An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom

Abstract

Summary Professional conflict between nurse anaesthetists and anaesthesiologists in the United States of America is well known in the UK but has not been explored and documented in detail. We present an account, based on critical analysis of published literature and other documentary evidence, of the historical, professional and financial factors which have led to this. In the USA, anaesthesia developed as a nursing specialty until physicians began to take on this work after the Second World War. Payment arrangements between the 1960s and the 1990s made anaesthesiology a lucrative career choice for medical graduates and this led both to considerable growth in the number of anaesthesiologists and to a strengthening of the resolve of nurse anaesthetists to retain their scope of work and preserve their professional status. Changes in payment regulations in the 1980s and 1990s threatened anaesthesiologists' income and led to re‐appraisal of evidence over relative cost‐effectiveness and safety of different provider models. More recently, the terms of engagement have shifted from disputes over evidence to political lobbying to promote the professional capabilities and status of each of the anaesthesia providers. Factors of relevance to possible changes in the provision of anaesthesia in the United Kingdom are highlighted.

Anaesthesia education in Nepal - What residents think

“…In the developed world, anesthesia has progressed to a comprehensive medical specialty in the past few decades with a well established presence in allied disciplines, including intensive care medicine, emergency medicine, and pain therapy. 5 However, in developing countries, anesthesia is mostly focused on intraoperative patient care for basic surgical procedures. 6 Anaesthesia in less developed countries has often gained little or no interest.…”

“…6 Anaesthesia in less developed countries has often gained little or no interest. 5 The condition in Nepal is no different however progress has been made. It is necessary that good education be provided to lift the overall condition of any speciality.…”

Anaesthetic practitioners in the UK: promise, perils and psychology

“…As this seemed relevant to our work for the SDO, we traced the history and development of professional relationships in the United States [14]. The commonly held view amongst UK anaesthetists appears to be that American nurse anaesthetists, like Frankenstein's monster, took on an independent life of their own and then set about destroying their creator.…”

<p>Anesthesiologists Have an Important Role in Preclinical Nurse Anesthesia Education</p>

“…Unfortunately, even after the potential advantages have been identified for NAPs and anesthesiologists, there are significant impediments to such joint ventures, in addition to those obstacles posed by professional organizations. 38 Like many relatively homogeneous university groups, academic nursing programs including NAPs resist incorporating "outsiders" into their folds. The foundations of these territorial reflexes are likely numerous, but the bottom line is that an anesthesiologist in a NAP may not be readily accepted as a peer by other NAP faculty.…”