Based on years of experience in anesthesiology, doing more complex cases than you will ever do in your life. 99.5% of anesthetics are technicians work, period. AAs and CRNAs believe they can do exactly what you do, and for the most part, they are right. It is primarily a technical skill...a technician.
As an anesthesiology attending at a major university, after several years I decided to try an experiment. Gave 100 adult patients, inpatients and outpatients, exactly the same doses of fentanyl, propofol, tracrium (racemic atracurium for the nubes), intubate, and adjusted desfluorane. No other drugs, no other interventions, no extra lines, no extra monitoring. All 100 did exactly the same...a perfect outcome without significant fluxuations in vital signs, had no end organ damage, and were happy with the anesthetic.
In anesthesia, you bat 1000 all the time.
The anesthesiologists and public become so insouciant regarding the accepted level of risk as being close to zero, that when there is a rare death or serious injury, it can make local if not regional news. Anesthesiology has virtually nothing to do with the treatment of chronic pain. The early pain physicians were anesthesiologists because they knew a little about local anesthetics, IV narcotics (no training in oral narcotics, sorry), and blind regional blocks.
These techniques work well for the acute pain patient but are of little value to the chronic pain physician, and the specialty of pain rapidly evolved away from the anesthesiology model and their 100% success rate. Pain physicians embraced and developed the skills of surgeons, internal medicine physicians, orthopedists, psychiatrists, PMR, and rheumatologists, all areas in which anesthesiologists have little training or skills. The populations we treat are different, the scope of practice is different, the skill sets are different, and the decision making is far more advanced.
Don't get me wrong- there is nothing wrong with being a technician. It provides an excellent income and a fairly decent lifestyle. And technicians are certainly needed in medicine. But for the most part, if an anesthesiologist never read any journal articles, performed any research, did any CME, or advanced their skills in any way, they would have the skills at the time of finishing residency to provide a lifetime of care for their patients with virtually equal outcomes.
Of course there are exceptions, but these depend largely on the work environment....those doing liver transplants are anything but technicians. But the enormous safety of anesthesia overall is more a function of the advances in the medications, monitoring, and relative standardization of techniques and diagnosis rather than due to the superlative skills and mental prowess of anesthesiologists.
CRNAs have virtually equal outcomes despite their lack of doing anything useful to advance the research in the field over the past 100 years and in spite of their whiney shift work mentality. Being an anesthesiologist is working at the behest of someone else to which the patient comes for care. People do not come to anesthesiologist to provide long term medication care or monitoring, for a surgical solution to their problem, or to enhance their function.
People come to anesthesiologists because they provide a technical skill that is necessary so that someone else can do their job. And they do an outstanding job rendering technically adept anesthesia. But they are not pain physicians....different specialty.
