Is the Future of Anesthesiology (for MD/DO Physicians) Dead?

The above question has been at the forefront of the minds of many anesthesiologists and certified registered nurse anesthetists (CRNAs) in the United States for a few years now. In 2021, a Wisconsin hospital was making headlines for its decision to “replace all anesthesiologists with CRNAs.” This event sparked debates and speculations about the future of anesthesiology for MD/DO physicians. However, a nuanced examination reveals a more complex and balanced perspective.

Current Landscape

The decision at Watertown Regional Medical Center, while significant, does not signal the demise of physician anesthesiologists across the United States. For Watertown Regional Medical Center, a medical staffing agency now oversees the anesthesiology team. Dr. Adam Dachman, a surgeon at the hospital, emphasized that the misconception of physicians being required to administer anesthesia prompted this change. However, it is crucial to recognize this as an isolated incident rather than a nationwide trend.

In the world today, both CRNAs and physician anesthesiologists play crucial roles in anesthesia care. Drawing parallels to patient interactions in clinics, the differences in educational backgrounds, training duration, autonomy, and responsibility between these two professions are evident. 

While CRNAs are vital members of the anesthesia care team, they do not replace the specialized expertise and training that physician anesthesiologists bring to the field. To stay relevant, anesthesiologists are encouraged to focus on complex patients with comorbidities, requiring specialized care. Additional training, like critical care medicine, can enhance anesthesiologist’s skills and marketability.

Anesthesia Care Team Model

Physician anesthesiologists often work collaboratively with CRNAs in the anesthesia care team model. In this setup, an MD anesthesiologist supervises multiple CRNAs working in different operating rooms simultaneously. The American Society of Anesthesiologists emphasizes that anesthesiologists personally provide or direct anesthesia care, reinforcing the supervisory role in this model.

Legislative Changes

In 19 primarily Western states (Wisconsin, Arizona, Oklahoma, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, California, Colorado, and Kentucky), legislation allows CRNAs to opt out of physician supervision. The main reason for this shift was the shortage of physician anesthesiologists in rural hospitals. 

Allowing CRNAs to practice independently aimed to enhance surgical accessibility for patients in these underserved areas. As one can imagine, a small community like Watertown, Wisconsin, probably faces challenges in recruiting and retaining a complete team of MD anesthesiologists, necessitating the reliance on CRNAs for staffing.

Other Concerning Factors

While technology and artificial intelligence have made advances in medicine, they are not at a point where they can fully replace anesthesiologists. Machines lack the ability to respond to acute events and think broadly about complex cases. They are supportive tools but not replacements. 

Technology will continue to evolve, but human expertise remains crucial in anesthesiology. Medicine, as a whole, is witnessing the expansion of advanced practice providers, so being open to these changes and learning to adapt to new technology is crucial.

In recent times, there has been a growing concern regarding the variability of salaries, although they consistently rank among the highest in the medical field. The perceived decline in earnings could be attributed to various factors, including the impact of the COVID-19 pandemic on elective procedures. Additionally, salary levels tend to fluctuate based on geographical location. To address this, it is advisable to assess the demand for anesthesiologists in a preferred area or collaborate with a locum agency to identify communities experiencing a demand for your specialized skills. 

This proactive approach allows anesthesiologists to navigate salary fluctuations more strategically and align their expertise with areas where their services are in high demand.

While the role of CRNAs in American healthcare is undeniable, the idea that they will replace physician anesthesiologists nationwide is highly unlikely. The future for physician anesthesiologists remains promising, especially in complex surgical cases and major medical centers. 

Consilium’s Divisional Vice President of Anesthesia, John Moberly supported this conclusion by saying, “We are confident that CRNAs will continue to play a major role for the medically underserved areas along with providing support to the facilities with higher volume general cases so that acute needs can be provided by specialized physician care.”

Collaboration between CRNAs and MD anesthesiologists within the anesthesia care team model ensures a balanced and effective approach to anesthesia care, safeguarding patient safety and the future of the profession. Shadley Hawkins, Divisional Vice President of Account Management concludes, “In 2024 we will continue to see the partnership between Anesthesiologists and CRNAs grow to meet the needs of the community. Consilium, with its unwavering commitment to pioneering excellence in locum healthcare solutions, eagerly anticipates this transformative growth.”

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