AANA Launches New Campaign for Independent Practice on Capitol Hill

[TeslaCoil]

This must be stopped-

http://www.asahq.org/advocacy/fda-a...ampaign-in-response-to-congressional-hearings

Its time for a physician-only society for Anesthesiology. We need proper representation, without the conflicting interests.

---

Members don't see this ad.

 

[Consigliere]

This must be stopped-

http://www.asahq.org/advocacy/fda-a...ampaign-in-response-to-congressional-hearings

Its time for a physician-only society for Anesthesiology. We need proper representation, without the conflicting interests.

We already have one - it's called the American Society of Anesthesiogists or ASA for short. They do not represent my interests whatsoever which is why they have never, nor will they ever, get one cent of my money.

 

[deleted126335]

We already have one - it's called the American Society of Anesthesiogists or ASA for short. They do not represent my interests whatsoever which is why they have never, nor will they ever, get one cent of my money.

I have donated $1000/ year for many years. You are a freeloader.



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[deleted126335]

This is a political game. Political games are determined by money. And the AANA plays this game better than the ASA.

ASAPAC collects more money than CRNAPAC. However they have many more allies.

 

[Mman]

This is a political game. Political games are determined by money. And the AANA plays this game better than the ASA.

It's also a voting issue. There are roughly 3x as many nurses in the country as docs.

 

[deleted171991]

If this was a voting issue, we should win this in a landslide. Why would the public ever choose to receive care from nurses rather than doctors?

The fact that ASA(PAC) keep defending the ACT model makes them useless. Why do you think there has been no advertising campaign pointing out that being cared for by a physician is better than a nurse, even one remotely (in every sense of the word) supervised by a doctor? Because it's not in the fat cats' interest, and they are the ones who're (pun intended) running those organizations.

ASA is to anesthesiologists as AMA is to internists. Both have nothing to do with the best interests of mere mortals.

 

[Mman]

If this was a voting issue, we should win this in a landslide. Why would the public ever choose to receive care from nurses rather than doctors?

1) more nurses vote than doctors. representatives want to get re-elected so they support bills that their voters like. A pro nurse bill gets a lot of nurses to vote for you.

2) Advocating anything seen as against nurses is not exactly PC. You almost can't say anything bad about the profession or you risk getting skewered in public opinion. They are all hard working, underpaid, and care about nothing except patient well being. If you want to restrict their ability to help patients, you are the bad guy. Or at least that's what their lobby would have you believe and it's a tricky line to walk going against it.

Nurses are all about what is best for their patient. Unless you give them the option of doing what is best for themselves and not quite as good for their patient. Then they are all about themselves, but will push crappy research to prove they are "just as good as doctors" except they care more.

 

[Spinach Dip]

If this was a voting issue, we should win this in a landslide. Why would the public ever choose to receive care from nurses rather than doctors?

One of the main reasons CRNAs have made this much progress is because a solid 90% of this country doesn't even know what a CRNA is.

 

[TeslaCoil]

We already have one - it's called the American Society of Anesthesiogists or ASA for short. They do not represent my interests whatsoever which is why they have never, nor will they ever, get one cent of my money.

This is a puzzling response to what I posted. Forgive my ignorance, but how do we already have one, if your interests aren't being represented? What I'm saying is, we need one that does, in fact, represent the physician, and that is, in fact, worth your money. If you are a physician that is.

 

[TeslaCoil]

1) more nurses vote than doctors. representatives want to get re-elected so they support bills that their voters like. A pro nurse bill gets a lot of nurses to vote for you.

2) Advocating anything seen as against nurses is not exactly PC. You almost can't say anything bad about the profession or you risk getting skewered in public opinion. They are all hard working, underpaid, and care about nothing except patient well being. If you want to restrict their ability to help patients, you are the bad guy. Or at least that's what their lobby would have you believe and it's a tricky line to walk going against it.

Nurses are all about what is best for their patient. Unless you give them the option of doing what is best for themselves and not quite as good for their patient. Then they are all about themselves, but will push crappy research to prove they are "just as good as doctors" except they care more.

How does any of the above negate the fact that nurses are not trained or qualified to assess the need for, and deliver life saving measures in the OR?

 

[BLADEMDA]

How does any of the above negate the fact that nurses are not trained or qualified to assess the need for, and deliver life saving measures in the OR?

Correct sentence should read "not as qualified" instead of not qualified at all.

 

[TeslaCoil]

Correct sentence should read "not as qualified" instead of not qualified at all.

Mmmm Nah. Let's go with, "hardly qualified".

 

[criticalelement]

Correct sentence should read "not as qualified" instead of not qualified at all.

Lets stick with NOT QUALIFIED AT ALL. I believe that to be true. sort of like being a almost pregnant. you either are or you arent

 

[TeslaCoil]

Lets stick with NOT QUALIFIED AT ALL. I believe that to be true. sort of like being a almost pregnant. you either are or you arent

Or that. Sure. Not at all it is.

 

[Consigliere]

I have donated $1000/ year for many years. You are a freeloader.



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Hey, if you want to throw away your money that's up to you.

 

[gasdoc77]

Yesterday at the gym, the lady working comes up to me and says "remember that guy who I mentioned who works out here who is a CRNA and is looking for a job" and I say "yeah". She says "well he and another CRNA formed their own company and now they do anesthesia in doctor's offices around town." We can talk about encroachment in other specialties, but often they aren't out hanging up shingles and taking jobs that docs could have.

 

[deleted126335]

In what ways do you think the ASA/ASAPAC could be more effective?



If this was a voting issue, we should win this in a landslide. Why would the public ever choose to receive care from nurses rather than doctors?

I have no idea what would be effective. I do have tremendous personal confidence in the abilities and motives in the few individuals that I have known who are active.

People don't know who gives their anesthetic. They perceive it as safe and routine and therefore a commodity. Just like they don't know who reads their X-rays or MRIs or path slides. They perceive them all as interchangeable. They perceive these services as a commodity. That coupled with the massive financial pressures in healthcare is why we are losing.

 

[deleted126335]

Hey, if you want to throw away your money that's up to you.

I don't consider it wasted. When I was younger I considered it an investment or a way to try and insure my biggest investment-the value of my education and training. Now that I am older, writing the check gives me a measure of satisfaction as an FU to the AANA types.

Don't forget your state PAC too, deadbeat.

 

[Mad Jack]

In what ways do you think the ASA/ASAPAC could be more effective?



If this was a voting issue, we should win this in a landslide. Why would the public ever choose to receive care from nurses rather than doctors?

Because they view doctors as "others," and nurses as "like them." That's the problem with everything in America going down the road of the "rich" versus everyone else (even if we're not all that rich to begin with, but you know, they look at our pre-tax salaries and think we must be loaded).

 

[Consigliere]

I don't consider it wasted. When I was younger I considered it an investment or a way to try and insure my biggest investment-the value of my education and training. Now that I am older, writing the check gives me a measure of satisfaction as an FU to the AANA types.

Don't forget your state PAC too, deadbeat.

LOL! How are all those donations working out for ya', tool? Preventing the spread of independent CRNA practice? Preventing the soon to be independent practice by CRNAs at VA's across the country?

 

[KashN]

Yesterday at the gym, the lady working comes up to me and says "remember that guy who I mentioned who works out here who is a CRNA and is looking for a job" and I say "yeah". She says "well he and another CRNA formed their own company and now they do anesthesia in doctor's offices around town." We can talk about encroachment in other specialties, but often they aren't out hanging up shingles and taking jobs that docs could have.

I personally know multiple PAs and NPs that have opened up their own urgent cares and FP offices. The PAs just have a doc signed on to the company who agrees to be available electronically if needed. The NPs of course don't have to do this because as we all know nurses are special and don't need physicians :/
The point is that this type of Midlevel encroachment is not specific to CRNAs just maybe more wide spread.
Also, at these urgent cares the PA/NP (owner) is the boss of the MDs that they staff the urgent care with. Now that would be a *****y situation.


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[deleted171991]

I personally know multiple PAs and NPs that have opened up their own urgent cares and FP offices. The PAs just have a doc signed on to the company who agrees to be available electronically if needed. The NPs of course don't have to do this because as we all know nurses are special and don't need physicians :/
The point is that this type of Midlevel encroachment is not specific to CRNAs just maybe more wide spread.
Also, at these urgent cares the PA/NP (owner) is the boss of the MDs that they staff the urgent care with. Now that would be a *****y situation.


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I would personally have zero problems with this arrangement. They can dig their own grave independently, as far as I am concerned. This would only lead to the smart people continuing to see good doctors (who can make concierge-level money), and the rest being happy with midlevel care. May the best (wo)man win. (One could wonder why don't those docs just open their own urgent care business.) The midlevels also wouldn't get to do a lifetime "residency" for good money, where they steal all our knowledge and tricks, until they feel comfortable to set out on their own.

What I have a problem with is the coming anesthesia status quo, which considers supervising non-compliant CRNAs as the normal model, which considers anesthesiologists some kind of CRNA consultants who do the paperwork and put out the fires while the CRNA plays games on the doc's license. Not only that, but this kind of setting leads sooner or later to loss of manual skills by the docs, making them truly dependent on CRNAs. One can see that in academia on a daily basis. On top of this, one is just a hired gun, who works one's butt off for the corporate overlords while taking the increased malpractice risks (compared to when working solo), with no real chances of independence/true partnership.

Recently I admitted a patient to the ICU and, being an anesthesiologist, I reflexively told the midlevel how to dose the dilaudid prn (it was a sick patient I did not want to end up sicker). It prompted a knee-jerk "I don't need to be told how to do this" which I did not react to, then 5 minutes later in the conversation, after I explained a bunch of other things about the patient, I hear "so what was the dosing you suggested?". And the ICU is way better than the OR when about midlevel compliance with physician requests; also, there is much more true supervision (for now).

 

[TeslaCoil]

I have no idea what would be effective. I do have tremendous personal confidence in the abilities and motives in the few individuals that I have known who are active.

People don't know who gives their anesthetic. They perceive it as safe and routine and therefore a commodity. Just like they don't know who reads their X-rays or MRIs or path slides. They perceive them all as interchangeable. They perceive these services as a commodity. That coupled with the massive financial pressures in healthcare is why we are losing.

We're losing because we arent aggressive enough.

 

[deleted126335]

LOL! How are all those donations working out for ya', tool? Preventing the spread of independent CRNA practice? Preventing the soon to be independent practice by CRNAs at VA's across the country?

I think that things would be even worse were it not for the efforts of the ASAPAC. Of course, no way to prove your view or mine.

 

[Consigliere]

I think that things would be even worse were it not for the efforts of the ASAPAC. Of course, no way to prove your view or mine.

Probably true. I just received something about optometrists wanting to do injections and minor surgical procedures. Ain't that some sh_t? Midlevel creep is everywhere.......

 

[TeslaCoil]

I think that things would be even worse were it not for the efforts of the ASAPAC. Of course, no way to prove your view or mine.

Im not saying they didnt make a difference, I'm saying we didnt get our full money's worth because they could have easily done more/ been more aggressive. The problem is that they TAKE MONEY FROM CRNA'S AND CNA'S TOO. Hence my point about conflicting interests. I dont know why the ASA is not a physician-only group but we need one desperately.

 

[TeslaCoil]

For example- did anybody notice that whenever they report on these sorts of conflicts, the articles that come out are as non-confrontational and attempt to remain as neutral as possible? Just click on the link above and see for yourself.

 

[deleted171991]

For example- did anybody notice that whenever they report on these sort of conflicts, the articles that come out are as non-confrontational and attempt to remain as neutral as possible? Just click on the link above and see for yourself.

That's because they don't serve their membership, but the corporations the ASA leaders have interests in (be it academia, AMCs, or big private groups), so they will defend the ACT model tooth and nail, including not upsetting the nurses, God forbid. They cannot say anything really negative about CRNAs without having to apologize at home. These people, who are so personally invested against the membership's interests, should have never lead the organization, but not only that, they are basically dynastic and get to groom their own replacements.

It's the model described in "The Rape of Emergency Medicine" decades ago. Everybody should take the time to read it; it's prophetic. History has a tendency to repeat itself.

 

[TeslaCoil]

Alright, so why dont we form The Society of Physician Anesthesiologists? Or something to that effect?

 

[deleted171991]

Alright, so why dont we form The Society of Physician Anesthesiologists? Or something to that effect?

Because sheep will always be afraid of disturbing the status quo. It's much easier just to keep doing what we are doing.

P.S. By the way, it beats me why these types of conversations are not automatically moved by the mods to the Private Forum. A good number of threads belong there, not out in the open.

 

[Mman]

Because sheep will always be afraid of disturbing the status quo. It's much easier just to keep doing what we are doing.

P.S. By the way, it beats me why these types of conversations are not automatically moved by the mods to the Private Forum. A good number of threads belong there, not out in the open.

this forum is dedicated to anesthesiology, it would seem whether a thread should be in the private forum or not should be if the person starting it wants it there or not. Public discussion of issues about anesthesiology is fair game for this forum.

 

[Arch Guillotti]

P.S. By the way, it beats me why these types of conversations are not automatically moved by the mods to the Private Forum. A good number of threads belong there, not out in the open.

It isn't really up to me. If a threads belongs in the private forum, the OP should start it there.

Sometimes I will move a thread there if requested by the OP. I don't just do it on my own because I feel like it.

 

[TeslaCoil]

Why should this be in the private forum?

 

[Chloroform4Life]

Why should this be in the private forum?

We don't want to upset our CRNA overlords.

 

[Chloroform4Life]

Btw. Go sign petition at safevacare.org.

 

[TeslaCoil]

We don't want to upset our CRNA overlords.

Mmmk. Well this is my disclaimer to all of my CRNA homies: It is my professional opinion thus far, that while there is a place for CRNA's in the healthcare model, they should not be allowed to practice independently by law. While this may offend some CRNA's, my intention is not to offend anyone. My intentions are A) to protect the interests of patients undergoing anesthesia care, and B) to prevent the undue socio-economic ramifications imparted upon the physician anesthesiologist. All future statements regarding this issue made by myself, will reflect the above.

I don't know what everyone else is planning to do, but I, for one, will do everything and anything possible to prevent legalization of independent CRNA practice. Period. My most sincere apologies if this offends the fat cats and/or CRNA's in any way.

 

[BLADEMDA]

Mmmk. Well this is my disclaimer to all of my CRNA homies: It is my professional opinion thus far, that while there is a place for CRNA's in the healthcare model, they should not be allowed to practice independently by law. While this may offend some CRNA's, my intention is not to offend anyone. My intentions are A) to protect the interests of patients undergoing anesthesia care, and B) to prevent the undue socio-economic ramifications imparted upon the physician anesthesiologist. All future statements regarding this issue made by myself, will reflect the above.

I don't know what everyone else is planning to do, but I, for one, will do everything and anything possible to prevent legalization of independent CRNA practice. Period. My most sincere apologies if this offends the fat cats and/or CRNA's in any way.

I agree with your above post but not with a previous one which stated that "CRNAs are not qualified to deliver anesthesia or life-savings measures in the O.R." That statement is false and doesn't help the debate/situation. CRNAs are qualified midlevel providers, as are AAs, and as such, should be supervised by a Physician Anesthesiologist to promote the best possible patient care.

CRNAs are mostly unqualified to provide Independent care because they lack the medical education and experience necessary in all situations.

 

[TeslaCoil]

I agree with your above post but not with a previous one which stated that "CRNAs are not qualified to deliver anesthesia or life-savings measures in the O.R." That statement is false and doesn't help the debate/situation. CRNAs are qualified midlevel providers, as are AAs, and as such, should be supervised by a Physician Anesthesiologist to promote the best possible patient care.

CRNAs are mostly unqualified to provide Independent care because they lack the medical education and experience necessary in all situations.

Firstly, I never said, in ANY post of mine, that CRNA's are not qualified to deliver anesthesia in the OR. I welcome CRNA's, I love CRNA's, I just don't think they are qualified to practice independent of direct physician supervision.

With utmost respect, I have to disagree with you on that one point you mentioned. I dont believe that they are qualified for that, hence the very need for physician supervision. The physician is there for exactly that purpose- because we know how to rapidly assess the need for and deliver life saving measures, in the rare cases where they are required.

Of course CRNA's are safe to practice independently 95% or 99% or whatever amount of the time, but thats because 95% of the time the case/patient is not predisposed to disaster. I suppose it's a matter of what level of risk you are comfortable with. Personally, if it were me on the table, and I'm sure I speak for the multitude when I say, that I prefer the lowest amount of risk physically possible. This is where the doctor makes the difference. Independent CRNA practice IMHO would be a step backward in patient safety overall.

 

[DreamLover]

This is a political game. Political games are determined by money. And the AANA plays this game better than the ASA.

They absolutely do. In fact, they preach and/or teach their propaganda in training. They're taught to be outspoken about their capabilities and that they're just as good if not better etc etc etc. my anesthesiology residency was too busy working my butt off to teach me about political BS and how to combat all of the rhetoric. The AANA is WAY better at lobbying than the ASA is....it's feels almost like a lost cause.


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[Random Anesthesiologist]

I would personally have zero problems with this arrangement. They can dig their own grave independently, as far as I am concerned. This would only lead to the smart people continuing to see good doctors (who can make concierge-level money), and the rest being happy with midlevel care. May the best (wo)man win. (One could wonder why don't those docs just open their own urgent care business.) The midlevels also wouldn't get to do a lifetime "residency" for good money, where they steal all our knowledge and tricks, until they feel comfortable to set out on their own.

What I have a problem with is the coming anesthesia status quo, which considers supervising non-compliant CRNAs as the normal model, which considers anesthesiologists some kind of CRNA consultants who do the paperwork and put out the fires while the CRNA plays games on the doc's license. Not only that, but this kind of setting leads sooner or later to loss of manual skills by the docs, making them truly dependent on CRNAs. One can see that in academia on a daily basis. On top of this, one is just a hired gun, who works one's butt off for the corporate overlords while taking the increased malpractice risks (compared to when working solo), with no real chances of independence/true partnership.

Recently I admitted a patient to the ICU and, being an anesthesiologist, I reflexively told the midlevel how to dose the dilaudid prn (it was a sick patient I did not want to end up sicker). It prompted a knee-jerk "I don't need to be told how to do this" which I did not react to, then 5 minutes later in the conversation, after I explained a bunch of other things about the patient, I hear "so what was the dosing you suggested?". And the ICU is way better than the OR when about midlevel compliance with physician requests; also, there is much more true supervision (for now).

I am 100% with you. I would also say, that if CRNAs want to be independent, they need to be truly independent with legislation written that they can't blame an MD for their mistakes, since they are, in effect the "independent expert". If their outcomes are poor, it will show pretty quickly. The western world is filling fast with Asa 3+, even for day surgery.

If their outcomes are ok then we need to re-evaluate what we are doing.

The tricky part is defining "outcomes". Intraop complications? Self-reported or mandatory chart review (because how many crnas self-report anything?), 30-day morbidity/mortality? 6-month?.
I'm pretty confident this is the part that would stop them in their tracks - if the public knew

 

[TeslaCoil]

They absolutely do. In fact, they preach and/or teach their propaganda in training. They're taught to be outspoken about their capabilities and that they're just as good if not better etc etc etc. my anesthesiology residency was too busy working my butt off to teach me about political BS and how to combat all of the rhetoric. The AANA is WAY better at lobbying than the ASA is....it's feels almost like a lost cause.


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True, but the ASA now provides this for physicians as well:

https://www.asahq.org/meetings/legislative-conference-2016/leadership-and-spokesperson-training

Although I don't know how comparable it is. I'm not sure what qualifications are required to attend the legislative conference in DC this May, but its definitely an event I would love to attend.

Also, I know that some residency programs have created titled positions in partnership with the ASA in order to train residents to better represent the physician lobby. I'm assuming they will all also be at the legislative conference in May.

 

[jwk]

True, but the ASA now provides this for physicians as well:

https://www.asahq.org/meetings/legislative-conference-2016/leadership-and-spokesperson-training

Although I don't know how comparable it is. I'm not sure what qualifications are required to attend the legislative conference in DC this May, but its definitely an event I would love to attend.

Also, I know that some residency programs have created titled positions in partnership with the ASA in order to train residents to better represent the physician lobby. I'm assuming they will all also be at the legislative conference in May.

Sign up through your state anesthesia component society. It's an eye-opening experience. BTW, this is not something new. It's been going on annually for many years - I went to my first one more than 10 years ago.

 

[criticalelement]

Sign up through your state anesthesia component society. It's an eye-opening experience. BTW, this is not something new. It's been going on annually for many years - I went to my first one more than 10 years ago.

The way to stop the CRNAs.. very easy.. Make AA legislation in all 50 states. And hire AAs preferentially. Allow PAs ato administer anesthesia in all 50 states. This kinda thing will make the CRNAs quakein their boots.

 

[jwk]

The way to stop the CRNAs.. very easy.. Make AA legislation in all 50 states. And hire AAs preferentially. Allow PAs ato administer anesthesia in all 50 states. This kinda thing will make the CRNAs quakein their boots.

It's funny - CRNAs are pretty much against AAs and seek to limit/eliminate our right to practice through any means possible. AAs just want to be able to practice where we want, and hope that our capabilities (and absence of delusions of superior independent grandeur) make us the preferred provider. In a number of practices that employ both AAs and CRNAs, AAs are easily the preferred ones to hire.

 

[aneftp]

I am 100% with you. I would also say, that if CRNAs want to be independent, they need to be truly independent with legislation written that they can't blame an MD for their mistakes, since they are, in effect the "independent expert". If their outcomes are poor, it will show pretty quickly. The western world is filling fast with Asa 3+, even for day surgery.

If their outcomes are ok then we need to re-evaluate what we are doing.

The tricky part is defining "outcomes". Intraop complications? Self-reported or mandatory chart review (because how many crnas self-report anything?), 30-day morbidity/mortality? 6-month?.
I'm pretty confident this is the part that would stop them in their tracks - if the public knew

1. Anesthesia continues to evolve and become even safer than even 10 years ago (glidescope/video scope use).

I want to see the updated ASA closed claims cases reflecting modern data routine video scope usage for difficult airways. I betcha claims are way down due to improvements in safety.

2. Hospitals especially rural only CRNA only can continue to cherry pick and punt difficult cases to larger hospital centers.

It's all adds up to a very low probability that we can prove safety benefits of MD over seeing anesthesia delivery.

Sadly. No one will fund a double blinded CRNA vs md study due to ethical concerns.

Would you sign up ur 2 year old kid for a double blind study having open heart surgery and not know how the anesthesia qualifications whether they are MD or CRNA going solo?

 

[GravelRider]

The way to stop the CRNAs.. very easy.. Make AA legislation in all 50 states. And hire AAs preferentially. Allow PAs ato administer anesthesia in all 50 states. This kinda thing will make the CRNAs quakein their boots.

Do we think CRNAs are just going to go away? They are going to quake in their boots so much that they will find alternative careers? Saying that is as naive as people like Bernie Sanders talking about single payer healthcare systems...do we think the insurance companies are just going to say it was good while it lasted and roll over?

There is no amount of legislation that will solve this problem. This is a capitalism problem. The CRNAs are out-competing the cr*p out of us. They have better marketing and are not afraid to "get dirty" to show why they are just as good as doctors. Unfortunately, the income of most anesthesiologists relies on the work of CRNAs. The ASA is too busy trying to change the specialty in order to accommodate CRNAs rather than fight them on this. We've already lost. The writing is on the wall...it's only a matter of time until CRNAs have complete independent practice and we'll be staffing pre-op clinics.

 

[TeslaCoil]

1. Anesthesia continues to evolve and become even safer than even 10 years ago (glidescope/video scope use).

I want to see the updated ASA closed claims cases reflecting modern data routine video scope usage for difficult airways. I betcha claims are way down due to improvements in safety.

2. Hospitals especially rural only CRNA only can continue to cherry pick and punt difficult cases to larger hospital centers.

It's all adds up to a very low probability that we can prove safety benefits of MD over seeing anesthesia delivery.

Sadly. No one will fund a double blinded CRNA vs md study due to ethical concerns.

Would you sign up ur 2 year old kid for a double blind study having open heart surgery and not know how the anesthesia qualifications whether they are MD or CRNA going solo?

I dont think this sort of thinking is what we need. I was made to believe by several high ups who I encountered on the interview trail this year, that data already is being generated which shows statistically significant benefits to using a physician supervised model vs independent CRNA model. Very interested to see where these developments lead. I think with strong, motivated leadership, we can stop all this madness.

 

[Man o War]

Do we think CRNAs are just going to go away? They are going to quake in their boots so much that they will find alternative careers? Saying that is as naive as people like Bernie Sanders talking about single payer healthcare systems...do we think the insurance companies are just going to say it was good while it lasted and roll over?

There is no amount of legislation that will solve this problem. This is a capitalism problem. The CRNAs are out-competing the cr*p out of us. They have better marketing and are not afraid to "get dirty" to show why they are just as good as doctors. Unfortunately, the income of most anesthesiologists relies on the work of CRNAs. The ASA is too busy trying to change the specialty in order to accommodate CRNAs rather than fight them on this. We've already lost. The writing is on the wall...it's only a matter of time until CRNAs have complete independent practice and we'll be staffing pre-op clinics.

In my opinion this will be a self limiting phenomenon IF they ever get independent practice AND the hospitals go for it (both of those happening is highly unlikely). I know for a fact if you start putting unsupervised CRNAs in cardiac ORs, difficult peds cases, and academic/tertiary care centers with some of the sickest patients there are, they will kill people and they will kill lots of people. It will be very obvious to everyone too. I have worked with some extremely strong CRNAs in the cardiac ORs during my career and there's no way they can handle most of those patients alone on a wide scale. Also, think about what percentage of CRNAs you've worked with over the years are really strong enough to work alone safely. For me, it's a VERY small minority, and even then I wouldn't trust them alone with really sick high ASA level patients.

 

[GravelRider]

In my opinion this will be a self limiting phenomenon IF they ever get independent practice AND the hospitals go for it (both of those happening is highly unlikely). I know for a fact if you start putting unsupervised CRNAs in cardiac ORs, difficult peds cases, and academic/tertiary care centers with some of the sickest patients there are, they will kill people and they will kill lots of people. It will be very obvious to everyone too. I have worked with some extremely strong CRNAs in the cardiac ORs during my career and there's no way they can handle most of those patients alone on a wide scale. Also, think about what percentage of CRNAs you've worked with over the years are really strong enough to work alone safely. For me, it's a VERY small minority, and even then I wouldn't trust them alone with really sick high ASA level patients.

I totally agree with you. However, the vast majority of the cases that we do are routine cases. These are the cases that generate revenue in our current reimbursement system. As much as I love doing a complicated case and thinking through all of the management decisions, I also love having days where I can pop a couple spinals in for TKAs and do nerve blocks on healthy outpatients for sports medicine procedures. I don't know about you, but I don't want to do ASA 3s and 4s all the time.

The point I am trying to make is that they are winning the marketing battle...by a lot. They are just so much better at marketing themselves to the hospitals, patients, and politicians. We've been afraid to "take the gloves off" so to speak because we are trying to be diplomatic. We rely on them to shoulder the workload so we can drive sweet cars and buy McMansions on the shore. It's awkward to create a campaign saying how much better we are than them, but then pop into work on Monday morning and be congenial.

 

[Nivens]

I haven't read the entirety of this thread, but I'm rotating through general cardiology right now, and a cardiac nurse asks me today: "Do you think she has a right bundle? Because I saw rabbit ears on her tele."

Patient had a LBBB with a slurred R wave in V6 that she took for "bunny ears".

The world will always need doctors.