Access to anesthesia care, without patient safety, isn’t a solution

OPINION – Most policy discussions about improving health care in California start with talking about “access” – the lower the costs, and the more people cared for…the better. But that plan only works if, alongside access, quality of care improves with it. Access to anesthesia care, without safety, isn’t a solution.

This is especially true when undergoing surgery. We place trust in the doctors (anesthesiologists) who put us to sleep, and the doctors (surgeons) who operate on us, confident they are equipped to keep us safe and make sure we wake up safely with the best possible outcome. Yet some advocates have pushed to replace anesthesiologists, who are physicians who undergo 12,000-16,000 hours of anesthesia training, with nurse anesthetists (CRNAs), despite evidence that anesthesiologist-led care decreases the risk of patient death and complications. Further research found that patients are far more likely to have an “unexpected disposition” (admission to the hospital or death) if their anesthesia was solely provided by a nurse anesthetist rather than a physician who is an anesthesiologist.

As physicians who undergo 4 years of college, 4 years of medical school and 4+ years of anesthesiology residency training, anesthesiologists have the advanced training and expertise to make difficult decisions and diagnoses that nurse anesthetists (CRNA) cannot. For many cases and many patients – CRNA care is absolutely appropriate and safe. But there is an essential role for physician-led anesthesia care in every facility – so that a physician is available to make difficult diagnoses, treat patients with complex conditions, and handle life-threatening complications that may arise during a surgery. To be clear, nurse anesthetists are a critical part of the anesthesia care team, but the skills and level of training for nurse anesthetists are not the same as, and cannot replace, a physician’s advanced training and skill set.

It is very important that we do not create a tiered system of care, where only certain communities have access to physicians, while rural or less wealthy areas only have access to nurses. All patients – no matter their race, income, or demographics – deserve access to physician-led care: that is the standard of care amongst California’s major health systems such as the University of California medical centers, Stanford Medical Center, and Kaiser Permanente.

It might sound obvious that people are generally healthier when cared for by doctors. But it is worth remembering, given that some political groups advocate for stretching staffing resources in the name of expanding access. We cannot condone or encourage a system that sanctions unequal access to physicians and unequal outcomes for patients. Instead, let’s focus on addressing the many inequities that already exist to improve health outcomes for minority and disadvantaged patient populations. Stretching healthcare access while undermining safety will only make existing problems worse.

Unfortunately, we recently saw proof of this with reported harm to patients in Modesto and documented in investigations led by the California Department of Public Health (CDPH).  Regulatory inspections of Stanislaus Surgical Hospital were highly critical of how the facility managed medical emergencies and indicated concerns about how the delivery of anesthesia by nurse anesthetists (CRNAs) was being utilized in patient care without physician/anesthesiologist leadership. There were alarming findings regarding the risk of patient harm, and inspectors declared that the problems were serious enough to pose a major threat to patient safety with issuance of “immediate jeopardy” to the hospital.

This situation should serve a big wake-up call for healthcare facilities across the state. Healthcare administrators must enact strategies to protect patients and ensure compliance with existing patient safety regulations and scope-of-practice rules for different providers. Otherwise, patients pay the price.

By providing access to proven, well-designed physician-led anesthesia care — with transparency about the team providers and responsible deployment of those professionals in the right roles — we can safeguard patient safety when seconds count and minutes matter. Let’s be clear — this isn’t a turf war or political game — it’s about ensuring patient safety for all Californians in all communities. There is nothing more important than keeping our patients safe while undergoing anesthesia care for their surgery.

Amid conversations to improve California’s health care, remember – healthcare access, without patient safety, isn’t a solution.

Antonio Hernandez Conte, MD, MBA, FASA, is Immediate Past-President, California Society of Anesthesiologists.