Physician Supervision of Nurse Anesthetists
Citing patient safety concerns, the American Society of Anesthesiologists (ASA) has spent much of the last two or three years vigorously opposing a federal government initiative to loosen "physician supervision" restrictions on nurse anesthetists. I support the ASA's effort completely. But all too often, many anesthesiologists give in to pressures in a way that undermines our case and may even cause us to appear as hypocrites. If we are to push for physician supervision of CRNAs, then each and every anesthesiologist must practice what we preach.

The ASA's guidelines for anesthesiologists who supervise nurse anesthetists clearly state that the anesthesiologist is responsible for the preop evaluation and prescription and implementation of the anesthesia plan. When we ask the CRNAs who have graduated from our program about their concerns in starting private practice, their No. 1 response is that they have serious concerns about the quality and completeness of the preoperative evaluation done on their patients. When we survey residents who have graduated, we get an indication to why: Pushed by demands for greater efficiency, some anesthesiologists may be cutting corners in preoperative evaluations and directing CRNAs to anesthetize sub-optimally prepared patients. One of the most common concerns among this group regards the intense "production pressures" from hospital administrators and surgeons to manage the ORs on schedule and avoid canceling scheduled cases.

Dr. Maurer ('maurerw@ccf.org')) practices at the Cleveland Clinic Foundation.