Advocacy, the SCA and the value of
Recently, the president elect of the Society of Cardiovascular Anesthesiologists, Dr. Scott T. Reeves, had the opportunity to testify at the South Carolina Board of Medical Examiners meeting in Columbia, SC. The meeting included testimony of nurse practitioners from the SC Board of Nursing who introduced themselves as doctors and explained to the SC Board of Medical Examiners why there was no longer a need to have physician supervision for any advance practice nurse as well as the need to no longer place limits on their scope of practice. In their arguments to no longer place limits on their scope of practice they included placement of TEE, image acquisition and interpretation for surgical decision making to all CRNAs’ scope of nursing care.
The reason according to the SC Board of Nursing request to add TEE privileges was because several of their CRNA members had requested it although no documentation of training or experience was provided.
Dr. Reeves not only represented the SCA at this meeting but also the American Society of Echocardiography (ASE) as Chair, Committee of Perioperative Echocardiography as well as the Chairman of the Department of Anesthesia & Perioperative Medicine at the Medical University of South Carolina. In addition, support for the position that perioperative TEE is the practice of medicine came from the American Society of Anesthesiologists (ASA) as well as the American Society of Echocardiography (ASE) and the American College of Cardiology (ACC).
In the end, the South Carolina Board of Medical Examiners voted unanimously against the expanded scope of practice document and against the increase in scope for CRNAs doing TEE and added for the record that the Board considered the practice of transesophageal echocardiography to be exclusively part of the practice of medicine.
This story is important and interesting on many levels. The first, of course, is that we should be made aware (if we were not already) of the agenda of some within the nursing community to expand their role of practice to include work which requires complex skill, knowledge and judgment that most experienced physicians have already recognized to be best performed in the hands of physician specialists.
On another level this story accentuates the value proposition reality of the physician specialist.
Training, certification, and credentialing are objective hurdles as well as subjective symbols that indicate a measure of experience and expertise that should be and can be expected from a patient. We physicians, who are specialists, differentiate ourselves by these standards of expectation because we are indeed different. Our value is ultimately defined by this difference. It is an objective difference and it is a difference that can and should be defined.
Finally, this story teaches us the value of being engaged, networked and involved. Dr. Reeves was able to represent at this meeting not only the voice of SCA, but the ASE as well. Many of us stay active in multiple societies and simultaneously wear multiple hats. This is a good thing and I wish to continue to encourage all of us to stay involved. It expands our understanding and our reach. The more we cross over, the better we are understood and the better we understand.
The SCA has always taken a position to remain engaged. Among current members on SCA’s Board of Directors, Chris Troianos for example, also serves on the ASA Committee on Economics and represents the SCA, Rob Sladen was Chair of the IARS Board of Trustees (whereas Jamie Ramsay, an SCA past president, is the current Chair), Jerrold Levy currently also serves as representative for Cardiothoracic and Vascular Surgery, Thrombosis Scientific Councils of the American Heart Association, Glenn Gravlee is the past president of the American Board of Anesthesiology (ABA), and Colleen Koch also serves on the IARS’ Board of Trustees. There are many, many more examples of collateral integration among our leadership in the SCA. This opportunity for networking is also true throughout our society. Among all of our members within the SCA most are also involved in other societies with many holding committee chair or officer positions. I am therefore going to ask our Membership Committee led by Dr. Glenn Murphy to work with our administrative office to begin recording in our membership database information about member collateral society membership including past and/or current positions, practice guideline authorship roles and other important roles and responsibilities. I have asked that our membership database be modified going forward to accommodate these changes, so that an example of what our SCA membership listing may look like is provided below:
Steven N. Konstadt, MD, MBA, FACC, Chair Department of Anesthesiology Maimonides Hospital, Brooklyn, New York, Indian Association Cardiothoracic Anesthesia Education Committee member (2011-present)
Solomon Aronson, MD, MBA, FACC, FACCP, FAHA, FASE, Exec vice Chair Anesthesiology Duke Univ Medical Center, past chair intraoperative council (2000-01) ASE, NBE Board of Directors (2004-2007), Joint Commission Council (2012-13)
Scott T. Reeves, MD, MBA, FASE, Chair, Committee of Perioperative Echocardiography ASE (2011-12), Chairman of the Department of Anesthesia & Perioperative Medicine at the Medical University of South Carolina.
And so on….I believe these changes in our membership database will help us serve each other better in the future.
In keeping with the theme of the importance of networking and being engaged, I would also like to inform our membership about the status of the Flawless Operative Cardiovascular Unified Systems project (FOCUS). This multidiscipline safety project aimed at reducing Human Error in Cardiovascular Surgery initiated by the SCA and a project to which we in the SCA have been heavily committed is now managed by the SCA Foundation (SCAF). Beyond the clear mission to advance patient safety, one of the other goals of the SCA for initiating and supporting the FOCUS project was to provide opportunities for junior faculty in cardiovascular anesthesia careers to advance their visibility in the field. To date it is my pleasure to draw attention to two such individuals. Both Drs. Elizabeth Martinez (MGH) and Jake Abernathy (MUSC) are examples of how the SCA, by supporting FOCUS, has allowed younger members to have a huge career boost. Hopefully, there will be many others.
To date the references for the manuscripts that have been published (or soon to be published) by the SCA members involved in this important safety project are listed below:
- Spiess BD, Wahr JA, Nussmeier NA Bring Your Life Into FOCUS. Anesth Analg 2010;110:283-287
- Spiess BD, Wahr JA, Nussmeier NA FOCUS - A Patient Safety Initiative. AHA Connection 8(1);17, Spring 2010
- Martinez, EA, Thompson DA, Errett NA, Kim GR, Bauer L, Lubomski LH, Gurses AP, Marsteller JA, Mohit B, Goeschel CA, Pronovost PJ Review article: high stakes and high risk: a focused qualitative review of hazards during cardiac surgery. Anesth Analg 2011;112:1061
- Martinez EA, Shore A, Colantuoni E, Herzer K, Thompson D, Gurses A, Marsteller J, Bauer L, Kim G, Goeschel C, Cleary K, Pronovost PJ, Pham JC Cardiac surgery errors: results from the UK National Reporting and Learning System. Int J Qual Health Care 2011;23:151
- Spiess BD Human Errors in Medicine: Change in Cardiac Operating Rooms through the FOCUS Initiative. JECT 2011;43:P33-P38
- Thompson DA, Kass N, Holzmueller C, Marsteller JA, Martinez EA, Gurses AP, Kanchuger M, Schwann NM, Gibson CS, Bauer L, Pronovost PJ Variation in Local Institutional Review Board Evaluations of a Multicenter Patient Safety Study. J Healthc Qual 2011 May 25. doi: 10.1111/j.1945-1474.2011.00150.x.
Going forward, I am also pleased to announce that these data soon will be available to the general SCA membership for purposes of epidemiologic research and observation hypothesis testing. For those members who are interested in accessing the data for investigational purposes, please contact the SCAF Executive Director, Chris Riely at email@example.com who will provide further information regarding the FOCUS Data Request policy and procedures. Data requests will then be forwarded to the FOCUS Steering Committee, Data Committee and Publications Committee for review.
The entire SCAF FOCUS Data Request Policy will be posted on the SCA and SCAF websites for your review. It is meant to facilitate SCA membership with generation of high quality manuscripts, while avoiding inconsistencies and redundancies. In addition the policy is meant to protect the scientific integrity of the data. The policy provides authorship guidelines such that all investigators have the opportunity to participate in and receive appropriate publication credit for the presentation of FOCUS data.