The NYTimes published an editorial yesterday which debated the practice of allowing unsupervised, yet highly trained nurses to provide anesthesia care. California recently joined 14 other states in allowing the practice; Colorado is set to approve it as well. The cost savings are clear:
In the long run, there also could be savings to the health care system if nurses delivered more of the care. It costs more than six times as much to train an anesthesiologist as a nurse anesthetist, and anesthesiologists earn twice as much a year, on average, as the nurses do ($150,000 for nurse anesthetists and $337,000 for anesthesiologists, according to a Rand Corporation analysis).
The risk seems minimal (although the studies were funded by the professional association of nurses, a potentially biased group):
Analysts at the Research Triangle Institute found that there was no evidence of increased deaths or complications in 14 states that had opted out of requiring that a physician (usually an anesthesiologist or the operating surgeon) supervise the nurse anesthetists. The analysts recommended that nurse anesthetists be allowed to work without supervision in all states. Researchers at the Lewin Group judged nurse anesthetists acting without supervision as the most cost-effective way to deliver anesthesia care.
In developing countries, the practice of shifting tasks from more highly skilled professionals to lower, more cost-effective positions is referred to as “taskshifting”. In 2006, the WHO made a series of recommendations (full booklet here) to alleviate health worker shortages through taskshifting. Some countries find the practice controversial, including Swaziland, as this recent article reports.