Monday, October 21, 2013

Where The Battle Has Already Been Lost

We recently had some traveling nurses come work at our hospital. Their most recent assignments had been at some East Coast medical center. They remarked with astonishment that we have actual anesthesiologists working inside the operating rooms.

"Why do you sound so surprised?" I asked them. They informed me that at the prior hospital back east that they've worked in, CRNA's were the ONLY ones in the operating rooms administering anesthesia. What were the anesthesiologists doing outside while the operations were going on? Seemed like they were in charge of getting the next patient ready for the case, having the anesthesia consents signed, and writing post op notes on the floor. "Didn't they ever come into the OR to do cases?" I further inquired. No, they said. And the surgeons preferred to have the nurses giving the anesthesia at their institution.

I was dumbfounded. And depressed. Something has gone terribly wrong with the way that anesthesiology group has decided to practice at that hospital. This was coming from a state that had not yet opted out of physician supervision of CRNA's. But for all intents and purposes the CRNA's were running the show in their operating rooms. Imagine that you've spent hundreds of thousands of dollars getting your medical education. Spent years out of your life that you will never get back studying to become an anesthesiologist. Then at the end, you are nothing more than a paper pusher and face greeter. That appears to be the functions of their anesthesiologists. 

The longer this situation continues, the worse it will be for those doctors. As the nurses pointed out, the surgeons actually start preferring to work with the CRNA's. The less exposure the surgeons have to the expertise of their anesthesiologists, the less they can trust them or respect their hard earned anesthesia experience. They won't have gone through the difficult cases together, fought the same battles, or share the same war stories. Instead the anesthesiologists over there are on the outside looking in.

Now maybe the anesthesiologists at that hospital prefer to work in this fashion. Perhaps they like not stressing in the operating rooms. It could be that they like to go get their coffee and bathroom breaks anytime they wanted instead of rushing between cases. Maybe their accountants told them that they can make more money hiring CRNA's to work than to bring in more anesthesiologists. But if anesthesiologists start taking this attitude, then it becomes easier for hospitals, and states, to say they want their CRNA's to work without the oversight of anesthesiologists protecting the patients. If anesthesiologists are reduced to little more than legal secretaries and nurse practitioners, then anesthesiology as a relevant clinical field of medicine will be irretrievably lost.


  1. As a 4th year med student getting ready to start the anesthesiology interview trail, this is pretty scary.

  2. This is nothing new. Anesthesiologists RARELY enter ANY operating room east if the Rocky Mountains. I am a CRNA who has not worked with an MDA for a decade. I have been the head of anesthesia departments and I perform image guided pain management injections. I have not had a single death or injury during that entire time. That is not due to luck. That is not due to "only doing ASA I or II patients". It is due to skill, knowledge and vigilance. This happens with physical status I-VE patients.

    The battle has already been lost. As much as I dislike our President's policies in general, the Affordable Care Act will spell the ruin of MD and DO anesthesia. I am sorry. Maybe you can switch to being an intensivist. Wait.... Acute Care NPs with DNPs are taking that over too.... :-)

    Have a nice day!

  3. I just left a care team practice and now practice solo. Contrary to what is portrayed I have great respect for certain anesthesiologists that I worked with and for MD's like yourself who actually practice anesthesia. Unfortunately I am not aware of any group in the entire state I came from that had any MD's actually doing their own cases. Instead they would do the preops, sign the chart, take a nap in their chair and bitch about how much more work they were doing then their partners. Half of them could not do blocks yet of course I was not allowed to either due to being "just a nurse" despite having personally performed 100 peripheral nerve blocks during training. Your points are all absolutely valid, although I think you are greatly mistaken as to how prevalent the situation is that you describe. The ACT practice is the norm in the East unlike the West where it is predominately all MD or all CRNA. Our heart surgeon verbalized on a regular basis how he just wished certain MDs would just stay out of the room after swooping in to screw things up. Usually these individuals were the weakest practitioners including both CRNA and MD yet had the biggest egos and threw their weight around the most. If I ever had the opportunity to work with an MD like yourself I know there are things I could learn and would enjoy it. As for the others I hope you understand the reasons for there being no love lost.