American Legion Survey Finds Veterans Overwhelmingly Prefer a Physician Over a Nurse to Provide Anesthesia Care During Surgery

Posted: October 10, 2023 | Word Count: 735

An American Legion nationwide survey of Veterans found they overwhelmingly prefer a physician over a nurse to provide anesthesia care during their surgery and expect the same quality of health care as provided at the top-rated civilian hospitals. The survey results revealing Veterans’ views and concerns were included in a statement submitted by the American Legion for a recent House Veterans’ Affairs Subcommittee on Health hearing.

The American Society of Anesthesiologists (ASA) testified at the hearing and urged Congress to block a U.S. Department of Veterans Affairs (VA) Office of Nursing Services’ proposal to remove physician anesthesiologists from the surgical care of Veterans. The nurses’ proposal would change the standard of care for Veterans by dismantling the anesthesiologist-nurse team-based model of anesthesia care and move VA to a rarely used nurse-only model.

ASA President-Elect Ronald L. Harter, M.D., FASA, testified and outlined key facts and evidence illustrating how Veterans’ health is best served by VA’s existing physician-nurse anesthesia team-based model of care — a model used in the nation’s top hospitals.

“ASA is committed to Veterans and knows that the physician-led anesthesia care team model serves Veterans best,” Dr. Harter said. “This issue is not about what ASA wants or even what the VA Office of Nursing Services wants. The issue is what is best for the health and well-being of our nation’s Veterans. VA has the right policy in place right now and we need the Subcommittee to continue to support it.”

The American Legion’s survey found that that Veterans also want the same level of care as the nation’s top hospitals. Among the American Legion’s survey findings:

  • 61% preferred a physician administer anesthesia care while only 4% chose a nurse. The remainder had no preference.
  • 91% expect the same quality of health care as the top-rated civilian hospitals.
  • 71% believed VA will have a different standard of care if nurse anesthetists replace physician anesthesiologists.
  • 52% said they would seek care outside of VA if their only choice was to have a nurse administer anesthesia.

During the hearing, Dr. Harter testified that VA already addressed this issue and made the right decision in their multi-year 2016 rulemaking when they prioritized the needs of Veterans and maintained the anesthesiologist-nurse anesthesia care team model — the most common model of anesthesia care in the country.

“Anesthesia and surgery are inherently dangerous for anyone, and VA patients often have poorer health status, such as diabetes, congestive heart failure, coronary and peripheral vascular disease, renal failure and chronic obstructive pulmonary disease,” Dr. Harter said. “It is an imperative that Veterans have an anesthesiologist involved in their care.”

PACT Act Veterans exposed to Agent Orange, Burn Pits and other toxic substances require an even higher level of care under anesthesia. “It makes no sense for VA to spend billions of dollars to treat PACT Act Veterans with respiratory disease and then put them at greater risk by adopting a lower standard of care,” Dr. Harter added.

Anesthesiologists and nurse anesthetists are not interchangeable health care professionals. Nurse anesthetists are excellent nurse practitioners, but their education and training are far less extensive and in-depth than anesthesiologists’ training. An anesthesiologist’s education and training include 12 to 14 years following high school, including medical school and residency, and 12,000 to 16,000 hours of clinical training. In contrast, a nurse anesthetist’s education and training ranges from four to six years after high school — less than half a physician’s training and an average of approximately 2,500 hours of anesthesia care training — less than one-fifth that of physicians.

Other key points Dr. Harter made:

  • VA’s current anesthesia policy is one of the most thoroughly researched, studied and reviewed policies existing in VA. The current policy, Anesthesia Services Directive 1123, represents a safe, well-established and functional compromised approach to anesthesia care delivery. No changes are clinically appropriate or necessary.
  • There is no demonstrated shortage of anesthesia clinicians necessitating a change in the delivery of anesthesia care within the VA.
  • VA’s reliance on nursing organization’s self-funded studies is ill-advised. There is no unbiased literature to support the safety of the nurse-only model of anesthesia. To the contrary, VA’s own analysis raised questions about the safety of the Office of Nursing Services’ proposal to remove anesthesiologists from the care team model.

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