The physician anesthesiologist vs. CRNA debate

Why is this even a debate?

It seems to me that the CRNA-led debate is financial… once you tease through all the fluff.

So here’s some literature I found:

As an anesthesiologist, I work in an MD-only anesthesia group. This is by choice: I prefer doing my own cases and being responsible for my own liabilities. The times I have required an anesthetic, I have requested a physician anesthesiologist. As a resident, I had very good insurance coverage, so I wanted a physician for my surgery. At that time, I was ok with having a resident anesthesiologist paired with an attending anesthesiologist for my case. My second surgery was done at my current hospital, and we only have MD anesthesiologists. Perhaps I’m biased? I know and I understand the path/journey/training it takes to get to become a physician anesthesiologist. I want someone who is well-trained, independently thinks, vigilant, and knowledgeable.

I’m sure there are great CRNAs out there… but when I was a resident… we used to supervise CRNAs in our final training year…. and it was scary some of things they would do. Who extubates from a trach R&R on 30% FiO2? Yeah, that particular CRNA told me they had 30 years experience. 30 years experience of doing something wrong doesn’t equate to 30 years of knowledgeable experience. And let’s not forget that CRNAs need a 15 minute morning break, 30 minute lunch break, and 15 minute afternoon break and they go home when their “shift” ends (even if it’s in the middle of a complex case). I take a break when I can… I eat lunch and take a bathroom break when I can…. and I choose to stay and finish complex cases for better continuity of care.

Would you want a nurse practitioner or physician assistant solely performing your surgery without a surgeon? I know I would NOT. I think there’s plenty of room for teamwork in healthcare. This is how to improve hospital efficiency and patient care. My fear is if CRNAs gain independence for purely financial reasons. But then, they will have to carry their own liability, cover their own breaks, take night call and discover that they had it so good in a healthcare team.

Opinions from other physician anesthesiologists:

 

Bottom line in my opinion:

  • Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training specifically in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
  • Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school.  The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
  • I will continue to be FOR team-based physician-led anesthesia care.

The healthcare debate

Here it is.  I didn’t want to opine, but it’s here and I can’t get away from the topic.  I see it at work.  I watch it at home.  It comes up in discussions…  so in order to make it stop, I’m going to give you an idea of what I see and what I think about Obamacare and whatever else is out there.

April 2015

Public Integrity: Insurers backed Obamacare, then undermined it.  Now they’re profiting from it.

February 2016

Talking Points Memo: The real reason insurance companies are complaining about Obamacare

August 2016

CNN: Will Obamacare survive as insurers pull out?

October 2016

Salon: Making a killing under Obamacare: The ACA get blamed for rising premiums, while insurance companies are reaping massive profits

November 2016

Portland Press Herald: Maine Voices — The problem isn’t Obamacare; it’s the insurance companies

December 2016

NYT: Health insurers list demands if affordable care act is killed

The Huffington Post: The Obamacare paradox — The real reason health insurance companies don’t like the ACA

January 2017

Market Watch: I’m a former health insurance CEO and this is what Obamacare repeal will do.

Great Z’s: Liberals are out of touch

March 2017

LA Times: Here’s the secret payoff to health insurance CEOs buried in the GOP Obamacare repeal bill

Common Dreams: Why big insurance adores the American Healthcare Act

What I see:

When Obamacare was initiated, I recall seeing a patient who had broken her foot while hiking locally.  She had a surgeon who was covered under Obamacare, as well as an anesthesiologist.  However, the hospital chose not to accept Obamacare and she had to pay out of pocket for her overnight stay.

It seems that we’re seeing more and more insurance companies pulling out of the system because it doesn’t seem to be profitable for them.  Insurance companies are a business; they’re not looking after the wellbeing of the patient.  Physicians, nurses, caretakers, the care team look after the wellbeing of the patient.

How many people do you know are satisfied with their insurance coverage?

I’m covered by Anthem on a PPO plan with about 240 physicians.  My insurance rate is lousy for the coverage I receive — a high deductible plan.  I’m young and healthy and take responsibility for my health — why am I paying $620/mo for barely there medical coverage as a physician?  Well, the answer is that our company makeup is a majority of older partners who skew the coverage toward a higher premium — basically a mini-Obamacare environment.  I’m subsidizing their health coverage… and someday, hopefully I will still be healthy bc I’m responsible for my health (keypoint right there folks) and doing everything I can now to give my body the best fighting chance to survive into “old” age.

My question: 

Anyone think to make insurance companies accountable with transparency re: ACA?  Start there.  Does anyone else think it’s odd that the people who are helping shape the bill don’t actually participate in the care/exchanges like the public?  All the while, government and insurance companies dictate coverage and force physicians into tougher situations to deliver care.  Is this what you (the public) want?  When was the last time you saw the fine print of the bills being passed?  Don’t just follow the masses, look for the details and truth for yourself.

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What government officials have for insurance: