A nationwide shortage of anesthesia care providers has placed an additional post-pandemic strain on Providence, the Inland Northwest’s largest health care system.

“It really came to a head immediately after the height of COVID, where we found ourselves in a situation where we had a lack of anesthesia personnel,” says Dr. Erik Condon, who was appointed to chief of surgery at Providence Sacred Heart Medical Center and Providence Holy Family Hospital last week.

Condon, who joined Providence in 2013, previously served as the division lead for anesthesia services.

The workforce shortage isn't exclusive to Spokane, however.

Industry data provided to the Journal by Condon shows a projected nationwide shortage of 12,500 anesthesiologists by 2033.

“Some areas are much more affected than others, but we certainly feel it here," says Condon.

Two bills intended to address the anesthesia workforce shortage currently are working their way through the Washington state Legislature, both of which were still alive as of mid-February. One would  establish anesthesiologist assistants as a new health profession, and the other would expand educational opportunities for certified registered nurse anesthetists. 

Anesthesiologists and certified registered nurse anesthetists, or CRNAs, are the two most common types of anesthesia providers in the U.S., Condon says. There also is a shortage of CRNAs, he adds.

The anesthesia provider shortage wasn’t noticeable prior to the pandemic, Condon says.

“Since COVID, we had a lot of people who transitioned into different jobs, different lifestyles in terms of how much they wanted to work, where they wanted to work,” he says.

An aging workforce, a lack of people coming out of the anesthesia care training pipeline, and a growing population are among the other factors contributing to the labor issue, Condon says.

“The workforce typically tends to be older in our field, and so as people retire, there’s just more people retiring than coming into it,” he says.

Impacts of the shortage are felt across the board—for patients, hospitals, and hospital staff.

For patients, the anesthesia provider shortage can lead to longer wait times for some procedures.

“For certain elective procedures, surgeons aren’t able to get them through as quickly as we’d like,” Condon says. “We’re still taking care of all of our acute and emergent surgeries that we have an obligation to take care of for our community.”

Providence hospitals, which are already grappling with post-pandemic financial woes, have been forced to rely on costly traveling anesthesia providers.

“We love them. We’re grateful for their support, but they’re very expensive,” says Condon.

Often bearing the brunt of the shortage, Providence’s anesthesia care personnel, including Condon, are working longer, more rigorous hours to make up for the lack of workers. Many anesthesia care personnel end up being asked to work on vacation days, Condon says.

“It puts a big stress on those that are here,” he says. “It makes it more complex and difficult to manage the operating room and surgeons, and getting all these cases done and organized because we have to deal with that constraint.”

The quality of care at Providence hasn't suffered amid the shortage, Condon adds.

Spokane’s next largest health care system, MultiCare, hasn’t been impacted by the shortage to the same degree Providence has.

“In the Inland Northwest, we have a close working relationship with our anesthesia group, and while staffing shortages have affected us, we have not had to stop or delay any services due to anesthesia staffing shortages,” says Dan Springer, chief operating officer for MultiCare Deaconess Hospital and MultiCare Valley Hospital.

Anesthesia services at MultiCare’s facilities are provided by an outside anesthesia group that the health care system contracts with.

Senate Bill 5184, if passed, would establish anesthesiologist assistants as a new health profession in the state of Washington, ultimately tapping into a new pipeline of existing anesthesia care providers.

“Bill 5184 is certainly not going to solve all the problems, but it’s one solution of a few that have been proven effective and safe in other states,” says Sarah Brown, a certified anesthesiologist assistant and president of Washington Academy of Anesthesiologist Assistants.

Anesthesiology assistants are already authorized to work in 20 states, Washington, D.C., and the territory of Guam, says Brown, who lives in Spokane.

The main difference between anesthesiologist assistants and CRNAs is that in Washington, CRNAs are allowed to work independently of anesthesiologists, while anesthesiologist assistants would be required to work under the direction and supervision of an anesthesiologist in a team-based care model, Brown says.

According to the American Society of Anesthesiologists, CRNA education requirements include a bachelor's degree in nursing, a minimum of one year of acute care experience, and 24 to 36 months in a master's or doctorate-level program.

Anesthesiologist assistant education requirements include a bachelor's degree with pre-medical science requirements, as well as a 24- to 28-month master's level program.

Prior to moving to Washington in 2015, Brown worked as an anesthesiologist assistant in her home state of Georgia. After her move, she frequently traveled back and forth to Georgia to continue practicing anesthesia care.

Now, however, with her second child on the way, Brown is unable to make that commute to continue practicing. She says she would work as an anesthesiologist assistant in Washington if she were authorized to do so.

“It’s unfortunate that I and others like me who live in this state for various reasons aren’t able to fill these jobs that have been open for a long time,” she says.

Providence and MultiCare both support the anesthesiologist assistant bill, Condon and Springer say separately.

“They form a fairly small minority of the total anesthesia providers in the U.S., but do quality work and work competently with anesthesiologists in a team-based setting in other states,” Condon says. “It would be helpful, generally speaking, for the state of Washington for some practices to have that option.”

Adding the additional type of anesthesia care provider wouldn’t be a total solution, however, says Condon.

“The long-term solution is to train more people,” he says.

There are two residency programs in the state of Washington—one through the University of Washington and one through Virginia Mason University, both in Seattle.

The lengthy and costly education requirements to become an anesthesiologist likely keep a lot of people from pursuing that career, Condon contends.

Gonzaga University offers the state’s only CRNA program. There are no CRNA programs in Idaho, and just one in Oregon, located in Portland.

Condon says Gonzaga is doing a great job of increasing the number of students that it's training, but since it is the only CRNA program in Washington, the pipeline isn’t large enough.

The other bill, Senate Bill 6286, if passed, could help increase the supply of CRNAs in Washington by reducing barriers and expanding educational opportunities.

The bill would create a grant program that would be intended to create more clinical placements for nurse anesthesia residents to complete their required clinical hours to earn their degree and related licensure, the bill reads. 

Both SB 5184 and SB 6286 passed through the senate and are currently moving through the house.

“The patients in Washington would very much benefit from (SB 5184) and from any bill that’s going to address health care workforce shortages,” says Brown.