Nurse anesthetists have been excluded from a new Department of Veterans Affairs' (VA's) policy that permits certified nurse midwives, nurse practitioners, and clinical nurse specialists to practice independently of direct physician supervision. Certified registered nurse anesthetist (CRNA) anesthesia practice will continue to require anesthesiologist supervision.
Before adoption of the new policy, TMA joined more than 75 national specialty societies and state medical associations in voicing their strong opposition to the proposed rule. TMA and the organizations outlined their concerns in a letter to David J. Shulkin, MD, VA undersecretary. The letter urged the VA to consider policy alternatives that prioritize team-based care rather than independent nursing practice.
The Coalition of State Medical Societies, of which TMA is a member, also sent a strongly worded letter to the VA, stating, "Our veterans have earned and deserve the highest quality and best care, but this rule would lower the standard of care for veterans around the country." That letter pointed out, for example, that CRNAs "do not have the 12,000 to 16,000 hours of clinical training and nearly a decade of formal postgraduate education and residency training that enables anesthesiologists to prevent and respond competently and swiftly in critical emergencies before, during and after surgery."
The American Medical Association says it is "disappointed" by the VA's decision to allow most advanced practice registered nurses within the VA to practice independently of a physician's clinical oversight, regardless of individual state law.
AMA issued this statement regarding the VA's adoption of the rule:
Providing coordinated, physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans, especially given the highly-complex medical care that veterans often require. The nation's top health care systems rely on these physician-led teams to achieve improved care and patient health, while reducing costs. We expect the same for our country's veterans, and look to these systems as evidence that physician-led, team-based models of care are the future of American health care.
We would also like to acknowledge the VA for clarifying that radiology studies can only be performed and read by individuals who are credentialed in radiology. With over 10,000 hours of education and training, physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine, in addition to the valuable care provided by advanced practice nurses and other primary care clinicians that are part of the care team.
Action, Dec. 15, 2016