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A Terrible Blow to Academia
Started by Orchard
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Unbelievable. I guess anesthesia academic medicine is just going to have to crumble away before any changes are made.
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Hate to have to bring it up, but the AANA used their political connections to make this happen.
militarymd said:
Can someone tell me why we line up to train these guys when they pull this kind of sh#t all the time? And why the hell doesn't the ASA do something about it? I mean, I am not trying to say get rid of them, but why the hell do we train them? Let them train each other....
...Just because you get to f-ck me up the a s s, doesn't mean I gotta like it too!
Xclamp said:
Good question. I would like to hear from folks in here who hire CRNAs. It amazes me to see that people are smart enough to be outstanding doctors and clinicians, but fail to use their insight when it comes to fattening their wallets. I mean they fail to see that by traning CRNAs they are just handing the specialty over to them since, eventually, they will outnumber us and we will have, in fact, given up our place in the OR all in the name of money.
Why can't people just realize this? At times, I wish I had the ability to cane people's ass like they do in Singapore when I see them doing this s**t.
And don't give me this BS about me being just a med student and not knowing how the real world works because it doesn't take a genius to realize how things got to be the way they are.
If I was the ASA president, I would spend my time learning how one gets to be part of that CMS committee and recruiting a group of anesthesiologists and making sure I support them financially,pay them 800K each to get them run for a seat, become part of that committee and change that dumb rule. I bet you the AANA already has people there doing just that. That's how you play the game, not sending letters that are getting shredded by the AANA member sitting on the CMS board.
It is a business.
It doesn't make sense for me to be sitting in a 3 hour breast reduction (staring at the monitors and charting vital signs) when I could be doing other things....starting cases, preop patients, handling consults, etc.
It doesn't make sense for me to be sitting in a 3 hour breast reduction (staring at the monitors and charting vital signs) when I could be doing other things....starting cases, preop patients, handling consults, etc.
In some form or another, this has been discussed at length with me on every rotation in anesthesia and every interview so far. Academic attending MDA's are allowed to bill at about 40%, I think, when supervising two rooms. Considering payment is about 50%, academics looks at about a 20% recoup, apparently. Surgeons, on the other hand, can bill 100% for each case, even if they let 10 different residents run 10 different rooms and are only there for the 'important' parts, unlike MDA's, who are only supposed to be there for induction, emergence, and any problems, right? 🙄
I would have to argue that the ASA is potentially a much more powerful lobby organization than the AANA. Am I wrong?
I would have to argue that the ASA is potentially a much more powerful lobby organization than the AANA. Am I wrong?
Idiopathic said:
Not without more support and funding from its constituents. BTW, I just renewed my membership in the ASA with a $1,000 donation ASAPAC today.
militarymd said:
Mil,
I hear ya bro...and believe me I know it's a WASTE for a MDA to sit in the eye room all day when he/she can cover a couple different rooms with nurses/AA's, but these guys (AANA) are taking this **** to a whole different level. It's all about gettin' the biggest piece of the pie as you can, I understand that. The thing that chaps my a s s is they are always trying to undermine our efforts in the OR. Some are good and fun to work with (usaully more junior level) and some don't listen to a goddam thing you say. It's not ME MD YOU NURSE, but it's my f#ckin' responsiblity my hide my name at the top of that chart. You can't have it both ways.
This is not about swining d#icks and seeing which one of ours hangs lowest, it's about liability. I agree it's a very complicated issue, and can't be easily solved.
UTSouthwestern said:
That $1000 donation should be mandatory for all anesthesiologists, $300 for residents since they benefit too for all the ASA accomplishments.
Following your lead, I just donated $200 since this is important to me.
'Thank You, your contribution of $200 has been made.
Please save this for your records
Contribution Amount: $200
Transaction Number: VKVA0D5E****'
Though the AANA may have lobbied against this don't believe the AANA alone has the power to crush this proposal. Had the groups bit their tongues, combined lobbying efforts on this one issue, and worked together it probrably would have passed. I know anesthesiologists at many institutions that I train were very upset that the ASA took a do it alone stance that possed a greater risk of failing as opposed to a unilat front that had a much better chance of approval. I think the pride definetly hampered a good thing that could have benefited both sides for once. Instead it was the same old them and against us mindset with the same results = nothing positive for either side.
Most CRNA programs train within private practice anesthesiology groups. Going in on it together would have financially benefited many of your associates greatly.
I dont know what its going to take for each group to realize that both are here to stay and both groups are aggressive as hell. Policy, especially pertaining to reimburstment issues will continue to arise and as long as one group doesn't include the other leading the other to not support it, then we will all get the same results. This post is not at all ment to be bashing in anyway, just stating that if the two groups would just work together on just a few things than both groups can get what they want, as opposed to spending a ton of lobbying money and getting no result. It doesnt seem to complicated, someday the boxing gloves will just have to come off for a round and the two groups work together to get major policy changed.
Pride though a good thing to have, sometimes has adverse effects.
Most CRNA programs train within private practice anesthesiology groups. Going in on it together would have financially benefited many of your associates greatly.
I dont know what its going to take for each group to realize that both are here to stay and both groups are aggressive as hell. Policy, especially pertaining to reimburstment issues will continue to arise and as long as one group doesn't include the other leading the other to not support it, then we will all get the same results. This post is not at all ment to be bashing in anyway, just stating that if the two groups would just work together on just a few things than both groups can get what they want, as opposed to spending a ton of lobbying money and getting no result. It doesnt seem to complicated, someday the boxing gloves will just have to come off for a round and the two groups work together to get major policy changed.
Pride though a good thing to have, sometimes has adverse effects.
Reminds me when I was runnin' around giggin' some locum tenens jobs in Florida and the medical community was whining about the medical malpractice insur. problem in Fl. Those little whinnin' primadonnas wailed for more PAC money to the AMA and FMA and county medical societies. Write letters to your congressman and travel to Tallahassee to march on the steps of the capitol. Yada, yada ,yada. Some stopped their practices for 1 whole day! WOW, like that 's going to do something. The little primadonnas needed to stop working for 30 days!! Zip was game but the other little piano
-handed wussies couldn't hang with that concept. Zip would bring them mofos to their knees in quick fashion. ---Zippy
-handed wussies couldn't hang with that concept. Zip would bring them mofos to their knees in quick fashion. ---Zippy
zippy2u said:
👍
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nitecap said:
You have no clue what you are talking about. The AANA chose to sabotage this effort and when you say if the two groups would just work together, you should add "on the positions of the AANA." The AANA does not compromise to "benefit all." The AANA would just as soon see the ASA crumble and all anesthesiologists out of the workplace.
Hard tactics call for hard tactics. So be it.
Thats the attitude Im talking about. Actually the AANA was for this as long as language was inserted to address similar issues concerning SRNA training and reimburstment. The language was not added therefore the AANA did not support it. The AANA was more than willing to support the proposal had it included the language, it did not therefore the AANA legally lobbied against it. Why not just include the lang. and get what you want that is overall going to benifit anesthesiology greatly. Instead it was just money spent on nothing. Thats all Im trying to say, sometimes you have to make sacrafices that you may not like to get things that you really want. Seems all just missed the boat here.
UT's attitude is right on and comes from the fact that the AANA stabbed us in the back!! They agreed to stay out of the issue, then went behind the scenes to sabotage the effort. 😡
The root of the problem comes from the false idea that CRNAs are equal with MDAs in providing anesthesia care. That is simply false. The AANA's official position is that CRNAs can provide equal care that an MDA can. This position is fundamentally flawed as CRNAs cannot provide equal care because they don't receive equal training (med school or residency) that MDAs receive.
Studies show that overall, patient outcome is not affected by CRNAs providing care, however this is due to the fact that a MDA is there to help them out if they get in hot water. For run of the mill cases, most individual CRNAs are fine and they do a great job. Most of the time, they know their place and the limits of what they can and should do in terms of patient care. It's the political rhetoric that comes down from the national level that is poisoning the issue. When the AANA determines and makes it their official position that CRNAs are equal to MDAs in providing anesthesia care, that falsehood must be fought and that flawed position changed.
We can "all get along", but the AANA has to yield on this issue. Compromise is not going to work because in the end, CRNAs cannot provide anesthesia care equal to MDAs. If you believe that, compromise patients, you will. 👎
The root of the problem comes from the false idea that CRNAs are equal with MDAs in providing anesthesia care. That is simply false. The AANA's official position is that CRNAs can provide equal care that an MDA can. This position is fundamentally flawed as CRNAs cannot provide equal care because they don't receive equal training (med school or residency) that MDAs receive.
Studies show that overall, patient outcome is not affected by CRNAs providing care, however this is due to the fact that a MDA is there to help them out if they get in hot water. For run of the mill cases, most individual CRNAs are fine and they do a great job. Most of the time, they know their place and the limits of what they can and should do in terms of patient care. It's the political rhetoric that comes down from the national level that is poisoning the issue. When the AANA determines and makes it their official position that CRNAs are equal to MDAs in providing anesthesia care, that falsehood must be fought and that flawed position changed.
We can "all get along", but the AANA has to yield on this issue. Compromise is not going to work because in the end, CRNAs cannot provide anesthesia care equal to MDAs. If you believe that, compromise patients, you will. 👎
Look Im not comparing either profession, im just stating the facts about the current issue. The ASA new that the AANA was not with them when the language they wanted was not included. Yes originaly AANA was all for it, but the two could not reach a comprimise. The ASA was not stabbed in the back, they were stabbed in the front. They knew that they did not have the support of the AANA.
Not ranting about who is better mumbo jumbo. Just stating that it is sad the two professional organizations couldnt reach a comprimise, agree on something, get the proposed changes passed, both reeping finacial benefits, and then after they could have gotten back to the normal soapopera drama they are used to and love so much.
Not ranting about who is better mumbo jumbo. Just stating that it is sad the two professional organizations couldnt reach a comprimise, agree on something, get the proposed changes passed, both reeping finacial benefits, and then after they could have gotten back to the normal soapopera drama they are used to and love so much.
Xclamp said:
I work with some CRNAs who have done anesthesia longer than I have been alive. We have mutual respect for each other.
I work with some recent grads.....too new to have an attitude.
There are some who are my age......wow...talk about a chip on their shoulder....these are the ones who will denigrate other CRNAs....the new grads and senior experienced folks.
What are you going to do??? I just want the OR to run smoothly.
I can understand your aggrevation if an employee or co-worker of yours has a chip of their shoulder and the work day is not running smoothly. NOt sure how things run so smoothly at the program I attend.
On one hand we have the Anesthesia residency program with at least 10-13 attendings, 20-30 residents that all have egos of course, all pumped up and excited to do what they do ya know. Faculty is very into the ASA and all politics involved.
In the same hall we have the CRNA program 40 students, about 10 attending CRNA faculty. All with egos, all excited to do what they do.
Faculty are presidents of AANA state associations, and sit on a ton of AANA committees.
Despite these vast differences the two programs coexist and have for decades. The thing is politics is not brought into the OR or anywhere in the work environment. What one wants to do, teach or support is done on their own time and not in the work place.
At the hospitals its all about the patient and the learning experience. Its all about doing the best you can, the safest you can, the most efficient you can. Politcal agenda and jargon is not tolerated by either directors of either the residency or srna programs. I believe that this can be modeled by all. SRNA's and Residents I find especially on this board to be very emotionally attached to their beliefs and supports and are quick to flame at the mouth, me included. However this is never a problem at work. We take call, assist each other ect.
Of course their is always some undercover competition going on between say senior SRNA's and upper level residents trying to turn the rooms over faster. Trying to have faster extubations ect. ****tt we even play anesthesia jeapardy as SRNA's/CRNA's vs residents at least once every few months. Every once in a while we take some of their written tests and they take ours just for reviews.
In the private practice why cant you just hire a person and say from date of hire listen we are all about the patient and the practice here and give fore warning that politics and crap is not allowed in the OR area by neither profession. It seems as though if rules were in place or at least a work culture or climate that didnt allow it, you may not have issues like this. Again I know nothing about the ends and outs of private practice I just know that if a residency and crna program can exist within the same hallway and classrooms and OR's, and each filled with intensly politically active people of both sides, than a private practice can exist in the same way.
You should reprimand the CRNA and tell him his work ethic and attitude is unacceptable straight up.
On one hand we have the Anesthesia residency program with at least 10-13 attendings, 20-30 residents that all have egos of course, all pumped up and excited to do what they do ya know. Faculty is very into the ASA and all politics involved.
In the same hall we have the CRNA program 40 students, about 10 attending CRNA faculty. All with egos, all excited to do what they do.
Faculty are presidents of AANA state associations, and sit on a ton of AANA committees.
Despite these vast differences the two programs coexist and have for decades. The thing is politics is not brought into the OR or anywhere in the work environment. What one wants to do, teach or support is done on their own time and not in the work place.
At the hospitals its all about the patient and the learning experience. Its all about doing the best you can, the safest you can, the most efficient you can. Politcal agenda and jargon is not tolerated by either directors of either the residency or srna programs. I believe that this can be modeled by all. SRNA's and Residents I find especially on this board to be very emotionally attached to their beliefs and supports and are quick to flame at the mouth, me included. However this is never a problem at work. We take call, assist each other ect.
Of course their is always some undercover competition going on between say senior SRNA's and upper level residents trying to turn the rooms over faster. Trying to have faster extubations ect. ****tt we even play anesthesia jeapardy as SRNA's/CRNA's vs residents at least once every few months. Every once in a while we take some of their written tests and they take ours just for reviews.
In the private practice why cant you just hire a person and say from date of hire listen we are all about the patient and the practice here and give fore warning that politics and crap is not allowed in the OR area by neither profession. It seems as though if rules were in place or at least a work culture or climate that didnt allow it, you may not have issues like this. Again I know nothing about the ends and outs of private practice I just know that if a residency and crna program can exist within the same hallway and classrooms and OR's, and each filled with intensly politically active people of both sides, than a private practice can exist in the same way.
You should reprimand the CRNA and tell him his work ethic and attitude is unacceptable straight up.
Reimbursement for residents and nurse anesthesia students under CMS are entirely different issues. They're not part of the same subset of regulations. As I understand it, both organizations were going to support each other in their OWN efforts at payment reform. Not only did the AANA not support the changes in resident payments, they actively campaigned against it. Payments regarding SRNA's is an entirely separate issue with an entirely different set of regulations to be addressed. The ASA was still willing to support those changes. I'll bet they don't now. The lack of good faith on the part of organized nurse anesthesia is appalling, and the backlash has already started.nitecap said:
UTSW has it 100% right.
toughlife said:
If you are indeed a medical student.. YOu have wisdom beyond your years.. I didnt figure out what was going on until i was a 2nd year anesthesia resident.
I was in training with a crna program.. What insolent sons of bitches.. They want complete practice autonomy. thats pretty bold for the level of education they possess. gettting back to the point, that is what was going on in the 80s and 90s. Practices would hire all crnas and supervise t hem to make more money. This created th ebeast. So eventually they say to hospitals that they are cheaper and more cost effective etc..
I am in a all MD practice. I would urge more people to join all MD practices, encourage resident education, and (even though im not an ASA member because i was so pissed at them) support the ASA. I think I will become more involved because this has to stop. Residents spend a lot of time becoming trained; its not fair when they graduate they have to compete with nurses who say they are equal and have legislation to back them up.
militarymd said:
IT makes sense because that is YOUR job. Staring at the monitors for three hours. ANd maybe 5 hours if thats what is needed.. IF you didnt like it you shouldn't have become an anesthesiologist.
nitecap said:
I am at a University program with CRNAs and SRNAs (please call um residents). Either you are at a truly special program or you are full of @*&it. The senior residents here spend thier days doing hearts, AAAs, complicated Neuro etc. The CRNA/SRNAs do NONE of these cases here. Whats the point of seeing who can extubate faster?? Extubate the patient when the are ready, especially when you have a complicated patient. And the residents gather to take the nurse anesthesia exams?? I call your bs.
As for the issue at hand, it has nothing to with the nurses. Medicare reimbursement IS unfair to our attendings and departments, esp when compared to the reimbursement rules for surgery and medicine atttendings. If the AANA has lobbied to undermine this effort for change then thats really unfortunate. Its time for the ASA to get off the high road and take this org to task.
If you're not a member of the ASA, I hope you'll reconsider - the arguments may get tossed around on this website, but the ASA is the organization that is actually fighting your battles for you, whether you're a member or not. The AANA has a much higher percentage of it's practitioners as dues-paying members than the ASA. Involvement is the key - financially as well as your time. Not everyone is a political junkie, but EVERYONE has the time to write letters and emails, and EVERYONE needs to be aware of the issues. I'm an AA, but I'm a member of the ASA and GSA as well as my own association, and am constantly writing emails, letters, and even articles about this very topic.davvid2700 said:
davvid2700 said:
Amen!
Typical american mentality of "I am too good to do that job". I am amazed at americans' attitude about work. It's like they are too good to do anything. What is this crap about "I won't do this job because it pays less than the half a million that I am used to making or not enough to support my jetsetting lifestyle", Bulls**t!
Why in the hell do you think people from other countries continue to come here in hoards looking for jobs? Not because they like americans or they want to live in this materialistic, money-driven society but because they know people here refuse to do jobs they considere beneath them. Granted they are ****ty jobs but still. Now use that logic and apply it to militaryMD's comment about not being worth his time sitting in the OR charting vitals and you have a perfect millieu for a CRNA takeover.
If I was the anesthesiologist making 350K, I would even sweep and mop that god damn OR after every case to show them how much I like my job and how hard I am willing to work at it to keep it.
Come on people, get over that god damn apathy and think about other things besides business and money before it's too late.
I hear all residents bitch about nurse anest all the time and then smile politely when they are relieved for lunch or a break by them.. do you ever see anyone come in and relieve the surgeons during the case? NO!
One of the residents I work a lot with, whom I have a great deal of respect for, won't even answer them when they come in the room. A few times he has told them to get the f' out. Take some ownership of your patient and your career. Maybe if hospital management sees 10 nurse anesth in the lounge while residents are plugging away they won't pay them or train them anymore. I for one would rather sit on my ass, starve, get home late and watch the end-tidal CO2 roll by then ever let f'in nurse relieve me so I could get to my little juan burrito...
as far as private practice I think Mil hit it on the head "it's a buisness". money talks and bs walks - so i won;t go there. but as a soon to be resident i will be a total f'in prick to these leeches. go to medical school if you think your a doctor - oh wait you couldn't get in.
One of the residents I work a lot with, whom I have a great deal of respect for, won't even answer them when they come in the room. A few times he has told them to get the f' out. Take some ownership of your patient and your career. Maybe if hospital management sees 10 nurse anesth in the lounge while residents are plugging away they won't pay them or train them anymore. I for one would rather sit on my ass, starve, get home late and watch the end-tidal CO2 roll by then ever let f'in nurse relieve me so I could get to my little juan burrito...
as far as private practice I think Mil hit it on the head "it's a buisness". money talks and bs walks - so i won;t go there. but as a soon to be resident i will be a total f'in prick to these leeches. go to medical school if you think your a doctor - oh wait you couldn't get in.
MAC10 said:
We train at many different facilities within the med center hear. Some seniors here and there and all over. I didnt even mention senior residents either, I said upper level (not first years). Look I have no problem with any resident, I go out when we are all off together. Though seniors are spread out many are still at our main hospital, all are cool for the most part. They love what they do and love to teach what they know so I am all ears.
And JWK CMS regs for Residents as well as SRNA's are not all that different here are regulations for Texas:
Code of Federal Regulations
Title 42. Public Health
Chapter IV: CMS, DHHS
Part 414. Payment for Medicare Part B Medical and other services
Subpart B. Physicians and other Practitioners
414.46
Physician working with only two residents
Maximun Ratio 1:2 Residents only. Base units for both cases
Time units for documented face to face time in each case
Here is CRNA's part that would have benefited Anesthsiologist
it is in same place.
414.46 Additional rules for payment of anesthesia services
medical direction
Maximum ration 1:4 (CRNA, resident, Intern, AA)
SRNA maximun ratio 1:2
MD=50% total units
See the unit ratios are in the same section addressing both SRNA and Residents. From what I hear on this side is that both organizations were at the table discussing the issue. AANA said that we support it 100% if the language is changed to also up SRNA reimburstments equally as well. ASA refused so AANA pulled out and lobbied against it.
So no JWK its not all that seperate. As you can see guidlines for SRNA and residents are both in the Code of Federal Regulations, title 42, chapter IV, CMS part 414.46. The language easily could have been changed and the change most likely would have passed. Then all the anesthesiologits across the country, even those not associated with residency programs that train CRNA's could have reeped the financial benefits. This is a fine example of what happens when the 2 groups cant work together even when their is something on the line that will totally and absolutely help both sides as well as the field in general. With more money their are more providers, more research and innovation and just happier people overall.
Im not saying that this is any one sides fault, I think they are both to blame for being stubborn and not putting their pride aside just for one issue. You guys are evidently very involved in the ASA and perhaps some of you younger residents and practitioners will be future leaders of the ASA. I myself will be the same within the AANA. I sure hope we can learn from the mistakes of our current leaders and at least step up and come togther when these future issues arise again. It just seems plain stupid, earlier posters complained that their attendings are getting ripped by medicare, well if the 2 could have worked together their might just be a little hope. The AANA again did not stab anyone in the back, the ASA refused to make changes that would effect SRNA's therefore the AANA backed out. Had the AANA went ahead with the support despite no language addressing SRNA reimburstment, can you honestly say that the ASA would have supported a AANA change to the regulations concering SRNA's in the future. With the history between the 2 organizations I find that highly unlikely.
And listen I am not pushing a political agenda here, I have been quite as all hellll lately. But some people here just need facts. With Residents and others thinking that the AANA stabbed the ASA in the back without the ASA knowing anything that is just not the case and it only leads to an even more hostile future relationships. The ASA knew very well that the AANA was not on board before the language was submitted.
Hockeyguy said:
That would last about a week. If nurse anesthesia is the only relief, take it. Otherwise you will starve all day. The difference between you and surgery dude is that when the case is done he is going down to the cafeteria while you are hustling to get your room turned over, drugs and see the next patient. Hey gotta eat and piss sometime. If you choose not to say more to um then you have to then thats your choice.
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Just a thought, but at the places I rotated at last year, the residents get lunch breaks by the attendings. If the attendings aren't even stepping in for 30 minutes for each resident, and instead relying on CRNAs to do that, maybe there isn't enough supervision going on anyways. The end of the day is a different matter, that was CRNA relief everywhere I visited.
Regardless, I feel the sentiments by UTSW and others are right on. We need to draw a line in the sand and defend our turf. This is either going to be a turf battle in coming years or a hostile takeover, one or the other. I think the generation that is coming in recognizes the stakes because we have never had it sweet in private practice like in past days. The people who are in the biz right now need to make some tough calls and stand up strong for the profession of anesthesiologist, or there will be nothing left for our generation to fight for when it is our turn.
Regardless, I feel the sentiments by UTSW and others are right on. We need to draw a line in the sand and defend our turf. This is either going to be a turf battle in coming years or a hostile takeover, one or the other. I think the generation that is coming in recognizes the stakes because we have never had it sweet in private practice like in past days. The people who are in the biz right now need to make some tough calls and stand up strong for the profession of anesthesiologist, or there will be nothing left for our generation to fight for when it is our turn.
Hockeyguy said:
Not talking to someone ia a bit immature, dont you think? Your resident (as well as this entire thread) is a great way to study for the psych section of the boards. Self defence mechanisms:
Displacement: Transferring anger towards the people that hire the CRNAs towards the individuals themselves.
Splitting: All CRNAs are terrible people and are the enemy
Sublimation: Skipping lunch and dinner to protect the patients from the CRNAs
Ok, so I'm no psychiatrist. 🙂
But being mean to people doesnt solve anything, demanding that your professional organization representing you not roll and agressively takes on a fight and makes a strong case to its members and potential members that action is needed to gather up funds seems a more useful and constructive way to get what you want.
blocks said:
Lunch breaks are usually given by nurses(except in heart room) or other residents. Attendings are usually supervsing 2 rooms at the same time and need to be able to float around if something goes wrong.
BTW, anyone checked out aana.com recently. Intersting, I saw like one educational link and alot of political bs. I wonder...when the nurse anesthesias get their doctorate of nursing, are they still going to be nurse anestheisa or are they going to be Certified Reigistered Nurse Doctors? Im confused already.
Hmmm...I just remember the places where I was, the attendings would be in the room for breaks and from a student perspective that would be the best time to be one-on-one and let the attendings get to know you. Granted, these were places where I think that CRNA's played a more limited role than others. Guess it varies from residency to residency.
MAC10 said:
Actually, I think the official title is Certified Registered Acknowledged Recognized Nurse Doctor Anesthetist Doctor, Esquire, LTD., Copyright MMV
Actually they are debating a name right now. Some suggestions are Doctorate of Nurse Anesthesia, Doctorate of Advanced Nursing but no one is even near a name. Their will also be specific regulations that will not allow one who is a Doctorate CRNA to use the word doctor in the clinical setting. It will only be used in the educational setting. They realize this would be confusing and that is the last thing they want. They do not in any way want to tie the two professions together. Anesthesiologist practice is regulated by the boards of medicine and CRNA boards of nursing.
MAC10 said:
Well he is a CA-3 so he lasted more than than "about a week".
I am a rookie here(pgy1) It seems like there is a pretty easy solution. MDAs pretty much control the anesthesia department and all the university medical centers in the country and control a majority of the contracts with the private hospitals. Why not speed up the process of opening more AA schools, support them in greating practice rights in all 50 states, and make it a habit to hire them instead of nurses. Problem solved. Try to open 5-7 new AA schools/year for the next 8-10 years make them university based within the medical school.
This would greatly weaken the AANP as a lobby and it would be much better for us we would had a midlevel provider that is commited to the team approach that would not be underminding us.
just my $.02
This would greatly weaken the AANP as a lobby and it would be much better for us we would had a midlevel provider that is commited to the team approach that would not be underminding us.
just my $.02
UTSouthwestern said:
EXACTLY!!! Money talks and all else walks in the political world. CRNAs are able to get their way for the most part by contributing very nicely to these politicians...and more power to them! What MDAs need to do is quit talking crap and contribute to the ASA so that WE can pay these same politicians to help our cause. Bottom line is if we don't unite and start fighting back with our wallets instead of our wits, the CRNAs are going to continue to bend us over! By the way, I am only a MS-IV applying to anesthesia for next year and I have given $200 to the ASA....not much, but I can't afford too much right now during interview season! I sure as hell care about the field I am going to dedicate my life to and I'm just not going to sit around hoping that other people will walk the walk. Right now, the CRNAs are talking the talk, but they are also walking the walk. We must unite!
davvid2700 said:
I chose anesthesiology as a stepping stone to critical care medicine. I completed a fellowship and have become board certified in both.
Intensivists don't sit in the ICU and stare at the monitors for hours on end, and we take care of the sickest patients in the hospital.
Intensivists measure successful outcomes in survival...patient mortality can be as high as 100%, depending on cause of admission....
Whereas, the OR stuff....we're measuring outcomes in % of PONV??? Where the vast majority of the patients do extremely well...essentially zero percent mortality, and in this environment, you say we need to be one on one????
Come on, that makes no sense.
Don't get me wrong, I enjoy being in the OR, however, it makes no economic/medical sense to stay in just one OR.
That 25 year old ASA 1 undergoing a hernia repair under GA just does not need a physician to sit there and chart vital signs. That is a waste of resources.
However, if you have the luxury of having all these doctors available to chart vital signs, that's great.
I believe a lot of CRNA/MD practices start because of inability to recruit enough MDs. A situation that I am in right now.
That 25 year old ASA 1 undergoing a hernia repair under GA just does not need a physician to sit there and chart vital signs. That is a waste of resources.
However, if you have the luxury of having all these doctors available to chart vital signs, that's great.
I believe a lot of CRNA/MD practices start because of inability to recruit enough MDs. A situation that I am in right now.
militarymd said:
man... you should join the aana
the 25 yo healthy patient au contraire is exactly the patient that needs and deserves an MD present to chart vital signs
If you pay enough money MDs will come.. There are all MD practices with 50 MDS.. Cedars sinai in Los Angeles is an all md practice of like 100 mds... pretty impressive
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driverabu said:
Good job.. You are in medical school and also a budding politician. That is awesome. Its a very convoluted battle.. lots of issues.. lots of twists and turns... unfortunately for us and fortunately for the opposition in residency between the work hours and the nature of anesthesia its tough to get involved politically. Im just starting to get involved. im a year out..
davvid2700 said:
Where do you propose we find this money?
militarymd said:
let me rephrase..
IF you pay what mds deserve.. they will come.....
and i dont think crnas are any cheaper.. I would bet that in your practice a crna gets paid 130-150k per year with only 40 hour work week.. and you have to hire two of them to make up for one md who you can start in the mid 200s with incentives.. who doesnt work 40 hours a week and can do all types of cases..
davvid2700 said:
No, no...let ME rephrase...
Where do I get the money to pay the MDs??????
The insurance companies sure won't pay it.
The hospital pays for the CRNAs.
davvid2700 said:
Sounds to me like you don't know a whole lot about running an OR. This is the second 15 OR suite I'm directing, and it doesn't work like you're suggesting.
