Anesthesiology is Dying

[Consigliere]

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Only a matter of time, gents:

http://www.aana.com/optoutstudy/

 

[countingdays]

Only a matter of time, gents:

http://www.aana.com/optoutstudy/

Anesthesiology isn't dying. The practice of medicine is dying.
Tried and true and demanding physician train is being replace by the absolute minimum education and intelligence required to not kill too many people.
This is true of almost all fields of medicine, not just anesthesiology.

The problem that lets undertrained pseudo-doctors in the door is money. Maybe medical school should be cheaper. I know I'd learn just as much from a stack of books plus and anatomy lab as I did from the first two years of medical school. It should cost $1000 not $100000. I'm not really sure why it costs $100000 to round and write notes for M3-4 either.

Maybe a 5 year medical school should be an option straight out of high school too.

We should probably train real doctors for less money. No one wants pseudo doctor NPs and CRNAs all else being equal. We can't control their propaganda effectively, they have established themselves as the victim somehow. It's amazing that average students can work 3-4 days a week and make $80,000 - $200,000 and present themselves as the victims, but it seems to work. We can sweep the rug out from under them by producing more doctors at less cost.

Falling salaries are inevitable. The question is whether the lower salaries will be paid to doctors or pseudo-doctors. If we don't lower the cost of physicians, we will be largely replaced by lesser practitioners to the detriment of our families and friends.

 

[VoiceofReason]

so what is the worst case scenario here? I can live with lower reimbursements if thats all we're really looking at.

Im really interested in anesthesia as a 3rd year student, what alternatives do you suggest?

 

[BLADEMDA]

Only a matter of time, gents:

http://www.aana.com/optoutstudy/

“The results validate what we have known all along—that the quality of care and safety record of nurse anesthetists is of the highest caliber, regardless of physician supervision,” said James Walker, CRNA, DNP, president of the American Association of Nurse Anesthetists (AANA). “The data clearly show that there has not been a disparity in care in states that have opted out of the supervision requirement. In fact, the opt-out states have given nurse anesthetists the opportunity to prove, beyond a shadow of a doubt, what patients are most interested in knowing, and that is whether anesthesia is equally safe when provided by CRNAs or their physician counterparts. I’m happy to emphatically report that yes, it is.”



I agree with you. By the time those in the Ivory tower realize the AANA/CRNAs have seized this field it will be too late. Academia is the last Group to recognize that as the community hospitals fall prey to the AANA Propaganda machine so will the entire specialty.​

 

[BLADEMDA]

so what is the worst case scenario here? I can live with lower reimbursements if thats all we're really looking at.

Im really interested in anesthesia as a 3rd year student, what alternatives do you suggest?

Read my thread on "do not go into Anesthesiology" and go post at Nurse fantasyland.org. Find out what you are up against.

 

[proman]

I just quickly read the study. They found that states that opted out had lower mortality rates than non-opt out states BEFORE they opted out. They also found that anesthesiologists had higher acuity patients and more complex cases. Their model failed to adequately adjust for the acuity/complexity difference. So statements like:

nurse anesthetists practicing solo in opt-out
states had a lower incidence of complications
(odds ratios were 0.798 before opting out and
0.813 after) relative to solo anesthesiologists in
non-opt-out states.

really don't apply because they failed to adjust for state-state confounding. Overall this study contributes nothing. We need to compare specific diagnoses/operations adjusted for patient acuity.

 

[BLADEMDA]

I just quickly read the study. They found that states that opted out had lower mortality rates than non-opt out states BEFORE they opted out. They also found that anesthesiologists had higher acuity patients and more complex cases. Their model failed to adequately adjust for the acuity/complexity difference. So statements like:

nurse anesthetists practicing solo in opt-out
states had a lower incidence of complications
(odds ratios were 0.798 before opting out and
0.813 after) relative to solo anesthesiologists in
non-opt-out states.

really don't apply because they failed to adjust for state-state confounding. Overall this study contributes nothing. We need to compare specific diagnoses/operations adjusted for patient acuity.

So, you think I need a study to tell me what is obvious to any Attending in this field? The study is just more propaganda that our Lawyer Legislators will be confused with when the AANA Union comes knocking on your state's door.

 

[BLADEMDA]

Either we fight back with our own studies and data or we will go quietly into the night.

The ASA and Chaipersons fail to recognize that the AANA's continued assault is the biggest threat to Anesthesiology; The academics are worried we don't publish enough. Yet, how come the AANA has achieved political victories without any adding anything to this field?

How arrogant and complacent the leadership has become in the Ivory towers while the Anesthesia Nurses achieve victory after victory with only one rag journal. The leadership must expose Solo CRNA care for what it truly is: Dangerous and Expensive.

The world and our patients await the response.

 

[Consigliere]

so what is the worst case scenario here? I can live with lower reimbursements if thats all we're really looking at.

Im really interested in anesthesia as a 3rd year student, what alternatives do you suggest?

Any speciality other than anesthesiology.

 

[lakersbaby]

Any speciality other than anesthesiology.

im a 4th year about 3 weeks from applying and you guys are making me pretty depressed now. its pretty much too late to change.

 

[IlDestriero]

im a 4th year about 3 weeks from applying and you guys are making me pretty depressed now. its pretty much too late to change.

Do what you want. As long as you're not looking at the $$ you will always have a job. It may be a little different, and it may be in Australia ...

 

[sevoflurane]

It's not going to happen over night, but by the time some of you are done with residency, the atmosphere will likely be different. Maybe drastically, maybe not.... I don't know. But... definitely different.

Go into anesthesia because you like it. If you are doing it for the $$ then you shouldn't be in anesthesia anyways.

 

[hoyden]

Maybe a 5 year medical school should be an option straight out of high school too.

What's wrong with that? 6 year medical school straight out from high school is a standard in most countries all over the world. However, all over the world the standard high school education is much higher than that in the US...The level of high school in the US is abysmal..

 

[hoyden]

So, you think I need a study to tell me what is obvious to any Attending in this field? The study is just more propaganda that our Lawyer Legislators will be confused with when the AANA Union comes knocking on your state's door.

You do not need any studies... you need a different House, Senate and the President... then different agenda will be en vogue therefore different propaganda will ensue...

 

[Deanmonster]

legislators will not look at these studies in depth. Starting in 2014, they will look at only one thing... cost. They will probably cite these crap studies when giving free reign to CRNAs, though.

 

[bronx43]

You do not need any studies... you need a different House, Senate and the President... then different agenda will be en vogue therefore different propaganda will ensue...

Explain how a different administration is going to realistically end an unsustainable health care system?

 

[BLADEMDA]

Explain how a different administration is going to realistically end an unsustainable health care system?

Obamacare which is now law has ended this system. Just give the law the ten years it needs to "socialize" the system. Socialists need not worry as DENIAL OF CARE is coming to the U.S. just as it exists elsewhere in the world. Everyone will get basic care but "elective" care/surgery will be severely restricted. Of course, you know who decides what is elective?

Since we are going socialistic when does European style tort reform/no lawsuits hit the U.S. health care system? My guess is that occurs after we all get a govt. paycheck; but, the Dems. will keep the right to sue for as long as possible even after Uncle Sam is footing the bill.

 

[hoyden]

Explain how a different administration is going to realistically end an unsustainable health care system?

They might start from saving an enormous amount of money in the system already - mainly through tort reform...when we won't be flushing down the toilet billions of dollars for saving those not eligible for saving in order to avoid the lawsuit.

Not even to mention billions spent for the just in case reason...

 

[pgg]

What's wrong with that? 6 year medical school straight out from high school is a standard in most countries all over the world. However, all over the world the standard high school education is much higher than that in the US...The level of high school in the US is abysmal..

I don't know how the admissions committees would sort through high school students. In my high school graduating class alone, I knew at least 20 or 25 people with 4.0 averages and very high SAT/ACT scores like me, and some of them struggled or even fell apart in college. I can think of maybe 4 or 5 who went on to great things (med schools, top law schools, engineering degrees, etc).

As you say, US high schools are terrible when it comes to teaching to the potential of the top 1-2%, to say nothing about stratifying them for admissions purposes. Improvement there would really need to happen before med schools could deep select 18-year-olds with any success.

From what I understand, there are fewer US med schools with combined undergrad programs now than 20 years ago, mainly because the attrition rate was so high.

 

[hoyden]

Obamacare which is now law has ended this system. Just give the law the ten years it needs to "socialize" the system. Socialists need not worry as DENIAL OF CARE is coming to the U.S. just as it exists elsewhere in the world. Everyone will get basic care but "elective" care/surgery will be severely restricted. Of course, you know who decides what is elective?

Since we are going socialistic when does European style tort reform/no lawsuits hit the U.S. health care system? My guess is that occurs after we all get a govt. paycheck; but, the Dems. will keep the right to sue for as long as possible even after Uncle Sam is footing the bill.

That is exactly right and I can't even say it is not reasonable for a lot of cases we do now - pacemakers for 100 y.o. severe Alzheimer impaired nursing home patient in order to fix their broken hip...which they broke while lying in bed... studies show that no matter what we do they will still die in 6 months
Or spending billions in NICU to save a 24 week-old preemie with his head full of blood and no chances to survive with no severe neurological sequelae( not even to mention that the kid is born to illegals who pay nothing in taxes but still are entitled for everything)...
Or keeping alive in SICU for a year (!!!) a patient who was just kept alive by and all high-tech available procedures and treatments, until the family finally realized that there is no future and agreed for withdrawal of care, otherwise the cycle might go forever...

All of this paired to horror stories of people of the productive age and segment of society not being able to receive necessary treatment, because they have reached the ceiling in their insurance...

To some degree I want that socialism to come
Because this nonsense will stop.
However, together with it will inevitably come another nonsense and corruption. And I am not sure which is worst ( in the moral aspect, I mean).

 

[hoyden]

I don't know how the admissions committees would sort through high school students. In my high school graduating class alone, I knew at least 20 or 25 people with 4.0 averages and very high SAT/ACT scores like me, and some of them struggled or even fell apart in college. I can think of maybe 4 or 5 who went on to great things (med schools, top law schools, engineering degrees, etc).

As you say, US high schools are terrible when it comes to teaching to the potential of the top 1-2%, to say nothing about stratifying them for admissions purposes. Improvement there would really need to happen before med schools could deep select 18-year-olds with any success.

From what I understand, there are fewer US med schools with combined undergrad programs now than 20 years ago, mainly because the attrition rate was so high.

I have to add some clarification - in order to implement the system of 6 year-long medical school education straightforward from high school, the curriculum and requirements of the high school have to be changed first - in order to meet much higher standards...basically high school graduate eligible for medical or law school has to have a diploma equivalent now for that pre-med or pre-law college( and the education has to be designed to fit BOTH).
Obviously this type of secondary education reform is not thinkable in this educational climate where standards are being constantly lowered in order to fit PC...

 

[hoyden]

.

 

[countingdays]

The way things are going, all doctors salaries are all going to be undercut by paraprofessionals sooner or later. The alternative is to train more doctors at lower cost. Of course that would also drive down our salaries.

I think our profession and the public will be better served by increased supply of doctors at decreased cost rather than continued growth in the number of paraprofessionals.

 

[maceo]

the study was funded by the aana. isnt that a surprise..

 

[maceo]

I find it interesting that the nurse anesthetists want to claim complete independent practice yet no where in their curriculum is there a requirement for a real chemistry class. you know the one where you had a five hour lab once a week.. our specialty is founded on this.

 

[lane]

legislators will not look at these studies in depth. Starting in 2014, they will look at only one thing... cost. They will probably cite these crap studies when giving free reign to CRNAs, though.

If the healthcare bill or the Arizona immigration law is any indication, they won't bother to read it at all.

 

[InductionAgent]

im a 4th year about 3 weeks from applying and you guys are making me pretty depressed now. its pretty much too late to change.

No field of medicine is without its problems or encroachments. Furthermore, in this economy, virtually no profession is without its own unique woes.

To the medical student, just focus on being the best anesthesiologist possible when you finish residency. Like most things in life, it matters most what is going on within you, not around you.

To the doom-and-gloomers:

You're not helping the situation by dissuading competent and motivated medical students from pursuing anesthesiology. If you succeed in this effort, it makes AANA propaganda self-fulfilling by decreasing the caliber of anesthesiologists.

 

[CambieMD]

I left primary care to retrain as an anesthesiologist. Things are chaning and will continue to change. I knew the issues in anesthesiology when I decided to leave primary care.

You will always need physicians. The debates will continue to rage on. I heard them as a PCP.

There are certain issues that are unique to anesthesia.

We can combat some of those who hope for our demise by supporting those who advocate for us and being the best anesthesiologists that we can possibly be.

If you are afraid to apply to anesthesia because you are unsure of the future , I can understand that. I will never go back to primary care. There is nothing like trouble shooting a problem and fixing it on the spot. I get that satisfaction from anesthesia.
I came to anesthesia because I love the body of knowledge involved in its' practice.

It may be raining right now but the sky is not falling.

Cambie

 

[guitarguy09]

the study was funded by the aana. isnt that a surprise..

these types of studies always are and it drives me crazy. how about they spend some of their money on improving pt care by putting out more clinical studies instead of constantly trying to inflate the public's misguided perception of themselves....

it's so frustrating that they constantly do these studies but don't adequately account for the increased complexity of the patients that the anesthesiologist is doing in comparison to the CRNA... ughhh

i'm post-call and i now have a headache...

 

[BLADEMDA]

yeah, but it makes things better for those of us who are out practicing. During 1995-2000 quality med students stayed away in droves. Following this, The period from 2000-2008 were some of the best years ever for anesthesiologists out in practice.

Just thought I might share another possible agenda of some of the doom and gloomers.

Your post is incorrect in a number of ways. First, you are attempting to change the subject from the very real threat of CRNAs taking work from new graduates and all MD practices. Second, the Residency directors will fill all the slots with less desirable candidates but they will fill them. Third, ObamaCare is going to alter reimbursement for all of us circa 2018-2020. Hence, your post is moot as the current MS4 will just be entering the work force by the time the Obamacare law takes full effect. Fourth, I am looking forward to slowing down as are others once reimbursement craters in 2018. Fifth, my posts have never been about protecting my wealth or job; they have always been about saving the medical specialty from irrelevance.


When I was a Medical Student I chose Anesthesiology; it did not choose me. I would not make the same decision today (2010) based upon what I foresee likely to happen to this field/specialty. My advice is that the top tier Med Student should look elsewhere for a career. We will not win this war against the AANA. We lack the vision and the leadership to win.

 

[Mman]

Only a matter of time, gents:

http://www.aana.com/optoutstudy/

I spend my entire day preventing harm to patients when the CRNA can't do it themselves. That's essentially my entire day. And I work with some very good CRNAs. The vast majority of our nearly 100 are quite good, but I'm still amazed by what they don't know. The bad CRNAs (think they know everything) are a ticking time bomb that I attempt to defuse on a daily basis.

I'm not even factoring in the times I have to stand up to surgeons when a nurse would back down.

The crazy faction of CRNA land that wants independence are basically insane and if they got their wish nationwide, the mortality in the OR would be significantly worse. Nobody with a sane mind even argues it.

 

[BLADEMDA]

AANA Statement
The most substantial difference between CRNAs and anesthesiologists is that prior to anesthesia education, anesthesiologists receive medical education while CRNAs receive a nursing education. However, the anesthesia part of the education is very similar for both providers, and both professionals are educated to perform the same clinical anesthesia services. CRNAs and anesthesiologists are both educated to use the same anesthesia processes and techniques in the provision of anesthesia and related services. The practice of anesthesia is a recognized specialty within both the nursing and medical professions. Both CRNAs and anesthesiologists administer anesthesia for all types of surgical procedures, from the simplest to the most complex, either as single providers or in a "care team setting". There are currently 87 accredited nurse anesthesia education programs in the United States lasting between 24-36 months, depending upon the university. As of 1998, all programs offer a master's degree level for advance practice nurses, and these programs are accredited by the Council of Accreditation of Nurse Anesthesia Educational Programs which is recognized by the U.S. Department of Education. THE PROPOSED HCFA RULE PROMOTES COMPETITION AND ACCESS TO ANESTHESIA

 

[igottaquestion]

if they got their wish nationwide, the mortality in the OR would be significantly worse.

I think this type of point is being woefully overlooked in these doom-and-gloom threads. Anesthesiologists going solo only on the riskiest patients and putting out CRNA fires for the rest sounds like a reasonable prediction for the future, but I speculate (as a mere medical student) that too many OR deaths would occur for anesthesiology to be given to nursing entirely (despite the cost savings).

 

[BLADEMDA]

I think this type of point is being woefully overlooked in these doom-and-gloom threads. Anesthesiologists going solo only on the riskiest patients and putting out CRNA fires for the rest sounds like a reasonable prediction for the future, but I speculate (as a mere medical student) that too many OR deaths would occur for anesthesiology to be given to nursing entirely (despite the cost savings).

Are you willing to bet your entire career on that theory? What will you do if you are wrong?

 

[IlDestriero]

I spend my entire day preventing harm to patients when the CRNA can't do it themselves. That's essentially my entire day. And I work with some very good CRNAs. The vast majority of our nearly 100 are quite good, but I'm still amazed by what they don't know. The bad CRNAs (think they know everything) are a ticking time bomb that I attempt to defuse on a daily basis.

I'm not even factoring in the times I have to stand up to surgeons when a nurse would back down.

The crazy faction of CRNA land that wants independence are basically insane and if they got their wish nationwide, the mortality in the OR would be significantly worse. Nobody with a sane mind even argues it.

I'm with you 100% and see it all the time, though with residents and fellows as well (to a lesser degree). I was doing a spine with an experienced CRNA a couple months back, I was gone about 45 min. Woke a patient, saw another and started a case. I went back and was dumbfounded to see my perfectly stable patient in significant distress due to OBVIOUS hypovolemia. An intern could have guessed what the problem was. It was absolutely textbook, with obvious blood loss in the bucket. She was like, "oh good I was just about to call you. I'm not sure what's going on, I started the dopamine..." I don't trust her with much anymore, and she doesn't do spines anymore either. We can't be there to check up on them q15 minutes. And they're much better here than the last place. Maybe the best thing for us is some independent practice CRNA assassinations. The surgeons will be on board shortly thereafter. Where I used to work the peds surgeons refused work with CRNAs due to a bad outcome a decade earlier. I was happy to oblige.

 

[igottaquestion]

Are you willing to bet your entire career on that theory? What will you do if you are wrong?

I guess I would milk the final days of the silver age for all they're worth, live modest and save well, and work fewer hours if the crap hits the fan. With the decline factored in by 2020, it still beats many other areas of medicine right now (I think).

 

[BLADEMDA]

I guess I would milk the final days of the silver age for all they're worth, live modest and save well, and work fewer hours if the crap hits the fan. With the decline factored in by 2020, it still beats many other areas of medicine right now (I think).

Best of Luck to you.

 

[Coastie]

The immense ignorance contained within that AANA statement is astonishing. Anyone who thinks that anesthesiology is somehow not a mix of vast fields of medicine is a complete *****. These fields include critical care, pharmacology, physiology, cardiology, pulmonology, with some additional neurology/anatomy/surgery/emergency medicine...need I go on?

Yet, a nurse, without the rigorous academic background of a physician, not to mention the basic/clinical sciences, critical thinking skills, and experience claims to be able to practice this area of medicine, one of the most acute, independently, often with just an online mill degree?

How can anyone support or even think this? Is the AANA really that stupid?

AANA Statement
The most substantial difference between CRNAs and anesthesiologists is that prior to anesthesia education, anesthesiologists receive medical education while CRNAs receive a nursing education. However, the anesthesia part of the education is very similar for both providers, and both professionals are educated to perform the same clinical anesthesia services. CRNAs and anesthesiologists are both educated to use the same anesthesia processes and techniques in the provision of anesthesia and related services. The practice of anesthesia is a recognized specialty within both the nursing and medical professions. Both CRNAs and anesthesiologists administer anesthesia for all types of surgical procedures, from the simplest to the most complex, either as single providers or in a "care team setting". There are currently 87 accredited nurse anesthesia education programs in the United States lasting between 24-36 months, depending upon the university. As of 1998, all programs offer a master's degree level for advance practice nurses, and these programs are accredited by the Council of Accreditation of Nurse Anesthesia Educational Programs which is recognized by the U.S. Department of Education. THE PROPOSED HCFA RULE PROMOTES COMPETITION AND ACCESS TO ANESTHESIA

 

[BLADEMDA]

The immense ignorance contained within that AANA statement is astonishing. Anyone who thinks that anesthesiology is somehow not a mix of vast fields of medicine is a complete *****. These fields include critical care, pharmacology, physiology, cardiology, pulmonology, with some additional neurology/anatomy/surgery/emergency medicine...need I go on?

Yet, a nurse, without the rigorous academic background of a physician, not to mention the basic/clinical sciences, critical thinking skills, and experience claims to be able to practice this area of medicine, one of the most acute, independently, often with just an online mill degree?

How can anyone support or even think this? Is the AANA really that stupid?

Yes. Must I remind you that 15 states and CMS agree with them.

 

[BLADEMDA]

15 states as of July 2009)

• Iowa opted out of the federal supervision requirement in December 2001.​
• Nebraska opted out in February 2002.​
• Idaho opted out in March 2002.​
• Minnesota opted out in April 2002.​
• New Hampshire opted out in June 2002.​
• New Mexico opted out in November 2002.​
• Kansas opted out in March 2003.​
• North Dakota opted out in October 2003.​
• Washington opted out in October 2003.​
• Alaska opted out in October 2003.​
• Oregon opted out in December 2003.​
• Montana opted out in January 2004.
  (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.)​
• South Dakota opted out in March 2005.​
• Wisconsin opted out in June 2005.​
• California opted out in July 2009.​

 

[kazuma]

.....

 

[SleepIsGood]

Only a matter of time, gents:

http://www.aana.com/optoutstudy/

I URGE EVERYONE to email the ASA. I just did.. They need to see this and RESPOND.

 

[gaspasser2004]

You are assuming that once the AANA legislative agenda occurs, that all the decks of the Titanic will sink equally. There are still regions of the country and strong MD controlled practices in the rest of the country that will also hold out for many years, areas that will be the last to be encroached on by independent CRNAS. There are still hospital administrators that simply don't buy what they are selling. Docs in those types of situations will be able to hold decent positions for quite a few years.

I agree with this completely.

 

[BLADEMDA]

You are assuming that once the AANA legislative agenda occurs, that all the decks of the Titanic will sink equally. There are still regions of the country and strong MD controlled practices in the rest of the country that will also hold out for many years, areas that will be the last to be encroached on by independent CRNAS. There are still hospital administrators that simply don't buy what they are selling. Docs in those types of situations will be able to hold decent positions for quite a few years.

Current Anesthesiologists are likely to find employment or stay employed for the next two decades. Paradigm shifts take time but once they begin they are hard to stop. This is why the AANA continues to publish juck science and push for Independence. Over tme the plan is to abolish supervison ratios and then supervision completely. The plan seems to be working. But, the larger question still remains if a MS3/MS4 should invest the next 4-5 years of his/her life pursuing a field that is dying or likely to be demoted to Nursing level duty. For those with other options and strong credentials I urge a careful analysis.

 

[BLADEMDA]

Any speciality other than anesthesiology.

"Nurse anesthetists get essentially the same training in anesthesia as anesthesiologists. So in this case, a nurse is just about a perfect substitute for the doctor," Jerry Cromwell, a health economist at the Research Triangle Institute in North Carolina who led one study, said in a statement.

"Eliminating physician supervision will not only allow nurses to do what they are trained and highly qualified to do, but it will encourage hospitals and surgeons to use a more cost-effective mix of anesthetists."