[jmb12686]

Not sure why this was down voted. Having many medical professionals in my family, I have come to understand this particular issue. Not much different than an inexperienced airplane copilot or junior developer.

Those with less training (nurse anesthetists to be specific) tend to get themselves into trouble and only then call on a MD trained anesthetist for assistance. Furthermore, hospital networks are able to more easily "push around" nurse anesthetists which in the end creates an environment where bad decisions can occur.

To make a distilled analogy, this would be the potentially niave junior dev, pushed by management to ship code / tech debt, despite the advice or mentorship from a senior dev, and only asking for assistance when production is on fire.

However the topic of cost management and profit tactics in US medical system is a broader topic, hospital system administrators and their C-suite management in the USA love cheaper alternatives that are directly employed by the hospital (think nurses, PAs, nurse anesthetists, etc). The hospital system can directly enforce efficiency metrics (think, more money for the hospital, not better care for the patient) and doesn't have to negotiate contracts with a group of specialist doctors.