Should physicians let NP/PA take over primary care and anesthesia?

[BestDoctorEver]

There have been many debates about NP/PA encroaching into primary care and anesthesia and I have heard that physicians are often the ones who carry the malpractice burden because most of the time these people (NP/PA) are working 'under the supervision' (whatever that means) of a physician... Also, I think that when **** hit the fan, most people won't go after the NP/PA; they most likely will go after the MD/DO because that where they think the money is... Why would physicians take such big risk for other health care professionals? Should the system phase out PCP/(maybe)Anesthesia MD/DO where people don't have to go to med school to become a full scope provider and let them have all the BS that comes with that... Do you think these NP/PA will they try to encroach further if physician let them?

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[neusu]

We should just come out and say it that we're creating a 2-tiered system. Those who can afford an MD will get an MD. Those who can't, get the PA/NP.

 

[BestDoctorEver]

We should just come out and say it that we're creating a 2-tiered system. Those who can afford an MD will get an MD. Those who can't, get the PA/NP.

Don't you think the insurance companies will force their clients to see NP/PA because it will be cheaper?

 

[BestDoctorEver]

@Tired I was specifically talking about primary care and anesthesia where mid-levels claim they do an equal or a better job than their physician counterpart... and they said they have study (ies) to back up their claim... I know certain specialties are off for mid levels. However, from glancing the anesthesia forum, there are some complaints about the job market being saturated and part of these complaints is that mid levels are flooding the market... That what the reason I was asking why physicians are supervising them and carry the malpractice burden when these midlevels are saying they can do the job as well as physicians?

 

[colbgw02]

The other question is whether or not mid-level primary care visits generate more subspecialty referrals. At my hospital (military, so completely different model in terms of money), we have a significant number of mid-level clinics in primary care, as well as resident and attending clinics in both primary care and the subspecialties. I can tell you that, anecdotally, patients seen by the mid-level primary care providers are disproportionately more likely to be referred to my surgical clinic. Those referrals are also more likely to occur early, without any treatment or diagnostics by the referring provider, and are more frequently "inappropriate referrals" (ie - patients that did not need specialty evaluation and resulted in no specialty-specific treatment). If that is occurring in the civilian world as well, seeing a mid-level for primary care may actually increase costs for insurance companies.

This is my experience as well. I realize that a series of anecdotes does not equal data, but I firmly believe that physicians can, will, and should outperform mid-levels in the primary care setting. From both public relations (patients) and monetary (insurance companies), I still think we overcome this challenge by focusing on quality. If someone wants an extra 10 minutes to talk about their hangnail, then by all means, go see a nurse practitioner. But if you want someone to distinguish between the knee pain that requires ibuprofen and rest vs. the knee pain that needs an MRI and ortho referral, then give me a physician.

 

[DermViser]

@Tired I was specifically talking about primary care and anesthesia where mid-levels claim they do an equal or a better job than their physician counterpart... and they said they have study (ies) to back up their claim... I know certain specialties are off for mid levels. However, from glancing the anesthesia forum, there are some complaints about the job market being saturated and part of these complaints is that mid levels are flooding the market... That what the reason I was asking why physicians are supervising them and carry the malpractice burden when these midlevels are saying they can do the job as well as physicians?

 

[DermViser]

This is my experience as well. I realize that a series of anecdotes does not equal data, but I firmly believe that physicians can, will, and should outperform mid-levels in the primary care setting. From both public relations (patients) and monetary (insurance companies), I still think we overcome this challenge by focusing on quality. If someone wants an extra 10 minutes to talk about their hangnail, then by all means, go see a nurse practitioner. But if you want someone to distinguish between the knee pain that requires ibuprofen and rest vs. the knee pain that needs an MRI and ortho referral, then give me a physician.

And how is a patient supposed to know that? They don't have the distinguishing capability that you do.

 

[Nasrudin]

I officially don't give 2 ****s about this issue any longer. You can't fight dumb. It wins as soon as you begin.

Give the people what they want.

Here's my sentiment towards The Public summed up in the sublime words of the great Bojack Horseman: "Suck my d!ck..dumb****s!"

 

[Psai]

@Tired I was specifically talking about primary care and anesthesia where mid-levels claim they do an equal or a better job than their physician counterpart... and they said they have study (ies) to back up their claim... I know certain specialties are off for mid levels. However, from glancing the anesthesia forum, there are some complaints about the job market being saturated and part of these complaints is that mid levels are flooding the market... That what the reason I was asking why physicians are supervising them and carry the malpractice burden when these midlevels are saying they can do the job as well as physicians?

Anyone can claim anything. Also you can make a study say anything. Just find the right endpoints, something soft such as blood pressures or patient satisfaction and you can easily claim equivalence.

 

[colbgw02]

And how is a patient supposed to know that? They don't have the distinguishing capability that you do.

Answer in the post you quoted - public relations. The patients don't need to understand the medicine; they just need to feel like they're getting better quality care. This is a selling point for NPs, but that's only because physicians stink at PR. NPs don't actually care about the patients more - they just sell themselves better. We can fix that.

 

[radkat101]

Are there currently any systems in place in the US that allow medical students who are unable to match (or decide they'd rather be an NP/PA) , to take the equivalent role of an NP or PA? I thought a read an article somewhere about one/some state(s) doing this.

 

[DermViser]

Are there currently any systems in place in the US that allow medical students who are unable to match (or decide they'd rather be an NP/PA) , to take the equivalent role of an NP or PA? I thought a read an article somewhere about one/some state(s) doing this.

Missouri - the assistant physician.

 

[radkat101]

Missouri - the assistant physician.

Ahh yeah. What's your opinion on this? Do you think employers would prefer them if more states started doing this? I'm sure we'd see a flood of applications from IMG/ FMGs, but at least they would have finished 4 years of medical school and passed step 1 &2 right?

 

[Kahreek]

there will not be a 2 tier system, price is a huge thing, I think md salaries will drop by huge amounts. And probably md will have more and more the job of coordinating np or pa. At least in primary care settings.

 

[Psai]

It's not that simple. If we're going to claim that we are physician scientists, we have an obligation to address things scientifically. You wouldn't argue that diabetics don't need close blood glucose monitoring because "you can make a study say anything" so you shouldn't do it here either.

Take a look at this article if you get bored. Health Affairs is a serious, respected journal. They reviewed 500,000 cases and found no significant difference in patient outcomes. I have never seen a study with this many data points.

No Harm Found When Nurse Anesthetists
Work Without Supervision by Physicians
Health Affairs, Brian Dulisse and Jerry Cromwell,
2010(29):1469-1475.

Ultimately this is something that Gas needs to figure out for themselves. However, from my perspective, suggesting that CRNAs provide inferior care is completely the wrong approach to take. First of all, that notion is unsupported by any literature that I am aware of. Second, you can't really make that argument, then turn around and hire them. It's intellectually inconsistent.

There are a lot of great reasons to prefer anesthesia-supervised care over CRNA independent practice. Anesthesiology offers a range of services that CRNAs are not capable of, including ICU-level medical care, superior preoperative evaluation, improved ability to diagnose/manage/treat medical diseases, and significant dilution of the medicolegal liabilities inherrent in surgical care. If I were an anesthesiologist, these are the thing that I would be emphasizing to hospitals and surgeons. I don't think this is even a discussion that needs to be had with the general public, since ultimately it is hospitals and surgeons who will make the call on the desirability of independent CRNA practices.

FWIW - as an eventual attending surgeon, I find it highly unlikely I would ever utilize the services of an independent CRNA.

"This research was funded by the American Association of Nurse Anesthetists. The authors are wholly responsible for the data, analyses, and conclusions."
Paper written by two health economists, not people in health care. They analyzed differences by age 75+, male, african american and came to the conclusion that there was little difference in patient characteristics between patients taken care of in opt-out states vs non-opt-out states. Not even a hint of ASA status of the patient and used icd codes instead.

 

[Kahreek]

Are there currently any systems in place in the US that allow medical students who are unable to match (or decide they'd rather be an NP/PA) , to take the equivalent role of an NP or PA? I thought a read an article somewhere about one/some state(s) doing this.

that is just unfortunate, being boarded in fm is insanely better for you career.

 

[fab4fan]

We should just come out and say it that we're creating a 2-tiered system. Those who can afford an MD will get an MD. Those who can't, get the PA/NP.

How does that affect the people who want, even need a physician, not a PA/NP?

 

[Silent Cool]

We should just come out and say it that we're creating a 2-tiered system. Those who can afford an MD will get an MD. Those who can't, get the PA/NP.

That's exactly what my mother predicted about 5-6 years ago. I completely agree.

 

[DermViser]

How does that affect the people who want, even need a physician, not a PA/NP?

Tough for the ones who can't afford an MD then. Let them get the NP to take care of all their primary care needs.

 

[fab4fan]

Tough for the ones who can't afford an MD then. Let them get the NP to take care of all their primary care needs.

I certainly don't want an NP managing anything regarding my health care needs, including primary care. You soundlike you're angry with the patients. They're not the ones who should suffer.

 

[Mad Jack]

If you give them primary care and anesthesia, they'll point and say, "look, we took over these areas of medicine just fine! Why shouldn't we able to do cardiology/surgery/dermatology(already happening)/emergency medicine(already happening)? We're just as good as doctors, but cheaper and more "holistic" blah blah blah." Handing midlevels entire specialties would give them a foothold from which they'll seek to take over as much of the rest of medicine as they can.

 

[DermViser]

I certainly don't want an NP managing anything regarding my health care needs, including primary care. You soundlike you're angry with the patients. They're not the ones who should suffer.

Patients believe that NPs are more caring, listen to them more, and have the same outcomes as physicians. Fine. Give them what they want, and let them benefit from or suffer from the consequences. Only then will they see how valuable physicians are. Instead of wasting residency spots in primary care (since the public doesn't care), all physicians can become specialists so that everyone works at the "top of their license".

 

[wadewilson90]

Yeh, encourage more NPs to take on role of PCP. Could ease up some lack of PC issues.

 

[colbgw02]

I certainly don't want an NP managing anything regarding my health care needs, including primary care. You soundlike you're angry with the patients. They're not the ones who should suffer.

For better or worse, suffering doesn't really have anything to do with it. Some people receive better healthcare than others, and money, education, & geography have a lot to do with it. Conceptually, having NPs treat conditions better managed by physicians is no more an issue than having my pancreatic tumor operated on by the local guy as opposed to the world renowned expert at Mayo. The question is whether or not the expected baseline level of care is up to standard. If a PA or NP can provide the same fundamental level of care with the same level of efficiency as a physician, then they deserve to take what they can get.

 

[PL198]

I certainly don't want an NP managing anything regarding my health care needs, including primary care. You soundlike you're angry with the patients. They're not the ones who should suffer.

They don't have to. The average person isn't dumb enough that they can't figure out it's unlikely that a NP has the same knowledge and ability to treat them as an MD does. Just because some organization tells them that, doesn't mean they can't think about the issue on their own.

I'm not angry at patients at all. If they want NP care, they can get it. If they want MD care, they can get that too, they'll just have to pay more for it, just like I had to pay more in both money and time to train to become an MD vs becoming an NP.

 

[fab4fan]

Patients believe that NPs are more caring, listen to them more, and have the same outcomes as physicians. Fine. Give them what they want, and let them benefit from or suffer from the consequences. Only then will they see how valuable physicians are. Instead of wasting residency spots in primary care (since the public doesn't care), all physicians can become specialists so that everyone works at the "top of their license".

You're making a generalization that isn't true for all patients. I know several people who don't work in health care, and they have no desire to be cared for by NPs. I also know quite a few nurses who feel the same way. My own feelings are why I sweetly but firmly say, No, thank you, I'll wait for my doctor" when the NP student wants to see me before the family doctor. I feel like if I let him/her see me, I'm contributing to the problem.

 

[fab4fan]

For better or worse, suffering doesn't really have anything to do with it. Some people receive better healthcare than others, and money, education, & geography have a lot to do with it. Conceptually, having NPs treat conditions better managed by physicians is no more an issue than having my pancreatic tumor operated on by the local guy as opposed to the world renowned expert at Mayo. The question is whether or not the expected baseline level of care is up to standard. If a PA or NP can provide the same fundamental level of care with the same level of efficiency as a physician, then they deserve to take what they can get.

I can't agree that NPs are able to provide the same level of care; not when you have people who graduate and go straight to NP school (online) with zero patient care experience. It used to be a requirement that a nurse have 5y of experience, and there were no online programs, so there was a greater chance that the students were learning material, not sitting in front of the computer taking an open book test.

I guess I'm lucky that my medical issues aren't ones that can be managed by a family physician, so unless I get a nasty sinus infection, I don't really need to see my family doc that much.

 

[fab4fan]

They don't have to. The average person isn't dumb enough that they can't figure out it's unlikely that a NP has the same knowledge and ability to treat them as an MD does. Just because some organization tells them that, doesn't mean they can't think about the issue on their own.

I'm not angry at patients at all. If they want NP care, they can get it. If they want MD care, they can get that too, they'll just have to pay more for it, just like I had to pay more in both money and time to train to become an MD vs becoming an NP.

My comment about being angry was more an observation at something DermViser said. If Medicare starts making me pay a co-pay to see an MD/DO v an NP, that's fine with me.

 

[PL198]

You're making a generalization that isn't true for all patients. I know several people who don't work in health care, and they have no desire to be cared for by NPs. I also know quite a few nurses who feel the same way. My own feelings are why I sweetly but firmly say, No, thank you, I'll wait for my doctor" when the NP student wants to see me before the family doctor. I feel like if I let him/her see me, I'm contributing to the problem.

I agree but I think the bigger problem is the average person isn't even aware if they're seeing an MD or an NP.

 

[fab4fan]

I agree but I think the bigger problem is the average person isn't even aware if they're seeing an MD or an NP.

Providers should be telling the patients, and patients should be asking.

 

[colbgw02]

I can't agree that NPs are able to provide the same level of care; not when you have people who graduate and go straight to NP school (online) with zero patient care experience. It used to be a requirement that a nurse have 5y of experience, and there were no online programs, so there was a greater chance that the students were learning material, not sitting in front of the computer taking an open book test.

I guess I'm lucky that my medical issues aren't ones that can be managed by a family physician, so unless I get a nasty sinus infection, I don't really need to see my family doc that much.

I'm on record - to include in this thread - as saying that NPs and PAs can't provide the same level of care, so I agree with you on that point. I was addressing a hypothetical.

 

[michaelrack]

(4) If you want to do anesthesia, and you don't want the malpractice burden of supervising CRNAs, then don't hire them. But you probably will, if your accountant says they will make you more money.

It would be more accurate to say: If you want to do anesthesia, and you don't want the malpractice burden of supervising CRNAs, then don't join a practice or take a hospital job that requires you to supervise CRNA's. Fewer and fewer doctors are in the position to make hiring decisions.

 

[Psai]

It would be more accurate to say: If you want to do anesthesia, and you don't want the malpractice burden of supervising CRNAs, then don't join a practice or take a hospital job that requires you to supervise CRNA's. Fewer and fewer doctors are in the position to make hiring decisions.

Easy to say that but location can limit you. Many people would prefer to avoid bfe

 

[Psai]

This is the typical response you guys use when the CRNAs whip out this study. And I think it's a total non-starter. Criticizing a study methodology may raise questions about the strength of its conclusions, but in no way does it argue for the counter-conclusion. You don't need to resort to this to prove the value of your field; what you do need to do is cultivate your relationships with your surgeons and your institutions, proving your value as a specialty.

The counter conclusion is self evident. When you take smarter people, train them harder and longer, they will be better. No one thinks that little league can match up with the mlb although they both play baseball. And i didn't even bring up that so called research, you're the one posting a crappy study so I don't even know what you're trying to do here. Has anyone ever walked you through how to evaluate research articles

 

[Psai]

Yawn yeah good luck being the physician supervisor for these nurses with all that pharmacology knowledge you have. Anesthesiology won't be the only thing dying if it goes away

 

[member1000765]

You're making a generalization that isn't true for all patients. I know several people who don't work in health care, and they have no desire to be cared for by NPs. I also know quite a few nurses who feel the same way. My own feelings are why I sweetly but firmly say, No, thank you, I'll wait for my doctor" when the NP student wants to see me before the family doctor. I feel like if I let him/her see me, I'm contributing to the problem.

I don't have a ton of experience with NP's acting in the role of PCP's outside of the VA system, but from the number of non-surgical BS consults that flooded our VA surgical clinic on a daily basis for things that are easily within the scope of management of a PCP, I got the impression that they are essentially acting in the role of a triage nurse. They spend time listening to the patients give a bazillion complaints about everything that is wrong with their life, and then they consult out for management. Oh, you have headaches? Let me send you to the neurologist. Your nose is stuffy at night? Well let's get you in to see the ENT. Trouble peeing? The urologist should be able to help with that. Knees ache? Why let's set up an appointment with ortho! Issues that could (and should) be managed in one visit by one physician end up being managed over the course of several months by multiple different specialists who instead of actually seeing patients who need to go to the OR are medically managing patients who should have been treated by the PCP at the first visit. So while it may be cheaper to have the NP functioning in that position rather than an MD, it takes the patients longer to get the same standard of care and unnecessarily fills up slots in the specialists' clinics, which I think leads to decreased patient care.

A really good primary care doctor is worth his/her weight in gold and should be treated as such.

 

[alpinism]

Won't need to. Hospitals will always keep a couple anesthesiologists around to serve as nominal physician supervisors. You have no shortage of your own people willing to sell our your community for a few dollars. Meanwhile the rest of you will sit around impotently complaining about how no one respects your superior skill set.

Oh wait, that's what's already happening.

Sad but true.

As long as certain physicians support and even enable midlevel encroachment, it will continue to happen.

Like everything in medicine, it all comes down to money.

 

[michaelrack]

Easy to say that but location can limit you. Many people would prefer to avoid bfe

Regarding my post (#37): You are right, of course. I was just pointing out that few anesthesiologists (or other doctors, for that matter), will be in the position to decide if they want to hire midlevels. A larger amount (not all ) will be in the position to decide if they want to work in a practice situation involving midlevels.

 

[BestDoctorEver]

So while it may be cheaper to have the NP functioning in that position rather than an MD, it takes the patients longer to get the same standard of care and unnecessarily fills up slots in the specialists' clinics, which I think leads to decreased patient care.

A really good primary care doctor is worth his/her weight in gold and should be treated as such.

If NP consult out more than real PCP (MD/DO); therefore, it is not cheaper at the end... I just don't understand why NP keep gaining ground when most of the physicians I have talked to told me that they don't trust most NP to carry out effective medical treatments... I had a physician who flatly told me he would not let an NP treat him for even HTN...

 

[BestDoctorEver]

I make a big distinction between PAs and NPs, though this may just be a function of my specialty. I would happily be treated by a PA, not so much with NPs. Even in practices where both have the exact same job, the PAs I work with are far superior in work ethic, knowledge, and technical skill. Anecdotal, obviously, but that will shape who I ultimately hire down the road.

The same physicians I talked to told me the same thing... They think PAs, for the most part, are more knowledgable than NPs...

 

[PL198]

These same physicians I talked to told me the same thing... They think PAs, for the most part, are more knowledgable than NPs...

That's because of the whole culture behind each of the two professions. You have one under the medical boards where obviously they aren't expected to be physicians, but there is still a higher expectation of knowledge, vs the nursing boards which focus more on care instead of knowledge.

 

[Psai]

I make a big distinction between PAs and NPs, though this may just be a function of my specialty. I would happily be treated by a PA, not so much with NPs. Even in practices where both have the exact same job, the PAs I work with are far superior in work ethic, knowledge, and technical skill. Anecdotal, obviously, but that will shape who I ultimately hire down the road.

But nurses and doctors are equivalent for anesthesia of course

 

[jdh71]

I haven't read the thread and I'm not going to. When it comes to PAs and NPs I often think the wrong question(s) is/are asked and the wrong responses given.

It's not an either/or proposition.

PA and NPs simply need roles appropriate defined in such a way that they are allowed to EXTEND what we do in any given day or situation. Medicine is nuanced and require a physician but not every action or decision requires a physician to directly handle it, like putting in basic admit orders or dictating a transfer summary when a patient leaves the MICU. NPs and PAs can titrate hypertension meds in patients on one or two meds. They can adjust long acting insulin on a type II who brings in a record of their sugars. All of this can then be supervised and billed under the auspices of the physician. It's better for patients if physicians are left to the more complicated and nuanced tasks because more can get done.

 

[anbuitachi]

It's not that simple. If we're going to claim that we are physician scientists, we have an obligation to address things scientifically. You wouldn't argue that diabetics don't need close blood glucose monitoring because "you can make a study say anything" so you shouldn't do it here either.

Take a look at this article if you get bored. Health Affairs is a serious, respected journal. They reviewed 500,000 cases and found no significant difference in patient outcomes. I have never seen a study with this many data points.

No Harm Found When Nurse Anesthetists
Work Without Supervision by Physicians
Health Affairs, Brian Dulisse and Jerry Cromwell,
2010(29):1469-1475.

Ultimately this is something that Gas needs to figure out for themselves. However, from my perspective, suggesting that CRNAs provide inferior care is completely the wrong approach to take. First of all, that notion is unsupported by any literature that I am aware of. Second, you can't really make that argument, then turn around and hire them. It's intellectually inconsistent.

There are a lot of great reasons to prefer anesthesia-supervised care over CRNA independent practice. Anesthesiology offers a range of services that CRNAs are not capable of, including ICU-level medical care, superior preoperative evaluation, improved ability to diagnose/manage/treat medical diseases, and significant dilution of the medicolegal liabilities inherrent in surgical care. If I were an anesthesiologist, these are the thing that I would be emphasizing to hospitals and surgeons. I don't think this is even a discussion that needs to be had with the general public, since ultimately it is hospitals and surgeons who will make the call on the desirability of independent CRNA practices.

FWIW - as an eventual attending surgeon, I find it highly unlikely I would ever utilize the services of an independent CRNA.

This project is directly funded by AANA.

Seriously just read the article. It's obviously biased. "both certified registered nurse anesthetists and anesthesiolo-gists undergo similar classroom and clinical
training in anesthesia care"
Really? Anesthesiologists get like 10x the amount of training. How is that similar.

Article also doesn't factor in complexity of cases.

If NP consult out more than real PCP (MD/DO); therefore, it is not cheaper at the end... I just don't understand why NP keep gaining ground when most of the physicians I have talked to told me that they don't trust most NP to carry out effective medical treatments... I had a physician who flatly told me he would not let an NP treat him for even HTN...

cause they complain a lot more to where it matters

 

[Tired]

This project is directly funded by AANA.
Seriously just read the article. It's obviously biased. "both certified registered nurse anesthetists and anesthesiolo-gists undergo similar classroom and clinical
training in anesthesia care"
Really? Anesthesiologists get like 10x the amount of training. How is that similar.
Article also doesn't factor in complexity of cases.

Ugh, same line, different poster.

They must pass out a script in Gas Forums.

 

[DrOwnage]

Have any of you guys ever seen an NP for care and noticed a gap in knowledge between yourself and them? I'm curious since we are all med students or physicians on here.

 

[anbuitachi]

Ugh, same line, different poster.

They must pass out a script in Gas Forums.

or just read the article and use your brain. crna requirements are published. anesthesiology resident requirements are published as well. but i guess that doesn't matter to you since in your mind you probably believe crna are the greatest human beings on the planet already.

 

[Bryan O’Blivion]

It's not that simple. If we're going to claim that we are physician scientists, we have an obligation to address things scientifically. You wouldn't argue that diabetics don't need close blood glucose monitoring because "you can make a study say anything" so you shouldn't do it here either.

Take a look at this article if you get bored. Health Affairs is a serious, respected journal. They reviewed 500,000 cases and found no significant difference in patient outcomes. I have never seen a study with this many data points.

No Harm Found When Nurse Anesthetists
Work Without Supervision by Physicians
Health Affairs, Brian Dulisse and Jerry Cromwell,
2010(29):1469-1475.

Ultimately this is something that Gas needs to figure out for themselves. However, from my perspective, suggesting that CRNAs provide inferior care is completely the wrong approach to take. First of all, that notion is unsupported by any literature that I am aware of. Second, you can't really make that argument, then turn around and hire them. It's intellectually inconsistent.

There are a lot of great reasons to prefer anesthesia-supervised care over CRNA independent practice. Anesthesiology offers a range of services that CRNAs are not capable of, including ICU-level medical care, superior preoperative evaluation, improved ability to diagnose/manage/treat medical diseases, and significant dilution of the medicolegal liabilities inherrent in surgical care. If I were an anesthesiologist, these are the thing that I would be emphasizing to hospitals and surgeons. I don't think this is even a discussion that needs to be had with the general public, since ultimately it is hospitals and surgeons who will make the call on the desirability of independent CRNA practices.

FWIW - as an eventual attending surgeon, I find it highly unlikely I would ever utilize the services of an independent CRNA.

Agree with this^. As an anesthesia provider, one needs to be thinking about how one brings value to the hospital as whole, not simply relying on providing a single service. My personal belief is that one simply will not be able to directly compete with the nurse anesthetist by having more training. One can legitimately argue about the quality of the studies produced by the AANA, but you can't really argue about the larger point, which is that a significant volume of cases which constitute the throughput of a hospital can be performed more cheaply with more or less equivalent outcomes, if you just have an anesthesiologist performing bread and butter cases vs. a CRNA. Yes, on a individual basis, likely most people would prefer to have their anesthesia provided by an MD/DO anesthesiologist if they could compare the training. But patients don't consume health care in this manner, and can't exert this kind of market force.

You have to bring more to the table by bringing a distinct additional skill set that is readily apparent and that can be demonstrated. Having greater involvement the overall management of the flow of patients through the process of peri-operative care is likely going to have to be a significant part of the job. That or finding a niche where one does not directly compete, such as the focus provided by fellowship.

Regarding primary care... This is a much more difficult problem. The benefit of good quality primary care that is accomplished by a broad and deep training is easy to understand qualitatively, but exceedingly difficult to prove in a quantitative manner that can demonstrates value to those who hold the purse strings. Patients themselves can directly exert more market forces here, but let's face it, the days of the sole proprietorship primary care practice have long been dwindling.

 

[Tired]

or just read the article and use your brain. crna requirements are published. anesthesiology resident requirements are published as well. but i guess that doesn't matter to you since in your mind you probably believe crna are the greatest human beings on the planet already.

You might consider reading this thread, instead of just isolated posts.

 

[Tired]

Have any of you guys ever seen an NP for care and noticed a gap in knowledge between yourself and them? I'm curious since we are all med students or physicians on here.

Daily. Hourly. Pretty much every time I see them work.