Across the United States, healthcare facilities struggle to maintain a constant supply of anesthesiologists. In 2022, 78% of facilities reported an anesthesia staffing shortage according to the American Society of Anesthesiologists (ASA), and the issue is only getting worse—the U.S. Health Resources and Services Administration (HRSA) projects a shortfall of 8,450 anesthesiologists by 2037. In response, some hospitals and surgical centers have relied on certified registered nurse anesthetists (CRNAs) to fill in the gaps, with these providers representing more than 80% of the anesthesia providers in rural America, according to the American Association of Nurse Anesthesiology (AANA). If you’re a hiring manager at a hospital that’s dealing with a shortage of anesthesia providers, you might be wondering whether you should take on anesthesiologists or CRNAs to ensure coverage. In this article, we’ll be examining CRNA vs anesthesiologist roles, exploring their differences and why you should consider taking on locum tenens providers to address your anesthesia staffing needs.
What is a CRNA?
A certified registered nurse anesthetist (CRNA) is a type of advanced practice registered nurse (APRN) who specializes in administering anesthesia, monitoring patients under anesthesia, providing post-anesthesia care, and educating patients and their families about anesthesia effects and procedures.
To become a CRNA, a person must:
- Earn a bachelor’s degree or higher in nursing or other similar major
- Become a licensed registered nurse (RN)
- Work for at least one year as an RN in a critical care environment
- Graduate with a doctorate in nurse anesthesia (DNP) from an accredited school
- Complete the certification exam given by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
What does a CRNA do?
CRNAs play a crucial role in various healthcare settings, performing a wide range of duties related to anesthesia care. In general, the roles and responsibilities of CRNAs can be distilled down into five main areas, according to the AANA:
- Preoperative
- Conduct comprehensive patient assessments and develop personalized anesthesia plans
- Provide patient education, obtain informed consent, and administer preanesthetic medications
- Intraoperative
- Implement patient-specific anesthesia plans, including various techniques and pain management strategies
- Administer anesthetic medications and insert monitoring devices for comprehensive patient care
- Postoperative
- Manage emergence from anesthesia and conduct postanesthesia evaluations
- Provide postoperative care, including pain management and patient education for recovery
- Pain Management
- Provide comprehensive pain management services, including acute, chronic, and interventional techniques
- Implement multimodal and regional anesthesia approaches for various patient needs, including obstetric care
- Other
- Prescribe medications and provide emergency care, including advanced airway management and resuscitation
- Perform and interpret diagnostic tests, using various technologies to deliver comprehensive patient care
Where do CRNAs work?
CRNAs serve as the exclusive providers of anesthesia services in roughly 33% of all hospitals across the United States, according to the AANA. This percentage increases significantly in rural areas, where they are the only anesthesia professionals in over 66% of hospitals.
CRNAs can be found in many different types of healthcare environments, including:
- Hospitals
- Ambulatory surgical centers
- Dental offices
- Pain management clinics
- Military facilities
- Obstetric departments
CRNA Scope of Practice By State
What a CRNA can and cannot do depends immensely on the state in which they work. Some states allow CRNAs to work without anesthesiologist supervision, and some also allow CRNAs to prescribe medication.
Here’s a breakdown of CRNA practice authority by state:
CRNAs aren’t required to have authority to prescribe medications in order to provide anesthesia care. But since CRNA scope of practice can include the prescribing of other medications beyond their typical scope of practice, there are differing prescriptive authority for CRNAs by state:
What is an anesthesiologist?
An anesthesiologist is a licensed physician who specializes in directing anesthesia care, administering anesthesia, and caring for patients before, during, and after surgeries and other invasive medical procedures. As the leader of an anesthesia care team (ACT), an anesthesiologist is responsible for the safety of patients before, during, and after administration of anesthesia.
To become an anesthesiologist, a person must:
- Earn a bachelor’s degree in a related field while satisfying pre-med requirements
- Earn a medical degree from an accredited medical school
- Pass the United States Medical Licensing Examination (USMLE)
- Complete a four-year anesthesiology residency program after medical school
- Obtain a valid, unencumbered state medical license
It’s voluntary, but 75% of anesthesiologists pass the American Board of Anesthesiology (ABA) exam, according to the American Society of Anesthesiologists. After residency, anesthesiologists can enter an additional fellowship program for one year of specialty training in areas such as cardiac anesthesia, pediatric anesthesia, obstetric anesthesia, and more. Anesthesiologists can also gain certification in subspecialties, such as critical care medicine or pain medicine.
What does an anesthesiologist do?
As mentioned previously, anesthesiologists are primarily responsible for directing anesthesia care and pain management through all stages of a surgical procedure. Like CRNAs, an anesthesiologist’s responsibilities fall under a few main buckets:
- Preoperative
- Evaluate a patient’s current state of health
- Create a detailed and safe anesthesia plan in accordance with the patient’s surgical procedure and health
- Intraoperative
- Administer anesthesia and monitor vital signs
- Ensure that normal bodily functions continue through administration of fluids, blood, and medications
- Postoperative
- Monitor patients as they emerge from the effects of anesthesia and conduct postanesthesia evaluations
- Determine when a person has recovered from anesthesia and decide when to discharge the patient from the hospital
- Pain Management
- Manage postoperative pain through the use of medications and other therapy
- Care for patients undergoing less-intensive surgery to manage pain during the procedure
Where do anesthesiologists work?
Similar to CRNAs, anesthesiologists work in a wide variety of healthcare settings, specifically those in which surgical procedures are commonly performed. These include:
- Hospitals
- Ambulatory surgical centers
- Dental offices
- Pain management clinics
- Military facilities
- Obstetric departments
Anesthesiologist Scope of Practice
As medical doctors, anesthesiologists are not as limited in their scope of practice than their CRNA counterparts. This means that anesthesiologists are generally qualified to administer anesthesia and prescribe medications as necessary before, during, and after putting a patient under the effects of anesthesia.
In some states, anesthesiologists must supervise CRNAs and other members of the anesthesia care team (ACT), taking on more of an overseer role.
CRNA vs Anesthesiologist: Which should I staff?
Now that you have a more comprehensive understanding of CRNA vs anesthesiologist roles, a major question remains: Which is best for my facility? Here are some key items to consider:
- Facility Type and Location
- Rural hospitals and smaller facilities: CRNAs are often the primary anesthesia providers in these settings due to their versatility and cost-effectiveness.
- Large urban hospitals and academic medical centers: These typically benefit from a mix of both CRNAs and anesthesiologists, with anesthesiologists often taking on supervisory roles.
- Complexity of Procedures
- Routine surgeries and less complex cases: CRNAs can handle these efficiently and effectively.
- High-risk patients and complex surgeries: Anesthesiologists may be preferred due to their extensive medical training.
- State Regulations
- Consider your state’s laws regarding CRNA practice authority and supervision requirements.
- Cost Considerations
- CRNAs generally command lower salaries than anesthesiologists, potentially offering cost savings for facilities.
- Availability
- Given the projected shortage of anesthesiologists, CRNAs may be more readily available in some areas.
Ultimately, the best staffing solution often involves a combination of both CRNAs and anesthesiologists, tailored to your facility’s specific needs, patient population, and regulatory environment. Many successful healthcare facilities utilize a mixed model, also known as the anesthesia care team (ACT) model leveraging the strengths of both professions, as well as certified anesthesia assistants (CAAs), to provide comprehensive, cost-effective anesthesia care.
Why Staff Locum Tenens Anesthesia Providers?
Locum tenens CRNAs and anesthesiologists offer healthcare facilities a flexible solution to address staffing shortages and fluctuating demand. By bringing in these temporary medical providers, hospitals and surgical centers can maintain optimal patient care without the long-term commitment of permanent hires.
Locum tenens providers also allow facilities to evaluate different staffing models and skill mixes before making permanent changes to their anesthesia teams. Moreover, these temporary professionals can help prevent burnout among permanent staff by filling gaps in coverage and reducing overtime, ultimately contributing to better patient outcomes and improved operational efficiency.
Partner with Wellhart for Anesthesia Staffing
Need CRNAs or anesthesiologists at your medical facility? When you partner with us, we’ll leverage our extensive network of locum tenens providers to find qualified medical professionals that meet your needs. Contact us today to get started!