California Gov. Arnold Schwarzenegger's decision to opt out of a Medicare provision that requires physician supervision of nurses administering anesthesia has now gone through. A lawsuit preventing this has failed and now times are a changin'. This game plan by the Gov was an effort to save money and since CRNAs cost less, well, you get the idea. Forget the fact that an anesthesiologist has eight years of training after college, must complete a four-year clinical residency, and must pass several written and oral exams for certification, while a nurse anesthetist has about three years of training and must pass one three-hour certification exam. A bigger issue is the tension this will cause. What was meant as a relationship built on collaboration turns into one of competition. This is happening or has happened with nurse practitioners and nurse midwives as well. The attorney representing the CRNAs stated that this change "ensures that California can continue to provide access to critical anesthesia services, particularly in rural areas". Remember that line. It is the same line used by all the organizations trying to get solo privileges. In five years, you will see how few CRNAs will go into the country with the rural folk. This is about money not about access. Now before anyone rips me a new one by replying that "I'm a CRNA and I do everything the doc does" I want to warn you that I am not blogging this to pick a fight. The bottom line is that the training is not the same. You have to pay the dues (as noted above) that anesthesiologists do. And what seems like a good idea, practicing independently, I predict will lead to some bad blood which is not good for anyone.