AANA Economics

[FutrrENT]

As abhorrent as I find the push for CRNA pain management to be, I think that using phrases like "murses" and "Ms. Zwerling" ill represents us as a group of professionals.

Getting uppity about the phrase "MDA" (which you should) is a little weak sauce if you're calling them "murses" in the next breath.

We can fundamentally disagree with the basic premise that a nursing board can declare anything in the realm of medicine to be within the scope of nursing and therefore claim it as an opportunity for practice explansion, but let's keep the debate and our opposition professional.

Dude, that kind of "we are better than that, turn the other cheek" attitude is exactly the kind of passivity that has bought you this problem with nurses. I find it utterly amazing that I, who will be entering a field that is well-protected from these doc-wannabe nurses, am more willing to take the aggressive stance against them than you are.

Mid-level nurses should be ridiculed at every opportunity. They deserve it. They are nothing more than a bunch of cheating, marginally-trained scumbags who want to practice medicine without getting a medical education. That in itself deserves scorn and ridicule at every turn. If you're smart, you'll turn the abbreviation "CRNA" into a four-letter word and make it common knowledge to all what exactly they are and where they fit on the totem pole. Put simply, you need to start fighting dirty.

And I for one, once I'm done with residency, will start using the term "male nurse" in reference to male CRNAs, NP's (and any of these clowns that might have bought one of those bogus DNAP or DNP degrees) and I will do it in a clinical setting. To hell with professionalism. Ever since nurses have started claiming to us and the public that they're as good as physicians, professionalism has gone out the window. At very least, ridiculing the ones that try to play doctor is hardly a distortion of the truth.

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[Consigliere]

Hey, did that Zwerling clown have a stroke or something? I detect a bit of right-sided facial droop.

 

[Coastie]

The rise of the noctor must be met head on. The best way to do it is with each patient interaction, every hospital committee, as well as outspending and outsmarting them in the political arena.

It's insane to think that absolutely unqualified people have convinced the public that they are able to perform something that they are completely unqualified to do. We definitely have our work cut out for us.

I'd like to thank FutrENT for standing up for our specialty even though he is a surgeon in the making. Every physician should stand together to fight these selfish "practitioners" who are trying to destroy American medicine one patient at a time.

 

[BeddingfieldMD]

I'd like to thank FutrENT for standing up for our specialty even though he is a surgeon in the making. Every physician should stand together to fight these selfish "practitioners" who are trying to destroy American medicine one patient at a time.

Yeah, seriously. Much unlike the clown general surgeon from Cleveland, Ohio (this guy, Dr. Parks: http://www.ohiosurgery.blogspot.com/) who made this comment on the KevinMD blog (http://www.kevinmd.com/blog/2011/02/asa-patients-demand-physicians-provide-anesthesia-care.html) that was featured in one of this month's ASAP emails:

"buckeye surgeon February 15, 2011 at 5:57 am
For most surgical procedures, CRNA’s provide equivalent medical care at a fraction of the cost. Those are the facts. I know it’s uncomfortable for the Anesthesiologist lobby, but you reap what you sow. You guys wanted to be able to run three rooms at a time while while your “lackey” anesthesia assistants had to sit in the cold operating suites for the duration of the cases while you enjoyed doughnuts in the OR control room.

And the argument about the reduction in anesthesia-related deaths is self defeating. Systems management led to the virtual elimination of general anesthesia as a significant risk for death, not any one individual brilliant anesthesiologist. Fail-safe mechanisms like continuous pulse ox monitoring, end tidal CO2 determinations, fiberop

tic intubation, and better pre-operative evaluations allowed even mediocre anesthesiologists to achieve extraordinary low complication rates. These practice standards were then easily passed on to nurse anesthetists."

 

[WholeLottaGame7]

The rise of the noctor must be met head on. The best way to do it is with each patient interaction, every hospital committee, as well as outspending and outsmarting them in the political arena.

It's insane to think that absolutely unqualified people have convinced the public that they are able to perform something that they are completely unqualified to do. We definitely have our work cut out for us.

I'd like to thank FutrENT for standing up for our specialty even though he is a surgeon in the making. Every physician should stand together to fight these selfish "practitioners" who are trying to destroy American medicine one patient at a time.

Agree with Hawaiian Bruin. I respect the passion, but I will disagree strongly with the approach. I know most of it is for show (and we are all impressed by your internet testosterone levels btw), but there is no way that anyone can act like this in a real-world job and and keep that job for very long, particularly as a resident.

More importantly, I fail to see how becoming a profession of d**ks is going to advance our cause. Thinking that shouting "But they're a bunch of murses!" repeatedly is going to be more efficacious than actually showing real, concrete differences in patient care is laughable.

I think everybody agrees that the danger here lies in a group of professionals not knowing what they don't know. Their die-hard support of that crappy Health Affairs article only reinforces that. But sadly, for many people crappy info is better than no info, so like it or not, the onus has been placed on us to refute it.

 

[WholeLottaGame7]

Yeah, seriously. Much unlike the clown general surgeon from Cleveland, Ohio (this guy, Dr. Parks: http://www.ohiosurgery.blogspot.com/) who made this comment on the KevinMD blog (http://www.kevinmd.com/blog/2011/02/asa-patients-demand-physicians-provide-anesthesia-care.html) that was featured in one of this month's ASAP emails:

"buckeye surgeon February 15, 2011 at 5:57 am
For most surgical procedures, CRNA’s provide equivalent medical care at a fraction of the cost. Those are the facts. I know it’s uncomfortable for the Anesthesiologist lobby, but you reap what you sow. You guys wanted to be able to run three rooms at a time while while your “lackey” anesthesia assistants had to sit in the cold operating suites for the duration of the cases while you enjoyed doughnuts in the OR control room.

And the argument about the reduction in anesthesia-related deaths is self defeating. Systems management led to the virtual elimination of general anesthesia as a significant risk for death, not any one individual brilliant anesthesiologist. Fail-safe mechanisms like continuous pulse ox monitoring, end tidal CO2 determinations, fiberop

tic intubation, and better pre-operative evaluations allowed even mediocre anesthesiologists to achieve extraordinary low complication rates. These practice standards were then easily passed on to nurse anesthetists."

What a terrible argument. So just because the airline industry is ridiculously safe due to systems management, does that mean pilot training is less rigorous now?

 

[BeddingfieldMD]

I think everybody agrees that the danger here lies in a group of professionals not knowing what they don't know. Their die-hard support of that crappy Health Affairs article only reinforces that. But sadly, for many people crappy info is better than no info, so like it or not, the onus has been placed on us to refute it.

Problem is, what IRB is going to approve the ideal study, which would be something like randomizing ASA 3/4 patients either to a nurse anesthetist (without possibility of anesthesiologist intervention or assistance) vs. an anesthesiologist? Would be interesting for anesthesiology departments throughout the country to start flooding IRBs with such study proposals and see if something slipped through the cracks. You could then watch that virtually no patient except maybe a few demented folks would ever sign up for such a study.

I guess someone could set up a survey asking patients if they would be willing to participate in such a study. Get med students at some university to ask a bunch of patients that question. Guarantee you the only people who would agree would be maybe some nurse anesthetists and their spouses...maybe. Would make for an interesting press release, at least.

 

[OB1🤙]

Dude, that kind of "we are better than that, turn the other cheek" attitude is exactly the kind of passivity that has bought you this problem with nurses. I find it utterly amazing that I, who will be entering a field that is well-protected from these doc-wannabe nurses, am more willing to take the aggressive stance against them than you are.

Note that I did not once ever say to turn the other cheek. I promote this issue among the residents I work with constantly, and my name is right there on the ASAPAC donor list, and has been for years. Accusing me of passivity on this issue is a display of ignorance on your part.

I said that these issues need to be debated professionally. Aggressively AND professionally. The two are not mutually exclusive. You can be passionate about this without being juvenile. I appreciate your interest in casting your lot with our struggle, but if it is to amount to anything- if it is to effect change- it must be done professionally.

ASA president-elect Jerry Cohen has an outstanding piece in the February ASA newsletter about this. If anyone hasn't yet read it, do so now. His approach is exactly what we need.

Mid-level nurses should be ridiculed at every opportunity. They deserve it. They are nothing more than a bunch of cheating, marginally-trained scumbags who want to practice medicine without getting a medical education.

Realize that most CRNAs are the furthest thing from scumbags. The vocal minority might have its head up its collective ass, but your average CRNA is just a hardworking professional trying to make a living.

That in itself deserves scorn and ridicule at every turn. If you're smart, you'll turn the abbreviation "CRNA" into a four-letter word and make it common knowledge to all what exactly they are and where they fit on the totem pole. Put simply, you need to start fighting dirty.

I agree with the sentiment that the educational background of providers should be prominently displayed, as in the giant letter tags that are starting to become en vogue. But automatic scorn and ridicule? No.

And I for one, once I'm done with residency, will start using the term "male nurse" in reference to male CRNAs, NP's (and any of these clowns that might have bought one of those bogus DNAP or DNP degrees) and I will do it in a clinical setting. To hell with professionalism.

Explain to me how the gender of the CRNA or NP has anything to do with anything.

Again, to effect change, this absolutely must be done professionally. You're a doctor. If you want the respect of the public, you have to conduct yourself in a way that engenders it. Fight hard, but fight clean.

 

[FutrrENT]

Note that I did not once ever say to turn the other cheek. I promote this issue among the residents I work with constantly, and my name is right there on the ASAPAC donor list, and has been for years. Accusing me of passivity on this issue is a display of ignorance on your part.

I said that these issues need to be debated professionally. Aggressively AND professionally. The two are not mutually exclusive. You can be passionate about this without being juvenile. I appreciate your interest in casting your lot with our struggle, but if it is to amount to anything- if it is to effect change- it must be done professionally.

ASA president-elect Jerry Cohen has an outstanding piece in the February ASA newsletter about this. If anyone hasn't yet read it, do so now. His approach is exactly what we need.


Realize that most CRNAs are the furthest thing from scumbags. The vocal minority might have its head up its collective ass, but your average CRNA is just a hardworking professional trying to make a living.



I agree with the sentiment that the educational background of providers should be prominently displayed, as in the giant letter tags that are starting to become en vogue. But automatic scorn and ridicule? No.



Explain to me how the gender of the CRNA or NP has anything to do with anything.

Again, to effect change, this absolutely must be done professionally. You're a doctor. If you want the respect of the public, you have to conduct yourself in a way that engenders it. Fight hard, but fight clean.

You guys are getting handed your hats by a bunch of nurses who are fighting the fight in the most unprofessional manner possible - fabricating highly questionable ‘studies' that they do the same job as you (and cheaper), fabricating sham "doctoral degrees" to pad their credentials, and pulling the rug out from under your feet by swaying state after state after state into essentially taking the position that you are extraneous members of the health care team.

That, my friend, is unprofessional. You cannot contest an issue professionally with an unprofessional entity -- i.e. one that is willing to get what it wants by hook or by crook.

Furthermore, if I were in your shoes, I wouldn't give a damn what the "average CRNA" is. The bottom line is that they are all CRNAs. You see, the other part of your problem (as the anesthesiology profession), in addition to your historically passive stance on the matter, is that you've failed to treat CRNAs as one entity. It sounds to me like many of you still say, "well, maybe a handful of CRNAs want to eradicate anesthesiologists, but not the CRNA's I work with. The ones I work with know their place." It's kind of like a gay person voting for a Republican candidate and saying, "Well, the Republican I voted for supports gay rights"....while the party as a whole, with whom this candidate will collaborate and support, opposes gay rights. See my point? You can't treat your enemies as unique individuals. In this case, it's not "divide and conquer", rather, it's "lump together and conquer".

The reality is that you're not going to win this contest by being "professional". Apparently, nobody in a position to make decisions cares about your level of professionalism or your training. Politicians don't give a hoot how much more training you have than CRNAs. As long as CRNAs aren't killing people left and right and they work cheaper, they're going to get their way. Your job (and the physicians around you) should be making every effort to paint CRNAs in a (deservedly) bad light. Tactfully berate them in front of patients. Whenever I see patients referred to ENT by a nurse-practitioner, I make absolutely sure to question the nurse-practitioner's clinical judgment in front of the patient whenever possible, i.e. to plant the seeds of doubt in that patient's mind. Tactfully berate CRNAs to other health care workers. Make their credentials a matter of suspicion. That is the one area where CRNAs can't return the favor, as anesthesiologists' credentials are clear and unassailable.

 

[OB1🤙]

Since I'm not going to change your mind and you're not going to change mine, I'll continue to do my part by donating to the ASAPAC, doing a fellowship, encouraging awareness amongst my colleagues of actionable issues, and demonstrating by my performance as a consultant in all perioperative arenas what the difference in training is.

You can go ahead and continue tactfully berating people and calling people murses.

As you were.

 

[Coastie]

Did you mean to direct your testosterone comment elsewhere? I don't see how what I wrote, that you quoted, was inappropriate.

Agree with Hawaiian Bruin. I respect the passion, but I will disagree strongly with the approach. I know most of it is for show (and we are all impressed by your internet testosterone levels btw), but there is no way that anyone can act like this in a real-world job and and keep that job for very long, particularly as a resident.

More importantly, I fail to see how becoming a profession of d**ks is going to advance our cause. Thinking that shouting "But they're a bunch of murses!" repeatedly is going to be more efficacious than actually showing real, concrete differences in patient care is laughable.

I think everybody agrees that the danger here lies in a group of professionals not knowing what they don't know. Their die-hard support of that crappy Health Affairs article only reinforces that. But sadly, for many people crappy info is better than no info, so like it or not, the onus has been placed on us to refute it.

 

[WholeLottaGame7]

Did you mean to direct your testosterone comment elsewhere? I don't see how what I wrote, that you quoted, was inappropriate.

Yeah, that wasn't at you, that was at FutrrENT.

Problem is, what IRB is going to approve the ideal study, which would be something like randomizing ASA 3/4 patients either to a nurse anesthetist (without possibility of anesthesiologist intervention or assistance) vs. an anesthesiologist?

What if the study looked at IRB approval/rejection rates and reasons for said rejections? Seems like if 99% of IRBs rejected the study on the basis of it being unethical, that that would be a meaningful result in and of itself.

Only half-joking. Plus, since IRBs consist of non-physician medical personnel and community members, the CRNA lobby couldn't accuse it of bias. Double plus, I doubt many CRNAs sit on IRBs.

 

[countingdays]

Yeah, that wasn't at you, that was at FutrrENT.



What if the study looked at IRB approval/rejection rates and reasons for said rejections? Seems like if 99% of IRBs rejected the study on the basis of it being unethical, that that would be a meaningful result in and of itself.

Only half-joking. Plus, since IRBs consist of non-physician medical personnel and community members, the CRNA lobby couldn't accuse it of bias. Double plus, I doubt many CRNAs sit on IRBs.

I think that's a great idea actually. People can make all the political statements they want when nothing is on the line. Let's get IRBs (doctors, nurses, lay people) to decide based on what they really think, not just what they think should apply to other people.

 

[lakersbaby]

You guys are getting handed your hats by a bunch of nurses who are fighting the fight in the most unprofessional manner possible - fabricating highly questionable ‘studies’ that they do the same job as you (and cheaper), fabricating sham “doctoral degrees” to pad their credentials, and pulling the rug out from under your feet by swaying state after state after state into essentially taking the position that you are extraneous members of the health care team.

That, my friend, is unprofessional. You cannot contest an issue professionally with an unprofessional entity -- i.e. one that is willing to get what it wants by hook or by crook.

Furthermore, if I were in your shoes, I wouldn’t give a damn what the “average CRNA” is. The bottom line is that they are all CRNAs. You see, the other part of your problem (as the anesthesiology profession), in addition to your historically passive stance on the matter, is that you’ve failed to treat CRNAs as one entity. It sounds to me like many of you still say, “well, maybe a handful of CRNAs want to eradicate anesthesiologists, but not the CRNA’s I work with. The ones I work with know their place.” It’s kind of like a gay person voting for a Republican candidate and saying, “Well, the Republican I voted for supports gay rights”....while the party as a whole, with whom this candidate will collaborate and support, opposes gay rights. See my point? You can’t treat your enemies as unique individuals. In this case, it’s not “divide and conquer”, rather, it’s “lump together and conquer”.

The reality is that you’re not going to win this contest by being “professional”. Apparently, nobody in a position to make decisions cares about your level of professionalism or your training. Politicians don’t give a hoot how much more training you have than CRNAs. As long as CRNAs aren’t killing people left and right and they work cheaper, they’re going to get their way. Your job (and the physicians around you) should be making every effort to paint CRNAs in a (deservedly) bad light. Tactfully berate them in front of patients. Whenever I see patients referred to ENT by a nurse-practitioner, I make absolutely sure to question the nurse-practitioner’s clinical judgment in front of the patient whenever possible, i.e. to plant the seeds of doubt in that patient’s mind. Tactfully berate CRNAs to other health care workers. Make their credentials a matter of suspicion. That is the one area where CRNAs can’t return the favor, as anesthesiologists’ credentials are clear and unassailable.

amen brotha

 

[RemyMcswain]

I think the best way to win this battle is to create value.

Hospitals need to be presented with two options: CRNA only practice vs MD solo or with PAs. In looking at these two options, the hospitals need to see that, with the MD option, you get more bang for your buck.

How does that happen? Perioperative services: ICU, Tele-ICU, pain. I interviewed at a few places where they were literally in the process of erecting buildings devoted to critical care services. In my humble 4th year student opinion, thats the future of american in-patient medicine. Patients sick as **** waiting to get surgery or having just been operated on, still intubated, recovering in ICU. Who do you think is best to staff these inpatient floors.

On my 1 month anesthesia rotation I saw 2 obnoxious, young, FEMALE CRNAs, completely lose their **** in the middle of a case. "uhhh, uhhhhhh, GET DR. X!!" True story. I can recount this story in front of all of congress and no one is going to give a ****. The only thing anyone cares about is $$$. That's not a defeatist attitude. Im matching anesthesia and I feel very confident in the resilience of this field. I know that Anesthesiologists have a skill set that can be expanded outside the OR in an economic model where hospital administrators look at the two options and say "well ****, my dollar goes farther with the MD option."

 

[BeddingfieldMD]

What if the study looked at IRB approval/rejection rates and reasons for said rejections? Seems like if 99% of IRBs rejected the study on the basis of it being unethical, that that would be a meaningful result in and of itself.

Only half-joking. Plus, since IRBs consist of non-physician medical personnel and community members, the CRNA lobby couldn't accuse it of bias. Double plus, I doubt many CRNAs sit on IRBs.

Yeah, that's what I was thinking. Then the ASA could compile the information, demonstrate that we attempted to duplicate the oft-quoted CRNA study with a more robust study (not just a chart review using billing info) but after dozens if not hundreds of attempts, couldn't get the study approved by ANY legitimate review board because none deemed it ethical to subject patients to such a study.

Sure, it's kind of a cheesey maneuver, but it would make an interesting press release nonetheless...which I guess is all that matters these days.

 

[BeddingfieldMD]

I think the best way to win this battle is to create value.

Hospitals need to be presented with two options: CRNA only practice vs MD solo or with PAs. In looking at these two options, the hospitals need to see that, with the MD option, you get more bang for your buck.

That seems a long road to haul, though. As far as I recall, AAs can only practice in a dozen or so states. That leaves a LOT of territory for the CRNAs where there just aren't enough anesthesiologists to have MD-only practices. Granted, we're obviously still in the process of trying to expand AA territory, but that's been a battle heavily fought by the CRNA lobby for the last 30 years or so.

How does that happen? Perioperative services: ICU, Tele-ICU, pain. I interviewed at a few places where they were literally in the process of erecting buildings devoted to critical care services. In my humble 4th year student opinion, thats the future of american in-patient medicine. Patients sick as **** waiting to get surgery or having just been operated on, still intubated, recovering in ICU. Who do you think is best to staff these inpatient floors.

Yes, I agree that anesthesiologists have a lot to offer to hospitals generally when it comes to acute care, airway management, etc. But I think it's also a bad outcome if we end up being the ones who are basically surgical hospitalists occasionally peeking into the OR while CRNAs work solo in the ORs 40 hours a week doing all the easy cases (generally on some of the best insured individuals) with no inpatient responsibility.

I can recount this story in front of all of congress and no one is going to give a ****. The only thing anyone cares about is $$$. That's not a defeatist attitude. Im matching anesthesia and I feel very confident in the resilience of this field. I know that Anesthesiologists have a skill set that can be expanded outside the OR in an economic model where hospital administrators look at the two options and say "well ****, my dollar goes farther with the MD option."

Sad to say, but what will eventually get the public's attention is when more and more hospitals in rural areas do start operating on sicker and sicker patients with CRNA-only practices and people start dying perioperatively. But much like the dangerous intersection downtown, it takes a few accidents to get a stop light.

 

[FutrrENT]

Yeah, that's what I was thinking. Then the ASA could compile the information, demonstrate that we attempted to duplicate the oft-quoted CRNA study with a more robust study (not just a chart review using billing info) but after dozens if not hundreds of attempts, couldn't get the study approved by ANY legitimate review board because none deemed it ethical to subject patients to such a study.

Sure, it's kind of a cheesey maneuver, but it would make an interesting press release nonetheless...which I guess is all that matters these days.

It won’t work. Consider this: the studies mentioned over and over by CRNAs are awful -- anyone actually reading these studies carefully and understanding just how weak the data is would see how invalid those studies are. Yet somehow those studies were helpful in advancing their agenda. What does this tell you? That the people making the decisions don’t read the studies or pay attention to the details. What you are proposing above, while a very valid and telling argument, involves too many details. Too many dots to connect. To make the argument “We tried to perform a study comparing outcomes of cases involving ASA 3 and 4 patients handled by anesthesiologists vs. CRNAs, but couldn’t get approval for it because the IRB felt it would be unethical to subject ASA 3’s and 4’s to CRNA-only care.” You’ll find that the average person will lose interest after “We tried to...”.

What CRNAs have are studies that say, “CRNAs are just as good as anesthesiologists”. Doesn’t matter that these studies are biased (i.e. funded by the AANA) and exceptionally weak due to poor data. What matters is that the ‘results’ are easy for everyone to understand.

That’s what you guys need.

 

[FutrrENT]

That seems a long road to haul, though. As far as I recall, AAs can only practice in a dozen or so states. That leaves a LOT of territory for the CRNAs where there just aren't enough anesthesiologists to have MD-only practices. Granted, we're obviously still in the process of trying to expand AA territory, but that's been a battle heavily fought by the CRNA lobby for the last 30 years or so.



Yes, I agree that anesthesiologists have a lot to offer to hospitals generally when it comes to acute care, airway management, etc. But I think it's also a bad outcome if we end up being the ones who are basically surgical hospitalists occasionally peeking into the OR while CRNAs work solo in the ORs 40 hours a week doing all the easy cases (generally on some of the best insured individuals) with no inpatient responsibility.



Sad to say, but what will eventually get the public's attention is when more and more hospitals in rural areas do start operating on sicker and sicker patients with CRNA-only practices and people start dying perioperatively. But much like the dangerous intersection downtown, it takes a few accidents to get a stop light.

Look at it this way: any ‘sick’ patient dumb enough to let a nurse-anesthetist handle their anesthesia deserves whatever outcome they may get. People should live with the consequences of their choices. Don’t let it bother you.

 

[Stank811]

I am always surprised by the number of posters on here who are so doom and gloom. I personally just don't see the CRNA's as a threat. I think they are shooting themselves in the foot.

My under-educated prediction/guess:

CRNA group as a whole will continue to push the "equivalence" card so that they can practice "independently" in all 50 states and get paid the same for their services. Will they get close...probably.

But in order to do this they will have to do something about the large number of undereducated CRNAs that are being pushed out of the CRNA farms around the US. They will do this by tighter regulation over how their students meet their min. requirements. When this begins to happen there will be many sites that will be forced to either shut down, decrease the number of students at their sites, or continue to produce poor independent practitioners.

Then comes the mandatory DNP which will further cause a decrease in programs and students if the requirements are enforced which will create a midlevel vacuum. I feel this vacuum should be and will be filled with more AA programs opening.

So when this happens the CRNA group will demand complete independence and equal pay which puts them competing head to head with physicians but with out the leverage of "we are cheaper" they loose on a number of levels.

So once they get to this point, what will they fight for....rights to supervise AA or open fellowships in pain, hearts, etc...but again remember we are the ones with control over teaching them...so I don't see this happening

So what we should focus on is ensuring AA license in all 50 states and make sure that the law firmly states that AA can only be supervised by physicians only and not DNPs.

I also agree that there will be a continued push for anesthesiologists to be involved outside the OR in the ICU and on the floor in the setting of a pain service but I don't feel that we will be leaving the OR's.

Just my thoughts regarding the next 20 yrs.

 

[BeddingfieldMD]

So what we should focus on is ensuring AA license in all 50 states and make sure that the law firmly states that AA can only be supervised by physicians only and not DNPs.

I agree. I can't believe AAs have been around for several decades and still are only allowed to practice in a dozen or so states. Given that they're typically members of the ASA, now one of the largest medical PACs in dollar amount, there's no excuse for this to continue.

 

[Arch Guillotti]

Mid-level nurses should be ridiculed at every opportunity. They deserve it. They are nothing more than a bunch of cheating, marginally-trained scumbags who want to practice medicine without getting a medical education. That in itself deserves scorn and ridicule at every turn. If you're smart, you'll turn the abbreviation "CRNA" into a four-letter word and make it common knowledge to all what exactly they are and where they fit on the totem pole. Put simply, you need to start fighting dirty.

And I for one, once I'm done with residency, will start using the term "male nurse" in reference to male CRNAs, NP's (and any of these clowns that might have bought one of those bogus DNAP or DNP degrees) and I will do it in a clinical setting. To hell with professionalism. Ever since nurses have started claiming to us and the public that they're as good as physicians, professionalism has gone out the window. At very least, ridiculing the ones that try to play doctor is hardly a distortion of the truth.

All of us here on this board feel the same about the whole midlevel/CRNA/degree creep/DNP garbage.

Personally I am an ASA member and have a recurrent contribution to the ASAPAC.

I think that ridiculing others (although we all secretly probably want to) is none too swift. There are better ways to fight the battle than to pick silly little local fights with people that you have to work with everyday. You may just end up making things harder on yourself.

 

[BLADEMDA]

All of us here on this board feel the same about the whole midlevel/CRNA/degree creep/DNP garbage.

Personally I am an ASA member and have a recurrent contribution to the ASAPAC.

I think that ridiculing others (although we all secretly probably want to) is none too swift. There are better ways to fight the battle than to pick silly little local fights with people that you have to work with everyday. You may just end up making things harder on yourself.

Arch,

I have been guilty of ridiculing CRNAs in the past. However, I have come to realize that "name calling" only makes the name caller look foolish. We must win this WAR based on its merits and public opinion.

Insulting individual CRNAs where you work will only make your life harder. Plus, in this day and age of "political correctness" I doubt the Medical Staff will tolerate such behavior.

 

[BLADEMDA]

http://www.youtube.com/watch?v=BP6AutFe8Yo



http://www.youtube.com/watch?v=1NMTLje1xiM&feature=related

Can somebody post the you tube video directly on this thread? This way you can just hit the play button. Thanks

 

[BLADEMDA]

http://www.youtube.com/watch?v=ZZOAMBUlVEM

 

[FutrrENT]

http://www.youtube.com/watch?v=ZZOAMBUlVEM

Plastic surgeons who do this should have their licenses revoked.

I’m dead f’ing serious. Under no circumstance will I operate in a place where anesthesiologists aren’t around.

 

[BeddingfieldMD]

Plastic surgeons who do this should have their licenses revoked.

I’m dead f’ing serious. Under no circumstance will I operate in a place where anesthesiologists aren’t around.

I agree, of course. I would never allow my wife or anyone else I knew interested even in "just cosmetic procedures" to have their surgeries done at such a place.

I seriously think these places are ticking time bombs for trial attorneys to pay off their vacation homes.

 

[FutrrENT]

I agree, of course. I would never allow my wife or anyone else I knew interested even in "just cosmetic procedures" to have their surgeries done at such a place.

I seriously think these places are ticking time bombs for trial attorneys to pay off their vacation homes.

This is one area where I am on the trial lawyers’ side. I say, let the trial attorneys tear these plastic surgeons a new a-hole. Anyone willing to compromise patient safety in order to make more money deserves to have their bank accounts emptied.

 

[Bertelman]

http://www.youtube.com/watch?v=ZZOAMBUlVEM

I didn't realize inhalational agents were associated with post-op pain. Guess I've been treating my patients poorly all this time.

If they *NEVER* use gas, why is there an iso vaporizer on that old-school Narkomed?

 

[Maybeknot]

I'm an ENT resident here, so I apologize if I'm a little late to the party. I was perusing the web recently when I came across this:

Reinforced by years of Colorado case law, the "Captain of the Ship" doctrine holds that it is the physician - usually the surgeon, but also potentially the obstetrician or family physician - who is in charge in the operating room, and, therefore, is legally responsible and liable for the acts and omissions of nurses in the OR. An opt-out will not change the fact that physicians will still be fully liable for the acts or omissions of a CRNA under Captain of the Ship.

http://archive.constantcontact.com/fs096/1102839655460/archive/1103724051964.html

Are you sh*tting me? Am I really going to be responsible for the actions of an incompetent CRNA in Colorado?

Remind me to never practice there....

And remind me to find out who the nursing lobby has in their back pockets that they can pass legislation to (1) get independent practice while (2) simultaneously passing responsibility for their mistakes to the surgeon.

 

[jwk]

So once they get to this point, what will they fight for....rights to supervise AA or open fellowships in pain, hearts, etc...but again remember we are the ones with control over teaching them...so I don't see this happening

So what we should focus on is ensuring AA license in all 50 states and make sure that the law firmly states that AA can only be supervised by physicians only and not DNPs.

Thanks for your support of AA's.

And trust me on this one - AA's will NEVER be supervised/directed by CRNA's.

 

[FutrrENT]

Arch,

I have been guilty of ridiculing CRNAs in the past. However, I have come to realize that "name calling" only makes the name caller look foolish. We must win this WAR based on its merits and public opinion.

Insulting individual CRNAs where you work will only make your life harder. Plus, in this day and age of "political correctness" I doubt the Medical Staff will tolerate such behavior.

That sounds fine and dandy, Blade, but we both know that nobody gives a rat’s ass about the merits of your superior education and training to that of a nurse-anesthetist. If anyone did, there wouldn’t even be an opt-out option.

 

[Plead the Fifth]

I see a lot of hand-wringing in this thread and justifiably so. However, I'm of the opinion that the AANA may be shooting themselves in the foot in regards to flooding the market with CRNAs. Although I'm a resident, I've been around long enough to see some really good CRNAs who obviously are a cut above the rest of their RN counterparts. I would trust these CRNAs with myself or my loved ones. On the other hand, where I train, we have a lot of SRNAs rotate through. And to be honest, I wouldn't let these SRNAs put my neighbor's dog to sleep much less myself or a family member. I admit I'm not sure what the admission standards are for nurse anesthetist schools but it seems that the only requirement is to be an RN and the ability to breathe. I have CRNAs routinely say in passing and in the usual break room gossip just how awful many of their own SRNAs are. Inevitably, these SRNAs still get 'certified' (somehow) and are slowly filtering into an OR near you. But don't worry, a few ****-ups later, and state medical boards will be clamoring for MD *A* 's in their OR's.

 

[Consigliere]

I see a lot of hand-wringing in this thread and justifiably so. However, I'm of the opinion that the AANA may be shooting themselves in the foot in regards to flooding the market with CRNAs. Although I'm a resident, I've been around long enough to see some really good CRNAs who obviously are a cut above the rest of their RN counterparts. I would trust these CRNAs with myself or my loved ones. On the other hand, where I train, we have a lot of SRNAs rotate through. And to be honest, I wouldn't let these SRNAs put my neighbor's dog to sleep much less myself or a family member. I admit I'm not sure what the admission standards are for nurse anesthetist schools but it seems that the only requirement is to be an RN and the ability to breathe. I have CRNAs routinely say in passing and in the usual break room gossip just how awful many of their own SRNAs are. Inevitably, these SRNAs still get 'certified' (somehow) and are slowly filtering into an OR near you. But don't worry, a few ****-ups later, and state medical boards will be clamoring for MD *A* 's in their OR's.

Ummm.....sorry, but no they won't.

 

[jwk]

I see a lot of hand-wringing in this thread and justifiably so. However, I'm of the opinion that the AANA may be shooting themselves in the foot in regards to flooding the market with CRNAs. Although I'm a resident, I've been around long enough to see some really good CRNAs who obviously are a cut above the rest of their RN counterparts. I would trust these CRNAs with myself or my loved ones. On the other hand, where I train, we have a lot of SRNAs rotate through. And to be honest, I wouldn't let these SRNAs put my neighbor's dog to sleep much less myself or a family member. I admit I'm not sure what the admission standards are for nurse anesthetist schools but it seems that the only requirement is to be an RN and the ability to breathe. I have CRNAs routinely say in passing and in the usual break room gossip just how awful many of their own SRNAs are. Inevitably, these SRNAs still get 'certified' (somehow) and are slowly filtering into an OR near you. But don't worry, a few ****-ups later, and state medical boards will be clamoring for MD *A* 's in their OR's.

They've been around for 100 years - I don't think they're going anywhere. Hell, even AA's have now been around for 40 years. We're not going anywhere either BTW (just a note to my CRNA friends who might be tuning in )

 

[deleted126335]

Ummm.....sorry, but no they won't.

Correct. At least two state medical boards actually supported the opt out. Undoubtedly at the behest of surgeons and OBs.