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Kentucky opt-out

Discussion in 'Anesthesiology' started by kron13, Apr 26, 2012.

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  1. kron13

    kron13 Junior Member

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    SDN Members don't see this ad. (About Ads)
    Last night, with no public discussion or announcement, Gov Steve Beshear signed a bill making Kentucky the next opt out state. There was no time to do anything about this. Just wanted to let the community here know about it.

    When my hospital makes changes in the coming months I will post a general summary of them here to let people know how bills like this affect anesthesia groups.
  2. kron13

    kron13 Junior Member

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    Point of clarification as I realized this forum is largely students and residents. Opt-out is code for- CRNAs can practice without MD supervision and bill medicare and medicaid.
  3. sevoflurane

    sevoflurane Ride

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    I'm sorry to hear this.
  4. jwk

    jwk AA-C ASA-PAC Contributor

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    Most of us understand exactly what the opt-out is. What's unfortunate is that it was done without any public discussion and announcement, which is exactly opposite the way things are supposed to be. HOWEVER - trust me on this - the CRNA's have known about this for a while. Funny how things happen.

    Funnier too when hospitals where the anesthesiologists have some control and/or influence start hiring AA's preferentially to CRNA's whenever possible. Colorado is a prime example - opt out a year or so ago, and AA's have made new inroads into the state where there had only been a small handful for 20 years. I'm also aware of two large hospitals in a midwestern state that have previously been CRNA's only, and the MD's finally stood up and said "enough is enough" and are on an AA hiring binge. Love it, love it, love it!
  5. gasblaster

    gasblaster ASA Member

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    It's quite ridiculous that this happened without any opportunity for discussion and was slipped under the radar.
  6. gasblaster

    gasblaster ASA Member

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    I think most of us medical students interested in anesthesia and residents are well aware of the opt out issue. Well I would at least hope so.
  7. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    So, the Opt Out continues. In the last 3 years how many does it make now? Colorado, California and now Kentucky? The total number is 17 and counting.




    Gubernatorial Opt-Out Letters
    • Iowa (December 2001)
    • Nebraska (February 2002)
    • Idaho (March 2002)
    • Minnesota (April 2002)
    • New Hampshire (June 2002)
    • New Mexico (November 2002)
    • Kansas (March 2003)
    • North Dakota (October 2003)
    • Washington (October 2003)
    • Alaska (October 2003)
    • Oregon (December 2003)
    • Montana (January 2004)
      (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana's opt-out, therefore, is currently in effect.)
    • Montana Re-Opt-Out Letter
    • South Dakota (March 2005)
    • Wisconsin (June 2005)
    • California (effective July 17, 2009)
    • Colorado (September 2010) (For Critical Access Hospitals (CAHs) and specified rural hospitals)
    • Kentucky (April 2012)
  8. yappy

    yappy

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    If this trend continues the physicians will need to make sure that their MD/AA teams are more cost effective, professional, and efficient than their competitor CRNA. Maybe add value where your additional education allows to [that can be measured by admins] & shape public opinion in your favor.

    All those things may allow you to "pour boiling hot oil" over your competitors' head to secure a dominate place in the market.
    Last edited: Apr 26, 2012
  9. pretenda

    pretenda ASA Member

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    IMHO the ASA should be far more focused on advancing AA practice than blocking CRNA independence when taking limited resources into consideration.

    Although its dangerousl unleashing a horde of independent newly minted CRNAs on the unsuspecting public its obviously part of the future. AA's with MD's having their back in the court of public opinion is not as obvious a part of this future. The greed of the CRNAs who claim to want to expand access shines through in their fight against AA practice (just browse their website for the lack of respect geared towards them) even though theyre trained in a similar manner with similar credentials behinds their names. Sure a couple of murses pound their chest about their training being geared more towards independence but rarely will you find any factual examples demonstrating this difference in training.
  10. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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  11. sevoflurane

    sevoflurane Ride

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    I don't agree with this. It needs to be met head first. Looking the other way is not the solution.

    More importantly, it needs to be fought at the State Level. Some states aren't giving them room to breathe. These states are examples for others to follow.... and it will be an ongoing battle for years to come.
  12. W222

    W222 2K Member

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    A few interesting people I have met recently. Three NPs, two who are now working their old "RN" job and another who is doing non-clinical work. Also, someone who was in a CRNA program who is working again as an RN. I am wonding if perhaps things aren't so great out there, maybe the mid-level organizations promises of complete independence and boatloads of cash are fairy tales.
  13. gasblaster

    gasblaster ASA Member

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    When I was looking up more information on the Kentucky opt-out, I came across one of the CRNA websites/forums (which I guess I never realized existed). On the front page was poll asking "are we producing too many new graduates" and it was heavily weighted towards the "yes" end. Obviously, can't put a lot of weight on it, but I thought it was interesting.
  14. Idiopathic

    Idiopathic Newly Minted Lifetime Donor

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    no matter what discipline or specialty you ask this of, id imagine the answer will always be yes
  15. gasblaster

    gasblaster ASA Member

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    Primary care?
  16. darby11

    darby11

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    I find it hard to believe that it is the ASAs job to know these things and they had no idea. Begs the question. Is the ASA in cahoots with AANA?
  17. darby11

    darby11

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    i keep saying this. The way to fix the crna problem is to say WHO CARES. Let them practice independently and go on a grand scale openin up AA schools.
  18. kron13

    kron13 Junior Member

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    The governors office promised formal dialogue with all 3 parties-Asa, aana, hOspitals. Well they broke the promise. He signed it late at night. Told noone. Freely states in the optoutletter that he consulted with aana and hospitals. No mention of Asa or ksa. Asa an ksa went nuts yesterday when rumors hit. It was too late though. Letter signed the night before.

    Those are the facts. Now my opinion. Politicians saw this as a way to free up some cash in healthcare. Also did a solid for nurses and hospitals. Good friends to have with elections looming. What did it cost them? Pissed off a tiny number Of mds. That's it. Good political move. Public has no idea what this issue is and this was done so quietly virtually noone noticed. Again smart politics.

    What did I learn? Unless you are aligned with the powerful side you will get crushed by the government. Forget getting a fair shake. The facts,your rights etc... Totally meaningless. Totally.

    Good luck guys. Save your money. This is coming for all of us.
  19. Josh1

    Josh1

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    All these decisions are financial. A politician has no idea about patient safety or level of training. All they see are CRNA=MD, and the CRNA is cheaper so they think they are helping. Politicians see this because of the CRNA-funded studies that say this, as of now there is no study directly comparing anesthesiologists to CRNAs that shows that anesthesiologists are superior, until that happens their is no 'evidence based medicine' (the buzzword of the day) to have an anesthesiologist. The end line in the abstract to "Surgical Mortality and Type of Anesthesia Provider" reads: Hospitals without anesthesiologists had results similar to hospitals with anesthesiologists or directed anesthesia care. Read between the lines.

    In approximately one decade 17 states have opted out, in 20 years all states will be unless their politicians think it is unsafe. That is the future.
    Either start hiring AAs, take a pay cut and make the practice cheaper or produce studies to show a difference are the only ways to fight this.
    People should be realistic, who cares what the job pool is like for CRNAs, the pay will always be better than for regular RN work, that is not going to do anything to hinder this.
  20. darby11

    darby11

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    You said it. Start Hiring AAs. I always say this. Lobby your lpoliticians to pass AA legislation. If this continues all of anesthesia will be relegated to NURSES. It will be the dumbing down of the profession. ANd the people who will suffer.. Unknowing patients.
  21. gasblaster

    gasblaster ASA Member

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    Probably a question and topic that has been addressed before, but why hasn't there been any signifcant research from the MD side. I'm sure there isn't a lack of research interest. I've seen the small studies from essentailly the AANA. Is it that setting up such a study would be difficult?
  22. TheSweetness

    TheSweetness ASA Member

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  23. darby11

    darby11

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  24. sevoflurane

    sevoflurane Ride

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    Below is an email I received from the KSA president. I urge all of you reading this to call the governors office and let your thoughts be heard, either directly or by message. It is easy to do.

    All attendings, residents, med students, civilians... anybody. You don't have to live there to let them know your feelings.


    As many of you may have already heard, the Governor has signed an opt-out letter. KSA has worked diligently and successfully for more than a dozen years with three (3) different Governor's against opt-out. Last year, the KY Hospital Association joined the nurse anesthetists in lobbying the Governor to opt out. KSA has been in regular dialogue with the Governor’s Office; we have asked them for a formal meeting, and we have asked for the letter to be rescinded. We have also spoken with ASA staff today about our options and will be exploring all of them.

    At this point, I encourage you to call the Governor’s Office at (502) 564-2611 and register your opposition to this action. You should have gotten the call to action from the ASA, but in case you want to review the key points, I have attached that to this e-mail. A little noise goes a long way in Frankfort. Please let your voices be heard. When you call, ask to leave a message for the Governor. If you have a personal relationship with the Governor or any member of his staff, please ask to speak directly with him/her. I have attached talking points for you to use. Please let us know if you receive any feedback.

    Thank you.

    Sincerely,
    Heidi M Koenig, MD
    President, Kentucky Society of Anesthesiologists
  25. Taurus

    Taurus Paul Revere of Medicine

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    What the CRNA's don't understand is that they are riding on the coattails of the anesthesiologists. Their inflated salaries are due to reimbursement rates that are assuming that physicians with their requisite years of training are either directly delivering or supervising the anesthesia. If all 50 states go independent and CMS and insurance companies begin to realize that anesthesia delivery is mainly a nursing function, reimbursement rates will fall hard.

    The NP's in Oregon tried to pass a law recently to mandate their reimbursement levels are same as physicians. However, as people pointed out, the insurance companies would lower physician rates to match NP's instead of the other way around.

    Legislation Giving Nurse Practitioners Equal Pay Appears Dead

    If the bill passed, they claimed, insurance companies would decrease the reimbursement rate of primary care physicians rather than increase the rates paid to nurse practitioners.​

    This is why it is critical for all anesthesiologists to support AA's. Every practice should hire AA's. Every anesthesiology program should start an AA program. This is not the time to stick your head in the sand and imagine it's not your problem. If the CRNA's achieve their goals, primary care will begin to look really attractive compared to anesthesiology.
  26. med12345

    med12345

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    My question may be naive.

    What practical significance does this have in the day to day function of the operating rooms within a hospital? Do CRNAs and MD work completely independent of one another? Who picks what cases? Does this do away completely with the team model in these states? What if a CRNA doesn't want to work without an MD? Will this be required? Will CRNAs begin to form private groups and hire billing companies?

    I'd love someone's perspective on this.
  27. jwk

    jwk AA-C ASA-PAC Contributor

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    Wrong! That website is for PA's who are interested in anesthesia, NOT AA's.

    The official website for the American Academy of Anesthesiologist Assistants (AAAA) is www.anesthetist.org . The AAAA is the national organization for AA's, and has a very close working relationship wih the ASA.
  28. jwk

    jwk AA-C ASA-PAC Contributor

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    I can assure you the ASA is not even close to being in cahoots with the AANA. Not even close. You need to learn a lot more about the politics of this whole situation before you start throwing out these uninformed statements.
  29. goosegas

    goosegas

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    To clarify your clarification, the CRNA's could already practice without MD supervision and bill Medicare/caid even without Opt Out. Opt Out isn't a practice issue but rather a (hospital) billing issue. In a non Opt Out state, in order for the hospital to bill Part A, they needed to have a supervision requirement in their bylaws in order to receive payment. Opt Out has no impact on the CRNA's ability to bill Medicare.

    Really, I don't think it has much practical significance. If a hospital anesthesia department is made up of docs and CRNA's that practice as an ACT, then nothing changes. If a CRNA is a solo practitioner in a rural facility by themselves, the hospital can remove the supervision requirement from their bylaws if they wish. But it doesn't change anything because the CRNA is still the only anesthesia provider and they still work with surgeons.

    Opt Out simply defers to State law or facility bylaws.
  30. pretenda

    pretenda ASA Member

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    Like all creeping forms of leftism that reduce standards this will never be reversed.


    Take the ball out of their court and support equally qualified and equally trained AAs. Amazing how the nurses perceive other equally qualified providers that also expand access to care and reduce costs without threatening patient safety.
  31. matthi

    matthi

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    Lord, nurses are so stupid. I sometimes wonder how much further along healthcare would be if we didn't have to deal with their nagging:mad:
  32. baller71457

    baller71457

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    Really? This is your 1st post?
  33. jwk

    jwk AA-C ASA-PAC Contributor

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    Thanks for your support!
  34. matthi

    matthi

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    yes, as you can see I am quite irked by this policy change
  35. pretenda

    pretenda ASA Member

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    you tell em whats up nurse matt! nobody likes a nag
  36. Gregory1

    Gregory1

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    SRNA here, been an ICU nurse for about 6 years and have 2 semesters down of anesthesia school. (worked trauma transplant at Duke, Charged an ICU, worked Neuro ICU, Cardiac ICU, basically from a nursing perspective there is nothing that I can't handle without the support of a competent MD).
    My father is a CRNA, navy trained with about 25 years experience and has worked in both a team approach and as an independent contractor. He has instructed both CRNA students and MDAs. I think experience has to count for something.
    Unlike most of my peers, I don't see a problem with allowing AAs to practice under the supervision of an Anesthesiologist I did however receive instruction from my teachers to call and oppose a recent bill that would have allowed AAs to practice in Kentucky. The only justifiable reason I could come up with was quite selfish, Job Security.
    I will concede that I will not have the education that an Anesthesiologist has upon graduation, nor the experience. My plan is to go somewhere that does a variety of cases with a team approach to gain experience, and then possibly move to a rural area to practice, with or without an anesthesiologist. All research points to no difference in outcomes between CRNA or Anesthesiologists, of course depending on who did the research CRNAs or MDAs the research may be skewed. The reason this bill was passed was simple, $$.
    Something I have noticed that I think is a disgrace is the apparent laziness of the MDAs (not all, but some). Where I currently practice, I have not seen a MDA do a single case. They supervise from a lounge with a flat scree television playing on their phones. As a SRNA I would appreciate if they took the time to come in the room, maybe teach us something, or act like they are interested in what they do. I have worked places where this was not the case, and really appreciate Anesthesiologists that would escort their patients to the unit and gave excellent reports doing their profession proud and looking out for their patients' best interests.
    avg salary around here for CRNA 150,000 to 180,000
    avg salary around here for MDA 300,000-450,000
    Check out Gaswork.com
    I think the salary difference is appropriate (you should be paid for your education, not your responsibility). If CRNA's aren't supervised, we have the same responsibility.
    One question I do have is: What is the difference in Malpractice Insurance between CRNA and MDA?
  37. okayplayer

    okayplayer Senior Member

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    Ban this troll. This is not a site for nurses. Good bye.
  38. darby11

    darby11

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    you are a loser troll. You think its easy supervising idiots like you. THere are Major plans for opening up AA schools in every single state. your salary will become nothing. DOnt ever post on this site again. go back to murse anesthesia.com. Anesthesiologist dont sit on the stool cuz thats a MURSES job like you.
  39. nycitygas

    nycitygas

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    There are plans to open up AA schools every state?
  40. Idiopathic

    Idiopathic Newly Minted Lifetime Donor

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    :poke:
  41. jwk

    jwk AA-C ASA-PAC Contributor

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    Interesting how you put this - you received "instruction from your teachers to call and oppose a recent bill that would have allowed AAs to practice in Kentucky". Was this an assignment? Did you get extra points on a test if you called? Did you call or contact anyone, and if you did, did you actually use the conscience you're trying to convey that you have in your post and SUPPORT AA practice? Or are you just one of the sheep that blindly follows the buffoons at the AANA? After all - you claim to see that it's a simple money issue.

    It's funny to me - CRNA's just LOVE to claim they're capable of independent judgment, yet few actually use it when it comes to anything to do with practice rights. How blatantly friggin hypocritical is it to argue that anesthesiologists should not interfere with CRNA practice rights, and in the next breath, claim that AA's shouldn't be allowed to practice?

    It's also funny to me that you complain about anesthesiologists not teaching you. Why the hell should they? CRNA's and the AANA constantly bash anesthesiologists - they claim they're equal to anesthesiologists. So why is it that they're not capable of teaching their own? Explain to me WHY you need an anesthesiologist to teach you. Explain to me why an anesthesiologist SHOULD teach you. Docs in a lot of areas are finally realizing that teaching those who seek to replace them makes absolutely no sense whatsoever, and they've stopped doing it. Good for them!
  42. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    You seem like a bright fellow. CRNA education is inferior to a Board Certified Anesthesiologist. Does that make CRNAs unsafe? No. But, it does mean there are limitations to a CRNAs scope of practice in terms of safety and morbidity. What are those limitations? It depends on the skill/knowledge of that particular CRNA. CRNA training varies widly from one program to another making any generalized statement inaccurate. MD Education is more standardized and highly scrutinized making a Board Certified Anesthesiologist a better prepared provider for Independent practice (as a general rule).

    AAs are just as safe as CRNAs in an ACT practice. You know that to be true. Yet, you disparage the profession anyway to improve your job prospects/income. Sad.

    CRNAs should be supervised in all high acuity settings. Anyone saying otherwise is either ignorant or has a political agenda or both. The ASA 3 of ten years ago has become the ASA4 of today. The walking dead go to the OR every day in the USA and it is BOTH our jobs to get them through the perioperative procedure alive.

    It is human nature to want more than you have; it is pure greed and selfishness to disparage another profession to get it. CRNAs are competent midlevel providers who play a valuable role in our health care system. But, Independent Practitioners require a higher level of DOCUMENTED training, testing and knowledge before being turned loose on the public.
    Last edited: May 3, 2012
  43. saratoga733

    saratoga733

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    "It's also funny to me that you complain about anesthesiologists not teaching you. Why the hell should they? CRNA's and the AANA constantly bash anesthesiologists - they claim they're equal to anesthesiologists. So why is it that they're not capable of teaching their own? Explain to me WHY you need an anesthesiologist to teach you. Explain to me why an anesthesiologist SHOULD teach you. Docs in a lot of areas are finally realizing that teaching those who seek to replace them makes absolutely no sense whatsoever, and they've stopped doing it. Good for them!"

    Great point. I stopped teaching them the second I realized they were back stabbing ingrates. Sure at work I smile and exchange pleasantries but believe me that is all that is exchanged. If only more Anesthesiologist around the country adopt this practice, the whole idea/discussion/legislation of crnas' practicing solo will be stopped dead in its tracks.
  44. pretenda

    pretenda ASA Member

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    It wasn't that trolly of a post and has decent points. Does a twenty year vet crna who has seen and done it all really "need" the supervision a newbie 24 yr old crna whos placed two cvcs in their life does? Of course youll never hear delusional nurses acknowledge the vast difference between a board cert md and a fresh crna. I can understand how certain things might appear from gregs perspective but you have to understand why mds have no interest in teaching you as your national organization is attempting to eliminate our profession and honestly you have no idea what a supervising anesthesiologist is doing while youre stool sitting.
  45. Consigliere

    Consigliere

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    I do the very same thing. If they ask a pointed question my reply is "look it up."
  46. EtherBunny

    EtherBunny

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    The AANA claims that there is NO difference between a board certified anesthesiologist and a freshly minted grad from a CRNA program. According to the AANA, the training is "equivalent."

    Obviously the claim is ridiculous, but this is the propaganda that the AANA relentlessly distributes to politicians and hospital administrators nationwide.
  47. Gregory1

    Gregory1

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    Troll, back stabbing ingrates, loser, stupid, Not teaching those you want to supervise- really! I would expect more from a "doctor." Sad... If this is the opinion of those that were in a supervisory positions of CRNAs, it is no wonder that they want to be independent.
  48. flashgordon

    flashgordon

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    Open your eyes ladies and gents... CRNAs are not your friend. They are a shady and politically motivated group who want to earn what they can't achieve through proper education and training. Double your salary by lying through your teeth and putting lives at risk. Well played AANA.

    Donate to the ASA-PAC and support the AA profession. If not, then YOU are part of the problem as well.
  49. Southpaw

    Southpaw ASA Member

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    I found Gregory's post spot-on and not at all trollish. I wish some of you would be more open to discourse. Fact of the matter is, a lot of the MDs in our field are ridiculously lazy. It's a fact; face it, accept it, and hope it changes. Meanwhile, there is a patient asleep under anesthesia. Who's caring for them? If we call it a care team, we need to play our part. Work smarter and work harder.
  50. saratoga733

    saratoga733

    Joined:
    Oct 31, 2007
    Messages:
    139
    Location:
    Northeast
    Status:
    Attending Physician
    SDN 5+ Year Member
    buddy, there in lies the rub-- i certainly have no problems teaching those i supervise. however your NATIONAL ORGANIZATION has already made it crystal clear that supervision is not welcome!

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