Anesthesia provision in the US
In the United States, anesthesia can be administered independently by anesthesiologists or by nurse anesthetists.
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 is insufficient to allow one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology as additional license, training, and professional standards must also be met. It is not required to be board certified in the USA in order to practice anesthesiology. According to an American Society of Anesthesiologists (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 anesthetics. 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 anesthetic, following up the patient in the post-anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.
As a long-standing profession in the United States, advanced practice registered 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 four year Bachelor of Science degree and more than 1 year of critical care nursing experience. During 3 years of graduate school focusing on anesthesiology, they practice to complete a master's degree in nurse anesthesia and must pass the NBCRNA national certification exam. As of 2014 17 governors have opted out of the CRNA supervision requirement of the Centers of Medicare and Medicaid Services (CMS). The remaining states maintain that CRNAs must work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals with similar anesthesia training. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all of 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.
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