In California on March 15, 2012 in the suit California Society of Anesthesiologists v. Superior Court of City and County of San Francisco it was ruled by the appellate court that CRNAs are allowed to practice anesthesia in California without direct physician supervision. The implications of this ruling are huge. If this appeal holds, then CRNAs can now practice and bill for anesthesia services. Current federal law denies Medicare reimbursements to hospitals that allow nurses to give anesthesia without supervision, unless, however, a state’s governor formally opts out of that requirement after consulting with the state’s medical board. In California, that is what Governor Schwarzenegger did while he was still in office. On the surface this seems like a disastrous ruling for the CSA and Anesthesiologists. Now physicians are being forced to "compete" head to head with lesser trained practitioners of Anesthesia for their share of the pie. One could make the argument, why not hire a nurse anesthetist? I can get more or less the "same" care for about a third of the cost of hiring an Anesthesiologist. On the surface it seems like a simple economic decision. More hospitals should hire CRNAs if that is the case.
However, it is not that simple. Physician Anesthesiologists provide so much more than just direct anesthesia care in the operating room or OB.
First off, for the price of an anesthesiologist, one typically gets a physician who typically works 60-80 hour weeks, sometimes a lot more, day and night. Physicians are not bound by any 6-2 working hours. Their duty is to provide patient care from start to finish, not shift work. Nurse anesthetists on the other hand, typically work 40 hour weeks, usually during the daytime hours. When their time is done, they can usually just clock out. An anesthesiologist on the other hand on a typical day may be supervising multiple rooms, taking care of a busy OB suite, monitoring patients in the PACU, fielding consults from the ICU, ED and dealing with hospital administrative duties. Not to mention a physician is also often on call multiple times a week, available to provide care at any hour of the day. Anesthesiologists can't just "clock out" after a certain number of hours. Anesthesiologists breadth of duties are expansive and beyond just the anesthetic care of patients in the operating room or OB suite. After rigorous training in medical school and even more demanding training while in residency, anesthesiologists become skilled problem solvers with a skill set that places them above and beyond being just a well trained anesthesia provider. Anesthesiologists are first and foremost, physicians, and with that distinction also comes with it a wealth of knowledge and unique skills that cannot ever be replaced or supplanted by certified registered nurse anesthetists. Perhaps one day we will look back on this ruling as a blessing, because it will serve to remind us that there is so much more to being an anesthesiologist than just providing "anesthesia".
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