Just for the sake of civil discussion here is what i think.
I know anesthesiologists (some of my attendings) that need someone in the room as well and cannot, apparently, practice medicine that well. That comment runs through ALL of medicine and every other profession in existence. How does this prove your point?
I have also saved one CRNA at my institution. 3 of them have saved me and ive seen them save a couple of attendings. Some of my attendings BOAST about how good some of the CRNAs are. One diagnosed a VAE when the attending was scratching his head and another caught a previously undiagnosed core pulmonale on and EKG just this week that a cardiologist apparently cleared and missed as did my attending AND me. This stuff happens all the time. Forgive me if i give them credit for being competent. You seem to choose a couple of bad experiences and decide thats the blanket for their profession, i disagree and its based on my personal experience.
I find Zerwling to be clumsy and comical in those videos (im sure thats why they were chosen to be placed on the PSA website) but what he says is not incorrect in MOST cases. Moreover ive read the issue in PA. It has nothing to DO with anesthesiologist in the room or not, its about the need for a PHYSICIAN of anykind signing the anesthesia record post op. That includes DPMs, DDS, DVMs and DO/MDs surgeons. As far as i can tell this has nothing to do with independence from anesthesiologists at all as they already HAVE IT. Its all about billing and the need for a physician to sign the chart. As it stands, they dont need anesthesiologists to practice in PA (or any other state) in the USA. So the cage rattling about "safety" is a total sham by the PSA since this dosent change the current practice setting in ANY way.
Now, who would i rather doing a big transplant or some complex separation etc? Id likely choose an anesthesiologist. The reason for this is b/c we tend to get MUCH more exposure to these types of cases and the management involved in them than CRNAs do. However thats where i see the main difference.
I believe (as does the rest of mainstream anesthesiology) that CRNAs can provide as good an anesthetic as I can in just about every other instance. We will ALWAYS run the large teaching institutions and the large city hospitals. That will never change. The ACT practice will be the reality in those places forever. I agree that ACTs are the best practice model b/c there will be those 1% cases where the medical knowledge i bring from my time in various rotations will allow me to make a difference in a case where the CRNA cannot. However, if im realistic, I also believe that the same thing would be true if in the case of PAs & NPs. If we were the ones doing everything hands on all the time (lets remove RNs from the ER and ICU as well) then we might make that 1% difference everywhere. Afterall, the PA or NP dosent have my training and all they need is for me to sign their charts ONCE every 6 months without EVER seeing the pt. Yet that isnt done because the difference is irrelevant.
Anyway, thats my personal belief as well as the belief at my institution. If you feel differently your entitled to that but respect the fact that not every anesthesiologist feels the same way as you.
PA Legislature:
Can you think of ANY scenario where an Anesthesiologist would be needed in the room?
ZWERLING:
No. Well, maybe in a teaching hospital where they are needed to train Resident Anesthesiologists.
CASE CLOSED! I have saved CRNA's many times my friend. Without me there would be dozens of dead patients in my area and probably thousands across the USA. This is the reality of the real world outside the political arena CREME. The FACT is your average community college graduate with a BRIDGE To BSN then 28 months at a community hospital becoming a CRNA CAN'T PRACTICE MEDICINE VERY WELL! This means they NEED supervision when working at the BIG medical centers across the USA.
Those of us like JPP and Mil MD work with CRNA's every day. We don't have a beef with the "average" CRNA who recognizes his/her limitations. We have a congenial realtionship with them and recognize each individual's skill set.
But, for any CRNA to claim that ANESTHESIOLOGISTS ARE NEVER NEEDED in the room is a blatant lie.
Anytime Mods please feel free to close this thread as CRNA's like Creme won't EVER admit the truth.
Blade