AANA Economics

[BLADEMDA]

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Moderators, I would like to professionally discuss the economics of the Solo CRNA in our health care system, both current and future, and its possible impact on the Specialty of Anesthesiology.

I believe there is a great deal of misunderstanding among SDN members that the war between the ASA and the AANA is about money when in fact, it's all about power and control.

Sure, the AANA goal in short/intermediate term is about raising the pay and work opportunities of CRNAs but long term its about total control.

 

[BLADEMDA]

"The MDs are simply wasting more money trying to hang onto an archaic and expensive system that favors them doing less work for more money as opposed to partnering with CRNAs to make the same money but have to actually give anesthesia for a living.

Pathetic in my opinion. They should simply compete in the market place or create mixed groups. It will happen regardless of all their whining and already is.

Its like all the BS chat on SDN that " if a pt had a choice they would choose an MD" yet none of em want to put their money where their mouths are and compete in the market place under that premise. Gee, wonder why."

CRNA

 

[BLADEMDA]

"The MDs are simply wasting more money trying to hang onto an archaic and expensive system that favors them doing less work for more money as opposed to partnering with CRNAs to make the same money but have to actually give anesthesia for a living.

Pathetic in my opinion. They should simply compete in the market place or create mixed groups. It will happen regardless of all their whining and already is.

Its like all the BS chat on SDN that " if a pt had a choice they would choose an MD" yet none of em want to put their money where their mouths are and compete in the market place under that premise. Gee, wonder why."

CRNA

Let's examine the economics of such a national system of Solo CRNA with some MD (A)s mixed into the practice. Everyone does his/her own case.
How does such a system affect Anesthesiology and Nurse Anesthesia not to mention the AA profession?

 

[BLADEMDA]

First, let's get to the money as that is where the CRNAs think the issue lies.
Does the CRNA make more money going Solo? Yes. In fact, most CRNAs (including the poster of that comment) expect to earn $200K plus benefits MINIMUM for Solo work. When I speak to CRNAs they openly state that Solo work should pay at least 50% more than supervision/medical direction.

They claim the added responsibility and stress are easily worth an additional 50% pay raise. In fact, when you look at the Solo CRNA pay nationally it is much closer to $200K plus benefits than the $135K most get under supervision.

Hence, in the short term the AANA/militant CRNA seeks independence to earn more money. They view the fight with the ASA as a necessity to get that extra money.

But, what are the long term effects of such a policy of "mixed groups"?

 

[BLADEMDA]

Since the AANA claims "equivalency" in terms of CRNA=MD (A) the "mixed group" sends a strong message that the claim is true. Hence, "expensive" MD Anesthesiologists should be replaced with Midlevel Anesthesia Nurses wherever possible. In the short run the "mixed group" does save some money to the hospital in terms of stipend but at what long term cost?

If the "mixed group" model were to become the predominant player in our hospital systems newly graduated MD (A)s would be forced to accept lower salaries. This in turn would force the CRNA to accept a lower salary to keep his job or compete for a new one. Finally, the AA would be forced into a major paycut to keep his/her job.

So, who ends up the winner here over the long term? the AANA.

As Medical Students begin to realize that CRNAS can function independently in a Group setting AND newly graduated Anesthesiologists were competing with Advanced Nurses for jobs the Residencies would dry up.

Once the Residencies start drying up what happens to the Specialty of Anesthesiology? The AA profession? Who is the only player left standing?

 

[BLADEMDA]

Once the AANA becomes the dominant player in a Advanced Nursing Field the final blow will come to Anesthesiology. Politicians will cut reimbursement for all "providers of anesthesia" (per the AANA we are all "equivalent") to an appropriate Advanced Nursing level.

The few remaining Anesthesiology Residencies will close or "morph" into DNAP programs. The USA ends up as the only First World Country without MD Anesthesiology.

This is why "mixed groups" is a bad idea for MD(A), CRNA and AA.

 

[BLADEMDA]

Hospital By-Laws:


Mixed Groups also send a strong message that CRNAs should and can function Independently. This may mean a CRNA run Group can challenge for the contract. After all, why not hire the CRNA run Group and save even more money? Let the CRNAs hire the ONE MD (A).

The result is the "mixed group" or Solo CRNA defeats the last barrier against Solo CRNA practice in "opt-out" States.

 

[BLADEMDA]

Economics and Statistics:

I firmly believe (as do others) that Solo CRNA practice will result in a slight bump up in mortality and increased morbidity. So, won't National, State or Local statistics show this bump up?

No. Everyone involved with this charade will mask any increase or simply alter the numbers. The same way the government alters CPI and Unemployment figures.

Once the "system" is saving money by paying all anesthesia providers a healthy $95K salary the bean counters won't let the truth get in the way.

 

[BLADEMDA]

I donate to State and National PACs to stop the AANA agenda. I hope all those who care about the future of our Specialty will do the same.

I also hope that in the future another Anesthesia Nursing Association will be formed that will partner with the ASA and the AAAA; this would be beneficial for the advancement of the field and protection of patient care.

 

[leaverus]

I don't understand how hospitals (that are not in BFE) would permit completely independent CRNA practice when they don't allow ANY doctor to continue practicing who cannot attain board-certification within a certain number of years (5 in my case). How then can providers who are not even physicians convince hospital administrators to allow them to practice equivalently to a physician?

 

[deleted126335]

Economics and Statistics:

I firmly believe (as do others) that Solo CRNA practice will result in a slight bump up in mortality and increased morbidity. So, won't National, State or Local statistics show this bump up?

No. Everyone involved with this charade will mask any increase or simply alter the numbers. The same way the government alters CPI and Unemployment figures.

Once the "system" is saving money by paying all anesthesia providers a healthy $95K salary the bean counters won't let the truth get in the way.

Nailed it. 👍

 

[335230]

ok

 

[BLADEMDA]

Blade, what about people who do a fellowship - which is what you have advised in the past?

Don't get me wrong - I appreciate what you are saying.

But, you see a time when pediatric, CT fellowships, or even pain guys are replaced .. ie crna's dispensing oxycontin and doing rf ablation ? Cardiac surgeons not concerns who is on their cases ? Parents obsessing about their kids and not demanding a peds fellowship anesthesiologist on their case?

What is the situation when nurses run the PACU , do involved pain consults ? Furthermore, where is John Edwards II in this situation..

This thread is about the "economics of anesthesia" as the AANA Would have it. If the AANA gets its way DNAP CRNAs will have 3-6 month "fellowships" just like Anesthesiologists. The AANA will then administer its own "equivalent" fellowship exam. Then, the Boards of Nursing in many States will "allow" that CRNA to practice that area of "Nursing."

Only continued legal challenges to what defines Nursing vs. Medicine (e.g. Pain Medicine in Louisiana) will stop or slow down the assault.

The hospital by-law committees/medical staff is the final barrier to Solo CRNA practice in all areas of Anesthesiology. Any Group which facilitates Solo CRNA practice in its hospital is simply speeding up the process of its eventual demise. Once CRNAs practice in a "mixed group" setting expect more legal challenges and restraint of trade lawsuits.

 

[BLADEMDA]

Blade, what about people who do a fellowship - which is what you have advised in the past?

Don't get me wrong - I appreciate what you are saying.

But, you see a time when pediatric, CT fellowships, or even pain guys are replaced .. ie crna's dispensing oxycontin and doing rf ablation ? Cardiac surgeons not concerns who is on their cases ? Parents obsessing about their kids and not demanding a peds fellowship anesthesiologist on their case?

What is the situation when nurses run the PACU , do involved pain consults ? Furthermore, where is John Edwards II in this situation..

A direct answer is that IMHO, hospitals and even CRNA groups will want fellowshiped trained MD (A)s around to do cases or bail CRNAS out. Hence, the demand for these skilled Physician providers will persist for the next 20 years (or longer). The question remains is what will that job pay (Nursing level duty?) and who will be in control of this field (AANA and CRNA run groups?).

 

[Laryngophed]

Blade, I have a question. How do we (well, you guys for the next 3.5+) years clearly delineate what is practicing medicine versus practicing nursing? The easy answer is give money to PACs, but even politicians will require some form of proof that CRNAs aren't equivalent to MDs. How do you prove that without unethically endangering patients?

 

[BLADEMDA]

"The MDs are simply wasting more money trying to hang onto an archaic and expensive system that favors them doing less work for more money as opposed to partnering with CRNAs to make the same money but have to actually give anesthesia for a living.

Pathetic in my opinion. They should simply compete in the market place or create mixed groups. It will happen regardless of all their whining and already is.

Its like all the BS chat on SDN that " if a pt had a choice they would choose an MD" yet none of em want to put their money where their mouths are and compete in the market place under that premise. Gee, wonder why."

CRNA

Mr. CRNA:

Anesthesia and health care in general is not a free market place item. In fact, it is extremely regulated by National, State and Hospital regulatory Boards.

Anyone who claims let the free marketplace decide when it comes to health care is kidding himself. This field is highly regulated, controlled and will continue to be so for the foreseeable future.

For example, Would Joe Public want a Nursing APN to be doing his Heart Bypass or Craniotomy? What if that Nursing APN has done a 1 year fellowship and is "certified" by the Board of Nursing? Would an E.R. patient be able to truly choose his Board Certified Physician Provider OVER that Nurse APN? What if the hospital decided to save money by only employing the Nurse APN on nights and weekends? How does one choose a provider during an Ambulance ride to the E.R.?

Health Care is regulated for a reason. Society demands certain standards from its providers. The AANA claims its newly minted CRNA is equal to a newly minted Anesthesiologist. As of today most State and local authorities aren't buying the rhetoric. But, who is to say that the propaganda won't end up becoming reality in the future.

 

[BLADEMDA]

Blade, I have a question. How do we (well, you guys for the next 3.5+) years clearly delineate what is practicing medicine versus practicing nursing? The easy answer is give money to PACs, but even politicians will require some form of proof that CRNAs aren't equivalent to MDs. How do you prove that without unethically endangering patients?

Do you really believe that Obama and Sebelius don't know the difference between APN/CRNA rhetoric and the facts? These people are very smart and when it comes to their family or themselves my bet is they want Physician level care. I highly doubt Mr. CRNA will be putting President Obama to sleep anytime soon.

The bean counters know the truth but are willing to sacrifice a degree of safety to save money. That is the cold, hard reality. The AANA junk science is just cover to allow them to do it.

Over the next few years the AANA will continue to hammer away at independent practice rights and "equivalency" studies so more States will grant Opt-Out. But, the Medical Staff/Hospital By-law hurdle is still a big one. The AANA will need more activist Judges to declare "restraint of trade" when Hospitals restrict CRNA privileges. Those lawsuits are next on the AANA agenda.

Or, the ObamaCare Law/Sebelius Health care system can unilaterally declare Anesthesia is a Nursing level duty and should be paid as such. This would speed up the demise of the Specialty of Anesthesiology.

 

[countingdays]

Blade, I have a question. How do we (well, you guys for the next 3.5+) years clearly delineate what is practicing medicine versus practicing nursing? The easy answer is give money to PACs, but even politicians will require some form of proof that CRNAs aren't equivalent to MDs. How do you prove that without unethically endangering patients?

You just never take a job working side by side with independent crnas. Then it's up to the hospitals to decide whether they would rather require supervision (even if the state's law doesn't require it) or whether they'll really go all-nurse for anesthesia at their facility. Today, most hospitals require supervision even in opt out states. That practice may not last forever.

We can't give the hospital the option of using independent nurses for the easy stuff and using doctors for difficult cases and to bail out na's with unexpected difficulties. That's the worst possible situation for doctors. You get all the difficult cases and associated liability while they get all the easy, profitable cases.

Some hospitals might go all-nurse to save money vs care team model. They can do what they want. Ideally the surgeons would take their cases elsewhere, but they could probably be bought off with convenient scheduling or some money. In the end, bad outcomes in nurse anesthesia facilities are the only thing that will make surgeons, hospitals, and patients demand physician supervision.

The problem is that even if some hospitals have only na's while others have MD-only or ACT model, the more difficult cases and sicker patients will tend to be done in physician facilities. Nurses will continue to have good outcomes by doing easy cases. It's very unlikely that nurses will be left alone, doing large numbers of big cases to the point where increase M&M will be demonstrable.

 

[Laryngophed]

Do you really believe that Obama and Sebelius don't know the difference between APN/CRNA rhetoric and the facts? These people are very smart and when it comes to their family or themselves my bet is they want Physician level care. I highly doubt Mr. CRNA will be putting President Obama to sleep anytime soon.

The bean counters know the truth but are willing to sacrifice a degree of safety to save money. That is the cold, hard reality. The AANA junk science is just cover to allow them to do it.

Over the next few years the AANA will continue to hammer away at independent practice rights and "equivalency" studies so more States will grant Opt-Out. But, the Medical Staff/Hospital By-law hurdle is still a big one. The AANA will need more activist Judges to declare "restraint of trade" when Hospitals restrict CRNA privileges. Those lawsuits are next on the AANA agenda.

Or, the ObamaCare Law/Sebelius Health care system can unilaterally declare Anesthesia is a Nursing level duty and should be paid as such. This would speed up the demise of the Specialty of Anesthesiology.

Whoa there, big fella. I am on your side, I'm just posing a question. This board talks lots about the impending troubles, but I don't know that enough real answers come up. Often I read about donating to the ASAPAC, but what more can be done? It'll be a while before I'm really in a position to do anything. Being a lowly medical student, I have the same license to practice medicine as the CRNAs but I'm interested to hear what attendings, fellow and residents think are the answers.

 

[Laryngophed]

You just never take a job working side by side with independent crnas. Then it's up to the hospitals to decide whether they would rather require supervision (even if the state's law doesn't require it) or whether they'll really go all-nurse for anesthesia at their facility. Today, most hospitals require supervision even in opt out states. That practice may not last forever.

We can't give the hospital the option of using independent nurses for the easy stuff and using doctors for difficult cases and to bail out na's with unexpected difficulties. That's the worst possible situation for doctors. You get all the difficult cases and associated liability while they get all the easy, profitable cases.

Some hospitals might go all-nurse to save money vs care team model. They can do what they want. Ideally the surgeons would take their cases elsewhere, but they could probably be bought off with convenient scheduling or some money. In the end, bad outcomes in nurse anesthesia facilities are the only thing that will make surgeons, hospitals, and patients demand physician supervision.

The problem is that even if some hospitals have only na's while others have MD-only or ACT model, the more difficult cases and sicker patients will tend to be done in physician facilities. Nurses will continue to have good outcomes by doing easy cases. It's very unlikely that nurses will be left alone, doing large numbers of big cases to the point where increase M&M will be demonstrable.

Ah, this is the kind of response for which I had hoped. That seems reasonable enough. What happens in the interim if most hospitals turn to indy-CRNAs? Will the docs be willing to take the necessary pay cuts to work in a given area?

 

[countingdays]

Moderators, I would like to professionally discuss the economics of the Solo CRNA in our health care system, both current and future, and its possible impact on the Specialty of Anesthesiology.

I believe there is a great deal of misunderstanding among SDN members that the war between the ASA and the AANA is about money when in fact, it's all about power and control.

Sure, the AANA goal in short/intermediate term is about raising the pay and work opportunities of CRNAs but long term its about total control.

The current trend as far as I can tell would lead to independent nurses doing all the easy cases that reimburse well while physicians will do the bigger, sicker cases. Hospitals will never let nurses bill independently and make a fortune, so they'll hire crnas as employees, collect what they bill, and pay the lowest salary that supply/demand allows. The nurses won't ever reap the benefits of their political actions. The winner would be the hospital, not na's. The looser would be partners of anesthesiology groups.

On the other hand, most anesthesia groups aren't offering fair partnership tracks anyway. They're mostly AMCs or groups that just want to exploit new grads, fewer and fewer are offering true partnerships, so there isn't much difference from the new grad point of view. But that's another topic.

 

[BLADEMDA]

Whoa there, big fella. I am on your side, I'm just posing a question. This board talks lots about the impending troubles, but I don't know that enough real answers come up. Often I read about donating to the ASAPAC, but what more can be done? It'll be a while before I'm really in a position to do anything. Being a lowly medical student, I have the same license to practice medicine as the CRNAs but I'm interested to hear what attendings, fellow and residents think are the answers.

I will certainly state a few "answers" for you.

1. Academia- We need academics to recognize the problem and help address it. We need Bold leadership here. Department Chaipersons should require AKT of all SNRAs and Residents. Other comparisons should and can be done. We need to refute the AANA junk science and we have the tools to do it. But, so far we don't have the courage/BA@@s to tackle the AANA monster.

2. Open and encourage more AA Schools. Use AAs wherever possible.

3. Get AAs licensed in all 50 States

4. Donate to National and State PACS

5. Fight all AANA "opt-out" requests

6. Stay active at the State and Hospital levels

7. Require a 2 hour "political course" in anesthesia politics prior to graduation from Residency. (We can learn from the AANA on this one).

8. Discuss the cold, hard facts amongst all Residency Staff

9. Don't accept the rhetoric or propaganda. This war is about power and control NOT just money. Keep posting the truth.

10. Never accept the "mixed group setting" model. Either supervise/direct CRNAs or do your own cases.

 

[BLADEMDA]

The current trend as far as I can tell would lead to independent nurses doing all the easy cases that reimburse well while physicians will do the bigger, sicker cases. Hospitals will never let nurses bill independently and make a fortune, so they'll hire crnas as employees, collect what they bill, and pay the lowest salary that supply/demand allows. The nurses won't ever reap the benefits of their political actions. The winner would be the hospital, not na's. The looser would be partners of anesthesiology groups.

On the other hand, most anesthesia groups aren't offering fair partnership tracks anyway, so there isn't much difference from the new grad point of view. But that's another topic.

The biggest "losers" will be the PATIENT and the second will be the slow demise of the Medical Specialty of Anesthesiology

 

[Laryngophed]

I will certainly state a few "answers" for you.

1. Academia- We need academics to recognize the problem and help address it. We need Bold leadership here. Department Chaipersons should require AKT of all SNRAs and Residents. Other comparisons should and can be done. We need to refute the AANA junk science and we have the tools to do it. But, so far we don't have the courage/BA@@s to tackle the AANA monster.

2. Open and encourage more AA Schools. Use AAs wherever possible.

3. Get AAs licensed in all 50 States

4. Donate to National and State PACS

5. Fight all AANA "opt-out" requests

6. Stay active at the State and Hospital levels

7. Require a 2 hour "political course" in anesthesia politics prior to graduation from Residency. (We can learn from the AANA on this one).

8. Discuss the cold, hard facts amongst all Residency Staff

9. Don't accept the rhetoric or propaganda. This war is about power and control NOT just money. Keep posting the truth.

10. Never accept the "mixed group setting" model. Either supervise/direct CRNAs or do your own cases.

Cool! Great response. I am just a medical student, but because gas is on my short list at the moment (like that means anything) I'm certainly interested in learning about the problems associated with it. More than that, I really want to hear what the people in a position to change it, think are the MOAs that must be taken to do as much.

By the way, I have a buddy who is planning a change of career and wants to go to AA school. I vomited all of the information I could to him to help him get in school. Not just because he's my buddy, but also because he wants to be an AA and I have the opportunity to sway him and keep him from thinking about becoming a CRNA.

 

[BLADEMDA]

The current trend as far as I can tell would lead to independent nurses doing all the easy cases that reimburse well while physicians will do the bigger, sicker cases. Hospitals will never let nurses bill independently and make a fortune, so they'll hire crnas as employees, collect what they bill, and pay the lowest salary that supply/demand allows. The nurses won't ever reap the benefits of their political actions. The winner would be the hospital, not na's. The looser would be partners of anesthesiology groups.

On the other hand, most anesthesia groups aren't offering fair partnership tracks anyway. They're mostly AMCs or groups that just want to exploit new grads, fewer and fewer are offering true partnerships, so there isn't much difference from the new grad point of view. But that's another topic.

So, would you work in a "mixed group setting" alongside CRNAs? Would you work for a CRNA run Group? How do you feel about earning 25% more than a CRNA or even earning the same income as the CRNA partners?

Money is just one aspect of the AANA agenda; the more important goal is "equivalency" in all areas of Anesthesia.

 

[countingdays]

So, would you work in a "mixed group setting" alongside CRNAs? Would you work for a CRNA run Group? How do you feel about earning 25% more than a CRNA or even earning the same income as the CRNA partners?

Money is just one aspect of the AANA agenda; the more important goal is "equivalency" in all areas of Anesthesia.

Right now, if I see a job posting that suggests you work beside independent crnas, I view it as a total deal breaker. I never look at that job again and certainly don't express any interest in it. In the future, we may not have that option.

 

[BLADEMDA]

Right now, if I see a job posting that suggests you work beside independent crnas, I view it as a total deal breaker. I never look at that job again and certainly don't express any interest in it. In the future, we may not have that option.

I agree with you. If the CRNAS and the AANA get their way the next "evolution" in our field will be the mixed group setting. I hope all Residents and Fellows understand that such a model is just a "bridge" to the 100% Solo CRNA group with maybe one MDA (yes, you will be called that) helping to put out fires.

Anyone joining a mixed group setting is either broke or unemployed as such a model is simply the beginning of the end of our Specialty.

 

[deleted126335]

]You just never take a job working side by side with independent crnas[/B]. Then it's up to the hospitals to decide whether they would rather require supervision (even if the state's law doesn't require it) or whether they'll really go all-nurse for anesthesia at their facility. Today, most hospitals require supervision even in opt out states. That practice may not last forever.

We can't give the hospital the option of using independent nurses for the easy stuff and using doctors for difficult cases and to bail out na's with unexpected difficulties. That's the worst possible situation for doctors. You get all the difficult cases and associated liability while they get all the easy, profitable cases.

Some hospitals might go all-nurse to save money vs care team model. They can do what they want. Ideally the surgeons would take their cases elsewhere, but they could probably be bought off with convenient scheduling or some money. In the end, bad outcomes in nurse anesthesia facilities are the only thing that will make surgeons, hospitals, and patients demand physician supervision.

The problem is that even if some hospitals have only na's while others have MD-only or ACT model, the more difficult cases and sicker patients will tend to be done in physician facilities. Nurses will continue to have good outcomes by doing easy cases. It's very unlikely that nurses will be left alone, doing large numbers of big cases to the point where increase M&M will be demonstrable.

People will do whatever they have to to pay the mortgage.

 

[BLADEMDA]

"Blade is making an attack on the idea of mixed groups of independent practitioners (CRNAs and MDAs) however, this is absolutely the future of anesthesia. The VAST majority of CRNAs would be quite happy working in a practice where they get full scope of practice and 100% autonomy even if that means the MDAs make 2-3X as much a year. It really isnt about money and power but about doing what one is trained to do. I love my job, I count many of the CRNAs and MDAs in my group as very good friends and great people. We dont have ANY political issues in our group. We dont have infighting between CRNAs and MDAs and we all make good money. Welcome to the future where the CRNAs are happy, the MDAs are happy and the facility is happy. Wow, what a horrible thing, right blade?"

First of all, there are very few MDAs or CRNAs who work solo at all. So this is extremely rare. Most are apart of groups of some sort. The average CRNA salary was 160K last year. Most CRNAs who work independently (which is different from solo) make in the 180-200K range 1099. So right off the bat you have to take ~20% off for bennies making the range for independent 170-180K. Solo CRNAs are often fee for service. If i worked fee for service last year I would have made ~240K (1099). I know this because i keep a record of my cases over a 6 month period for negotiation of contract purposes. It is all then a function of payor mix and contracts with insurance companies as to what one might make. On average solo CRNAs are getting 5-10$ less per unit than an MDA doing the same case for the same private insurer. The only time we are guaranteed to get the same pay is IHS, MEDICARE and TRICARE.

So the reality here is quite different from what blade presents.


his is full of BS. The actuality is the MDAs in my grp make more than the national average. Not only do they make money by doing actual anesthesia everyday as fee for service (every one of them work hard), but they also make some money from every CRNA in the groups work. None of us mind at all since they pay us very well and we are independent practitioners. Our MDAs do extremely well as do our CRNAs. As for AAs, they are doomed and we all know it. None of them would function either legally or otherwise in my practice.

 

[BLADEMDA]

I won't be quoting anymore CRNA rhetoric or propaganda on this thread (after the next post). If you want to read about CRNA "equivalency" I recommend you visit the militant Nurse web site.

The fact is a mixed group setting is the interim step in the destruction of our specialty. CRNAs should never have gained Independent practice rights. But, that battle was lost decades ago. Now, they are busy publishing junk science to gain a real foothold in our major hospitals. The mixed group setting with Solo CRNAs is simply another step towards 100% Solo CRNA practices with maybe one token MDA employed by the hospital or CRNA Group.

The current battles may be about money but the ultimate result of a mixed Group setting is the replacement of MD Anesthesiologists with a second tier provider (good enough?) at a lower cost. This will drive the majority of Med Students away from Anesthesiology and destroy the specialty over time. In the end the USA ends up with the CRNA as the primary provider of all anesthetics without any MD Anesthesiology presence.

 

[BLADEMDA]

"Of course an all CRNA group should be able to compete for a contract. The hospital can then make the decision as to what they want. It is time to stop suggesting there is a patient outcome difference when clearly there has not been, ever. Just stick to the facts and play in the marketplace." Militant CRNA

 

[BLADEMDA]

People will do whatever they have to to pay the mortgage.

Yes. The AANA is counting on that fact.

 

[BLADEMDA]

 

[WholeLottaGame7]

I don't know if it will be the end of anesthesiology, but it will certainly be the end of anesthesiology as we currently know it. Granted, my experience is limited, but I see a lot of parallels between our field and family medicine. APNs working independently in areas understaffed by MDs, as physician extenders in areas with sufficient MDs. I think MD salaries will fall more towards primary care numbers, at which point the impetus to choose a CRNA over MD for cost-cutting reasons is abolished. At that point it becomes about efficacy; if we provide a better product for similar prices, it will be a no-brainer. If there's really no difference, well, it was a fight we weren't going to win anyway.

 

[BLADEMDA]

I don't know if it will be the end of anesthesiology, but it will certainly be the end of anesthesiology as we currently know it. Granted, my experience is limited, but I see a lot of parallels between our field and family medicine. APNs working independently in areas understaffed by MDs, as physician extenders in areas with sufficient MDs. I think MD salaries will fall more towards primary care numbers, at which point the impetus to choose a CRNA over MD for cost-cutting reasons is abolished. At that point it becomes about efficacy; if we provide a better product for similar prices, it will be a no-brainer. If there's really no difference, well, it was a fight we weren't going to win anyway.

Patients can choose their Primary Care provider. The reason behind APNs for Family Medicine is because Primary Care providers are in insufficient supply vs. demand.

Anesthesia is a very different animal. In the hospital setting the patient may get stuck with the "solo CRNA" or be forced into cancellation. The hospital ends up "choosing" the provider type/mix and not the patient.

As for salry differential that may evaporate as well once Hospitals and payers realize this is the domain of independent Nursing providers.

Why would medical students choose to be a colleague with Advanced practice Nurses in a hospital setting? At least in Family practice YOU run the show and your office. Who is to say that in the future some Militant CRNA (who is you EQUAL and COLLEAGUE per the AANA) isn't your Boss?

What type of Medical Student will Match into this Nursing Field of the future? The best and the brightest will shun this field leaving only the bottom of the Class to enter ever shrinking Residency Programs.

The next time somebody important brings up the AANA and SRNA training at our Academic medical centers please remember this thread.

 

[quescare]

I will certainly state a few "answers" for you.

1. Academia- We need academics to recognize the problem and help address it. We need Bold leadership here. Department Chaipersons should require AKT of all SNRAs and Residents. Other comparisons should and can be done. We need to refute the AANA junk science and we have the tools to do it. But, so far we don't have the courage/BA@@s to tackle the AANA monster.

2. Open and encourage more AA Schools. Use AAs wherever possible.

3. Get AAs licensed in all 50 States

4. Donate to National and State PACS

5. Fight all AANA "opt-out" requests

6. Stay active at the State and Hospital levels

7. Require a 2 hour "political course" in anesthesia politics prior to graduation from Residency. (We can learn from the AANA on this one).

8. Discuss the cold, hard facts amongst all Residency Staff

9. Don't accept the rhetoric or propaganda. This war is about power and control NOT just money. Keep posting the truth.

10. Never accept the "mixed group setting" model. Either supervise/direct CRNAs or do your own cases.

1.) No study will ever be the be all end all study. The only people willing to put the time, effort and $ into such a study would necessarily also have an interest in the result so someone will always be able to cry "bias and junk science" regardless of the outcome or how well the study is done.

2. and 3.) Tell me how this is a good idea, other than AAs are by regulation and law unable to work independently and must be spoonfed what you wish them to be fed and regurgitate?

9.) I am not accepting your propaganda and rhetoric, as you have not given any convincing arguments based in fact. You are fear mongering and using emotion both of which are humorous coming from someone with as much education and training in medicine as you present yourself to be. Your posts with pictures are even more ridiculous and appear as nothing more than grandstanding.

 

[quescare]

In the end the USA ends up with the CRNA as the primary provider of all anesthetics without any MD Anesthesiology presence.

Isn't how the field of anesthesia began?

 

[BLADEMDA]

1.) No study will ever be the be all end all study. The only people willing to put the time, effort and $ into such a study would necessarily also have an interest in the result so someone will always be able to cry "bias and junk science" regardless of the outcome or how well the study is done.

2. and 3.) Tell me how this is a good idea, other than AAs are by regulation and law unable to work independently and must be spoonfed what you wish them to be fed and regurgitate?

9.) I am not accepting your propaganda and rhetoric, as you have not given any convincing arguments based in fact. You are fear mongering and using emotion both of which are humorous coming from someone with as much education and training in medicine as you present yourself to be. Your posts with pictures are even more ridiculous and appear as nothing more than grandstanding.

This thread isn't an "attack" on any CRNA. I am merely stating my view on AANA econmics as I see it.

1. We need studies to refute recent AANA sponsored publications regarding "equivalence" between CRNA and MD (A). The anesthesia knowledge test is just one measure of POTENTIAL importance for providers. Unlike the AANA and the militant CRNA, I endorse the publication of test scores between "EQUAL" provider Groups. After all, Is "EQUAL" really equal when it comes to knowledge? Let the Legislators decide whether TEST SCORES matter when it comes to patient safety.

I would include Senior CRNA Academic Medical Staff along with MD Attendings in grading/scoring these test results. Let the chips fall where they may.

2. AA=CRNA. Please show me one study where AA safety is below CRNA.
Since AA=CRNA there is nothing wrong in supporting the group of providers which stands with the Medical Specialty of Anesthesiology and BEST PATIENT care.

3. AAs are cheaper than Solo CRNAs and provide equal quality/safety. Solo CRNAs are expensive and IMHO unqualified to provide care to our sickest patients without MD input.

9. I am not fear mongering. The AANA agenda is FACT and once a Nurse is Equal to a Doctor and has all the same practice rights why on earth would anyone go to medical school? Since you have no idea the sacrifices involved in becoming a Doctor (money, time, tests, I.Q., etc.) I don't expect you to grasp this point.

 

[BLADEMDA]

Isn't how the field of anesthesia began?

The field of Surgery began with Barbers. Is that how we want it today and in the future?

 

[leaverus]

So, would you work in a "mixed group setting" alongside CRNAs? Would you work for a CRNA run Group?

That's exactly the job i'm STUCK in right now. It's horrible working alongside people with INFERIOR training who think they are as knowledgeable and skilled as you are. There is an undercurrent of - and occasionally outright - animosity and arrogance. When i took this job out of residency i was under the impression that i would "supervising" CRNAs in the traditional sense. Turns out, what that really meant was that i would simply be signing off on charts as the "supervising" doc in order to satisfy hospital bylaws; but the CRNAs really practice independently (and are encouraged to do so by the director of our group). There are a couple of hospitals within reasonable driving distance of me who employ NO CRNAs and hopefully they may be hiring within the next several months so i can get the hell outta here. If i can help it, i will never work with another CRNA again, but i wonder if these MD-only groups will last much longer so i may not even have that choice?

 

[24858]

The field of Surgery began with Barbers. Is that how we want it today and in the future?

Love it, hilarious.
Are we not responsible for educating the vast majority of these fools? We need to stop training crnas. Pure and simple. Stop training these back stabbers.

 

[BLADEMDA]

That's exactly the job i'm STUCK in right now. It's horrible working alongside people with INFERIOR training who think they are as knowledgeable and skilled as you are. There is an undercurrent of - and occasionally outright - animosity and arrogance. When i took this job out of residency i was under the impression that i would "supervising" CRNAs in the traditional sense. Turns out, what that really meant was that i would simply be signing off on charts as the "supervising" doc in order to satisfy hospital bylaws; but the CRNAs really practice independently (and are encouraged to do so by the director of our group). There are a couple of hospitals within reasonable driving distance of me who employ NO CRNAs and hopefully they may be hiring within the next several months so i can get the hell outta here. If i can help it, i will never work with another CRNA again, but i wonder if these MD-only groups will last much longer so i may not even have that choice?

Thank you for your post. Your current Group is employing these "semi-solo" CRNAs for monetary gain. Since CRNAS are expensive and MD (A)s even more so they are cutting corners by allowing CRNAs to function in an Independent manner. While the BEST CRNAS (a select Group of experienced CRNAS usually ex-military) may be up to this task with only minimal assistance the vast majoroty of your CRNA "colleagues" lack the skill and education to act as an Independent provider.

 

[BLADEMDA]

Q: What is the difference between a CRNA and an anesthesiologist?
A: The most substantial difference between CRNAs and anesthesiologists is that prior to anesthesia education, anesthesiologists receive medical education while CRNAs receive nursing education. However, the anesthesia part of the education is very similar for both providers. They are both educated to use the same anesthesia processes in the provision of anesthesia and related services.

This information is brought to you by the
American Association of Nurse Anesthetists
222 S. Prospect Avenue
Park Ridge, IL 60068-4001
847-692-7050

​

 

[jwk]

2. and 3.) Tell me how this is a good idea, other than AAs are by regulation and law unable to work independently and must be spoonfed what you wish them to be fed and regurgitate?

Ah, being spoonfed. That's the specialty of the AANA and what they tell their members about AA's.

You act like working independently is the be all and end all for CRNA's. It's not. MOST CRNA's work in anesthesia care team practices, with many of those under a significant degree of MD supervision or medical direction. Transplants, hearts, major neuro, major peds, and many other specialties and procedures are simply not done in practices with CRNA's only.

We have CRNA students from several different programs rotate through my hospital. They are NEVER left unattended, NEVER do regional, and NEVER do central lines in our facilities. MOST of them actually want to come work for us because we are a high quality, high volume practice with an excellent reputation in our area.

You wanna work in BFE independently? Be my guest. Wanna work in an outpatient surgery center doing bread and butter stuff while we do the big cases across the street? Be my guest - although in my town, most of those centers have anesthesiologists running the show.

 

[quescare]

This thread isn't an "attack" on any CRNA. I am merely stating my view on AANA econmics as I see it.

1. We need studies to refute recent AANA sponsored publications regarding "equivalence" between CRNA and MD (A). The anesthesia knowledge test is just one measure of POTENTIAL importance for providers. Unlike the AANA and the militant CRNA, I endorse the publication of test scores between "EQUAL" provider Groups. After all, Is "EQUAL" really equal when it comes to knowledge? Let the Legislators decide whether TEST SCORES matter when it comes to patient safety.

I would include Senior CRNA Academic Medical Staff along with MD Attendings in grading/scoring these test results. Let the chips fall where they may.

2. AA=CRNA. Please show me one study where AA safety is below CRNA.
Since AA=CRNA there is nothing wrong in supporting the group of providers which stands with the Medical Specialty of Anesthesiology and BEST PATIENT care.

3. AAs are cheaper than Solo CRNAs and provide equal quality/safety. Solo CRNAs are expensive and IMHO unqualified to provide care to our sickest patients without MD input.

9. I am not fear mongering. The AANA agenda is FACT and once a Nurse is Equal to a Doctor and has all the same practice rights why on earth would anyone go to medical school? Since you have no idea the sacrifices involved in becoming a Doctor (money, time, tests, I.Q., etc.) I don't expect you to grasp this point.

1.) Test scores on what test? Those results would perhaps be telling, perhaps not. Unfortunately as there are incredible anesthesiologists who provide incredible patient care, there are also some on the other end of the spectrum. The same exists within the realm of nurse anesthetists. So unless you get literally "everyone" to take this test someone will cry foul. Also, who will care about these test results? Not too many people, because many people only care about results. Like I stated above, that study won't ever be done to everyone's satisfaction.

2. and 3.) You say that AA = CRNA in safety so they are interchangeable. AAs are only able to work based upon the supervision and guidance of the supervising anesthesiologist, in theory doing what the anesthesiologist tells them to do. So then AA is doing what the anesthesiologist would do = anesthesiologist. So you are saying that anesthesiologist = CRNA. I can agree to that.

Comparing someone who provides solo service to someone who MUST be under a physician's supervision is comparing apples with radishes. Not even the same type of food, so not a valid comparison.

9.) Please show me this fact you speak of, from the AANA. As to the sacrifices necessary, I am aware of the sacrifices necessary to both routes as neither route is just a leisurely stroll with unicorns farting rainbows and skittles falling from the sky.

 

[jwk]

1.) Test scores on what test? Those results would perhaps be telling, perhaps not. Unfortunately as there are incredible anesthesiologists who provide incredible patient care, there are also some on the other end of the spectrum. The same exists within the realm of nurse anesthetists. So unless you get literally "everyone" to take this test someone will cry foul. Also, who will care about these test results? Not too many people, because many people only care about results. Like I stated above, that study won't ever be done to everyone's satisfaction.

2. and 3.) You say that AA = CRNA in safety so they are interchangeable. AAs are only able to work based upon the supervision and guidance of the supervising anesthesiologist, in theory doing what the anesthesiologist tells them to do. So then AA is doing what the anesthesiologist would do = anesthesiologist. So you are saying that anesthesiologist = CRNA. I can agree to that.

Comparing someone who provides solo service to someone who MUST be under a physician's supervision is comparing apples with radishes. Not even the same type of food, so not a valid comparison.

Mikey, I thought you didn't hang out over here.

 

[Coastie]

Isn't how the field of anesthesia began?

Hey troll:

No, it isn't.

Nurses were the late-comers to anesthesia. Your own wiki article states as such.

 

[BLADEMDA]

1.) Test scores on what test? Those results would perhaps be telling, perhaps not. Unfortunately as there are incredible anesthesiologists who provide incredible patient care, there are also some on the other end of the spectrum. The same exists within the realm of nurse anesthetists. So unless you get literally "everyone" to take this test someone will cry foul. Also, who will care about these test results? Not too many people, because many people only care about results. Like I stated above, that study won't ever be done to everyone's satisfaction.

2. and 3.) You say that AA = CRNA in safety so they are interchangeable. AAs are only able to work based upon the supervision and guidance of the supervising anesthesiologist, in theory doing what the anesthesiologist tells them to do. So then AA is doing what the anesthesiologist would do = anesthesiologist. So you are saying that anesthesiologist = CRNA. I can agree to that.

Comparing someone who provides solo service to someone who MUST be under a physician's supervision is comparing apples with radishes. Not even the same type of food, so not a valid comparison.

9.) Please show me this fact you speak of, from the AANA. As to the sacrifices necessary, I am aware of the sacrifices necessary to both routes as neither route is just a leisurely stroll with unicorns farting rainbows and skittles falling from the sky.

1) Test Scores on the Anesthesia Knowledege Test. This test would be given to Senior SRNAs and CA-3 Residents. The results would then be compared, analyzed and published.

2) Since CURRENTLY most CRNAs and AAs work in an ACT practice these practices can hire AAs or CRNAs. They are interchangeable. Just ask JWK. That is why Georgia has more AAs than CRNAs and I don't believe the AA is any less intelligent than CRNAs. Do you?

9) I have shown you this "fact." Did you learn to read in high school or community college?

 

[Coastie]

1.) Test scores on what test? Those results would perhaps be telling, perhaps not. Unfortunately as there are incredible anesthesiologists who provide incredible patient care, there are also some on the other end of the spectrum. The same exists within the realm of nurse anesthetists. So unless you get literally "everyone" to take this test someone will cry foul. Also, who will care about these test results? Not too many people, because many people only care about results. Like I stated above, that study won't ever be done to everyone's satisfaction.

2. and 3.) You say that AA = CRNA in safety so they are interchangeable. AAs are only able to work based upon the supervision and guidance of the supervising anesthesiologist, in theory doing what the anesthesiologist tells them to do. So then AA is doing what the anesthesiologist would do = anesthesiologist. So you are saying that anesthesiologist = CRNA. I can agree to that.

Comparing someone who provides solo service to someone who MUST be under a physician's supervision is comparing apples with radishes. Not even the same type of food, so not a valid comparison.

9.) Please show me this fact you speak of, from the AANA. As to the sacrifices necessary, I am aware of the sacrifices necessary to both routes as neither route is just a leisurely stroll with unicorns farting rainbows and skittles falling from the sky.

Yet another militant-mursey.org troll boy. Are you upset about gaswork jobs for CRNAs going down? Is the saturation of the market getting to you, such that you have to continually create fake names on SDN to post the same drivel over and over?

The tests you need to take to show equivalence are the MCAT, USMLE 1/2/3, Oral and Written Boards...and every test for every class in medical school, plus do the appropriate rotations as outlined by the LCME. Period.

 

[deleted126335]

1.) Test scores on what test? Those results would perhaps be telling, perhaps not. Unfortunately as there are incredible anesthesiologists who provide incredible patient care, there are also some on the other end of the spectrum. The same exists within the realm of nurse anesthetists. So unless you get literally "everyone" to take this test someone will cry foul. Also, who will care about these test results? Not too many people, because many people only care about results. Like I stated above, that study won't ever be done to everyone's satisfaction.

2. and 3.) You say that AA = CRNA in safety so they are interchangeable. AAs are only able to work based upon the supervision and guidance of the supervising anesthesiologist, in theory doing what the anesthesiologist tells them to do. So then AA is doing what the anesthesiologist would do = anesthesiologist. So you are saying that anesthesiologist = CRNA. I can agree to that.

Comparing someone who provides solo service to someone who MUST be under a physician's supervision is comparing apples with radishes. Not even the same type of food, so not a valid comparison.

9.) Please show me this fact you speak of, from the AANA. As to the sacrifices necessary, I am aware of the sacrifices necessary to both routes as neither route is just a leisurely stroll with unicorns farting rainbows and skittles falling from the sky.

The stroke of a legislative pen can and has changed a CRNA scope of practice. Usually, but not always expanding it.

There are many institutions where as a matter of institutional policy CRNAs must be supervised by an anesthesiologist. Granted this is a matter of institutional policy and not state law. I would venture to say that this is most hospitals and most CRNAs function this way. That supervision may be lax or very tight as many of you lament.