Provider shortage of Anesthesiologists and CRNAs. 6,000 Anesthesiologists retired in 2020. CRNAs utilized independently in greater number of facilities

Utilization of greater ratios of Physicians to AA/CRNAs for higher leveraged care team models 

Increasing employment of anesthesia providers by hospitals, ASCs and systems

Movement of surgical procedures to facility owned ASCs – elimination of CMS prohibited outpatient procedures

COVID related retirements are exacerbating the problem short term

Several states made independent practice waivers permanent

Commercial insurance companies are reducing rates, canceling contracts.