Anesthesia leaders face a diverse set of challenges in 2026 as the workforce shortage continues to shift across geographies, markets and practice settings.
Melissa Croad, CRNA, APRN, president of the Massachusetts Association of Nurse Anesthesiology, recently joined Becker’s to discuss how her organization will approach the anesthesia provider shortage in the year ahead.
Editor’s note: This response has been lightly edited for clarity and length.
Question: How are you thinking about or approaching the anesthesia shortage in 2026? How will this be different from your current approach, if at all?
Ms. Croad: It is important to consider that the anesthesia provider shortage is, in part, perceived and manufactured. Anesthesia practice models whereby physician anesthesiologists unnecessarily “supervise” certified registered nurse Anesthetists in prescribed ratios in the Medical Direction/Anesthesia Care Team models are expensive and unsustainable, as the physicians are unavailable to provide anesthesia themselves. This decreases access, as there are fewer providers available to deliver care and increases costs, as they are being paid for an unnecessary service.
CRNAs are recognized as independent practitioners in Massachusetts, like other advanced practice registered nurses. There are no laws or regulations requiring physician supervision for CRNAs to practice. On Jan. 1, 2021, Governor Charlie Baker signed the “Patients First Act” into law, which granted full practice authority to all APRNs in the Commonwealth. Additionally, on June 4, 2024, Governor Maura Healey opted out of the CRNA supervision requirement set by the CMS in the Conditions of Participation for Medicare Part A. This move made Massachusetts the 25th state in the U.S. to opt out of this requirement.
It is irresponsible to pay physician anesthesiologists to only supervise CRNAs who do not require supervision. These practice models are increasingly finding it difficult to recruit and retain CRNAs in Massachusetts, as CRNAs desire working environments where they can utilize their full scope of services and autonomy to provide the best patient care. Unless and until both INDEPENDENT anesthesia providers (CRNAs AND physician anesthesiologists) are personally administering full-service anesthesia services, it is impossible to determine what, if any, shortage there actually is.
It is imperative to note that the Massachusetts Association of Nurse Anesthesiology DOES NOT support the elimination of physician anesthesiologists from patient care. Rather, we support the Consultative Practice Model. The consultative model is defined as an anesthesia practice model staffed primarily by CRNAs, with anesthesiologists serving as consultants. Like the CRNA model, the consultative model has been shown to tolerate financial fluctuations in procedural volumes as long as the number of physician anesthesiologists utilized maximizes efficiency. This model limits duplication of services, improves efficiency and reduces costs compared with anesthesiologist medical direction/ACT practice models. Additionally, practice models that recognize and respect the full scope of practice and autonomy of both CRNAs and physician anesthesiologists tend to recruit and retain their providers. Over the past year, I have crossed state lines over the border into New Hampshire to work in such a practice model. I find this practice model fulfilling and rewarding to work utilizing my full scope of services with autonomy, alongside some amazing CRNAs and physician anesthesiologists, providing the best care for our patients. MANA’s approach in 2026 will focus on promoting and supporting the implementation of Consultative Practice Models in facilities in Massachusetts.