Physician Supervision of Nurse Anesthetists
Citing patient safety concerns, the American Society of Anesthesiologists (ASA) has spent much of the last two or three years vigorously opposing a federal government initiative to loosen "physician supervision" restrictions on nurse anesthetists. I support the ASA's effort completely. But all too often, many anesthesiologists give in to pressures in a way that undermines our case and may even cause us to appear as hypocrites. If we are to push for physician supervision of CRNAs, then each and every anesthesiologist must practice what we preach.

The ASA's guidelines for anesthesiologists who supervise nurse anesthetists clearly state that the anesthesiologist is responsible for the preop evaluation and prescription and implementation of the anesthesia plan. When we ask the CRNAs who have graduated from our program about their concerns in starting private practice, their No. 1 response is that they have serious concerns about the quality and completeness of the preoperative evaluation done on their patients. When we survey residents who have graduated, we get an indication to why: Pushed by demands for greater efficiency, some anesthesiologists may be cutting corners in preoperative evaluations and directing CRNAs to anesthetize sub-optimally prepared patients. One of the most common concerns among this group regards the intense "production pressures" from hospital administrators and surgeons to manage the ORs on schedule and avoid canceling scheduled cases.

Dr. Maurer ('[email protected]')) practices at the Cleveland Clinic Foundation.

In a misguided attempt to increase productivity, some anesthesiologists may be supervising more rooms than is appropriate and spreading themselves too thin, thereby unable to give CRNAs the consultation and supervision they need.

When we are on call at home and fail to come in to the hospital at 2 a.m., leaving the surgeon to supervise the nurse anesthetist because "it's an easy case and the CRNA can handle it," we display to our surgical colleagues, operating room staff and hospital administrators that our demands to totally direct the care of the anesthetized patients may be at times based more on our own personal convenience rather than the safety of the patient.

Although the majority of anesthesiologists practice responsibly, enough practitioners diverge from the standard to severely weaken the ASA's case. Physicians who allow themselves to slip into the belief that just one person's behavior won't make a difference should remember the saying from the Farmers Almanac: "No snowflake in an avalanche ever feels responsible." Each individual bears the ultimate responsibility for protecting patients from unnecessary danger in the OR and upholding the noble standards of our profession. Only those of us who accept this responsibility and take it seriously deserve the title of anesthesiologist.