Nurse "Anesthesiology"

[berlog]

I find it offensive that this CRNA program at in Albany calls themselves a "Nurse Anesthesiology" program. This is obviously misleading and they should use Nurse Anesthesia for their name. This seems like an intentional attempt to blur the lines between physicians and nurses. How do they get away with it? Is there anything that could be done?

http://www.amc.edu/academic/NurseAnes/index.cfm

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[Psai]

It's how these midlevels play the game. No we aren't physician's assistants anymore, we are physician assistants. They are after our positions and instead of putting more effort into their education and training, they want to take the shortcut. Why bother going through the hassle of getting into medical school, working hard, learning things, doing a residency with long hours? Just call yourself a doctor of anesthesiology, award yourself a shiny "board certification" and spend a few bucks lobbying legislators for increased scope of practice and decreased oversight by a real doctor. When the ASA lets you blur the lines and decides that the best course is to concede the OR to crnas, why not just take it all?

 

[AlphaBeta<3]

It's how these midlevels play the game. No we aren't physician's assistants anymore, we are physician assistants. They are after our positions and instead of putting more effort into their education and training, they want to take the shortcut. Why bother going through the hassle of getting into medical school, working hard, learning things, doing a residency with long hours? Just call yourself a doctor of anesthesiology, award yourself a shiny "board certification" and spend a few bucks lobbying legislators for increased scope of practice and decreased oversight by a real doctor. When the ASA lets you blur the lines and decides that the best course is to concede the OR to crnas, why not just take it all?

it's not that serious lol
The difference comes in your paycheck, what does the title matter?

 

[GA8314]

it's not that serious lol
The difference comes in your paycheck, what does the title matter?

It's meant to obfuscate the difference between and MD/DO and CRNA. "Nurse Anesthesiology".

Little things like this are done intentionally by mid-levels. "Residencies" "Fellowships" etc. etc. It's ridiculous but not benign.

 

[Psai]

it's not that serious lol
The difference comes in your paycheck, what does the title matter?

It's because the title matters. The word doctor means something to patients. It definitely doesn't mean a nurse dressed in doctor clothes. When nurses tell patients that they're doctors when they're not and do a poor job, it makes us look bad.

They're coming after the paycheck too. "Equal pay for equal work" is the prevailing mantra of the supposedly downtrodden. If there is no difference in title and the difference in clinical responsibility is minimized with words, why would they pay you more? They claim to be board certified, fellowship trained doctors. Pas introduce themselves as the hospitalist without any mention of "pa". Midlevels in the icu refer to themselves as intensivists despite not having an md or a do. If they convince hospital administrators to hire them because they're cheaper, where does your paycheck go? It goes into the pockets of the midlevel instead after the hospital administrators and insurance company ceos take their share.

Do you think that people who aren't in medicine understand the difference in training? What they look at is the bottom line. These guys cost 300k, those guys cost 200k. They're both board-certified, fellowship trained doctors of anesthesiology. Let's go with the 200k anesthesia provider. Who cares if they work fewer hours and have less training as long as we get enough warm bodies in the rooms to make the surgeons happy? Does it matter that the board certification is a sham? That the fellowship is a 9 month course in health disparities in rural ohio? That the doctorate of nursepractic is a 2 year training writing seminar for nurses? Now they have an extra 100k per provider to put into their annual bonuses, f the patients.

 

[FCMike11]

It's meant to obfuscate the difference between and MD/DO and CRNA. "Nurse Anesthesiology".

Little things like this are done intentionally by mid-levels. "Residencies" "Fellowships" etc. etc. It's ridiculous but not benign.

Genuine question: what would you have PAs call their additional years of training, instead of a residency?

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[Random Anesthesiologist]

it's not that serious lol
The difference comes in your paycheck, what does the title matter?

Some people take more pride in their career than just a paycheck. If it was just about money, I wouldn't have even become a physician.

 

[Random Anesthesiologist]

Genuine question: what would you have PAs call their additional years of training, instead of a residency?

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Well, since a physician is still a physician after 3-10 years of residency, how about "PA"?

 

[Psai]

Genuine question: what would you have PAs call their additional years of training, instead of a residency?

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"pa"
It's not a residency. And there are nursing schools taking a one semester course and calling it residency. That's a slap in the face.

 

[Random Anesthesiologist]

"pa"
It's not a residency. And there are nursing schools taking a one semester course and calling it residency. That's a slap in the face.

No kidding. If nurses actually knew the history behind the reason why it's called residency and looked at resident hours (it's cute they think residents work under 80 hours a week), they'd run screaming.

Lord forbid they don't get their breaks, lunches, or go home on time (and that's all nurses). Ever try to get info at shift change?

 

[rakotomazoto]

http://www.amc.edu/academic/NurseAnes/index.cfm

Apparently, they do a rotation in "kidney transplant". Top-notch stuff! Can't wait to have one of these nursing anesthesiologists on the case to protect me from expensive and inferior physician anesthesiolgy if I ever need to go to the OR.

Went to the link to see for myself and it was only seconds before a pop-up asked me if I would like to fill out a survey from Albany Medical College. Happy to oblige. Although one online review is a drop in the ocean, it was nice to vent a little. Maybe no one will ever really listen but I have to try. If we don't speak up at every opportunity, then why wouldn't the legislators and administrators believe the mid level propaganda machine?

Most mid levels that I know personally are happy to take care of patients in their corner of the medical system and recognize the scope of their training. However, as I slog through one ridiculous case after another and roll from the ICU to the OR and back again and compare that experience to bouncing into the surgery center, doing some quick hand cases under MAC and bouncing out the door at 3-5pm Mon-Fri, I have less and less patience for anyone who wants to equate mid level work to being a physician. To some degree, this is all a reflection of a sad trend of entitlement in society, but that is opening a whole other can of worms. I am NOT frustrated that I work longer hours and do more complicated cases, that is actually why I chose this specialty and would choose it again without question. Honestly, my hours are nothing compared to past generations of physicians. That being said, it is amazing how much I have learned and I am still just a CA-1. I think there is real satisfaction in working hard and making difficult clinical decisions in real time in the OR. But mid levels just want to play dress-up and pretend to be something they are not at the expense of patients.

 

[FCMike11]

"pa"
It's not a residency. And there are nursing schools taking a one semester course and calling it residency. That's a slap in the face.

When I was considering applying to PA school I was looking at programs such as these for post-graduate training. What would be the alternative to calling it a residency? Not arguing the full purpose of this thread, just wondering on this particular instance.

https://www.einstein.yu.edu/departments/medicine/divisions/critical-care/pa-residency.aspx

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[FCMike11]

No kidding. If nurses actually knew the history behind the reason why it's called residency and looked at resident hours (it's cute they think residents work under 80 hours a week), they'd run screaming.

Lord forbid they don't get their breaks, lunches, or go home on time (and that's all nurses). Ever try to get info at shift change?

I am a nurse and it's a bit disingenuous to assume all nurses are like this. But, unfortunately, it's the bad ones who stick out/are remembered.

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[Random Anesthesiologist]

I am a nurse and it's a bit disingenuous to assume all nurses are like this. But, unfortunately, it's the bad ones who stick out/are remembered.

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It's not disingenuous. I get you want to protect your specialty. However, you must be blind to the constant propaganda, from as big as nurses saying outright they are equivalent to physicians to as small as dumb Facebook memes. Are 100.00% of nurses like this? Probably not. But I'm willing to bet > 75% of them are. It's not necessarily derogatory. Shift work is shift work and there are other things on their minds. Physicians are trained differently, and it shows when the time clock comes around, or by not having a time clock, sometimes at the expense of our personal lives.

But seriously, have you ever tried to get something done at shift change?

 

[Psai]

When I was considering applying to PA school I was looking at programs such as these for post-graduate training. What would be the alternative to calling it a residency? Not arguing the full purpose of this thread, just wondering on this particular instance.

https://www.einstein.yu.edu/departments/medicine/divisions/critical-care/pa-residency.aspx

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Something that doesn't imply that you're basically living in the hospital when you're not. Have you ever fallen asleep in the hospital because you were too tired from being there for too long and just couldn't do anything else? I have, on multiple occasions, and I haven't even started residency yet.

 

[IlDestriero]

Feel free to express your thoughtfully worded concerns to the person with the power to affect change in Albany.

James J. Barba, President and CEO Albany Medical Center43 New Scholar Ave., Mail Code 114 Albany, NY 12208ph: 518-262-3125 (Ask to be connected to the president’s office)
email: [email protected]


--
Il Destriero

 

[FCMike11]

It's not disingenuous. I get you want to protect your specialty. However, you must be blind to the constant propaganda, from as big as nurses saying outright they are equivalent to physicians to as small as dumb Facebook memes. Are 100.00% of nurses like this? Probably not. But I'm willing to bet > 75% of them are. It's not necessarily derogatory. Shift work is shift work and there are other things on their minds. Physicians are trained differently, and it shows when the time clock comes around, or by not having a time clock, sometimes at the expense of our personal lives.

But seriously, have you ever tried to get something done at shift change?

No. I completely see the "propaganda" as you say and have seen it first hand in a friend of mines NP course lectures. PA school is my only other option...I am in agreement with majority of posters here that NP training occurring online is a joke. Same for the fact that you can set up your own rotations.

I may have misinterpreted your tone, however, if there is something urgent going on with my patient I will see it to completion, regardless of whether or not I have given report. Sure, there are crappy nurses that once they give report they put their hands up "your problem now!". At least in my unit this isn't the case (majority of the time).

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[Gern Blansten]

PA school is my only other option...

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Several nurses in my med school class. Just take the leap if you seriously feel this way. Many before you have do e the same. NP is the easy way out.

 

[FCMike11]

Several nurses in my med school class. Just take the leap if you seriously feel this way. Many before you have do e the same. NP is the easy way out.

What I meant by that was, if I didn't matriculate into medical school I would never consider NP school (with PA school being my only other choice). That being said, I did shadow a PA pretty extensively (this is a time when I was pretty conflicted, had just had my second child-unsure about time commitments). This experience turned me off to the profession (PA) and definitely made me realize all or nothing (sounds cliché but is definitely the truth for me).

I am fortunate enough to have an amazing, supportive spouse (with a decent job who will support me while in school). Just waiting on my MCAT now (results Tuesday) which will determine my next move..

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[deleted171991]

It's how these midlevels play the game. No we aren't physician's assistants anymore, we are physician assistants. They are after our positions and instead of putting more effort into their education and training, they want to take the shortcut. Why bother going through the hassle of getting into medical school, working hard, learning things, doing a residency with long hours? Just call yourself a doctor of anesthesiology, award yourself a shiny "board certification" and spend a few bucks lobbying legislators for increased scope of practice and decreased oversight by a real doctor. When the ASA lets you blur the lines and decides that the best course is to concede the OR to crnas, why not just take it all?

Except now they are not physician assistants, they are physician associates.

And they are not midlevels, physician extenders, or allied health providers, no, siree. They are associate providers, or advanced practice providers, or healthcare providers, or healthcare professionals, or clinicians, or whatever Newspeak PC bull**** the bureaucracy has invented.

 

[Random Anesthesiologist]

What I meant by that was, if I didn't matriculate into medical school I would never consider NP school (with PA school being my only other choice). That being said, I did shadow a PA pretty extensively (this is a time when I was pretty conflicted, had just had my second child-unsure about time commitments). This experience turned me off to the profession (PA) and definitely made me realize all or nothing (sounds cliché but is definitely the truth for me).

I am fortunate enough to have an amazing, supportive spouse (with a decent job who will support me while in school). Just waiting on my MCAT now (results Tuesday) which will determine my next move..

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Good luck to you. In my experience nurses turned physician are very conscientious and really appreciate their medical training. I sincerely hope you did well.

 

[Psai]

Good luck to you. In my experience nurses turned physician are very conscientious and really appreciate their medical training. I sincerely hope you did well.

I've found that the biggest voices against midlevel expansion are the people who have been midlevels before. "Man, there's so much I didn't know" is the common refrain. If only it was possible to show them all how much they're missing.

 

[deleted171991]

I've found that the biggest voices against midlevel expansion are the people who have been midlevels before. "Man, there's so much I didn't know" is the common refrain. If only it was possible to show them all how much they're missing.

Agree.

This is like anesthesiologists who become intensivists.

 

[Carbocation1]

Nurse anesthesia mills keep pumping record amount of graduates while Anesthesiology is remaining more stable. They are a cheap commodity like a Honda, while the Anesthesiologist is more like a safe/luxurious Mercedes-Benz. Which one do you want to ride in if your life depended on it?

 

[Doctor4Life1769]

Aren't Hondas considered to be pretty reliable cars at an affordable cost?
I wouldn't consider CRNAs to be Hondas or Toyotas, but rather a Kia.

 

[Carbocation1]

Aren't Hondas considered to be pretty reliable cars at an affordable cost?
I wouldn't consider CRNAs to be Hondas or Toyotas, but rather a Kia.

https://hondaquality.wordpress.com/honda-reliability-myth-busted-data-shows-otherwise/
"a company that only sells 10% of the cars contributes 35% of the worst cars on the market"

 

[Doctor4Life1769]

Good point, but the data is from cars over a decade old.

 

[Psai]

Aren't Hondas considered to be pretty reliable cars at an affordable cost?
I wouldn't consider CRNAs to be Hondas or Toyotas, but rather a Kia.

AAs are toyotas

crnas are jeeps

 

[deleted171991]

AAs are toyotas

crnas are jeeps

But a bunch of people prefer to own Jeeps. Kills me every time, since it's among the least reliable brands.

What I am trying to say is that most people are not smart and/or informed. All most of them want is bread and circuses.

 

[cbrons]

Except now they are not physician assistants, they are physician associates.

And they are not midlevels, physician extenders, or allied health providers, no, siree. They are associate providers, or advanced practice providers, or healthcare providers, or healthcare professionals, or clinicians, or whatever Newspeak PC bull**** the bureaucracy has invented.

Thats why I said that the term "provider" in the literature and accepted phraseology of hospitals is not benign. The purpose of that language is to get the public to gradually see physicians blended into a group with non-physicians, all being equal "providers" and that the degree doesn't really matter. "The PROVIDER will see you now."

http://forums.studentdoctor.net/threads/provider.1167955/
http://www.kevinmd.com/blog/2015/10/why-we-need-to-stop-calling-physicians-providers.html
http://www.kevinmd.com/blog/2015/11...pen-letter-to-the-ama-and-medical-boards.html

 

[cbrons]

And this one (May 3rd from JAMA): http://jama.jamanetwork.com/article.aspx?articleid=2506307

Eliminating the Term Primary Care “Provider” Consequences of Language for the Future of Primary Care

 

[easternether]

It's meant to obfuscate the difference between and MD/DO and CRNA. "Nurse Anesthesiology".

Little things like this are done intentionally by mid-levels. "Residencies" "Fellowships" etc. etc. It's ridiculous but not benign.

This is a sign of things to come. They cannot pay doctors less but can pay mid-level providers more and give them additional training to bring them up to the doctor level.

 

[Random Anesthesiologist]

This is a sign of things to come. They cannot pay doctors less but can pay mid-level providers more and give them additional training to bring them up to the doctor level.

"Doctor level" is not physician level. You want physician level, go to medical school and get a comprehensive medical education (in addition to any other graduate education that many have nowadays), then complete a residency +/- fellowship, pass USMLE 1,2,2,3 and two written and an oral anesthesiology board, then maintain 750 CME every 10 years.

 

[NontradCA]

No. I completely see the "propaganda" as you say and have seen it first hand in a friend of mines NP course lectures. PA school is my only other option...I am in agreement with majority of posters here that NP training occurring online is a joke. Same for the fact that you can set up your own rotations.

I may have misinterpreted your tone, however, if there is something urgent going on with my patient I will see it to completion, regardless of whether or not I have given report. Sure, there are crappy nurses that once they give report they put their hands up "your problem now!". At least in my unit this isn't the case (majority of the time).

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Don't go to PA school man. Be a CRNA or an NP, it's a much better option.

 

[BLADEMDA]

"Doctor level" is not physician level. You want physician level, go to medical school and get a comprehensive medical education (in addition to any other graduate education that many have nowadays), then complete a residency +/- fellowship, pass USMLE 1,2,2,3 and two written and an oral anesthesiology board, then maintain 750 CME every 10 years.

Why do all that when you can become a CRNA, DNP and claim equivalency? It's far easier to lobby Federal and State govts. to obtain Independent practice rights than it is to actually earn those rights through the educational system.

Next time someone tells you there are no shortcuts to independent medical practice you can tell them they are wrong.

 

[Random Anesthesiologist]

Why do all that when you can become a CRNA, DNP and claim equivalency? It's far easier to lobby Federal and State govts. to obtain Independent practice rights than it is to actually earn those rights through the educational system.

Next time someone tells you there are no shortcuts to independent medical practice you can tell them they are wrong.

Idk. Personally I would feel like a fraud if I were a midlevel trying to pass myself off as a physician by calling myself "Doctor".

If one is just looking for a lucrative healthcare field, CRNA is the way to go. Nothing against that. But it's not equal to a physician.

 

[hookgrip]

If one is just looking for a lucrative healthcare field, CRNA is the way to go. Nothing against that. But it's not equal to a physician.

The gravy train for CRNAs has gotta end at some point, right?

 

[Random Anesthesiologist]

The gravy train for CRNAs has gotta end at some point, right?

They'll still be the highest paid nursing specialty.

 

[hookgrip]

They'll still be the highest paid nursing specialty.

Sure, but seeing as CRNA schools keep pumping out more and more questionably qualified CRNAs, I wonder when supply will exceed demand.

 

[Random Anesthesiologist]

Sure, but seeing as CRNA schools keep pumping out more and more questionably qualified CRNAs, I wonder when supply will exceed demand.

Who knows.

 

[Psai]

Sure, but seeing as CRNA schools keep pumping out more and more questionably qualified CRNAs, I wonder when supply will exceed demand.

They aren't trying to get rid of anesthesiologists and anesthesiology assistants for no reason

 

[hookgrip]

They aren't trying to get rid of anesthesiologists and anesthesiology assistants for no reason

Maybe I'm naive, I can't really see this happening.

 

[deepstate2016]

Perhaps you will take a sufficient cut to compete on price, when we reach pediatric level salaries who will want to be in the profession? The answer is to add more value to your service.

 

[deleted171991]

Maybe I'm naive, I can't really see this happening.

The only thing CRNAs can compete on is price. In a worst-case scenario, MDs can always agree to take a pay cut. Who will want to hire CRNAs then?

So you want a race to the bottom with CRNAs? Even if we win, we lose. Big time. The only winners are the organizations employing the competing suckers.

The only solution is decreasing the number of residency grads, so that anesthesiologists will remain highly sought after. Which ain't happening. Ergo, any smart student shouldn't touch anesthesiology with a pole. Knowing what I know now, I wouldn't. And I am sorry I have to say this, but if one doesn't see any better specialty fit or path, then maybe one shouldn't be in medical school in the first place.

If you think a fellowship will protect you, think again. Unless that fellowship requires a good amount of physician-level judgment, it won't. First step for the AANA is independence, second step is going for anything that is highly productive and protocoled (community cardiac comes to mind, especially if there is a cardiologist who does the TEEs). There is already an overproduction of CRNAs, and not enough easy patients/procedures. (There is also an overproduction of anesthesiologists, for most markets, by the way.) Physicians will be the firefighters, covering more and more rooms at a time, and/or will work at a fraction of today's incomes, and/or will move to BFE (or wherever noone wants to go, or do what noone wants to do, to maintain a higher income than CRNAs). Yes, patients will suffer more harm with nurse coverage, but healthcare organizations only care about their bottom line (and definitely not about your future malpractice history, career or job satisfaction). This won't happen overnight, but faster than you think. Even just 5 years is a long time in anesthesia nowadays. (Heck, it was only about 10 years ago when I decided to go into anesthesia.)

Tl;dr: if you want anesthesia, go become a CRNA, or AA, don't waste your time and money with medical school.

 

[patriot6]

So you want a race to the bottom with CRNAs? Even if we win, we lose. Big time. The only winners are the organizations employing the competing suckers.

The only solution is decreasing the number of residency grads, so that anesthesiologists will remain highly sought after. Which ain't happening. Ergo, any smart student shouldn't touch anesthesiology with a pole. Knowing what I know now, I wouldn't. And I am sorry I have to say this, but if one doesn't see any better specialty fit or path, then maybe one shouldn't be in medical school in the first place.

If you think a fellowship will protect you, think again. Unless that fellowship requires a good amount of physician-level judgment, it won't. First step for the AANA is independence, second step is going for anything that is highly productive and protocoled (community cardiac comes to mind, especially if there is a cardiologist who does the TEEs). There is already an overproduction of CRNAs, and not enough easy patients/procedures. (There is also an overproduction of anesthesiologists, for most markets, by the way.) Physicians will be the firefighters, covering more and more rooms at a time, and/or will work at a fraction of today's incomes, and/or will move to BFE (or wherever noone wants to go, or do what noone wants to do, to maintain a higher income than CRNAs). Yes, patients will suffer more harm with nurse coverage, but healthcare organizations only care about their bottom line (and definitely not about your future malpractice history, career or job satisfaction). This won't happen overnight, but faster than you think. Even just 5 years is a long time in anesthesia nowadays. (Heck, it was only about 10 years ago when I decided to go into anesthesia.)

Tl;dr: if you want anesthesia, go become a CRNA, or AA, don't waste your time and money with medical school.

I need to stop reading this forum.

 

[Turtlez]

I need to stop reading this forum.

Agree. It's toxic.

 

[Chloroform4Life]

The truth hurts. Im going to bury my head in the sands as long as I can.

 

[deleted162650]

The only solution is decreasing the number of residency grads, so that anesthesiologists will remain highly sought after.

I hear this argument regularly on this forum. Just to play devil's advocate, what happens if we do this, and 15 years from now there is a significant (and now real) shortage of Anesthesiologists? Doesn't that then add fuel to the AANA argument that they are needed to improve access to care, and that now it's even more important for them to practice independently. Not only that, but they will go around spouting how the "MDA's" intentionally reduced their numbers to preserve income leaving pts high and dry without enough "providers"???

I honestly don't know the right answer. I just see the "we need to reduce our numbers" argument potentially backfiring.

 

[Psai]

Right answer: Stop being lazy. Don't train or use crnas.

 

[deleted171991]

I hear this argument regularly on this forum. Just to play devil's advocate, what happens if we do this, and 15 years from now there is a significant (and now real) shortage of Anesthesiologists? Doesn't that then add fuel to the AANA argument that they are needed to improve access to care, and that now it's even more important for them to practice independently. Not only that, but they will go around spouting how the "MDA's" intentionally reduced their numbers to preserve income leaving pts high and dry without enough "providers"???

I honestly don't know the right answer. I just see the "we need to reduce our numbers" argument potentially backfiring.

We did the opposite, increasing the number of anesthesiologists. At the same time, dear Medcorp realized that midlevels are cheaper, quality be damned, so now we have a ton of anesthesiology grads working crappy jobs. Not to be left behind, Medicare screwed us by subsidizing only CRNAs in rural hospitals. Why wouldn't we cut back? The market is telling us we don't really need more anesthesiologists, except mostly where no man has gone before, or would want to go.

The main reason anesthesiology rebounded after they screwed with us 25 years ago was exactly our low numbers. As long as we have a ton of grads, I can only see things getting worse. It's not doom and gloom, it's very cold calculation.