Anesthesiologists Outraged Over New Policy. A change in Medicare regulations will now allow nurse anaesthetists to administer anaesthesia during surgery without being under the supervision of an anaesthesiologist or other medical doctor. Nurses argue that this is good policy for underserved areas where no anaesthesiologists are available; the MDs counter that in such areas the nurse should be supervised by the surgeon performing the surgery (whom Medicare hasn’t yet ofund a way to do away with). The rhetoric about serving the underserved just doesn’t hold up to scrutiny, and this smacks of more meddling with lives to save an almighty dollar. Besides, who thinks it is going to remain restricted to medically underserved areas?

The closest I come to having seen anything like this in my own specialty of psychiatry is the growing encroachment of cheaper “nurse clinical specialists” managing psychiatric outpatients’ medications in place of psychiatrists. Unfortunately, I have rarely seen one who has the breadth and depth of perspective to do justice to sorting out the complicated patients, often the sickest in the mental health arena, they tend to treat, since they usually appear to be hired by the public sector mental health clinics that are under the tightest budgets. Being at the receiving end of the fruits of their difficulties managing their patients in the community, I can attest to the fact that patients simply do not od as well under their care as under the care of a physician, and end up requiring psychiatric hospitalization at a far greater rate than patients who have psychiatrists. And that’s just expensive hospital bills; in the realm of anaesthesia, we’ re talking about mortality. WCVB Boston