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TagsBY DAVID L. KNOWLTON
COMMENTARY
Unlike so many others in the health care policy arena who find themselves concerned with bottom lines, gored oxen and political consequences, my job as President and CEO of the New Jersey Health Care Quality Institute is a relatively easy one. I have a clear focus: health care quality and patient safety.
So when the Institute was asked to weigh in on the issue of whether New Jersey Advanced Practice Nurse Anesthetists should remain the only Advanced Practice Nurses required to have the presence or direct supervision of a physician certified in their specialty (Anesthesiologists), we did not hesitate. The clear answer from a patient safety point of view is unequivocally "No." The cause of health care quality is not advanced by requiring supervision and may, in fact, be harmed. In my view patient safety is the only issue that should matter in this increasingly heated issue exchange.
It is important to understand the history of anesthesiology in America to fully comprehend this issue and why nurses are an equal, if not superior choice, medically for this procedure. As I testified before the Department of Health and Senior Services Health Care Administration Board which correctly advanced regulations eliminating the supervision requirement, the very first professional that provided dedicated coverage to a patient under anesthesia was a nurse. That was more than 125 years ago. Physicians did not follow until some three decades later. Since that time, nurse anesthetists have grown to providing more than 25 million anesthesia applications annually with a safety record of which nearly every medical professional would be proud.In fact, this is not even a close call when it comes to patient safety. Every peer-reviewed study that has ever been conducted on the issue — and there have been many — has reached the same conclusion. Nurse Anesthetists have performed at the same level of Anesthesiologists or better than Anesthesiologists. It's a safe record and in the field of health care quality, where there are so many failures in this nation for which we should be ashamed, this is one to be admired.
I will cite just one of the studies not only because it is the most recent, but because it is also the most comprehensive and the most compelling. The study was published in the August 2010 issue of Health Affairs and it says everything one needs to know just by its title, "No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians." The study examined nearly 500,000 individual cases and confirms what previous studies have clearly demonstrated: Advanced Practice Nurse Anesthetists provide safe, high-quality care. The study also shows the quality of care administered is optimal, regardless of whether physician supervision is conducted or not.
This most recent study followed up on a Federal government decision in 2001 that permitted states to "opt out" of the Medicare physician supervision requirement for Nurse Anesthetists. Since this option was offered, 16 states — most recently Colorado this past September — have opted out. The study concluded that the Medicare physician supervision rule is obsolete and unnecessary. In fact, one of the study's authors, Jerry Cromwell, PhD, said "We find no evidence that opting out of the oversight requirement harms patients in any way."
And there is an objective approach to assess this risk. As imperfect as the medical malpractice insurance system is, it is still a good gauge of risk and dangers. It is interesting to note that the average New Jersey physician Anesthesiologist's malpractice rate ranges from $14,124 to $31,843 annually. Compare that to the $120,198 to $197,425 range for OB/GYN's. This difference in rates demonstrates that an OB/GYN has at least six and up to 16 times the risk of an Anesthesiologist.
Interestingly enough, Certified Nurse Midwives, who have similar degree and licensure requirements as Nurse Anesthetists, may practice and treat patients independently. These Midwives work unsupervised in both hospital Labor & Delivery units as well as free-standing birthing centers. It seems counterintuitive to require a physician to be present to directly supervise a Nurse Anesthetist's care while no such oversight is deemed necessary for Nurse Midwives given that both nursing specialties have an excellent safety record and Nurse Anesthetists have between six and 16 times less risk involved in the care they provide. Additionally, while Nurse Midwives often practice on their own with no physician present or even nearby, Nurse Anesthetists never practice without a physician present and part of their team. Further, the current Advanced Practice Nursing rules require collaboration by a physician with all of their protocols and medications before they can be administered. Requiring the unnecessary, duplicative and costly presence of an Anesthesiologist to supervise an Advanced Practice Nurse Anesthetists makes no sense whatsoever.
New Jersey should do the right thing and take the course that leads to better health care quality outcomes. The Commissioner of Health & Senior Services should ignore the distracting, economically-motivated arguments on this issue and focus only on quality, safety and the health of the patient. That path is clear; Advanced Practice Nurse Anesthetists should be treated as all other Advanced Practice Nurses and should not be required to have an Anesthesiologist present for the safe delivery of their care.
David L. Knowlton, President and CEO of the New Jersey Health Care Quality Institute headquartered in West Trenton, is a former Deputy Commissioner of Health during the administration of Governor Tom Kean.
Um...if you see Medicare fraud every day, report it. You'll make millions on the whistleblower lawsuit. Unless you're lying.
I, too, am in favor of a collaborative model where both providers can work together for the overall good of the patient, but we both know that there are providers on both sides of the fence that are not in favor of this stance. Moreover, I do agree that Medicare fraud is a problem, and I am sure that both anesthesiologists and independent nurse anesthetists have manipulated the system in the past to their benefit.
I am sure that the analogous nursing forum is a beacon of light for all humanity and certainly not a “bastion of character assignation, insults, vitriol, misinformation, fear mongering, and propaganda.”
I am also certain that a nurse anesthetist would not “actively deceive the public for their own benefit”, such as the times I’ve seen a CRNA be called “Dr.” by a patient with no correction being made by the CRNA or how some advanced nurses will get their DNP and introduce themselves as “Dr. Smith” to patients, knowing that with the introduction of that title a patient thinks you are a Doctor of Medicine instead of a Doctor of Nursing Practice. And let’s not mention the “journal articles” such as the one being used in this author’s commentary that are sponsored by the AANA. Certainly, there is no bias in the reporting of data and results in those “studies.” It's shocking that it didn’t get published in Science or Nature.
And certainly, no nurse anesthetist would “fall so low to use tactics to minimize another group of healthcare professionals” who aim to serve our public. This is clearly demonstrated by the vigor with which some CRNA’s bash Anesthesiologist Assistants (AA’s) and their qualifications to do the job they are trained to do. “Tactics” such as trying to block legislation to open AA schools across the nation would certainly not be attempted by our great country’s nurse anesthetists.
However, I do agree that autonomous and collaborative practices will continue to thrive. Unfortunately for us and the general population, Mr. Deutsch, not everyone shares that same sentiment.
Warmest regards to you as well, sir.
There is plenty of rebuttal to the article and comments...on both ends.
However, none specifically dedicated to your personal attack on someone who may or may not have had addiction issues. Any credibility you had was lost when readers saw that post.
Again, I throw this out there...what do you call a medical student who was ranked last in his/her graduating class?
Doctor.
doctorbyyourside.org
The anesthesiology forum on SDN has truly become a bastion of character assignation, insults, vitriol, misinformation, fear mongering, and propaganda. - CLEARLY demonstrated in the comments on this article.
It is a sad state when your profession has fallen so low to use such tactics to minimize another group of healthcare professionals in this manner.
Meanwhile, autonomous/collaborative practices will continue to thrive.
Best regards -
JD
There were two in that thread, actually. And others on that site. If you think the idea is isolated, you're mistaken. Time will tell.
A lot of people try to make this argument seem like it is all about patient care and safety and cost savings. Let’s stop lying to ourselves. It is about entitlement and money. For an appendectomy, the reimbursement paid for the anesthesia for that surgery from the insurance company is the same whether a physician anesthesiologist or a nurse anesthetist bills for it. The physician may get a bigger cut than the nurse anesthetist does depending on how the money is divided in their group practice after the patient pays but the amount that the patient has to pay on their bill for the service is exactly the same no matter who does the billing. There is NO cost savings to the patient at all. There are some nurse anesthetists who think they can do what an anesthesiologist does because they can start an IV, sit in the operating room by themselves and push some drugs through a syringe. As such, they expect to be compensated like a physician. There is so much more to the practice of Anesthesiology than that. Anesthesiology is the practice of medicine just as every other medical specialty is. Unfortunately, those who are not physicians and don’t understand what the practice of medicine is will never appreciate and understand that fact. Patients should not have to be the ones who find out the hard way that there is indeed a difference.
Anesthesiologists (physicians) must complete a 4 year pre-med college curriculum making stellar grades, take the extremely difficult MCAT test to get into medical school, and complete 4 years of medical school. During medical school, they learn all aspects of medicine and do hands-on rotations during medical school in every medical specialty including surgery, ob-gyn, pediatrics, internal medicine, and critical care just to name a few. They earn a professional M.D. degree after this time. Then they complete a 4 year residency in anesthesiology, including a 1 year internship in medicine, surgery, or a combination of both. Some even do an additional 1-2 year fellowship in anesthesiology sub-specialties, such as cardiothoracic, pediatric, regional, pain, or critical care to further specialize their training in the specialty.
Total years of education to become an anesthesiologist= 12-14 years
Approximately 50% of CRNAs (nurse anesthetists) do NOT have a 4 yr bachelor degree, but rather a 2 yr RN degree. They then go on to complete 2 yrs of nurse anesthesia school (master’s level degree). Many states do not even require that a CRNA have the master’s degree, and in the states that do require it, there are clauses that 'grandfather' in the older CRNAs with only the 2 yr RN and 2 yr nurse anesthesia school. These particular states also vary with the cutoff date, with some states even grandfathering in these CRNAs back to 2003. Additionally, SRNA’s (student nurse anesthetists) rely heavily on Anesthesiologists (physicians) to teach them during the clinical portions of their 2 year nurse anesthesia school education.
Total years of education to become a nurse anesthetist= 4-6 years
To become a CRNA (nurse anesthetist) there are only 2 board exams to pass.
Upon completion of nursing school, the applicants sits for the NCLEX board exam and must pass it to receive the 'RN' or 'BSN' (bachelor’s level degree). This board exam is only 75 multiple choice questions with FIVE hours to complete it. The applicant can fail and retake this exam an infinite number of times.
NCE (National Certification Examination) is the second and final exam to take upon completion of nurse anesthesia school. This test is only 100 multiple choice questions with 3 hours to complete. After this test, a CRNA says that they are “board certified.”
Total number of board questions to become a CRNA= 175 multiple choice questions.
To become an Anesthesiologist (M.D., physician) there are 6 board exams to pass.
To first become a licenced Medical Doctor, you must sit for and pass a series of exams called the United States Medical Licensing Exams (3 exams or 'Steps').
Step 1: taken upon completion of year 2 in medical school. 8 hour exam, 350 questions.
Step 2 CK (clinical knowledge): taken upon completion of year 3 in medical school. 9 hour exam, 370 questions.
Step 2 CS (clinical skills): also taken upon completion of year 3 in medical school. 8 hours, 12 live patient encounters.
Step 3, 2 days: taken during Internship (first year of residency). Day one, 8 hours 336 questions. Day two, 4 hours 144 questions.
In most cases, failure to pass Step 1 or Step 2 results in the medical student getting dismissed from the medical school and that person never becoming a physician in any specialty. If the applicant fails to pass all 3 Steps in a 7 yr period, he or she will not become a licensed physician.
The American Board of Anesthesiology (2 exams)
Part 1: Written Boards: taken upon completion of 4 years of Anesthesia Residency, 4 hours, 250 questions.
Part 2: Oral Boards: taken upon successfully passing the written boards, Two 35 minute oral exams.
Total number of board questions to become a board certified anesthesiologist= 1450, in addition to over 9 hours of demonstrating clinical skills and answering oral board questions and case scenarios.
Recertification.
The recertification process is completely different. CRNAs do NOT have to take another board exam for the rest of their life. All they have to do is 'recertify' every 2 years. By 'recertify', all they have to do is prove to the AANA that they have completed 40 hours of CME (continuing medical education) in a 2 year period. Only 20 hrs/year of continuing education that can easily be accomplished during a weekend course or with a couple of online powerpoint presentations.
On the other hand, Anesthesiologists have to average approximately 50 CME hours every year, complete case evaluations, complete a hands-on simulation course which demonstrates valuable crisis management techniques, and take another written board exam (4 hours 200 questions) every 7-10 years to be able to continue practicing as a “board certified” Anesthesiologist.
Really bad example to choose.
Most anesthesiologists do not believe this.
2. Art Zwerling's record speaks for itself. His career exemplifies openness and integrity. He practices is the OR everyday. He does not waste time bashing other professions, and nether will I.
Autonomous practices are the future. If you don't believe me, ask the professionals - CRNAs and anesthesiologists - who say so.
http://www.nurse-anesthesia.org/showthread.php/11650-Nurses-are-an-equal-if-not-superior-choice-to-administer-anesthesia
Doctor.
If you define being a physician as someone who "cures diseases" there are very few physicians in this world. What Doctors due on a daily basis in all specialties is not curing disease it is managing pathology. So is it any different when an anesthesiologist manages intra-operative heart failure, dysrhythmia, COPD, asthma, pulmonary HTN, anaphylactic shock, sepsis, PE, hemorrhagic shock etc when compared to cardiologist, pulmonologist, ER physician, internal medicine doctor. I think many individuals feel that since anesthesiologist do not treat pathology of a particular disease process chronically that they do not treat or "cure" pathology which is an incredible underestimation of an anesthesiologist skill level. Not to mention there are a large number of fellowship trained anesthesiologist who are attending physicians in charge of running critical care units all over the united states, who are able to perform TEE to help with the diagnosis of intra-operative cardiac pathology, who treat the sickest babies all over the country and the list can go on and on. So to state that "anesthesia is the only medical specialty that is not dedicated to the curing of disease. Rather, it is the removal of pain, along with the optimization of each patient's unique disease status. Many CRNAs are fully capable of doing this, and doing it independently." is an extreme over simplification of the practice of anesthesia. Can a CRNA give an anesthetic without supervision to a 35 yo male with crohns disease requiring a small bowel resection with out any adverse outcomes I would say yes...can a CRNA do the same procedure on the same patient with severe pulmHTN without any adverse outcomes I would say no. So how can you give CRNAs independence to practice independently when the vast majority are unable to provide anesthesia to more complex patients without supervision. Are you saying that CRNAs should be independent of supervision and get to pick and choose what cases they are capable of doing while getting paid the same as an anesthesiologist with only a fraction of an anesthesiologist education and knowledge level? Explain to me how this is good for patient safety and how this is going to make healthcare more affordable?
In my time delivering anesthesia, I've seen many CRNAs and MDAs, some excellent, some horrible. Indeed, anesthetic knowledge and it's practice is within the scope of both - but how this knowledge is used is on a continuum. In isolation, yes - CRNAs and MDAs both possess the knowledge needed to practice independently. In reality, both providers can be used efficiently and collaboratively. Thus, the best model would be a collaborative one, not a supervisory model.
Unfortunately, for reasons not at all related to patient saftey, and closely related to preservation and greed, physicians have said they are needed in every anesthetic. This is an outright lie, and should be treated as such. Physician consultation is at times helpful, especially since their experience can be broader in comparison.
But all providers have their limits - even physicians - and this is exemplified in how often they consult one another. In the same way, CRNAs know when they need to consult a physician - be it an anesthesiologist, cardiologist, or surgeon. They are full professionals in their own right - and the practice model for anesthesia MUST be a collaborative one if it is to be mindful of the professionals involved, and financially stable.
But this model will never be endorsed by the ASA, because it admits that 1) Registered Nurses can be educated to act independently at the highest practice standards, and can even advance the science of anesthesia and 2) it puts CRNAs and MDAs on too close of a playing field. Simply, this removes too many potential dollars out of the pockets of those leading the ASA.
While some physicians are truly worth every dollar they are paid - others make their living 'supervising' from outside of the operating room. These physicians are often the loudest when it comes to how much they are needed.
Keep in mind anesthesia is the only medical specialty that is not dedicated to the curing of disease. Rather, it is the removal of pain, along with the optimization of each patient's unique disease status. Many CRNAs are fully capable of doing this, and doing it independently. Others benefit greatly from physician consultation.
In addition, not all anesthesiologists are equal. Some barely meet requirements, and enter their practice with minimal training in certain aspects of anesthesia. Many are never certified in anestheisa. Yet, we trust them because of their "MD," which may very well be from a sub-standard, non-American school.
For example - I've spoken to many new attendings that were deficient in regional anesthesia, while many CRNAs, especially military trained CRNAs, are not only excellent at regional anesthesia, but are leading the field in new techniques.
Physicians who comment here and disparage CRNAs are ruining their credibility. CRNAs have and will continue to provide excellent services to Americans, as they have been doing, with the same saftey rate of their physician counterparts, for over 100 years. Unfortunantly for the ASA, the time of society swallowing the ASAs propaganda coming to a close. Many new MDAs are fighting more fiercely than ever, but some new attendings are embracing the collaborative model.
Clinicians in collaborative practices know that greater productivity is found when all clinicians have autonomy and respect. They know that their national organizations would be better off spending their time focused on patients, rather than the need to defend themselves or the need to demonize others. They know that anesthesia is a unique field in American medicine, one that has been shared by many professionals, including dentists. And of course - they know that patients - because patients ARE the focus of our careers - patients will be better off when collaborative models become the standard in American anesthesia.
Advanced practice nurses, while helpful in many situations clinically, function best when they must defer/refer/collaborate with their affiliated physicians due to their general lack of knowledge and skill in caring for the more difficult and challenging situations, eg., hypertension or heart failure for primary care, higher risk pregnancy and cesarean section, and more difficult surgeries or patients for anesthesia care. They do not equate with physicians, and especially CRNAs do not equate with Anesthesiologists.
The study that Knowlton cites is a typical response and bureaucratic example, one that superficially seems to show nurse anesthesia care is as good as physician care, when the reality is that the data is NOT clinical, it is based on administrative billing data. Such data is inherently limited and NOT applicable for reaching clinical conclusions. It is not scientific to do so.
Here in California, we recently had Governator Shwartzenegger, a miserably failed politician, unilaterally decide to allow the state to opt out of the time-honored mandate that CRNAs be supervised by physicians (he did not consult with the State Medical Board, the state anesthesiology society, or allow public comment on this policy change, all of which are required by law). In my l letter to the Governator, I wrote the following, which is my opinion of CRNAs:
"I firmly believe that nurse anesthetists should NOT be allowed to practice independently under any circumstances.
I have practiced anesthesia for 22 years in a variety of circumstances, including academic settings and private practice. I have been an anesthesiology administrator for many years as well. I have had the opportunity to interact with, supervise, work with and teach Nurse Anesthetists (CRNA) and student nurse anesthetists, so I believe that I can speak with confidence and significant experience regarding training, standards of care and qualifications of CRNAs.
The training and education that CRNAs receive, while more extensive that regular Registered Nurses, is not even comparable to that which Anesthesiologists undertake. Two years of nursing education, one year of critical care nursing training and one year of anesthesia does not compare with four years of medical school and 4 years of internship and residency training, neither in length nor scope nor depth of education and experience.
I have worked with many CRNAs. Their skill level, training, experience, confidence and quality of care vary widely. Some CRNAs are excellent and compare favorably with their physician counterparts. However, the vast majority, in my experience, do not. This is not to say that do not fulfill a role in anesthesia delivery and in some operating rooms; however, in my opinion, it is most safely accomplished under the oversight and supervision of a physician, and preferably an anesthesiologist. Allowing any CRNA to practice independently, while only few can adequately do so, is frankly dangerous and a significant threat to patient safety.
I hope that our current unrelenting drive to 'improved' healthcare does not incorporate opinions such as those of Mr. Knowlton and other bureaucrats, most of whom are not truly seeking to improve patient safety, but are merely trying to minimize costs while pushing personal agendas.
CRNA - Has completed nurse anesthetist training. Good.
DNP - Doctor of Nursing Practice. Now Mr. Zwerling is Dr. Zwerling. A bit misleading?
DAAPM - Diplomate of the American Academy of Pain Management. Check out their website. This is NOT board certification. You pay the fee and take a test, but mostly you pay the fee. A search in my area included nurses, doctors, dentists, naturopaths, etc. You decide how useful this is.
I appreciate your commentary and view it as only that. You probably should have mentioned that your name appears on the Board of Trustees of the New Jersey State Nurses Association. Not exactly an unbiased source are you? Also, I found it interesting that the New Jersey Health Care Quality Institute supports the Leapfrog Group's initiative to have ICU's staffed by critical care physicians. Are you aware that it is an anesthesiologist who heads up this Leapfrog committee? So patients in ICU's deserve a physician /anesthesiologist but not in the OR?? Seems a bit of a double standard. Anesthesia in America was introduced by Crawford Long and popularized by Morton (neither were nurses). Physicians became involved in anesthesia to improve its safety. Anesthesia has an amazing safety profile thanks to the hard work of anesthesiologists. Physicians are the ones writing the textbooks, conducting research and development, staffing committees, formulating guidelines and advancing the field. Where would we be without these anesthesiologists? Probably still dropping ether. You also alluded to a "study" in the journal of Health Affairs. This "research" is politically-charged and poorly designed. It was privately funded by the American Association of Nurse Anesthetists and involved a retrospective chart review of billing codes. This is hardly good evidence based medicine. Every other "study" has the same flaws, and is no more than political propaganda. You then went on a strange tangent about independent midwives. You are absolutely correct that they can practice independently and there is no "data" to suggest that women in New Jersey are better served by an OB/GYN. This is of course true until a patient needs an emergent operative delivery (i.e. C-section) when it's sure nice to have a MD nearby. I currently work with CRNA's and have the opportunity to train student nurses anesthetists (in addition to physician residents). I appreciate the skill set and knowledge of my CRNA colleagues. I do not totally disagree with your argument (i.e. independent CRNA practice), but I believe it is much more complex than a few simple paragraphs. If you want a real study then randomize new CRNA grads and physician anesthesiologist to all areas of anesthesia including high risk OB, emergency heart surgery, complex pediatrics and pain medicine and let's see how it goes. However, no physician (myself included), patient or CRNA in their right mind would allow this to happen. Like all things in life, the answer probably lies somewhere between the two extremes. Thank you for presenting one of those extremes.
Mr. Knowlton would have you believe that the mere title of an article is sufficient to tell you "everything one needs to know". Incredible. That means I can just read the headlines in the newspaper and skip all that other stuff that takes up space - you know, things like facts, opinions, real data, etc. Apparently all that is unnecessary. All I need to do is create the headline or title and the content doesn't matter. Tell me, where and when do they teach this in school? Just think what would happen if we took the title of this article as gospel, instead of the pitiful piece of political pandering that it is.
Mr. Knowlton is a political bean counter at best, and a political hack at worst. Like any bean counter in any business, the mantra is "cheaper is better". That of course is absurd on it's face. One can try to make an argument that CRNA's with 6-7 years of post-high-school education are "equal" to physician anesthesiologists with twelve years of post high-school education, but that argument falls on it's face as well. The idea that CRNA's are a "superior choice" seems to suggest an opinion that is bought and paid for, much like the opinion in the Health Affairs article Mr. Knowlotn cites, that was indeed a study bought and paid for by the American Association of Nurse Anesthetists.
Mr. Knowlton also appears to have a problem interpreting data and making conclusions vased on that data. Although the malpractice rates for OB/GYN doctors is certainly significantely higher than an anesthesiologist, you can't make the the lowest rate of one and the highest rate of the other and claim the risk is "16 times" higher. He calls this objective, while his entire article is loaded with subjective puffery and opinions with no basis in fact.
The comparison to nurse midwives is misleading at best. CNMs do not have the full scope of practice that OB/GYN physcians do, so using them as an argument to broaden nurse anesthesia scope of practice is pointless.
And while we're discussing facts, or the lack thereof - Mr. Zwerling's opinion noted in the response above would have you believe that Mr. Knowlton's opinions somehow represent "science rather the PR rhetoric". Nothing could be further from the truth, and lets remember that Mr. Zwerling is hardly an unbiased respondent to this article.
Editorials by their very nature are full of opinions and short on facts. Mr. Knowlton's effort most assuredly fits that criteria.
Its time we stop fighting this turf war and concentrate on all our patients.
Elizabeth WT
CRNA
Maryland
I could masquerade as an OR RN and tell a bunch of defamatory stories about things Ive seen Anesthesiologist do as well but I am not as unprofessional as my detractors obviously are. Sufficed to say I challenge them all to prove ANYTHING they are saying here. The fact is their comments here only serve to evidence what Mr Knowlton has said about the REAL reasons ($$$$) they attack us so vehemently. He echos what recent California Supreme court Judge Busch said when the MDs attempted to sue the government to stop CRNAs from practicing independently in this comment
"In the final order, Judge Busch said that while the CSA and CMA seemed to suggest that the opt-out creates safety risks for patients, they “did not present any evidence on that point nor did they substantively rebut the evidence presented by [CANA] demonstrating that the opt-out does not present safety risks.” Evidence presented by CANA included two national anesthesia studies published in 2010 that confirmed the safety and cost-effectiveness of nurse anesthetists."
Obviously he saw through the smoke and mirrors as well.
Cindy G.
Trenton
Johs Salter.
N J
How many hours have you spent in an OR? I am an OR nurse at an institution that uses both CRNA and Doctors to provide the anesthesia and I can tell you that there are some CRNA that I would allow do my operations if I was have a hernia repair or even bowel resection etc but at the same time these are the experienced CRNAs. I would never let a newly graduated CRNA touch me without doctor supervision even for the simplest procedure. But on the other hand I would have no problem letting a newly graduate anesthesiologist provide my anesthesia. Trust me when I say it is a good thing that CRNAs are supervised until the doctors have spent years continuing to teach the CRNAs after graduation.
Mindy W, RN
It disgusts me that Mr. Knowlton who could only dream of having the intellectual capabilities of getting into medical school feels he can sit from his ivory tower as CEO and equate nurses with physicians. Please get an MD (or even an RN), and then pass judgement on an issue you are so clearly ignorant about.
To all other patients who may be reading, I can only tell you that having a physician looking over your care is worth every penny. It certainly saved my life
Thomas L
Patient Advocate
New Jersey
Thank you for an honest, and well reasoned response to the Trojan Horse of "Patient Safety" that the ASA continues to attempt to sell to the public. You have eloquently and accurately placed the realities of anesthesia outcomes where they ought to be; founded in science rather than PR rhetoric.
The truly unfortunate issues are the tremendous loss of resources and professional discord this has generated. Our patients and economy would be much better served by paying attention to the science rather than the political rhetoric of any trade organization.
Thanks once again for having the integrity and courage to publically state your arguement in favor of autonomous/cooperative CRNA practice.
Best regards,
Art Zwerling, CRNA, DNP, DAAPM
Elkins Park, PA