A Nurse-Doctor "Scope of Practice" Spat: It's Really About Rural Health Care

Published on
February 10, 2010

To most reporters, a recent lawsuit filed by California doctors to stop nurse specialists from administering unsupervised anesthesia looks like a yawn-worthy turf war over who gets to do what in medicine.

As far as I can tell, no mainstream California media outlet picked up the story. I can just see the thought bubbles (having been guilty of it myself in the past). That's inside baseball. It's not a local story, right?

Think again.

Cheryl Clark of Health Leaders Media digs a little deeper and finds an important story about access to health care in California's rural communities. That story's worth following as the lawsuit progresses.

The lawsuit filed by 40,000 California doctors last week to halt nurse anesthetists' newly obtained ability to administer anesthesia without physician supervision opened the floodgates of fury.

The vitriol was reflected in dozens of heated-and some quite nasty-comments beneath HealthLeaders Media's online story, and on the Wall Street Journal's Health Blog. There's a lot at stake in a scope of practice fight: Authority, responsibility, and billings for Medicare patients

Beneath the din, however, is the underlying crux of the issue: the impact of the physician shortage on rural hospitals, which struggle to find and contract with primary care or specialty doctors willing to work in their areas, and especially at contract rates the poorer, smaller hospitals can afford.

Clark goes on to explain how the lawsuit and access to rural health care are linked (it's a bit wonky, but stay with her), and criticizes the litigious docs for wanting the best of both worlds:

Physicians can't insist on one hand that they want to resolve the problem of rural physician shortages, and then try to block this rule in California. It seems like an effort to strengthen the need for their services in places where far too few of them want to practice.

Clark's story suggests a couple of intriguing and, yes, local story ideas for enterprising reporters in both rural and urban communities.

1. If you cover a rural area, ask your local hospital director, any nurse anesthetists and surgeons how the system works now (check out Clark's article for specific information on some rule-bending that occurs) and how access to health care might change if nurse anesthetists could provide anesthesia without doctor supervision.

2. How will this affect plastic surgery practices and outpatient surgery centers? If plastic surgeons and other practitioners save money by not having board-certified anesthesiologists at the bedside, would those savings be passed on to consumers?

If I've missed any mainstream media coverage of the California lawsuit, let me know in the comments below. You need to be a registered member of Center for Health Journalism Digital to leave a comment, so if you haven't joined yet, click here. It's easy, quick and free. You can follow us on Twitter, too, @ReportingHealth.

And finally, a hat tip to @KentBottles who alerted me to this story. He's worth following on Twitter.