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Am I famous yet?

January 24, 2013

Wow.  A lot of push-back from readers on my recent post about Nurse Practitioners, which was guest-posted on KevinMD.  I am very pleased to spark such great discussion.  Here are some of the points brought up:

1. “I’m an anesthesiologist.  Why am I harshing on primary care doctors?”  I’m very sorry if it appeared that I was.  I believe physician extenders can be useful in all medical fields.  Certified nurse anesthetists are wonderful.  They can do everything I can do managing routine cases, and most of anesthesia is routine cases. 

2. “You think physician extenders should be allowed to practice independently.”  I never said this.  If there’s a shortage of primary care doctors, let PA’s and NP’s handle all the routine stuff.  Have the doctor oversee, consult, and spend his/her time talking to and listening to and examining patients who need a person with more training.  If there were a shortage of anesthesiologists I would say let the CRNAs handle all the routine stuff and have the doctors handle the complicated stuff.

3. “So what DO you need an MD for?”  The hard stuff.  The unusual stuff. The stuff that requires the doctor to use all that education he has. 

4. “I don’ see you advocating for your own physician extenders, CRNAs.”  Wow.  Sorry about that.  I advocate for them every day, it just wasn’t made clear in my article. 

5. “What about billing?”  This is not about money, at least in my case.  The department chairs and lobbyists will push for anesthesia turf.  I have no interest in that game.  Health care is expensive and costs WILL be cut, in ways doctors don’t like, unless we step up and accept ways to cut our own costs that work for us.

Look at it this way:  Say you go to the dentist.  Who do you spend most of your time with?  The hygenist.  Why?  Because there is no reason for the dentist to do what a less-trained person can do just fine.  The dentist comes in to chat and deal with any problems that arise from the examination of the hygenist.  The dentist does the hard stuff, the stuff that requires all his education.  Medicine can be the same way.  All doctors complain about paperwork and other distractions from the care of patients.  Primary care doctors especially feel this way because they get an unfair percentage of this burden.  So make primary care an awesome place to be by taking away all that stuff.  Let the people with less training go in and do the cleaning and the paperwork.  Let the doctor do the hard stuff.  Everyone would want to be a primary care doctor because it would be so nice to be freed of all the extraneous bulls—.

Let’s get doctors back to doctoring.  Let everyone else do the rest.  That’s all I’m saying.


From → Healthcare

  1. Thank you for your support and clarity of thinking. I couldn’t agree more. Nurse practitioners often have more time to spend with the patients, and don’t mind doing the things some physicians feel are menial, but make a difference in patient understanding, satisfaction and therefore compliance. Since most of the healthcare dollars today are spent on preventable disease, an educated patient will represent a significant cost savings.

  2. Hey there

    Just wanted to thank you for your support. I am sure you are getting alot of push back from physicians for your comments but I am equally sure you realize it is all about money. As an independent CRNA doing the right thing for patients it is really nice to see an Anesthesiologist acknowledge that the right thing for patients isnt always the right thing for pocket books or association politics.

    Kudos to you and have a great weekend

  3. Joe Lesser CRNA MSNA permalink

    Thank you for your support also, but as a CRNA with decades of experience doing my own cases both in the military and civilian life, I am not a physician extender. I am an independent practitioner, and if you speak with CRNAs who have served in the current conflicts, you will hear that they are very much independent practitioners.
    Thanks again

    • Joe, thanks for the feedback. I can speak only to private anesthesia practice and academic medicine. In those settings CRNAS are NOT independent practitioners in the sense that they cannot bill on their own, and their charts require a physicians signature. My CRNAs do “practice independently” but I do have to put a signature on it. Those are the rules here in Massachusetts. I am very interested in hearing that the military uses independent CRNA’s. I didn’t knpw that.

  4. I appreciate your outlook on advanced practice nurses. They are based in the are of caring as one book says. However, I somewhat grimaced on your ending on KevinMD where you mention a brain tumor…. needing different levels. That complex level of care is a place where advance practice nurses will shine, for they really will and do take the load off of the MD/ team. They make sure that some of the minor things are not forgotten and are good at clarifying issues at the level patients understand and need.

    • I’d have to look back on what I said, but I didn’t mean that APRNs aren’t useful in neurosurgery. My institution uses them heavily for their patients and they are great.

  5. Hello Shirie! I am a primary health care NP who has worked as an advanced practice nurse for nearly 20 years…in Canada’s far north, in First Nations communities, in downtown Toronto and Halifax, and even out on the Coast Guard Icebreakers to the arctic. I absolutely loved your article on “Why your Nurse Practitioner Is Your Friend.” You clearly are secure in who you are professionally as I’m sure you are personally, and you are confident enough to voice how NPs continue to make a substantial contribution to the health of patients. Good on you! Just as I recognize the value of a great collaborating physician colleague, I also value the contribution of other health care professionals whom together, help me to provide the most comprehensive care to patients. Teamwork is often the solution to most problems, not just the input of one individual, whether it has to do with families, communities, schools, or health care. Recognizing both our strengths and weaknesses and building on our collective knowledge and expertise to provide the best health care with our patients seems to me a wise undertaking. Thank you for your article. It’s the best one I’ve read in years…as well as the most honest. I have shared it with several of my NP colleagues already! Bravo!

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