Cutting costs by cutting doctors

Doctors are great.  Nothing like a well-trained physician.  I’m grateful for them– especially considering my son has a rare genetic disease.  That said, one way we waste a lot of money on medical care in this country is by having things done by doctors that could be done by well-trained nurses.  Excellent case in point– anesthesia during surgery.  Really interseting Op-Ed in the N&O today persuasively makes the case that here is an area where we could save tons in costs, without any reduction in care or health outcomes whatsoever.  What’s stopping us?  The political power of doctors, I presume.  The details:

Two groups of medical professionals are trained to administer anesthesia: nurses who have been specially trained as nurse anesthetists and physicians specially trained as anesthesiologists. Despite compelling evidence that both groups provide equally safe anesthesia care, the majority of states, including North Carolina, still adhere to a federal government rule requiring nurse anesthetists to be supervised by physician anesthesiologists when providing care to Medicare and Medicaid patients…

Today, postgraduate education and clinical training in the specialty of anesthesia is remarkably similar for both groups, occurring in the same settings. As a result, both groups can independently provide an equivalent level of safe and effective anesthesia care.

A recent analysis found that in states whose governors opted out of the Medicare and Medicaid requirements for physician supervision of nurse anesthetists, there was no increase in patient complications or deaths. The independent report by RTI International recommended that nurse anesthetists be allowed to practice without supervision in all states…

So how wasteful is a system in which we train physician anesthesiologists who will ultimately supervise nurse anesthetists? According to the Rand Corporation, it costs somewhat more than six times as much to train a physician anesthesiologist as to train a nurse anesthetist, and the anesthesiologist earns twice as much on average per year. Similarly, a 2010 study of anesthesia delivery models by The Lewin Group found the most cost-effective delivery model by far is nurse anesthetists working without supervision.

More importantly, both the Rand and Lewin Group studies found there is no significant difference in quality of care when a certified registered nurse anesthetist delivers anesthesia versus a physician anesthesiologist.

These compelling findings are not a recent revelation. In 1980, the Centers for Disease Control and Prevention said the frequency of adverse outcomes associated with anesthesia was so low that a full-scale study of the issue was unwarranted.

I think this might be an interesting test case to watch to see if we can truly begin to approach our health care costs in a more rational manner.  If we cannot take this obvious and completely warranted step to seriously reduce costs without at all affecting the quality of care, its hard to imagine taking more difficult steps.

About Steve Greene
Professor of Political Science at NC State

2 Responses to Cutting costs by cutting doctors

  1. CRNAsAreTheFutureOfHealthCare says:

    CRNAs are highly skilled, well-educated safe anesthesia providers!

    The Time Has Come for All States to Opt-Out regarding unnecessary, enormously expensive physician supervision.

    Bravo to the author for his/her bold and true article based not on opinion, but RESEARCH!

    Taxpayers/patients everywhere are taking note and are demanding their anesthesia be provided by the most safe, efficient providers–> Certified Registered Nurse Anesthetists!

    • Steve Greene says:

      Agreed on the first part. On the other hand, I’m pretty sure that 90% plus of taxpayers/patients are clueless on the matter. It would be nice if they weren’t. Not to mention the people who irrationally believe that a doctor is always better no matter what.

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