Leopoldo Rodriguez: The surgical suite is no place for so-called ‘collaboration’

Anesthesia_Aisys-CS21
Yes, the word, 'collaboration' has a nice ring to it. But life-saving decisions must be made in the blink of an eye.

When the now-famous US Airways Flight 1549 struck a flock of birds while taking off from LaGuardia Airport, the pilot had to make several critical split-second decisions. The “Miracle on the Hudson” occurred primarily because of two things. First, pilot “Sully” Sullenberger had received extensive training on how to handle such an emergency, and second, there was a clear and unambiguous chain of command.

Had the protocol been for Sully to turn to his co-pilot, seek counsel, and collaborate on what should or should not be done, calamity would have occurred long before a final decision could be rendered.

That is how it can be during surgery or, frankly, almost any time anesthesia is administered to a patient.

There are times when a patient takes an immediate and unexpected turn for the worse in a matter of seconds, and it is during those critical moments that lifesaving decisions must be made in the blink of an eye. The good news is that current Florida law ensures that a physician must supervise all anesthesia services. In this regard, Florida already has in place the safest and most cost-effective model (the physician-led model) for providing anesthesia medicine to patients. This model ensures patients who receive anesthesia do so under the direct care of a Florida physician, and when split-second decisions must be made, there is a clear and unambiguous chain of command when “Sully” is needed.

As with most “good news,” there also is a bit of “bad news.”

Relying on a set of false assumptions and misleading wordsmithing, publicists for Florida’s nurse association are claiming Florida law should be changed to allow for “a collaboration model” and that the more highly trained physician anesthesiologist should be forced to “collaborate” with the nurse on duty – even to the point where there doesn’t even have to be a physician on-site. (And to extend the above metaphor, imagine for a moment if we allowed the co-pilot to fly while Captain Sullenberger wasn’t even on the plane.)

These lobbyists are promoting false concepts on several fronts. The first falsehood is that Certified Registered Nurse Anesthetists (CRNA’s) have nearly the same training as physician anesthesiologists. This notion is absurd on its face. Nurses do not attend medical school and have about one-eighth the number of clinical hours an anesthesiologist has. This also doesn’t consider the undeniable fact that nurses are trained differently and, while they are a vital part of the care team, they simply do not have the years of classroom training nor the thousands of hours of clinical training to make vital split-second medical decisions when things go wrong.

The second falsehood is that, somehow, allowing co-pilots to fly airplanes (using the metaphor from above) will help alleviate the pilot shortage.

With that in mind, let us be reminded the nurse’s own association is simultaneously claiming a historic nurse shortage (So how does expanding their scope of practice not make this problem worse?) but somehow this will mean there will no longer be a shortage of either nurses or physicians.

And finally, through artful wording, they falsely imply that 43 states have already moved to a model where nurses can legally oversee anesthesia without the supervision of an actual doctor. The real number of states that have fully enacted laws doing this (very bad) idea is exactly five – not 43 – and those all are small rural states. As of this writing, fortunately, 97% of Americans live in states where physician-led anesthesia medicine is still the model.

And let’s hope Florida will remain that way. As it stands, Florida already has a good law that has been proven time and time again to be the safest, and the physician-led care model for anesthesia also saves our state precious health care dollars.

Yes, the word “collaboration” has a nice ring to it. But as someone who has been in a surgical suite many times when split-second life-saving decisions must be made, it is good to know that “Sully” doesn’t have to stop and confer with his co-pilot.

___

Leopoldo Rodriguez, MD, MBA, FAAP, FASA, is the current president of the Florida Society of Anesthesiologists.

Guest Author


16 comments

  • politics

    January 25, 2022 at 12:47 pm

    They better learn loose teeth situations also. What the rules think collage.medical school,residency This was always the situation
    For what I read a anesthesiologist has more education in the field of medicine science. dental,cardio ,lungs, weight.maybe age heart attacks.suffixation etc
    well with all that understood does collaborator mean money.and misleading wordsmith now hmm

  • politics

    January 25, 2022 at 1:26 pm

    I think all this began with the office manager directing the physician. Florida is becoming corp medical now.
    Probably has to do with hedge funding.
    discount carding collaboration taking the mile.
    I think someone somewhere wants the industry.But what do I know.

  • Michael Dinos

    January 25, 2022 at 4:09 pm

    If these decisions are made in split seconds then it is absolutely the crna making them. As they are the providers in the OR delivering anesthesia. It is also commonplace for crnas to be the sole providers of anesthesia in many facilities, where there are no MDAs to be found. Aren’t you the one with the call system for providers to call you in a emergency? Perhaps you should sit your own cases if these split second emergencies can only be handled by MDAs. Surely you cannot get from the lounge to the room in a split second? But you already know this. More fear mongering. Carry on!

    • Chris Davis

      January 26, 2022 at 12:03 pm

      The tide is turning my friend. Physicians are less willing to sign onto groups or facilities where midlevel supervision is required. As such, physician anesthesiologists are sitting their own cases (as they had been before the rise of corporate medicine cutting patient care in return for a beefed up bottom line.) I don’t see how a reasonable person could make the argument that the extensive training in medical school, residency, and sometimes fellowship is somehow at all equivalent with the comparatively non-existent training a CRNA would receive. Either you’re biased or you’re a CRNA who is willfully ignorant of this fact. More training brings better outcomes. Would you advise a loved one to receive anesthesia under person A with 13 years of training or person B with 4 years of training (and nursing does not equate to medicine). I think the choice is obvious.

      • Michael Dinos

        January 26, 2022 at 12:14 pm

        Great. Can’t wait until the day you all sit your own cases. However I’m afraid there are way too many money hungry MDAs who enjoy collecting off of the CRNAs who work for them.as for my loved ones. I would advise them to receive care from the person who is delivering anesthesia everyday in the operating room and caring for them throughout their Perioperative course. And in fact that would be a crna.
        I would not advise them to receive care from someone who graduated medical school in 1985 and does their own cases 1% of the time. Just because MD or DO follows the name doesn’t equal superior care. We all know that.

    • Amber C

      January 28, 2022 at 12:11 pm

      First- there is no such thing as an MDA (medical doctor anesthesiologist). There is only an anesthesiologist and a nurse anesthetist. Please stop misleading the public with false title appropriation.
      Secondly, many anesthesiologists (myself included) sit their own cases and prefer to do so.

      • Michael Dinos- Nurse Anesthesiologist

        January 28, 2022 at 1:57 pm

        First- I actually learned the term “MDA” from physician anesthesiologists. So maybe clean up your own house before you come talking that nonsense over here. Second- congratulations. We are all proud of you for doing your own work.

        • Amber C

          January 28, 2022 at 3:58 pm

          That’s adorable. Trying to change your name to sound like us. Imitation is the best form of flattery after all. Regardless, it does not change the vast differences in education between the two and it never will. We are happy to welcome more anesthesiologists into the fold- just apply to medical school and complete an anesthesiology residency.

  • Michael Dinos

    January 25, 2022 at 4:26 pm

    Will anesthesiologist be Medically Directing CRNAs or AAs? Always
    What percentage of the time will anesthesiologist be personally providing anesthesia care?
    1% doing own cases

    Here is a job posting for a physician anesthesiologist. Skill atrophy is real. Not doing your own cases produces a inferior provider.

    Can you imagine the audacity of “captain sully”thinking he could land the plane if he was only piloting 1% of the time in his career? No thank you.

  • EUGENE KIM

    January 26, 2022 at 12:21 pm

    Speaking from personal experience I have “rescued” many patients from situations the CRNA either didn’t recognize or didn’t know how to respond. Yes personally performing the anesthetic gives closest proximity but usually we can be there in seconds when medically directing. The only exception I have to the Captain Sully analogy is that CRNAs are not copilots. Copilots have all the training; they simply lack the experience of the senior pilot. Therefore this is a false analogy. Medical and nursing training are different. A more fitting analogy would be that of an automotive engineer to a mechanic.

    • Michael Dinos

      January 26, 2022 at 1:07 pm

      That’s the thing about anecdotal stories. They mean nothing. I’m sure crnas can say the same about rescuing physician colleagues. And I would hope you can be there in seconds and not just “usually”. After all, if you are billing medical direction it’s required. Interesting choice of words there. Also, CRNAs are the pilots. Maybe not in your institution or your experience but your ignorance doesn’t invalidate the fact that crnas provide anesthesia everyday without a MDA “supervising”. You all keep creating new analogies while we will be working to care for patients as we’ve done forever. Seems to be working for you.

  • Michael Dinos

    January 28, 2022 at 4:28 pm

    Thanks Amber C. Interesting you bring up name change. Your organization refers to you now as “physician anesthesiologist”. Look for yourself at good old Leopoldo’s last satire piece he wrote. Do you bark at dental anesthesiologists also? Seems like a lot of wasted energy to me.
    Don’t worry about name changes. Just make sure you’re adding value to your practice. If you’re sitting your own cases that’s great. I’ve never worked with a “physician anesthesiologist” involved in any aspect of my anesthetic. Our outcomes are the same. If they weren’t, there would be no independent CRNAs! Enjoy the competition 🙂

  • Amber C

    January 28, 2022 at 5:57 pm

    Maybe when you are in practice for more than a few years you will get up to speed. I see you graduated in 2018- a mere fledgling.

    Good thing the Supreme Court of New Hampshire ruled that nurse anesthetists may not use the term anesthesiologist. A first step toward rectifying this misleading title misappropriation nationwide.

    Also interesting the Council on Accreditation of Nurse Anesthesia Educational Programs defines an anesthesiologists as an MD or DO who has completely a residency. Talk about getting your own house in order.

    • Michael Dinos

      January 28, 2022 at 6:20 pm

      Ah yes. Maybe once I’m in practice for more than a few years I’ll allow you to do my pre ops. Most likely not though. Duplication of service is completely unnecessary and wasteful. Since you looked me up, you should see I live in Texas, not NH. I hope your anesthesia delivery is better than your research. Regards “Amber C”

      • Amber C

        January 28, 2022 at 7:14 pm

        Reading is not your strongest skill I see. I will use small words for you. First NH, then the rest will follow.
        And for once we agree, your attempt to duplicate what we provide as MD/DOs makes you unnecessary and wasteful. Thank you for proving my point.

  • Michael D

    January 28, 2022 at 7:55 pm

    Attempt? Interesting. Crnas have been delivering anesthesia independently from MDAs since the beginning. Also, So brave of you to call crnas unnecessary and wasteful while hiding anonymously behind your computer screen lol. Speaks volume of your character. Try to have a better evening

Comments are closed.


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