Montana anesthesiologists opposed to integrating CRNAs amid crushing shortages

Montana health systems and hospitals are being crushed by anesthesiologist shortages, but anesthesiologists are still opposed to integrating certified registered nurse anesthetists into health systems, Billings Gazette reported Jan. 6. 

CRNAs have advertised themselves as a solution to staffing shortages exacerbated by the COVID-19 pandemic. Hospitals have begun relying on expensive traveling anesthesiologists, according to the report. Other states have integrated CRNAs to ease challenges, but Montana has been slow to follow suit. 

According to Alison Carter, CRNA, secretary and treasurer of the Montana Association of Nurse Anesthesiology, hospitals in metropolitan areas have resisted integrating CRNAs, although CRNAs are providing care in ASCs and other facilities.

Additionally, in Montana, CRNAs can and do operate independently without anesthesiologists in rural areas — the state, like other rural states where physician shortages are obstacles to care, adopted an opt-out law that allows CRNAs to practice independently. 

The conflict has come to a head in Billings, Mont. Billings Anesthesiology renewed its contract with Billings Clinic in November, but before the contract was settled, some anesthesiologists left to work at other hospitals, and the remaining physicians were offered wages comparable to traveling anesthesiologists, which isn't sustainable, said one anesthesiologist at the practice.  

Billings Anesthesiology briefly considered adding CRNAs to its workforce, but the idea was abandoned. The practice said it is only willing to introduce a model where CRNAs work under the supervision of a physician. 

This proposal, however, stirs tension among physicians who prefer to work on their own, according to the report. Many CRNAs are pushing for health systems and hospitals to allow for CRNAs to operate either independently or under physician supervision —  what they see as a cost-efficient solution to physician shortages. 

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