Expanding the anesthesiologist assistant pipeline would add more providers to the anesthesia workforce, but whether it would add access is a different question.
The current shortage isn’t just a pipeline problem. It’s a mismatch between where providers are trained, what models facilities can afford and which communities can attract coverage at all.
Four ASC and anesthesia leaders recently connected with Becker’s to discuss how the growing anesthesiologist assistant pipeline could help address the workforce shortage in certain areas and situations.
Note: Responses were lightly edited for clarity and length.
Question: As CRNAs gain independent-practice authority in more states, could expanding the anesthesiologist assistant pipeline relieve staffing shortages?
Scott Bergman. President of Peak Health Associates: Expanding the anesthesiologist assistant pipeline can help address anesthesia staffing shortages, but it should be viewed as a complement, not a substitute, for anesthesiologists or CRNAs. Additional anesthesiologist assistants give ASCs another tool to build a scalable, reliable anesthesia workforce. CRNAs and AAs can both be part of a broader, appropriately designed anesthesia model that puts providers where they add the most value. For ASCs, the bigger risk is not having too many anesthesia professionals — it is having too few to keep ORs staffed, cases moving and surgeons and patients from taking their business elsewhere.
Michael Bernard, MD. Chief Medical Officer of Ambulatory Anesthesia Solutions (Novi, Mich.): Expanding the anesthesiologist assistant pipeline would help alleviate the anesthesia staffing shortage. We are facing a national shortage of anesthesia providers at the same time that demand for anesthesia services continues to grow. I don’t view adding more AAs as creating another workforce competing for the same OR time. We need to expand the overall anesthesia workforce and give facilities more options for building staffing models that fit their clinical and operational needs.
The expansion of independent-practice authority for CRNAs has helped create additional flexibility, particularly in markets where physician anesthesiologists are difficult to recruit. Ultimately, however, each facility needs to determine the model that is appropriate based on its case mix, patient population, safety considerations, economics and local market conditions. Within our organization, we use a variety of models depending on the needs of our facility partners, including physician-led care teams, physician anesthesiologists and CRNAs practicing alongside one another independently, independent CRNA practice, and solo physician anesthesiologist practice.
There is no single staffing model that will solve the anesthesia shortage. With an aging physician anesthesiologist and CRNA workforce and continued growth in demand for anesthesia services, expanding the AA pipeline gives us another important tool in the toolbox. We need more qualified anesthesia professionals entering the workforce, and greater flexibility in how we deploy them, if we are going to adequately staff the growing demand for anesthesia services.
Alex Blair. Vice President, Operations of Amsurg (Nashville, Tenn.): Anesthesiologist assistants can play a valuable role in the anesthesia workforce, but unlike CRNAs, in the states where AAs are authorized to practice, they are required to practice under the supervision of an anesthesiologist. As more states recognize CRNAs’ ability to practice independently, the key workforce question becomes not simply how many providers we can train, but which provider models offer the greatest flexibility, scalability and access to care.
In the ASC environment, anesthesia reimbursement is often insufficient to support both anesthesiologist and AA compensation without additional financial support. This economic reality has contributed to a significant increase in anesthesia subsidy and stipend requests from anesthesia providers across the industry. As a result, health systems, ASCs and physician groups are increasingly exploring alternative staffing structures, including developing internal anesthesia platforms and CRNA-led models to reduce reliance on third-party vendors and the margins associated with those arrangements.
The larger challenge is not necessarily a shortage of anesthesia professionals overall, but rather a mismatch between workforce supply, care delivery models and geographic distribution. Many underserved, rural and lower-volume markets struggle to attract anesthesia coverage because of reimbursement constraints and supervision requirements. In those settings, CRNAs often provide the most practical and sustainable solution due to their ability to practice with greater autonomy while delivering safe, high-quality care.
Expanding the AA pipeline may increase the number of anesthesia providers available to medically directed practices, but it does little to address access challenges in areas where anesthesiologist availability is already the limiting factor. By contrast, expanding the CRNA workforce increases capacity across a broader range of practice settings, including independent, collaborative and physician-led models.
Ultimately, this should not be viewed as an “AA versus CRNA” debate. The goal should be to maximize patient access to safe, high-quality anesthesia care while maintaining economic sustainability for healthcare organizations. To achieve that objective, policymakers and payers must support fair reimbursement structures that recognize the value CRNAs bring to the healthcare system and enable providers to practice at the top of their education, training and licensure.
Tracy Young, CRNA. President of the American Association of Nurse Anesthesiology (Rosemont, Ill.): CRNAs are true force multipliers in the anesthesia workforce because they can add independent clinical capacity across a wide range of practice settings.
That distinction matters when we talk about workforce shortages and access to care. Anesthesiologist assistants practice within an anesthesiologist-led care team and require physician anesthesiologist supervision and direction, typically within a defined medical direction model of no more than one anesthesiologist to four AAs. Their ability to expand access is therefore tied to the availability and the affordability of anesthesiologists to direct them.
CRNAs are different. They can provide the full scope of anesthesia care and, in most settings, do so without requiring an anesthesiologist to be part of the model or being constrained by the physician-to-provider ratios associated with medical direction billing. In states that remove physician supervision requirements, that flexibility becomes even greater because it reduces unnecessary structural barriers and allows hospitals to build anesthesia models around the actual needs of their patients and resources of the communities. It can also reduce the perceived liability concerns some surgeons have when they are placed in the position of being the “supervising physician” in non-opt out states despite having little or no formal anesthesia training.
Access, however, is not just about how many providers are available. It is also about how many providers a local hospital or surgery center can afford to be part of the team. An AA always requires the additional cost and availability of a physician anesthesiologist as part of the care model, while a CRNA is appropriately trained and can function as the sole anesthesia professional. That makes the CRNA model particularly important for rural and underserved facilities where both workforce supply and financial resources are limited.
As policymakers look at the future anesthesia workforce, the focus should not simply be on increasing headcount. It should be on how effectively and affordably each provider type expands access. One additional CRNA can represent one additional anesthetizing location, with the flexibility to provide that care without requiring another anesthesia professional for oversight, as AAs do. That is why CRNAs are true force multipliers in the anesthesia workforce.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
