Doctors oppose replacing VA physician anesthesiologists with nurses

Replacing doctors with nurses for the administration of anesthesia could lower quality of care and jeopardize lives, says the American Society of Anesthesiologists.

By Stephen Feller

SCHAUMBURG, Ill., May 25 (UPI) -- A doctors group has come out in strong opposition to a plan by the U.S. Department of Veterans Affairs to increase the roles of advanced practice registered nurses, raising concerns that in at least one case the change is unwarranted and potentially dangerous.

The American Society of Anesthesiologists has decided to oppose the change because, at least in the case of anesthesiologists, physicians have far more education and experience to draw on with patients, and there is no shortage of them.


The VA's proposed rule, published today in the Federal Register, subdivides APRNs into four categories: certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist and certified nurse-midwife. The purpose of the rule is to explicitly spell out full practice authority for each APRN within the VA in order to fill vacancies and use resources better within the department.

The ASA contends, however, the rule change is unnecessary for anesthesiologists because there is no shortage or problem with the delivery of this part of care in the agency.

"There are no issues with access to anesthesia care in VA -- this policy lowers Veterans' standard of care," Dr. Jane Fitch, past president of the ASA and a former nurse anesthetist, said in a press release. "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."


Physician anesthesiologists spend 12 to 14 years in school and between 12,000 and 16,000 hours in clinical training to specialize in anesthesia and pain control, compared to about half the schooling and 2,500 hours of clinical training required for a nurse anesthetist, according to the ASA.

The new rule, if approved, could lead to VA hospitals abandoning the team-based model of anesthesia that allows for continuous and more comprehensive care, the organization said, potentially damaging the high level of care expected at VA facilities.

The American Nurses' Association offered cautious support for the rule change before it was published in the Federal Register, based on concerns of overall doctor shortages for several years, saying on its website that "limiting APRNs practice in the Veterans Health Administration puts our veterans at risk due to backlogs and waitlists for receiving treatment."

In the proposal, the VA states it is looking to increase the role of APRNs in the agency's facilities to one similar to those in non-VA healthcare facilities while maintaining quality of care. For its part, the ASA says the plan, at least as far anesthesiology is concerned, could make it difficult to ensure that level of care is possible.


"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 Dr. Daniel Cole, president of the American Society of Anesthesiologists.

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