Tariq Naseem, MD, an anesthesiologist and interventionist at Los Angeles-based Smidt Heart Institute, joined Becker's to discuss how the anesthesia provider shortage is affecting care delivery.
Editor's note: This interview was edited lightly for clarity and length.
Question: How will the anesthesia provider shortage affect care delivery in the next five years?
Dr. Tariq Naseem: I think it will come down to that procedures will be performed at places that can afford to retain an anesthesiologist. Places that want to get cases done in a more affordable fashion will struggle. We've already seen that. A lot of these places, for instance, like ASCs are utilizing more and more nurse anesthetists for this purpose. I think the struggle will be how to get anesthesiologists. It's going to become harder and harder if it's just too expensive to provide that coverage.
Hospitals, like large ones, academic-based centers, will be able to retain them, but the moment you go into a pure, clinical, revenue-based production, it's hard. As an example — a few weeks ago, I was talking to a gastroenterologist who said he just joined an ASC who promised they would have anesthesia coverage for him. They didn't, so he's doing cases under sedation instead. But for some procedures, this cannot be done for a longer duration because patients can't tolerate it.
Q: What are the solutions?
TN: I've been thinking about this so much for so long. In the short term, meaning within the next five to 10 years, the goal would be how to maximize anesthesia coverage. The way to do that — it's been going on a little in academia — is that you use anesthesiologists as perioperative specialists. So it's not so much as a 1-to-1 anesthesiologist-to-extender ratio, but rather using CRNAs and anesthesiologist assistants as much as possible.
There's nothing wrong with nurse anesthetists, but the question comes down to how comfortable you are doing cases with nurse anesthetists and no physician available, period. God forbid it's an emergency or there's any crisis and we do not have an anesthesiologist, MD-trained person in the building. So that's a way to ensure that the patient care is not affected in any way, and the availability of anesthesiologists is not hampering clinical production. Right now, a lot of places are saying they need an anesthesiologist in every operating room, which is not ideal or sustainable. But having an anesthesiologist cover three to five operating rooms with an anesthesiologist assistant or CRNA could ensure that the care is optimal.
It's just not possible to suddenly improve the shortage, or decrease the amount of time you need to train an anesthesiologist — the lag time on that is about 10 to 15 years. This one was a hard one to predict its severity because with the COVID-19 pandemic, a lot of older anesthesiologists retired earlier than expected. And this generation was one of the most experienced and hard working. The new generation, whether you like it or not, is one that does not want to work 80 hours a week. We've lost experienced physicians who work a lot with those who value quality of life a little bit more. And there's nothing wrong with that, but it's a combination of those two factors that are shifting the workforce. The market needs to adapt for that, and we're just in a tough spot at this time.