The fight for veterans’ anesthesia care sits at the intersection of healthcare access, patient safety, and workforce challenges. Across the Veterans Health Administration (VHA), thousands of surgeries, from joint replacements to cancer resections, depend on reliable anesthesia teams. Nonetheless, persistent staffing gaps, uneven geographic coverage, and long-running debates over scope of practice create bottlenecks that delay procedures and, ultimately, quality healthcare for the nation’s veterans.
At the heart of the controversy is who can do what, where, and under whose supervision. Certified Registered Nurse Anesthetists (CRNAs) and physician anesthesiologists both deliver anesthesia care, often in collaboration with each other. In major VA medical centers, the model frequently looks like a coordinated team: physicians lead complex cases and intensive perioperative planning while CRNAs provide continuous hands-on care before, during, and after surgery. In lower-resource facilities or facilities without sufficient anesthesiologist coverage, however, tension arises between the goal of increasing anesthesia coverage and maintaining the VA’s longstanding model of anesthesia care.¹⁻³
The VA utilizes a physician-led model of anesthesia care. Some states and healthcare systems do the same, while others allow CRNAs to deliver anesthesia care autonomously. Proponents of expanding CRNAs’ full practice authority inside the VA argue that standardized, nationwide autonomy would allow for facilities to respond more efficiently to shortages, cover satellite clinics, and trim wait times without compromising medical outcomes. There is ample evidence showing that anesthesia safety is the product of training, protocols, monitoring, and systems design, rather than a single credential. However, others point out that high-acuity veterans (often older, with multiple comorbidities and complex pain or cardiopulmonary histories) benefit from physician-led care, particularly for major surgery, advanced regional techniques, or hemodynamically fragile patients.⁴⁻⁶
The VA faces the same pressures as the broader U.S. healthcare system: a shrinking anesthesia workforce, rising surgical demand, and competition with private-sector hospitals for talent. The fight for veterans’ anesthesia care mirrors tensions that exist in anesthesia care for many other systems. Pay parity and locality adjustments help recruitment, but retention depends directly on the establishment of predictable schedules, access to modern equipment, and a professional culture that values both disciplines.
Innovative solutions such as tele-anesthesia for preoperative assessments and centralized scheduling can extend limited expertise across multiple sites. In addition, perioperative surgical homes, integrating anesthesia, surgery, nursing, and pharmacy, can reduce the rates of cancellations and improve recovery outcomes. Making recruitment a shared mission through incentives and career growth opportunities, meanwhile, may help attract and retain talent, and increasing transparency could help build trust and accountability.⁷⁻¹¹ Whether the model for veterans’ anesthesia care continues in the same direction or shifts direction remains to be seen, with CRNA and anesthesiologist professional groups continuing to argue different cases.
References
1. Smith, A. F., Kane, M. & Milne, R. Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review†. British Journal of Anaesthesia 93, 540–545 (2004). DOI: 10.1093/bja/aeh240
2. Banerjee, S. & Askin, N. Anesthesia Care Provided by Nurses. (Canadian Agency for Drugs and Technologies in Health, Ottawa (ON), 2021).
3. Lewis, S. R., Nicholson, A., Smith, A. F. & Alderson, P. Physician anaesthetists versus non‐physician providers of anaesthesia for surgical patients. Cochrane Database Syst Rev 2014, CD010357 (2014). DOI: 10.1002/14651858.CD010357.pub2
4. CRNA, A. B. Commentary: This rule change would improve care at veterans hospitals. https://nysana.memberclicks.net/index.php?option=com_dailyplanetblog&view=entry&year=2024&month=11&day=10&id=84:times-union-veterans-day-2024.
5. AANA | News | AANA Champions Full Practice Authority for CRNAs in the Veterans Health Administration. AANA – American Association of Nurse Anesthesiology https://www.aana.com/news/aana-champions-full-practice-authority-for-crnas-in-the-veterans-health-administration/.
6. VA Publishes Proposed Rule Recognizing VHA CRNAs, APRNs to Full Practice Authority | Vermont Nurse Anesthetist Association. https://vtana.org/va-publishes-proposed-rule-recognizing-vha-crnas-aprns-to-full-practice-authority/.
7. Walker, A. VA Loses 3.2% of Nursing Workforce in One Year — What’s Driving the Mass Exodus? Nurse.org https://nurse.org/news/va-nursing-crisis-nurse-exodus-impact/.
8. Office, U. S. G. A. Veterans Health Care: Staffing Challenges and Recommendations for Improvement | U.S. GAO. https://www.gao.gov/products/gao-23-106836.
9. Heckman, J. VA’s severe health care staffing shortages are on the rise, watchdog finds. https://federalnewsnetwork.com/workforce/2025/08/vas-severe-health-care-staffing-shortages-are-on-the-rise-watchdog-finds/ (2025).
10. 5 reasons federal cuts are hitting veterans especially hard | PBS News. https://www.pbs.org/newshour/politics/5-reasons-federal-cuts-are-hitting-veterans-especially-hard.
11. VA to reduce staff by nearly 30K by end of FY2025. https://news.va.gov/press-room/va-to-reduce-staff-by-nearly-30k-by-end-of-fy2025/.