GEOGRAPHICAL DISPARITIES & DISBURSEMENT OF MICHIGAN ANESTHESIA PROVIDERS: A WORKFORCE STUDY

Abstract

As more Americans are insured now than ever before under the Affordable Care Act, the demand for healthcare services and healthcare providers has increased in the United States. It is crucial to examine the forces impacting the anesthesia workforce, as increasing numbers of insured individuals has a direct effect on availability and access to anesthesia, surgical, and pain management services. In Michigan, there are three types of anesthesia providers which include certified registered nurse anesthetists (CRNAs), anesthesiologists, and certified anesthesiologist assistants (CAAs). In response to intensive efforts on the part of the Michigan Association of Nurse Anesthetists to remove barriers to practice for CRNAs, the Michigan Society of Anesthesiologists has proposed that CAAs can replace CRNAs in rural and underserved areas of Michigan. The purpose of this workforce study was to answer the following question: In rural and underserved areas of Michigan, does the use of CAAs in comparison to the use of CRNAs provide increased access to high quality cost-effective anesthesia services? Results revealed that CRNAs are the most prevalent provider in all population classifications: rural, urban, and metropolitan. On examining the number of anesthesia providers per 10,000 people in rural populations, it was determined that there is an average of 0.35 CRNAs present in rural areas compared to 0.05 anesthesiologists and 0.05 CAAs, indicating that CRNAs are seven times more prevalent than anesthesiologists and CAAs in rural areas. In addition, CRNAs are nearly 10 times more likely than anesthesiologists to work in a critical access hospital in Michigan. These results suggest that CAAs are not increasing access to anesthesia services in rural and underserved areas of Michigan.