To the Editor
I read the recent APSF edition regarding fatigue and sleep deprivation with great interest as I myself struggled to stay awake one morning after call. It occurred to me that in my 20 years of practice that by far the greatest cause of fatigue, stress, and sleep deprivation to me has been the escalating and incessant demands of obstetrical anesthesia and specifically labor epidurals. The evolving standard of “every woman in labor deserves an epidural upon request” has enabled a small subgroup of patients to consume a disproportionately large amount of available anesthesia manpower. What was once a privilege of a few has become an entitlement to all and a tremendous drain on anesthesia resources.
I would estimate that labor epidurals represent less than 5% of patient volume and reimbursement to us nationwide but account for greater than 50% of the demand for after hour anesthesia services.
If we, as a specialty, are serious about addressing the problem of fatigue caused by sleep deprivation, the obvious place to start would be to re-evaluate our professional obligation to perform these underfunded and non-essential procedures after hours.
The standards set for us by hospital administrators, obstetricians, and our own ASA, regarding provision of labor epidural analgesia are not feasible in hospitals where anesthesia providers must work the next day following call. Total ablation of labor pain is a noble goal, but the cost to anesthesia providers in monetary and physical expenditure far exceeds the reimbursement. We should not have to “burn the candle at both ends” in order to appease one overly demanding group of patients by night and risk detriment to others who are entitled to our best efforts by day. Those of us in small groups who toil under these conditions could use some relief. I hope ASA and APSF policy makers are listening and can help in this regard.
TH Parker, Jr., MD