Are CRNAs Proof of Too Much Emphasis on Specialization?

Among the many changes observed in medicine over the last few decades is an ever-growing focus on specialization. Specialists are certainly appreciated for the skills and abilities they possess. But are we placing too much emphasis on specialization? To answer that question, let us take a look at the certified registered nurse anesthetist (CRNA).

A CRNA undergoes a very rigorous educational program comparable to what a physician anesthetist undergoes. Furthermore, CRNAs are required to be board certified on a national level. A typical CRNA completes upwards of 9,000 clinical hours before beginning to practice.

The interesting thing about CRNA jobs is that they tend to be limited to the operating room environment. However, CRNAs have skills and training that go well beyond the OR. According to a recent piece written by the Pennsylvania Association of Nurse Anesthetists’ Jessica Poole, CRNAs can contribute in a lot of other areas.

Emergency and Critical Care

Poole explained that CRNAs are trained to deal with medical emergencies. They are skilled in providing both emergency and critical care, making them more than capable of handling critically ill patients outside of the OR. Poole even went as far as to say that CRNAs should be allowed to practice without restriction while the country seeks to bring an end to the COVID-19 pandemic.

A thoughtful approach to Poole’s argument reveals that she makes a good point. CRNAs are more than capable of working alongside other advanced practice nurses and RNs to care for patients critically ill with COVID-19. They are more than capable of pitching in to help nurse practitioners, physician assistants, and even the doctors themselves.

Anesthesiology might be the CRNAs specialty, but that is not all he or she knows. Their scope of practice isn’t even limited to administering anesthesia. CRNA jobs go way beyond that one task – even under normal conditions. During emergencies, they take on even more responsibility.

Specialties and Fragmentation

Again, specialties are not a bad thing in and of themselves. But perhaps it’s time healthcare policymakers and regulators consider the possibility that highly specialized medicine is also highly fragmented medicine. That may not be a good thing for patients.

We have seen in other industries how fragmentation can encourage inefficiency and higher costs. Fragmentation can also lead to duplication of services. It can lead to having too many hands in the pot at any one time.

Our system might do better if we placed less emphasis on specialization and more on scope of practice. Rather than a CRNA going onto the Health Jobs Nationwide website in search of a job in his/her particular field, maybe he or she should be looking at all advanced practice nursing jobs instead.

Us vs. Them Mentality

As much as Poole made a particularly good point in her post, it is hard to read it and not come away with the impression that an ‘us versus them’ mentality exists in medicine. This mentality is actually fairly prevalent in the healthcare sector. One specialty claims to be uniquely qualified to handle certain kinds of situation to the exclusion of all others. Another specialty jumps up and defends its ability to address those same situations.

In some cases, it certainly seems like clinicians are competing against one another rather than working together for the good of patients. Part of that is unavoidable human nature. But a bigger part might be our growing focus on specialties. Maybe it’s time to emphasize specialty less and overall patient care more.

It is something to think about as we emerge from the COVID-19 pandemic. After all, nothing in healthcare lasts forever.