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One glaring example is the growing trend of asking or requiring physicians to work outside their scope of practice. In anesthesiology—my own specialty—a national shortage of anesthesiologists has driven up demand and salaries, creating hiring challenges for many institutions. To address this, hospitals are turning to legal loopholes that allow non-anesthesiologists to direct anesthesia care—a decision that places both patients and physicians at risk.
The Role of Pennsylvania’s Act 60 of 2021
Pennsylvania’s Act 60 of 2021 exemplifies this dangerous trend. The law permits Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia care under the “overall direction” of surgeons or proceduralists when anesthesiologists are unavailable. This means hospitals can avoid employing anesthesiologists entirely, leaving surgeons responsible for overseeing anesthesia care—a role for which they are not trained.
The implications are profound. Under the “Captain of the Ship” doctrine, surgeons are already held accountable for everything that happens in the operating room. While this doctrine has evolved to reflect the collaborative nature of modern surgical teams, Act 60 reinstates a liability burden on surgeons, particularly during critical anesthesia procedures like intubation or managing failed spinals. Even if a surgeon avoids intervening directly, their legal exposure persists because they are deemed to have “overall direction” of anesthesia services.
What’s at Stake?
The lack of clear definitions in Act 60 compounds the problem. For instance, the law defines “overall direction” as supervision by a “qualified individual” who is onsite but not necessarily present in the operating room. However, Pennsylvania Department of Health regulations specify that such a qualified individual must possess the expertise to perform all tasks typically required of an anesthesiologist. In practice, many surgeons lack this specialized training, yet they are being forced into this role.
This approach is not only unfair to surgeons but also jeopardizes patient safety. Anesthesiology is a complex field that demands years of specialized training to manage life functions, respond to emergencies, and ensure safe anesthesia delivery. Expecting a surgeon or proceduralist to shoulder these responsibilities—often as a cost-saving measure—is both unethical and unsafe.
The Bigger Picture
The challenges in anesthesiology reflect a broader issue across medical specialties: the erosion of physicians’ autonomy and the growing expectation to stretch beyond their expertise. These trends undermine the integrity of patient care and put healthcare providers at odds with the ethical standards of their professions.
Moving Forward
Physicians, medical societies, and policymakers must come together to address this troubling shift. Hospitals should prioritize patient safety over financial expediency by ensuring the right specialists are available for every procedure. Clearer laws and regulations are also needed to protect both patients and physicians from the risks of working outside their scope of practice.
Healthcare decisions should be driven by expertise, collaboration, and patient outcomes—not by the bottom line. It’s time to put the focus back where it belongs: on safe, ethical care for every patient.
About the Author
Dr. Joseph F. Answine is a Assistant Professor of Anesthesiology at Penn State Health. Answine is also the American Society of Anesthesiologists alternate director for Pennsylvania, and vice president of scientific affairs, Pennsylvania Society of Anesthesiologists.
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