The physician vs. crna debate has reared its ugly head…. yet again. There have been multiple bills presented to suggest crna independence WITHOUT physician anesthesiologist oversight. In 2017, proposals were made to the Veteran’s Affairs to replace physicians with crnas. Here’s what they found when they looked at the VA databases to conclude that nurses will continue with physician oversight in anesthesia:
Current laws in 45 states and the District of Columbia all require physician involvement for anesthesia care and the VA in 2017 decided to maintain its physician-led, team-based model of care. The 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.”
Here’s my evidence and reasons why I believe the care of the patient is best when it is physician-led. After all, would you want a nurse or assistant doing your actual surgery? The ultimate goal is patient safety.
Physician anesthesiologists have up to 14 years of post-graduate medical education and residency training, which includes 12,000-16,000 hours of clinical training, nearly seven times more training than nurse anesthetists.
From 2010:
- The Doctors, the nurses, and the anesthesia
- Putting surgery patients at risk
- WSJ: Follow-up: Anesthesiologists, Nurse Anesthetists, and Evidence
From 2011:
From 2017:
Yet, here’s another debate that shows there’s no difference in an anesthesia care team setting with an anesthesia assistant and a crna:
- Anesthesiology. Anesthesia Care Team Composition and Surgical Outcomes. May 2018. Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay and medical spending.
- Anesthesiology News, June 2018: Surgical Outcomes Similar Between Anesthesiologist Assistants and Nurse Anesthetists
- http://wana-crna.org/pwdocs/ChartCRNAvsAA2012.pdf
- ASA: Statement comparing AA and CRNA education and practice
- Anesthesiology News, July 2018: ASA, AANA Clash Over Anesthesiology Shortages, Practice Authority in VA Hospitals
Bottom line in my opinion:
- Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
- Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school. The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
- I will continue to be FOR team-based physician-led anesthesia care.
