As a physician anesthesiologist, I’m a physician first and an anesthesiologist second. I’m not only responsible for delivering anesthesia and ensuring my patients do not feel pain during their procedure or surgery, but also, helping ensure that my patients make it out of these procedures alive.
That might seem like a strong statement, but many people don’t realize anesthesia and surgery are inherently dangerous. During a procedure, I monitor every heartbeat, the patient’s blood pressure, breathing and other vital signs. But even in routine procedures, complications occur and those vital signs can change instantly – threatening the patient’s life.
My education and medical training as a physician have prepared me to know exactly what to do when the heartbeat stops, blood pressure falls to a dangerous level, or any other medical complication occurs. I instantly identify and diagnose the problem and direct the surgical team to pause what they’re doing if needed, so we can ensure the patient is safe. Once the patient is stabilized, the surgery can proceed and the patient returns to the arms of their loved ones.
Gov. Doug Ducey’s recent decision to opt-out of the Centers for Medicare & Medicaid Services’ accreditation standard for hospitals and other settings eliminates the longstanding requirement for physician supervision of nurse anesthetists, even though 80% of Arizona voters overwhelmingly want a physician managing medical complications or emergencies during surgery.
Ducey’s decision was made without input from the public or the state’s medical community and risks patients’ lives – and for no reason. Eliminating physician supervision and allowing nurses to administer anesthesia without physician oversight results in zero cost savings for patients as Medicare, Medicaid and most third-party insurers pay the same fees for anesthesia whether administered by a nurse anesthetist or physician. It simply lowers the standard of care for patients.
Our governor has dismantled the highly successful anesthesia care team model and will now allow nurses to administer anesthesia without physician involvement. For some patients, this can mean the difference between life and death – something I see all the time.
I recently had a very healthy man in his early 60s undergo a routine outpatient procedure to repair a hernia. He was a rancher, worked in the hot Arizona sun and had not experienced health issues. Theoretically, this should have been easy for him and the surgical team. However, while he was on the operating table, he had a massive heart attack that would have killed him instantly if it had happened at home. This was confirmed by a cardiologist after the procedure, who found the patient had a life-threatening narrowing of a vessel going to his heart, known as the “widow maker artery.” But just minutes after experiencing cardiac arrest and having no pulse during his outpatient procedure, we got his heart back to a normal rhythm, and he survived to return to his family.
Without physician involvement in his anesthetic care, I can’t say this patient would still be alive today. Physicians are medical experts with up to 14 years of post-graduate medical education and residency training, including 12,000 to 16,000 hours of clinical training, so nearly twice the education and five times the training of nurse anesthetists.
Our residency is called a residency on purpose because for four years, we practically live in the hospital, actively participating in an accredited medical program and on a gradual basis, demonstrating our ability to safely practice medicine without other physician oversight. We are at the hospital day in and day out, working so many hours that we put our lives on hold. We sacrifice spending time with friends, family and traveling — the things that many people in their late 20s and early 30s do, because we’re putting in all of our time and effort into learning how to keep people alive. And we do it with no regrets, because it is our calling.
Just as you would not remove the surgeon (a physician) from the operating room during a surgical procedure and allow a physician assistant to operate alone, what sense does it make to remove physician involvement from the patient’s anesthesia care and allow a nurse to perform alone?
Community members, lawmakers, people of Arizona, I beg you to ask yourselves: who do you want in charge of your anesthesia care? If it was your family member, your child, your spouse, your parent – would you want a physician in charge of the anesthetic care, or a nurse working alone? Call the governor and demand he rescind his decision to remove physicians from the anesthesia care team.
Heidi Tavel is an anesthesiologist practicing in Tucson.