Physician Anesthesiologists, Veterans and VA Anesthesia Chiefs Urge VA to Uphold Physician-Led Anesthesia Care to Protect Veterans’ Lives

In response to a recently released rule by the U.S. Department of Veterans Affairs (VA), the American Society of Anesthesiologists (ASA) wants Americans to protect Veterans by asking VA to uphold the national standard of anesthesia care that ensures health and safety.

ASA continues to work to ensure that the Department retains the well-established, physician-led anesthesia care team model that is the national standard for anesthesia care. ASA urges VA to uphold its current patient safety-centered policies governing anesthesia care including the Advance Practice Nurses final rule (38 CFR § 17.415) and Directive 1123, which provide for physician-led anesthesia care for Veterans. While the VA’s recently issued rule, “Authority of VA Professionals to Practice Health Care,” does not directly address surgical patient safety standards, it leaves open the possibility of changes to the standards in the future. ASA opposes any weakening of protections that ensure patients have access to the safe, physician-led model of anesthesia care.

“Our nation’s Veterans have earned and deserve the safest, highest-quality anesthesia care. Our Veterans are often sicker and have multiple medical conditions that put them at greater risk for complications, and the VA must continue to ensure the involvement of a physician anesthesiologist in Veterans’ care,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “Removing physician anesthesiologists and replacing them with nurses lowers the standard of care and jeopardizes Veterans’ lives.”

To date, both the Trump and Obama administrations have recognized the unique nature of the acute care surgical setting and preserved the longstanding and nationally recognized standard of physician-led anesthesia care. Veterans’ right to this standard of care was reaffirmed after an exhaustive, multi-year review that garnered a record-breaking number of comments. More than 200,000 comments were submitted during two public rule makings, which overwhelmingly directed VA to ensure our nation’s Veterans do not receive a lower standard of anesthesia care than the general public.

Independent research supports physician-led anesthesia care. VA’s own internal evaluation reviewed studies that were commissioned by nurses aimed to show health outcomes from independently-practicing nurse anesthetists. The VA review concluded that the evidence was biased and insufficient to support making any policy changes. 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.”

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. By comparison, nurse anesthetists have about half the education and up to 2,500 hours of clinical training. 

In April, VA’s Executive in Charge, Richard Stone, M.D., issued a memo encouraging VA medical facilities to change their hospital bylaws to allow for the provision of nurse-only anesthesia care, citing a physician shortage. The memo is strongly opposed by more than 350 of VA’s own frontline anesthesia medical experts who urged VA to rescind the “Stone Memo” by invoking VA’s “Stop the Line” patient safety initiative – an initiative through which any VA employee can notify VA leadership of any risk to Veterans’ health.

“There are no issues with access to anesthesia care in the VA that necessitate this change,” Dr. Philip said. “We look forward to having a robust and ongoing dialogue with VA to ensure all VA facilities continue to provide physician-led anesthesia care.” 

According to VA, there are 884 physician anesthesiologists and 938 nurse anesthetists on staff and no work force shortages.

The Interim Final Rule was posted to the Federal Register Nov. 12 and is open for public comment for 60 days. ASA urges every American who cares about safe VA care and the well-being of Veterans to visit www.SafeVACare.org, and speak out. Post a comment to urge the VA to uphold the national standard of anesthesia care.

American Society of Anesthesiologists

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook, follow ASALifeline on Twitter.