UMAB CRNA Assc Dir statements

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

MountaineerDoc

Member
10+ Year Member
7+ Year Member
15+ Year Member
Joined
Aug 16, 2004
Messages
49
Reaction score
0
In my most recent UMAB alumni magazine there is an article about UMABs' new CRNA program (page 29-30, this is the link http://www.oea.umaryland.edu/communications/magazine/2005/05Magazine_Impact.pdf ). Here are a few quotes from the program's assc director, Caleb Rogovin, CRNA, MS, CCRN, CEN;

"The major difference between a CRNA and a physician anesthesia provider is the educational preparation,"

"There isn't anything that I can't do, only some things I am not allowed to do."

..."At the University's Shock Trauma Center, there is no limitation on what the CRNA can do in the OR." 😱

Am I reading into this? 😕
 
MountaineerDoc said:
Am I reading into this? 😕

This is the most important quote in the whole article:

"The endotracheal tube is removed and he is wheeled into recovery. The nurse anesthetist’s job, for this patient at least, is done."

This is the difference between a CRNA and an Anesthesiologist. You'd never hear those words uttered about an MDA, because they absolutely wouldn't be true.

-Skip
 
Skip Intro said:
This is the most important quote in the whole article:

"The endotracheal tube is removed and he is wheeled into recovery. The nurse anesthetist's job, for this patient at least, is done."

This is the difference between a CRNA and an Anesthesiologist. You'd never hear those words uttered about an MDA, because they absolutely wouldn't be true.

-Skip

Exactly! The PACU nurse calls you, Mr. BigShot CRNA, and states that the patient who you just "....wheeled into recovery" has had decreased urine output over the past hour and is now becoming becoming mildly anxious and hypotensive, how would you work this up Mr. BigShot CRNA? Heheheh.

Or, the PACU nurse calls you, Ms. Awesome CRNA, and states that the patient who you just "...wheeled into recovery" and that your job "...is done" is now having mild difficulty grasping the little cup of water by his bedside and feels weak lifting his arm above his head, how would you work that up Ms. Awesome CRNA?

Or, the pre-op holding area nurse calls you Mr. Cool CRNA to evaluate a .....

I could just go on and on and on.
 
Sandpaper said:
Exactly! The PACU nurse calls you, Mr. BigShot CRNA, and states that the patient who you just "....wheeled into recovery" has had decreased urine output over the past hour and is now becoming becoming mildly anxious and hypotensive, how would you work this up Mr. BigShot CRNA? Heheheh.

Or, the PACU nurse calls you, Ms. Awesome CRNA, and states that the patient who you just "...wheeled into recovery" and that your job "...is done" is now having mild difficulty grasping the little cup of water by his bedside and feels weak lifting his arm above his head, how would you work that up Ms. Awesome CRNA?

Or, the pre-op holding area nurse calls you Mr. Cool CRNA to evaluate a .....

I could just go on and on and on.


Check this stud out..

http://www.sahp.vcu.edu/nrsa/MFallacaro.htm

Yeah, but these days.. You can be a CRNA and be called Doctor after doing a 1-2 year clinical doctorate for nursing. Plus, They can practice independently of Anesthesiologists in a number of states. Especially after the insurance companies and lawyers consider them "legal equivalents" to MD Anesth in some places. (This seems to be a growing nationwide trend unfortunately) They do this for a reason... because the money grubbing lawyers and insurance co. can pay them less to do the same job, and the CRNAs don't mind undercutting MD salaries.

This is going to bite Americans in the ass once you have the wonderful Utopia that is Socialized medicine in the US. It's not so bad when your young and healthy and need minor surgery.. but just wait till your 65 and need CABG on top of have a myriad of other health complications and are on a bucketful of meds.. then you'll get a phone call from your health insurance telling you that you'll be having “Dr. jimbob CRNA” controlling your vitals while your under. 👎 Sorry.. No thanks!!

There is nothing wrong with wanting a more universal healthcare system.. but it won't work in the US.. at least not how things are now. Because Americans care too much about money and like to give the jobs to "specialized" Allied Health care workers or "alternative medical practitioners". You know they have a government regulated universal healthcare system in the UK.. but you know what. They also have more medical graduates proportionally going into GP training programs. They have rural GP jobs that are better reimbursed. That way you have a real medically trained physician who give regular preventative checkups to their citizens at a reduced cost. Not like in the US where you only go to see your doctor when you are sick as a dog and are in real trouble. They are saying that Alternative medicine is the way to go in the US now.. and that they do a better job of treating people. Well you know what. What sort of people usually visit alternative med clinics.. you usually don’t see any overweight blue collar Archie Bunkers who have type II diabetes walking in to see their herbalist. Haha.. Healthy people who already live healthy lifestyles or for at least healthy living is a Priority for them are the ones who usually visit these “alterna docs”. So of course they have a great preventative healthcare track record!! Also, in the UK you don’t have med graduates going into the workforce with over 200k in student loan debt like in the US. You don’t have Allied health workers specializing and moving in and taking jobs from physicians. And you Also don’t have doctors having to deal with such crazy high malpractice rates put in place by trail lawyers like John Edwards. Get rid of these things first.. and then maybe we can try and workout a plausible and reasonable universal approach to healthcare coverage in the US. Till then.. Good Luck America!
 
The Doctor of Nursing Science degree (DNSc) typically requires 3-4 years to complete and is a research NOT a clinical doctorate. This is a totally different course of study than a clinical doctorate, and doesn’t grant any sort of increase in clinical privileges. Please have at least some sense of what you’re talking about before propagating these falsehoods that just get everyone upset. Furthermore, the supervision requirements aren’t about independent practice, but Medicare reimbursement. CRNAs can practice without an Anesthesiologist in all 50 states.

Texas is attempting to chance the laws to state that CRNAs require Anesthesiologist supervision. During the testimony, the panel saw right through the MD’s argument about “patient safety” and asked him if it was “all about the money.” If I can find the link, I’ll post it. By saying this, I DO NOT equate MDs to CRNAs, but almost 110 years of practice and no studies that have thus far found differences in MD vs. CRNA outcomes speak volumes.
 
There is a good proverb in my native language - a stingy guy always pays twice.
 
gasgodess said:
ether_screen said:
CRNAs can practice without an Anesthesiologist in all 50 states.

QUOTE]



Actually, as of Jan, 2004 only 12 states allowed CRNAs to practice without supervision.

http://www.aana.com/press/2004/mt_012604.asp

Please stop trying to incite folks on this site.

Ya, but how many states are being lobbied to let them practice independantly. That number of 12 used to be zero, and it has changed quickly.
 
stoic said:
gasgodess said:
Ya, but how many states are being lobbied to let them practice independantly. That number of 12 used to be zero, and it has changed quickly.

yes but you are forgetting one thing. We are still in the middle of an anesthesia-care provider shortage. The states mentioned in the article are rural states and I can only imagine that the shortage is much more severe there. The decisions made there are necessary for now. People forget that until about 60 years ago nurses were the only ones doing what anesthesiologists do. Our field is a young one, but it came into existence for a reason. As this shortage reverses I have confidence that it will not pose a threat to anesthesiologists.
 
gasgodess said:
ether_screen said:
CRNAs can practice without an Anesthesiologist in all 50 states.

QUOTE]



Actually, as of Jan, 2004 only 12 states allowed CRNAs to practice without supervision.

http://www.aana.com/press/2004/mt_012604.asp

Please stop trying to incite folks on this site.

EtherScreen's statement is still correct. CRNA's can practice without an anesthesiologist in all 50 states. They can practice independent of physician supervision in 12 states, the so-called Medicare opt-out states.
 
jwk said:
gasgodess said:
Not trying to incite a feud here. If you have knowledge that I don't then please point me in the right direction. If you need to read the appeals case or the section of the hospital code referred to PM me me and I'll provide it

EtherScreen's statement is still correct. CRNA's can practice without an anesthesiologist in all 50 states. They can practice independent of physician supervision in 12 states, the so-called Medicare opt-out states.

.

I don't beleive you can in NY. I think we'e still one of the 50 states. The NYS Hospital Code 405.13 prevents it. In terms of office based practice, there was recent litigation filed on behalf of the NYS association of nurse anesthetists to to have a comment which stated that CRNAs could only practice under the supervision of a physician, dentist, or podiatrist qualified to adminster anesthesia ruled null and void but the case was dismissed by the NYS court of appeals. I will always admit when I am wrong so feel free to correct me but these were the facts as of a few months ago.

Please provide some literature which states that CRNAs can practice independently in all 50 states please. Thank you. You can PM them to me.
 
I would also like to state for the record that I have respect for all CRNAs. There is a CRNA program at my school and I have learned from some very good ones. I unlike some others on this forum do not belive in starting a pissing war with CRNAs. We will all have to work together at some point. I just want to get the facts straight.

I also appreciate that this discussion is being talked about within in a thread clearly labeled for this discussion. I really hope that members of this forum would contain this debate to threads such as these and not infiltrate others. It is disrespectful and robs others from learning and participating the initial intentions of threads unrelated to CRNA issues.

Thank you.
 
Before this takes the turn down the wrong path, I would like to follow-up by saying that MY beef with this Assc Directors comments is the obvious missing comments regarding the teamwork they should have with the anesthesiologist, and the blatant know-it-all comments. The CRNAs starting training there are going to be coming out with this mentality/attitude that thier instructors are voicing. This program needs to be reined in by someone at UMAB before it ruins the residency program over time is my feelings... 😡
 
MountaineerDoc said:
Before this takes the turn down the wrong path, I would like to follow-up by saying that MY beef with this Assc Directors comments is the obvious missing comments regarding the teamwork they should have with the anesthesiologist, and the blatant know-it-all comments. The CRNAs starting training there are going to be coming out with this mentality/attitude that thier instructors are voicing. This program needs to be reined in by someone at UMAB before it ruins the residency program over time is my feelings... 😡

Not to completely open a can-o-worms...

I have to mostly agree with MountaineerDoc's sentiment. The analogy I like to think of as the difference between CRNA's/AA's and MDA's is the same one that exists between an enlisted man and an officer in the Armed Forces. There is no doubt that, say, a Sergeant Major in the Army commands a ton of respect from everyone, including Generals. There's also little doubt that he can do just about any job in the army that there is. I'd take him any day over a fresh-out-of-OCS Second Lieutenant if I had a job that I really needed to get done.

HOWEVER...

The level of responsibility is still different. An officer has had both a broader as well as a more leadership-focused training and, as a result, more is expected of him/her. Therefore, when he/she makes a decision, they are the responsible party and will bear the full brunt of that decision - be it good or bad. By definition, he/she is really the one in charge. It has little to do with ability or who's actually doing the job, and everything to do with accountability. It has to do with who's ultimately going to be called into question when the doo-doo hits the fan. With the increased responsibility and accountability, there is a commensurate increase in compensation.

So, when an MDA says to a CRNA something to the effect of, "I heard what you want to do, and I see your point, but you will still please do it this way" it should get done that way. The MDA will bear the responsibility of that decision. That's why, much like in the military world, it's called an "order" - and CRNA's take orders from MDAs. MDAs are trained to be "consultants in anesthesia" and not just "gas passers". Still, it's not just about knowledge, but also about accountability and responsibility and breadth of practice. CRNAs are probably technically equally capable to any MDA in many regards, but still they just don't have the depth and breadth of medical training that an MDA does. Sorry, CRNAs/SRNAs who may be reading this but, that's an inarguable fact. And, it does make a difference in patient care, especially at the fringes.

That's the difference.

Now, what these "opt out" states have, in effect, done is allow the Sergeant Majors to run the Army simply because there aren't enough officers. Again, this is more about a lack of what-has-previously-been-determined-to-be-requisite leadership - and only time and careful study will tell if the experiment going on in these 12 "opt out" states will actually work.

-TT
 
everyone wants to be a doctor(and feel that they can do the same job) but no one want to go to medical school for the priviledge.

it only works because people allow it though.

maybe medical students and residents should petition for shorter training periods, since people seem to think our education is obviously overkill...or is it? 🙄
 
:clap:

Very well said, Skip.
 
ether_screen said:
The Doctor of Nursing Science degree (DNSc) typically requires 3-4 years to complete and is a research NOT a clinical doctorate. This is a totally different course of study than a clinical doctorate, and doesn’t grant any sort of increase in clinical privileges. .


I am aware of both the DNS and the clinical doctorate. I am aware that the research oriented DNS requires a longer period to complete. I was referring to the clin doc. .. also, as far as I know. as long as you have your cert in CRNA.. neither "doctor degree" (DNSc or ClinDoc) expands your scope of practice. But DOES gives the CRNA more political clout in attempting to push for independance of physican supervision and the coveted title of "Doctor".


BTW.. A similar thing is going on in the field of Physical therapy. Now all physical therapy programs are changing to give the "doctor" degree of DPT. You can have someone who graduated from PT program 20 years ago when they were all "bachelors" and someone who gradutes these days with a "doctorate" (DPT). They both have the SAME scope of practice! It is just a political move to compete with the encroachment of Chriopractors who want to do "sports medicine". Chiropractors have direct access to patients. and PTs do not.. but if they have a DPT and call themselves doctors just like Chiropractors DC degree. This way they can fight off the threat of chiros moving in.. and not rely on physcian referrals for patients. But is this a good idea? prob not.

LIke I said.. It's all about money and politics.
 
gasgodess said:
stoic said:
yes but you are forgetting one thing. We are still in the middle of an anesthesia-care provider shortage. The states mentioned in the article are rural states and I can only imagine that the shortage is much more severe there. The decisions made there are necessary for now. .

Are they? I just think that a better way to handle this is instead of granting specilized nurses equal footing with residency trained physicans.. why don't you just make rural jobs more attractive to medically trained anesthsiologist?

gasgodess said:
stoic said:
People forget that until about 60 years ago nurses were the only ones doing what anesthesiologists do. Our field is a young one, but it came into existence for a reason.

You sure about that? Actually wasn't it a Dentist who was the first to come up with the idea of and clinical use of anesthisa in medicine? After which it was used by medically trained surgeons.. who then trained nurses in the use of it.
 
Whodathunkit said:
everyone wants to be a doctor(and feel that they can do the same job) but no one want to go to medical school for the priviledge.

it only works because people allow it though.

maybe medical students and residents should petition for shorter training periods, since people seem to think our education is obviously overkill...or is it? 🙄



👍 Good idea! :idea:
 
gasgodess said:
jwk said:
.

I don't beleive you can in NY. I think we'e still one of the 50 states. The NYS Hospital Code 405.13 prevents it. In terms of office based practice, there was recent litigation filed on behalf of the NYS association of nurse anesthetists to to have a comment which stated that CRNAs could only practice under the supervision of a physician, dentist, or podiatrist qualified to adminster anesthesia ruled null and void but the case was dismissed by the NYS court of appeals. I will always admit when I am wrong so feel free to correct me but these were the facts as of a few months ago.

Please provide some literature which states that CRNAs can practice independently in all 50 states please. Thank you. You can PM them to me.

The New York State Health Department writes regulations to regulate hospitals in the state. One such regulation is the New State Hospital Code. Section 405 of the Code deals with anesthesia services provided in hospitals.



In the Code is the only place where the practice of nurse anesthetists is described. Provisions authorizing CRNA practice are the following.



405.13 Anesthesia Services (a)(1)"…. Anesthesia shall be administered in accordance with their credentials by the following:

(iv) certified registered nurse anesthetists (CRNAs) under the supervision of an anesthesiologist who is immediately available as needed or under the supervision of the operating physician who has been found qualified by the governing body of the medical staff to supervise the administration of anesthetics and who has accepted responsibility for the supervision of the CRNA; "



According to a February 1, 1989 letter from Dr. David Axelrod (then the NYS Commissioner of Health) to all hospital administrators in New York, the regulation does not require that supervisory physicians be able to perform the specific activities they supervise. Further, it was the Commissioner's opinion, the regulation does not affect the respective legal liabilities of operating physicians and CRNAs.
 
OzDDS said:
gasgodess said:
Are they? I just think that a better way to handle this is instead of granting specilized nurses equal footing with residency trained physicans.. why don't you just make rural jobs more attractive to medically trained anesthsiologist?

gasgodess said:
You sure about that? Actually wasn't it a Dentist who was the first to come up with the idea of and clinical use of anesthisa in medicine? After which it was used by medically trained surgeons.. who then trained nurses in the use of it.

I didn't say nurses invented anesthesia. Look my point was just that the practice of nurses administering anesthesia is not a new one.

I think, as I am told that rural jobs are being made to be more attractive pay wise to get more anesthesiologists out there, but I don't know about you, but you couldn't pay me enough to work in West Bumblef&*K. There is still a shortage at kleast for the next few years.
 
mwbeah said:
gasgodess said:
The New York State Health Department writes regulations to regulate hospitals in the state. One such regulation is the New State Hospital Code. Section 405 of the Code deals with anesthesia services provided in hospitals.



In the Code is the only place where the practice of nurse anesthetists is described. Provisions authorizing CRNA practice are the following.



405.13 Anesthesia Services (a)(1)"…. Anesthesia shall be administered in accordance with their credentials by the following:

(iv) certified registered nurse anesthetists (CRNAs) under the supervision of an anesthesiologist who is immediately available as needed or under the supervision of the operating physician who has been found qualified by the governing body of the medical staff to supervise the administration of anesthetics and who has accepted responsibility for the supervision of the CRNA; "



According to a February 1, 1989 letter from Dr. David Axelrod (then the NYS Commissioner of Health) to all hospital administrators in New York, the regulation does not require that supervisory physicians be able to perform the specific activities they supervise. Further, it was the Commissioner's opinion, the regulation does not affect the respective legal liabilities of operating physicians and CRNAs.

Very good point mw, but it is also followed by this, for office based care anway. With all of these rugualtions. Although not explicitly stated, the only physician's who really do this in the real world are anesthesiologists, practically anyway. It is possible that other docs get CME training, but not very plausible.

Would've have been better to just PM me, but since you want to copy and paste webpages onto this site here it goes. This was as of 1997.


“Anesthesia should be administered only by a licensed, qualified and competent practitioner. Registered professional nurses (RNs) who administer anesthesia as part of a medical, dental or podiatric procedure (including but not limited to CRNAs) should have training and experience appropriate to the level of anesthesia administered, and function in accordance with their scope of practice. Supervision of the anesthesia component of the medical, dental or podiatric procedure should be provided by a physician, dentist or podiatrist who is physically present, who is qualified by law, regulation or hospital appointment to perform and supervise the administration of the anesthesia and who has accepted responsibility for supervision. The physician, dentist or podiatrist providing supervision should: “1. perform a preanesthetic examination and evaluation; “2. prescribe the anesthesia; “3. assure that qualified practitioners participate; “4. remain physically present during the entire perioperative period and immediately available for diagnosis, treatment and management of anesthesia- related complications or emergencies; and “5. assure the provision of indicated postanesthesia care.”


This has caused controversary as of late and have been the reason for the lawsuits, because it implies that an anesthesthesiologist be on site as well.

Anyway, all of this is says nothing anyway. Truth is anesthesiologists will need CRNAs just like CRNAs need anesthesiologists. Anesthesia related topics are becoming more prevalant in the media and in the end the public will decide. I believe that the layman will actively choose to seek out an anesthesiologist for their care based on fear of their outcome given the increased coverage. So in the end I don't this debate really matters. The CRNA's field won't die and neither will anesthesiology. There is more than enough room for both of us.
 
okay here is reality

1) CRNAs are here to stay
2) it is only a matter of time before they convert their Master's degree into a clinical doctorate (just like in the 80's they converted their Bachelor's degree into a MSN degree)
3) there will never be a good outcome study comparing MDs and CRNAs - since what is needed is a good prospective randomized blinded study (which is near impossible as patients won't consent to that, surgeons won't consent to that)... so all you are left with is comparing cases done by MDs and CRNAs retrospectively that weren't blinded, and that is like comparing oranges and apples and therefore a weak study...
4) CRNAs can p[ractice without anesthesiologist supervision in all 50 states - they can bill medicare in 12 states without any physician supervision
5) CRNAs (after a few years of experience) can provide 98-99% of the care that an MD can provide.... so functionally they are equivalent in 98-99% of the cases in the OR. However, they will never take over the care provided at major tertiary/quarternary referral hospitals where the patients are too complex and too critically ill. Surgeons recognize that, patients recognize that, hospital administrators recognize that....
 
The level of responsibility is still different. An officer has had both a broader as well as a more leadership-focused training and, as a result, more is expected of him/her.

Outstanding! Hooah!!!

BTW.. A similar thing is going on in the field of Physical therapy.

Exactly, that's why I chose to become a real doctor...

LIke I said.. It's all about money and politics
and I left the APTA long ago...
 
I know there are CRNAs reading this these posts, and what I would be interested in knowing is what the Dr of UMABs program stated a uniform feeling within your profession and/or training? that CRNAs are able to do everything, but legally are restrained from actually doing so?

Coming from an allied health profession, our minds were filled (brain-washed) with this nonsense while I was in school, which has only become worse in my previous field (PT) a degree (DPT). However, I remember how the profession laughed at the Chrios being called doctors and now since we can't beat them we are joining them.
 
Tenesma said:
okay here is reality

1) CRNAs are here to stay
2) it is only a matter of time before they convert their Master's degree into a clinical doctorate (just like in the 80's they converted their Bachelor's degree into a MSN degree)
3) there will never be a good outcome study comparing MDs and CRNAs - since what is needed is a good prospective randomized blinded study (which is near impossible as patients won't consent to that, surgeons won't consent to that)... so all you are left with is comparing cases done by MDs and CRNAs retrospectively that weren't blinded, and that is like comparing oranges and apples and therefore a weak study...
4) CRNAs can p[ractice without anesthesiologist supervision in all 50 states - they can bill medicare in 12 states without any physician supervision
5) CRNAs (after a few years of experience) can provide 98-99% of the care that an MD can provide.... so functionally they are equivalent in 98-99% of the cases in the OR. However, they will never take over the care provided at major tertiary/quarternary referral hospitals where the patients are too complex and too critically ill. Surgeons recognize that, patients recognize that, hospital administrators recognize that....


Ok then.. if no one is going to do anything about this in the US.. then maybe Someone should be making the CRNAs pay 98-99% of the malpractice and take 98-99% of the real responsiblity as an anesth. :idea:
 
OzDDS said:
Ok then.. if no one is going to do anything about this in the US.. then maybe Someone should be making the CRNAs pay 98-99% of the malpractice and take 98-99% of the real responsiblity as an anesth. :idea:

Unfortunately, the supposition, and subsequently proposed solution, upon which this statement is predicated just simply isn't true. CRNA's cannot and do not provide "98-99% of the care that an MD can provide". That's like saying, out of 100 completely different types of surgical cases out there, a CRNA is sufficiently trained to do all but 1 or 2 of them on their own (i.e., without someone telling them what to do). I just don't find this to be factually accurate. Not to mention patient management in the PACU, SICU... (etc.).

The only verifiable truth is that the VAST majority of surgeries are "bread and butter" cases, and that CRNAs do actually provide about 60-65% of total anesthesia services in the U.S. This does not mean that they are technically trained, nor independently capable of, running 98-99% of all types of cases on their own. Nor do they actually do this.

Now, they may be able to do them with direction, but that's the whole point. I've got no doubts that an expertly-trained CRNA, as far as technical skills go, can do just about anything an MDA can. However, I do not feel - and have seen it demonstrably shown on a personal, anecdotal level (anywhere from a fresh-out-of-school CRNA to a 20+-years-of-experience CRNA instructor) - the same way about their clinical decision making.

Therein lies the rub.

-Skip
 
I think there is an inherent bias by assuming what a CRNA can and cannot do based on the fact that many of you that work with CRNAs do so under the ACT approach. What you are not witnessing is the capacity in which CRNAs practice when not under the supervision of an MDA. Surgeons clearly don’t know anesthesia, and guess what? CRNAs find themselves in a much more independent role where they are “allowed” to exercise their decision-making skills, and up to now, no one has been able to prove this is a bad thing; although many of you may be of a different opinion. But what do we know about opinions?
 
ether_screen said:
I think there is an inherent bias by assuming what a CRNA can and cannot do based on the fact that many of you that work with CRNAs do so under the ACT approach. What you are not witnessing is the capacity in which CRNAs practice when not under the supervision of an MDA. Surgeons clearly don’t know anesthesia, and guess what? CRNAs find themselves in a much more independent role where they are “allowed” to exercise their decision-making skills, and up to now, no one has been able to prove this is a bad thing; although many of you may be of a different opinion. But what do we know about opinions?

First, surgeons know a lot more about anesthesia than you give them credit for. Just because they don't stand behind the screen and run things themselves, don't assume that they "clearly don't know anesthesia".

Secondly, there actually is data out there, albeit limited, that refutes what you are saying. For example, see these studies:

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10861159

Furthermore, anesthesiologists predominately reside and practice in metropolitan areas...

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15098514

... where tertiary centers are and where the difficult cases will more often present for surgical treatment. So, it's not unfair to conclude - at this time - that anesthesiologists take on more difficult cases and/or have better outcomes in general. The current data supports this. Still, no one would disagree that we need more data.

So, as I said before, these opt-out states are conducting a de facto experiment potentially at the public's expense. Time, and careful study, will tell if the assertions inherent in your response are indeed true. Regardless, at least my opinion is supported, in part, by the data. So, I think what you really meant to say is what do we know about unsupported opinions and, at least in your response, speculation, right?

-Skip
 
"Recently, at the national level a decision was made to transition all advanced nursing practice masters to the clinical doctoral level. Programs that educate NPs, CNS, anesthetists, and midwives must all convert to the Doctorate of Nursing Practice not later than 2015."

http://www.up.edu/up_sub.asp?ctnt=121&mnu=40&chl=300&lvl=2

😱 Here we go!
 
OzDDS said:
"Recently, at the national level a decision was made to transition all advanced nursing practice masters to the clinical doctoral level. Programs that educate NPs, CNS, anesthetists, and midwives must all convert to the Doctorate of Nursing Practice not later than 2015."

http://www.up.edu/up_sub.asp?ctnt=121&mnu=40&chl=300&lvl=2

😱 Here we go!

It looks like a recommendation, but does the AACN have any real authority to mandate this kind of move? They certainly don't have the ability to change state laws and state nursing regulations in 50 states just because it sounds good on paper. It's been more than 20 years since a BSN was going to be the entry-level educational requirement for RN's. That hasn't happened either. There are still many 2 yr ASN programs around the country.

And if it happens, just like it is now, it will be a very long transition. 1/3 of practicing CRNA's have no degree (or didn't at the time they finished anesthesia school), much less a master's, which is a relatively recent requirement for CRNA programs.

It will be interesting to see what the rank-and-file thinks, not just the professional organizations. A doctorate of any sort won't expand their scope of practice - what't the real point besides being Doctor Nurse pick your specialty ?
 
skip... what are you worried about? CRNAs will never replace us, there will always be a need for us.... even CRNAs understand their role in healthcare and work well with us - just ignore these CRNA students/propagandists and you wild do fine
 
Tenesma said:
skip... what are you worried about? CRNAs will never replace us, there will always be a need for us.... even CRNAs understand their role in healthcare and work well with us - just ignore these CRNA students/propagandists and you wild do fine

Not worried at all. Just sharing some facts. 🙂

-Skip
 
nitecap said:
Sandpaper are you even a MD or are you just a med student/resident. QUOTE]


Look, I really don't want to be part of this debate, and personally I think CRNAs are a tremendous asset, they rock (although my personal experience has been with those with years of experience, not with students). But, I want to point out, at least for my own well being, that while residents are still in training and very far from being attendings, they each have an MD. Now, I know I am a lowly medical student only about to graduate. And, when I graduate and become a resident, I will not yet be trained in anesthesiology, but I will have put in more than eight years of school to have a doctorate degree in medicine. Sorry to be picky about this detail. We have worked for it, regardless of anyones position in this discussion.
 
Dear nitecap,

In addition to reiterating the fact that residents are indeed MDs (or DOs), I'd just like to give a big 👎 to the ridiculous and prejudicial stereotypes that you recycle and try to keep alive about a purported predominance of lazy attendings who sit around and reap all the glory of the CRNA's hard work. Sorry, but that's just bullsh*t and I think you know it.

Without letting this devolve into another threadbare "us vs. them" thread, suffice it to say, nitecap, that - throughout your entire post - you still cannot deny, even if your scenarios are the "norm" in your hospital (which reflect NOTHING of my experiences thus far), the supervising physician is still taking responsibility for your work. You should take it as a huge compliment, especially since you are just an SRNA, that these attendings you work with have enough confidence in your work that they give you a long leash. So, go ahead and gripe about your lazy attendings who take credit for what you do. Just remember who's countersigning your documentation. Don't think that matters for much? Tell me what happens the first time you get sued.

-Skip
 
Skip Intro said:
Dear nitecap,

In addition to reiterating the fact that residents are indeed MDs (or DOs), I'd just like to give a big 👎 to the ridiculous and prejudicial stereotypes that you recycle and try to keep alive about a purported predominance of lazy attendings who sit around and reap all the glory of the CRNA's hard work. Sorry, but that's just bullsh*t and I think you know it.

Without letting this devolve into another threadbare "us vs. them" thread, suffice it to say, nitecap, that - throughout your entire post - you still cannot deny, even if your scenarios are the "norm" in your hospital (which reflect NOTHING of my experiences thus far), the supervising physician is still taking responsibility for your work. You should take it as a huge compliment, especially since you are just an SRNA, that these attendings you work with have enough confidence in your work that they give you a long leash. So, go ahead and gripe about your lazy attendings who take credit for what you do. Just remember who's countersigning your documentation. Don't think that matters for much? Tell me what happens the first time you get sued.

-Skip


Something else to consider: An attending at on of my institution's hospitals says that he needs to "give the residents just enough rope to hang themselves. If I don't allow them to get into trouble and then get themselves out, I 'm not really doing my job which is to mold them into anesthesiologists that can think and act for themselves."

Willamette
 
Skip Intro said:
the supervising physician is still taking responsibility for your work. You should take it as a huge compliment, especially since you are just an SRNA, that these attendings you work with have enough confidence in your work that they give you a long leash. So, go ahead and gripe about your lazy attendings who take credit for what you do. Just remember who's countersigning your documentation. Don't think that matters for much? Tell me what happens the first time you get sued.

-Skip


Thank You! Well said. 👍
 
CRNA's and anesthesiologists can both do their own jobs well. What bothers me is people who didn't go to medical school or get a PhD being called doctor. Getting an NP would allow CRNA's to say, "Hi I'm Doctor Smith." While true I guess, it would be completely misleading to your patients who will hear doctor and think MD. If you want to be a doctor go to medical school. If you want to be a CRNA, keep up the good work and keep the title nurse.
 
I'm confused on that one. Nurse Practitioners can be called Doctor? Where in their title does it say Doctor? They're called "Nurse" Practitioners not "Doctor" Practitioners. I don't get it. Definitely very misleading.
 
The only person who should introduce themself as "doctor" should be a graduate of an allopathic or osteopathic medical school, period. This business of deceptively calling yourself "Dr." when you are a nurse Ph.D. is knowingly misrepresenting yourself to a patient and close to malpractice.

Do the job, do it well, and a nurse or midlevel is deserving of every bit of the respect that a doctor should get, on a person to person basis. But don't play games with your patients. A third year medical student who competed their PhD would be sent through the ringer if they cleverly introduced themself as "Dr" to their patient without clarifying....the same standard should be there for anyone else.
 
So where does one draw the line with the "Doctor" title? DDS, DMD, DC, OD, DPM, DVM, etc., all routinely use "Doctor". (Interestingly, attorney JD's do not) One of you says it's OK for PhD's, but another says no for "nurse PhD".

I'm just playing devil's advocate here, since I've stated in other posts in other threads that I think "Doctor" should be reserved for physicians when in a medical environment. But still, there have always been "non-physician" doctors in any number of fields. It's inconsistent to say it's appropriate for a PhD in anatomy or physiology to be referred to as "Doctor" simply because they're associated with a medical school (which I would suppose most of you would agree with) yet not afford the same honorific to a "nurse PhD" or PhD's in other fields within a medical environment. A PhD is a PhD, regardless of the field, right? Of course that would probably be considered different than DNSc, DPT, PharmD, etc. - or would it? 😉

Just stirring the pot a little......
 
Top