Understanding Professional Jurisdiction Changes in the Field of Anesthesiology

Scott Feyereisen, Joseph P Broschak, Beth Goodrick

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists’ (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs’ autonomy. Implications for the professions and health services literature are discussed.

Original languageEnglish (US)
JournalMedical Care Research and Review
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Nurse Anesthetists
Anesthesiology
Nurses
Physicians
Dissent and Disputes
Medicare
Health Care Costs
Health Services
Anesthetics
Health

Keywords

  • anesthesia
  • health care policy
  • jurisdictional change
  • power
  • professions

ASJC Scopus subject areas

  • Health Policy

Cite this

Understanding Professional Jurisdiction Changes in the Field of Anesthesiology. / Feyereisen, Scott; Broschak, Joseph P; Goodrick, Beth.

In: Medical Care Research and Review, 01.01.2017.

Research output: Contribution to journalArticle

@article{3adee58c28f548bd9c16e556d80def34,
title = "Understanding Professional Jurisdiction Changes in the Field of Anesthesiology",
abstract = "We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists’ (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs’ autonomy. Implications for the professions and health services literature are discussed.",
keywords = "anesthesia, health care policy, jurisdictional change, power, professions",
author = "Scott Feyereisen and Broschak, {Joseph P} and Beth Goodrick",
year = "2017",
month = "1",
day = "1",
doi = "10.1177/1077558716687889",
language = "English (US)",
journal = "Medical Care Research and Review",
issn = "1077-5587",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Understanding Professional Jurisdiction Changes in the Field of Anesthesiology

AU - Feyereisen, Scott

AU - Broschak, Joseph P

AU - Goodrick, Beth

PY - 2017/1/1

Y1 - 2017/1/1

N2 - We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists’ (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs’ autonomy. Implications for the professions and health services literature are discussed.

AB - We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists’ (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs’ autonomy. Implications for the professions and health services literature are discussed.

KW - anesthesia

KW - health care policy

KW - jurisdictional change

KW - power

KW - professions

UR - http://www.scopus.com/inward/record.url?scp=85042398466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042398466&partnerID=8YFLogxK

U2 - 10.1177/1077558716687889

DO - 10.1177/1077558716687889

M3 - Article

C2 - 29148326

AN - SCOPUS:85042398466

JO - Medical Care Research and Review

JF - Medical Care Research and Review

SN - 1077-5587

ER -