The Future for Anesthesia

The role of an anesthesiologist vs. and anesthetist: Is it worth the extra

schooling to become a doctor, or is a nurse anesthetist taking over the
position a positive, cheaper alternative?
By: Marc Roettger

Introduction
My name is Marc Roettger, and Im in Independent Study Mentorship
Health Science Technology during the fall semester of the 2015-2016
school year, taught by Mrs. Kristi Click. My mentors name is Dr.
Arceneaux, one of the anesthesiologist at Memorial Herman
Southeast, and my topic of study is the differences between an
anesthesiologist and a nurse anesthetist, discussing whether it is
worth paying for a doctor or if an anesthetist is a positive alternative.
The focus of this topic is over the Nursing Handbook Debate.

My Mentor and I

"Memorial Hermann Southeast Hospital in Houston , TX." YP.com. N.p.,

n.d. Web. 06 Oct. 2015.
<http://www.yellowpages.com/houstontx/mip/memorial-hermann-southeast- hospital-15781524>

Independent Study Mentorship

ISM is a course designed for students wishing to mentor under an adult professional in a chosen
career, whether it be multidisciplinary or health science.
Course Requirements:

Complete an in-depth mentorship/study in an area of interest (must be approved by ISM teacher)

Document a minimum of 2 hours of mentorship activities each week (Mentorship Activity Log)
Complete a Journal Entry each week documenting your mentorship experiences (ISM Student Journal)
Complete an ISM Professional Portfolio (online format) showcasing assignments completed during the
course and the final project
Complete all of the required assignments (See Class Assignment Calendar and ISM Grading Sheet)
Complete a Mid-Term Presentation (must include PowerPoint)
Develop a final product and presentation at the collegiate/professional level that is presented to a panel of
graders at the conclusion of the semester (must include PowerPoint, visuals, completed product, portfolio
and handouts; See Product Guidelines section for guidance). The final presentation will count as the
FINAL EXAM Grade for this course. The grade is based on the Mentors Evaluation- 50% and Grader
Evaluations- 25% each of the presentation.

My Project
For my semester project, Im going to do an in depth study over the
role of an anesthesiologist verses an anesthetist
is it worth the extra schooling and the added expense to have an
established anesthesiologist, or is an anesthetist taking over the
duties a positive, cheaper alternative?
I chose this specific topic after talking with my mentor, Dr. Arceneaux,
because it is a very popular debate in the current media, and it could
potentially affect Dr. Arceneaux directly.

Anesthesiologist
An anesthesiologist:

Medical Doctor
Provides care before during and after a surgery
Responsible for administering appropriate anesthesia for pain management
Watches for adverse reactions pre, during and post op

"General Information on Anesthesiologists." Anesthesiologist Information: Job Description, Education and Training. N.p., n.d. Web. 18 Nov. 2015.

Anesthetist
Todays anesthetist can expect to work in the same locations as a
anesthesiologist
Provide patient care before, during and post operation
Administer and maintain anesthesia
Participate in the patients pain management

"General Information on CRNAs." Certified Registered Nurse Anesthetist Information: Job Description, Education and Training. N.p., n.d. Web. 18 Nov. 2015.

My Product

Pre-operation
Pre-op:

Patient consultation
Meeting with the patient to determine risk factors
The doctor has to disclose what he is going to do
Administer a local or general anesthetic

During Surgery
During surgery:
Monitor the patients vitals
Including: heart rate, blood pressure, oxygen in the blood and temperature

Make sure that the patient remains unconscious

May have to do whatever the doctor may require
Could include adjusting the bed etc.

Datex-Ohmeda
Aestiva/5
Medwrench. Medwrench. N.p., n.d. Web. 18
Nov. 2015. <www.medwrench.com>.

Ultane Sevoflurane
Primal Critical Care Incorporation. Sasrx.com.
N.p., n.d. Web. 18 Nov. 2015.
<https://www.sasrx.com/img_catalog/23743
30_l.jpg>.

Anesthesia machine
The white canisters are vaporizers for
inhalation anesthetic

Michael Jackson Drug

IV induction agent (they give it pt. goes to
sleep)
Theory that it killed Michael jackson

Vital signs monitor

The Ventilator
Controls breathing when the pt. is paralyzed

BIS Monitor
Monitors brain waves
Not 100% accurate but does show how deep
asleep the pt. is

CO2 Absorber
Circle system
Fresh air goes in but to some extent you rebreath your own air
This gets rid of CO2 so the pt. is damaged

Post-operation
Post-operation:
Responsible for the patients comfort and well-being throughout surgery
Might need to administer whatever is needed for post-op pain

Nursing Handbook Debate

Nursing Handbook Debate, which has been highlighting how the VA is
considering a proposal that would require VAs nurse anesthetist to be
designated as independent practitioners, regardless of individual
state regulations.
"VHA: A Microcosm of the Scope of Practice Debate." VHA: A Microcosm of the Scope of Practice Debate. N.p., n.d. Web. 07Oct. 2015. <
https://www.advisory.com/daily-briefing/2014/01/29/vha-a-microcosm-of-the-scope-of-practice-debate >

"Possible VA Change in Advanced Nursing Roles Sparks Heated Debate." US Medicine Possible VA Change in Advanced Nursing Roles Sparks
Heated Debate Comments. N.p., 07 Jan. 2014. Web. 07 Oct. 2015. < http://www.usmedicine.com/agencies/department-ofveterans-affairs/possible-va-change-in-advanced-nursing-roles-sparks-heated-debate/>

Perspectives
To get a complete understanding of the debate and to be able to
make an inform decision, you need to understand the possible
perspectives of people who have a similar opinion or complete
different opinion

Hospital Perspective
Hospital perspective, not all hospitals pay their anesthesiologist, the
anesthesiologist bills the patient directly, so having an experienced
doctor is not necessarily a financial burden for the hospital.

Statistics for Hospital Perspective

Anesthesiologist Salary: average $300,000 to $450,000: so middle
$400,000
Anesthetist Salary: average $110,000 to $200,000: so around
$160,000

"Job Outlook for Anesthesiologists." Anesthesiologist Salary and Pay Rates. N.p., n.d. Web. 04
Nov. 2015. < http://www.anesthesiazone.com/anesthesiologist-salaries.aspx >
"Job Outlook for Nurse Anesthetists." CRNA Salary Information: Nurse Anesthetist Salaries and

Pay Rates. N.p., n.d. Web. 05 Nov. 2015. < http://www.anesthesiazone.com/crna-

salaries.aspx >

Patient Perspective
From a patient view point, some patients might like the fact that they
dont have to pay as much for the anesthesia part of their surgery,
while some might just want the more experienced doctor.

Reasoning
A nurse anesthetist being able to act on their own without any
supervision will more than likely have established themselves in that
hospital so they could potentially charge whatever they want.
In the end, it might end up costing the same for a nurse anesthetist as
an anesthesiologist
Discloser: Im not saying that an anesthetist is not capable of doing
the job

Reasoning Discloser
Again Im not saying that the nurse anesthetist couldnt do the job
Dr. Fairweather at Memorial Herman gave a good example: Once he
was in surgery and when they got in the patient, the patients organs
were reversed
A pilot could teach someone to fly in three days tops but they
wouldnt have the experience to face any unforeseen issues

Survey
I conducted a survey as part of my class
Out of 100 responses
Question 7: What matters more to you when it comes to your doctor?
93% Experience
7% Cost

Question 10: Would you rather have an anesthesiologist or a nurse

anesthetist supervising your surgery?
85% Anesthesiologist
15% Anesthetist

Surgeons Perspective
From the surgeons view point, maybe the surgeon, who is the most
directly responsible for the outcome of the surgery, would probably
want a doctor, at the very least, supervising, over a nurse by
themselves, regardless of how much it will cost.

Conclusion
So, is it worth the extra schooling to become a doctor, or is a nurse anesthetist taking over the
position a positive, cheaper alternative? My hope is that through this presentation, I have
highlighted most of the point of views that could impact a decision like this, and have shown the
impact this could have on the medical community and the patients that are in their care. I want to
have given enough information, so that my audience could make an informed decision of their
own regarding this topic. So

Special Thank You

To my mentor, Dr. Arceneaux
To my teacher, Mrs. Click
And to my Evaluators, Dr. Arceneaux, Mrs. Arceneaux, and Mrs.
Seghers

Citations
Pictures:
Slide 12:
Medwrench. Medwrench. N.p., n.d. Web. 18
Nov. 2015. <www.medwrench.com>.

Slide 13:
Primal Critical Care Incorporation. Sasrx.com. N.p., n.d. Web. 18 Nov. 2015.
<https://www.sasrx.com/img_catalog/2374330_l.jpg>.

Slide 3:
"Memorial Hermann Southeast Hospital in Houston , TX." YP.com. N.p., n.d. Web. 06 Oct.
2015. <http://www.yellowpages.com/houston-tx/mip/memorial-hermannsoutheast-hospital-15781524>

Citations
Information:
Slide 7:

"General Information on Anesthesiologists." Anesthesiologist Information: Job Description, Education and Training. N.p., n.d. Web. 18
Nov. 2015.

Slide 8:

"General Information on CRNAs." Certified Registered Nurse Anesthetist Information: Job Description, Education and Training. N.p., n.d.
Web. 18 Nov. 2015.

Slide 15:

"VHA: A Microcosm of the Scope of Practice Debate." VHA: A Microcosm of the Scope of Practice Debate. N.p., n.d. Web.
07Oct. 2015. < https://www.advisory.com/daily-briefing/2014/01/29/vha-a-microcosm-of-the-scope-of-practicedebate >
"Possible VA Change in Advanced Nursing Roles Sparks Heated Debate." US Medicine Possible VA Change in Advanced Nursing
Roles Sparks Heated Debate Comments. N.p., 07 Jan. 2014. Web. 07 Oct. 2015. <
http://www.usmedicine.com/agencies/department-of-veterans-affairs/possible-va-change-in-advanced-nursingroles-sparks-heated-debate/>

Slide 18:

"Job Outlook for Anesthesiologists." Anesthesiologist Salary and Pay Rates. N.p., n.d. Web. 04
Nov. 2015. < http://www.anesthesiazone.com/anesthesiologist-salaries.aspx >
"Job Outlook for Nurse Anesthetists." CRNA Salary Information: Nurse Anesthetist Salaries and
Pay Rates. N.p., n.d. Web. 05 Nov. 2015. < http://www.anesthesiazone.com/crnasalaries.aspx >