What can be done to stop the bastardization of medicine?

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marshall21

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I know this topic has been discussed in detail on this and other forums but there still isn't a clear answer. Over the past decade or two there seems to have been a significant bastardization of the profession and the value of education in general.

Today I overheard someone describing how they were in school to get their BSN and that they had plans to become an NP. I asked them why they didn't become a doctor (ie physician), and they answered, "Oh, my school is actually heading that way." (DNP). I made sure to clarify for him that I meant why didn't he become a physician. My point was still lost on him...that DNP and physician are not the same.

What has happened for society to get to the point where it's okay for NPs to obfuscate and confuse the general public so that they can fee like "doctors"? How is this even remotely acceptable to the public at large? I very seriously doubt that the nurses can justify the development of the DNP in the name of improved patient care. It's just a title change obtained after an online course or two.

So, finally, what can we as physicians do about it? What is the most effective action for me to take as a resident/fellow/attending? I embrace the idea of not teaching CRNAs our trade, not hiring a CRNA if ever in a position to do so, etc. But it seems so ineffective in the grand scheme of things. Is there anything else to do in addition to giving heavily to ASA-PAC?

My wife and I have now committed to clarifying exactly what people mean when they introduce themselves as Doctor Smith. It does something like, "Hi. I'm Dr. Smith." "Oh, so you're a physician...?"

I'm just so disgusted by all of it. There are ways to earn the title of Dr and to wear a white coat and practice medicine. It's called medical school and residency. If you don't want to do that or can't do that, then those specific honors and privileges should not be yours to sport about.

Has the midwife encroachment on obstetrics created any similar dynamics? How have obstetricians successfully or unsuccessfully dealt with it?

It's saddening and frustrating to see the 4 years undergrad, 2 years masters, 4 years med school, 1 year internship, 4 years flight surgery, and upcoming 3 years residency all be cheapened by a NP with an online DNP course asserting that our education, skill, and academic prowess is supposedly the same. To the everyday Joe, a "doctor" (DNP) in a white coat is just as qualified as I am and has made the same sacrifices as I have.
 
I introduce myself as doctor to my patients and im a dds
 
I think that's common and makes sense. But I bet there's no confusion as to your profession or your services. A dentist introducing himself as doctor to patients in his dental clinic leaves little room for confusion. A nurse introducing herself as doctor in a hospital, clinic or dental clinic would undoubtedly be misrepresentation.
 
I agree i was just messing around a little. I actually do work in a hospital but when i walk in a room i always say "Dr. Smith the dental resident".

It is highly confusing though to deal with cna, rn, np, dnp, snra, crna, etc...i personally have no idea what their training and priviledges are/differ. And it seems that there is always a status struggle between them.

And last week i had to take a patient to the OR for dental ext and the crna told me a nasal intubation was impossible on this Asa 1 normal stature 22 year old...but the anesthesiologist walked in 30 seconds later and had it done in 3 minutes

Anecdotal i know, but it still hinders my operations on a day to day basis
 
We kind of have to bastardize medicine in order to placate the masses who demand services they and no one else wants to pay for. The costs must be shifted from the short term and visible, to the long term and invisible.

Just as the average person considers McDonald's "food" and doesn't realize they're eating a hollow veneer of calories devoid of actual nutrition, they know not the difference between Dr. Johnson the MD, and "Dr. Kevin" the PA/NP in the white coat and scrubs whose seeing them "today".

In fact they probably prefer "Dr. Kevin" because he "cares about the patient" and is willing to write for all the VicoSomaXanax + adderall the patient wants without being all "judgmental" like mean ole Dr. Johnson.


marshall21 said:
I know this topic has been discussed in detail on this and other forums but there still isn't a clear answer. Over the past decade or two there seems to have been a significant bastardization of the profession and the value of education in general.

Today I overheard someone describing how they were in school to get their BSN and that they had plans to become an NP. I asked them why they didn't become a doctor (ie physician), and they answered, "Oh, my school is actually heading that way." (DNP). I made sure to clarify for him that I meant why didn't he become a physician. My point was still lost on him...that DNP and physician are not the same.

What has happened for society to get to the point where it's okay for NPs to obfuscate and confuse the general public so that they can fee like "doctors"? How is this even remotely acceptable to the public at large? I very seriously doubt that the nurses can justify the development of the DNP in the name of improved patient care. It's just a title change obtained after an online course or two.

So, finally, what can we as physicians do about it? What is the most effective action for me to take as a resident/fellow/attending? I embrace the idea of not teaching CRNAs our trade, not hiring a CRNA if ever in a position to do so, etc. But it seems so ineffective in the grand scheme of things. Is there anything else to do in addition to giving heavily to ASA-PAC?

My wife and I have now committed to clarifying exactly what people mean when they introduce themselves as Doctor Smith. It does something like, "Hi. I'm Dr. Smith." "Oh, so you're a physician...?"

I'm just so disgusted by all of it. There are ways to earn the title of Dr and to wear a white coat and practice medicine. It's called medical school and residency. If you don't want to do that or can't do that, then those specific honors and privileges should not be yours to sport about.

Has the midwife encroachment on obstetrics created any similar dynamics? How have obstetricians successfully or unsuccessfully dealt with it?

It's saddening and frustrating to see the 4 years undergrad, 2 years masters, 4 years med school, 1 year internship, 4 years flight surgery, and upcoming 3 years residency all be cheapened by a NP with an online DNP course asserting that our education, skill, and academic prowess is supposedly the same. To the everyday Joe, a "doctor" (DNP) in a white coat is just as qualified as I am and has made the same sacrifices as I have.
Click to expand...
 
I hear the frustration and sadness in your post and many on these here boards share it. The sad reality is that the pendulum is swinging hard in the midlevel direction. The online doctorates are just window dressing and an effort to cover the movement with legitimacy.

The only people to blame are those that came before us. The last generation of MDs had to watch their incomes dwindle and one of the ways to counteract it was to leverage the mid-level and make up the difference off their backs. Now that their homes are paid for and kids are in school they don't care about the mess they made.

Medicine has always been a business and the consumer decides who profits. I do the best work I can everyday and think like a physician and not a technician. The consumer who chooses a midlevel over an MD deserves the care they get. Its harder for us who pass the gas because the consumer generally has no clue what we do. Education is one way I guess.

I wish whoever started doctorbyyourside.org would promote it more.
 
I was pre-opping a patient, 65 yo F w/hx of depression, obesity, GERD, HTN, and poorly controlled type 2 DM for some minor procedure. I start running through her list of home meds and she is on one of the trendy SSNRIs and abilify. I ask her how she came to be on abilify and the woman who was her ride chimes in..." Oh, I started her on that because her depression was not responding to the antidepressent I put her on." I thought I was listening to a commercial for abilify. I asked, "are you a physician?" I get the "I am an NP and I have my own practice. We have been friends for years." I then asked the patient if she knew that her diabetes was poorly controlled and that abilify could be an issue with her blood sugar control and obesity. Nothing but blank stare from both of them.

Recently, a mid-level who trying to put in a central line caused a major vascular injury and, instead of recognizing it, simply went along and treated some numbers while the patient bled out.

I had an NP pimp me about why we hyperventilate head injuries, best part was when an attending surgeon just started pimping the NP out about another topic and then when she didn't know the answer said, "he knows all this, you don't."

When will the insanity stop?
 
The bastardization of anesthesiology will stop when MDs stop whoring out their field to CRNAs in order to make $$$$.

300k wasnt good enough for you guys -- you wanted the 500k so you whored out your field to CRNAs.

MD greed is what caused this midlevel problem.
 
These stories are SO common. I hear them all the time here on the forums and elsewhere. But what can be done? It's clear that some physicians a generation or two before today's current residents contributed to the CRNA's market share that we see today. We know how we got here, but how do we get out?

Is it possible that malpractice insurers will eventually not cover independently practicing mid-levels after some well publicized tragedies? A practitioner who can't obtain malpractice coverage would have a hard time finding employment. Is this the path to independently practicing mid-levels becoming unemployable?

My thought is that a budding anesthesiologist has to now do a fellowship to protect against the trends we now see with CRNA hiring practices. Are all of the sub-specialties still safe from mid-level encroachment? I can't imagine NP's running the ICU or CRNA's seriously "specializing" in pediatric or CT anesthesia. Am I wrong?
 
I think you touched on the most of the big things you can do on a individual basis. Dont teach them your trade, if you work in a group that uses midlevels attempt to make it a 50/50 mix with CRNA and AA, if your state doesnt have fair AA legislation work on lobbying at state level, continue to donate to state and national PACs...if you do all of this I think you will be doing more than the vast majority of PP folks working currently.
 
Well, we're in the business of helping people, but you're exactly correct. Unfortunately, patients wouldn't be able to get the care they needed, if they could only rely on Physicians, as they wouldn't be able to meet demand. Excessive regulations are putting Physicians out of business, and NP, PAs etc... are gaining prominence to compensate for this shortage.
 
bdrensch said:
Unfortunately, patients wouldn't be able to get the care they needed, if they could only rely on Physicians, as they wouldn't be able to meet demand.
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I don't buy this. ****ty care is no better than no care at all.
 
In my opinion this whole midlevel advancement is essentially driven by the gov't based on big business lobbying (hospitals etc) in order to inject competition into the market in hopes to drive down staffing cost...I don't really believe the whole hype of providing care to the masses either...it all comes down to money, but I don't feel it will drive down systems cost it will only cause an explosion of cost because these "DNP's who are doing "exactly" what physicians do should be compensated accordingly". The DNP degree will be equivalent to the MBA int he future, worth no more than a RN degree in my opinion...there is only one way to be part of the A team and we all know the route. Unfortunately my opinion is this will take decades to play itself out and will be painful to watch.
 
desflurane said:
The consumer who chooses a midlevel over an MD deserves the care they get.
Click to expand...

If patients were making an informed decision to pay less for midlevel care (in any specialty, not just anesthesia) then I'd have no objection. People should be free to partake in any risky behavior they wish, whether it's riding a motorcycle on an LA freeway, going to a NP who can't manage diabetes, or letting some random strip-mall CRNA-mill trained clown knock them out for surgery.

The problems are
- most patients don't actually have a choice
- most of the ones who do have a choice aren't told that they have a choice
- they're not actually paying less (though insurance cos and facilities may get a bigger cut)
- systematic, deliberate deception from midlevel associations to hide the risks

The left tail of the midlevel bell curve is really, really long ...
 
@pgg- agree with you but also believe, maybe foolishly, that truth prevails.

Why is it that I'm constantly humbled by what I don't know or fully understand yet the midlevels are completely convinced that perioperative medicine can be mastered in two years of reading Morgan and Mikhail?
 
desflurane said:
@pgg- agree with you but also believe, maybe foolishly, that truth prevails.

Why is it that I'm constantly humbled by what I don't know or fully understand yet the midlevels are completely convinced that perioperative medicine can be mastered in two years of reading Morgan and Mikhail?
Click to expand...

This is so true. It is also what scares the crap out of me when listening to mid levels talk about things.
 
W222 said:
I don't buy this. ****ty care is no better than no care at all.
Click to expand...

How can you fairly make that assessment? Obviously MDs have superiority education and experience, but in many instances the midlevel positions take care of the more mundane and routine tasks, or in some instances, may have more experience in certain specialties in rural areas where a specialized doctor may not be available. if you took out all the PAs and NPs in the country, people would die, plain and simple. "****ty care" is absolutely better than no care at all. What an irresponsible statement. Truth is, the one-size-fits-all policies that regulates MD licensing, training, and education is what causes the problems. As well as excessive physician liability of course. I see these midlevel positions as a necessary evil.
 
bdrensch said:
How can you fairly make that assessment? Obviously MDs have superiority education and experience, but in many instances the midlevel positions take care of the more mundane and routine tasks, or in some instances, may have more experience in certain specialties in rural areas where a specialized doctor may not be available. if you took out all the PAs and NPs in the country, people would die, plain and simple. "****ty care" is absolutely better than no care at all. What an irresponsible statement. Truth is, the one-size-fits-all policies that regulates MD licensing, training, and education is what causes the problems. As well as excessive physician liability of course. I see these midlevel positions as a necessary evil.
Click to expand...
No one is arguing that nurses are not an integral part of health care delivery. They are. But I think what is at the heart of the issue here is the incessant desire by some to play doctor foregoing the requisite education/training. Online courses, weekend seminars, etc do not suffice. As it relates to anesthesia, the creation of the online DNP and the AANA's unyielding efforts to promote CRNA independence is a slap in the face of not only physicians but a grave injustice to patients as well. Sure, if you were in the boonies somewhere... common sense tells you make do with 'what you have.'
 
Why is it always the nurses who are criticized? Pharmacy and physical therapy are a couple of medical fields that require doctorates yet I don't read day in day out about how they're MD wannabes. If a nurse is stupid enough and douchebaggery (if that's a word) enough to refer to themselves (its not just chicks) as a dr in front of a patient then I'm still confident that the average pt can distinguish physician from other personnel. Let it freaking go!!
 
baller71457 said:
Why is it always the nurses who are criticized? Pharmacy and physical therapy are a couple of medical fields that require doctorates yet I don't read day in day out about how they're MD wannabes. If a nurse is stupid enough and douchebaggery (if that's a word) enough to refer to themselves (its not just chicks) as a dr in front of a patient then I'm still confident that the average pt can distinguish physician from other personnel. Let it freaking go!!
Click to expand...

Oh My...

These youngin's are so cute when they get rilled up and angry.

Look at you typing with frustration in your eyes...it's just so adorable.

You hang in there!
 
epidural man said:
Oh My...

These youngin's are so cute when they get rilled up and angry.

Look at you typing with frustration in your eyes...it's just so adorable.

You hang in there!
Click to expand...

I suggest you read a thread from jetpro from a couple of months ago about how "senior" members are so quick to disrespect "junior" members.
 
baller71457 said:
I suggest you read a thread from jetpro from a couple of months ago about how "senior" members are so quick to disrespect "junior" members.
Click to expand...

Aw, he's just waxing nostalgic over the time when his own illusions were shattered.

I remember the exact nurse interaction when my naive friendly smile froze on my face and I realized with gut-wrenching clarity exactly what I'd gotten myself into by going to medical school.
 
pgg said:
Aw, he's just waxing nostalgic over the time when his own illusions were shattered.

I remember the exact nurse interaction when my naive friendly smile froze on my face and I realized with gut-wrenching clarity exactly what I'd gotten myself into by going to medical school.
Click to expand...


Yeah, what he said.
 
baller71457 said:
Why is it always the nurses who are criticized? Pharmacy and physical therapy are a couple of medical fields that require doctorates yet I don't read day in day out about how they're MD wannabes. If a nurse is stupid enough and douchebaggery (if that's a word) enough to refer to themselves (its not just chicks) as a dr in front of a patient then I'm still confident that the average pt can distinguish physician from other personnel. Let it freaking go!!
Click to expand...

It is because, for the most part, these two professions (pharm and PT) have not encroached as NP's and CRNA's have. That's not to say they won't in the future as PharmD's want Rx privileges and PT's are doing more things like accupuncture. CRNA's and NP's have deemed themselves equivalent. That is the big difference.
If people do as you wish and "Let it freakin' go," you will be the one to suffer the most since you are still a med student. Almost every specialty has seen encroachment by mid level providers:
Ophthalmology-Optometrists want to do cataract operations
Anesthesiology-CRNA's want, and often have, independent practice
Orthopedics-Podiatrists want to classify their practice as anything below the knee.
Psychiatrists-Psychologists want Rx privileges
Obstetrics-Nurse midwives want to have c-section privileges
Family Medicine-The horse is out of the barn with NP's claiming equivalence
Radiology-a different kind of encroachment as image quality allows distance reading from other providers in distant lands for much cheaper
I could go on and on, but these are the most obvious. The house of medicine must stand together, or all will suffer. Unfortunately, our representative organization (AMA) does not seem to be the answer as discussed heavily in another thread. It seems all specialties are in survival mode trying to protect themselves. I'm not sure what the answer is, but I am pretty sure that letting it go is not the answer.
I think you would be surprised how many nurses are in on line NP programs where they set up their own clinicals and have no standards of training. Most of the others are maneuvering into the ICU to get their one year experience so that they can apply to CRNA school. The rest are either approaching retirement or have family issues that prevent their ambitions at this time. I foresee a time when we will have a huge nursing shortage and a huge overabundance of NP's wearing their long coats around the hospital playing doctor. I would love to see a survey done of nursing students entering nursing school to see what their interests were for where they would be 6 or 7 years down the road. If done anonymously and if they answered honestly, I bet only 25% would have any interest in being "just a nurse." I think the majority see nursing school as the new quick way to get to be a physician equivalent without the time and $$$ investment. Why wouldn't they? That is what it has become. It is really a disservice the important field of nursing.
What if 75% of entering medical students had ambitions to become physician executives and get MBA's, JD's, MPH's etc and wanted to do whatever they could to get away from treating patients? That is essentially what we are seeing with nursing. Nursing school is simply a means to an end.
 
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baller71457 said:
I'm still confident that the average pt can distinguish physician from other personnel.
Click to expand...

I disagree with you. Without clear assistance of clearly marked ID badges as "Physican" or "Nurse" and clear distinct and honest introductions, the average patient has no idea who the players are in their care. Something as simple as the white coat or the introduction as "anesthesia resident" for the sRNA will completely obfuscate things for even the most seasoned health care consumers.
I am happy that you look for the best in others, but it is naive and it will cost you if you are not cautious. Always be leery of what your mid levels are saying when you are not around. You might be surprised.
 
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DavesNotHere said:
I introduce myself as doctor to my patients and im a dds
Click to expand...

Love the Cheech and Chong reference in your name.

There are many "doctors" that I do not begrudge them being called doctor:
Physicians-went to med school
Dentists-earned it by going to a selective and rigorous process of dental school
Chiropractors-they almost never mix with medical doctors, so there is never really any confusion
Scientists-They earned their PhD and do not see patients clinically

Others, I feel, should not flaunt the "doctor" name unless they are in the academic setting and dealing with their students:
Psychologists-I feel that they mislead patients to believe they went to medical school
Optometrists-almost always confusing to unknowing patients
Any nurse doctoral degree-almost all online and almost all a sham
Physical Therapists-inappropriate in a clinical setting
PharmD-confusing for patients if they refer to themselves as doctor
JD's-not accepted as norm and just sounds weird
Theology doctorates-just seems weird
Doctor of education-in my experience, they flaunt this as part of a power trip and want doctors and nurses to refer to them as doctor. Just annoying.

The best thing would be for physicians to completely abandon the doctor name and let everyone else have it. Then we would just refer to ourselves as physicians. It would take a while to get rid of the doctor name, but it could work.
 
desflurane said:
Pulled this from Sermo:

NP Run ER in Upstate NY.

Hope I don't ever need emergency services in upstate NY.
Click to expand...

After reading articles like the one above, I truly am amazed that society is accepting of this. The idea of having to take my wife, daughter or mother to the ED where the most highly trained provider there is a NP scares the crap out of me.

I think there's this idea that is working its way through the medical industry that NPs/CRNAs are the same as physicians. In the eye of the consumer, and shamefully the employer, the end product is often the same. A person goes in for an uncomplicated anesthetic administered by a CRNA and they emerge healthy and pain free. Or someone goes to the NP for a sprained ankle and they leave with a brace and RICE instructions. Clearly, same end result as if they had seen a physician.

To better understand where the value of a physician is, compare the whole situation to the aviation industry. As many of you know, it really isn't that hard to "fly" a plane. Any Joe off the street could keep a plane aloft after about 3 minutes of instruction. Why then don't consumers and airlines accept lower standards for who pilots their airliners? Liability? Is there no liability in anesthetic delivery? I think what we're all looking for in a pilot is not just someone who can keep the plane aloft, but someone who can handle the minor and major problems that can arise when we're 30,000 ft over the Atlantic. What we expect in our pilot is an expert. Someone who has several thousand hours of experience, judgement formed by rigorous formal education and a thorough knowledge of how the aircraft works. Most people may not realize that the pilots are intimately familiar with workings of every system of the aircraft (hydraulics, electrical, power production, etc.)

Likewise, I would think that anything less than an expert in medical science (physician) would be unacceptable to Americans who want nothing but the best. People are counting on their pilot being able to land in the Hudson River if necessary (US Air 1549). Shouldn't they be counting on their doctor to handle the unexpected as well? And doesn't that ability to make the right call come from experience, judgment and knowledge? And isn't it an extremely easy argument to make that physicians possess the most experience and knowledge and therefore will have the best judgement, and are therefore the only acceptable choice when it comes to running an ED or managing anesthesia.

Why do people demand the best "organic, cage-free, hormone free" chicken but then are willing to see an NP or CRNA. Our current American society so commonly only accepts the best when it comes to cars, cell phones, lattes, and everything else, but is willing to see the equivalent of a MS II for their healthcare. I don't get it.
 
marshall21 said:
After reading articles like the one above, I truly am amazed that society is accepting of this. The idea of having to take my wife, daughter or mother to the ED where the most highly trained provider there is a NP scares the crap out of me.

I think there's this idea that is working its way through the medical industry that NPs/CRNAs are the same as physicians. In the eye of the consumer, and shamefully the employer, the end product is often the same. A person goes in for an uncomplicated anesthetic administered by a CRNA and they emerge healthy and pain free. Or someone goes to the NP for a sprained ankle and they leave with a brace and RICE instructions. Clearly, same end result as if they had seen a physician.

To better understand where the value of a physician is, compare the whole situation to the aviation industry. As many of you know, it really isn't that hard to "fly" a plane. Any Joe off the street could keep a plane aloft after about 3 minutes of instruction. Why then don't consumers and airlines accept lower standards for who pilots their airliners? Liability? Is there no liability in anesthetic delivery? I think what we're all looking for in a pilot is not just someone who can keep the plane aloft, but someone who can handle the minor and major problems that can arise when we're 30,000 ft over the Atlantic. What we expect in our pilot is an expert. Someone who has several thousand hours of experience, judgement formed by rigorous formal education and a thorough knowledge of how the aircraft works. Most people may not realize that the pilots are intimately familiar with workings of every system of the aircraft (hydraulics, electrical, power production, etc.)

Likewise, I would think that anything less than an expert in medical science (physician) would be unacceptable to Americans who want nothing but the best. People are counting on their pilot being able to land in the Hudson River if necessary (US Air 1549). Shouldn't they be counting on their doctor to handle the unexpected as well? And doesn't that ability to make the right call come from experience, judgment and knowledge? And isn't it an extremely easy argument to make that physicians possess the most experience and knowledge and therefore will have the best judgement, and are therefore the only acceptable choice when it comes to running an ED or managing anesthesia.

Why do people demand the best "organic, cage-free, hormone free" chicken but then are willing to see an NP or CRNA. Our current American society so commonly only accepts the best when it comes to cars, cell phones, lattes, and everything else, but is willing to see the equivalent of a MS II for their healthcare. I don't get it.
Click to expand...

Disclaimer: I'm a med student interested in anesthesia, but I don't aim to speak like I know everything about Anesthesia, b/c I don't at all. Just giving my 'unexperienced' opinion. take it for what it is.

Marshall,
I'm in agreement with you. Sully, the pilot, did an excellent job. As I'm just a med student, I would guess that anesthesiologists earn their money for being able to handle unexpected events. There is a new thread about Malignant Hyperthermia where some attendings and residents contributed to how they handled a case that went south. After reading it, I looked up MH to learn about the situations these folks had seen. Could a CRNA handle that? I don't know. But the doc is expected to know how to handle it.

I worked in food service before med school, and the kitchen staff always griped about how management was awful, and how they weren't doing any of the work, and how much better of a job they could do, etc. Well, the folks in management jumped through the hoops to get there, perhaps sought higher education and put in their time doing the grunt work.

The folks in the kitchen would say that management couldn't even do the kitchen staff job (i.e. operate the broiler, work the salad station). Truth is, the folks in management had to start with a low job. Yes the person who works the grill may be very good at it b/c that is what they do everyday, but the manager can also do that, and take the inventory, place weekly orders, create schedules, hire/fire folks, deal with no shows who call in "sick," complete safety paperwork, and babysit grown-ups. The list does go on.

In any industry, everyone has a role. And there will always be folks who work lower in the ranks who think they can do it better; well great, jump through the hoops to get there. Then there is legislation.... but that is a different story.

I admire the skill of a lot of the anesthesiologists I have met and spent time with. They have ice water in their veins when things go bad.

One of my close friends is an ophthalmology resident in a state where the optometrists are allowed to define their scope of practice. Same crap, the governor signed the bill even after consulting with a leader in ophtho, probably b/c of donation$$. Competition/the threat of competition exists in every industry, medicine is not immune to it. As a student, I understand that and have been warned.

Just a question, I have heard a small minority of crnas want independence, so say they get it? Are all of the crnas going to flood the market and work independently. I don't really think so. Perhaps those who don't think they need supervision will, maybe 10%. What do you think Blade? The other 90% may not want the responsibility/liability, and there is nothing wrong with that at all. Everyone has a job description and should fill it. So if this 10% can compete for contracts, and say they get one at a hospital, with no oversight if the hospital bylaws allow it, and something bad occurs on the crna's watch, should an anesthesiologist from another group step in and help?

I don't think a hospital wants the risk or the reputation of higher than normal mortality under anesthetic....IF this were to occur with crna only anesthesia for all types of cases. IF there are more deaths due to crna only anesthesia for all types of cases, the public were very quickly find out the difference between them and an anesthesiologist. I've read some attendings posts about these folks being "careful what you wish for."


I tell my family to see a physician. Nothing at all against NPs, but if they tell me they went to see one, I would tell them to go see a doc instead. Everyone has their role, and for me and my family, I would rather visit the professional with the most extensive training and fund of knowledge, and we are all allowed that request, but that service doesn't come free. The skilled worker is worth his/her wage.

Sorry for the long post, Merry Christmas, all.
 
"A massive city of ~4000 people. I'm sure the hospital is loaded with complex pts."

Thats not the point, its the precedent, the slippery slope towards acceptance anywhere where dollars saved > quality/safety is the mentality.

Also, small townsfolk are not the bastion of health. They ride their tractors all day long in the sun with a bite of chew in their lip, finish the day sitting by an indoor fireplace smoking a pipe, and eat meals cooked with bacon grease they have saved in a tin can in their fridge.
 
SitraAchra said:
Good luck in residency with that self righteousness victim approach.
Click to expand...

Like I said earlier, "don't be so quick.......", I just don't feel the need to flex my d$$k size on an Internet forum, but I'd be willing to match my credentials against the majority here.
 
.
 
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