Anesthesiologist instead of a CRNA

[turbojet]

Hi: i Have been monitoring this forum for a while now and I have learned a lot from the factual and informative replies. First, let me say that I'm, a 55 year-old airline pilot and not a doctor, I have upcoming surgery and I'm looking for a way to insure that my anesthesia is optimal. My only "medical" background is that I was accepted into med school (didn't graduate) back in 1978, so if it's inappropriate for me to post a question here, just let me know and I will stop. Briefly, I have read the posts about CRNA vs anesthesiologist and I want to have my anesthesia done by an anesthesiologist not a nurse (CRNA). As a former military pilot, I was involved in a serious accident a while back and a military CRNA did my anesthesia; it was a disaster (GA and she let the sevo vaporizer run dry). I have no axe to grind (only nightmares) with CRNA's, I just want to optimize my surgical experience (meaning get an anesthesiologist) now that I am back in civilian life. I have put several surgeries/procedures on hold because I can't find a place that will do them with an anesthesiologist not a CRNA. I understand that many facilities multiple CRNA's loosely "supervised" by an anesthesiologist (if you are lucky), but I don't want that. I need a yearly colonoscopy (family history of FAP) and ulnar nerve transposistion at the elbow to relieve severe numbness. I have delayed both procedures because I can't be assured to have an anesthesiologist 1:1 doing the case. Everyone whom I have spoken with in the various anesthesia departments has told me the same thing: CRNA's are equal to MD's, I'm in PA and I guess that we are an opt-out state), the CRNA's often brag about how much they make (they would hate me if they knew my salary) and the anesthesiologists seem angry that a nurse is basically running the show and that they percieve themselves being edged out of a lucrative job. Again, the politics mean little to me it's certian that a lot of ill will exists between CRNA and anesthesioligists. The few doc that I have spoken with say that they would want ananesthesiologist to do their own surgery, but that as an "outsider" I would just get whomever was available: CRNA, AA, SNRA etc. I just want to stop my *ss form bleeding and to get my hands fixed.

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[BLADEMDA]

 

[turbojet]

Thats what I'm afraid might happen; I just need to work another 10 years until retirement and havin a CRNA do my anesthesia is too dangerout. Is this reasonable and how can I make sure that I will get an anesthesiologist? One physician told me that the CRNA's have a powerful lobby and that I would basically have to accept almost anyone doing my anesthesia. Great care in the USA.

 

[BLADEMDA]

BP had this rig certified and checked by the U.S. govt. BP claimed this deep water rig was "just as safe" as the other rigs. IN fact, they even had the U.S. govt. seal of approval. Before the leak BP was claiming like the AANA/CRNA "equivalence" to the other rigs. No study had ever proven that deep water rig wasn't safe. So, BP claimed the "data" indicated that rig was equal to the others. Now, do you need a study about deep water rigs needing EXTRA safety precautions? Or, will a million gallons of oil suffice as proof?

Similarly, the AANA claims CRNA's are just as safe as MD's. All the current (faulty) data seems to indicate that fact. Where is your proof? IF the AANA gets that solo practice for CRNAs the public will get all the proof it needs once again.

 

[BLADEMDA]

Thats what I'm afraid might happen; I just need to work another 10 years until retirement and havin a CRNA do my anesthesia is too dangerout. Is this reasonable and how can I make sure that I will get an anesthesiologist? One physician told me that the CRNA's have a powerful lobby and that I would basically have to accept almost anyone doing my anesthesia. Great care in the USA.

Why not call the Group responsible for your care? Ask to speak with an Anesthesiologist and better yet, request an informal 5 minute meeting with him or her. You sound like a great patient who most MD's wouldn't mind talking to about your procedure.

 

[BLADEMDA]

“What happened to all the stakeholders — Congress, environmental groups, industry, the government — all stakeholders involved were lulled into a sense of what has turned out to be false security,” David J. Hayes, the deputy interior secretary, said in an interview.


Wait until these same ***** Legislators allow midlevel Nurses to practice Independently in our hospitals. When the body count starts rising will they cover it up? Or, will they then use a common sense approach to re-evaluate the safety of community college graduates with an online BSN practicing Medicine under the guise of Nursing. The vast majority of CRNAS are under educated and lack the knowledge to practice this field of Medicine Independently. Maybe, Obamacare doesn't mind a small bump in mortality on Grandma. After all, that is the subgroup (along with Peds) that will have the biggest increase in morbidity/mortality. Think of the savings to Medicare and Social Security over 20 years.

 

[BLADEMDA]

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.
The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

"Principles for Allocation of Scarce Medical Interventions" The Lancet, January 31, 2009 The Reaper Curve: Ezekiel Emanuel used the above chart in a Lancet article to illustrate the ages on which health spending should be focused.



Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."
True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."
In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).
Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).
"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.
"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

 

[BLADEMDA]

Now, Imagine Obamacare decides that Grandma gets Solo CRNA care for that redoCABG/AVR or Thoracotomy. Think of the future savings to society if solo CRNA care does what we all know it will do!

Hell, we may save even more money by getting the bottom quartile of CRNAs to work solo in our tertiary care centers. Think of the savings to the U.S. govt in terms of Social Security and future medical expenses.

 

[proman]

I see you're in Virginia. If you're willing to travel to Baltimore, I can tell you of several hospitals that have both high quality orthopedic surgeons and would be able to accommodate your request. PM me if interested.

 

[loveoforganic]

FWIW, a journal article that's been cited quite a bit has CRNAs having significantly worse outcomes than anesthesiologists (without controlling for case complexity and whatnot), but anesthesia care teams (anesthesiologist + CRNA/resident) had significantly better outcomes than both (with a much larger effect size than anesthesiologist vs CRNA). So I'm not sure I'd be too opposed to a CRNA working in general, under supervision.

 

[jennyboo]

Hi: i Have been monitoring this forum for a while now and I have learned a lot from the factual and informative replies. First, let me say that I'm, a 55 year-old airline pilot and not a doctor, I have upcoming surgery and I'm looking for a way to insure that my anesthesia is optimal. My only "medical" background is that I was accepted into med school (didn't graduate) back in 1978, so if it's inappropriate for me to post a question here, just let me know and I will stop. Briefly, I have read the posts about CRNA vs anesthesiologist and I want to have my anesthesia done by an anesthesiologist not a nurse (CRNA). As a former military pilot, I was involved in a serious accident a while back and a military CRNA did my anesthesia; it was a disaster (GA and she let the sevo vaporizer run dry). I have no axe to grind (only nightmares) with CRNA's, I just want to optimize my surgical experience (meaning get an anesthesiologist) now that I am back in civilian life. I have put several surgeries/procedures on hold because I can't find a place that will do them with an anesthesiologist not a CRNA. I understand that many facilities multiple CRNA's loosely "supervised" by an anesthesiologist (if you are lucky), but I don't want that. I need a yearly colonoscopy (family history of FAP) and ulnar nerve transposistion at the elbow to relieve severe numbness. I have delayed both procedures because I can't be assured to have an anesthesiologist 1:1 doing the case. Everyone whom I have spoken with in the various anesthesia departments has told me the same thing: CRNA's are equal to MD's, I'm in PA and I guess that we are an opt-out state), the CRNA's often brag about how much they make (they would hate me if they knew my salary) and the anesthesiologists seem angry that a nurse is basically running the show and that they percieve themselves being edged out of a lucrative job. Again, the politics mean little to me it's certian that a lot of ill will exists between CRNA and anesthesioligists. The few doc that I have spoken with say that they would want ananesthesiologist to do their own surgery, but that as an "outsider" I would just get whomever was available: CRNA, AA, SNRA etc. I just want to stop my *ss form bleeding and to get my hands fixed.

Just speak to an anesthesiologist from the group ahead of time (not on the day of surgery when the staffing is already set) and make your request. Not an opt-out state --> they should be able to handle it.

 

[IlDestriero]

A CRNA in PA will be supervised by an Anesthesiologist. The level of that supervision is unknowable, but it will not be like your military experience, likely with an unsupervised CRNA. You may end up with a resident if the group has a training program. That could be better, or not. If you are worried, I suggest you find a surgeon that works with an anesthesia group that does all their own cases (no trainees or CRNAs, direct provider only). They are around.
A prearranged anesthesiologist may not be available in a group that supervises exclusively. They may not have the staff to support your request.

 

[cfdavid]

personally, i think the OP is mega-trolling.....

cf

 

[urge]

Have surgery in Manhattan. Most private practices are MD only.

A resident might not be that bad either.

 

[bullard]

personally, i think the OP is mega-trolling.....

cf

My thoughts exactly...I hope I'm wrong.

 

[turbojet]

Thanks for the replies; the suggestions are quite useful. I live in PA which is an opt out state; I just moved from VA (didn't know that VA was not an opt out state). I have spoken with several anesthesia groups in PA and they were quite willing to discuss my options; I was surprized at the candor among the anesthesiologists. They all agreed that having an anesthesiologist was safer than a CRNA (supervision varied from none to some), but they could offer few suggestions as to how to make sure that my case was done by an anesthesiologist. Basically, they said that I could request such and wait until the day of surgery and see of staffing would permit this request. The last anesthesiologist who spoke with me said that she would ratherbe doing her own cases, but she has no choice but to supervise multiple CRNA's or change jobs. This is with the largest university-affiliated medical center in Pittsburgh. She lamented that the CRNA's have a powerful lobby and that a patient has few choices in selecting an anesthesia provider. I may use my backup plan to travel to a non opt-out state to have the ortho surgery. The local endo center told me that they only use unsupervised CRNA's for colonoscopy, which bothers me since I need them yearly. Luckily I was able to find a doc who agreed to do the exam without drugs. I appreciate all of the suggestions; as a layman I'm surprized that the public seems to accept this situation in PA or other opt-out states. I can't see how anyone would feel as safe with a CRNA (supervised or not) as they would with a physician, but it appears that choice of a physician provider is not a reasonable option.

 

[IlDestriero]

PA is not an opt out state. They are required to be supervised. In the GI suite, I guess the Gastroenterologist is supervising them. Makes me feel safe. Supervision by someone who hasn't thought about code drugs since before fellowship. Independent practice is not allowed in PA at this time.
This is sounding more trollish, complete with misinformation.
Just go to Pitt and have a resident do the case, supervised by an MD. They'll do it if you request no CRNA. They are big enough to support your request.
Any MD who doesn't want to supervise can just move to a new job where it is not required. Simple as that. For everyone who wants to do their own cases there's someone who wants to supervise.

 

[maceo]

personally, i think the OP is mega-trolling.....

cf

oh i agree. i agree.. troll written all over this thread I would close it toot sweet

 

[turbojet]

Thanks for the correction; I'm new to PA and just assumed that this was an opt out state from the attitudes that I have encountered. The CRNA told me that she didn't need to be supervised by an anesthesiologist, I just assumed that this meant that PA is an opt out state. A bad assumption, but please understand how confusing this is for a layman. I now understand that "supervision" can be done my the surgeon for the CRNA; this sounds even more dangerous. I think that the average patient assumes that supervision means by an anesthesiologist.

 

[turbojet]

hey guys: trolling? I don't think so. I appreciate the info even with a few disparaging comments. Read my first post, I never claimed to be a provider......I'm just trying to get an anesthesiologist not a CRNA...and for the record: UPMC would not guarantee that my anesthesia would be done by an anesthesiologist.....and they are the biggest provider in town.

 

[lushmd]

Turbojet, at UPMC all anesthetics are supervised by an attending anesthesiologist. As far as having an anesthesiologist directly provide sedation for your colonoscopy, there are some attendings that do "hands-on" work but rarely for that sort of procedure. Depending on the specific UPMC facility, you may be able to request that a resident (still supervised by an attending anesthesiologist) provides your anesthesia (anesthesiology residents do not rotate through all UPMC facilities); this sort of request should be made well ahead of time. The same holds true for your upper extremity surgery. If you are interested in having a nerve block for this procedure, this would be done by a resident or fellow (not CRNA) under direct supervision of an attending anesthesiologist.

I must say that I find this discussion (at least the part re sedation for a colonoscopy) somewhat curious given your recent post in the IM forum. Having said that, I applaud your desire to receive the best anesthesia care possible and have responded in kind.

PS If you'd like, feel free to PM me the name of your gastroenterologist/surgeon and the specific UPMC facility where your procedure(s) would be done and I may be able to provide some more specific advice. I am curious which UPMC attending you spoke to. If you don't mind, please PM me their name. Thanks.

 

[jwk]

OK, I'll give you my non-physician opinion just for some real-world perspective.

First, and right up front - if you want an anesthesiologist to do your procedure, of any type, and they have them on staff, there really is no good reason you can't have one if you arrange for it in advance. But if you can't, go elsewhere if you feel that strongly about it. It's that simple.

At my hospital, as long as you arrange it a few days in advance, you can get an anesthesiologist. Show up the day of surgery without that advanced call and chances are, it's not going to happen. Probably 95% of our procedures (and 99.9% of endoscopy cases) are done by our AA's and CRNA's, and every one of them is medically directed. The other 5% are done by the anesthesiologists, but the OR schedule and assignments are done 24 hrs in advance, and there is usually a reason an anesthesiologist is assigned to a certain room or case, so chances are, they're not going to change rooms the day of surgery. We generally are informed in advance by the surgeon if the patient wants an MD, or the surgeon tells them to call our office in advance to make the request. Same day MD requests are actually rare for us - we will try to accomodate these requests same day, but most of the time it won't happen, and the patient will have the option of continuing with an anesthetist, or postponing surgery till another day.

All of the docs in my group still do cases, start to finish, on a regular basis, including those who are primarily in the pain clinic. However, there are a lot of places around where the anesthesiologists NEVER do a case, and I mean absolutely NEVER. Honestly, I would not want ANYONE, MD or otherwise, doing my anesthesia who has not personally administered an anesthetic in five years, and that truly will be the case at some facilities. I know there are some that think the worst anesthesiologist one can imagine will still be better than an excellent AA or CRNA. I would humbly and totally disagree. You will hear plenty of horror stories about the evils and misdeeds of CRNA's, but that belies the simple fact that thousands upon thousands of anesthetics are administered every day by CRNA's (and AA's), the majority of which are medically directed or supervised at some level, and done without incident. I've been doing this for 30 years, have probably done in excess of 35,000 anesthetics, and knock on wood, am incident free.

Again - it's certainly your decision and your right to have your care done by your choice of providers. If you want MD-only anesthesia, by all means go somewhere that can be done.

 

[Arch Guillotti]

There is no definite evidence that the OP is a troll, then again the trolldar is pinging all over the place.

Caveat emptor!

 

[leviathan]

A bit of a digression, but...I have a friend who wants to be a nurse practitioner and said their training is just as rigorous as a family physician's, and their exams are just as tough.

I'm just finishing my second year of medical school, haven't even started clerkship yet. For fun, I googled for a Family Nurse Practitioner practice licensing exam, took it, and guess what, I aced it with flying colors. The only questions I got wrong I discovered were because they had mistakes in the answers, either due to outdated information or that they were just plain wrong.

I couldn't even describe how absolutely unprepared I would be to be in a family clinic right now before even starting clerkship, yet I'm able to take the exam for NPs and pass with flying colors? What does that say to you if an exam that deems them ready to practice independently and take care of patients can be passed by a medical student who hasn't even started the most substantial half of their training, nevermind completed residency? Someting isn't right about that...and these people could be the future of primary care for a large population of Americans. I can only imagine that CRNAs have the same woefully inadequate training.

As for the OP, I would strongly agree with your fears about having a CRNA deliver your care. I'm sure someone on here could point you in the right direction to a group that will offer you an MD to offer your anesthesia.

 

[bogatyr]

Here's a different approach you might consider. What does everyone think about this? Anesthesiologists are consultants to your orthopedic surgeon or gastroenterologist. What you need to do is tell the surgeon, "I will not have anyone other than a physician administer my anesthetic. You will not perform an operation on me if there is a nurse anesthetist in the operating room." Since most people don't care, the surgeon is probably not going to respond favorably, but if patients across the board start demanding MD/DO only anesthesia, it will make them think twice about whom they are using to deliver their anesthesia.

To get what you want I think it's just going to require more leg/internetwork on your part to find a place that doesn't utilize lesser trained providers. And you may have to pay out of pocket since it may not be in your insurance network.

 

[tucker27705]

I supervise occ in our gi suite 3-4 AAs. On a few occ at the end of the day I'll do 1 or 2 procedures myself. Down to one room, why should I sup 1 Aa? Send him/her home or to the main OR.
I don't think a pt could realistically request an MD to do sedation for a colo at our hospital. Wouldn't fly. Furthermore, if you're healthy, you'd do fine with any of our AA's.
For the ortho procedure? Again, AA supervision should be fine if you're healthy. If the surgeon says ok, get blocked first (unless worried about nerve injury and needs assessment at end of procedure).
I hate being in the healthy ortho rooms, boring. Good AA territory. Put me in vasc, thoracic, cranis, peds, etc. Save run of the mill cases for the AA's and CRNAs and we'll all be well off.
Healthy breast augs? Those are all mine baby.
Tuck

 

[deleted307836]

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[sevoflurane]

Interesting and informative post, thanks jwk
Assuming CRNAs are restricted to a ACT/medically directed practice I really don't see how you can make such a statement -- all while passively accusing the supervising anesthesiologists on this board of being accessories to assault.

It happens. If you are running 4 rooms, you can't be there for everything. You are forced to trust (or not) your CRNA. All CRNA's are not created equally. Some are excellent. Some don't know WTF they are doing. As a resident I was forced to take over many cases that were being covered by CRNA's. I saw some messed up shait. Seriously. We also had some that were good enough to do pediatric crani's. That was by far the exception to the rule.

 

[deleted307836]

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[jwk]

Do most hospitals/groups have anesthesiologists on in-house call or something in case issues like this come up? That's what I always assumed, though I guess I shouldn't have.

Ah, there's one of the big issues. There are, unfortunately, far too many groups where the anesthesiologists are 7-3 M-F and leave everything after hours and weekends to CRNA's. That's not an ACT practice - that's lazy.

 

[ProRealDoc]

Ah, there's one of the big issues. There are, unfortunately, far too many groups where the anesthesiologists are 7-3 M-F and leave everything after hours and weekends to CRNA's. That's not an ACT practice - that's lazy.

👍

 

[leviathan]

Good job, it sounds like you adequately sought the necessary information to base that conclusion upon. You're a mod, seriously?

Assuming CRNAs are restricted to a ACT/medically directed practice I really don't see how you can make such a statement -- all while passively accusing the supervising anesthesiologists on this board of being accessories to assault.

Are you trying to say that a CRNA is as qualified as an MD at delivering anesthesia? If not, then what is your argument? Some people don't want to roll the dice by having their life depend on a lesser-trained individual.

 

[Planktonmd]

In this country, the good United States of America, Anesthesia is administered by nurses in the majority of places.
If you want to guarantee that your anesthesia is provided by a physician then go have your procedure done somewhere else, like Canada for example.
If I were you I would not insist on having an MD in the room doing the anesthetic but I would insist on having an anesthesiologist supervising the procedure.
Nurses can provide safe anesthesia care as long as there is an anesthesiologist closely supervising them.

 

[deleted307836]

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[Soon2BENT]

There are many issues here. As doctors, one thing we need to do if we want to be seen differently than CRNAs is the distinguish ourselves from CRNAs. That may be through extra training, scientific work, etc. CRNAs will never completely take over the field of anesthesia because they don't take the time to contribute to advancing the field of anesthesia. (Most of their research centers around proving they're better than us, rather than improving delivery of anesthesia).

Now, I'll admit, CRNAs are needed, because not all residency graduates want to go to the middle of Kansas to practice, but they need coverage there. Physicians will always be in the very least a supervisory role in major metropolitan areas.

The ASA needs to continue to lobby strong and we as physicians need to conduct ourselves appropriately so that we can maintain our field and maintain the lifestyles we're accustomed to.

 

[maceo]

Nurses can provide safe anesthesia care as long as there is an anesthesiologist closely supervising them.

very very true// when you are supervising// its truly an eye opening experience.

 

[sebsvenmdc]

A bit of a digression, but...I have a friend who wants to be a nurse practitioner and said their training is just as rigorous as a family physician's, and their exams are just as tough.

I'm just finishing my second year of medical school, haven't even started clerkship yet. For fun, I googled for a Family Nurse Practitioner practice licensing exam, took it, and guess what, I aced it with flying colors. The only questions I got wrong I discovered were because they had mistakes in the answers, either due to outdated information or that they were just plain wrong.

I couldn't even describe how absolutely unprepared I would be to be in a family clinic right now before even starting clerkship, yet I'm able to take the exam for NPs and pass with flying colors? What does that say to you if an exam that deems them ready to practice independently and take care of patients can be passed by a medical student who hasn't even started the most substantial half of their training, nevermind completed residency? Someting isn't right about that...and these people could be the future of primary care for a large population of Americans. I can only imagine that CRNAs have the same woefully inadequate training.

As for the OP, I would strongly agree with your fears about having a CRNA deliver your care. I'm sure someone on here could point you in the right direction to a group that will offer you an MD to offer your anesthesia.

I applaud your approach! Seriously, this is an excellent way to prove the discrepancy between our education and theirs. FPs need to directly challenge the NPs, blow their tests out of the water, then ask the NPs to take their board exams. As an anesthesiologist, I would relish taking on a CRNA when it comes to MCQ tests. It's not impossible that I would be out-scored, but I would do much better than the bulk of them. The filter for CRNA programs is not as intense as that for med school. Getting into CRNA school requires a GRE of like 1100. That's probably like a 21 on the MCAT.

 

[476515678234896]

love this

 

[valerod]

hey guys: trolling? I don't think so. I appreciate the info even with a few disparaging comments. Read my first post, I never claimed to be a provider......I'm just trying to get an anesthesiologist not a CRNA...and for the record: UPMC would not guarantee that my anesthesia would be done by an anesthesiologist.....and they are the biggest provider in town.

Let the sevo run dry? I once caught a physician anesthesiologist who was overdosing my patient with heparin for hours.... Does that make you feel safer?

The fact that you had a bad dog does not mean you cant find a good one 🙂

 

[valerod]

A bit of a digression, but...I have a friend who wants to be a nurse practitioner and said their training is just as rigorous as a family physician's, and their exams are just as tough.

I'm just finishing my second year of medical school, haven't even started clerkship yet. For fun, I googled for a Family Nurse Practitioner practice licensing exam, took it, and guess what, I aced it with flying colors. The only questions I got wrong I discovered were because they had mistakes in the answers, either due to outdated information or that they were just plain wrong.

I couldn't even describe how absolutely unprepared I would be to be in a family clinic right now before even starting clerkship, yet I'm able to take the exam for NPs and pass with flying colors? What does that say to you if an exam that deems them ready to practice independently and take care of patients can be passed by a medical student who hasn't even started the most substantial half of their training, nevermind completed residency? Someting isn't right about that...and these people could be the future of primary care for a large population of Americans. I can only imagine that CRNAs have the same woefully inadequate training.

As for the OP, I would strongly agree with your fears about having a CRNA deliver your care. I'm sure someone on here could point you in the right direction to a group that will offer you an MD to offer your anesthesia.

You should take a CRNA exam. I'm sure you will ACE that too!

 

[Consigliere]

You should take a CRNA exam. I'm sure you will ACE that too!

That "certifying exam" is an effing joke. Every CRNA I'm friendly with has told me of the MINIMAL preparation they did for that test and aced it.

 

[Apollyon]

Have there been any "studies" as to this question: do CRNAs prefer/ask for/demand anesthesiologists, or CRNAs, when they themselves or family needs anesthesia? I've heard it said that CRNAs want doctors for themselves, but has it been put to paper?

 

[jl lin]

I am a RN, and I only share this, as a critical care nurse, to say that I have not been able to avoid any longer much of the arrogance that is coming out of nursing these days.

At first I thought many on this board were blowing the midlevels vs. physician issue out of perspective. I have since changed my mind for a number of reasons.

And while it is true that many of the CCRNs and even some CRNAs I know don't take the extreme overstepping positions of others of influence in nursing, what I am seeing in the media and literature is that many, at high political levels do believe that they are NOT overstepping, and that they honestly DO NOT believe that they need to be supervised. It is completely insane.

What many CRNAs, w/ or w/o PhDs, are citing is literature that shows that CRNAs and MDAs/DOAs M&Ms are equal. Not looking a the specifics of the literature and evaluating it all in perspective, I say, OK. I will give them the benefit of the doubt on that. . .but here is the thing. . .

How much of those M&M stats are indeed taken from information pertaining to SUPERVISED AND TEAM (supported) efforts w/ board certified MDAs/DOAs on staff???


It's nice to say that the numbers look similiar, but for the most part, they must be taken with the perspective that the CRNAs are still supervised and supported by the MDAs or DOs of Anesthesia that are there with the cases. In most places indeed CRNAs are still supervised. And at least it used to be that even in rural settings the surgeon is still supervising over the CRNAs.


I am really embarrassed b/c I didn't want to believe how much certain influences in nursing are going way out of bounds--and it seems to all be fitting in nicely with Obamacare.

As a CCRN or not, I want a say in the care provider. I want a choice. I want to say, "Hey. I want the board certified MDA/DOA directing my child's anesthesia care." And this is certainly what I have done in the past with my children when they needed surgery.

So they are showing numbers that may well be reflecting the supervised and supported stats. What will those stats be without physician supervision and support and guidance? I do believe their M&Ms will jump high as more and more anesthesiologists are pushed out.

And so what happens then? Only the rich and famous get the MDAs/DOAs directing their cases? Everyone else gets screwed. Thanks Obamacare and ANA.

This kind of idiotic manuevering is why the ANA hasn't got a dime from me.

 

[jl lin]

Have there been any "studies" as to this question: do CRNAs prefer/ask for/demand anesthesiologists, or CRNAs, when they themselves or family needs anesthesia? I've heard it said that CRNAs want doctors for themselves, but has it been put to paper?

Again, though not a CRNA, but as an intensive care RN, I have and will continue to demand that a BC anesthesiologist provide care for my family members or me.

 

[jl lin]

I recently read this bit from a CRNA PhD. I honestly feel as though I am going to vomit now. I am embarassed for the nursing profession.

"The educational preparation of CRNAs and anesthesiologists isn't better or worse, it is just different.

Many docs and CRNAs work very well together as colleagues.

****But in the OR there is absolutely no difference in our scopes of practice. What the anesthesiologist has is an unrestricted medical license allowing them to work outside of the perioperative period.

The fight is about the ASA trying to take away our CHOICE of how we can work not about safety. The fact is that without CRNAs the ORs in America shut down."





So b/c some supposed 33% of rural hospitals across the states don't have BC anesthesiologists at their helms--b/c no one really wants to go there--we make the exception the rule. This is what this person is going by anyway--the fact that supposedly some 33% of hospitals in rurual America don 't have or require BC anesthesiologists heading the team. Wow. How does making such a rule by exception, and running with it across the country advanced excellence in care?


I never realized how extreme a number of these folks in nursing are, and I am a nurse. I guess I was lucky that I hadn't seen this attitude among my colleagues.

I am totally disgusted by what this means--for patients, healthcare, and for physicians.

So Pandora's Box is open and Americans are stuck with it?

 

[Southpaw]

I am embarassed for the nursing profession.

Thank you for the support.

So b/c some supposed 33% of rural hospitals across the states don't have BC anesthesiologists at their helms--b/c no one really wants to go there--we make the except the rule. How does that advanced excellence in care? I mean it doesn't.

Anesthesiologists don't work in rural, or 'critical access', hospitals because legislation was passed around a decade ago which made it economically impossible for those hospitals to bring us in. There is legislation that states 'critical access' hospitals are eligible for extra Medicare 'funds' and they can use that money to pay CRNAs. Anesthesiologists, and by virture AAs, aren't eligible for this money. We have no idea how much money these hospitals are getting, but those CRNAs are extremely well paid and it's believed that those hospitals also make a profit out of the deal. Of course, if you talk to a militant CRNA they'll only claim that Anesthesiologists simply refuse to work in rural areas. Nothing could be further from the truth. I'm not saying we'd all jump at the chance to work in BFE Rural USA, but I am saying 1) hospitals won't hire us because we're not eligible for the extra Medicare funds and 2) CRNAs have flocked to these hospitals because they work independently and make a lot of money.

I am totally disgusted by what this means--for patients, healthcare, and for physicians.

You're correct in that the media and this administration have been extremely forgiving of poorly designed research, only caring what the title of a study says and running wild with it. The amount of critical thinking involved when discussing outcomes based on billing data research is laughable. In the end, the media and this administration have done a great disservice to patients in this country.

 

[Denatured]

Anesthesiologists don't work in rural, or 'critical access', hospitals because legislation was passed around a decade ago which made it economically impossible for those hospitals to bring us in. There is legislation that states 'critical access' hospitals are eligible for extra Medicare 'funds' and they can use that money to pay CRNAs. Anesthesiologists, and by virture AAs, aren't eligible for this money. We have no idea how much money these hospitals are getting, but those CRNAs are extremely well paid and it's believed that those hospitals also make a profit out of the deal. Of course, if you talk to a militant CRNA they'll only claim that Anesthesiologists simply refuse to work in rural areas. Nothing could be further from the truth. I'm not saying we'd all jump at the chance to work in BFE Rural USA, but I am saying 1) hospitals won't hire us because we're not eligible for the extra Medicare funds and 2) CRNAs have flocked to these hospitals because they work independently and make a lot of money.

Could you point me to some area where I can read this legislation, or it's name. I have not heard of it and would be interested in hearing more.

 

[IlDestriero]

Could you point me to some area where I can read this legislation, or it's name. I have not heard of it and would be interested in hearing more.

It is referred to as "rural pass through" and allows CRNAs, but not MDs, to be reimbursed at Medicare Part A rates. It's odd that they would exclude Anesthesiologists, there are certainly some that would love to work in rural America but, ironically, cannot because of this legislation. There are efforts to expand this to less rural hospitals. How about letting us in the game? Other physicians practicing in rural physician shortage areas are eligible. I'm not going though.😉
http://www.law.cornell.edu/uscode/42/usc_sec_42_00001395--ww000-.html

 

[Mman]

It is referred to as "rural pass through" and allows CRNAs, but not MDs, to be reimbursed at Medicare Part A rates. It's odd that they would exclude Anesthesiologists, there are certainly some that would love to work in rural America but, ironically, cannot because of this legislation. There are efforts to expand this to less rural hospitals. How about letting us in the game? Other physicians practicing in rural physician shortage areas are eligible. I'm not going though.😉
http://www.law.cornell.edu/uscode/42/usc_sec_42_00001395--ww000-.html

I would imagine that if you employ the CRNAs yourself, you would do just fine in those situations. It would simply be a matter of bidding for the hospital contract.

 

[Southpaw]

I would imagine that if you employ the CRNAs yourself, you would do just fine in those situations. It would simply be a matter of bidding for the hospital contract.

Anesthesiologists are not eligible to bill in those hospitals. The original bill, introduced in 1986, provides Medicare Part A funding to 'critical access' hospitals to employ CRNAs and AAs. It was a simple mistake to not include Anesthesiologists, but as you can see, it's EXTREMELY difficult to change legislation once it's enacted. In short, an Anesthesiologist can't employ CRNAs to go into those hospitals and bill for the anesthesia care provided. Just like AAs can't work in those hospitals because they depend on the ACT team led by the Anesthesiologist.

As it stands, 'critical access' hospitals are probably fine with the current arrangement. They get some unlisted amount of money from Medicare Part A, toss some to the nurses, and keep some for themselves. If they were to go out and hire an MD group to provide the service, even if it was an ACT team including CRNAs, they'd not longer get Medicare Part A funds according to current legislation.