If it isn’t enough that the medical community is at war against all the outside factors that are stripping away the ability for us to take care of patients, there is also a battle raging amongst the providers themselves. This battle is over the role, and of course payment, of “mid-level providers.” That would include physician assistants, nurse practitioners and certified registered nurse anesthetists. In my 6 years of medical practice as an emergency physician, and my 7 years of medical training, I have worked with many mid-levels in many situations. And I have seen the appropriate use and of course then unfortunate reality of using these mostly altruistic people.
    As a recent Wall Street Journal article pointed out, some of these nurses with advanced degrees (usually master’s degree after getting an RN degree) are making much more money than some primary care physicians with medical degrees. The article and ensuing comments from readers shows a marked division between seemingly two camps.
    The first includes mostly physicians who feel that 12-15 years of higher education and knowledge should lead to more earning potential than a master’s level education mixed with some clinical experience.
    The second camp are mainly the nurses and their supporters who say that a certified nurse anesthetist performs “99%” of all that their supervising anesthesiologists (an MD) can do and they should get paid at the same level instead of 60% of an average anesthesiologist.
    I am married to a critical care anesthesiologist, and I am an MD, so I am for sure in the camp that when I need a surgery only someone with a medical degree will do my anesthesia.  They are better trained and studies show when you factor out case by case basis those with medical degrees have less complications. 2 years of extra schooling doesn’t equal the knowledge gained in medical school and training, no matter how many years of experience. It is one thing to know and follow a protocol. But to understand a medical issue to it’s very scientific core and react when a situation goes bad, takes more than limited training can provide. This is not to say that nurse anesthetists can’t continue their role in medicine. And that is to make money for the hospital.
    Lost in this discussion is the fact that anesthesiologists and nurse anesthetist get paid a lot of money because they work in a situation that makes money. Surgeries can not go forward without some one to take the patient under and most surgeries are money makers for the hospital. And this money must be used to pay for the thousands of money losers that a hospital provides everyday. Like the primary care or pediatric clinic, or the internist that admits the 30 year old with chest pain that really has gas, strictly out of fear of malpractice.
    Anesthesiologist should make good money, as a nurse anesthetist that helps drive that system should as well.  But a system that rewards magic bullet medicine and not preventive medicine is a broken one. And a society that values the number of home runs you hit more than it’s healthcare providers is broken as well. No it is not the athlete or the anesthetist fault that the market pays them well, but these things do have ripple effects on other things, like money available for primary care maintenance and ultimately the number of doctors who go into primary care. This cycle is conveniently why we need to use mid level providers in the first place. Pediatricians, family doctors and internists shouldn’t be pissed they make less than a nurse with have the education they do. But their patients sure should be.
    Can we put a price on our health? Lawyers try to all the time. Europe does it when it rations care for it’s social healthcare system. Paying more to cut out the cancer and the radiation to shrink the tumor than to a primary care doctor and to the patient in incentives to prevent the cancer in the first place is backwards thinking. For my money, preventing diabetes is cash better spent than paying hugh amounts of money for diabetes related hospital admissions and diabetic drugs after the fact.  And who can help prevent this? Primary care doctors.     
    Give them time (money), resources ( money) and help (money) and they can utilize every advantage for prevention. We all know we must maintain a car or it will break down prematurely. Why is it so hard to get that concept to stick towards the health of our own living organisms?  If we can keep our original engines running it would benefit everyone, through less pain and suffering and less health care money spent per person. Then the nurse anesthetist and anesthesiologist would really have something to fight over...fewer cases.