The Rest-Assure Standard: What physician anesthesia actually means.

Most surgery centers deliver anesthesia through nurse anesthetists. We chose not to. Here's the difference — and why it mattered enough for us to build the whole facility around it.

If you have surgery at an outpatient facility in the United States today, there is a very good chance your anesthesia will be delivered by a Certified Registered Nurse Anesthetist — a CRNA — not by a physician. In many states, CRNAs are permitted to practice without any physician supervision at all. In most others, a physician 'supervises' the anesthetic without being personally present in the operating room.

This is the industry norm. At Newport Center for Special Surgery, it is not our norm. And it has not been our norm since 1996.

The distinction, plainly stated.

A physician anesthesiologist is a medical doctor (MD or DO) who completed medical school, a year of general medical internship, and a three-year residency in anesthesiology. Board certification requires passing rigorous written and oral examinations. Total training: minimum eight years post-college.

A Certified Registered Nurse Anesthetist is a registered nurse who completed a master's or doctoral program in nurse anesthesia. Total training: minimum six to eight years post-college depending on the program, though only two to three of those years are focused on anesthesia specifically, and none are within the medical residency framework.

Both are trained. Both are licensed. The training paths are different in duration, depth, and framework. Whether the difference matters in the operating room is a question the surgical community has debated for decades. Our position is that it matters.

What 'physician anesthesia' means at NCSS.

Every anesthetic delivered at NCSS since our opening in 1996 has been administered personally by a board-certified physician anesthesiologist. Not supervised. Delivered.

That physician meets you before your case. They review your history. They manage the induction, the maintenance, and the emergence. They monitor your vital signs continuously. They make every decision, moment to moment, that affects your body's response to the anesthetic.

There are no CRNAs on our staff. Not one.

Why we made this choice.

When I founded NCSS in 1996, the outpatient surgery model was being built out at scale across the country. The economics were clear: CRNAs cost less per case than physician anesthesiologists, and margins in outpatient surgery are tight. Most new centers made the rational business choice to staff CRNAs. Many still do.

I made a different choice, for reasons that were partly clinical and partly philosophical.

Clinically: the operating room is a place where things sometimes go wrong quickly. When they do, the difference between clinical training frameworks can matter — not always, not usually, but in the moments when it does, it matters a great deal. I wanted every patient at our facility to have a physician managing their anesthesia, every time, without exception.

Philosophically: patients typically do not know the difference between a CRNA and a physician anesthesiologist. They assume that 'anesthesia' is delivered by 'an anesthesiologist,' and that word means the same thing everywhere. It does not. I did not want to build a business that depended on that assumption.

The cost trade-off, honestly stated.

Physician anesthesia is more expensive per case than CRNA anesthesia. This is not a small difference. Over 30 years, we have absorbed millions of dollars in additional anesthesia cost compared to what we could have spent under a CRNA staffing model.

We have never regretted it.

But we should be honest that this is a cost that gets built into surgical pricing, and it is part of the reason our facility fees are competitive but not the cheapest in Orange County. It is also part of why our safety record — zero hospital transfers from our facility, ever — is what it is. Not the only reason. But part of it.

What to ask, anywhere you consider surgery.

If you are considering surgery at any outpatient facility — ours or another — three questions to ask are:

Who will administer my anesthesia? A physician anesthesiologist, or a CRNA?

Will that person be personally present in the operating room the entire time? Or supervising from elsewhere in the building?

What is your facility's rate of hospital transfers or admissions from unexpected events during surgery?

The answers will not always align with what you might assume. The point is not that CRNA-staffed centers are bad places to have surgery — many are excellent, and there is meaningful debate in the anesthesia community about how much the training difference matters in a well-designed practice. The point is that you deserve to know, and it is your right to ask.

At NCSS, the answer to all three questions is the same. It has been the same since our first day, and it will be the same on our last.

H. Rand Scott, MD is founder and Medical Director of Newport Center for Special Surgery. Board-certified anesthesiologist, subspecialty training in interventional pain management at Penn State Milton S. Hershey Medical Center. He personally offers a free Rest-Assure pre-operative consultation to every scheduled surgical patient at NCSS.