Aaron Stewart: Changing the Math on the Anesthesia Stipend | Live from the Anesthesia Economics Summit

This episode of the Anesthesia Economics Podcast was recorded live at the Anesthesia Economics Summit in Charleston.

In this conversation, Jeff talks with Aaron Stewart, CFO of Symmetry Anesthesia, who  breaks down how anesthesia coverage models are evolving and why there’s no one-size-fits-all approach for hospitals. 

Aaron explains how financial modeling helps facilities understand cost drivers, structure care teams, and make more informed decisions. The discussion highlights the shift toward physician-CRNA models, the realities of provider shortages, and why controlling costs matters more than simply reducing them. Stewart also shares how scale, staffing flexibility, and market dynamics shape where and how anesthesia groups can succeed.

Explore our full episode page to watch a video or read a transcript of the full interview: https://www.medaxion.com/aaron-stewart-symmetry-anesthesia-cfo-on-changing-the-math-on-the-anesthesia-stipend

Jeff McLaren introduces the speakers and panelists whose discussions were recorded live at the 2026 Anesthesia Economics Summit.

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Transcript

Introduction

SPEAKER_01 0:06

Here we have Aaron Stewart with Symmetry. Aaron, you gave a great presentation a minute ago. So thank you for that. I wanted to maybe ask you a few questions and maybe you could cover some of the same information in abbreviative form that you provided in the presentation. So you discussed a financial model that you use. Is that financial model used for internal assessment on how you would approach a prospective facility, or is it used in real time as you're working through coverage modalities with the facility to try to dial in what's affordable from their perspective? Or maybe it's

Financial Model

SPEAKER_01 0:50

both?

SPEAKER_00 0:50

Yeah, I think the answer really is both because what we've learned is that there's not a one-size-fits-all coverage model to any facility. And we've also known that kind of subsidies can't be avoided when it comes to anesthesia. And so that model is really something that's used to, as we're kind of thinking through and working through with the facilities of, hey, what's the right fit? What's the impact of some of the decisions that are being made, right? And so a couple of the inputs are around the structure of the care team, right? And so that the large largest differences may be all position versus all CRNA, right?

SPEAKER_01 1:30

If you just kind of show the difference of direction or just supervision, how far are they going?

Cost Drivers

SPEAKER_00 1:36

You've got it exactly right. And so it's it's really a tool that's used kind of initially and then during the conversations just to help one provide clarity around what's driving the cost, right, and kind of where those inputs are. And then two, just cost isn't necessarily the first and it shouldn't be the very first consideration when you're structuring your anesthesia coverage.

SPEAKER_01 1:58

You know, I would imagine that a tool like that, and it's great, would be really helpful as an education tool for your counterpart, you know, at the you know, the CFO at the hospital that may not really fully understand all the levers that can be pulled to drive cost or to change cost dynamics.

Educating CFOs

SPEAKER_00 2:21

Yeah, that that's exactly right. So I uh I created it just to educate myself because I used I used to be, you know, similar to one of the counterparts, one of those guys, right? So first I had to educate myself, and and so that that that's part of it is just using it as a tool to educate counterparts and then also just to collaborate and figure out okay, well, uh what can we do to address what the true needs are?

SPEAKER_01 2:44

I would imagine too, just coming um as a CFO, speaking to a CFO, that that's comforting for them to have that kind of mechanism where you can have a real conversation around the dynamics of of coverage that are driving cost. Um in terms of that kind of approach of looking at coverage models, do you see or do you receive when you when you begin those conversations, do you have enough data where you can do modeling ahead to a large extent? Or is this part of a discovery process where you're getting certain dynamics in a conversation and you're inputting into that model that then advances the discussion? Yeah, it's maybe that's both too. Yeah, I don't know.

Data Inputs

SPEAKER_00 3:35

It's a little bit of both, but it it's kind of a starting point, but we definitely do need inputs when we think about kind of volume, kind of historical and projected, right, and utilization and around points of service, and then what the desired care team is. And and what we try to do is we don't frame the conversation entirely around cost. Cost is the elephant in the room, but it's framing around kind of what what's the true need here. Is it in it a lot of times it's not to reduce costs, it's to control cost, but but what we hear it's more around okay, points of service, or we're all physicians, we need to move to a care team model, or we don't have enough physicians, we need to move.

SPEAKER_01 4:15

See a lot of that still?

SPEAKER_00 4:16

The all-physician shops? We've um we

Physician Models

SPEAKER_00 4:19

we see some of them. So there's one that uh uh came up recently as a 150-bed hospital that was all physician, and that they received notice from their uh coverage provider with like 60 days of that the contracts coming to an end. Um, go find some coverage. So interesting. So that that's the other thing that comes into play when you think about the the provider market when it comes to anesthesia is they're scarce resources, both the physicians and the CRNAs, but a more moving towards a more kind of physician plus CRNA care team leveraged model kind of helps uh uh mitigate some of that risk.

SPEAKER_01 5:01

Um, you know, uh do you guys see particular opportunity in hospitals of that size, which might be more rural? Um, or do you see opportunity for for symmetry in more larger metro areas? And maybe this hospital wasn't a metro area, but just maybe a smaller hospital in that area.

Market Opportunity

SPEAKER_00 5:24

Yeah, so I I I think the the bigger opportunities for symmetry would be a larger metro area, just because it for for any uh uh staffing firm kind of having the economies of scale and being able to, you know, share resources right uh w within a team, I think that's important. So we

Staffing Strategy

SPEAKER_00 5:44

we saw one of the presentations talked about the scheduling model, right? And I always think about the right care at the right time, and it not all days are created equal and not all shifts are created equal. And so to really be able to provide the best scale, it it's kind of being in a market that's small enough that you have concentration there, that if you need to staff providers down, move them from one facility to the other, or staff up kind of conversely.

Scaling Care

SPEAKER_01 6:10

So yeah, I think that's I think that's a a challenge that many of the health systems that are in-sourcing anesthesia, you know, they're treating each facility as an isolate in terms of a labor pool, and they're not looking at multiple facilities in their system as a potential um broader pool for shared resources between individual facilities. And that's frankly how large practices achieve scale, you know, for the last 20 years, right? Was looking at a pool of facilities, not just a single facility. So that that makes a lot of sense. And I I guess that's one way you inject opportunity to markets where you're in, where you have multiple facilities. That's right. Um, Aaron, thank you for the time today. I really appreciate your thoughts. Thanks for having me. All right, absolutely.