Anesthesia care models are shifting fast as workforce shortages, reimbursement pressure and changing scope-of-practice laws push organizations to rethink how certified registered nurse anesthetists and anesthesiologists cover the OR.
Workforce shortage spurs cultural rethink
Leaders say the current anesthesia workforce environment is creating both strain and opportunity. Marco Fernandez, MD, an anesthesiologist with Chicago Anesthesia Leaders and president of Midwest Anesthesia Partners and the Association for Independent Medicine, described the COVID-19 pandemic and consolidation wave as a “demand-and-supply shock” for the specialty, which he sees as a chance to unify.
“Our biggest asset is our members, and the high demand for, and low supply of, our services gives us an opportunity to stay independent and collaborate with all of our stakeholders,” he told Becker’s. “We will continue to struggle as a specialty because some of the focus is on the differences between the MDs, CRNAs and certified anesthesiologist assistants, instead of the threads that can unite us.”
The specialty is facing a shortage of 6,300 anesthesiologists by 2036, according to a 2025 Medicus Healthcare Solutions white paper, driven by rising surgical demand alongside a training bottleneck, with residency positions failing to expand enough to meet workforce needs.
Many leaders say that staffing models only work if the culture supports them.
Brian Cohen, MD, administrative chief with Miami Anesthesia Services, told Becker’s that collaboration between anesthesiologists and CRNAs has to be embedded in leadership behavior, not just job descriptions.
“Collaboration between anesthesiologists and CRNAs is built into the core culture of an organization,” he said. “This begins at the top and cannot only be words — it requires follow-through and actions. It is built on trust and mutual respect and relies on the ability to push egos aside for the sake of performance.”
When that culture exists, he added, organizations gain flexibility. Instead of forcing a single approach everywhere, teams can choose a staffing model that fits daily clinical needs and budget realities.
Leaders see transparency as path to alignment
According to Dr. Cohen, transparency about anesthesia economics is a practical way anesthesia leaders can build alignment.
“One of our most productive exercises is showing surgeons how many Medicare or commercial cases it takes to cover the cost of one anesthesia clinician, per day,” he said. “Then, they can decide how many rooms they want to run. We’re service providers, but we need to arm facilities with information so they can make informed staffing decisions. That transparency and education strengthen trust and help balance cost-benefit considerations between CRNA and anesthesiologist models.”
This shared financial literacy helps stakeholders talk about staffing tradeoffs without framing the discussion as “MD versus CRNA,” he said. It also strengthens trust, especially in surgeon-owned ASCs where operational decisions are tightly tied to margins.
States look to reforming CRNA rules to fill shortages
In states requiring CRNA supervision, the question becomes operational when anesthesia care teams struggle to function when there aren’t enough anesthesiologists to supervise multiple rooms, Jeff Tieder, MSN, CRNA, clinical assistant professor at the University of Tennessee at Chattanooga, told Becker’s. Thus, economic pressure is accelerating shifts away from traditional supervision-heavy ratios.
CRNA leaders argue that collaboration can help organizations see the full staffing picture more clearly. Melissa Croad, CRNA, APRN, government relations director for the Massachusetts Association of Nurse Anesthetists, told Becker’s last year perceived shortages can sometimes be tied to practice models themselves.
If anesthesiologists are supervising rather than personally administering anesthesia, she said, they may inadvertently be “contributing to the shortages.” Ms. Croad also emphasized that collaborative environments, where anesthesiologists and CRNAs both practice fully and consult as needed, can be more efficient and better for morale.
Collaboration is becoming more urgent as CRNA practice authority expands in many states. Since June 2024, multiple states have introduced or enacted changes that reduce supervision requirements or clarify autonomous practice. Federal legislation has also been introduced to allow CRNAs and anesthesiologists to provide anesthesia autonomously in the Department of Veterans Affairs system.
The American Society of Anesthesiologists continues to advocate for physician-led team models, arguing they are the “gold standard.” Meanwhile, CRNA leaders point to studies suggesting outcomes are comparable and note that independent CRNA practice is already widespread, especially in rural America.
“Every year, across the country, CRNA-backed bills are introduced to weaken existing state-based anesthesia care delivery standards. And every year, ASA, our state components and patient safety stakeholders work to defeat those bills. Last year alone, lawmakers refused to enact nurse-backed bills in 17 states,” Donald Arnold, MD, immediate past president of the ASA and chair of the department of anesthesiology at Mercy Hospital St. Louis, told Becker’s.
“The physician-led, team-based model of anesthesia is the most common model of anesthesia care in the United States,” said Dr. Arnold. “It is the gold standard of anesthesia and the model of care used in all the nation’s top hospitals. … ASA supports keeping the nurse-only model rare and preserving the physician-led, team-based model of care. We also note that survey after survey demonstrates that patients overwhelmingly want and expect a physician to lead their anesthesia care.”