As anesthesiologist shortages continue across the U.S., some ASCs are rethinking their anesthesia care delivery.
One emerging solution is the certified registered nurse anesthetist-only model. While still uncommon, a growing number of centers are finding it both viable and sustainable.
Here are five things ASCs should know when evaluating CRNA-only anesthesia:
1. Shortages are driving the shift
Dan Zahumensky, administrator of Seattle-based Proliance Surgeons’ ENT service line and executive director of Bellevue and Puget Sound Ear, Nose and Throat, and South Seattle Otolaryngology, told Becker’s that his ASCs’ shift to CRNA-only coverage wasn’t optional. Their physician anesthesia group struggled to provide consistent staffing through the summer of 2024 due to a shortage of anesthesiologists and rising pay demands. By late fall, the group opted not to renew its contract.
Proliance leaders quickly began evaluating CRNA groups. Within months, they secured coverage at a lower daily stipend than physician groups demanded.
This scenario is increasingly common nationwide. A Medicus Healthcare Solutions report projects the U.S. will face a shortage of 6,300 anesthesiologists by 2026, with more than half of current anesthesiologists older than 55. Meanwhile, CRNAs already account for more than 80% of anesthesia providers in rural counties.
2. The transition requires clear communication
Proliance’s transition spanned about four months. Leaders involved their quality committee, held surgeon interviews with CRNAs and provided transparent communication with staff and patients, Mr. Zahumensky told Becker’s. He also said physician partners were supportive and staff had “no hesitation.” Patients were reassured about provider skill sets, and the ASC has since avoided moving cases to hospitals for anesthesia concerns.
3. Recruitment and retention may be easier with CRNAs
While anesthesiologists are in short supply, CRNAs are growing in number. The Bureau of Labor Statistics projects 38% growth in the profession by 2032, making it one of the fastest-growing healthcare roles.
Proliance found recruitment smoother under the CRNA-only model. Their contracted group handled credentialing and coverage, even quickly replacing a CRNA who wasn’t comfortable with pediatric cases.
Still, the CRNA workforce isn’t without challenges. A projected shortage of 12,500 CRNAs by 2033 could strain supply, particularly in competitive urban markets.
4. Costs and workflows matter
CRNA-only models often align better with ASC goals, with streamlined workflows, cost-effective care and rapid patient turnover.
“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.”
Jeff Tieder, MSN, CRNA, of the University of Tennessee at Chattanooga, said the trend reflects both economic and clinical realities.
“The demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objectives of these facilities,” he told Becker’s.
Mr. Zahumensky emphasized the importance of running long-term financial models: What would reimbursement look like under MD-led vs. CRNA-only care? Can stipends be sustained? What billing arrangements are possible?
5. The model remains contentious
“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, immediate past 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.”