As certified registered nurse anesthetists gain broader legal authority to practice independently in many states and as the anesthesia workforce shortage deepens, many leaders are seeing ASCs adopting CRNA-only anesthesia models.
A white paper from Medicus Healthcare Solutions found that 75% of CRNAs reported practicing without physician oversight as of 2023. Additionally, CRNAs now account for over 80% of anesthesia providers in rural counties and administer more than 50 million anesthetics annually in the U.S., according to the report.
“Most of the ASCs in my area are also becoming CRNA-only,” Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker’s. “This helps keep costs down for anesthesia services.”
In Mr. Johnson’s market, most ASCs are for-profit and physician-owned, meaning they often lack additional staff to assist with complex cases.
Jeff Tieder, MSN, CRNA, clinical assistant professor in the nurse anesthesia program at the University of Tennessee at Chattanooga, echoed this shift. He said many ASCs are moving away from the traditional physician-supervised model. According to Mr. Tieder, CRNA-only models demand “streamlined workflows, cost-effective care and rapid patient turnover without compromising safety.”
“These demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objective of these facilities,” he said. “The growing pressure to contain costs while maintaining safety is elevating the visibility and necessity of CRNAs. With the physician anesthesia shortage looming and reimbursement models shifting, CRNAs will continue to be at the forefront of innovative and sustainable anesthesia delivery.”
Mr. Tieder also pointed to evolving anesthetic techniques that support same-day discharges and minimize complications. He cited the growing use of opioid-sparing or opioid-free protocols, increased regional anesthesia and fast-track recovery strategies as examples of changes enabling efficient ASC care.
“When we look at the economics of reimbursement in the ASC, it just doesn’t often make sense to have a supervising physician anesthesiologist,” Mr. Tieder said.
With the physician anesthesia shortage expected to peak in the next three to five years, many anticipate CRNAs will take on even greater leadership roles in ASC settings.
“We haven’t even hit the physician anesthesia shortage yet,” Mr. Tieder said. “That’s predicted to peak in the next three to five years. As that happens, I think CRNAs are positioned to be more of the leaders, particularly in the ASC.”
By 2026, the U.S. is projected to face a shortage of 6,300 anesthesiologists, according to another report from Medicus Healthcare Solutions. Currently, there are more than 7,700 patients per anesthesiologist. Over 56% of anesthesiologists are older than 55 and more than 17% are nearing retirement.
Meanwhile, the CRNA workforce is also under pressure. By 2033, the U.S. is projected to face a shortage of about 12,500 CRNAs, nearly 22% of the current workforce. However, demand remains high, with the Bureau of Labor Statistics projecting 38% growth in the field by 2032, making a CRNA one of the fastest-growing healthcare roles.
Allyn Wilcock, CRNA, owner of Advanced Anesthesia Services and Northwest Healing and Wellness in Snoqualmie, Wash., noted that CRNAs need tailored training to succeed in outpatient settings, which differ substantially from hospitals.
“People coming into ambulatory surgery settings have different places they could go. They have more options … so customer service becomes much more important,” Mr. Wilcox said. “We try to walk [new providers] through and have competencies that they have to check off to make sure they’re appropriately prepared for an outpatient setting.”
While CRNA advocates point to safety, efficiency and expanding access, critics continue to argue that physician-led models offer higher standards of care.
“Anesthesia without physician oversight is rare. Nearly everyone in our country –– 95% of the population – lives where a physician-led team-based model of anesthesia care is the expected, standard practice. The nation’s top-rated hospitals all employ the physician-led model; not a single one of these institutions allows nurse-only anesthesia care. Physician-led care is the status quo and the model that safeguards patient safety, ” Ronald Harter, MD, president of the American Society of Anesthesiologists told Becker’s. “While a handful of states are removing physician supervision requirements, the physician-led anesthesia model of care is still the predominant one being used.”
The debate around CRNA autonomy remains contentious.
“Every year, across the country, CRNA-backed bills are introduced to weaken existing state-based anesthesia care delivery standards,” Donald Arnold, MD, president of the American Society of Anesthesiologists and chair of anesthesiology at Mercy Hospital St. Louis, told Becker’s. “And every year, ASA, our state components, and patient safety stakeholders work to defeat those bills. … The physician-led, team-based model of anesthesia is the most common model of anesthesia care in the United States. It is the gold standard … ASA supports keeping the nurse-only model rare and preserving the physician-led, team-based model of care.”
Melissa Croad, CRNA, government relations director for the Massachusetts Association of Nurse Anesthetists, challenged the basis of these safety concerns.
“There have been numerous studies showing that nurse anesthetists’ outcomes are the same as physician anesthesiologists,” she told Becker’s. “It’s already happening — CRNAs are already working independently. If we were unsafe and killing people, we would know it. My response to that would be, ‘Where are we stuffing the bodies?’… The best study is the status quo. Especially in rural areas like Nebraska and Montana, they are receiving care from about 99% CRNAs. It is hard for me to qualify where [ASA] is coming from with safety concerns when this type of care is happening all day every day.”
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