2025 Taught Us This

Firefighting In Anesthesia Management Is No Longer Enough

As 2025 comes to a close, I’ve spent some time reflecting on the past year in anesthesia, not just on what happened, but on how we as an industry often responded to it.

Staffing shortages. Contract pressure. Rising labor costs. Burnout. Declining margins. Regulatory uncertainty.
None of these were new problems for many anesthesia groups or hospitals attempting to insource anesthesia departments.

What was exposed in 2025 was something more fundamental: the limits of being reactive in today’s anesthesia environment.

For years, many anesthesia groups and departments survived by being excellent firefighters. A shift fell apart? Patch it. A provider quit? Backfill it. A credentialing deadline missed? Backfill that too. Put out the fire and move on.

In 2025, that model began to break down, and the consequences became visible not only internally but externally as well, as organizations continued to spend premium dollars reacting to recurring issues instead of solving the underlying problems.

Treating Symptoms vs. Curing the Disease

There’s a medical analogy that fits perfectly here.

Reactive organizations treat symptoms.
Proactive organizations treat disease.

Firefighting feels productive. It’s urgent. It’s visible. It gets praise in the moment. But like treating pain without addressing the underlying pathology, it rarely solves the problem. It just delays it until the next flare-up, often worse than before.

Proactive work is quieter. It takes time. It requires thinking ahead, asking uncomfortable questions, and making decisions before there is a crisis. It feels inefficient in the short term, but it is the only thing that actually changes outcomes.

2025 exposed how many anesthesia groups or departments were still built almost entirely around symptom management.

The Backdrop Isn’t Changing in 2026

Here’s the hard truth:
The environment that exposed these weaknesses in 2025 is not going away in 2026.

If anything, it will intensify.

• Workforce supply remains tight
• Labor expectations continue to rise
• Rural and community hospitals remain financially fragile
• Facilities are less tolerant of instability
• Providers are more selective about where they work

Organizations that sit back and wait to react will remain exposed. They will experience repeated staffing crises, volatile economics, cultural erosion, and stalled growth or worse, continued business contraction through lost contracts.

Organizations that move upstream and tackle the core issues will separate themselves.

Proactive Fire Prevention Looks Like This

Proactive organizations do not wait for the fire to occur; they analyze issues early, identify root causes, and implement strategies to prevent recurrence.

They invest time in strategy at the departmental level, not just corporate strategy decks that sit on shelves.

They ask:

• Why does this issue keep recurring?

• What system allowed this to happen?

• What decision did we defer because it was uncomfortable?

• What process do we rely on that only works when everyone is heroic?

They build:

• Clear staffing models instead of constant exceptions

• Defined escalation pathways instead of chaos

• Standardized workflows instead of tribal knowledge

• Predictable economics instead of surprises

• Cultures that reward teamwork over short-term wins

Most importantly, they intentionally make time for strategic thinking. While it may feel counterintuitive to step back when things are busy and fires are actively burning, that is precisely when strategic thinking is most critical. This requires a deliberate and consistent practice, with dedicated time each week focused on true problem-solving and fire prevention, not just reactive firefighting..

Strategy Is Not Optional Anymore

One of the biggest lessons from 2025 is that strategy can no longer be something we get to “when things calm down.”

They won’t.

Strategic decision-making must happen at:

• The site level

• The department level

• The regional level

• The leadership level

And those decisions must be executed well by teams supported with consistent processes and workflows. Strategy without execution is just philosophy. Execution without strategy is just motion.

Operational excellence is where the two meet.

Who Will Thrive in 2026

In 2026, we will see a clearer divide.

Reactive organizations will:

• Continue firefighting

• Chase short-term fixes

• Pay higher and higher premiums for instability

• Struggle with culture and retention

Proactive organizations will:

• Achieve more stable staffing

• Operate with clearer economics

• Grow organically and sustainably

• Attract high-quality clinicians who value the whole experience, not just the rate

The reward for doing the hard, upstream work is not applause.
It’s stability.

And in anesthesia, stability is becoming the most valuable currency of all.

A Final Thought

Firefighters are heroes.
But the best outcome is the fire that never starts.

2025 made it clear: being good at reacting is no longer enough.
2026 will belong to those willing to step back, think strategically, and build systems that prevent the fire in the first place.

The question for each of us isn’t whether we’re busy.
It’s whether we’re solving problems or just managing them.