Washington State has quietly become a national leader in anesthesia workforce innovation. As one of only 25 states to opt out of federal physician-supervision requirements for Certified Registered Nurse Anesthetists (CRNAs), it offers a legal and clinical environment where flexible staffing models thrive. This autonomy, combined with Washington’s mix of advanced urban hospitals and remote critical-access facilities, makes the state an ideal proving ground for hybrid anesthesia delivery.
In these models, CRNAs lead where appropriate, while anesthesiologists step in for high-acuity or complex cases. The result is a scalable system that preserves quality and safety while improving recruitment, retention, and cost-efficiency.
How Washington’s Hybrid Staffing Model Operates
Across Washington, facilities have adopted different variations of the hybrid model depending on their setting, case mix, and available resources. A typical ambulatory surgery center in Seattle or Bellevue may use CRNAs to lead low-risk rooms, such as those focused on orthopedic, GI, or plastic surgery procedures. A floating anesthesiologist provides support for nerve blocks, complex inductions, and emergency cases. This structure keeps per-case labor costs predictable in a high-wage metro environment.
In mid-size regional hospitals like those in Yakima or the Tri-Cities, facilities often use a 1:3 MD-to-CRNA ratio for scheduled daytime procedures. At night, CRNAs may take solo call, with anesthesiologists available via telehealth. This approach allows 24/7 coverage without requiring two in-house providers overnight.
In rural or critical-access sites like Colville or Omak, the model often shifts to 100 percent CRNA coverage. These facilities may schedule monthly visits from an anesthesiologist for peer review and assistance with complex cases. This setup meets CMS opt-out regulations while saving smaller hospitals hundreds of thousands in annual subsidy costs.
Data Shows Clear Workforce Benefits
A 2025 white paper from the Massachusetts Association of Nurse Anesthesiology (MANA) analyzed results from hospitals using what they termed an “Efficiency-Driven Anesthesia Model.” When those findings are applied to Washington’s wage and vacancy data, a compelling pattern emerges.
In traditional 1:4 MD-to-CRNA care-team setups, CRNA roles in Washington can take 9 to 12 months to fill. Facilities using a hybrid model reduce that timeline to just 4 to 6 months. CRNA turnover drops from 18 percent to 10 percent over two years, and anesthesiologist satisfaction rises from 61 percent to 78 percent.
Why? CRNAs want autonomy, and Washington’s regulatory environment allows it. Anesthesia schedules built around independence support provider satisfaction and reduce burnout. For physicians, hybrid models shift the focus away from routine room coverage toward high-impact clinical consultation, regional techniques, and leadership roles. These changes also support flexible scheduling perks like four-day workweeks and telehealth-based pre-op evaluations, benefits increasingly expected by top candidates in the Puget Sound area.
Hybrid Models Create Real Financial Gains
Hybrid anesthesia staffing also delivers measurable financial advantages. Using Washington’s published wage averages—approximately $243,000 annually for CRNAs and $514,000 for anesthesiologists—a six-room ambulatory center in King County can reduce anesthesia labor costs by 25 to 30 percent compared to all-MD coverage.
Increased efficiency adds further upside. Redeploying anesthesiologists to block rooms or complex turnovers allows CRNAs to start routine cases on time. For example, Providence Spokane reported a 14 percent reduction in first-case delays in 2024 after shifting CRNAs into lead roles while MDs handled pre-op regional anesthesia.
Even modest changes to staffing structure can yield an extra case per day, which significantly improves throughput and facility revenue without compromising safety.
Steps Washington Leaders Can Take Today
Audit your case mix. Determine how many of your procedures truly require in-room physician presence. Use ASA scores, comorbidity data, and case complexity to inform decisions.
Review your facility’s bylaws. If they still mandate blanket physician supervision, revise them to match Washington’s opt-out status. This simple step can unlock new scheduling flexibility.
Pilot a hybrid block. Start with a low-acuity, high-volume service line, such as screening colonoscopies. Track key metrics like cost per anesthetized minute, first-case start time, and provider satisfaction to assess performance.
Use the model as a recruiting tool. Emphasize CRNA autonomy and physician leadership in job postings and interviews. These features are magnets for high-caliber clinicians in a region where competition for talent is intense.
Why This Model Works in Washington
The hybrid anesthesia model is not a theoretical exercise—it is an operational reality in Washington, backed by performance data and workforce trends. It respects the strengths of both CRNAs and anesthesiologists while giving facilities the ability to tailor staffing to their needs and budgets.
By recognizing the value of CRNA independence and supporting anesthesiologist specialization, Washington has created a template that improves care, reduces costs, and strengthens recruitment. This balanced approach is already paying dividends for hospitals, ASCs, and providers statewide.
Advanced Anesthesia Services: Leading the Hybrid Model
At Advanced Anesthesia Services, we’ve embraced this model from the ground up. Our CRNAs are empowered to practice independently, while our anesthesiologists provide specialized oversight and consultative support. This combination improves patient outcomes, supports clinician wellness, and helps facilities meet their financial goals.
To learn how we implement this approach across Washington, connect with our team or visit our careers page today.
