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Separation of Powers

October 18, 2013

My husband and I are both anesthesiologists, and as such we receive double the amount of anesthesia-related propaganda and news.  Most of this goes immediately into the paper recycling bin, but because of the controversy regarding the Affordable Care Act I have actually been skimming a few of these publications to see what my colleagues are saying about various issues.  I have been struck by two general trends in the current literature: first, anesthesiologists seem to be running scared, and the second is the glaring lack of any nurse anesthetist input or participation or support in the American Society of Anesthesiologists.

These two trends are, of course, related.  As nurses push for more autonomy, physicians push back.  This is about turf and money and I get it.  It is the language that is striking.  In the latest issue of the ASA newsletter, October 2013 there are at least three articles that refer specifically to “physician anesthesiologists” a not-so-subtle use of exclusionary language.  The ASA has a whole new page on it’s website called “When Seconds Count” in which the goal is to “increase awareness about the critical role PHYSICIAN (my capitals added) anesthesiologists play.  It is filled with personal stories about how death and destruction would have occurred if the PHYSICIAN anesthesiologist were not present.  The ASA was at the National Conference of State Legislators, promoting physician anesthesiologists in a joint physician booth called “Physicians Advocating for Patients”.  The Massachusetts Society of Anesthesiologists has a newsletter called the Anesthesia Record in which a recent article by a lawyer addressed the issue of nurses and independent practice.  Here is what Edward J Brennan Jr, Esq. says:  “The bills would eliminate the long-standing standard of care requiring a nurse anesthetist to administer anesthesia under the supervision of a qualified physician and therefore compromise the safety and care of patients in the Commonwealth.”  Now I’m not a lawyer but the “and therefore” presupposes that there is some hard evidence that more autonomy would indeed harm patients.  No evidence or references were forthcoming.

Now, whatever you think about nursing autonomy is a little bit irrelevant here.  Believe it or not, I am not promoting nursing autonomy.  The problem is the stark adversarial language the ASA uses with regard to our own valuable helpers, nurse anesthetists.  Why do physician anesthesiologists find it so necessary to spend large amounts of money and time promoting their own services and discrediting the nurses?  Why do we feel the need to have website defending what we do and insisting we can do it so much better and more safely?  Are we afraid people might find out it’s not necessarily true?  Are we pissed off that a recent study showed that a lot of people don’t even know that anesthesiologists are doctors at all?  Does it chafe us just a little when our patient refers to us as “the anesthetist” and the surgeon as “the doctor”?  Our own professional insecurities are no excuse for exclusion of a large part of our workforce.  We work side by side with nurse anesthetists every day.  We do most of the same things.  And yet the professional literature completely discounts or ignores the efforts of these smart people.  The ASA has no room to allow nurses into clinical discussions and learning opportunities that would benefit patients greatly.  Far from promoting patient safety, this turf battle is doing harm to patient care by not allowing people to work together and respect each other’s contributions to the care of patients.  Can we stop acting like Democrats and Republicans and work together?


From → Healthcare

  1. Matt, CRNA permalink

    Dr. Leng,
    Finally a physician colleague says it out loud. The AANA isn’t any better at making nice either I might add. In a time of healthcare costs hurtling toward 20% GDP, aging baby boomers, and the introduction of the ACA, we are all going to have to do more with/for less. Reality dictates that neither MDA nor CRNA can go it alone in all situations. Do I believe that CRNA’s deserve a level of autonomy? Yes. Do I believe that in difficult situations and tough cases working side by side with an MDA makes good sense? Yes. I find it interesting that there are less than 100,000 anesthesia providers in the U.S., including those in training. This number is roughly split down the middle MDA vs CRNA. Geographically, CRNA’s provide independent anesthetics in rural areas more often than not. Team anesthesia is more likely practiced in urban areas. All MDA practices are the exception not the rule in general. Do we see a tremendous amount of literature supporting any one model being better than the other? If so I haven’t seen it. Obviously the situation is exponentially more complex than I paint here. I am simply suggesting that there is a middle way. Shouldn’t we be focusing on how we can collectively best care for our patients, not how hard we can lobby to put the other guy out of business?

  2. Dr Leng

    Thank you so much for saying what we all know to be true. I appreciate your candor and honesty. The fact is CRNAs who work independently (like myself) do a safe and quality job just as Anesthesiologist do and CRNAs who work with Anesthesiologists do. The main reason that many CRNAs become Anti-Anesthesiologist has alot more to do with rhetoric from the ASA and treatment in the OR by Anesthesiologist who buy into it than anything else.

    Clearly there is a place for independent CRNAs, independent Anesthesiologists and team care. Why we cannot just drop the inflated egos and be honest, like you, I have no idea.

    Thank you again.

  3. Greetings! I’ve been reading your weblog for a while now and finally got the bravery to go ahead and give
    you a shout out from Humble Tx! Just wanted to tell you keep
    up the excellent work!

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