Drew Wilson
A research paper by Florida Atlantic University professors adds a wrinkle to the annual scope-of-practice battle between certified registered nurse anesthetists and physician anesthesiologists.
CRNAs are highly trained nurses who administer anesthesia care. Florida law requires CRNAs to practice under a supervising physician, making autonomous practice unattainable to some practitioners with advanced nursing degrees.
The trade group representing CRNAs, the Florida Association of Nurse Anesthetists (FANA), makes a scope-of-practice play nearly every Legislative Session. Thus far, they haven’t been successful.
Still, FANA’s top argument in favor centers on health care access. CRNAs claim that some Floridians can’t get quality anesthesia care under the current paradigm, but the FAU paper says that’s an inaccurate narrative.
The paper focuses on “opt-out” provisions, which allow patients — typically those in rural states — who may not be able to get speedy care from a physician anesthesiologist to be treated by a CRNA who a physician doesn’t supervise after they are informed of the potential risks.
Lead author Scott Feyereisen, Ph.D., examined hospital data from 2010 through 2021 and found no meaningful increase in access to anesthesia care in states with “opt-out” provisions.
“We discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals,” the paper reads, with a subsequent section noting, “Notably, opt-out provisions do not improve access in rural counties.” The study did find that “surgical access limitations still exist” in rural states but that “opt-out” provisions have done little to ameliorate the shortage.
The Florida Society of Anesthesiologists (FSA), a trade group representing physician anesthesiologists (and FANA’s foil), funded Feyereisen’s research. The latest report is a follow-up on prior research that also found opt-out provisions had no impact. FSA hailed the findings, asserting that they prove what medical doctors have been saying all along.
“We have long suspected — based on our direct field experiences — that when states dangerously expand the scope of practice for CRNAs, allowing them to perform anesthesia services without the supervision of a physician, areas with nurse shortages do not benefit. This detailed analysis by three respected FAU professors clearly bears this out,” said FSA President Asha Padmanabhan.
“Not only is the practice of allowing nurses to independently practice anesthesia medicine without physician supervision costly and potentially dangerous, but this paper also demonstrates that it does not yield more nurses working in underserved areas.”
Padmanabhan concluded, “In the end, the data unequivocally showed that taking the costly and potentially dangerous steps of expanding scope in anesthesia medicine does not improve access to care — especially in rural communities.”
5 comments
Michael MacKinnon
January 20, 2025 at 11:44 pm
This study, far from undermining opt-out policies, inadvertently underscores their critical role in meeting the nation’s anesthesia workforce needs. By failing to account for the policies’ practical and economic benefits, or even providing evidence against their effectiveness, the authors weaken their own conclusions. The study’s flawed methodology, lack of robust data, and misinterpretation of results serve only to highlight the strengths of opt-out policies. These policies remain a vital solution for improving access to care, reducing costs, and empowering CRNAs to practice to the full extent of their training. Until credible research provides evidence to the contrary, the case for opt-out policies remains overwhelmingly strong.
Sara
January 26, 2025 at 5:25 pm
Tell me you’re a CRNA without telling me you’re a CRNA. This didn’t look at scope of practice, it looked at if ACCESS was increased with opt-out. It wasn’t. You’re whole comment is out of line
Richard DeMonge
January 23, 2025 at 3:57 pm
So much for unbiased reporting. This article is full of bias. The entire study was funded by the Florida society of anesthesiologists and they have a stake in showing bias results to the public. CRNAs have been providing high quality and safe anesthesia in this country for well over a century and they improve access to care. Only reason why the FSA cares so much is because CRNAs are a direct competitors to their wallets!
Greta Vladinov
January 23, 2025 at 8:17 pm
The study by Feyereisen, McConnell, and Puro (2024) on state anesthesia policy interventions raises significant concerns due to conflicts of interest and the authors’ lack of clinical expertise in anesthesiology. Funded by the Florida Society of Anesthesiologists (FSA), the study introduces significant bias against Certified Registered Nurse Anesthetists (CRNAs), questioning the objectivity of its findings. The authors’ backgrounds in management and sociology do not provide sufficient expertise for a study on anesthesia policy. The use of terms like “risk of CRNA services” introduces additional bias. For instance, the study notes a 14% greater risk of CRNA services usage among rural hospitals with state Medicaid expansion, framing this negatively despite the fact these are positive findings and CRNAs provide essential care to underinsured populations with higher risks for chronic health conditions.
CRNAs play a critical role in providing safe and cost-effective anesthesia care in the United States. They are highly trained professionals delivering anesthesia services in various settings, including rural and underserved areas. Their contributions are vital to ensuring access to anesthesia care for all patients.
Sarah Bodin
January 25, 2025 at 8:21 am
This is an important study demonstrating that the outcome of “opt-out” legislation is not having the intended outcome of greater access to anesthesia care in states adopting it. As Florida lawmakers move forward in making health policy, this study should inform decisions about support for the highest quality medical care for Floridians. Kudos to the legislature for supporting more medical education funds in last years’ session.
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