Gov't involvement

[Pebbles]

I have been in the healthcare setting for several years now. Over the years I have seen several changes in reguards to job duties. An example: when I worked as a CNA we were not allowed to catheterize or draw blood, now they can (if trained to do so). Another example would be nursing. Years ago nurses use to be able to take two cups of coffee and set down with the patient and discuss their concerns. As we all know this is not the case. It use to be only physicians could care for Centrals. Now nurses are able. Where will this job advancement stop?

The reason I am writing this is:

A physician that I know was on capital hill about a month ago trying to maintain the physicians leadership ability. Currently, the gov't wants to exit the need for Anesthesiologists and fully utilize Nurse anesthetists. If they are successfull, where will this stop?

I am very much for job advancement, but where does it stop? I am concerned that the anesthesiologist may be a thing of the past. I really feel that NA, NP and PA's are excellent resources but there needs to be a physician to lead the team.

What is your opinion?

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[Sherry]

I too am concerned about advanced practice nurses and PAs "overstepping" beyond there limitations. However, CRNAs (certified registered nurse anesthetists) have been aound longer than anesthesiologists believe it or not [see Watchful Care: A History of America's Nurse Anesthetists]. I do not believe they are going away any time soon. They have proven to be very competent and cost effective over and over again...hence the shift. Medicine is a buisness (remember?!?!)

Do not forget that in the OR there is a "Captain of the Ship": the SURGEON. He is ultimately responsible for everything that occurs while on watch. If a surgeon assesses the CRNA as incompetent, then he/she by all means has the right and obligation to excuse him/her from the procedure and can refuse to work with them in the future.

There is no doubt in my mind that anesthesiology is at risk. But think about PAs and NPs in family practice. Does this mean that family practice docs too are at risk (simply rhetorical).

Medicine is certainly evolving. That is why we all need to be active members of our various professional organizaions. We need to be effective in our written and oral communications. We need to support one another as a whole. We need to let our voices be heard at through the ballot box, and support our lobbies with our financial contributions. Otherwise we will have no say in this ever evolving system we love and work so hard to maintain.

 

[1918]

I too wonder about this. Managed care has already led to the blurring of the line between primary care physicians and APRN's (just one example.) You are seeing this in NYC and elsewhere.

If this is a topic of interest, please see the following article in The Journal of the American Medical Association, Jan. 5, 2000, Vol. 283, No.1. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

I fear that this line will continue to get blurred, especially when it comes to PCP's.

I agree that physicians need to be more involved in matters of public policy -- and not simply in a reflexive manner, but proactive.

I am curious to hear others' thoughts on this subject.

[This message has been edited by 1918 (edited 05-24-2000).]

 

[doctor_sig]

Sherry's points are very true. Both my parents are CRNA's, one is primarily in education (though he does work in the OR occasionally) and one purely clinical. They work hard, and have the respect of the surgeons and MDs they work with. They also have the respect of their patients, and my mother in particular is one of the most requested caregivers at the hospital. The letters M.D. do not guarantee superior care or exceptional leadership. If they were that much better, then hospitals would be able to justify the cost to patients of their higher salaries. But the fact is that CRNAs are just as well trained on the anethesia side of things, with even more training in direct patient care, as most have had experience as APRNs before their anesthesia training.

The bottom line of the issue is that this shift will stop when the specialized training for a field cannot be conferred on anyone with less than an MD. If a caregiver is equally competent, but does not have his/her MD, what is the problem. Training is training, whether it results in letters after your name or not. If you know how to render care and can do it effectively and more cost-effectively, why shouldn't you be allowed to practice? There is a kind of Darwinism at work here, like it or not. Those personnel which prove unneccesary are eventually lost, while needed personnel expand to fill the void as needed. You don't need an MD to put someone to sleep, so why should the patient have to pay for one? In case you're wondering, this is coming from one who hopes to be an MD someday.

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Dr. Sig
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