Professional politics and the challenge of anesthesia availability in rural hospitals

Abstract

Rural areas that are struggling to recruit and retain qualified health practitioners are caught in the crossfire of turf battles between allied health practitioners and physician groups. The most intensely political of these inter-occupational turf battles is between anesthesiologists (MDAs) and certified registered nurse anesthetists (CRNAs), who are the sole providers of anesthesia in two-thirds of rural hospitals (American Association of Nurse Anesthetists (AANA), 2007a, 2007b). The ability of many rural hospitals to provide anesthesia services is dependent on CRNAs. This study uses data collected from CRNAs in Iowa and Arizona in 2005 to focus on the impact of the turf battle on the professional interactions and opinions of CRNAs. Arizona and Iowa were chosen for this study because not only do the policies in these states contrast with each other, but the contexts in which CRNAs practice are also dissimilar. The majority of Arizona's CRNAs work in urban areas in close proximity with MDAs. Most CRNAs in Arizona report that their workplace interactions with MDAs have suffered as a result of the turf battle, despite the lack of any action to opt out of the federal Medicare requirement of physician supervision of CRNAs. While most CRNAs in Iowa perceive that job opportunities and the quality and cost of health care have improved as a result of opting out of the federal supervision requirement of CRNAs, the impact on their social interactions in the workplace depends on location and the structural context of their work. Most CRNAs in Iowa's urban areas continue to work in a structural context of de facto supervision by MDAs. As a result, only a minority report that their professional interactions in the workplace have improved. The outcome for Iowa's rural CRNAs is decidedly different. The majority function as independent practitioners and have experienced an improvement in their social interactions in the workplace and greater economic reward. These occupational privileges should improve the ability of Iowa's rural hospitals to recruit and retain CRNAs and, as a consequence, surgical services in rural areas.