Winning The War

At the just completed ASA conference in San Francisco, Dr. John B. Neeld, Jr. delivered the prestigious Emery A Rovenstine Memorial Lecture to thousands of anesthesiologists in the audience. Dr. Neeld is a former president of the ASA back in 1999. His talk was titled, "Winning The War." As you might guess, it has nothing to do with the war on poverty, drugs, or Afghanistan. Instead it is a call to arms against the encroachment of CRNA's into our profession.

"We are in a war over the provision of anesthesia for patients," he said. "The safety and survival of millions of patients demand that we win this war. I call upon ASA to appropriate $1 million to fund outcomes research to demonstrate the value of physician-led anesthesia teams." He notes that the nurses are quickly gathering allies in all the right political offices to expand their practices. The Obamacare laws even forbid payment discrimination by federal programs for delivery of medical services no matter whether they are performed by MD's or CRNA's. Continues Dr. Neeld, "Failure to prove that anesthesiologist-led care is the gold standard will submit millions of patients to increased risk. Performing these outcomes studies is all about the patient."

Bravo Dr. Neeld. We do need to prove to everybody, especially the people who are paying our bills, that anesthesiologists deliver a higher quality of anesthesia and increased levels of safety to our patients than CRNA's. However the proof is in the pudding. Just having a gut feeling about our superiority in providing anesthesia due to our longer training period or hearing anecdotal tales of scary nurse anesthetists' misadventures in the operating rooms don't sway anybody's perception that anesthesiologists cost too much money.

As I have mentioned, we have pretty much shot ourselves in the foot with our drive to improve patient safety in the OR. While it is great for patients that anesthesia has now become one of the safest fields in medicine, it has greatly complicated our ability to market ourselves as the better anesthesia providers. With anesthesia complications now running so low, it is nigh impossible to prove one way or another the differences in outcomes between MD's and CRNA's. With the ASA's stated goals of eventually have zero anesthesia complications, this will only exacerbate our high cost image problems. After all, if a procedure is highly risky, patients will want the physician who is the most highly trained and has the most experience. However, if the risk becomes very low, regardless of who is doing it, the urgency to want only the best trained provider becomes less immediate and people start shopping around using other factors besides training, such as cost. For example, nobody is going to cost shop a neurosurgeon for a brain tumor resection because the procedure has a relatively high risk of complications. The patient will want the best surgeon available. However if anesthesia risks are practically zero, regardless of who is administering it, then costs will definitely become a consideration, which it already has for many hospitals and insurance companies.

So Dr. Neeld should be commended for stepping into this minefield. However, any chance that some studies will show the superiority of anesthesiologists over CRNA's will be years away and cost millions of dollars to conduct. And in the end it may just prove that the outcomes are the same regardless of who is pushing the big syringe and little syringe as the ASA's zero anesthesia complications initiatives become widely adopted by all anesthesia providers, whether they be doctors or nurses.

Where is the next great peril to anesthesiologists about to occur? Read about it here.