ASA email today 8/7/19. Just got this.

[deleted126335]

An Open Letter to AANA Leadership

August 7, 2019
AANA Board of Directors
C/o Gary Brydges, PhD, DNP, MBA, ACNP-BC, CRNA, FAAN, President
Kathryn Jansky, MHS, CRNA, APRN USA, LTC (ret), President-Elect
American Association of Nurse Anesthetists
222 S. Prospect Avenue
Park Ridge, IL 60068-4037
Dear Colleagues:
As the elected officers of the American Society of Anesthesiologists, we wish to extend our best wishes for a successful annual meeting and our congratulations to outgoing and incoming board members. Your role is a critical one in representing the many thousands of nurse anesthetists who make critically important contributions within our shared professional space. Throughout the years, both personal and professional relationships with nurses have been among the most rewarding experiences of our careers. We rely on your skills, knowledge, experience and compassion to provide the best possible care to the patients we serve.
We strongly believe the physician-led anesthesia care team model provides the highest levels of patient care. But a critical element of the care team model is that all members of the team feel respected and honored for their contributions. We have concerns that recently, some have lost sight of this critical element and its significant contribution to patient care.
We acknowledge that our efforts to promote physician-led anesthesia care cannot be viewed as successful if they make any members of the care team feel marginalized. Going forward, we are committed to acting with this principle in mind. Similarly, we believe messaging promoting the significant value of nurse anesthetists can be delivered without denigrating physicians. We ask that you commit to acting with this principle in mind.
Most anesthesia care team members enjoy harmonious and collaborative physician–nurse relationships. The priorities of both our professional societies should reflect this. As ambassadors of our respective professions, our shared goal must be to promote collaboration and harmony among all care team members and maintain shared focus on improving quality and safety in patient care.
We invite you to join us in celebrating the collaboration and harmony that are the hallmarks of our shared professional work. We look forward to working with you toward our common goal of providing the best possible care to the patients we serve.
Sincerely,
Linda J. Mason, M.D., FASA
ASA President
Mary Dale Peterson, M.D., MHA, FACHE, FASA
ASA President-Elect
cc:
Randall Moore, D.N.P., M.B.A., CRNA
Paul Pomerantz, FACHE



Bolded emphasis mine. My interpretation: We know that you are considering changing your name to "Nurse Anesthesiologists". Don't poke the bear. Individual CRNAs and SRNAs might be looked upon as your embassy. You s

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Members don't see this ad.

 

[Lecithin5]

I didn’t know what to make of this message- was it strong? Weak? Necessary? Valuable? Groveling? Honestly don’t know

 

[T-burglar]

I didn’t know what to make of this message- was it strong? Weak? Necessary? Valuable? Groveling? Honestly don’t know

Agreed. Very long letter that could be interpreted any way you want. Seems toothless.

 

[urge]

Agreed. Very long letter that could be interpreted any way you want. Seems toothless.

I view it as “we are watching you and keeping tabs”.

 

[Ronin786]

What is this bull****? "We acknowledge that our efforts to promote physician-led anesthesia care cannot be viewed as successful if they make any members of the care team feel marginalized."

Apologies for adopting the WHO statement of what anesthesia is?

 

[AdmiralChz]

I view it as “we are watching you and keeping tabs”.

Yes. It’s an olive branch of sorts, by most accounts their “We are the Answer” campaign has backfired nationally. Just around here: several sub specialty sites cancelled their SRNA rotations and we scrapped a plan to add an OB rotation. It was easy to point to that statement when the nursing school called foul. We no longer allow senior nurses to serve on any committees without a physician present (and even then, it’s rare).

It’s an opportunity for them to back off their ridiculous, heinous rhetoric that has been building especially this year (but it’s been worse, anyone remember that douche canoe AANA president who trolled MDs on Twitter all day??). It’s unlikely to work but it’s something that isn’t goading. Pulling out of the ASPF and going against nearly every non-insurance based entity in supporting the new surprise billing bill have marginalized them nationally.

 

[NicMouse64]

Yes. It’s an olive branch of sorts, by most accounts their “We are the Answer” campaign has backfired nationally. Just around here: several sub specialty sites cancelled their SRNA rotations and we scrapped a plan to add an OB rotation. It was easy to point to that statement when the nursing school called foul. We no longer allow senior nurses to serve on any committees without a physician present (and even then, it’s rare).

It’s an opportunity for them to back off their ridiculous, heinous rhetoric that has been building especially this year (but it’s been worse, anyone remember that douche canoe AANA president who trolled MDs on Twitter all day??). It’s unlikely to work but it’s something that isn’t goading. Pulling out of the ASPF and going against nearly every non-insurance based entity in supporting the new surprise billing bill have marginalized them nationally.

I guess why were SRNAs getting access to those in the first place?

 

[2Fast2Des]

I guess why were SRNAs getting access to those in the first place?

That's ok, they'll just watch YouTube videos of procedures and claim them as credit

 

[mmag]

That's ok, they'll just watch YouTube videos of procedures and claim them as credit

That seems pretty reasonable. Considering there's actually a whole "pain fellowship" for CRNAs that is viritual - simulation based and online.

USF Office of Graduate Studies | University of South Florida

www.usf.edu

 

[aneftp]

My main gripe is most anesthesia forums are public. But crnas lock down their forums to the public. It’s no secret what they are saying behind our backs. Cause crnas have shown me some of the posts about MDs. We know how nasty their posts are. 10x worst than what’s on here. Why do they feel the need to go in secret while trying to promote themselves as equal to the public.

 

[2Fast2Des]

That seems pretty reasonable. Considering there's actually a whole "pain fellowship" for CRNAs that is viritual - simulation based and online.

USF Office of Graduate Studies | University of South Florida

www.usf.edu

The head of the program, John Maye, PhD, CRNA, CAPT(Ret) USN. ADAIPM,RN-BC, Professor. I think he's missing a few letters.

 

[deleted171991]

The more letters the more insecure.

 

[2Fast2Des]

The more letters the more insecure.

CRNAs in residency who were doing their PhD schooling would write their name as Super Noctor PhD-C, talk about trumping up qualifications. Taking credit for a degree still in the process of studying to obtain, no shame

 

[deleted171991]

CRNAs in residency who were doing their PhD schooling would write their name as Super Noctor PhD-C, talk about trumping up qualifications. Taking credit for a degree still in the process of studying to obtain, no shame

That's because doctors are p-ssies and don't call them out.

I would put in every hospital bylaws a rule that any misrepresentation of degrees/clinical roles anywhere (not only at the workplace, even by omission - not correcting the patient's misconception) will result in immediate and irreversible loss of privileges and dismissal, no excuses.

 

[dannyboy1]

That's because doctors are p-ssies and don't call them out.

I would put in every hospital bylaws a rule that any misrepresentation of degrees/clinical roles anywhere (not only at the workplace, even by omission - not correcting the patient's misconception) will result in immediate and irreversible loss of privileges and dismissal, no excuses.

Not sure why you think the hospital gives two $hits about our squabbles with CRNA/APRN....

 

[deleted126335]

Not sure why you think the hospital gives two $hits about our squabbles with CRNA/APRN....

They do care. It is in their interest (hospital admin) that APPs be considered interchangeable providers with physicians.

The medical exec committee and med staff are another matter. Of course if they are mostly employed by the healthcare system, they might just eat ****.

 

[pgg]

 

[deleted171991]

Not sure why you think the hospital gives two $hits about our squabbles with CRNA/APRN....

The bylaws are voted by the medical staff, not the hospital. Now is the time, before midlevels get admitting and voting privileges.

 

[deleted171991]

That letter is absolutely useless. The only useful thing would be to come out against the "team" model in medicine, and to fight against it like the AANA does (except we would point out that physician-only care is better than "team" care, because one simply cannot provide meaningful supervision at today's ratios, and when one is not really in a supervisory hiring/firing role). The team model is obviously not working in places where the clinically supervising physicians are not the employers, or don't have a say in hiring/firing; it's just leading to physician burnout.

The ASA should also get into the habit of outing bad employers, who mistreat anesthesiologists when they speak up against CRNAs, hence putting patients at risk. But the ASA is just another worthless political organization whose leaders are only interested in putting the job on their CV (with few exceptions), so I am not holding my breath.

 

[Planktonmd]

Another attempt by the ASA to bribe the AANA into cooperation!
It never worked before so I am not sure why this ASA president thinks it will work now.

 

[nimbus]

That letter is absolutely useless. The only useful thing would be to come out against the "team" model in medicine, and to fight against it like the AANA does (except we would point out that physician-only care is better than "team" care, because one simply cannot provide meaningful supervision at today's ratios, and when one is not really in a supervisory hiring/firing role). The team model is obviously not working in places where the clinically supervising physicians are not the employers, or don't have a say in hiring/firing; it's just leading to physician burnout.

The ASA should also get into the habit of outing bad employers, who mistreat anesthesiologists when they speak up against CRNAs, hence putting patients at risk. But the ASA is just another worthless political organization whose leaders are only interested in putting the job on their CV (with few exceptions), so I am not holding my breath.

Emergency medicine has 2 major professional organizations, the ACEP and the AAEM. ACEP is majorly supported by corporate interests like the ASA while AAEM is not. I believe we need an organization similar to the AAEM that advocates for individual practitioners and independent groups and against the corporate practice of medicine. The ASA completely ignores the fact that Wall Street corporatization is a bigger threat to anesthesia than CRNA’s. Is there a single example where things got better at work for anesthesiologists after a buyout?



“Since the end of the millennium, there has been a steady rise in the number of large contract management groups (CMGs) acquiring emergency physician contracts. At this point, about one-third of all practicing emergency physicians work for one of them. This degree of "corporatization" far surpasses any other medical specialty and creates a tenuous situation for the future since emergency physician qualifications, working conditions and professional compensation are tied to the bottom line of an economically volatile industry.

AAEM believes that corporate ownership of emergency department contracts represents a violation of the public protections afforded by state prohibitions of the corporate practice of medicine. Additionally, emergency physicians may unwittingly risk their licensure by aiding and abetting the unlawful corporate practice of medicine. The Board of Trustees of the AMA has provided a comprehensive review on the issue as it relates to practicing physicians. AAEM became involved with legal challenges regarding the corporate practice of medicine with large corporations, TeamHealth in California and EmCare in the state of Minnesota. AAEM also participated in a successful action related to the corporate practice of emergency medicine in California involving Catholic Healthcare West.

AAEM has raised concerns with the Office of the Inspector General and the attorney general's office in various states that such corporate employment arrangements may involve prohibited fee-splitting activities under current state and federal statutes. AAEM members are cautioned about accepting employment with corporate groups and AAEM suggests that hospitals examine such an arrangement with due diligence.

AAEM believes that emergency physicians must remain free of corporate influence because of their difficult role as advocates for the under and uninsured patient. The AAEM firmly believes it is in the best interest of the patients to have emergency physicians unencumbered by the profit concerns of a corporation. AAEM is always willing to assist in this matter in order to help emergency physicians secure a physician-owned group, which is the best model for professional satisfaction and care quality.”

History | AAEM - American Academy of Emergency Medicine

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care.

www.aaem.org

 

[blockstar]

 

[deleted171991]

View attachment 275692

QED. There is no reasoning with a manipulating narcissistic bully.

They hide their incompetence behind the "patient care" and "professional" BS. I see the same time and again with (semi-)independent midlevels and allied healthcare providers, and even with some younger nurses. Some are as DUMB as to actually think they are/deserve to be the physicians' equals in the "patient care team" (Stalin would be proud of that expression), another example of the American anti-intellectual mania (like the current populism and demagoguery). That's the textbook definition of one not knowing what one doesn't know. The rare exceptions just confirm the rule.

 

[AdmiralChz]

“The AANA has always appreciated and respected anesthesiologists’ contribution to our shared specialty”

This statement is so tone-deaf and full of hubris that it’s almost unbelievable, but there you go.

The ONLY thing good thing here is the recognition that anesthesiologist = MD. Otherwise, they threw the olive branch right back to us with a middle finger.

Whatever. At my ACT shop it’s physician-led, patient-centric. The nurses are part of the team but by no means lead it - want to do that? Hit up medical school.

 

[blockstar]

Advocate for, train, and hire AAs. They actually want to be part of a team. Nurses dont, they all contribute to and support the AANA, no matter how they feel or act at work this is their endgame if they contribute to this organization.
Let them go to their independent states and work. Hire an AA ten times out of ten if you need help staffing operating rooms.

 

[Endee]

Their (AANA) educational comparison vs our (AAAA) educational comparison.

 

[pgg]

Ooooo! I guess it's time for another strongly worded letter.

 

[deleted171991]

Ooooo! I guess it's time for another strongly worded letter.

When they go low, we go high. </sarcasm>

 

[HIPAAHasOneP]

View attachment 275692

Wow! I really hope Anesthesiologists stand up to them. If I have the choice, I prefer anesthesiologists. I requested anesthesiologist only prior to a surgery earlier this year, and I very much appreciated that they accommodated my request. The day of the surgery all the patients were lined up with only a curtain in between, and when the anesthesiologist came by to see me he whispered, "Thanks for choosing us." I gave him a thumbs up and said, "I'm glad you're here."

 

[AdmiralChz]

Just wanted to circle back here, there’s a bit of fake news on this. That original awful graph isn’t officially from the AANA it’s from some rando pro-CRNA website not formally endorsed by anyone. Might just be a shell or mock website meant to inflame. Russians at it again!

Education - CRNA Safe

CRNAs are highly educated advanced practice registered nurses who deliver anesthesia to patients in exactly the same ways and just as safely as physician anesthesiologists.

crnasafe.com

 

[Endee]

Plausible deniability. AANA does a lot of their PR work this way and it lets them blame their unprofessional lying propaganda on “rogue elements.” It’s like the “nurse anesthesiologist” thing. Technically not an AANA led effort but all of them at the top supported it. And when ASA pushes back then they can say it wasn’t them. Meanwhile the damage has been done and the public is misled.

Just wanted to circle back here, there’s a bit of fake news on this. That original awful graph isn’t officially from the AANA it’s from some rando pro-CRNA website not formally endorsed by anyone. Might just be a shell or mock website meant to inflame. Russians at it again!

Education - CRNA Safe

CRNAs are highly educated advanced practice registered nurses who deliver anesthesia to patients in exactly the same ways and just as safely as physician anesthesiologists.

crnasafe.com

 

[deleted126335]

Obviously the amendment was defeated. Anybody know by how much?

 

[deleted171991]

Obviously the amendment was defeated. Anybody know by how much?

By a (few) million bucks?

 

[drmwvr]

Letter was interesting...Neville Chamberlain kept coming to mind for some reason...

 

[ToKingdomCome]

I feel like my shop values the AA's more than the residents especially with case assignments and giving residents "busy work" like giving lunch breaks and stuff. Is this common at some residencies?

 

[hununuh]

I feel like my shop values the AA's more than the residents especially with case assignments and giving residents "busy work" like giving lunch breaks and stuff. Is this common at some residencies?

I think that's a big red flag for the residency program.. Residents should get the best learning cases possible every day. At my program, CRNAs get the left over cases/breaks.

 

[deleted697535]

View attachment 275692

You boys are getting you ****ing asses handed to ye...

 

[ToKingdomCome]

I think that's a big red flag for the residency program.. Residents should get the best learning cases possible every day. At my program, CRNAs get the left over cases/breaks.

How common is it for programs to have residents double up on cases?

 

[Mman]

How common is it for programs to have residents double up on cases?

should never happen IMHO other than maybe first month when you are still learning the basics of how to chart and give an anesthetic

 

[ToKingdomCome]

should never happen IMHO other than maybe first month when you are still learning the basics of how to chart and give an anesthetic

Well damn

 

[pgg]

How common is it for programs to have residents double up on cases?

On call, it's fine. Desirable actually for a senior resident to be teaching a junior resident.

For scheduled days, it's not a big deal if it's rare. If it's the normal state of affairs ACGME would not be OK with it and the program would definitely take hit on it because the program doesn't have sufficient volume for the number of residents it has.

 

[hununuh]

How common is it for programs to have residents double up on cases?

Only during first 2 months when CA-1’s are paired up.

During the call, if its a ****show trauma case, there will be multiple residents helping out, but thats not really “doubling up” since you need all hands on deck for those cases.

If the program is doing it to meet the numbers, i.e. two residents in the same thoracic case and both residents count that case towards their thorac numbers, then thats REALLY bad.

Hope you are not a resident stuck in that situation.

 

[abolt18]

On call, it's fine. Desirable actually for a senior resident to be teaching a junior resident.

For scheduled days, it's not a big deal if it's rare. If it's the normal state of affairs ACGME would not be OK with it and the program would definitely take hit on it because the program doesn't have sufficient volume for the number of residents it has.

We have a "supervisor" rotation during our 4th year where you function as the attending and consult with the actual attending (who usually just hides in the corner and stays away unless needed) so in those you're "doubled" but not really because that supervising resident is doing the preops and bouncing between rooms while the resident who is doing the case... Does the case.

Overnight call shifts we'll occasionally get doubled up junior with senior. Pretty certain that's just so the night attending can chill.

 

[Ferrismonk]

should never happen IMHO other than maybe first month when you are still learning the basics of how to chart and give an anesthetic

Maybe for a busy kid ENT room with q10 minute cases...

 

[Mman]

Maybe for a busy kid ENT room with q10 minute cases...

no way. Maybe if you each just alternated cases, but not 2 for each case.

 

[D P356]

View attachment 275692

I view this as

“we are just as good/safe as you”

then in the third paragraph, “keep teaching our students and don’t diminish their education. That will show us you value our collaboration.”

A little contradiction.

 

[blockstar]

I view this as

“we are just as good/safe as you”

then in the third paragraph, “keep teaching our students and don’t diminish their education. That will show us you value our collaboration.”

A little contradiction.

Everything their national organization says is a contradiction and/or hypocritical.

Half my CRNA friends on fb put up fire emojis or power to the people fist emojis in response to this email.

Same ones then respond to the Anesthesiologist, AA, CRNA education chart like its blasphemy to compare masters education without a year in the icu and doctoral education.

Only way this ends is get AAs in every state.

 

[Noyac]

That seems pretty reasonable. Considering there's actually a whole "pain fellowship" for CRNAs that is viritual - simulation based and online.

USF Office of Graduate Studies | University of South Florida

www.usf.edu

I am pretty sure we had one of these “pain fellowship” members on this site recently.

 

[Noyac]

That's because doctors are p-ssies and don't call them out.

I would put in every hospital bylaws a rule that any misrepresentation of degrees/clinical roles anywhere (not only at the workplace, even by omission - not correcting the patient's misconception) will result in immediate and irreversible loss of privileges and dismissal, no excuses.

Who you calling a p…ssy? I called out the imposter.

 

[ToKingdomCome]

On call, it's fine. Desirable actually for a senior resident to be teaching a junior resident.

For scheduled days, it's not a big deal if it's rare. If it's the normal state of affairs ACGME would not be OK with it and the program would definitely take hit on it because the program doesn't have sufficient volume for the number of residents it has.

Such a shame. Guess I’m being trained to be a CRNA at my program