I think you probably know a lot about this topic than I do, and I respect your expertise (of which I have none on the topic) but what you are claiming is highly debatable:
"EVIDENCE-BASED REVIEW DID NOT FIND NURSE ANESTHETISTS' CARE EQUAL TO THAT OF PHYSICIAN ANESTHESIOLOGISTS
In July 2014, The Cochrane Collaboration published a literature review, "Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients." Of more than 8,000 titles/abstracts screened by the authors, only six articles were included in their qualitative review.1
In this review, the researchers attempt to assess the safety and effectiveness of different models of anesthesia care delivery. The authors properly conclude that, when considered as a group, currently available scientific evidence is unable to answer this question. Although the authors "hoped that this [the review] may lead to an increase in confidence in the skills of NPAs [nurse anesthetists] within the anaesthetic community..." (p. 4), their review provided no such support.
â€¢ No new data were presented.
â€¢ There were no studies that focused on outcomes for high-risk patients.
The American Society of AnesthesiologistsÂ® (ASAÂ®) believes it is time for a new research agenda. Among the questions to be addressed are patient experience measures and outcomes beyond death and complications resulting from anesthesia. We believe no other specialty is positioned better to help answer these questions."
DEVELOPED AND ISSUED BY THE ASA COMMITTEE ON HEALTH POLICY RESEARCH.
"Dr. Jane Fitch, recently elected First Vice President of the American Society of Anesthesiologists, began her career as a nurse anesthetist with a master's degree. Troubled by her limited knowledge compared to the physicians she worked with, she soon went back for eight more years of education-completing medical school, residency, and then a fellowship in cardiac anesthesiology. While she was a nurse anesthetist, "I didn't know how much I didn't know," Dr. Fitch says."
Death within 30 days of admission was determined from the HCFA Vital Status file. Complications (table 3) were identified using a set of 41 events defined by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and CPT (Physician's Current Procedural Terminology, 4th edition) codes available from HCFA databases for the hospital stay of interest, previous hospital stays, and outpatient visits within 3 months before the index hospital stay. CPT codes billed before the hospital stay were used to determine long-standing conditions that would aid in distinguishing complications from comorbidities. Failure-to-rescue rate (FR) was defined as the 30-day death rate in those in whom either a complication developed or who died without a recorded complication. "
"After adjustments for severity of illness and other confounding variables, we found higher mortality and failure-to-rescue rates for patients who underwent operations without medical direction by an anesthesiologist."
Anesthesiologist Direction and Patient Outcomes | Anesthesiology | ASA Publications
I realize the bias involved in Anesthesiologist reports, but my point is that this issue is, and has been, debatable for a long, long time, as you probably are aware. I still side with the CRNA after all is said and done, but I'm not simply going to ignore and write off the research presented from the MDAs. I present this information only because I care so much about the future of CRNAs and anesthesia, and I only want the best outcomes for patients; with all due respect.