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American Society of Anesthesiologists Testifies at House Veterans Affairs Subcommittee

Urges Congress to Block VA Nurses’ Efforts to Remove Anesthesiologists from Veterans' Care

Monday, September 18th, 2023

WASHINGTON, D.C. — The American Society of Anesthesiologists (ASA) will testify tomorrow before the House Veterans Affairs Subcommittee on Health Oversight and urge Congress to block a U.S. Department of Veterans Affairs (VA) Office of Nursing Services’ proposal to remove physician anesthesiologists from the surgical care of Veterans. The nurses' proposal would lower the standard of care for Veterans by dismantling the team-based model of anesthesia care and move VA to a rarely used nurse-only model.

ASA President-Elect Ronald L. Harter, M.D., FASA, will deliver the testimony and outline key facts and evidence illustrating how Veterans’ health is best served by the VA’s existing, proven physician-nurse anesthesia team-based model of care — a model used in the nation’s top hospitals.

“ASA is committed to Veterans and knows that the physician-led anesthesia care team model serves Veterans best,” Dr. Harter said. “This issue is not about what ASA wants or even what the VA Office of Nursing Services wants. The issue is what is best for the health and well-being of our nation’s Veterans, including the new PACT Act Veterans. VA has the right policy in place right now and we need the Subcommittee to continue to support it.”

Harter will testify that VA already addressed this issue and made the right decision in their multi-year 2016 rulemaking when they prioritized the needs of Veterans and maintained the physician-led anesthesia care team model — the most common model of anesthesia care in the country.

“Anesthesia and surgery are inherently dangerous for anyone, and VA patients often have poorer health status, such as diabetes, congestive heart failure, coronary and peripheral vascular disease, renal failure and chronic obstructive pulmonary disease,” Dr. Harter said. “It is an imperative that Veterans have an anesthesiologist involved in their care.”

“PACT Act Veterans exposed to Agent Orange, Burn Pits and other toxic substances require an even higher level of care under anesthesia. It makes no sense for VA to spend billions of dollars to treat PACT Act Veterans with respiratory disease and then put them at greater risk by adopting a lower standard of care,” Dr. Harter added.

Anesthesiologists and nurse anesthetists are not interchangeable health care professionals. Nurse anesthetists are excellent nurse practitioners, but their education and training are far less extensive and in-depth than anesthesiologists’ training. An anesthesiologist’s education and training include 12 to 14 years following high school, including medical school and residency, and 12,000 to 16,000 hours of clinical training. In contrast, a nurse anesthetist’s education and training ranges from four to six years after high school — less than half a physician’s training and an average of approximately 2,500 hours of anesthesia care training — less than one-fifth that of physicians.

Other key points Dr. Harter will make:

  • VA’s current anesthesia policy is one of the most thoroughly researched, studied and reviewed policies existing in VA. The current policy, Anesthesia Services Directive 1123, represents a safe, well-established and functional compromised approach to anesthesia care delivery. No changes are clinically appropriate or necessary.

  • There is no demonstrated shortage of anesthesia clinicians necessitating a change in the delivery of anesthesia care within the VA. ASA closely tracks vacancies for anesthesiologists through the official employment website for the federal government. According to, on September 14, 2023, the number of openings for anesthesiologists was 31 throughout the country, or a job openings rate of 2.9%, which is at or below a typical vacancy rate.

  • There is no unbiased literature to support the safety of eliminating physician clinical oversight of anesthesia. To the contrary, VA’s own studies and data raise questions about the safety of the Office of Nurses Services’ proposal to remove anesthesiologists from the care of Veterans.

The bottom line, Harter will testify, Veterans have certainly earned the right to receive the same level of anesthesia care that is provided in all the nation’s leading civilian hospitals.

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