MacGyver said:
jetproppilot is EXACTLY why CRNAs are in the position they are in right now.
Notice his nonchalant "why cant we all get along" attitude.
Many people have called him out, stating "how will you feel about it when CRNAs become your principal competitors"?
The short answer to this is that jpp wont have to worry about it, because he will have already made his money and cashed out before that happens. Thats the way it works with all these MDA ****** who are selling the profession down the river. They dont give a damn about long term future, as long as they can hire 50 CRNAs and make an extra 100k per year they dont give a **** if the profession is hurt as a result. They will be sipping margaritas on their yacht by the time CRNAs reach sufficient critical mass to take on MDAs directly.
As I've told you guys time and time again, its these MDAs who are the serious threat to the profession. They are the ones letting CRNAs run cases totally unsupervised. They are the ones giving the CRNA lobby the ammo they need to make their case in legislatures (i.e. our MDAs already allow us to do X, Y, Z unsupervised so we might as well codify that into new state regs).
Without MDAs like jpp running rampant, CRNAs could make a lot of noise but they wouldnt have any clinical data to back up their claims that they can replace MDAs. Jpp and his MDA ilk are the ones who give the CRNAs all this clinical data. The CRNA lobby has a plastic toy gun without MDAs, but with the cooperation of jpp and his boys, they have now turned that plastic gun into a 50 caliber machine gun.
OK, out of lurk mode on this forum.
I'm a CRNA, applying to med school for 2006, and hopefully to an MDA residency one day.
Jetproppilot and I go WAY back. He and I were resident and SRNA at the same hospital at the same time (separate programs). We did several training rotations together, purely by happenstance. He and I worked together for several years after training, up until very recently. A few rambling replies to various previous posts on this thread:
1. CRNAs don't require MDA-specific supervision BY STATE LAW anywhere. AAs do require MDA-specific supervision everywhere.
2. In approximately half the states, CRNAs practice completely independently of physician supervision BY STATE LAW. The other states require a generic physician or dentist somewhere in the CRNA's chain of command, mainly due to technical details of pharmacy rules, again BY STATE LAW.
3. State law can always be superceded by local hospital by-laws if more restrictive, but cannot be looser than state law, when it comes to supervision.
If Dr. Big Kahuna Surgeon at a hospital in a no-supervision state demands an MDA, you can bet the hospital will have MDAs supervising the CRNAs, even though BY STATE LAW the CRNAs practice independently. If the local MDAs play their politics right (and hey, that's just part of life and I accept it) they get themselves mandated by hospital staff by-laws, even if not required by state law. CRNAs becoming direct competition at XYZ Hospital can be eliminated simply by having MDA requirements written in the by-laws. Most surgeons support that philosophy, irregardless of their correct/incorrect knowledge base of "captain of the ship" doctrine currently held in medicolegal circles.
4. The supervision ratio requirement is strictly concerned with Medicare reimbursement issues. It is not STATE LAW. The opt-out issue also falls under this category.
5. As Jetproppilot alluded to previously, the vast majority of experienced CRNAs and MDAs enjoy a cordial working relationship, where each respects the other's technical skills, book knowledge, and unique background each brings to the OR (CRNAs with the nursing perspective of patient care, MDAs with the physician perspective. Both are invaluable, and the two perspectives working together are greater than the sum of their parts.)
A senior MDA partner in my MDA/CRNA group frequently tells our SRNAs, "the safest anesthesia is not an MDA alone, it's not a CRNA alone, it's MDA and CRNA working together."
Maybe this is not the norm everywhere, but my MDAs work their asses off. They are the antithesis of lazy lounge lizards. Our workload simply could not be accomplished without an MDA/CRNA team effort.
6. I've worked in all types of anesthesia settings:
-- MDA/CRNA group at large private hospital, CRNAs on the stool, MDAs floating
-- unsupervised CRNA at a teaching university hospital
-- group practice where MDA is on his own stool as I'm on mine
-- COMPLETELY by myself on an aircraft carrier at sea, where I was the entire anesthesia department (thought which came to my mind one evening: who's going to do MY anesthesia if I should need an emergent appy??)
Objectively speaking, I'm very comfortable doing it all by myself, except perhaps CABGs and some of the more exotic regional blocks. But, there is no such thing as too much IV access, just as there is no such thing as too many heads and hands at the head of the table, especially when the brown stuff starts flowing. I feel the vast majority of anesthesia providers I work with agree.
7. Jetproppilot and his cohorts probably make 3 times what I do. Good for them. They've earned every penny, based on the duration and expense of their education and training, ultimate supervisory responsibility, inherent sub-conscious stress of their position, and (when you stop to think about it) the incredible responsibility taken on each time an anesthetic is initiated. We've become so good at what we do that it looks simple, easy, and cookbook to the outsider.
8. Main differences between CRNAs and AAs.
-- CRNAs start anesthesia training after earning a BSN and working several years in an ICU setting as an RN. Most AAs have a BS, but no patient care experience (except perhaps EMT or resp tech) when starting anesthesia training.
-- CRNAs are considered "licensed independent practitioners" in the military and are deployed by themselves to the combat areas. AAs are not utilized in the military.
-- By law, CRNAs do not require an MDA anywhere. AAs must have an MDA (not just any old physician) always "immediately available." If you have one MDA supervising AAs, and that MDA gives an AA a lunch break, the MDA is no longer "immediately available" to supervise the other AAs on the stool. Walking a very fine legal line there, especially vis a vis federal reimbursement. Not a problem if you have one MDA giving a CRNA lunch break, with other independent CRNAs still on their own stools.
9. Working at an ambulatory surgery center as the CRNA "floater," doing 50 preop assessments before 3pm. Yes, been there, done that. It's called "part of the job" and I'm free to find work elsewhere if I wished. But given how the vast vast majority of people who have ever walked the face of the earth would gladly trade their huge problems for my penny-ante annoyances, I count my blessings and thank God every night that I have the opportunity and privilege to take care of helpless, scared, hurting people in their moment of need. Even if it means going 50 preops, with smiling face and non-judgemental persona.
