How do CRNAs/SRNAs benefit anesthesiology residents? - page 12

by HawaiiRN | 17,586 Views | 118 Comments

I was searching for information on the Wake Forest CRNA program and happened upon this information on the Wake Forest anesthesiology program. Dr. Royster has an interesting view on how CRNA's/SRNAs affect and benefit the... Read More


  1. 0
    Quote from loisane
    .....Let the CRNAs do the cases, and get the ologist if there is a need. This is a way to make the best use of every team members talents and improve efficiency. It would probably solve the provider shortage.....
    Exactly. I've often heard it said that there really is no provider shortage in American anesthesia. Only a maldistribution of providers.

    On the one hand, some folks say, get the docs away from CNBC, off the stock broker hotline, out of the lounge, into the ORs, and onto their own damn stools, doing cases. Not pretending to stupervise. Plenty of providers.

    But of course, for the average consumer to pay doctor-level prices for routine everyday bread and butter anesthesia, that's wasteful. And many MDAs would be bored to tears. Reading golf magazines, leaving the OR, on the phone to the broker anyway, etc.

    In the arcane terminology of third party reimbursement, 'non-medically directed' anesthesia departments such as Loisane describes above are the truly cost effective approach for hospitals. Many entrepreneurial MDAs understand this; they just won't turn loose of their control, as that would clearly show that 'supervision' is in fact nothing more than reimbursement lingo, and that arcane lingo is not now -- nor was it ever intended to be -- proscriptive of any standard of care.

    Listen to Loisane, kiddos; she knows her stuff.

    deepz
  2. 0
    Gaspassah,

    I haven't had a chance to say, but I REALLY appreciate the court cases you posted. I wish I could say that I've had time to look them up, I haven't. I've just been too busy with work stuff recently. I will take a look at some point, just don't know when yet. But thank you for posting those.

    Loisane ... you're right, this discussion has gotten pretty far away from the anesthesia care team topic that it started on. In the very end, I don't know what's going to happen with this model of care. If nothing else, I hope it ends up that CNRAs and anesthesiologists have an amicable relationship. From what I hear, in the private world, this is true.

    I think anesthesiology, from a physician point of view, is going to stress this perioperative role more and more. Right now, the ABA is considering tacking on more time in the ICU during an anesthesiologist's residency. Abroad, many anesthesiologists have to spend a year in ICU training as a part of their residency. A lot of physicians are changing their practices, cardiothoracic surgeons have to contend with interventional cardiologists, general surgeons with GI docs, neurosurgeons with interventional neuroradiologists ... everyone's practice will change eventually.

    I don't really know what's going to happen in our case. I disagree with Deepz, this is not an issue of economics. I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist. As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half. So perhaps in that case, many of you are thinking that the reimbursement will simply drop to half, therefore the health care consumer is only paying half what they were before, to get anesthesia care (in this case, imagine there is no supervision, CRNAs are treated as exact equals to an anesthesiologist). So in this case, if an anesthesiologist does a case, he gets X amount, if a CRNA does a case, they get X amount.

    While I think this sounds like it would be agreeable to CRNAs, you know it would not be. Can you imagine the **** storm that the AANA would create if before, you got paid X to do an anesthetic, but now that nurses and physicians are equal in this matter, you got paid half of X? I just don't see that happening, so I don't think it's an issue of the economics of it all.

    You said you thought there might be cases when the expertise of an anesthesiologist would be needed, but not every case. But which cases? I imagine you wouldn't necessarily know, so that would mean that every hospital in America that performs surgeries should at least have a consultant anesthesiologist on staff, just in case one of those emergencies arises. But every hospital does not have an anesthesiologist, and they'll never get one if the anesthesiologist receives his/her only compensation from consultation.

    As for the leadership of the ASA. I don't really know. I know very little about the attitude of the leadership. From a financial point of view, I'll lead a very good life if supervision of CRNAs in an anesthesia care team stays the predominant model. And I know I'll lead a good life if anesthesiologists are the sole providers of anesthesia care in this country. But if CRNAs are doing all their own cases under a full scope of practice, well, how will this help me? You really just then become my direct competition for employment. The ASA is protecting the practice of anesthesiology for me ... so I wouldn't be reclaiming anesthesiology, I'd just be giving a bigger chunk to you if I tried to vote in a more pro-CRNA leadership. Why would I want to do that?

    Quote from deepz
    Exactly. I've often heard it said that there really is no provider shortage in American anesthesia. Only a maldistribution of providers.

    On the one hand, some folks say, get the docs away from CNBC, off the stock broker hotline, out of the lounge, into the ORs, and onto their own damn stools, doing cases. Not pretending to stupervise. Plenty of providers.

    But of course, for the average consumer to pay doctor-level prices for routine everyday bread and butter anesthesia, that's wasteful. And many MDAs would be bored to tears. Reading golf magazines, leaving the OR, on the phone to the broker anyway, etc.

    In the arcane terminology of third party reimbursement, 'non-medically directed' anesthesia departments such as Loisane describes above are the truly cost effective approach for hospitals. Many entrepreneurial MDAs understand this; they just won't turn loose of their control, as that would clearly show that 'supervision' is in fact nothing more than reimbursement lingo, and that arcane lingo is not now -- nor was it ever intended to be -- proscriptive of any standard of care.

    Listen to Loisane, kiddos; she knows her stuff.

    deepz
    Deepz, I'm not sure you've ever had anything positive or constructive to say in this discussion, if I'm mistaken, I'd hope someone would point it out to me. It's always something negative, it's always a jab at anesthesiologists, the ASA, or AAs, and rarely is it backed up by any kind of real facts or substantial proof. This last message is a great example, you could have made a simple comment about the anesthesia provider shortage and supervision not really being "proscriptive of any standard of care", but you ruined a perfectly reasonable argument with comments about CNBC, golf, and stock brokers.

    Again though, I'm going to agree with you, Loisane makes good posts, people could learn a lot from her approach, including me.

    TD
  3. 0
    Quote from TejasDoc
    Gaspassah,

    I haven't had a chance to say, but I REALLY appreciate the court cases you posted. I wish I could say that I've had time to look them up, I haven't. I've just been too busy with work stuff recently. I will take a look at some point, just don't know when yet. But thank you for posting those.

    Loisane ... you're right, this discussion has gotten pretty far away from the anesthesia care team topic that it started on. In the very end, I don't know what's going to happen with this model of care. If nothing else, I hope it ends up that CNRAs and anesthesiologists have an amicable relationship. From what I hear, in the private world, this is true.

    I think anesthesiology, from a physician point of view, is going to stress this perioperative role more and more. Right now, the ABA is considering tacking on more time in the ICU during an anesthesiologist's residency. Abroad, many anesthesiologists have to spend a year in ICU training as a part of their residency. A lot of physicians are changing their practices, cardiothoracic surgeons have to contend with interventional cardiologists, general surgeons with GI docs, neurosurgeons with interventional neuroradiologists ... everyone's practice will change eventually.

    I don't really know what's going to happen in our case. I disagree with Deepz, this is not an issue of economics. I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist. As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half. So perhaps in that case, many of you are thinking that the reimbursement will simply drop to half, therefore the health care consumer is only paying half what they were before, to get anesthesia care (in this case, imagine there is no supervision, CRNAs are treated as exact equals to an anesthesiologist). So in this case, if an anesthesiologist does a case, he gets X amount, if a CRNA does a case, they get X amount.

    While I think this sounds like it would be agreeable to CRNAs, you know it would not be. Can you imagine the **** storm that the AANA would create if before, you got paid X to do an anesthetic, but now that nurses and physicians are equal in this matter, you got paid half of X? I just don't see that happening, so I don't think it's an issue of the economics of it all.

    You said you thought there might be cases when the expertise of an anesthesiologist would be needed, but not every case. But which cases? I imagine you wouldn't necessarily know, so that would mean that every hospital in America that performs surgeries should at least have a consultant anesthesiologist on staff, just in case one of those emergencies arises. But every hospital does not have an anesthesiologist, and they'll never get one if the anesthesiologist receives his/her only compensation from consultation.

    As for the leadership of the ASA. I don't really know. I know very little about the attitude of the leadership. From a financial point of view, I'll lead a very good life if supervision of CRNAs in an anesthesia care team stays the predominant model. And I know I'll lead a good life if anesthesiologists are the sole providers of anesthesia care in this country. But if CRNAs are doing all their own cases under a full scope of practice, well, how will this help me? You really just then become my direct competition for employment. The ASA is protecting the practice of anesthesiology for me ... so I wouldn't be reclaiming anesthesiology, I'd just be giving a bigger chunk to you if I tried to vote in a more pro-CRNA leadership. Why would I want to do that?



    Deepz, I'm not sure you've ever had anything positive or constructive to say in this discussion, if I'm mistaken, I'd hope someone would point it out to me. It's always something negative, it's always a jab at anesthesiologists, the ASA, or AAs, and rarely is it backed up by any kind of real facts or substantial proof. This last message is a great example, you could have made a simple comment about the anesthesia provider shortage and supervision not really being "proscriptive of any standard of care", but you ruined a perfectly reasonable argument with comments about CNBC, golf, and stock brokers.

    Again though, I'm going to agree with you, Loisane makes good posts, people could learn a lot from her approach, including me.

    TD
    As a CRNA I too am getting tired of the tone of the posts in general. This board is sounding more and more like the studentdoc fourm some love to bash. There are good and bad providers in all aspects of healthcare and the sooner we work to eliminate those and not compete to provide healthcare the better. The Docs that have been here have all been helpful and controversial at the same time. We have managed to drive some of them away as well as some of the experts in our field. I too am not finding much of anything of interest here any longer. I check back from time to time but in general, so long guys and good luck.
  4. 0
    Quote from TejasDoc
    .....I disagree with Deepz, this is not an issue of economics. I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist. As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half. ....
    Well, what can one say about such ignorant speculation? The 50/50 conditions you cite, TD, apply only to Medicare reimbursement. (And you furnish no references!) It appears you might possibly need a bit more experience out in the real world of anesthesia and anesthesia billing before you pontificate about what is cost-effective. You just don't know what you don't know. Sorry.


    [/QUOTE]Deepz, I'm not sure you've ever had anything positive or constructive to say in this discussion, if I'm mistaken, I'd hope someone would point it out to me. It's always something negative, it's always a jab at anesthesiologists, the ASA, or AAs, and rarely is it backed up by any kind of real facts or substantial proof. This last message is a great example, you could have made a simple comment about the anesthesia provider shortage and supervision not really being "proscriptive of any standard of care", but you ruined a perfectly reasonable argument with comments about CNBC, golf, and stock brokers.[/QUOTE]

    Touchy, touchy. What's your HANDICAP? Negativity and snottiness, again, seem to be *your* specialty, doctor. "Point it out" to you? Again, we nurses don't need to *prove* anything to you. Again, we don't need your supervision in order to form and express freely our own opinions. You, sir, are perfectly welcome to delete my every post. You are also welcome to your own opinions (however speculative and uninformed, and I'm sure there might be more appropriate places for you to post them than here) and yet we here are under no obligation to take your posts as anything more than the egoistic voice of inexperience. Again, you post ad hominem attacks. Again, that M-Diety attitude shining through. Enough already.

    !
  5. 0
    As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half.
    i'm not real sure but i think i read it on here once and i looked it up in the medicare website, but i think a crna working independantly can bill and is reimbursed 75% of mda billing. i'm not real sure about this one tho.
    d
  6. 0
    TD
    I have much the same resent (if that’s what you call it) as deepz.(although he is older and wiser) I appreciate that for some fraction of your posts you’ve had a calm tone. I just wanted you to know that I noticed that.
    I want to explain what you call this (golf.. bla bla bla paradigm) from what I saw when I was working in the ICU and the floor.
    Your right that they may not be golfing or checking their stocks but from a nurses standpoint they are ABSENT. As we stand there at the bedside doing the labor of healing, Where are they??? I used to ask myself that every day. He came in and wrote orders. Where is he going now? Oh, he must have other patients to round. on but everyday. He can never stay and help take care of HIS patients? Ever. I never saw a physician paying the price I thought I or any of my colleges were paying physically. So in one light I agree they may not be golfing but one thing is true. They aren’t here at the bedside either. They must be somewhere…. Doing something… and one is left up to his own imagination to speculate where and what exactly they are doing day in and day out whilst their patients sit in a hospital room. I want to see em swing a hammer, pick up a rifle and get muddy if you will. I do think they could earn mine and many others respect.
  7. 0
    Quote from alansmith52
    TD
    Your right that they may not be golfing or checking their stocks but from a nurses standpoint they are ABSENT. As we stand there at the bedside doing the labor of healing, Where are they??? I used to ask myself that every day. He came in and wrote orders. Where is he going now? Oh, he must have other patients to round. on but everyday. He can never stay and help take care of HIS patients? Ever. I never saw a physician paying the price I thought I or any of my colleges were paying physically. So in one light I agree they may not be golfing but one thing is true. They aren’t here at the bedside either. They must be somewhere…. Doing something… and one is left up to his own imagination to speculate where and what exactly they are doing day in and day out whilst their patients sit in a hospital room. I want to see em swing a hammer, pick up a rifle and get muddy if you will. I do think they could earn mine and many others respect.
    At the risk of destroying a cliche....you can't know another one's life until you've walked in his/her moccasins....or something like that. And in the novel tradition of LONG posts:

    The art of nursing derives from our continual contact with the patient over time...hours....sometimes days and even weeks for some patients. We continuously monitor, watch for trends, coordinate therapies....etc. The patient(s) we have are our sole responsiblility for a time limited period, an 8, 10, 12h shift. For anesthesia...we have the luxury of one patient at a time from preop to intraop to postop....that's our one and only responsibility.

    For docs...well, depending on the practice...rounds in the morning, often starting at 0600. An internal medicine doc friend said he averages 10-15 inpatients, sometimes up to 30 during a really bad flu season or covering his partner's patients on a weekend. Hmmm, 10 min/patient X 15 patients = 150 min. That's 2 1/2h alone for MINIMAL assessment of what's going on with a patient. OK, so that's morning rounds...0600-0830. Office hours from 0900-1700. Since it's difficult to fully assess a patient in 10-15 min, the day will probably run over. Most practices shoot for seeing 25-30 patients a day. Not a lot of 'get to really know you' time. The exceptional practitioners are able to do it. Often spending extra time when warranted...ooops, there goes the schedule. Then there's a pile of phone calls from patients, other physicians, nurses, parents, friends at the 'end' of the day. Oh, then there's the return to the hospital (or more facilities depending on where the patients are admitted) to revisit the 'critical' patients. That's probably another hour, at least.

    My point is there's a lot we, as nurses, may not appreciate what goes on in other professions. I am acutely aware of physicians who hit the golf course at 1000 after rounds and breakfast. I'm not that naive. What I wanted to point out was one of, what I view, as a basic difference between medicine and nursing....a diagnosis/pill/treatment and a presence/continual monitoring/always there. That's a broad generalization. The two disciplines cross over in many facets. When it's needed, the doc is there at the bedside for an hour (I hear cyberspace gasps!), but yes, in the ICU environment there's been many times the docs....attendings, fellows, residents, interns, and private practice doctors, have spent long periods of time talking with the patient and family, assessing the overall situation and evaluating what will be the best course for this patient at this time.

    We, as nurses, are assigned 2 patients in ICU, one intubated, 5 IV infusions, comatose, grieving family; second patient, 2 days postop CABG, IABP dc'd that am, sitting up in chair late evening, eating dinner. Really, who are you going to spend more of your time with? And are you going to be called at 0930 after 12h nights to come in and d/c the nipride infusion on the postop carotid? When your shift is done, it's done. This is not including the nit-noid nursing meetings or ACLS or (gasp) narcotics count is off. When you're done with the shift you go home and are not contacted about a patient until you show up for the next shift.

    Not to discount the misbehavior described. I've seen that in action. Yoda the cardiologist (Star Wars to those too young to know who Yoda is; he only looked like him, not near as calming and pleasant of a personality) would throw a HISSY FIT if the charts were not lined up, in order, at 0700 SHARP PRIOR to his arrival in the CICU. Woe be to the newbie who failed to have the chart up there on time....That behavior was uncalled for, and as I grew as an RN in experience, my responses to those individuals was adapted to "the progress notes are in the second drawer under 'progress notes'", and under my breath, same damn place they've been since 1982.


    And before deepz kicks in: this is a post attempting to open minds in the ICU environment.

    For the anesthesia environments I've been exposed to, yes, we had several donut-eating, stock broker watching dead weights who didn't carry their fair share. Group of 8 docs and about 24 CRNAs. Complaints from CRNAs, surgeons, et al, the donut eaters were drummed out of the group. Down to 6 docs, and yes, they are working, involved in the cases, and OMG actually MEETING the 7 TEFRA rules and DOCUMENTING if the 7 TEFRA rules were NOT met! What has this world come to?!! (there's no tongue-in-cheek smilie, we need one)

    PG
  8. 0
    Quote from TejasDoc
    I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist.
    To really address cost, you have to look at "total cost to society". In addition to patterns of reimbursement, you have to look at cost to educate the professional. Our government is very much in the business of offsetting the cost of education for health professionals. So the cost of that education is passed on (at least partially) to all taxpayers. I don't pretend to know enough about how it all works to have specific opinions. But I think it is reasonable for all of us to at least be aware of the complexity of a true cost analysis.

    I know you like sources, so I have a couple for you. I know, you are busy trying to learn medicine/anesthesiology! I suggest the age old method of letting them stack up until you can get to them. (Actually, I think I have only read one of these, in its entirety). I have a few topics of interest, that I keep in mind. Whenever I run across an article, I hang onto it. Used to be that meant making a copy, and throwing it on the ever increasing pile of paper in my office. Now it is easier, if you can find an internet source for full text articles, just save it on your hard drive in alot less space. Or just keep a list of the references, and dig up the articles later. (This is a great way to do a less painful lit search, for any of you interested in doing research someday in your professional life.)

    Anyway, the articles. Both are by Jerry Cromwell PhD, a health economist. He does have AANA affiliations (but I believe we should read everything with a critical eye, regardless).

    Alternative cost-effective anesthesia care teams. Nursing Economics. July/August 2000. 18(4)

    Barriers to achieving a cost-effective workforce mix:Lessons from anesthesiology. Journal of Health Politics, Policy and Law. December 1999. 24(6). 1331-1361.

    Quote from TejasDoc
    As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half.
    But if we limit our theoretical discussion to the ACT, the total reimbursement for the entire case could be considered being paid to the team. The particulars for how it is divided at that point, are probably best left for another discussion.
    Quote from TejasDoc
    You said you thought there might be cases when the expertise of an anesthesiologist would be needed, but not every case. But which cases?
    Each institution would need to make these predictions. This is what health care administrators do (or are supposed to do!) Some places might need one ologist for a suite of 12 rooms. Another place, with lots of high risk patients might need several for 12 rooms. Some places might elect to have CRNAs only.

    These questions are completely appropriate, and very important. I am usually the first one to say "follow the money, it will explain everything".

    So I do not in any way want to discount the role of money in this. But here is one glaring thing about all this that really sticks in my craw. How come we are making decisions about how we will deliver care, based on reimbursement policy? Shouldn't it be the other way around? I think it is all part of a pattern of what is wrong with health care, the bean counters are telling the health care professionals how to take care of patients. The whole thing is backwards!

    I think it would be the greatest thing if nurse anesthesia and anesthesiology could find a way to talk the same language. To put the needs of patients first (I mean on a global/professional level. There is no doubt that this is done on a clinical level, already). Then figure out the absolute best way to deliver care. Then work together to fix reimbursement so it a better match for the reality of how that care is actually delivered.

    Quote from TejasDoc
    From a financial point of view, I'll lead a very good life if supervision of CRNAs in an anesthesia care team stays the predominant model.
    But you will have to jump through the 7 TEFRA hoops, or risk committing fraud. I have worked in such departments. You need LOTS of ologists to be able to keep it up. If you don't have enough, the ologists are running themselves ragged, trying to keep up with all the cases. And they end up attending to details that don't really need their attention. It seems like a tremendous waste of talent, skills, and resources to me.
    Quote from TejasDoc
    But if CRNAs are doing all their own cases under a full scope of practice, well, how will this help me? You really just then become my direct competition for employment.
    If we are comparing two independent practices, this is true. I hope you won't take this as avoidance, but I'm not going to go there. This is complicated enough, just limiting the discussion to ACT function.

    Quote from TejasDoc
    The ASA is protecting the practice of anesthesiology for me ... so I wouldn't be reclaiming anesthesiology,...
    There are innovative ACT functioning with full CRNA scope, I bet they are making money. These ologists, IM(extremely)HO, have found a way to put more "medicine" back in their practices. Hence my reference to "reclaiming anesthesiology". They are focusing on providing the care that they are uniquely qualified to provide-the perioperative medical support. When you carve out an innovative niche for yourself, you don't have to worry so much about competition. The roadblock to more of this, IMHO, is the ASA's definition of nurse anesthesia as delegated medicine.
    Quote from TejasDoc
    I'd just be giving a bigger chunk to you if I tried to vote in a more pro-CRNA leadership. Why would I want to do that?
    Another very good question, to which I wish I had a great, winning answer. I know an answer exits, but it will take me some more personal/professional growth to develop it. I am glad you asked it, because it motivates me to find the answer to it.

    This is the purpose of civilized debate and negotiation. Of course, I wouldn't characterize my suggestion as voting in more pro-CRNA leadership. But obviously, that is how it is perceived. So my challenge, is how can I make you see it the way I do? I need first to see it the way you do. And then we keep talking until we both see it the same way.

    Our professions still have far to go. But I am encouraged by the process.


    loisane crna
  9. 0
    Quote from TejasDoc
    So I'm not really sure, what was wrong with that statement that made? I said absolutely nothing about anesthesiologists or supervision, not a thing. All the things you wrote about have to do with increased knowledge, which is exactly what I was talking about. BUT, since you brought it up. While I can't prove that anesthesiologists are not the reason why anesthesia is so much safer now than 100 years ago, I would be surprised if you can prove that is was NOT anesthesiologists. Like I said, I can't prove it, but I could put forth some arguments that would support the possibility. Anyway, I just had to chime in and say that you're putting words in my mouth or you're not reading my posts carefully enough. Either way, if you're going to call me out about something I've said, I should have said it.



    Why is the word 'order' here in quotes? Does someone actually have to put an order in the chart for anesthesia services to be provided in the states that require physician supervision? Is that the only involvement that they have? If they have to put an actual order in the chart, then I don't understand why 'order' would be in quotes. AND, if they have to put an order in the chart, then I don't understand how they're not liable if something goes wrong and it is determined that anesthesia was at fault. If I'm in the ICU, and I write an order for a dopamine drip, and it is later determined that the dopamine drip killed the patient, I'm screwed. And I wouldn't have administered the drip, the ICU nurse would have administered the drip, but I wrote the order ... sooooooo. But maybe it's a different kind of order, I don't know.



    I don't think we can throw around the word 'order' unless we're talking about a medical order from a physician, as we all know it. From our point of view as health care professionals, physician orders have a very specific meaning, if this isn't the right word, we need to find out what is the right word.

    Countless lawsuits ... but not just lawsuits, countless lawsuits ... so, I need a lawsuit to use as a reference. Just one, something I look up, something that is a matter of record in a court of law here in the United States. What would be even better is the precedent setting case in this matter. But since there are countless numbers of them, any really juicy one will do, but I need a real point of reference.



    I'm glad you also find it hard to believe that all states do not require the services of an anesthesiologist for the provision of anesthesia care. Whew, I didn't think we'd agree on anything. :> Actually, I'm getting the distinct feeling you're not reading my posts. To be totally honest, I don't care. Read my posts, don't read my posts, save 'em, burn 'em, whatever. But if you're going to argue with me about issues that I've already commented on, at least make sure that you're quoting me properly. I didn't say that the states required anesthesiologist supervision, I said some states require PHYSICIAN supervision, and then asked if a physician is in a position to supervise anesthesia care, shouldn't that physician be an anesthesiologist. Now I've said it twice.



    Ok, it's decided, you're not reading a thing I'm writing. I actually wrote out a list of things and said "Let's just call these 'practice priviledges' to make it easy." So why did you ask what I was talking about? I spelled out specifically what I was talking about and called the group of things I was talking about 'practice priviledges'.

    So your post was really just jumping down my case about a bunch of things I didn't actually say. Please let me know if you find those cases, I think they'd make interesting reading.



    Nope, he didn't, he actually did a very bad job. Loisane, you do such a good job posting, your comments are well thought out and well articulated. I'm going to agree with gaspassah on this one and say you've got him beat.

    TD
    My comment concerns the improved safety of anesthesia over the last 100 years: Improved drugs and monitoring! Can you imagine dropping ether and not having pulse oximetry or the other 'standard' monitors we employ today? It's not the arrival of the latecomers, anesthesiologists, to the practice of anesthesia that can take credit for the improved safety. The accumulation of knowledge is huge, leading to evidence-based practice. Did you know that the first anesthetic-related death is from aspiration? Now, patients are NPO based on such data, just as surgical procedures have improved over the years due to better equipment and a huge compilation of data and 'learning from the past'.


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