Hey Everyone, I'm an MS4 and am excited to be starting my anesthesiology residency this June. I've been following the forum for a long time, but now I finally have something I'd like to post to get your comments on. Yesterday, over dinner, my soon to be in-laws were asking me questions about what an anesthesiologist does. One in-law started going on about the stereotypical "sit on a stool and do crossword puzzles" rant. I calmly and professionally educated her about the role of the anesthesiologist and then followed it up by e-mailing the lifelinetomodernmedicine.com link to those involved in our discussion to give a more thorough explanation of what it is an anesthesiologist does. My wife's sister e-mailed me today saying she had looked at the site and commented on an article she ran across about Colorado becoming an opt out state (the article was dated 2010, but she thought it was recent), stating that given she may be moving to CO for graduate school, it was something she would follow. I responded with the below e-mail and shared my opinion on the issue with her.
I expect that over the years I will have many more opportunities to educate people on this highly controversial topic, and I want to be sure I am arguing my point with information which my peers in anesthesiology consider accurate. I would appreciate it if you would comment on what I wrote to her below regarding any inaccuracies or misinformation I may have given so that I don't perpetuate that information in the future. Thanks in advance.
"Hey XXXX,
Thanks for checking it out. Just an FYI, the Colorado legislation you mentioned ended up going through, so nurse anesthetists in CO, along with 15 other states in the US deliver anesthesia without the supervision of a physician. It's both a good and bad thing--good because it allows people to get surgery in rural areas where many physician anesthesiologists would rather not practice or where hospitals can't afford to have anesthesiologists around (quality healthcare costs money, and not all hospitals are created equal in that regard). Allowing certified registered nurse anesthetists (CRNAs) to practice unsupervised does increase access to healthcare in these areas and is thought to be relatively safe. Those in favor of doing what CO did often cite a couple of studies which showed no difference in outcomes when anesthesia is given by a nurse vs. when it is given by a physician. Unfortunately, these studies on which state governments have based their decisions to allow CRNAs to practice without supervision, are not good studies. They are both biased and inadequately designed to support the conclusions that government officials draw from them and a perfect example of the government ignoring experts and making decisions on things they know nothing about. While CRNAs are perfectly capable of handling the delivery of routine anesthesia care, it is when things don't go according to plan that patient's deserve to have an anesthesiologist in the room taking care of them. The discrepancies in training between CRNAs and MDs are just too great to say that CRNAs are equivalent to anesthesiologists in terms of managing life-threatening problems that arise during surgery.
Some argue that allowing CRNAs to practice unsupervised saves healthcare dollars, but this isn't necessarily true because in the states that do allow this to happen, it costs Medicare the same number of dollars to have a CRNA give anesthesia as it does to have an MD give anesthesia. A bill from a CRNA is identical to a bill from an anesthesiologist as far as Medicare is concerned. Patients and the government pay the same amount to each provider. People also argue that it costs more to train an anesthesiologist compared to what it costs to train a CRNA since resident anesthesiologist salaries come from the Medicare budget, which is not the case for CRNAs in training. This is true, it does cost more to train an anesthesiologist, but that is because the training is longer (4 years of residency for an MD vs. 1-2 years of clinical anesthesia training for a CRNA) and more robust, but at the same time, resident anesthesiologists are providing a service to the hospitals in which they work and actually end up being paid what translates into a somewhat low wage when the number of hours worked is considered. Residents actually save hospitals money, because if residents weren't around, hospitals would have to pay more fully licensed physicians to perform the tasks covered by residents. Additionally, the length and expense of training an anesthesiologist translates to much greater clinical experience which then translates into increased patient safety. To say that it costs too much to train an anesthesiologist and that CRNAs with less training can do the same exact job is to say that dollars and cents are more important than patient safety and a patient's right to have the most qualified individual in the room while they are having surgery under anesthesia. And that is essentially what this whole issue--a very controversial one which has been around for years--boils down to. Increased patient safety versus decreased healthcare costs. Personally, I am on the increased patient safety side of the fence, but many of the powers that be (i.e. state governments) aren't.
Sorry for the rant. As a future anesthesiologist, I feel obligated to share "our" side of the story when opportunities arise. I do appreciate you taking a second to check out the website I sent you, as well as your interest in the CO legislation. Now I will put a lid on it."
That's it, end of e-mail. Again, any comments are appreciated.
I expect that over the years I will have many more opportunities to educate people on this highly controversial topic, and I want to be sure I am arguing my point with information which my peers in anesthesiology consider accurate. I would appreciate it if you would comment on what I wrote to her below regarding any inaccuracies or misinformation I may have given so that I don't perpetuate that information in the future. Thanks in advance.
"Hey XXXX,
Thanks for checking it out. Just an FYI, the Colorado legislation you mentioned ended up going through, so nurse anesthetists in CO, along with 15 other states in the US deliver anesthesia without the supervision of a physician. It's both a good and bad thing--good because it allows people to get surgery in rural areas where many physician anesthesiologists would rather not practice or where hospitals can't afford to have anesthesiologists around (quality healthcare costs money, and not all hospitals are created equal in that regard). Allowing certified registered nurse anesthetists (CRNAs) to practice unsupervised does increase access to healthcare in these areas and is thought to be relatively safe. Those in favor of doing what CO did often cite a couple of studies which showed no difference in outcomes when anesthesia is given by a nurse vs. when it is given by a physician. Unfortunately, these studies on which state governments have based their decisions to allow CRNAs to practice without supervision, are not good studies. They are both biased and inadequately designed to support the conclusions that government officials draw from them and a perfect example of the government ignoring experts and making decisions on things they know nothing about. While CRNAs are perfectly capable of handling the delivery of routine anesthesia care, it is when things don't go according to plan that patient's deserve to have an anesthesiologist in the room taking care of them. The discrepancies in training between CRNAs and MDs are just too great to say that CRNAs are equivalent to anesthesiologists in terms of managing life-threatening problems that arise during surgery.
Some argue that allowing CRNAs to practice unsupervised saves healthcare dollars, but this isn't necessarily true because in the states that do allow this to happen, it costs Medicare the same number of dollars to have a CRNA give anesthesia as it does to have an MD give anesthesia. A bill from a CRNA is identical to a bill from an anesthesiologist as far as Medicare is concerned. Patients and the government pay the same amount to each provider. People also argue that it costs more to train an anesthesiologist compared to what it costs to train a CRNA since resident anesthesiologist salaries come from the Medicare budget, which is not the case for CRNAs in training. This is true, it does cost more to train an anesthesiologist, but that is because the training is longer (4 years of residency for an MD vs. 1-2 years of clinical anesthesia training for a CRNA) and more robust, but at the same time, resident anesthesiologists are providing a service to the hospitals in which they work and actually end up being paid what translates into a somewhat low wage when the number of hours worked is considered. Residents actually save hospitals money, because if residents weren't around, hospitals would have to pay more fully licensed physicians to perform the tasks covered by residents. Additionally, the length and expense of training an anesthesiologist translates to much greater clinical experience which then translates into increased patient safety. To say that it costs too much to train an anesthesiologist and that CRNAs with less training can do the same exact job is to say that dollars and cents are more important than patient safety and a patient's right to have the most qualified individual in the room while they are having surgery under anesthesia. And that is essentially what this whole issue--a very controversial one which has been around for years--boils down to. Increased patient safety versus decreased healthcare costs. Personally, I am on the increased patient safety side of the fence, but many of the powers that be (i.e. state governments) aren't.
Sorry for the rant. As a future anesthesiologist, I feel obligated to share "our" side of the story when opportunities arise. I do appreciate you taking a second to check out the website I sent you, as well as your interest in the CO legislation. Now I will put a lid on it."
That's it, end of e-mail. Again, any comments are appreciated.
