Using Nurses Instead of Doctors

One of the little-discussed drivers of higher health costs are the state, and sometimes federal, regulations that require providers with certain licensure to perform some procedures or require certain staffing ratios.  Health Affairs publishes research looking at the necessity of one such requirement.  Anesthesia can be administered by either anesthesiologists, who are doctors, or nurse anesthetists.  For years, most states required that a nurse anesthetist be supervised by a physician and Medicare required such supervision to pay for the services of a nurse anesthetist.  Then CMS decided to create an opt-out whereby states could ask Medicare to allow nurse anesthetists to perform their duties without supervision.  The researchers looked to see if this change in policy led to worse outcomes.  (Health Affairs Article)

The authors examined tens of thousands of cases to ascertain whether there was any increase in mortality or complications when anesthesiologists did the work alone, versus nurse anesthetists alone, versus a team of anesthesiologists and nurse anesthetists.  What they found was that the nurse anesthetists actually appeared to have slightly lower rates of mortality and complications when practicing alone and unsupervised than did anesthesiologists acting alone.   Some of this may be due to anesthesiologists handling more complex patients, but not enough to affect the basic finding.

Physicians have historically zealously guarded their professional turf.  Physicians are also typically much higher cost than other health professionals.  It is not hard to assume that physicians’ turf protection is actually designed to maintain high incomes.  The country can’t afford this any longer and allowing less expensive professionals to provide services is one proven method to reduce unit costs.  And when research shows that quality doesn’t suffer, it is inexcusable not to eliminate regulatory protection for doctors’ incomes.