Why Anesthesia Groups Keep Failing
This isn’t bad luck. It’s bad strategy.
Anesthesia did not break because the work got harder. It broke because short-termism was a clever strategy until the ground shifted under everyone’s feet. For years, the model worked well enough. Clinician costs stayed manageable, reimbursement stayed predictable, and quick fixes often looked like smart business decisions.
Then everything changed at once. Clinician costs exploded upward. Reimbursement sank downward. The gap widened so fast that even well-run groups felt a jolt. Short-term thinking, once merely insufficient, suddenly became a liability.
For a long time, anesthesia could get away with reacting instead of leading. But the bill always comes due. And in anesthesia, it just arrived.
I call it what it is: short term expedient, long term stupid.
The Addiction to the Immediate
Short termism is now the default setting in healthcare, but anesthesia has perfected it.
Groups build for the next renewal cycle instead of the next decade. They optimize for cost in a system that punishes cheapness. They tolerate ineffective leaders because confrontation feels harder than the consequences of letting them stay. They talk endlessly about culture and retention while cutting the investments that create both.
This mindset survived only because conditions allowed it to. When contracts were stable and staffing was predictable, the cracks stayed hidden. But stress reveals what comfort conceals. In the last five years, anesthesia’s structural weaknesses have become impossible to ignore.
If you spend a decade making short-term decisions, you should not be surprised when you wake up with a long-term problem.
From Service to Commodity
Anesthesia used to win on trust. It was a professional service defined by skill, reliability, and partnership. The relationship mattered.
Today, anesthesia functions much more like a commodity. Interchangeable. Transactional. Price driven. Hospitals under pressure began shopping for anesthesia like they were buying linen contracts. And many groups made themselves replaceable by acting like vendors instead of strategic partners.
The market rewarded volume and speed. Groups scaled faster than their leadership capacity. Some took on sites they could not support. Many neglected the systems required to sustain high performance.
They grew for the sake of growth, not mastery. And in that process, they lost both.
The Symptoms of Short Termism
You can spot short-term orientation without even looking at the financials. The patterns show up everywhere:
Undisciplined growth and constant site churn
No alignment with hospital surgical or perioperative strategy
Leaders kept in place long after they have demonstrated they cannot lead
No meaningful process for leadership identification, development, or accountability
Poor client relationship management
Win it and forget it contract start ups
Practice models anchored in nostalgia rather than current reality
A quiet acceptance that anesthesia is a commodity and behaving accordingly
Each decision seems logical in the moment. Together, they form a slow-motion collapse.
The Leadership Variable
Here is the part most groups still refuse to grasp: the single most important variable that determines whether an anesthesia practice succeeds or fails is the performance of its site level leaders. Nothing else comes close.
Not market share. Not payer mix. Not even compensation structure.
Leadership.
Strong site leaders stabilize contracts, build trust with hospitals, protect clinical culture, and attract talent. Weak leaders burn trust, drive turnover, and push groups into defensive posture. Yet the industry continues to treat leadership as an afterthought instead of the strategic lever it truly is.
Many organizations say they value leadership development. They put it on slides. They host a workshop. They mention it at conferences. But very few take meaningful steps to develop, support, and evaluate leaders in a systematic way.
The consequences are predictable. Contract losses. Morale problems. Turnover. Strained hospital relationships. Defensive negotiations.
Long term oriented organizations treat leadership as infrastructure. They select carefully. They coach intentionally. They hold people accountable. They transition underperforming leaders out of roles with clarity and pace.
You cannot scale dysfunction. You can only multiply it.
The Real Cost of Short Term Thinking
Short-term thinking never feels like failure in the moment. It feels like relief. You win the contract. Patch the hole. Kick the problem six months down the road.
But every expedient decision adds structural debt. Eventually the system buckles.
We are watching that buckle unfold in real time.
Small and regional groups that operated on thin margins for years have disappeared almost overnight. Many that remain are hanging by a thread, one RFP away from extinction. We have seen large platform groups declare bankruptcy, and more are clearly circling the drain. And still, nearly all of these organizations keep leaning on the same short-term strategy that put them in this position.
Once you see the pattern, you cannot stop seeing it.
Short-term decisions feel easy. Long-term consequences do not.
What Long Term Orientation Actually Looks Like
Long-term orientation is not glamorous. It is steady, disciplined, and often quiet. It does not generate headlines. But it works.
You can recognize it immediately:
Growth that matches leadership capacity and operational capability
Leadership pipelines that identify, develop, and reward high performers
Clear expectations and accountability for site leaders
Client partnerships built on transparency and shared goals
Practice models updated to meet current clinical and economic realities
A culture that values consistency, patience, professionalism, and performance
This approach looks simple from the outside. It is not. It requires courage to slow down when the market pressures you to sprint. It requires clarity to say no when others are saying yes. And it requires a leadership philosophy that treats the next decade as more important than the next renewal.
Long-term orientation is the real strategic moat in anesthesia. Very few have the discipline to build it. Even fewer have the patience to maintain it.
The Long Game
Short term expedient, long term stupid.
If that phrase stings, it probably should.
Anesthesia does not need more buzzwords or transformations. It needs leaders willing to think beyond the next crisis and beyond the next RFP. It needs organizations willing to do the hard work now instead of hoping for a softer landing later.
The real question is not whether you can win a contract. The real question is whether you can keep one without losing your people, your partners, your reputation, or your integrity.
In anesthesia, your time horizon is your strategy. If you choose a short horizon, you have already chosen your ceiling.
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