Many patients in the Metropolitan Detroit area are unaware of Beaumont Health’s impending change to its anesthesia staffing structure. To cut costs and streamline services, Michigan’s largest healthcare provider announced changes that, instead of protecting patients, will save Beaumont millions of dollars. A legal battle casts doubt on whether hospitals in the system can maintain necessary staffing levels under this model.

The “new anesthesia model” is Beaumont’s latest attempt to maximize revenue for the health care system at the expense of patients’ well-being. The decision is horrible for the patients who depend upon Beaumont for their healthcare. “Do you have a Beaumont doctor” has been replaced by, “Does Beaumont have any doctors.”

Beaumont’s Upheaval of Anesthesia Service Providers

In June, Beaumont advised more than 70 highly-trained anesthesiologists that their jobs were being replaced by Texas-based NorthStar Anesthesia. Beginning August 20, 2020, NorthStar will supply and manage both anesthesiologists and certified registered nurse anesthetists (CRNAs).  This is a significant change from the health system’s prior practices. Until now, Beaumont employed the CRNAs directly and contracted with Anesthesia Associates of Ann Arbor (A4) to provide anesthesiologists. CRNAs will take over many procedures previously performed by the anesthesiologists, and the new anesthesiologists will not have the same level of experience or training as the current group of anesthesiologists.    

The change in anesthesiology staffing will affect services at Beaumont’s various campuses. These nationally ranked facilities routinely perform sophisticated surgeries such as liver transplants, cardiac and pediatric procedures, high-risk obstetrics, advanced neurosurgery, and other innovative and complicated procedures. Inherently dangerous operations like these require carefully coordinated care by teams of anesthesia professionals to avoid or mitigate risks to patients.

Unprepared to take over, NorthStar is scrambling to recruit physicians, even aggressively appealing to doctors restricted by non-competition agreements with other anesthesia service providers (including A4). A recent circuit court order barring this ongoing practice makes it even more unlikely that NorthStar can bring in enough qualified anesthesia professionals to continue to provide its ordinary volume of elite-level surgical services.

Increasing Risks for Patients and Providers

Consistency, training, and familiarity help mitigate risks in all aspects of care. Bringing in a new staff of anesthesiologists and CRNAs unfamiliar with the locations, surgical suites, and resources and without the same level of training and experience increases the risk of patient harm. During the COVID-19 pandemic, experienced anesthesia professionals are especially vital to successfully intubating critical patients. Adding unnecessary risk is not only unreasonable but also negligent during this crisis.

In any medical setting, increased physician workloads and staff reductions place patients in peril. According to reports about Northstar’s contract, lone anesthesiologists will be responsible for multiple operating rooms simultaneously with fewer active CRNAs. The strain on the system and possible confusion over assignments will be potentially catastrophic, such as when multiple patients require unexpected additional support or experience complications during surgery.

Outsourcing’s Impact on Educational Programs

Historically, Beaumont has been one of the premier academic medical centers in the United States and a top producer of physicians in Michigan. According to its website, it has over 930 physicians-in-training in 94 programs: 799 residents in 45 accredited programs, 109 fellows in 33 accredited programs, and 21 fellows in 16 highly specialized programs for which ACGME accreditation is not available. Its eight teaching hospitals are affiliated with the Oakland University William Beaumont School of Medicine, the Michigan State University College of Osteopathic Medicine, and the Wayne State University School of Medicine.

Outsourcing its anesthesia services will likely have a significant negative impact on Beaumont’s ability to train physicians and maintain its reputation in medical academia. Reports indicate the NorthStar contract will result in a lower ratio of anesthesiologists to CRNAs than Beaumont historically has allowed, which could jeopardize its anesthesiology residency program.

Malpractice Caps Put Profits Over Patients

When patients are injured or die due to medical errors and doctors’ negligence, medical malpractice lawsuits allow victims to hold hospitals and physicians liable for their mistakes. Unfortunately, statutory caps on the damages plaintiffs can recover in medical malpractice cases often make it more attractive for healthcare providers to cut costs to maximize profits than to ensure patient safety. Beaumont’s cost to resolve anesthesiology-related malpractice actions will be less than maintaining the current staff of experienced anesthesiologists and CRNAs.

Although the cost-benefit analysis may weigh in favor of Beaumont’s bottom line, it will come at the expense of patient safety. While a patient typically selects the surgeon they want to perform a procedure, rarely does the patient choose the anesthesiologist or CRNA. Patients and families of patients undergoing operations at Beaumont Health’s hospitals need to be aware of this troubling change in anesthesiology staffing – or pay the price.