Dear Editor:
Anesthesia without physician oversight is rare. Nearly everyone in our country –– 95% of the population – lives where a physician-led team-based model of anesthesia care is the expected, standard practice. The nation’s top-rated hospitals all employ the physician-led model; not a single one of these institutions allows nurse-only anesthesia care. Physician-led care is the status quo and the model that safeguards patient safety, which is why it was disturbing to read Claire Wallace’s article, “'The best study is the status quo': How CRNAs can work independently to alleviate provider shortages.”
While a handful of states are removing physician supervision requirements, the physician-led anesthesia model of care is still the predominant one being used. The article notes that “some states still continue to limit their [nurse anesthetist] scope of practice citing safety concerns.” Those concerns are legitimate and warranted. The Modesto Bee recently reported on allegations of risk of harm to patients and ongoing investigations by the California Department of Public Health when the unsupervised delivery of anesthesia by nurse anesthetists was utilized at Stanislaus Surgical Hospital. The findings are alarming; the inspectors declared that the problems were serious enough to pose an immediate threat to patient safety.
There also are no unbiased studies that show nurse anesthetists can ensure the same safety and outcomes in surgery as physician anesthesiologists. However, there is independent research published in the peer-reviewed journal Anesthesiology that shows that the presence of a physician anesthesiologist in surgery prevented 6.9 excess deaths per 1,000 cases in which an anesthesia-related or surgical complication occurred. Other research has shown that eliminating physician-led care does not improve access or save medical costs.
Workforce challenges are affecting all hospitals, health systems and specialties at every level including physicians and nurses. Allowing nurses to work without physician oversight is not the answer, nor is it the status quo.
Sincerely,
Ronald L. Harter, M.D., FASA
President
American Society of Anesthesiologists