The challenges facing anaesthesiology in Argentina: specialisation, market dynamics, and current issues

Dr. Carlos Alberto Díaz. Full Professor, ISALUD University. 2025. Strategic Management at ISALUD University.

Summary

This article examines the multiple challenges and complexities facing anesthesiology in Argentina, focusing on issues of professional specialization, market dynamics, and current barriers to providing coverage. It reviews how anesthesiology has evolved as a medical specialty, emphasizing the crucial roles that scientific societies, the state, and educational institutions have played in establishing and regulating the profession.

A persistent shortage of certified anesthesiologists is identified as a serious problem, creating bottlenecks that hinder the scheduling of surgeries, lengthen waiting lists and hospital stays, and reduce overall system efficiency. The text also discusses key economic factors, including the payment structure and the income gap between anesthesiologists and other medical specialists, along with the collective negotiation practices within the profession.

The impact of this shortage is analyzed for both public and private sectors, as well as the role of collective bargaining and judicial intervention in resolving disputes within the field. The article highlights the importance of technical innovation, ongoing professional development, and new technologies as drivers of improved patient safety and outcomes. Nevertheless, access and resource barriers continue to persist, especially in public hospitals.

In closing, the article proposes strategic reforms: increasing the number of trained professionals, optimizing operating room management, boosting teamwork and collaboration, strengthening human resource planning, and promoting the integration of anesthesiologists throughout all areas of care and hospital governance. The ultimate aim is to achieve safer, more efficient, and patient-centered anesthesiology practice, ready to meet the present and future demands of the health system.

Introduction:

Medical specialties evolve from the consolidation of independent bodies of knowledge. However, this progress does not occur automatically; it relies primarily on the work of medical societies that regulate and validate access to these skills considered relevant and necessary (Patiño and Rodriguez 2015).

Medical professionalization is not simply a matter of formal processes, but rather a dynamic in which groups of professionals seek certain privileges to carry out their work (Machado, 1991; Detsky et al., 2012). Consequently, these transformations have unique characteristics depending on the context in which they occur and become established.

The process through which specific knowledge becomes a scientific discipline requires at least two key stages to ensure independent development: first, legitimizing this knowledge as a subject for public policy; second, state recognition of educational spaces for training professionals and supporting the labor market.

In this regard, formal educational institutions play a fundamental role (Buschini, 2015). Studying professionalization processes, such as medical specialties, always reveals the participation of various actors, with the state being the most prominent. Professionalization results from actions aimed at defining the boundaries of a profession within contexts of power. To understand its evolution, it is necessary to describe and analyze the political processes involved in its historical formation. Under these conditions, varying degrees of exclusivity are negotiated for performing specific tasks, training professionals, and interacting with other professions in the same field (Freidson, 1978; Schapira, 2003; Faccia, 2015).

During this period of relative price adjustment, professional incomes are postponed due to market conditions; factors such as differentiated fee schedules and increased out-of-pocket expenses for beneficiaries have led to an insufficient adjustment. For example, physicians earn between 18,000 and 30,000 per consultation according to medical directories, an amount that must cover all office-related expenses. For appendectomies, fees may range from 123,000 to 229,000, based on consultations with different specialists. Regarding the pre-anesthetic visit, anesthesiologists typically receive a variable amount that is usually around 30% of the total intervention cost.

Unresolved Problem in Our Health System.

In our country, for more than thirty years, there has been a persistent issue related to the number of certified anesthesia professionals. Certification in anesthesiology has been officially recognized since 1980, when the Buenos Aires Anesthesiology Association (now the Association of Anesthesia, Analgesia, and Resuscitation of Buenos Aires, AAARBA) became the authorized entity to issue these certificates and train residents. Its members must be affiliated with the association in order to bill private health insurers and social security providers. This requirement has also extended to the public hospital sector through hospital modules. Fewer provinces now have anesthesiologists on fixed contracts with monthly salaries.

When fees, service values, or on-call payments are negotiated, conflicts often arise in which funders are at a disadvantage: because the presence of anesthesiologists is essential for surgeries and critical patient care, failure to reach an agreement can lead to the suspension of scheduled procedures. These corporate dynamics create a pronounced asymmetry and force the funder to accept conditions under a “take it or leave it” system.

In 2017, due to a shortage of anesthesiologists in public hospitals, the statute was amended so that affiliated members must provide services in public hospitals under a “mandate” that extends for five years after completing residency.

The high cost associated with anesthesiology is justified by the guaranteed quality of service and the number of certified anesthesiologists, which is insufficient compared to current and projected demand. This situation generates multiple areas for analysis that require appropriate discussion, free from particular interests or biases. The number of interventions could be increased, as operating room productivity is currently low and there is potential for more anesthetic procedures. However, the shortage of anesthesiologists represents a bottleneck that causes negative externalities, such as prolonged hospital stays and associated consequences.

For the ARCA collecting entity and its affiliates, the association handles withholding income taxes, which greatly simplifies the corresponding tax obligations.

2. When fees, service values, or on-call payments are negotiated, conflicts often arise in which funders are at a disadvantage: because the presence of anesthesiologists is essential for surgeries and critical patient care, failure to reach an agreement can lead to the suspension of scheduled procedures. These corporate dynamics create a pronounced asymmetry and force the funder to accept conditions under a “take it or leave it” system.

In 2017, due to a shortage of anesthesiologists in public hospitals, the statute was amended so that affiliated members must provide services in public hospitals under a “mandate” that extends for five years after completing residency.

3. The high cost associated with anesthesiology is justified by the guaranteed quality of service and the number of certified anesthesiologists, which is insufficient compared to current and projected demand. This situation generates multiple areas for analysis that require appropriate discussion, free from particular interests or biases. The number of interventions could be increased, as operating room productivity is currently low and there is potential for more anesthetic procedures. However, the shortage of anesthesiologists represents a bottleneck that causes negative externalities, such as prolonged hospital stays and associated consequences.

All the Positives of the Anesthesiology Specialty

Anesthesiology is a highly complex medical specialty that has undergone remarkable evolution and revolutionary changes. Without its advancements, many surgical breakthroughs would not have been possible. Thanks to less invasive surgical techniques and sophisticated pathophysiological management during operations, there have been improvements in dosing, gas exchange, and reductions in blood transfusions. The development of precise administration methods and the use of reliable technology for surveillance and monitoring have marked the history of this discipline with technical and pharmacological innovations, allowing for better patient outcomes and the ability to perform longer, more complex surgeries in fragile individuals. Additionally, recent technologies such as simulation, genomics, artificial intelligence, and robotics promise ongoing improvements in patient safety and are expected to overcome current challenges, making anesthesia safer, more effective, and more personalized.

As a result, some studies show that mortality rates have dropped dramatically: from 6.4 deaths per 10,000 operations in the 1940s to 0.4 per 100,000 by the late 1980s. Today, the risk is even lower, with fewer than one death for every 200,000 to 300,000 anesthetic procedures performed.

In low- and middle-income countries such as Argentina, there are specific challenges related to inequalities in access to care, resource shortages, a lack of qualified personnel, and insufficient ongoing education, all of which hinder progress toward safe and affordable anesthetic care.

To address these issues, it is necessary to implement collaborative actions and initiatives across technical, human, and organizational domains, following recommended standards. The integration of simulation as a method for learning, training, and evaluation can significantly transform real-world patient experiences.

The specialty’s progress is rooted in three major factors: high-quality training, anesthetic drugs, and reliable monitoring.

Since the 1980s and 1990s, the most commonly used volatile anesthetics have been isoflurane, desflurane, and sevoflurane, which offer pharmacological advantages and greater safety compared to their predecessors. Inhaled anesthesia was the preferred option until the arrival of thiopental in 1934, a barbiturate that allowed induction and maintenance of general anesthesia. Etomidate later emerged, noted for its hemodynamic stability. Subsequently, ketamine and propofol—developed in the 1970s—gained importance due to rapid recovery and stable hemodynamic effects. Dexmedetomidine was also introduced as an intravenous adjunct, providing sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties with hemodynamic stability. Several neuromuscular agents were developed as well: succinylcholine, pancuronium, vecuronium, atracurium, rocuronium, mivacurium, and cisatracurium, tailored to various clinical needs. In addition, advances in opioids have been noteworthy: fentanyl was discovered in 1950, followed by alfentanil and sufentanil, designed to modify pharmacological properties, and remifentanil—an ultra-short-acting opioid with a higher risk of dependence due to its high lipid solubility and rapid onset.

Furthermore, the ongoing education of anesthesiologists has been emphasized by the Buenos Aires Association of Anesthesiology and the Federation, as well as the implementation of national and international safety protocols and recommendations, the creation of standardized checklists, the conferral of degrees and authorizations, and both professional and administrative oversight.

In Argentina, anesthesiology has advanced in both technique and training, making surgery safer through better anesthetic control, updated monitoring, and safe drugs. New graduates receive excellent preparation before earning their degrees, which contributes to the existence of high-quality operating rooms.

Many anesthesia-related risks are directly linked to the patient’s health status. Factors such as obesity, advanced age, smoking, cannabis use, and sleep apnea can increase the risk of complications. Additionally, patients’ regular medications may interact with anesthetic agents, altering their response and requiring treatment adjustments. Preoperative stress and anxiety can also negatively affect the physiological response to anesthesia, raising the risk of adverse events. Therefore, it is essential that the medical team takes the time to inform and reassure the patient about the procedure. Patient concern or lack of knowledge about anesthesia can intensify stress, impacting hemodynamic stability, sensitivity to anesthetic drugs, and the occurrence of postoperative complications. Ultimately, the patient’s medical history is crucial in determining the anesthetic technique, but a comprehensive preoperative evaluation allows for assessment of general health and adaptation of anesthetic management, significantly reducing the risk of complications.

The use of ultrasound as a guide for nerve blocks or for accessing deep vessels with greater precision is another important advancement in anesthesiology.

The Not-So-Good Aspects

The shortage of anesthesiologists in the public sector limits the capacity to meet surgical demand, frequently resulting in restrictions on scheduling procedures—even when patients are fasting and the surgical team is ready. This situation contributes to longer waiting lists, though it is not the only factor; nonetheless, addressing it is desirable. It is essential that the public sector increases the number of procedures by at least 50%.

Periodically, in connection with requests for fee increases, scheduled activities are suspended for several months, triggering substantial debates that escalate to the courts. Although these rulings do not set legal precedent, they have significant consequences for both funding entities and professional groups involved, as they fall under what is known as “abuse of dominant position.”

A legal decision established that consumer protection laws do not apply to anesthesiologists, but healthcare is nonetheless an essential service.

In Mendoza, in 2022, a health emergency law was enacted after 68 appointed anesthesiologists resigned. The local union attempted to have the law declared unconstitutional, but the courts rejected the claim.

When the Ramón Carrillo Hospital in San Luis opened—a project in which I participated—fewer operating rooms than planned were activated: seven out of the intended fourteen. Collaboration had to be requested from the Anesthesiology Federation. The institution, in its first full year of operation, performed nearly a thousand surgeries per month—about twelve thousand per year—compared to the previous hospital’s three thousand annual procedures.

Currently, there is an ongoing labor action against IOMA, the health insurance provider of Buenos Aires Province, due to disputes over low rates and delayed payments, forcing the Anesthesiology Association of La Plata to suspend scheduled surgeries as of December 15, 2025. This conflict affects all patients covered by an insurer with two million members.

These are just a few examples that, to varying degrees, show that negotiation channels are inadequate and the underlying conflict remains unresolved; negotiations are always very contentious.

1. Anesthesiologists are a key component in both the fixed and variable costs of operating room hours; thus, as an intermediate product, they also affect the final product. Although estimates vary widely, their share can reach up to 20% of a surgical center’s costs.
2. Restricting the number of authorized specialists limits the expansion of operating rooms and the number of interventions, since local associations have the authority to approve specialists from other regions. These associations wield more power than national or provincial ministries. Limiting the supply of anesthesiologists is problematic given the constantly increasing demand for surgeries; it creates bottlenecks, long waiting lists, and work overload, all of which affect care and scheduling. Each surgery requires a qualified anesthesiologist responsible for the perioperative process and patient’s life. It is not possible to increase the number of anesthesiologists without agreement, as they can only practice in the province where they were trained—as is the case in Chaco.
3. Negotiating once conflict has already arisen is not ideal, as it involves additional stakeholders. First, the association must demonstrate its bargaining power, its ability to sustain the conflict, and alignment among its members, who understand that once industrial action is underway, they are in a position to accept the negotiated terms. This harms organizational climate and relationships.
4. Operating room scheduling is somewhat rigid because professionals agree in advance on how many procedures they will perform, on which days, at what times, and with whom. This is due to favorable selection. Not all responsibility should be placed on anesthesiologists, since the limitation of modules for scheduled surgeries, poor scheduling, and services that have become accustomed to light workloads also play a role.
5. There is a preference for working under a private practice model rather than in hospital modules within the public sector, creating incentives to avoid surgeries for patients with social health coverage, as these procedures are included within the module.
6. In certain cases and contracts, anesthesiologists may earn higher fees than surgeons.
7. Anesthesiologists typically meet their patients only when they enter the operating room, at which point they ask questions and review the medical history. Pre-anesthetic evaluations are not routinely conducted as recommended. This can lead to cases involving difficult airway anatomy or patients on undisclosed medications, sometimes resulting in canceled procedures—issues that could be prevented with earlier assessments.
8. Anesthesia staff are responsible for covering the operating rooms. They do not get paid for mere “availability,” but ensure that procedures are performed by professionals they propose to management, which then accepts them based on risk control criteria. There is typically a 30- to 45-minute window to respond to a call. Naturally, those managing activities have incentives to assign themselves surgical procedures that, due to their duration and remuneration, increase their earnings.
9. The selection of a surgeon should be based on proven effectiveness in performing surgical procedures. It is crucial to coordinate interdisciplinary work with other professionals, who, due to prior commitments, may request temporary postponement of some interventions to enable participation in multiple surgeries. Prioritization should be based on system needs, not personal convenience.
10. Anesthesiologists are often not physically present at the facility but respond to calls. There is a growing trend to work at multiple sites, creating a mix of services for private insurers and social health plans that pay less.
11. The professional association also secures malpractice insurance agreements and maintains a legal medical team to protect its members, regardless of case outcomes.
12. The fact that anesthesiologists earn so much more than other specialists is not the fault of the professionals or their associations, but of authorities who fail to balance compensation. This is being addressed in our country, as there is now also a shortage of specialists, necessitating more competitive remuneration.
13. Incentives favor the selection of shorter procedures and long lists, discouraging participation in complex surgeries. Consequently, there is a shortage of professionals to provide anesthesia for cardiovascular surgeries, liver transplants, kidney-pancreas transplants, heart, and lung operations.
14. Another serious concern is that for many anesthesiologists, patients are seen not as individuals but as codes in the nomenclature. This is problematic for any doctor, but especially for those with the expertise to handle such complex procedures.
15. Anesthesiologists do not typically interact or collaborate with other specialties, leading to friction with intensive care or progressive care units—especially when patients are transferred insufficiently resuscitated, with metabolic acidosis and elevated lactic acid levels. This means transitions are not always managed properly.
16. Not enough is done to alleviate patients’ fear of anesthesia or surgery. Communication problems are common.
17. The anesthesiology program can be altered for convenience, affecting hospital operations.

Potential Solutions:

• Modify negotiation strategies for both parties. Define health as an essential service so that surgeries whose diagnosis and intervention could mean a loss of opportunity for the patient cannot be suspended.
• Hold regular meetings with specialists and their representatives, not only when problems or complaints arise. Negotiations during a conflict involve additional factors, such as demonstrating union strength among anesthesiologists, since yielding can trigger similar effects in other agreements and regions; for this reason, negotiating after things escalate is too late—it should be done proactively.
• Gradually increase the number of anesthesiologists and verify how the number of registered or performed procedures grows. Aim to increase the number of new entrants by 40% over the next five years. Currently, the country has 5,200 qualified professionals, which is insufficient, especially for the public sector.
• Ensure associations open more residency slots, so those completing their training can bill for their services and are not restricted in their professional freedom.
• Confirm that the number of incoming residents exceeds those leaving the profession.
• Concentrate more work within institutions to avoid wasted time and resources due to physicians traveling between locations, which impacts handling of unexpected situations.
• Improve the organization of surgical programs to reduce downtime and make anesthesiologists’ workdays more productive.
• Optimize logistics for orderlies and supplies to decrease unnecessary waiting times.
• Emphasize adherence to schedules, especially the start of the first surgery each day.
• Confirm surgeries the day before to reduce cancellations and patient waiting times.
• Increase available modules in the public sector to raise the number of surgeries. Expand scheduling to afternoons and weekends.
• Extend operating room usage hours until 9:00 PM.
• Assign a team member to see all patients before they enter the operating room and record their review in the clinical history.
• Shorten the time anesthesiologists must devote to the public sector, allowing them to work in the private sector as well. Encourage experienced anesthesiologists to return to the public sector, recognizing their role in training others.
• Allow fourth-year residents to perform procedures independently in surgical departments alongside more experienced colleagues.
• Include fifth-year residents in rotations at different facilities to give them practical experience and help them discover future workplaces.
• Improve financial recognition for those performing complex and lengthy procedures.
• Develop monitoring systems for computerized anesthesiology records.
• Have anesthesiologists participate in decisions about materials, devices, endotracheal tubes, and anesthesia tables.
• Avoid conflicts by signing long-term agreements with scheduled updates tied to increases in prepaid quotas or salary adjustments in social health plans. Update the value of certain surgeries and codes selectively, as updating all at once can make negotiations more rigid.
• Act immediately when payment delays occur to prevent issues from escalating into strikes.
• Integrate anesthesiologists into all hospital technical committees and patient quality and safety meetings—they have much to contribute.
• Avoid disruptive behaviors in operating rooms that may negatively affect the organizational climate.

Implementing measures to improve training, professional recognition, and the integration of anesthesiologists in various hospital settings is essential for optimizing care quality and ensuring patient safety.

It is vital to encourage participation in decision-making, develop modern monitoring systems, and update labor agreements—these steps strengthen the commitment and efficiency of the anesthesiology team.

Additionally, providing training experiences for residents, recognizing those who perform complex procedures, and fostering the return of experienced professionals to the public sector all positively impact the availability and excellence of human resources.

These strategies, combined with collaborative work and effective conflict management, will help consolidate a safer anesthesiology practice that meets current challenges in accessibility, operational management, patient flow, professional relationships, training activities, postoperative care, patient understanding, and delivering person-centered anesthesia.

Conclusion

This is a longstanding issue. Professionals are highly trained and better compensated, and surgical procedures are increasingly safe. However, there is a pressing need for more anaesthetists—about 20% more. The mandate must be revised. Agreements should be reached so that professionals who completed their residencies in provinces experiencing conflict can join the pool of specialists authorised to bill social health insurance schemes, as enabled by professional associations. It is important to recognise the need to improve productivity in public hospitals. Negotiations should progress independently of any disputes. Long-term agreements must be established, with adjustments linked to revenue collection. Social health insurance providers should maintain a mutually agreed value, adjusted in line with salary corrections. The management of operating theatres needs improvement, ensuring no idle time between procedures. Anaesthetists should be trained for highly complex surgeries. Alternative training pathways should be explored so that the health system reaches the required number of professionals, and so that they can be deployed in other provinces, as current distribution is inadequate.

Desflurane is in the process of being banned due to its environmental impact, a move already seen in Scotland and soon to be implemented in Great Britain and the United States. The path towards establishing a body of knowledge as a scientific discipline requires at least two further stages to ensure its development and autonomy: firstly, the legitimisation of such knowledge as a subject of public policy; secondly, and as a consequence, state recognition of training institutions that secure the foundations of the professional market. Formal educational institutions play a central role in this process (Buschini, 2015). The analysis of professionalisation processes—such as those affecting medical specialties—consistently reveals a set of essential actors, among which the State stands out. Professionalisation results from a series of actions aimed at defining the remit of a given profession within a framework of power relations. Understanding its development requires a detailed political and historical analysis, as it is within these conditions that varying degrees of exclusivity are negotiated for performing specialised tasks, training future professionals, and collaborating with other professions (Freidson, 1978; Schapira, 2003; Faccia, 2015).

In the midst of a dispute lasting over a year between the Association of Anaesthetists (Adaarc) and the Provincial Health Insurance Administration (Apross, the provincial health insurer), professionals recently decided to suspend 1,000 scheduled surgeries to demand higher fees and in response to the province’s intention to create an anaesthetist training school with the National University of Córdoba. On that occasion, Adaarc stated that it would train future residents in anaesthesiology but refused to participate in indiscriminate training, noting that residents received little hands-on practice and that the association would not support poor-quality training. Adaarc prepares those who win competitive selection to fill posts.

The National Commission for the Defence of Competition (CNDC) recommended to the Secretariat of Industry and Commerce (SIyC) the imposition of sanctions, including a fine, against the Austral Association of Anaesthesia, Analgesia and Resuscitation following an investigation by the National Directorate of Anti-Competitive Conduct. The investigation found that the association had committed exclusionary abuse of its dominant position. Proceedings began on 31 August 2017 after a complaint from the Social Health Insurance Fund for Trade Employees (OSECAC) against the Austral Association, which represents over 90% of anaesthetists in Chubut province. The association negotiates contracts with various health fund administrators, acting as an intermediary between these administrators and its affiliated doctors for the collection of professional fees.

This led to the rescheduling of 500 surgeries at Hospital Notti in Mendoza, after all 68 provincial anaesthetists resigned en masse. Half of the population lacks social health insurance.

«Anesthesia is a medically induced state that temporarily blocks pain and other sensations. It can cause muscle relaxation, loss of consciousness, and amnesia regarding the procedure, depending on the type used,» explains Dr Matías Folcini, Head of the Anaesthesia Service at Austral University Hospital.