Guest Author
Do you remember the movie, “Jurassic Park?”
It was based on what seemed like a brilliant idea: clone dinosaurs. It seemed a good solution — until, of course, everything went horribly wrong. It turns out that letting velociraptors roam free wasn’t just dangerous; it was also a spectacularly bad plan for solving humanity’s problems. Expanding the scope of practice of Certified Registered Nurse Anesthetists (CRNAs) feels a lot like that. In theory, it may sound like a good idea, but in practice, it’s risky and doesn’t deliver the ‘promised’ results.
Let’s dive into why.
The setup: Who are nurse anesthetists and what do they want?
Nurse anesthetists are skilled professionals who assist in delivering anesthesia, an essential part of the anesthesia care TEAM. However, some nurse anesthetists want to take on more than their training allows — like administering anesthesia without any supervision from a physician. In fact, part of the failure was that Hammond thought he could go it alone and engage in something that was far outside of his league.
Spoiler alert: it didn’t end well.”
The plot twists: Their arguments fall apart
Over the years, nurse anesthetists have tried several pitches to sell this bad idea, but each one crumbles under scrutiny:
— “It’s safe!”
A study they funded to show that letting them work alone wouldn’t harm patients, unfortunately, proved the opposite: patients were more likely to have serious complications, especially the really sick ones, proving that so-called “independent practice” was a dangerous proposition.
— “It will save money!”
Next, they argued that letting nurse anesthetists work solo would lower costs. But anesthesia billing doesn’t work that way — insurance pays the same regardless of who delivers the medicine. Plus, what is the cost of fixing mistakes from complications? Priceless (and not in the fun credit-card-commercial way).
— “It will help patients in rural areas get surgery faster!”
This is the latest claim: Letting nurse anesthetists work alone will cause them to relocate to rural communities. Sounds great, except for one problem: it’s not true. Florida already has a severe nurse shortage, and overloading nurse anesthetists with responsibilities they’re not trained for won’t suddenly fix it. Nor will they magically uproot themselves from well-paying jobs in urban areas to move into rural communities.
The facts: What science says
A new study from professors at Florida Atlantic University (FAU) — funded by the Florida Society of Anesthesiologists and the American Society of Anesthesiologists—looked into this rural access claim. This group of professors was approached because they had released several prior studies in this arena. Spoiler alert: it’s not working and there is no evidence that it will work. States that expanded Nurse Anesthetists’ roles outside of their training (and allowed for independent practice) DID NOT see any increase in care for underserved rural areas.
The takeaway: Keep the team together
Nurse anesthetists are an important part of the anesthesia care team — emphasis on “team.” Like Jurassic Park, where things worked best when the experts stuck to their lanes (before the dinosaurs started eating everyone), anesthesia care needs strong leadership from physicians to stay safe and effective. Removing physician supervision isn’t just a bad idea—it’s a very real disaster waiting to happen. And especially in relation to their latest false claim, it won’t help solve Florida’s healthcare access in rural areas either.
Let’s focus on real solutions, not risky sequels no one asked for. After all, we’ve seen how those movies turn out — and to be sure, we are not talking about a movie thriller but a truly scary proposition.
When it comes to anesthesia, we know that the physician-led team model works. It’s not just the safest but also the most cost-effective means of administering anesthesia medicine – and it is not science fiction but a proven scientific fact.
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Dr. Asha Padmanabhan, M.D. is a Board-Certified Anesthesiologist and the Florida Society of Anesthesiologists president.
6 comments
Patrick
February 12, 2025 at 8:59 am
This is a woefully uninformed viewpoint, and a poorly written opinion to boot.
I’ve never seen the movie you mentioned? Please tell me why this has anything to do with the provision of anesthesia?
Who is this ‘Hammond’ you’ve mentioned here? Someone from the science fiction movie you previously discussed?
Why does the employment status and related demographics have anything to do with this? Aren’t Nurse Anesthetists highly educated nurses, with training beyond that needed for ‘merely’ an RN to practice? Why would they need to concern themselves with the perpetual shortage of ‘regular’ RNs? That’s not the work they’re engaged in.
Please consider revising this for clarity.
Tom Breazeal
February 14, 2025 at 1:40 pm
You’ve never seen Jurassic Park? You need to sit this one out…
Robert Faust
February 12, 2025 at 10:35 am
Lies and more lies. Always guarding their paycheck. Note how every “study” is paid for by their lobbying groups? CRNAs practice independently in almost half of the states and have the same or better care than any other model. Meanwhile the ASA/FASA advocate for poorly trained AAs as they are not a threat. Sad that, as usual, physicians out their greed before patient care.
Seth Edwards
February 14, 2025 at 5:34 pm
Now who’s telling the lies? AA’s are exceptionally well trained and are interchangeable with CRNAs in the the Anesthesia Care Team model of anesthesia delivery. You are likely a nurse who has never seen much less worked with an AA, and yet you so freely disparage a whole profession of health care providors with a long history of safe and effective care.
Mark Dobbbertien
February 14, 2025 at 8:44 pm
While Certified Registered Nurse Anesthetists (CRNAs) play a critical role in anesthesia care, they should not have independent practice in Florida due to patient safety concerns, differences in training between CRNAs and anesthesiologists, and the need for physician oversight in complex cases.
I. Patient Safety Risks
• Anesthesia complications can arise suddenly and require rapid, expert intervention.
• Anesthesiologists have more extensive training in handling rare but life-threatening emergencies.
• Studies show that anesthesia-related complications are lower in supervised settings.
II. Differences in Training and Expertise
• CRNAs typically complete 7-8 years of education, while anesthesiologists complete 12-14 years, including extensive residency training.
• Anesthesiologists are trained in perioperative medicine, pain management, and intensive care, offering a broader medical perspective.
• The depth of knowledge gained through medical school and residency equips anesthesiologists to manage high-risk patients more effectively.
III. Complexity of Cases in Florida’s Diverse Healthcare System
• Florida has a large elderly population with multiple health conditions requiring specialized care.
• High-acuity cases (e.g., cardiac, trauma, and pediatric surgeries) demand the expertise of a physician-led anesthesia team.
• Independent CRNA practice may be suitable for routine procedures but poses risks in complex cases without physician oversight.
IV. Collaborative Models Ensure Quality Care
• Supervision does not mean micromanagement; it allows CRNAs to work at their full scope while ensuring physician backup when necessary.
• The current team-based approach balances efficiency, patient safety, and cost-effectiveness.
• Maintaining a collaborative model avoids unnecessary risks without limiting CRNAs’ essential contributions.
Conclusion:
While CRNAs are valuable anesthesia providers, independent practice could compromise patient safety in complex cases. Florida should maintain its physician-supervised model to ensure the highest standards of care.
Jason
February 15, 2025 at 7:33 am
Imagine what all could be accomplished if the lobbying dollars for Anesthesiologists and Nurse Anesthetists worked together to fight insurance companies and hospitals for fair reimbursement and pay for all of us? And also utilizing the saved time to advance the field of Anesthesiology by each of our societies?
On day one of medical school, my training focused on how to lead and direct a medical team. This just isn’t the focus for nursing school as the focus is taking orders and making them happen. It is a root difference in training across the board for doctors versus nurses. The supervision model in anesthesiology is a continuance from this concept, and it provides the safest model for patient care. Any divergence from the current model goes against standard of care and should not be considered.
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