A Victory for Anesthesiologists!

[Alpha_Male]

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Hooray!

New Jersey Supreme Court Unanimously Upholds Office-Based Surgery Regulations
The New Jersey Supreme Court affirmed the Appellate Division's decision and held that the office-based surgery regulations challenged by the New Jersey Association of Nurse Anesthetists were within the Board of Medical Examiners' delegated authority. The Court agreed with the Appellate Division's holding that the administration of anesthesia is the practice of medicine and that the regulations fall squarely within the Board's core jurisdiction, the licensing and qualifications of physicians, and how they perform their professional services. It also agreed that while the regulations have an indirect impact on the CRNAs' profession, the BME is not regulating the nursing profession, but rather the physicians who offer anesthesia in an office setting.

Recognizing the unique nature of the office setting, the Court held that the "wealth of testimony adduced at the public hearings on the regulations supported the need for enhanced education and oversight." This decision upheld the requirement that a qualified physician must supervise a nurse anesthetist who administers and monitors general or regional anesthesia. The regulations specify how many hours of continuing medical education in anesthesia the supervising physician must have completed. Lastly, the Court recognized the value of having an anesthesiologist involved in the delivery of anesthesia care. It is "fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur."

 

[UTSouthwestern]

There will be many more of these legal challenges up coming. Our national and state societies are working hard to espouse patient safety and the practice of medicine.

 

[toughlife]

Hooray!

New Jersey Supreme Court Unanimously Upholds Office-Based Surgery Regulations
The New Jersey Supreme Court affirmed the Appellate Division's decision and held that the office-based surgery regulations challenged by the New Jersey Association of Nurse Anesthetists were within the Board of Medical Examiners' delegated authority. The Court agreed with the Appellate Division's holding that the administration of anesthesia is the practice of medicine and that the regulations fall squarely within the Board's core jurisdiction, the licensing and qualifications of physicians, and how they perform their professional services. It also agreed that while the regulations have an indirect impact on the CRNAs' profession, the BME is not regulating the nursing profession, but rather the physicians who offer anesthesia in an office setting.

Recognizing the unique nature of the office setting, the Court held that the "wealth of testimony adduced at the public hearings on the regulations supported the need for enhanced education and oversight." This decision upheld the requirement that a qualified physician must supervise a nurse anesthetist who administers and monitors general or regional anesthesia. The regulations specify how many hours of continuing medical education in anesthesia the supervising physician must have completed. Lastly, the Court recognized the value of having an anesthesiologist involved in the delivery of anesthesia care. It is "fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur."

Awesome! That is exactly the way it should be. I got goose bumps when I read this. Let's hope that trend continues and keep supporting the ASA.

 

[Alpha_Male]

Bump

 

[juddson]

Did you notice that the new jersey regulations require that the physician gas man performing a supervisory role be "physically present" during the administration of general anesthetic? Doesn't that mean that the MDA may no longer supervise 2 or 3 CRNA's at one time in New Jersey?

judd

 

[UTSouthwestern]

Did you notice that the new jersey regulations require that the physician gas man performing a supervisory role be "physically present" during the administration of general anesthetic? Doesn't that mean that the MDA may no longer supervise 2 or 3 CRNA's at one time in New Jersey?

judd

Don't think it means at all times throughout the case.

 

[VolatileAgent]

It is "fundamentally reasonable that additional education and training would enable anesthesiologists administering or overseeing anesthesia to better protect patients and to respond when complications occur."

i think that is what is key.

 

[hoop_jumper]

This will be a short lived victory as an SRNA I can tell you that eventually CRNAs will be doing office anesthesia in all 50 states. Look at how many states have opted out of the Medicare part A supervision requirements (14) and even Montana opted back out even though the Governor's brother is an anesthesiologist. The days of physician control are over, even AA's are starting to demand independence and increased skills. The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost. I personally do not believe Anesthesia requires a physiscian to administer or supervise an experienced CRNA. Just my .02 cents worth

 

[jetproppilot]

This will be a short lived victory as an SRNA I can tell you that eventually CRNAs will be doing office anesthesia in all 50 states. Look at how many states have opted out of the Medicare part A supervision requirements (14) and even Montana opted back out even though the Governor's brother is an anesthesiologist. The days of physician control are over, even AA's are starting to demand independence and increased skills. The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost. I personally do not believe Anesthesia requires a physiscian to administer or supervise an experienced CRNA. Just my .02 cents worth

So dude, you havent even started working yet, you have no experience, and you're gonna come to a physician board and post something like that?
Geez, has anyone ever told you that you have absolutely no class at all?

 

[xampower]

This will be a short lived victory as an SRNA I can tell you that eventually CRNAs will be doing office anesthesia in all 50 states. Look at how many states have opted out of the Medicare part A supervision requirements (14) and even Montana opted back out even though the Governor's brother is an anesthesiologist. The days of physician control are over, even AA's are starting to demand independence and increased skills. The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost. I personally do not believe Anesthesia requires a physiscian to administer or supervise an experienced CRNA. Just my .02 cents worth

First, I agree with jetproppilot. Before you make such blatantly incorrect statements...do your homework. It only makes you look more rediculous..
Here is one of many references that prove you have no clue what you are talking about.

Influence of the Type of Anesthesia Provider on Costs of Labor Analgesia to the Texas Medicaid Program.
Anesthesiology. 101(4):991-998, October 2004.
Abouleish, Amr E. M.D.,M.B.A. *; Prough, Donald S. M.D. +; Vadhera, Rakesh B. M.D., F.R.C.A.,F.F.A.R.C.S.I.

Their conclusion: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

Do your homework!!!!!

 

[militarymd]

The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost.

There was a prospective controlled trial looking at whether the use of the pulse oximetry improved outcome in the perioperative period. The results were that pulse oximetry made no difference....10,000+ patients.

Are you going to stop using a pulse ox?

Life insurance companies exist because they know that people who buy insurance will rarely use them....meaning that for the vast majority of people who buy life insurance they are wasting their money.....

Should people stop buying life insurance?

There were NO studies documenting the efficacy of intubation in respiratory failure.

Should we stop intubating people who have respiratory failure?

Please answer all questions honestly.

 

[miamidc]

You are obviosly living in a somewhat sheltered life of a student nurse anesthesist. There now have been countless of studies out that confirm just how important it is to have an MD on board. Sure when u are putting a 30 yr old ASA 1 to sleep that is pretty healty, u are probably going to be sitting down in that comefy chair of your's and think, hey this isn't so bad, my gardener can do this, and you will feel all special pretending to think you have the same skills as a board certified anesthesiologist. Tell me, would you feel so high and mighty when you have to administer a general anesthetic to a ASA class 3 or 4, going through cardiac surgery...I really don't think so, your knowledge in complex pathophysiology and your training in handling the most serious and life-threatening of complications that can happen in the matter of 2 or 3 heartbeats is very, very limited my friend. And the reason we get the big bucks, and the reason CRNA will never hold on to full autonomy is because we save a hell of a lot more lives than you do. And what if that was you or your wife or mother, or your kids in that OR. Would you want a CRNA or a MDA to be the go to guy when all hell breaks loose?. I know who I would choose, homey. Good luck with your profession and god help u if you DON't have a physican watching your back, to make sure you don't kill someones daughter one day!


By the way there is plenty of recent literature out on this issue, I suggest that u do your research. Laters 🙂

 

[militarymd]

Tell me, would you feel so high and mighty when you have to administer a general anesthetic to a ASA class 3 or 4, going through cardiac surgery...I really don't think so, your knowledge in complex pathophysiology and your training in handling the most serious and life-threatening of complications that can happen in the matter of 2 or 3 heartbeats is very, very limited my friend.

Whoa....hold on cowboy....There is a difference between being a good anesthetist and a good consultant in anesthesia.

CRNAs are expected to be anesthetists.

Anesthesiologists are expected to be phyisicans AND anesthetists.

Unfortunately, many, including most of us, confuse being a good anesthetist with being a good physician.

There are Board Certified anesthesiologists I know who I wouldn't let anesthetize my rabid dog, because they are poor anesthetists....However, I would let them direct my medical care during complex surgery if there is a good CRNA with him.

Although I would have no problems having a CRNA anesthetize me (ASA I..run 8 minute miles...bench press 1.5 my body weight....5 % body fat....MP0 A/W)...I wouldn't want that CRNA alone without a good anesthesiologist around.

Bottom line...the jobs are different....Patients do the best when both are involved.

 

[UTSouthwestern]

Whoa....hold on cowboy....There is a difference between being a good anesthetist and a good consultant in anesthesia.

CRNAs are expected to be anesthetists.

Anesthesiologists are expected to be phyisicans AND anesthetists.

Unfortunately, many, including most of us, confuse being a good anesthetist with being a good physician.

There are Board Certified anesthesiologists I know who I wouldn't let anesthetize my rabid dog, because they are poor anesthetists....However, I would let them direct my medical care during complex surgery if there is a good CRNA with him.

Although I would have no problems having a CRNA anesthetize me (ASA I..run 8 minute miles...bench press 1.5 my body weight....5 % body fat....MP0 A/W)...I wouldn't want that CRNA alone without a good anesthesiologist around.

Bottom line...the jobs are different....Patients do the best when both are involved.

You have a Mallampati ZERO 😱 airway? Wow! 😀

 

[jetproppilot]

Whoa....hold on cowboy....There is a difference between being a good anesthetist and a good consultant in anesthesia.

CRNAs are expected to be anesthetists.

Anesthesiologists are expected to be phyisicans AND anesthetists.

Unfortunately, many, including most of us, confuse being a good anesthetist with being a good physician.

There are Board Certified anesthesiologists I know who I wouldn't let anesthetize my rabid dog, because they are poor anesthetists....However, I would let them direct my medical care during complex surgery if there is a good CRNA with him.

Although I would have no problems having a CRNA anesthetize me (ASA I..run 8 minute miles...bench press 1.5 my body weight....5 % body fat....MP0 A/W)...I wouldn't want that CRNA alone without a good anesthesiologist around.

Bottom line...the jobs are different....Patients do the best when both are involved.

Tell me you're a black belt in some martial art and I'll genuflect in your honor. 😀

 

[toughlife]

This will be a short lived victory as an SRNA I can tell you that eventually CRNAs will be doing office anesthesia in all 50 states. Look at how many states have opted out of the Medicare part A supervision requirements (14) and even Montana opted back out even though the Governor's brother is an anesthesiologist. The days of physician control are over, even AA's are starting to demand independence and increased skills. The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost. I personally do not believe Anesthesia requires a physiscian to administer or supervise an experienced CRNA. Just my .02 cents worth

Ahh the voice of ignorance.

 

[TKD1stdan]

First, I agree with jetproppilot. Before you make such blatantly incorrect statements...do your homework. It only makes you look more rediculous..
Here is one of many references that prove you have no clue what you are talking about.

Influence of the Type of Anesthesia Provider on Costs of Labor Analgesia to the Texas Medicaid Program.
Anesthesiology. 101(4):991-998, October 2004.
Abouleish, Amr E. M.D.,M.B.A. *; Prough, Donald S. M.D. +; Vadhera, Rakesh B. M.D., F.R.C.A.,F.F.A.R.C.S.I.

Their conclusion: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

Do your homework!!!!!

Talk about RIDICULOUS. Why don't you learn to spell before you try to tackle research, let alone anesthesia.

 

[xampower]

Talk about RIDICULOUS. Why don't you learn to spell before you try to tackle research, let alone anesthesia.

Dude, this isn't a spelling bee forum and we're not writing term papers. You must have a lot of free time in your life to sit around and proofread posts on an internet forum. But thanks for your service.

 

[toughlife]

Talk about RIDICULOUS. Why don't you learn to spell before you try to tackle research, let alone anesthesia.

Yet another disgruntled SRNA/CRNA mad over the NJ supreme court decision. 😀

 

[blocks]

Talk about RIDICULOUS. Why don't you learn to spell before you try to tackle research, let alone anesthesia.

My mother-in law is a legal secretary at a firm in West L.A., and is constantly correcting her boss' spelling and grammar in the notes/dictations she transcribes. He is a grad of a tip top law school, and pulls in >$30,000/month as a partner in a key national firm with internationally known clients. Her boss and we laugh about it all the time, but believe me she knows that that is her role, and that his role is to run the firm, thus generating clients, business, cash, and good times. I am pretty sure he "learned to spell" before tackling law school, let alone being a partner. Is she a better speller? Is she more intelligent, or more focused? Maybe, or maybe he's not interested in those types of details, his time is better spent elsewhere, and perhaps overlooking such details from time to time is not significant in the big picture.

Get it?

 

[hoop_jumper]

I am just pointing out that your small victory is insignificant. You lost in Florida and 14 states have opted out. The New Jersey decision can be remedied in the legislature. I think you are getting your hopes up only to have them crushed at some future date. Whenever the ASA goes up against the AANA they continually are on the losing end of the argument. Even many posters on this forum complain about the ASA. The times are changing and CRNA schools are a lot more structured and competitive than say 20 years ago when many were hospital based. You are right that I am in school and I know I will need some backup from experienced anesthesia providers when I am finished but that doesn't mean the provider will be an anesthesiologist.

 

[toughlife]

I am just pointing out that your small victory is insignificant. You lost in Florida and 14 states have opted out. The New Jersey decision can be remedied in the legislature. I think you are getting your hopes up only to have them crushed at some future date. Whenever the ASA goes up against the AANA they continually are on the losing end of the argument. Even many posters on this forum complain about the ASA. The times are changing and CRNA schools are a lot more structured and competitive than say 20 years ago when many were hospital based. You are right that I am in school and I know I will need some backup from experienced anesthesia providers when I am finished but that doesn't mean the provider will be an anesthesiologist.

The person who was complaining about the ASA was one of your brethren (a CRNA pretending to be an anesthesiologist, remember Justin?).

Yeah when the patient is crashing you can always count on the surgeons and the scrub techs to bail you out. So far I have noticed they are very happy to jump in to help whenever something goes wrong with anesthesia.

 

[SigmaSRNA]

I guess a verse from " COOM BY YA" is out of the question.

 

[Monty Python]

This will be a short lived victory as an SRNA I can tell you that eventually CRNAs will be doing office anesthesia in all 50 states. Look at how many states have opted out of the Medicare part A supervision requirements (14) and even Montana opted back out even though the Governor's brother is an anesthesiologist. The days of physician control are over, even AA's are starting to demand independence and increased skills. The fact is no study has showed any difference in outcome from either a CRNA or Anesthesiologist administering anesthesia. CRNAs are performing about 99% of what anesthesiologist do and the training is 1/6th the cost. I personally do not believe Anesthesia requires a physiscian to administer or supervise an experienced CRNA. Just my .02 cents worth

Dear SRNA:

I'm a CRNA, speaking with 10+ years experience. I've given anesthesia in all modes of practice and locations. I've been TOTALLY by myself on an aircraft carrier in the middle of the ocean, in a mid-size hospital with only CRNAs available (and no one floating), at a large private hospital with both a CRNA and anesthesiologist always floating and available, at university hospital doing horrendous trauma at 0200 and the J1 visa anesthesiologist didn't speaky Englishy, etc etc. A few gentle thoughts:

1. i'm perfectly comfortable working in whatever environment life brings me. I enjoy being solo, I enjoy being with other CRNAs, and I enjoy being with anesthesiologists in the team model. I've instructed both SRNAs and anesthesia MD residents in the OR with pleasure. What I will NOT tolerate in anyone (no matter what their stripe) is a haughty attitude, stupidity, laziness, or lack of professional and compassionate bedside manner. Life's too short for such BS and our patients deserve better.

2. no matter how good your professor is in your "Professional Aspects" or "Issues and Trends" seminars, the university of the real world is a much better teacher.

3. politics is part of the anesthesia scene. No matter whether you or I (or anyone else) thinks that right or wrong, good or bad, it really doesn't matter. It's really no different than the politics in ANY other business, and it's no cleaner nor no dirtier than in any other aspect of the real world. Not that I particularly like that aspect of anesthesia, but it comes with the territory and so I made the conscious decision to live with it. What I can change and improve I make the effort to do so. What I can't change I let roll off my back.

4. the opt-outs, legal battles, legislative endeavors and other machinations of ASA and AANA are a direct fallout of government policies. Prior to medicare there was "live and let live." Now with gov't medical reimbursement policies being the shining example of the "law of unintended consequences"
the two anesthesia professions are at each other's throat, and 99.9% of that angst is caused by the Almighty Dollar. What a waste of time, energy, and emotional currency. For some people (a few CRNAs and a few anesthesiologists alike) life revolves around control = power = increased income. How very sad. How very very sad. What a horrible way to go through life. And I have yet to see "ultimate happiness and life satisfaction" available in a package for purchase at Target lately. In my community, there are some CRNAs and anesthesiologists who live in castles, driving $$$$$ cars, and who are miserable deep down inside.

5. I applaud your underlying enthusiasm for anesthesia in your original post; however may I suggest you channel your energies at the moment towards passing your boards, yet keep your eyes and ears open to the profession. After you graduate, get involved in whatever medium you feel is best to improve yourself and your profession. Just keep in mind that the totality of the anesthesia workplace is a constantly evolving entity, played on a multitude of levels. Diplomacy, tact, and sometimes saying nothing when you're bursting to yell out are hard-won skills yet invaluable in the real world.

6. No matter where life takes you, always count your blessings. 99.99999% of the people alive at this moment on Earth would gladly trade their problems and life circumstances for your (or mine) penny-ante irritants. Life is not fair, and then we die. Make the best of it, live with vigor in a way which allows you to look at yourself squarely in the mirror without flinching, and enjoy your days.

 

[coccygodynia]

Dear SRNA:

I'm a CRNA, speaking with 10+ years experience. I've given anesthesia in all modes of practice and locations. I've been TOTALLY by myself on an aircraft carrier in the middle of the ocean, in a mid-size hospital with only CRNAs available (and no one floating), at a large private hospital with both a CRNA and anesthesiologist always floating and available, at university hospital doing horrendous trauma at 0200 and the J1 visa anesthesiologist didn't speaky Englishy, etc etc. A few gentle thoughts:

1. i'm perfectly comfortable working in whatever environment life brings me. I enjoy being solo, I enjoy being with other CRNAs, and I enjoy being with anesthesiologists in the team model. I've instructed both SRNAs and anesthesia MD residents in the OR with pleasure. What I will NOT tolerate in anyone (no matter what their stripe) is a haughty attitude, stupidity, laziness, or lack of professional and compassionate bedside manner. Life's too short for such BS and our patients deserve better.

2. no matter how good your professor is in your "Professional Aspects" or "Issues and Trends" seminars, the university of the real world is a much better teacher.

3. politics is part of the anesthesia scene. No matter whether you or I (or anyone else) thinks that right or wrong, good or bad, it really doesn't matter. It's really no different than the politics in ANY other business, and it's no cleaner nor no dirtier than in any other aspect of the real world. Not that I particularly like that aspect of anesthesia, but it comes with the territory and so I made the conscious decision to live with it. What I can change and improve I make the effort to do so. What I can't change I let roll off my back.

4. the opt-outs, legal battles, legislative endeavors and other machinations of ASA and AANA are a direct fallout of government policies. Prior to medicare there was "live and let live." Now with gov't medical reimbursement policies being the shining example of the "law of unintended consequences"
the two anesthesia professions are at each other's throat, and 99.9% of that angst is caused by the Almighty Dollar. What a waste of time, energy, and emotional currency. For some people (a few CRNAs and a few anesthesiologists alike) life revolves around control = power = increased income. How very sad. How very very sad. What a horrible way to go through life. And I have yet to see "ultimate happiness and life satisfaction" available in a package for purchase at Target lately. In my community, there are some CRNAs and anesthesiologists who live in castles, driving $$$$$ cars, and who are miserable deep down inside.

5. I applaud your underlying enthusiasm for anesthesia in your original post; however may I suggest you channel your energies at the moment towards passing your boards, yet keep your eyes and ears open to the profession. After you graduate, get involved in whatever medium you feel is best to improve yourself and your profession. Just keep in mind that the totality of the anesthesia workplace is a constantly evolving entity, played on a multitude of levels. Diplomacy, tact, and sometimes saying nothing when you're bursting to yell out are hard-won skills yet invaluable in the real world.

6. No matter where life takes you, always count your blessings. 99.99999% of the people alive at this moment on Earth would gladly trade their problems and life circumstances for your (or mine) penny-ante irritants. Life is not fair, and then we die. Make the best of it, live with vigor in a way which allows you to look at yourself squarely in the mirror without flinching, and enjoy your days.

👍 Very well said. Some of the attitudes on this board can be a bit abrasive. Especially when they're coming from relatively inexperienced providers. BTW - thank you for serving this country.

 

[anesthesiadrew]

👍 Very well said. Some of the attitudes on this board can be a bit abrasive. Especially when they're coming from relatively inexperienced providers. BTW - thank you for serving this country.

I second that. A big wholehearted 'thank you' for serving our country.

 

[jetproppilot]

I second that. A big wholehearted 'thank you' for serving our country.

And I third that, Don. You're the man.

 

[TKD1stdan]

Yet another disgruntled SRNA/CRNA mad over the NJ supreme court decision. 😀

How do you know who or what I am? I don't care what side of this argument you represent. This is a debate that is never going to be solved unless one type of practitioner either ceases to practice or totally transforms job duties so that the two do not overlap. Just for the record there is nothing in my profile and no I'm not a CRNA or SRNA so there goes your theory.

 

[cloud9]

How do you know who or what I am? I don't care what side of this argument you represent. This is a debate that is never going to be solved unless one type of practitioner either ceases to practice or totally transforms job duties so that the two do not overlap. Just for the record there is nothing in my profile and no I'm not a CRNA or SRNA so there goes your theory.

Actually, I think it was an hypothesis, not a theory. 😉

 

[toughlife]

How do you know who or what I am? I don't care what side of this argument you represent. This is a debate that is never going to be solved unless one type of practitioner either ceases to practice or totally transforms job duties so that the two do not overlap. Just for the record there is nothing in my profile and no I'm not a CRNA or SRNA so there goes your theory.

I guess you could be an AA but I still would bet that you are either a SRNA/CRNA or a nurse hoping to become one of these. If I am wrong then..oh well.

I think the transformation you speak of is already happening. The faculty at my institution mainly supervise the CRNAs and spend most of their time teaching the residents (CRNAs are solely used to do the cases that have no educational value for residents). I surmise it will be even more so in the future. I do believe however, the supervision requirement is essential.

I am going into academics and also getting a masters in hospital administration. I hope to then have a voice as to how things unfold in the future. I guess you can figure whose side I will be on.

 

[anesthesiadrew]

I think the transformation you speak of is already happening. The faculty at my institution mainly supervise the CRNAs and spend most of their time teaching the residents (CRNAs are solely used to do the cases that have no educational value for residents). I surmise it will be even more so in the future. I do believe however, the supervision requirement is essential.

Not all places operate like the sheltered centers that worship residents. CRNAs that work in these areas, well, its their own damn fault for working at places like that. Reality is going to bite you in the posterior when you move away from an academic teaching center.

 

[militarymd]

Reality is going to bite you in the posterior when you move away from an academic teaching center.

And what is that "reality"?

 

[coccygodynia]

And what is that "reality"?

I think Drew is talking about centers that utilize CRNA's for every operation (heart/liver/lung transplants, pedi hearts, scoliosis repair and any other "educational case" you can name).

Please correct me if I'm wrong.

 

[anesthesiadrew]

I think Drew is talking about centers that utilize CRNA's for every operation (heart/liver/lung transplants, pedi hearts, scoliosis repair and any other "educational case" you can name).

Please correct me if I'm wrong.

I could go on and on about my location, but it is suffice to say that it is a very large multi-system facility, 4 air ambulances (one in another state because we have such a pull in the surrounding area), level one peds and adult trauma, multiple anesthesia satellite centers in addition to adult/children's main ors.....blah, blah, blah. Oh and teaching center also for medicine and SRNA program.

Anesthesiologist do not run cases at our facilities. CRNAs deliver competant care and senior SRNAs run rooms with anesthesiologist supervision (apply this term loosely) with no CRNA supervision. We are the sole county-wide OB providers and this is truly a CRNA practice. MDs carry pagers but go up to the floor less than one time a week to sign papers. We do all of the above operations, with exception of pedi hearts. Other than that, you name it and we do it.

There are locations that treat CRNAs like crap. Others don't. Some places run MD only groups. Some do not.

What I am saying is that there are a multitude of organizations / facilities and if some of you think that all places are run like the model that is often at anesthesia training centers (CRNAs only doing cases that no one wants and are crappy ASA I or II cases) then you are sadly mistaken.

We just hired a MD fresh out of residency, won't say where because it doesn't matter. He is having a little trouble adjusting to the fact that our practice is largely a CRNA practice. I think his opinion of how things run or how things he thought SHOULD run just got thrown upside down. He's great to work with, but a little set back at how he thought CRNAs do easy, uncomplicated cases with strict supervision is more than a little wrong.
Supervision here is showing up on induction and sometimes during extubation. CRNAs extubate without calling. Some allow senior students to do so. As a rule, junior students absolutely do not do this, but I was told one night on-call to go ahead and extubate via phone. Our program knows how to run a CRNA practice and also how to work the SRNAs in such a way that our graduates are very highly sought after. I have taken over airways from residents during codes and in the OR. Our MDs will let SRNAs tackle difficult airways over residents or medical students and no these individuals are not happy about some "damn nurse" doing it or being told by another physician that one of us is going to do something. This is not bragging at all physicians, but we are capable providers of anesthesia and airway obtainment. This is in no way taking away from your substantial contributions and long-standing education, just don't think CRNAs are MD handmaindens that do easy cases and don't have the proper education in order to do so.

And toughlife, where did the imposter justin admit to being a CRNA? This is something you proposed one time and then assumed it to be true.

 

[militarymd]

There is a difference between being a good anesthetist and a good consultant in anesthesia.

CRNAs are expected to be anesthetists.

Anesthesiologists are expected to be phyisicans AND anesthetists.

Unfortunately, many, including most of us, confuse being a good anesthetist with being a good physician.

There are Board Certified anesthesiologists I know who I wouldn't let anesthetize my rabid dog, because they are poor anesthetists....However, I would let them direct my medical care during complex surgery if there is a good CRNA with him.


Bottom line...the jobs are different....Patients do the best when both are involved.

Note above.

 

[anesthesiadrew]

Note above.

I couldn't agree more. I appreciate having anesthesiologist around, it is a very stimulating environment from a learning aspect as a student.

This wasn't a troll post and for the most part I keep quiet, this is your forum after all. You all probably don't care to hear about CRNAs and I can appreciate that. I for one do learn by reading the posts, but my reply was aimed at one individual in particular, certainly not one who wields the force such as yourself.

Thanks for all the teaching.

 

[jetproppilot]

I couldn't agree more. I appreciate having anesthesiologist around, it is a very stimulating environment from a learning aspect as a student.

This wasn't a troll post and for the most part I keep quiet, this is your forum after all. You all probably don't care to hear about CRNAs and I can appreciate that. I for one do learn by reading the posts, but my reply was aimed at one individual in particular, certainly not one who wields the force such as yourself.

Thanks for all the teaching.

Go back through my posts if you at any point think I don't appreciate CRNAs, respect CRNAs, recognize their importance, etc etc etc

 

[jetproppilot]

You all probably don't care to hear about CRNAs and I can appreciate that.

Ask Trinity Alumnus (he's a CRNA) about my relationship with CRNAs.

 

[jetproppilot]

Ask Trinity Alumnus (he's a CRNA) about my relationship with CRNAs.

BTW, I am not implying that I think your posts are aimed at me. Merely pointing out that MDs can be very content with their practice while concominantly giving respect to CRNAs and teaching SRNAs (which we do on a daily basis).

I do not feel threatened by CRNAs, as you initial post implied. Rather, I recognize the value of the team approach. You should've thought about how to word your initial post. It was comical. Your threats of CRNAs taking over the anesthesia realm affect me as much as Bill Clinton's statement:..."I...DID NOT HAVE SEX WITH THAT WOMAN!!..."

 

[anesthesiadrew]

BTW, I am not implying that I think your posts are aimed at me. Merely pointing out that MDs can be very content with their practice while concominantly giving respect to CRNAs and teaching SRNAs (which we do on a daily basis).

Thank you.

I do not feel threatened by CRNAs, as you initial post implied. Rather, I recognize the value of the team approach. You should've thought about how to word your initial post. It was comical. Your threats of CRNAs taking over the anesthesia realm affect me as much as Bill Clinton's statement:..."I...DID NOT HAVE SEX WITH THAT WOMAN!!..."

Doods, please see toughlife's post on this page, #30. My responses were aimed at his description and general opinion of CRNAs in paragraph two of this post. I never meant to imply CRNAs were taking over. Toughie has some things to learn however, if he thinks that CRNAs do easy cases in most environments.

 

[jetproppilot]

Thank you.





Doods, please see toughlife's post on this page, #30. My responses were aimed at his description and general opinion of CRNAs in paragraph two of this post. I never meant to imply CRNAs were taking over. Toughie has some things to learn however, if he thinks that CRNAs do easy cases in most environments.

Fire at will, anesthesiadrew.
I respect your position (albeit green, naive, unexperienced, too-bold-for-your-position), but you need to respect ours.
Lets not have a misunderstanding here. MilitaryMDs post concerning "anesthetists are expected to be anesthetists, anesthesiologists are expected to be anesthetists and anesthesiologists" is not an attempt to "one-up" you. It is reality.
Do not discount the educational process and the inherent thinking-rationale-product of physician training in this country. We are not trained to "protocol-react" to a problem. We do not say to ourselves "BP down, page 123 says decrease volatile agent and give ephedrine." We are trained, via sacrificing more than a decade of our lives to learning our trade, to think on a tertiary level.
Medical problem during an operation? Don't look at the orthopedic surgeon during a hip revision on an 89 year old with CAD, ESRD, and DM for answers during your unsupervised case in Plano, Texas. Earn your 200k annual salary, react like you have been robotically trained to react, and hope for the best. You have chosen to have no anestheiologist backup. Is that truly the best model for the patient?
Anesthesiologists have endured years and years of training. Medical training beyond the anesthesia years, experiences of being presented with a clinical dilemma and working through it.
Do you know how to treat an MI? Pulmonary embolism? Congestive heart failure? DKA? What laboratory data represents a risk to the patient verses just an obstructionalist's standpoint, cancelling the case needlessly?
These medical problems exist in the OR periodically, just like they do in Eckerds in the diapers aisle. And they need to be addressed by a physician.

Don't misunderstand this post, anesthesiadrew. I am speaking from an anesthesiologists standpoint after nine years of practice. I've made my cash. I am comfortable, and my future is comfortable. This post is not cash oriented. I no longer have the need/desire to try and defend anesthesiologists based on my need to make a living.
Reality speaks in the conflicts between MDs and CRNAs. Its all about the benjamins, and if you believe anything else, you are very naive.
I can tell you from "the other side" of the benjamin fight that CRNA-only anesthesia is not the best model for the patient. If you are working in an unsupervised practice, you are working solely with your knowledge and the knowledge of the surgeon's.
Read MilitaryMD/mine/UT's posts concerning different clinical scenerios.

Are you really telling me that you, by yourself, can offer the same level of care to a critically ill patient during an operation? Don't look at the general/orthopedic/neuro/ENT/pediatric surgeon for clues, dude. Its all on your shoulders.

 

[TKD1stdan]

I guess you could be an AA but I still would bet that you are either a SRNA/CRNA or a nurse hoping to become one of these. If I am wrong then..oh well.
QUOTE]

Nope, strike two...There are some people that are not CRNAs, SRNAs or nurses that see that these professionals can provide high quality care. It's unfortunate that so much time in the realm of anesthesia is devoted to turf wars when both practitioners are equally involved and dedicated to medicine/nursing.

 

[anesthesiadrew]

Fire at will, anesthesiadrew.
I respect your position (albeit green, naive, unexperienced, too-bold-for-your-position), but you need to respect ours.
Lets not have a misunderstanding here. MilitaryMDs post concerning "anesthetists are expected to be anesthetists, anesthesiologists are expected to be anesthetists and anesthesiologists" is not an attempt to "one-up" you. It is reality.
Do not discount the educational process and the inherent thinking-rationale-product of physician training in this country. We are not trained to "protocol-react" to a problem. We do not say to ourselves "BP down, page 123 says decrease volatile agent and give ephedrine." We are trained, via sacrificing more than a decade of our lives to learning our trade, to think on a tertiary level.
Medical problem during an operation? Don't look at the orthopedic surgeon during a hip revision on an 89 year old with CAD, ESRD, and DM for answers during your unsupervised case in Plano, Texas. Earn your 200k annual salary, react like you have been robotically trained to react, and hope for the best. You have chosen to have no anestheiologist backup. Is that truly the best model for the patient?
Anesthesiologists have endured years and years of training. Medical training beyond the anesthesia years, experiences of being presented with a clinical dilemma and working through it.
Do you know how to treat an MI? Pulmonary embolism? Congestive heart failure? DKA? What laboratory data represents a risk to the patient verses just an obstructionalist's standpoint, cancelling the case needlessly?
These medical problems exist in the OR periodically, just like they do in Eckerds in the diapers aisle. And they need to be addressed by a physician.

Don't misunderstand this post, anesthesiadrew. I am speaking from an anesthesiologists standpoint after nine years of practice. I've made my cash. I am comfortable, and my future is comfortable. This post is not cash oriented. I no longer have the need/desire to try and defend anesthesiologists based on my need to make a living.
Reality speaks in the conflicts between MDs and CRNAs. Its all about the benjamins, and if you believe anything else, you are very naive.
I can tell you from "the other side" of the benjamin fight that CRNA-only anesthesia is not the best model for the patient. If you are working in an unsupervised practice, you are working solely with your knowledge and the knowledge of the surgeon's.
Read MilitaryMD/mine/UT's posts concerning different clinical scenerios.

Are you really telling me that you, by yourself, can offer the same level of care to a critically ill patient during an operation? Don't look at the general/orthopedic/neuro/ENT/pediatric surgeon for clues, dude. Its all on your shoulders.

Up to this point I have certainly enjoyed your posts; however, this post is certainly out of the blue....Are you post-call or something? You are jumping to conclusions and putting statements into my posts that simply aren't there.

I never said anything other than some members in residency who think CRNAs do only ASA I cases may have something to learn when he or she gets out of residency and into the real world. PEROID. CRNAs do very sick patients where I work and MDs do not sit cases. The only cases we don't do that come to mind are pedi hearts and CRNAs manage to do just fine. That is all I have said.

I actually agreed with MilitaryMDs post and have said nothing but complimentary things about anesthesiologists and the time spent in training and I also said I was glad to have MDs around. I never took his post as "one-upping me". Why would I agree with him if I thought this?

As far as your opinion of "protocol thinking" of CRNAs you and I will have to disagree. If you honestly think that CRNAs don't think about medicines at the receptor level with cause and effect taken into consideration when choosing these items, then you have had the pleasure of enjoying the company of some shotty CRNAs.

Let's see, what else...Never said I wanted to work alone, nor did I want to have some surgeon tell me what to do so I don't know where you are coming from on that one either. I see your point, but you brought it up. Since you brought up the 200K subject, that's fairly easy to do without winging it solo. In fact, we had a first year grad last year pull just less than 20K of that working in the ATC model in Georgia.

Dude I'm a student and freely admit it. No, I don't know how to manage those all of the conditions you mentioned now but you don't know me personally and I don't know you. So for you to say that I can't manage it one day in the future is just plain wrong and I don't know what you are used to as far as CRNAs but I know plenty that can and do on a daily basis. I'm going to leave it at that.

I never said I was equal to nor could provide care equal to an anesthesiologist, so please point that out for me sometime will ya?

Dude, reread my post, you got it wrong from the start and here we end up. Toughlife is anti-CRNA and that is plainly obvious. I have ignored him for some time now. Post #30 is more than a little off. I simply stated that CRNAs do sick patients where I work. That's all. I went on to agree with militarymd.
Never said I wanted to work alone, never said CRNAs were taking over, never said I could replace an MD, and I actually agreed with your friend MiltaryMD. NO ONE IS JUMPING YOUR BUDS SO COOL OFF.

My "position" as you so eloquently phrase it as being "too bold" is that CRNAs can and do deliver anesthesia, with minimal supervision, on some sick patients. If you say BS on this, then please PM me and I have a facilty to show you.

 

[toughlife]

I could go on and on about my location, but it is suffice to say that it is a very large multi-system facility, 4 air ambulances (one in another state because we have such a pull in the surrounding area), level one peds and adult trauma, multiple anesthesia satellite centers in addition to adult/children's main ors.....blah, blah, blah. Oh and teaching center also for medicine and SRNA program.

Anesthesiologist do not run cases at our facilities. CRNAs deliver competant care and senior SRNAs run rooms with anesthesiologist supervision (apply this term loosely) with no CRNA supervision. We are the sole county-wide OB providers and this is truly a CRNA practice. MDs carry pagers but go up to the floor less than one time a week to sign papers. We do all of the above operations, with exception of pedi hearts. Other than that, you name it and we do it.

There are locations that treat CRNAs like crap. Others don't. Some places run MD only groups. Some do not.

What I am saying is that there are a multitude of organizations / facilities and if some of you think that all places are run like the model that is often at anesthesia training centers (CRNAs only doing cases that no one wants and are crappy ASA I or II cases) then you are sadly mistaken.

We just hired a MD fresh out of residency, won't say where because it doesn't matter. He is having a little trouble adjusting to the fact that our practice is largely a CRNA practice. I think his opinion of how things run or how things he thought SHOULD run just got thrown upside down. He's great to work with, but a little set back at how he thought CRNAs do easy, uncomplicated cases with strict supervision is more than a little wrong.
Supervision here is showing up on induction and sometimes during extubation. CRNAs extubate without calling. Some allow senior students to do so. As a rule, junior students absolutely do not do this, but I was told one night on-call to go ahead and extubate via phone. Our program knows how to run a CRNA practice and also how to work the SRNAs in such a way that our graduates are very highly sought after. I have taken over airways from residents during codes and in the OR. Our MDs will let SRNAs tackle difficult airways over residents or medical students and no these individuals are not happy about some "damn nurse" doing it or being told by another physician that one of us is going to do something. This is not bragging at all physicians, but we are capable providers of anesthesia and airway obtainment. This is in no way taking away from your substantial contributions and long-standing education, just don't think CRNAs are MD handmaindens that do easy cases and don't have the proper education in order to do so.

And toughlife, where did the imposter justin admit to being a CRNA? This is something you proposed one time and then assumed it to be true.

What else could Justin be besides an annoying CRNA? I think we all have enough sense to know he ain't no MD/DO.

At my institutions CRNAs do as they are told. To give you an idea, at the beginning of my rotation, I wanted to do lots of intubations and the CRNAs wanted to used LMA. The attending would tell them I needed to practice so the patient would get a tube. He would tell them how he wanted the case run in order to make sure the med students got to practice what they wanted. All I had to do was ask the attending and I got to do whatever I wanted. If I wanted to practice art lines, I'd just ask and it happened. The attendings at my institution are all about teaching med students and residents not kissing CRNA's culo.

To me all CRNAs are trained operators who use a cookbook approach to delivering anesthesia. We need more AAs in anesthesia.

 

[toughlife]

Fire at will, anesthesiadrew.
I respect your position (albeit green, naive, unexperienced, too-bold-for-your-position), but you need to respect ours.
Lets not have a misunderstanding here. MilitaryMDs post concerning "anesthetists are expected to be anesthetists, anesthesiologists are expected to be anesthetists and anesthesiologists" is not an attempt to "one-up" you. It is reality.
Do not discount the educational process and the inherent thinking-rationale-product of physician training in this country. We are not trained to "protocol-react" to a problem. We do not say to ourselves "BP down, page 123 says decrease volatile agent and give ephedrine." We are trained, via sacrificing more than a decade of our lives to learning our trade, to think on a tertiary level.
Medical problem during an operation? Don't look at the orthopedic surgeon during a hip revision on an 89 year old with CAD, ESRD, and DM for answers during your unsupervised case in Plano, Texas. Earn your 200k annual salary, react like you have been robotically trained to react, and hope for the best. You have chosen to have no anestheiologist backup. Is that truly the best model for the patient?
Anesthesiologists have endured years and years of training. Medical training beyond the anesthesia years, experiences of being presented with a clinical dilemma and working through it.
Do you know how to treat an MI? Pulmonary embolism? Congestive heart failure? DKA? What laboratory data represents a risk to the patient verses just an obstructionalist's standpoint, cancelling the case needlessly?
These medical problems exist in the OR periodically, just like they do in Eckerds in the diapers aisle. And they need to be addressed by a physician.

Don't misunderstand this post, anesthesiadrew. I am speaking from an anesthesiologists standpoint after nine years of practice. I've made my cash. I am comfortable, and my future is comfortable. This post is not cash oriented. I no longer have the need/desire to try and defend anesthesiologists based on my need to make a living.
Reality speaks in the conflicts between MDs and CRNAs. Its all about the benjamins, and if you believe anything else, you are very naive.
I can tell you from "the other side" of the benjamin fight that CRNA-only anesthesia is not the best model for the patient. If you are working in an unsupervised practice, you are working solely with your knowledge and the knowledge of the surgeon's.
Read MilitaryMD/mine/UT's posts concerning different clinical scenerios.

Are you really telling me that you, by yourself, can offer the same level of care to a critically ill patient during an operation? Don't look at the general/orthopedic/neuro/ENT/pediatric surgeon for clues, dude. Its all on your shoulders.

This is the best post yet! Just telling it like it is, Damn! I like it.

 

[toughlife]

I guess you could be an AA but I still would bet that you are either a SRNA/CRNA or a nurse hoping to become one of these. If I am wrong then..oh well.
QUOTE]

Nope, strike two...There are some people that are not CRNAs, SRNAs or nurses that see that these professionals can provide high quality care. It's unfortunate that so much time in the realm of anesthesia is devoted to turf wars when both practitioners are equally involved and dedicated to medicine/nursing.

Equally involved and dedicated but not equally knowledgeable.

 

[toughlife]

Up to this point I have certainly enjoyed your posts; however, this post is certainly out of the blue....Are you post-call or something? You are jumping to conclusions and putting statements into my posts that simply aren't there.

I never said anything other than some members in residency who think CRNAs do only ASA I cases may have something to learn when he or she gets out of residency and into the real world. PEROID. CRNAs do very sick patients where I work and MDs do not sit cases. The only cases we don't do that come to mind are pedi hearts and CRNAs manage to do just fine. That is all I have said.

I actually agreed with MilitaryMDs post and have said nothing but complimentary things about anesthesiologists and the time spent in training and I also said I was glad to have MDs around. I never took his post as "one-upping me". Why would I agree with him if I thought this?

As far as your opinion of "protocol thinking" of CRNAs you and I will have to disagree. If you honestly think that CRNAs don't think about medicines at the receptor level with cause and effect taken into consideration when choosing these items, then you have had the pleasure of enjoying the company of some shotty CRNAs.

Let's see, what else...Never said I wanted to work alone, nor did I want to have some surgeon tell me what to do so I don't know where you are coming from on that one either. I see your point, but you brought it up. Since you brought up the 200K subject, that's fairly easy to do without winging it solo. In fact, we had a first year grad last year pull just less than 20K of that working in the ATC model in Georgia.

Dude I'm a student and freely admit it. No, I don't know how to manage those all of the conditions you mentioned now but you don't know me personally and I don't know you. So for you to say that I can't manage it one day in the future is just plain wrong and I don't know what you are used to as far as CRNAs but I know plenty that can and do on a daily basis. I'm going to leave it at that.

I never said I was equal to nor could provide care equal to an anesthesiologist, so please point that out for me sometime will ya?

Dude, reread my post, you got it wrong from the start and here we end up. Toughlife is anti-CRNA and that is plainly obvious. I have ignored him for some time now. Post #30 is more than a little off. I simply stated that CRNAs do sick patients where I work. That's all. I went on to agree with militarymd.
Never said I wanted to work alone, never said CRNAs were taking over, never said I could replace an MD, and I actually agreed with your friend MiltaryMD. NO ONE IS JUMPING YOUR BUDS SO COOL OFF.

My "position" as you so eloquently phrase it as being "too bold" is that CRNAs can and do deliver anesthesia, with minimal supervision, on some sick patients. If you say BS on this, then please PM me and I have a facilty to show you.

You are just a god damn srna, get the hell out of here and return to your allnurses.com forum.

 

[jetproppilot]

Fire at will, anesthesiadrew.
I respect your position (albeit green, naive, unexperienced, too-bold-for-your-position), but you need to respect ours.
Lets not have a misunderstanding here. MilitaryMDs post concerning "anesthetists are expected to be anesthetists, anesthesiologists are expected to be anesthetists and anesthesiologists" is not an attempt to "one-up" you. It is reality.
Do not discount the educational process and the inherent thinking-rationale-product of physician training in this country. We are not trained to "protocol-react" to a problem. We do not say to ourselves "BP down, page 123 says decrease volatile agent and give ephedrine." We are trained, via sacrificing more than a decade of our lives to learning our trade, to think on a tertiary level.
Medical problem during an operation? Don't look at the orthopedic surgeon during a hip revision on an 89 year old with CAD, ESRD, and DM for answers during your unsupervised case in Plano, Texas. Earn your 200k annual salary, react like you have been robotically trained to react, and hope for the best. You have chosen to have no anestheiologist backup. Is that truly the best model for the patient?
Anesthesiologists have endured years and years of training. Medical training beyond the anesthesia years, experiences of being presented with a clinical dilemma and working through it.
Do you know how to treat an MI? Pulmonary embolism? Congestive heart failure? DKA? What laboratory data represents a risk to the patient verses just an obstructionalist's standpoint, cancelling the case needlessly?
These medical problems exist in the OR periodically, just like they do in Eckerds in the diapers aisle. And they need to be addressed by a physician.

Don't misunderstand this post, anesthesiadrew. I am speaking from an anesthesiologists standpoint after nine years of practice. I've made my cash. I am comfortable, and my future is comfortable. This post is not cash oriented. I no longer have the need/desire to try and defend anesthesiologists based on my need to make a living.
Reality speaks in the conflicts between MDs and CRNAs. Its all about the benjamins, and if you believe anything else, you are very naive.
I can tell you from "the other side" of the benjamin fight that CRNA-only anesthesia is not the best model for the patient. If you are working in an unsupervised practice, you are working solely with your knowledge and the knowledge of the surgeon's.
Read MilitaryMD/mine/UT's posts concerning different clinical scenerios.

Are you really telling me that you, by yourself, can offer the same level of care to a critically ill patient during an operation? Don't look at the general/orthopedic/neuro/ENT/pediatric surgeon for clues, dude. Its all on your shoulders.

"Robotic" in the above post was a poor choice of words. I was trying to point out the fact that we are trained differently. Word retracted.

This post was not meant to "blast" CRNAs. You all know my stance on CRNAs. Rather, it was meant to address multiple posts on this thread that imply "anesthesiologists are losing footing" and implications that this job can be done without us.

Know what? This job COULD be done without us. But it is not the best way. Just like a midwife can deliver a baby. I don't think thats the best way.

My dad was an airline pilot. And I'm a pilot. I could crawl into one of the twin engine turboprops that airlines use to fly passengers from small cities to their bigger hubs, and, with you and your family in the back, I could probably get you there without a problem.
Does that make it the best option for you and your family sitting in the back?
BELIEVE ME, you'd rather have my old man or some other airline pilot in the cockpit.

Just because things are done a certain way doesnt mean its the best way for patients.

The combined MD-CRNA model is the most efficient, safest model, hands down.

 

[anesthesiadrew]

To me all CRNAs are trained operators who use a cookbook approach to delivering anesthesia. We need more AAs in anesthesia.

And what approach do AAs use? Or is it more perceived control over AAs than CRNAs?

 

[anesthesiadrew]

You are just a god damn srna, get the hell out of here and return to your allnurses.com forum.

Lovely attitude. With that stance you'd better stay in academics. You have a wonderful budding attitude of a Type A prick, hope the MI hits soon. Bet you'll make a wonderful dingus attending someday.