Nurses and Doctors Square Off Over Anesthesia Battle

nurses and doctors square off over anesthesia battle

A pending bill in the state Senate would lift Michigan's requirement that physicians must supervise nurse anesthetist while they administer anesthesia.  The bill would allow nurses with advanced training as Certified Registered Nurse Anesthetists to order and administer anesthesia pre-operatively, perioperatively and postoperatively. 


But the bill is not popular with physicians in Michigan.  Physicians are usually responsible for overseeing all cases in the operating room and are present for induction and intubation, (when the patient is given anesthesia and a breathing tube is placed). They supervise several rooms at once and are there in the case of emergencies, but they are rarely seen during any given day. 

Nurse Anesthetists have a master's degree with specialization in anesthesia.  Most applicants into the CRNA program have one year of acute care.  27 months of education along with 2500 hours in the operating room are required to graduate. The average salary of a CRNA in the state of Michigan is $171, 520

The anesthesiologist is required to complete four years of medical school and four years of residency.  Average salary in Michigan for an anesthesiologist is  $263,230

Source: U.S. Bureau of Labor Statistics, May 2014

The Michigan bill would make it possible for CRNAs to independently practice anesthesia.  But the bill has physicians in an uproar as they claim to be more qualified. While nurses claim, they can provide the same care and treatment for a fraction of the expense, a factor that is essential to lowering the cost of medical treatment, at a time when all treatment costs are under scrutiny by the health care system. 

Michigan is not the only state to have considered this issue.  Expanding roles for advanced practice nurses is becoming more common in all states. These nurses are highly skilled in their field, and physicians are finding themselves scrambling to maintain their traditional control of the healthcare market.

In the past doctors were exclusively authorized to insert peripheral central catheters, (PICC lines). But nurses are now permitted to insert these catheters in patients, for long-term therapies like antibiotics, chemotherapy..., etc.  This has lowered the cost for the procedure substantially because RNs are now able to provide this service without the supervision of a physician and it is no longer necessary to do this procedure in a hospital. Patients can be in a nursing home, or home health setting. This cuts the expense of these procedures in half, in many cases. 

Nurses are allowed to "determine proper placement," but they are not permitted to "read" the Xray. It's simply a word game for the benefit of the physician.  They still want their hand in some part of the procedure so they can get paid. Many doctors still perform PICC lines but charge three times as much. This is not very attractive to health insurance companies and the entire healthcare system.  

It seems like a no-brainer, and the message is clear here: Physicians are in competition with advanced practice nurses.  Medical doctors will have to lower their charges and improve their bedside manner or find themselves increasingly on the sidelines.   As advanced practice RNs are becoming more common, patients are experiencing the care and compassion of a nurse combined with the in-depth training that is similar or exceeds the care of a physician.  

Times are changing and the days of physicians dominating leadership of the healthcare system are dwindling. High pay for little work is no longer acceptable, even for physicians.  The old excuse that "I gave up my twenties," is no longer valid for exorbitant charges and bad attitudes. 

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