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Anesthesiology/anesthesia provider: nurse or physician?


0p wrote at 2012-05-07 15:08:32
Thanks for your help; I just had the surgery with anesthesiologist-only care.,all it took was a meeting with the administrator and the head of the anesthesia dept and we put my expectations on the consent (along with "I'm not conseting to CRNA services") and we both signed and all went well.  Interestingly enough, the anesthesiologist who did my case agreed with me and stated  that she would not want a CRNA doing her own anesthesia.  Thanks again.

Robert wrote at 2012-05-16 14:42:01
Please stop this hatred of CRNAs... It is a well-establish profession.  They have Master's degrees with specialization in Anesthesia.  They are board certified as well.  The medical world (surgery; nurses; physicians; respiratory therapists; CRNAs; NPs and even Anesthesia Assistants (AAs)  need to coexist!

op wrote at 2012-05-19 20:24:26
Robert: as the original poster let me respond to your comment; I don't "hate" anybody, I just want the most qualified provider performing my anesthesia.  An anesthesiologist is much more qualified than any nurse (including one with 20 months of CRNA school). I work in a large university medical center and many "insiders" are requesting anesthesiologist-only for their own surgeries; it's common sense that this is much safer than CRNA involvement and if requested in advance the patient will get his wish every time.....just be firm and polite.

Mike MacKinnon wrote at 2012-05-25 01:20:42
Dr Starkman

Actually, your comment about actuaries and liability insurance risk is somewhat wrong. Yes, it costs more in a care team for the Anesthesiologist since they are part of the anesthetic, however the liability insurance for a CRNA working without Anesthesiologists is about 50% LESS than that for an Anesthesiologist working independently. It is important to note that this is the exact same coverage, 1/3 million. So your answer is quite misleading here. It is actually CHEAPER for a CRNA to be insured to do the same cases than an anesthesiologist at the same coverage.

Additionally, surgeons working with solo/autonomous CRNAs (like me) do not incur any additional liability than they do when working with anesthesiologists only. This is born out 100% in the literature and case law.


op wrote at 2012-06-02 03:00:10
The original question was: who is more qualified to administer my anesthesia, a CRNA (a nurse) or an anesthesiologist (a physician)?  I didn't consider having a CRNA (nurse) more or loss (usually less) supervised by an anesthesiologist..I'm sure that if I agreed to this that a nurse would be basically practicing medicine (not legal in my state and not safe IMHO)..I don't have anything against CRNA; if someone wants a nurse doing their anesthesia, fine, I would certianly not want this for myself or for my family. Neither would my doctor...Dr. Starkman was 100% correct; when I met with adminsitration and anesthesia and asked a simple question: "my insurance pays for an anesthesiologist (not just a nurse (CRNA) it safer to have an anesthesiologist personally perform my case or "supervise a bunch of CRNA (all nurses)?"  Hands down, everyone said that the anesthesiologist was far safer; they try to have CRNA do as much of the "leg work" as possible, but when 1 anesthesiologist is supervising 4 CRNA, safety goes out the window........I asked for anesthesiologist-only care (and put this on the consent "I'm consenting to anesthesiologist X personally performing all of my anesthetic care, not supervising other cases etc....she signed, I signed and all went well.  Why have you insurance pay for steak (anesthesiologist) and accept hamburger (CRNA)?  O.K., that sounds bad, I actually just want an anesthesiologist doing all of my anesthesia. Who wants their anesthesia to be dangerous? not me.  Oh, yes, I'm a health care provider and I believe that CRNA can be assist in anesthesia, but as solo (or as minimally supervised nurses administering anesthesia), I don't think that they are safe, not by a longshot.  Please don't compare the education, experience of ANY nurse (and that includes CRNA, sorry, Mike) to that of an anesthesiologist (a physician)....And please, let's not quote meaningless stats; CRNA are "bailed-out" everyday by the supervising anesthesiologist in every state..but this isn't recorded anywhere in the stats.....patients who undergo CRA (nurse)-only anesthesia rarely die on the table, but I doubt that a nurse is as expert in intraoperative monitoring as an anesthesiologist.....CRNA are nurses not physicians.....I hate to see the poor patient who has outpatient surgrey with poor CRNA anesthesia...they are pushed out the door, oversedated and they realize how horrible the surgical experience actually was and how they were at the "mercy" of a nurse during surgery.....been there, done that..once.....never again.....I was seriously burned/injured after a crash which resulted in surgery..I had no choice but to accept a nurse/crna for the surgery and debridement......during the ortho surgery, the CRNA let the Sevo vaporizer run dry (not sure what that means) except that I woke up in agony as my leg was being reconstructed....many hours of painful recovery, I refused drugs since a crna had messed up my care..............

davey wrote at 2012-06-27 04:27:42
Mr. Op,  You are entitled to your opinion, and you have certainly stated it, more than once.  You are entitled to whomever you wish as your anesthesia provider, but please be aware that the majority of anesthetics are performed by CRNA's in this country, and done so quite safely.  CRNA's are not "assistants" and are not solely utilized for "leg work".  I can probably count on one hand, the number of times that I have been "bailed out" by an anesthesiologist in over 37 years.  Just where did you pull that tidbit of information about bailouts in the first place?  Your statements about safety are way out of line and only serve to add fuel to a fire that needs no extra fuel.  There are very good providers on both sides of the issue. Your uneducated personal opinions would be better served on the Jerry Springer show.  

becky wrote at 2012-12-05 03:33:17
Davey: your comments eloquently express why many educated and informed patients are refusing nurse-anesthesia(CRNA)..During my career, I have personally advocated for midleval "practitioners" to function at their highest competency (this includes nursed assisting in anesthesia-crna).  But when I read your arrogant, and downright silly comments, I'm sure that readers will understand why only an anesthesiologist is qualified to perform anesthesia alone.  crna/nurses/AA/helpers..are not anesthesiologists..don't put your life at risk by consenting to crna "care".  Most insurance plans pay for an anesthesiologist, not a nurse. Make it clear: "I'm consenting to anesthesiologist-only care personally administered by Dr. X and he/she will be responsible for all of my anesthesia care.  I refuse any and all crna "care"...It works every time; the patient gets a real anesthesiologist, not a nurse (crna with maybe 20 months of nurse anesthetist training)

teacher wrote at 2013-04-23 03:05:21
My PCP would require that all anesthesia care administered to her or any of her family be personally be performed by an  anesthesiologist (MD/DO) and NOT by a nurse (RN or RN with some nurse anesthetist training...A CRNA)........I'm not sure why anyone would consent to a nurse(a crna or aa) being involved with their "anesthesia" when an anesthesiologist is the only safe opton?

anesthesiologistfor me wrote at 2013-06-21 02:48:19
I was just informed that I need surgery and anesthesia. My wife is an advance-practice nurse (NP).  I told my surgeon that I want anesthesiologist-only anesthesia and the anesthesiologist readily agreed.  No crna/aa involvement at all.  I mentioned that I will add: "I'm not consenting to any services from crna " to the consent and my anesthesiologist told me that she thought tiss great idea.  She would want nothing less for herself or for her family.


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JM Starkman, MD


Over twenty-five years of adult and pediatric, inpatient and outpatient clinical anesthesia practice--some private, some group.

American Association of Physicians and Surgeons. My county medical society.

[not a researcher]

American medical school graduate. Board Certified. Fellowship trained Cardiovascular and Pediatric anesthesia subspecialist.

Past/Present Clients
Over 20,000 anesthetics, the majority of which have been personally managed, with less than 5% consisting of supervising nurse anesthetists or in-training resident physicians.

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