Buzzfeed CRNA "secrets straight from the source"

[vector2]

You are correct that the answer lies in finances. You're wrong in which financial angle it will come from. My personal thought is that our friendly medical malpractice lawyers are the ones who will tilt this battle. Right now, the CRNAs make slightly less than anesthesiologists, but bear (what they percieve) to be little liability. Hospitals view anesthesia services as an expense and dont care if its CRNAs or anesthesiologists, long as the services are provided without interruption. Lawsuits from poor nursing care changes that calculus.

Here's the math:
Medical Direction:
Anesthesiologist: $450,000/yr - W2 - 55hrs/week
CRNA: $300,000/yr - 1099 - 45 hrs/week
4 Sites to staff and 1 person free for codes, OB, etc = 1 Anesthesiologist + 4 CRNAs = 1,650,000 annually

Physician Only:
Anesthesiologist: $450,000 x 5 = $2,250,000 annually (will sit on committees, work on protocols, collaborate with surgeons, and other tangible physician benefits as compared to punch the clock and better give me my breaks CRNA care)

Difference: 2,250,000 - 1,650,000 = $600,000 x 8 years = $4,800,000

1 Lawsuit due to ****ty CRNA care = $5,000,000 judgement, bad publicity, local outrage, state involvement, calls for change

The care provided by CRNAs is inferior. Nobody wants to admit this out loud in public, but for those of us who work with them, we know this to be true. What the math shows is that 1 lawsuit across 8 years undoes 8 years! of "cost savings" by using inferior anesthsia providers. This math is unnavoidable. More and more lawsuits are naming CRNAs since people are wisening up to their inferior care and shadowy "top of the license" until something bad happens then I become "just following physician orders" care.

Happy to hear counter arguments.

Your logic is theoretically sound, but I'm skeptical of how it will play out in the real-world. Until I see that malpractice insurers are seriously going up on the premiums they charge CRNAs, I have no reason to believe that administrators will take [CRNA directed] lawsuits seriously.

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[nimbus]

More and more lawsuits are naming CRNAs since people are wisening up to their inferior care and shadowy "top of the license" until something bad happens then I become "just following physician orders" care.

Are there really more and more lawsuits naming CRNAs?


This is an important assumption and the basis of your argument. Is it true? How did you come to this information? Is anybody even keeping track?

 

[Dr. Rude]

Are there really more and more lawsuits naming CRNAs?


This is an important assumption and the basis of your argument. Is it true? How did you come to this information? Is anybody even keeping track?

Not a lawyer, but....IMO, People are blowing the North Carolina case out of proportion to its importance.
Prior to this CRNAs in NC had above average protection from liability. Now they have more typical responsibility.
E.g., in the states that I have practiced let's say a CRNA extubates a patient too early and the patient has a bad outcome. Both the doc and the CRNA would be named and if the case is settled or if a verdict there would typically be liability assigned to both parties and they would both take a hit. Not necessarily 50-50. Prior to this decision, in NC the CRNA would be totally insulated as they were acting under the direction of a physician. Now, in NC, the CRNA is fair game. Given that the anesthesiologist and the parties settled, the CRNA is sole target. in the few states that I have practiced, settlements of other defendants are not admissible. So it is worth the while of the plaintiff to try to lay it all on the CRNA.

 

[IMGASMD]

I am not really up to date but here’s what I’ve found

“The decision by a three-judge majority drew a sharp dissent from two other judges, including the chief justice, who said it could force nurses to purchase malpractice insurance and raised difficult questions including what to do when a nurse and a physician disagree.”

“Left unanswered is what constitutes adequate collaboration or what happens when the physician and (nurse anesthetist) disagree,” the dissenting justice wrote. “The uncertainty created by the majority’s new standard highlights why such policy decisions should be left to the legislature, not this court.”

——

 

[Mad Jack]

Part of the problem is that some anesthesiologists think “sitting the stool” is beneath them.

Most likely the CRNA works in such a practice and thinks that is the only type of anesthesiologist that exists

 

[Mad Jack]

You are correct that the answer lies in finances. You're wrong in which financial angle it will come from. My personal thought is that our friendly medical malpractice lawyers are the ones who will tilt this battle. Right now, the CRNAs make slightly less than anesthesiologists, but bear (what they percieve) to be little liability. Hospitals view anesthesia services as an expense and dont care if its CRNAs or anesthesiologists, long as the services are provided without interruption. Lawsuits from poor nursing care changes that calculus.

Here's the math:
Medical Direction:
Anesthesiologist: $450,000/yr - W2 - 55hrs/week
CRNA: $300,000/yr - 1099 - 45 hrs/week
4 Sites to staff and 1 person free for codes, OB, etc = 1 Anesthesiologist + 4 CRNAs = 1,650,000 annually

Physician Only:
Anesthesiologist: $450,000 x 5 = $2,250,000 annually (will sit on committees, work on protocols, collaborate with surgeons, and other tangible physician benefits as compared to punch the clock and better give me my breaks CRNA care)

Difference: 2,250,000 - 1,650,000 = $600,000 x 8 years = $4,800,000

1 Lawsuit due to ****ty CRNA care = $5,000,000 judgement, bad publicity, local outrage, state involvement, calls for change

The care provided by CRNAs is inferior. Nobody wants to admit this out loud in public, but for those of us who work with them, we know this to be true. What the math shows is that 1 lawsuit across 8 years undoes 8 years! of "cost savings" by using inferior anesthsia providers. This math is unnavoidable. More and more lawsuits are naming CRNAs since people are wisening up to their inferior care and shadowy "top of the license" until something bad happens then I become "just following physician orders" care.

Happy to hear counter arguments.

You also left out that the physicians provide 50 more hours of coverage each week for that price each year, which makes the difference in cost even less due to the extra work that can be done

 

[Hoya11]

You are correct that the answer lies in finances. You're wrong in which financial angle it will come from. My personal thought is that our friendly medical malpractice lawyers are the ones who will tilt this battle. Right now, the CRNAs make slightly less than anesthesiologists, but bear (what they percieve) to be little liability. Hospitals view anesthesia services as an expense and dont care if its CRNAs or anesthesiologists, long as the services are provided without interruption. Lawsuits from poor nursing care changes that calculus.

Here's the math:
Medical Direction:
Anesthesiologist: $450,000/yr - W2 - 55hrs/week
CRNA: $300,000/yr - 1099 - 45 hrs/week
4 Sites to staff and 1 person free for codes, OB, etc = 1 Anesthesiologist + 4 CRNAs = 1,650,000 annually

Physician Only:
Anesthesiologist: $450,000 x 5 = $2,250,000 annually (will sit on committees, work on protocols, collaborate with surgeons, and other tangible physician benefits as compared to punch the clock and better give me my breaks CRNA care)

Difference: 2,250,000 - 1,650,000 = $600,000 x 8 years = $4,800,000

1 Lawsuit due to ****ty CRNA care = $5,000,000 judgement, bad publicity, local outrage, state involvement, calls for change

The care provided by CRNAs is inferior. Nobody wants to admit this out loud in public, but for those of us who work with them, we know this to be true. What the math shows is that 1 lawsuit across 8 years undoes 8 years! of "cost savings" by using inferior anesthsia providers. This math is unnavoidable. More and more lawsuits are naming CRNAs since people are wisening up to their inferior care and shadowy "top of the license" until something bad happens then I become "just following physician orders" care.

Happy to hear counter arguments.

In the above model there is no vacation cost or consideration. Who gives each doc 8 weeks of vacation in the md only model ?

MD only model will need an entire physician to supply those weeks. So you need 6 MDs. An additional 450k.

In the medical direction model you need to provide 8 weeks of MD vacation at a cost of 10 k per week is additional 80k.

Also the challenge of physically finding the number of MDs to do MD only .. at an increased cost ..

Agree it’s lower quality to supervise. But isn’t it lower quality when you see a PA in the ER? Have a “rev nurse” respond to emergencies ?
We are not the only one using nurses to expand manpower at the sacrifice of quality ..

 

[GaseousClay]

Surgery risks go up depending upon the anesthesiologist's workload

Most major surgeries would not be possible without anesthesia to render a patient unconscious and pain free and to ensure that their vital functions—including blood pressure, breathing, and heart rate and rhythm—remain stable throughout the procedure.

medicalxpress.com

When compared to an anesthesiologist directing anesthesia for one to two overlapping surgeries, directing anesthesia for two to three or three to four overlapping surgeries led to an increase in the rate of morbidity and mortality. Instances where the anesthesiologist was directing three to four surgeries at a time had a complication rate of 5.75%, a 14% increase compared to the complication rate of 5.06% for one to two overlapping surgeries.

suck it CRNA

 

[OptionOffense]

Agree it’s lower quality to supervise.

It isnt lower quality if there is actual medical direction not the sham med dir practices that it has become. My predicition is it will become more and more difficult to work these sham med direction jobs so it will become more difficult to fill these jobs thus having to pay more to recruit and something is going to have to give either ALL MD or ALL CRNA. cant be mixed. It is a lot easier to replace RNs than MDs

 

[OptionOffense]

I am not really up to date but here’s what I’ve found

“The decision by a three-judge majority drew a sharp dissent from two other judges, including the chief justice, who said it could force nurses to purchase malpractice insurance and raised difficult questions including what to do when a nurse and a physician disagree.”

“Left unanswered is what constitutes adequate collaboration or what happens when the physician and (nurse anesthetist) disagree,” the dissenting justice wrote. “The uncertainty created by the majority’s new standard highlights why such policy decisions should be left to the legislature, not this court.”

——

Now the cat is out of the bag? The judges are in chambers scratching their asses (and heads) saying "What the **** is collaboration? What happens if the nurse and physician disagree? What happens then?" I still dont know. Can anyone answer why I would have to collaborate with a nurse as a physician and what that looks like?: because the judges cannot answer that question.

 

[Bryan O’Blivion]

The problem is that there are many anesthesiologists who like sham practices, because it allows them to make more money with less work. The CRNA who wrote this probably works somewhere where they do all the heavy lifting and the docs coast. Unfortunately, there are more than a few folks who take advantage of the supervision model, and give cause to the sentiment in the buzz feed clickbait above. It seems grossly insulting to those of us who do work hard, manage busy ORs, do our jobs, and give our best effort every day. But you have to have to be willfully obtuse not to observe the situation this CRNA is complaining about.

 

[OptionOffense]

. It seems grossly insulting to those of us who do work hard, manage busy ORs, do our jobs, and give our best effort every day. But you have to have to be willfully obtuse not to observe the situation this CRNA is complaining about.

Here is the thing, in many med direction practices your hard work would not be well-received because of what it looks like.

 

[Bryan O’Blivion]

Here is the thing, in many med direction practices your hard work would not be well-received because of what it looks like.

That’s very true. A great deal of what we do is completely invisible. That notwithstanding, there are definitely some docs who are abusers, and it makes us all look bad, particularly since what we do is often so invisible.

 

[GaseousClay]

That’s very true. A great deal of what we do is completely invisible. That notwithstanding, there are definitely some docs who are abusers, and it makes us all look bad, particularly since what we do is often so invisible.

agreed there quite a number of lazy fools and they are the ones who sold out our profession years ago.

 

[nimbus]

There needs to be more of a nuanced answer than this. A lot more to it than this.

Agree. That’s why I said it is only part of the problem. There are many other factors too. But that is a part we can influence.

 

[jwk]

The problem is that there are many anesthesiologists who like sham practices, because it allows them to make more money with less work. The CRNA who wrote this probably works somewhere where they do all the heavy lifting and the docs coast. Unfortunately, there are more than a few folks who take advantage of the supervision model, and give cause to the sentiment in the buzz feed clickbait above. It seems grossly insulting to those of us who do work hard, manage busy ORs, do our jobs, and give our best effort every day. But you have to have to be willfully obtuse not to observe the situation this CRNA is complaining about.

If your group is billing QZ for your CRNAs, in general you're part of the problem.

 

[Bryan O’Blivion]

If your group is billing QZ for your CRNAs, in general you're part of the problem.

I will decline to answer this specifically on a public message board, but yes, I agree with you.