Nurse Anesthetists, Anesthesiologists, and the VA System: Are Changes Needed?

Susan B. Yox, RN, EdD; Bret S. Stetka, MD; Juan Quintana, CRNA, DNP, MHS; Daniel J. Cole, MD


July 08, 2016

What Do Veterans Think?

Medscape: What do the veterans think about this proposal? The proposal is supported by a number of veterans groups and by AARP, which includes 3.7 million veteran households. Do any veterans groups oppose the change? What other proposals or recommendations might improve access to care for veterans?

Dr Quintana: Many groups support the proposed rule. AARP, which represents millions of veterans, is a powerful voice in favor of the VA utilizing CRNAs and other APRNs to their full scope of practice. Thousands of veterans and their families have already written in support of the proposed rule; those who received lifesaving care at the hands of CRNAs while serving in war-torn countries are big supporters of these anesthesia experts being utilized to their full scope of practice to reduce wait times for healthcare.

We find that the veterans who support the anesthesiologists' point of view may not be familiar with what APRNs and CRNAs, do and it is largely because they have not had exposure to these professions before. Changing these opinions will be a matter of educating them about what CRNAs can do and how the proposed rule will help veterans receive access to care more quickly and efficiently. Such solutions as hiring additional providers become nonsolutions when budget constraints are considered—another reason why better utilization of existing expert resources is an obvious solution to the problem of long wait times.

Dr Cole: The American Veterans (AMVETS), the Association of the United States Navy, and the National Guard Association of the United States are among the veterans groups who oppose the change and are advocating against it. In terms of improving access to care, we can only comment on anesthesia, and removing physician anesthesiologists from surgery and replacing them with nurses is not needed to improve veterans' access to anesthesia care. It will however, lower their standard of care and may risk their lives.

Medscape: Some have suggested that patients should be permitted to choose whether they wish to have care by a nurse anesthetist or a physician. Is this a realistic suggestion? Are VA patients able to choose who will administer their anesthesia?

Dr Cole: We believe the VA has a responsibility to provide veterans with the safest and highest-quality anesthesia care possible. It's not a realistic suggestion to eliminate the physician involvement in anesthesia care that is required by law in 46 states and the District of Columbia.

Dr Quintana: Typically, patients in the private sector and in the military cannot choose their anesthesia provider; this is especially true for soldiers on the front lines, who receive the highest-quality care possible from anesthesia professionals (almost always CRNAs) who serve right there with them close to the action. Staffing, scheduling, case load, facility requirements, and other factors all come into play to determine who provides a patient's anesthesia care in VA and private sector facilities. From the standpoint of provider qualifications and safety record, veterans should feel equally comfortable receiving their care from a CRNA or a board-certified anesthesiologist.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.