Correspondence Course CRNA Training

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Aether2000

algosdoc
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Some CRNAs for quite some time have had "distance training" = correspondence school. Recently Duke school of nursing announced (July 2011) that the majority of a CRNA wannabe's training can be completed in small rural hospitals. This is in stark contrast to anesthesiology training, that unlike CRNAs, receive hands on instruction in some of the finest academic centers in the country under the watchful eye of professors and assistant professors. The dichotomy between these approaches is astonishing when the CRNAs claim their care and training are equivalent to that of an anesthesiologist. The points:
1. CRNAs are moving further and further away from homogeneity in their training, and now can receive the vast majority of training in small rural hospitals and over the internet. Given this fact, the training of CRNAs is vastly inferior to that of MDs and DOs in anesthesiology.
2. Remember this fact before you hire onto a group that may employ CRNAs that were trained in hicksville.
3. Hire a physician to do a physician's job. If you have hiring authority, consider hiring physicians instead of CRNAs. They are not at all trained in the same manner as MDs or even other CRNAs, yet fully intend to compete with MDs as independent practitioners.

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Some CRNAs for quite some time have had "distance training" = correspondence school. Recently Duke school of nursing announced (July 2011) that the majority of a CRNA wannabe's training can be completed in small rural hospitals. This is in stark contrast to anesthesiology training, that unlike CRNAs, receive hands on instruction in some of the finest academic centers in the country under the watchful eye of professors and assistant professors. The dichotomy between these approaches is astonishing when the CRNAs claim their care and training are equivalent to that of an anesthesiologist. The points:
1. CRNAs are moving further and further away from homogeneity in their training, and now can receive the vast majority of training in small rural hospitals and over the internet. Given this fact, the training of CRNAs is vastly inferior to that of MDs and DOs in anesthesiology.
2. Remember this fact before you hire onto a group that may employ CRNAs that were trained in hicksville.
3. Hire a physician to do a physician's job. If you have hiring authority, consider hiring physicians instead of CRNAs. They are not at all trained in the same manner as MDs or even other CRNAs, yet fully intend to compete with MDs as independent practitioners.

I guess they didn't read the Flexner Report....
 
When I was in the Navy, we had our own SRNA's and occasionally some outside rotators. The outside ones came from some shady community hospital a couple hours away. The difference was night and day. We really tried to train ours to practice without supervision. In the field, deployed to some remote crap hole, they need to be able to function, or our guys were going to die. The community guys were horrendous. I can't imagine having to work with any of them. AND we didn't accept them until they were almost done.:scared:
I'd give you examples but, honestly, you wouldn't believe me.
I'll never train them again.
 
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Here is another correspondance course for CRNAs circa 2008 published in Anesthesia News. Note, the students are sent DVDs to study, and may preceptor in DOCTOR'S OFFICES. What kind of doctor doing surgery in a doctors office knows anything about anesthesia? They are learning anesthesia from DVDs and plastic surgeons. OMG!!!!!
Resident physicians, this is the type of crap education CRNAs have and appear to be proud of- if you have a shred of ethics remaining by the end of your job search, then don't enable the systemic dumbing down of anesthesia delivery by working with CRNAs. Find ethical anesthesia groups that don't use CRNAs. If the groups have CRNAs, then encourage their replacement with bona fide anesthesiologists that are trained by professional anesthesiologists, not by a set of DVDs and plastic surgeons in some isolated office.

Learning to Be a Nurse Anesthetist — from a Distance
By Nancy Deutsch, RN, contributor.

The inaugural class of the nation’s first accredited nurse anesthetist distance-learning program, offered by Mountain State University in West Virginia, is about to graduate, and these nurses will be very much in demand.

“Most nurses graduate from anesthetist programs with about 10 job offers,” said Wayne Ellis, Ph.D., CRNA, who is program director of Mountain State’s nurse anesthetist program.

While there are approximately 100 nurse anesthesia programs in the United States, Mountain State is the first school to offer the master’s program in a distance-learning format, Ellis said.

Traditional programs demand that students come to the university, stay on campus and conduct clinical placements that are close to the university, according to Ellis. “This entails a major move and disruption of the family for basically three years.”

Mountain State University’s program is different. Students must attend for 30 straight months, but the majority of the course work, and much of the clinical placement, can be completed near the student’s own home.

MSU students can attend 29 clinical sites, including sites in Florida, Michigan, Pennsylvania, Alabama and Tennessee. Doctors’ offices and hospitals that hire nurse anesthetists are usually willing to accommodate students, and to have staff act as preceptors, because they hope to lure students to work there after graduation, according to Ellis. He also estimates that about 25 percent of the anesthetist workforce is expected to retire in the next five years, and an individual hospital can save up to $75,000 by hiring a student rather than going through a headhunter to fill a position. The majority of rural hospitals rely on nurse anesthetists.

“The clinical preceptors are excellent and feel like they are a vital part of the program,” he added.

Ellis and assistant program director, Ann Bostic, often travel to the clinical sites to help students and to evaluate their progress.

The students initially complete 15 months of lecture work, which is provided to them on DVDs. On the DVDs, a teacher holds classes, much as if the student were attending in person. “They create a classroom at their convenience,” Ellis said. “The lectures get changed every year because the data changes.”

The students must also attend the university for three 12-hour days every three weeks so they can work in the simulation labs, Ellis said.

The total cost for the program, including books, fees, and tuition, comes to approximately $60,000. This does not include what the student also pays for transportation to the Beckley, West Virginia, campus every three weeks, or for accommodations while they are there.

The educational investment should be well worth it, however. After graduation, students will find that they are well compensated. New nurse anesthetists can earn $120,000 a year, and significantly more after gaining several years of experience.

Michael Ratliff, 34, of Lebanon, Virginia, is about to finish the course at MSU. He always wanted to become a nurse anesthetist, but couldn’t uproot his family. “The thing that most appealed to me was the distance education side of it,” said Ratliff, who worked in critical care before the program. “Picking everyone up and moving them was not feasible.”

“I think it’s a good program and will only get better,” he said, but noted that distance education is not for everyone. “The hardest thing is that it’s not for people who are not self-motivated. Make sure you realize you have to be self-directed to succeed.”

Students are told that the course requires so much work they will be unable to maintain an outside job while doing the program, which Ratliff found to be true. He initially worked one day a week, but gave it up a few months into his studies.

“It’s a completely new aspect of study” compared to what he learned in nursing school, Ratliff said. The course is heavily concentrated on science, and “the level of knowledge is immense.”

The level of interest from potential employers was also high. “The demand is such that I was offered a job at every site I’ve been to,” he reported. He chose to stay at the hospital closest to home.

Ratliff is one of the program’s first 14 students who graduate October 27, and another four will graduate between December and March, as they are still completing their theses.

Mountain State’s new program is quickly becoming very popular. The staff members are already interviewing for 2009 admissions and will have to narrow down the applicants to choose their next 30 students, Ellis said. All applicants must have a nursing degree and at least one year of post-graduate experience.

Ellis was involved in the distance program’s development and is very excited to see the first students graduate and become full-fledged working members of a profession he himself enjoys. “I’m almost ready to walk on clouds myself.”
 
Here is another correspondance course for CRNAs circa 2008 published in Anesthesia News. Note, the students are sent DVDs to study, and may preceptor in DOCTOR'S OFFICES. What kind of doctor doing surgery in a doctors office knows anything about anesthesia? They are learning anesthesia from DVDs and plastic surgeons. OMG!!!!!
Resident physicians, this is the type of crap education CRNAs have and appear to be proud of- if you have a shred of ethics remaining by the end of your job search, then don't enable the systemic dumbing down of anesthesia delivery by working with CRNAs. Find ethical anesthesia groups that don't use CRNAs. If the groups have CRNAs, then encourage their replacement with bona fide anesthesiologists that are trained by professional anesthesiologists, not by a set of DVDs and plastic surgeons in some isolated office.

Learning to Be a Nurse Anesthetist — from a Distance
By Nancy Deutsch, RN, contributor.

The inaugural class of the nation’s first accredited nurse anesthetist distance-learning program, offered by Mountain State University in West Virginia, is about to graduate, and these nurses will be very much in demand.

“Most nurses graduate from anesthetist programs with about 10 job offers,” said Wayne Ellis, Ph.D., CRNA, who is program director of Mountain State’s nurse anesthetist program.

While there are approximately 100 nurse anesthesia programs in the United States, Mountain State is the first school to offer the master’s program in a distance-learning format, Ellis said.

Traditional programs demand that students come to the university, stay on campus and conduct clinical placements that are close to the university, according to Ellis. “This entails a major move and disruption of the family for basically three years.”

Mountain State University’s program is different. Students must attend for 30 straight months, but the majority of the course work, and much of the clinical placement, can be completed near the student’s own home.

MSU students can attend 29 clinical sites, including sites in Florida, Michigan, Pennsylvania, Alabama and Tennessee. Doctors’ offices and hospitals that hire nurse anesthetists are usually willing to accommodate students, and to have staff act as preceptors, because they hope to lure students to work there after graduation, according to Ellis. He also estimates that about 25 percent of the anesthetist workforce is expected to retire in the next five years, and an individual hospital can save up to $75,000 by hiring a student rather than going through a headhunter to fill a position. The majority of rural hospitals rely on nurse anesthetists.

“The clinical preceptors are excellent and feel like they are a vital part of the program,” he added.

Ellis and assistant program director, Ann Bostic, often travel to the clinical sites to help students and to evaluate their progress.

The students initially complete 15 months of lecture work, which is provided to them on DVDs. On the DVDs, a teacher holds classes, much as if the student were attending in person. “They create a classroom at their convenience,” Ellis said. “The lectures get changed every year because the data changes.”

The students must also attend the university for three 12-hour days every three weeks so they can work in the simulation labs, Ellis said.

The total cost for the program, including books, fees, and tuition, comes to approximately $60,000. This does not include what the student also pays for transportation to the Beckley, West Virginia, campus every three weeks, or for accommodations while they are there.

The educational investment should be well worth it, however. After graduation, students will find that they are well compensated. New nurse anesthetists can earn $120,000 a year, and significantly more after gaining several years of experience.

Michael Ratliff, 34, of Lebanon, Virginia, is about to finish the course at MSU. He always wanted to become a nurse anesthetist, but couldn’t uproot his family. “The thing that most appealed to me was the distance education side of it,” said Ratliff, who worked in critical care before the program. “Picking everyone up and moving them was not feasible.”

“I think it’s a good program and will only get better,” he said, but noted that distance education is not for everyone. “The hardest thing is that it’s not for people who are not self-motivated. Make sure you realize you have to be self-directed to succeed.”

Students are told that the course requires so much work they will be unable to maintain an outside job while doing the program, which Ratliff found to be true. He initially worked one day a week, but gave it up a few months into his studies.

“It’s a completely new aspect of study” compared to what he learned in nursing school, Ratliff said. The course is heavily concentrated on science, and “the level of knowledge is immense.”

The level of interest from potential employers was also high. “The demand is such that I was offered a job at every site I’ve been to,” he reported. He chose to stay at the hospital closest to home.

Ratliff is one of the program’s first 14 students who graduate October 27, and another four will graduate between December and March, as they are still completing their theses.

Mountain State’s new program is quickly becoming very popular. The staff members are already interviewing for 2009 admissions and will have to narrow down the applicants to choose their next 30 students, Ellis said. All applicants must have a nursing degree and at least one year of post-graduate experience.

Ellis was involved in the distance program’s development and is very excited to see the first students graduate and become full-fledged working members of a profession he himself enjoys. “I’m almost ready to walk on clouds myself.”


This program lost their accreditation FYI.

http://www.mountainstate.edu/nursing/message-regarding-crna-program.aspx
 
There are several other programs in Florida and Texas that advertise "distance learning" (correspondence courses) for CRNAs. It appears that inadequate education is becoming quite popular. Also noted several CRNA schools have as a minimum pre-requisite GPA of 2.5, 2.75 or in some cases have no minimum at all.....
 
I know a CRNA who is currently completing her "doctorate in nurse anesthesia" by going 2-3 nights a week and completing a "thesis" using other people's actual research. I cannot fathom how this bull**** can take place. I know people in the hard sciences who slaved away in labs to earn a doctorate and actually contributed to their field in order to earn a doctorate.
 
Well maybe the loss of accreditation is a sign that there are some standards after all. This is the main problem they face when trying to make the MD=Crna argument...there is such HUGE variation in quality of their product. Variation exists for us MD/DO but 8 yrs post college education plus 5 national standardized exams (Steps 1-3 and Boards) have a way of making that variation less significant.
 
When I finished residency, I said to myself I would only work with an all MD/DO group. My group is all MD/DO with best of the best talent. I am so happy I don't have to deal with these cRNA clowns. If we were smart, we would all follow my lead.
 
When I finished residency, I said to myself I would only work with an all MD/DO group. My group is all MD/DO with best of the best talent. I am so happy I don't have to deal with these cRNA clowns. If we were smart, we would all follow my lead.

I agree but the problem is that the all MD groups are now the minority, not the majority. And many times you don't have a choice in the matter if you want to live in a city.
 
When I finished residency, I said to myself I would only work with an all MD/DO group. My group is all MD/DO with best of the best talent. I am so happy I don't have to deal with these cRNA clowns. If we were smart, we would all follow my lead.

There are fewer and fewer MD-only groups each year, especially with the encroachment of AMC's. Even so, it's simply not possible for every surgical procedure in this country to have an anesthesiologist personally performing the anesthesia. The next best thing is the Anesthesia Care Team (shown by decent studies to be the safest mode anyway) with an anesthesiologist personally involved in every anesthetic and providing medical direction for an AA or CRNA. My group has an anesthesiologist participating in every single anesthetic administered in our facilities, but unfortunately, with many ACT practices, many anesthesiologists abdicate that responsibility outside of 7-3 M-F. For those who are not in an all-MD group, and who are perfectly willing to let the CRNA's do all the work after hours, nights, weekends, and holidays, you reap what you sow.
 
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I know a CRNA who is currently completing her "doctorate in nurse anesthesia" by going 2-3 nights a week and completing a "thesis" using other people's actual research. I cannot fathom how this bull**** can take place. I know people in the hard sciences who slaved away in labs to earn a doctorate and actually contributed to their field in order to earn a doctorate.


Take a look at http://www.ttuhsc.edu/son/doctorate/default.aspx for another doctorate nursing program.


"Classes are both on-line and in "executive sessions" over 3 - 4 days on-campus at 3 times during the semester."

If you watch the little video at the bottom of the page....

"I did shop around at some of the other schools in Texas, and with the hours that were needed at those campuses I would have to be away from my family a lot more and would require more time away from work."

For a doctorate program? :eek::eek:
 
So my wife is a nurse in the SICU. Obviously, this is where the young ones go to spend a year to become CRNAs. One of her friends, 24 years old, just got out of nursing school, spent a year in the ICU and going to nurse anesthestist school "for the money," recently got accepted to school and we go out to celebrate. Her friend asks me which program is best for pediatric anesthesia. I tell her I have no idea but she should just try to learn as much as she can and then get hired by a group or hospital that handles a lot of peds cases. She freaks out a little bit and says just find out for me ok. Obviously, I tell her to find out herself. The girl finds out that the out of the two programs shes considering, one has two months of clinicals in peds, the other has four, but she didnt do well at that interview. My wife's friend is freaking out at work b/c she doesn't think shes going to be able to become a pediatric anesthestist without those two months.

Moral of the story. Some of these kids are so naive they think they're not only going to become an independent practicioner of anesthesia three years out of nursing school, but a specialist in anesthesia as well. After four months of training! I can understand the nurse whose been reporting to an MD for 10-15 years having had enough when they know they can handle a case on their own but its frustrating to think that the not even newly minted CRNAs can practice on their own with this level of training.
 
Larger anesthesia groups could easily be all MD. It is the choice of the directors of the group (perhaps started a trend long ago) that hired CRNAs as technicians or physician extenders. However the situation has changed drastically with CRNAs now achieving independence from all physician supervision or direction and claim they are better than physicians. They are getting correspondence doctorates so they can be called "Doctor". They are the enemy. The more astute and ethical groups long ago recognized that CRNAs are a detriment to their profession, as surgeons, hospital administrations, and even anesthesiologists began to think of them as equally capable. The tacit message groups that have CRNAs is that they are completely interchangeable with physicians, and now hospital administrators have started contracting with national anesthesia companies that hire primarily CRNAs. Entire MD groups have been replaced by CRNAs. To not recognize the magnitude of the problem is myopic by anesthesia groups but is usually due to the insouciance that comes with the directors of an anesthesia group being older and nearer retirement- they don't want to rock the boat because it simply does not affect them. The real reason for using CRNAs however was simple greed. But there is a way out.....the larger groups can replace CRNAs via attrition, and not hire them any longer. This will force the CRNAs to go increasingly to rural small hospitals where there are not as many cases performed. Eventually, there will be a glut of CRNAs that cannot work anywhere except in rural America, and the mills producing them will have to shut down. But this cannot be done without the resolve of ethical anesthesia groups that value the profession of anesthesiology, and will take the steps to no longer hire the enemy that has vowed to destroy them.
 
Larger anesthesia groups could easily be all MD. It is the choice of the directors of the group (perhaps started a trend long ago) that hired CRNAs as technicians or physician extenders. However the situation has changed drastically with CRNAs now achieving independence from all physician supervision or direction and claim they are better than physicians. They are getting correspondence doctorates so they can be called "Doctor". They are the enemy. The more astute and ethical groups long ago recognized that CRNAs are a detriment to their profession, as surgeons, hospital administrations, and even anesthesiologists began to think of them as equally capable. The tacit message groups that have CRNAs is that they are completely interchangeable with physicians, and now hospital administrators have started contracting with national anesthesia companies that hire primarily CRNAs. Entire MD groups have been replaced by CRNAs. To not recognize the magnitude of the problem is myopic by anesthesia groups but is usually due to the insouciance that comes with the directors of an anesthesia group being older and nearer retirement- they don't want to rock the boat because it simply does not affect them. The real reason for using CRNAs however was simple greed. But there is a way out.....the larger groups can replace CRNAs via attrition, and not hire them any longer. This will force the CRNAs to go increasingly to rural small hospitals where there are not as many cases performed. Eventually, there will be a glut of CRNAs that cannot work anywhere except in rural America, and the mills producing them will have to shut down. But this cannot be done without the resolve of ethical anesthesia groups that value the profession of anesthesiology, and will take the steps to no longer hire the enemy that has vowed to destroy them.

Just because a group uses CRNA's or AA's doesn't make them unethical. The problem with groups that uses anesthetists comes (as I pointed out above) when anesthesiologists in those groups abdicate their responsibilities at 3pm each weekday.

The AMC issue is a huge threat to anesthesiologists, and it surprises me how many are perfectly willing to become "just an employee". How do you prevent that? (Geez, I'm not a doc and I understand this issue very clearly.) Make sure you and your department provide value to the hospital. Serve on committees and medical staff leadership. Provide the services that the hospital wants, and be involved in planning for those services (new heart programs, whatever). The big bugaboo is stipends. If you take a stipend, there will ALWAYS be someone willing to do it for less. Only you and your group can decide what you are or are not willing to do for what you're getting reimbursed and whether or not a stipend is "necessary". I can tell you - a lot of CRNA-only groups are promoting themselves as "no stipend required". But - no stipends and great service provided by your all-MD or quality ACT practice is a hard thing for an AMC or all-CRNA group to undercut.
 
Just because a group uses CRNA's or AA's doesn't make them unethical. The problem with groups that uses anesthetists comes (as I pointed out above) when anesthesiologists in those groups abdicate their responsibilities at 3pm each weekday.

Yep.

It sends a certain message to everyone when 1st call is a CRNA and 2nd call is an anesthesiologist 6 days/week.
 
Larger anesthesia groups could easily be all MD. It is the choice of the directors of the group (perhaps started a trend long ago) that hired CRNAs as technicians or physician extenders. However the situation has changed drastically with CRNAs now achieving independence from all physician supervision or direction and claim they are better than physicians. They are getting correspondence doctorates so they can be called "Doctor". They are the enemy. The more astute and ethical groups long ago recognized that CRNAs are a detriment to their profession, as surgeons, hospital administrations, and even anesthesiologists began to think of them as equally capable. The tacit message groups that have CRNAs is that they are completely interchangeable with physicians, and now hospital administrators have started contracting with national anesthesia companies that hire primarily CRNAs. Entire MD groups have been replaced by CRNAs. To not recognize the magnitude of the problem is myopic by anesthesia groups but is usually due to the insouciance that comes with the directors of an anesthesia group being older and nearer retirement- they don't want to rock the boat because it simply does not affect them. The real reason for using CRNAs however was simple greed. But there is a way out.....the larger groups can replace CRNAs via attrition, and not hire them any longer. This will force the CRNAs to go increasingly to rural small hospitals where there are not as many cases performed. Eventually, there will be a glut of CRNAs that cannot work anywhere except in rural America, and the mills producing them will have to shut down. But this cannot be done without the resolve of ethical anesthesia groups that value the profession of anesthesiology, and will take the steps to no longer hire the enemy that has vowed to destroy them.
Algosdoc, nicely said...

I came upon Dr. Sibert's blog, read some of the comments by nurses there and was just floored. Coming from a training program with no CRNA exposure and currently working at an all MD group I didn't realize the threat mid-levels posed.

At my current gig we have SRNA's rotate through. In the interest of patient care, I have always been very generous with my knowledge. I now realize I am simply feeding the animal that wishes to bite my hands off. Going forward, I have vowed to contribute as little as possible to their education and will do my best to convince complacent colleagues to do the same.

We simply cannot leave our future to the politicians. I will go one step further than stop hiring CRNA's. Who trains the majority of CRNA's? Who runs the majority of Anesthesiology Dept? ANESTHESIOLOGISTS. The way I see it, all we have to do is STOP TRAINING THEM... yes even if it means making sacrifices with regards to the bottom line. Things wont change overnight but we can start to stem the tide. You can count on me to do my part...
 
I would like to do all my own cases, no residents, CRNAs, etc. I used to, but I can't now, not doing what I want, where I want. I like what I do and where I work, for many reasons, so I'm stuck here for now.
The ACT model works well, is safe, and is well established. Working in that system is the reality for much of the country, not selling out, as was suggested in several threads.
There are not enough anesthesiologists to displace even 1/2 the CRNAs, nowhere close, and there never will be. Though, their excessive production and decreased quality will come and bite them in the A ss, and sooner rather than later.
Groups staffing 4 or 5:1 could not hire enough physicians to change to MD only, it would take years of aggressive hiring. These physicians would also take a >30% cut in income. Think that's likely? Think you're going to hire 20 new people at that income level any time soon?
Small groups could dump CRNAs, my group could as well because of the way we staff. Most large groups could never do it. We won't either. Why? Money, of course. They increase production with decreased cost. That makes money to support research time, etc. without killing the bottom line.
I don't train SRNA's, that's good enough for me.
If you want to go out to Glendale, AZ and out bid Big Mike's group, and replace his model with all MDs, good luck. I hope you're willing to work cheap. He, and his group, could be padding the hospital's bottom line as employees as well. If that's the case, you'll never get in.
It's just a matter of time until the bad outcomes start happening, Anesthesiologists testifying about substandard care, etc. The pendulum will swing.
 
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Physicians working in quality anesthesiology groups without midlevels are not impoverished, nor are their commitments to the hospital OR out of control. What they do have is professional integrity, and are unwilling to compromise the care of their patients to some midlevel hack trained in hickville. Nor are they willing to sacrifice the ethics and continued survival of their profession for a few extra bucks supervising a CRNA prostituting for a cool two hundred grand. Those who came before us and took anesthesia from a technicians job and turned it into a medical science through dedicated research and teaching are to be supplanted by resurgence of the technician that politically believes they are fully capable of displacing the anesthesiologist. Large anesthesia groups that have 80% sheep and 20% shepherds will soon find the sheep have become politically astute, extremely aggressive in their advertising and marketing, and have every intention to replace the anesthesia care team with CRNAs. Or as is the case in an increasing number of small hospitals, the CRNA group wins the exclusive contract and then either jettisons the physicians or hires the physicians as employees. My point is the CRNA, with their increasing political power and lack of need of supervision or direction, is becoming the enemy. If you think you can continue to control them, you are mistaken.
 
Just to drive home the point even further, here are some quotes from CRNA forums recently:

"Actually, CRNAs are licensed independent providers and function upon their own accord. They do not function UNDER an MD license in any state. They are independent providers and are responsible for their own actions and decisions. CRNAs do not function with orders from an MD either. Supervision of CRNAs by an anesthesiologist is a billing function

No, CRNAs do not have to work under an MD license or direction. No, MDAs or physicians don't have to be anywhere in the building or planet for that matter during induction or emergence.
The shortest nurse anesthesia school is 24 months, and most are moving to add more time to include the DNP/DNAP curriculum. Study after study has shown equal care when given by independent CRNAs, MDAs, or CRNA/MDA teams. MDAs don't necessarily have increased responsibilities. In an ACT practice MDAs can often work as hard as they want to, if they want to sit in the break room all day that is what he/she will do. I like the fact that MDAs make a lot more than CRNAs it makes CRNAs a more economical commodity. Who wants to pay an MDA 2-3x as much to do exactly the same thing a CRNA does.

CRNAs are nurses so I have every faith they are educated and caring and are perfectly capable and conciencious....in some instances mor3e than MD's because we all know how they can be. We as nurses....we all deserve more pay. The amount of responsibility we are burdened with far supasses our reimbursement in our pockets.

If the MDA follows the INDEPENDENT GROUP's standard of care policy then they are able to bill medicare 100% value of their services. If they do not follow the independent group's standards then they are only allowed to bill 50% (or some appreciatively lower percentage) for their services. No one is being arrested, no licenses are being retracted in the latter case. It is merely a billing issue that some like to contort in order to inflate their egos. There is no state that bans independent practice of a CRNA. CRNAs are getting cheated of some earning power.

Education does not always = more money. CRNAs make more than a lot of physicians. This is supply and demand market. MDAs usually make more than CRNAs, but CRNAs' average salary is higher than FPs and a lot of general surgeons.

No, hospitals don't necessarily view MDAs/CRNAs differently. There are lots of hospitals that consider CRNAs as part of the medical group, and don't place them under the nursing structure at all. There are also lots of hospitals that use MDAs and CRNAs interchangeably

It costs around 1 million to train every anesthesiologist. It costs virtually nothing to train CRNAs, and SRNAs work for free during their clinicals making them great for hospitals' bottom line.

You are also correct that we are nurses, which makes us better at actually "caring" for people than MD's, and it does not mean that because you are a nurse your anesthetic is worse than an MDA-

CRNAs do not need MD presence for anything. We can function completely independent from them. We have the exact same scope of practice. Crna programs are a minimum of 24 months, most are greater than 27. Two years of experience is preferred as a minimum. Malpractice insurance is almost exactly the same between mda and crna. People should not post information they don't really know anything about. I am proud of being a nurse. My job is the exact same as a MDA, they don't do anything I don't. Crna's don't have collaborative practices. We do not need sponsoring MDs for licensure. We are independent providers.

Crna's don't have collaborative practices. We do not need sponsoring MDs for licensure. We are independent providers. We have been in competition for a long, long time. The best thing that could happen is to do away with the "team" approach. Let the market decide who they want to use. The scientific evidence is already on our side that we are just as safe as the MDA. Those lies don't wash anymore. We have been at war for some time now. BTW, we ARE just as good.
 
Just to drive home the point even further, here are some quotes from CRNA forums recently:



It costs around 1 million to train every anesthesiologist. It costs virtually nothing to train CRNAs, and SRNAs work for free during their clinicals making them great for hospitals' bottom line.

You are also correct that we are nurses, which makes us better at actually "caring" for people than MD's, and it does not mean that because you are a nurse your anesthetic is worse than an MDA-

These 2 are madness.
 
Just curious, but do you think this is new info for the forum? We talk about this stuff all the time.
I don't care what they write on their forum, those that have worked with them for years are acutely aware of their limitations, even in the superiorly trained military CRNAs.
 
Malpractice insurance is almost exactly the same between mda and crna.

This is complete BS. We pay out the nose compared to CRNAs.


No, MDAs or physicians don't have to be anywhere in the building or planet for that matter during induction or emergence.

For medicare/medicaide billing they do in non-opt out states.


The scientific evidence is already on our side that we are just as safe as the MDA.

What evidence? Those CRNA journals with no peer review? How about those where all cases reviewed are ASA 1 and 2s?


We have been in competition for a long, long time.

And this is what it all boils down to. Money and prestige. They may challenge my salary a bit at times, but I can always point to the fact that I could easily have gone into neurosurgery or derm, but I chose anesthesia. I could work in pain or in the ICU. They will always be a nurse.
 
It is not new to the forum, however recently CRNAs have been emboldened by some states that have not only opted out, but their nursing boards have encouraged complete independence from medicine. The American Nurses Association has taken an active role in many states, trying to expand the scope of practice, and convince legislators and judges that nurses are just as good as doctors, therefore the nursing boards should control their own scope of practice. There has been a sea change in the attitude of nurses in general over the past year, and the CRNAs are now starting to win battles by jettisoning entrenched anesthesiology groups. My purpose is not to bring recognition of their activities, but to encourage anesthesiology departments to reconsider their positions for the long term. Those that are considering hiring CRNAs: don't . Physicians that have a choice to work with all MDs or with hack midlevels that think they are equal to you, chose the all MD group. Groups that have CRNAs: consider attrition replacement of the CRNAs. Physicians who teach CRNAs: stop. We are at a crossroads of our profession where CRNA mills are cranking out far more graduates than ever before, and there are more practicing CRNAs than MDs with the gulf only widening. Only through re-examination of what our profession is worth to us and to our patients can we decide the course of action. It is definitely worth bringing up in your anesthesiology groups for discussion.
 
You know as much as people complain about CRNAs on this forum they also complain about reimbursement. And when the final straw is finally drawn and an anesthesiologists sees that he can make more by hiring CRNAs he does, its more money and less work. As a med student it pisses me off when an anesthesiologists doesn't take charge and own their patients and just rants about trying to get relief for lunch. What the CRNAs are saying about the market is correct, unless we start proving out value we will be squeezed out. Every time we don't know something during a timeout, every time we vocalize about not getting lunch when the surgeons don't even get a lunch, every time we don't move efficiently and take charge we are cutting our value down. What CRNAs are saying is correct: we will be judged based on the value we bring to the table compared to others. What I hope they're wrong about is what that judgment will be.
 
it's simply not possible for every surgical procedure in this country to have an anesthesiologist personally performing the anaesthesia......

.... The next best thing is the Anesthesia Care Team (shown by decent studies to be the safest mode anyway) with an anesthesiologist personally involved in every anesthetic and providing medical direction for an AA or CRNA.



Hmmm I think you guys need to think if this is actually true - here in Australia we have no CRNAs, and no AAs. In city's (all of them) every case is done by an anesthesiologist or trainee. Our training is 5 years of doing all your own cases.

In rural settings, a lot of cases are done by "family medicine" doctors with extra qualifications (12 months training) in anesthesia, bigger rural settings get "fly in - fly out" visiting anesthesiologists ... who come in for BIG $

Per capita we probably train a lot more anesthesiologists, and we probably do more out of hours work - but there is no midlevel encroachment, pay is good, people are happy and get very good quality service.
 
Hmmm I think you guys need to think if this is actually true - here in Australia we have no CRNAs, and no AAs. In city's (all of them) every case is done by an anesthesiologist or trainee. Our training is 5 years of doing all your own cases.

In rural settings, a lot of cases are done by "family medicine" doctors with extra qualifications (12 months training) in anesthesia, bigger rural settings get "fly in - fly out" visiting anesthesiologists ... who come in for BIG $

Per capita we probably train a lot more anesthesiologists, and we probably do more out of hours work - but there is no midlevel encroachment, pay is good, people are happy and get very good quality service.

What's the best pediatric hospital in the country?

With regard to replacing CRNAs, there are ~40,000 CRNAs in the US. It's not going to happen. The massive spread of ambulatory surgical centers and office based procedures over the last 20+ years created this monster, and anesthesia groups were happy to exploit it. ($$$$$)
 
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Another quote from 2011: "Don't worry. the evidence shows our profession is safe and sound with or without the ologists. and it isn't just nursing school..... it's crna school..... yeppers.... we are still nurses, but the level and intensity of crna school is great. When the ologist says they gave anesthesia, or that they're gonna be your anesthesia provider, rest assured that they're doing it from their office with the walkie-talkie next to the mouse on their desk. they'll be close by in case they need to fly in on their magic carpet and to provide an extra hand, but typically, the only thing the CRNA in trouble needs is just that.... an extra hand. Another CRNA is usually what they end up with while the MDA is trying to recall what it is they read in some journal somewhere."

If you have choices, DON'T HIRE THESE MIDLEVELS. If you can let them go via attrition, do it. No, we can't mass fire 40,000 hacks, but it has to start somewhere. The Ivy League should be a great place to bring quality and integrity back to the profession by using MDs.
 
I am only considering MD-only groups coming out of fellowship. I'm glad to hear that many of those graduating from residency and fellowship are doing the same. I suppose I'm lucky to have that luxury geographically.

Don't let the delusional fantasyland garbage that Big Mouth Mike spews get under your skin. We all know what the bell curve of CRNA knowledge, judgement, and ability looks like in reality.
 
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For medicare/medicaid billing they do in non-opt out states.

You need to understand the concept of the opt-out. CRNA's in non-opt out states have to have a physician present. That physician can be the operating surgeon who "orders" the anesthesia. In an opt-out state, they don't even need that. An anesthesiologist is not required and CRNA's, opt out state or not, do not have to have an anesthesiologist providing medical direction or supervision.
 
You need to understand the concept of the opt-out. CRNA's in non-opt out states have to have a physician present. That physician can be the operating surgeon who "orders" the anesthesia. In an opt-out state, they don't even need that. An anesthesiologist is not required and CRNA's, opt out state or not, do not have to have an anesthesiologist providing medical direction or supervision.

You didn't read the original quote from the CRNA. They said they didn't need an anesthesiologist or ANY physician to sign their charts. That isn't true in non-opt out states under CMS rules.
 
You need to understand the concept of the opt-out. CRNA's in non-opt out states have to have a physician present. That physician can be the operating surgeon who "orders" the anesthesia. In an opt-out state, they don't even need that. An anesthesiologist is not required and CRNA's, opt out state or not, do not have to have an anesthesiologist providing medical direction or supervision.
jwk, thanks for clarifying that... the situation is even more dire than i realize. even more dire than MOST realize.

to all the young anesthesiologists out there, please get active politically whether it's at the peer/ department/ hospital/ society/ or government level. stop training these ingrates and if that's not possible, no advanced training/ techniques of any kind. if even just a fraction of us follow my suggestion the idea of equivalence will be even more ludicrous than they are now no matter how many phony studies the AANA comes out with. also don't forget to contribute to the ASAPAC AND your STATE society PAC. i believe the biggest problem confronting us today is NOT the nurses but the complacency i see in us as a collective whole.
 
Okay - this thread is kind of eye opening.

When I was getting my medic training in the military I spent time in the OR to learn to intubate and some of time was with a physician and some with a CRNA. It was funny that the CRNA's commented on how little our training was (and yes, I kind of agree) yet reading this stuff makes me laugh because it sounds like they had a weak education too! I always enjoyed spending time with the physicians because I felt like they taught better and didn't have an attitude - an inferiority complex that I sensed in the CRNA's.

I was wondering if "all MD groups" ever hired DO's? Are they considered to be lower on the pole than an MD physician?
 
Okay - this thread is kind of eye opening.

When I was getting my medic training in the military I spent time in the OR to learn to intubate and some of time was with a physician and some with a CRNA. It was funny that the CRNA's commented on how little our training was (and yes, I kind of agree) yet reading this stuff makes me laugh because it sounds like they had a weak education too! I always enjoyed spending time with the physicians because I felt like they taught better and didn't have an attitude - an inferiority complex that I sensed in the CRNA's.

I was wondering if "all MD groups" ever hired DO's? Are they considered to be lower on the pole than an MD physician?

It's all about the last thing that you did. Do very well on the USMLE so that you can get into a great residency. After that, you'll be fine. If you struggle on he USMLE you might have some problems. The real benefit of a strong residency is the networking. :thumbup:
 
You know as much as people complain about CRNAs on this forum they also complain about reimbursement. And when the final straw is finally drawn and an anesthesiologists sees that he can make more by hiring CRNAs he does, its more money and less work. As a med student it pisses me off when an anesthesiologists doesn't take charge and own their patients and just rants about trying to get relief for lunch. What the CRNAs are saying about the market is correct, unless we start proving out value we will be squeezed out. Every time we don't know something during a timeout, every time we vocalize about not getting lunch when the surgeons don't even get a lunch, every time we don't move efficiently and take charge we are cutting our value down. What CRNAs are saying is correct: we will be judged based on the value we bring to the table compared to others. What I hope they're wrong about is what that judgment will be.

This is a very simplistic view of the care team model. In states where reimbursement is good, there are alot more md only groups. I work in a care team model in a state where a plumber making a house call makes more than I would in some cases. Esp Medicare and Medicaid cases. Your assertion that working in a care team is less work is flat wrong. I run 4 rooms everyday. Between inductions, emergences, pacu, preparing pts for the or in the holding area, putting out fires, there are days I barely have time to pee much less eat. Every once in a while I get to run my own room, compared to the days of running around like crazy it's like a fing vacation. In a typical day, I code out an average of 15 cases. Some days more, I have had some 60 endo type days, but rarely much less. Now I do agree that if you don't bring anything to the table you might as well not be there. To work in a care team and to do it right is a lot of work. If I could make 2/3 to 1/2 what I am making now and get to do my own cases I would but that is not the reality of where I live. I am geographically constrained to practice this way.
 
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