colorado opt out

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ctsicu

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Yet another state is going to possibly opt out...colorado will by Sept 1 unless otherwise convinced by the state medical board. Can you believe that so far, they voted to uphold the opt out???? That will be about 16 states total??? Not looking good.....
Members don't see this ad.
 
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Members don't see this ad :)
Would you say this is a good or bad thing for the future of AAs in CO?
 
badasshairday said:
Somebody tell me WHY? Why would the BOM support an opt out? Are they fools?
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As a soon to be CRNA I don't really see how this benefits CRNAs to any great degree. No matter what the State of Colorado says it still comes down to the policies of the hospital or anesthesia group as to whether or not they would allow CRNAs to be unsupervised. Wouldn't the main benefactor be Physician owned groups that employ CRNAs? Would they not have to follow the guidelines of TERFA and therefore make it easier on the physicians that manage/own the anesthesia group since they have the CRNA give up their billing rights for employment?
 
NOY - so much for the money you donate to ASA PAC; doesn't look like it's gonna stop this nonsense. I better shut the eff up though, since my state (NJ) might do the very same thing in the not so distant future.
 
The article states the driving force behind the opt-out is the Colorado Hospital Association. Here are the CO board members. I'd like to know who voted for the opt-out.

[FONT=Arial, Helvetica, sans-serif].

[FONT=Arial, Helvetica, sans-serif]Jandel T. Allen-Davis, M.D., President.
[FONT=Arial, Helvetica, sans-serif]Specialty: OB/GYN.
[FONT=Arial, Helvetica, sans-serif]Panel: A.
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/11.​

[FONT=Arial, Helvetica, sans-serif]Mark C. Watts, M.D., Vice President .
[FONT=Arial, Helvetica, sans-serif]Specialty: Neurosurgery .
[FONT=Arial, Helvetica, sans-serif]Panel: B .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/11.
Steven V. Berson, J.D., Public Member
[FONT=Arial, Helvetica, sans-serif]Panel: B .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/14.
[FONT=Arial, Helvetica, sans-serif]Lisa R. Butler, D.O.. [FONT=Arial, Helvetica, sans-serif], Secretary.
[FONT=Arial, Helvetica, sans-serif]Specialty: Family Physician.
[FONT=Arial, Helvetica, sans-serif]Panel: B .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/12.​
[FONT=Arial, Helvetica, sans-serif]Ned Calonge, M.D..
[FONT=Arial, Helvetica, sans-serif]Specialty: Family Practice and Preventive Medicine.
[FONT=Arial, Helvetica, sans-serif]Panel: B .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/11.
Eric Ryan Groce, D.O.
Specialty: Family Practice and Osteopathic Manipulative Treatment
Licensing Panel
Term Expires: 05/03/13
Candis A. Hewitt, Public Member
Panel A
Term Expires: 5/03/14
[FONT=Arial, Helvetica, sans-serif]Carlton Jennings, Public Member.
[FONT=Arial, Helvetica, sans-serif]Panel: B.
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/12.
Kyle Kirkpatrick, P.A.-C
Panel A
Term Expires: 05/03/13
[FONT=Arial, Helvetica, sans-serif]Kathleen Matthews , M.D..
[FONT=Arial, Helvetica, sans-serif]Specialty: Psychiatrist.
[FONT=Arial, Helvetica, sans-serif]Licensing Panel .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/13.
Jose A. Melendez, M.D.
Specialty: Anesthesiology
Panel:A
Term Expires: 05/03/2013



Leticia M. Overholt, M.D.
Specialty: Emergency Medicine
Panel: B
Term Expires: 05/03/13​
[FONT=Arial, Helvetica, sans-serif]Dennis A. Phelps, M.D..
[FONT=Arial, Helvetica, sans-serif]Specialty: Orthopaedic Surgeon .
[FONT=Arial, Helvetica, sans-serif]Panel: A .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/12.
[FONT=Arial, Helvetica, sans-serif]Stephen D. Schoenmakers, MS, Public Member .
[FONT=Arial, Helvetica, sans-serif]Licensing Panel .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/11.
[FONT=Arial, Helvetica, sans-serif]Dale J. Utt, D.O..
[FONT=Arial, Helvetica, sans-serif]Specialty: Family Practice .
[FONT=Arial, Helvetica, sans-serif]Panel: A .
[FONT=Arial, Helvetica, sans-serif]Term Expires: 05/03/14.
 
Why doesn't Jose Melendez (an anesthesiologist on the board), get up off his ass and demand that the Board of Medicine not support this? Jose can tell the OB/GYN on the panel that he'll push for Midwives to take over that specialty. He can ask the three family medicine docs if they support Nurse Practitioners taking over their specialty. Screw the psychiatrist, all you need is a psychologist. What don't these docs on the BOM get, they are all under attack by NONPHYSICIAN providers, and they are supporting a fricking opt-out... Is the ASA working on Jose and the rest of the Board?
 
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Sounds like ole Jose has drank the Kool Aid...
 
The vote supporting this measure is 7-6 in favor. I'd be very surprised if Jose Melendez voted for this.
 
Members don't see this ad :)
People should look closely at the list of board members, and then think really hard for a few minutes. It'll occur to you that there are a lot of people making major, major decisions about patient care within our field, who have absolutely no friggin' clue what we do and how it's different from what a nurse does. I mean no friggin' clue. Who's fault is that?

Friends, in this field if you are not part of the solution you are part of the problem. The ASA must get more vocal and more demonstrative, even if it makes making the nurses look bad which I know they don't want to do. The nurses have had their gloves off for a long time now. Folks, support the ASA, and most definitely support the ASAPAC.
 
Care to note how many of the opt out governors are Democrats vs Republicans? I'm not sure but it seems like more Republicans are AGAINST us than FOR us.
 
Southpaw said:
People should look closely at the list of board members, and then think really hard for a few minutes. It'll occur to you that there are a lot of people making major, major decisions about patient care within our field, who have absolutely no friggin' clue what we do and how it's different from what a nurse does. I mean no friggin' clue. Who's fault is that?

Friends, in this field if you are not part of the solution you are part of the problem. The ASA must get more vocal and more demonstrative, even if it makes making the nurses look bad which I know they don't want to do. The nurses have had their gloves off for a long time now. Folks, support the ASA, and most definitely support the ASAPAC.
Click to expand...

The ASA took out a full page ad in the Denver Post. They used tough language about CRNA safety. Still, too little and too late.
 
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Yes,

I love the ad. It is about time the ASA fights back. Now, how about some studies from academia? Just how good/competent are these newly minted solo CRNAs? If the providers are indeed equal on all OBJECTIVE measurements (tests, skills, reasoning, etc.) then the AANA has won.

But, without concrete evidence the Propaganda war belongs to the AANA; and to the victor belongs the spoils.
 
icon1.gif
Militant CRNA:

I wrote a letter as well.

I do not believe this is a new tactic by the ASA. They have used the same tactic OVER and OVER again. They simply make a veiled suggestion that Nurse Anesthetists could put patient safety at risk, evidence by proclamation essentially.

The funny thing is that CRNAs are working autonomously in CO NOW. They always have been. So from a billing perspective there is a requirement for medicare part A to have a 'supervising' physician however this is a NOT a dictation of practice by the surgeon. They do not control the anesthetic, they do not decide on the anesthetic nor do they have control over the CRNA. So, clearly there IS NO safety issue since CRNA are already practicing autonomously.

Its all smoke and mirrors.​
 
TecmoBowl said:
Care to note how many of the opt out governors are Democrats vs Republicans? I'm not sure but it seems like more Republicans are AGAINST us than FOR us.
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Yup. Many Republicans are for small government, few constraints, less regulation, let the marketplace decide, local decision making.
 
man_eating_money.jpg


Time for the ASA to sponsor some Academic studies comparing senior SRNAs to senior Residents. No point in running ads without EVIDENCE!
 
dr doze said:
Yup. Many Republicans are for small government, few constraints, less regulation, let the marketplace decide, local decision making.
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Agreed. So, remember every month you get Anesthesiology and A&A which doesn't have a SRNA/CRNA vs. Resident/Attending article is one less month we have to win the marketplace. What good are our Journals when we have no specialty left to practice? If a DNAP is all you need then we are about to go the way of the dinosaur. If however, a Medical Degree and Residency adds value (better skills, more knowledge, higher aptitude, etc) then shouldn't we publish and promote it?

Ladies and Gentleman the AANA isn't playing games anymore. The time has come to take the gloves off and get bloody.
 
I do love the irony here. The organization which created the monster is the only one that can stop it. What do you expect when you train the competition to do everything you do in the same building? Eventually the AANA will win this war. No doubt about it. California and then Colorado. Who is next? How long until the AANA sues for legal practice rights for DNAP CRNAS in a hospital setting?

We must strike back while it still matters.
 
milenovic_yugo_03.jpg


How much effort does it take to start publishing studies that the above car is a POS? If this was your car would you want BACK-UP available if your life depended on getting to your location?
 
Remember MEDICARE (CMS) pays the CRNA and the MD (A) the exact same reimbursement. So, the patient gets to ride in the Ferrari or the Yugo. Which one would you pick?

Also, rural hospitals get more money for Solo CRNA care than if they use MD (A)'s. This is called PASS-THROUGH Funding; hence, MD and CRNA are NOT competing in the same marketplace for the same dollars. Many Solo CRNAs are earning in excess of $300K working in rural USA. It wouldn't cost a whole lot more to get an MD (A) except the hospital FORFEITS the pass-through dollars.
 
Medicare Rural Pass-Through Funding for Certain Anesthesia Services
[FONT=Berkeley,Berkeley][FONT=Berkeley,Berkeley]CAHs may participate in the Medicare Rural Pass-Through Program to secure reasonable cost-based funding for certain anesthesia services as an incentive to continue to serve the Medicare population in rural areas. The ..[FONT=Berkeley Black,Berkeley Black][FONT=Berkeley Black,Berkeley Black]Code of Federal Regulations (CFR) ..[FONT=Berkeley,Berkeley][FONT=Berkeley,Berkeley]under 42 CFR Section 412.113(c) lists the specific requirements hospitals or CAHs must fulfill to receive rural pass-through funding from Medicare for anesthesia services furnished by certified registered nurse anesthetists (CRNA) that they employ or contract with to furnish such services to CAH patients. CAHs that qualify for a CRNA pass-through exemption receive reasonable cost for CRNA professional services
..
 
BLADEMDA said:
Agreed. So, remember every month you get Anesthesiology and A&A which doesn't have a SRNA/CRNA vs. Resident/Attending article is one less month we have to win the marketplace. What good are our Journals when we have no specialty left to practice? If a DNAP is all you need then we are about to go the way of the dinosaur. If however, a Medical Degree and Residency adds value (better skills, more knowledge, higher aptitude, etc) then shouldn't we publish and promote it?

Ladies and Gentleman the AANA isn't playing games anymore. The time has come to take the gloves off and get bloody.
Click to expand...

That's exactly what needs to happen. I want to see blood running and heads rolling. This needs to be 'Hamburger Hill" before the nurses are declared winners.

[youtube]http://www.youtube.com/watch?v=tp-DuEPuZQ0[youtube]
 
Southpaw said:
People should look closely at the list of board members, and then think really hard for a few minutes. It'll occur to you that there are a lot of people making major, major decisions about patient care within our field, who have absolutely no friggin' clue what we do and how it's different from what a nurse does. I mean no friggin' clue. Who's fault is that?

Friends, in this field if you are not part of the solution you are part of the problem. The ASA must get more vocal and more demonstrative, even if it makes making the nurses look bad which I know they don't want to do. The nurses have had their gloves off for a long time now. Folks, support the ASA, and most definitely support the ASAPAC.
Click to expand...

This is a fact.
 
Relationship with Physician [FONT=Garamond,Garamond][FONT=Garamond,Garamond]Many states have enacted hospital codes defining how anesthesia is to be delivered, including the requirement for physician supervision...[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]13..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT T..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Each state can choose to allow--or disallow—services by CRNAs without physician oversight...[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]14..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]The American Association of Nurse Anesthetists (AANA) defines ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]T..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]the scope of practice of a CRNA, even with physician supervision, as including: • Requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering pre-anesthetic medications and fluids; and obtaining informed consent for anesthesia. • Developing and implementing an anesthetic plan. • Initiating the anesthetic technique which may include: general, regional, local, and sedation. • Selecting, applying, and inserting appropriate non-invasive and invasive monitoring modalities for continuous evaluation of the patient's physical status. • Selecting, obtaining, and administering the anesthetics, adjuvant and accessory drugs, and fluids necessary to manage the anesthetic. • Managing a patient's airway and pulmonary status using current practice modalities. • Facilitating emergence and recovery from anesthesia by selecting, obtaining, ordering and administering medications, fluids, and ventilatory support. • Discharging the patient from a post-anesthesia care area and providing post-anesthesia follow-up evaluation and care. ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]9..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]American Society of Anesthesiologists (last visited Oct. 3, 2005) http://www.asahq.org/career/medical.htm. ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]10..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]American Association of Nurse Anesthetists, ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Advanced Education Requirements ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond](last updated 2005) http://www.aana.com/crna/sga/adv_ed_summary.asp. ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]11..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]American Association of Nurse Anesthetists. ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Qualifications and Capabilities of the Certified Registered Nurse Anesthetist ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]http://www.aana.com/crna/qualifications.asp (last visited Oct. 3, 2005) ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]12..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Id. ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]13..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Id. ..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]TP..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]14..[FONT=ZWAdobeF,ZWAdobeF][FONT=ZWAdobeF,ZWAdobeF]PT..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Christopher Gearon, Helen Fields, ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Medicine's Turf Wars (boundaries blurring between health professions and their responsibilities)..[FONT=Garamond,Garamond][FONT=Garamond,Garamond], U.S. News & World Report, vol. 138 no. 4 (Jan. 31, 2005). ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]AOA D..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]IVISION ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]O..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]F ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]S..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]TATE ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]G..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]OVERNMENT ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]A..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]FFAIRS ORIGINAL..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]: 11/01, ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]REVISED..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]: 12/03, 10/05 ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]11 • ..[FONT=Garamond,Garamond][FONT=Garamond,Garamond]Implementing acute and chronic pain management modalities. • Responding to emergency situations by providing air-way management, administration of emergency fluids and drugs, and using basic
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midlevel medical proffessionals[FONT=zwadobef,zwadobef][FONT=zwadobef,zwadobef]u ..[FONT=garamond,garamond][FONT=garamond,garamond]5-20 ..[FONT=garamond,garamond][FONT=garamond,garamond]• ..[FONT=garamond,garamond][FONT=garamond,garamond]a..[FONT=garamond,garamond][FONT=garamond,garamond]nesthesiologist ..[FONT=garamond,garamond][FONT=garamond,garamond]a..[FONT=garamond,garamond][FONT=garamond,garamond]ssistants ..[FONT=garamond,garamond][FONT=garamond,garamond]• c..[FONT=garamond,garamond][FONT=garamond,garamond]ertified ..[FONT=garamond,garamond][FONT=garamond,garamond]r..[FONT=garamond,garamond][FONT=garamond,garamond]egistered ..[FONT=garamond,garamond][FONT=garamond,garamond]n..[FONT=garamond,garamond][FONT=garamond,garamond]urse ..[FONT=garamond,garamond][FONT=garamond,garamond]a..[FONT=garamond,garamond][FONT=garamond,garamond]nesthetists ..[FONT=garamond,garamond][FONT=garamond,garamond]9-12 • n..[FONT=garamond,garamond][FONT=garamond,garamond]urse ..[FONT=garamond,garamond][FONT=garamond,garamond]p..[FONT=garamond,garamond][FONT=garamond,garamond]ractitioners ..[FONT=garamond,garamond][FONT=garamond,garamond]• p..[FONT=garamond,garamond][FONT=garamond,garamond]hysician ..[FONT=garamond,garamond][FONT=garamond,garamond]a..[FONT=garamond,garamond][FONT=garamond,garamond]ssistants ..

http://www.healthsciences.okstate.edu/college/clinical/crh/documents/Monograph%20Series%202005.pdf



CRNAs are Midlevels!
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.
 
CO might be another glimpse of the train that's about to run us over - a few of my ideas for helping with this are:

1) contribute to ASA PAC and demand they push back and get on top of this. if the ASA can't get its hands dirty with the un-PC nature of what it needs to do, then hire someone that can get it done.

2) join hospital committees such as this one in CO. As we can all see, this is where the power lies - not in our words, not in ads, not in studies, but in the power we wield with top level committees. The more we inject ourselves into the system(politics, committees, boards, etc) the more options we have to provide top notch care for our patients.

3) we got greedy and trained these nurses to do our job so we could take home more money, as someone mentioned above. We can stop training them, and we should - as a profession, we need to dig our heels into the ground and stop taking blood money from CRNA mills to train new SRNA's.:mad:
These are small steps, but one that will help in the long term, I believe. Please correct me if I'm wrong.
 
Editorial

Who Should Provide Anesthesia Care?

Published: September 6, 2010





Can a highly trained nurse deliver anesthetics as well as a physician who has specialized in anesthesiology, or does the nurse require close medical supervision? That issue emerges from two recent studies and from California’s decision last year to join 14 other states in freeing the nurses from a federal requirement that they be supervised by a physician. Colorado seems poised to join the group.
The issue is potentially important to patients and to health care reformers seeking to restrain costs and reduce reliance on high-priced medical specialists.
The two studies — hotly disputed by the American Society of Anesthesiologists — essentially concluded that there is no significant difference in the quality of care when the anesthetic is delivered by a certified registered nurse anesthetist or by an anesthesiologist. The studies were paid for by the professional association for the nurses, a potential conflict of interest, but were conducted by researchers at respected organizations.
Analysts at the Research Triangle Institute found that there was no evidence of increased deaths or complications in 14 states that had opted out of requiring that a physician (usually an anesthesiologist or the operating surgeon) supervise the nurse anesthetists. The analysts recommended that nurse anesthetists be allowed to work without supervision in all states. Researchers at the Lewin Group judged nurse anesthetists acting without supervision as the most cost-effective way to deliver anesthesia care.
Anesthesia has gotten remarkably safe in recent decades, with roughly one death occurring in every 200,000 to 300,000 cases in which anesthetics are administered during surgery, childbirth or other procedures.
There is not much difference between the two professions in the amount of training they get in administering and monitoring anesthetics. Where the anesthesiologists have a big advantage is in their much longer and broader medical training that, many doctors say, may better equip them to handle complex cases and the rare emergencies that can develop from anesthesia.
From a patient’s point of view, it would seem preferable to have a broadly trained anesthesiologist perform or supervise anesthesia services, but, in truth, the risk is minuscule either way.
Fifteen states have exempted the nurse anesthetists from a Medicare requirement that they be supervised by a physician. California’s move is being challenged in court by physician groups on procedural technicalities. The state’s reasoning, which appears sound, is that patients in areas short on anesthesiologists would lose access to surgery and childbirth services if no one else could deliver the anesthetic. The final decision ultimately rests with the hospitals on how best to serve their patients.
In the long run, there also could be savings to the health care system if nurses delivered more of the care. It costs more than six times as much to train an anesthesiologist as a nurse anesthetist, and anesthesiologists earn twice as much a year, on average, as the nurses do ($150,000 for nurse anesthetists and $337,000 for anesthesiologists, according to a Rand Corporation analysis). Those costs are absorbed by various institutions and public programs within the health care system. As health reformers seek ways to curb medical spending, they need to consider whether this is a safe place to do it.
 
I sent the NYT a letter. If you have a minute, perhaps you should too. There is a lot to refute, but I decided to focus on one particularly misleading line. I imagine the ASA will respond regarding the quality of the evidence behind the cited studies.

My letter:

In today's editorial, "Who Should Provide Anesthesia Care?", it is claimed that "There is not much difference between the two professions in the amount of training they get in administering and monitoring anesthetics." As a resident physician currently completing the third of my four years of residency in Anesthesiology, I am compelled to object. According to the American Association of Nurse Anesthetists*, the average student nurse anesthetist works only 1694 hours while they are in training. I average around 70 hours weekly (many residencies are closer to 80), and have worked that many hours in the past 6 months alone. We also spend hundreds of hours in ICUs and pain management clinics diagnosing and treating complex disease, far beyond the scope of practice for any nurse. While I do not deny that CRNAs play an important role in the delivery of safe and cost-effective anesthetics, claiming without evidence that our training is remotely similar to that of a CRNA is an insult to my fellow residents' commitment and sacrifice for a broad and deep knowledge of anesthesiology.

* https://www.aana.com/educuscrnas.aspx
 
BLADEMDA said:
Agreed. So, remember every month you get Anesthesiology and A&A which doesn't have a SRNA/CRNA vs. Resident/Attending article is one less month we have to win the marketplace. What good are our Journals when we have no specialty left to practice? If a DNAP is all you need then we are about to go the way of the dinosaur. If however, a Medical Degree and Residency adds value (better skills, more knowledge, higher aptitude, etc) then shouldn't we publish and promote it?

Ladies and Gentleman the AANA isn't playing games anymore. The time has come to take the gloves off and get bloody.
Click to expand...

How do we get any academic program to even considering funding and performing such a study? Would it get through any IRB given typical hospital and university politics, especially if they willingly train CRNAs and/or have an associated CRNA mill themselves?

Seems to me that the most effective thing is join these hospital boards and PACs. Lawmakers don't know nor do they care about the differences between physician anesthesiologists and nurse anesthetists from a training and education (and thus patient safety) stand point. But if we can make an economic argument in our favor, for example showing improved patient outcomes at lower cost, that might win over some votes.
 
gclax30 said:
How do we get any academic program to even considering funding and performing such a study? Would it get through any IRB given typical hospital and university politics, especially if they willingly train CRNAs and/or have an associated CRNA mill themselves?

Seems to me that the most effective thing is join these hospital boards and PACs. Lawmakers don't know nor do they care about the differences between physician anesthesiologists and nurse anesthetists from a training and education (and thus patient safety) stand point. But if we can make an economic argument in our favor, for example showing improved patient outcomes at lower cost, that might win over some votes.
Click to expand...

You're right on all fronts. The most effective thing is to be politically active nationally and locally.

There's no way an academic program would fund nor be able to get IRB approval for such a study. First and foremost, in the academic programs I've seen on 4th year rotations, residency, and through discussion with other residents, CRNAs don't generally do regional, hearts, thoracic, big vascular, transplants, remotely difficult peds, and even spinals and epidurals. How can you do a study there? Lastly, what does an academic program have to gain by making their nurses look bad? Nothing, that's what.

Look, everyone needs to realize this fight is a political one, not based on our respective differences in training. Our differences in training and abilities are clear to everyone but the most obtuse, narrow-minded of people. In such a political fight, you win by playing politics. Be active in the ASA, donate to the PAC, support your fellow residents and spread the word. Do a fellowship and expand your skill-set outside of the OR and into the ICU or pain clinic.
 
The bottom line is that the future of this specialty is very uncertain with regard to physician involvement. And I absolutely hate saying that because I love anesthesia. What is worse is that the majority of the academic big wigs really don't care about the future of the specialty either. They care about there own paycheck and that is about it. Of course there are exceptions to this. We are training too many CRNA's and not enough physicians. There has also been an anti-physician shift with regard to the news media. The fact like editorials in the NY Times discuss weather or not anesthesiologists are even needed and may be helping drive up the costs of healthcare is appalling. The news clip from a local Denver television station talking to a CRNA who smirked his way through the interview had no physician rebuttal. No anesthesiologist was interviewed on this particular clip. This shows that ASA has not done a good job promoting our interests. The best advice I have heard for young folks coming out or for those of us who have been out less than 10 years is to save your money and pay off your debt because you never know when you may have to go back and do extra training to "legitimize" yourself in the new world of healthcare reform that is coming down the pipeline.
 
gclax30 said:
How do we get any academic program to even considering funding and performing such a study? Would it get through any IRB given typical hospital and university politics, especially if they willingly train CRNAs and/or have an associated CRNA mill themselves?

Seems to me that the most effective thing is join these hospital boards and PACs. Lawmakers don't know nor do they care about the differences between physician anesthesiologists and nurse anesthetists from a training and education (and thus patient safety) stand point. But if we can make an economic argument in our favor, for example showing improved patient outcomes at lower cost, that might win over some votes.
Click to expand...


I disagree partly. NO EVIDENCE means the AANA will win. No studies and I guarantee DNAP CRNA with soon to be clinical fellowship= MDA by 2025.

Ony University backed studies showing a gap in knowledge and skills between practitioners can save the Specialty over the long run.
 
BLADEMDA said:
I disagree partly. NO EVIDENCE means the AANA will win. No studies and I guarantee DNAP CRNA with soon to be clinical fellowship= MDA by 2025.

Ony University backed studies showing a gap in knowledge and skills between practitioners can save the Specialty over the long run.
Click to expand...


I agree, we need these data. But we would have to pitch the study as a cost/benefit analysis or "efficiency" study with important economic implications for anyone (legislators) to give a crap.
 
gclax30 said:
I agree, we need these data. But we would have to pitch the study as a cost/benefit analysis or "efficiency" study with important economic implications for anyone (legislators) to give a crap.
Click to expand...

How about a study showing that hospitals in OptOut states continue to have physician supervision of nurse anesthestists the vast majority of the time therefore the nurses study is total BS?

The implication that OptOut doesn't lead to worse outcomes is that crnas are safe. That is obviously not a valid conclusion when the majority of crnas are still practicing under physician supervision, even if the billing coding doesn't reflect physician availability.

If we can't do our own study, we can still debunk theirs.
 
The Denver Post http://www.denverpost.com/search/ci_16026042


Colorado is going to opt-out in the rural areas.





"Gov. Bill Ritter is mulling whether Colorado should become the 16th state in the union to opt out of a federal Medicare rule that requires nurse anesthetists to work under the supervision of a doctor.
We think he should do it. The Ritter administration plans to consult with health officials in the states that have opted out of the rule, and we think that's wise.​



Such a move would give them the flexibility to deliver services without lowering the standard of care that is expected."​

Denver Post
 
Last edited:
Points: 1 points(1 votes)Re: Article Discussion: Putting surgery patients at risk

by SafeColorado on Yesterday, 2:14 pm
Colorado has 29 rural critical access hospitals. 5 of them provide no surgery, 7 provide the Anesthesiologist/CRNA model and they are located mostly in the western part of State. The remaining 17 rural hospitals follow the CRNA only model (mostly located in the eastern half of Colorado). When critical access rural hospitals hire CRNAs, they can pass a reasonable cost of the CRNA service to Medicare through "part A" (hospital reimbursement bill), which is much more generous than "part B" the professional fee (Anesthesiologists fee). CRNAs get hired by the critical access rural hospitals, because they get more money for CRNA services than they would for an Anesthesiologist providing the same service. How many current anesthesiologist job openings these 17 critical access rural hospitals are offering? I will save you the work, it is 0 (zero). In addition, these 17 hospitals cover only 17% of the population in Colorado. Thus if these hospitals would offer jobs to Anesthesiologists, it would be easy to cover the whole population in the State with MDs.
 
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