Anesthesiology may be one of the most essential but least understood specialties in healthcare.
As financial pressures mount and workforce challenges persist, leaders say outdated assumptions about anesthesia’s role are shaping decisions that could impact operating room efficiency, patient safety and access to care.
Question: What do you think is the biggest misconception about anesthesia right now?
Editor’s note: These responses have been lightly edited for clarity and length.
George Anastasian, MD. Director of Anesthesiology at White Plains (N.Y.) Hospital: A misconception is that we are just a service specialty. While we don’t have our own patients to bring to the hospital or ASC, surgeons may choose to do their cases at a facility where the anesthesia clinicians are known to be more skilled and vigilant.
Further, Anesthesiologists act as critical perioperative leaders by managing patient safety, optimizing efficiency, and driving financial performance across the surgical continuum. Many of us act as strategic leaders, bridging the gap between surgeons, nursing staff and administration, fostering collaborative governance to solve complex operational challenges. This certainly applies to hospital systems in the process of expansion and consolidation.
Ann Bassett, DNAP, APRN, CRNA. Lead CRNA at Lawrence (Kan.) Memorial Hospital: I think the biggest misconception that the payers, administration and other medical professionals get wrong about anesthesia is that giving anesthesia is easy. We are the airplane pilots in the operating room. We meet a patient the day of their procedure and have less than 10 minutes to make them feel safe and accept that we will give them an anesthetic that renders them unconscious, insensate, and, in most cases, immobile for the duration of the procedure.
At the end of the procedure, we will wake them up and return them to their pre-anesthetic state and to their loved ones. Take-off and landing can be smooth or bumpy, but the flight is usually smooth and uneventful. Pilots make flying look easy, and there is no misconception about their job. We make it look easy because we are vigilant, competent and follow protocols and guidelines.
Brian Cohen, MD. Administrative Chief of Miami Anesthesia Services: The biggest misconception about anesthesia right now is that the status quo is sustainable. Many stakeholders in healthcare assume that what we are doing today will work tomorrow or remain viable the next-day. That is simply not true.
Across the field, many organizations are operating in survival mode, relying on short-term fixes just to keep pace with current demands while buying time to build a more stable long-term strategy. Keep exploring innovation, partnerships, collaborative models. In anesthesia, we are trained to stay calm during chaos, but we also find comfort in the calm, which is where we are all trying to return.
Daniel Cole, MD. President of the Anesthesia Patient Safety Foundation: The scope of anesthesiology begins with the decision for surgery and extends until recovery is complete. Intraoperatively, it can feel like a solved problem, advanced monitors, excellent outcomes, with tight control.
But that confidence is rooted in the one place we see everything. In the operating room, continuous monitoring creates a cocoon of safety. Outside the operating room, monitoring breaks down, and so does safety. On the ward and at home, deterioration emerges in the gaps. The problem isn’t induction to emergence, it’s that our safety is compromised where our monitoring stops.
Antonio Hernandez Conte, MD. Past-President of the California Society of Anesthesiologists: I believe that the two biggest misconceptions about anesthesia right now are the following:
One is that hospital administrators and C-suite leaders believe that the anesthesia workforce shortage will only last for a short period of time. The second is that hospital administrators believe that there is an easy solution to the workforce issue.
It is imperative that hospital administrators work closely with anesthesiologist leaders at their respective facilities to create solutions that maintain patient safety, while also forging long-term solutions to workforce and staffing challenges. Every geographic region is impacted by its own unique dynamics, so there is not a 1-size-fits all solution for hospitals and facilities across the United States. Two guideposts must be a given, patient safety and high-quality of anesthesia services.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): The biggest misconception is that anesthesia is a variable, per-case cost or an à la carte service rather than an essential service line with fixed coverage requirements. In reality, anesthesia staffing ensures immediate availability for scheduled cases, add-ons and emergencies, enabling throughput, growth and access to care. Strong anesthesia partners are also critical to operations, providing real-time, on-the-ground insight into efficiency, workflow and performance across every procedural area.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): One misconception is that anesthesia practice is just getting patients asleep and waking them up. That is important, but it is much more. Patients arrive with pathologies that must be treated and medicines that must be adjusted. Diabetic patients, for instance, need their glucose measured and insulin ordered, hypertensive patients may need their blood pressures treated, and patients with pain need a safe analgesia plan. 1 to 4 percent of patients undergoing major surgery today die within 30 days postoperatively. Good anesthesia practice involves making medical diagnoses and interventions to improve outcomes.
Ron Levin, MD. Anesthesiologist in San Diego: CRNAs are equivalent to MDAs. Anesthesia is the practice of medicine. With an increasingly aging population with numerous comorbidities, a medical assessment based on years of medical and scientific study is needed to make this assessment for safe passage through surgery.
Leonard Lind, MD. Professor Emeritus of Anesthesiology at University of Cincinnati College of Medicine: The biggest problem is that administrators and surgeons view anesthesia providers as commodities, not as fellow doctors or advanced nursing professionals. If ASCs want engaged and cooperative colleagues, they should make anesthesia providers partners in the “business” of their center. Without excellent anesthesia care, most of the procedures done in ASCs would not be possible. Just ask any GI doctor how nurse sedation versus monitored anesthesia care or general anesthesia compare in regards to patient satisfaction and control of procedural conditions.
Michelle Reilly, DNP, CRNA. Chief CRNA, Anesthesia Co.-Frederick Division at Frederick (Md.) Health: The anesthesia industry continues to blur the line between reimbursement models and clinical capability. Medical direction is a billing construct, not a scope-of-practice limitation for CRNAs. Until that distinction is widely understood, facilities will continue to underutilize CRNAs and struggle to adapt to workforce and access pressures.
Luis Tollinche, MD. Chair and Professor in the Department of Anesthesiology at MetroHealth Medical Center (Cleveland): One of the common misconceptions about anesthesia relates to value. Many stakeholders still view anesthesia as a cost center rather than a driver of value. This overlooks the specialty’s central role in optimizing patients preoperatively, preventing complications intraoperatively and facilitating recovery postoperatively.
Anesthesiologists are uniquely positioned to improve throughput, reduce length of stay and enhance patient safety across the continuum of care. Misunderstanding this leads to short-sighted decisions in staffing and reimbursement. At its core, strong anesthesia leadership is essential to high-functioning perioperative systems.
Tammi Wittry, APRN, CRNA. Sanford USD Medical Center (Sioux Falls, S.D.): Healthcare administrators have a misconception of the importance of anesthesia providers in their health care system. With constant turnover of nursing and surgical techs, anesthesia providers are the constant safety factor in the room. They provide the expertise behind OR efficiency and patient safety.