Nurse Anesthetists

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Until recently, neither nurse anesthetists nor anesthesia assistants were welcomed by the medical establishment as possible substitutes for anesthesiologists; however, more recently, anesthesiologists have "rolled out the welcome mat" - a step that was symbolically supported by the creation of an "educational affiliate" membership category at the 1999 meeting of the American Society of Anesthesiologists.

The Nurse Anesthetists Trend

The trend to allow registered nurses and medical assistants more independence is long in the making, and has been a result of the following:

• Cost-cutting process that began to take over the management of healthcare in this country since the early Clinton years.
• Clinton specifically pushed through a revision to HCFA regulations that would allow registered nurse anesthesiologists to practice without physician supervision.
• Growth in this field has outstripped demand, creating a glut of anesthesiologists.

Anesthesia is one of the most highly contested areas in medicine. Anesthesiologists a few years out of med-school can easily reach salaries that top $300,000 per year - among the highest in the profession. As a result, the only justification for these extravagant salaries is in compensation for the risk undertaken by such practitioners. However, such risk is easily - and far less expensively - managed through insurance.

Cost Effectiveness and Nurse Anesthetists

In conducting a cost-effectiveness analysis (CEA) in this case one needs to consider that the procedure administered is virtually identical, regardless of who the administering professional is. Anesthesiologists claim that neither nurses nor assistants can treat patients with the same safety levels that they can, focusing especially on monitoring standards and airway management guidelines. Yet, these are minor issues easily resolved through proper training.

Both Assistants as well as nurses can provide better continuity of care than physicians, given that they are both far less expensive and that they are there with the patient - not only more hours every day, but also over the long-term, as such practitioners typically do not come and go as much as residents, fellows and physicians do.