We NEED to respond ASAP - 60 days

[maxxor]

Policy Management
AUGUST 3, 2016
Comments Slam VA Proposal

There were more than 167,000 comments posted to the Federal Register on the U.S. Department of Veterans Affairs (VA) proposal to remove physician anesthesiologists from the OR. And, as was reported in a press release from the American Society of Anesthesiologists (ASA), dated July 26, 2016, the public was not impressed with the idea.

Indeed, fully 90% of veterans rejected the proposed rule, and an estimated two-thirds of all comments opposed it.

The proposed policy would replace anesthesiologists with nurse anesthetists, a move that would necessarily lower the level of expertise in the OR, despite the fact that there is no shortage of physician anesthesiologists within the VA.

The radiologists stood with you guys. The ACR pushed hard for us to send in comments.

---

Members don't see this ad.

 

[KurtBrie]

I am worried that this is not accurate.

Our leaders dont explain how they come to this conclusion but the other side came to a different one and did explain it. Makes me concerned that there is some fudging going on and i really do not want it to be us.

The aana people also did a press release and I posted it below. Something is NOT right one way or another.

7 Facts About Record-Breaking Response to VA Proposal to Improve Veterans' Access to Care
For Immediate Release
July 28, 2016
For more information
Contact: AANA Public Relations

Striking a nerve with the American public unlike any previous Veterans Administration (VA) policy change, the VA’s proposed rule to improve veterans’ access to timely, quality healthcare through increased use of advanced practice registered nurses (APRNs) spurred an overwhelming response during the public comment period on the rule, said Juan Quintana, DNP, MHS, CRNA, president of the 49,000-member American Association of Nurse Anesthetists (AANA).

Weighing in on the VA’s proposal to allow APRNs, including Certified Registered Nurse Anesthetists (CRNAs), to practice to the full scope of their education, training and abilities in the VA health system, veterans and other interested Americans submitted an unprecedented 167,000+ letters to the VA during the 60-day comment period that concluded on July 25. In addition, veterans’ organizations, public interest groups, healthcare associations, government agencies, and other stakeholders have expressed their support for the rule through other forums, including a congressional hearing.

“Making full use of highly qualified, highly educated CRNAs and other APRNs who already work in the VA would reduce the long wait times for care experienced by many military vets, a problem that has plagued the administration for years,” said Quintana, who is a veteran himself. “We urge the VA to promptly finalize and implement the rule so that veterans no longer have to wait for the high quality care that they deserve and have earned.”

While it is likely to take the VA months to sift through the record-shattering volume of letters it received, a preliminary analysis of the comments is possible by searching phrases such as “veteran support” or “veteran oppose” on the regulations.gov website. Adding to the discussion, numerous veterans service organizations have also weighed in on the issue on behalf of their members.

1. The 167,000+ comments were more than 25 times the total number of comments received by the agency on all other regulatory proposals since 2006, when electronic submission of comments was first implemented.
   
2. Leading veterans’ service organizations collectively representing more than 1 million veterans have supported the proposed rule, including: Military Officers Association of America (390,000 members), AMVETS (250,000 members), Iraq and Afghanistan Veterans of America (200,000 members), Air Force Sergeants Association(100,000 members), Vietnam Veterans of America (75,000 members), and Paralyzed Veterans of America(60,000 members). On its website, the Iraq and Afghanistan Veterans of American bills itself as “The voice for 2.5 million post-9/11 veterans.” AMVETS, which opposed the rule early in the comment period, quickly changed direction and became a supporter of the VA’s proposal to grant full practice authority for APRNs.
   
3. AARP, whose membership includes more than 3.7 million veteran households, supports the rule.
   
4. The American Hospital Association (AHA), which lists more than 130 VA hospitals among its members, supports the rule.
   
5. The professional staff of the Federal Trade Commission (FTC) came out in support of the rule.
   
6. A search of the regulations.gov database of letters to the VA after the comment period closed revealed the following numbers: 86,381 letters used the phrase “veteran support,” nearly three times more than the 31,802 letters that used the phrase “veteran oppose.”
   
7. The idea of using APRNs to the full scope of their practice reflects the way the Department of Defense (DoD) already ensures top-notch care for active-duty personnel in all military service branches. APRNs, including CRNAs, nurse practitioners, nurse-midwives, and clinical nurse specialists, are granted full practice authority under the DoD system.

“The outpouring of support for the VA’s proposal to grant full practice authority to CRNAs and other APRNs has been staggering,” said Quintana. “Much like the preponderance of research data that confirm the quality and safety of care provided by CRNAs, the preponderance of facts shows that veterans’ organizations, AARP, the AHA and FTC, and thousands of veterans and citizens are in favor of the VA’s proposed solution to dangerously long wait times for healthcare endured by our military heroes.

“It is unfortunate that some physician groups were so desperate at the end of the comment period that they sent waves of form letters opposing the rule in a vain attempt to pad the final tally to their advantage. These efforts still came up short,” Quintana said. “It’s well known that in the final count these types of impersonal letters get lumped together and viewed as a singular response from a special interest group, rather than as a unique or sincere comment about the issue at hand.”

Policy Management
AUGUST 3, 2016
Comments Slam VA Proposal

There were more than 167,000 comments posted to the Federal Register on the U.S. Department of Veterans Affairs (VA) proposal to remove physician anesthesiologists from the OR. And, as was reported in a press release from the American Society of Anesthesiologists (ASA), dated July 26, 2016, the public was not impressed with the idea.

Indeed, fully 90% of veterans rejected the proposed rule, and an estimated two-thirds of all comments opposed it.

The proposed policy would replace anesthesiologists with nurse anesthetists, a move that would necessarily lower the level of expertise in the OR, despite the fact that there is no shortage of physician anesthesiologists within the VA.

 

[aneftp]

I am worried that this is not accurate.

Our leaders dont explain how they come to this conclusion but the other side came to a different one and did explain it. Makes me concerned that there is some fudging going on and i really do not want it to be us.

The aana people also did a press release and I posted it below. Something is NOT right one way or another.

7 Facts About Record-Breaking Response to VA Proposal to Improve Veterans' Access to Care
For Immediate Release
July 28, 2016
For more information
Contact: AANA Public Relations

Striking a nerve with the American public unlike any previous Veterans Administration (VA) policy change, the VA’s proposed rule to improve veterans’ access to timely, quality healthcare through increased use of advanced practice registered nurses (APRNs) spurred an overwhelming response during the public comment period on the rule, said Juan Quintana, DNP, MHS, CRNA, president of the 49,000-member American Association of Nurse Anesthetists (AANA).

Weighing in on the VA’s proposal to allow APRNs, including Certified Registered Nurse Anesthetists (CRNAs), to practice to the full scope of their education, training and abilities in the VA health system, veterans and other interested Americans submitted an unprecedented 167,000+ letters to the VA during the 60-day comment period that concluded on July 25. In addition, veterans’ organizations, public interest groups, healthcare associations, government agencies, and other stakeholders have expressed their support for the rule through other forums, including a congressional hearing.

“Making full use of highly qualified, highly educated CRNAs and other APRNs who already work in the VA would reduce the long wait times for care experienced by many military vets, a problem that has plagued the administration for years,” said Quintana, who is a veteran himself. “We urge the VA to promptly finalize and implement the rule so that veterans no longer have to wait for the high quality care that they deserve and have earned.”

While it is likely to take the VA months to sift through the record-shattering volume of letters it received, a preliminary analysis of the comments is possible by searching phrases such as “veteran support” or “veteran oppose” on the regulations.gov website. Adding to the discussion, numerous veterans service organizations have also weighed in on the issue on behalf of their members.

1. The 167,000+ comments were more than 25 times the total number of comments received by the agency on all other regulatory proposals since 2006, when electronic submission of comments was first implemented.
   
2. Leading veterans’ service organizations collectively representing more than 1 million veterans have supported the proposed rule, including: Military Officers Association of America (390,000 members), AMVETS (250,000 members), Iraq and Afghanistan Veterans of America (200,000 members), Air Force Sergeants Association(100,000 members), Vietnam Veterans of America (75,000 members), and Paralyzed Veterans of America(60,000 members). On its website, the Iraq and Afghanistan Veterans of American bills itself as “The voice for 2.5 million post-9/11 veterans.” AMVETS, which opposed the rule early in the comment period, quickly changed direction and became a supporter of the VA’s proposal to grant full practice authority for APRNs.
   
3. AARP, whose membership includes more than 3.7 million veteran households, supports the rule.
   
4. The American Hospital Association (AHA), which lists more than 130 VA hospitals among its members, supports the rule.
   
5. The professional staff of the Federal Trade Commission (FTC) came out in support of the rule.
   
6. A search of the regulations.gov database of letters to the VA after the comment period closed revealed the following numbers: 86,381 letters used the phrase “veteran support,” nearly three times more than the 31,802 letters that used the phrase “veteran oppose.”
   
7. The idea of using APRNs to the full scope of their practice reflects the way the Department of Defense (DoD) already ensures top-notch care for active-duty personnel in all military service branches. APRNs, including CRNAs, nurse practitioners, nurse-midwives, and clinical nurse specialists, are granted full practice authority under the DoD system.

“The outpouring of support for the VA’s proposal to grant full practice authority to CRNAs and other APRNs has been staggering,” said Quintana. “Much like the preponderance of research data that confirm the quality and safety of care provided by CRNAs, the preponderance of facts shows that veterans’ organizations, AARP, the AHA and FTC, and thousands of veterans and citizens are in favor of the VA’s proposed solution to dangerously long wait times for healthcare endured by our military heroes.

“It is unfortunate that some physician groups were so desperate at the end of the comment period that they sent waves of form letters opposing the rule in a vain attempt to pad the final tally to their advantage. These efforts still came up short,” Quintana said. “It’s well known that in the final count these types of impersonal letters get lumped together and viewed as a singular response from a special interest group, rather than as a unique or sincere comment about the issue at hand.”

I say let abandon the VA. Let the crnas for themsleves. Turn the Va into a 24/7 operation. None of this shutting down the ORs around 5-6pm (many with only one Or running after 2pm. Most anesthesia folks only work 4 days a week full time anyways.
So make them work more.

Let's see how many crnas stay if they end up working 60 plus hours a week for $130-150k! It's about access isn't it? Give vets access by doing elective surgery after hours.

Than you will hear AANA flip the switch and say "we are RNs". We are unionized and will demand overtime hours and split differential and demand to make 280k-300k a year.

 

[KurtBrie]

Hehehehhe

This would certainly cause a "shortage" in providers!

I say let abandon the VA. Let the crnas for themsleves. Turn the Va into a 24/7 operation. None of this shutting down the ORs around 5-6pm (many with only one Or running after 2pm. Most anesthesia folks only work 4 days a week full time anyways.
So make them work more.

Let's see how many crnas stay if they end up working 60 plus hours a week for $130-150k! It's about access isn't it? Give vets access by doing elective surgery after hours.

Than you will hear AANA flip the switch and say "we are RNs". We are unionized and will demand overtime hours and split differential and demand to make 280k-300k a year.

 

[Man o War]

I am worried that this is not accurate.

Our leaders dont explain how they come to this conclusion but the other side came to a different one and did explain it. Makes me concerned that there is some fudging going on and i really do not want it to be us.

The aana people also did a press release and I posted it below. Something is NOT right one way or another.

7 Facts About Record-Breaking Response to VA Proposal to Improve Veterans' Access to Care
For Immediate Release
July 28, 2016
For more information
Contact: AANA Public Relations

Striking a nerve with the American public unlike any previous Veterans Administration (VA) policy change, the VA’s proposed rule to improve veterans’ access to timely, quality healthcare through increased use of advanced practice registered nurses (APRNs) spurred an overwhelming response during the public comment period on the rule, said Juan Quintana, DNP, MHS, CRNA, president of the 49,000-member American Association of Nurse Anesthetists (AANA).

Weighing in on the VA’s proposal to allow APRNs, including Certified Registered Nurse Anesthetists (CRNAs), to practice to the full scope of their education, training and abilities in the VA health system, veterans and other interested Americans submitted an unprecedented 167,000+ letters to the VA during the 60-day comment period that concluded on July 25. In addition, veterans’ organizations, public interest groups, healthcare associations, government agencies, and other stakeholders have expressed their support for the rule through other forums, including a congressional hearing.

“Making full use of highly qualified, highly educated CRNAs and other APRNs who already work in the VA would reduce the long wait times for care experienced by many military vets, a problem that has plagued the administration for years,” said Quintana, who is a veteran himself. “We urge the VA to promptly finalize and implement the rule so that veterans no longer have to wait for the high quality care that they deserve and have earned.”

While it is likely to take the VA months to sift through the record-shattering volume of letters it received, a preliminary analysis of the comments is possible by searching phrases such as “veteran support” or “veteran oppose” on the regulations.gov website. Adding to the discussion, numerous veterans service organizations have also weighed in on the issue on behalf of their members.

1. The 167,000+ comments were more than 25 times the total number of comments received by the agency on all other regulatory proposals since 2006, when electronic submission of comments was first implemented.
   
2. Leading veterans’ service organizations collectively representing more than 1 million veterans have supported the proposed rule, including: Military Officers Association of America (390,000 members), AMVETS (250,000 members), Iraq and Afghanistan Veterans of America (200,000 members), Air Force Sergeants Association(100,000 members), Vietnam Veterans of America (75,000 members), and Paralyzed Veterans of America(60,000 members). On its website, the Iraq and Afghanistan Veterans of American bills itself as “The voice for 2.5 million post-9/11 veterans.” AMVETS, which opposed the rule early in the comment period, quickly changed direction and became a supporter of the VA’s proposal to grant full practice authority for APRNs.
   
3. AARP, whose membership includes more than 3.7 million veteran households, supports the rule.
   
4. The American Hospital Association (AHA), which lists more than 130 VA hospitals among its members, supports the rule.
   
5. The professional staff of the Federal Trade Commission (FTC) came out in support of the rule.
   
6. A search of the regulations.gov database of letters to the VA after the comment period closed revealed the following numbers: 86,381 letters used the phrase “veteran support,” nearly three times more than the 31,802 letters that used the phrase “veteran oppose.”
   
7. The idea of using APRNs to the full scope of their practice reflects the way the Department of Defense (DoD) already ensures top-notch care for active-duty personnel in all military service branches. APRNs, including CRNAs, nurse practitioners, nurse-midwives, and clinical nurse specialists, are granted full practice authority under the DoD system.

“The outpouring of support for the VA’s proposal to grant full practice authority to CRNAs and other APRNs has been staggering,” said Quintana. “Much like the preponderance of research data that confirm the quality and safety of care provided by CRNAs, the preponderance of facts shows that veterans’ organizations, AARP, the AHA and FTC, and thousands of veterans and citizens are in favor of the VA’s proposed solution to dangerously long wait times for healthcare endured by our military heroes.

“It is unfortunate that some physician groups were so desperate at the end of the comment period that they sent waves of form letters opposing the rule in a vain attempt to pad the final tally to their advantage. These efforts still came up short,” Quintana said. “It’s well known that in the final count these types of impersonal letters get lumped together and viewed as a singular response from a special interest group, rather than as a unique or sincere comment about the issue at hand.”

Who knows. This group however shamelessly spins even the most obvious of facts, so I wouldn't put a lot of stock in their take on the situation. This is the same group that says "hey the Cochrane review showed equivalence!!" despite the fact that the reviewers clearly said the data was problematic and no conclusion could be drawn as a result.
Also, the FTC supports this rule every single time it comes up so that's nothing new.

 

[Man o War]

The radiologists stood with you guys. The ACR pushed hard for us to send in comments.

Thank you all, physicians need to stand together against this encroachment.

 

[Random Anesthesiologist]

https://www.justice.gov/usao-mdga/p...s-more-1-million-resolve-kickback-allegations

 

[Consigliere]

https://www.justice.gov/usao-mdga/p...s-more-1-million-resolve-kickback-allegations

Hahahahaha! This is how they obtain contracts, though.

 

[Pooh & Annie]

You people get this?

https://echo4.bluehornet.com/hosted...7693f20db831727349b&ei=7n2R8BYN1&schema=echo4

 

[BLADEMDA]

Unfortunately, we have learned that some nurse anesthetists who oppose our efforts have attempted to politicize your support of high-quality care for our Veterans. Among other tactics, they have located the comments of some of our members in the Federal Register and circulated them at work and elsewhere, often accompanied by false and potentially defamatory assertions that our members do not respect our nurse anesthetist colleagues. Nothing could be further from the truth.

 

[maxxor]

You people get this?

https://echo4.bluehornet.com/hosted...7693f20db831727349b&ei=7n2R8BYN1&schema=echo4

Damn that's dirty.

 

[Man o War]

You people get this?

https://echo4.bluehornet.com/hosted...7693f20db831727349b&ei=7n2R8BYN1&schema=echo4

Well, it's way past time for them to get a dose of that too. I've seen comments online that I'm appalled someone would write under their own name in a public forum. Maybe these CRNAs' departments should be made aware of their extracurricular rantings. I've seen nurses fired for far less than some of the filth I've seen written online on this subject in the last month.
And to think some "Ologist" or "Ollie" somewhere took the time to train and share their knowledge with these folks. Smh

 

[Noyac]

Well, it's way past time for them to get a dose of that too. I've seen comments online that I'm appalled someone would write under their own name in a public forum. Maybe these CRNAs' departments should be made aware of their extracurricular rantings. I've seen nurses fired for far less than some of the filth I've seen written online on this subject in the last month.
And to think some "Ologist" or "Ollie" somewhere took the time to train and share their knowledge with these folks. Smh

We need to be careful not to stoop to their level. I know how that sounds. I u dear stand that you can't bring a knife to a gun fight. But sometimes it's better to step away from the fight at work or on the forums and load the nuke.

I for one am extremely encouraged by this letter from the ASA.

 

[Man o War]

We need to be careful not to stoop to their level. I know how that sounds. I u dear stand that you can't bring a knife to a gun fight. But sometimes it's better to step away from the fight at work or on the forums and load the nuke.

I for one am extremely encouraged by this letter from the ASA.

I get that, but when a nurse is slandering an entire department and individual doctors, that should be addressed. This email was rather vague, but it sounds like that's what they are doing on behalf of the doctors who are filing reports unless I misinterpreted this post.

 

[Noyac]

I get that, but when a nurse is slandering an entire department and individual doctors, that should be addressed. This email was rather vague, but it sounds like that's what they are doing on behalf of the doctors who are filing reports unless I misinterpreted this post.

Quote from the ASA
"In addition, our General Counsel is monitoring individual cases to determine whether court intervention may be appropriate to address defamation, unlawful anti-competitive conduct and other legal claims."
Now if they throw this statement out there and then do nothing I will be more than disappointed.

Part of the issue is, if the ASA decides to start to take a more aggressive stance against the AANA and we discount it every time, they may just go back to their usual passive approach. But if we jump on board we may be able to shift their approach. I'm fed up with the passivity. This is a shift in my book. I say encourage more of this.

Also, I am in direct communication with ASA aboard members and a potential future president. We are putting more and more pressure on the old farts. Let's at least show them we like this change even if it isn't committing to anything, yet.

 

[Consigliere]

Quote from the ASA
"In addition, our General Counsel is monitoring individual cases to determine whether court intervention may be appropriate to address defamation, unlawful anti-competitive conduct and other legal claims."
Now if they throw this statement out there and then do nothing I will be more than disappointed.

Part of the issue is, if the ASA decides to start to take a more aggressive stance against the AANA and we discount it every time, they may just go back to their usual passive approach. But if we jump on board we may be able to shift their approach. I'm fed up with the passivity. This is a shift in my book. I say encourage more of this.

Also, I am in direct communication with ASA aboard members and a potential future president. We are putting more and more pressure on the old farts. Let's at least show them we like this change even if it isn't committing to anything, yet.

I'm guardedly optimistic that they MAY do just that but won't hold my breath. Not surprised the sleazeball CRNAs are acting in such a manner.

 

[Arch Guillotti]

You people get this?

https://echo4.bluehornet.com/hosted...7693f20db831727349b&ei=7n2R8BYN1&schema=echo4

This was discussed a while ago.

 

[Noyac]

Not surprised the sleazeball CRNAs are acting in such a manner.

I don't think of them as "sleezeballs" but I totally get where you are coming from. Professionalism is something people must learn. Nursing school isn't prepared to teach this like medical school is. We are constantly surrounded by extremely high achieving, respected people every day in medical school and residency. It's not like we have a course on professionalism ( actually, some schools may) but we get it through the daily interactions with these people that society has deemed to be the leaders. "Professionalism is the basis of medicine's contract with society". It's difficult to define professionalism in words ( confidence, competitence, compassion and integrity are some terms used) but everyone knows it when they see it. In our training we see it often.

To quote Norig Ellison, M.D., "Professionalism starts with a commitment to achieve something more satisfying than immediate personal gain and requires a commitment and devotion to quality, excellence and personal sacrifice that goes beyond an eight-hour day. Professionalism must rest on a solid base of education, experience and skill and must encompass real respect for other professionals as well as patients." This flies in the face of nursing. They claim to be the ones devoted to pt care but when the clock hits the end of their shift they run for the doors. Their "solid base of education" frequently comes from on-line courses without the in depth hands on training. And their respect for professionals ( anesthesiologists in this situation) is nonexistent.

 

[GravelRider]

I don't think of them as "sleezeballs" but I totally get where you are coming from. Professionalism is something people must learn. Nursing school isn't prepared to teach this like medical school is. We are constantly surrounded by extremely high achieving, respected people every day in medical school and residency. It's not like we have a course on professionalism ( actually, some schools may) but we get it through the daily interactions with these people that society has deemed to be the leaders. "Professionalism is the basis of medicine's contract with society". It's difficult to define professionalism in words ( confidence, competitence, compassion and integrity are some terms used) but everyone knows it when they see it. In our training we see it often.

To quote Norig Ellison, M.D., "Professionalism starts with a commitment to achieve something more satisfying than immediate personal gain and requires a commitment and devotion to quality, excellence and personal sacrifice that goes beyond an eight-hour day. Professionalism must rest on a solid base of education, experience and skill and must encompass real respect for other professionals as well as patients." This flies in the face of nursing. They claim to be the ones devoted to pt care but when the clock hits the end of their shift they run for the doors. Their "solid base of education" frequently comes from on-line courses without the in depth hands on training. And their respect for professionals ( anesthesiologists in this situation) is nonexistent.

Professionalism is dying in medicine too. First of all, the amount of expensive and often unnecessary care in the United States is astounding. Much of this over treatment is being caused by the corporate consolidation of medicine. To add to that, these large healthcare entities capitalize on that professionalism psychology as a way to underpay physicians. We are creating a generation of physicians who feel overworked and underpaid and therefore fall back on the "clock punching" psychology because they are being treated as "clock punchers." Professionalism is a two-way street. It's easy to act professional when you are treated as such, but when a large hospital system treats you as an interchangeable cog in a system, it's hard to maintain that high ground.

Medicine may have had a contract with society based on professionalism, but that contract was sold long ago. Healthcare is bankrupting the country and as a result, much of that trust by the public has been lost. Until physicians decide to take back the profession from the greed that has caused this, we will continue to see erosion of professionalism amongst doctors.

 

[Consigliere]

I don't think of them as "sleezeballs" but I totally get where you are coming from. Professionalism is something people must learn. Nursing school isn't prepared to teach this like medical school is. We are constantly surrounded by extremely high achieving, respected people every day in medical school and residency. It's not like we have a course on professionalism ( actually, some schools may) but we get it through the daily interactions with these people that society has deemed to be the leaders. "Professionalism is the basis of medicine's contract with society". It's difficult to define professionalism in words ( confidence, competitence, compassion and integrity are some terms used) but everyone knows it when they see it. In our training we see it often.

Oddly enough, we did have a whole series of lectures on professionalism throughout my residency. I think it may even be a mandatory component of an anesthesiology residency nowadays.

And I stand by what I said...trying to foment dissent amongst your colleagues by selectively gathering comments and posting them all over the hospital is sleazeball behavior and reiterates a point I have been making for years: CRNAs MUST be your employees and not someone else's. If a midlevel pulled these shenanigans in my group, they would be immediately terminated.

 

[CardioDad]

This was discussed a while ago.

I LOVE YOU GUYS! And my heart is breaking...

I have been reading this forum for two years now; mostly for education but also for the entertainment provided when you snark or discuss music. So thanks.

I've never felt compelled to post before now since my only connection to medicine is by family. My father was an IM/Card and sibling is ID. I am fascinated by medicine, ergo my reading, but sadly drew the short straw when it comes to blood, needles and vomit: I hit the phobia trifecta! Still, having been exposed to 'old fart' medicine and its now-dying professionalism all of my life, I feel very connected to this conversation.

I want to say that I, a layperson, support your position 100%. I wish all patients understood what you (and, resultantly, they) are facing. My dad always insisted that an anesthesiologist (one of his long-time buddies) take care of his family during any surgery. In the early days of CRNAs and ASCs, long after we'd left home, he taught us to ask 1) for a board certified physician and 2) whether we'd be monitored by that doctor or by others. Accordingly, I've paid extra, out-of-network on my health plan, for an anesthesiologist to cover two day surgeries that I had performed in two different hospitals. Frankly, it scares the absolute **** out of me to think of a mid-level managing my life.

My father was a true gentleman doctor and thought he would die wearing his stethoscope. However, he retired in his 60's, stating the practice of medicine was too fractious. To the end, he supported his beloved UNC Medical School, bequeathing it some of his estate. I daresay that he would take it all back if he could read Dr. Roper's letter to the AANA (or whomever), never mind that Dr. Ross was forced to apologize for stating her private opinion. Fractious seems far too innocent a word for what is happening now...


TL DR If I, a layperson, face a non-emergent surgery in the future, may I please PM some of you to see who is closest to me? YOU are the folks I want at my head - not some CRNA from Fly.By.Night Skool of Anesthesia. I will gladly pay for your expertise, experience, education and professionalism. Unless you're blasting death metal into my subconscious while I'm under.

Signed,
Medical Snob
get off my lawn

 

[Arch Guillotti]

And I stand by what I said...trying to foment dissent amongst your colleagues by selectively gathering comments and posting them all over the hospital is sleazeball behavior and reiterates a point I have been making for years: CRNAs MUST be your employees and not someone else's. If a midlevel pulled these shenanigans in my group, they would be immediately terminated.

Pick your poison. Employing the CRNA's has been the road to ruin for some groups.

 

[deepstate2016]

If you write it on The INTERNET expect people to know sheeshh!

 

[Pooh & Annie]

This was discussed a while ago.

At the time the ASA was recommending that people word their letters "cautiously". This new ASA email makes it sound like it didn't really matter how they were worded.

 

[Arch Guillotti]

Oddly enough, we did have a whole series of lectures on professionalism throughout my residency. I think it may even be a mandatory component of an anesthesiology residency nowadays.

And I stand by what I said...trying to foment dissent amongst your colleagues by selectively gathering comments and posting them all over the hospital is sleazeball behavior and reiterates a point I have been making for years: CRNAs MUST be your employees and not someone else's. If a midlevel pulled these shenanigans in my group, they would be immediately terminated.

Of course it is "better" to be able to hire and fire the CRNA's. Unfortunately when you employ them you bear the financial responsibility for them, have to deal with their headaches, and potentially make you dependent upon a subsidy.

 

[deleted126335]

Pick your poison. Employing the CRNA's has been the road to ruin for some groups.

Double edged sword. Loved the control. The fact that we employed them delayed our eventual employment by the hospital. The only reason we got anything in our "buyout" was our corporate owned employment contracts of the docs AND CRNAs. Historically, it has been very lucrative for the docs to be private and the hospital to own the CRNAs. I suspect that those days are gone and in this environment having the hospital own the CRNAs makes the docs more vulnerable to being owned without any buyout.

 

[Psai]

Double edged sword. Loved the control. The fact that we employed them delayed our eventual employment by the hospital. The only reason we got anything in our "buyout" was our corporate owned employment contracts of the docs AND CRNAs. Historically, it has been very lucrative for the docs to be private and the hospital to own the CRNAs. I suspect that those days are gone and in this environment having the hospital own the CRNAs makes the docs more vulnerable to being owned without any buyout.

This is exactly what happened to a group I know. Docs got bought out, the new docs got totally screwed and a bunch of them looked for other jobs in the area. The quality of anesthesia care at that hospital went way down.

 

[BLADEMDA]

If you write it on The INTERNET expect people to know sheeshh!

Sure. They can "know" and discuss it in private but to post comments at the workplace with the intent to disparage an individual and encourage animosity is disgusting to say the least and an outright fireable offense at the worst.

 

[Consigliere]

Of course it is "better" to be able to hire and fire the CRNA's. Unfortunately when you employ them you bear the financial responsibility for them, have to deal with their headaches, and potentially make you dependent upon a subsidy.

Known. Still better than not being able to get rid of the troublemakers. MUCH better.

 

[Consigliere]

Pick your poison. Employing the CRNA's has been the road to ruin for some groups.

Not my group. We just picked up an additional contract for another hospital and a surgicenter.