The term “anesthesia care team” (ACT) describes the collaboration among physician anesthesiologists (MDAs), advanced practice providers (APPs), and anesthesia residents in delivering anesthesia. Anesthesia care teams enable organizations to expand anesthesia capacity by having MDAs supervise or direct APPs, such as certified registered nurse anesthetists (CRNAs) or certified anesthesiologist assistants (CAAs). While this arrangement often functions effectively, interprofessional conflicts can arise, leading to tension and turnover. To understand the roots of animosity between different anesthesia provider types, it is helpful to explore the history of the profession in the United States.
A Brief History of Anesthesia in the U.S.
Modern anesthesia is credited to American dentist William Morton, who, in the late 1800s, began using sulfuric ether for dental procedures. At the time, physicians were scarce, and few chose to specialize in anesthesia, preferring surgical careers. As a result, nurses were enlisted to deliver anesthesia, with some becoming influential pioneers in the field. By World War I, nurses, all women, were employed by the U.S. Military to administer anesthesia in increasingly dangerous combat settings. Their reputation for providing quality care solidified their role in the specialty. However, disputes soon arose over who “owned” the profession of anesthesia.
Two key events significantly shaped the current dynamics within the field:
- The Dagmar Nelson Case (1934): A nurse named Dagmar Nelson was sued by physicians in Los Angeles, California, for allegedly practicing medicine illegally by providing independent anesthesia services. Nelson’s defense argued that the lawsuit aimed to eliminate nurses as competition in the anesthesia market. The Supreme Court ultimately ruled in Nelson’s favor, establishing a legal precedent for nurses’ role in anesthesia. This case remains relevant today as debates over scope of practice and professional competition between CRNAs and MDAs continue at federal and state levels.
- The Creation of the CAA Profession: In response to a shortage of anesthesia providers in the 1960s, physicians developed training programs for certified anesthesiologist assistants (CAAs). Unlike CRNAs, CAAs were trained with a restricted scope of practice, requiring supervision by an MDA and prohibiting independent practice. This distinction fueled tensions, with CRNAs alleging that MDAs created the CAA profession to reduce competition and limit CRNA opportunities. MDAs, in turn, argued they were addressing workforce shortages.
Current Challenges in Anesthesia Care Teams
These historical events underpin ongoing professional conflicts in anesthesia. Tensions often extend beyond policy debates, impacting clinical environments. For instance:
- Negative interprofessional interactions are frequently cited as reasons for burnout and turnover among both MDAs and APPs.
- Efforts to enhance one provider type’s role often coincide with attempts to diminish the visibility or contributions of other types.
Recommendations for a Collaborative ACT
Understanding the history of anesthesia is critical to fostering collaboration and building successful ACTs. Key strategies include:
- Cultivate a unified work culture: Encourage all providers to operate as one cohesive team.
- Respect professional roles: Define and value the unique expertise of each provider type.
- Active leadership: Ensure leaders take measurable steps to promote collegiality and unity.
- Zero tolerance for divisive behavior: Enforce policies against actions that undermine teamwork.
- Address noncompliance proactively: End work relationships with providers unwilling to align with collaborative goals.
By implementing these measures, anesthesia departments can mitigate conflict and create a supportive, effective practice environment.
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