A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Recently, discussion about health care has reached a fever pitch, between changes in policy, adjustments to scope of practice and a multitude of other medical issues. As health care providers, it is our duty to provide the highest level of medical care to all patients to safeguard their health. We are the catalysts for change and we need to recognize practices and beliefs that are potentially harmful to those we’ve vowed to protect.
Some argue nurses and physicians are equally qualified and should be allowed to practice within the same capacity. That is unequivocally false. Rather than draw battle lines between the two disciplines, we should harness the differences and find a way to work cooperatively in the best interest of patients. The physician-led care team approach to medicine is the most logical and safe choice.
Arguments about the appropriateness and benefits of the physician-led care model occur daily in the specialty of anesthesiology. Nurse anesthetists would like to practice anesthesia care without the guidance and supervision of a physician anesthesiologist, citing comparable education and training to that of medical or osteopathic doctors.
This is a dangerous misconception. They simply are not the same.
There is no substitute for the rigorous and thorough education of medical school. After four years of undergraduate training, physician anesthesiologists complete four years of medical school and four years of post-doctoral internship and residency. Many nurses only have two to three years of post-graduate training. Physician anesthesiologists have 10,000 to 14,000 hours of clinical training, compared to the 1,000 to 2,500 hours completed by nurse anesthetists.
The education and training of nurse anesthetists and physician anesthesiologists are not comparable. Physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery. While nurses provide routine support, physicians’ advanced training can make the difference between life and death when critical medical decisions need to be made and seconds count to ensure optimal patient outcomes.
The fact remains: There are substantive differences between physician and non-physician members of an Anesthesia Care Team. These differences have a direct impact on the safety of the patient.
I’ve heard countless stories from my physician anesthesiologist colleagues illustrating the moments where advanced training made a critical difference. Many diagnose underlying and seemingly unrelated health conditions during pre-surgical screenings that, left undetected, would have proved fatal to the patient during their scheduled procedure. Likewise, routine procedures can become decidedly complex, and emergency intervention beyond the scope of non-physician experience and training is imperative to save the life of the patient.
Non-physician health care professionals play an important role on the care team. When their skills are combined with appropriate physician supervision, patients can receive the safest, highest-quality care available. After all, we can’t forget why we’ve dedicated our lives to health care: to keep our patients as safe as possible. Providing care below the gold standard is irresponsible and, frankly, unacceptable.
Kenneth Elmassian is on the American Society of Anesthesiologists’ Committee on Communications and is a member of the ASA board of directors.
