The commentary below from Dr. Jay H. Epstein is in response to Peter Schorsch’s Jan. 8 post on SaintPetersBlog.com urging legislators to give nurse anesthetists the authority to administer anesthesia without the supervision of a doctor.
When it comes to anesthesia, lives should not be put in jeopardy.
Thank you for this opportunity to address several points raised in your recent blog in which you advocate allowing nurses to do the work of physicians when it comes to the administration of anesthesia.
First, you inaccurately state that “national studies have shown time and time again” that nurse anesthetists deliver the same quality of care as a physician.
There are no such studies.
While this statement is demonstrably false, it is presumably based on a misreading of a single study (the data used in it is eight years old) that was paid for by the national nurse anesthetist lobbyist group (the AANA.)
But even taking their data (and not the editorialized title) at face value, please note that the actual data in the study clearly shows two things that directly and immediately counter your premise.
First, the study states that the physicians were generally involved in more complicated surgeries than the nurses, yet their mortality rates were not significantly different. If physicians were dealing with sicker patients and more complicated surgeries and the outcomes were no different, then the logical conclusion is that physicians provided a higher standard of safe care. There should have been a mortality difference, but there was not.
Second, the study shows that in the states that have allowed nurses to act without a doctor’s supervision, mortality rates not only increased over time (from 1.76 to 2.03 per 100 patients) but in the final year of the study (2005) the mortality rate in so-called “opt-out” states was more than 50 percent higher than in states that required doctor supervision. 50 percent higher!
To sum up, the only “recent” study (with data that is nearly a decade old) that is on point actually shows — with extreme clarity — that doctor-led anesthesia care is safer than when nurses act without the supervision of a trained physician. There are no other recent studies.
Considering the differences in education, training, and experience between anesthesiologist physicians and nurse anesthetists, these results are hardly surprising.
Physician anesthesiologists have twice the schooling and more than seven times the clinical training of anesthetists, and the nature of that training is very different.
Nurses are trained to be medical technicians (and to be clear, they are a vital and valued part of the anesthesia care team) while anesthesiology physicians are medical doctors who are trained to understand underlying medical comorbidities, formulate medical diagnoses, and recognize the intersection between surgery, medicine, and pharmacology. The appreciation of these complex interactions is crucial.
The administration of anesthesia is much more dangerous than it appears and involves far more than simply slipping on a mask or injecting someone with medicine. A patient’s outcome depends upon a detailed review of their medical history, the careful selection of a properly designed anesthetic plan, contingency plans for complications, and diagnostic skills to assess and treat postoperative problems.
In short, there is a reason we have twice the education and more than seven times the clinical hours.
The expansion of healthcare access must take into account safety, outcomes, cost, need, and — quite simply — proven results. There is not projected to be a shortage of anesthesia physicians or anesthetists, as we heard in testimony earlier this month. There is, however, according to the nursing industry, a chronic shortage of nurses that is projected to be the worst shortage in more than 50 years.
The physician-led anesthesia care team model works very well and there is no urgent need to look for alternative delivery systems. When they are facing a procedure, Floridians deserve to have the best-trained clinician available and directing their care. That person is a physician anesthesiologist.