It is the opt out and its issues I'd like to focus on in this post. The who-provides-best-care-at-lowest-cost debate rages on in many a forum but here I would like to present mostly facts with a smidge of opinion (with sarcastic overtones of course).
The opt out was designed to address the issue of anesthesia care shortages nationwide by giving individual states the right to grant crnas the ability to practice without physician supervision.
This 2001 rule was created to give states “flexibility to improve access to anesthesia services without the burden associated with duplicative regulatory oversight,” said Jeffrey Kang, MD, then director of the Centers for Medicare & Medicaid Services (CMS) Office of Clinical Standards and Quality.
Since 2001, 15 states have invoked the "opt-out" and have granted this privilege. The ASA, obviously, has opposed and the AANA, obviously, has supported. The last state to "opt-out" was none other than California. This came as quite the surprise to many as California has quite a large number of anesthesiologists. The California Society of Anesthesiologists is in the process of filing a lawsuit to overturn the opt-out. More info on that here.
From my sources on the ground, most hospitals and surgery centers still require supervision so there hasn't been any major upheavals in the state as far as I know. I have heard of an anesthesia-trained pain physician fire his MD anesthesia support staff and hire crnas to give sedation in his block shop. Hmmm. Updates to follow.
For my opinion I will summarize an excellent lecture entitled "How Might Anesthesia be Delivered?" by
John P. Abenstein, MD, Associate Professor of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
Future Impact on anesthesiologists: anesthesia today (is) easier to administer than 30 yr ago, but patients (are) sicker today, with more comorbidities and physiologic changes; result—switch of anesthesiologists’ work effort from administration of anesthetic to providing medical care; in speaker’s opinion, anesthesiologists should leverage knowledge and skills and use technologic advances to increase productivity and improve quality, reliability, and reproducibility of care; will be accomplished through industrial solutions (automated processes overseen remotely by highly skilled operators, with small number of individuals on floor to troubleshoot).
Thoughts?
Update 2/6/10: Coverage from the WSJ here. Note the particularly active comment section.








