Hello all...
I am a long time reader, and have never been motivated to post before now. I have to admit, I'm exteremely disheartened by all these political threads both here and on SDN about scope of practice of anesthesiology! Make no mistake, I'm the first one to advocate preserving the right to practice for CRNAs, but there is an important factor we are leaving out of these discussions...the patient!
It seems as though these discussions are no longer about what's important. They read very much like a pissing match over "territory" of CRNAs vs. MDs. We need to worry less about our "rights" and our paychecks, and more about the most important person in the OR, the PATIENT!
When it comes right down to it, we all know that when a patient crumps, its GREAT to have a second mind and set of hands there. So I have to ask, what's the big deal about supervision? I for one love the idea of having an MD there to help me out if a patient cant be ventilated, or if they are in sever bronchospasm. I know that the docs feel the same way about me. Again....having that kind of team approach only benefits the patient.
I also think we have to acknowledge one thing. I know some people aren't going to like this, but MDs do have more extensive training and education than us. I for one know that the MD I work with in the heart room knows alot more about managing acute MI than I do, and if a patient starts going ischemic I am GLAD to have him there. If I was having a CABG, I would certainly want MD backup, and I think other CRNAs would be hard pressed to disagree! They supervise us because they should! I work quite frequently on the labor deck at my institution. I know I would be quite put off if RNs suddenly started putting in and managing epidurals. Why? Because they don't have equivalent education! Nonetheless, I believe it would be of benefit to the PATIENT to have the RN there to assist should a probelm arise. And if you're concerned about your paycheck, I have to ask why. It's unfair to refer to MDs as "making $700K off of CRNAs" and the like. First off, I don't know an MD making that much in anesthesia. Regardless, they go through a minimum of 12 years of training...more if they pursue a fellowship. It makes sense that they make more money. They also have a considerable burden of debt...the MD I work with has $250k in loans from undergraduate and med school combined. My debt, and the debt of most CRNAs, does not approach that. bottom line is, we make a nice living doing what we do, and most of us get a huge amount of satisfaction from it without regard to whether or not we are being supervised by an MD.
Getting back to the patient, the most important person(I want to reiterate that): I read all over this forum that there is no evidence that supervised anesthesia is superior outcome-wise to non-superivsed anesthesia. I wish this were true, because it would simplify a complex issue, but it's not. If you check out this article:
http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-200007000-00026.htm;jsessionid=C2Yi8r1TJNa1YQPms0ChEn9pxFt9A19yChuQu6dWGq3PoFadx2Zq!250931426!-949856145!9001!-1
There's a pretty clear advantage to having supervision in the OR in terms of mortality. Don't trust the MDs journal you say? Well, I'm not sure I do either, but there are studies in our own journal that, depending on how you interpret them, you could conclude that there is either no difference OR an advantage to being supervised. Of course, there are problems with these studies, as with all studies, but the BOTTOM LINE is the same....there is a paucity of good evidence, and neither the CRNAs nor the MDs can make any claims either way about outcomes. It's inappropriate, and just not good science at this point in time. And even if there were good science to support unsupervised anesthesia, it would not change the central issue.
Why do I bring up the research? Just to drive home my point again. why does it matter? We should be worried about our patients, not who gets a bigger paycheck or whether or not we are supervised. The same goes for the MDs...however I would caution CRNAs....the MDs appear, to the public at least, to be more interested in patient safety than we are. Has anyone read the recent article in the Wall Street Journal about anesthesiology as a field of medicine? If you haven't you should....
http://webreprints.djreprints.com/1254400029287.html
This article was brought to my attention BY A PATIENT, along with a question about what CRNAs do to improve patient safety. It scared me when I could not answer. In the past, the WSJ has continually criticized anesthesiologists for poor outcomes, publicizing unfortunate and rare cases as routine, and thus making anesthesia practitioners as a whole look bad. With that in mind, I think that this article is a real breakthrough for anesthesiologists. In contrast, our website (AANA) reads like a childish attack on MDs (IMHO). In my opinion, publicizing this type of attitude is not the way to move our initiatives forward.
I'm done. If you took the time to read this long-winded rant, I thank you. I want to emphasize that ALL of the above goes for the "other" side of the conflict as well. I hope they have a similar voice of reason on their forums.
The patient is the important person. Ask yourself this: if you were on the table for a CABG, or if your wife of child was going under the knife, do you want your anesthesia provider thinking solely about the case, or do you want them thinking about how to thwart the MDs? Let's make a good name for ourselves and keep the patient at the center of our attention.
Jon
