Are surgeons on the side of anesthesiologists?

[bronx43]

I've heard in the past that surgeons have stuck up for anesthesiologists, because they don't want unsupervised CRNAs in their OR. Is this true? I mean, it does make sense, since CRNAs aren't the only ones responsible should something happen during the procedure. I doubt surgeons want their patients dying in the OR due to some incapable CRNAs.

---

Members don't see this ad.

 

[ProRealDoc]

I've heard in the past that surgeons have stuck up for anesthesiologists, because they don't want unsupervised CRNAs in their OR. Is this true? I mean, it does make sense, since CRNAs aren't the only ones responsible should something happen during the procedure. I doubt surgeons want their patients dying in the OR due to some incapable CRNAs.

Depends on the surgeon. I know of a group where the CT surgeons absolutely refuse to have CRNAs in their ORs and only want anesthesiologists.

 

[GasEmDee]

Depends on the surgeon. I know of a group where the CT surgeons absolutely refuse to have CRNAs in their ORs and only want anesthesiologists.

That has been my experience. The surgeons I have worked with in PP vehemently argue for anesthesiologists, and one even said "you don't just pay anesthesiologists for what they do, but you also pay them for what doesn't happen." I am in an all-MD group, though, and these surgeons have not worked with CRNAs, to my knowledge.

 

[RxBoy]

I've heard in the past that surgeons have stuck up for anesthesiologists, because they don't want unsupervised CRNAs in their OR. Is this true? I mean, it does make sense, since CRNAs aren't the only ones responsible should something happen during the procedure. I doubt surgeons want their patients dying in the OR due to some incapable CRNAs.

I think for the more advanced surgical fields (neuro, ortho, CV, ect.) they would much rather prefer their physician counterpart however I feel some general surgeons actually prefer CRNAs. Main reason isn't because they work hard, but simply because they are more obedient. If the surgeon asks for something, CRNA many times will do it even though it poses harm to the patient because they feel the surgeon knows more. Anesthesiologists have a full understanding of medicine and can legitimately argue their point such as canceling a case, something many surgeons don't like to tolerate.

 

[cfdavid]

Surgeons will support anesthesiologists as long as they feel there is additional value provided by an MD/DO.

In my experience, surgeons are very interested in seeing more anesthesiologists than the typical 4:1 ratio in the area.

But, this is only because of a great group of MD/DO's. It's obvious what they bring to the perioperative table. So, they are in demand. It's that simple.

All is not lost, though we DO need to fight on two fronts. 1) Adding a LOT of value whereever possible (especially when we're up against bogus cost-analyses being put out by the AANA), and 2) becoming more politically active.

cf

 

[Idiopathic]

Surgeons will support anesthesiologists as long as they feel there is additional value provided by an MD/DO.

In my experience, surgeons are very interested in seeing more anesthesiologists than the typical 4:1 ratio in the area.

But, this is only because of a great group of MD/DO's. It's obvious what they bring to the perioperative table. So, they are in demand. It's that simple.

All is not lost, though we DO need to fight on two fronts. 1) Adding a LOT of value whereever possible (especially when we're up against bogus cost-analyses being put out by the AANA), and 2) becoming more politically active.

cf

Hey cf, what exactly is your experience in these matters?

 

[cfdavid]

Hey cf, what exactly is your experience in these matters?

My experience is paying attention which, it seems, too many of the old guard haven't done in a long long time.

If what I said is NOT simply common sense to you, then you have my sympathies.

In the meantime, as others point out, we're faced with serious cost pressures (market forces within healthcare) and pseudoscientific reports coming out of the AANA. In tough economic times, these reports can get the attention of bean counters with dire consequences to the profession.

On one hand, we have CRNAs earning respect (the good ones) of surgeons (perhaps why, as Doze eluded, not ENOUGH surgeons support anesthesiologists, in his opinion). And, it's becoming more and more common to see supervisory-oriented groups as opposed to physician only (or even anything much less than 1:3 or 1:4), as another recent post from someone currently in the market for a job has pointed out.

On the other hand, the variability amongst CRNA's seems to make many surgeons either annoyed, or nervous, or both. Which is a major opportunity for those in, or going into, anesthesiology.

So, do you really want to debate that 1) we MUST add meaningful value to the perioperative process, and 2) we must get more involved in supporting/protecting our rights as a profession?

Really? Because I hate to break it to you, but it takes ZERO experience administering anesthetic in order to make these observations. And, if you think it does, then again, you have my sympathies. Because, it's precisely people with NO experience administering anesthetic whom have an overwhelmingly disproportionate amount of say as to where things go in the future, whether that be the federal government, or hospital administration.

On the other point I made, it's been my experience over the past 4 years (so, I guess that answers your question) as a med student shadowing both surgeons and anesthesiologists, and thus far as a PGY1, that surgeon attitudes towards CRNAs is deteriorating quite a bit due them having such a narrow, protocol driven if you will, mentality/training. More than a few surgeons and surgical residents have commented to me about this....

Again, these are opportunities which our profession can, and must exploit. The details of how to exploit these opportunities can be for another discussion, and I'm very interested in delving into these possibilities going forward. So, Idiopathic, my question to you is are you part of the solution or part of the problem??

cf

 

[Versatil]

I've heard in the past that surgeons have stuck up for anesthesiologists, because they don't want unsupervised CRNAs in their OR. Is this true? I mean, it does make sense, since CRNAs aren't the only ones responsible should something happen during the procedure. I doubt surgeons want their patients dying in the OR due to some incapable CRNAs.

Are surgeons on the side of anesthesiologists?
Not at all, almost like everybody. They all hate us. The surgeons order of canada doesn't recognize anesthesiology as a whole speciality. For them, we're almost still at the stage of general practitioner. But we gain more ground everyday. One day, anesthesiologists will be considered as a full speciality and we're going to be listened this time.

 

[Idiopathic]

My experience is paying attention which, it seems, too many of the old guard haven't done in a long long time.

If what I said is NOT simply common sense to you, then you have my sympathies.

In the meantime, as others point out, we're faced with serious cost pressures (market forces within healthcare) and pseudoscientific reports coming out of the AANA. In tough economic times, these reports can get the attention of bean counters with dire consequences to the profession.

On one hand, we have CRNAs earning respect (the good ones) of surgeons (perhaps why, as Doze eluded, not ENOUGH surgeons support anesthesiologists, in his opinion). And, it's becoming more and more common to see supervisory-oriented groups as opposed to physician only (or even anything much less than 1:3 or 1:4), as another recent post from someone currently in the market for a job has pointed out.

On the other hand, the variability amongst CRNA's seems to make many surgeons either annoyed, or nervous, or both. Which is a major opportunity for those in, or going into, anesthesiology.

So, do you really want to debate that 1) we MUST add meaningful value to the perioperative process, and 2) we must get more involved in supporting/protecting our rights as a profession?

Really? Because I hate to break it to you, but it takes ZERO experience administering anesthetic in order to make these observations. And, if you think it does, then again, you have my sympathies. Because, it's precisely people with NO experience administering anesthetic whom have an overwhelmingly disproportionate amount of say as to where things go in the future, whether that be the federal government, or hospital administration.

On the other point I made, it's been my experience over the past 4 years (so, I guess that answers your question) as a med student shadowing both surgeons and anesthesiologists, and thus far as a PGY1, that surgeon attitudes towards CRNAs is deteriorating quite a bit due them having such a narrow, protocol driven if you will, mentality/training. More than a few surgeons and surgical residents have commented to me about this....

Again, these are opportunities which our profession can, and must exploit. The details of how to exploit these opportunities can be for another discussion, and I'm very interested in delving into these possibilities going forward. So, Idiopathic, my question to you is are you part of the solution or part of the problem??

cf

okay so your experience is from these forums...just wanted to clarify.

are we talking about academic centers or private practice surgery centers? younger surgeons or more experienced ones? it doesnt take a medical degree to deliver anesthesia to ASA1 or 2 patients all day for knee scopes and cataracts and mammoplasty and to argue that it does just doesnt fly anymore. THAT HORSE IS OUT OF THE BARN. Those surgeons want to see what they see every day, whether thats a CRNA with an attending nearby, a solo attending, a senior resident...whatever, they just want consistency. (admittedly this changes when you encounter a problem, but we made anesthesia so darn safe...)

I think your assessment of surgeons and CRNAs in private practice is dead wrong. They dont care who is behind the drapes as long as things go smooth. Many PP surgeons contract with groups, get used to providers and if you told them "hey John who youve been working with for 2 years is a CRNA, wed like to bring in an MD anesthesiologist instead" do you think they would respond with "thank god, my patients and I have been suffering through this ordeal for so long". Doubtful. Do these surgeons want MDs who try different varieties of anesthetic delivery on a whim? Or do they want regimented (dare I say, protocol driven?) care that is not fundamentally different from patient to patient. (2+2, LMA, des, zofran, eat, pee, good-bye, lather, rinse, repeat)

I just think you should experience the dynamic before you claim to appreciate all the nuances. Assuming that surgeons naturally would rather have MD-run cases may be shortsighted, and lets not forget, there are plenty of MDs that dont want to do their own cases...does that hurt or help the cause? Can we really fix the true problem when people are so used to the system and the only ones who are gaining power are the technicians who deliver the care? Honestly, tell me what is the fight - to get rid of CRNAs (will never happen) or to stop their progression where it is, or to scale it back. Id love to get rid of opt-out provisions but there will need to be a disaster of epidemic proportions (not likely) before that happens, or costs will have to converge to the point that there will be no incentive to use CRNAs (nobody wants that), so where does this 'change' come from?

Im as nervous as you are about the future. I have no idea where the change will come from, but Im not optimistic that its going to come from a regression of the current system. Im trying to make myself better, in the meantime.

 

[Idiopathic]

Id also like to ask you what you think our "rights" are as physicians? No sarcasm intended with that statement, just curious.

 

[Coastie]

okay so your experience is from these forums...just wanted to clarify.

are we talking about academic centers or private practice surgery centers? younger surgeons or more experienced ones? it doesnt take a medical degree to deliver anesthesia to ASA1 or 2 patients all day for knee scopes and cataracts and mammoplasty and to argue that it does just doesnt fly anymore. THAT HORSE IS OUT OF THE BARN. Those surgeons want to see what they see every day, whether thats a CRNA with an attending nearby, a solo attending, a senior resident...whatever, they just want consistency. (admittedly this changes when you encounter a problem, but we made anesthesia so darn safe...)

I think your assessment of surgeons and CRNAs in private practice is dead wrong. They dont care who is behind the drapes as long as things go smooth. Many PP surgeons contract with groups, get used to providers and if you told them "hey John who youve been working with for 2 years is a CRNA, wed like to bring in an MD anesthesiologist instead" do you think they would respond with "thank god, my patients and I have been suffering through this ordeal for so long". Doubtful. Do these surgeons want MDs who try different varieties of anesthetic delivery on a whim? Or do they want regimented (dare I say, protocol driven?) care that is not fundamentally different from patient to patient. (2+2, LMA, des, zofran, eat, pee, good-bye, lather, rinse, repeat)

I just think you should experience the dynamic before you claim to appreciate all the nuances. Assuming that surgeons naturally would rather have MD-run cases may be shortsighted, and lets not forget, there are plenty of MDs that dont want to do their own cases...does that hurt or help the cause? Can we really fix the true problem when people are so used to the system and the only ones who are gaining power are the technicians who deliver the care? Honestly, tell me what is the fight - to get rid of CRNAs (will never happen) or to stop their progression where it is, or to scale it back. Id love to get rid of opt-out provisions but there will need to be a disaster of epidemic proportions (not likely) before that happens, or costs will have to converge to the point that there will be no incentive to use CRNAs (nobody wants that), so where does this 'change' come from?

Im as nervous as you are about the future. I have no idea where the change will come from, but Im not optimistic that its going to come from a regression of the current system. Im trying to make myself better, in the meantime.

So, we should just take ASA 3/4 patients? Just hearts? Just sick pedi? Abandon the OR?

What kind of degree does is take to do "standard cases" on ASA 1/2 pts?

It's like the fam med guys. Give the "chip shots" to the nurses, leaving the docs with less and less. "Protocolize" the "easy" cases..Sounds like a slippery slope to me.

The horse isn't out of the barn unless we give it up to the nurses. Do you want non-physicians practicing any sort of medicine without a license?

I recommend we move this thread to the private forum where physicians can discuss the issue.

 

[Sergio99]

Hello,

In my experience, which may not be the same as yours, I have seen a few surgeons who like us, like working with us, respect us and would never do a case of any kind with a CRNA, but as I said, they are only "a few." The vast majority don't care who stands at the head of the table, as long as he or she is alive, checks the vitals and gives relaxants, and a not too big but sizable proportion would much rather have a CRNA because CRNAs are more obedient and make the surgeon feel more important.

Greetings

 

[cfdavid]

okay so your experience is from these forums...just wanted to clarify.

are we talking about academic centers or private practice surgery centers? younger surgeons or more experienced ones? it doesnt take a medical degree to deliver anesthesia to ASA1 or 2 patients all day for knee scopes and cataracts and mammoplasty and to argue that it does just doesnt fly anymore. THAT HORSE IS OUT OF THE BARN. Those surgeons want to see what they see every day, whether thats a CRNA with an attending nearby, a solo attending, a senior resident...whatever, they just want consistency. (admittedly this changes when you encounter a problem, but we made anesthesia so darn safe...)

I think your assessment of surgeons and CRNAs in private practice is dead wrong. They dont care who is behind the drapes as long as things go smooth. Many PP surgeons contract with groups, get used to providers and if you told them "hey John who youve been working with for 2 years is a CRNA, wed like to bring in an MD anesthesiologist instead" do you think they would respond with "thank god, my patients and I have been suffering through this ordeal for so long". Doubtful. Do these surgeons want MDs who try different varieties of anesthetic delivery on a whim? Or do they want regimented (dare I say, protocol driven?) care that is not fundamentally different from patient to patient. (2+2, LMA, des, zofran, eat, pee, good-bye, lather, rinse, repeat)

I just think you should experience the dynamic before you claim to appreciate all the nuances. Assuming that surgeons naturally would rather have MD-run cases may be shortsighted, and lets not forget, there are plenty of MDs that dont want to do their own cases...does that hurt or help the cause? Can we really fix the true problem when people are so used to the system and the only ones who are gaining power are the technicians who deliver the care? Honestly, tell me what is the fight - to get rid of CRNAs (will never happen) or to stop their progression where it is, or to scale it back. Id love to get rid of opt-out provisions but there will need to be a disaster of epidemic proportions (not likely) before that happens, or costs will have to converge to the point that there will be no incentive to use CRNAs (nobody wants that), so where does this 'change' come from?

Im as nervous as you are about the future. I have no idea where the change will come from, but Im not optimistic that its going to come from a regression of the current system. Im trying to make myself better, in the meantime.

You would certainly know the bold more so than I. I'll admit that readily. However, it's also possible that my "distance" from the OR (until June) has afforded me, and others, with a different perspective. I'm an anesthesiology resident in the SICU this month. I'm interacting with a lot of surgeons. Some have made statements suggesting that they DO value a physician anesthesiologist. Other experiences, even during med school surgery rotations suggest the same.

I believe these are opportunities. Are there challenges? Sure, but they can be overcome. I have many ideas on how this can be done. It all starts there. We should pick back up on these topics in the private forum.

cf

 

[Winged Scapula]

It depends on the surgeon and what their motivation is.

For example, my partner and I both have privileges at a local hospital. I stopped going there when they fired the house group (all MD/DO) and hired a group heavy with CRNAs. I refused to use the CRNAs because I want better care for my patients (even if they are typically seen as easy cases) and because I felt that the house gas group was treated unfairly. Besides I couldn't stand looking at the flowered jackets the CRNAs wore in the OR.

However, my partner hasn't stopped operating there. While she admits she would prefer an anesthesiologist, she prefers this hospital because she's been going there so long that its just easier for her - the staff knows what she wants, how she wants it, etc.

Its surgeons like her that you need to really sell yourself on because as long as everything else goes well, they will not see the benefit you provide or make any effort to change things.

But believe me, at least amongst my peers, there are plenty who feel the way I do.

 

[Consigliere]

It depends on the surgeon and what their motivation is.

For example, my partner and I both have privileges at a local hospital. I stopped going there when they fired the house group (all MD/DO) and hired a group heavy with CRNAs. I refused to use the CRNAs because I want better care for my patients (even if they are typically seen as easy cases) and because I felt that the house gas group was treated unfairly. Besides I couldn't stand looking at the flowered jackets the CRNAs wore in the OR.

However, my partner hasn't stopped operating there. While she admits she would prefer an anesthesiologist, she prefers this hospital because she's been going there so long that its just easier for her - the staff knows what she wants, how she wants it, etc.

Its surgeons like her that you need to really sell yourself on because as long as everything else goes well, they will not see the benefit you provide or make any effort to change things.

But believe me, at least amongst my peers, there are plenty who feel the way I do.

EXCELLENT!

 

[drmwvr]

I've heard in the past that surgeons have stuck up for anesthesiologists, because they don't want unsupervised CRNAs in their OR. Is this true?
....

Whatever surgeons want, it is for the benefit of their own ends and no one else's. If you are the beneficiary of what works for them, good for you. What works for them, however, changes as they become more accustomed to what they've been pacified with. Anesthesiologists are tools in the hands of surgeons and if it is to their benefit to pitch us under the lorrie to acheive their ends, they won't think twice. Hospital administrators in the States are very well aware of this and are more than happy to oblige. We have no friends but each other. Cheers!

 

[Stank811]

At our academic facility the anesthesiologist continue to gain popularity in regards to critical care. The SICU is both surgical and anesthesiology run but several of the specialized surgical teams will be sending their patients to a separate surgical ICU to be staffed only by anesthesiologist because they prefer our patient management compared to surgery or pulmonary critical care. Hope to continue to see a similar trend at our institute and others because it can only help our cause in the long run in my opinion.

 

[cfdavid]

At our academic facility the anesthesiologist continue to gain popularity in regards to critical care. The SICU is both surgical and anesthesiology run but several of the specialized surgical teams will be sending their patients to a separate surgical ICU to be staffed only by anesthesiologist because they prefer our patient management compared to surgery or pulmonary critical care. Hope to continue to see a similar trend at our institute and others because it can only help our cause in the long run in my opinion.

These are huge opportunities for our profession. We need to capitalize on them.

I almost frigging puked today as I was working up a case of hypernatremia in the SICU. It's an open unit, so that's exactly the kind of stuff that the primary teams are NOT going to do, but we should.

Can sodium/water balance be a difficult topic? Sure. But, it's f.cking medicine!!! One should know their limits, but I always thought that MD stood for Doctor of Medicine...... I'm sitting there working up this guys water deficit to be given via his NJ tube, walk over to the nurse to find out HOW she's going to give the free water I'm recommending, and she says "Oh, Dr. X (nephro) just gave me the order".

WTF??? That's total BS. But, the bigger point is that we NEED to know medicine and NOT be afraid to work up medical issues. Jesus Christ.

And, it was the surgical NP who wrote the consult. Sure, that could be blamed on the NP, but frankly, the surgeons aren't going to spend time (or maybe even have the skills anymore) to play around with that stuff.

So, here we are in an open unit, and we're consulting nephro for a straightforward case of hypernatremia. Wow.

I've said it before and I'll say it again, surgeons have a broad skill set. Especially the general/trauma guys. But, they DO have shortcomings, for sure. These, we must "exploit". Not to be antagonistic towards our surgical colleagues, but rather to FILL A VOID in knowledge.

Don't you all think that a surgeon would look very differently at an anesthesiologist if he/she KNEW that we could take those problems off of their hands?

Do you know how often we consult cardiology in the ICU for A-fib?? It's ridiculous. Seriously, I support getting them involved for follow up, and for the more refractory cases. But starting a cardizem drip, or amio for that matter isn't exactly something requiring a cardiologist. Sure, as an OP, the cards dudes can tweak the meds, attempt cardioversion, and manage/determine long-term anticoagulation.

We clearly over consult, and I think my institution isn't alone in this. It's costly, and this is a void that an anesthesiologist can fill, at least in the SICU.

Sure, the OR is different, but even then, having the skills that the surgeons DON'T have ADDS VALUE.

cf