This doesnt necessarily have to happen. When I spent 6wks in Europe, I asked the dept chairs at two of the hospitals that I worked at how they managed their CRNAs . In parts of Scandinavia, CRNAs are able to practice independently but two CRNAs have to be present to start and end a case. Not sure why they made it a rule that 2 RNs=1MD but any ways, they both told me that the problem that american anesthesiologists have is that we have yet to fully define the the CRNA scope of practice. By that, I mean we dont limit them. In the hospitals that I worked, they were not allowed to perform any regional, place epidurals or even central lines. One of the hospitals didnt even allow them to place arterial lines. Yes, they learned how to do these procedures in their training but the MDs decided what they did. Some of the attendings wouldnt even allow them to intubate or extubate. Their only role was to push medication and free up the MDs so that they could do other stuff in the hospital. The problem is that we are allowing them to do these procedures. Another thing that I thought was kind of cool was that anesthesiologists placed all invasive lines for the entire hospital. They had a "line room" within the OR area and everything except for IR placed lines were placed by the anesthesiologists. The only overlap with IR was for PICC lines. If they were too busy with other stuff, we placed the lines under fluoro since the room was also used for pain ESIs. Mediports, chemo ports, etc were all placed by anesthesiologists. I just think we as a specialty need to follow our European colleagues who are already under nationalized health care, have the same "problem"(minus AAs, didnt see any over there) yet are still progressing as a specialty. Going there further affirmed my desire to be an anesthesiologist. In Sweden, the anesthesiologist is one of the most highly regarded physician. The med students I met there repeatedly told me that many thought it was as stressful as neurosurgery and it was very competitive to get an anesthesiology residency.
In terms of perioperative physicians, the anesthesiologists there were responsible for not only the PACUs, ORs and ICUs(they are all ICU boarded since residency is 5yrs), but also the surgical floors and ERs. The surgical floors were basically step down units. The surgeons only came to the hospital to operate so we were responsible for medically managing the patients the 1-2 days in step down before going to a hospitalist unit. The ER was different than ours since everything coming to the ER was surgical. The ER was basically two large operating rooms. There were no ED physicians at the hospital. (their urgent care was basically like our EDs). 2 anesthesiologists were assigned to the trauma pager and basically they would wheel the pt from the ambulance or helicopter to the ED operating room. So yes, I would definitely choose this specialty again and if things go sour here, I'll pack up and move to Europe 🙂
