Jane Fitch MD, prior CRNA, now Anesthesiologist elected president ASA

allnurses Guide · May 17, 2014

And yet with all this logic not one study conducted by anyone can show a difference between the care from anesthesiologists and the care done by CRNAs.

AnesRN · May 17, 2014

And yet with all this logic not one study conducted by anyone can show a difference between the care from anesthesiologists and the care done by CRNAs.

Haha oh man. Do you understand what axiomatic means? If we become better/more developed as providers with a broader range of clinical experience, so do the MDAs. That logic does not only apply to us. However, because the MDAs have a residency where they train in a variety of settings (ICU, Pulmonology, Cardiology, Nephrology, etc.) where they are the diagnosticians, they are exposed to a larger range of clinical experience. Like i said, I'm not trying to be flippant, but this is elementarily axiomatic. The research by Ms. Kumar backs this up.

allnurses Guide · May 17, 2014

Haha oh man. Do you understand what axiomatic means? If we become better/more developed as providers with a broader range of clinical experience, so do the MDAs. That logic does not only apply to us. However, because the MDAs have a residency where they train in a variety of settings (ICU, Pulmonology, Cardiology, Nephrology, etc.) where they are the diagnosticians, they are exposed to a larger range of clinical experience. Like i said, I'm not trying to be flippant, but this is elementarily axiomatic. The research by Ms. Kumar backs this up.

Then logically by your assumptions then there should have been some differences shown in the care between anesthesiologists and CRNAs by now then.

AnesRN · May 17, 2014

Then logically by your assumptions then there should have been some differences shown in the care between anesthesiologists and CRNAs by now then.

Unfortunately, due to the political hostility fueled by BOTH groups, I don't think we will ever see an unbiased, well designed research study. But, should a study be published in a peer-reviewed, non-biased journal (i.e., Health Affairs, American Journal of Public Health, etc.) I think we could all come to some sort of consensus. However, to say that there should have been some differences shown in the care between anesthesiologists and CRNAs by now, I believe, ignores the fact that it hasn't been truly assessed yet, as mentioned, by an unbiased, well designed research study. If there have been, you are welcome to post links/abstracts/etc., I may well be simply unaware of them.

allnurses Guide · May 17, 2014

Unfortunately, due to the political hostility fueled by BOTH groups, I don't think we will ever see an unbiased, well designed research study. But, should a study be published in a peer-reviewed, non-biased journal (i.e., Health Affairs, American Journal of Public Health, etc.) I think we could all come to some sort of consensus. However, to say that there should have been some differences shown in the care between anesthesiologists and CRNAs by now, I believe, ignores the fact that it hasn't been truly assessed yet, as mentioned, by an unbiased, well designed research study. If there have been, you are welcome to post links/abstracts/etc., I may well be simply unaware of them.

If you are truly a CRNA then all those studies are easily accessible to you either through a simple pubmed, internet, and/or AANA website.

I would also like to see how you came to conclusion that all these studies are poorly designed. Simply saying a study was funded by X group does not automatically make it a poorly designed study, even if was true that all the studies on CRNA safety had been funded by nursing groups which they have not been.

allnurses Guide · May 17, 2014

Quality Care in Anesthesia

SrNaOnMyWaY · Sep 21, 2014

Ok, I have to throw in my 2 cents. Are you serious?? This is your argument? Obviously this longwinded bundle of jealousy isn't going to respond appropriately to whatever information we provide him with, if this is what he thinks goes on. The only classes that are online (in my DNP CRNA program, and I can bet I speak for all of them) are specifically the DNP classes, and they are hybrid. They don't want to waste our precious time making us come to class if we can learn just as well communicating online, and only meet when it is necessary.

Allow me to enlighten you. There aren't any anesthesia classes that are online, which if you focused some of that wasted energy you have on educating yourself before you speak about something so confidently, you would know. The more posts I read from you the less respect I have for you as a person and as an anesthesia provider. We are all professionals and should act and treat each other as such. Now you just sound completely foolish.

I see - so you get a doctorate degree based on courses that tell you to read studies so you'll be a better CRNA? Is that pretty much the gist of it?
"I've read about Swans - I'm sure I could put one in".
"Yes Mr. Smith - Those blocks looked really easy on the youtube video in my DNAP class - I've never done one, but I DO have my doctorate where I read about evidenced based practice, so I'm sure I get do it without too much trouble".

jwk · Sep 21, 2014

Ok, I have to throw in my 2 cents. Are you serious?? This is your argument? Obviously this longwinded bundle of jealousy isn't going to respond appropriately to whatever information we provide him with, if this is what he thinks goes on. The only classes that are online (in my DNP CRNA program, and I can bet I speak for all of them) are specifically the DNP classes, and they are hybrid. They don't want to waste our precious time making us come to class if we can learn just as well communicating online, and only meet when it is necessary.
Allow me to enlighten you. There aren't any anesthesia classes that are online, which if you focused some of that wasted energy you have on educating yourself before you speak about something so confidently, you would know. The more posts I read from you the less respect I have for you as a person and as an anesthesia provider. We are all professionals and should act and treat each other as such. Now you just sound completely foolish.

Try and follow the entire conversation, not just a single post.

MatyIce · Sep 23, 2014

And this, really, is the main point, and the only one that matters. Say, hypothetically, that MDAs have to go through 12 or 20 years of anesthesia residency before they begin practicing. If the data keeps showing that CRNAs are just as safe as these MDAs, we can talk hours and cases and training all day long, it just doesn't matter. The question isn't who spends more time in training, the question is who's training is the most efficient? Who receives the necessary training without wasteful, additional years.
Doctors used to be the only ones who could put in IVs (see reference). Now my techs can do it. Whenever there is a new standard of care set, the market then works to perform that standard as efficiently as possible. Anesthesia is no different. Doctors should continue doing what they do best - reaching for better standards of care. That means researching, inventing, and experimenting. However, attempting to guard current territory in the name of patient safety, in the face of much research negating that argument, is not only unbecoming, but its futile. The market will win. Make all the silly Youtube videos you want about "When seconds count..." The market will win.
History of Intravenous catheters

JWK, you should reread the posts that you conveniently disregard in your argument. You are wrong. Yes, physicians are very well-trained, but so are nurses. The two disciplines come from very different starting points, but this doesn't mean one is better than the other at a specific specialty. I see new docs come out of med school with all their residency training and pathophysiology classes that couldn't hold a candle to a good ICU nurse. I'm not referring to anything fancy either like managing a CABG patient out of surgery. I'm referring to running a code. CRNA's do it just as good as MDA's. We say that nursing will move forward with more attention to research and EBP. Well, the research has been conducted and the proof is there. This is about money. Plain and simple.

SrNaOnMyWaY · Sep 23, 2014

Try and follow the entire conversation, not just a single post.

I did read the entire conversation, if that's what you want to call it. I chose to comment on a single post because otherwise I would be here all day. Trust me, I have plenty to say, but my more experienced colleagues have already beat me to the punch and I just don't see the point in repeating their points.

chemokine · Sep 30, 2014

I wanted to add some perspective on the current state of research on this subject and the biases involved.

A recent literature review was done by the Cochrane Collaboration (a highly regarded independent organization which conducts literature reviews on various medical topics and has no connection to the ASA or AANA). The summary of their work states this:

"No definitive statement can be made about the possible superiority of one type of anaesthesia care over another." See here

The ASA references this review on their website. They state this:

"Nurse anesthetist care not equal to physician anesthesiologist-led care, comprehensive evidence-based review finds, American Society of Anesthesiologists® calls for further examination" See here

So the review says no differences could be found yet the ASA makes an assertive claim that the review found CRNA care to be unequal to that of MD care. This is simply a bold-faced lie.

To be fair, let's see what the AANA has to say:

"Researchers Find No Differences in Care Provided by CRNAs and Anesthesiologists: Cochrane Collaboration" See here

I was disappointed to see this statement since it is also untrue. Funny that this is the exact opposite statement that the ASA made and each organization is claiming these things true while the review itself says neither. To be clear, the research didn't "find no differences" (that would be an assertive claim). Rather the research did not find any differences (nor did it find an equality). This wording is very significant because the logic changes based on it. As soon as you say the "review found" or the "researchers find" then you are not being truthful since the review did not claim to make a finding either way. The review basically said nothing except that it was not able to make any claims on the subject due to insufficient studies out there.

To their credit though, the AANA does eventually state the review conclusion verbatim "No definitive statement can be made about the possible superiority of one type of anesthesia care over another," which I quoted above. The ASA does not ever state the true conclusion.

allnurses Guide · Sep 30, 2014

I wanted to add some perspective on the current state of research on this subject and the biases involved.
A recent literature review was done by the Cochrane Collaboration (a highly regarded independent organization which conducts literature reviews on various medical topics and has no connection to the ASA or AANA). The summary of their work states this:
"No definitive statement can be made about the possible superiority of one type of anaesthesia care over another." See here
The ASA references this review on their website. They state this:
"Nurse anesthetist care not equal to physician anesthesiologist-led care, comprehensive evidence-based review finds, American Society of Anesthesiologists® calls for further examination" See here
So the review says no differences could be found yet the ASA makes an assertive claim that the review found CRNA care to be unequal to that of MD care. This is simply a bold-faced lie.
To be fair, let's see what the AANA has to say:
"Researchers Find No Differences in Care Provided by CRNAs and Anesthesiologists: Cochrane Collaboration" See here
I was disappointed to see this statement since it is also untrue. Funny that this is the exact opposite statement that the ASA made and each organization is claiming these things true while the review itself says neither. To be clear, the research didn't "find no differences" (that would be an assertive claim). Rather the research did not find any differences (nor did it find an equality). This wording is very significant because the logic changes based on it. As soon as you say the "review found" or the "researchers find" then you are not being truthful since the review did not claim to make a finding either way. The review basically said nothing except that it was not able to make any claims on the subject due to insufficient studies out there.
To their credit though, the AANA does eventually state the review conclusion verbatim "No definitive statement can be made about the possible superiority of one type of anesthesia care over another," which I quoted above. The ASA does not ever state the true conclusion.

The Cochrane reviews are basically only good for comparing large randomized trials with similar methods that can compared statistically. Since, we rarely would just assign one patient to one type of provider versus another most of the methods looking at anesthesia providers have utilized other means to look at potential differences.

It is actually harder to do the type of research where you don't randomize patient populations versus large retrospective studies where population characteristics, type of operation, anesthesia practice etc. have to be accounted for.

IMHO, which is backed up by numerous studies, there will never be a study that shows a difference in the two types of independent anesthesia providers.