Physician Anesthesiologists Oppose Legislation Risking Veterans’ Lives
Doctors Should Not Be Replaced with Nurses for Anesthesia Care during Surgery
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To protect our nation’s Veterans, the American Society of Anesthesiologists (ASA) urges extreme caution when considering the “Veterans Health Care Staffing Improvement Act,” S. 2279. As currently drafted, this legislation contains a misguided provision that removes physician anesthesiologists from surgery and replaces them with nurses. Veterans will receive a lower standard of care, jeopardizing their safety and lives, if physician involvement is eliminated from anesthesia care in surgery.

Although the purpose of the legislation, introduced Nov. 10 in the U.S. Senate, is admirable, proposing to ease the transition of military health care providers to the Department of Veterans Affairs (VA); it also includes provisions abandoning the physician-nurse team-based model of care for all advanced practice registered nurses (APRN), including nurse anesthetists, in the VA. Senators sponsoring the legislation note the act proposes “common-sense” changes in staffing policies to improve Veterans’ care at health care facilities by addressing the shortfall of medical staff. However, there is no shortage of physician anesthesiologists or nurse anesthetists in the VA system.

Surgery and anesthesia care inherently contain risk, and this is true even more so for Veterans, who often have complex medical conditions that pose a heightened risk of complications during surgery. Physician involvement when performing surgery on our Veterans is much more critical than providing typical primary care or treating chronic health conditions.

The legislation would eliminate the existing and proven model of care where physician anesthesiologists and nurse anesthetists work together as a team to ensure our Veterans receive the highest quality and safest anesthesia care.

“Taking physicians out of surgical care is not a common-sense solution for our VA patients who are often sicker, older and have multiple medical conditions that put them at greater risk for complications,” said ASA President Daniel J. Cole, M.D. “The team-based model of care ensures all Veterans have access to a physician anesthesiologist should an emergency or complication occur. This legislation will place our Veterans at increased risk. There can be no compromise on the highest-quality, safest medical care for those who have served our country”

Similar dangerous proposals have been considered, and when it comes to the subject of substituting nurses for physicians in anesthesia care, the VA’s own experts on surgical anesthesia care, the Chiefs of Anesthesiology, have told VA leadership that a policy substituting nurses for physicians “would directly compromise patient safety and limit our ability to provide quality care to Veterans.” (Letter from VA Chiefs to Secretary Shinseki, Dr. Petzel, and Dr. Jesse - Oct 1, 2013.)

Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training to specialize in anesthesia care and pain control, with the necessary knowledge to understand and treat the entire human body. By comparison, nurse anesthetists have only about 1,650 hours of clinical training.

The Veterans Health Care Staffing Improvement Act was introduced by Senators Merkley (Oregon) and Rounds (South Dakota). The bill has also been co-sponsored by Senators Tillis (North Carolina), Warner (Virginia), Shaheen (New Hampshire), Wyden (Oregon), Tester (Montana) and Brown (Ohio). ASA strongly urges reconsideration of the provisions that lower the standard of care for Veterans and puts their health and lives at risk in surgery.
More information about the proposed legislation and the importance of physician-led, anesthesia care is available at

Founded in 1905, the American Society of Anesthesiologists (ASA®) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.