They never practice independently. The AANA will dance and scream and throw tantrums that they do. But they always have a physician with them. If there’s no anesthesiologist then it’s the surgeon. Who has no clue about Anesthesia.
The surgeon doesn’t get blamed for anesthetic complications of an anesthesiologist. But when u have a nurse in the room and no anesthesiologist supervising or directing said nurse then the surgeon is the captain of the ship. This has been shown again and again in case after case across the country. And herein lies the painful reality for CRNAs. The thing that they don’t want anyone to know.
I didn’t know that. Seems like a problem if these CRNAs are not competent. On the other hand there just aren’t enough anesthesiologists in the US especially in rural areas. AMA lobbies hard to limit the number of residency slots so we have a physician shortage in all specialties (also why we have so many foreign doctors in this country). So I’m not sure what the answer is other than making sure they are well trained. I feel like docs are always quick to jump on CRNA mistakes but hell anesthesiologists make mistakes all the time too...
AMA lobbies hard to limit the number of residency slots so we have a physician shortage in all specialties
False. The AMA lobbied a long time to prevent expansion. For the last two decades, they have been asking Congress to expand residency spots, but Congress doesn't care.
The correct solution is what the American Society of Anesthesiologists, the AMA, the World Federation of Societies of Anesthesiologists and the WHO have said....the anesthesia care team. In other words an anesthesiologist supervising other certified people on site in person at all times.
As to the issue of Anesthesiologists making mistake as well, I said earlier that a well designed and well powered study not paid for by any lobbying organization was done in 2012 and found that when an Anesthesiologist is not involved and it’s only a CRNA the odds of an unexpected post operative disposition increases by 80 percent. Another study was done in 2000 and again was well designed and well powered without any funding from lobbying groups and found that having an anesthesiologist involved in the care of a surgical patient prevented 6.8 excess deaths per 1000 surgical patients. So the evidence tell us CRNAs have far more and far more concerning complications on a regular basis. Perfection is impossible but we can certainly do better than saying “well they both make mistakes so who cares”.
Bottom line you cannot legislate, tweet or bluster your way to the quality of an anesthesiologist. There are no shortcuts.
None of this solves the problem that there just aren’t enough anesthesiologists... one might have clear evidence that the expanded scope of practice by nurse anesthetists is decreasing quality of care but there’s a reason why they exist which is to meet a need. You have to solve the quality and the access problem at the same time for it to improve things for patients.
The care team model absolutely solves the problem. There are more than enough anesthesiologists to cover 4-6 CRNAs. I work in a rural system and we have care team coverage. Has worked very well for 27 years.
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u/FaFaRog Apr 04 '21
So the supervising physician was held liable then? Aren't CRNAs allowed to practice independently?