Anesthesia 101: Subspecialty Needs

By: Howard Greenfield, M.D.

Critical care. OB. Pain. Cardiovascular. Pediatric. Anesthesia sub-specialties have evolved to address an often complex and challenging subset of patients. Each come with their own set of needs – whether it be staffing, amount of experience or resources – and can have varying degrees of profitability.

Here are a few things to consider for these subspecialties:

Beyond the three years of clinical anesthesia training, anesthesia subspecialists complete a one or two year fellowship in a chosen subspecialty. This higher level of training and experience makes subspecialists desirable. In fact, some surgeons will only work with anesthesia subspecialists in their particular field.

These subspecialties require advanced American Board of Anesthesiology (ABA) certifications which mandate ongoing training and examinations. It is important to have a system in place at your facility to monitor whether your staff is up-to- date on their certifications, and to understand if you have enough certified staff to match your case volume for each service line. Surgeons will often be clear as to their expectations of anesthesia expertise, and will expect the facility to provide specialty trained anesthesia personnel.

Technology and Techniques
Different surgical procedures and anesthesia subspecialties necessitate the use of more advanced monitoring devices during anesthesia preparation and administration. For example, cardiovascular anesthesia now commonly requires intra-operative transesophogeal echocardiography. While most cardiac fellowship-trained anesthesiologists are quite comfortable performing these procedures, many general anesthesiologists are not. Anesthesiologists who are experts with this technology can facilitate efficient completion of cases and will have a positive impact on patient outcomes. Similarly, specific anesthesia devices, techniques and procedures for subspecialties are oftentimes necessary, particularly for neuroanesthesia, high risk OB and pediatric anesthesia.

Beyond ensuring hospitals have the specific anesthesia tools needed for their subspecialty cases, readily available, trained specialists are needed to interpret the data. Keep in mind that all of this equipment and specialized staffing can create logistical headaches, therefore, scheduling must be done by individuals who understand exactly what each procedure will require in terms of both manpower and technology. Your anesthesia provider should work closely with OR nursing to facilitate their staffing to meet your specific subspecialty needs.

Due to their advanced training and differentiated skills, subspecialty-trained anesthesiologists are often 10-20% more expensive than general anesthesiologists. In facilities paying anesthesia subsidies, this can be a meaningful expenditure; however, it must be counterbalanced by the significant hospital contribution margin often achieved by these high-level cases. A business case for investment in specialty-trained providers must consider the potential opportunity to gain local market share and additional cases by offering a stronger support structure for these often complex and challenging service lines.

An accurate accounting of each service line’s case volume will give you invaluable information to help you evaluate if your hospital’s current anesthesia coverage is effective and efficient or if you should explore an alternative model.