The big boys are afraid of losing their cut of the pie. The other half goes to the anesthesiologist supervising the nurse, who must examine the patient beforehand but whose involvement thereafter may be minimal. A single anesthesiologist may be supervising, and receive payment for, up to four simultaneous operations in neighboring operating rooms. If the federal rule changes, states may see a green light to drop their own requirements, to help rein in costs and to allow hospitals more flexibility in staff selection. Anesthetists already work without anesthesiologists in some rural and inner-city facilities that cannot afford or cannot attract anesthesiologists.
Nurses also work unsupervised in office settings like plastic surgery centers.
But anesthesiologists worry that a rule change for Medicare patients in hospitals could create the impression that the federal government endorses the practice across the board, and worsen what some studies indicate is a growing glut of anesthesiologists by causing jobs to be eliminated. Many lawmakers are unpersuaded by the nurses' arguments for states' rights and are not ready to let the invisible hand of the market determine operating room staffs. Lobbying has been intense. They may have spent themselves to a stalemate in Washington. There are five bills now in Congress, three calling for more study and two affirming the change.