Expert: Ronald Levy, M.D. - 4/7/2009

Question
Do you believe a patient has the 'right' to insist their care in ANY MAC case be provided directly by an MDA vs CRNA, and should that choice be binding upon the medical institution?  My personal preference is to have an individual with the most depth of understanding for the potential things which might occur, and to me that is the better educated MDA.  In my profession of Engineering, I am frequently retained because I earned a Ph.D., hold professional registration in several states, and have 15 years experience.  Shouldn't the discriminating client / patient be able to insist upon the highest trained individual for any task?  A friend I spoke with about this believes insurance companies pay hospitals less for the services of a CRNA (because of their lesser qualifications) but I doubt that.
Your thoughts please.

Answer
Every patient has the right to ask for an MDA for any case (not just MAC) but that doesn't mean that the hospital has to (or even can) provide that. Each hospital contracts with an anesthesia group. In most places that is an MDA group that may or may not have CRNAs working with them. Some places only use CRNAs (usually because these are in smaller hospitals and MDAs can't make the kind of income they'd like). If the hospital cannot provide (or the anesthesia group won't guarantee an MDA) then you may have to go to a different hospital. Hospitals are under no obligation to provide MDAs. This is in no meant to put down CRNAs. I know many CRNAs who provide as good an anesthetic as some MDAs but you, as the consumer, choose who can treat you.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston