Authors

  • Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Comments

Ty

RE: "Hours of Boredom"... I practice in a small hospital with three ORs and several surgeons who are fairly busy. In this particular location, I do not have the pleasure of working alongside an anesthesiologist. However I have worked with anesthesiologists in many different settings. The responsibilities, concerns and daily issues are the same for us CRNAs who work independantly with surgeons, as they are for anesthesiologists who work by themselves or who supervise others. Both CRNAs and MDAs have human weaknesses and bad days. We all know those MDAs and CRNAs with whom we would choose to entrust the lives of our own families.

What makes these providers good at what they do has as much to do with compassion and vigilance as it does knowledge and skill. CRNAs are required to read the same texbooks and demonstrate mastery over the same knowledge and skills as do anesthesiologists. There are no studies that show outcomes are better with one provider over another. So why must there be a need to consider the differences between us? The bottom line is the standard of care is the same, no matter which board has licensed the provider. Hopefully the provider is vigilant and is genuinely concerned with the patient's well-being.

mkeamy

Vigilance and compassion are not the exclusive provinces of MD anesthesiologists, it is true, and I will take a diligent and vigilant CRNA over an inattentive MD anesthesiologist every time. Having said that, CRNA's and MD's may have read the same anesthesia textbooks, but my perspective on anesthesiology is a medical perspective; as I have noted on more than 1 occasion, an ICU nurse can render a patient unconscious with a diprivan drip and some vecuronium, so what's the big deal. What an MD anesthesiologist ought to be providing is comprehensive medical management, something that a CRNA is not trained to do. It is too bad that this whole line of discussion devolves to the economic/profane so quickly. I have even found CRNA's on line attacking anesthesia assistants (or whatever they are called) that some "enterprising" MD anesthesiologists are training to give anesthetics cheaper than CRNAs (so they can make more money?). The better argument than CRNAs are equal to MDAs, is that peri-operative medical management has not yet been proven to improve outcome in many categories of cases. Trust me, when I am clipping a cerebral aneurysm in an insulind dependent diabetic with coronary disease who has DI, I'm using a lot of my medical training from IM and my critical care fellowship. I do not practice in the Anesthesia care team mode on purpose; I could make more money, but I always felt the CRNAs with whom I worked to be resentful and some of the MD anesthesiologists became, well lazy... it spoiled the colleagial atmosphere. As I have told my state legislature in the past, perhaps the CRNA's are just a lot smarter than me; I spent 13 years in college, medical school and clinical training, and am still intellectually challenged. Maybe I'm just slow, but maybe I am trained to see deeper into the physiologic and medical situation. What I will tell you is that although I see many loose ends in patients that lazy docs and lesser trained nursing colleagues don't see, I have no data to prove it affects outcomes.
Thanks for your thoughts; enjoy your practice...

Ty

It is unfortunate that the argument ends up how you have so stated. It seems to always come back to an assumption that more years in school equates with more retention of useful knowledge, with the further differentiation of "medical knowledge" from nursing education. Again, the textbooks are the same and the content in them remain the same.

Your reference to ICU nursing is counterproductive to your argument, as there are too many professionals out there who know the reality of what goes on in the SICU/CVICU. In my experience, I had to possess enough understanding of "internal medicine" to interpret invasive monitoring, titrate vasoactive substances, manage controlled ventilation, administer and document response to countless medications and so on. Yes these are tasks, and the "big picture" takes some time to come into focus, but as I recall medical students and most residents were not even permitted in these units without direct supervision, and had limited if any similar experience. They often asked me to explain to them what they were looking at. Most physicians I talk with admit to getting the perspective that you describe sometime after residency.

Yes there is a lot of learning to be had during the CRNA curriculum, and not everyone is given the same assurance of pass/fail. I had a limit of 6 credit hours of "C" grade in my program. But when I provide quality anesthesia for aneurysm clippings, hernias and everything in-between, I am glad for the academic rigor of my program. The rewards of seeing my patients comfortable and satisfied postoperatively are worth it.

Finally, there is no need to try and equate CRNAs with MDAs. The service of anesthesia is worth whatever society decides it to be worth. I can't think of any other profession that deserves more consideration given its responsibilities.


Ty

I apologize for this being left off....

Thank you for the conversation and best wishes to you and to everyone who reads this board.

Ty

Doctor of Record

I found your thoughts in the paragraph disucssing the patient not just being a client interesting. I'm an anesthesiologist and chair of our hospital's ethics committee. I've come across this idea a lot. In our medical system, we seem to forget the humanity of the physician (except his or her fallibility!). As physicians we are like pilots: our job is to travel with you towards a certain goal. What's often lost is the fact we travel with you. We place ourselves at risk with you. It may not be as obvious as with a pilot in flight, but I assure you we risk a piece of ourselves with every encounter. Consider living with the thought you were responsible for someones death (or life!). Or being confronted with reminders of your own mortality on a daily basis. Our humanity as physicians is part of the process. WWW.MORTALITYANDFRIENDS.BLOGSPOT.COM

ED drugs

CRNAs are required to read the same texbooks and demonstrate mastery over the same knowledge and skills as do anesthesiologists. There are no studies that show outcomes are better with one provider over another.

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