(BPT) - The nation's Veterans deserve the highest-quality health care and 91% of them expect the same quality of care the public receives at the top-rated civilian hospitals. However, a proposal by the U.S. Department of Veterans Affairs (VA) could potentially affect Veterans' safety during surgery by replacing physician anesthesiologists with nurse anesthetists.

VA's proposal would change how anesthesia is delivered in VA facilities from the current proven physician-led, team-based model of anesthesia care - where anesthesiologists supervise nurse anesthetists - to a nurse-only model. Physician anesthesiologists provide expert care in surgery, especially for Veterans who tend to be older, sicker and have conditions associated with military service like Agent Orange and burn pit exposure, which put them at greater risk for complications during surgery.

'Surgery is inherently dangerous, and Veterans in VA hospitals deserve the best care. The physician-nurse anesthesia model of care is used in the nation's top civilian hospitals, and should remain as the model in VA hospitals,' said ASA President Ronald L. Harter, MD, FASA. 'VA's existing policy provides that care. There is no reason to change it.'

During Physician Anesthesiologists Week, the American Society of Anesthesiologists (ASA) is asking Americans to help protect Safe VA Care.

Veterans expect the highest-quality health care

In addition to overwhelmingly expecting the same quality of health care as provided at the top-rated civilian hospitals, a recent national survey by the American Legion found a majority of Veterans prefer a physician over a nurse to provide anesthesia care during their surgery. According to the survey, 71% believe VA will have a lower standard of care if nurse anesthetists replace physician anesthesiologists and 52% of them would seek care outside of VA if their only choice was to have a nurse administer their anesthesia.

Physician supervision of anesthesia care is not only required by the nation's top hospitals, but also the laws in 45 states, to ensure the safety and best outcomes for patients.

VA has successfully relied upon the proven team-based model of anesthesia care for decades and reaffirmed this standard of care in 2017 after a multiyear review, which 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 in VA hospitals.

'VA's current anesthesia policy is one of the most thoroughly researched, studied and reviewed policies existing in VA,' said Dr. Harter. 'There is no need to make changes especially since eliminating physician-led care does not improve access to care or save medical costs and the current anesthesiology workforce in VA is adequate to assure Veterans receive timely access to anesthesia care. The national nursing shortage also makes the VA proposal for a nurse-only model impractical and unworkable.'

Physicians ensure safety with education and training to make a difference

VA's Quality Enhancement Research Initiative (QUERI) 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.'

Nurse anesthetists are qualified members of the Anesthesia Team Model, but anesthesiologists have twice the education and five times the hours of clinical training of nurses. They receive 12 to 14 years of education, including medical school and residency, 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 medical issues that arise during surgery.

Protect Safe VA Care

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