The Changing Role of Anesthesiology: How Will the Specialty Adapt as Procedures Go Outpatient?

The future of anesthesiology may look very different from its past. Advances in administering anesthesia, coupled with the growth of minimally invasive surgical techniques, have allowed the number of procedures performed in the outpatient setting to grow, a trend that is expected to continue exponentially. As techniques become more advanced, increasingly complex procedures will be able to be performed outside the hospital in outpatient surgery centers and even physician offices.

"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," says 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.

Moving procedures to the lowest-cost setting while maintaining the highest standard of safety and quality aligns with the aims of healthcare reform but presents a challenge for anesthesiologists, CRNAs and hospitals.

With demand for anesthesia professionals far outpacing supply, this migration of procedures outside the hospital stretches an already thin workforce even further. In addition, financial support of hospital-based anesthesia departments may increase since the procedures that move outside the hospital will involve healthier and better insured patients leaving less revenue to support the hospital-based groups.  

Faced with rising costs of anesthesia care and a lack of supply, more physicians trained in areas other than anesthesia may begin to feel they can provide the necessary support to administer anesthesia during their procedures, explains Dr. Schares. For a delivery system that seeks to reduce costs, this type of staffing change could be welcomed in appropriate situations so long that it does not put patients at risk.

"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," says Dr. Schares. “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."

As techniques advance allowing providers beyond anesthesiologists and certified registered nurse anesthetists to administer sedation, anesthesiologists will be forced to evolve beyond their traditional duties.

"I think that anesthesia is actively trying to identify its role in the delivery of care," says Dr. Schares. "We have perfected a lot of techniques to where a lot of non-anesthesia providers think they can do it."

As result, there is an ongoing conversation among the anesthesia community on how the role will evolve and expand. Two ideas that are being considered are renewing anesthesiologists' role in critical and intensive care and that of anesthesiologists as the "quarterback" of the surgical home, where they would serve as preoperative and perioperative physicians, in addition to intraoperative ones. However, Dr. Shares adds, "There's absolutely no consensus on that at this time."

Regardless of the route anesthesiologists take, their importance in healthcare delivery won't diminish, but will grow as they move from anesthesia administration to oversight and beyond, both within and outside the traditional surgical setting.

More Articles on Anesthesia:

The Benefits of Partnering OR Managers and Anesthesia Departments
Significant Changes for Anesthesia Ahead: How Will Your Career be Impacted?
Improving Anesthesia Performance Requires Challenging the Status Quo

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