ratio are based on a study that has been cited for significant flaws.
The author then uses this calculation and applies it to all U.S. surger-
ies, although only a fraction of surgical cases uses 1:3 medical direc-
tion for anesthesia care.
This discussion regarding healthcare spending is not about a turf
battle, it is about quality health care and the safety of our patients.
Nurse anesthetists are valuable members of the anesthesia care team,
but they are not physicians and cannot replace physicians. In fact,
eliminating physician-anesthesiologists may actually cost more, as
other physicians may be needed to consult or provide the services of
a physician-anesthesiologist.
We cannot risk potentially expensive complications or jeopardize
patients' lives. There's a reason 46 states and the District of Columbia,
by statute or regulation, require nurse anesthetists to work in a team-
based relationship with a physician, whether through physician super-
vision, collaboration, direction, consultation, agreement or some
other arrangement for anesthesia delivery. Let's be clear: Independent
research on anesthesia outcomes conclude that care is safer when a
physician-anesthesiologist is involved. There are no independent stud-
ies showing that nurse-only anesthesia care provides safer care or a
level of care comparable to team-based anesthesia.
The anesthesia care team is a model proven to provide patients with
high-quality and safe care. The focus should be on looking for ways to
continue to improve that team rather than eliminate members from it.
OSM
Dr. Dombrowski (jdombrowski@dcpaindoc.com) is director of the
Washington Pain Center in the District of Columbia. He serves on the
Outpatient Surgery Magazine editorial board.
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