Mike Mackinnon, certified registered nurse anesthetists and owner of Show Low, Ariz.-based Mackinnon Anesthesia, joined Becker's to share five key notes on anesthesia care and shortages.
Editor's note: This was edited lightly for clarity and length.
Mike Mackinnon:
1. Direct performance vs. supervision in anesthesia care
It is crucial to recognize that the core issue contributing to the perceived shortage of anesthesia providers is not a lack of trained professionals, but rather the current practice model in which many physician anesthesiologists are supervising rather than directly performing anesthesia. In a common 1:4 supervisory model, one physician anesthesiologist oversees four anesthesia providers. This model results in five providers doing the work of four, with the most expensive provider in the group not directly performing cases or generating revenue.
2. Impact on outcomes and physician
Numerous studies have demonstrated that the outcomes of anesthesia care provided by CRNAs are comparable to those provided by physician anesthesiologists. The high standards of education, training and certification for CRNAs ensure that they are fully capable of delivering safe and effective anesthesia care. By having more physician anesthesiologists directly involved in performing anesthesia rather than supervising, we can maximize the utilization of their extensive training and reduce the artificial shortage of anesthesia providers.
3. Economic considerations
The current supervisory model contributes significantly to the increasing costs of anesthesia services. With approximately 75% of physician anesthesiologists primarily involved in supervisory roles, a substantial portion of our anesthesia workforce is not being utilized to its full potential. Of the estimated 55,000 physician anesthesiologists in the U.S., about 41,000 are contributing to the shortage by not regularly performing anesthesia. If even half of these professionals returned to direct patient care, it would result in an immediate infusion of approximately 20,000 providers into the workforce, effectively creating a surplus and driving down costs.
4. Limiting scope of practice and access to care
Furthermore, limiting the scope of practice by creating obstructions to having providers work to the top of their license is not in alignment with the goals of expanding access to care in a fiscally responsible manner. By allowing all anesthesia providers, including CRNAs, to fully utilize their training and skills, we can increase access to high-quality anesthesia services, particularly in underserved areas. This approach not only enhances patient care, but also supports a more efficient and cost-effective healthcare system.
5. Addressing the title misappropriation debate
The issue of title misappropriation is often cited as a concern, yet it is largely a red herring. Patients are discerning and understand the distinctions between different types of anesthesia providers based on their titles:
- “Physician anesthesiologist” clearly indicates a medical doctor.
- “Nurse anesthesiologist” signifies an APRN
- “Dentist anesthesiologist” identifies a dental professional with anesthesia training.
- “Anesthesiologist assistant” denotes an assistant role, not a physician.
This clarity in titles ensures that patients are well-informed about who is providing their anesthesia care.