(BPT) - Nine out of 10 Americans agree: the nation’s Veterans deserve nothing less than the highest-quality health care. Yet a proposal by the U.S. Department of Veterans Affairs (VA) risks lowering their standard of care by replacing highly trained physician anesthesiologists with nurses in surgery.
Surgery is inherently dangerous, and VA’s proposal could deny Veterans access to the same standard of care available for 95% of Americans, which requires the involvement of a physician in anesthesia care to ensure a patient’s health and safety.
During Physician Anesthesiologists Week, Jan. 29-Feb. 4, the American Society of Anesthesiologists (ASA) is asking Americans to help protect Safe VA Care. Michael W. Champeau, M.D., FASA, ASA president, explains the proposal, and how it could put our Veterans at risk.
Q: How does VA’s proposed change to anesthesia care impact Veterans?
A: Physician anesthesiologists currently work shoulder to shoulder as peers with VA’s surgeons to keep Veterans safe in surgery and ensure the best outcomes from a procedure. VA’s new National Standards of Practice would eliminate physician anesthesiologists and the proven team-based model of anesthesia care — where physician anesthesiologists supervise nurse anesthetists — with a nurse-only model. Replacing highly trained physician anesthesiologists with nurses in surgery is potentially dangerous, especially for Veterans. Many Veterans may be older, sicker and have conditions associated with military service, such as Agent Orange and burn pit exposure, which puts them at greater risk for complications during surgery.
Q: Why is VA proposing this change?
A: According to ASA, "There are currently no anesthesiology workforce or access issues and absolutely no need to replace VA’s longstanding patient safety policy for anesthesia care. There is no reason to propose this change to advance a solution to a problem that doesn’t exist, would harm the lives of Veterans and is not supported by research, since the data clearly shows that anesthesia is safest when a physician anesthesiologist is involved."
VA also has provided anesthesia care under the team-based model for decades and in 2017 reaffirmed this standard of anesthesia care after an exhaustive, multiyear review. The review collected a record-breaking number of public comments — more than 200,000, including 25,000 comments from Veterans and their families — to the Federal Register to keep the physician-led anesthesia model.
Q: What is the difference between a physician anesthesiologist and a nurse anesthetist?
A: Physician anesthesiologists have twice the education and five times the hours of clinical training of nurse anesthetists. They 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. Nurse anesthetists are qualified members in the Anesthesia Team Model, but they can’t replace a physician. They did not attend medical school and have only 2,500 hours of clinical training.
Q: How does VA’s proposed changes in anesthesia care compare to the standard of care available for most Americans?
A: All of the U.S. News and World Report top-rated hospitals in our country use the team model of anesthesia care with oversight by anesthesiologists, which also is the standard of the World Health Organization (WHO). This level of care also is required by laws in nearly every state.
Q: What research is available to support the importance of physician-led anesthesia care?
A: Independent research, including VA’s own research, supports the importance of physician oversight in Veterans’ anesthesia care. No independent studies show nurse anesthetists can ensure the same safety and outcomes in surgery as physician anesthesiologists. Research also shows that eliminating physician-led care does not improve access or save medical costs.
Q: How can Americans help protect Veterans’ health and safety?
A: Visit SafeVACare.org to submit a comment to the Federal Register on the importance of maintaining safe, high-quality physician-led anesthesia care for our nation’s Veterans.
“VA’s proposal unfairly lowers the standard of care for our veterans and it’s clear that no science or necessity supports a change,” said Dr. Champeau. “Our veterans deserve nothing but the best health care. That’s why we’re telling VA to stop this risky plan.”