Anyone who works in health care knows how territorial we doctors can get when someone tries to “invade our sphere”.  Look at the wide array of opinions on nurses being sanctioned to do what was previously a physician-only job (i.e. nurse anesthetists, nurse practitioners, etc).  My personal feelings on CRNAs aside (I will say I have no animosity toward the profession in general), I have to take issue with the American Association of Nurse Anesthetists (AANA) and their recent letter to Speaker of the House Nancy Pelosi regarding the ongoing health care reform debate.

The letter begins by offering the support of the AANA’s 40,000 members for HR 3200 and continues with the admission that while far from perfect, HR 3200, in their view, provides an laudable launching pad for health care reform.

The next paragraph outlines several “critical provisions” within the legislation that are supported by the AANA.  Inclusive to those provisions is repeal of the Sustainable Growth Rate formula that “threatens gargantuan 21.5% cuts to anesthesia and all Part B services unless Congress acts by January 2010…”

The third paragraph takes on a more “touchy-feely” (i.e. anecdotal) angle to personalize/emotionalize the issue… the AANA states that patients without insurance come to a CRNA’s care in worse physical condition than someone with insurance (cute soundbite but lacking any sort of peer-reviewed study/published facts/etc to account for that claim).  The best part is yet to come though… what I perceive to be the true colors of the AANA:

“We are disappointed that among the most vocal opponents of initiatives to expand coverage are anesthesiologist colleagues who may currently bill for four anesthesia patients’ cases simultaneously.”

Wow.

I was a little floored, okay, really floored by that comment in a letter of record to a public official.  That crushing sensation in my chest isn’t angina but rather its the bus (that my profession was just thrown under) as it runs over me!

First of all, to address anesthesiologists as “colleagues” in a letter to the Speaker of the House, and then be described in the next keystroke as disappointments, obstructionists, and greedy charlatans is a bit, um, lacking class.  That’s putting it mildly.

Secondly, it seems ill-advised to bite the hand that feeds you.  Yes, there are some states where CRNAs are free to practice outside the purview of anesthesiologists but many require physician oversight.  Inflammatory statements of this nature can only serve to lessen the relationship that exists between physician anesthesiologists and nurse anesthetists.  Guess what ultimately suffers from such strain, be it on an individual, community or national organizational level?  Patient care.  Why is the AANA pitting CRNAs against MDs in this debate?  One has to question their motives.

In my opinion, it appears the AANA is talking out of both sides of its mouth.  While advocating the repeal of the SGR formula to prevent “gargantuan” cuts to anesthesia-related reimbursements, the AANA decries the LEGAL billing practices of physicians who are ultimately responsible for the patients given anesthesia by CRNAs.  Applaud the SGR formula repeal but denigrate your “colleagues” for being paid for all of their work?  Weak.

On a final note, I have to wonder how many of the 40,000 AANA members really do support HR 3200?  Recall the hub-bub of the AMA’s endorsement of HR 3200…

See a copy of the AANA’s letter:

http://capwiz.com/asa/attachments/1_2009_08_04_AANA_support_letter_for_H.R._3200.pdf