The anesthesiologist shortage is now a 'full-blown crisis.' Should Canada use nurse anesthetists?

The effects of a shortage of anesthesiologists could be improved if specially trained nurses were allowed to provide anesthesia care — something they do in the United States, nursing advocates say. 

But physicians' groups have pushed back against the idea in at least two provinces since it was raised more than 25 years ago, even as surgical wait times have grown since the pandemic.

In the U.S., there are 65,000 certified registered nurse anesthetists (CRNAs) working. In Canada, nurses haven't been able to provide anesthesia since the Second World War ended, says Valerie Grdisa, the CEO of the Canadian Nurses Association. .

Now nurse associations, and some Canadian nurses working in the U.S. as nurse anesthetists, are calling attention to how effectively they could solve the dearth of anesthesia care providers in this country. 

While Grdisa notes that the U.S. health-care system has considerable problems with access and cost, one thing it does well is making efficient use of its employees.

"They're optimizing their very talented workforce in ways we're not [in order] to get better value for money at same or equal outcomes," said Grdisa, who holds a PhD in nursing. She was part of an effort to establish a nurse practitioner program in anesthesia at the University of Toronto that ran for a few years in the early 2000s, but she said it was dismantled before graduates could enter the Ontario health-care workforce after "an active physician lobby" convinced the province to abandon the idea.

Nurse anesthetists in the U.S. administer more than 58 million anesthetics — drugs that cause a loss of feeling or awareness — to patients each year, according to the American Association of Nurse Anesthesiology. In rural areas, they provide more than 80 per cent of anesthesia care.

Canadian nurse Joe Toma lives in Windsor, Ont., and works as a nurse anesthetist just across the border in Detroit at a hospital called Henry Ford Health. He says three classmates who graduated with him from CRNA training also make the same half-hour commute each day.

On the day he spoke with CBC, Toma said he had done a shift in the endoscopy unit, where the interior of a patient's organ is examined with a scope. Since one anesthesiologist can oversee up to four CRNAs at his hospital, Toma and two others were in rooms with patients, while the anesthesiologist worked in the pre-op area evaluating patients ahead of their procedures.

"So that's like a great utilization right there where one person is out in the pre-op and recovery area evaluating patients and able to respond if any emergency occurred," Toma said. 

"Obviously Canada has long wait times and I think everybody knows that one of the major contributing factors is the lack of anesthesia providers," he said. "So, if you had CRNAs in Canada, you would definitely improve operating room access to Canadian citizens."

In the years leading into the pandemic, surgical wait times were long but improving, according to data from the Canadian Institute for Health Information (CIHI). But closures associated with COVID-19 meant close to 600,000 fewer surgeries than normal were performed in the two years between April 2020 and March 2022. 

While surgical volumes have returned to pre-pandemic levels, the CIHI data shows that today fewer people get their surgeries within the recommended timeframe — 48 hours for a hip fracture, for example — than they did in 2019.

An editorial published late last year in the Canadian Journal of Anesthesia said the shortage of anesthesiologists in Canada has evolved into a full-blown crisis and creates a major barrier to surgical access, "with the majority of Canadian anesthesiology departments now reporting significant challenges with recruitment and retention."