CRNA Court Victory is a Win for Rural Hospitals

A California appeals court ruling that allows certified registered nurse anesthetists in that state to do their jobs without physician supervision isn't about patient safety, or even access to care. It's about money.

2 comments on "CRNA Court Victory is a Win for Rural Hospitals"
16788087 (3/29/2012 at 2:25 PM)

excellent comment by Barry. I would like to add, one thing often overlooked in the conversation about utility/cost of 'CRNA vs. Anesthesiologist' is much of the value add that physician anesthesiologists can bring to the 'service' of anesthesia that nurses, by definition, cannot. Examples being; most MD Anesthesiologists are well trained and experienced with providing ultrasound guided regional anesthesia, training and experience in acute post op pain management, ability to act as a physician consultant with deep understanding of the wide breath and depth of disease states, training and experience in the use of ultrasound for cardiac evaluation, training and experience in managing a patients' preoperative evaluation, and thus saving dollars and improving outcomes. There are many functions anesthesiologists, trained and encultured as physicians, can perform that nurses, by their training and culture cannot, is not within their scope of practice, or are not comfortable with. The challenge for the specialty of anesthesiology, and especially for older generation anesthesiologists, is to show our value perioperatively and OUTside of the operating room. As noted, precision medicine is making the technical practice of anesthesiology to be a lower level function as compared to how anesthesia was practiced decades ago-thus, O.R anesthesia is being disintermediated away from needing physicians. However, there is much within the purvue of Perioperative medicine that physician anesthesiologists are uniquely qualified to do, and should step up to do, so as not to make this specialty obsolete.
Barry W. Brasfield, M.D. (3/28/2012 at 6:31 PM)

The relationships between anesthesiologists and CRNAs represent what Clayton Christiansen ("The Innovator's Prescription")would classify as a "disruptive innovation": anesthesiologists, through research and training, have rendered anesthesia care so safe that it is virtually impossible to statistically demonstrate any difference in the "quality of care." Therefore, provision of anesthesia is no longer an "intuitive" medical service, but a "precision" medical service. The marketplace will continue to adjust to this development over the next decade or more...


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