Trained anesthesia providers are essential to areas such as labor and delivery, trauma, surgeries, pain management and other areas of healthcare that require general, local or regional anesthesia. These areas all require either a certified registered nurse anesthetist (CRNA) or an anesthesiologist (AN). After 8 plus years of education and a board certification, CRNAs walk into the health care community and are told they must be supervised by a physician anesthesiologist throughout their whole career. Evidence shows that in order to resolve financial issues and supply appropriate, safe, and accessible anesthesia care, certified registered nurse anesthetists should not require supervision by a physician anesthesiologist. However, there are many places that don't allow CRNAs to practice at their full potential.
The current federal law requires states to comply with CRNA supervision. However, on
November 13, 2001 states were granted the opportunity to opt out of this supervision plan. The American Association of Nurse Anesthetists (AANA) says that to do this the governor is required to send a letter stating that the opt-out is consistent with the state law, in the citizen’s best interest, and has been approved by both the state board of nursing and the state board of medicine (“Federal Supervision Rule/Opt-Out Information.”). There are currently 17 states opted out, including Idaho, Washington, Oregon, and Montana. Following this change hospitals in these 17 states gave, “the message that they appreciate the flexibility that the requirements allow,” said Karen Milgate, the American Hospital Association senior director (Dunn). This change was a key part of allowing hospitals to decide what staffing will best fit their needs, this also greatly helped supply anesthesia providers in the US.
The country was, and still is lacking the availability of appropriate anesthesia care. Almost 25 years ago, “during the 1990s, many anesthesiologist programs reduced in size or closed.” 10 years later, in 2000 there was a 75% drop (nearly 1,200) in anesthesia graduates, and a 2% decrease (1,000) in CRNA graduates (Rowland 68). Still today there has been a proven shortage of anesthesia providers nationwide. RAND, a healthcare research organization, ran multiple scenarios for 2020 anesthesia care and came up with a shortage of about 4,500 ANs and a surplus of 8,000 CRNAs (Daugherty). Allowing CRNAS to practice full scope is the easiest way to fix the issue, and then some. This shortage is affecting all areas of the community, including our brave veterans. In December of 2016, the Veterans association established the final rule, denying CRNAs full practice authority. While they stated, “the denial was not due to any lack of capability on nurse anesthetists,” their ruling was in direct contrast to a survey showing 22% anesthesia care shortage in VHA facilities (“AANA to VHA”). Again, allowing CRNAs to practice full scope will give our American heroes quicker access to anesthesia care. There are some areas in the country that, because of an increase in surgeries, are now experiencing a shortage of ANs. In rural communities, anesthesiologists are hard to bring in because they make so much more in urban areas. There have been many times when an AN couldn't be found and a CRNA was relied on to safely provide anesthesia care. This is why the National Rural Health Association’s director of affairs, Darin Johnson, already recognized the successful care being given without supervision (Dunn). The Lewis-Clark Valley is much like these areas, we are “driven by the general aging of the US population and the increased use of medical resources associated with serving older patients” (Rowland). A sole anesthesiologist will not be able to keep up with the demands of the community. Even with adequate numbers, the anesthesiologist's fee will crush an average citizen’s bank account.
Independent CRNAs are likely to resolve multiple financial issues that are currently harming our nation. Anesthesiologists are currently the highest paid medical group, in 2016 they made $6,000 more than the average surgeon (“Anesthesia Salaries Are Increasing”). The salary increase started back in 1999 when there was a 14.5% change in one year. Since then it has been steady at 1.2% annually, which is still more than other fields (Rowland 67). An anesthesiologist’s salary is currently 2.5x higher than that of a CRNA, which can only mean expensive anesthesia care. In order for a hospital to stay in business and keep surgeries going, they must be adequately staffed in the anesthesia department. However, when ANs are making a much better salary in private practice it becomes hard for hospitals to retain faculty after residency and they end up paying the anesthesiologists more than they need to (Rowland 68). This is caused by lack of competition, which can be greatly opened up by granting CRNAs full practice authority. Not only are CRNA salaries lower, but they are also able to provide at a lower cost. A study and report conducted by The Lewin Group showed several things. First, if a CRNA and AN both brought in the same amount of revenue, having a CRNA on staff, rather than an AN, would save patients 50%. Secondly, the cost per procedure for a CRNA is $104.78, while the cost of an AN is $215.73 (The Lewin Group, Inc.). Giving CRNAs authority to work independently from an anesthesiologist is an easy, fast way to lower costs to the patients.
Unsupervised CRNA care is safe and supported by many. The Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health shows its support for full practice authority for CRNAs.
Nurses have the opportunity to play a central role in transforming the health care system to create a more accessible, high-quality, and value-driven environment for patients. If the system is to capitalize on this opportunity, however, the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted. (Jordan 103)
Not only is the change supported, but evidence also shows that there is no safety risk in allowing CRNAs full practice. After the 2001 opt-out opportunity, the Research Triangle Institute (RTI) published findings in Health Affairs stating that patient outcomes did not vary based on who provided anesthesia, whether it was a solo anesthesiologist, solo certified registered nurse anesthetist or CRNAs supervised by ANs (Jordan 103). CRNAs have proven that they are more than capable of successfully, and safely administering anesthesia at the same quality as an anesthesiologist would.
Multiple pieces of evidence have been brought to point, but why would some still believe that supervision is necessary? With the increased availability and affordability that unsupervised CRNAs could bring while still maintaining outstanding quality, there is no reason for any state in the US to deny the opt-out opportunity. Citizens of this great nation should have access to the many benefits that independent CRNAs bring, and taking this step will help to transform the healthcare system for present and future generations. Is this a nation that educates the world’s best and brightest healthcare providers, only to send them out and limit their abilities with a supervision law? Or should it create opportunities for them to use the knowledge obtained over years of education to provide for as many patients as they can?
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