At first glance, anesthesia looks like any other clinical department. Recruit clinicians. Schedule coverage. Bill for services. Maintain compliance. 

But anesthesia is different — and when hospitals try to fold it into their general infrastructure, cracks appear fast. 

Why Anesthesia Service Line Management is Different 

Unlike other specialties, anesthesia operates at the intersection of nearly every case in your OR schedule, plus an increasing number of NORA (non-operating room anesthesia) procedures. The service line’s performance impacts both patient safety and hospital profitability, every day. 

Recruitment and Retention in Anesthesia Require More Than Pay 

Competitive compensation matters, but so do flexible scheduling, PTO structures, and professional autonomy. Anesthesia providers expect — and need — arrangements that often exceed what’s offered to other employed clinicians. Without these, turnover rises and recruitment costs increase. 

The Complexity of Anesthesia Billing and Compliance 

Anesthesia billing follows unique guidelines with high risk for errors. Splitting this responsibility among already-stretched hospital managers can lead to compliance issues and missed revenue. A dedicated anesthesia billing specialist — with access to anesthesia-specific analytics — is critical for revenue capture and risk reduction. 

Why Anesthesia Leadership Needs a Dyad Structure 

Successful anesthesia programs pair a physician leader (anesthesiologist) with a dedicated administrator, reporting directly to top leadership. Large departments also benefit from dedicated IT support for anesthesia-specific analytics. Without this structure, performance monitoring and decision-making suffer. 

 The Risks of Folding Anesthesia Into General Hospital Infrastructure 

When anesthesia is treated like any other department, the result is often: 

  • Higher turnover and recruitment costs 
  • Missed revenue opportunities due to billing gaps 
  • Inefficient coverage that strains staff and inflates overtime 
  • Leadership blind spots in a service line that touches every surgical patient 

Bottom line: General hospital infrastructure can’t absorb anesthesia without sacrificing efficiency, compliance, and profitability. 

This is the first in our four-part series on the most common misconceptions in anesthesia service line management — and what it takes to avoid them. Next, we’ll look at why anesthesia leadership isn’t interchangeable with other specialties, and how overlooking this difference can jeopardize both safety and efficiency.