One of the frequent remarks we hear around the operating room is “the surgeon is the captain of the ship.” In the early years of surgery and even until recently it was assumed that all medical care in the operating room was under the direction of the surgeon. This made sense in the early years of surgery when the anesthesia was in the hands of a nurse while the surgeon operated. This was a difficult time for patients since the surgeon remained focused on the surgery and had little time to be interrupted by the nurse when things got out of hand. In that era neither the surgeon nor the nurse received advanced training in anesthesia. In addition, we must consider the surgeon was preoccupied by the work and risk of the surgery having little time to administrate the anesthetic.
In the last 30 years, surgery and anesthesia have changed tremendously and for the better. Those entrusted to perform an anesthetic are much better trained than in the previous era. Today an anesthesiologist attends medical school followed by a rigorous residency in anesthesia. Many will then attend 1 to 2 yrs. of fellowship training such as in Pain, Cardiovascular, Pediatrics or Obstetrics. In most cases a CRNA (Certified Registered Nurse Anesthetist) will obtain extensive training first to become an RN followed by experience in an ICU. They will then enter into a CRNA training program that originally led to a master’s degree but now many programs expect their graduates to finish a PHD program which is as much as an anesthesiologist spends in training. Today CRNAs and anesthesiologists work hand in hand taking care of patients using an Anesthesia Care Team model in which the nurse does most the hands-on work and the anesthesiologist offers help and advice under the concept of “Medical Direction.” In this setting, the patient receives comprehensive care from a medical team.
In many areas of the country CRNAs work on their own but usually in rural setting and with uncomplicated cases.
In either scenario, it is important to note that these highly-trained professionals give all the medical anesthesia care to patients whether the case is simple or complicated. The surgeon is now allowed to focus entirely on the surgical management of the case and does not have to be distracted by anesthetic or medical issues.
So, the question remains, “Who is the captain of the ship?” A surgical case in most cases is managed by two distinct parties in consultation with each other, the anesthesia team handling the anesthesia and all medical issues, whereas the surgeon deals with the surgery. This makes great sense since the better qualified individual can handle what they do best. The era of the surgeon being the sole Captain of the Ship is effectively over.