Practicing at the “Top of the License”

Check this out. We have done versions of this riff before. Doctors complaining that while NPs and PAs are exhorted to practice at the “top of their licenses,” MDs are increasingly relegated to grunt work. But this time around, the complainant is an anesthesiologist, who wonders why in Europe, anesthesiologists always have an assistant in the OR, while in the US it’s a solo act. 

SO. Here’s the part that confuses me about this. Unless I am missing a point, the establishment of the role of the certified registered nurse anesthetist (CRNA), with multiples thereof working under the supervision of an anesthesiologist, is one of the best examples of the leveraging of physician time with which I am familiar. Check in at our local surgi-center for a procedure, and you get a quick interview with the MD. Into the OR you go, and the CRNA is the one who is hitting you with propofol. Makes sense. Well leveraged. 

Bottom Line. In years to come, it will be fascinating to continue to watch the shifting of roles amongst physicians and other medical professionals. Hopefully, the focus will remain on efficiency and safety of patient care, and politics will be left by the wayside!

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