April 2000
Volume 64 |
Number 4
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ADMINISTRATIVE UPDATE
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| Educational Affiliate
Status for Nonphysician Practitioners |
John B. Neeld, Jr., M.D.
Immediate Past President
ASA's October 1998 House of Delegates approved a resolution from
New Jersey authored by then Director of District 5 and current
ASA Assistant Treasurer Roger A. Moore, M.D. The resolution directed
the President to assign a committee to determine whether ASA should
offer some type of membership status to nonphysician practitioners
(NPPs), i.e., nurse anesthetists and anesthesiologists' assistants
(AAs). I appointed an Ad Hoc Committee on Anesthetist Relationships,
chaired by Burton S. Epstein, M.D., to evaluate the issue and
report to the 1999 House of Delegates.
The committee unanimously recommended "that there be created
an educational affiliate category of nonvoting ASA membership
open to those nurse anesthetists and AAs who are sponsored by
at least two active ASA members and who subscribe in writing to
the 'Guidelines for the Ethical Practice of Anesthesiology' and
the statement on the 'Anesthesia Care Team' as approved by the
House of Delegates." After extensive discussion and minor additions
in the Reference Committee, the recommendation passed the House
without discussion.
ASA President Ronald A. MacKenzie, D.O., has appointed an Ad
Hoc Committee chaired by Steven D. Goldfien, M.D., to recommend
the appropriate benefits and other terms of educational affiliate
membership for consideration by the ASA House of Delegates in
October 2000.
While the decision to create an educational affiliate status
within ASA represents a fundamental change in long-standing ASA
policy, it also represents our Society's recognition of its fundamental
mission to improve the quality and safety of anesthesia care throughout
our nation, whether provided in the personal performance mode
or care team mode. We cannot fulfill our safety mission without
making positive efforts to improve the working relationships among
members of the care team and without developing educational programs
specifically targeted for NPPs who practice in the care team.
Additionally, the action by the House recognizes the reality
of the growing role of nonphysician practitioners in almost every
medical specialty and the reality of the total provider supply
in anesthesia practice. The demographics of residency recruitment
during the 1990s clearly indicate that the number of new physicians
entering the specialty will be barely adequate to equal anesthesiologist
attrition for the foreseeable future. This fact seems to assure
that the care team mode of practice will continue to be utilized
by a sizable and perhaps increasing percentage of our members
in the years ahead.
Thus ASA has developed a reasonable proposal that is consistent
with the facts of anesthesiologist shortages and has the promise
to continue our leadership role in protecting the safety of patients.
Finally, as the specialty society most familiar with the realities
of practicing with nonphysicians, we can provide a model to our
physician colleagues in other specialties as to how the demonstrated
skills of appropriately educated NPPs can be utilized efficiently,
while ensuring that every patient also has access to the unique
knowledge and skills that only a physician can bring to patient
care.
ASA has once again taken a leadership role in medicine and recognizes
the need for new relationships with NPPs that promote improved
patient safety in all practice settings.
Our members should commend the vision and courage of ASA's committees
and its House of Delegates and should actively work to make this
new initiative a resounding success.
The recently announced intent of the Health Care Financing Administration
to implement its proposed rule change that would remove the requirement
of physician supervision of nurse anesthetists from the Medicare
conditions of participation poses an increased risk to patients,
according to the results of the Silber study published in abstract
form in October 1998. The rules change makes it even more timely
and imperative that ASA strengthen the anesthesia care team by
developing first-rate education programs specifically directed
to NPPs who practice with anesthesiologists.
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