What’s the hottest topic in the media regarding health care? A change in the VA (Veteran’s Administration) handbook, that’s what. The proposed change would allow advanced-practice nurses to utilize the full extent of their training. And wow, what a stir this is causing! TV and radio ads—for and against the change—are plentiful, and lines are being drawn.
I’ve been an advanced practice nurse for 23 years, and my specialty is anesthesia. It’s no surprise that I’m in favor of the proposed ruling. I’m also retired from the Air Force reserves with 20 years service, and I’m kinda partial to our veterans.
Lets examine a few facts and thoughts:
- Currently, 16 states already allow me to practice my trade independently (without physician supervision).
- Almost every anesthetic given to soldiers throughout U.S. history has been by nurse anesthetists.
- CRNAs deliver 2/3 of all anesthetics given in the U.S., and are the sole providers in most rural hospitals.
- All Army Forward Surgical Teams are made up of 20-person crews, 2 of which are Certified Registered Nurse Anesthetists (CRNAs). It is perfectly absurd to assume that nurse anesthetists are good enough to stabilize our critically wounded soldiers in the field, but somehow conclude that we need supervision to care for our veterans while stateside under controlled conditions.
- At many VA hospitals, nurse anesthetists are already practicing without physician supervision.
- Besides patient safety, we’re talking about taxpayer dollars. We taxpayers foot the bill for VA care in addition to Medicaid and Medicare.
- There have been legions of studies showing that patient morbidity and mortality is not affected by type of anesthesia provider. Patient outcomes are virtually the same whether a CRNA or an anesthesiologist is at the head of the surgical table, in all types of cases.
- 100% of CRNAs are certified by the National Board of Certified Registered Nurse Anesthetists. We can only practice as CRNAs after passing our boards. Anesthesiologists, however, can practice if they don’t pass their boards. As a result, 22% of practicing anesthesiologists aren’t board certified. Usually, this is glossed over by stating that they are “Board Eligible.” CRNAs are currently trying to collect data on the percent of anesthesiologists within the VA who are “Board Eligible.”
So, why are so many physicians objecting to the bill? In short, it’s not the outcome—it’s the income.
Follow the money.
When supervision of CRNAs is required, anesthesiologists can hide behind the skills of nurse anesthetists. I can honestly tell you that there have been thousands of surgeries in which I’ve stood at the head of the table throughout the entirety of a surgery, conducting an anesthetic, while an anesthesiologist was in the doctor’s lounge, sometimes literally asleep, allegedly supervising my anesthetic (and billing the general public for it). The biggest money generator for anesthesiologists is when they can supervise (and bill for) four simultaneously-running operating rooms.
If advance practice nurses are allowed to practice to the full extent of their training without supervision, well … physicians can connect the dots. And they’d like to keep their seats in the lounge.
In order to scare the general public, ads funded by the ASA, the American Society of Anesthesiologists, tell us that the VA wants to replace doctors with nurses. Our vets deserve better, they claim.
The real truth is that the VA handbook change has been fought—tooth and nail—for the past 3 years. Almost all the objection has come from the ASA. Meanwhile, our vets could have been better served not just by CRNAs practicing independently, but scores of advanced practice nurses could have been tending to our vets.
There are some great anesthesiologists out there, just as there are great (and bad) CRNAs. I was trained by some wonderful, kind, and wildly talented physicians who wanted nothing more than for me to be the best practitioner I could be. There is a bell curve for talent among both nurse anesthetists and anesthesiologists. But collectively, what anesthesiologists are doing is little short of robbing U.S. taxpayers and keeping our vets languishing in limbo. CRNAs have proven again and again that we can practice independently and keep our patients safe. Let us help them.
I’d like to share a very short (less than 2 minutes) video produced by the American Association of Nurse Anesthetists: