Wednesday, July 13, 2016

Cage Fight At The VA

There is a cage fight going on at the Veterans Affairs hospital near you. It involves the VA's recent proposal to allow advanced practice nurses (APRN's) to practice to the "full extent of their education, training, and certification without the clinical supervision of physicians, regardless of individual state regulations." The ASA is having none of this.

This is the number one battle right now for the ASA. It's importance to the society and specialty is bigger than Obamacare, bigger than MACRA. Though NP's could potentially supplant physicians in other specialties like internal medicine, anesthesiology is uniquely susceptible to being replaced by nurses in clinical practice.

Medscape has lined up the president of the ASA, Daniel J. Cole, M.D. and the president of the AANA, Juan Quintana, DNP, MHS, CRNA, to go mano a mano to breakdown this controversy. Reading the interviews tells me that the two sides will never come to terms with each other. It's war. It's a fight to the death. Both sides are talking past each other, reciting their respective journal statistics without acknowledging the merits of the other. This will not end until one combatant is down on the mat, bleeding profusely out of every orifice, barely conscious. Then victory will be declared until the next president of the U.S. is elected, fresh lobbyists are hired, and new members of Congress are bribed. Then the fight will be renewed once again.

While the entire article is worth reading, I could barely get past the terrible picture of Dr. Cole in the article. Here's a screenshot.

Why is the man purple? He looks like he got some terrible spray tan going on where they loaded the nozzles with blueberry juice instead of tanning pigment. Or maybe he just came back from a blueberry pie eating contest where the contestants aren't allowed to use their hands. Regardless this horrible picture is very distracting and unfortunately lowers the quality of Dr. Cole's arguments. Looks count.

By comparison, Mr. Quintana's skin tone is more appropriate in his picture.

Not to sound too paranoid, but I think there is some conspiracy going on in the graphic design studio at Medscape to make the anesthesiologists' side less credible. Step it up Medscape. There is no place in your supposedly nonpartisan news coverage for this kind of blatant favoritism.


  1. Yes, anesthesiologists walked right into this quagmire with their casual reliance on extenders to perform duties that had previously been the exclusive province of physicians. At the same time the same could be said for internists relying on physician extenders such as nurse practitioners and PA's.
    Now you may say that many professions have legally authorized subordinates, and you would be right. Lawyers have paralegals, but no one is going to hire an independent paralegal and expect himself to be well represented in the eyes of the court. Attorneys have been very wise to preserve their legal authority and exclusive rights and privileges, while doctors have not been so wise.
    Having a formal professional subordinate and preserving your professional privileges needn't be mutually exclusive. We just need a professional organization representing us that understands the fight. You don't see the ABA insisting that you are luckier, better protected or safer with a lawyer representing you rather than a clerk or a para. A lawyer spent too much time, energy and money obtaining his well deserved privilege to face daily quality showdowns with his subordinates. So why do we need the AMA telling the world that you're "safer" with an MD than with an RN? This is the wrong argument. This isn't a quality grudge match. The MD is the Doctor. Let's find the correct, and politically tenable, way to make THAT argument.

  2. Is this blog still active?

  3. This blog is dead. That's a shame because I really enjoyed it.