Drew Wilson
There’s a scope-of-practice battle going on between physician anesthesiologists and certified registered nurse anesthetists.
CRNAs say they can handle most anesthesia work without physician supervision, but medical doctors don’t agree. According to a new poll, neither do Florida voters.
The Mason-Dixon Polling & Strategy survey, commissioned by the Florida Society of Anesthesiologists (FSA), showed 80 percent of Florida voters thought physician anesthesiologists should be the chief decision-makers in the operating room. Another 15 percent said CRNAs “should be on equal footing” when it comes to anesthesia decisions while 5 percent were unsure.
The number of dissenters was cut in half when asked who they would want in the room if they had to be put under — 92 percent said they wanted the MD on hand, while just 6 percent said they would be fine with a CRNA.
Additionally, 85 percent of those polled told Mason-Dixon that “giving anesthesia to patients is a complicated and difficult job that should only be performed directly by or under the supervision of a trained physician.”
Brad Coker, Mason-Dixon’s CEO and managing director, said “these results make it clear that Floridians strongly favor physician-led anesthesia care. The size of the statewide margin is significant.”
While the prior questions dance around a bill being considered by lawmakers in the 2019 Legislative Session, a fourth query addresses it directly.
HB 821 would delete a provision in state law requiring advanced practice registered nurses (APRNs) to be supervised by medical doctors, which would open the door to autonomous practice.
CRNAs fall under the APRN umbrella alongside certified nurse practitioners, certified nurse midwives and clinical nurse specialists. The Florida Association of Nurse Anesthetists and other APRNs groups say the rule is “antiquated,” and bill sponsor state Rep. Cary Pigman, a medical doctor, and House Speaker Jose Oliva agree.
Medical doctors, however, say their supervision is needed to ensure patient safety. And Florida voters are firmly on their side.
The poll asked whether respondents agreed or disagreed that “having nurses administer anesthesia without the supervision of a doctor is a very dangerous idea.”
More than half of those polled said they “strongly agree” with that statement and another 15 percent said they “somewhat agree,” for a combined total of 71 percent. Only 24 percent disagreed — 15 percent “somewhat” and 9 percent “strongly.” The balance was unsure.
“Physician-led patient-centered care is the safest and most cost-effective model for providing anesthesia care,” FSA President Knox Kerr said. “Florida has a good law that not only ensures patient safety but also saves precious health care dollars. We are pleased the public sees that this good public policy should stand.”
HB 821 has cleared its first committee on a 10-3 vote and is scheduled to go before the Health Care Appropriations Subcommittee Tuesday.
41 comments
Dr. Debra Diaz
March 26, 2019 at 7:45 am
Please ask the FSA to provide evidence based data to prove anesthesia care is unsafe when provided by CRNAs. They can’t. Speaking of evidence based; how many people did you poll. Who did you poll? Are you aware the physician anesthesiologists “supervise” from their offices? Are you aware the military CRNAs are independent practitioners? In my 24 years in the US Navy, I have never been supervised. The safety studies do not bear out that CRNAs are unsafe. Let’s talk scientifically and not fear monger.
Adam
March 28, 2019 at 12:26 pm
This is simply untrue. Most states require a physician to be immediately available. This does not mean the office.
Anesthesia Guy
March 31, 2019 at 7:47 am
They “supervise” 4 rooms at a time from the office. If 2 emergencies happen in those 4 rooms, then the crna is the one making the decisions not the doctor.
It’s all about money, no one person can safely “supervise” 4 rooms
Larry Owens CDR, USN-Ret
April 3, 2019 at 12:49 pm
Wrong. Most states do not require Supv
Raymond Blacklidge
March 26, 2019 at 7:47 am
Sure let Voters decide medical issues. After all surely we all can just google it and make a decision. To even suggest that a poll should influence an important medical issue is absurd. Some nurses and PA’s know more about certain areas of medical care than most doctors. Let the professionals argue this out and stop citing silly polls. My two bits.
Lorri A Cook
March 28, 2019 at 2:29 am
I wonder if voters think that on the day of their surgery, some float-pool nurse is going to get floated to the O.R. as anesthetist?
Jim
March 30, 2019 at 9:12 pm
Your comment shows how ignorant thou address of the issue. A nurse CANNOT simply flat to the OR. A board certified anaesthetist had MORE training based on hours in school than an anesthesiologist. Look it up.
stan
April 5, 2019 at 7:58 am
yes the wording on this survey is misleading.
Nurse Anesthesiologist
March 26, 2019 at 8:34 am
It is very obvious that this pseudo journalist is not more than a fake news distributor. I think that FANA and the AANA should look into legal
action.
Eric
March 26, 2019 at 8:36 am
More “turfism” by the FSA. I wonder if the polled know who’s actually in the procedure 90% of the time? I work in an ACT model and have for 15 years. I work with a good group of MDs and CRNAs but the truth is, we as CRNAs are often “solo”because the MD is managing a myriad of other issues, often administrative. I’m not blaming the MDs but it’s the model they’ve created for max reimbursement. I also wonder if the polled know that bit of the equation?
Rob Docker
March 26, 2019 at 7:57 pm
Let’s start with disclosing that you are a nurse with a doctorate and not a medical doctor. Recently the World Health Organzation determined that all anesthesia should be led by a physician. CRNAs, nurses, need to be supervied. The American Academy of Nurse Anesthetists quit the Anesthesia Patient Safety Foundation because they could not strong arm them to remove their endorsement of the WHO.
Eric
March 27, 2019 at 6:24 am
Rob, I’m old school. I’m a Master’s degree in Nurse Anesthesia. I understand well this age old battle is about who controls the purse strings. The ASA and FSA can hide behind “patient safety” but that doesn’t measure up to the longstanding record of CRNAs and outcomes.
Vance
March 28, 2019 at 4:17 am
So the WHO (WORLD HEALTH ORGANIZATION), is composed of mostly physicians from around the world, and they concluded that. So how many of those countries have someone like a CRNA? Did you know that in some of those countries involved with the WHO, the nursing care is basic, and the doctors take blood pressures, and the nurses only do some basic patient care and give medications. Nurses around the world have different education standards, as do doctors. The issue is most of these individuals have never worked with CRNA’s or non- anesthesiologists as the WHO likes to call them, the have only worked with other Doctors. I will take a US CRNA trained provider over most other trained anesthesiologists around the world hands down. The issue is turf, bottom line…
Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. COCHRANE LIBRARY 2014.
Key results Most studies stated that there was no difference in the number of people who died when given anaesthetic by either a nurse anaesthetist or a medically qualified anaesthetist. One study stated that there was a lower rate of death for nurse anaesthetists compared to medically qualified anaesthetists. One study stated that the risk of death was lower for nurse anaesthetists compared to those being supervised by an anaesthetist or working within an anaesthetic team, whilst another stated the risk of death was higher compared to a supervised or team approach. Other studies gave varied results. Similarly, there were variations between studies for the rates of complications for patients depending on their anaesthetic provider.Quality of the evidence Much of the data came from large databases, which may have contained inaccuracies in reporting. There may also be important differences between patients that might account for variation in study results, for example, whether patients who were more ill were treated by a medically qualified anaesthetist, or whether nurse anaesthetists worked in hospitals that had fewer resources. Several of the studies had allowed for these potential differences in their analysis, however it was unclear to us whether this had been done sufficiently well to allow us to be confident about the results. There was also potential confounding from the funding sources for some of these studies. Conclusion As none of the data were of sufficiently high quality and the studies presented inconsistent findings, we concluded that it was not possible to say whether there were any differences in care between medically qualified anaesthetists and nurse anaesthetists from the available evidence.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010357.pub2/epdf/full
https://www.npr.org/sections/goatsandsoda/2017/08/10/530885138/imagine-facing-surgery-without-an-anesthesiologist-on-hand
Safe anesthesia and surgical care are not available when needed for 5 billion of the world’s 7 billion people. There are major deficiencies in the specialist surgical workforce in many parts of the world, and specific data on the anesthesia workforce are lacking. Methods: The World Federation of Societies of Anaesthesiologists conducted a workforce survey during 2015 and 2016. The aim of the survey was to collect detailed information on physician anesthesia provider (PAP) and non-physician anesthesia provider (NPAP) numbers, distribution, and training. Data were categorized according to World Health Organization regional groups and World Bank income groups. Results: We obtained information for 153 of 197 countries, representing 97.5% of the world’s population. There were marked differences in the density of PAPs between World Health Organization regions and between World Bank income groups, ranging from 0 to over 20 PAP per 100,000 population. Seventy-seven countries reported a PAP density of <5, with particularly low densities in the African and South-East Asia regions. NPAPs make up a large part of the global anesthesia workforce, especially in countries with limited resources. Even when NPAPs are included, 70 countries had a total anesthesia provider density of <5 per 100,000. Using current population data, over 136,000 additional PAPs would be needed immediately to achieve a minimum density of 5 per 100,000 population in all countries. Conclusions: The World Federation of Societies of Anaesthesiologists Global Anesthesia Workforce Survey is the most comprehensive study of the global anesthesia workforce to date. It is the first step in a process of ongoing data collection and longitudinal follow-up. The authors recommend an interim goal of at least 5 specialist physician anesthesia providers (anesthesiologists) per 100,000 population. A marked increase in training of PAPs and NPAPs will need to occur if we are to have any hope of achieving safe anesthesia for all by 2030.
Actual Health Services Researcher
March 26, 2019 at 9:29 am
There are so many errors to address in this “survey” and poorly written article. I could never address them all without taking up the entire comment section. Here are a few of the problems as they pertain to this seemingly poorly conducted research and the ineffective attempt made in this article to dissimulation the results:
1- Survey research always faces the risk for 4 types of error: sampling, coverage, measurement, and no response. The assertion made by this article is “80 percent of Florida voters thought physician anesthesiologists should be the chief decision-makers in the operating room”. There are two major problems with this. Did Mason-Dixon poll EVERY Florida voter? According to the Florida Division of Elections there were 13,397,063 registered Florida voters in 2019. Did Mason-Dixon survey all of these voters? No, this would be extremely costly and would require a multimodal sampling approach to reach voters who, for example, do not own a computer (coverage error and sampling error). Claiming that “80 percent of Florida voters” said anything is inaccurate. The other problem with this statement is the wording “in the operating room”. In, as in located in the operating room at all times. This is impossible if supervising more than one CRNA. Quite simply, this is not factual. Also, who funded this research? (Potential for bias).
2- As Dr. Debra Diaz stated, we have no information about the sample (is it representative of the population we say we are sampling? What is the sample size? What was the sampling method used?)
3- Were the concepts adequately defined? Every good survey must take the time to throroughly define the concepts and variables it seeks to measure. How were CRNAs and MD anesthesiologists defined? Did Mason-Dixon include description such as years of education and trading? Did the developer define what “supervision” really means with accuracy. Without this information provided to the reader the results are further meaningless.
4- We must always look to the quality of the items. A survey is only as good as what we are asking and what options we have to select in response. While we do not have this information provided we do have one item offered with direct quotations by the writer: “having nurses administer anesthesia without the supervision of a doctor is a very dangerous idea.” There are so many things wrong with this item but most importantly the fact that this survey is riddled with bias, emotionally suggestive language, and measurement error. The item reads “nurses” it does not read “CRNAs”, therefore an entirely different concept is being measured (measurement error) Any response to this question is absolutely meaningless. In addition, applying the word dangerous is a survey trick used for extremely poorly written surveys to make the reader select a choice based on emotion the writer of the survey thinks they should feel.
This survey, and article, are most certainly fake news.
Brad RICHARDSON
March 26, 2019 at 10:45 am
Most people are truly unaware that Nurse Anesthetist (Nurse Anesthesiologists) exist. When I introduce myself to a patient they ask are you my anesthesiologist, and I tell them I am a nurse. Instead of slanting an article, or using a biased survey, how about researching the topic first. In many States CRNAs administer anesthesia without a Physician Anesthesiologist. In those rural States where it isn’t a vacation spot you can’t get a Physician Anesthesiologist to want to live/work there. In the US military, you can’t get Physician Anesthesiologists to into forward combat zones where it is dangerous. How about Africa during the Ebola outbreak (oh hell no) just CRNAs there. What about after 5pm? Suddenly CRNAs are very capable of handling an anesthetic without Physician Anesthesiologist supervision. How about a woman in labor and needing that epidural or an emergency C-section? Care to guess what the percentage of CRNAs handle that independently? Did you even look at the numbers or data before you published a politically biased article?
AC
March 28, 2019 at 12:30 pm
Categorically untrue. I have to think most NAs are aware of rural pass through and the reason hospitals in critical access areas are incentivized to hire mid level providers. Yet we still hear this old argument.
Carl
March 30, 2019 at 10:46 pm
The term “mid-level provider” is a misnomer and an insult. We are trained. licensed, and certified to independently provide anesthesia. The only reason we can’t always provide anesthesia independently is that some hospitals have policies that restrict our practice and require “supervision”…but, we are really not even supervised in these hospitals. The anesthesiologist is usually only in the OR for less than 5 minutes, as a formality, since they are legally required to be in the room for a a significant part of the anesthetic…which intubation is considered significant. We manage the whole case, beginning to end, making all of the decisions on the management of anesthesia and which drugs to administer and how much to give. We extubate the patients on our own and take the pt to the recovery room on our own. The anesthesiologist usually doesn’t see the patient again.
John
March 26, 2019 at 12:42 pm
It’s obvious Drew is in someone’s pocket. CRNAs ARE the providers in almost all ORs in Fla! The ASA is only good at scare tactics with no evidence. Pseudo-journalism without solid facts should be a crime. Using a biased approach to this article should be a setting for a lawsuit. You’re a HACK!
Robert Docker
March 26, 2019 at 7:55 pm
Recently the World Health Organzation determined that all anesthesia should be led by a physician. CRNAs, nurses, need to be supervied. The American Academy of Nurse Anesthetists quit the Anesthesia Patient Safety Foundation because they could not strong arm them to remove their endorsement of the WHO.
Robert Docker
March 26, 2019 at 7:53 pm
Recently the World Health Organzation determined that all anesthesia should be led by a physician. CRNAs, nurses, need to be supervied. The American Academy of Nurse Anesthetists quit the Anesthesia Patient Safety Foundation because they could not strong arm them to remove their endorsement of the WHO.
Missing FL Man Anesthesiologist
March 27, 2019 at 7:13 am
𝐃𝐞𝐟𝐢𝐧𝐞 “𝐢𝐫𝐨𝐧𝐲.”
In this misleading article and poll attempting to disparage the high degree of education and training CRNAs receive and practice with every day across the country, we thought readers would find the following two things humorous:
1) They ignorantly grabbed a screenshot of copyrighted material from the 𝘈𝘮𝘦𝘳𝘪𝘤𝘢𝘯 𝘈𝘴𝘴𝘰𝘤𝘪𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘕𝘶𝘳𝘴𝘦 𝘈𝘯𝘦𝘴𝘵𝘩𝘦𝘵𝘪𝘴𝘵𝘴’ video “CRNAs: The Future of Anesthesia Care Today!”
(𝙨𝙩𝙤𝙡𝙚𝙣 from the 1:09 mark… link to the video: http://www.future-of-anesthesia-care-today.com/)
2) The two individuals in the stolen screenshot are 𝙗𝙤𝙩𝙝 independently-practicing CRNAs! One is performing a highly specialized pain management technique, while the second CRNA is providing monitored sedation in a facility where “𝗧𝗛𝗘𝗥𝗘 𝗔𝗥𝗘 𝗡𝗢 𝗣𝗛𝗬𝗦𝗜𝗖𝗜𝗔𝗡 𝗔𝗡𝗘𝗦𝗧𝗛𝗘𝗦𝗜𝗢𝗟𝗢𝗚𝗜𝗦𝗧𝗦 𝗣𝗥𝗘𝗦𝗘𝗡𝗧.”
So in summary, not only do physician anesthesiologists steal credit for patient care in cases they are not performing, they do it in misleading articles as well.
JIM WEBB
March 27, 2019 at 4:11 pm
Public doesn’t know what goes on in the ORs. CRNAs do all of the work and make most decisions. Most Anesthesiologist stay out of the room and just manage the board. This varies between hospitals but on average the CRNAs handle most cases.
Ricardo Rosado
March 30, 2019 at 9:58 pm
Isn’t that awesome? Some I bet he didn’t even wrote the article. It was given to him with a nice check to publish it with his name.
KEN ROBISON
March 27, 2019 at 3:24 pm
Dr Mark Warner provides a very lame excuse for APSF incorporating WHO guidelines because he believes countries that do not have NURSE ANESTHESIOGISTS equal to the training for these practioners in USA are incapable of understanding the distinction.
JIM WEBB
March 27, 2019 at 4:12 pm
Public doesn’t know what goes on in the ORs. CRNAs do all of the work and make most decisions. Most Anesthesiologist stay out of the room and just manage the board. This varies between hospitals but on average the CRNAs handle most cases.
Robert Bland
March 27, 2019 at 6:15 pm
The “poll” funded by the physician’s association had leading questions. The question isn’t about “nurses”: it is about Advanced Practice Registered Nurses (APRNs) that have the requisite education, experience, and expertise to work within their scope (or area) of care. The studies show over and over that APRNs and CRNAs collaborate with physicians and other health care providers to produce the same or better outcomes than physicians. Floridians are as safe or safer with autonomous APRNs. The physicians’ organizations are being intellectually dishonest and blatant shills while using “scare” tactics. Supervision from the lounge or across a county isn’t supervision; it’s a money maker for a physician that add more cost to healthcare without any benefit.
Dan Giraffe speaking to the public
March 28, 2019 at 11:38 am
If you are a member of the public reading these responses, you are seeing an on-line lobbying campaign by nurses trying to persuade you that nurses are the same as physicians. They’ll get indignant if you don’t believe them. They will throw out bogus “facts.” Watch out for the studies the nurses and the Florida Association of Nurse Anesthetists quote – the nurses national organization paid for the studies to show that they are the same as physicians.
Anesthesiologist and the Florida Society of Anesthesiologists (FSA) support working with nurses in what is called a “team-based” model of care – a physician and nurse working together to provide care. Sounds reasonable right? In fact, that is how all the care in FL is currently provided. And FYI, it doesn’t cost you or your insurers a penny more than if an individual anesthesiologist provided your care. The education, skill and training of BOTH providers being used to provide great care. Sensible, right?
Here is the rub: There are a small group of nurses who have an unhealthy hatred of anesthesiologists. Who knows why They want to kick the anesthesiologist off the team. In most places, physicians and nurses work great together. Ask them. But this small group has an agenda that they want you to buy. That is the core of this debate. It is really that simple.
Tell your legislator that you like the team-based model of anesthesia.
Nurses are not the same as physicians. Don’t let them fool you. You know better.
Carl
March 30, 2019 at 11:02 pm
Dan, you are a joke! The public can do their own research and determine if CRNAs are well qualified to provide anesthesia independently. “Nurse are not doctors”…what a joke and a misleading statement! We are not just nurses…we have gone through masters and doctoral level anesthesia training programs…we are very highly educated, trained, and specialized nurses, who are actually licensed and certified to administer anesthesia independently. To the public: do you research. People like Dan are lying to you and misleading you.
Thomas
April 2, 2019 at 8:44 pm
Dan – On what planet do you spend most of your time?
Tobias Reid MD PhD
March 27, 2019 at 10:50 pm
The case management and administration of anesthesia should be by a licensed physician, however in cases where there is no anesthesiologist physician available the CRNA should be able to handle the care, another option of supervision is Telemedicine Live.
Rachel
April 2, 2019 at 10:40 pm
I administer anesthesia and manage the cases I am assigned to day in and day out, in a supposed “physician supervised” setting. 99% of the time the docs may never even put in a glove or touch a syringe. They *might* be around 5 minutes of the whole case. I’ve done 12, 13, 14 hour cases where I don’t see them a total of 30 minutes throughout the whole day. They are typically in their office, drinking coffee in the lounge, looking at a computer. I do 99% of all care for the patient – deciding what type of anesthetic they need, induction,intubation, extubation, invasive lines, and every minute in between deciding what drugs to give and how much, giving blood, etc., with no doc in sight. Yet…. I’m “unsafe” without their “supervision”. The truth is, I do not need them for majority of all the cases I do. I don’t think looking through the crack of the OR door and saying “need anything?” Counts as supervision or “directing”. It is laughable and the public and other providers NOT on the front lines in the OR just don’t know it. CRNAS practice either independently or are “supervised” by a non-present 99.99% of the case physician. Behind the scenes, what they dont want people to know, is We make the decisions and do all the work.
Dino Kattato
April 6, 2019 at 8:46 am
Physician anesthesiologists tried that once, from the golf course. The day I get supervised by Max Headroom, is the day I leave that OR.
Lonely CRNA
April 6, 2019 at 10:05 am
Who wrote this scare tactic crap? What a joke. I have been performing cardiothoracic anesthesia for 20 years without “help”. Although there is a physician anesthesiologist somewhere trying to find the end of the Internet, they are rarely seen in the most difficult cases in the OR. They are getting paid to “supervise” the case but have no clue what is even going on. If the general public knew what actually happens in the OR we wouldn’t need to have this discussion. The really scary thing is having a physician anesthesiologist doing a case when he hasn’t touched a ventilator in 10 years.
US citizen
March 28, 2019 at 12:18 pm
Members of the AANA (nurse anesthetist) fight for equal footing to the MD anesthesiologist in public view and for hospital privileges. However, years of medical training separate nurses from doctors. Nurses do 2 years of anesthesia training in basic cases. Physicians complete 4 years of anesthesia training in complex cases, and that is after 4 years of medical school training.
It is easy to claim equal clinical outcomes when the scope of practice is different.
Patients have the right to request a physician anesthesiologist to provide their care. Patients also have the right to request a nurse anesthetist. Nurses also have the right to apply to medical school and complete residency to gain equal rights to MD anesthesiologists.
Carl
March 30, 2019 at 11:11 pm
First of all, you are insulting your colleague D.O. and other degreed physician Anesthesiologists. MDs are not the only anesthesia providers! Second, you are lying! CRNAs train to handle the same complex cases that physician anesthesiologists do. Public: don’t let these con artists fool you. Do your own research!
LD
April 3, 2019 at 3:17 pm
Everyone wants to be a physician, nobody wants to go to medical school…
certified registered nurse anesthesiologist
April 6, 2019 at 12:20 pm
Everyone wants to get paid, no everyone wants to DELIVER the anesthetic….
Stef
March 30, 2019 at 10:13 pm
This article is completely biased with ignorance in many areas. The majority of the public has no education regarding what actually occurs in the operating room and what education CRNA’s have received to be able to work as a Certified Register Nurse Anesthetist!! In my “supervised” facility, the anesthesiologist does a quick preoperative assessment of the patient. The nurse anesthetist follows with their own assessment ( to fill in the gaps), takes the patient into the operating room and delivers the patient a professional, evidence based anesthetic! 90% of the time no anesthesiologist ever enters the operating room!! The anesthesiologist will then sign the patient out of the recovery room to be discharged. That, my American Citizens, is the majority of the “supervised” anesthetics provided in this country. I frequently catch anesthesiologists lying to the patients saying “yes I will be giving you your anesthesia today”. If anesthesiologists truly felt that CRNAs were unsafe for independent practice then why are they not “supervising” us in the OR.?? Anesthesiologists are attempting to secure their positions because they are not as cost-effective as having a CRNA provide anesthesia. The evidence clearly demonstrates that an anesthesiologist’s care is not superior to that of a Certified Registered Nurse Anesthetist.
Thomas
April 2, 2019 at 7:48 pm
A number of Physician Anesthesist fear being in the OR for our more complex cases. Our most respected and skilled surgeons regularly request CRNAs for such cases and are quite vocal when one isn’t assigned to their room.
Rob
April 4, 2019 at 9:37 pm
Joan Rivers insisted on physician anesthesiologists. Sleep WELL knowing Certified Registered Nurse Anesthesiologists care about their patients and not about their pocketbooks. 100% of CRNAs are board certified, more than 20% of physician anesthesiologists are NOT!
download betfair casino app
April 6, 2019 at 1:14 pm
A number of them charge for this, still. From MACD to RSI or Bollinger
bands to Variance, using every indicator might help
against you will. What looks good in theory doesn’t
work so well in verifiable truth. http://webtoman.com/casinos-on-the-internet-an-crucial-way-to-appreciate-and-make-cash/
Comments are closed.