March 1997
Volume 61 |
Number 3
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| Letters to the
Editor |
'Mangled' Care? Back to Basics!
It is becoming apparent that "Managed Care" might often
be called "Mangled Care." The mandate seems to be "Cut
Costs at All Costs." The unconscionable compensation and
perks received by some of the CEOs involved make attempts at cost
containment under which the treating physician must work seem
even more outrageous.
I have a solution for our specialty. Armed with my trusty copy
of John Snow's monograph on The Inhalation of the Vapour of
Ether, I propose that we return to the "good old days"
of one pound cans of ether, complete with a safety pin through
the lead seal. Many of us could still do a very safe job of open-drop
ether anesthesia. It is difficult to imagine a more cost-effective
form of anesthesia. The HMOs, CEOs and "bean counters"
would love it. We might go so far as to suggest that the leading
teaching institutions might once again have endowed chairs of
"Open Drop Ethereal Aetherization."
I must insist on the opportunity of being permitted to etherize
the CEO of any of the large HMOs who might have a need for safe,
basic, no-frills anesthesia.
Dale D. Morgan, M.D.
Cedar Rapids, Iowa
Is There a Nurse in the House?
As a practicing member of ASA and as chief of the section of
anesthesiology, which has 15 anesthesiologists and two certified
nurse anesthetists, I strongly support the ASA's position that
the administration of anesthesia is the practice of medicine and
should be performed by or under the medical direction of an anesthesiologist.
I believe ASA and its membership must continue to make the strongest
efforts to educate the public, including patients, other physicians,
hospital administrators and legislators. One of the many ways
to accomplish this would be to publish the results of a survey
of these various groups, asking the question, "If you or
a member of your family were undergoing a surgical procedure,
would you request an 'advanced practice nurse clinical specialist'
or a physician to be responsible for coordinating, directing and
supervising your anesthesia care during the perioperative period?"
It has been my experience coordinating all the patient requests
that not one patient has ever requested a nurse instead of a doctor
to be responsible for their anesthesia care.
It also appears to be quite hypocritical of the nursing profession
to try and "obtain through legislation," rather than
education and training, the ability to practice medicine. This
is the same group of professionals who are asking for physician
support in helping them argue that the use of less-educated and
less-trained "patient care technicians" severely compromises
the care of patients in exchange for cost savings.
Michael A. Less, M.D.
Hinsdale, Illinois
Match Figures' 'Darker Side'
Alan W. Grogono, M.D., is to be congratulated for a valuable
work in collecting information about job opportunities available
for anesthesia graduates [ASA
NEWSLETTER, December 1996]. We need this information to
give reassurance to the students entering the specialty and to
help us all in planning our training.
Although Dr. Grogono stresses that "only 29 (2.7 percent)
were actually unemployed," there is another and less comforting
conclusion that can be drawn from his data. If one extrapolates
from his response rate (68 percent of graduates) to a presumed
total population, then his documented 518 full- or part-time practice
positions would translate to a total of 822 clinical practice
positions available. Regardless of the validity of that extrapolation
(and the safer assumption would be that the nonresponders had
less success!), this would represent "real" jobs for
less than half of the 1996 graduates! If those 234 taking fellowships
are added to the 1997 pool, we may expect that percentage to fall
even lower.
Dr. Grogono's positive thoughts are greatly appreciated. Nevertheless,
his data support a re-evaluation of the total number of training
slots offered in this country. There have been modest declines
in the total number of positions offered through the [National
Residency] Match, but the
total number still appears to be in excess of the real jobs available.
The temptation to employ the "cheap labor" provided
by residents (with the remunerative "pass-throughs"
afforded to the hospitals) appears to continue to be too seductive.
Isn't it time for the Association of Anesthesiology Program Directors
to acknowledge the darker side of these figures rather than settling
for the specious satisfaction of an "unemployment" rate
of only 2.7 percent?
Michael F. Mulroy, M.D.
Seattle, Washington
Editor's Comment: Dr. Mulroy's interpretation of Dr.
Grogono's interpretation of the data notwithstanding, the budget
adjustments of Medicare by the federal government will markedly
diminish available "pass-throughs." The mandate for
increased primary care over specialty training continues to drive
teaching hospitals to cut or eliminate specialty training. The
most vulnerable programs seem to be radiology, anesthesiology
and pathology.
No specialty, including anesthesiology, has guaranteed every
graduating resident the position of their choice at the salary
of their choice.
Finally, placing a cap on anesthesiologists in training does
not simultaneously restrict the output of nurse anesthetists.
- E.L.
The views and opinions expressed in the "Letters
to the Editor" are those of the authors and do not necessarily
reflect the views of ASA or the NEWSLETTER Editorial Board.
The Editor has the authority to accept or reject any letter submitted
for publication. Letters must be signed (although name may be
withheld on request) and are subject to editing and abridgment.
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