Anesthesiologists oppose proposed VA rule


JEFFERSON CITY, Mo. – The Missouri Society of Anesthesiologists (MSA) is pushing against a new potential Veterans Administration rule that they believe could put the agency’s patients at risk.

A little over two months ago, the VA created a rule that would mandate independent practice for nurses with advanced training, like nurse practitioners and nurse anesthetists, to use their full repertoire of skills without the oversight of a doctor. The VA has a widely acknowledged doctor shortage, and the rule is designed to allow well-trained and specialized nurses fill the gaps to provide better access to care and decrease long wait times.

David Jackson, the executive director of the MSA says that’s all well and good, but it could also lead to a dramatic loss of care, specifically because of how high-risk anesthesiology is. The rule would allow nurse practitioners, even those who have not been trained in anesthesiology practices, to administer anesthesia (among other duties).

Meanwhile, the primary problem that plagues the VA, namely the low, thin-stretched number of physicians, does not apply to physician anesthesiologists.

“The problem is there is no shortage of physician anesthesiologists,” Jackson said. “If you don’t have an access problem, there’s no reason to include them in this rule.”

The rule change could also see VA hospitals move away from anesthesia specialization altogether, even though anesthetists are among the most rigorously specialized and educated professionals within the health care industry.

“In Missouri and every state, you have some form of position supervision of anesthesia,” Jackson said. Nurse anesthetists and physician anesthesiologists typically work together as anesthesia care teams. This rule, Jackson argues, would remove anesthesiologists from the entire VA system.

While the risk of general anesthesia is generally low in this day and age, it still requires a precise touch to keep people unconscious and free of any sensation during invasive operations. That in turn makes complicated and dangerous surgeries less risky.

Jackson says that a two-month public commentary period came to an end this week, but that the MSA and their supporters made their voices heard with a social media and web campaign and even a radio spot (posted above). Of the 167,000-plus comments submitted nationally, Jackson says that over two-thirds of the comments wanted to reject the change, and 95 percent of veterans were opposed to it.

He also believes there’s an easy fix for the VA to pursue: simply remove the anesthesiology stipulation from the proposed rule.

“We want to continue the anesthesiologist method currently in practice,” he said. “If it’s allowed in civilian hospitals across the country, why not in the VA?”

UPDATED – 2:30 p.m. July 29: Multiple small corrections and clarifications made.