Joseph L. Fink III, J.D.
Public Member, NBCRNA (2008-2015)
Part of the
post-World War II Baby Boom, I grew up in a small town, Tyrone, in the Appalachian portion
of Central Pennsylvania. When I was a youngster
the population of the town was about 7,000; now it’s around 4,000. There was a hospital in town
constructed with Hill-Burton Program funds after World War II. The professionals in town included
three physicians who were general
practitioners and one surgeon.
There was no anesthesiologist but thankfully, there was one CRNA. Her surname (I cannot
recall her first name because
no one ever used it) was Cimino and everyone called
her Cimmy. Cimmy was about 4’ 11’ in height but very much taller when
her stature in the community was measured. She was what made needed surgery
possible and she was always
ready to serve. She was different
from the other nurses
at the hospital who in those days wore the traditional white nursing uniforms,
white stockings and shoes, and one of those distinctive white nursing caps; Cimmy always
wore scrubs and a colorful
bandana. (In that era in Appalachian Pennsylvania all
nurses were female).
got linked with the NBCRNA during the 1990’s when Peggy McFadden, a CRNA
from the Lexington area where I now
live who was enrolled in a graduate health
law course I was teaching at the University of Kentucky,
approached me about an opening for a Public Member on the Council
on Recertification. That was in the days when the Council on Recertification was separate from the Council
on Certification. I served in that role as Public Member from 1993-1999. I was succeeded
my best friend (other than
wife), Larry Simonsmeier, J.D., from Portland, OR.
During that period I had the honor of working with Susan Caulk, CRNA, truly a living legend in the nurse anesthesia
field. That first stint as
Public Member started
my learning curve about nurse anesthesia, a process
that continues to this day. My service with NBCRNA concluded after the September, 2015 meeting. What
have I learned during this opportunity to serve?
First and foremost, NBCRNA’s obligations run to the public and, as a result, on to the individual patient. This is in contrast
with a professional membership organizations such as the AANA, the principal
purpose of which is to advance the interests of the profession. One of my key responsibilities as the Public Member was to remind everyone of that at key points or junctures
in discussions. My experience was, fortunately, that the NBCRNA members did not need reminded of that expectation very often; patient
welfare was always at the fore of the considerations of the Board
members and staff.
Members of the NBCRNA and the outstanding staff members perpetually have kept their focus exactly where it should be – on the health and welfare
of patients being served by CRNA’s.
During my six year tenure
there have been extremely few times when I have felt the need to discharge
my responsibilities as the Board member charged with asserting
the view of the public to remind
everyone of our collective and principal overarching purpose. That reflects all the best on the efforts of the NBCRNA members with
whom I have served.
I have been a first-hand witness
to the very sound decision making
of the members of the NBCRNA. Board members
make a very substantial commitment of volunteer time along with motivation
and dedication to their service
in this role.
As Chair of the NBCRNA Review
and Appeal Committee I had the privilege
of working with the Committee members, staff and Legal Counsel
to assure that a mechanism or pathway was working well for consideration of exceptional circumstances that interfered with pursuit of initial
certification or renewal
of certificant status.
Balancing the central
concern for patient
welfare with the need for appropriate flexibility and compassion when considering exceptional circumstances has
been the focus of that group.
From time to time it has proven helpful to ask myself “What does the patient
expect when the CRNA is seated
by the side of the
operating table?” Here’s what I have concluded:
- Provider competence;
- Care consistent with the highest contemporary standards irrespective of location -- urban, suburban or rural;
- Care consistent with the highest contemporary standards irrespective of age, gender or ethnicity of provider; and
- Accountability and transparency
All of this came home to roost
when I was diagnosed with prostate
cancer in October,
2010. I chose the surgical
approach to dealing with that challenge and received great benefit
from the services of Christie Arkle, CRNA, at the University of Kentucky Hospital.
That experience as a patient
has been carried forward through my service
with NBCRNA. It has colored
or flavored my service
as a Public Member of the Board.
It has been my experience that professionals sometimes view themselves as being in a field where only others in the specialty
can assess their abilities. But beginning with the addition
of non- licensee members of the public to professional licensure boards during the consumer movement of the 1970’s, patients and the public have come to recognize and assert their role in assuring
the professional competence of those
who practice on them.
After all, it was the public, acting
through the agencies
of government, that granted the initial
licensure to practice
the actions of legislatures and nursing
Subsequently, membership on those same nursing boards, acting on behalf
of the public, was expanded to include a seated public member from outside the profession. About the same time along came mandatory continuing professional education for renewal
of licensure. This involvement of a representative of the public perspective was carried forward to the Councils on Certification and Recertification and thus on to the NBCRNA.
And what does the public think? Programs
aimed at professionals and collectively designated as “maintenance of competence” are important. A 2010 survey
sponsored by the
American Board of
Medical Specialties and focused on physicians found that 95% of the
public rates participation by their physician in maintenance of competency activities as important.
Another study focused on physicians by Consumers’ Checkbook, an independent nonprofit consumer organization founded
during the 1970’s,
found that “participation in an on-going maintenance of competence program is evidence
that a physician is taking extra steps beyond getting initial certification to continue
to keep up-to-date and improve.” Fortunately, the vast majority of
CRNA’s recognize and
acknowledge this responsibility.
at the risk of being indicted
for overly focusing
on colleagues in the medical
profession, a quotation from an article
in the December 10, 2014 issue of JAMA provides insight:
“Professional societies and physicians have a duty to criticize the problems
with Maintenance of Competence
programs, but also to participate actively in improving them. They must guard against the temptation to ‘dumb down’ measures to appease angry
colleagues, and thus run the risk of ending up with an MOC system that simply does not accomplish the task at hand, a commitment to lifelong
learning. They should
recognize the difficulty of creating what physicians want – a system that evaluates them based on what they do, but does not disrupt then as
it does so.”*
Graduate Medical Education programs
in anesthesia will never produce a sufficient number of anesthesiologists to meet the total demand for anesthesia-related services and to facilitate all the surgical procedures
necessary to preserve and restore the health
During my short time serving both the public and the nurse anesthesia profession, the profession has grown in scope and number of practitioners. Now there is even subspecialty certification for CRNA’s who focus their practices
on non-surgical pain management. Think of all the various
procedures and interventions available to address
maladies now that were unavailable when I was growing
up in Central Pennsylvania.
It has been an honor to have worked
with a parade of outstanding leaders,
starting with Susan Caulk and Karen Plaus and on through many others on the staff in the Illinois office, as well as the volunteers, both CRNA’s and non-CRNA’s, with whom I’ve been privileged to serve over the years. With my two stints of service on the Council on Recertification from 1993-1999 and then on the NBCRNA from 2008-2015 I have learned
a tremendous amount.
I will be eternally grateful for this
* Lee TH. Certifying the Good Physician: A Work in Progress. JAMA 2014(Dec 10);312:2340-2342.