D.C. Opts Out, Despite a Coordinated Physician Campaign to Stop It

The Anesthesia Brief  ·  Issue #12

If you're thinking it, we're talking about it.

By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA

Six things worth knowing today. Let's get into it.

D.C. Opts Out, Despite a Coordinated Physician Campaign to Stop It

Washington D.C. became the newest jurisdiction to opt out of the federal requirement that a physician supervise CRNAs, per AANA's own announcement this week. This one did not happen quietly. On August 17, ten physician and surgical organizations, including the AMA, the American Society of Anesthesiologists, and the American College of Surgeons, sent D.C.'s mayor a joint letter urging her to reject the opt-out. Their argument, D.C. is a fully urban jurisdiction with no demonstrated access problem, and a cited 2024 survey found 85 percent of D.C. voters wanted anesthesiologist oversight kept in place.

D.C. opted out anyway. Mayor Bowser's own letter said only that it was "in the best interest of District residents," without citing a specific study, so here is the evidence her decision lines up with. A 2010 Health Affairs analysis of Medicare data from fourteen opt-out states (Dulisse and Cromwell) found no increase in inpatient deaths or complications after physician supervision was removed, a finding that has held up as the most cited safety data on this exact question for over a decade. The opposition letter's own studies argue opt-out has not measurably improved access, which is a real, separate point, not a safety finding. Both things can be true, opt-out has not been shown to hurt patients, and it has not been shown to fix an access problem either.

That is real, organized resistance from the top of physician advocacy, and it still did not stop this. If you have ever been told your own state's scope fight is just paperwork, this is what it actually takes to move one, a coordinated national opposition campaign, real safety data behind the other side, and CRNAs and local officials pushing through it regardless.

Our take is at the bottom of this issue ↓

Read Delaware's Law, Then Check Your Own State

If you're a Delaware CRNA, pull up HB435 and read exactly what changed in your scope, pay, and safety protections, then check that your facility's policies actually match it. If you're anywhere else, look up where your state's bill sits right now and email your rep this week, don't wait for someone else to carry it.

Delaware's Law, One Month Later

Delaware's law from a few weeks back is still worth a check-in. The governor signed HB435 on August 31, locking CRNA scope, pay, and safety protections into state code. Same lesson as D.C., a law on the books does not mean your facility has already caught up to it, so check your own credentialing packet before you assume anything changed for you personally.

→ Full scope tracker + your state

Etomidate and Remifentanil, Again

Etomidate and remifentanil flipped back into shortage status as of mid-September, the same two drugs that gave everyone trouble earlier this year. Confirm with pharmacy before your next case and have your backup induction agent and dosing ready, don't assume last week's supply is this week's supply.

→ Full shortage list

The Hypotension Monitor Everyone's Debating

The Acumen HPI hypotension-prediction monitor is FDA-cleared and showing up in more ORs, promising a heads-up before a pressure crash hits. But several 2023 to 2025 analyses question whether the algorithm is catching something real or just reflecting how its training data was labeled, so don't let a green light replace your own eyes on the pressure trend.

→ Tech watch

On D.C.'s Scope Fight

We keep watching this same fight play out. A state or a district decides CRNAs have earned the right to practice to their license, and right on cue, the same national physician groups show up with the same letter, no evidence, no access problem, vote it down. This time it was the AMA, ASA, and eight more organizations, writing directly to D.C.'s mayor, backed by a voter survey and a stack of citations.

D.C. opted out anyway. That is not a paperwork win. That is CRNAs and the people who back them outlasting a coordinated campaign from the most powerful physician lobbies in the country.

We are not pretending patient safety is nothing, it is the entire point of this job. But the opposition keeps citing studies on access while skipping the actual safety data, a 2010 Health Affairs review of Medicare outcomes across fourteen opt-out states, Dulisse and Cromwell, found no increase in deaths or complications once physician supervision was removed. Fifteen years later, nobody has published anything that overturns it.

The same physician groups who say CRNAs need supervision Monday through Friday have no problem with a CRNA running the OR completely alone all night, every weekend, and every holiday, whenever the physician isn't actually in the building. Apparently we're only dangerous during business hours.

- Marc & Shantall

All episodes  ·  Blog  ·  Rate Calculator

Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, ASHP / openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health, BLS, AANA.

You're receiving this because you subscribed to The Anesthesia Brief.