Allow only physicians to be responsible for anesthesia care

Nov 13, 2010 Full story: The Times 35

Unpleasant as it may be, envision a situation in which you or a loved one are about to undergo surgery requiring anesthesia.

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safe anesthesia

Pittsburgh, PA

#21 Dec 14, 2010
maybe I'm a hypocrite physician...I have a brain scan (colonoscopy) scheduled for 0700 tomorrow and a CRNA is standing by (with an anesthesiologist supervising; hopefully somewhere close at hand)..oh the humanity!!! I can get any provider that I want (including the chief of anes) to do my procedure...and I'm letting a nurse (a relative) do it..........
DRBNMD

Cold Lake, Canada

#22 Mar 29, 2011
CRNA wrote:
I have been practicing anesthesia for over 25 years. This discussion has been going on for as long as I can remember. I have been in hospitals that have opted to have only physician anesthetists and within months have recruited the CRNAs back. The only MD approach does not work for many reasons and not appreciating the role each brings to the table misses the point that it is about the patient. CRNAs are competent and do not need supervision. All physicians have specialty MDs to consult with when problems arise and CRNAs do the same every day. The difference is that the specialty MDs don't obtain a fee for the referral as anesthesiologists get a fee for the supervision of CRNAs. For the MDs, it is all about the money.
Oops, too bad the MD-only approach is the only approach in the U.K., Canada, Australia, and New Zealand. The Commonwealth countries manage just fine without CRNA's. Of course, anaesthetists (physicians) in those countries train to higher standards than either CRNA's or MD's in the USA, and cost less than any model used in the United States.

The answer is for MD's in the USA to get off their lazy butts and start doing their jobs, and stop scamming the system. They tied their own noose, and now the US pays more for a lower standard of training than other English-speaking countries.

Plus, "anesthesia providers" in the USA are way too weak and subservient to the surgeons, mainly because they are so busy fighting with each other and downgrading the specialty. Divide and rule.

Vaseline's in the bottom drawer of the anesthesia cart...it'll make it less painful.

As for me, I switched to the British system years ago. Hard to bring myself up to first-world standards, but well worth it in the end.

Have fun rearranging the deck chairs on the Titanic!
stanley

Louisville, KY

#23 Apr 1, 2011
I am so happy for you....KTHANXGBYE
Anesthesia Provider

Winchester, VA

#24 Apr 2, 2011
Stay in England... Away from my patients
visitor

Pittsburgh, PA

#25 Apr 11, 2011
Anesthesia in the UK is provided by phyicians; a huge improvement over the USA system in which any wannabee can be an "anesthesia provider"...gee, if I'm a nurse, I guess that I can be an "anesthesia provider"????? not for me ormy family, no CRNA is doing my case, not by a long shot
Anesthesia Provider

Winchester, VA

#26 Apr 13, 2011
visitor wrote:
Anesthesia in the UK is provided by phyicians; a huge improvement over the USA system in which any wannabee can be an "anesthesia provider"...gee, if I'm a nurse, I guess that I can be an "anesthesia provider"????? not for me ormy family, no CRNA is doing my case, not by a long shot
Nor do I want to...go " visit" a library and do some research on a topic before posting uneducated opinion.
Dr Steven Haen

Pershore, UK

#27 May 4, 2011
I would like to introduce my self as an Australian Mathematician with a possible solution for you all. There is a software system used in Australian Hospitals for anaesthetics / pre operative assessment and recovry that has allowed both the anaesthetic nurse and physician a level playing field. I have no commercial interest as the system was built by the Australian Government to overcome these issues and more. My email is catheve@btintrnet.com if you would like further information?

Kind regards

Steven Haken
LMD wrote:
21 November 2010
Dear Editor,
I am writing to you regarding the recent Op-Ed "Allow Only Physicians to be Responsible for Anesthesia Care" by Ervin Moss, MD, Executive Medical Director,
New Jersey State Society of Anesthesiologists. Dr. Moss's letter is not only offensive to the profession of Certified Registered Nurse Anesthetists, but also contains inaccuracies.
Our extensive didactic and clinical education has been recognized for many years. Yes, we do attend four years of college, and then we must have a minimum of one year of acute care experience (many applicants have significantly more experience), PRIOR to attending a nurse anesthesia program, which is generally another 24-36 months, resulting in a Masters degree. The New Jersey Board of Nursing recognized CRNA's as advanced practice nurses in their regulations in 2009. Many other states had already done so. By law, advanced practice nurses in New Jersey do not work under supervision.
As per our training, certification and scope of practice, we are able to perform various types of anesthesia and we are trained to provide anesthesia to all patients undergoing any surgery in all settings. Many of my colleagues have been deployed and cared for our soldiers and wounded civilians overseas in combat situations, without physician supervision, providing excellent, life saving care.
It is true that anesthesia has become much safer. Much of this improvement is due to improved technology and safety measures, not because " the number of anesthesiologists had increased sufficiently to appropriately control the process". If that were in fact the case, why is there not an increase in morbidity and mortality in areas where there is not anesthesiologist supervision?
Although the current regulations state we must work 'under supervision', the reality is that we work in collaboration with all physicians. Prior to surgery, we discuss the anesthetic needs with the surgeon. Even here in New Jersey, when working with an anesthesiologist, our true working relationship has been one of collaboration, not of supervision. Recent research has demonstrated that there is no significant difference in outcomes whether anesthesia is administered by a Certified Registered Nurse Anesthetist or an Anesthesiologist.
As a Certified Registered Nurse Anesthetist, when I am involved with the care of a patient, I am in the room for the entire procedure unless relieved by another anesthesia provider for a break. During this time, my only focus is on the care of that patient. I am not involved with any other issues. Dr. Moss was correct about the fact that sometimes things do happen requiring the need to make quick decisions. As advanced practice nurses specializing in anesthesia, we are trained to make these quick decisions. In such a situation, there may not be time to wait for the anesthesiologist to come before responding. We also know when we need to call for more expert advice or assistance.
Anesthesiologists do have a very important role. I respect and work well with many of them. This issue is not about replacing them, however, it is about allowing Certified Registered Nurse Anesthetists to practice within their scope of practice which will only serve to enhance care and anesthesia services.
Sincerely,
Linda M. DeLamar, APN, CRNA, MSN, MS, CH, MAJ, USAFR , Retired
Dr Steven Haen

Pershore, UK

#28 May 4, 2011
I would like to introduce my self as an Australian Mathematician with a possible solution for you all. There is a software system used in Australian Hospitals for anaesthetics / pre operative assessment and recovry that has allowed both the anaesthetic nurse and physician a level playing field. I have no commercial interest as the system was built by the Australian Government to overcome these issues and more. My email is catheve@btintrnet.com if you would like further information?
Kind regards
Steven Haken
physician

Pittsburgh, PA

#29 May 17, 2011
you are a nurse and you have clients, physicians have patients. You do not.
Anesthesia Provider

Winchester, VA

#30 May 19, 2011
Physicians are largely whiney, lazy patient herders. I've seen it for years. Let all the CRNAs do the cases and then complain when CRNAs practice independently. NEWS to MDAS... CRNA Only Anesthesia is SAFER than MDA anesthesia because most MDA's supervise and don't actually practice anesthesia. And for those that actually do your own cases... That's fine... But stop the ASA dramatic reimbursement BS regarding CRNAs as unfit. Go to work and stop hating on advanced practice nurse anesthetists... Afterall... You choose a field where CRNAs do the EXACT same job as an MDA... And now you act as though you are better because of 2 letters?!
CRNA Student

Greenville, NC

#31 Jul 16, 2013
Just some facts of where it all started; enjoy.

As of Mortonís demonstration, the physicians most knowledgeable on the subject of anesthesia inevitably were surgeons; there were no physicians specially trained to provide anesthesia. The surgeons, of necessity, relied on their operating room nurses to administer the ether under their direction while they operated. It was undoubtedly Morton and his fellow surgeons who gave the orders, who decided how much ether to use, and who were the proverbial captain of the anesthesia ship.

So it was that nurses became the first professional group to administer ether, then the anesthetic of choice, in the United States, doing so under the surgeonís direction. By the late 1800s, nurse anesthesia had become a recognized nursing specialty, and training, almost entirely empirically in the operating room, began to be available. Ultimately, the process gave rise to the certified registered nurse anesthetist. At that time, a relatively untrained person could manage anesthesia without great misadventure because the primary choice of anesthetic agent in the U.S., ether, both supported respiration and was relatively well tolerated hemodynamically. The surgeon was close at hand and firmly in charge.

Since: Apr 13

Location hidden

#32 Jul 17, 2013
wow this topic has lost its story..
response

Rochester, PA

#33 Aug 14, 2013
and that's why crna are suboptimal when it comes to anesthesia...
Augusto

Grafton, OH

#34 Aug 22, 2013
For myself and my loved ones, I would demand a board-certified anesthesiologist. An RN Anesthesist would be like having an RN cardiolotist instead of a MD cardiologist were I to need a heart operation. I would not like a chiropractor to operate on me instead of an orthopedic MD surgeon either. It about $$$ and I am unconcerned about cost. Cost containment is the concern of Obamacare, hospital bureaucrats and insurance companies. If Anesthesiologists have such a sweet deal, then CR N A should stop whining and get their MD and board certification.
Gas Man

Falls Church, VA

#35 Aug 28, 2013
You'd have a cardiologist perform your heart surgery? Brave soul... I think I'd opt for a cardiac surgeon myself... Apples to oranges my friend, apples to oranges.

And concerning the "$$$", as far as the patient is concerned, the anesthesia is billed at the same rate, be it an MD or a CRNA providing it.

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