Archive Anesthesia 2016

Who Should Deliver Anesthesia?

The turf war between MDs and CRNAs heats up.

Shirie Leng, MD


anesthesiologists BEHIND THE MASK Physician anesthesiologists and nurse anesthetists both lay claim to safe patient care.

The Department of Veterans Affairs thinks it has the answer to cutting wait times for veterans who need surgery and other medical care: Let nurse anesthetists work without a doctor's supervision. The country's largest healthcare system wants to give CRNAs the authority to administer anesthesia and prescribe medications, among other things, on their own. The VA's recent proposal picked at the scab of a decades-old turf war waged by the American Society of Anesthesiologists and the American Association of Nurse Anesthetists. The battle is playing out on a national and very public stage, but the debate centers on a familiar argument that has been discussed for years in surgery centers and community hospitals: How much is patient safety worth?

The bottom line
It shouldn't come as a shock that both organizations are touting the clinical expertise of their members. The ASA makes the argument that CRNA-only anesthesia is unsafe, and produced a position paper to back its claim ( Of course, the AANA has similar research to cite, and makes the argument that CRNAs are perfectly capable of providing safe anesthesia, that they do so in areas in which doctors are not available and that such services are vital to the functioning of underserved areas. Studies funded on both sides of this particular argument have not conclusively convinced anyone that anesthesia, broadly stated, provided by one practitioner is safer than that provided by the other (

The contention, as far as I can see, is really between the professional societies, not actual practitioners. Today, the vast majority of anesthesiologists and nurse anesthetists work together harmoniously as team members. In ambulatory anesthesia, which accounts for an increasingly large percentage of the revenue earned by most anesthesia practices, these collaborations are particularly important. Both parties are generally perfectly happy with the physician supervision of CRNAs arrangement. I can't speak for all CRNAs, but the ones I know have little interest in independent practice.

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