Anesthesiologists perform a vast amount of essential, yet uncompensated, work that sustains the safety, efficiency, and quality of modern healthcare. This chapter explores the breadth of these activities—from preoperative record review, interprofessional consultation, and airway management, to hospital committee leadership, advocacy, education, and global health efforts. While traditional compensation models reward only intraoperative time, much of anesthesiologists’ professional contribution occurs outside the operating room and beyond what is captured in billing data. These uncompensated activities—including after-hours availability, credentialing maintenance, academic scholarship, and administrative service—represent both the altruism and systemic vulnerability of the specialty. They enhance patient outcomes, optimize workflow, and reinforce institutional performance, yet they also contribute to burnout, inequity, and professional undervaluation when unrecognized. By quantifying and contextualizing these invisible efforts, this chapter argues for a more comprehensive understanding of anesthesiology’s value to healthcare. It calls for institutional and policy reforms that align recognition and compensation with the true scope of anesthesiologists’ clinical and nonclinical work—ensuring sustainability for the specialty and the systems it supports.