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Editor's Note: This letter is in response to Cheryl Clark's Feb. 10 online column, "Nurse Anesthetists Battle Overlooks Rural Doctor Shortage."

Training Makes a Major Difference
Healthcare delivery benefits from a team approach. When each member of the team plays the role they are educated and trained to play, the patient wins. There are vast differences in the education and training of a physician and a nurse anesthetist, and these differences are why we support nurse anesthetist working as part of a physician-led team.

The training a nurse anesthetist receives is approximately three years of postgraduate training, whereas a physician anesthesiologist receives eight years of postgraduate training. To practice as a nurse anesthetist, you must pass a three-hour, multiple-choice certification exam. To practice as an anesthesiologist, you must sit for several separate exams following successful completion of a four-year residency to become board-certified.

While we agree that we need to work to increase the physician workforce nationwide to ensure patients have access to physicians, there is a severe nursing shortage in our country as well. We need to focus on training more health professionals overall—doctors and nurses—so patients can have access to the healthcare professionals they need.

Rebecca J. Patchin, MD
AMA Board of Trusteess
Loma Linda, CA

Editor's Note: This letter is in response to the roundup on "Technology: Opportunities, Challenges" in the February issue's Surveillance section.

The Making of the Message
"Technology opportunities" are not the magic solution for healthcare emergency message broadcasts. Gee-whiz speed and multimodal methods are indeed real-time wonders. Fantastic! However, in healthcare, it's not the messaging methods but the messages themselves that delay mass notifications. Why?

Healthcare leaders, like any corporate management, are very attentive to all the nuances potentially gleaned from emergency messages. Liability implications, cultural misinterpretations, and mass panic, etc. Constipated communication, as some have said.

Healthcare facilities are polar opposites from public safety agencies. No quick decisions, no quick action, outside of life-or-death emergency rooms. Healthcare leadership decision-making is consensus-driven, based upon hours, days, and even months of academic research and inoffensive wording.

Chief Donald E. White, CHSP, CHCM, CHEP
Director of Safety and Security
Northern Virginia Mental Health Institute
Falls Church, VA

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