|RESPONSE TO COMMENTS
|Year : 2020 | Volume
| Issue : 3 | Page : 254
Why not non-physician anaesthesia providers?
Mukul C Kapoor
Department of Anaesthesiology, Max Smart Super Specialty Hospital, Saket, Delhi, India
|Date of Submission||16-Feb-2020|
|Date of Acceptance||17-Feb-2020|
|Date of Web Publication||11-Mar-2020|
Dr. Mukul C Kapoor
6 Dayanand Vihar, Delhi - 110 092
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor MC. Why not non-physician anaesthesia providers?. Indian J Anaesth 2020;64:254
I read with interest the correspondence from Dr. Dasgupta and appreciate the concern raised about non-physician anaesthesia providers (NPAPs), especially nurse anaesthetists.
The American Society of Anesthesiologists (ASA) was also very reluctant to permit NPAPs to practice and engaged in a prolonged, expensive legal dispute to curtail nurse anaesthetists. They contended that physician anaesthesiologists undertake nearly double the education and ten-times the clinical training of NPAPs. However, the support of the American Medical Association and surgery organisations helped nurse anaesthetists get legal sanction. The ASA issued a statement, in 2014, that they appreciate NPAPs to be integral parts of anaesthesia teams but insisted that the anaesthesia team be physician lead.
Delivering the Rovenstine Lecture, at the Annual meet of ASA in 2012, Patricia A Kapur urged fellow physician anaesthesiologists to not limit their vision by their experience with NPAPs. She reminded the ASA members that based on the complexity of cases, we already assign senior/junior or experienced/less experienced anaesthesia providers. The same principle needs to be followed for NPAPs. She also reminded the house that Ronald Miller had earlier expressed a similar view. Ronald Miller wrote that during the period of the ASA-NPAP dispute, the prevalence of physician extenders in numerous other specialties grew dramatically and benefitted these specialities.
The shortage of physician anaesthesiologists is global, and India is no exception. This shortage deprives patients of quality surgical care, and mortality/morbidity rises as patients remain on long waiting lists. In cognisance of the inability to have an adequate number of physician anaesthesiologists, the World Federation of Societies of Anaesthesiologists (WFSA) endorsed structured training programmes for nurse anaesthetists in some African nations. These programmes have resulted in good training outcomes.
India is short of physician anaesthesiologists, and there is no way to bridge the gap in numbers. It is time, India takes a cue from the developed and the developing world to introduce a structured programme to produce well-trained and safe NPAPs. A formal government approved training will impart a separate legal status to NPAPs. This training must be monitored and audited by the Indian Society of Anaesthesiologists.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Miller R, Hannenberg A. Anesthesiology's choices for the next century. ASA Newsletter 2005;36-7.
Kapur PA. Leading into the future: The 50th
annual Rovenstine lecture. Anesthesiology 2012;116:758-67.