Arizona opts out of physician supervision requirement for CRNAs

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My understanding is the NY provision is only through April 22nd. The AZ exemption has no limitations on it.
 
Here we go! It’s the same with NPs and PAs in the clinic! Using the crisis to their advantage.
 
To be fair, there is talk about allowing residents to practice unsupervised to meet staffing needs at our (major academic) hospital.
 
SaltyDog said:
So halting all elective procedures = needing more anesthesia providers 😕
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It’s half baked logic that the Arizona nursing board fed to this idiotic governor. Yeah it’s all about rural healthcare please...
 
The real mortality for COVID19 will come from surge patients, over filled hospitals and clinical triage and decision making. The Italian experience has been to intubate, intubate, and fill ICUs and then they get screwed when the next patient came in...Now what do you do. Ask the CRNA, NP or APP how to manage the vent, triage pts, make clinical decisions, wean the ventilator. Any tube monkey could put an ETT in...hell we should have EMTs do it and have the apex physician sit far away. We are swimming in real deep ocean requirements for clinical medicine right now.
There are no bow tied protocols out there for the midlevels...Its a perfect storm for a catastrophic mess-up from the midlevels and I would love to watch them flounder. Imagine ER PAs or CRNA independently going around intubating every COVID patient. It would overwhelm the system massively.
Our worth is knowing what to do, when to do it, when not to do it, and how to wean it. Do these midlevels have the sphincter tone to send asymptomatic or mildly symptomatic patients home for watchful waiting, do they have the ability to know when to deescalate therapy or when to move on to something else proning, ECMO, palliation...

We are about to witness true knowledge versus Trump-gee golly-I think-I hope - CRNA,NP, APP meltdowns.
 
Consigliere said:
Within the next 10 years I predict CRNAs having independent practice rights in all 50 states.
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And I agree, although unhappily, with this prediction. We no longer respect knowledge in the US anymore and as previously mentioned on SDN we no longer rule by knowledge but we follow entertainers, gossipers, and shock jocks.
Just look at Dr. Fauci who is an editor of Harrison's internal medicine getting contradicted by the president in every WH debriefing.
 
Modanq said:
And I agree, although unhappily, with this prediction. We no longer respect knowledge in the US anymore and as previously mentioned on SDN we no longer rule by knowledge but we follow entertainers, gossipers, and shock jocks.
Just look at Dr. Fauci who is an editor of Harrison's internal medicine getting contradicted by the president in every WH debriefing.
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Dr. Fauci has been a Harrison's editor since 1986 (11th edition). Trump has been a conman for longer. Trump wins.
 
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Modanq said:
The real mortality for COVID19 will come from surge patients, over filled hospitals and clinical triage and decision making. The Italian experience has been to intubate, intubate, and fill ICUs and then they get screwed when the next patient came in...Now what do you do. Ask the CRNA, NP or APP how to manage the vent, triage pts, make clinical decisions, wean the ventilator. Any tube monkey could put an ETT in...hell we should have EMTs do it and have the apex physician sit far away. We are swimming in real deep ocean requirements for clinical medicine right now.
There are no bow tied protocols out there for the midlevels...Its a perfect storm for a catastrophic mess-up from the midlevels and I would love to watch them flounder. Imagine ER PAs or CRNA independently going around intubating every COVID patient. It would overwhelm the system massively.
Our worth is knowing what to do, when to do it, when not to do it, and how to wean it. Do these midlevels have the sphincter tone to send asymptomatic or mildly symptomatic patients home for watchful waiting, do they have the ability to know when to deescalate therapy or when to move on to something else proning, ECMO, palliation...

We are about to witness true knowledge versus Trump-gee golly-I think-I hope - CRNA,NP, APP meltdowns.
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I am experiencing this firsthand as we speak. I have a senior resident and CRNAs in house at the moment with the number of rapid responses, code blues, and intubations going on (not to mention trauma coverage), and it's pointless taking CRNAs half the time to activations because there are so many "in-between" patients who need to be evaluated by a senior resident or physician. There are a ton of hypoxic pts on the floor who likely need HFNC and diuresis, not a tube monkey who's going to say OK when the PGY2 medicine resident asks for immediate intubation.
 
Yet, if you sign up for the ASA online covid townhall, it is open for crnas. Explain that to me. Please someone explain it.
 
Lecithin5 said:
Yet, if you sign up for the ASA online covid townhall, it is open for crnas. Explain that to me. Please someone explain it.
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The ASA is a sycophantic organization that has always kissed up to the big anesthesia corporations, hence they have always welcomed CRNAs and the "anesthesia care team" model. The little people don't seem to matter to them, hence I haven't been a member since graduation.
 
A part of me wants to say: fine, have your complete and utter independence. But: no more coming to academic weekly conferences and M and Ms; no more being allowed to attend anything that anesthesia depts or ASA sponsors; no option of being bailed out by docs or collaborating with docs for an anesthetic plan. We’ll also see how far research and development, clinical research, etc is carried by CRNAs. And their arrogance won’t allow them to accept any salary lower than anesthesiologists (as they can bill the same as physicians). Then, let that percolate for a bit. Then we’ll see what happens.
 
Lecithin5 said:
A part of me wants to say: fine, have your complete and utter independence. But: no more coming to academic weekly conferences and M and Ms; no more being allowed to attend anything that anesthesia depts or ASA sponsors; no option of being bailed out by docs or collaborating with docs for an anesthetic plan. We’ll also see how far research and development, clinical research, etc is carried by CRNAs. And their arrogance won’t allow them to accept any salary lower than anesthesiologists (as they can bill the same as physicians). Then, let that percolate for a bit. Then we’ll see what happens.
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Let's follow your logic. A high school student can choose the DNP CRNA route or your route to practice anesthesia. Which one will he/she most likely pick? Also, a 3rd year med student needs to pick a specialty. Does he/she choose to become a Physician Anesthesiologist when there is an equal Nurse Anesthesiologist right next door? What happens to the quality of the specialty? I'll let FFP answer that last question.
 
BLADEMDA said:
Let's follow your logic. A high school student can choose the DNP CRNA route or your route to practice anesthesia. Which one will he/she most likely pick? Also, a 3rd year med student needs to pick a specialty. Does he/she choose to become a Physician Anesthesiologist when there is an equal Nurse Anesthesiologist right next door? What happens to the quality of the specialty? I'll let FFP answer that last question.
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What does Dr. stand for, in America? Dinosaur.
 
Let them get their independence . The energy it takes resisting them is making people lose their love for the field of medicine . RN DNP CRNA can manage their own case and I do mine.
 
BLADEMDA said:
Let's follow your logic. A high school student can choose the DNP CRNA route or your route to practice anesthesia. Which one will he/she most likely pick? Also, a 3rd year med student needs to pick a specialty. Does he/she choose to become a Physician Anesthesiologist when there is an equal Nurse Anesthesiologist right next door? What happens to the quality of the specialty? I'll let FFP answer that last question.
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The specialty is being destroyed both from without and within. After seeing how things are done on auditions and the interview trail this year, I can safely tell you most residencies out there today are putting out an inferior product. The people coming out of these places are little more than super-CRNAs who will further blur the lines between nurse and physician in anesthesia. More and more PDs are willing to play ball and let the hospital administration dilute education and turn residents into cheap gas monkeys. And if they're not, guess what, they will find someone who is.

No, after seeing how things are done firsthand, I'm convinced it's the next generation of physicians that will hammer the final nail in the coffin of anesthesiology, and not through good old-fashioned selling out either.
 
zero0 said:
The specialty is being destroyed both from without and within. After seeing how things are done on auditions and the interview trail this year, I can safely tell you most residencies out there today are putting out an inferior product. The people coming out of these places are little more than super-CRNAs who will further blur the lines between nurse and physician in anesthesia. More and more PDs are willing to play ball and let the hospital administration dilute education and turn residents into cheap gas monkeys. And if they're not, guess what, they will find someone who is.

No, after seeing how things are done firsthand, I'm convinced it's the next generation of physicians that will hammer the final nail in the coffin of anesthesiology, and not through good old-fashioned selling out either.
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It’s really sad sight to see.
 
zero0 said:
The specialty is being destroyed both from without and within. After seeing how things are done on auditions and the interview trail this year, I can safely tell you most residencies out there today are putting out an inferior product. The people coming out of these places are little more than super-CRNAs who will further blur the lines between nurse and physician in anesthesia. More and more PDs are willing to play ball and let the hospital administration dilute education and turn residents into cheap gas monkeys. And if they're not, guess what, they will find someone who is.

No, after seeing how things are done firsthand, I'm convinced it's the next generation of physicians that will hammer the final nail in the coffin of anesthesiology, and not through good old-fashioned selling out either.
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Admittedly, it was ALWAYS going to be the next generation...
 
zero0 said:
The specialty is being destroyed both from without and within. After seeing how things are done on auditions and the interview trail this year, I can safely tell you most residencies out there today are putting out an inferior product. The people coming out of these places are little more than super-CRNAs who will further blur the lines between nurse and physician in anesthesia. More and more PDs are willing to play ball and let the hospital administration dilute education and turn residents into cheap gas monkeys. And if they're not, guess what, they will find someone who is.

No, after seeing how things are done firsthand, I'm convinced it's the next generation of physicians that will hammer the final nail in the coffin of anesthesiology, and not through good old-fashioned selling out either.
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Now that is a post I can respect!
 
zero0 said:
The specialty is being destroyed both from without and within. After seeing how things are done on auditions and the interview trail this year, I can safely tell you most residencies out there today are putting out an inferior product. The people coming out of these places are little more than super-CRNAs who will further blur the lines between nurse and physician in anesthesia. More and more PDs are willing to play ball and let the hospital administration dilute education and turn residents into cheap gas monkeys. And if they're not, guess what, they will find someone who is.

No, after seeing how things are done firsthand, I'm convinced it's the next generation of physicians that will hammer the final nail in the coffin of anesthesiology, and not through good old-fashioned selling out either.
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Yet, the MATCH rate says otherwise. Remember when you couldn't wait to get into Med School? Then ,there was the MATCH. Now, comes the cold, hard FFP realism that Santa really doesn't live in the North pole and there is no gold under the rainbow.
 
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This is becoming a massive manpower situation. Do you think it would make sense to have CRNAs wipe a$$es when they have a skill set that is actually useful? Do you want to be supervising or signing off on every line or intubation they do?

At the moment, most anesthesia departments are being asked to be procedure monkeys in the ICUs. No anesthesiologist is being expected to make more than basic vent adjustments. Like it or not, these things are completely in the skill set of CRNAs. What this means for CRNA independence going forward is up for debate, but sometimes in a crisis you do what you gotta do.

The governor of NY also granted all physicians complete immunity from civil liability for treating covid patients...so there’s that too.
 
BLADEMDA said:
Let's follow your logic. A high school student can choose the DNP CRNA route or your route to practice anesthesia. Which one will he/she most likely pick? Also, a 3rd year med student needs to pick a specialty. Does he/she choose to become a Physician Anesthesiologist when there is an equal Nurse Anesthesiologist right next door? What happens to the quality of the specialty? I'll let FFP answer that last question.
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So far, this past match showed increased interest for anesthesia and generated higher competition, despite CRNA being on attack. Our program received double amount of applications.
 
zyovka said:
So far, this past match showed increased interest for anesthesia and generated higher competition, despite CRNA being on attack. Our program received double amount of applications.
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That’s interesting because the number of anesthesia applicants in the match did not double. Maybe the reputation of your program is on the rise or people are just applying to more programs.
 
zyovka said:
So far, this past match showed increased interest for anesthesia and generated higher competition, despite CRNA being on attack. Our program received double amount of applications.
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With the huge increase in Med students over the past few years MATCHING has gotten competitive in terms of finding any position. That trend will continue so Anesthesiology will still get plenty of applicants per program. Programs will "fill" until the job market is such that graduates can't find work or salaries are low enough to push many into primary care. There really isn't that many choices for some Med Students and soon the Step 2 score will be the DEFINING measure for many PDs.

Med Schools may one day operate like law schools where only a 1/3 or 1/4 of the graduates are truly successful. The rest just pay a fortune to get a shot at the good life. But, once Med Schools suck you in/lure you in to a $80,000 per year education what are you choices upon graduation? Programs know these facts and exploit it to their advantage.
 
RadsWFA1900 said:
It’s half baked logic that the Arizona nursing board fed to this idiotic governor. Yeah it’s all about rural healthcare please...
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Two of the most radical and vocal anti-MD, anti-CAA CRNAs in the entire country are in Arizona. Blade knows exactly who I'm talking about.
 
jwk said:
Two of the most radical and vocal anti-MD, anti-CAA CRNAs in the entire country are in Arizona. Blade knows exactly who I'm talking about.
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Is the AAAA working in AZ to get an emergency declaration for AA practice? Show the governor the SCCM new staffing pyramid with CAA at the same level as CRNAs. The AZ government shouldn't be restricting the ability of people who want to work and want to help in this time of crisis.
 
Dochopeful13 said:
May I ask why you think this?
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Look at the accelerating pace this is occuring. AZ....FL within the next few years....other states will quickly follow suit. Nary a year goes by when another state caves and allows CRNAs independence.
 
mmag said:
Is the AAAA working in AZ to get an emergency declaration for AA practice? Show the governor the SCCM new staffing pyramid with CAA at the same level as CRNAs. The AZ government shouldn't be restricting the ability of people who want to work and want to help in this time of crisis.
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what makes you think AA's don't have in mind what the CRNA's do?
 
This changes nothing. They’re already turning healthy 18 year olds into vegetables under a surgeon’s “supervision”- see the thread on Rex Meeker. The plastic surgeon is now required by the medical board to use an anesthesiologist in future surgeries.
I’ve worked in opt out states- the vast majority of hospitals still require them to be supervised by an anesthesiologist.
 
jwk said:
Two of the most radical and vocal anti-MD, anti-CAA CRNAs in the entire country are in Arizona. Blade knows exactly who I'm talking about.
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I'm sure Joe Rodriguez and Mike MacKinnon are celebrating. It's a big problem, and their ego prevents recognition of it, when you're part of an organization that recommends all CRNAs stay home as opposed to helping in the ICU (as, you know, NURSES, which they should be proud to be) when the country is in a pandemic. They're too busy still trying to decide what to call themselves....
 
Southpaw said:
I'm sure Joe Rodriguez and Mike MacKinnon are celebrating. It's a big problem, and their ego prevents recognition of it, when you're part of an organization that recommends all CRNAs stay home as opposed to helping in the ICU (as, you know, NURSES, which they should be proud to be) when the country is in a pandemic. They're too busy still trying to decide what to call themselves....
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I feel sorry for Mike at least. He spent years all over this board talking about how much he wanted to be a doctor. Those posts are still here and can be searched under his name.
We see where that failure has led.
It’s very unfortunate for patients.
 
BLADEMDA said:
With the huge increase in Med students over the past few years MATCHING has gotten competitive in terms of finding any position. That trend will continue so Anesthesiology will still get plenty of applicants per program. Programs will "fill" until the job market is such that graduates can't find work or salaries are low enough to push many into primary care. There really isn't that many choices for some Med Students and soon the Step 2 score will be the DEFINING measure for many PDs.

Med Schools may one day operate like law schools where only a 1/3 or 1/4 of the graduates are truly successful. The rest just pay a fortune to get a shot at the good life. But, once Med Schools suck you in/lure you in to a $80,000 per year education what are you choices upon graduation? Programs know these facts and exploit it to their advantage.
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Difference is law school is 3 years with no internship/residency. That means 25/26 year old out there trying to find jobs. And most jobs open at public defender jobs at $50-70k a year.

it’s like saying np doing arnp schools for 2 years and finding arnp jobs for 50-70k.

they won’t do it.

they know most arnp jobs pay $80–120k now already.

so while I think replaceable md jobs even EM and anes will see salary decrease with more mid levels. I also see them working more shifts 14-16 a month in anesthesia even as docs. And your hourly wage isn’t much less but your will be working less. Aka getting paid $250k “full time” but working more like 40 hours. A hard cap 40 hours with overtime possibly. It will be hard to make 400-500k. Similar how it is hard for independent locums crna to make more than 350k. But most can make 250-300k range.
 
mmag said:
Is the AAAA working in AZ to get an emergency declaration for AA practice? Show the governor the SCCM new staffing pyramid with CAA at the same level as CRNAs. The AZ government shouldn't be restricting the ability of people who want to work and want to help in this time of crisis.
Click to expand...
We're looking at every state to see how the current laws are being adapted/modified/suspended to see if they might possibly allow CAA practice on at least a temporary basis. We certainly have the support of the ASA and the surgeon general at the moment.
 
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