Critical Debate on Establishing a Scheme for Nurse Anesthetists in Japan

Abstract

For decades, a chronic shortage of anesthesiologists in Japan has been a serious problem. According to a personal survey conducted from 2002 to 2006 by Koichi Tsuzaki, MD (Associate Professor of Anesthesiology, Keio University School of Medicine, Tokyo Japan), more than one million surgical procedures required general anesthesia while only 6207 qualified anesthesiologists were available. The annual procedure volume per anesthesiologist ranges from 174 to 209 in Japan (Table 1; these data were obtained from our written communication with Dr Tzuzaki on December 20, 2008). However, anesthesiologist manpower is much less than this. The actual number of surgeries requiring general anesthesia was underestimated by this survey, which did not collect data from all Japanese medical institutions. Moreover, the Japanese Society of Anesthesiologists (JSA) reported that over 30% of general anesthetic practices are provided by surgeons, and not by anesthesiology specialists.1 While the shortage of surgeons has recently emerged as a critical issue, this crisis jeopardizes the already depleted manpower for anesthetic practice. In Japan, only medical doctors (MDs) are allowed to administer general, spinal, and epidural anesthesia and nerve blocks. Therefore, it has been suggested that non-MDs should be trained to administer anesthesia. These non-MDs include both nurses and dental anesthetists (dentists who administer general anesthesia in orofacial and dental surgeries). The Ministry of Health, Labor and Welfare in Japan has proposed the introduction of a nurse anesthetist. Critical debate has been ongoing but the proposal remains controversial.2 The JSA strongly opposes this idea, insisting that anesthesia is a medical practice and has to be performed by well-trained MDs. Moreover, the JSA argues that the lack of governmental resources hinders the establishment of the alternative pathway of educating a registered nurse into becoming a qualified nurse anesthetist because it will necessitate additional manpower and cost. We believe that we have to refuse a system such as that of the Certified Registered Nurse Anesthetists in the United States, where nurse anesthetists can administer anesthesia without supervision by MD anesthesiologists. The Japanese Association of Critical Debate on Establishing a Scheme for Nurse Anesthetists in Japan