VA proposal removes physician anesthesiologists from surgery, potentially jeopardizing Veterans’ safety

The nation’s Veterans deserve nothing less than the highest-quality surgical care. Yet a proposal by the U.S. Department of Veterans Affairs (VA) lowers the quality of care, potentially threatening the lives and safety of Veterans by eliminating physician anesthesiologists from the surgical team and replacing them with nurses.

“Surgery is inherently dangerous and removing highly trained physician anesthesiologists from the care of patients is wrong,” said American Society of Anesthesiologists (ASA) President Randall M. Clark, M.D., FASA. “It is particularly concerning for VA patients, many of whom are older, sicker and have conditions as a result of military service that put them at greater risk for complications during surgery.”

The VA proposal seeks to change how anesthesia is delivered in the VA from an Anesthesia Team Model — where physician anesthesiologists supervise nurse anesthetists — to a nurse-only model.

During Physician Anesthesiologists Week, Jan. 30-Feb. 5, ASA is asking Americans to help protect Safe VA Care.

Veterans deserve the highest standard of care

Laws in nearly every state and the policies of the nation’s top hospitals and health systems require physician supervision of anesthesia care to ensure the safety and best outcomes for patients. The physician-led anesthesia model also is preferred by nine out of 10 surgeons, according to an independent survey conducted by PSB for ASA in December 2019. VA has relied upon this model for decades.

“No science or necessity supports the change in how anesthesia is delivered in the VA,” Dr. Clark said. “The proposal also has raised the concerns of VA’s own frontline anesthesiologists who have repeatedly called for the proposal’s withdrawal.”

Hundreds of anesthesiologists and anesthesiology chiefs throughout VA’s hospital system have urged VA leadership four times to rescind these proposals by invoking VA’s “Stop the Line” patient safety initiative — an initiative where any VA employee can notify VA leadership of any risk to Veterans’ health. VA has not responded to the whistleblower notifications.

Previously, in 2017, Veterans’ right to this high-quality standard of care was reaffirmed after a multiyear review by VA that garnered a record-breaking number of public comments — more than 200,000, including 25,000 comments from Veterans and their families — in support of the physician-led anesthesia model.

Physicians ensure safety, outcomes and access

Independent research supports the importance of physician leadership in Veterans’ anesthesia care. VA’s own Quality Enhancement Research Initiative (QUERI) specifically raised questions about the safety of replacing physician anesthesiologists with nurses, noting it could not discern “whether more complex surgeries can be safely managed by certified registered nurse anesthetists, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal.”

No independent research shows that nurse anesthetists can ensure the same safety and outcomes in surgery as physician-led care. There also are no anesthesiology workforce shortages or issues with access to anesthesia care in the VA system that necessitate the change.

Education and training make a difference

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 do not attend medical school and have about half the education and only up to 2,500 hours of clinical training.

Protect Safe VA Care

Submit your letter to Congress to ask VA to protect Veterans’ health and safety.

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