demand is what remains after anesthesiologist groups step back from sites they cannot staff.
The pay arithmetic explains why that is not a pure bargain. CRNA pay rose 59% from 2019 to 2026 while anesthesiologist pay rose 29%, according to figures cited in that report. Marit Health puts average total compensation at $565,071 for anesthesiologists and $290,002 for CRNAs, so a wide gap remains, but one anesthesiologist quoted warned that CRNA salaries are approaching unsustainable levels. The share of centers expecting to pay anesthesia stipends climbed from 28% in 2024 to 44% in 2025, per VMG Health. A center that goes CRNA-only to save money is buying into a labor market where its new hires have more bargaining power each year.
Supervision rules and case acuity set the ceiling
Twenty-seven states have opted out of the federal physician supervision requirement, with Vermont and Ohio joining in July 2026 and Washington, D.C. in September. An opt-out removes only the federal condition. It does not widen CRNA scope under state law, and the American Society of Anesthesiologists points out that states using words such as collaboration or direction still expect physician involvement. In states that have not opted out, including New York, the operating surgeon can serve as the supervising physician at an ASC, which fits the role Niagara’s surgeons now hold.
California shows the enforcement risk. Regulators cited a Modesto surgical hospital for using CRNAs in place of anesthesiologists, and a second Modesto hospital received an immediate jeopardy citation from CMS for CRNA-led sedation. The California Association of Nurse Anesthesiology sued the state health department on October 1 and says the enforcement led to nearly 1,000 canceled procedures. Acuity adds pressure from the other direction: CMS added 560 codes to the ASC covered list for 2026, including ablations, coronary interventions and posterior lumbar interbody fusion, and one anesthesia group leader cautioned that a CRNA group that was doing fine may struggle as sicker patients move into ASCs.
For anesthesiologists, that points toward ASC work that is defined by acuity and hospital-grade skills; the group leader quoted requires every anesthesiologist, cardiac specialists included, to work in both settings. For CRNAs, it points toward bargaining power with centers that have few alternatives. For surgeons, it points toward contract language about who carries supervision responsibility.
What to watch in the next survey
Three numbers will show which way this is heading: the 24% of centers still without adequate access, the 30.9% running CRNA-only groups, and the 44% expecting to pay stipends. If the CRNA-only share rises while reported access holds near 76%, the cost-driven model is working on the metric centers track, and the pay gap between the two professions will narrow faster than it has. If access slips back while stipend expectations keep climbing, the improvement was bought, and centers will have been paying more for the same coverage.
Sources
The dilemma behind ASCs’ CRNA-only shift – Becker’s ASC Review
Which ASCs are being hit harest by the anesthesia crisis? – Becker’s ASC Review
ASCs that rely solely on anesthesiologists report higher access – Becker’s ASC Review
Flat anesthesia subsidies drop nearly 50% in 3 years – Becker’s ASC Review