Originally Posted by jwk
Sidestepping again - that's why I gave the example that CNM's don't do C-Sections.
So you see no difference between an MD who has a fellowship in pain management and a CRNA that's attended a weekend or at best a week-long NAPES course? Politics and money aside, it's the patient that is clearly short-changed in the end.
I see the difference in a Pain Fellow versus any other provider, assuming the completion of a fellowship in an accredited program (relatively few out there, No?). However the fallacy in the argument is as follows: Even within the physician's world, Pain Fellows are not the only ones hanging a shingle out for "pain management".
"Pain management" is currently the domain of many disciplines. I am sure that PMR, Neurology, Physical Therapists, Chiropractic doctors, interventional radiologists and anesthesia providers would probably argue with you that pain fellows are the only ones who can manage pain appropriately. All are trained and educated to manage pain. I am partial to anesthesia providers, whether MD or CRNA, for obvious reasons- but I see the other providers point.
Your comparison of CNM's inability to do C-sections does not hold due to the fact that CNM's are not educated or trained to perform the procedure. All anesthesia providers are trained and educated in pharmacologic pain management, and the rational/indications for usage of the techniques. A skill such as needle placement or intrathecal pump placement can be learned easily.
As for Scope of practice for
any profession, it is defined by 3 things:
1. Professional Association (ASA for the docs and AA's, AANA for the CRNA's)- Usually worded in all sides to prevent limitations to practice. (note- Could jab jwk here- will take the high road.)
2. State legislatures- Medical boards for the docs and AA's, Nursing boards for the NP's/CRNA's ( Usually worded to maximally benefit the population of the state and protect citizenry)
3.)Institutional/Individual Priviledging- Defines the exact procedures that each provider may perform. Here is where the "scope" as most people think about it is defined. (This is where even the docs get limitations. Example- An anesthesiologist may be priviledged to place a central line, but not to place a chest tube if a pneumo is created. Similarly- so that I am not accused of picking on anyone- A general surgeon would not be allowed to perform a craniotomy. And a corporate tax lawyer would not typically be allowed to represent someone for a death penalty case.)
So even though my professional scope will be the practice of all things nurse anesthesia, and a state approves that scope, a facility may restrict my practice by institutional priviledges. So legally-As there has been many a court precedent set- as long as I am performing the anesthesia it is the practice of
nursing and regulated soley by the board of nursing. I will only say this about the LA court ruling- See deepz's post.
Hoping this clarifies the issues a little.
Would you like to comment?
