When I served in the U.S. Navy as a military doctor, I had the opportunity to work alongside some of our country’s best and bravest. Whether in friendly waters or the combat zones of Afghanistan, we sounded a unifying refrain: teamwork.
The Navy has no official motto, but one that’s stuck around is Non sibi sed patriae — not self, but country. Our goal is to work together under pressure toward a greater mission.
There’s a similar feeling in the hospitals and operating rooms of the Roanoke area, where I serve as a physician anesthesiologist alongside some of Virginia’s most skilled health care professionals, which include certified registered nurse anesthetists, or CRNAs. Our patients are the focus. Their safety and well-being is our mission. And we achieve the best results for those patients when the health care providers work together as a team.
But the General Assembly now faces legislation that could break apart this team-based approach to health care, diminish access and weaken patient safety.
The proposal, House Bill 1322, would remove the requirement for a doctor to be present during anesthesia care, and allow any CRNA to provide anesthesia for any procedure to any type of patient. My fellow physicians in the Virginia Society of Anesthesiologists and I consider this proposed change to state law too far-reaching. It fails to consider the complexities of anesthesia care and the highest quality of care for which we all strive.
That’s why I join with hundreds of health care colleagues across Virginia in urging legislators to vote against the proposed changes and protect current state law.
If you’ve ever faced a surgical procedure, you’ve likely encountered a physician anesthesiologist like me. We’re medical doctors who help you fall asleep during general anesthesia before surgery and provide ways to most effectively block and manage pain. We help determine whether surgery can be performed. We lead the team that cares for you before, during and after surgery. We’re also there if something goes wrong or there are complications — because anesthesia always carries inherent risk, even with the healthiest patients. CRNAs are indispensable members of this team, and we all share a mission to ensure your comfort and safety.
Virginia state law stands behind this team-based approach, balancing patient safety with the needs of the health care system where you live. We know that a hospital in downtown Richmond differs from a hospital in Southwest Virginia. But we should strive for the highest levels of care for patients wherever they live.
That’s one reason Virginia’s law is among the most lenient of our neighboring states. It allows for nurse anesthetists to practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry or dentistry. This expands the number of professionals who can help patients while ensuring that doctors remain an integral part of that service.
For context, there are more stringent requirements for physician availability in Maryland, where the law requires a doctor to be physically available at all times and prioritizes consultation with an anesthesiologist. In Tennessee, state law requires direct supervision by a physician, requiring them to be physically present in the same building.
Virginia law recognizes the crucial role of physicians in every anesthetic while providing flexibility. It supports hospitals throughout the state by allowing them to adapt their model of care to meet the needs of the facility. Some hospitals might require physician anesthesiologists to supervise nurse anesthetists. Others might allow surgeons to serve as the supervisor.
Either way, the doctor’s role provides cohesive service. Even in healthy patients, complications can arise. Patients benefit when everyone works together. Communication and coordination is essential for successful outcomes. Teamwork under pressure.
Patients, too, deserve to choose whether they receive care from a physician or a CRNA, the same way they might decide whether to see a medical doctor or nurse practitioner in primary care, or an OB-GYN or nurse midwife when having a baby.
In operating rooms and on battlefields, teamwork saves lives. Every team member’s expertise is invaluable, and the physician anesthesiologist’s role on the team is a crucial component of that. The proposed changes in HB 1322 threaten to pull doctors further away from Virginia patients.
The team-based approach to anesthesia care is a model that’s proven its worth time and again. Let’s continue to support this model — and the Virginia patients who benefit from it. Our patients trust us with their lives. Let’s ensure that our laws reflect the highest standards of care, provide access, and keep patients as the focus of our unwavering mission.
Dr. Robert Shafer, who retired from the U.S. Navy after 20 years as a military doctor, serves as vice president of Anesthesiology Consultants of Virginia Inc., and is an assistant professor at the Virginia Tech Carilion School of Medicine.