<p>Ongoing hospital structural reforms and the catalogue of outpatient surgical procedures are bringing about fundamental changes in healthcare delivery and reimbursement. These developments will have a&#xa0;substantial impact on the future of vascular access surgery. The mandatory shift towards outpatient care, combined with the absence of vascular access surgery in specialized service groups with defined quality standards, fails to acknowledge both the complex patient population and the highly specialized nature of the procedures. Currently, the transition of arteriovenous (AV) access surgery to the outpatient setting is politically driven and demanded by healthcare payers; however, existing reimbursement structures do not cover the costs, neither in the outpatient physician sector nor in hospital care. Analyses from the German Shunt Registry, cost calculations and survey results from an interdisciplinary, cross-sectoral working group of members of the interdisciplinary Working Group for Dialysis Access (IAD), illustrate the current realities of vascular access surgery practice. Under the prevailing conditions, outpatient vascular access surgery cannot be performed in an economically viable manner. This jeopardizes the survival of specialized surgical units as well as the nationwide availability of care for hemodialysis patients, whose lives depend on a&#xa0;functioning vascular access. The evidence presented here may serve as a&#xa0;basis for constructive negotiations between policymakers, payers and healthcare providers, with the goal of safeguarding the future provision of high-quality, evidence-based vascular access surgery for the benefit of our patients.</p>