American Society of Anesthesiologists Urges Congress to Block VA Nurses’ Efforts to Remove Anesthesiologists from Veterans’ Care

WASHINGTON, D.C. — The American Society of Anesthesiologists (ASA) testified today before the House Veterans’ Affairs Subcommittee on Health and urged Congress to block a U.S. Department of Veterans Affairs (VA) Office of Nursing Services’ proposal to remove physician anesthesiologists from the surgical care of Veterans. The nurses’ proposal would lower the standard of care for Veterans by dismantling the team-based model of anesthesia care and move VA to a rarely used nurse-only model.

ASA President-Elect Ronald L. Harter, M.D., FASA, delivered the testimony and outlined key facts and evidence illustrating how Veterans’ health is best served by the VA’s existing, proven physician-nurse anesthesia team-based model of care — a model used in the nation’s top hospitals.

“ASA is committed to Veterans and knows that the physician-led anesthesia care team model serves Veterans best,” Dr. Harter said. “This issue is not about what ASA wants or even what the VA Office of Nursing Services wants. The issue is what is best for the health and well-being of our nation’s Veterans, including the new PACT Act Veterans. VA has the right policy in place right now and we need the Subcommittee to continue to support it.”

The American Legion submitted a statement for the record at today’s hearing and reported the results of their nationwide survey of Veterans, which found they overwhelmingly prefer a physician over a nurse to provide anesthesia care during the surgery. Among the American Legion’s survey findings:

• 61% preferred a physician administer anesthesia care while only 4% chose a nurse. The remainder had no preference.
• 91% expect the same quality of health care as the top-rated civilian hospitals.
• 71% believed VA will have a different standard of care if nurse anesthetists replace physician anesthesiologists.
• 52% said they would seek care outside of VA if their only choice was to have a nurse administer anesthesia.

“The American Legion’s survey confirms that our nation’s Veterans not only deserve the best care, they want the best care,” Dr. Harter said.

During the hearing, Harter testified that VA already addressed this issue and made the right decision in their multi-year 2016 rulemaking when they prioritized the needs of Veterans and maintained the physician-led anesthesia care team model — the most common model of anesthesia care in the country.

“Anesthesia and surgery are inherently dangerous for anyone, and VA patients often have poorer health status, such as diabetes, congestive heart failure, coronary and peripheral vascular disease, renal failure and chronic obstructive pulmonary disease,” Dr. Harter said. “It is an imperative that Veterans have an anesthesiologist involved in their care.”

“PACT Act Veterans exposed to Agent Orange, Burn Pits and other toxic substances require an even higher level of care under anesthesia. It makes no sense for VA to spend billions of dollars to treat PACT Act Veterans with respiratory disease and then put them at greater risk by adopting a lower standard of care,” Dr. Harter added.

Anesthesiologists and nurse anesthetists are not interchangeable health care professionals. Nurse anesthetists are excellent nurse practitioners, but their education and training are far less extensive and in-depth than anesthesiologists’ training. An anesthesiologist’s education and training include 12 to 14 years following high school, including medical school and residency, and 12,000 to 16,000 hours of clinical training. In contrast, a nurse anesthetist’s education and training ranges from four to six years after high school — less than half a physician’s training and an average of approximately 2,500 hours of anesthesia care training — less than one-fifth that of physicians.

Other key points Dr. Harter made:

• VA’s current anesthesia policy is one of the most thoroughly researched, studied and reviewed policies existing in VA. The current policy, Anesthesia Services Directive 1123, represents a safe, well-established and functional compromised approach to anesthesia care delivery. No changes are clinically appropriate or necessary.
• There is no demonstrated shortage of anesthesia clinicians necessitating a change in the delivery of anesthesia care within the VA. ASA closely tracks vacancies for anesthesiologists through the official employment website for the federal government. According to USAJOBS.gov, on September 14, 2023, the number of openings for anesthesiologists was 31 throughout the country, or a job openings rate of 2.9%, which is at or below a typical vacancy rate.
• There is no unbiased literature to support the safety of eliminating physician clinical oversight of anesthesia. To the contrary, VA’s own studies and data raise questions about the safety of the Office of Nurses Services’ proposal to remove anesthesiologists from the care of Veterans.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook and follow ASALifeline on Twitter.

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