Anesthesia provision in the United States

In the United States, anesthesia can be administered independently by anesthesiologists or by nurse anesthetists.

Anesthesia providers

Anesthesiologists

Anesthesiologists are physicians specializing in the practice of anesthesiology.

The training of an anesthesiologist typically consists of 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency. Completion of the written and oral Board examinations by a Physician is insufficient to allow one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology as additional license, training, and professional standards must also be met. It is not required to be board certified in the USA in order to practice anesthesiology. According to an American Society of Anesthesiologists (ASA) press release Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually.[1]

Other specialties within medicine are closely affiliated to anesthesiology. These include intensive care medicine and pain medicine. Specialists in these disciplines have usually done some training in anesthetics. Anesthesiology is not limited to the operation itself. Anesthesiologists are termed "peri-operative physicians", and involve themselves in optimizing the patient's health before surgery, performing the anesthetic, following up the patient in the post-anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.

Nurse Anesthetists

As a long-standing profession in the United States, advanced practice registered nurses specializing in the provision of anesthesia are Certified Registered Nurse Anesthetists (CRNAs). As of 2007 CRNAs represent 50% of the anesthesia workforce in the United States, with 36,000 providers, according to the American Association of Nurse Anesthetists, and administer approximately 27 million anesthetics each year. Thirty-four percent of nurse anesthetists practice in communities of less than 50,000. CRNAs begin their education with a four year Bachelor of Science degree and more than 1 year of critical care nursing experience. After 3 years of graduation school focusing on anesthesiology, they practice to complete a master's degree in nurse anesthesia and must then pass a national certification exam. Although JCAHO and Medicare don't require supervision as well as 33 states, the remaining states require CRNAs to work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals with anesthesia training and who request their services.[2] CRNAs administer anesthesia in all types of surgical cases, and are able to apply all of the accepted anesthetic techniques—general, regional, local, or sedation. Nurse Anesthetists are able to practice anesthesia independently in some states, as well as in Anesthesia Care Teams.[3]

Anesthesiologist Assistants

Anesthesiologist Assistants are another group who participate in anesthetic care. They earn a master's degree and can practice only under Anesthesiologist supervision in eighteen states through licensing, certification or physician delegation.[4] Anesthesiologist Assistant's responsibilities in the ACT settings are similar to those of CRNAs.

Anesthesia Care Teams

According to the ASA statement on the Anesthesia Care Team, anesthesia care personally performed or medically directed by an anesthesiologist constitutes the practice of medicine. According to the American Association of Nurse Anesthetists and state law in all fifty states, anesthesia care provided by a Certified Registered Nurse Anesthetist is considered the practice of nursing. Certain aspects of physician directed anesthesia care may be delegated to other properly trained and credentialed professionals.[5]

Law regarding anesthesia provision

It has been established that, under US law, anesthesia is both the practice of medicine and nursing. Frank v. South,[6] Chalmers-Francis v. Nelson[7] and other court decisions determined that anesthesia was the practice of Nursing as well as Medicine.[8] As such, the practice of anesthesia in the US may be delivered by either a nurse anesthetist or an anesthesiologist. The decisions have not been challenged since the Dagmar Nelson case.[9] In addition to legal decisions, individual hospital and surgical facility policies also regulate the granting of anesthesia clinical privileges.

See also

References

  1. ↑ "ASA Fast Facts: Anesthesiologists Provide Or Participate In 90 Percent Of All Annual Anesthetics". ASA. Retrieved 2007-03-22.
  2. ↑ "Legal Issues of Nurse Anesthesia Practice" (PDF). American Association of Nurse Anesthetists. May 2010. Retrieved 17 January 2016.
  3. ↑ "Anethesiology Care Team". durhamregional.org. Archived from the original on 2006-08-21. Retrieved 2007-02-11.
  4. ↑ "Five facts about AAs". American Academy of Anesthesiologist Assistants. Archived from the original on 2006-09-26. Retrieved 2007-02-08.
  5. ↑ "The ASA Anesthesia Care Team statement" (PDF). American Society of Anesthesologists. October 13, 2013. Retrieved January 17, 2016.
  6. ↑ 175 Ky 416, 194 SW 375 (1917)
  7. ↑ 6 Cal 2d 402 (1936)
  8. ↑ "The Practice of Anesthesia (Position Statement)". American Association of Nurse Anesthetists. Retrieved 17 January 2016.
  9. ↑ "The administration of anesthesia and the practice of medicine". AANA. 2006-02-01. Retrieved 2007-02-10.
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