The safe delivery of anesthesia depends on a highly trained and diverse workforce. While anesthesiologists—physicians with extensive training in physiology, pharmacology, perioperative medicine, and crisis management—remain the only professionals qualified to independently manage the full spectrum of anesthesia care, the workforce also includes certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants (AAs). Each group contributes unique strengths, and together they form the backbone of anesthesia services across the United States. Anesthesiologists serve as perioperative leaders, guiding preoperative optimization, intraoperative management, and postoperative care, while also advancing patient safety, simulation, and research. CRNAs, trained through graduate-level nursing programs, provide technical expertise in anesthetic delivery, often in community and rural settings, but their training does not encompass the breadth of diagnostic reasoning or systems-based care intrinsic to anesthesiologists. AAs, trained in master’s-level programs modeled after physician assistant curricula, always practice under the supervision of anesthesiologists and extend physician-led coverage. The Anesthesia Care Team model—integrating anesthesiologists, CRNAs, and AAs—is the predominant workforce structure in the United States. It balances access, scalability, and safety by combining technical proficiency with physician oversight, especially for complex or high-risk cases. Global workforce structures vary: high-income countries rely on physician-led care, while low- and middle-income nations often depend heavily on nurse anesthetists or non-physician providers due to physician shortages. For internists, understanding the anesthesia workforce clarifies collaboration during perioperative evaluations and critical care. While anesthesia may appear to be a technical task, it is in fact the orchestration of physiology, pharmacology, and patient safety—an effort best led by anesthesiologists, with CRNAs and AAs serving as essential partners in care delivery.