Thursday, March 17, 2016

The Fallacy of Opting Out of Physician Led Anesthesia Care

One of the canards of the AANA's relentless pursuit of independent practice for CRNA's is that physician anesthesiologists just don't want to work in rural or low reimbursement settings. This limits the access of residents to crucial anesthesia services. If nurse anesthetists are allowed to work without physician supervision, according to their conceit, this would open up the wonderful world of anesthesia to all these disadvantaged people.

Now a new study has shown how much of a red herring this theory truly is. In a paper in Anesthesia and Analgesia, researchers from Stanford School of Medicine compared the rates of anesthesia use in Medicare patients from the 17 states who opted out of physician supervision to the other states who have not. They stratified the opt out states by the year they began the policy. The results should surprise nobody outside the AANA.

In the states that have opted out since 2001, anesthesia utilization increased 16% compared to 32% for non opt out states. For the states that have had no supervision since 2002, anesthesia use went up 18% compared to 26% for physician led anesthesia care. The trend is the same up to the most recent state that opted out in 2009, California. Only here was there a slight increase in anesthesia utilization for non supervised anesthesia use, 5% vs. 4%. The difference is so slight as to be almost meaningless.

As one can see, just because nurse anesthetists can practice independently doesn't mean more people will have access to anesthesia services. The issue is much more complicated than this one dimensional argument. But it is an easy way to fool legislatures and governors into thinking three year nursing school trained personnel are the equivalent of minimum eight year post graduate trained physician anesthesiologists.

By the way, the study was sponsored by the American Society of Anesthesiologists, if that makes any difference to you.

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