Va considering independent crna practice

[jeffblue]

http://www.asahq.org/For-Members/Ad...ress-Regarding-Nursing-Handbook-while-VA.aspx

This is one of the worst ideas that someone can think of. Pound for pound Va patients are some of the sickest patients at any hospital.

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Members don't see this ad.

 

[aneftp]

They don't care. They don't want to run real studies double blinded comparing md to CRNA.

Honestly there is probably data available. But results can be skewed cause bigger or more complicated cases can be transferred out of critical access CRNA only practices. They do a lot of bread and butter. I know a couple of CRNAs who practice in Crna only critical access. Anything complicated gets shipped out.

A "big case" is like small bowel obstruction.

 

[Consigliere]

It's the future, gang. This speciality is in a death spiral that we cannot get out of. Plan your exit strategy and.........I TOLD YOU SO!

 

[countingdays]

It's the future, gang. This speciality is in a death spiral that we cannot get out of. Plan your exit strategy and.........I TOLD YOU SO!

+1

At this point, applying to anesthesiology is just foolish.

 

[gas2014]

Can we draft legislation that a nurse must take and pass the following 18 exams to practice Anesthesiology independently in the United States?


MCAT
USMLE Step 1
Pediatrics NBME shelf exam
OBGYN NBME shelf exam
Psychiatry NBME shelf exam
Surgery NBME shelf exam
Internal Medicine NBME shelf exam
Neurology NBME shelf exam
Family Medicine NBME shelf exam
USMLE Step 2 CK
USMLE Step 2 CS
USMLE Step 3
ABA BASIC Exam
CA-1 In-training exam
CA-2 In-training exam
CA-3 In-training exam
ABA Advanced Exam
ABA Oral Exam

 

[countingdays]

Just to flip the Anesthesia On/Off Switch?

Can we draft legislation that a nurse must take and pass the following 18 exams to practice Anesthesiology independently in the United States?


MCAT
USMLE Step 1
Pediatrics NBME shelf exam
OBGYN NBME shelf exam
Psychiatry NBME shelf exam
Surgery NBME shelf exam
Internal Medicine NBME shelf exam
Neurology NBME shelf exam
Family Medicine NBME shelf exam
USMLE Step 2 CK
USMLE Step 2 CS
USMLE Step 3
ABA BASIC Exam
CA-1 In-training exam
CA-2 In-training exam
CA-3 In-training exam
ABA Advanced Exam
ABA Oral Exam

 

[criticalelement]

I heard someone talking in the lounge about something like a public comments period before this becomes implemented at the Va. ANyone know of the latest? Seems like an asinine thing to implement. Only the best for the Veterans in the name of saving a buck.

 

[deleted171991]

I heard someone talking in the lounge about something like a public comments period before this becomes implemented at the Va. ANyone know of the latest? Seems like an asinine thing to implement. Only the best for the Veterans in the name of saving a buck.

This was expected. Don't forget that the military was the first to allow independent CRNA practice (for healthy active military, but still). They are famous about having anesthesiologists overruled by higher-ranking CRNAs. No surprise here. The blind leading the blind.

 

[pgg]

They are famous about having anesthesiologists overruled by higher-ranking CRNAs.

It's a famous and oft hand-wrung hypothetical that never actually happens in real life.

 

[deleted171991]

It's a famous and oft hand-wrung hypothetical that never actually happens in real life.

Actually it does. I had an ex-military colleague who had had to work there for a few years after residency. It's exactly why he hated it: his commander was a CRNA and he was overruled on a regular basis, regardless of good medical science. At least, that's what he told me. He hates CRNAs and only works in solo places.

 

[deleted171991]

Can we draft legislation that a nurse must take and pass the following 18 exams to practice Anesthesiology independently in the United States?


MCAT
USMLE Step 1
Pediatrics NBME shelf exam
OBGYN NBME shelf exam
Psychiatry NBME shelf exam
Surgery NBME shelf exam
Internal Medicine NBME shelf exam
Neurology NBME shelf exam
Family Medicine NBME shelf exam
USMLE Step 2 CK
USMLE Step 2 CS
USMLE Step 3
ABA BASIC Exam
CA-1 In-training exam
CA-2 In-training exam
CA-3 In-training exam
ABA Advanced Exam
ABA Oral Exam

Not everybody needs to be a mechanic to drive a car, or to repair it, and not every mechanic needs to be whatever-certified.

 

[pgg]

Actually it does. I had an ex-military colleague who had had to work there for a few years after residency. It's exactly why he hated it: his commander was a CRNA and he was overruled on a regular basis, regardless of good medical science. At least, that's what he told me. He hates CRNAs and only works in solo places.

A distinction needs to be made between trivial admin decisions (like the call schedule, or what brand ET tubes to order), and dictating or managing actual medical care. The former happens, the latter doesn't.

When I was just out of residency, I was at a small Navy hospital where my dept head was a O5 CRNA. It wasn't always ideal but she never tried to tell me anything about anesthesia. The entire concept is laughable.

It's possible for nurses to rise higher than dept head and be directors or even command hospitals (hell, the surgeon general of the Army is a nurse), where they an make decisions that significantly affect how ORs run ... but again, they don't (can't) tell doctors what drugs to prescribe, what procedures to do, how to do them, or even to a particular procedure at all.

There are some valid criticisms of the way the milmed admin behemoth runs, but nurses directing doctors in a professional capacity isn't one of them.

 

[deleted171991]

A distinction needs to be made between trivial admin decisions (like the call schedule, or what brand ET tubes to order), and dictating or managing actual medical care. The former happens, the latter doesn't.

It was the latter. Also, when he was paired with higher-ranking CRNAs, they did whatever they wanted to, regardless of his instructions. Of course, this is all hearsay. But this supposedly happened about 10 years ago, so I can imagine how bad it is now.

 

[pgg]

We don't get "paired" with CRNAs. They're required to consult an anesthesiologist for ASA 3+ patients but that's as far as any kind of "pairing" goes. They're not directed/supervised or obligated to do what we tell them. We don't sign their charts.

The notion that a higher ranking CRNA could order an anesthesiologist to do a case a certain way, when we don't even tell them how to do theirs - regardless of rank - is a bizarre story. I don't know what else to say about the subject, except that there's more to your friend's story.

 

[deleted171991]

We don't get "paired" with CRNAs. They're required to consult an anesthesiologist for ASA 3+ patients but that's as far as any kind of "pairing" goes. They're not directed/supervised or obligated to do what we tell them. We don't sign their charts

Was there any period when military hospitals worked in an ACT model, before CRNAs became independent? The way I remember it, he described supervising CRNAs and not having his instructions followed. Maybe I remember it wrong.

 

[pgg]

Hmmm. I supposed it's possible, before my time. Not in the Navy since 2000ish when I first set foot in an OR.

It's just ... odd.

 

[Spinach Dip]

It's the future, gang. This speciality is in a death spiral that we cannot get out of. Plan your exit strategy and.........I TOLD YOU SO!

+1

At this point, applying to anesthesiology is just foolish.

Reap what you (and your colleagues) sow.

 

[Spinach Dip]

Reap what you (and your colleagues) sow.

But don't worry, the PSH model will save us all!