Allow only physicians to be responsible for anesthesia care

CRNA wrote:

I have been practicing anesthesia for over 25 years. This discussion has been going on for as long as I can remember. I have been in hospitals that have opted to have only physician anesthetists and within months have recruited the CRNAs back. The only MD approach does not work for many reasons and not appreciating the role each brings to the table misses the point that it is about the patient. CRNAs are competent and do not need supervision. All physicians have specialty MDs to consult with when problems arise and CRNAs do the same every day. The difference is that the specialty MDs don't obtain a fee for the referral as anesthesiologists get a fee for the supervision of CRNAs. For the MDs, it is all about the money.

visitor wrote:

Anesthesia in the UK is provided by phyicians; a huge improvement over the USA system in which any wannabee can be an "anesthesia provider"...gee, if I'm a nurse, I guess that I can be an "anesthesia provider"????? not for me ormy family, no CRNA is doing my case, not by a long shot

LMD wrote:

21 November 2010
Dear Editor,
I am writing to you regarding the recent Op-Ed "Allow Only Physicians to be Responsible for Anesthesia Care" by Ervin Moss, MD, Executive Medical Director,
New Jersey State Society of Anesthesiologists. Dr. Moss's letter is not only offensive to the profession of Certified Registered Nurse Anesthetists, but also contains inaccuracies.
Our extensive didactic and clinical education has been recognized for many years. Yes, we do attend four years of college, and then we must have a minimum of one year of acute care experience (many applicants have significantly more experience), PRIOR to attending a nurse anesthesia program, which is generally another 24-36 months, resulting in a Masters degree. The New Jersey Board of Nursing recognized CRNA's as advanced practice nurses in their regulations in 2009. Many other states had already done so. By law, advanced practice nurses in New Jersey do not work under supervision.
As per our training, certification and scope of practice, we are able to perform various types of anesthesia and we are trained to provide anesthesia to all patients undergoing any surgery in all settings. Many of my colleagues have been deployed and cared for our soldiers and wounded civilians overseas in combat situations, without physician supervision, providing excellent, life saving care.
It is true that anesthesia has become much safer. Much of this improvement is due to improved technology and safety measures, not because " the number of anesthesiologists had increased sufficiently to appropriately control the process". If that were in fact the case, why is there not an increase in morbidity and mortality in areas where there is not anesthesiologist supervision?
Although the current regulations state we must work 'under supervision', the reality is that we work in collaboration with all physicians. Prior to surgery, we discuss the anesthetic needs with the surgeon. Even here in New Jersey, when working with an anesthesiologist, our true working relationship has been one of collaboration, not of supervision. Recent research has demonstrated that there is no significant difference in outcomes whether anesthesia is administered by a Certified Registered Nurse Anesthetist or an Anesthesiologist.
As a Certified Registered Nurse Anesthetist, when I am involved with the care of a patient, I am in the room for the entire procedure unless relieved by another anesthesia provider for a break. During this time, my only focus is on the care of that patient. I am not involved with any other issues. Dr. Moss was correct about the fact that sometimes things do happen requiring the need to make quick decisions. As advanced practice nurses specializing in anesthesia, we are trained to make these quick decisions. In such a situation, there may not be time to wait for the anesthesiologist to come before responding. We also know when we need to call for more expert advice or assistance.
Anesthesiologists do have a very important role. I respect and work well with many of them. This issue is not about replacing them, however, it is about allowing Certified Registered Nurse Anesthetists to practice within their scope of practice which will only serve to enhance care and anesthesia services.
Sincerely,
Linda M. DeLamar, APN, CRNA, MSN, MS, CH, MAJ, USAFR , Retired