I've spent some time in the past working in a NICU, where NNP's and neonatologists worked both side by side and "under" the attending. That is, the NNP's presented their patient's to the attending each morning on rounds, much like a resident would.
Now, these NNP's were awesome. They could perform almost all procedures of an attending and direct the care of ultra-sick kiddo's. But i never once heard an NNP state, "We can do anything that the doctors can". In practice, they might be able to. But in the end, the responsibility wasn't theirs.
So how is it that CRNA's can often state, "We can do anything an MDA can"? I've known some excellent CRNA's who are able to run a normal, average case nearly indepentently. But I've yet to meet a CRNA who is fellowship trained in peds, CT, neuro, OB, transplant, regional, etc. I've yet to hear of a CRNA opening their own Pain clinic. I've yet to hear of a CRNA who routinely performs TEE's. Nor do I know of any CRNA's who attend on surgical ICU patients. You mention CRNA's preoping patients. What about complicated preops, such as the pregnant woman with significant AS?
I'm very glad CRNA's are well enough trained to feel so confident in their roles. Like all midlevel practitioners, they are indispensable to modern healthcare in America. I can't remember the last time I heard a midwife say they could do everything an obstetrician could. Or a PA state that their training was equal to that of a physician. While they can extend the abilities of physicians extremely well, their training does not allow them to be a replacement.
One MDA I know tackled the issue like this: If you have worked to be a respectable, well-trained and competent anesthesiologist,there will always be a demand for your care of the patient.
