Florida bill to Address Shortage of Anesthesia Providers Deserves support

By Laura Molina

When it comes to an issue as complex as healthcare, there are no one-size-fits-all solutions.  It will take ingenuity and grit to find ways to keep all Floridians healthy and to ensure that everyone has access to care.

Fortunately for patients in our state, Senator Ana Maria Rodriguez and Representative Mike Giallombardo have introduced bills in the Florida legislature, SB 718 and HB 649, Autonomous Practice by a Certified Registered Nurse Anesthetist (CRNA), that would offer hospitals, surgical centers, and doctor’s offices a choice in their anesthesia delivery models and an opportunity to address anesthesia workforce shortages that meet their patients’ needs.

Under current statute, CRNAs are required to be supervised by a physician or dentist. In some facilities, this supervision is conducted as part of an anesthesia care team model (ACT) where 4 or more CRNAs work with a single physician anesthesiologist to assess, plan, deliver, and reassess care for surgical patients. Opponents to the autonomous practice bills would have you believe the ACT model is the only model being used.

What they don’t want you to know is that the ACT model is not the only option, nor do they admit that the duplicative model can increase the cost of staffing a single operating room by 50% to 200% with no improvement in quality. Many healthcare facilities already flex between anesthesia staffing models within a single day under current statute.

The Florida Association of Nurse Anesthesiology (FANA) and the more than 6400 CRNAs in the state have been fighting for the better part of a decade to bring these commonsense solutions to Florida.  Forty-three other states have enacted similar legislation while Florida continues to be left behind, year after year. This means that Florida is one of only 7 states remaining where anesthesia care is statutorily confined to restrictive and expensive models that not only don’t increase quality, but hinder access.

That redundant cost is absorbed by the facility and can even force the facility to close. Due to cost pressures, eight rural hospitals in Florida have shut down since 2005 and an additional eight are at risk of closing. Some facilities terminate their inpatient and surgical services, including closing labor and delivery units.  When obstetrical units close, maternal morbidity increases.

The reality is, the supervision model is expensive and misleads the public with the pretense of the protection of “physician-led” anesthesia care. In truth, throughout Florida, many of the supervising physicians are not physician anesthesiologists, and they may not have had any in-depth anesthesia training since participating in a short rotation in their medical school days.

CRNAs are highly trained, advanced practice nurses who deliver anesthesia care autonomously in such rigorous settings as the United States military. To practice, Florida CRNAs first obtain a 4-year undergraduate nursing degree, then an average of 4+ years of critical care nursing experience followed by a doctorate in the field for a total minimum of 10 years of education and experience.  SB 718/HB 649 does not sever the collaborative relationships between CRNAs and their physician colleagues.

We should all be concerned with the future of anesthesia care in Florida. According to Florida Department of Health (DOH) data, 16 of our counties have no anesthesia providers residing within their county borders. In fact, the American Society of Anesthesiologists reported in June 2024 that “the percentage of facilities reporting an anesthesia staffing shortage increased from 35% in early 2020…to 78% in late 2022.”

To make matters worse, more than 30% of new CRNA graduates leave annually, largely to other states that offer autonomous practice models. Florida is educating the anesthesia workforce for the rest of the country. 

SB 718/ HB 649 would not increase CRNAs’ scope of practice or grant additional anesthesia techniques. It would simply remove the written protocol which has to be signed by a physician or dentist.

For years, FANA has clearly communicated to policymakers that removing physician supervision of CRNAs does not mandate any specific anesthesia model – it simply leaves the choice to individual healthcare facilities. Ignoring this fact, the Florida Society of Anesthesiology (FSA) commissioned a study with Florida Atlantic University (FAU) which ended up validating that preservation of choice in models exists despite statutory variations across the nation. The FAU researchers found that utilization of CRNAs nearly doubled, from 2010 to 2021. The same study also showed that there is greater utilization of CRNA services in facilities with higher percentages of inpatient days for those patients served by Medicare and Medicaid. This finding speaks directly to the provision of CRNA services to underserved and vulnerable populations.

Let’s focus on solutions rather than creating obstacles. SB 718/ HB 649 offer increased access to excellent anesthesia care with no budget requests. These bills epitomize the patient-centered, efficient, free-market innovation that Florida needs NOW.  

Laura Molina, DNP, APRN, CRNA is president of the Florida Association of Nurse Anesthesiology (FANA).