Expert: JM Starkman, MD - 9/24/2010

Question
Hi Dr:  Five years ago I had ortho surgery to repair a torn meniscus in my knee; before the surgery I met with the anesthesiologist and told her that I wanted an anesthesiologist to do (or manage my case withour managing other cases) my case not a CRNA, SRNA, AA or any other less qualified provider.  She told me that she did her own cases and all went well.  I have no axe to grind with the CRNA (I teach at the university and many of them have been in my classes).  I just don't believe that a nurse can do the same job as a physician and if the anesthesiologist is supervising multiple CRNA, that's less than ideal and I don't want to take that risk.  Last month I torn the meniscus again and need surgery which the ortho doc says requires general anesthesia which is his call and o.k. with me.  I met with the same anesthesiologist and she told me that things have changed at the facility where she works and now the cases are done by CRNA and she supervises multiple cases at one time.  She said that this is usually not a problem but not as good as having her do the general anesthesia herself.  She was totally honest and I cancelled the surgery; at no time did she say that the CRNA were not qualified, but it's obvious that they are not physicians and the "multiple CRNA supervised by one anesthesiologist" is an accident waiting to happen (in my opinion).  Is it unreasonable for a patient undergoing general anesthesia to specify an anesthesiologist manage his and only his case?   Off the record, I have had more than one anesthesia doc tell me that they have little choice as to supervising multiple CRNA; the one who did my first case mentioned that: "she went to med school to practice medicine, not to supervise nurses"....Is this the state of affairs in anesthesia today?  Thanks for your opinion.

Answer
Yes, this is the state of affairs today, as I've discussed in this forum previously. You and your anesthesiologist are doing what you need to do, however, to 1) survive to practice anesthesia and 2) get your surgery done the way you prefer.  

It is NOT unreasonable to have the doctor you chose take care of you!!!  How preposterous that that question is even raised today!   Imagine substituting a similar situation in another area of our world today and how unacceptable a similar answer would be:  You go to your favorite steak restaurant, order a $40 filet and get told "no, here at this price you'll be getting day old hamburger instead--irrespective of what you-the-customer wants!"  How far would THAT  fly?

Now, off my soapbox:  The dirty little secret in surgery circles today is that when surgeons, anesthesiologists or hospital administrators have surgery THEY always request (and get) a 1-on-1 anesthesiologist. So, try this: tell your surgeon the surgery's off unless he puts pressure on the hospital administration and their anesthesia group to provide you with your wishes. Or, ask your surgeon if he can do the case at another hospital  where they can provide a 1:1 anesthesiologist.  Or, alternatively, you could speak directly to your hospital's administrator about the whole matter---very often they are the ones who've shoe-horned their anesthesia departments into business arrangements that effectively forced them to utilized CRNA providers to stay afloat financially.  If none of that does any good call around to some other hospitals and ask those administrators if their anesthesia departments provide for 1:1 anesthesia.  Good luck!  Thanks for writing.