A Cry For Help

[Noyac]

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The ASA won't do it. The academic centers won't do it. So that leaves us.

I'm talking about taking on the nurses. We need to demand that anesthesia dept's stop training crna's. I don't know how to get their attention beyond boycotting those centers that currently train nurses. This is not a money issue this is a pt safety issue an the nurses are running amuck with this. Putting out false/biased studies and gaining ground daily.

I am proposing that as anesthesia students, we stop interviewing and stop applying to those places that are currently training crna's. I don't mean the ones that use crna's just the ones training them. Make it clear when you are out on the interview trail that you are considering the program because they "don't" train crna's. I don't know how many of them are left but if all the best and brightest students flock to these programs some may start to get the message.

Next we need studies. Well designed studies which show the truth. The ASA needs to get on the ball here. I'm in an all MD practice. I'm more than willing to participate in any study. Why are they not contacting us out there in the real world?

ASA

 

[Noyac]

BTW, the University of New Mexico uses AA's. Give them a look. The education there is top notch.

 

[WaveEquation]

The ASA won't do it. The academic centers won't do it. So that leaves us.

I'm talking about taking on the nurses. We need to demand that anesthesia dept's stop training crna's. I don't know how to get their attention beyond boycotting those centers that currently train nurses. This is not a money issue this is a pt safety issue an the nurses are running amuck with this. Putting out false/biased studies and gaining ground daily.

I am proposing that as anesthesia students, we stop interviewing and stop applying to those places that are currently training crna's. I don't mean the ones that use crna's just the ones training them. Make it clear when you are out on the interview trail that you are considering the program because they "don't" train crna's. I don't know how many of them are left but if all the best and brightest students flock to these programs some may start to get the message.

Next we need studies. Well designed studies which show the truth. The ASA needs to get on the ball here. I'm in an all MD practice. I'm more than willing to participate in any study. Why are they not contacting us out there in the real world?

ASA

Sounds like a good plan. Now, the best way for us to identify those institutions that train CRNAs is probably a website with a list of programs? http://webapps.aana.com/AccreditedPrograms/accreditedprograms.asp?State=AL

The problem is that there are some good places that are training CRNAs. Such as Mayo Clinic and UAB. At the least, we could bring up this weakness of their programs in interviews.

What is the ratio of anesthesiologists to CRNAs in this country? We need to take them on, this is an embarrassing problem. If they can do the same job as physicians with less training, competition, sacrifice (in effort and time), and rigorous education, then that means that either:
1) CRNAs are smarter than physicians on average
2) Physicians are way over-qualified for the same job that can be done with CRNA-level training

Obviously, 1) can be debunked in about 2s. 2) is what they will go after. So, we need to show them up professionally. Pull them apart as clinicians. The perioperative management is huge. If providing anesthesia in the OR is just 1 component of the services that we offer, they are not equivalent, and they should be paid less. If we can somehow show hospitals that it's more economical for us to be involved because in addition to our OR services, we provide management that CRNAs cannot including pre- and post-op care...then that should demonstrate that CRNAs are less cost-saving.

ASA needs to develop studies with a design to compare apples to apples. The average ASA of patients needs to be similar...like MD-3 and CRNA-3...not MD-4, CRNA-2. We also need to account for post-operative end-points like acute kidney injury, MIs, et cetera that demonstrate superior care - beyond the extreme of mortality - among MDs.

Who cares if we design the study with a vested interest. The AANA already did this. It's pathetic that they aren't getting pushed back by a group of professionals with superior education, training, and intelligence on average.

 

[Noyac]

Don't get caught up in the programs with the big names. Those programs often have many fellows as well as crna's that suck up the cases. The current talk on Mayo is, big name poor experience. Start thinking outside the box. Look at programs that have it all and don't sacrifice education or experience for prestige.

We have many discussions on the so called "Ivory towers" here. Search for them. I think Cleveland Clinic is probably one of the worst.

 

[Noyac]

If your program shows up here,

http://webapps.aana.com/AccreditedPrograms/accreditedprograms.asp?State=all

Think long and hard.

 

[bostonblaz]

I think it would be better if we just stoped hiring them. No jobs means surplus. Blaz

 

[countingdays]

I think it would be better if we just stoped hiring them. No jobs means surplus. Blaz

Any MD groups have it in their hospital contracts that they must be notified if discussions are to occur with any other group regarding anesthesia services? In the end, you can practice all-MD model, but you might just have your contract undercut by a care-team AMC. If you are willing to match their offer in terms of service and stipend amount, which might involve a salary cut for yourselves, then great. I wonder if you won't find out until it's too late that you need to renegotiate though.

 

[sevoflurane]

This is for real. Stop using them. We have given up so much already. Now with Obama plus the media... Well, our jobs and our patients are at risk. I can't provide the top quality care I give every single one of my patients if I'm running 4 rooms. It just isn't possible. Spoke to a resident colleague of mine who went ACT this past week.... Wow... The things I heard. Ridiculous and freak'n dangerous.

 

[yasawa]

Would ones salary really decrease that much if groups changed to an all MD model? Wouldnt it just mean that you would have to work more hours for the same salary? I think the main advantage we have with the new generation of residents is that we all know the struggle and are willing to work 60+hrs in private practive for the same salary as long as it means there will be an end to the ACT model. I think all the groups need to stop being selfish and match whatever salary these ACT model companies are offering hospitals. In the end, every hospital is going to start looking for areas to make cuts once Obama care rolls out. Maybe groups need to start being proactive and start offering hospitals more overnight coverage or extra call without the added pay. My aunt is a hospital exec and the only reason she is against the ACT model is b/c myself as well as my cousin(her son) are anesthesia residents. She constantly tells me that the main problem with the anesthesiology group at her hospital is that they are not willing to restructure their contract such that more services are offered for the same price. In the end, if this group continues to refuse to make any changes, the hospital will be forced to go with an ACT model. As physicians, we need to start realizing that unfortunately we no longer work in an environment where MDs are in charge and have all the power. People with MBAs are now making all the decisions and inorder to survive in this environment we need to start thinking like business people.

 

[maceo]

The ASA won't do it. The academic centers won't do it. So that leaves us.

I'm talking about taking on the nurses. We need to demand that anesthesia dept's stop training crna's. I don't know how to get their attention beyond boycotting those centers that currently train nurses. This is not a money issue this is a pt safety issue an the nurses are running amuck with this. Putting out false/biased studies and gaining ground daily.

I am proposing that as anesthesia students, we stop interviewing and stop applying to those places that are currently training crna's. I don't mean the ones that use crna's just the ones training them. Make it clear when you are out on the interview trail that you are considering the program because they "don't" train crna's. I don't know how many of them are left but if all the best and brightest students flock to these programs some may start to get the message.

Next we need studies. Well designed studies which show the truth. The ASA needs to get on the ball here. I'm in an all MD practice. I'm more than willing to participate in any study. Why are they not contacting us out there in the real world?

ASA

CRNAs are not the problem. We need qualified people to monitor the patients in a safe manner, so we can be at 3-4 different places at once. Seriously. The problem is CRNAs who dont understand their role. Their role is to monitor the patients in the or and conduct the course of anesthesia the way WE(anesthesiologist) want it to be done and the wy we deem it to be safe. Anything more is overstepping their boundaries and operating outside of what their role and job description is. That is the problem. CRNAs who feel they have seen enough or trained enough to do away with us. So they lobby, they commision poorly designed and flawed studies to try to sway the public and legislatures. But the fact still remains, it is OUR job to prescribe and design the anesthetic plan. Not theirs.

We still need the nurses so not training them is not the solution. the solution is to SUPPORT AAs and PAs to deliver anesthesia. we need to support this profession because they have consistently demonstrated that they support and advocate the team approach to medicine. when have you heard of a PA designing a study stating that they are better than physician. So, write the ASA. i do and did just last week and advocate opening up AA schools.. and retraining PA anesthetists to deliver anesthesia the way we prescribe.

 

[seinfeld]

CRNAs are not the problem. We need qualified people to monitor the patients in a safe manner, so we can be at 3-4 different places at once. Seriously. The problem is CRNAs who dont understand their role. Their role is to monitor the patients in the or and conduct the course of anesthesia the way WE(anesthesiologist) want it to be done and the wy we deem it to be safe. Anything more is overstepping their boundaries and operating outside of what their role and job description is. That is the problem. CRNAs who feel they have seen enough or trained enough to do away with us. So they lobby, they commision poorly designed and flawed studies to try to sway the public and legislatures. But the fact still remains, it is OUR job to prescribe and design the anesthetic plan. Not theirs.

We still need the nurses so not training them is not the solution. the solution is to SUPPORT AAs and PAs to deliver anesthesia. we need to support this profession because they have consistently demonstrated that they support and advocate the team approach to medicine. when have you heard of a PA designing a study stating that they are better than physician. So, write the ASA. i do and did just last week and advocate opening up AA schools.. and retraining PA anesthetists to deliver anesthesia the way we prescribe.

I agree. its not that they exist, someone needs to exist. I work in a decent size city in upstate NY but docs are not pouring in. Cant imagine what its like for patients in rural areas where getting anyone to provide anesthesia is a problem. How many people out there are wiling to do one month a year in a rural area to support the notion of Anethesiologist only care? This is what the politicians have to look at when they make these decisions. They have people who need care. Anesthesiologists are not jumping at the chance to practice in the UP of michigan, the adirondacks of NY, or rural montana.

Overall Its a matter of semantics and what is deemed appropriate for the job title. Look the chief of staff for the president knows just as much about what is going on in the white as the president, perhaps more, but he still doesn't get to make all the big decisions because thats not his job description. Interesting i dont have these conflicts when working with NPs and PAs in the ICU. There is no doubt that in the end my decision is the one. If CRNAs had better competition from any source they would not feel so bold.

I also agree that unless we as doctors can show we provide better outcomes then what leg do we have to stand on? The buzz words these days are quality metrics. We need to move toward being seen as physicians, in the traditional sense, within our hospitals and not just concerned about what time we get out and what kind of car we drive.

 

[WaveEquation]

CRNAs are not the problem. We need qualified people to monitor the patients in a safe manner, so we can be at 3-4 different places at once. Seriously. The problem is CRNAs who dont understand their role. Their role is to monitor the patients in the or and conduct the course of anesthesia the way WE(anesthesiologist) want it to be done and the wy we deem it to be safe. Anything more is overstepping their boundaries and operating outside of what their role and job description is. That is the problem. CRNAs who feel they have seen enough or trained enough to do away with us. So they lobby, they commision poorly designed and flawed studies to try to sway the public and legislatures. But the fact still remains, it is OUR job to prescribe and design the anesthetic plan. Not theirs.

We still need the nurses so not training them is not the solution. the solution is to SUPPORT AAs and PAs to deliver anesthesia. we need to support this profession because they have consistently demonstrated that they support and advocate the team approach to medicine. when have you heard of a PA designing a study stating that they are better than physician. So, write the ASA. i do and did just last week and advocate opening up AA schools.. and retraining PA anesthetists to deliver anesthesia the way we prescribe.

I know I'm just a student, but hear this point out. It seems that many CRNAs are the problem. They used to be benign, nicely controlled, and our host-relationship with them was mutually beneficial (symbiotic?). Now, they have transformed into a malignancy that needs to be destroyed. I vote we replace them with AAs and PAs. The CRNAs are always going to fight for what they once had...we need to remove them, and replace them with those that have never had the intoxicating-inappropriately-physician-like success, namely AAs or PAs willing to receive perhaps 2/3 of their salaries.

We can incorporate a cheaper business model for hospitals with teams consisting of MDs and AAs/PAs rather than MDs and CRNAs. Anesthesiologists need to be aggressive in perioperative management...NOT just the OR. That way, we are not replaceable by CRNAs because we do things outside of their realm (i.e. post-op care). If anything, hospitals realize they need both the OR help of CRNAs and MDs...but we present to them that CRNAs are replaceable with AAs and PAs.

Also, we need to conduct studies with a broader diversity of end-points such as various levels of AKI to demonstrate better post-operative outcomes of MDs relative to CRNAs.

CRNAs are not - for the most part - out to be team players. They are out to compete with anesthesiologists. It's pathetic and ridiculous. We need to take them on. We can beat them. If the ratio of MDs (anesthesiologists...NOT freaking "MDAs!") to CRNAs is 1:1, we have to get the ASA more powerful than the AANA. We have no excuse. It's time to band as brothers (and sisters) and unite as physicians for our common good.

 

[maceo]

I also agree that unless we as doctors can show we provide better outcomes then what leg do we have to stand on? The buzz words these days are quality metrics. We need to move toward being seen as physicians, in the traditional sense, within our hospitals and not just concerned about what time we get out and what kind of car we drive.

We dont need studies. TO design such a a study is foolish and immature not to mention unethical. We dont need two chiefs dictating the anesthesia. One person dictates the anesthesia (ANESthesioogist) and one delivers (CRNA). That model exists everywhere in medicine. Why is anesthesia different. there is not enough of us to dictate and deliver at the same time. just isnt. will never be. CRNAs are like hysterical adolescents who just are not happy with their station in life and start crying and having temper tantrums. And thats never pleasnat for anyone when an adolescent has a temper tantrum. especially if its out in the public.


SUpport AA legislation, donate to the Quad A write your local congressman. Lets get them recognized in every state. IN states that they are not recognized lets support PA anesthetists to be trained. We need a choice. the time has come. The time is now.

 

[sideways]

I hope you guys realize that the only way around your predicament is through legislation (or a huge ad public awareness campaign - probably the best approach). Any attempts at boycotts are just going to get bottom feeders to fill the spots. Say what you will about bottom feeders, but these bottom feeders are actual physicians or physicians-in-training - hardly a group that triggers the social radar branding of ne'er-do-wells. I doubt cries of "can you believe they're taking on the bottom quartile of medical students!!!" are going to be heard with much response.

Anyway, I'm not being raggy, I'm throwing out my observations. I have a feeling anesthesiology is going to be a growing interest of mine, and I'd appreciate if your profession gets its fuuucking act together.

Here's a thought: visible ads indicating that nurses are providing anesthesia to some people. Inform the public, THROUGH MEDIA, that anesthesiology is a specialty of medicine and many hospitals are using nurses trained in the delivery of anesthesia in an effort to save money. Ask the very simple rhetorical question: who would you rather rely upon to keep your husband, wife, mother, father, son, or daughter alive and healthy during their most medically vulnerable moments . . . a doctor or a nurse?

To be frank, I find the response of the anesthesiology leadership pathetic. And I can assure you I'm not alone. Many of my fellow medical student colleagues find the field very interesting, but we have, and currently are, sacrificing far too much to become physicians to piss it away and join a specialty that is completely resigning itself to extinction because the collective members of the specialty are either too spineless, too blind, or too uncreative to deal with a problem that is killing the specialty.

 

[WaveEquation]

I hope you guys realize that the only way around your predicament is through legislation (or a huge ad public awareness campaign - probably the best approach). Any attempts at boycotts are just going to get bottom feeders to fill the spots. Say what you will about bottom feeders, but these bottom feeders are actual physicians or physicians-in-training - hardly a group that triggers the social radar branding of ne'er-do-wells. I doubt cries of "can you believe they're taking on the bottom quartile of medical students!!!" are going to be heard with much response.

Anyway, I'm not being raggy, I'm throwing out my observations. I have a feeling anesthesiology is going to be a growing interest of mine, and I'd appreciate if your profession gets its fuuucking act together.

Here's a thought: visible ads indicating that nurses are providing anesthesia to some people. Inform the public, THROUGH MEDIA, that anesthesiology is a specialty of medicine and many hospitals are using nurses trained in the delivery of anesthesia in an effort to save money. Ask the very simple rhetorical question: who would you rather rely upon to keep your husband, wife, mother, father, son, or daughter alive and healthy during their most medically vulnerable moments . . . a doctor or a nurse?

To be frank, I find the response of the anesthesiology leadership pathetic. And I can assure you I'm not alone. Many of my fellow medical student colleagues find the field very interesting, but we have, and currently are, sacrificing far too much to become physicians to piss it away and join a specialty that is completely resigning itself to extinction because the collective members of the specialty are either too spineless, too blind, or too uncreative to deal with a problem that is killing the specialty.

What the hell is that about, Junior? The average Step 1 score for Charting Outcomes for Anesthesiology was 225 when the average nationwide score was about 220.

Not bottom quartile. My stats are sick, btw. And I'm not spineless, my balls are titanium. People tell me I should be a surgeon all the time. I tell them I'm not that stupid.

 

[sideways]

What the hell is that about, Junior? The average Step 1 score for Charting Outcomes for Anesthesiology was 225 when the average nationwide score was about 220.

Not bottom quartile. My stats are sick, btw. And I'm not spineless, my balls are titanium. People tell me I should be a surgeon all the time. I tell them I'm not that stupid.

I'm not referring to the stats of anesthesiology in general. I'm talking of attempts to convince applicants to boycott applying to programs training CRNA's. That won't solve **** and will only have uncompetitive applicants diving for the spots.

As far as your balls, with respect, from the current crop of medical students interested in your field, start using them.

 

[WaveEquation]

I'm not referring to the stats of anesthesiology in general. I'm talking of attempts to convince applicants to boycott applying to programs training CRNA's. That won't solve **** and will only have uncompetitive applicants diving for the spots.

As far as your balls, with respect, from the current crop of medical students interested in your field, start using them.

With respect to my "current crop of med students"...oh, yeah, which group of students is this...the group of students at YOUR medical school, the SDN group of students, or some other fanciful group of med students in your head. That's not the most enlightening comment. With respect, watch your attitude, or you'll find yourself isolated from everyone else as the one other people don't want to work with. This applies generally in life. The most successful are those that are either exceptional at what they can do and can afford to be full of it OR those that are very popular because a lot of people can work with them. You might not be in category 1, so be a little less offensive in your approach or you'll draw some fire.

 

[sideways]

With respect to my "current crop of med students"...oh, yeah, which group of students is this...the group of students at YOUR medical school, the SDN group of students, or some other fanciful group of med students in your head. That's not the most enlightening comment. With respect, watch your attitude, or you'll find yourself isolated from everyone else as the one other people don't want to work with. This applies generally in life. The most successful are those that are either exceptional at what they can do and can afford to be full of it OR those that are very popular because a lot of people can work with them. You might not be in category 1, so be a little less offensive in your approach or you'll draw some fire.

Save your life lessons. I don't need them. This is the internet - I'm choosing to be caustic. I do just fine in social interactions. Thanks.

EDIT: I'm referring to ALL current medical students *****. If that's not clear to you from the context of everything I've written so far, then you absolutely suck at reading.

 

[WaveEquation]

Save your life lessons. I don't need them. This is the internet - I'm choosing to be caustic. I do just fine in social interactions. Thanks.

EDIT: I'm referring to ALL current medical students *****. If that's not clear to you from the context of everything I've written so far, then you absolutely suck at reading.

No, you're an idiot for thinking you can assess all medical students interested in the field of anesthesiology. You suck at writing. You also come across as an abrasive piece of crap that I would knock through the wall. I'm sure you do very well socially especially given your ability to come onto a forum and sound like a complete DB of a MS3 and piss off other people.

 

[gaspassertw]

I think Emory only has AAs... not CRNAs. I was impressed with their leadership when I interviewed there last year.

 

[sideways]

No, you're an idiot for thinking you can assess all medical students interested in the field of anesthesiology. You suck at writing. You also come across as an abrasive piece of crap that I would knock through the wall. I'm sure you do very well socially especially given your ability to come onto a forum and sound like a complete DB of a MS3 and piss off other people.

This thread isn't about our pissing match. Not interested in the debate you're engaging me in. I'm more interested in the comments of Attendings and Residents on my initial post and their evolving strategy in dealing with nurses. That's it. Peace out.

 

[maceo]

Many of my fellow medical student colleagues find the field very interesting, but we have, and currently are, sacrificing far too much to become physicians to piss it away and join a specialty that is completely resigning itself to extinction because the collective members of the specialty are either too spineless, too blind, or too uncreative to deal with a problem that is killing the specialty.

hey sideways, love the movie.


hey dont go into anesthesia then if you are having reservations. i can assure you we have problems.. and more to come. but thats also medicine in general. so.... Anesthesiology is not going to be extinct. Do you really think NURSES who havent even taken a formal physics class is going to take you job away? seriously... cmon...

 

[ProRealDoc]

I agree. its not that they exist, someone needs to exist. I work in a decent size city in upstate NY but docs are not pouring in. Cant imagine what its like for patients in rural areas where getting anyone to provide anesthesia is a problem. How many people out there are wiling to do one month a year in a rural area to support the notion of Anethesiologist only care? This is what the politicians have to look at when they make these decisions. They have people who need care. Anesthesiologists are not jumping at the chance to practice in the UP of michigan, the adirondacks of NY, or rural montana.

Overall Its a matter of semantics and what is deemed appropriate for the job title. Look the chief of staff for the president knows just as much about what is going on in the white as the president, perhaps more, but he still doesn't get to make all the big decisions because thats not his job description. Interesting i dont have these conflicts when working with NPs and PAs in the ICU. There is no doubt that in the end my decision is the one. If CRNAs had better competition from any source they would not feel so bold.

I also agree that unless we as doctors can show we provide better outcomes then what leg do we have to stand on? The buzz words these days are quality metrics. We need to move toward being seen as physicians, in the traditional sense, within our hospitals and not just concerned about what time we get out and what kind of car we drive.[/QUOTE]


👍

 

[countingdays]

A billboard costs $1000-3000 a month. Now that's just about my entire salary as a fellow, but I bet some of you bigshot attendings could manage that. A group of 5 or 10 attendings could keep billboards up for as long as you want. So do it! Today!

 

[sideways]

hey sideways, love the movie.


hey dont go into anesthesia then if you are having reservations. i can assure you we have problems.. and more to come. but thats also medicine in general. so.... Anesthesiology is not going to be extinct. Do you really think NURSES who havent even taken a formal physics class is going to take you job away? seriously... cmon...

i have no idea man. all i know is what i read on this site. sure it seems very bizarre that nurses can squeeze out an entire medical specialty, but that very strangeness is what is making me say WTF is going on with what i read here? what in the hell has gone wrong to make this even a discussion? why is there even talk of ****ING NURSES taking over anesthesia? someone/something is failing the profession. who is it? what is it? find it and kill it is my rx. what other option is there?

 

[Dejavu]

Don't get caught up in the programs with the big names. Those programs often have many fellows as well as crna's that suck up the cases. The current talk on Mayo is, big name poor experience. Start thinking outside the box. Look at programs that have it all and don't sacrifice education or experience for prestige.

We have many discussions on the so called "Ivory towers" here. Search for them. I think Cleveland Clinic is probably one of the worst.

Without any desire to start something, I beg to disagree with part of this post. I would love to see the data behind the comment about Mayo's residency experience.

I invite anyone to talk to our residents. They will quickly debunk this comment about Mayo. A caveat...I only work at Mayo Rochester, so I can only comment about our program.

 

[seinfeld]

CRNAs are like hysterical adolescents who just are not happy with their station in life and start crying and having temper tantrums. And thats never pleasnat for anyone when an adolescent has a temper tantrum. especially if its out in the public.

I think your generalization is unfounded. I know a few surgeons and anesthesiologists who are not happy with their place in life and whine and have temper tantrums on a daily basis. The vast majority of crnas i have ever worked with are not militant, just like the majority of muslims are not terrorists. We should not fight extremism with extremism. Legislation is needed to ensure people stay within their job description.

I reiterate, unless we can prove that CRNAs are so unsafe as to preclude their use in situations where anesthesiologists are unavailable and unwilling to go, politicians will find it hard to leave their constituents without access to any form anesthetic care.

 

[maceo]

and debunk noyacs cleveland clinic theory you get more experience there.. than you will i think anywhere. they do every case imaginable many times over.. I interviewed there once, and i know many people that graduated that place.

 

[Bertelman]

I think your generalization is unfounded. I know a few surgeons and anesthesiologists who are not happy with their place in life and whine and have temper tantrums on a daily basis. The vast majority of crnas i have ever worked with are not militant, just like the majority of muslims are not terrorists. We should not fight extremism with extremism. Legislation is needed to ensure people stay within their job description.

I reiterate, unless we can prove that CRNAs are so unsafe as to preclude their use in situations where anesthesiologists are unavailable and unwilling to go, politicians will find it hard to leave their constituents without access to any form anesthetic care.

👍

 

[Noyac]

I reiterate, unless we can prove that CRNAs are so unsafe as to preclude their use in situations where anesthesiologists are unavailable and unwilling to go, politicians will find it hard to leave their constituents without access to any form anesthetic care.

This is not often the case. My hospital was listed by the governor as a critical access hospital. WTF. We have 10 full time anesthesiologists working here. We can cover more cases than the surgeons can book. There are another 4-5 anesthesiologists down the road. Neither of the two facilities employ crna's and neither wish to. Nobody in my community goes "without" anesthesia care. This opt-out is not entirely about access. It is about political agendas.

 

[Noyac]

The Univ of Colorado has also begun to privilege AA's. They still train crna's at the main hospital but not at Children's. This is a step in the right direction.

 

[Noyac]

Without any desire to start something, I beg to disagree with part of this post. I would love to see the data behind the comment about Mayo's residency experience.

I invite anyone to talk to our residents. They will quickly debunk this comment about Mayo. A caveat...I only work at Mayo Rochester, so I can only comment about our program.

Are you training crna's there? How about AA's?
Do crna's do regional? How about central lines? Are they in on the bigger cases while a resident is doing his or her 25th total joint? Do they get out at 3:30pm while a resident is kept late and sent in to relieve them?

These are some of the questions you guys need to ask while interviewing.

 

[Noyac]

I just realized that some of you may be misunderstanding my intentions here. I am not saying to stop using crna's. I'm saying stop training them at our facilities and start training AA's in their place if you need to train someone besides doctors. Let's get AA's privileged in every state.
These midlevels are a tool to be used to help physicians better care for patients. Stop training them to replace physicians.

If some of you feel defensive about this then please, sit back and think about why you are defensive here. Is it because I am completely wrong? Or is it because there may be some truth to what I am saying?

Just because there are a bunch a good crna's out there that enjoy their role in the ACT system doesn't mean we don't have a real fight on our hands. It is the few in the offices of the aana and in our political offices that don't feel this way. Lou Ann Willroy is the CEO of the Colorado Rural Health Center, she stated in 2003 that she not only wants to REPLACE physicians with nurses but that she thinks nurses are better. This is what we are dealing with people.

 

[maceo]

This opt-out is not entirely about access. It is about political agendas.

I agree with you. I knew it was a matter of time.

It is about political agendas. We have to play politics and play it better.

Every one of us should start thinking about whehter or not your state has AA legislation and if not why? If they dont write to you rcongressman and ask why. Furthermore, we should support having a way to train PAs to become anesthetists. This is a gem of a midlevel with broad training that can be tapped. THey are involved in many other medical specialties and there is no reason they cant be trained to become anesthetists..

 

[leaverus]

OK, someone please explain to me why AAs are so advantageous over CRNAs?? I don't mean NOW, i get that. I mean 20 yrs down the road, when AAs are clamoring for more scope of practice and $$ - because you know that's inevitable. I understand we need to protect ourselves now, but we also need to look out for the future of our specialty; i don't wanna be a sellout like the past scumbags who only cared about making a buck. BTW, i've never encountered an AA and i'm not even sure there are any in this state.

 

[Coastie]

Without any desire to start something, I beg to disagree with part of this post. I would love to see the data behind the comment about Mayo's residency experience.

I invite anyone to talk to our residents. They will quickly debunk this comment about Mayo. A caveat...I only work at Mayo Rochester, so I can only comment about our program.

You guys have a CRNA school, right?

I've heard that you don't allow regional, neuraxial, or central line placement for SRNAs/CRNAs. Is this true?

 

[Noyac]

OK, someone please explain to me why AAs are so advantageous over CRNAs?? I don't mean NOW, i get that. I mean 20 yrs down the road, when AAs are clamoring for more scope of practice and $$ - because you know that's inevitable. I understand we need to protect ourselves now, but we also need to look out for the future of our specialty; i don't wanna be a sellout like the past scumbags who only cared about making a buck. BTW, i've never encountered an AA and i'm not even sure there are any in this state.

First of all. AA's are trained to be an extension of the physician (probably someone here can say that better than me). They can not perform without a physician by law. I know that this was how the advanced practice nurses started out and look at where they are now but the political activity of PA's and AA's is quite different from nursing. Plus they are better trained and on average more intelligent than someone with a nursing background.

You are right, "what's to stop them from acting out in the future like the nurses are now?" I believe we have learned a hard lesson here with the nurses and how they refuse to put patients first in healthcare but would rather push their self indulging agendas. That doesn't mean that some physicians won't become lazy as they did in the past and give more and more opportunities to the AA's but at least we will have the experience to deal with it at the time. Their numbers are too small to mount a force like the nurses have. And if you have ever worked with one, they are different. They understand their role and they know their limits.

 

[Coastie]

CRNAs pick random physician names in random locales and try to connect them to anonymous docs on SDN.

What a child this militant murse is....They use thug tactics and legislative maneuvers to gain what they could never gain using old fashioned hard work, raw intelligence, and business smarts.

How the American people could want murses to practice solo medicine is beyond me.

 

[Noyac]

I agree with you. I knew it was a matter of time.

It is about political agendas. We have to play politics and play it better.

Every one of us should start thinking about whehter or not your state has AA legislation and if not why? If they dont write to you rcongressman and ask why. Furthermore, we should support having a way to train PAs to become anesthetists. This is a gem of a midlevel with broad training that can be tapped. THey are involved in many other medical specialties and there is no reason they cant be trained to become anesthetists..

maceo, we have a lot of work to do.

http://utahsurgeonsforsafeanesthesia.com/index.asp

 

[Endee]

And if you have ever worked with one, they are different. They understand their role and they know their limits.

I think this is important, and it all goes back to the training programs. Our profession's philosophy is to support the physician anesthesiologist. That is the role we learn in school and are happy to put into practice. All of my classmates and my program's recent graduates feel autonomous in caring for patients while still practicing fully in the realm of the anesthesia care team model, led by a physician anesthesiologist. We believe in that model, because it is the safest.

Supporting AA's is supporting physician led and directed anesthesia, because we in turn support anesthesiologists. Unlike supporting CRNA's, which is supporting someone who more likely than not was trained to believe they can do the job without you.

 

[smgilles]

You guys have a CRNA school, right?

I've heard that you don't allow regional, neuraxial, or central line placement for SRNAs/CRNAs. Is this true?

Very true, they aren't even allowed advanced airways (fiberoptics, etc). These are all done by the residents or the consultant if a resident is not available, since we often have more big cases than residents. With >100 OR's it's difficult to staff all of them with residents.

I will gladly debunk Noyac's assumption about Mayo (Rochester) for any medical student or resident thinking about a fellowship here.

 

[MRW]

As a current AA student, let me add another thing you can do to help the cause. Is your hospital training AA's? Why not contact one or all of the AA schools and tell them you want AA students to rotate through your hospital. You can take them under your wing for a month or two at a time and fill their (our) minds with some of your knowledge and ways of doing things.

 

[MRW]

BTW, i've never encountered an AA and i'm not even sure there are any in this state.

Do you live in one of the following states?
Florida
Georgia
Colorado
S. Carolina
N. Carolina
Alabama
Kentucky
Missouri
New Mexico
Ohio
Oklahoma
Vermont
D.C.
Michigan
New Hampshire
Texas
West Virginia
Wisconsin

 

[Bertelman]

OK. So I'm Joe Public. I understand that doctors have more education than CRNAs. I believe that is a valid point, and I want my mother to have the very best possible person delivering her anesthesia.

Tell me, why are anesthesiologists so excited about getting AAs into our hospitals? Do they have more education than nurses? Or are they just less threatening politically? If they don't have more education than nurses, or even worse, have less education than nurses, how is my mother going to benefit from that? What exactly does an AA have that a CRNA does not?

 

[countingdays]

OK. So I'm Joe Public. I understand that doctors have more education than CRNAs. I believe that is a valid point, and I want my mother to have the very best possible person delivering her anesthesia.

Tell me, why are anesthesiologists so excited about getting AAs into our hospitals? Do they have more education than nurses? Or are they just less threatening politically? If they don't have more education than nurses, or even worse, have less education than nurses, how is my mother going to benefit from that? What exactly does an AA have that a CRNA does not?

As I understand it,
It's based on the assumed future choice between a crna alone or an aa-md care team. Your mother would be better off with a care team than with a nurse pretending to be a doctor.
It's also based on the idea that nurses will be reminded that they are midlevel, not doctors, if they can be replaced by aa's. If they are easily replaced, they might quit trying to award themselves md's through court cases and legislation.
AAs also offer the advantage of not removing nurses from regular nursing jobs. With most reasonably good nurses leaving nursing to be pseudo doctors, crna's apn's, your mother's nursing care will suffer.

 

[cchoukal]

As I understand it,
It's based on the assumed future choice between a crna alone or an aa-md care team. Your mother would be better off with a care team than with a nurse pretending to be a doctor.
It's also based on the idea that nurses will be reminded that they are midlevel, not doctors, if they can be replaced by aa's. If they are easily replaced, they might quit trying to award themselves md's through court cases and legislation.
AAs also offer the advantage of not removing nurses from regular nursing jobs. With most reasonably good nurses leaving nursing to be pseudo doctors, crna's apn's, your mother's nursing care will suffer.

I've never seen anyone make this comment, so I'll say what I've been thinking for years. I don't think there's any good reason to think that PAs or AAs will be any more content than CRNAs to continue to practice under supervision. Do they not have aspirations beyond supervised practice? Do they not have a lobby in congress? Will they not eventually gain sufficient experience to feel like they no longer need physician supervision? Aren't we just trading one problem for another?

 

[Noyac]

I've never seen anyone make this comment, so I'll say what I've been thinking for years. I don't think there's any good reason to think that PAs or AAs will be any more content than CRNAs to continue to practice under supervision. Do they not have aspirations beyond supervised practice? Do they not have a lobby in congress? Will they not eventually gain sufficient experience to feel like they no longer need physician supervision? Aren't we just trading one problem for another?

Correct me if I'm wrong but I've never seen the PA's lobby standing in front of congress tell the members that they are as good as the doctors they work with and that congress should give them independence. PA's have been working in the healthcare industry for quite some time now. They aren't asking for independence. AA's are the same.

 

[maceo]

OK. So I'm Joe Public. I understand that doctors have more education than CRNAs. I believe that is a valid point, and I want my mother to have the very best possible person delivering her anesthesia.

Tell me, why are anesthesiologists so excited about getting AAs into our hospitals? Do they have more education than nurses? Or are they just less threatening politically? If they don't have more education than nurses, or even worse, have less education than nurses, how is my mother going to benefit from that? What exactly does an AA have that a CRNA does not?

great question. people can correct me if i am wrong but AA/PA schools almost require the same requirements to get into medical school and many if not all take the mcat. Thus, they have a more broad science backround and a stronger undergrad education more suitable then nursing for medical decision making. NUrses dont even take real chemistry or physics classes. And lastly, I believe AAs have more academic humility which is essential I repeat essential for lifelong learning and improvements. Crnas know everything before they even start school. Dumb asses. they dont even know what they dont know.

So i believe your mother would be well served by having an AA as part of the team taking care of her the above being a few among many.

 

[maceo]

I've never seen anyone make this comment, so I'll say what I've been thinking for years. I don't think there's any good reason to think that PAs or AAs will be any more content than CRNAs to continue to practice under supervision. Do they not have aspirations beyond supervised practice? Do they not have a lobby in congress? Will they not eventually gain sufficient experience to feel like they no longer need physician supervision? Aren't we just trading one problem for another?

Just look at the Physician Assistants now in other specialties. are they clamoring for independence? Are there studies showing that PAs are better than physicians? are more cost effective? I dont know of any do you? The crnas are yelling and screaming that theyve been doing anesthesia for a hundred years before we even started doing anestheisia. My retort.. there is a reason we got involved in anesthesia in the first place. There is a reason why it is a medical specialty.

 

[Noyac]

OK. So I'm Joe Public. I understand that doctors have more education than CRNAs. I believe that is a valid point, and I want my mother to have the very best possible person delivering her anesthesia.

Tell me, why are anesthesiologists so excited about getting AAs into our hospitals? Do they have more education than nurses? Or are they just less threatening politically? If they don't have more education than nurses, or even worse, have less education than nurses, how is my mother going to benefit from that? What exactly does an AA have that a CRNA does not?

I'm gonna give you my honest answer. Just like I told the ASA representatives I've been talking with all week. If you want the best care for your mother then have an anesthesiologist that you know and trust do the case. There is no better way.

I understand that there are not enough of us to cover all locations so therefore the ACT model has gained ground. It's better than nurses working independently since this way they are supervised and the cases all get covered. Now lets just replace the nurses with specialty trained AA's. We still need to supervise but at least there is a cordial relationship there. AA's may or may not be better than nurses but at least they are not rouge providers with a false sense of achievement.

The ACT model is not the best model. An all MD model is better. But unfortunately that is not possible everywhere.