Five leaders in anesthesia recently joined Becker’s to discuss things that are and are not working in the world of anesthesia.
Editor’s note: Responses have been lightly edited for clarity and length.
What is working:
Steve Wilstead, CRNA. University Medical Center Southern Nevada (Las Vegas): Allowing independence from anesthesiologist supervision for CRNAs. We are trained to provide complete, competent and safe care through all the areas of practice.
Michael Mielniczek, CRNA. Independent Contractor (Washington): Anesthesia is experiencing some of the most significant advancements in its history, making procedures safer and more efficient. Video laryngoscopes have replaced fiberoptic intubation in many cases, offering clearer visualization and easier management of difficult airways with minimal setup.
The rise of point-of-care ultrasound with AI has further enhanced safety and precision. With a handheld probe connected to a smartphone, anesthesia providers can quickly assess gastric contents in real time—helping me make safer anesthetic decisions even in cases of unclear NPO status or GLP-1 use.
These technological improvements, paired with refined drug selection and enhanced monitoring, have made anesthesia safer, faster, and more effective than ever before.
Jeffrey Tieder, MSN, CRNA. Clinical Assistant Professor at University of Tennessee at Chattanooga: Several positive trends are shaping the future of anesthesia and improving patient care. One major advancement is the growing adoption of opioid-free anesthesia, which has led to an increased emphasis on peripheral regional anesthesia techniques. This shift enhances patient recovery, reduces opioid-related side effects, and improves overall outcomes. CRNAs are at the forefront of this movement, leveraging their expertise in regional anesthesia to provide effective pain management solutions.
Additionally, healthcare facilities are exploring more efficient anesthesia care models, including CRNA-only practices and collaborative care teams where all providers take on cases directly. These models help address provider shortages, optimize resources, and improve patient access to high-quality anesthesia services. As demand for anesthesia care continues to grow, CRNAs remain essential in expanding access, enhancing efficiency, and delivering exceptional care.
Cory Koenig, DO. Vice President of Operations at Providence Anesthesiology Associate (Charlotte, N.C.): From a high level, the quality, clinical care, and patient safety aspects of anesthesia are very consistent. For the most part, these aspects have now become expected and a given by insurers, hospitals, administrators and patients. Proper patient selection, preoperative optimization, multimodal analgesia, proficiency with regional techniques and ultrasound use have become standard. Enhanced recovery after surgery policies and protocols are so commonplace that there are essentially no anesthetic differences between those labeled as ERAS and those that are not. The technological and pharmacology advances within the speciality are key in all these areas.
David Vierra, MD. Anesthesiologist in Santa Barbara, Calif.: What’s working is that anesthesiologists continue to provide excellent care and are continually improving patient care and safety. There is a reason that anesthesiology is recognized as a leading specialty for quality and patient safety — anesthesiologists are constantly searching for ways to better care for patients and improve patient outcomes and satisfaction.
What isn’t working:
SW: As a CRNA, it is obvious that an anesthesiologist supervising from the doctors’ lounge does not help the anesthesia provider shortage. It does hyperinflate the cost of anesthesia care by removing the anesthesiologist from being able to open another OR to care for more needy patients. CRNAs do not need supervision. We are trained to safely care for all ages/needs of the surgical patient.
MM: While technology continues to advance, the adoption of new skills and tools in clinical practice is lagging. Despite the availability of safer and more efficient innovations, many anesthesia providers remain hesitant or not educated to integrate them into everyday care.
As John Nagelhout, CRNA, PhD—a longtime professor at Kaiser Permanente School of Anesthesia and author of the Nurse Anesthesia textbook—famously said, “The most dangerous words someone can say are: ‘We’ve always done it this way.’” To keep pace with modern medicine, the anesthesia community must prioritize ongoing education and normalize the use of emerging technologies in daily practice.
JT: The anesthesia profession is facing several challenges that impact both patient care and provider sustainability. One significant issue is the decline in year-over-year reimbursement, which affects anesthesia practices across the board. Additionally, CRNA services are often reimbursed at only 85% of physician rates for the same procedures, despite providing high-quality, evidence-based care.
Another challenge is efforts to limit CRNA practice, even as the demand for anesthesia services continues to rise. CRNAs play a critical role in expanding access to care, particularly in rural and underserved areas, and are best utilized when able to practice to the full scope of their training and expertise. Given the growing provider shortage, ensuring CRNAs can contribute at the highest level benefits patients, healthcare facilities, and the entire anesthesia profession.
CK: We are at a time where many surgeons, administrators and facilities are just now starting to realize that one of the biggest keys to being successful involves partnering with anesthesia. If a strong partnership cannot be made with the anesthesia group, anesthesia services will quickly become the largest cost and/or liability for the facility. Every surgeon, unfortunately, cannot have two true flip rooms. [Operating rooms] cannot support its cost to open it with only one or two cases. Facilities cannot shut down by 3 p.m. and fail to utilize p.m. block times. OR utilization rates must be very high. Block times requirements must be monitored and enforced. Payor mixes need to be over 50% commercial. The type of surgery speciality matters. Cataracts can be done safely and effectively with RN sedation protocols and appropriate screen criteria. Anesthesia can not always just open up an extra room with one day’s notice. Facility hours must be followed consistently. Facilities can help educate patients and participate in upfront collections and site-of-service collections for the anesthesia fees along with the surgeon and facility fees. Some facilities may consider building breaks in to the schedule to cut down on staffing costs. Others may have no choice but to consider changing to a 4-day per week schedule until ORs are efficiently and fully utilized.
It really comes down to staffing and costs. Staffing costs are entirely too high for anesthesia services to be a second thought. While this is a challenge and takes effort, those facilities that do fully partner with anesthesia can be highly successful. When the goal of anesthesia is to deliver reliable, high-quality, safe, anesthesia care in the most efficient, cost-effective manner, it should align closely with those of the facility. While any or all of these things can never guarantee that anesthesia will not require financial support, they are certainly tools to consider to decrease those costs.
DV: Reimbursement. At all levels.
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