Anesthesia provision in the US

Anesthesia provision in the United States refers to practice of administering anesthesia in the United States. Anesthesia can be administered independently by anesthesiologists or by nurse anesthetists.

Anesthesiologists
Anesthesiologists are physicians specializing in the practice of anesthesiology. The training of an anesthesiologist typically consists of 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency. Completion of the written and oral Board examinations by a Physician allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology. According to an ASA press release Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually.

Other specialties within medicine are closely affiliated to anesthesiology. These include intensive care medicine and pain medicine. Specialists in these disciplines have usually done some training in anaesthetics. Anesthesiology is not limited to the operation itself. Anesthesiologists are termed "peri-operative physicians", and involve themselves in optimizing the patient's health before surgery, performing the anaesthetic, following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.

Nurse Anesthetists
In the United States, advanced practice nurses specializing in the provision of anesthesia are Certified Registered Nurse Anesthetists (CRNAs). As of 2007 CRNAs represent 50% of the anesthesia workforce in the United States, with 36,000 providers, according to the American Association of Nurse Anesthetists, and administer approximately 27 million anesthetics each year. Thirty-four percent of nurse anesthetists practice in communities of less than 50,000. CRNAs begin their education with a Bachelors of Science degree and at least 1 year of critical care nursing experience. After appropriate preparation, they gain a masters degree in nurse anesthesia and must then pass a certification exam. The average CRNA student has 5-7 years of nursing experience before entering a 27-30 month masters level anesthesia program. CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques -- general, regional, local, or sedation. Nurse Anesthetists are able to practice anesthesia independently in some states, as well as in Anesthesia Care Teams.

Anesthesiologist Assistants
Anesthesiologist Assistants are another group who participate in anesthestic care. They earn a masters degree and can practice only under direct Anesthesiologist supervision in sixteen states through licensing, certification or physician delegation. Anesthesiologist Assistant's responsibilities in the ACT settings are similar to those of CRNAs.

Anesthesia Care Teams
According to the ASA statement on the Anesthesia Care Team, anesthesia care personally performed or medically directed by an anesthesiologist constitutes the practice of medicine. According the American Association of Nurse Anesthetists and state law in all fifty states, anesthesia care provided by a Certified Registered Nurse Anesthetist is considered the practice of nursing. Certain aspects of physician directed anesthesia care may be delegated to other properly trained and credentialed professionals.

Law regarding anesthesia provision
It has been established that, under US law, anesthesia is both the practice of medicine and nursing. Frank v. South, Chalmers-Francis v. Nelson and other court decisions determined that anesthesia was the practice of Nursing as well as Medicine. As such, the practice of anesthesia in the US may be delivered by either a Nurse Anesthetist or an Anesthesiologist. The decisions have not been challenged since the Dagmar Nelson case. In addition to legal decisions, individual hospital and surgical facility policies also regulate the granting of anesthesia clinical privileges.