LETTERS: BETTER PATIENT CARE IS THE GOAL

To the editor:

Recently, a local group of nurse anesthetists responded to a letter written by Dr. Stephen Stigers in which he expressed concern regarding a proposal to eliminate the federal requirement for physician supervision of anesthesia provided by nurse anesthetists. We would like to address a number of points made in that letter.

First, in their letter the nurses states that should the rule be adopted, little would change in operating rooms across the country in terms of working relationships between certified registered nurse anesthetists and anesthesiologists. The same would be true if the rule is not adopted. CRNAs would still be free to practice in rural settings, but they would continue to practice under physician supervision.

Second, the nurses claim that Dr. Stigers "has substituted the issue of quality for the real issue of a desire to control the Medicare flow of money for anesthesia services." We could just as well make the case that the nurse anesthetists are trying to do the same thing. But this issue is not about money. In many cases, particularly in rural settings, the operating surgeon satisfies the requirement for physician supervision. No anesthesiologist benefits. Likewise, this proposal does not affect the cost of anesthesia services. The cost to the patient or the taxpayer is essentially the same under Medicare whether or not anesthesia is administered by an anesthesiologist or by a nurse anesthetist. The real issue is whether CRNAs should have to practice under the inconvenience of physician supervision.

Third, the nurses point out that they have "completed an advanced-practice anesthesia program." and that "all nurse anesthesia programs are now master's level." In addition to obtaining a doctorate in medicine, an anesthesiologist has to complete a minimum of four years of post-medical school training. We have great respect for nurse anesthetists, but the fact is their training is not comparable to that of their physician counterparts. Anesthesiologists, like all physicians, are trained in the practice of general medicine. Patients presenting for surgery frequently have a variety of medical conditions. This is particularly true of Medicare-age patients. Medical emergencies can arise unexpectedly at any time. We believe that a physician should be involved in the patient's care throughout the perioperative period to assist with these situations.

Fourth, the nurses claim that "patient outcomes vary insignificantly between CRNA and anesthesiologists." This statement is misleading, since 90 percent of those anesthetics provided by CRNAs are supervised by an anesthesiologist or other physician.

In our current practice, we are all board-certified anesthesiologists, including Dr. Stigers. Most of the anesthetics provided by our group are provided by physicians, but we do employ two CRNAs. We have great respect for our two CRNAs. Not one of us would hesitate to have them provide an anesthetic for ourselves or our family members. We would, however, insist that a physician be involved to assist them in the event of an unexpected medical emergency.

Whether this proposal is approved or not, it is ultimately the responsibility of health-care consumers to learn about the different models of anesthesia practice and to make an educated choice with which they are comfortable. If a patient undergoing surgery wishes to have a physician involved in the administration of anesthesia, he should have that option. We as a community will only lose this option if we allow it to be gradually legislated away.

DR. JEFFREY S. STEELE, DR. THOMAS E. COX, DR. ROBERT J. GILE, DR. JOSEPH K. ESSMYER, DR. GERARD R. SCHROEDER, DR. ROBERT C. VANDERGRAAF, DR. TERRY L. CLEAVER, DR. WAI E. CHIU and DR. STEPHEN M. BRENNAN

Cape Anesthesia Group

Cape Girardeau