By Randy Moore, CRNA, MBA

I joined Joe Rodriguez on Anesthesia Deconstructed this month for a wide-ranging conversation about what really broke the anesthesia market and where it’s heading.

The discussion built on themes from my piece What Really Broke the Anesthesia Market. The central point: this wasn’t a sudden implosion. It was a predictable failure of workforce planning, accelerated by COVID and magnified by the No Surprises Act.

A few highlights:

• We saw it coming. By 2013–2014, the supply-demand imbalance was obvious if you looked at demographics and surgical volume trends.
• Why no action? Same reason most strategies fail: no ownership, no prioritization, no resources. Nobody "owned" the CRNA workforce problem.
• Hospitals run ORs like a bake sale. Surgeons drive volume, administrators chase market share, and anesthesia eats the inefficiency. Until incentives align, dysfunction wins.
• COVID was an accelerant. It accelerated surgical migration to ASCs and reset workforce expectations almost overnight.
• NSA flipped the leverage. Before the No Surprises Act, out-of-network status gave groups negotiating power. Post-NSA, insurers hold the cards, and groups lost leverage almost instantly.

We also went personal. I talked about the cost of unchecked ambition, running too hot for too long, and learning to be more intentional about the people I choose to build with.

Signal: No one is coming to fix this for us. Strategy only matters if someone takes ownership, commits resources, and leans into the hard problems early. Otherwise, we are stuck waiting until there is blood in the water.