{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/nurse-anesthetists/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Nurse Anesthetists",
    "soc_code": "29-1151",
    "category": "Healthcare",
    "us_employment": 51840,
    "median_annual_wage": 236590
  },
  "verdict": "SAFE",
  "risk_resistance": 89,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 17,
    "embodiment": 19,
    "liability_shield": 19,
    "trust_premium": 15,
    "judgment_accountability": 19
  },
  "reasoning": {
    "task_resistance": "Closed-loop propofol TCI systems and automated record-keeping shave off the documentation and steady-state infusion adjustments, but the core of the day — mask ventilation, direct or video laryngoscopy on an unexpected Grade III airway, ultrasound-guided interscalene or adductor canal blocks, and repositioning a patient whose blood pressure drops on turning prone — has no digitisable substitute, which is why this sits at 17 rather than a perfect 20.",
    "embodiment": "You are gloved and at the head of the bed in an OR, obstetric suite, or endoscopy room for the whole case: hands on the airway, drawing and pushing drugs, doing cricoid pressure, managing a Bair Hugger and lines, and physically moving with the patient to PACU — the only reason it isn't 20 is that the environment is a controlled OR rather than a roadside or rooftop.",
    "liability_shield": "CRNAs hold an RN licence plus NBCRNA certification and independent APRN prescriptive authority, sign their own anesthesia record, and in opt-out states bill and are sued in their own name without a physician co-signature — the 19 rather than 20 reflects that in supervised-practice states an anesthesiologist may share captain-of-the-ship exposure.",
    "trust_premium": "The pre-op interview where you assess Mallampati, NPO status, and a patient's terror of going under does real work, and OB patients often ask for the CRNA who placed their last epidural, but most cases involve a patient you meet twenty minutes before they lose consciousness and never see again — a persistent relationship, unlike surgery or primary care, is not the deliverable, hence 15 not 19.",
    "judgment_accountability": "You decide alone and in seconds whether a desaturating patient needs a supraglottic rescue or a surgical airway, whether that ST change is ischemia or artifact, whether to proceed with a case when the potassium comes back at 6.1, and how much bupivacaine is safe in a 48kg patient on anticoagulants — irreversible calls with no time to escalate, which is what 19 looks like."
  },
  "rationale": "A CRNA's hour-by-hour work is physical and high-stakes: intubating, placing IV and regional blocks, titrating drugs to a patient's live hemodynamics, and rescuing airways when a case goes wrong. AI can pre-screen charts, draft anesthesia records, and flag risk scores, but no current system can hold a laryngoscope or own the decision to push epinephrine. State licensure plus APRN scope rules require a credentialed human physically present and personally liable for every case.",
  "outlook": "Demand grows with surgical volume and rural anesthesia shortages; AI absorbs the paperwork and monitoring alarms while the CRNA keeps the hands, the license, and the liability.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "CMS finalizing removal of the physician-supervision opt-out ambiguity in favor of full independent CRNA billing/practice in more states (currently ~25 opt-out states; state bills in Ohio, Pennsylvania, Michigan recur), plus Joint Commission or malpractice-carrier requirements that a named anesthesia provider physically present sign the intraoperative record — makes the CRNA the sole liable signer rather than a co-signer",
        "plausibility": "plausible",
        "would_add": 1
      },
      {
        "dimension": "trust_premium",
        "change": "Hospital or surgery-center marketing and payer contracts that specify a dedicated 1:1 anesthesia provider per case rather than anesthesiologist-directed teams covering 4 rooms with monitoring software; also patient-consent forms that name and disclose the individual provider, which some state informed-consent statutes (e.g., Pennsylvania's MCARE Act) already push toward",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "task_resistance",
        "change": "If closed-loop TIVA/TCI depth-of-anesthesia titration systems (McSleepy-type, and BIS-guided propofol control now in trials) take over routine ASA I-II maintenance, the residual CRNA caseload skews to ASA III-IV, difficult airways, obstetric and trauma emergencies — the judgment tier — raising the share of the day AI cannot do",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "judgment_accountability",
        "change": "Little headroom; already near ceiling. A formal requirement that the anesthesia provider hold veto authority over surgical go/no-go on airway or hemodynamic grounds, written into hospital bylaws, would harden it",
        "plausibility": "plausible",
        "would_add": 1
      }
    ],
    "ceiling_note": "At 89/100 with four dimensions at 17-19, the realistic gain is a few points in trust_premium; everything else is at or near ceiling. The larger risk to this occupation is not AI substitution but staffing-model economics — anesthesiologist-directed team ratios widening as monitoring software improves, which cuts headcount without touching any dimension score."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2017,
        "emp": 42620,
        "wage": 165120
      },
      {
        "y": 2018,
        "emp": 43520,
        "wage": 167950
      },
      {
        "y": 2019,
        "emp": 43570,
        "wage": 174790
      },
      {
        "y": 2020,
        "emp": 41960,
        "wage": 183580
      },
      {
        "y": 2021,
        "emp": 43950,
        "wage": 195610
      },
      {
        "y": 2022,
        "emp": 46540,
        "wage": 203090
      },
      {
        "y": 2023,
        "emp": 47810,
        "wage": 212650
      },
      {
        "y": 2024,
        "emp": 50350,
        "wage": 223210
      },
      {
        "y": 2025,
        "emp": 51840,
        "wage": 236590
      }
    ],
    "from": 2017,
    "to": 2025,
    "change_pct": 21.6,
    "comparable_from": 2019,
    "spans_soc_revision": true
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}