In 2024, Massachusetts and Washington, D.C., have removed practice restrictions from certified registered nurse anesthetists, allowing them to practice independently with fewer physician oversight requirements.
The decisions come as a shortage of anesthesia professionals is ongoing nationwide, forcing some facilities to cancel surgeries over a lack of providers.
CRNAs currently administer more than 50 million anesthetics to patients in the U.S. every year, especially in rural areas, yet some states still continue to limit their scope of practice citing safety concerns.
In addition, several schools are bolstering their CRNA training and licensing programs in an effort to counteract ongoing shortages.
Melissa Picceri Croad, CRNA, APRN, who provides anesthesia services throughout Massachusetts and New Hampshire and serves as the government relations director for the Massachusetts Association of Nurse Anesthetists, spoke with Becker's about how CRNAs can serve their communities to alleviate shortages, fears around ongoing reimbursement cuts and ongoing safety concerns surrounding CRNAs' independent practice abilities.
Question: Why are CRNAs necessary amid a growing anesthesia provider shortage?
Melissa Picceri Croad: One of the things, especially in Massachusetts, it all goes back to practice models. There is a perceived shortage of anesthesia providers between CRNAs and physicians. If physician anesthesiologists are working in practice models where they are not personally administering anesthesia and instead are supervising CRNAs, they are contributing to the shortages. If they stopped supervising nurse anesthetists, who do not need supervision, and started actually providing anesthesia themselves, then that would help alleviate the perceived shortage. In other words, until and unless every provider is personally administering anesthesia at the top of their license, we don't really know what the true shortage is.
There are currently more physician anesthesiologists retiring than entering into the profession. Right now, they are struggling to keep up with the demand. Nurse anesthetists are not as bad, and we are putting out way more young talent and opening up way more training programs across the country. In the last year, two or three more programs have opened. Our numbers are not quite as bad as physicians. When we talk about shortages, practice models are often creating perceived shortages.
Q: Some physician groups have expressed safety concerns over CRNAs practicing unsupervised. Do you share those concerns or see any in the workplace?
MCP: There have been numerous studies showing that nurse anesthetists' outcomes are the same as physician anesthesiologists. It's already happening — CRNAs are already working independently. If we were unsafe and killing people, we would know it. My response to that would be, "Where are we stuffing the bodies?" The best study is the status quo. CRNAs are already working independently everywhere and we just don't see a problem with that. Especially in the rural areas. In big Western states with large rural areas like Nebraska and Montana, they are receiving care from about 99% CRNAs. It is hard for me to qualify where they are coming from with safety concerns when this type of care is happening all day every day.
Q: What other trends are you keeping an eye on in the anesthesia space?
MCP: We're carefully watching staffing shortages versus perceived shortages. We are watching the number of new CRNAs coming out into practice to fill any voids. We are seeing, across the country, the trend away from traditional ratio staffing models, because they are expensive and inefficient. The Northeast in general is notoriously behind on trends and has historically been a very restrictive environment for all advanced practitioners, not just CRNAs. The trend really is turning away from traditional supervisory models, where a physician supervises a set number of CRNAs every day, and turning more to collaborative practice.
In Massachusetts, we do not really see this happening yet. We are still very physician led in many places, but there is an organization that took a contract in New Hampshire and CRNAs are crossing the state lines in search of better work environments. Here, we're not restricted and we can utilize and provide the care that we have been trained to give. I come up here about 20 hours a week and work here and it's a dream. It's a wonderful environment where we have wonderful physician anesthesiologists that we work together with. They administer, we administer and we collaborate with each other in an open environment to do what is best for patients. That's a really important trend we are hoping will become more and more normalized.
Q: How are recent cuts of CRNA reimbursements poised to impact the industry?
MCP: Reimbursements for nurse anesthesia services are being reduced, and this is not a good trend to see. I provide the same service as a physician anesthesiologist, but somehow my services are only worth 85% of whatever the fee schedule is negotiated for physicians. On its face, people say, "Well, I am a physician and you're not." Am I only giving 85% of an anesthetic? Also, you have to think about the consumer. Are they getting a 15% discount if they come to an all CRNA practice? They're still getting 100% of the care and the cost. The other thing about reimbursements is it's not like reimbursements come to me and that's my paycheck. It'll go to the business entity. Reimbursements go to whatever entity where you are employed. Hospitals still have to run their anesthesia departments at cost, yet if certain providers are getting fewer reimbursements, they are at an operating loss as well.