News & Media

Opinion: Don't Cut Physicians Out of Surgical Anesthesia Administration

Wednesday, March 24, 2021
This is an op-ed from MSMS President S. Bobby Mukkamala, MD, which first published in The Detroit News on March 20, 2021.


The global pandemic has changed the way we think about health care and about health care providers. We’re learning more each day about the value of care, about the dangers of many common and underlying health challenges, and about the heroism of doctors, nurses, techs, mid-level providers and others on the front line of the fight against COVID-19.

One thing that’ll never change, though, is Michigan physicians’ commitment to putting the needs of Michigan’s patients first, every time.

That’s why we were excited to learn the state House of Representatives was rolling out a health care reform agenda designed to better meet those patients’ needs.

Our commitment to patient safety is also, however, why Michigan’s front-line physician community was so disappointed by one of the bills in the package, and why we’re encouraging lawmakers to reject it.

House Bill 4359 would remove physician involvement in anesthesia care from offices and operating rooms across the state. Instead, under the bill, nurse anesthetists could plan and administer anesthesia, including responding to serious problems which may arise during a procedure, with no physician involvement. It dismantles the physician/CRNA care team model.

Every anesthetic, from “light sedation” through general anesthesia, requires careful planning and proper administration to see a patient safely through what would otherwise be a painful procedure. 

With an aging population and increasingly complex surgical interventions, physician involvement in this care is more important than ever. House Bill 4359 would mean that physicians would no longer need to be involved in anesthesia care during surgery — outpatient settings, clinics, dental facilities, you name it.

That’s a dangerous approach, and one that would put Michigan far outside the mainstream when it comes to patient care requirements. In fact, only five states in the nation by statute or regulation authorize nurse anesthetists to practice outside the relationship of a physician.

Patients certainly understand the risk. Polling conducted last week by EPIC-MRA shows that 66% of voters oppose legislation to end supervision of anesthesia care. Only 14% support it. 

When pollsters offered respondents the option between receiving anesthesia care with or without physician involvement, only 10% said they’d opt for unsupervised care.

Patients expect, and the state of Michigan requires, physician supervision of anesthesia care for a reason.

Physicians have well over a decade of education and specialized training to evaluate patients before they receive anesthesia or undergo treatments for chronic pain, while nurse anesthetists have as little as two years of postgraduate training.

When lives are on the line, a physician’s training and experience matters.

It enables them to make split-second medical decisions to provide life-saving assistance, and treat any number of catastrophic complications which may occur when a patient is under anesthesia. Assuring the safety of patients before, during and after anesthesia requires the broad understanding of medical diagnosis and treatment acquired over many years of training and education.

It’s important to know, too, that this isn’t new legislation. Every year or two the same bill resurfaces, and every year or two lawmakers look into it, learn how dangerous it is for patients and reject it.

Supporters claim the bill would save money by taking physicians out of the equation. They’re wrong. Whether it’s private insurance, Medicare or Medicaid, anesthesia care is reimbursed at the same rates whether a physician supervises it or not.

They claim physician supervision doesn’t matter, but if the pandemic has taught us anything it’s just how important it is that patients have access to the highest quality care.

Michigan’s physician community encourages the House and the Senate to put Michigan patients first. We urge them to do the right thing and reject House Bill 4359 — again.