Anesthesiologists being replaced by CRNAs???

Specialties CRNA

Published

I was vacationing in the tropics a few weeks ago and met three handsome Anesthesiologists while sun bathing at the pool. We all chatted a little until the topic of our professions came up. I told them I was starting nursing school (ABSN Program) in a few weeks & how excited I was. I then proceeded further by saying I also hope to pursue a graduate degree as a CRNA or NP (note at this point I had no idea these guys were anesthesiologists). Why did I mentioned becoming a CRNA, b/c the stares I got from all three were nothing but pure EVIL STARES! By their looks I knew I said something wrong but had no idea what it was until they told me they were Anesthesiologists & fear that CRNAs were taking away their jobs at a cheaper price, and with the new health care laws just passed its going to get worst for them. This was totally unexpected 'cause all I planned to do that day was to relax by the poolside & sip pina coladas all day! However, they went on trying to convince me of all the reasons as to why I should not pursue a CRNA career & that eventually the national anesthesia board (not sure if this was the organization they mentioned) was no longer going to certify CRNA training and eventually they'll be no more training because there is no longer a shortage of Anesthesiologists. The shocker of this whole conversation was two of the anesthesiologists mentioned, with conviction, they wish they had pursue a CRNA career instead where they would have accumulated less debt with almost the same income or they wish they had chosen another specialty.

I was pretty shocked hearing these remarks & would love to hear your opinions :)

I agree, I want to hear specifics. I have heard many general statement. Never specifics. Especially the ones about crnas becoming MDA and then saying "the things I never knew". What things? If you want to change crnas opinions you need facts and specifics, not vaque "your not safte". If someone could prove I was unsafe, I would be more than willing to change it.

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Surgeons sign off on us when we don't have an anesthesiologist. But most surgeons will admit they know nothing of anesthesia and depend on us to do that. They are completely clueless to our job, with the exception of some of the trauma surgeons I have worked with--they understand fluid resucitation. Surgeons supervision of us is mainly just for paperwork, they don't actually moniter our actions and intervene. They do surgery. They depend on us to know what we are doing. And the comment of us just being nurses makes it sound like being a nurse automatically makes us uneducated and dangerous. Physicians use this tactic alot when trying to make the public take their side. "oh, but they are nurses, not doctors". Some of the public might think it takes a doctor to know anything, I know better. It is this public opinion I think that is really driving the DNP, then we will be able to say, "I'm a doctor in my field too".

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Something I can't stand is how some anestesiologists will say "do you want a nurse to do your anesthesia". They try to make it sound like the surgeon just started shouting on his was down the hall, hey I need to do a surgery, is there any nurse who wants to jump in and do the anesthetic. Like just any nurse could jump in and do it, making it sound like the nurse has no real training to do it. I am nurse, I also have a graduate degree and am highly trained to do anesthesia. It is demeaning to my profession to make it sound like some untrained nurse might do an anesthetic. I should be referred to as a nurse anesthetist when a mda references us to the public. To tell the public some nurse is doing anesthesia is a form of fear mongering, a political ploy for people who usually have no real evidence to support their claim.

I guess my biggest complaint is it impunes my education and ability to try and lump me in with "just nurses". How would physicians feel if someone kept implying they had the skills of a medical student instead of an experienced physcian in whatever field they were in. That is the best analogy I could think of for this situation. I am very proud to be a nurse, but I do not like it when people use the term to try and take away from my accomplishments. Implying I have no training or education in anesthesia.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Bryan,

You might want to clarify. Maybe in YOUR state the surgeon is consider to be the supervising physician due to Medicare billing requirements, NOT practice requirements. The following states have totally independent practice.

1) Alaska

2) New Mexico

3) New Hampshire

4) Minnesota

5) Nebraska

6) Iowa

7) Kansas

8) North Dakota

9) Oregon

10) Washington

11) Idaho

12) Montana

13) California

14) Colorado

In the other states, the surgeon is considered "supervising" for BILLING medicare ONLY or to meet a few states requirements. This supervision is a general oversight for his patient. They are not anesthesia experts and the states do not expect them to give the orders. BTW, there has never been a case of a surgeon being held liable for a CRNA's malpractice either.

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This 'real nurse's' privileges (according to the medical staff credentialing committee)are as follows:

Administer general anesthetic; administer regional anesthetic including spinal, epidural, ankle block, axillary block, interscalene block, popliteal block, femoral nerve block; Securing airway with ETT, LMA, FOI, etc.;

Insertion of arterial line, central line, PA catheter;

Too many more to list, but it's the same set of privileges granted to the MDAs.

A certain degree bestowed upon someone doesn't inherently include safety...where are you coming up with the 'safer if done by a doc' philosophy? Sounds like wishful thinking but the studies and data banks strongly contradict that line of thinking. I did 2 emergency cases over the past 36 hours...patients are fine, one guy has even gone home! The surgeon is always grateful and pleased! Hospitals want happy surgeons. Whether it's a CRNA or an MDA who provides good service, administration doesn't really care. If I were 'insecure' as you suggest, I would then go back to medical school but I am secure that my education and experience continues to serve me well and make me a safe and vigilant anesthesia provider. It was your insecurity that made you go to medical school. I have worked with a lot of docs who are outstanding and I always take advantage of any learning opportunities from them, simply because they have been doing anesthesia longer than I have. I also gleen any learning opportunities from a very seasoned CRNA, too. There is nothing like years of experience, regardless of your degree. I still think you probably have some regrets of doing the MD route, cramming your brain full of minutia, regurgitating it back on an exam, and forgetting most of it by the time you actually pick up a laryngoscope for the first time as an anesthesia resident. Many docs actually tell me they wouldn't go to med school if they had it to do all over again.

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Your correct, I should have been clear about that. Thanks.

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Having worked on both sides of this equation gives me a unique viewpoint. Surgeons do surgery and I haven't met one who knew beans about anesthesia. CRNA are useful providers, when properly supervised by an anesthesiologist they provide an invaluable service. Trying to "prove" which side is right (anesthesiologist supervised CRNA vs solo CRNA) is a waste of time; it's an opinion and it's a decision that should be left up to the patient.

LOL...please define 'properly supervised'....is it proper supervision when the ologist is in the office on the computer, or even outside going for a jog???

Also, it has already been proven that all models of anesthesia delivery are equally safe. And no, it wasn't a waste of time(your words), as several studies have been done and all point to the same conclusion. That has already been put to rest. Closed claims cases and data banks have been studied ad nauseum...can't argue with the numbers and anyone who does argue with the numbers looks foolish and uninformed.:jester:

Leaving certain medical decisions 'up to the patient' makes no sense, as most lay people are clueless about the intricacies of all the people involved in their perioperative care. As I stated in another post, that's like asking the patient if they want a total knee by Johnson and Johnson or Zimmer and the patient choses JNJ because that's what they have 'heard of'. Do you tell a pt that an RNFA will be suturing/closing the wound and that it's not safe because the RNFA isn't a doctor? Just because the general public has 'heard of' an anesthesiologist or has 'heard of' Johnson and Johnson doesn't mean they are informed to make certain decisions about their care. I have never worked at a facility where the patient is even presented with the option about who administers their anesthesia. Each facility decides what anesthesia model they will have on staff and that's the end of it. The surgeons usually have a big say in that policy-making process. I worked at a place where the surgeons preferred CRNAs, so, no MDAs were on staff; I have also worked at a facility where a few orthopods wanted only docs, so, those surgeons only worked with MDAs. It goes both ways and both ways are safe!:yeah:

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Specializes in CRNA, Finally retired.
Bryan,

You might want to clarify. Maybe in YOUR state the surgeon is consider to be the supervising physician due to Medicare billing requirements, NOT practice requirements. The following states have totally independent practice.

1) Alaska

2) New Mexico

3) New Hampshire

4) Minnesota

5) Nebraska

6) Iowa

7) Kansas

8) North Dakota

9) Oregon

10) Washington

11) Idaho

12) Montana

13) California

14) Colorado

In the other states, the surgeon is considered "supervising" for BILLING medicare ONLY or to meet a few states requirements. This supervision is a general oversight for his patient. They are not anesthesia experts and the states do not expect them to give the orders. BTW, there has never been a case of a surgeon being held liable for a CRNA's malpractice either.

And I'm old enough to remember why these Medicare billing regulations came about. It had nothing to be with "safety" but rather, billing fraud by MDA's who never got out of their street clothes but billed for procedure done by a CRNA.

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patients DESERVE an anestesiologist, not a nurse managing their anesthesia. I was a CRNA before going to med school..............give it a rest......it's not about money, it's about patient safety....................solo CRNA practice isn't safe, we all know that.....

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Specializes in Anesthesia, Pain, Emergency Medicine.

You do understand evidenced based medicine? I would hope so. Here are some peer reviewed studies that contradict what you are saying. BTW, there are NO studies supporting your thesis.

So, IF you are a physician, you might consider looking up evidenced based medicine. I'm sorry the literature does not support your beliefs. Now lets see if you are adult enough to actually research the question yourself.

BTW, think about the thousands of hospitals across the country that have no MDAs, ie; CRNA only anesthesia.

Do you really think that would have been going on for decades if it were unsafe?

Have a nice day,

Ron

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

  1. Brian Dulisse1 and
  2. Jerry Cromwell2,*
  3. doi: 10.1377/hlthaff.2008.0966 Health Aff August 2010 vol. 29 no. 8 1469-1475

  1. Forrest WH

. Outcome: the effect of the provider. In: Hirsch RA, Forrest WH, Orkin FK, Wollman H, editors. Health care delivery in anesthesia. Philadelphia (PA): G.F. Stickley; 1980. p. 137-42.

  1. Simonson DC,
  2. Ahern MM,
  3. Hendryx MS

. Anesthesia staffing and anesthetic complications during cesarean delivery: a retrospective analysis. Nurs Res. 2007;56(1):9-17.

CrossRefMedlineWeb of Science

Study Shows CRNA-Only Anesthesia Delivery Most Cost Effective

Data Show No Difference in Quality or Safety by Anesthesia Provider or Delivery Model

Park Ridge, Ill.--A Certified Registered Nurse Anesthetist (CRNA) acting as the sole anesthesia provider is the most cost effective model of anesthesia delivery, according to a new study conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economics.

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....it's not about money, it's about patient safety....................solo CRNA practice isn't safe, we all know that.....

You keep saying this, but saying it doesn't make it so. Do you have any evidence that CRNA practice is less safe, or producing poorer outcomes, than physician practice?

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The facilities (and there are MANY!) that credential and grant CRNAs privileges don't agree with you! You look like a complete goof when you say 'we all know that'...By the way, who is 'we all'? If you can provide concrete sound evidence, I might be inclined to think you had a point...just because you couldn't hack it in solo practice and felt insecure enough to go back to med school doesn't mean the rest of us in solo practice fall short of being competent providers. Obviously you are feeling the need to justify having to totally repeat an anesthesia career from the very beginning. Look at the time and expense, only to end up in the same place but with a different set of initials after your name! Please disclose who 'we all' is and demystify for all of us your concrete evidence that states MDA involvement in anesthesia delivery is safer...you CAN'T do it and we all know that you know you can't! It has been put to rest, by the way! It continues to be put to rest every year that the data banks are reviewed!

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