Anesthesia's Political Landscape

I don't want to make this blog a forum for anesthesiology's political agenda, but I feel that I should advocate for my specialty. As a resident, I think it is important for me to learn about and understand issues facing the field, and one of these is the role of certified registered nurse anesthetists or CRNAs. CRNAs are a valuable and vital component to the anesthesia team. Nurses who undergo additional training can be licensed to provide general anesthesia, and they work at many places, from community hospitals to academic centers. They are generally supervised by an MD anesthesiologist unless a state opts out of that requirement. California has done so, so in this state, CRNAs can practice independently. The state society of anesthesiologists has objected to this "opt-out" but it seems that it is here to stay. What should you (the public) know about CRNAs? For the most part, they provide anesthesia for low acuity cases; some studies have shown that much of the Medicare billing by CRNAs are for colonoscopies and cataracts. For most anesthetics, CRNAs are a perfectly appropriate provider. However, their training is different than that of anesthesiologists; a nurse's skill set, approach to clinical problems, and background is very different than a physician's. The California Society of Anesthesiologists feels that this is significant enough to warrant physician oversight of CRNAs. I personally cannot comment on it as I haven't worked all that much with CRNAs. Many hospitals, despite the "opt-out," still have physician supervision of CRNAs. There are also other issues with CRNAs, especially in performing pain procedures, and again, anesthesiologists as a whole are reluctant to allow them to practice independently. In any case, all patients should know who their providers are and be aware whether a CRNA is practicing with an anesthesiologist or independently.