AANA-"removing physician supervision is the right thing to do"

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Matthew9Thirtyfive said:
I’m confused about something. I’ve seen on this forum an issue with CRNAs ignoring the medical direction given by the MD/DO. How is this tolerated? I don’t understand how these people aren’t fired.
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In some departments, they would be.
In others, they do it because they can. There would be consequences for some docs in some departments if they escalated. Even if successful.
 
dr doze said:
In some departments, they would be.
In others, they do it because they can. There would be consequences for some docs in some departments if they escalated. Even if successful.
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That's bonkers to me. How undervalue and unappreciated do you have to be to have your admin give zero ****s that the midlevels are ignoring your direction.
 
Matthew9Thirtyfive said:
I’m confused about something. I’ve seen on this forum an issue with CRNAs ignoring the medical direction given by the MD/DO. How is this tolerated? I don’t understand how these people aren’t fired.
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Unless the CRNAs are employed by the anesthesiologist group or unless periop administration is on the anesthesiologists’ side, there is no recourse. Unsurprisingly, administration is rarely on the MD’s side because so many groups have weak anesthesiology representation and/or nursing presence is strong, all the way from the lowest clipboard nurse up to the CNO.

Another factor is having high supervision ratios of nurses who are not employed by the docs. Their negotiation leverage is an order of magnitude above yours because you are expendable whereas the OR grinds to a halt if enough of them walk.
 
I am so incredibly embarrassed for our profession right now.

You geezers on here blame the current generation of residents for being soft. We are soft as hell, I will not argue that, but at my well known academic institution I have embarrassments for attendings of each and every practicing generation that are doing their part to turn this specialty into something terrible. Some attendings will only do work if that means they get to leave earlier. Some attendings will only work with CRNAs. You are at an academic institution ... you should be furthering the field and training the next generation. Instead you line your pockets while the bridge gives out in your rearview mirror. I have attendings that scold me for coming back from my lunch break early because now they have to come to the room for extubation, instead of just letting the CRNA extubate themself so the lazy attending doesn't have to show his/her face.

I have disappointments for attendings in their 30's ... 40's .. 50's .. and very much 60's. This more than anything makes me fear for this specialty. I don't know how we came to be such spineless creatures and let nurses take one of the coolest specialties away right under our noses. I'm not even sure they're taking it, we're just giving it away. I have one attending (ONE) that is by the book. He is present for every induction, emergence, everything as we should be. And he is a giant "pain in the ass" to everyone because he plays by the rules. What a joke. I'm glad I have him, because if it weren't for him training me I wouldn't have anything to base my practice off of except for my other coward attendings.
 
As someone six months into their CA-1 year, it's so disappointing how true all of this is.

I frequented this forum throughout medical school and while applying for residency. I used to see a lot of people here screaming that the sky if falling, etc. I would usually think these are burnt out, miserable outliers, especially since everyone I would see in real life seemed generally happy. I would wonder, "if these guys hate their job/lives so much, why do they basically live on this forum..." Now only six months in, I've realized it's a "misery loves company" kinda situation... which is why I guess I'm here in the middle of the night while on call!
 
Omppu27 said:
As someone six months into their CA-1 year, it's so disappointing how true all of this is.

I frequented this forum throughout medical school and while applying for residency. I used to see a lot of people here screaming that the sky if falling, etc. I would usually think these are burnt out, miserable outliers, especially since everyone I would see in real life seemed generally happy. I would wonder, "if these guys hate their job/lives so much, why do they basically live on this forum..." Now only six months in, I've realized it's a "misery loves company" kinda situation... which is why I guess I'm here in the middle of the night while on call!
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Kids these days. Jeez.
 
Omppu27 said:
As someone six months into their CA-1 year, it's so disappointing how true all of this is.

I frequented this forum throughout medical school and while applying for residency. I used to see a lot of people here screaming that the sky if falling, etc. I would usually think these are burnt out, miserable outliers, especially since everyone I would see in real life seemed generally happy. I would wonder, "if these guys hate their job/lives so much, why do they basically live on this forum..." Now only six months in, I've realized it's a "misery loves company" kinda situation... which is why I guess I'm here in the middle of the night while on call!
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Kudos to you for admitting the truth. Sorry you're stuck in this bullsh_it "speciality." Do what you must to survive.
 
Omppu27 said:
As someone six months into their CA-1 year, it's so disappointing how true all of this is.

I frequented this forum throughout medical school and while applying for residency. I used to see a lot of people here screaming that the sky if falling, etc. I would usually think these are burnt out, miserable outliers, especially since everyone I would see in real life seemed generally happy. I would wonder, "if these guys hate their job/lives so much, why do they basically live on this forum..." Now only six months in, I've realized it's a "misery loves company" kinda situation... which is why I guess I'm here in the middle of the night while on call!
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Never fails to amaze me how much premeds and med students think they know. Sure, the guy with zero experience in anything other than staying in the library for prolonged periods and failing with chicks on tinder knows more about medicine than the attending who's been doing it for twenty years.
 
GassYous said:
Never fails to amaze me how much premeds and med students think they know. Sure, the guy with zero experience in anything other than staying in the library for prolonged periods and failing with chicks on tinder knows more about medicine than the attending who's been doing it for twenty years.
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I learned from you all and stayed the hell away 😉
 
Omppu27 said:
As someone six months into their CA-1 year, it's so disappointing how true all of this is.

I frequented this forum throughout medical school and while applying for residency. I used to see a lot of people here screaming that the sky if falling, etc. I would usually think these are burnt out, miserable outliers, especially since everyone I would see in real life seemed generally happy. I would wonder, "if these guys hate their job/lives so much, why do they basically live on this forum..." Now only six months in, I've realized it's a "misery loves company" kinda situation... which is why I guess I'm here in the middle of the night while on call!
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Would you choose anesthesiology again? Or what specialty would you choose now that you have started to agree with posters on this forum?
 
sice4 said:
Would you choose anesthesiology again? Or what specialty would you choose now that you have started to agree with posters on this forum?
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I doubt s/he has the experience to figure that out.

Our usual advice here is: anything that allows you to work independently, not just as an employee. Anything where patients will come to see YOU, not just a generic "provider", AKA you "own" your patients.
 
FFP said:
For a medical student, it's very hard to discern what's true, especially when few of us ever share our true opinions with them, in the real world (nor do we advertise them in the newspaper).
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This is true. As someone who has been in the military for 8 years, I know a lot of the grumbling about the military is just people who really shouldn’t have served and isn’t that big of a deal. But there are also real concerns. It’s hard to know the difference for people who don’t have the experience.

It’s the same here. It’s hard to know how much is signal and noise here because I just don’t have any experience in the field. So I think it’s tempting for med students here to just convince themselves it’s all noise.
 
Matthew9Thirtyfive said:
This is true. As someone who has been in the military for 8 years, I know a lot of the grumbling about the military is just people who really shouldn’t have served and isn’t that big of a deal. But there are also real concerns. It’s hard to know the difference for people who don’t have the experience.

It’s the same here. It’s hard to know how much is signal and noise here because I just don’t have any experience in the field. So I think it’s tempting for med students here to just convince themselves it’s all noise.
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Medical students should always remind themselves that there is no smoke without fire, and keep researching that smoke.

In our case, some states are still way better than others, so it matters where one will live after one is done with training.
 
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I’ve become a scorched earther...let it burn. It’s already been a slow burn and If the powers that be haven’t listened to us yet to reverse the trend, they never will. In addition it’s hard to cut through all the politics of the ASA anyway. The moment the reckoning occurs and there isn’t reimbursement for supervision, we will all be acting independently and there will be competition for jobs. There will be a mass exodus into retirement for both CRNAs and anesthesiologists. The former because many of them actually do rely on supervision but won’t admit it and the latter because they couldn’t sit a case to save their (or the patients) life. This will lead to a shortage of anesthesia professionals and a decent salary will result. It won’t be 95% of current top salary or anything like that, but it won’t be as bad as current Medicare rates either. CRNAs and anesthesiologists will compete for jobs (that sucks and is degrading...but a lot of stuff in medicine is already degrading as a physician). primary care already competes with mid levels for jobs, as does ER. The BS fighting will be essentially over..that’s a good thing.

But but but...patient safety you might say. I say let the hospitals decide that. It shouldn’t be a federal government mandated thing. I say the above actually may improve patient safety. Remove the financial incentives and all of a sudden patient safety and outcomes matter again. As demand rises for the true quality provider and our incomes rise with it, we actually approach the elusive free market health care where the salary matches the added value.

I know it’s far more complicated with private payers, and I know this isn’t a popular view, but doesn’t mean it’s the wrong direction and doesn’t mean I hate the specialty, I just hate the politics. So the solution for me is to remove the politics and keep it local. I can actually have a major impact on the local politics of the hospital and specialty without dedicating my life to it as a career.
 
OneFellSwoop said:
I’ve become a scorched earther...let it burn. It’s already been a slow burn and If the powers that be haven’t listened to us yet to reverse the trend, they never will. In addition it’s hard to cut through all the politics of the ASA anyway. The moment the reckoning occurs and there isn’t reimbursement for supervision, we will all be acting independently and there will be competition for jobs. There will be a mass exodus into retirement for both CRNAs and anesthesiologists. The former because many of them actually do rely on supervision but won’t admit it and the latter because they couldn’t sit a case to save their (or the patients) life. This will lead to a shortage of anesthesia professionals and a decent salary will result. It won’t be 95% of current top salary or anything like that, but it won’t be as bad as current Medicare rates either. CRNAs and anesthesiologists will compete for jobs (that sucks and is degrading...but a lot of stuff in medicine is already degrading as a physician). primary care already competes with mid levels for jobs, as does ER. The BS fighting will be essentially over..that’s a good thing.

But but but...patient safety you might say. I say let the hospitals decide that. It shouldn’t be a federal government mandated thing. I say the above actually may improve patient safety. Remove the financial incentives and all of a sudden patient safety and outcomes matter again. As demand rises for the true quality provider and our incomes rise with it, we actually approach the elusive free market health care where the salary matches the added value.

I know it’s far more complicated with private payers, and I know this isn’t a popular view, but doesn’t mean it’s the wrong direction and doesn’t mean I hate the specialty, I just hate the politics. So the solution for me is to remove the politics and keep it local. I can actually have a major impact on the local politics of the hospital and specialty without dedicating my life to it as a career.
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Wrong. You will get replaced.
 
I agree with OneFellSwoop.

I don't expect the position to be popular, primarily because most of this profession makes its money from the ACT/supervision role.

Stop training them. Stop employing them. Stop making money from their labor. Stop bailing them out. Let the CRNAs compete against physicians and let's see where the chips fall. If it turns out they can run GI labs as safely and efficiently (or even more efficiently) than physicians, them's the breaks. If surgeons prefer to work with CRNAs because CRNAs are easier to cajole, them's the breaks. If they can manage sick patients as well as physicians, then shame on physicians for letting their skills lapse.

There is simply no equating the training of medical school and residency with CRNA training. If you are a physician and can't differentiate yourself from a CRNA, shame on you.

Shame on physicians for growing fat and lazy. Shame on our professional organizations for looking the other way, so long as the checks clear. While the vast majority of anesthesiologists are in bed with CRNAs and an evaporating minority of anesthesiologists work in physician-only groups, it's understandable that the ASA has to tread carefully--or, more accurately: ignore the issue altogether.

Not so the nurses. They are unanimous, organized, and motivated--all while physicians dither.

Stop supervising them. Just stop.

If your surgeons don't prefer having a physician administering the anesthetic to a CRNA, you either need some professional remediation, or a new group of surgeons.

If administrators prefer CRNAs to physicians, it's the physicians who are the problem. (Right now, CRNAs aren't undercutting physicians. Perhaps that needs to be noted. All anesthetic reimbursements are blind to the expertise of the "anesthetic provider." CRNAs get the same reimbursement per CPT code as physicians do.)

If insurance companies are willing to pay independent CRNAs exactly the same as doctors, then we take the question to the patients, and tell them TO DEMAND A PHYSICIAN.

Honestly, a PR campaign is looooooong overdue. There is no appetite for it, because so many anesthesiologists remain in bed with CRNAs (and so many anesthesiologists somehow think "sitting the stool" is beneath them).
 
GassYous said:
Wrong. You will get replaced.
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I'm not afraid of direct competition. Not at all. Any hospital that thinks that a CRNA can replace me is a hospital I will avoid--both as a doctor and as a patient.

Now, if the CRNAs have to drop their rates to correspond with their lack of training, that's a different story. I'm not afraid of direct competition, but I don't exactly relish the thought of CRNAs undercutting us. But I'm not foolish to tilt against market forces. When they start undercutting us, we'll start campaigning on our more rigorous training and expertise. CRNAs can have the Jitterbug and entry-level cell phone equivalents. Board-certified physicians will be the iPhone. We might not be the largest, just the best (and most profitable). I can live with that.
 
likewhatevs said:
I agree with OneFellSwoop.

I don't expect the position to be popular, primarily because most of this profession makes its money from the ACT/supervision role.

Stop training them. Stop employing them. Stop making money from their labor. Stop bailing them out. Let the CRNAs compete against physicians and let's see where the chips fall. If it turns out they can run GI labs as safely and efficiently (or even more efficiently) than physicians, them's the breaks. If surgeons prefer to work with CRNAs because CRNAs are easier to cajole, them's the breaks. If they can manage sick patients as well as physicians, then shame on physicians for letting their skills lapse.

There is simply no equating the training of medical school and residency with CRNA training. If you are a physician and can't differentiate yourself from a CRNA, shame on you.

Shame on physicians for growing fat and lazy. Shame on our professional organizations for looking the other way, so long as the checks clear. While the vast majority of anesthesiologists are in bed with CRNAs and an evaporating minority of anesthesiologists work in physician-only groups, it's understandable that the ASA has to tread carefully--or, more accurately: ignore the issue altogether.

Not so the nurses. They are unanimous, organized, and motivated--all while physicians dither.

Stop supervising them. Just stop.

If your surgeons don't prefer having a physician administering the anesthetic to a CRNA, you either need some professional remediation, or a new group of surgeons.

If administrators prefer CRNAs to physicians, it's the physicians who are the problem. (Right now, CRNAs aren't undercutting physicians. Perhaps that needs to be noted. All anesthetic reimbursements are blind to the expertise of the "anesthetic provider." CRNAs get the same reimbursement per CPT code as physicians do.)

If insurance companies are willing to pay independent CRNAs exactly the same as doctors, then we take the question to the patients, and tell them TO DEMAND A PHYSICIAN.

Honestly, a PR campaign is looooooong overdue. There is no appetite for it, because so many anesthesiologists remain in bed with CRNAs (and so many anesthesiologists somehow think "sitting the stool" is beneath them).
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This would make sense if we weren’t operating in essentially a post fact world. Even if you can separate yourself from a CRNA it won’t matter because the people that matter won’t recognize it or literally choose to ignore it for rea$on$.
 
likewhatevs said:
I'm not afraid of direct competition. Not at all. Any hospital that thinks that a CRNA can replace me is a hospital I will avoid--both as a doctor and as a patient.

Now, if the CRNAs have to drop their rates to correspond with their lack of training, that's a different story. I'm not afraid of direct competition, but I don't exactly relish the thought of CRNAs undercutting us. But I'm not foolish to tilt against market forces. When they start undercutting us, we'll start campaigning on our more rigorous training and expertise. CRNAs can have the Jitterbug and entry-level cell phone equivalents. Board-certified physicians will be the iPhone. We might not be the largest, just the best (and most profitable). I can live with that.
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Yep.
 
I see a lot of posts on here that say ‘stop training SRNAs’ etc as if most people that train them have a choice in the matter, other than when choosing a practice. Sure, if you’re in private practice and your group is making money from the SRNA school that’s one thing, but how much say do you think the average academic anesthesiologist (or intensivist, or internist, or any other specialty that has to train NPs) has in choosing what nursing programs they serve as a training site for? And how do you know that a hospital with no CRNAs or SRNAs will remain that way?

Consider it another way, purely hypothetical of course: let’s say you’re happily working in an academic practice and the CRNAs and hospital leadership (also nurses) want to start having SRNAs. You will not receive additional compensation for this. You also won’t have to give them breaks or even be nice to them, but you do have to let them intubate your patients, start IVs/a-lines, and participate in department lectures. Do you threaten to quit if they go through with it? And do you actually pick up and move your family when, inevitably, they don’t care what you think?
 
likewhatevs said:
I'm not afraid of direct competition. Not at all. Any hospital that thinks that a CRNA can replace me is a hospital I will avoid--both as a doctor and as a patient.

Now, if the CRNAs have to drop their rates to correspond with their lack of training, that's a different story. I'm not afraid of direct competition, but I don't exactly relish the thought of CRNAs undercutting us. But I'm not foolish to tilt against market forces. When they start undercutting us, we'll start campaigning on our more rigorous training and expertise. CRNAs can have the Jitterbug and entry-level cell phone equivalents. Board-certified physicians will be the iPhone. We might not be the largest, just the best (and most profitable). I can live with that.
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Look at the jobs being posted for em, peds, medicine, psych, etc. They are advertising for mid levels while the admin are cutting physician hours. The bean counters won't give you the opportunity to compete.
 
ace_inhibitor111 said:
Wow, is it really as bad as people here are saying? Any advice for someone applying anesthesiology this cycle lol? Looks like most specialties are circling the drain i.e. EM, IM, pediatrics, etc. Even psychiatry with PHNPs and 30% increase in residency spots. I’m down to sit out a year if it’s really this bad but don’t exactly know where else to turn.
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Get your DNP as fast as you can

Edit: I am only half kidding
 
jw3600 said:
This would make sense if we weren’t operating in essentially a post fact world. Even if you can separate yourself from a CRNA it won’t matter because the people that matter won’t recognize it or literally choose to ignore it for rea$on$.
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Yup. We are fu(ked. The only question for me is how much longer do we have and can I still have a decent career before it all crashes and burns...
 
dannyboy1 said:
Yup. We are fu(ked. The only question for me is how much longer do we have and can I still have a decent career before it all crashes and burns...
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Depends on your definition of “fu(ked”

Will things be less lucrative in the future? YES

Will the differences in scope, professional standing, authority, hourly rate between anesthesiologists and CRNAs be narrowing? Very probably.

Will there be huge variations in all of the above between local practices? YES.

Will we be able to make a good living as compared to 95+% of Americans? Yes.
 
dannyboy1 said:
Yup. We are fu(ked. The only question for me is how much longer do we have and can I still have a decent career before it all crashes and burns...
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The AANA narrative has changed and evolved over time. The thing that remains unchanged is that they are lying out of their ass.

1. CRNAs are as well trained and experienced as anesthesiologists. (Despite having a fraction of training and education)

2. Anesthesia is so simple that nurses can do it. Anesthesiologists do not need to be involved. (This claim often also involve some comment about how the first anesthesia providers were nurses which is also a lie)

3. CRNAs are actually "doctors" (of nursing) and (nurse) "anesthesiologists".

And the biggest LIE of all: CRNAs are cheaper

With all this venom that AANA spits out the only other thing they haven't talked about is how their education and training requirements have not appreciably changed. Despite "upgrading" their degree from masters to nursing doctorate.

I'm not worried at all about the future of our specialty. CRNAs are already being paid per hour as much as anesthesiologists with much less liability and responsibility. You can betcha that when this fight hits AANA bottom line and compensation they will not be singing the same tune
 
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It seems nursing mafia will take over the role of anesthesiologists, critical care (with physician in teleICU), pediatrics, labor&delivery, psych and primary care. Seems like doom and gloom for medical students. Doctors from all specialities should join together (like avengers) to fight scope creep against NP and PA organization. There are too big for just one organisation (ASA or AAEM) to fight and win.
 
I honestly doubt midlevels can play the modern critical care game without a physician at bedside. Critical care is beginning to involve the ultrasound exam, more and more, and it's a relatively complex ultrasound (heart, lungs, liver, kidney) with PW/CW Doppler; anything else is beginning to look like amateur hour. Let's not mention all the complex individual physiology and the counter-intuitive decisions (e.g. diurese while on pressors). Maybe teleICU will work for critical access hospitals, but not for real ICUs, not without a visible worsening of outcomes.

I will keep refusing teleICU work. This is a specialty that requires a relatively low patient census and frequent checks on the patients (for decent care), at least the former being incompatible with the teleICU business model. One cannot know a patient well if one is busy with many others. Heck, even in the OR, if one covers more than 2-3 rooms, that's not really physician-directed care anymore.

If we go to a teleICU world, I am sure we're going to see concierge CCM, for people who can afford being seen by a real doctor, but that's a different story.

tl;dr: The sicker the patients, the lower the risk for midlevel encroachment and recipe-based medicine. "Usual care" inflicts more harm than good in sick patients.
 
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FFP said:
I honestly doubt midlevels can play the modern critical care game without a physician at bedside. Critical care is beginning to involve the ultrasound exam, more and more, and it's a relatively complex ultrasound (heart, lungs, liver, kidney) with PW/CW Doppler; anything else is beginning to look like amateur hour. Let's not mention all the complex individual physiology and the counter-intuitive decisions (e.g. diurese while on pressors). Maybe teleICU will work for critical access hospitals, but not for real ICUs, not without a visible worsening of outcomes.
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I get where you’re coming from, I do, but this same argument is made from the EM folks. Literally exactly the same with ultrasound. And yet they are losing ground at the most rapid pace of all specialties - part (most) of it is private equity takeovers, but a huge portion is due to PA/NP fellowships and they think they can run the place. The same is true of critical care, especially in the surgical side. I saw it in training and it was frightening.
 
AdmiralChz said:
I get where you’re coming from, I do, but this same argument is made from the EM folks. Literally exactly the same with ultrasound. And yet they are losing ground at the most rapid pace of all specialties - part (most) of it is private equity takeovers, but a huge portion is due to PA/NP fellowships and they think they can run the place. The same is true of critical care, especially in the surgical side. I saw it in training and it was frightening.
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That's because surgeons will always love midlevels who kiss butt versus physicians who actually think and push back. Where have I seen this before? The OR?

Good luck to all those patients. They will need it. A good part of my job, as a surgical intensivist, can be to prevent and fix surgical dumbness in the ICU.
 
MirrorTodd said:
I know we're all talking about how people especially residents shouldn't complain. But I have done **** all today to actually make me a better doctor. I gave breaks to CRNA's in the cardiac rooms this morning and now I've been sitting around for the past 4 ****ing hours waiting for a perivalvular leak to get started. This is a huge waste of my time as a resident. They should've sent me home at noon so I could ****ing study. They are likely paying some crna to sit around as well, so its wasting money and wasting my time. You bet your ass I expect to relieved at 6, because I don't deserve to be treated like this as a resident. I deserve to be trained or at least have my time respected. /rant
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They have CRNAs doing heart cases while the resident is assigned to breaks?? lol. Sadly, a lot of programs these days just treat residents as cheap labor without concern for teaching/learning.
 
MirrorTodd said:
Admittedly, this isn't my home institution. This is a private hospital that takes us on to help fulfill our minimum requirements and is not specifically geared towards cardiac. They don't really owe us ****, their focus is entirely on their product. I don't fault them for it, it's just frustrating for myself.
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They DO owe you ****. You shouldn't be just cheap labor. You guys have to tell your PD. ACGME would also love to hear about stuff like this.
 
I think I'm just gonna delete my posts instead. There is no way in hell I'd trust "the system" to protect me. I might as well be the peasant bringing my grievances to King Joffrey. (hyperbole I know, but I DO NOT trust, nor would I advise anyone else to trust the system that is currently in place for medical graduates.)
 
FFP said:
The yearly ACGME survey IS anonymous.
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Seriously? What happens after the ACGME survey. The resident above can always send an anonymous complaint to the ACGME, but what happens next?

ACGME visits, administration grills the residents, maybe the resident gets outed, or more likely the PD just figures out who sent the comment. If program goes on probation it’s bad for the residents and the programs. It’s always in the residents best interest to keep their head down and just finish their training.
 
I'm excited for this to happen. I'm curious to see how it plays out from my safe vantage point in the tertiary referral level cardiothoracic rooms and cath labs. Current residents should consider sub-specializing in something physician level (not nerve blocks and OB) if you want to be safe. I don't feel sorry for you if you chose anesthesia thinking you could do nursing level cases for your whole career.
 
T-burglar said:
I'm excited for this to happen. I'm curious to see how it plays out from my safe vantage point in the tertiary referral level cardiothoracic rooms and cath labs. Current residents should consider sub-specializing in something physician level (not nerve blocks and OB) if you want to be safe. I don't feel sorry for you if you chose anesthesia thinking you could do nursing level cases for your whole career.
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Isn’t this the whole problem, people claiming a lap chole doesn’t need a physician. It’s a slippery slope, people making laws don’t see the difference.

Also, the majority of anesthesia cases are easy cases. This type of thinking is selling out the profession.
 
dipriMAN said:
Isn’t this the whole problem, people claiming a lap chole doesn’t need a physician. It’s a slippery slope, people making laws don’t see the difference.

Also, the majority of anesthesia cases are easy cases. This type of thinking is selling out the profession.
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Last I heard healthy 18 year olds are still dying from elective breast augmentations and sick cardiac patients still go to the community hospital to get their gallbladders out. Plus CRNAs are becoming "pediatric" or "cardiac" specialists so if anyone thinks they are overskilled or safe they are wrong.
 
T-burglar said:
I'm excited for this to happen. I'm curious to see how it plays out from my safe vantage point in the tertiary referral level cardiothoracic rooms and cath labs. Current residents should consider sub-specializing in something physician level (not nerve blocks and OB) if you want to be safe. I don't feel sorry for you if you chose anesthesia thinking you could do nursing level cases for your whole career.
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I will also say, your cases aren’t safe either. The surgeons can drop you in a second and have a cardiologist come do an echo. There’s already CRNAs doing cardiac and thoracic cases.
 
dipriMAN said:
I will also say, your cases aren’t safe either. The surgeons can drop you in a second and have a cardiologist come do an echo. There’s already CRNAs doing cardiac and thoracic cases.
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CRNAs are in the room for complex pediatric cardiac surgery cases at many, if not most, of the brand name academic centers. Cardiologists are routinely doing the TEE for these cases. Feeling safe?
 
Cardiologists always do pediatric cardiac TEE. That is extremely specialized and anesthesiolgists are never going to be consultant level operators for that imaging. That’s a small area and doesn’t worry me.
 
Some of the worst cases of my career have been young, healthy women having babies with a complication. My daughters are child bearing age- no way I’m rolling the dice on their lives with an independent nurse.
Like I’ve said before, this stuff keeps me awake at night with worry, and not for financial/job reasons.
We need to stop thinking that young, healthy patients don’t need us. They absolutely do.
 
The industry is trying to maximize profit by lowering skilled labor costs. If the acceptable loss is kept at a reasonable mark, they don’t care. If your MD license is sheltering all the liability, even better. So, a few things are needed for change to happen.

People need to know what they are paying for: not physician care, but nursing care.
A physician union and pr campaign. What happened to if you want to keep your doctor you can?
 
T-burglar said:
I'm excited for this to happen. I'm curious to see how it plays out from my safe vantage point in the tertiary referral level cardiothoracic rooms and cath labs. Current residents should consider sub-specializing in something physician level (not nerve blocks and OB) if you want to be safe. I don't feel sorry for you if you chose anesthesia thinking you could do nursing level cases for your whole career.
Click to expand...

only in this field do you get physicians so passive and weak that they will happily throw their colleagues under the bus and cede their territory to poorly trained NURSES. Imagine hearing a surgeon say “i don’t feel sorry if you chose surgery thinking you could do appys and hernias all day”.

how pathetic. We are in sad times when we have people who won’t even defend their field anonymously from behind a keyboard.
 
Man o War said:
Some of the worst cases of my career have been young, healthy women having babies with a complication. My daughters are child bearing age- no way I’m rolling the dice on their lives with an independent nurse.
Like I’ve said before, this stuff keeps me awake at night with worry, and not for financial/job reasons.
We need to stop thinking that young, healthy patients don’t need us. They absolutely do.
Click to expand...
Nobody cares. The overwhelming majority of these cases go off without a hitch. The bean counters care about profits/loss this month or quarter. They don’t give a $hit about some lawsuit which may pay out 5 years after the event which may (or may not) have been prevented by the presence of a physician.
 
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