As payers and many patients demand medical services at affordable rates, more and more surgical procedures occur in the ambulatory surgery center (ASC) setting. Now we are even seeing increasingly more complex procedures moving to ASCs. In addition, physician offices are becoming increasingly popular settings for procedures once reserved for hospital operating rooms. Thomas Schares, MD, chief of anesthesia at Desert Regional Medical Center in Palm Springs, Calif., and director of medical affairs for Somnia Anesthesia’s California and New Mexico operations recently commented in an interview with Becker’s Hospital Review:
“As techniques and medication continue to evolve and improve, opportunities increase to do more procedures outside the traditional hospital setting or even within the hospital setting but outside of the traditional operating room environment.”
Moving procedures away from the hospital setting is a challenge to anesthesiologists, primarily regarding quality control and an increasing shortage of anesthesia doctors. Physicians trained in other specialties may feel qualified to give anesthesia to their own patients. Yet, the trend is attractive to healthcare systems struggling to bring costs down. Dr. Schares noted:
“Nobody will dispute that the anesthesiologist is the expert; CMS has, in fact, acknowledged this and mandated that anesthesiology departments oversee all anesthesia activities in their hospitals. I believe going forward [decisions about who delivers anesthesia] should be overseen with evidenced-based criteria and be steered by anesthesia providers in any location.”
Some hospitals are developing techniques that allow non-anesthesiologists to give anesthesia, meaning the role of the anesthesiologist must adapt. There is an ongoing discussion within the anesthesia community on how their role should expand and evolve – but there is no consensus. One idea is to revive the role of anesthetists in critical care and intensive care. Another is to have the anesthesiologist serve as a quarterback in the surgical home, where they also function as both preoperative and postoperative physicians.
Until recently, most states required that CRNAs work directly under the supervision of a physician anesthesiologist. But now 17 states allow CRNAs to work without supervision. These states include Washington, Wisconsin and trendsetting California. As we move toward a world with stronger preventative health measures in place, complex and technical surgical cases should decrease, to be replaced by more diagnostic and less-invasive procedures. These shorter cases fall within the scope of the ability of CRNAs. As most anesthesiologists are aware, there is a shortage today of physician anesthesiologists. Yet, the Bureau of Labor Statistics finds there are 17 percent more nurse anesthetists than their physician counterparts.
Some would argue the evidence shows unsupervised CRNAs provide positive outcomes at lower costs to the nation’s healthcare system.
This deepens the struggle for anesthesiologists to remain relevant. Many physician members of anesthesiology groups find it necessary to showcase their unique experience and training. Every physician anesthesiologist agrees that their residency was arduous and intense – making them the most qualified to manage the care of certain populations such as chronic pain sufferers, cardiac, or other special medical needs groups. They must also find ways to effectively demonstrate their value as a practice to key stakeholders.
No one doubts that the role of anesthetists is changing. Now is the time for anesthesiologists to explore their options. Those that don’t like the changes may choose the path of retirement. Secondary pursuits such as research, health care technology or administrative roles in ambulatory surgical centers or hospitals may be appealing. Others may embrace the evolution and adapt with it. These individuals may find that change is not only manageable, but enjoyable and rewarding.
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