Agreed. This is a HUGE red flag that interviewees should look out for. This is wrong on SO MANY different levels. For major teaching hospitals out there who do this, think how many surgery residents see this and think, "anesthesiologists think it's safe for CRNAs to do the biggest cases." This is probably the only exposure the surgery residents will have to the practice of anesthesiology until they're in the community. At some point, some of these surgeons are going to be on hospital committes, with major input on hiring models.
Hopefully the anesthesia attendings at these programs are making frequent visits to these ORs, so the surgeons know who's making the decisions.
Interesting perspective.
I was having a discussion recently with one of our vascular surgeons about this very subject. His take is a little different than yours.
He's 100% on the side of having an Anesthesiologist -
all the time and
exclusively - doing his cases. And, he always gets one.
Here's why...
He's been practicing for roughly 25 years, and tells me he's seen it all. He told me about a case about 15 years ago (or so) that convinced him only to have an anesthesiologist.
He was doing an awake carotid endarterectomy on a patient. The patient had been blocked, touched-up, and fully localized during the case. Everything went smoothly, as do the vast majority of his cases, until the very end of the case. He'd thrown the last couple of sutures in, and broke scrub. They moved the stretcher into the room and were getting ready to move the patient over to the bed when the patient suddenly couldn't move the entire right side of his body. The surgeon asked the patient if he felt okay. Aphasic.
He looked at the nurse anesthetist and said, "Put him to sleep. NOW! I've gotta go back in."
The nurse anesthetist got (according to him) a panicked, deer-in-the-headlights look and said back to him, "Ummm... we don't normally do this for these cases. I'm not sure that I should put him to sleep. Hang on a second."
The surgeon said, "Look, I don't care what you normally do. I'm not asking you for your opinion. This guy's brain is in trouble. I'm going to re-scrub,
put the patient to sleep now. Put him on 100% oxygen. Paralyze him. Get everything else ready."
Again, the nurse anesthetist says back to him, "Hang on a second." She then goes to the back of the room, picks up the phone, and starts to call someone.
Well, as you can imagine, this is when he goes completely ballistic. He walks over and - as he tells me - literally rips the phone out of the wall and throws it on the ground.
"
GET OFF THE F**KING PHONE AND PUT THE F**KING PATIENT TO SLEEP RIGHT NOW OR YOU'RE NEVER WORKING IN THIS HOSPITAL AGAIN!"
About that time, the circulator put out an "Anesthesia STAT to OR 'X'" on the overhead. An anesthesiologist shows up, and within about 2 minutes from his arrival the patient is asleep, intubated, and on the ventilator.
Now, as you can probably imagine, this surgeon got into deep doo-doo for the outburst. But, everyone in the room got the message. And, he tells me, he's never since worked with a CRNA. No one will even dare to schedule one in his room.
So, Pooh & Annie, I agree that we are conditioned to believe what is normal and acceptable by our own observations and empirical experiences. But, ultimately,
I guess it all depends on who you ask.
(And, yes, boys-and-girls, that is a 100% true story told to me by a 57-year-old vascular surgeon who's seen everything under the sun. You just can't make this stuff up.)
-copro
