Special Topics Review: Certified Registered Nurse Anesthetist as Pain Manager Professional

Certified Registered Nurse Anesthetist as Pain Manager Professional


April 2024

Background: Traditional Model

Certified Registered Nurse Anesthetists (“CRNAs”) are advanced practice nurses; generally, with one year of experience in critical care medicine followed by an additional three-year training period in anesthesiology practices and procedures. Traditional physicians (“MDs”) practicing anesthesiology receive more training via medical school (four years) and a residency (four years). Traditionally, the MD would supervise a CRNA in the normal functions of their duties and the CRNA would provide a supportive role to the physician-led care team. Currently, 24 states have opted-out of physician supervision.

A Change to the Traditional Model

27 states currently allow CRNAs to practice anesthesiology alone without supervision. This was in response to rural hospitals and communities with inadequate numbers of physician anesthesiologists that had trouble recruiting and retaining qualified providers.

The rising costs of physician employment and decreasing reimbursement rates could force hospital and hospital systems to perform anesthetics with more cost-effective labor practices. Rather than physician anesthesiologists personally performing anesthesia, hospitals will utilize CRNAs supervised by physician anesthesiologists in an anesthesia care team model, or in some states, CRNAs working alone.

An Outlook on the Future

According to the Association of American of Medical Colleges (“AAMC”), by 2034 there will be a deficit of between 37,800 and 124,000 physicians as shown in the table below.

Projected Physician Shortages

The Bureau of Labor Statistics (“BLS”) projects the CRNA employment market will grow by 45% over the next ten years. An estimated 29,400 projected jobs annually over the next decade. While the role is not the same level as an MD, increasing competition by CRNAs will place pressure on MDs and hospital administration to allow CRNAs to practice independently.

A Hand in Pain Management:

CRNAs increasingly have a part to play in pain management – especially in rural areas that experience difficulty recruiting pain management physicians. The National Board of Certification and Recertification for Nurse Anesthetists created a certification in Non-Surgical Pain Management. (“NSPMC-C”) in 2014.

Additionally, there is growth of the opiate addiction problem. An estimated 6 to 12 percent of patients treated with opioids develop an addiction, said Michael D. McGee, MD. Additionally, per the American Association of Nurse Anesthesiology, “[the AANA] believes that moving from a unimodal approach of using opioid drugs to manage chronic and acute pain to a more patient-centered, multidisciplinary, multimodal opioid-sparing treatment approach optimizes patient engagement in their own pain care.” That will also reduce the risk of patients developing substance use disorder.

The Centers for Disease Control and Prevention’s (“CDC”) final guidelines in their “2022 Clinical Practice Guidelines for Prescribing Opioids” recognize the role of CRNAs as pain management providers. “The final guidelines acknowledge that advanced practice registered nurses (“APRNs”) such as CRNAs, in addition to physicians, manage pain. Furthermore, the final guidelines recommend that nonopioid therapies are preferred for providers, including CRNAs, treating subacute and chronic pain and should maximize the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient.”

Additionally, with the expansion of CRNA pain management fellowship programs (Texas Christian University, Middle Tennessee, and the University of South Florida), CRNAs will increasingly be seen as a viable alternative to the physician-led model of care – especially in rural/difficult-to-recruit areas.

Finally, per AANA President Angela Mund, DNP, CRNA, “Many patients rely on CRNAs as their primary pain specialist, and CRNAs play an essential role in assuring that rural America has access to critical anesthesia services. CRNAs often serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures and allowing patients to receive this important care close to home.”

CRNAs will have an increasingly have a larger role in the specialty of non-anesthesia pain management, especially in difficult-to-recruit/rural areas as they prove competent in alternative pain management methodologies.

Please contact Carnahan Group for additional information or a focused analysis of a particular arrangement.

Prepared by John Michael Li

Click here to view the PDF version of this article Certified Registered Nurse Anesthetist as Pain Manager Professional.

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