How MD anesthesiologists have become victims of their own excellence

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Taken from  KevinMD.com’s blog:

How MD anesthesiologists have become victims of their own excellence

Comments below that tended to resonate with my thoughts.

Med Nerd At Large January 22, 2011 at 6:20 pm

It seems like the author is criticizing medical students and physicians for choosing certain specialties as opposed to primary care. While we do need more primary care providers, simply supplanting roles traditionally held by physicians will only compromise patient care.

To examine the author’s primary example, the CRNA vs MD debate, yes most CRNAs can provide equitable anesthesia to most patients as their MD counterparts. I can attest to this fact as I see it on a daily basis as both a medical student and an anesthesia tech. However, while the author may claim that it doesn’t matter who’s behind the curtain during your average cholecystectomy, any anesthesiologist knows that it makes a world of difference the second that patient unexpectedly goes into laryngospasm.

The moment something goes wrong, the first thing a CRNA does is call for the anesthesiologist. This may be an uncommon scenario, but completely replacing Anesthesiologists with CRNAs might make the difference in those patient’s survival. Patient care is ultimately compromised by the simple fact that they’re not getting “the best.”

This truth can be extrapolated to the rest of medicine. Yes, a tech/PA/nurse with less medical training might get the job done 80% of the time, but what about that remaining 20%? Are you as a parent comfortable taking your child to a PA who will most likely misdiagnose your child’s sudden fever and malaise as a viral syndrome, when in reality it’s Kawasaki’s resulting from a previous virus and could potentially kill them?

CRNAs are great, as are PAs, nurses, and techs. I know, love, and work with a lot of really great ones! But they should stay CRNAs, PAs, nurses etc. and not try and play doctor. They’re might be very capable in their respective professions, but they aren’t trained to be physicians and many should quit kidding themselves.

And I’ll choose whatever specialty strikes my fancy without feeling an ounce of guilt. As for primary care, I’m not busting my tail through nearly a decade of medical training, sacrificing my twenties, and taking on nearly $200,000 in debt to work a job that only pays 3/4 that yearly and forces me to keep working 80+ hours after residency. I want to have a family and a life outside of medicine too. So yeah, I’ll keep killing myself now and enjoy that ENT job later. I’ll make more money, work less hours (still 60+), have less headaches, and see my wife and children more. And I’ll be better at my job than any tech with less training. Who would you rather have doing your thyroid surgery?

James Gaulte January 22, 2011 at 7:14 pm

The Lewin Group is a subsidiary of Ingenix which is owned by UnitedHealth Group. Clearly a health insurer is interested in a less expensive way to delivery care..This study plays into that nicely but will we hear a rebuttal from the anesthesiologists ?

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