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

[deleted126335]

It was a Sophie’s choice of either fight for Anesthesiologist only supervision of CRNAs (which we were destined to lose because there just weren’t enough of us) or advocate for for physician/dentist supervision requirements. I don’t blame ASA leadership for that choice.

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[Planktonmd]

It was a Sophie’s choice of either fight for Anesthesiologist only supervision of CRNAs (which we were destined to lose because there just weren’t enough of us) or advocate for for physician/dentist supervision requirements. I don’t blame ASA leadership for that choice.

Why do you think you were destined to lose? Why everywhere else on this planet anesthesiologists did not lose this fight?
This was a poor political decision my friend and we need to admit it.

 

[deleted126335]

Because there were entire regions of states that had zero anesthesiologists-we just weren’t there. Let alone trying to own every sedation case in every health care facility. Even if it was a mistake, which I don’t believe...you move on.

 

[Ready_User_1]

Correct me if I am way off, but wouldn't independent midlevels create a HUGE disparity of care received with those who have money seeking out physicians and those who don't seeing midlevels and receiving lesser quality of care?

 

[IMGASMD]

Because there were entire regions of states that had zero anesthesiologists-we just weren’t there. Let alone trying to own every sedation case in every health care facility. Even if it was a mistake, which I don’t believe...you move on.

I agree with the move on part.

I don’t necessarily think that we should own every sedation case though. I thought out west screening colonoscopy does not necessarily need to be done with anesthesiologists, or insurance just don’t pay.

There are too many factors in this fight we are engaging in. Are we okay for doing only ASA3+ cases? Are we trying to drive CRNA out of existence? There are older folks who probably cannot do their own cases anymore, should they stop practice? Can we advocate a different fee structure if the patient choose a physician vs crna vs RN? Fee for service? Insurance company black boxes? Just few questions that there won’t be any agreed upon answers.

ASA is the only thing we got right now. If all actually join and demand a vote on these issues, maybe there can be more consensus. Fat chances. For now I just throw a few bucks at our PAC hopefully they will keep the conversations going and stay relevant on the hill.

 

[Mman]

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.

Gee, if only they released financial information on this....

2017 operating revenue: $50M
2017 total revenue from advertising and industry sponsors: $2M

But sure, they are entirely funded by AMCs

 

[Mman]

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

please tell whoever you heard it from that they are incorrect

 

[vector2]

Car broke down so I’ve been taking rideshare to work for the last couple days. Driver picks me up outside of hospital, we get to chatting. He tells me he’s also in healthcare and is some kinda tech at another hospital, so I assume he knows more than Joe Schmoe public. Asks what I do, I say anesthesiologist. His next question: “CRNA or MD?”

All I can say with my n=2 of talking to the public this week is that if the Aana wants to win the naming/title battle it isn’t gonna be that hard

 

[hypnosMD]

Gee, if only they released financial information on this....

2017 operating revenue: $50M
2017 total revenue from advertising and industry sponsors: $2M

But sure, they are entirely funded by AMCs

And until I see the ASA take a meaningful stance against midlevel encroachment and AMC’s, they will never get a penny. As far as I’m concerned, it’s just like any other top-heavy organization. Even if they get most of their money from lowly dues payers, the handful of big players who pay the 2 million are the ones with the seat at the table (effectively lobbiests)who drive the narrative.
The only way for Joe Anesthesiologist to have a voice is to stop paying dues until things are done visibly. This whole “behind the scenes” thing is the same tiredcrap we are fed by politicians.

 

[chocomorsel]

Gee, if only they released financial information on this....

2017 operating revenue: $50M
2017 total revenue from advertising and industry sponsors: $2M

But sure, they are entirely funded by AMCs

Well... I have been to a couple of meetings and have seen plenty of exhibits sponsored by AMCs; plenty of dues paying members work for and have sold out to the AMCs; I suspect some of these AMCs as part of their financial package automatically pay employees’ ASA memebership because many employers do so.....
The AMCs have a hand in more than the 2 million you want to discredit @Plankton on. I honestly have no idea how much but it’s clearly a lot more than you claim since their members pay dues directly or indirectly, the pay to go to meetings, pay to show exhibits, and of course the part you pointed out.

 

[blockstar]

AMCs will always push supervisory role. Correct me if Im wrong.

 

[jwk]

The AANA did it because the Anesthesiologists Assistants starting calling themselves "anesthestists."

Not correct, sorry.

 

[Matthew9Thirtyfive]

Asks what I do, I say anesthesiologist. His next question: “CRNA or MD?”

What did you say?

 

[Mman]

Well... I have been to a couple of meetings and have seen plenty of exhibits sponsored by AMCs; plenty of dues paying members work for and have sold out to the AMCs; I suspect some of these AMCs as part of their financial package automatically pay employees’ ASA memebership because many employers do so.....
The AMCs have a hand in more than the 2 million you want to discredit @Plankton on. I honestly have no idea how much but it’s clearly a lot more than you claim since their members pay dues directly or indirectly, the pay to go to meetings, pay to show exhibits, and of course the part you pointed out.

So are you claiming that every doc who works for an AMC (potentially having their ASA dues paid by AMC) is in lock step support of the AMC's positions?

 

[2Fast2Des]

One of my attendings in residency vehemently vouched for supervising as the model of care, that it is here to stay for good, and is better care. Meanwhile CRNAs did literally whatever they wanted with no consequences meanwhile other attendings/residents who the nurses had issue with were chewed out if they told them how to do anything. That's what the ASA is vouching for. Not sure what their purpose is except to say hey we're good too even though our teammates don't want us and actually trying to replace us but we still want to work with them. Very oxymoronic

 

[chocomorsel]

So are you claiming that every doc who works for an AMC (potentially having their ASA dues paid by AMC) is in lock step support of the AMC's positions?

If you’re working for them and they are paying your dues, then you are in support of their plans. Whether you are in lock step with them or not in your views. It’s an indirect effect.

But yeah, way to try and change it up.

 

[Mman]

If you’re working for them and they are paying your dues, then you are in support of their plans. Whether you are in lock step with them or not in your views. It’s an indirect effect.

But yeah, way to try and change it up.

We have plenty of AMC employed physicians on this forum that rail against them and my relevant point is that a tiny portion of the ASA's revenue is derived from AMCs. People like to talk about the boogey man that is AMCs and how they control the ASA, but objective evidence says that is simply false.

 

[skypilot]

When an Anesthesiologist is too old to do their own cases, isn't it time to retire? When I am working solo (usually) it is sometimes at 3 am with nobody else around to help me.

If I can't cut it anymore on those cases, it is probably time to hang up the laryngoscope. How can I bail out a CRNA if I can't even do my own cases?

 

[IMGASMD]

When an Anesthesiologist is too old to do their own cases, isn't it time to retire? When I am working solo (usually) it is sometimes at 3 am with nobody else around to help me.

If I can't cut it anymore on those cases, it is probably time to hang up the laryngoscope. How can I bail out a CRNA if I can't even do my own cases?

Of course that’s what we would say. How about those who are in question? They’re fine “supervising” one day, the next day you tell them they have to do asa3+ cases alone?
We are by no means a singular voice.

 

[Splenda88]

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

Or 'less anesthesiologists'

Can people stop saying 'physician anesthesiologist'? If you say 'anesthesiologist', everyone knows you are referring to a physician. I have never heard 'physician cardiologists' or 'physician neuronsurgeons'...

 

[IMGASMD]

Or 'less anesthesiologists'

Can people stop saying 'physician anesthesiologist'? If you say 'anesthesiologist', everyone knows you are referring to a physician. I have never heard 'physician cardiologists' or 'physician neuronsurgeons'...

https://www.oplc.nh.gov/nursing/documents/nh-bon-nurse-anesthesiologist.pdf

This is part of the rhetoric..... and pretty soon even “I am Doctor IMGASMD.” is not enough.
Some states have specific previsions so only physician can identify themselves as Doctor in hospitals. Since chiropractors can advertise themselves as doctors.....

 

[GaseousClay]

haha i just read them saying a "LANDMARK" study proves they are safer...wow such clowns

 

[flightnurse2MD]

Too harsh?

 

[leaverus]

Car broke down so I’ve been taking rideshare to work for the last couple days. Driver picks me up outside of hospital, we get to chatting. He tells me he’s also in healthcare and is some kinda tech at another hospital, so I assume he knows more than Joe Schmoe public. Asks what I do, I say anesthesiologist. His next question: “CRNA or MD?”

I always answer that question saying "I'm a physician." If then pressed for specialty I'll say anesthesia.

 

[PieOHmy]

I don’t blame ASA leadership for that choice.

This statement underscores our relative importance in the grand scheme of things.

NO way would it be ok for people to say its ok for nurses to operate on patients and let the anesthesiologist supervise "who knows little about surgery: but in anesthesia somehow it is an ok thing to defend.

 

[Booze Aldrin]

Huh. You mean the world isn't black and white?

The nurses will continue to kick physicians arses by taking the black and white approach while physicians impotently engage in autistic squabbles to pick out the perfect shade of grey.

One side is out to get all the marbles and goes for the jugular at every opening.

The other side is all "gee whizz good sir, if it please you, it depends on the blah blah blah and the whoop dee doop"

Wonder who's gonna win.

 

[hckyplyr]

Why not get ZdoggMD involved? If the ASA isn't getting the message out to people, ZdoggMD has over 1.3 million viewers on facebook, he's always doing videos advocating for physicians and letting the truth be known. He isn't afraid to say what needs to be said. He may get just as infuriated with these AANA claims as we are. Just a thought.

 

[PieOHmy]

Why not get ZdoggMD involved? If the ASA isn't getting the message out to people, ZdoggMD has over 1.3 million viewers on facebook, he's always doing videos advocating for physicians and letting the truth be known. He isn't afraid to say what needs to be said. He may get just as infuriated with these AANA claims as we are. Just a thought.

Politically zdogg plays the game. He wont speak out vehemtly against the nurses cuz he knows the ****storm that will ensue. He doesnt have the intestinal fortitude for this. Which makes him not relevant imo.
Sort of like stand up comics who wont really go even near "in appropriate territory". They are not funny.
The most successful comics are the comics who say it like it is regardless of who gets offended and they are reg in the zone of in appropiratemess.
the PC ones absolutely suck

 

[Mman]

Politically zdogg plays the game. He wont speak out vehemtly against the nurses cuz he knows the ****storm that will ensue. He doesnt have the intestinal fortitude for this. Which makes him not relevant imo.
Sort of like stand up comics who wont really go even near "in appropriate territory". They are not funny.
The most successful comics are the comics who say it like it is regardless of who gets offended and they are reg in the zone of in appropiratemess.
the PC ones absolutely suck

nursing is one job that nobody can ever say anything bad about in the public sphere. For some reason it's OK to make jokes about doctors and how your nurse is just there to keep the doc from killing you and blah blah blah, but if you say one bad thing about even a single nurse you have the wrath of 3 million of them directed at you.

I find it odd that this is somehow the PC norm in this country.

 

[Planktonmd]

Gee, if only they released financial information on this....

2017 operating revenue: $50M
2017 total revenue from advertising and industry sponsors: $2M

But sure, they are entirely funded by AMCs

That's not what that report you attached says!
Take a look:
Dues $24,440,000,
Educational Products & Other Revenues $10,050,000
Meetings $5,680,000
Publications $4,350,000
Exhibits $4,160,000
Advertising & Corporate Support $2,120,000

All these categories (other than dues) are avenues where money could be channeled from sponsors, it's about 50% of the revenue.

 

[Dan Giraffe]

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

Really? This sounds like a CRNA or a physician married to one who is trying to discredit the only folks actually fighting for our specialty. You wrote: "so don't expect them to represent you or to be the advocates of anesthesiology as a medical specialty." As I have mentioned previously, I just attended the ASA's Legislative Conference in Washington, DC. We learned loads about ASA's activities at both the federal and state level. What should ASA be doing to be an "advocate of anesthesiology?" Please share.

 

[Dan Giraffe]

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.

Planktonmd, YOU need to go to an ASA event. ASA absolutely believes that anesthesia should be provided by an anesthesiologist or supervised by an anesthesiologist. But where are the supervision requirements? In state and federal law and regulation. If ASA were to say, only an anesthesiologist could supervise, we would lose every single state and federal supervision requirement. Is that your preference? You must not be familiar with fly-over country. There are too many small facilities that only need one anesthesia provider. The AANA would argue, we MUST have independent practice because we don't have any anesthesiologists here in this tiny rural hospital that does 600 cases a year. Boom, the state legislature says, OK we need to keep our rural hospitals open so we will give nurses independent practice in the state.

 

[Mman]

That's not what that report you attached says!
Take a look:
Dues $24,440,000,
Educational Products & Other Revenues $10,050,000
Meetings $5,680,000
Publications $4,350,000
Exhibits $4,160,000
Advertising & Corporate Support $2,120,000

All these categories (other than dues) are avenues where money could be channeled from sponsors, it's about 50% of the revenue.

so now you are telling me that my subscription dues to Anesthesiology is money funneled from an AMC? Annual meeting registration fees? Money people pay for CME credits? Money vendors pay to exhibit equipment at the ASA annual technical gallery?

Do you walk around in a tinfoil hat?

You have literally no idea what you are talking about and your opinion is based on factually incorrect information.

 

[GaseousClay]

Why not get ZdoggMD involved? If the ASA isn't getting the message out to people, ZdoggMD has over 1.3 million viewers on facebook, he's always doing videos advocating for physicians and letting the truth be known. He isn't afraid to say what needs to be said. He may get just as infuriated with these AANA claims as we are. Just a thought.

zDogg spends every other post of his kissing the a$$es of nurses. He would never even dream of challenging them and jeopardize losing a lot of his viewer base.

 

[Planktonmd]

OK, Sorry for bringing up that the ASA had actually endorsed CRNA supervision by non anesthesiologists almost 20 years ago!
At that time they were trying to play nice with the AANA to avoid conflict and basically buried their heads in the sand.
Now you guys go enjoy your Kool-Aid and don't mind people spreading unfounded stories like me.

 

[Planktonmd]

so now you are telling me that my subscription dues to Anesthesiology is money funneled from an AMC? Annual meeting registration fees? Money people pay for CME credits? Money vendors pay to exhibit equipment at the ASA annual technical gallery?

Do you walk around in a tinfoil hat?

You have literally no idea what you are talking about and your opinion is based on factually incorrect information.

I am not sure why you are getting so upset and defensive? Calm down before you pop a hernia

 

[Planktonmd]

Planktonmd=Fake news.

So you just joined the forum 3 days ago and posted 7 messages and you are already trolling and attacking people... very interesting!

 

[Mman]

I am not sure why you are getting so upset and defensive? Calm down before you pop a hernia

because your opinion is indefensible and crazy. I support the ASA and donate money to ASAPAC (in addition to all the money I donate to local political races).

 

[hypnosMD]

That's not what that report you attached says!
Take a look:
Dues $24,440,000,
Educational Products & Other Revenues $10,050,000
Meetings $5,680,000
Publications $4,350,000
Exhibits $4,160,000
Advertising & Corporate Support $2,120,000

All these categories (other than dues) are avenues where money could be channeled from sponsors, it's about 50% of the revenue.

I’m with Plank on this one. The battle is a battle of public perception. We needn’t respond to the AANA statement directly (since it sounded like a petulant teenager and was self defeating). The ASA needs to launch a very aggressive very public campaign about the risk of anesthesia, the importance of a physician (anesthesiologist) being involved and the rigorous metrics that must be met to even get into medical school notwithstanding the path that follows. Our bar is high because the stakes are high. The claims of working behind the scenes have done nothing. ASA must also be the voice for all the employed docs who cannot speak out. They must take a highly visible position to defend the specialty.

 

[Dan Giraffe]

One of my attendings in residency vehemently vouched for supervising as the model of care, that it is here to stay for good, and is better care. Meanwhile CRNAs did literally whatever they wanted with no consequences meanwhile other attendings/residents who the nurses had issue with were chewed out if they told them how to do anything. That's what the ASA is vouching for. Not sure what their purpose is except to say hey we're good too even though our teammates don't want us and actually trying to replace us but we still want to work with them. Very oxymoronic

Sounds like your attending is THE problem... And that's not what the ASA is vouching for. #StoptheSelfLoathing

 

[Dan Giraffe]

I’m with Plank on this one. The battle is a battle of public perception. We needn’t respond to the AANA statement directly (since it sounded like a petulant teenager and was self defeating). The ASA needs to launch a very aggressive very public campaign about the risk of anesthesia, the importance of a physician (anesthesiologist) being involved and the rigorous metrics that must be met to even get into medical school notwithstanding the path that follows. Our bar is high because the stakes are high. The claims of working behind the scenes have done nothing. ASA must also be the voice for all the employed docs who cannot speak out. They must take a highly visible position to defend the specialty.

So you just joined the forum 3 days ago and posted 7 messages and you are already trolling and attacking people... very interesting!

You are right. That was wrong. Sorry. I didn't mean to attack you personally. PlanktonMD's Information = Fake News. Make that 9 posts.

 

[Mman]

I’m with Plank on this one. The battle is a battle of public perception. We needn’t respond to the AANA statement directly (since it sounded like a petulant teenager and was self defeating). The ASA needs to launch a very aggressive very public campaign about the risk of anesthesia, the importance of a physician (anesthesiologist) being involved and the rigorous metrics that must be met to even get into medical school notwithstanding the path that follows. Our bar is high because the stakes are high. The claims of working behind the scenes have done nothing. ASA must also be the voice for all the employed docs who cannot speak out. They must take a highly visible position to defend the specialty.

"Plank"'s point isn't that the ASA should educate the public about the importance of anesthesiologists. He is literally arguing that the ASA funding is controlled by AMCs and does not advocate for anesthesiologists. That is factually incorrect.

Nobody here is arguing in favor of the AANA.

 

[hypnosMD]

"Plank"'s point isn't that the ASA should educate the public about the importance of anesthesiologists. He is literally arguing that the ASA funding is controlled by AMCs and does not advocate for anesthesiologists. That is factually incorrect.

Nobody here is arguing in favor of the AANA.

I find it telling how aggressive you are about squashing anyone who rocks the AMC boat. Most of your posts seem to support a side agenda.

 

[skypilot]

I’m with Plank on this one. The battle is a battle of public perception. We needn’t respond to the AANA statement directly (since it sounded like a petulant teenager and was self defeating). The ASA needs to launch a very aggressive very public campaign about the risk of anesthesia, the importance of a physician (anesthesiologist) being involved and the rigorous metrics that must be met to even get into medical school notwithstanding the path that follows. Our bar is high because the stakes are high. The claims of working behind the scenes have done nothing. ASA must also be the voice for all the employed docs who cannot speak out. They must take a highly visible position to defend the specialty.

Yes

 

[Mman]

I find it telling how aggressive you are about squashing anyone who rocks the AMC boat. Most of your posts seem to support a side agenda.

want to know what is really funny? We've taken over 4 contracts from AMCs and will probably get several more this year. I'm not aggressive because I like AMCs, I'm aggressive because I am 100% correct.

My group is doing as much as anybody to beat them into submission.

AMCs aren't even the enemy when it comes to CRNA issues. They have spent millions on politics and helping fight back against CRNA independence.

 

[Block-Buster]

so how do you usurp their contracts? tell us more.

 

[Mman]

so how do you usurp their contracts? tell us more.

hospitals are getting sick of them. They call us up and ask us to participate in the RFP process. They award us the contract.

 

[Crabbygas]

Those of you who think that AMC's don't have a big voice with the ASA aren't using much imagination. I happen to know one very large AMC that, "Saves its docs the trouble" of joining the ASA. The AMC signs up all of their docs for membership whether they want it or not and deducts the dues from their yearly CME allowance. I'll bet that when an AMC that signs up a thousand or so members calls the ASA picks up the phone pretty quick.

 

[Planktonmd]

I really don't want to argue with anyone here and I respect everyone's political affiliations, but I truly believe that the ASA has not been the advocate they claim to be, and when it really mattered they did not take action to claim this field as a medical specialty above the level of nursing.
We are now all paying the price of their impotence and inaction.
And as they attempt to do damage control of their horrible inaction when action was desperately needed, they again choose to align themselves with these blood sucking corporations.
It's sad... but it is the reality.

 

[PieOHmy]

I really don't want to argue with anyone here and I respect everyone's political affiliations, but I truly believe that the ASA has not been the advocate they claim to be, and when it really mattered they did not take action to claim this field as a medical specialty above the level of nursing.
We are now all paying the price of their impotence and inaction.
And as they attempt to do damage control of their horrible inaction when action was desperately needed, they again chose to align themselves with these blood sucking corporations.
It's sad... but it is the reality.

The ASA vision is extremely murky and it is all over the place. T hey need to zero in on 1 or 2 missions and NEVER waver from these.
I do not support the ASA, they are not looking out for the working stiff day to day anesthesiologists who are getting it from all sides. We have zero advocates in practice. The surgeons are against us by and large, the CRNAs are against us, administrators are marginalizing us, AANA are putting out a pr campaign against us. And all they can do is try to sell me on MOCA. They are extending training requirements, making more board exams, making residency more in-efficient w hile more and more CRNAs are practicing autonomusly. Even when t hey are in an Anesthesia C are team t hey want to practice independently.