Finally, some good publicity for CRNAs!

Published Feb 18, 2005

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US News & World Report has published an article titled "Medicine's Turf Wars" in the January 31, 2005 issue that contains positive information about nurse anesthetists (see below).

The pertinent passage is:

"Safety studies have played a major role in the mother of all turf battles, which has been waged between those two professions, anesthesiologists and nurse anesthetists, who ensure that, every year, more than 26 million Americans feel no pain when they go under the knife. In general, anesthesia is extremely safe (only one death occurs for every 250,000 times it's administered, a dramatic improvement since the early 1980s, when two deaths occurred per 10,000 anesthetics administered). And 65 percent of all anesthesia care is delivered by certified registered nurse anesthetists, critical-care nurses with a graduate degree in anesthesia, who train for several years in order to sit for certification. Medicare has long recognized their qualifications and reimbursed them for their services. The two professions are extremely courteous to one another when individuals meet in an operating room.

But that courtesy masks a fierce dispute raging between the American Society of Anesthesiologists and the American Academy of Nurse Anesthetists. One part of this row involved nurse anesthetists' wanting to be paid for services rendered in hospitals and surgical centers without physician supervision. It has been left up to each state to allow--or disallow--that care without physician oversight.

To date, 12 mostly rural states have said there's no need for docs. The states have been swayed by safety data on anesthesia providers. "If there is a difference, the studies to date have not shown that," says Cooper.

Now the battle has shifted to doctors' offices. Florida has been the flashpoint. During the late 1990s, the number of office-based surgeries--largely lucrative cosmetic surgery operations--in the state skyrocketed. The practice wasn't well regulated, office facilities often lacked emergency care, and there were a number of highly publicized deaths.

"Office surgery is like the Wild West; it's the last frontier," says Rebecca Welch, president of the Florida Society of Anesthesiologists. While there are no data showing that CRNA s have trouble providing safe anesthesia in office settings, Welch says, "we feel like we are the experts" with a medical school background. Florida's state medical board apparently agreed and created standards for office-based surgeries that insisted anesthesiologists had to supervise CRNA s.

Nurse anesthetists felt the impact immediately. Victor Ortiz, a CRNA from Davie, Fla., says that right after the supervision rule took effect in 2002, "70 percent of my income got swept away." Why? Most surgeons concluded it wasn't economical or necessary to have both an anesthesiologist and a CRNA in their office. "[The medical board] was saying you're unsafe . . . but you read unbiased studies, and they show that you are safe. This was about control and turf," Ortiz says. So Ortiz sued the state medical board. Last summer, a Florida appellate court ruled the board overstepped its bounds with the anesthesiologist supervision rule, a decision affirmed last month by the Florida Supreme Court. "I'm elated," Ortiz says.

Now, another anesthesia battle is shaping up in New Jersey. The Garden State has passed an office-based-supervision rule similar to the one recently knocked down in Florida. It goes into effect in February. Local nurse anesthetists are gearing up for a court challenge, and they hope the outcome will be similar to Florida's as well."