Anaesthesia should remain physician based service.

EDITOR We read with interest the articles 1 2 that you recently published in response to the Audit Commission's Anaesthesia under Examination,3 which revisits the topic of nurse anaesthetists. We trained as anaesthetists in the United Kingdom but now work in the United States.

Nurse anaesthetists in the United States always work under the direction of a physician and, despite our initial reservations, we have all been pleasantly surprised by the experience of working with this highly qualified group of professionals. Minimal requirements for entry to the training programmes of two to three years are a nursing or basic science college degree and one year's experience in critical care nursing. Fear of unemployment in recent years has produced a sharp fall in applications to anaesthesia residency programmes.4 Most programmes have downsized, and a few have closed altogether. Rather than appoint more consultants, many hospitals have recruited nurse anaesthetists to meet their commitments an expensive solution as salaries for nurse anaesthetists, which average £50 000, are more than twice those of residents.

The US Health Care Financing Administration recently announced a proposal to eliminate the federal requirement for supervision of nurse anaesthetists by physicians. This move is being supported by the American Association of Nurse Anesthetists. If approved, the proposal could allow independent practice in some states. The American Society of Anesthesiologists has urged its members to respond “vigorously” to the proposal.

Why can't nurses be a part of anaesthesia in Britain? The simple answer is: “It's too late.” Assuming that a pool of …