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February 10, 1999

Nonphysician Clinicians in the Health Care Workforce—Reply

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;281(6):509-511. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-6-jac80022

In Reply: In response to Dr Owens, we want to reiterate that our data collection included not only NPC organizations but also the Health Policy Tracking Service at the National Conference of State Legislatures and the Internet Web sites of individual states. From these sources we concluded that CRNAs have the authority to practice independent of physician supervision in 18 states. However, Owens cites the technical report prepared by Squires, Sanders, and Dempsey, LLP, for the American Society of Anesthesiologists as showing that only New Hampshire allows CRNAs to be independent of physician involvement. While New Hampshire is alone in not placing some oversight limitation on CRNAs, the limitations imposed in 17 other states do not preclude CRNAs from practicing independently. Some of these limitations constrain their practices to specific guidelines and privileges; some mandate that CRNAs maintain collaborative and collegial relationships with a physician, dentist, or podiatrist; and some mandate that a physician be the director of the hospital anesthesia service. None of these stipulations creates the requirement for physician supervision of CRNAs. Moreover, even among the states that have such a requirement, the supervising physician is often the operating surgeon, dentist, or podiatrist rather than an anesthesiologist.