Is an ASC right for you?
By Scott Wiesenberger, MD
Whether you are starting out in your anesthesia career or looking for a change of pace, you may be thinking: Is an ambulatory surgery center (ASC) the right environment for me? ASCs are dynamic health settings that have seen tremendous change in recent years. Broadly speaking, ASCs are free-standing facilities that focus on same-day procedures for patients expected to be ambulatory and usually able to return home without an overnight stay. Through constant innovation of invasive surgical techniques, the nature of the ASC is transforming. This has rippling effects for the anesthesia clinical team and presents a unique set of challenges and opportunities.
If you are evaluating a position at an ASC environment, or considering the opportunity to be cross-credentialed at a hospital and ASC, here are some key points to consider.
How has the ASC environment changed in recent years?
An ASC used to be a place where straightforward, low-risk procedures occurred outside of a hospital setting. Clinicians could depend on a typical schedule and case mix and saw ASCs as a lower-stress environment. In the past decade, we have seen a dramatic shift in patient caseload and acuity at surgery centers. ASCs have proved themselves able to handle the care of sicker patients and more complex surgeries safely and efficiently. This has led to an increase in procedures moving to the ASC setting, especially for orthopedics, spine, urology, and gastrointestinal. With this change comes a greater demand on the anesthesia team—the likelihood of extended case times, less predictable shift end times, and faster turnaround times.
In some ways, the nature of an ASC can make it more challenging than a hospital. ASC anesthesia teams are not supported by anesthesia technicians; all inventory and restocking responsibilities fall solely on the ASC anesthesia team. Additionally, ASCs do not include post-call days for procedures that run long. However, ASC schedules typically have no nights, no (or limited) weekends, no holidays, and no call.
Who makes up the team at a modern ASC?
Modern ASCs require a fluid, skilled, and efficient workforce. ASCs attract physician anesthesiologists, certified registered nurse anesthetists (CRNAs), and certified anesthesiologist assistants (CAAs) (in states where CAAs practice) who are interested in fast-paced environments, seek more independence, have an interest in specialization, and whose work-life balance allows for greater flexibility. In a week, an ASC site may experience an increase in pediatric patients one day and see a high regional anesthesia case load the next day. To stay agile, ASCs benefit from a diverse staffing pool of core full-time clinicians, cross-credentialed clinicians, and independent contractors. This allows a team to maintain stability as staffing needs vary for the increasing demands of higher acuity care.
How can I evaluate a prospective ASC role?
It is important to remember that every facility is different—with different patient populations, different case mixes, and different personalities. Successful ASCs should value transparency in the hiring process. If you are considering an ASC position without a recent background in the environment, make sure you have ample opportunities during the interview process to speak with the chief CRNA or chief physician anesthesiologist. You can and should expect to be fully supported through your interview and onboarding periods.
Ask questions about what is different at this ASC in comparison to your current health setting and seek advice from your peers. At NAPA, when we bring new members onto the team, we invest in them from the beginning and make sure they go through an orientation and training before they are in an operating room alone. Even when we are short-staffed and eager to have a new clinician begin independent practice, we know it is important to give that person time to become familiar with the center, the clinical expectations, the surgical team, and the patient population. At the end of the day, we want all team members to embrace open-mindedness, we want them to know what they are taking on, and we want to put them in a position for long-term success.
All health settings are critical to patient care. ASCs are an exciting and evolving environment that come with a distinct lifestyle and expectations. If an ASC is in your future, get to know the team, the setting, and the role you will be stepping into. Understand how the ASC environment has changed at the site, and how it is different from your current experiences in a hospital, office, or ASC, so you can be sure the career transition is right for you.
Scott Wiesenberger, MD, serves as NAPA’s Area Vice President for Maryland in the Mid-Atlantic region. He received his medical degree from the University of Miami School of Medicine. He completed his internship in internal medicine at Johns Hopkins at Sinai Hospital and his anesthesia residency with the University of Miami at Jackson Memorial Hospital. He is a Diplomate of the American Board of Anesthesiology and has been practicing in the ASC setting since 2010.