Canada's health-care system, renowned for its universal coverage, is facing a severe challenge with a shortage of anesthesiologists that has escalated into a full-blown crisis. Ranked as the second-most expensive among OECD nations, the Canadian system struggles to meet population needs for anesthesia services, particularly in rural areas. This shortage impedes surgical access and prolongs wait times, which have been exacerbated by the COVID-19 pandemic. Amidst growing concerns, the debate over introducing certified registered nurse anesthetists (CRNAs) into the Canadian healthcare system gains momentum.
Anesthesiologists are in short supply across Canada, with rural regions experiencing the brunt of this scarcity. In these areas, nurse anesthetists provide over 80% of anesthesia care. Despite this reliance on nurse anesthetists in rural settings, the Canadian Anesthesiologists' Society opposes the formal introduction of CRNAs into the national healthcare framework. This stance contrasts sharply with the United States, where approximately 65,000 CRNAs operate effectively. In contrast, Canada witnesses its own trained nurse anesthetists migrating southward for opportunities.
"It's really unfortunate that we have these skilled, highly talented nurses across the nation that seek graduate-level education south of the border, and they cannot be optimized in the Canadian health-care system." – Valerie Grdisa
The shortage of anesthesiologists is not merely a logistical hurdle but a significant barrier to timely surgical operations. Surgical wait times have surged since the onset of the pandemic, partly due to this deficit. Although not the sole factor for surgery cancellations, the lack of anesthesia providers contributes heavily to the problem. This issue has been addressed in a "patchwork manner" at provincial and local levels without a cohesive national strategy—a point of contention for over three decades.
"Obviously Canada has long wait times and I think everybody knows that one of the major contributing factors is the lack of anesthesia providers," – Joe Toma
Calls to incorporate CRNAs in Canada aim to enhance workforce optimization and potentially reduce costs within the healthcare system. The Canadian Nurses Association advocates for this integration, emphasizing the benefits of cost efficiency and resource utilization. The B.C. Nurses' Union supports this initiative, highlighting the collaborative potential among health disciplines to improve patient care.
"Utilizing nurse anesthetists in B.C. would be a positive step towards collaboration among various health disciplines and be beneficial to improving patient care," – B.C. Nurses' Union
Despite these arguments, systemic resistance persists due to deeply ingrained biases within the physician-dominant framework of Canadian healthcare. This reluctance to adapt hampers potential workforce optimization and cost reduction strategies that could alleviate the current crisis.
"a physician-dominant system in Canada" has prevented nurse anesthetists from working here, "even though we know that it would be better workforce optimization and reduce costs." – Valerie Grdisa
The editorial from the Canadian Journal of Anesthesia calls for an appraisal of these biases and openness to new ideas as Canada grapples with its anesthesia crisis.
"Such appraisal will necessarily involve an examination of our own longstanding biases and an openness to new ideas." – An editorial in the Canadian Journal of Anesthesia
In contrast to Canadian practices, U.S. healthcare systems optimize their workforce by utilizing CRNAs extensively, achieving better value for money with similar outcomes.
"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," – Valerie Grdisa
The potential introduction of CRNAs in Canada also finds support among medical professionals who recognize their absence as a missed opportunity.
"I am friends with nurses who work in operating rooms in southern Ontario, and they have told me that they don't understand how there are no nurse anesthetists practising in Canada," – Dr. Brian Goldman
However, some Canadian physicians prefer alternative solutions, expressing skepticism about adopting American models.
"We prefer to work on an anesthetist assistant system that we have instead of importing American solutions," – Dr. Giuseppe Fuda
Fuda acknowledges that while anesthesia shortages contribute to surgical delays, other factors such as nursing shortages, unavailable beds, sick calls, and missing equipment also play a role.
"There are other reasons why, unfortunately, surgeries are cancelled. And that could be due to a nursing shortage or beds that are not available. Sick calls, sometimes even equipment that is missing," – Dr. Giuseppe Fuda
Amid these challenges, a national strategy remains elusive despite longstanding advocacy. The absence of a unified approach exacerbates regional disparities and complicates efforts to address the crisis effectively.
"It seems as if nothing is changing." – Josh Booth
