Dr. Steven Gayer: VA proposal will endanger our nation’s veterans

Veterans Affairs (Large)
Dr. Steven Gayer
Dr. Steven Gayer

The Department of Veterans Affairs was created, in Lincoln’s moving prose, to care “for those who shall have borne the battle.”

Yet in a departure from well-established VA policy and medical protocol, the agency recently announced its intention to remove physician anesthesiologists from surgery and replace them with nurses lowering the standard of care for veterans and potentially jeopardizing their lives. The proposed policy was posted to the Federal Register, with comments being accepted through July 25.

The VA’s proposal is not only completely unnecessary — and solves no identifiable anesthesia care problem within the VA — it is a risky move.

Allow me to explain …

Anesthesia care teams are most often led by physician anesthesiologists who safely guide patients through dangerous surgeries. It is a proven model of care where physician anesthesiologists and nurse anesthetists work together as a team. Often the medical judgment of the physician — developed over a decade of advanced education and training — makes a crucial difference in the patient’s health.

While nurse anesthetists are well trained, competent, and compassionate providers of care for our veterans, they are not medically trained physicians. Their contribution is crucial, but occurs within the context of a coordinated team under the direction and guidance of a physician anesthesiologist.

Nurse anesthetists have about half the education of a physician and about 2,500 hours of clinical training, compared to the 12,000 — 16,000 hours completed by a physician. The VA’s proposal would remove the physician from the equation and toss aside the standard of anesthesia care received daily by most Americans every day.

So what’s driving this?

Other specialty areas such as psychiatry and gastroenterology have well-documented doctor shortages and those shortages must be addressed. However, when it comes to surgical and procedural anesthesia, there is simply no shortage of physician anesthesiologists. A December 2015 VA report identifying the 10 most hard-to-fill occupations did not list anesthesia. This followed another recent analysis that did not list physician anesthesiologists as among the 12 identified in shortage.

The leading experts on anesthesia care in the VA, the Chiefs of Anesthesiology, have twice expressed concern that the new policy “would directly compromise patient safety and limit our ability to provide quality care to Veterans.”

What can be done to halt this dangerous proposal?

Leading veterans’ service organizations are opposed to this policy change, including AMVETS and the Association of the U.S. Navy as well as a bipartisan group of more than 90 members of Congress. They caution that “we find this proposed shift from the current guidelines unnecessary and worrisome for our nation’s veteran community and we believe it is in the best interest of our veterans that the VHA continue to administer anesthesia under the current guidelines.”

For those who would like to express their concerns and urge the VA not to remove physician anesthesiologists from surgery in the VA please visit www.safeVAcare.org.

Veterans deserve safe, physician-led anesthesia care and every American has an obligation to support efforts to protect their health and repay their service to our nation.

___

Dr. Steven Gayer is a Board Certified Anesthesiologist and a Professor of Anesthesiology at the University of Miami. He serves as the president of the Florida Society of Anesthesiologists.

 

Guest Author


26 comments

  • How about some data?

    June 25, 2016 at 3:43 pm

    What about the 21 states that allow Nurse Anesthetists to practice independently? Are their mortality rates higher? Or how about on the battlefield, where there are only CRNA’s and no Anesthesiologists? Why is that? Is there any science to back up your claim that this is a “risky move”?

    • Robert Clark

      June 26, 2016 at 1:51 pm

      “Lowering the standard of care and potentially jeopardizing their lives”,
      Do you honestly believe this comment? As the last reply comment stated, there is no proof to back up this ambiguous statement. If not the majority, a large percentage of the surgical anesthetics performed in this country are by CRNAs, without any anesthesiologist direction. Several studies have demonstrated that there is not a clinical difference in safety outcomes in either directed or non directed anesthetics. There are many reasons, primarily economic, for you to want an anesthesiologist involved in a surgical anesthetic, but please don’t make safety claims, that are not justified with any facts. If it were truly more dangerous, this would surely be demonstrated by studies comparing the two side by side.

    • Patient

      June 26, 2016 at 2:45 pm

      I recently had surgery and the anesthesiologist, who was rude and short, asked me a few questions and left. Then I met the CRNA, who took the time to explain to me process of anesthesia and that she was going to be in the room the entire time watching over me and providing my anesthesia. When I woke up, she was there. She told me she never left my side. I then remember the rude anesthesiologist telling her not to print the chart because he had to sign in. What was that about? I totally trusted the CRNA, she was amazing! Amanda was her name I think?

  • Juan F. Quintana DNP, MHS, CRNA

    June 26, 2016 at 11:39 am

    When I read opinions like yours I keep asking myself, isn’t it time for evidence to trump politics when it comes to the health of our veterans. And as a reminder, there’s no evidence supporting the arguments you make or of the groups opposing the rule – all baseless rhetoric. The VA proposal to allow Certified Registered Nurse Anesthetists (CRNAs) and other APRNs to practice to the full scope of their education, licensure, and abilities is based on strong evidence, not frivolity. This logical decision is backed by the results of an independent assessment of the VHA health system ordered by Congress and published in 2015. The assessment identified 14 research studies that provide abundant evidence that APRNs deliver patient care just as safely as physicians. It confirmed that physician organizations lack evidence to support their claims that APRNs (including CRNAs) put patients at risk working without physician supervision. In anesthesia alone there have been 9 studies since 2000 confirming that CRNAs ensure access to safe anesthesia care to millions of Americans—including Veterans. The latest study, titled “Scope of Practice Laws and Anesthesia Complications: No Measurable Impact of Certified Registered Nurse Anesthetist Expanded Scope of Practice on Anesthesia-related Complications,” was published just this month in the journal Medical Care.

    I tire of our physician community claiming they provide better services because they spend more time getting their education. On the contrary, the healthcare community in general should applaud the excellent higher education of APRNs and CRNAs. The educational curriculum of APRNs achieves equal or better results than our physician colleagues in a shorter amount of time.

    The evidence is clear, the best anesthesia providers are those administering anesthesia to our vets who need services, not those “supervising” the administration of anesthesia. Some VA facilities don’t even use anesthesiologists in their anesthesia department yet provide excellent care to our vets and have been doing so for years. Yet BOTH CRNAs and anesthesiologists are needed to work to their full capacity. That’s the point of the proposed rule, not one provider replacing another. The VHA Independent Assessment identified delays in cardiovascular surgery for lack of anesthesia support, rapidly increasing demand for procedures requiring anesthesia outside of the operating room, and slow production of colonoscopy services in comparison with the private sector. Current VA policy recommends that CRNAs and anesthesiologists work together but does not require, nor has it ever required CRNAs to be supervised by anesthesiologists or other physicians. The proposed policy change supports a surgical team-based model of care to fully utilize the knowledge, skills, and abilities of CRNAs to practice to their full authority. CRNAs and anesthesiologists will continue to work with physicians, like surgeons, and other healthcare providers to continue providing the best quality care possible to Veterans.

    Despite the facts, anesthesiologists persist in making bombastic statements like “CRNAs will hurt Vets” without evidence to support their claims. This is a terrible disservice to our Veterans and the public in general. Don’t get caught up in the anesthesiologists’ fear-mongering rhetoric and theatrics. Data clearly show CRNA care is as good as or better than that of anesthesiologists (http://www.future-of-anesthesia-care-today.com/research.php). It’s interesting, too, that these same doctors don’t insist on being assigned to the front lines during military actions to care for soldiers horribly injured during battle – leaving this up to CRNAs to handle. Somehow, in their view, caring for our wounded warriors at the point of injury is less complicated than caring for Veterans stateside. To suggest as much is insulting to CRNAs, Veterans, and any intelligent person. The nation’s 49,000+ CRNAs encourage Florida’s Vets and those who care about them to express support for the VA proposal at https://veteransaccesstocare.com/joinus/.
    .

    Juan Quintana, DNP, MHS, CRNA
    President,

  • Paul Pellini

    June 26, 2016 at 1:25 pm

    Hi there, Dr. Gayer. I am a certified registered nurse anesthetist and you are not giving all of the facts. You are actually just feeding into the hysteria in order to derail processes and care that is already being given in the manner in which the VA is proposing.
    I am a retired naval officer and provided anesthesia care on the front line of the battlefield in two separate wars without the direction or help of an anesthesiologist. I also provided anesthesia to Sailors and Marines on board of a naval vessel without the help or guidance of an anesthesiologist. Here in the United States now that I’m retired I also provide care for ASA 1-4 patients routinely at an all nurse anesthetist practice without the guidance or presence of an anesthesiologist.
    None of the heroes i’ve cared for overseas and none of our patients here at home received anything less than the best possible anesthesia care from me or my peers. In addition, all of their outcomes in regards to the anesthesia they received were no different had an anesthesiologist performed them personally. As a matter of fact, I routinely have patients return to hospital practices where I work requesting my services specifically. Even in places where I work collaboratively with an anesthesiologist and also without supervision in those collaborative practices patient’s request me by name. The military has been utilizing certified registered nurse anesthetist as the sole providers of anesthesia in many battlefield and shipboard situations since the Civil War.
    Can you please explain to the public now given the facts how granting full practice authority to nurse anesthetist in the VA system endangers patients? Also, could you clarify the fact that the VA is not replacing anesthesiologists with nurse anesthetist… They are granting them full practice authority. What you are stating is completely different altogether. Thank you.

    • Honest answer

      June 28, 2016 at 5:58 pm

      When you say ASA 1-4 , ASA becomes a part of your career. Sticking a tube down someone’s throat, doing a spinal or epidural can all be taught to anyone safely. Anaesthesia is not merely administration of Anaesthesia, that’s a small part of it. Development of guidelines for all patient groups and scenarios, research, advancement in procedures, intensive care, pain medicine etc etc are all part of Anaesthetics. When you misguide people and yourself by saying that you deliver safe Anaesthesia, do you even know that before even starting Anaesthesia training, all physicians go to a place called ‘medical school’? Have you ever studied and been examined in neuroanatomy, neurophysiology, detailed pharmacology of all drugs, detailed physiology of all systems in the body, psychiatry, internal medicine, surgery, Paediatrics, gynae and obs, detailed anatomy, histology, embryology, and the list goes on. The difference between a CRNA and physician anaesthesiologist is that the physician knows A-Z of anything he or she touches on a patient’s body. Sticking needles and tubes safely is important but isn’t everything. You don’t even know how nerves regenerate at biochemical, histological and anatomical level if they get damaged as an example. Don’t fool yourself and the public. You may get independent care, but you will still need to go to medical school (if you can score high enough in MCAT etc) and then clear license exams and then Anaesthesia training. Enough of this. Anyone can do what you are doing. You can’t provide better care than an experienced physician. You don’t have enough knowledge to do that.

  • Kathleen Keegan

    June 26, 2016 at 1:41 pm

    We( CRNA’s)have been doing Anesthesia a lot longer than anesthesiologists and our sucess rate is equal to or better than MDA’s. It was there studies that proved this.

  • Brenda

    June 26, 2016 at 2:17 pm

    So, even if doing a four year residency, physician anesthesiologists had logged 3000-4000 hours of clinical training, per year? ? Wow!

  • Louis Castellano

    June 26, 2016 at 2:19 pm

    The battle of the ASA (American Society of Anesthesiologists) on the advanced practice nurses, including nurse practioners (NPs) and Certified Registered Nurse Anesthetists (CRNAs) is purely political and fueled by financial gain and security. There are at least two VA hospitals, which provide anesthesia solely by CRNAs. But even more dramatic is the fact that CRNAs within all branches of the military practice independently providing excellent anesthesia to our armed service members. Additionally, both the Institute of Medicine and an independent study conducted by the VHA for congress concluded that it would be more beneficial to give both nurse practitioners and CRNAs independent practice rights within the VA. The conclusions came from data which showed that care was equal, if not safer, when conducted by NPs and CRNAs. Additionally, CRNAs are the most efficient and economic way to get our veterans the care they need, costing often a quarter of what an anesthesiologist does, while providing equal care. Essentially, this act is not attempting to eliminate anesthesiologist or put “nurses” into roles they are not prepared for. Rather, it would ensure that the advanced practice nurses are able to practice to the full scope of their training, allowing for better access to care for our veterans. Lastly, the field of anesthesia is one that was pioneered by nurse anesthetists. For decades, nurses have been providing quality anesthesia, and while still nurses, many of these are master and doctorally prepared nurses who came from the most intense nursing backgrounds, then received an additional 2-3 years of training, specifically in anesthesia. Nurse anesthetists currently perform approximately half of all anesthesia in our country and are the prevalent anesthesia providers in the rural areas of our country. It’s not only right, but a benefit to our economy and our veterans to allow them to practice to the fullness of their training. Lastly, it is a great untruth to say that anyone is attempting to remove anesthesiologist or the care team model from the VA. While some, including the author of the above article, want to depict nurses as usurping authority, it is rather allowing them to keep doing what they have been doing already. The role of the anesthesiologist would remain the same. Here is a link to a fact sheet from the American Association of Nurse Anesthetists:http://www.aana.com/…/1-PAGER%20VHA%20Frequently…

  • Desmorph CRNA

    June 26, 2016 at 3:20 pm

    As a 28 year Army Veteran and Certified Registered Nurse Anesthetist (CRNA) who has been mobilized multiple times, I feel the need to correct your misinformed article objecting to the VHA proposal to expand Veterans access to high quality care by recognizing CRNAs and other Advanced Practice Registered Nurses (APRNs) to their Full Practice Authority. The opposition to this policy (primarily supervising physicians anesthesiologists) continues to perpetuate inaccurate and inflammatory information about safe CRNA care in an attempt to further restrict American Veterans access to high-quality healthcare; and to unfairly and maliciously slander the proven decades-long record of CRNA delivered anesthesia. The true motivation behind the physicians’ desperate push to nullify the proposed VHA ruling is money. This is—and always has been—about physician anesthesiologists wanting to preserve their abilities to bill and collect for “supervising” CRNA’s who are actually providing anesthesia. It is NOT about safety, as they claim. The bottom line: If this ruling goes into force, the physicians will lose their ability to bill and collect for anesthetics provided by CRNA’s—and in most cases the supervision ratio is 4:1. That means one physician anesthesiologists can (and does!) make money off of 4 CRNA’s without lifting a syringe or touching a patient. Ever. Is that the kind of anesthetic care our Veterans deserve? Is that the health care model American tax payers want to learn is occurring right under their noses?
    Across this nation, CRNA’s provide safe and efficient anesthesia—independently and without physician supervision of any kind—every single day. In fact, even in most systems where the “anesthesia care-team model” is employed, CRNA’s are the sole providers of care after-hours, on weekends and on holidays. I know because I work in such a setting. After 5pm and on all weekends/holidays, our CRNA’s are the only anesthesia provider. We pull all of the call. Independently. Our one anesthesiologist exists during normal business hours to “sign” our records so that the physician-run anesthesia management group can bill for all of the cases done by the four CRNA’s under their employ. Yet, the CRNA’s assess, plan and implement ALL of the anesthetics.

    • Honest answer

      June 28, 2016 at 6:03 pm

      When you say that supervising anaesthesiologist does nothing, do you even know that whatever you have ever done and will ever do, that was all developed by that anaesthesiologist as well? What kind of nonsense are you talking?

  • Ryan

    June 26, 2016 at 3:21 pm

    Interesting propaganda that just isn’t true. I was talking to my internal medicine physician today, he asked about this very issue. He told me that the VA should pass this initiative because of the lack of care. He has a friend who is a women’s health ARNP, the VA has made her due Primary care despite her 20 years of women’s health because they don’t have staff! Don’t be fooled by physicians who look at this purely political! Vote for care to be administered and improved to our veterans!!

  • My Pager Not Working

    June 26, 2016 at 3:51 pm

    Clearly CRNAs are not capable of caring for patients on their own, except on the battlefield and the 20+ states that have opted out….oh, and in those cases where the MD simply signs the bill from a remote location; or when they wake up and come out of the call room and the cases are done. If there isn’t a shortage, why the need for AAs? This is an opinion piece, not based on facts other than political rhetoric. Perfect site for it.

  • Dr. John McDonough

    June 26, 2016 at 5:05 pm

    The good doctor Gayer may actually believe, and I suspect that he actually does believe, that what he is claiming is true. In reality it is not. What is says is his opinion. Period. I would also respectfully point out that it is opinion that is not supported by, but is in fact is contradicted by facts, clearly supported by research. It had been clearly shown, and well reported that there is no difference in outcome whether an anesthetic is administered by a Certified Registered Nurse Anesthetist or an physician anesthesiologist. This is a fact that many anesthesiologists have trouble believing, but that does not mean it is not true. A while ago many educated people insisted that the earth was flat. Data has shown us otherwise. People opposed to the proposed VA policy revision to permit Advanced Practice Nurses to practice to the level to which they were educated come to you with opinions, unsupported claims and hysterical rhetoric. Those in favor come with facts, research and hard data. Who should you believe?

  • Stephen

    June 26, 2016 at 7:57 pm

    Please report some data. That is a true benchmark.

  • David

    June 26, 2016 at 8:22 pm

    DR GAYER, Just where do you get your evidence that the VA proposal to allow ARNP’s, including CRNA’s to practice to their fullest will harm veterans? There is no where in this proposed missive that states that anesthesiologists will be taken out of the mix in the VA surgical services. The VA hospitals will continue to practice, regarding CRNA’s, in the anesthesia care team model. The only areas that CRNA’s and the like will be practicing without phyician oversight is in areas where that are not enough physician practicioners to do the job. Your anemic posting that suggests that the Anesthesiologists are being forced out lacks evidence, merit or even the most basic evidence. Clearly you are either ignorant, uninformed, or just plain biased in your views.and I suspect that all three come into play here. You should, prior to posting such an ignorant view, research your facts before folks find out just how ignorant you really are.

  • Cindy E.

    June 26, 2016 at 8:40 pm

    It’s evident that physicians are trying to bombard media outlets and create fear among veterans. Anesthesia across the county is safely provided by nurse anesthetist without direct supervision from physicians. These independent practitioners have been proven to have the same patient outcomes to other anesthesiologist and CRNAs who work in the team based model. This is a sad and unsupported attempt to discredit CRNAs who have been in the front lines of anesthesia for decades.

  • Sarah Thomas

    June 26, 2016 at 8:46 pm

    Dr Gayer,
    The practice of anesthesia is over 100 years old. Nurse anesthetists were the only anesthesia providers at the beginning, working through the infancy of the profession, caring for patients from every walk of life. The pay was low and the conditions were often very difficult. We have grown with the profession with a body of caring and extremely competent and well educated individuals. I’d like you to check your “facts” on our educational and clinical hours again. You are not telling the truth.
    I am a CRNA at the VA with over 20 years of experience in the field of anesthesia.
    If I am good enough to care for our veterans on the front lines and in the battlefields without an anesthesiologist involved in directing my care, if I am able to give anesthesia as a sole practitioner where the anesthesiologists don’t want to practice, if I am able to cover an entire hospital (including labor and delivery) all by myself during the nighttime hours while the anesthesiologist is at home in bed, then I am certainly able to care for our veterans in my hospital capably and independently and more cost effectively.
    I challenge you to ask any of our most well deserving veterans who I care for every single day if they, for a moment, believe that they are getting any less than outstanding care.
    I doubt you’d get a taker.

  • You have absolutely no data to back up your claims

    June 26, 2016 at 9:24 pm

    You should provide evidence that shows differences in clinical outcomes between CRNAs and physician anestheists. There is no evidence that suggests that anesthesiologists provide safer care. And as you know there has been research into this. On the battlefield CRNAs provide almost all of the anesthesia and there’s nobody saying that our soldiers are getting inadequate care there. Also, please don’t act as though The nurse anesthetists training is some inadequate walk in the park. It is the closest thing to medical school that you will find. No one appreciates a physician who is trying to mislead the general public.

  • Dino Kattato

    June 26, 2016 at 10:08 pm

    12-16000 hours? Really?? Guess I should count my bachelors too.

  • Reighard

    June 26, 2016 at 11:21 pm

    Please do not play up your MD as a security blanket. Do not pretentiously display this title while tarnishing another and taking advantage of conventional knowledge, without giving the lay public the real story. Either you are not very well informed or you are trying to misinform your readers. This proposal does not end team based care, but it does ensure efficient and effective use of the VHA’s health care workforce. NURSE ANESTHETISTS are tried and true, front line providers of safe anesthesia from start to finish, in wartime and in the private sector. Study after study of CRNA safety profiles prove it. We owe the veterans and the public a solution. You and I, as people who help people, should be truthful above all things. The VHA will be none the wiser to be misled by such scare tactic propaganda that will not provide more access to our nation’s veterans. The status quo has not worked as evidenced by very delayed care to Veterans themselves, and something has to change. Why not go with a solution that has been studied and has consistently proved to be a safe and effective? To everyone…the VHA proposal for APRN Full Practice Authority did not come out of thin air, but the oppressing claims of the opposing opinion surely does. This proposal is synonymous with the recommendations of the National Academy of Medicine, formerly the Institute of Medicine, a highly esteemed group of experts in science, engineering and medicine, that advises that advanced practice registered nurses should practice at the top of their education and training. This opinion is evidence based, non-biased, and non-governmental. SUPPORT this proposal now. http://www.veteransaccesstocare.com

  • CRNA Vet

    June 27, 2016 at 10:53 am

    If truly indeed you MDAs including DOs believe it is a disservice and “lowering standard of care” to our Vets to have CRNAs care for them; then why are YOU not volunteering your “excellent service due to amassed amount of clinical hours” to care for our soldiers on the front line at war?? Oh wait, physician anesthesia was not even a medical field until late 1940’s when physicians realized money could be profited in this field, then decided to have a hand in it….please get your facts and supporting evidence straight before you run your mouth about who should give our VETS the better care. I can guarantee you any military CRNA who has served for this country and has been at the front lines with our wounded soldiers have provided better anesthesia care and pain management than any MDA who has had over 20,000 hours of clinical hours. So, can we count on you for the next tour in Afghanistan?
    I can assure you, continue this rant and it wont be long until every MDA will be required to put in 3 years of military service for our soldiers….why not? because you claim to be better….
    one more question….have you intubated a patient in darkness with night vision goggles, while bombs surrounded you? Think about it…because it is people like us that you have your freedom, that you have the audacity to rant, that you can drink your morning coffee in your break room and check your stocks….yes, it is us, the lower standard of care providers you so-call us doing the work while you claim it “your work”….
    God Bless our Vets

  • Debbie Malina, CRNA, MBA, DNSc, FNAP

    June 27, 2016 at 11:57 am

    This ‘crying wolf’ cheat beating mentality is getting old. There is simply NO evidence that physician outcomes are any better than that of APRNs. So they fall back on “the time physicians spend obtaining their education” argument , trying to equate that time safer care and outcomes. There is no evidence of that. The evidence is clear, however, that that additional time and money equates to NO BETTER outcomes. The evidence: CRNAs have been providing safe solo anesthesia care to active military since the Civil War, are the only anesthesia providers in some VA facilities already, on the front-lines of battle, in rural America – and a host of other places around the US. Let’s – once and for all – let the FACTS speak for themselves, and not this hysterical rhetoric.

  • J S

    June 27, 2016 at 2:31 pm

    “My name is Susan M. Perry, PhD, CRNA, APRN, Colonel, USAF, NC retired. I served in the United States Military as an active duty officer for 25 years, retiring in December of 2014. For 16 of those years, I was a Certified Registered Nurse Anesthetist. For 8 of those years I served at the Uniformed Services University educating and training CRNAs for the Department of Defense. My position at retirement was Senior Air Force Faculty at the Daniel K. Inoyue Graduate School of Nursing. I also served as Consultant to the AF Surgeon General for CRNA Education. Now I am the Senior Assistant Dean for Clinical Graduate Studies at the University of South Florida.
    During my active duty time I was deployed 4 times. During all but one of those deployments I was the ONLY anesthesia provider at the deployed location. In fact, one of those times I was substituted for an anesthesiologist who obtained a “waiver” not to be deployed. Not one of those times did anyone question that I was able to administer anesthesia without supervision. I was deployed to Saudi Arabia to care for the entire Prince Sultan Airbase contingency operation. I was deployed to Qatar and performed independent anesthesia on the first wave of our OIF casualties, including our service dogs. I was deployed to Honduras in support of our special forces/humanitarian missions and was the anesthesia provider who developed the rotary wing aircraft surgical services contingency plan. I had all of our anesthesia training lectures translated for their school and led seminars on pediatric anesthesia for the anesthesia staff in the Honduran hospitals. There was NO other anesthesia provider there at any time. I was deployed to Peru as the operations commander.
    The men and women I saved, thousands of miles from home, now come to the VA for care. Who should be there to take care of them? The civilian anesthesiologist who were sleeping at home while I improvised a way to do surgery in a sand storm with no electricity? While I figured out how to administer anesthesia to a child when there was no oxygen for recovery? When I was stationed in Bitburg Germany with the closest anesthesiologist in England, and I raced in a snow storm to put in an IV and save a mother who was hemorrhaging and losing her baby, allowing both to survive? I don’t think so, I think CRNAs have been the anesthesia provider for over a 100 years and the anesthesiologist that have “supervised” the CRNAs have walked in, given breaks and in the cases of the one place I was deployed with an anesthesiologist? During the night that we had 3 special forces troops come in for surgery with gunshot injuries to the head and neck and we worked all through the night. The anesthesiologist called me in from my rest period to do anesthesia for the most severely wounded while she slept in the middle of the tent. I finally woke her up to take over at the end the case so I could get some sleep because I was coming on duty in 3 hours. To not allow CRNAs and other APRNS to practice independently is discrimination, pure and simple and should not be allowed in the United States of America and certainly not in the VA.

    Respectfully,
    Susan M. Perry, PhD, CRNA, ARNP, Colonel, USAF, NC retired
    Senior Assistant Dean Clinical Graduate Programs/Director CRNA Program
    University of South Florida College of Nursing”

  • Tracy Castleman, MS, CRNA, APN

    June 27, 2016 at 4:44 pm

    Although Dr Steven Gayers commentary about the value of Aneshtesiologist vs Nurse Anesthetists sounds compelling there is absolutely no evidence to support his opinion. As a matter of fact there is quite a bit of evidence to challenge is opinion and ALL policy should be driven by unbiased, researched based evidence as opposed to financially worried personal opinion. The most compelling FACT: CRNAs are the only member of the anesthesia care team caring for our soldiers on the front line of battle every day since WW1. There are no Anesthesiologist looking to supervise those CRNAs. The heart of the Anesthesiologists message is simply this, they are not asking to replace the CRNA, they are not asking to do the work or provide the anesthesia, their argument is simply this, you must continue to pay a very steep salary for us to be available in case help might be needed. In other words, much like paying for your land line phone IN CASE your cell phone dies, you’re paying for a duplicate service that’s not really doing anything for you. I have tremendous respect for my physician anesthesiologist colleagues who work along side of me, sitting at the head of the table in the OR caring for patients. I cannot respect those who sit in the lounge, preparing bills, paperwork and watching ESPN, while falsely claiming that the very CRNAs who are caring for the patients are poor substitutes. You can’t have it both ways. If you get paid for someone else’s work while claiming at your own, then the “substitute” must be acceptable. Give the Vets the respect they deserve, with quality and consisten care.

  • Honest answer

    June 28, 2016 at 6:13 pm

    Really surprising to find out about all the CRNAs who are working in the field for decades and have administered the safest Anaesthesia. Research shows that they don’t make any mistakes. Maybe they aren’t even human. If we do more research, we may find out that CRNAs also invented the wheel and were administering safest Anaesthesia when Jesus was born. They should start doing heart transplants and neurosurgery too because there won’t be any failures.

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