Proposed Bylaws Change at Minneapolis VA Medical Center
NAVAPD has become aware of a proposed amendment to the bylaws at the Minneapolis VA Medical Center. This change would eliminate physician oversight of anesthesia care, permitting Certified Registered Nurse Anesthetists (CRNAs) to practice independently.
Concerns and Implications
Leaders at the Minneapolis VA Medical Center are pursuing this change, a decision with significant consequences for both patient care and safety. NAVAPD is deeply concerned, highlighting that the proposal violates VA Directives. Although the change is being justified by citing staffing shortages, NAVAPD has learned that recent departures of anesthesiologists are linked to management problems—not workforce shortages, as leadership suggests.
Facility Complexity and Patient Needs
The Minneapolis VA is designated as a Level 1a facility, the highest complexity category in the VA system. It conducts advanced and high-risk surgical procedures, caring for some of the nation’s sickest Veterans, including those requiring cardiac, vascular, thoracic, and neurosurgical operations.
Regulatory Violations
The proposal directly contravenes VHA Directive 1220, which requires 24-hour anesthesiologist coverage at facilities providing surgical services. Implementing this change would undermine recruitment, discourage anesthesiologists from joining the staff, and foster an unsustainable and hostile environment, ultimately signaling that physician anesthesiologists are not valued.
Veteran and Public Opinions
According to a 2023 Ipsos/NAVREF survey, 86% of Veterans believe VA leaders should prioritize quality care over cost savings.
More than 70% of Americans, regardless of political affiliation, agree that quality of care should be the VA’s primary focus.
A 2023 American Legion national survey found that 74% of Veterans think it is essential for anesthesia to be administered by a physician anesthesiologist, and 52% would consider seeking care elsewhere if that standard were not upheld.
Alternative Solutions to the Staffing Crisis
NAVAPD has identified several options to address the staffing crisis without compromising quality of care:
The Integrated Critical Staffing Program (ICSP) enables rapid deployment of contract physicians throughout the VA system.
The Disaster Emergency Medical Personnel System (DEMPS) allows VA facilities to bring in credentialed clinicians during emergencies.
The Hampton VAMC recently used targeted locum tenens contracts to recruit anesthesiologists during a similar shortage.
Potential Impact on Care Models
The proposed bylaws revision may alter anesthesia staffing models at the facility, restricting surgeons’ access to anesthesiologists. It could also introduce a nurse-only anesthesia model that might spread to other VA hospitals.
Advocacy and Response
NAVAPD responded swiftly when alerted to the change. Dr. Abate sent a letter to SECVA requesting the suspension of the proposed bylaw amendment and reached out to Senator Moran and Senator Blumenthal for immediate intervention. Other policy stakeholders have also been contacted, and Senator Moran’s office has referred the matter for review. SECVA has indicated that the proposed change will be reviewed as well.
Call to Action
Earlier this week, NAVAPD issued a call to action via email, encouraging members—and their physician, anesthesia, and surgeon colleagues—to sign the “Stop The Line” letter. Members are also urged to invite their Veteran patients to add their support.
Next Steps
As NAVAPD receives further information and updates on the situation, they will keep members informed. Members are encouraged to contact their Congressional Representatives to advocate for the continued presence of physician-led anesthesia care throughout the VA system.