The anesthesiologist assistant model is not a good fit for WA

Our health care system is undergoing significant changes and our Legislature is considering several proposals to improve access to care. As a certified registered nurse anesthetist (CRNA) living in Vancouver, I have been working with my colleagues to share ideas with lawmakers on how to lower barriers to anesthesia care for all Washingtonians.

Fortunately, Washington already has a model for anesthesia care that allows for both physician anesthesiologists and CRNAs to practice to their full training, certification and education. This means that CRNAs, like physician anesthesiologists, may provide anesthesia care under state law for patients independently and without supervision. CRNAs provide a full range of anesthesia care in the military, surgical centers, birthing suites, plastic surgery clinics, dental offices and ketamine clinics, to name just a few. During the pandemic crisis, CRNAs provided advanced airway management, advanced hemodynamic monitoring, invasive line placement and management to help care for patients suffering from severe COVID-19 cases. Washington’s existing laws are especially helpful during a staffing crisis, like during COVID, because our current licensed providers can independently care for patients.

There are several ways that we can further support access to care. Some larger hospitals’ bylaws can be updated to reflect state law so that CRNAs may practice independently at those facilities, just like they do at many hospitals and clinics already in Washington. Our state can invest more in higher education to make it possible for our universities to increase cohort size. Hospitals and universities can also improve their collaboration for finding clinical placements so that our training pipeline is more efficient. These proposals will improve access to care.

Unfortunately, there is one proposal in our Legislature that would not benefit patients. House Bill 1038 and Senate Bill 5184 would change Washington’s model of care to allow for anesthesiologist assistants (AA). These assistants do not have the training, education, or certification to practice independently. This means that they can only provide care under the direct supervision of a physician anesthesiologist. In Washington’s rural communities, where CRNAs provide care in 93% of hospitals and are the only anesthesia provider in 72% of hospitals, patients would not benefit. In large cities and underserved areas, a physician anesthesiologist must be physically present for them to care for patients. This can result in delayed cases and fewer patients getting care per day as this approach limits the number of patients this staffing model can treat.

Furthermore, under the proposed bills, patients will be paying for two anesthesia providers for their care instead of just a physician or a CRNA, increasing the cost of their care. Finally, there is no training program in Washington for AAs, so we’d be starting from scratch. This proposal isn’t a good fit for our state.

CRNAs are proud to provide safe anesthesia care. I have centered my practice in caring for our nation’s heroes — in fact, CRNAs are the primary anesthesia care providers for our military. I was inspired to join nursing while volunteering at a local hospital in Honolulu. After thousands of hours of clinical training, patient care experience and an advanced degree in anesthesiology, I am honored that I can help continue that nursing tradition of providing care to our veterans.

The Legislature can invest more effort in the solutions that utilize existing resources more efficiently to increase health care access and set aside proposals that just don’t make sense in Washington.