AANA Launches New Campaign for Independent Practice on Capitol Hill

[deleted126335]

I haven't read the entirety of this thread, but I'm rotating through general cardiology right now, and a cardiac nurse asks me today: "Do you think she has a right bundle? Because I saw rabbit ears on her tele."

Patient had a LBBB with a slurred R wave in V6 that she took for "bunny ears".

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[Nivens]

View attachment 201302

Important, yes. Valued, no.

 

[criticalelement]

For me, it's a VERY small minority, .

Whoah, as long as to YOU it's a small minority we will call off all the independent practice talk. Thank you so much.

 

[Man o War]

Whoah, as long as to YOU it's a small minority we will call off all the independent practice talk. Thank you so much.

Yep to me. My opinion.
And you know what they say about those.

 

[Man o War]

I totally agree with you. However, the vast majority of the cases that we do are routine cases. These are the cases that generate revenue in our current reimbursement system. As much as I love doing a complicated case and thinking through all of the management decisions, I also love having days where I can pop a couple spinals in for TKAs and do nerve blocks on healthy outpatients for sports medicine procedures. I don't know about you, but I don't want to do ASA 3s and 4s all the time.

The point I am trying to make is that they are winning the marketing battle...by a lot. They are just so much better at marketing themselves to the hospitals, patients, and politicians. We've been afraid to "take the gloves off" so to speak because we are trying to be diplomatic. We rely on them to shoulder the workload so we can drive sweet cars and buy McMansions on the shore. It's awkward to create a campaign saying how much better we are than them, but then pop into work on Monday morning and be congenial.

I hear you. I agree it's weird. I just really don't see the worst case scenarios coming to fruition with them. There will always be places where they practice with no supervision, but for that to become the standard of care is a real long shot I believe. Older,
sicker, more obese patients make it even more unlikely. I'd love to know how many of them really want no back up and the liability/responsibility that comes with that given their limited training.

 

[deleted126335]

I hear you. I agree it's weird. I just really don't see the worst case scenarios coming to fruition with them. There will always be places where they practice with no supervision, but for that to become the standard of care is a real long shot I believe. Older,
sicker, more obese patients make it even more unlikely. I'd love to know how many of them really want no back up and the liability/responsibility that comes with that given their limited training.

There are plenty who will be more than happy to have us as little more than the fire department, to have one doc covering 8 rooms or more, where they do the Preop, do a quick curbside consult with you, then write in the record "case discussed with Dr. Man o War" to dilute out liability, do their thing and only call us if they have trouble. Also have us pick up the pieces post op. Don't fool yourself.


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[TeslaCoil]

There are plenty who will be more than happy to have us as little more than the fire department, to have one doc covering 8 rooms or more, where they do the Preop, do a quick curbside consult with you, then write in the record "case discussed with Dr. Man o War" to dilute out liability, do their thing and only call us if they have trouble. Also have us pick up the pieces post op. Don't fool yourself.


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Of course there are "those". They need to be pushed back against. Its time for docs to start taking off the gloves a bit too. Im less and less concerned with PR by the day.

 

[Man o War]

There are plenty who will be more than happy to have us as little more than the fire department, to have one doc covering 8 rooms or more, where they do the Preop, do a quick curbside consult with you, then write in the record "case discussed with Dr. Man o War" to dilute out liability, do their thing and only call us if they have trouble. Also have us pick up the pieces post op. Don't fool yourself.


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Then why hasn't this happened yet? People have been saying this since I was a med student and resident many moons ago and nowhere I have worked or moonlit has this type of arrangement. None of my friends from residency or ex partners work in this type of arrangement. Even the cheap ass AMCs don't do this in any of the places I've worked.

 

[deleted171991]

Then why hasn't this happened yet? People have been saying this since I was a med student and resident many moons ago and nowhere I have worked or moonlit has this type of arrangement. None of my friends from residency or ex partners work in this type of arrangement. Even the cheap ass AMCs don't do this in any of the places I've worked.

We're getting there. It will take 5-10 years after they become independent at the VA, just watch what happens.

I remember being asked, during one of my residency interviews, about the CRNA threat, and I just shrugged it off. When I started my residency, there were less than 5 in my program. When I finished, there were more than 50. That's how fast things happen, once they start happening.

Regarding AMCs: nobody wants to be the guinea pig where malpractice is involved. But once a critical number is reached, many more will adopt the model. It's like with progress in anything. And greed is a very powerful engine of progress.

 

[Man o War]

We're getting there. It will take 5-10 years after they become independent at the VA, just watch what happens.

I remember being asked, during one of my residency interviews, about the CRNA threat, and I just shrugged it off. When I started my residency, there were less than 5 in my program. When I finished, there were more than 50. That's how fast things happen, once they start happening.

Regarding AMCs: nobody wants to be the guinea pig where malpractice is involved. But once a critical number is reached, many more will adopt the model. It's like with progress in anything. And greed is a very strong engine of progress.

I guess time will tell. It's just interesting that this same conversation has been happening for so long and armageddon has never come. This feels like Y2K over and over and over again.

 

[deleted171991]

I guess time will tell. It's just interesting that this same conversation has been happening for so long and armageddon has never come. This feels like Y2K over and over and over again.

I know. That's exactly how I used to feel about the CRNA threat when I went into anesthesia.

It's like a bear market: you can't predict when it will happen, just that it will, and that it will be probably bad.

 

[Carbocation1]

Cut down the booze spending and throw some money at your professional organization. Stand up for yourselves and make sure your ASA represent your interests.

 

[GA8314]

Cut down the booze spending and throw some money at your professional organization. Stand up for yourselves and make sure your ASA represent your interests.

Agreed. I do think the ASA is getting it. I was at the practice management conference and I can tell you the the top leadership were legit talking about the need to snuff out the VA issue. They weren't faking their enthusiasm on that issue either. Sure, you may not agree with every measure or every outcome of the ASA (or your state society), but participation and donation to PACs is the best bet to advocate on behalf of this (or any other) profession.

The president elect of the ASA (Jeff Plagenhoef) said that folks need to stop asking what the ASA is doing when they haven't even gone to http://www.safevacare.org and shared it with 5 of their family members. Sometimes national societies can only do so much. Some things need to be done via grassroots. Of course the ASA set up the site in the first place, but again, they can only do so much.

When's the last time the naysayers have donated $ to the ASA or wrote to their local congresspeople? Stop waiting for someone else to fix the problem. The AANA is a great example of how grassroots endeavors can be successful. We have the $$, but it takes more than that.

That being said, this is just "business as usual". We are no different than an American chemical company (or consortium) who MUST lobby to protect their interests (think dumping by Chinese owned firms). Or a device manufacturer lobbying to fast track their device via the FDA. You choose the example in business. They are everywhere.

Part of doing business in the US is lobbying and supporting your societies. It's not personal.

Take the emotion out of it while at the same time stepping up your efforts, realize it is a f.cking game, and you will be more at peace with yourself, and we will all have a more prosperous future. Not too hard.

 

[deleted171991]

Cut down the booze spending and throw some money at your professional organization. Stand up for yourselves and make sure your ASA represent your interests.

But I need the booze so I don't get depressed from what the ASA does.

 

[Jimmy Chitwood]

The thing I don't really understand about all this is how CRNAs actually benefit from independent practice. I feel like everyone loses here.

Having a physician supervisor, at worst, gives the CRNA someone to shoulder much of the liability, someone to bounce ideas off of, and an extra pair of hands to help start cases, etc.. At best, there is no doubt that we have more comprehensive medical training, and could be essential in complicated situations.

Money? They make excellent salaries, at least where I am. If they got widespread independent practice rights, I think they risk making less. Physician anesthesiologists would ultimately price themselves competitively, driving everyone's salary down.

And what about the patients? See my first point.

I am probably missing something, but I just don't see why this is desirable.

 

[psychbender]

It's desirable in that it addresses the inferiority complex of those pushing for independence, and makes them feel better about their choices in life.

 

[criticalelement]

The thing I don't really understand about all this is how CRNAs actually benefit from independent practice. I feel like everyone loses here.
.

There are many many many anesthesiologists with personality disorders who do not know how to communicate effectively, how to behave towards other humans in the best of circumstances. the specialty self selects those folks. Anyone wanna disagree? Throw in working with a CRNA(closely) who they deem inferior, thrown in a bit of stress and insecurity and they have an inner meltdown. This inner meltdown is manifest by demeaning crnas, rudeness, horrible body language. Imagine working with that daily!! It is no wonder they want to get rid of us. You have to make them do what you want them to do and make them think it was their idea. See how hard that is!

Residencies give poor training on how to properly supervise an anesthetic and how to have your wishes crystallized.

On top of that, you have many many lazy anesthesiologists who never answer pages, never come to the room, never offer to put in the iv, never offer to sit in the room during a long long case, . How would you like to work with someone like that? Would you want to get rid of that person?

You have to be engaged in all aspects of the patient care and never let the crnas think they are the ones doing the case and there is no back up which is what happens when one is never available

 

[deleted171991]

There are many many many anesthesiologists with personality disorders who do not know how to communicate effectively, how to behave towards other humans in the best of circumstances. the specialty self selects those folks. Anyone wanna disagree? Throw in working with a CRNA(closely) who they deem inferior, thrown in a bit of stress and insecurity and they have an inner meltdown. This inner meltdown is manifest by demeaning crnas, rudeness, horrible body language. Imagine working with that daily!! It is no wonder they want to get rid of us. You have to make them do what you want them to do and make them think it was their idea. See how hard that is!

Residencies give poor training on how to properly supervise an anesthetic and how to have your wishes crystallized.

On top of that, you have many many lazy anesthesiologists who never answer pages, never come to the room, never offer to put in the iv, never offer to sit in the room during a long long case, . How would you like to work with someone like that? Would you want to get rid of that person?

You have to be engaged in all aspects of the patient care and never let the crnas think they are the ones doing the case and there is no back up which is what happens when one is never available

Help! Somebody has hacked criticalelement's account.

 

[chocomorsel]

There are many many many anesthesiologists with personality disorders who do not know how to communicate effectively, how to behave towards other humans in the best of circumstances. the specialty self selects those folks. Anyone wanna disagree? Throw in working with a CRNA(closely) who they deem inferior, thrown in a bit of stress and insecurity and they have an inner meltdown. This inner meltdown is manifest by demeaning crnas, rudeness, horrible body language. Imagine working with that daily!! It is no wonder they want to get rid of us. You have to make them do what you want them to do and make them think it was their idea. See how hard that is!

Residencies give poor training on how to properly supervise an anesthetic and how to have your wishes crystallized.

On top of that, you have many many lazy anesthesiologists who never answer pages, never come to the room, never offer to put in the iv, never offer to sit in the room during a long long case, . How would you like to work with someone like that? Would you want to get rid of that person?

You have to be engaged in all aspects of the patient care and never let the crnas think they are the ones doing the case and there is no back up which is what happens when one is never available

Holy crap! You just described to the T my old boss! The CRNAs hated him. He was very demeaning, and sexist. His best friend was one of the Male CRNAs and he could do no wrong. Blatantly disrespected other MDs by not following our orders and being rude. But the rest of the CRNAs were treated like ****. And he never answered his phone to sign out patients in PACU or see ones in preop. On the days when he and another anesthesiologist were running the board, well the other one did most of the work.
So glad I don't work there anymore. He certainly had a personality disorder.