Controversy Rages Around Nurse Anesthetists

In one corner: certified registered nurse anesthetists (CRNAs). In the other corner: anesthesiologists.

This seems an unlikely fight, since nurse anesthetists and anesthesiologists are more natural allies than enemies. After all, both groups give anesthesia to patients in the same ways in order to enable surgery and other medical procedures to be performed successfully. But an ongoing debate between these two professional groups recently became a full-blown legal battle. The issue? The decision by certain states to opt-out of a Medicare provision requiring nurse anesthetists to be supervised by a physician when administering anesthesia.

In April 2011, a Colorado judge upheld the state's right to allow nurse anesthetists to work without a supervising anesthesiologist, a Medicare requirement. Colorado had become the sixteenth state, in September 2010, to opt out of this Medicare provision, citing the need to provide such care in rural areas that often cannot attract or support a resident anesthesiologist. The Colorado Society of Anesthesiologists responded by filing a lawsuit against the state. According to the anesthesiologists, opting out would lead to "confusion and misunderstanding" about the responsibilities of physicians and CRNAs, and also would lead to a "diminished level" of care for patients.

Though this nurse vs. doctor battle got ugly at times, the result in Colorado points up the important role that nurse anesthetists play in the health care system and illustrates why the career is in high demand.

Education and compensation of nurse anesthetists

Contradicting the claims of the Colorado plaintiffs, studies undertaken by the Research Triangle Institute and the Lewin Group in 2010 concluded that patient care had not suffered at all in states that had opted out. While these studies were funded by the American Association of Nurse Anesthetists (AANA), leading some to question their impartiality, CRNAs unarguably are highly educated and rigorously trained to provide impeccable care. Nurse anesthetists must be registered nurses who have a bachelor's degree in nursing or an equivalent degree as well as a minimum of a master's degree from an accredited program in nurse anesthesia. According to the AANA, these master's programs last two to three years, include a clinical component and culminate with a national certification exam. Once practicing, CRNAs undertake significant continuing education to keep their licenses.

Given their intensive training, it makes sense that nurse anesthetists are well compensated. The Michigan Department of Energy, Labor and Economic Growth reports that in 2009, CRNAs employed in hospitals and related institutions nationwide earned an average annual salary of $146,000, and chief nurse anesthetists earned an average annual salary of $161,000. These numbers might be conservative; referring to a nationwide survey, The Dallas Business Journal reported in 2008 that the average CRNA salary of $185,000 surpassed the $172,000 average salary of a family physician.

Where nurse anesthetists fit into the big health care picture

Of course, salary is dependent on where a nurse anesthetist is employed, and CRNAs are crucial players in every medical arena, from traditional hospitals to war zones. As the situation in Colorado and other opt-out states like Nebraska, South Dakota and Montana makes clear, rural medical facilities are among the places where CRNAs have the greatest impact. According to the AANA, nurse anesthetists are the only providers of anesthesia in more than two-thirds of rural hospitals in the United States. The Denver Post reports that of the 38 rural Colorado hospitals that anesthetize patients, 24 rely solely on nurse anesthetists. The paper quotes the chief executive of the Rural Health Center, who, in supporting the opt-out decision, said that in these rural hospitals the CRNA usually has more expertise in anesthesia than the supervising physician.

Demand for nurse anesthetists is also being driven by the need to reduce costs within the health care industry. A New York Times editorial published just before the Colorado opt-out took effect pointed out that it is six times more expensive to educate an anesthesiologist than a nurse anesthetist. And though CRNAs make an ample salary, it is about half the average yearly wage of an anesthesiologist.

The Colorado District Court declared the nurse anesthetists the victors in their legal battle with the state anesthesiologist group, but both sides would doubtless agree that outside the courtroom, they are working every day toward the same goal: to safely administer anesthesia to patients. The satisfaction from doing this important work, coupled with the position's excellent growth prospects and high pay, earned nurse anesthetists the distinction of being ranked 13th on CNNMoney.com's 2010 list of the 100 best jobs in America.

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