Mar 3, 2019
6
5
11
Status
Other Health Professions Student
There has been such a push to broaden PA independent practice where I am, even to change their name to "Physician's Associate" to retain their initials. How long until we have to fight this same fight with AAs?
 
Dec 5, 2018
32
28
21
There has been such a push to broaden PA independent practice where I am, even to change their name to "Physician's Associate" to retain their initials. How long until we have to fight this same fight with AAs?
Much later than CRNAs

ASA should be pushing for AAs in every state to shut the AANA up for good.

ACT practice is obviously the only future for this specialty of medicine.
 
Mar 3, 2019
6
5
11
Status
Other Health Professions Student
Much later than CRNAs

ASA should be pushing for AAs in every state to shut the AANA up for good.

ACT practice is obviously the only future for this specialty of medicine.
I'm not sure... It may only cause us to fight on 2 fronts in the future. At the end of the day, it is another body in the OR capable of administering anesthetics in the eyes of administration. Nurses already have independent practice in some states and that likely won't be undone. ACT is obviously not the only future for this specialty.
 
  • Like
Reactions: epidural man

GaseousClay

:)
5+ Year Member
Oct 23, 2013
269
159
131
USA
Status
Resident [Any Field]
Question for those who are attendings or training at institutions with SRNA programs i.e duke, usc etc has this been passed around to faculty and residents? This should be addressed at every academic institution especially the unfortunate ones sharing education with SRNAs.
 
  • Like
Reactions: Monterosso

DrZzZz

ASA Member
5+ Year Member
Feb 6, 2014
168
109
131
Status
Resident [Any Field]
Question for those who are attendings or training at institutions with SRNA programs i.e duke, usc etc has this been passed around to faculty and residents? This should be addressed at every academic institution especially the unfortunate ones sharing education with SRNAs.
My guess is the residents are aware of the "statement", but there's no way in hell that academic staff is ensuring their awareness. They don't want to rock the boat I bet.
 

jwk

CAA, ASA-PAC Contributor
10+ Year Member
15+ Year Member
Apr 30, 2004
3,627
731
381
Atlanta, GA
There has been such a push to broaden PA independent practice where I am, even to change their name to "Physician's Associate" to retain their initials. How long until we have to fight this same fight with AAs?
Never.

I've been an AA for 40 years - that's 80% of the time the profession has been in existence. I've been involved with the leadership in my profession for many years. That topic isn't even mentioned, much less discussed.
 
Jan 22, 2019
364
342
41
Status
Resident [Any Field]
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 while more and more CRNAs are practicing autonomously. Even when they are in an Anesthesia C are team t hey want to practice independently.
This is happening in all area of medicine; I don't know why we are doing that to ourselves...
 
Last edited:
  • Like
Reactions: Gasper
Feb 25, 2016
649
753
81
Maybe I’m wrong, and I’m not saying it’s cool that they (midlevels) are using all our words (residency, fellowship, etc) these days but I suspect this is “simply” an organized way to formalize the training for being a typical Plastic Surgeons PA/APRN. Typically these midlevels turn out, pick their chosen field, and then require 6mo or so training by the Surgeon etc to become what the service requires whether that’s rounding or assisting in surgeries. The question I guess is why would CCF take this on instead of the individual surgeons/groups? Do applicants pay CCF similar to an SRNA school? Does CCF get gov funding somehow? Or is it because all the surgeons at CCF are employed and therefore CCF is paying for the training either way so they decided to formalize it?
 
  • Like
Reactions: sunshinefl

2Fast2Des

to become No One, one must be PP slick
2+ Year Member
Jun 29, 2016
378
243
81
Status
Attending Physician
Maybe I’m wrong, and I’m not saying it’s cool that they (midlevels) are using all our words (residency, fellowship, etc) these days but I suspect this is “simply” an organized way to formalize the training for being a typical Plastic Surgeons PA/APRN. Typically these midlevels turn out, pick their chosen field, and then require 6mo or so training by the Surgeon etc to become what the service requires whether that’s rounding or assisting in surgeries. The question I guess is why would CCF take this on instead of the individual surgeons/groups? Do applicants pay CCF similar to an SRNA school? Does CCF get gov funding somehow? Or is it because all the surgeons at CCF are employed and therefore CCF is paying for the training either way so they decided to formalize it?
Probably in house? I had heard they got rid of house officer physicians in the community hospitals, replaced them with NPs that the docs became responsible to teach all acute care skills. These NPs would rotate through different departments being taught by attendings to replace other docs... Insane!

I had a couple of patients that were seen by an ENT consult and Oncology as outpatient, and guess who saw them, CCF NPs, no attending. They're replacing even those specialists in Cleveland it seems...
 

Monterosso

ASA Member
7+ Year Member
Aug 28, 2009
25
4
141
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
I wonder if there is legislation that can ensure the term anesthesiologist is used properly.
Even Merriam-Webster knows: "Definition of anesthesiologist: a physician specializing in anesthesiology"

Interestingly, here's another definition: "made in exact imitation of something valuable or important with the intention to deceive or defraud."
.
.
Counterfeit.
 
Oct 11, 2016
372
325
81
Status
Attending Physician
Maybe I’m wrong, and I’m not saying it’s cool that they (midlevels) are using all our words (residency, fellowship, etc) these days but I suspect this is “simply” an organized way to formalize the training for being a typical Plastic Surgeons PA/APRN. Typically these midlevels turn out, pick their chosen field, and then require 6mo or so training by the Surgeon etc to become what the service requires whether that’s rounding or assisting in surgeries. The question I guess is why would CCF take this on instead of the individual surgeons/groups? Do applicants pay CCF similar to an SRNA school? Does CCF get gov funding somehow? Or is it because all the surgeons at CCF are employed and therefore CCF is paying for the training either way so they decided to formalize it?
Probably just the beginning. Soon we will have "acute care nurse practitioner - fellowship trained plastic surgeons" wanting to practice at the "top of their license".
 

ntsudent123

2+ Year Member
May 18, 2016
28
55
71
Maybe I’m wrong, and I’m not saying it’s cool that they (midlevels) are using all our words (residency, fellowship, etc) these days but I suspect this is “simply” an organized way to formalize the training for being a typical Plastic Surgeons PA/APRN. Typically these midlevels turn out, pick their chosen field, and then require 6mo or so training by the Surgeon etc to become what the service requires whether that’s rounding or assisting in surgeries. The question I guess is why would CCF take this on instead of the individual surgeons/groups? Do applicants pay CCF similar to an SRNA school? Does CCF get gov funding somehow? Or is it because all the surgeons at CCF are employed and therefore CCF is paying for the training either way so they decided to formalize it?

AMA passed a resolution long time ago stated that the titles "Doctor", "Residency", and "Resident" should be apply to only physician, dentist and podiatrist.

265622
 
Feb 25, 2016
649
753
81
Probably in house? I had heard they got rid of house officer physicians in the community hospitals, replaced them with NPs that the docs became responsible to teach all acute care skills. These NPs would rotate through different departments being taught by attendings to replace other docs... Insane!

I had a couple of patients that were seen by an ENT consult and Oncology as outpatient, and guess who saw them, CCF NPs, no attending. They're replacing even those specialists in Cleveland it seems...
Then the question becomes; at what point do docs revolt? Even if you’re an employee, at what point do docs say enough is enough? Especially when these types of providers increase the “patients seen” or throughput while obviously increasing risk. How many are each of us comfortable being responsible for?

In anesthesia groups were going to 4:1 for 2x money, but now it seems we are going to 2:1,3:1,4:1 without an increase in pay, only risk. Why?
 

calvnandhobbs68

I KNOW NOTHING
7+ Year Member
May 20, 2010
3,219
1,177
181
Status
Fellow [Any Field]
Probably in house? I had heard they got rid of house officer physicians in the community hospitals, replaced them with NPs that the docs became responsible to teach all acute care skills. These NPs would rotate through different departments being taught by attendings to replace other docs... Insane!

I had a couple of patients that were seen by an ENT consult and Oncology as outpatient, and guess who saw them, CCF NPs, no attending. They're replacing even those specialists in Cleveland it seems...
Just as fun to see all the psych NPs my patients see on the outpatient side who had to complete a whole grueling 500 "clinical hours" before they could get their psych certification. Who needs these useless residency programs when I could get certified in 13 weeks of full time work?

It's all over the place, med onc inpatient teams are basically all NPs with a few attendings.
 

dannyboy1

10+ Year Member
Aug 11, 2008
554
458
281
Status
Attending Physician
Then the question becomes; at what point do docs revolt? Even if you’re an employee, at what point do docs say enough is enough? Especially when these types of providers increase the “patients seen” or throughput while obviously increasing risk. How many are each of us comfortable being responsible for?

In anesthesia groups were going to 4:1 for 2x money, but now it seems we are going to 2:1,3:1,4:1 without an increase in pay, only risk. Why?
Lol. Never. People leave jobs because the salary is too low or the hours are too high. If the salary/hour ratio is reasonable you will always find docs willing to sign the chart.....
 

Twiggidy

ASA Member
2+ Year Member
Jan 13, 2015
2,717
2,443
81
The problem (as always) are the patients. They've accepted these things as the norm. They're ok with being seen by "a nurse". Rarely do they complain and say I want to be seen/taken care of by a "doctor". So the more patients accept it the more the bean counters start to realize the can have a clinic/hospital function without or with very little MDs. It's not our fault that we're better than the nurses, but it may be our fault that we're "expensive".
 

skypilot

2K Member
15+ Year Member
Dec 15, 2002
2,338
102
381
Beantown
Status
Attending Physician
The problem (as always) are the patients. They've accepted these things as the norm. They're ok with being seen by "a nurse". Rarely do they complain and say I want to be seen/taken care of by a "doctor". So the more patients accept it the more the bean counters start to realize the can have a clinic/hospital function without or with very little MDs. It's not our fault that we're better than the nurses, but it may be our fault that we're "expensive".
I hate to say this but I think cutting down on the number of Anesthesia grads will only make the situation worse. The only way to dominate the market is to produce lots of grads. The salaries will go down for a while. But if we say the market is saturated, and don't produce enough grads, guess who will step in to fill the void? The supervision ratios will rise, and eventually all the power will be in the hands of the ones who outnumber us 4:1.
 

bronx43

Word.
10+ Year Member
Apr 22, 2006
1,928
616
281
Status
Attending Physician
The problem (as always) are the patients. They've accepted these things as the norm. They're ok with being seen by "a nurse". Rarely do they complain and say I want to be seen/taken care of by a "doctor". So the more patients accept it the more the bean counters start to realize the can have a clinic/hospital function without or with very little MDs. It's not our fault that we're better than the nurses, but it may be our fault that we're "expensive".
The problem is that patient don’t even know who they are seeing until the day of their surgery. It’s not like they establish with an anesthesiologist in clinic who then will show up on the day of their surgery. They see their surgeon, whom they know and trust. Then all the random people that they meet on the day of their operation is just part of the “team.”
And out of the fraction of people who do actually realize that a nurse is performing their anesthesia, how many of them convince themselves that they are “probably ok” and don’t speak out in fear of being viewed negatively by all the highly educated “smart” people?

If you want the public to know, then you need to MAKE the public know. Right now, there appears to be too many ulterior motives in play to keep it on the DL.
 
  • Like
Reactions: wholeheartedly

Modanq

Member
10+ Year Member
Apr 7, 2005
213
151
281
36
Ann Arbor
Status
Stop training CRNAs. Let them loose and see what happens. Why would anyone teach any new techniques to CRNAs. We have free license to define our careers as physicians. I know I'll get flack on here for saying this but we should take every Anesthesiology resident and mandate they do either pain fellowship, CV or ICU in a 4 to 5 year program combined with their intern year - all categorical.

Within 5 years you will take over the market place of all pain and all ICUs by graduating 5000 intensivists or Interventional Pain docs. And with that base training there is an outlet valve mechanism to literally define ourselves. Not necessarily in practice where people may not practice icu or pain which is cool, as many of the members on here do not use their fellowship, but it's about the definition. The mission statement for the modern day Anesthesiologist... the optics...and I know it's a year of money loss...but when people think anesthesiology like in Europe, in the public, they think - ok Intensivist, Emergency Medicine, resucitationist, Anesthesiologists IE doctor. Instead of looking to midlevels tiers of care like anesthesia nurses and meddle with the "help" ie the bedside OR anesthesia nurse which is basically equivalent to the bedside ICU nurse, we should look to what other professional groups have done because it's not just Anesthesiology- its Emergency Medicine, it's all the medical specialties that are non procedural or procedural derm, rheum, family medicine, plastics etc that this is impacting. See ACEP reply on the EM forum about PA/NPs. This is going to be the big issue in the next 20 years. And every generation of medical professionals had quacks and in the end education, knowledge in the sciences, and trusting your training is fundamental.

We need to keep training our residents and fellows to do it all... Especially for patient safety and advancing the medical science.

You can read my other posts on here but in brief...
TTE and TEE diagnostic and therapeutic structural, REBOA, ECMO, ICE, neurophysiology, Neuromonitoring, Bronchs, trachs, vascular procedural teams, pain catheters, regional, complex blocks, regional cathters, sacral stims, complex multimodal anesthesia, ESI, rhizotomies, perc discectomies, Preprocedural testing stress imaging, pfts. We should own it all. So that our pts know that Anesthesiologists put their patients first - based on the value they provide. We can get you through any procedure you have in the hospital and hell if you don't want a procedure we can palliate you too.

What was a complex and groundbreaking scientific discovery in the 80s is now what CRNAs leach off of in practice (sevo, des, prop, precedex) all discovered on the backs of Physician scientists after CRNAs were throwing rags of ether on people's face. There is no sane person when given the option who will ever choose an RN to anesthetize them unless for the most basic case... unless they are marketed to incorrectly. Furthermore we need to remind our residents to get stronger, better, faster every day. Do you think any of these whack AANA nurses are doing complex multimodal anesthesia opioid sparing, block only anesthesia?
Hell I'm convinced the opioid epidemic is caused by CRNAs with the ****ty prop sux tube and loaded narcotic anesthesia they administer.

If they want to go head to head then let's have at it.
 

Wolverines83

ASA Member
7+ Year Member
Sep 29, 2010
579
151
181
NYC Metro
Status
Resident [Any Field]
The problem is that patient don’t even know who they are seeing until the day of their surgery. It’s not like they establish with an anesthesiologist in clinic who then will show up on the day of their surgery. They see their surgeon, whom they know and trust. Then all the random people that they meet on the day of their operation is just part of the “team.”
And out of the fraction of people who do actually realize that a nurse is performing their anesthesia, how many of them convince themselves that they are “probably ok” and don’t speak out in fear of being viewed negatively by all the highly educated “smart” people?

If you want the public to know, then you need to MAKE the public know. Right now, there appears to be too many ulterior motives in play to keep it on the DL.
I’ve made it a point lately to say “im dr wolverines your anesthesiologist...you will also meet so and so your nurse anesthetist who will be in the room with you.” I’d say about 50% of the patients say something along the lines of “wait what? You’re not doing it?” And of those about half have asked to have me stay the whole time. Totally anecdotal but it was a relief to realize that at least the patients in my area seem to care.
 

Gasper

10+ Year Member
7+ Year Member
Apr 11, 2009
11
9
251
Status
Medical Student
CCF is on the forefront of replacing physicians with mid level counterparts, no wonder Obama said it's the model system of healthcare
Yup. Critical care NP doing lines and procedures, SRNA program competing for cases, sports ortho surgicenter with lots of blocks only accessible to CRNA/SRNAs, and permanent cardiac CRNAs, just to name a few...
 

Gasper

10+ Year Member
7+ Year Member
Apr 11, 2009
11
9
251
Status
Medical Student
Stop training CRNAs. Let them loose and see what happens. Why would anyone teach any new techniques to CRNAs. We have free license to define our careers as physicians. I know I'll get flack on here for saying this but we should take every Anesthesiology resident and mandate they do either pain fellowship, CV or ICU in a 4 to 5 year program combined with their intern year - all categorical.

Within 5 years you will take over the market place of all pain and all ICUs by graduating 5000 intensivists or Interventional Pain docs. And with that base training there is an outlet valve mechanism to literally define ourselves. Not necessarily in practice where people may not practice icu or pain which is cool, as many of the members on here do not use their fellowship, but it's about the definition. The mission statement for the modern day Anesthesiologist... the optics...and I know it's a year of money loss...but when people think anesthesiology like in Europe, in the public, they think - ok Intensivist, Emergency Medicine, resucitationist, Anesthesiologists IE doctor. Instead of looking to midlevels tiers of care like anesthesia nurses and meddle with the "help" ie the bedside OR anesthesia nurse which is basically equivalent to the bedside ICU nurse, we should look to what other professional groups have done because it's not just Anesthesiology- its Emergency Medicine, it's all the medical specialties that are non procedural or procedural derm, rheum, family medicine, plastics etc that this is impacting. See ACEP reply on the EM forum about PA/NPs. This is going to be the big issue in the next 20 years. And every generation of medical professionals had quacks and in the end education, knowledge in the sciences, and trusting your training is fundamental.

We need to keep training our residents and fellows to do it all... Especially for patient safety and advancing the medical science.

You can read my other posts on here but in brief...
TTE and TEE diagnostic and therapeutic structural, REBOA, ECMO, ICE, neurophysiology, Neuromonitoring, Bronchs, trachs, vascular procedural teams, pain catheters, regional, complex blocks, regional cathters, sacral stims, complex multimodal anesthesia, ESI, rhizotomies, perc discectomies, Preprocedural testing stress imaging, pfts. We should own it all. So that our pts know that Anesthesiologists put their patients first - based on the value they provide. We can get you through any procedure you have in the hospital and hell if you don't want a procedure we can palliate you too.

What was a complex and groundbreaking scientific discovery in the 80s is now what CRNAs leach off of in practice (sevo, des, prop, precedex) all discovered on the backs of Physician scientists after CRNAs were throwing rags of ether on people's face. There is no sane person when given the option who will ever choose an RN to anesthetize them unless for the most basic case... unless they are marketed to incorrectly. Furthermore we need to remind our residents to get stronger, better, faster every day. Do you think any of these whack AANA nurses are doing complex multimodal anesthesia opioid sparing, block only anesthesia?
Hell I'm convinced the opioid epidemic is caused by CRNAs with the ****ty prop sux tube and loaded narcotic anesthesia they administer.

If they want to go head to head then let's have at it.
The problem is greed, laziness, complacency, and maybe most importantly, SRNA school is good money-making business. As long as the healthcare profit margin continues to shrink, there will always be big academic places like CCF, Duke, Emory, Columbia... running SRNA mills. Many private practice groups are under pressure by hospitals to hire CRNAs to cut cost. I don't know what the solution is, but earn money while you can. There's still plenty of jobs and money in this generation, but for our children's generation the future is bleak.
 
  • Like
Reactions: Modanq
Jan 22, 2019
364
342
41
Status
Resident [Any Field]
The problem is greed, laziness, complacency, and maybe most importantly, SRNA school is good money-making business. As long as the healthcare profit margin continues to shrink, there will always be big academic places like CCF, Duke, Emory, Columbia... running SRNA mills. Many private practice groups are under pressure by hospitals to hire CRNAs to cut cost. I don't know what the solution is, but earn money while you can. There's still plenty of jobs and money in this generation, but for our children's generation the future is bleak.
These mid level providers are running wild at Duke, Vandy, Emory etc...
 

bronx43

Word.
10+ Year Member
Apr 22, 2006
1,928
616
281
Status
Attending Physician
These mid level providers are running wild at Duke, Vandy, Emory etc...
Not just in the ORs... they’re literally everywhere.

It must be sobering for the patients (some of whom pay top dollar) who come to “top academic institutions” only to be seen and treated by a midlevel with or without close physician supervision.
 

sb247

Doer of things
5+ Year Member
Jul 5, 2012
19,831
29,517
131
Galt's Gulch
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.
To be clear though, that would also require the anesthesiologists actually making it happen when a patient actually wants a doctor running their case and not a crna.

I mentioned here a few years back demanding a doc for my daughters case and had push back (if my memory serves) about how unreasonable I was and how I would not have been accommodated at the shops a lot of posters here work at
 

sevoflurane

Ride
15+ Year Member
Jul 16, 2003
4,859
1,608
381
Visit site
Status
Attending Physician
To be clear though, that would also require the anesthesiologists actually making it happen when a patient actually wants a doctor running their case and not a crna.

I mentioned here a few years back demanding a doc for my daughters case and had push back (if my memory serves) about how unreasonable I was and how I would not have been accommodated at the shops a lot of posters here work at
You get an MD every single time at my shop. Even during residency, you get an MD if requested.

I know the ASA supports the ACT model.

I do not.
 

2Fast2Des

to become No One, one must be PP slick
2+ Year Member
Jun 29, 2016
378
243
81
Status
Attending Physician
You get an MD every single time at my shop. Even during residency, you get an MD if requested.

I know the ASA supports the ACT model.

I do not.
I remember a big case in residency I requested to be assigned to. Apparently the pt wanted a CRNA. She got an srna\crna, and the attending spent much time in that room because of the incompetency that ensued from the get go. They get what they ask for...
 

AdmiralChz

ASA Member
10+ Year Member
Sep 8, 2008
3,076
2,363
281
Mid-Atlantic
Status
Attending Physician
You get an MD every single time at my shop. Even during residency, you get an MD if requested.

I know the ASA supports the ACT model.

I do not.
I applaud you, but here we would need at least 50 additional docs to be MD only and we are a medium-sized group. For a large group in my state capital, they’d need almost 100 more docs. There simply aren’t the bodies out there for all MD everywhere, ACT is what we do to maintain appropriate physician-led, patient-centered care. The alternative would be independent CRNAs here and that is not an option, “wanting them to fail” like that isn’t fair to our patients. And how would you choose who gets the nurse, by insurance? Sounds like a bad headline waiting to happen - only the rich get MD care!

This campaign has definitely got (negative) attention, and I don’t think that helps their cause. Our group has been facing mounting pressure to offer regional and OB rotations to SRNAs as well as allow them to do CVLs (currently all we offer is a general rotation and they are never assigned their own room). We were able to use their ridiculous manifesto as ammunition to push back, and the group that currently offers those specialty rotations has put in 6 month notice that it is being stopped.
 

Spikebd

7+ Year Member
May 2, 2010
397
154
181
Status
Resident [Any Field]
I applaud you, but here we would need at least 50 additional docs to be MD only and we are a medium-sized group. For a large group in my state capital, they’d need almost 100 more docs. There simply aren’t the bodies out there for all MD everywhere, ACT is what we do to maintain appropriate physician-led, patient-centered care. The alternative would be independent CRNAs here and that is not an option, “wanting them to fail” like that isn’t fair to our patients. And how would you choose who gets the nurse, by insurance? Sounds like a bad headline waiting to happen - only the rich get MD care!

This campaign has definitely got (negative) attention, and I don’t think that helps their cause. Our group has been facing mounting pressure to offer regional and OB rotations to SRNAs as well as allow them to do CVLs (currently all we offer is a general rotation and they are never assigned their own room). We were able to use their ridiculous manifesto as ammunition to push back, and the group that currently offers those specialty rotations has put in 6 month notice that it is being stopped.
The incoming national healthcare system will require extensive CRNA, PA, and NP labor.
We will only need physician participation in a select few fields.
1. All surgical fields
2. GI procedural work
3. Interventional cardiology
4. Radiology
5. Pathology
6. Pain
7. Critical care

There’s basically independent NP’s in heme oncology at my academic institution. I couldn’t believe it. But, we can’t keep treating self pay, no pays and expect Cadillac care for everyone.
 

Urzuz

7+ Year Member
Aug 24, 2011
450
597
181
Status
Attending Physician
I applaud you, but here we would need at least 50 additional docs to be MD only and we are a medium-sized group. For a large group in my state capital, they’d need almost 100 more docs.
Forgive me for asking, but have you tried recruiting more physicians? I don’t think CRNA involvement has to be all-or-none. You can slowly phase them out. Advertise and recruit more anesthesiologists. Come up with a fair system with your partners that balances solo/supervision work and the pay differences that may be associated with it. Stop hiring CRNAs. Stop allowing them to do anything beyond being your eyes/ears while staring at vital signs.

Rome wasn’t built in a day, and no one is expecting you to hire 50 physicians overnight. Throwing your hands up and saying nothing can be done is short-sighted and is allowing the active bastardization of YOUR profession. But maybe, just maybe the CRNAs that you fire in favor of MD-only care will start speaking out against their ridiculous leadership and how this dick-swinging contest they are getting into with the ASA is leading to real-world repercussions.
 

Hoya11

Senior Member
10+ Year Member
Sep 4, 2004
859
392
281
Status
You get an MD every single time at my shop. Even during residency, you get an MD if requested.

I know the ASA supports the ACT model.

I do not.
But what about for colonoscopies, eye cases, foot cases, MD really?
 

Plead the Fifth

ASA Member
10+ Year Member
Mar 27, 2007
114
32
261
Status
Resident [Any Field]
But what about for colonoscopies, eye cases, foot cases, MD really?
We have anesthesiologist oversight at our surgicenter site. It’s 4 rooms of predominantly scopes, eyes, simple urology, and pain (minimal anesthesia involvement in pain procedures). CRNAs staff rooms - anesthesiologists take care pre/intro/post-op concerns and answer pre-surgical testing questions.
 

SaltyDog

Homey O'Stasis
10+ Year Member
Aug 10, 2007
3,541
5,961
281
Closer to Mexico
Status
Attending Physician
We have anesthesiologist oversight at our surgicenter site. It’s 4 rooms of predominantly scopes, eyes, simple urology, and pain (minimal anesthesia involvement in pain procedures). CRNAs staff rooms - anesthesiologists take care pre/intro/post-op concerns and answer pre-surgical testing questions.

Chart Monkey
 

chocomorsel

Senior Member
10+ Year Member
May 24, 2006
2,861
1,509
281
somewhere always warm
Status
Attending Physician
We have anesthesiologist oversight at our surgicenter site. It’s 4 rooms of predominantly scopes, eyes, simple urology, and pain (minimal anesthesia involvement in pain procedures). CRNAs staff rooms - anesthesiologists take care pre/intro/post-op concerns and answer pre-surgical testing questions
I used to live out West where it’s mostly physician only. And yes, even eyes and feet and pain get physicians only.
Why not?
 

sevoflurane

Ride
15+ Year Member
Jul 16, 2003
4,859
1,608
381
Visit site
Status
Attending Physician
But what about for colonoscopies, eye cases, foot cases, MD really?
Yeah. We do it all.
With 70+ Aneathesiologists, our rotations in those rooms are extremely rare, if at all.
The guys at the tail end of their career really don’t mind it.

I like foot cases.
Usually do regional for them.
 

sevoflurane

Ride
15+ Year Member
Jul 16, 2003
4,859
1,608
381
Visit site
Status
Attending Physician
Probably been a year or two since I’ve done an eyeball case. That being said, they pay well with a fast surgeon.
 
  • Like
Reactions: mmag

2Fast2Des

to become No One, one must be PP slick
2+ Year Member
Jun 29, 2016
378
243
81
Status
Attending Physician
But what about for colonoscopies, eye cases, foot cases, MD really?
I remember one of the omfs residents back in med school tell me, choose a residency based on what you will enjoy and to accept that most of any specialty will be bread and butter, and if you're okay with that you won't be disappointed if you don't actually see zebras all the time. He was right, yes they're boring but it's part of the variety we do. Can't claim we're awesome at everything but that we're too good for some. Except when I catch my CRNA turn a simple local asa1 case into why the F are the sats in the 60s and extreme jaw thrust being done and only caught it because I happened to walk in at the right time because I was never notified. So yeah I'll take an MD all day
 

nimbus

Member
10+ Year Member
Jan 14, 2006
3,952
3,817
281
Status
I remember one of the omfs residents back in med school tell me, choose a residency based on what you will enjoy and to accept that most of any specialty will be bread and butter, and if you're okay with that you won't be disappointed if you don't actually see zebras all the time. He was right, yes they're boring but it's part of the variety we do. Can't claim we're awesome at everything but that we're too good for some. Except when I catch my CRNA turn a simple local asa1 case into why the F are the sats in the 60s and extreme jaw thrust being done and only caught it because I happened to walk in at the right time because I was never notified. So yeah I'll take an MD all day

Yet some still argue that ACT is best.
 

2Fast2Des

to become No One, one must be PP slick
2+ Year Member
Jun 29, 2016
378
243
81
Status
Attending Physician
during residency, you were the ACT model
Yeah because that's the whole point, even a ca-2 is better than the dnp CRNA. Atleast when residents get in trouble they are aware enough to call for help