ASA: Patients demand physicians provide anesthesia care

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

ASA: Patients demand physicians provide anesthesia careWhen it comes to receiving anesthesia or pain-related care, patients overwhelmingly demand the care of a physician anesthesiologist over other non-physician providers. In a recent survey conducted by AMA, 70 percent of public respondents believed only a physician should administer and monitor anesthesia levels before and after surgery, while 80 percent believed only a physician should perform pain management techniques like spinal injections.

These findings clearly demonstrate the public’s opinion on which type of anesthesia provider they want overseeing their care. It is important to note that anesthesia providers work in a valuable team setting, called the Anesthesia Care Team model consisting of anesthesiologists who lead the team along with nurse anesthetists and anesthesiologist assistants who provide support. The AMA’s findings are further supported with the recent ASA Vital Health survey findings in which nearly 80 percent of survey respondents wanted an anesthesiologist to administer the anesthesia for their surgeries.

The public, patients really, have made their voices clear in the results of these two surveys- they want anesthesiologist leadership in their anesthetic care. While nurse anesthetists are able to perform the technical aspects in the administration of anesthesia, they simply do not have the education, training or skills to fully manage patients, respond to medical complications or advance the science of anesthesiology. Anesthesiologists have at least eight years of post-graduate education and training, while nurse anesthetists have only two to three years.

Due to the advanced training of anesthesiologists, they have been at the forefront of patient safety and quality initiatives throughout the history of the specialty. These advances have led to a dramatic decrease in anesthesia-related deaths over the past 25 years, from two deaths per 10,000 anesthetics administered to one death per 200,000 to 300,000 anesthetics administered.

Anesthesiologists continue to work toward further patient safety advances and also are working to universally extend their roles outside of the operating room as the physicians responsible for pre- and post-operative assessments, diagnostics and pain management, as well as blood transfusion and respiratory therapies.

John F. Dombrowski is on the Board of Directors of the American Society of Anesthesiologists.

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  • NShort

    I suspect that the survey did NOT provide a description of the education, training and experience of CRNAs and simply asked patients to choose between a MDA, CRNA, AA etc. The survey probably did not inform participants that most of the anesthesia in the USA is administered safely by CRNAs. Or inform them that the military uses CRNAs without a MDA within miles and miles. Or about the CRNA in rural America who is “supervised” by a MDA who is miles and miles away.
    The survey probably also did not describe what “supervision” really is….. a MDA perhaps checking in on a patient (or not) after a procedure is underway….the MDA “supervising” multiple patients at a time……the MDA “showing up” at the last minute while propofol is pushed right before a cardioversion.
    Let’s be real. Of course the public wants the person with the most credentials just as they want a plastic surgeon for the tiniest of lacerations just as they want a board certified MD to treat their UTI just as they want EVERYTHING that’s possible done at the point of death.
    But most important – the American public believes that their attending surgeon is probably in the OR throughout their entire procedure and we all know that isn’t true and isn’t even required by Medicare.

  • http://fertilityfile.com IVF-MD

    Dr. Dombrowski,

    Of course! Who wouldn’t prefer an MD vs a non-MD if that’s the only factor?

    BUT, how about repeating the survey?

    A: MD anesthesiologist + $1000 additional co-pay
    B: CRNA

    Or even

    A: MD anesthesiologist + $49.99 additional co-pay
    B: CRNA

    The free market has a powerful voice.

  • max

    The student has become the jedi master(or evil sith lord, depending how you view it). Anesthiologists trained crnas. Easy money. Sit back and watch that nurse do the work for you. Little did they know they were training their own obsolescence. Time to retrain old friend.

  • Umdnjay

    The price is based on the code billed not on level of training so the only savings is to the hospital, not the patient, not the taxpayer. Give me the most qualified person in the room thanks!

  • http://www.ohiosurgery.blogspot.com buckeye surgeon

    For most surgical procedures, CRNA’s provide equivalent medical care at a fraction of the cost. Those are the facts. I know it’s uncomfortable for the Anesthesiologist lobby, but you reap what you sow. You guys wanted to be able to run three rooms at a time while while your “lackey” anesthesia assistants had to sit in the cold operating suites for the duration of the cases while you enjoyed doughnuts in the OR control room.

    And the argument about the reduction in anesthesia-related deaths is self defeating. Systems management led to the virtual elimination of general anesthesia as a significant risk for death, not any one individual brilliant anesthesiologist. Fail-safe mechanisms like continuous pulse ox monitoring, end tidal CO2 determinations, fiberoptic intubation, and better pre-operative evaluations allowed even mediocre anesthesiologists to achieve extraordinary low complication rates. These practice standards were then easily passed on to nurse anesthetists.

    • Mike

      Dougnuts? Really?

      Are you prepared to assume the risk of being the only physican in the room when your morbidly obese, diabetic, vasculopath with hemophilia comes for surgery? With your apparently vast knowledge of anesthesia and comorbid disease?

  • http://www.myheartsisters.org Carolyn Thomas

    I love the concept of surveying the public to learn what is truly important to them.

    Perhaps ALL doctors – not just physician anesthesiologists – would welcome the findings of MORE patient preference surveys to justify important changes in health care delivery.

    But let’s not limit these public opinion surveys to just O.R. procedures.

    Let’s ask patients in crisis whether they would prefer short or long waiting times in the E.R.

    Let’s ask patients with chronic illnesses how they feel about Big Pharma drug reps recruiting their doctors as “thought leaders” to help teach other docs how to practice ‘marketing-based medicine’.

    Let’s ask heart patients if they are aware of the five large clinical trials that have shown implanting a coronary stent doesn’t reduce your risk of heart attack or death any better than just drugs – despite what your interventional cardiologist may have suggested.

    Let’s ask working class patients if they’re okay with almost one million Americans declaring medical bankruptcy every year because of crippling hospital bills.

    Surely public opinion surveys like these would help patients “make their voices clear” about what THEY prefer. But would doctors be as interested?

    And let’s not pretend that the American Society of Anesthesiologists’ sudden fascination with what the general public wants isn’t driven by self-serving motives.

    • http://fertilityfile.com IVF-MD

      I agree with you that medicine should be driven by the wants and needs as decided by patients themselves and not by the cookbook policies of insurance or government decision-makers.

      Surveys, as you suggest, can give a general idea of what people value, but they are not as accurate as just letting patient vote with their market voice. We don’t need elaborate polls and surveys to find out what patients want. Instead, just restrain the interference and meddling from third parties (insurance and govt) and let patients choose which doctors they wish to see. The ones that do a good job of delivering quality and making the patients happy will be rewarded and copied. The ones that deliver unsatisfactory care will be market-punished and eventually forced to improve or go away.

  • Heliox

    Most patients do not realize when they are getting a CRNA as opposed to an anesthesiologist. After years of observation,I notice anesthetists do great with routine cases, dropping a dozen LMAs for hysterectomies in a day for example. Give them a 500 pound guy with no neck or really unusual anatomy and they flounder.Plus, if something goes wrong like an obscure arrythmia, I want the help of an MD/DO and his vast knowledge base.

  • Mike

    The question is not one of Anesthesiologist vs. CRNA.

    Of course CRNAs are qualfied and well trained to adminster anesthetics. I am an anesthesiology resident and I would never advocate for an MD hands-on in every operating room.

    The actual issue at stake today is whether anesthesia should be SUPERVISED by a physician. Do the CRNAs out there really want to be all alone without backup when things are going south with a medically complicated, sick case? Is that the best for patients?

  • LastoftheZucchiniFlowers

    I have the highest respect for this specialty. After all – they keep us alive when we are ‘elsewhere’. There have been mix up of gases and other horrible mistakes ending in death by anesthesia. IF I am not mistaken – these are rarely (IF EVER) in CRNA cases. Please correct me if I am in error? I urge every single provider of medical care to read ‘The Checklist Manifesto’ by well known surgeon/author Atul Gawande. By having this procedure down cold in every single case, such horror can be avoided both by MD, and CRNA. I always marvel at how this specialty is paid BY THE MINUTE since other surgical units are often 15 minute segments or more. But God bless anesthesia and I mean that sincerely. BTW – patients RARELY even meet the actual anesthesiologist who administers the drugs. The H&P is often taken by another provider within the group.

  • gzuckier

    Insurers are very conscious of the fact that anesthesiologists don’t participate in their networks and don’t negotiate for reduced rates, so that kind of leaves them somewhat of a target.

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