Shocks to the health care system: Economic effects of COVID-19 on anesthesia services

The ongoing outbreak of the novel coronavirus, COVID-19, has had tremendous impacts on all aspects of the economy and society. The United States health care system is undergoing remarkable changes in response to the rapidly increased demand for critical care services. These rapid changes are disrupting the health care sector’s ability to function normally.

In a new article published in the journal Anesthesia & Analgesia, Tiffany Radcliff, PhD, professor of health policy and management and associate dean of research at the Texas A&M School of Public Health, and a researcher from the American Society of Anesthesiologists, shed light on the immediate economic shocks the pandemic had on anesthesiology practices and what might be expected in the future.

“Several quick changes in response to COVID-19 have had an immediate impact on anesthesiologists and their practices. While some of the disruptions are temporary, others will persist over the longer term,” Radcliff said. “Economic shocks are already evident for the supply chain and anesthesia workforce, and some temporary shocks may return with anticipated future waves of COVID-19.”

The first and most challenging impacts are due to the canceling or postponement of non-essential surgical procedures. This reduction has a direct negative financial impact on anesthesiology practices and can lead to workforce reductions for practices that specialize in these types of procedures. “For procedures that are still being performed, different methods of anesthesia may be required to reduce use of medications needed to support patients on ventilators. Nerve blocks and regional anesthesia are other options that can be considered,” Radcliff said. The reduction in non-essential surgeries also leads to an important indirect effect; namely, fewer opportunities to train new anesthesiologists. While reducing the demand for surgical anesthesia, the pandemic has dramatically increased demand for services for anesthesiologists with critical care training.

“Another major disruption to anesthesiology practice is related to the supply chain,” Radcliff said. She pointed specifically to more limited availability of anesthesiology resources such as anesthesia equipment being converted to support the shortage of ventilators, common drugs used in anesthesia delivery and personal protective equipment (PPE). Radcliff and her co-author anticipate that a new supply of ventilators will become available and will remain in hospital inventories after the pandemic, either to replace older equipment or be used as equipment reserves.

A third disruption highlighted in the article looms on the horizon: surges in demand for non-essential procedures that have been delayed by the pandemic. Once the pandemic wanes, procedures that have been postponed will need to be rescheduled along with others. This will lead to an increased demand for anesthesia services.

“There may be some hesitation to schedule or reschedule non-essential elective procedures when initially allowed, which may alleviate concerns about shortages of equipment and supplies that make meeting demand a challenge,” Radcliff said. With anticipated future waves of COVID-19, major disruptions will become less likely, according to Radcliff, as the market adjusts to innovate and develop best practices to prepare for later waves.

Although the current economic shocks the authors identify present important disruptions to anesthesiology practices, they also note that economic shocks are followed by a rapid recovery or a “new normal” once the emergency has passed. Radcliff observed that some anesthesia practices, such as those engaged in critical care, have fared better than others, though risks to provider health and safety are a real concern. The article indicates that longer-term effects on the anesthesia workforce are expected to be positive as medical students and residents could be drawn toward training in areas of anesthesia practice and practice arrangements that better-weathered the current shocks.

For now, the health care sector’s goals are focused on controlling the spread of COVID-19 and ensuring providers have the resources they need. During this challenging time, anesthesiologists have been integral in the response, which leads the authors to conclude that there is an optimistic outlook for anesthesiology practices once the pandemic subsides.