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, 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. CNRAs 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 areas — 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 areas 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 areas 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 which 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.”
