CRNA: We are the Answer - WTF????

[ProRealDoc]

Absolutely true. We employ several dozen CRNAs - but the percentage of them of our overall staff dwindles a little each year as more and more believe the independent practice mantra drilled into them literally from Day 1 of CRNA school.

Remember that they essentially coerce their members into membership in the AANA through cost incentives related to recertification.

Hire more AAs to replace them.

---

Members don't see this ad.

 

[GaseousClay]

Do we not have anyone involved in ASA leadership on this forum? What is our organization going to do in response? Likely nothing! Disgraceful.

 

[deleted126335]

It is addressed in this mornings ASA Monday morning outreach. (A weekly email from ASA)

ASAPAC also has a weekly Friday afternoon mailing called vital signs.

I suspect that you can sign up from the ASA website.

 

[zizzer]

Somebody shared it on the medicine reddit. There is lots of multi-specialty support for us on there at least:

 

[BigSupporter]

Hi, I'm a lay person/former patient and brand new to this board because of this thread. First, I was appalled at the accusatory, dismissive tone set by the new "CRNA: We are the answer" position statement, or whatever it is. My mother, now deceased, was a surgeon and worked her ass off to raise her area of practice, emergency medicine, into a specialty. And I'd be damned before I would let some nursing group tell me they could do what she did just as well -- if not better. I feel the same way about anesthesiologists.

Second, I have had two surgeries under general anesthesia in my lifetime. If I had an inkling my anesthesia care was being led by anyone but an anesthesiologist, I would stop the process and go to a hospital that provided physician-led and monitored anesthesia care. In fact, I asked for the attending while laying on the gurney out in the hallway before being wheeled into the operating room for my second surgery. Damn resident couldn't put the rubber wrap around my arm properly to put in the IV, she was so nervous!

Third, I value and respect so much the importance of good anesthesia care. You are literally holding people's lives in your hands! While I'd be OK with a nurse anesthetist being on hand to help monitor my care while I'm under, there is no way I would ever, ever knowingly allow myself to be put under or brought back by anyone but a board-certified anesthesiologist. And I suspect I'm not the only one. ASA needs to get the word out to the general public that CRNAs are seriously trying to horn in on the territory I believe rightfully belongs to well-paid, thoroughly trained anesthesiologists.

Full disclosure: I found this board while doing research for an anesthesiology group. I am a paid marketing professional. But I am NOT being paid to post my opinion here. This is straight from the heart -- and my personal experiences. Thank you for what you do.

 

[epidural man]

Don't you all find it unbelievably hipocritical that on one hand, the AANA is standing up SCREAMING - "WE ARE DIFFERENT! WE ARE BETTER! PICK ME! PICK ME!" And on the other hand, they are trying to disguise themselves as anesthesiologists and trick patients into thinking they are us. I find that very strange.

Pick a side. Are you better and unique? Then be proud. Stand up and shout it from the rooftops. Highlight your differences. Why are you trying to shroud yourself as us?

If I sell a car that I really feel is better quality, higher value then a TESLA - I'm certainly not going to try and get people to think my car I am selling is a Tesla, I'm gonna be proud of the brand.

I'm sure Ill get slack for this - but I agree with a lot of the AANA statement. How in the world is a supervising model more economical? No way is it more economical. In fact, the only reason I can see ANYONE arguing for a supervising model is so they work less and make a ton more money.

Also, who knows if outcomes are the same. No one knows. I believe outcomes are different, but I can't say that for sure. The only way to prove that would be to make them independent, make a concrete wall between practices - then compare outcomes.

If I were the ASA - I would sit down with the AANA and ask them what they want. If they want independence - here you go. What do you want to be called? Anesthesiologists? Great. Here you go. What do you want physician's to be called - and it has to be extremely distinct from your name. And part of this deal is you have to make sure that all your members are VERY CLEAR on who and what they are.

Finally - how is using AA's the answer? That never made sense to me.

To me - using someone even less trained to do our job, then say - "see, you really need highly skilled people to do this job, therefore we are going to use someone with even less skill to do it... See - CRNA's shouldn't practice independently"...makes no sense. It doesn't make our argument AT ALL.

To me, supervising model only weakens our position. It only levels the playing field. But it does line the pockets of many of you...so I get you fighting like hell to protect it.

If we assume we are a better clinical choice in some clinical situations - then in a system where resources are scarce, and there isn't enough anesthesia clinicians for all the cases, a non-superivosry model will make US much more valuable and highly paid.

However, if there truly is no difference, fighting for supervisory model makes sense.

 

[MoMoGesiologist]

Don't you all find it unbelievably hipocritical that on one hand, the AANA is standing up SCREAMING - "WE ARE DIFFERENT! WE ARE BETTER! PICK ME! PICK ME!" And on the other hand, they are trying to disguise themselves as anesthesiologists and trick patients into thinking they are us. I find that very strange.

Pick a side. Are you better and unique? Then be proud. Stand up and shout it from the rooftops. Highlight your differences. Why are you trying to shroud yourself as us?

If I sell a car that I really feel is better quality, higher value then a TESLA - I'm certainly not going to try and get people to think my car I am selling is a Tesla, I'm gonna be proud of the brand.

I'm sure Ill get slack for this - but I agree with a lot of the AANA statement. How in the world is a supervising model more economical? No way is it more economical. In fact, the only reason I can see ANYONE arguing for a supervising model is so they work less and make a ton more money.

Also, who knows if outcomes are the same. No one knows. I believe outcomes are different, but I can't say that for sure. The only way to prove that would be to make them independent, make a concrete wall between practices - then compare outcomes.

If I were the ASA - I would sit down with the AANA and ask them what they want. If they want independence - here you go. What do you want to be called? Anesthesiologists? Great. Here you go. What do you want physician's to be called - and it has to be extremely distinct from your name. And part of this deal is you have to make sure that all your members are VERY CLEAR on who and what they are.

Finally - how is using AA's the answer? That never made sense to me.

To me - using someone even less trained to do our job, then say - "see, you really need highly skilled people to do this job, therefore we are going to use someone with even less skill to do it... See - CRNA's shouldn't practice independently"...makes no sense. It doesn't make our argument AT ALL.

To me, supervising model only weakens our position. It only levels the playing field. But it does line the pockets of many of you...so I get you fighting like hell to protect it.

If we assume we are a better clinical choice in some clinical situations - then in a system where resources are scarce, and there isn't enough anesthesia clinicians for all the cases, a non-superivosry model will make US much more valuable and highly paid.

However, if there truly is no difference, fighting for supervisory model makes sense.

You don’t need an MD for every anesthesia case: ASA 1-2s, outpatient, GI, etc. Same as how you don’t need an MD for every cough or cold, lac repair, etc. You just need someone with an MD available when things go awry. Hence, the supervisory model works. All specialties work with and supervise nurses. An MD can’t and really doesn’t need to do it all. Not sure if I’m addressing your same concerns when you say the supervisory model is not economical and weakens our position.

 

[Lecithin5]

You don’t need an MD for every anesthesia case: ASA 1-2s, outpatient, GI, etc. Same as how you don’t need an MD for every cough or cold, lac repair, etc. You just need someone with an MD available when things go awry. Hence, the supervisory model works. All specialties work with and supervise nurses. An MD can’t and really doesn’t need to do it all. Not sure if I’m addressing your same concerns when you say the supervisory model is not economical and weakens our position.

Suffice it to say that on numerous occasions, I’ve bailed out crnas on so-called routine asa 1 and 2 cases.

 

[Man o War]

Don't you all find it unbelievably hipocritical that on one hand, the AANA is standing up SCREAMING - "WE ARE DIFFERENT! WE ARE BETTER! PICK ME! PICK ME!" And on the other hand, they are trying to disguise themselves as anesthesiologists and trick patients into thinking they are us. I find that very strange.

Pick a side. Are you better and unique? Then be proud. Stand up and shout it from the rooftops. Highlight your differences. Why are you trying to shroud yourself as us?

If I sell a car that I really feel is better quality, higher value then a TESLA - I'm certainly not going to try and get people to think my car I am selling is a Tesla, I'm gonna be proud of the brand.

I'm sure Ill get slack for this - but I agree with a lot of the AANA statement. How in the world is a supervising model more economical? No way is it more economical. In fact, the only reason I can see ANYONE arguing for a supervising model is so they work less and make a ton more money.

Also, who knows if outcomes are the same. No one knows. I believe outcomes are different, but I can't say that for sure. The only way to prove that would be to make them independent, make a concrete wall between practices - then compare outcomes.

If I were the ASA - I would sit down with the AANA and ask them what they want. If they want independence - here you go. What do you want to be called? Anesthesiologists? Great. Here you go. What do you want physician's to be called - and it has to be extremely distinct from your name. And part of this deal is you have to make sure that all your members are VERY CLEAR on who and what they are.

Finally - how is using AA's the answer? That never made sense to me.

To me - using someone even less trained to do our job, then say - "see, you really need highly skilled people to do this job, therefore we are going to use someone with even less skill to do it... See - CRNA's shouldn't practice independently"...makes no sense. It doesn't make our argument AT ALL.

To me, supervising model only weakens our position. It only levels the playing field. But it does line the pockets of many of you...so I get you fighting like hell to protect it.

If we assume we are a better clinical choice in some clinical situations - then in a system where resources are scarce, and there isn't enough anesthesia clinicians for all the cases, a non-superivosry model will make US much more valuable and highly paid.

However, if there truly is no difference, fighting for supervisory model makes sense.

There is NO WAY I am or anyone I love is undergoing any surgery with a solo CRNA after what I've seen over the course of my career. Routine or not, any ASA level, no way. That's enough evidence for me that the supervisory model needs to stay intact. Anesthesiologists who supervise have the most unique position to judge this- that's who sees tons of CRNAs in tons of different situations, and how they react. I do not care at all about money at this point in my career, I'm on the back end and I've made enough. Not the motivation at all for my opinion on this.

 

[zizzer]

How are AA's not trained as well as CRNAs? I've only heard this from CRNAs.

 

[sleepallday]

You don’t need an MD for every anesthesia case: ASA 1-2s, outpatient, GI, etc. Same as how you don’t need an MD for every cough or cold, lac repair, etc. You just need someone with an MD available when things go awry. Hence, the supervisory model works. All specialties work with and supervise nurses. An MD can’t and really doesn’t need to do it all. Not sure if I’m addressing your same concerns when you say the supervisory model is not economical and weakens our position.

You don't need them for the ASA 1-2's except when you do. Which seems to be way to common in my experience to trust them with independent practice. I've done this long enough to see its just not safe for the patient.

 

[deleted547339]

You don’t need an MD for every anesthesia case: ASA 1-2s, outpatient, GI, etc. Same as how you don’t need an MD for every cough or cold, lac repair, etc. You just need someone with an MD available when things go awry. Hence, the supervisory model works. All specialties work with and supervise nurses. An MD can’t and really doesn’t need to do it all. Not sure if I’m addressing your same concerns when you say the supervisory model is not economical and weakens our position.

Ummmm...no. I’m an ER doc and intensivist. Every cough and cold needs to be seen by a doc. I love my NPs, but they still miss basic things. I trust, but verify. I’ve picked up spinal epidural abscess in back pain my NPs wanted to DC. Appy’s. MIs. Often times, you need an MD in order to know things are even going awry.

I can’t believe any of you still train these jokers.

 

[Ronin786]

Somebody shared it on the medicine reddit. There is lots of multi-specialty support for us on there at least:

I know a lot of folks want the ASA to stoop to AANA levels, but this sort of level-headed response serves the purpose of showing the AANA as the greedy, self-centered organization that it is. Like Apelfbaum said, until a CRNA comes into the hospital and demands no physician take care of their loved one, there is no argument to be had.

The ASA's position needs to be loud and professional and emphasize that CRNAs can at best hope/pretend to be equal to anesthesiologists, but we are the gold standard that every patient deserves.

Heck, talk of rationing of care gets met with furor any time a politician brings it up. Independent CRNA practice is one such form.

On another note, there is no difference between a CRNA and an AA. They both serve the same purpose of facilitating a physician anesthesiologist's ability to supervise more patients. Don't ever buy into the myth that CRNAs have some sort of superior training.

 

[vector2]

Like Apelfbaum said, until a CRNA comes into the hospital and demands no physician take care of their loved one, there is no argument to be had.

IME, CRNAs are usually only particularly indignant towards anesthesiologists. The same militant CRNA who rolls their eyes when I make a suggestion would be quick to give a ‘yes sir, thank you sir’ if an ophtho asked for 2 units of prbcs during a cataract.

 

[hypnosMD]

Rhetoric and hyperbole should be met with the same. An ad should be issued showing a man named John with his family and dog who is scheduled to have anesthesia the next day. John doesn’t know that he won’t survive his anesthetic. Anesthesia is serious and every year people die. Make sure your loved one has a physician anesthesiologist directly involved in their care. When the stakes are this high, why would you settle for any less?

 

[Consigliere]

Rhetoric and hyperbole should be met with the same. An ad should be issued showing a man named John with his family and dog who is scheduled to have anesthesia the next day. John doesn’t know that he won’t survive his anesthetic. Anesthesia is serious and every year people die. Make sure your loved one has a physician anesthesiologist directly involved in their care. When the stakes are this high, why would you settle for any less?

Next president of the ASA right here gang!

 

[jwk]

How are AA's not trained as well as CRNAs? I've only heard this from CRNAs.

CRNAs have been spouting the same lies for decades.

 

[Splenda88]

"Physician anesthesiologists" WTF... Are there anesthesiologists in the US that are not physicians? These people really get on my nerves.

 

[OneFellSwoop]

"Physician anesthesiologists" WTF... Are there anesthesiologists in the US that are not physicians? These people really get on my nerves.

Agree. The ASA really screwed the pooch on that one. The ‘nurse anesthesiologist’ is an obvious trolling to the ridiculous modification of ‘physician anesthesiologist’. Saw that coming a mile away when the ASA wanted to add ‘physician’.

 

[Splenda88]

Agree. The ASA really screwed the pooch on that one. The ‘nurse anesthesiologist’ is an obvious trolling to the ridiculous modification of ‘physician anesthesiologist’. Saw that coming a mile away when the ASA wanted to add ‘physician’.

The ASA did that... Wow. I did not know that as an IM resident.

 

[Iso4ane]

Physician is a protected term. nurse is a protected term. Therefore from this moment forth we should use the term ‘_’ of anesthesia. I’m Dr OKZ and I’m your physician of anesthesia; that ‘Dr’ you met earlier will be my nurse of anesthesia.

No way they can complain about that.

 

[OneFellSwoop]

Physician is a protected term. nurse is a protected term. Therefore from this moment forth we should use the term ‘_’ of anesthesia. I’m Dr OKZ and I’m your physician of anesthesia; that ‘Dr’ you met earlier will be my nurse of anesthesia.

No way they can complain about that.

I’m sorry, but this is a pathetic approach. This embodies the spineless nature of anesthesiologists in general. Cardiologists aren’t allowing this to happen, neither are neurologists. I doubt those are protected terms either but protected or not isn’t the point. Have some pride in your specialty. Educate the public that anesthesiologists are physicians and that the qualifier isn’t necessary. This is what the ASA should have done. I’m not trying to be insulting, but take an honest re-read of your post.

 

[zizzer]

Just call them nurse anesthesists to patients and make it clear that they're helping you, while you make the decisions. Calling them CRNAs doesn't help because patients don't know what that is.

 

[Dan Giraffe]

Good lord. If only we had a society that had our best interests at heart. I'd call it something like the American Society of Anesthesiologists, with a mission to make sure to make sure that everyone from CEO to administrator to surgeon to nurse to patient knows the difference between an anesthesiologist and a lesser replacement (whether that replacement calls itself nurse anesthesiologist, nurse anesthetist, assistant anesthesiologist, assistant anesthetist or...) Why doesn't such a society exist??

I have a different perspective. I just attended the ASA's Legislative Conference. What I saw is quite the contrary of the comments above. ASA is incredibly active on these issues. What I learned was this: no one, not the ASA, not President Trump, not Nancy Pelosi and not Big Swinging Doc can stop the AANA from issuing unprofessional and provocative statements. This is America and, as others have pointed out, there is this thing call the First Amendment. The AANA can say whatever they want, just like you and me can post whatever we want on this site and on our Facebook page.

What ASA has focused on is actually winning the real battles at the federal and state level. Example: What is the only APRN that was not granted so-called "full practice authority" at the VA? The CRNAs. Let that sink in. The only APRNs not granted independent practice in the VA were the folks who wanted it most. That was because of ASA and folks like me who lobbied our lawmakers and submitted our comments as part of the campaign the ASA created and executed. At the Legislative Conference the ASA also unveiled a terrific video about what is happening in the states. The ASA and the state ASA societies are now 7-0 in 2019 in defeating nursing independent practice bills. These fights are vicious but ASA and our states are winning.

We also heard from a speaker about what the states and ASA are doing to fight the bogus "nurse anesthesiology" campaign. Again, what we learned is that "anesthesiologist" cannot be trademarked. But that ASA is working with states to block this term from used to trick patients. Texas and other states already have laws in place and New York is working on a new one.

 

[Dan Giraffe]

Just call them nurse anesthesists to patients and make it clear that they're helping you, while you make the decisions. Calling them CRNAs doesn't help because patients don't know what that is.

100% agree.

 

[Man o War]

100% agree.

Just call them nurse anesthesists to patients and make it clear that they're helping you, while you make the decisions. Calling them CRNAs doesn't help because patients don't know what that is.

This is why I said “anesthesia nurse” when I used to work with them. Patients for the most part understand “nurse” and “doctor”. Many of us forget that I think.
Also, I hope nobody here is introducing themselves to patients by their first names.

 

[zizzer]

Also, I hope nobody here is introducing themselves to patients by their first names.

I do because I'm young and a resident, but I always phrase it as, "I'm (full name), one of the anesthesiology resident physicians here." while showing my ID badge or scrub jacket, which clearly have MD on them.

 

[Consigliere]

Also, I hope nobody here is introducing themselves to patients by their first names.

Please know that if you are one of those hard on anesthesiologists that introduce themselves by their first name that I will immediately hate you. When I was "stupervising" CRNAs, 100% of the time I said "Hi, I'm Dr. Consigliere and I will be your anesthesiologist. The anesthesia nurse will be helping me but I am in charge of your care." I know some of them saw red but I didn't care since they were my employees and if they didn't like it they could GTFO.

 

[Man o War]

I do because I'm young and a resident, but I always phrase it as, "I'm (full name), one of the anesthesiology resident physicians here." while showing my ID badge or scrub jacket, which clearly have MD on them.

I don’t think this is the best approach considering what we are dealing with here. Introduce yourself as Dr such and such. The rest is fine.

 

[IMGASMD]

I do because I'm young and a resident, but I always phrase it as, "I'm (full name), one of the anesthesiology resident physicians here." while showing my ID badge or scrub jacket, which clearly have MD on them.

Never. Even my interns I told them to introduce as Dr. Smith. Had plenty of patients who said, no doctor had come see me all day (in Internal medicine.) when in fact was rounded on already.

Even worse if you’re young and female.

Hi I am Jane.
Are you a nurse?
No. I am a doctor.....

 

[MirrorTodd]

I do because I'm young and a resident, but I always phrase it as, "I'm (full name), one of the anesthesiology resident physicians here." while showing my ID badge or scrub jacket, which clearly have MD on them.

Agree with what others have said. I'm "relatively" young and a resident. One should always introduce themselves by their professional title while working in a professional setting until a good relationship has been established. Get used to calling yourself Dr So and so. What you say to patients matters as do first impressions.

 

[deleted126335]

I have a different perspective. I just attended the ASA's Legislative Conference. What I saw is quite the contrary of the comments above. ASA is incredibly active on these issues. What I learned was this: no one, not the ASA, not President Trump, not Nancy Pelosi and not Big Swinging Doc can stop the AANA from issuing unprofessional and provocative statements. This is America and, as others have pointed out, there is this thing call the First Amendment. The AANA can say whatever they want, just like you and me can post whatever we want on this site and on our Facebook page.

What ASA has focused on is actually winning the real battles at the federal and state level. Example: What is the only APRN that was not granted so-called "full practice authority" at the VA? The CRNAs. Let that sink in. The only APRNs not granted independent practice in the VA were the folks who wanted it most. That was because of ASA and folks like me who lobbied our lawmakers and submitted our comments as part of the campaign the ASA created and executed. At the Legislative Conference the ASA also unveiled a terrific video about what is happening in the states. The ASA and the state ASA societies are now 7-0 in 2019 in defeating nursing independent practice bills. These fights are vicious but ASA and our states are winning.

We also heard from a speaker about what the states and ASA are doing to fight the bogus "nurse anesthesiology" campaign. Again, what we learned is that "anesthesiologist" cannot be trademarked. But that ASA is working with states to block this term from used to trick patients. Texas and other states already have laws in place and New York is working on a new one.

You might want to check your individual state board of nursing regs. They may require members of the nursing profession. To identify themselves as such. Also med staff officers for local hospital policies. Especially those that sit on the bylaws committees. Corporate compliance office might take an interest if they are aware this is going on. Just let them know is that it can’t be good that a hospital employed PhD CRNA is introducing themselves as Dr. Smith your anesthesiologist. Imagine how a plaintiff lawyer could run with that. Anonymous Complaints to compliance office and state boards are often accepted.

 

[epidural man]

I’m sorry, but this is a pathetic approach. This embodies the spineless nature of anesthesiologists in general. Cardiologists aren’t allowing this to happen, neither are neurologists. I doubt those are protected terms either but protected or not isn’t the point. Have some pride in your specialty. Educate the public that anesthesiologists are physicians and that the qualifier isn’t necessary. This is what the ASA should have done. I’m not trying to be insulting, but take an honest re-read of your post.

Why is anesthesi-ologist protected?

-ologist /ɒlədʒɪst $ ɑːl-/ (also -logist) suffix [in nouns] a person who studies or has knowledge of a particular kind of science a biologist.

Think of all the people that employ the term ologist...

Who cares what we call ourselves. We just need buy in from the CRNA community that whatever they want to call themselves they have to agree to a term we call ourselves and that they have to be very upfront that WE are not THEM.

 

[epidural man]

I have a different perspective. I just attended the ASA's Legislative Conference. What I saw is quite the contrary of the comments above. ASA is incredibly active on these issues. What I learned was this: no one, not the ASA, not President Trump, not Nancy Pelosi and not Big Swinging Doc can stop the AANA from issuing unprofessional and provocative statements. This is America and, as others have pointed out, there is this thing call the First Amendment. The AANA can say whatever they want, just like you and me can post whatever we want on this site and on our Facebook page.

What ASA has focused on is actually winning the real battles at the federal and state level. Example: What is the only APRN that was not granted so-called "full practice authority" at the VA? The CRNAs. Let that sink in. The only APRNs not granted independent practice in the VA were the folks who wanted it most. That was because of ASA and folks like me who lobbied our lawmakers and submitted our comments as part of the campaign the ASA created and executed. At the Legislative Conference the ASA also unveiled a terrific video about what is happening in the states. The ASA and the state ASA societies are now 7-0 in 2019 in defeating nursing independent practice bills. These fights are vicious but ASA and our states are winning.

We also heard from a speaker about what the states and ASA are doing to fight the bogus "nurse anesthesiology" campaign. Again, what we learned is that "anesthesiologist" cannot be trademarked. But that ASA is working with states to block this term from used to trick patients. Texas and other states already have laws in place and New York is working on a new one.

Wow. This post makes me want to join the ASA. Maybe they’d at least stop sending me a mailer every week to join.

 

[epidural man]

There is NO WAY I am or anyone I love is undergoing any surgery with a solo CRNA after what I've seen over the course of my career. Routine or not, any ASA level, no way. That's enough evidence for me that the supervisory model needs to stay intact. Anesthesiologists who supervise have the most unique position to judge this- that's who sees tons of CRNAs in tons of different situations, and how they react. I do not care at all about money at this point in my career, I'm on the back end and I've made enough. Not the motivation at all for my opinion on this.

This is making my point exactly. Very few people would work in an all CRNA environment. So let’s make that happen. Let’s increase our demand and value. Let’s let them all work independently and refuse to work with them.

OR - another thought just occurred to me.

Let’s make them independent - put a steel barrier between the two practices. And WHEN they need our help (and they will...). they have to pay a HUGE consulting fee. Not the hospital, not the patient, but the individual CRNA or the CRNA practice.

Let’s leave stuff like this out of the government’s hands. Let the market decide. We can let CRNA’s decide if they work in an independent environment, or a dependent environment and see how that flies. My guess is the cost of my plan would become so arduous that not many independent CRNAs would exist. In fact, we probably could eliminate their existence.

Imagine this scenario in a supposed system of independence that requires the CRNA to pay a huge fee for Anesthesiologist consult. Imagine a simple case where the patient lied about NPO, and the CRNA did everything perfect but the patient aspirated and now is brain dead. The prosecuting attorney will hammer the CRNA about inferior training, ask “wait, you didn’t call a more qualified anesthesiologist because it would cost you money? This patient is brain dead because of your greed.” How many CRNAs will put up with that? That’s what will happen though.

But there has to be a steel barrier - a legislated barrier that could only be crossed with a legal fee. Make it illegal to help them without a required fee.

I’m telling you, if they really want independence, they need to know what true independence taste like and feels like. My guess is, you give them that, they won’t want it - and it will be too late and they have to live with it and their profession would eventually cease to exist - and our profession would be come extremely valuable.

 

[hununuh]

I have a different perspective. I just attended the ASA's Legislative Conference. What I saw is quite the contrary of the comments above. ASA is incredibly active on these issues. What I learned was this: no one, not the ASA, not President Trump, not Nancy Pelosi and not Big Swinging Doc can stop the AANA from issuing unprofessional and provocative statements. This is America and, as others have pointed out, there is this thing call the First Amendment. The AANA can say whatever they want, just like you and me can post whatever we want on this site and on our Facebook page.

What ASA has focused on is actually winning the real battles at the federal and state level. Example: What is the only APRN that was not granted so-called "full practice authority" at the VA? The CRNAs. Let that sink in. The only APRNs not granted independent practice in the VA were the folks who wanted it most. That was because of ASA and folks like me who lobbied our lawmakers and submitted our comments as part of the campaign the ASA created and executed. At the Legislative Conference the ASA also unveiled a terrific video about what is happening in the states. The ASA and the state ASA societies are now 7-0 in 2019 in defeating nursing independent practice bills. These fights are vicious but ASA and our states are winning.

We also heard from a speaker about what the states and ASA are doing to fight the bogus "nurse anesthesiology" campaign. Again, what we learned is that "anesthesiologist" cannot be trademarked. But that ASA is working with states to block this term from used to trick patients. Texas and other states already have laws in place and New York is working on a new one.

Thank you. That gives me hope.

 

[dannyboy1]

This is making my point exactly. Very few people would work in an all CRNA environment. So let’s make that happen. Let’s increase our demand and value. Let’s let them all work independently and refuse to work with them.

OR - another thought just occurred to me.

Let’s make them independent - put a steel barrier between the two practices. And WHEN they need our help (and they will...). they have to pay a HUGE consulting fee. Not the hospital, not the patient, but the individual CRNA or the CRNA practice.

Let’s leave stuff like this out of the government’s hands. Let the market decide. We can let CRNA’s decide if they work in an independent environment, or a dependent environment and see how that flies. My guess is the cost of my plan would become so arduous that not many independent CRNAs would exist. In fact, we probably could eliminate their existence.

Imagine this scenario in a supposed system of independence that requires the CRNA to pay a huge fee for Anesthesiologist consult. Imagine a simple case where the patient lied about NPO, and the CRNA did everything perfect but the patient aspirated and now is brain dead. The prosecuting attorney will hammer the CRNA about inferior training, ask “wait, you didn’t call a more qualified anesthesiologist because it would cost you money? This patient is brain dead because of your greed.” How many CRNAs will put up with that? That’s what will happen though.

But there has to be a steel barrier - a legislated barrier that could only be crossed with a legal fee. Make it illegal to help them without a required fee.

I’m telling you, if they really want independence, they need to know what true independence taste like and feels like. My guess is, you give them that, they won’t want it - and it will be too late and they have to live with it and their profession would eventually cease to exist - and our profession would be come extremely valuable.

Terrible idea. Bad outcomes are simply not common enough to make a significant dent in the safety profile numbers. If they are independent you can bet your a$$ that the AMC and hospital will hire them for the huge cost savings.

 

[hypnosMD]

Terrible idea. Bad outcomes are simply not common enough to make a significant dent in the safety profile numbers. If they are independent you can bet your a$$ that the AMC and hospital will hire them for the huge cost savings.

Which bring us back to the “one is one too many” campaign against OR deaths. The stakes are too high to try to reduce an anesthesiologist from being involved in every anesthetic delivered.

 

[Man o War]

This is making my point exactly. Very few people would work in an all CRNA environment. So let’s make that happen. Let’s increase our demand and value. Let’s let them all work independently and refuse to work with them.

OR - another thought just occurred to me.

Let’s make them independent - put a steel barrier between the two practices. And WHEN they need our help (and they will...). they have to pay a HUGE consulting fee. Not the hospital, not the patient, but the individual CRNA or the CRNA practice.

Let’s leave stuff like this out of the government’s hands. Let the market decide. We can let CRNA’s decide if they work in an independent environment, or a dependent environment and see how that flies. My guess is the cost of my plan would become so arduous that not many independent CRNAs would exist. In fact, we probably could eliminate their existence.

Imagine this scenario in a supposed system of independence that requires the CRNA to pay a huge fee for Anesthesiologist consult. Imagine a simple case where the patient lied about NPO, and the CRNA did everything perfect but the patient aspirated and now is brain dead. The prosecuting attorney will hammer the CRNA about inferior training, ask “wait, you didn’t call a more qualified anesthesiologist because it would cost you money? This patient is brain dead because of your greed.” How many CRNAs will put up with that? That’s what will happen though.

But there has to be a steel barrier - a legislated barrier that could only be crossed with a legal fee. Make it illegal to help them without a required fee.

I’m telling you, if they really want independence, they need to know what true independence taste like and feels like. My guess is, you give them that, they won’t want it - and it will be too late and they have to live with it and their profession would eventually cease to exist - and our profession would be come extremely valuable.

I understand what you’re saying...but then I immediately think it could be me or someone I love who has an unfortunate emergency situation and ends up at one of these facilities with only CRNAs.
Patients deserve better, especially in specialties like anesthesia and EM where they get what they get when they show up emergently.

 

[leaverus]

Even worse if you’re young and female.

Hi I am Jane.
Are you a nurse?
No. I am a doctor.....

in what way is this "worse" for a patient to ask this? statistically, the vast majority of nurses are women. the patient is making an assumption true, but it's an educated assumption.
as for the topic at hand, meh, i'm not worried. Docs will always be needed to take over on the dot when the CRNA's shift ends, even it's smack dab in the middle of an aneurysm clipping....

 

[Dan Giraffe]

The ASA did that... Wow. I did not know that as an IM resident.

Man, you are so wrong. Read the AANA's own material and stop the self-loathing. The AANA did it because the Anesthesiologists Assistants starting calling themselves "anesthestists." They also did it in response to the ASA issuing a revised statement on teaching student nurse anesthetists.

 

[IMGASMD]

in what way is this "worse" for a patient to ask this? statistically, the vast majority of nurses are women. the patient is making an assumption true, but it's an educated assumption.
as for the topic at hand, meh, i'm not worried. Docs will always be needed to take over on the dot when the CRNA's shift ends, even it's smack dab in the middle of an aneurysm clipping....

I apologize for not making it clear. It has nothing to do with betterment for the patients. It’s in response to physicians who introduce themselves with first name, full name, or whatever name without their official title. If we are arming up for the term “nurse anesthesiologists” we certainly should use the ones that we got.

Man, you are so wrong. Read the AANA's own material and stop the self-loathing. The AANA did it because the Anesthesiologists Assistants starting calling themselves "anesthestists." They also did it in response to the ASA issuing a revised statement on teaching student nurse anesthetists.

Now it’s much more clear to me then. I will start using “nurse anesthetist” when I introduce my nurses.

See what I did there....

 

[Dan Giraffe]

Please know that if you are one of those hard on anesthesiologists that introduce themselves by their first name that I will immediately hate you. When I was "stupervising" CRNAs, 100% of the time I said "Hi, I'm Dr. Consigliere and I will be your anesthesiologist. The anesthesia nurse will be helping me but I am in charge of your care." I know some of them saw red but I didn't care since they were my employees and if they didn't like it they could GTFO.

This is how you win! One patient at a time. If everyone did this, we wouldn't have half the problems we do with CRNAs.

 

[Planktonmd]

The ASA is unfortunately mainly funded by anesthesia management companies who have a vested interest in hiring more CRNAs and less Physician anesthesiologists, so don't expect them to represent you or to be the advocates of anesthesiology as a medical specialty.
The only reason why one should pay the ASA membership is unfortunately the discount on CMEs

 

[Mman]

The ASA is unfortunately mainly funded by anesthesia management companies who have a vested interest in hiring more CRNAs and less Physician anesthesiologists, so don't expect them to represent you or to be the advocates of anesthesiology as a medical specialty.

you got a link to back that incorrect statement up?

The ASA has continued to advocate for physician lead care for all patients under anesthesia and opposes any efforts at CRNA independence.

 

[MirrorTodd]

Terrible idea. Bad outcomes are simply not common enough to make a significant dent in the safety profile numbers. If they are independent you can bet your a$$ that the AMC and hospital will hire them for the huge cost savings.

Would it really be cheaper though? They'd still have to hire people for after hours and it's either an anesthesiologist who isn't going to do overnight shifts for nothing or it's crna's who will demand at least time and a half, not to mention the fact that crna's are already paid pretty damn highly for the "shift" work that comes with a nursing degree.

 

[PieOHmy]

The ASA is unfortunately mainly funded by anesthesia management companies who have a vested interest in hiring more CRNAs and less Physician anesthesiologists, so don't expect them to represent you or to be the advocates of anesthesiology as a medical specialty.
The only reason why one should pay the ASA membership is unfortunately the discount on CMEs

I just heard someone tell me this today about the AMCs funding the ASA.

 

[epidural man]

Terrible idea. Bad outcomes are simply not common enough to make a significant dent in the safety profile numbers. If they are independent you can bet your a$$ that the AMC and hospital will hire them for the huge cost savings.

Then if the numbers are so small, it doesn’t justify our argument that we are better.

We are better or we are not. If we are not, then so be it. Maybe we picked the wrong profession. Like I said, if one truly sees a difference, they will absolutely not argue for a supervisor model. The supervisor model makes sense in a world where they do as good of job as us and we want more money.

I personally think without the safety blanket, differences would show up very quickly. People would quickly choose MDs. They would demand it. I think it would take about 1 month. It would take one or two high-profile 60 minute cases and NO ONE would ever go to the CRNA run AMC or allow them near them in the hospital.

Sorry. We are going to loose this battle unless my brilliant plan is followed.

A few bad outcomes is the price that needs to be paid. And the CRNAs will take the shame with them to their grave. They are asking for it and they should have to live with it.

 

[deleted162650]

Sorry. We are going to loose this battle unless my brilliant plan is followed.

Trump, is that you??

 

[Planktonmd]

you got a link to back that incorrect statement up?

The ASA has continued to advocate for physician lead care for all patients under anesthesia and opposes any efforts at CRNA independence.

You need to go to an ASA event and see who is sponsoring everything my friend... but you can also sit here and pretend to know what you are talking about!
Your ASA ...Long time ago endorsed the concept that a CRNA can be supervised by a physician... not necessarily an anesthesiologist, this was when they sold out the whole specialty.
But you might have missed that little detail.