Jane Fitch MD, prior CRNA, now Anesthesiologist elected president ASA - page 12

by puppies'n kittens, MSN, DNP, CRNA | 23,675 Views | 116 Comments

Game over people... ASA president... Jane Fitch. Thoughts?... Read More


  1. 1
    Quote from ether511
    Some thoughts from a physician...

    1) The "evidence" vis-a-vis independent CRNAs vs. anesthesiologists: I think there is a lot of misunderstanding in the lay press and also on this forum about the actual significance of research in this area. There are some critical aspects of existing research that, for whatever reason, tend to be overlooked when it comes to interpretation of the data (i.e., claiming something to be "true" based on the "evidence"). First, people on this forum tend to discount the importance of statistical power. The incidence of adverse events in anesthesia is extremely low. This is an important to keep in mind because it means that you need absolutely MASSIVE studies (i.e., ungodly numbers of patients enrolled in studies) to find any statistically significant difference in outcomes. For example, let's say you wanted to study airplane crashes, in particular whether the extent of a pilot's prior aviation training makes any difference in the incidence of airplane crashes. You look at 100 flights--50 were flown by pilots from Top Gun aviation institute (10 years of training) and 50 by pilots who trained at Kickbutt U (5 years of training). You find no difference in outcome. Clearly extent of prior training makes no difference in the incidence of plane crashes! Right? The lay press gets wind of your publication and the headline reads: "Kickbutt U pilots found to be just as safe as Top Gun pilots." Well...not exactly.

    I forgot to mention that the incidence of plane crashes is 1 in 10 million flights (I don't know if that's the actual number, but you get my point). Given the rarity of plane crashes, you realize that you needed exponentially moreflights in your data set to reach any definitive conclusions (i.e., millions of flights most likely). This exemplifies the importance of adequate power in studies. The bottom line is that existing studies on the topic of independent CRNAs vs. anesthesiologists are underpowered to find any conclusive differences in outcomes.

    Second, people on this forum and also the lay press have a tendency to overlook the importance of study design. Retrospective studies don't prove anything! If you want to definitively address a scientific hypothesis in clinical medicine, the gold standard is a prospective, randomized controlled trial. Thus, to address the question (once and for all) whether clinical outcomes differ between independent CRNAs and anesthesiologists, you would have to do the following:

    a) Randomly assign patients to either an anesthesiologist or an independent CRNA, regardless of the experience level of the provider, case, ASA level, etc.
    b) Enroll literally millions of patients into the study.
    c) Have a blinded observer monitor the outcomes of interest.
    d) Neither the ASA nor the AANA can fund the study

    A study of this sort would put the controversy to rest, but you'll never see a study like this arise. Why? Because it would be prohibitively expensive. In addition, I think you may find some institutional review boards will shoot down a study of this sort on ethical grounds alone. One scenario in particular comes to mind: what if a patient presents with, for instance, an ascending aortic dissection, and this patient has unstable angina, an unsecured intracranial aneurysm, a nightmare airway, ARDS, and god knows what other ridiculous comorbidities. The case needs to go to the operating room urgently for repair of the dissection. The patient gets randomized to either: a CRNA fresh out of school or a board certified anesthesiologist right out of residency. Is this randomization ethical? I don't think so.

    2) Differences in the education of anesthesiologists vs. CRNAs: Again, there's a lot of misinformation presented on these forums, which reflects a poor understanding of the education of a physician. For some reason, all of the education that a physician acquires during medical school and internship is summarily dismissed on these forums as clinically irrelevant to the practice of anesthesia. As an attending physician, I find this line of thinking to be a bit ridiculous. What do you think medical students do throughout medical school--use some crayons on fancy coloring books and twiddle our thumbs? How can learning...

    **the anatomy of the heart via dissection in the cadaver lab
    **the physiology and pathophysiology of the heart (in excruciating detail)
    **the epidemiology of heart disease
    **the histology and histopathology of the heart (how the heart looks at the cellular level normally and in various disease states)
    **how to perform a detailed history and physical examination on a patient with heart disease
    **how to take the findings on history and physical to formulate a differential diagnosis
    **how to rationally order tests to clinch the diagnosis
    **how to interpret the results of these tests within the framework of the patient's history and physical examination
    **how to weigh the risks and benefits of various treatments for the patient's diagnosis
    **how to manage any side effects or complications that arise from your treatment recommendations

    ...how can these things not be relevant to the practice of anesthesia? These are the things that physicians learn through the course of medical school and internship. Correct me if I'm wrong, but I think they're exceedingly relevant to the practice of anesthesia.


    In addition, many people on this forum equate the experience of ICU nurses to the experience of doctors in training who rotate through ICUs and the wards. The truth of the matter is that the experience of an ICU nurse is diametrically different from that of a physician rotating through the ICU. It boils down to one simple question: why? The value that physicians bring to ICU environments is the ability to figure out why a patient is experiencing a particular issue, to tease out the etiology of problems in order to treat the patient effectively. Every day on rounds, physicians in training are forced to examine patients, analyze mountains of objective data, and magically arrive at a coherent plan for the day. I have NEVER seen an ICU nurse present overnight events, their findings on examination, pertinent positives in the objective data, their assessment of the situation (i.e., why things are the way they are) and provide a coherent plan to other physicians. I have NEVER heard an ICU nurse get chewed out by the attending physician after staying up for 36 hours straight, because the ICU nurse couldn't remember one item on the differential diagnosis for oliguria. Physicians are expected to perform focused history and physical examinations to generate differential diagnoses, rationally order tests and interpret the data from these tests to clinch the diagnosis, prescribe treatments after weighing risks and benefits, and deal with any problems that arise from these treatments. This is the basic expectation of all physicians in training who rotate through ICUs. It is not the expectation of ICU nurses. Plain and simple.

    There are significant differences in the professional education of CRNAs and anesthesiologists. This is the truth. Any reasonably informed person will acknowledge these obvious differences. Do these differences actually matter for the safe administration of an anesthetic...we don't know the answer to that question with any certainty (and we'll probably never know the answer). But please don't summarily dismiss medical school and internship as largely "irrelevant" formal education. Also, please don't reference all of the "evidence" that CRNAs are equivalent to anesthesiologists as gospel. The research is biased, retrospective, nonrandomized, and underpowered. In effect, the data are inconclusive, which is exactly what the Cochrane review concluded (shocking, isn't it?).
    1. Underpowered: Needleman/Minnick OB study reviewed 1.14 million OB records. Simpson OB study 134k records. Pine Study 404K. No harm found study had 500K cases. There are numerous anesthesia studies that looked not only at mortality, but also at complication rates and not one of them could ever find a significant difference between different provider models (unless you count the fact that at least one found anesthesiologists had worse outcomes). Statisticians are well aware of the need to have extremely large sample sizes to look at different occurrences in anesthesia. This has been accounted for, and physicians can rant and rave all they want, but yet they cannot provide any research of their own showing that they are safer than CRNAs/APNs even though they have the most well funded PACs in the United States. To me that suggests they have done they studies, but refused to release them because they have gotten the same results as every other published study about CRNA safety.

    You make assumptions that are not true with what CRNAs are required to learn and what they are not required to learn.

    1. Yes, I took anatomy in the cadaver lab in CRNA school.
    2. Yes, We all have to take Assessments class.
    3. Yes, CRNAs usually have years of experience of dealing with interpretation of labs even before coming to CRNA school. We get lab interpretation classes as part of curriculum in undergraduate and CRNA school.
    4. Yes, CRNAs take pathophysiology at the undergraduate and graduate level. We get to learn about epidemiology of the heart disease etc.
    5. .........Yes, there isn't one thing you mentioned that we are not taught and often don't have at least some experience with prior to going to CRNA school.


    Physicians so readily dismiss APN training even though the vast majority don't realize what kind of training APNs get, but when APNs state they are just as safe as physicians then we are suddenly dismissing and putting down physician training. That is interesting quandary.
    Most physicians refute all research that shows anything that you don't want to believe in about APNs even though all these APN studies were well powered, have met every pertinent statistical test needed, and have undergone extreme scientific scrutiny.


    Relevance of training and safety are proven through outcome studies, if you don't have them then you don't have anything but a well funded PAC.



    http://www.aana.com/aanaaffiliates/a...2012102009.pdf
    Study in Health Affairs Confirms Quality, Safety of Nurse Anesthetist Care
    Kitesurfing bum likes this.
  2. 1
    Quote from Mully
    Very impressive and objective write-up, Ether511. Opinions aside, you make many valid points.
    Eloquent write up with absolutely no valid points.
    Spoiled1 likes this.
  3. 0
    Some thoughts from an SRNA...

    Well there are some valid points. Take the education of a physician for instance. They go through an amazing amount of education, not only regarding anesthesia, but across many disciplines and practices. This shouldn't be discounted as irrelevant, as I'm sure much of the education the physician received in undergraduate and graduate school later assist them in providing anesthesia.

    And WTB, you make valid points about the education of CRNAs. I'm currently intimately aware of the rigorousness of the nurse anesthesia education as I'm getting my butt handed to me each and every day of the week from it.

    I think one point worth exploring is this though; if the incidence of plane crashes, or patient adverse outcomes are this rare, is the ASA's point that people have a 2 in 10 million chance of dying under the care of a CRNA as opposed to a 1 in 10 million chance with an MDA? (Not actual numbers, but the point remains). I mean, Ether511 said it his/herself - "The incidence of adverse events in anesthesia is extremely low." So with this incidences of adverse events so low, even with hundreds of CRNAs practicing independently throughout the country as we speak, why is it that the MDA is an end-all beat-all essential part of the anesthesia delivery system? For that one in a million patient?

    Even if this type of a statistic were true, which we've concluded is very difficult to prove, good luck proliferating that argument in our capitalistic, cost/benefit analyzing society. It would be like arguing that we should lower the highway speed limits to 30 mph to decrease automotive related deaths. You may be right, deaths may go down, but at what cost to efficiency?

    The truth is, it seems that the adverse affects patients undergo, at least those which are widely publicized, are much more likely to come from ill-preparedness, inattention, and just plain laziness, which span all disciplines. Joan Rivers didn't die because there was an MDA present as opposed to a CRNA. She died from what seems to be poor recognition of a treatable deterioration, something so obvious that someone in another forum said something like "...even an SRNA could recognize".
  4. 0
    Quote from Mully
    Some thoughts from an SRNA...

    Well there are some valid points. Take the education of a physician for instance. They go through an amazing amount of education, not only regarding anesthesia, but across many disciplines and practices. This shouldn't be discounted as irrelevant, as I'm sure much of the education the physician received in undergraduate and graduate school later assist them in providing anesthesia.

    And WTB, you make valid points about the education of CRNAs. I'm currently intimately aware of the rigorousness of the nurse anesthesia education as I'm getting my butt handed to me each and every day of the week from it.

    I think one point worth exploring is this though; if the incidence of plane crashes, or patient adverse outcomes are this rare, is the ASA's point that people have a 2 in 10 million chance of dying under the care of a CRNA as opposed to a 1 in 10 million chance with an MDA? (Not actual numbers, but the point remains). I mean, Ether511 said it his/herself - "The incidence of adverse events in anesthesia is extremely low." So with this incidences of adverse events so low, even with hundreds of CRNAs practicing independently throughout the country as we speak, why is it that the MDA is an end-all beat-all essential part of the anesthesia delivery system? For that one in a million patient?

    Even if this type of a statistic were true, which we've concluded is very difficult to prove, good luck proliferating that argument in our capitalistic, cost/benefit analyzing society. It would be like arguing that we should lower the highway speed limits to 30 mph to decrease automotive related deaths. You may be right, deaths may go down, but at what cost to efficiency?

    The truth is, it seems that the adverse affects patients undergo, at least those which are widely publicized, are much more likely to come from ill-preparedness, inattention, and just plain laziness, which span all disciplines. Joan Rivers didn't die because there was an MDA present as opposed to a CRNA. She died from what seems to be poor recognition of a treatable deterioration, something so obvious that someone in another forum said something like "...even an SRNA could recognize".
    Mortality is only one small part of data that is looked at in these studies. The other parts of these studies are what most physicians like to gloss over or not mention at all.


    "Analytic Methods

    We analyzed two outcomes measures: inpatient mortality and complications. Mortality is reported on the Medicare discharge abstract. To measure possible anesthesia complications, we identified seven relevant patient safety indicators developed by the Agency for Healthcare Research and Quality:15 complications of anesthesia (patient safety indicator 1); death in low-mortality diagnoses (indicator 2); failure to rescue from a complication of an underlying illness or medical care (indicator 4); iatrogenic pneumothorax, or collapsed lung (indicator 6); postoperative physiologic and metabolic derangements, or physical or chemical imbalances in the body (indicator 10); postoperative respiratory failure (indicator 11); and transfusion reaction (indicator 16). (Descriptions of each complication are provided in the online Appendix.)16"
    No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians
    Last edit by NRSKarenRN on Nov 16 : Reason: fixed link
  5. 1
    Quote from wtbcrna
    1. Underpowered: Needleman/Minnick OB study reviewed 1.14 million OB records. Simpson OB study 134k records. Pine Study 404K. No harm found study had 500K cases. There are numerous anesthesia studies that looked not only at mortality, but also at complication rates and not one of them could ever find a significant difference between different provider models (unless you count the fact that at least one found anesthesiologists had worse outcomes). Statisticians are well aware of the need to have extremely large sample sizes to look at different occurrences in anesthesia. This has been accounted for, and physicians can rant and rave all they want, but yet they cannot provide any research of their own showing that they are safer than CRNAs/APNs even though they have the most well funded PACs in the United States. To me that suggests they have done they studies, but refused to release them because they have gotten the same results as every other published study about CRNA safety.

    You make assumptions that are not true with what CRNAs are required to learn and what they are not required to learn.

    1. Yes, I took anatomy in the cadaver lab in CRNA school.
    2. Yes, We all have to take Assessments class.
    3. Yes, CRNAs usually have years of experience of dealing with interpretation of labs even before coming to CRNA school. We get lab interpretation classes as part of curriculum in undergraduate and CRNA school.
    4. Yes, CRNAs take pathophysiology at the undergraduate and graduate level. We get to learn about epidemiology of the heart disease etc.
    5. .........Yes, there isn't one thing you mentioned that we are not taught and often don't have at least some experience with prior to going to CRNA school.


    Physicians so readily dismiss APN training even though the vast majority don't realize what kind of training APNs get, but when APNs state they are just as safe as physicians then we are suddenly dismissing and putting down physician training. That is interesting quandary.
    Most physicians refute all research that shows anything that you don't want to believe in about APNs even though all these APN studies were well powered, have met every pertinent statistical test needed, and have undergone extreme scientific scrutiny.


    Relevance of training and safety are proven through outcome studies, if you don't have them then you don't have anything but a well funded PAC.



    http://www.aana.com/aanaaffiliates/a...2012102009.pdf
    Study in Health Affairs Confirms Quality, Safety of Nurse Anesthetist Care
    A few thoughts:

    1) The data that you reference is RETROSPECTIVE. Please see the body of my initial post. Retrospective data is far inferior to prospective data for the sake of proving scientific hypotheses (in this case, the notion that independent CRNA practice is just as safe as anesthesiologist practice). In fact, retrospective data doesn't prove anything. You need adequately powered, well designed, PROSPECTIVE, RANDOMIZED controlled trials to do that. Even meta-analyses can be crappy. As one of my old surgeon mentors used to tell me: if the data included in a meta-analysis are s&*t, the conclusions will be s*&t.


    2) Even if the trials you mention were prospective, they're not even close to the number of patients needed to find a difference in outcomes, especially for mortality. You would probably need close to 10 million patients in a prospective study to demonstrate any clinically significant difference (i.e., a 50% increase in mortality outcomes), taking into consideration the extraordinarily low incidence of anesthesia-related deaths annually in the modern era (which is roughly 8 deaths per million surgical cases annually). Any idea how much a study that large would cost? An astronomical amount! I don't know of a single prospective trial in recent history--in any field of medicine--with that number of test subjects enrolled.

    3) Yes, statisticians are very aware of statistical power issues, but this awareness (unfortunately) doesn't translate into consistently high quality studies in the literature. Just because a research paper has been vetted by the editorial board of a scientific journal doesn't even remotely mean that it's a high quality study that warrants a change in clinical practice patterns. Journals such as the Lancet, Nature, or the New England Journal of Medicine have very strict criteria for publication and, with very few exceptions, studies published in these high end journals tend to be very well designed and adequately powered to actually change clinical practice. But the majority of other journals have lower standards for publication. Sad but true. You really have to be careful these days in how you interpret published studies. There are so many hidden agendas, biases, and flaws in study design that detract from the validity of authors' conclusions. The Cochrane systematic review committee is one that I trust. If they say that the data are inconclusive--which is exactly what I would expect them to say in a sea of retrospective data--I would trust their assessment much more than any crappy, retrospective study referenced on this forum.

    4) You state that CRNAs take assessment classes. Great. What exactly does that mean? Is it the same skill set that physicians are expected to acquire in their training? Does it involve learning how to perform a history and physical examination, formulate a differential diagnosis, rationally order tests to narrow the differential diagnosis, and interpret those tests within the context of the patient's history and physical examination to arrive at the diagnosis? If so, in what clinical setting is this skill set tested? I've never seen SRNAs, registered nurses, or nursing students rounding on patients on the wards or in the ICU, getting pimped by attendings on the differentials for various disorders, what tests they would order, how they would interpret those tests, etc.

    If you're suggesting that CRNAs receive the same degree of training in clinical assessment as their physician colleagues, then let me get this straight: you're saying that I could take any CRNA out of the operating room, drop them into the middle of a neurology clinic, and--just like a physician--they could evaluate patients, formulate reasonable differential diagnoses, order the right tests, and arrive at the diagnosis? Is that what you're saying? Because when you throw out the term "assessment," that's how I'm interpreting it.

    Based on what I've observed as a medical student, intern, resident in two different specialties of medicine, and a fellow, I have a very hard time believing this. Maybe it was just the institutions that I trained at (quaternary care centers), but what I observed was physicians doing all of the rounding, probing through the seemingly endless data streams on patients, ordering the tests, and synthesizing all the information to arrive at plans. Nurses executed these plans and alerted physicians when any potentially troublesome issues arose on patients. But even with these alerts, it was always up to the physician to figure out what the hell was wrong with the patient and treat accordingly. Even when I was surgical sub specialist in training, I was in charge of the advanced practice nurses when we rounded. I examined the patient in the morning, I listened to the objective data from the intern's report, I reviewed the imaging studies, and (surprise, surprise) I formulated the plan for the day.

    The idea that nurses receive the same training as physicians seems a bit ludicrous to me, because it's totally contrary to everything I've experienced as a trainee and now as an attending. Yes, nurses play an extremely important role in patient care. I always treat the nurses in my clinic with respect and kindness. I appreciate what they do. If anything, I think nurses are under appreciated for the work they do. It's a noble profession. No question about it. But, c'mon man. The training of physicians is very different from the training of nurses, because the expected clinical roles and responsibilities are very different. The average nurse on the wards is not expected to do the same things as the average physician on the wards. On some level, how can you not acknowledge this? It's pretty obvious to me.
    Ready4Nurse likes this.
  6. 1
    Quote from ether511
    A few thoughts:

    1) The data that you reference is RETROSPECTIVE. Please see the body of my initial post. Retrospective data is far inferior to prospective data for the sake of proving scientific hypotheses (in this case, the notion that independent CRNA practice is just as safe as anesthesiologist practice). In fact, retrospective data doesn't prove anything. You need adequately powered, well designed, PROSPECTIVE, RANDOMIZED controlled trials to do that. Even meta-analyses can be crappy. As one of my old surgeon mentors used to tell me: if the data included in a meta-analysis are s&*t, the conclusions will be s*&t.


    2) Even if the trials you mention were prospective, they're not even close to the number of patients needed to find a difference in outcomes, especially for mortality. You would probably need close to 10 million patients in a prospective study to demonstrate any clinically significant difference (i.e., a 50% increase in mortality outcomes), taking into consideration the extraordinarily low incidence of anesthesia-related deaths annually in the modern era (which is roughly 8 deaths per million surgical cases annually). Any idea how much a study that large would cost? An astronomical amount! I don't know of a single prospective trial in recent history--in any field of medicine--with that number of test subjects enrolled.

    3) Yes, statisticians are very aware of statistical power issues, but this awareness (unfortunately) doesn't translate into consistently high quality studies in the literature. Just because a research paper has been vetted by the editorial board of a scientific journal doesn't even remotely mean that it's a high quality study that warrants a change in clinical practice patterns. Journals such as the Lancet, Nature, or the New England Journal of Medicine have very strict criteria for publication and, with very few exceptions, studies published in these high end journals tend to be very well designed and adequately powered to actually change clinical practice. But the majority of other journals have lower standards for publication. Sad but true. You really have to be careful these days in how you interpret published studies. There are so many hidden agendas, biases, and flaws in study design that detract from the validity of authors' conclusions. The Cochrane systematic review committee is one that I trust. If they say that the data are inconclusive--which is exactly what I would expect them to say in a sea of retrospective data--I would trust their assessment much more than any crappy, retrospective study referenced on this forum.

    4) You state that CRNAs take assessment classes. Great. What exactly does that mean? Is it the same skill set that physicians are expected to acquire in their training? Does it involve learning how to perform a history and physical examination, formulate a differential diagnosis, rationally order tests to narrow the differential diagnosis, and interpret those tests within the context of the patient's history and physical examination to arrive at the diagnosis? If so, in what clinical setting is this skill set tested? I've never seen SRNAs, registered nurses, or nursing students rounding on patients on the wards or in the ICU, getting pimped by attendings on the differentials for various disorders, what tests they would order, how they would interpret those tests, etc.

    If you're suggesting that CRNAs receive the same degree of training in clinical assessment as their physician colleagues, then let me get this straight: you're saying that I could take any CRNA out of the operating room, drop them into the middle of a neurology clinic, and--just like a physician--they could evaluate patients, formulate reasonable differential diagnoses, order the right tests, and arrive at the diagnosis? Is that what you're saying? Because when you throw out the term "assessment," that's how I'm interpreting it.

    Based on what I've observed as a medical student, intern, resident in two different specialties of medicine, and a fellow, I have a very hard time believing this. Maybe it was just the institutions that I trained at (quaternary care centers), but what I observed was physicians doing all of the rounding, probing through the seemingly endless data streams on patients, ordering the tests, and synthesizing all the information to arrive at plans. Nurses executed these plans and alerted physicians when any potentially troublesome issues arose on patients. But even with these alerts, it was always up to the physician to figure out what the hell was wrong with the patient and treat accordingly. Even when I was surgical sub specialist in training, I was in charge of the advanced practice nurses when we rounded. I examined the patient in the morning, I listened to the objective data from the intern's report, I reviewed the imaging studies, and (surprise, surprise) I formulated the plan for the day.

    The idea that nurses receive the same training as physicians seems a bit ludicrous to me, because it's totally contrary to everything I've experienced as a trainee and now as an attending. Yes, nurses play an extremely important role in patient care. I always treat the nurses in my clinic with respect and kindness. I appreciate what they do. If anything, I think nurses are under appreciated for the work they do. It's a noble profession. No question about it. But, c'mon man. The training of physicians is very different from the training of nurses, because the expected clinical roles and responsibilities are very different. The average nurse on the wards is not expected to do the same things as the average physician on the wards. On some level, how can you not acknowledge this? It's pretty obvious to me.
    Yes, I know the data is retrospective. That does not automatically make the data worthless or even less than a RCT. These studies are done this way since there isn't a real way to do RCT with this kind of data especially at the scale of hundreds of thousands.
    Stating that RCTs are the only way to "prove" anything is naive and defies most of the scientific literature.
    Again, mortality is only one measure in these studies. I would hope that a physician or any provider doesn't measure their practice by how many patients they do not kill in a day.
    These are some of the top journals in the country that have published these studies. With no lack of academic rigor or quality associated with any one of them. They are also over a variety of journals showing that it isn't bias by an individual journal. This also doesn't cover the fact that state boards of health and federal government commissioned studies have shown similar results.
    I am saying that CRNAs take health assessments classes. They learn to interpret labs and make differential diagnoses. I don't know of any SRNA that hasn't been pimped on what they know or what the differential diagnoses are. The format is sometimes different than the medical model, but it just depends on the training site. The CRNA training model does not as a rule utilize oral boards/preparation as much as the medical model of training.
    CRNAs are specialized to provide care for pre-op, intra-op, and immediately post-operative. CRNAs are not usually (depend on the program since some CRNA programs have ICU provider rotations) trained to provide care outside of those areas, but having worked with physicians and residents for a long time that training varies widely among physicians also.
    You obviously lack a fundamental understanding of what nurses are allowed to do that are not APNs. They cannot provide a medical diagnosis, they cannot prescribe medications, and they are not allowed to formulate a medical plan of care. That means they have to call the provider and have him or her do all those things while they provide the actual care to the patient.
    You are grasping at straws. You have absolutely no research to fall back on, so debate things that you think hold relevance when the research has shown time and again that it does not.
    I never stated that physician and nursing training are the same. I have trained with physicians in their medical school classes and trained with physicians at a combined SRNA/anesthesiology residency site. I have also trained medical students and physicians in clinical anesthesia skills. I realize that there are differences in training, but that still doesn't equate that CRNAs/APNs are less skilled or less safe at taking care of patients than physicians are.

    The roles of CRNAs and MDAs are often exactly the same. The same goes for any APN that works in the same speciality as a physician.

    A ward nurse is not a provider. The ward nurse is also not an ICU nurse. The critical care background is the basis of part of the CRNAs technical and theoretical background before going to CRNA school. It serves a similar purpose as internship for residency.
    Spoiled1 likes this.
  7. 3
    I'm an FNP, not a CRNA, but I work with lots of MDs.

    My question to ether would be, if their training as MDs is SO thorough, why am I constantly catching serious diagnoses (TB, brain tumors) in patients that my MD colleagues have seen and missed within the past few weeks before I see the patient? You bring up that they are supposed to be these amazing diagnosticians and while I have seen some that are, I see just as many that are foolhardy, brash and arrogant that spend 2 minutes speaking to a patient and less than that on an exam before writing orders. While this is only anecdotal, perception is reality. I have residents working with me that will sit and text all day while I attend to their patients. How is this superior care?
    Lev <3, NRSKarenRN, and wtbcrna like this.


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