I was recently honored by a request to write a piece for the journal Outpatient Surgery. Having duly provided a pithy and witty ditty about the Veteran’s Administration MD vs CRNA kerfuffle, the editor dutifully came back at me with an edit. He said: “Can you give a specific example of how the broad knowledge of medicine gives MD anesthesiologists an advantage?” or something to that effect. Hmmm… trying to stir the pot, I thought. Controversial? You want controversial? I thought. So I sent out an email/text/tweet to my colleagues specifically asking for examples of how the broader knowledge of medicine gave them an advantage when it came to the safe practice of anesthesia. Here are some of the responses I got (my friends will likely cease to be my friends after I post this):
“They’re [CRNAs, I assume] often pretty cocky and it’s usually because ignorance is bliss.”
“Just doesn’t demonstrate a solid foundation in the basics of physiology or pharmacology.”
“They often can’t think outside the box.”
“Physiology, pathology, pharmacology, anatomy is just not there. I think it’s a depth of knowledge and problem solving skills. Everything they know is very superficial.”
“Pathophysiology. That’s why we make the plan. They can complete it very competently, but don’t have the extent of knowledge regarding all conditions to make the safest plan for the patient.”
Of all these responses, the last is the only one that comes even close to a specific reason for the existence of the MD anesthesiologist.
Please don’t misunderstand – I truly believe that the presence of an MD in the supervision of the administration of anesthesia is very important. But, friends, we need to be very specific and persuasive. Simply saying “it’s not safe” and “we know better” isn’t going to sway administrators who see cost savings instead of patient savings. We can’t just say we’re worth our price. We have to prove it.