Physician anesthesiologists oppose VA rule replacing physicians with nurses in anesthesia

The American Society of Anesthesiologists (ASA) urges Americans to protect our nation's Veterans by opposing a U.S. Department of Veterans Affairs (VA) proposed policy that removes physician anesthesiologists from surgery and replaces them with nurses, lowering the standard of care and jeopardizing Veterans' lives.

The policy change is based on a shortage of some types of physicians in VA. However, there is no shortage of physician anesthesiologists and the change is not needed to improve access to anesthesia care in surgery. The policy would abandon a proven model of care where physician anesthesiologists and nurse anesthetists work together as a team to provide Veterans high-quality and safe anesthesia.

"Surgery and anesthesia are inherently dangerous requiring physician involvement, particularly for Veterans who are sicker and often have multiple medical conditions that put them at greater risk for complications," said ASA President Daniel J. Cole, M.D.

"There are no issues with access to anesthesia care in VA - this policy lowers Veterans' standard of care," said Jane C.K. Fitch, M.D., ASA past president and former nurse anesthetist. "The change also directly conflicts with the VA's core strategy to deliver high-quality, Veteran-centered care and endangers the lives of those who served our country and deserve better."

The VA's own internal evaluation of the relevant studies regarding health outcomes of patients receiving care from nurse anesthetists practicing independently concluded that the evidence was biased and insufficient to support making a policy change. VA's Quality Enhancement Research Initiative (QUERI) could not discern "whether more complex surgeries can be safely managed by CRNAs, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal."

The policy also conflicts with state laws that recognize the importance of physician involvement in the delivery of anesthesia. The leading experts on anesthesia care in the VA, the Chiefs of Anesthesiology, have twice expressed concern that the new policy "would directly compromise patient safety and limit our ability to provide quality care to Veterans." They received no response from the VA to their requests for meetings. Veterans membership organizations and a bipartisan group of more than 90 members of Congress also oppose the policy.

Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training to specialize in anesthesia care and pain control, with the necessary knowledge to understand and treat the entire human body (1). By comparison, nurse anesthetists have about half the education and almost 2,500 hours of clinical training (2).

The proposed policy would have all advanced practice registered nurses (APRNs), including nurse anesthetists, practice without the collaboration, supervision or direction of a physician. Individual VA hospitals will not be permitted to keep the proven model of team-based anesthesia care that ensures patients have access to a physician anesthesiologist if an emergency or complication occurs. Under the new policy, Veterans will not have access to physician anesthesiologists.

The proposed policy change will be posted to the Federal Register May 25 and is open for public comment for 60 days. ASA urges every American who cares about safe VA care and the well-being of the nation's Veterans to visit safevacare.org and post a comment to stop the VA from removing physician anesthesiologists from surgery.