T-burglar

2+ Year Member
May 13, 2017
462
680
Status (Visible)
  1. Attending Physician
I don’t know what to tell you, man. As a resident I could probably do most CT cases without an CT attending supervision without any difference in outcome.

I don’t see the point of CT fellowship training just for those remaining ~10% of cases that may have bad outcomes.

/s
1608137050305.gif
 
  • Like
Reactions: 1 user

OneFellSwoop

10+ Year Member
Sep 8, 2008
85
110
Status (Visible)
  1. Attending Physician
Not saying it’s right. But our specialty is now run by AMC’s or hospitals (no real difference, it’s all about the bottom line). From a business standpoint it makes very little sense to pay an MD twice as much as a CRNA especially when that MD is essentially extra as he is “supervising” the CRNA not actually doing a case. If I ran an anesthesia business I would come to that conclusion quickly. Really the only thing that is keeping us afloat is the supervision requirement by insurance, Medicare and some states. Once that goes, and it will, we are well and truly fu(ked.

Supervision is still around, but not for the reason you stated. An opt out state has no Medicare requirements for supervision, yet as far as I can tell, most major hospitals in these states have anesthesiologist supervision or direction. small hospitals have CRNA independence with little to no anesthesiologist involvement often due to rural pass through laws. Also, as far as I know, private insurers don’t care and aren’t legally obligated to determine whether or not hospitals have a supervision or direction model or independent CRNAs.

Medicare supervision laws have absolutely no bearing on whether or not an anesthesiologist is present only on physician presence (could be a surgeon). What’s keeping real CRNA independence at bay is the local hospital politics because the supervision/direction is usually a medical bylaws thing specific for each hospital. Which is why anesthesiologists need to be involved in their hospital’s committees.
In addition, if the coding for direction/supervision ever went away, well then that’s the real death of ACT or supervision practice models
 
  • Like
Reactions: 1 user

dipriMAN

2+ Year Member
Sep 4, 2017
879
802
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.
100%
 
  • Like
Reactions: 1 user
About the Ads

Fart Daddy Smooth

It's a Livin '
2+ Year Member
Jan 26, 2018
31
51
Status (Visible)
  1. Other Health Professions Student
RN here. To me, Organizing/unionizing seems like the best way for anesthesiologists to prevent further encroachment from CRNAs, but the idea never really gets brought up. Why not? A unified front of specialized physicians would have enormous leverage at the bargaining table.
 
  • Like
Reactions: 1 user

sloh

10+ Year Member
Mar 31, 2008
458
553
Southern California
Status (Visible)
  1. Attending Physician
RN here. To me, Organizing/unionizing seems like the best way for anesthesiologists to prevent further encroachment from CRNAs, but the idea never really gets brought up. Why not? A unified front of specialized physicians would have enormous leverage at the bargaining table.

Nash equilibrium: if each player has chosen a strategy—an action plan choosing its own action based on what it has seen happen so far in the game—and no player can increase its own expected payoff by changing its strategy while the other players keep theirs unchanged, then the current set of strategy choices constitutes a Nash equilibrium.

It’s not clear the benefits would even redound to current practicing physicians either. Most likely, it would benefit the next cohort. We are all financially motivated and self-interested.
 
  • Like
Reactions: 1 user
Jul 5, 2020
822
1,629
Status (Visible)
  1. Attending Physician
RN here. To me, Organizing/unionizing seems like the best way for anesthesiologists to prevent further encroachment from CRNAs, but the idea never really gets brought up. Why not? A unified front of specialized physicians would have enormous leverage at the bargaining table.

Organizing a group of American anesthesiologists? Like a society? Maybe we can give it a snazzy name... like the American Society of Anesthesiologists?

Supervision is still around, but not for the reason you stated. An opt out state has no Medicare requirements for supervision, yet as far as I can tell, most major hospitals in these states have anesthesiologist supervision or direction. small hospitals have CRNA independence with little to no anesthesiologist involvement often due to rural pass through laws. Also, as far as I know, private insurers don’t care and aren’t legally obligated to determine whether or not hospitals have a supervision or direction model or independent CRNAs.

Medicare supervision laws have absolutely no bearing on whether or not an anesthesiologist is present only on physician presence (could be a surgeon). What’s keeping real CRNA independence at bay is the local hospital politics because the supervision/direction is usually a medical bylaws thing specific for each hospital. Which is why anesthesiologists need to be involved in their hospital’s committees.
In addition, if the coding for direction/supervision ever went away, well then that’s the real death of ACT or supervision practice models

Not true about private insurers. Some are reimbursing less for crna only care. If they all do it will be the death knell for crna independence. Get paid less due to lower reimbursement AND be responsible for subpar care? Who would go for that? Even hospital admin are not that stupid. Hopefully.
 
Last edited:
  • Like
Reactions: 1 users

Katheudontas parateroumen

2+ Year Member
May 19, 2016
209
154
Status (Visible)
  1. Resident [Any Field]
Of course caveat I’m still a resident only seen things done at an academic place. However I think it’s really easy for us doctors to say “oh even a nurse is able to do this” since we see it around us all the time. But as a CA3 the amount of times I have to bail out a graduating SRNA from an airway or answer a simple question about medical management is quite a lot. I think we take our training as physicians for granted thinking anyone with enough on job training as nurse could do it. Maybe some can but I think a majority would not fly so well, especially coming out fresh. Doctors are trained to be independent right out the gate after residency.
 
  • Like
Reactions: 1 users

coffeebythelake

Supreme Commander Anesthesiologist
10+ Year Member
Apr 9, 2006
2,652
2,025
Status (Visible)
  1. Attending Physician
RN here. To me, Organizing/unionizing seems like the best way for anesthesiologists to prevent further encroachment from CRNAs, but the idea never really gets brought up. Why not? A unified front of specialized physicians would have enormous leverage at the bargaining table.

Have you seen some of the surgeon egos out there? Safety isn't a priority to some of them. It is about following the orders from the captain of the ship regardless of how ridiculous. You'll get CRNAs to follow orders a lot easier than you'll get an anesthesiologist.
 
  • Like
Reactions: 1 users

coffeebythelake

Supreme Commander Anesthesiologist
10+ Year Member
Apr 9, 2006
2,652
2,025
Status (Visible)
  1. Attending Physician
Organizing a group of American anesthesiologists? Like a society? Maybe we can give it a snazzy name... like the American Society of Anesthesiologists?

Thr ASA is weak and doesn't have the stomach to fight dirty like the AANA.

Not true about private insurers. Some are reimbursing less for crna only care. If they all do it will be the death knell for crna independence. Get paid less due to lower reimbursement AND be responsible for subpar care? Who would go for that? Even hospital admin are not that stupid.
Hopefully this occurs. Also need more malpractice lawyers to realize that CRNA only care does NOT meet the standard of care and that this is ripe pickings when preventable, bad things happen to patients
 
  • Like
Reactions: 1 users

patriot6

5+ Year Member
Nov 12, 2015
98
158
Status (Visible)
  1. Attending Physician
I’ve always felt that our value lies in our very broad skill set.... Weekly, I’m doing OB, cardiac, thoracic, peds, regional. There are a few crnas here comfortable with one of those... there are no crnas here comfortable with all of those. I’ll admit to a little naïveté (and maybe this is just the case at my shop) but I don’t feel a bit replaceable.
 
  • Like
Reactions: 3 users

dannyboy1

10+ Year Member
Aug 11, 2008
1,032
1,170
Status (Visible)
  1. Attending Physician
I’ve always felt that our value lies in our very broad skill set.... Weekly, I’m doing OB, cardiac, thoracic, peds, regional. There are a few crnas here comfortable with one of those... there are no crnas here comfortable with all of those. I’ll admit to a little naïveté (and maybe this is just the case at my shop) but I don’t feel a bit replaceable.
If you can’t do OB, thoracic, and basic regional, you have no business calling yourself an anesthesiologist. Cardiac and peds is a different story, but those are well established areas of specialization. The CRNA threat is to the 90% of cases that aren’t cardiac or peds.
 
  • Like
Reactions: 1 users

Matthew9Thirtyfive

Do it.
Staff member
Administrator
Volunteer Staff
5+ Year Member
Jan 11, 2016
21,684
37,942
Status (Visible)
  1. Medical Student
“Even before the story aired Thursday night on NewsNation, there was significant pressure directed at us by the AANP — The American Association of Nurse Practitioners — not to run the story, and alleging that our report unfairly maligns nurse practitioners in America.”

Of course they did.
 
  • Like
Reactions: 3 users

ProwlerturnGas

A little under the radar
10+ Year Member
Mar 18, 2006
240
118
Status (Visible)
  1. Attending Physician
Unfortunately until more stories like this come to light, and there is a national outcry, the insidious replacement of physicians will continue.
 

Matthew9Thirtyfive

Do it.
Staff member
Administrator
Volunteer Staff
5+ Year Member
Jan 11, 2016
21,684
37,942
Status (Visible)
  1. Medical Student
Unfortunately until more stories like this come to light, and there is a national outcry, the insidious replacement of physicians will continue.

It will take the right politician having a bad outcome for themselves or a family member.
 
  • Like
Reactions: 1 users

pasgasser2

5+ Year Member
Jan 27, 2015
29
19
Status (Visible)
  1. Attending Physician

anyone seen this yet? this should resonate with the public...post it, share it, tweet it, spread it
 
  • Like
  • Sad
Reactions: 6 users

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads