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Year : 2020  |  Volume : 64  |  Issue : 3  |  Page : 254  

Why not non-physician anaesthesia providers?

Department of Anaesthesiology, Max Smart Super Specialty Hospital, Saket, Delhi, India

Date of Submission16-Feb-2020
Date of Acceptance17-Feb-2020
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Mukul C Kapoor
6 Dayanand Vihar, Delhi - 110 092
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_152_20

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How to cite this article:
Kapoor MC. Why not non-physician anaesthesia providers?. Indian J Anaesth 2020;64:254

How to cite this URL:
Kapoor MC. Why not non-physician anaesthesia providers?. Indian J Anaesth [serial online] 2020 [cited 2021 Feb 28];64:254. Available from: https://www.ijaweb.org/text.asp?2020/64/3/254/280385

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.[1] 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.[2]

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.[3] 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.[1]

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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There are no conflicts of interest.

   References Top

Miller R, Hannenberg A. Anesthesiology's choices for the next century. ASA Newsletter 2005;36-7.  Back to cited text no. 1
American Society of Anesthesiologists. Nurse anesthetist care not equal to physician anesthesiologist-led care, comprehensive evidence-based review finds American Society of Anesthesiologists® calls for further examination. 2014 Aug 19. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2014/08/nurse-anesthetist-care-not-equal-to-physician-anesthesiologist-led-care. [Last accessed 2020 Feb 15].  Back to cited text no. 2
Kapur PA. Leading into the future: The 50th annual Rovenstine lecture. Anesthesiology 2012;116:758-67.  Back to cited text no. 3


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