Anesthesia provision in the US

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Anesthesia provision in the United States refers to practice of administering anesthesia in the United States. Anesthesia can be administered independently by anesthesiologists or by nurse anesthetists. According to the American Society of Anesthesiologists, Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually. ^[1]

According to the American Association of Nurse Anesthetists (AANA), Certified Registered Nurse Anesthetists (CRNAs) provide 65% of the anesthesia given annually in the United States.^[2] Nationwide provider statistics aren’t readily available, but multiple large studies show a consistent ratio of anesthesia providers with about 35% of anesthetics provided by physicians in solo practice, about 55% provided by CRNAs with anesthesiologist direction, and about 10% provided by CRNAs in solo practice. ^[3] ^[4] ^[5] ^[6]

1 Anesthesia providers
2 Law regarding anesthesia provision
3 See also
4 References

[edit] Anesthesia providers

[edit] 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 anesthesiologist allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology. According to the American Society of Anesthesiologists, Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually. ^[7]

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 anaesthetics. Anesthesiology is not limited to the operation itself. Many anesthesiologists consider themselves to be peri-operative physicians, and will involve themselves in optimizing the patient's health before surgery (colloquially called "work-up"), performing the anaesthetic, following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.

[edit] Nurse Anesthetists

In the United States, nurse practitioners specializing in the provision of anesthesia are known as Nurse anesthetists (CRNAs). As of 2007 CRNAs represent 50% of the anesthesia workforce in the United states with over 33000. According to the American Association of Nurse Anesthetists, CRNAs provide 27 million hands-on anesthetics each year, roughly two thirds of the US total and are the sole providers of anesthesia in more than 70 percent of rural area hospitals. Thirty-four percent of nurse anesthetists practice in communities of less than 50,000. CRNAs start school with a bachelors Science degree and at least 1 year of critical care nursing experience, and gain a masters degree in nurse anesthesia before passing the Certification Exam. The average CRNA student has 5-7 years of nursing experience before entering a 27-30 month masters level anesthesia program.^[8]

CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques -- general, regional, local, or sedation. Nurse Anesthetists are licensed to practice anesthesia independently, as well as in Anesthesia Care Teams, which are led by a physician anesthetist.^[9] CRNAs may also practice in parallel with their physician colleagues in certain institutions, both types of provider caring for their own patients independently and consulting whenever collaboration is appropriate to patient outcome.

[edit] Anesthesia assistants

Anesthesiologist Assistants are another group who participate in anesthestic care. They earn a masters degree and practice under physician supervision in sixteen states through licensing, certification or physician delegation^[10]. Anesthesiologist assistant's responsibilities in the ACT settings are similar to those of CRNAs.

[edit] 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 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. These professionals, medically directed by the anesthesiologist, comprise the Anesthesia Care Team. Although selected functions of overall anesthesia care may be delegated to appropriate members of the Anesthesia Care Team, responsibility and direction of the Anesthesia Care Team rest with the anesthesiologist.” Lawyers, however, do not adhere to this farcical notion as they sue everyone in site when a problem develops which may or may not be a true adverse outcome event. ^[11]

[edit] Law regarding anesthesia provision

It has been established that, under US law, anesthesia is both the practice of medicine and nursing. Frank v. South^[12], Chalmers-Francis v. Nelson^[13] and other court decisions determined that anesthesia was a proper nursing function when under the direction of a physician, though not necessarily an anestheologist. As such, anestheologists have no monopoly on the practice of anesthesia. The decisions have not been challenged since the Dagmar Nelson case.^[14] In addition to legal decisions, individual hospital and sugical facility policies also regulate the granting of anesthesia clinical privileges.