A tall, unbreachable wall separates physicians and everyone else—nurses, psychologists, physical therapists, etc. A medical doctor/anesthesiologist (MD) performs similar (sometimes identical) work to that done by a certified registered nurse anesthetist (CRNA). Yet their training, credentials, licensure, privileges, and autonomy can differ sharply. Some states require CRNAs to work under the supervision of a physician, who may or may not have expertise in anesthesia. In any state, a nurse anesthetist who wishes to become an anesthesiologist will essentially have to go back to square one to make that transition—with little credit given to prior training and experience. This physician/nonphysician distinction is deeply engrained in American healthcare. But does the demarcation serve the interests of patients? Or is it merely an artifact of physicians’ 20th century political power? (Economist Milton Friedman said long ago that the American Medical Association was “the strongest trade union in the United States.”) Here, health economist Bob Graboyes discusses this demarcation with Nina McLain (a CRNA and professor in Mississippi) and Murray Feldstein (a retired urologist who “supervised” CRNAs in Arizona). This is the fourth of the following four segments:
