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

Final Thoughts

Medscape: Would you like to clarify anything further at this time or make any final comments?

Dr Cole: We applaud the VA for their commitment to solving access issues to healthcare. However, there is no access problem to solve with anesthesia. VA Under Secretary for Health David Shulkin, MD, has said this numerous times.

Nurse anesthetists are valued members of the care team, but they are not interchangeable with physicians. There are vast gaps in training between physician anesthesiologists and nurse anesthetists. Nurse anesthetists have about one half the education of physicians and about 2500 hours of clinical training, compared with 12,000-16,000 hours completed by a physician. The extra training can often mean the difference between life and death.

There is no independent evidence to support this change. In fact, all the independent evidence supports retention of the VA's current policy. The VA's own internal review concluded that it could not discern "whether more complex surgeries can be safely managed by CRNAs."

The ASA shares a vision of better care for our veterans, with the highest-quality physician-led, veteran-centered care. There can be no compromise. Americans must answer the critical question for veterans at risk during surgery and anesthesia: When seconds count, who should be making their life and death decisions?

Dr Quintana: The number one priority of CRNAs and the AANA is ensuring our nation's veterans access to safe, timely, high-quality anesthesia care. The VA's proposed rule to allow CRNAs and other APRNs to practice to the full scope of their education, training, and abilities is a commonsense solution to the problem of long wait times for veterans to receive needed healthcare in VA facilities, for the following reasons:

  1. It enables VA facilities to maximize existing resources, both APRN/CRNA and physician.

  2. It is backed by recommendations from the National Academies of Medicine and an independent assessment of the VA health system ordered by Congress.

  3. It is supported by the scientific evidence of nine anesthesia safety research studies published in peer-reviewed journals since 2000.

  4. It would align VA health services with the Army, Navy, Air Force, Indian Health Services, and Combat Support Hospitals, which already allow CRNAs to work without physician supervision.

With VA-approved full practice authority, CRNAs will continue to work closely with physicians and other members of the patient care team to provide extraordinary care to our veterans. Support veterans' access [to healthcare] at


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