ahh dg!!! you heard me calling you!!!
soo if mds back in 2001 does a study on cited imperfect billing data (says so in its abstract) and comes to a conclusion and another crna favoring study uses billing information with the same weaknesses (noted in the abstract), how do you come to a conclusion that one is self serving and the other not ? ohh, i forgot to mention you have never seemed to show much in the way of respect for patient choice (reference our previous discussions on nps rating higher satisfaction levels than mds) but now such data is pertinent? well i guess ya gotta use the tool appropriate to the problem. if it's a nail use a hammer, and if it's a screw use a driver. we all do that to one extent or another so i understand completely. now before the flames get hot, i wanna say i really respect your tenacity. you are obviously a very intelligent person and i really appreciate you coming here. gives me the impetus to educate myself and do research.
ohh, before we go on, i'll post a little snippet from the same article you are quoting in the same fashion (just the part i wanna emphasize)
"this was a retrospective analysis based on administrative claims data and is limited by the associated errors inherent in using such data.(billing information on "one" states medicare patients. can't have that!! ohh wait, this is the md study so its ok to use such data) the accuracy of our definitions for anesthesiologist direction (or no direction) is only as reliable as the bills (or lack of bills) submitted by caregivers. we also cannot rule out the possibility that unobserved factors leading to undirected cases were associated with poor hospital support for the undirected anesthetist and patient. local, temporal, even psychologic factors may play a part in patient outcome, and such factors may not be noted in the available data set. for example, if anesthesiologists had a tendency not to submit bills for patients who died within 30 days of admission, our results could be skewed in favor of directed cases. although our clinical experience suggests that this scenario is quite unlikely, we cannot rule out this possibility. we also cannot rule out the possibility that undirected cases occur more often in emergency situations that developed outside of the emergency department"(silber et al, 2000)
"for example, if anesthesiologists had a tendency not to submit bills for patients who died within 30 days of admission" now this just can't be happening. what would be the point? almost as cheap a shot as the description of the crna favoring article in the asa position 1st paragraph.
anywho, what is important is that we can all read english and see from our own point of view. i still have no access to more than the abstract (not gonna pay 12$ for it) so i have yet to pour over the details to gauge the accuracy of the asa critique. it did not cite anything other than the comparison article, a "do you want a doctor or a crna? questionnaire", the old silber, 2000 article, and a article on the state of medical errors which i found quiet provocative and not very complimentary towards physicians or nurses.
matter of fact, i found in that last article what i "think" may be something holding back various medical boards from wanting to look tooooo deep into outcome studies. just imagine if we all had to retake our licensing boards periodically? specialty boards are retaken by board certified physicians and are one path for np specialties (in my state at least) but imagine if mds had to retake medical boards!!! here's an excerpt from the last article(to err is human, building a safer health system, 1999) in the citation of the asa position statement;
"[color=#632423]the iom report called for such licensing bodies
to "implement periodic re-examinations and re-licensing of
doctors, nurses, and other key providers, based on both com-
petence and knowledge of safety practices." 90
no state medical boards require routine testing of skills and
competency. 91 requirements for license renewal are general-
ly limited to continuing education, despite research indicat-
ing that continuing education alone has little or no impact on
practitioner competency. 92 once practitioners earns medical
license, they may never have to demonstrate their medical
competency again. professionals can become incompetent
over time because they don't keep up with current medical
knowledge, they suffer from drug addiction, alcoholism or
mental illness, or they just weren't that good in the first place
and their shortcomings only become evident as they treat
patients day after day. without ongoing testing, these kinds
of problems may not be recognized by licensing agencies
before serious harm occurs"(jewell & mcgiffert, 2009)
wouldn't that be a hoot? anyways i digress.
here is me trying to be conciliatory. when apns stay in their focus specialty, we do a good job (well, i will do a good job). for the same reason, anesthesiologists' defer/refer to im, im defers/refers to pulmonologists, blah blah blah. they do it because the other guy knows his own area more than the other guy. real simple stuff. in the same way, apns are given the load they are familiar with. now of course mds get the more complicated cases. nobody is arguing that (much). the case most of us make is that for the vast majority of patients, that level of training just isn't needed. it's like asking an indy car driver to pilot a school bus. sure he can do it, but is it necessary? (please insert your own analogy here. mine suxs). like the sith emperor shadah the wise, "he became so powerful that the only thing he feared was losing his power". this is a turf war and nothing more. mds don't want to give up control of the whole tree citing that they can pick the most difficult to reach fruit, and nurses don't want to be their lackeys doing the work and not getting the credit and autonomy they deserve as usual. i think zenman coined a provocative statement about looking into the microscope, and the diminishing returns of seeing deeper and deeper... (someone please correct my quote).
wow, i spent way too much time on this again. i need to sleep. got a flight in the am. g'night all.