Americans Say 'No' to Low-Level Assistants Providing Anesthesia to Civilian and Military Patients, Survey Reveals

5/29/2003

From: Christopher Bettin of the American Association of Nurse Anesthetists, 847-692-7050, ext. 3043; E-mail: cbettin@aana.com

PARK RIDGE, Ill., May 29 -- The vast majority of Americans would not want their anesthesia care to be provided by anesthesiologist assistants (AA) instead of physician anesthesiologists or Certified Registered Nurse Anesthetists (CRNAs), according to the results of a recent nationwide survey of registered voters.

Conducted by Public Opinion Strategies (POS), an independent research firm based in Alexandria, Va., the survey revealed that 85 percent of Americans would be concerned if they or their family members were scheduled to have surgery under anesthesia to be provided by an AA. In particular, women and senior respondents expressed the greatest concern about AAs providing anesthesia to them or their families.

The newest of the three types of anesthesia providers recognized in the United States, AAs have been around for more than 30 years. By comparison, nurse anesthetists have been providing anesthesia care in the United States since the late 1800s; anesthesiologists since the early 1900s.

Despite the fact that they have been in existence for more than a quarter of a century, there are fewer than 700 AAs in the country today. More than 36,000 anesthesiologists and 30,000 CRNAs provide more than 99 percent of the nation's anesthesia care, while AAs provide less than 1 percent and only under the direct supervision of an anesthesiologist. However, anesthesiologists are not required to remain in the operating room with the AA for the duration of a patient's surgery.

Currently, AAs are specifically licensed to practice in only six states, and are not officially recognized by the Department of Veterans Affairs (VA) or TRICARE, the main healthcare programs for active and retired military personnel. However, TRICARE is currently accepting public comments on a proposal to allow AAs to give anesthesia to military patients, veterans, and their families. The proposal was published in the Federal Register on April 3, 2003 (Volume 68, Number 64); the comment period closes June 2.

"Americans should be alarmed that there is a movement to have AAs recognized in more states, and also by the VA and TRICARE programs for military personnel, veterans, and their families," said Rodney Lester, CRNA, PhD, president of the American Association of Nurse Anesthetists (AANA). "The POS survey clearly shows that the public is not comfortable with the idea of AAs providing their anesthesia care, and for good reason. Little is known about these assistants. Their safety record has never been studied; they are not nearly as educated or experienced as CRNAs and anesthesiologists; and they are severely restricted in their scope of practice."

Survey respondents expressed their displeasure with the TRICARE proposal, with 83 percent indicating they are concerned about the federal government approving AAs in the military.

"There are significant differences in the education, experience, and scope of practice of AAs versus CRNAs and anesthesiologists," said Lester. "For instance, AAs are not required to have a healthcare education or background prior to beginning their anesthesia training. They could be an English major and qualify for AA school. CRNAs and anesthesiologists receive a minimum of seven and eight years of education and clinical experience respectively, all directly related to healthcare and anesthesia."

Lester also pointed out that CRNAs and anesthesiologists are qualified to provide every type of anesthesia care, including general, regional, and local, while AAs are not. For example, AAs who graduate from the Emory University program in Georgia do not receive clinical instruction in the administration of regional anesthesia, Lester said.

Survey results revealed that the public shares Lester's concerns. According to the results: -- 72 percent of respondents are very concerned that anesthesiologists, while responsible for supervising AAs, are not required to stay in the operating room with these assistants throughout the surgery; -- 66 percent are very concerned that no studies have ever been conducted to determine the safety record of AAs; -- 63 percent are very concerned that AAs can sit for their certification exam six months before completing their anesthesia education; and -- 59 percent are very concerned that AAs are not trained to provide all types of anesthesia.

In addition, said Lester, unlike CRNAs, AAs cannot practice unless directly supervised by an anesthesiologist. "This restriction is definitely necessary, but it does mean that AAs cannot take call; cannot practice in settings where anesthesiologists aren't available, such as most rural hospitals; and cannot be deployed in combat situations unless an anesthesiologist is deployed with them. The list goes on from there.

"The suggestion made in some circles that producing more AAs will help reduce the number of anesthesia provider vacancies simply doesn't hold water, not when AAs can only practice with anesthesiologists holding their hands," said Lester. Lester noted that there are only two AA programs in the country, compared with 85 nurse anesthesia programs. "Approximately 1,400 new nurse anesthetists will graduate from nurse anesthesia school this year, up from about 900 five years ago. More than 1,000 new anesthesiologists will probably complete their residencies. The vacancy situation is definitely being addressed. By comparison, approximately 40 new AAs will graduate this year. To suggest that AAs are the solution to the provider vacancy situation is ludicrous," Lester said.

"It's really quite amazing that the American Society of Anesthesiologists (ASA) has been pushing in recent years for AAs to be recognized in more states and in the military," said Lester. "The ASA has been telling the public for years that patient safety is its number one priority, and then the ASA goes out and extols the virtues of AAs whose safety record has never been studied, and whose educational background pales in comparison to that of anesthesiologists and CRNAs.

"The real reasons why the ASA is promoting AAs are obvious: control and money," said Lester. "AAs have to work with anesthesiologists, and anesthesiologists can bill for supervising them, even if that means 'supervising' them from the break room. It's a way for the ASA to control the anesthesia marketplace. That is definitely not in the best interests of our public or military patients."

------ About the American Association of Nurse Anesthetists Founded in 1931 and located in Park Ridge, Ill., AANA is the professional organization for more than 30,000 Certified Registered Nurse Anesthetists (CRNAs). As advanced practice nurses, CRNAs administer approximately 65 percent of the 26 million anesthetics delivered in the United States each year. CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two thirds of all rural hospitals.