A growing shortage of anesthesiologists in Canada has prompted discussion of how anesthesia provision can be expanded. Canadian anesthesiologists generally support a team approach in which physicians supervise alternative providers. In the U.S., nurses have worked as anesthetists for over 150 years, and their experiences of different models of anesthesia provision provide valuable insights into the potential pitfalls of the team approach as well as the benefits of autonomous nurse anesthetist roles. The authors conducted a qualitative study of the anesthesia team and the role of nurse anesthesia practice in the U.S., and here they present a summary of some of their preliminary findings and the implications for evolving models of care in Canada. Inefficiencies associated with the medical supervision and direction of Certified Registered Nurse Anesthetists are discussed.