Healthcare economics have always been defined by the supply of providers and demand for services. Over the past 22 years, the consolidation of healthcare facilities and competition among systems and networks has dramatically increased the demand for anesthesia services. This steady increase in demand and several COVID-related changes in the market have decreased the number of anesthesia providers available for coverage. Anesthesia has become a pawn on the chessboard of American healthcare as facilities have sought to provide more availability to surgeons and proceduralists. So how can hospitals and providers navigate finances during the current provider shortage?