Independent Practice Does Not Expand Rural Access

MYTH: Unsupervised practice by nurse anesthetists leads to increased access to care in rural areas.

FACT: Certified registered nurse anesthetists (CRNAs) cannot practice in areas where facilities don’t exist. An examination of county of residence data showed that both anesthesiologists and CRNAs are clustered around the 106 trauma hospitals (levels I-III) in Texas where anesthesia services are required. Anesthesiologists reside in every county with a trauma hospital, where they work and care for patients.1

Anesthesiologists are primarily responsible for the safety and well-being of patients before, during and after surgery. This may include:

  • Placing the patient in the state of controlled unconsciousness called “general anesthesia”
  • Providing “regional anesthetics,” in which only a portion of the body is made numb
  • Administering sedation when indicated for the relief of pain or anxiety

All of these anesthetics provide continuous pain relief and sustain patients’ critical life functions as they are affected throughout surgical, obstetrical or other medical procedures.
The role of the anesthesiologist extends beyond the operating room. The anesthesiologist is responsible for the preoperative assessment of the patient, an evaluation process that carefully considers both the patient’s current state of health and the planned surgical procedure. This evaluation allows anesthesiologists to make judgments about the safest anesthesia plan for each individual patient. The anesthesiologist also is responsible for the well being of the patient postoperatively, while the patient emerges from the effects of anesthesia. They often are involved in the management of acute postoperative pain, as well as chronic and cancer pain; cardiac and respiratory resuscitation; blood transfusion therapies; and respiratory therapy.

Nurse practitioners delivering emergency care without physician oversight increased lengths of stay and preventable hospitalizations.

In states that have granted independent practice to CRNAs, studies consistently show no increase in inpatient access to care. Patients travel the same distance to receive care in states with independent practice as states where CRNAs practice under the delegation of a physician.4

Oppose SB 1700 by Sen. César Blanco

  1. Texas Department of State Health Services. “Texas Trauma Facilities.” Texas Department of State Health Services, 15 Oct. 2022.
  2. Health Workforce Mapper.” American Medical Association, American Medical Association.
  3. O’Reilly, Kevin B. “3-Year Study of NPS in the ED: Worse Outcomes, Higher Costs.” American Medical Association, 10 Mar. 2023.
  4. Schneider JE, Ohsfeldt R, Li P, Miller TR, Scheibling C. Assessing the impact of state “opt-out” policy on access to and costs of surgeries and other procedures requiring anesthesia services. Health Econ Rev. 2017 Dec;7(1):10.

For more information regarding the care provided by anesthesiologists please visit https://tsa.org/advocacy/