CRNA issue: Considering writing letters to my med school

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W222

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I recently found out that my medical school alma mater has opened a CRNA school and I am considering writing a letter to the alumi association, the anesthesia dept chair, and the dean of the medical school. Anyone feel this is a bit pushy/rude? Anyone feel this could cause me some trouble in the future?

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I recently found out that my medical school alma mater has opened a CRNA school and I am considering writing a letter to the alumi association, the anesthesia dept chair, and the dean of the medical school. Anyone feel this is a bit pushy/rude? Anyone feel this could cause me some trouble in the future?

No. It's not pushy. But, you're up against a strong economic incentive given the money to be made teaching SRNA's.

The problem is that with all of the bitching we all do, we don't often offer up (or are in the position to offer up) viable alternative REVENUE STREAMS for these institutions. To simply say "stop training CRNA's" is a losers battle, and this is a big dilemma.

Perhaps PA-->PA-CA (certified anesthetist) is a nice alternative to the SRNA issue, and it offers up an alternative revenue stream which is absolutely essential as academia, and in fact medicine, becomes "exposed" to the economic realities that Joe-Small-Business has dealt with for his entire career......

Just some thoughts.

cf
 
No. It's not pushy. But, you're up against a strong economic incentive given the money to be made teaching SRNA's.

The problem is that with all of the bitching we all do, we don't often offer up (or are in the position to offer up) viable alternative REVENUE STREAMS for these institutions. To simply say "stop training CRNA's" is a losers battle, and this is a big dilemma.

Perhaps PA-->PA-CA (certified anesthetist) is a nice alternative to the SRNA issue, and it offers up an alternative revenue stream which is absolutely essential as academia, and in fact medicine, becomes "exposed" to the economic realities that Joe-Small-Business has dealt with for his entire career......

Just some thoughts.

cf
I don't know that it's "money to be made" as much as it is free labor.

Why is stopping the training of CRNA's necessarily a loser's battle? Surely here are places that have turned it around and said "we're not doing this any more". I'm having this discussion now elsewhere with a bunch of CRNA's. It's interesting that they demand to be trained by MD's, and feel that if MD's refuse to train them, it's somehow illegal restraint of trade. That's total crap. My point to them is if THEY can't teach their own everything they need to meet THEIR standards, they need to admit that they NEED MD's.
 
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I recently found out that my medical school alma mater has opened a CRNA school and I am considering writing a letter to the alumi association, the anesthesia dept chair, and the dean of the medical school. Anyone feel this is a bit pushy/rude? Anyone feel this could cause me some trouble in the future?


No harm in expressing your opinion but it may fall on deaf ears.
 
I don't know that it's "money to be made" as much as it is free labor.
Why is stopping the training of CRNA's necessarily a loser's battle? Surely here are places that have turned it around and said "we're not doing this any more". I'm having this discussion now elsewhere with a bunch of CRNA's. It's interesting that they demand to be trained by MD's, and feel that if MD's refuse to train them, it's somehow illegal restraint of trade. That's total crap. My point to them is if THEY can't teach their own everything they need to meet THEIR standards, they need to admit that they NEED MD's.

Not sure about this. Remember, there's still a CRNA in there, in addition to physician participation/supervision. At least that's the way it is at my institution. So, not sure on how they're saving in manpower.

But, if CRNA programs are like every other institution of higher learning, they're receiving a LOT in tuition, which is a big money maker for these places.

So, offering up alternatives to those revenue streams is important. AA schools (or PA--->PA-A) are a viable alternative to this problem.

That being said, I think Prorealdoc's last post is right on. This stuff needs to be handled by folks of a higher pay grade/seniority/more power than some junior dude.......

cf
 
I recently found out that my medical school alma mater has opened a CRNA school and I am considering writing a letter to the alumi association, the anesthesia dept chair, and the dean of the medical school. Anyone feel this is a bit pushy/rude? Anyone feel this could cause me some trouble in the future?

Keep in mind that it isn't your medical school that is opening a CRNA school, it has to be the nursing school at the university. The only role the medical school could have is the dept of anesthesiology allowing their students to rotate through.

There are CRNA schools affiliated with big name universities that have >90% of their clinical rotations at other sites. They are almost affiliated in name only and as a home base for classes with clinical rotations done at other hospitals.


Feel free to express anything you want, but keep in mind the medical school probably has almost nothing to do with it.
 
Look on the bright side, more CRNA schools, more glut of CRNA's in the future.

Try to get them to open an AA program.
 
Look on the bright side, more CRNA schools, more glut of CRNA's in the future.

Try to get them to open an AA program.

I was just notified that one of our state universities recently (maybe over a year now...) opened a CRNA school. Didn't even know it. The CRNA who told me this was disgruntled about how the "MDA"s at my institution "limit their practice" (those exact words).(no Central Lines or Regional blocks) Apparently, there's "bad blood" between the group (hybrid academic/PP) and the hospital employeed CRNA's and that many of them are "unhappy".

Yet, I'm already getting the feeling that the supply for CRNAs is starting to meet demand since from the few CRNA's I've spoken to state that it's not so easy to find a good job these days. And, in my area, apparently, these sign-on bonuses are becoming a thing of the past.

For example, the CRNA whith whom I was chatting stated that she's "been looking around", but clearly things are either not that bad where she is, OR things elsewhere aren't much better in terms of opportunities.

As for "limiting their practice", I almost said that the AANA is experiencing some long overdue Karma.....

This is an example of what physicians CAN do/implement in terms of hospital policy to begin taking back our field. If it means extra work, so be it. I know it's easier said than done, but if we don't "limit" certain activities (and this includes NP's doing procedures in ICU's) to "physician only", then this game is ours to lose. Look at our surgical colleagues as a good example of doing things, generally, right in this regard.
 
I was just notified that one of our state universities recently (maybe over a year now...) opened a CRNA school. Didn't even know it. The CRNA who told me this was disgruntled about how the "MDA"s at my institution "limit their practice" (those exact words).(no Central Lines or Regional blocks) Apparently, there's "bad blood" between the group (hybrid academic/PP) and the hospital employeed CRNA's and that many of them are "unhappy".

Yet, I'm already getting the feeling that the supply for CRNAs is starting to meet demand since from the few CRNA's I've spoken to state that it's not so easy to find a good job these days. And, in my area, apparently, these sign-on bonuses are becoming a thing of the past.

For example, the CRNA whith whom I was chatting stated that she's "been looking around", but clearly things are either not that bad where she is, OR things elsewhere aren't much better in terms of opportunities.

As for "limiting their practice", I almost said that the AANA is experiencing some long overdue Karma.....

This is an example of what physicians CAN do/implement in terms of hospital policy to begin taking back our field. If it means extra work, so be it. I know it's easier said than done, but if we don't "limit" certain activities (and this includes NP's doing procedures in ICU's) to "physician only", then this game is ours to lose. Look at our surgical colleagues as a good example of doing things, generally, right in this regard.

Exactly. Open up more CRNA schools but don't teach them anything good. Create a glut of marginally trained CRNA's. Then it's a race to the bottom. What good is autonomy when you don't have the training to back it up? Or worse, it exposes them to increased liability.

CRNA's can change the law to allow autonomy but they can't force an anesthesiologist to train them like they like train future anesthesiologists. Train a CRNA to the level that is appropriate for a midlevel anesthesia provider. Nothing more than that.
 
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Exactly. Open up more CRNA schools but don't teach them anything good. Create a glut of marginally trained CRNA's. Then it's a race to the bottom. What good is autonomy when you don't have the training to back it up? Or worse, it exposes them to increased liability.

CRNA's can change the law to allow autonomy but they can't force an anesthesiologist to train them like they like train future anesthesiologists. Train a CRNA to the level that is appropriate for a midlevel anesthesia provider. Nothing more than that.

I agree with this, and it's not mutually exclusive to training competent CRNA's ready to enter the ACT model. But, can anyone seriously make the arguement that they should be trained in EVERY facet of the practice of anesthesiology? I don't think so, because then we'll continue on this losers path of being the only field training the competition to do the job of a physician.

It really is as simple as "go to medical school" if you want to do the stuff doctors do. And, going forward, there shouldn't be any apologies for this kind of attitude.
 
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You guys do realize the opt out is not going to harm any Anesthisologist jobs. Whether or not a state opts out still does not mean the hospital is going to let CRNAs act independently without the act model. In rural facilities in every state CRNAs have always been acting independently. Surgeons don't dictate any anesthetic plan. They might suggest what they would like or say this is a quick case can we just do a local mac? If it is an appropriate anesthetic then we will go with it if not we won't. I have never met any othe the militant CRNAs you guys keep talking about. I have never met one CRNA who is trying to get rid of anesthesiologists. I know a lot of CRNA like to use the functional equivalent argument but I don't know of any CRNA that can utilize the TEE probe for cardiac surgery. If I did hearts or heads as a CRNA you are darn straight I want a physician to have my back. But it doesn't take and ASE certified mechanic to change spark plugs and I don't believe it takes anesthesia supervison to do an ASA 1 patient having a carpal tunnel release or a total knee replacement.
 
I don't think that opposition will prevent CRNA's from being independent. I think the best thing to do is accept that this is coming and improvise. What about making a provision that CRNA's can perform independent anesthesia on ASA 1 patients whereas MD supervision is needed for ASA 2-4. Compromise is the best way to go if you want to protect your turf.
 
I don't see where this changes anything. Just because a state opts out of CRNA supervision it still will not change things in any hospital they work other than the supervising physician not havng to cosign some paperwork. No major facility that participates in the ACT model is now going to get rid of anesthesiologists.



I don't think that opposition will prevent CRNA's from being independent. I think the best thing to do is accept that this is coming and improvise. What about making a provision that CRNA's can perform independent anesthesia on ASA 1 patients whereas MD supervision is needed for ASA 2-4. Compromise is the best way to go if you want to protect your turf.
 
I don't see where this changes anything. Just because a state opts out of CRNA supervision it still will not change things in any hospital they work other than the supervising physician not havng to cosign some paperwork. No major facility that participates in the ACT model is now going to get rid of anesthesiologists.


They will definitely not get rid of all anesthesiologists. But if they want to increase their profits... they might hire a CRNA at half the cost over an anesthesiologist. In the end it looks like anesthesiologists will have to lower their fees to compete with CRNAs.
 
You guys do realize the opt out is not going to harm any Anesthisologist jobs. Whether or not a state opts out still does not mean the hospital is going to let CRNAs act independently without the act model. In rural facilities in every state CRNAs have always been acting independently. Surgeons don't dictate any anesthetic plan. They might suggest what they would like or say this is a quick case can we just do a local mac? If it is an appropriate anesthetic then we will go with it if not we won't. I have never met any othe the militant CRNAs you guys keep talking about. I have never met one CRNA who is trying to get rid of anesthesiologists. I know a lot of CRNA like to use the functional equivalent argument but I don't know of any CRNA that can utilize the TEE probe for cardiac surgery. If I did hearts or heads as a CRNA you are darn straight I want a physician to have my back. But it doesn't take and ASE certified mechanic to change spark plugs and I don't believe it takes anesthesia supervison to do an ASA 1 patient having a carpal tunnel release or a total knee replacement.

That's the kind of short-sighted thinking that got anesthesiology and primary care physicians into the mess they are in today. Give them an inch, they want to take a mile. And they will lobby, propagandize, and lie to get their way. If physicians of yesterday had foresight, they would not have given an inch of turf to any of the midlevels.

From speaking to many physician colleagues, I'm glad that you are in the small minority who doesn't see anything wrong with the current state of affairs.
 
From speaking to many physician colleagues, I'm glad that you are in the small minority who doesn't see anything wrong with the current state of affairs.

Previous post history of pencan shows that they are a future CRNA. You shouldn't be surprised at their thoughts. I'm not saying there aren't physicians out there that share the same thoughts, as I know there are plenty, I'm just saying I wasn't surprised when I saw an earlier post by pencan saying "As a future CRNA...."
 
What changed in any of the states that opted out? How many Anesthesiologists lost their jobs? It's a non issue CRNAs have been practicing independently for decades nothing will change.


Previous post history of pencan shows that they are a future CRNA. You shouldn't be surprised at their thoughts. I'm not saying there aren't physicians out there that share the same thoughts, as I know there are plenty, I'm just saying I wasn't surprised when I saw an earlier post by pencan saying "As a future CRNA...."
 
What changed in any of the states that opted out? How many Anesthesiologists lost their jobs? It's a non issue CRNAs have been practicing independently for decades nothing will change.

Dude, what is your deal? It's "baby steps". Precedents are being made and they WILL eventually gain critical momentum, which might then be a problem for every one of us. You need a reality check.
 
I understand what you are saying about baby steps. But this is not a practice issue it's a billing issue. As a CRNA I don't see how this affects anesthesiologist job prospects at all. this is designed for rural facilities and I don't see any unintended consequences affecting an other apsect of care.

Dude, what is your deal? It's "baby steps". Precedents are being made and they WILL eventually gain critical momentum, which might then be a problem for every one of us. You need a reality check.
 
I understand what you are saying about baby steps. But this is not a practice issue it's a billing issue. As a CRNA I don't see how this affects anesthesiologist job prospects at all. this is designed for rural facilities and I don't see any unintended consequences affecting an other apsect of care.

Yeah, you wouldn't now, would you?

Suffice it to say Mrs. CRNA, you will not find future legislative battles as easy going forward as you have in the past. This is a fact.

Cheers.
 
What changed in any of the states that opted out? How many Anesthesiologists lost their jobs? It's a non issue CRNAs have been practicing independently for decades nothing will change.

I don't see why CRNA's have a problem with AA's either.

I mean, I don't know of one CRNA who has lost their job because of an AA.

:laugh:
 
Old news.....soon it will be all 50 states. I predict by 2014 all states will have opted out.

I doubt that will come true in that time frame. To opt out there can be no law stating that a CRNA must be supervised by a physician. While no state says they must be supervised by an anesthesiologist, some states, such as alabama, require physician supervision. So those laws would have to be overturned before an opt out be done.

Now that could happen, but I imagine it will take much longer than 2014.
 
We don't have a problem with AAs (no CRNAs that I know of). But one day they are going to demand their independance as well.




I don't see why CRNA's have a problem with AA's either.

I mean, I don't know of one CRNA who has lost their job because of an AA.

:laugh:
 
We don't have a problem with AAs (no CRNAs that I know of). But one day they are going to demand their independance as well.

And what is the difference between an independent CRNA or independent AA? The AA is governed by the BOM while the CRNA is governed by the BON.

I would rather have a profession that practices medicine to be governed by BOM. We wouldn't be having this problem with NP's and CRNA's if they were governed by BOM.

CRNA's and AA's both compete for the same jobs and therefore add to the CRNA glut. If practices could, most would replace half of their anesthesia staff with AA's. So CRNA's have a lot more to worry about in a glut than AA's.

In conclusion, there's a lot more upside than downside by supporting PA's and AA's.
 
I understand what you are saying about baby steps. But this is not a practice issue it's a billing issue. As a CRNA I don't see how this affects anesthesiologist job prospects at all. this is designed for rural facilities and I don't see any unintended consequences affecting an other apsect of care.

Forget about "why". The AANA has done a great job at pissing off the FUTURE of anesthesia. This next generation is simply NOT going to deal with you girls the same way as has been the historic past. It is what it is. This is another promise. Not a threat.
 
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