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This is so funny 😀
What is exactly "assesment skills"???
They don't teach those in medical school !
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CRNA with DNAP on SDN?
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This is so funny 😀
What is exactly "assesment skills"???
They don't teach those in medical school !
you're going to have to do better... provide a link to some source. (this sounds suspiciously like the aana argument that they provide "65% of the anesthetics" in this country, which is incredibly misleading.) we're talking about independent practice. and, you're quoting (without providing verification) a source from 1996. i'm sorry, but i'm gonna have to call bullsh*t.
So,
Many of you have read my posts. Our leadership needs to decide whether we are going to marry the AANA (we are already in bed with her) or go back to our wife (Full Metal Jacket against the AANA).
The idea that we can keep the "status quo" in place for the next twenty years is foolish. We must develop a real plan for the Specialty. We could CLOSE CRNA schools and Open AA programs (discussed before). We could cut back on Residency slots and require a fellowship while ramping up CRNA production. This means we evolve into PERIOPERATIVE MEDICINE over the next twenty years while the CRNA with DNAP becomes the primary stool sitter.
Currently, we have no real strategy and are "screwing" the next generation of Anesthesiologists. Universities and Community hospitals are pumping CRNA's out in record numbers and MORE Are opening every day. The same Chairperson who wanted you as a Resident is training your replacement SRNA/CRNA at the same time.
Where is the logic? In addition, the CRNA with DNAP will want Independence soon. We can have input into this situation or just continue the fight with the AANA.
My proposal is controversial but logical. Gradually cede the stool sitting to a highly qualified CRNA with DNAP over the next twenty years. We change the specialty to PERIOPERATIVE MEDICINE and evolve into our supervisory role for ACUTE/CRITICALLY ILL patients.
Alternatively, we can STOP training our competition and start training thousands more AA's IMMEDIATELY. Either way, we must decide to make peace or engage in all out war.
Blade
Many of you have read my posts. Our leadership needs to decide whether we are going to marry the AANA (we are already in bed with her) or go back to our wife (Full Metal Jacket against the AANA).
The idea that we can keep the "status quo" in place for the next twenty years is foolish. We must develop a real plan for the Specialty. We could CLOSE CRNA schools and Open AA programs (discussed before). We could cut back on Residency slots and require a fellowship while ramping up CRNA production. This means we evolve into PERIOPERATIVE MEDICINE over the next twenty years while the CRNA with DNAP becomes the primary stool sitter.
Currently, we have no real strategy and are "screwing" the next generation of Anesthesiologists. Universities and Community hospitals are pumping CRNA's out in record numbers and MORE Are opening every day. The same Chairperson who wanted you as a Resident is training your replacement SRNA/CRNA at the same time.
Where is the logic? In addition, the CRNA with DNAP will want Independence soon. We can have input into this situation or just continue the fight with the AANA.
My proposal is controversial but logical. Gradually cede the stool sitting to a highly qualified CRNA with DNAP over the next twenty years. We change the specialty to PERIOPERATIVE MEDICINE and evolve into our supervisory role for ACUTE/CRITICALLY ILL patients.
Alternatively, we can STOP training our competition and start training thousands more AA's IMMEDIATELY. Either way, we must decide to make peace or engage in all out war.
Blade
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First of all the ASA has no control over the AANA. Anesthesiologists are governed by state medical practice acts which is a statute that allows the state medical board to regulate practice. CRNAs are governed by the states Nurse practice act which grants the board of nursing to regulate CRNAs. The are 2 different professions regulate by 2 different administrative bodies given permission by 2 different statutes. Two accomplish what you are blabbing about would require that CRNA be included in the Medical practice act and regulate by medical boards. This would never happen as CRNAs would fight this till they die probrably.
Listen you worry about you standards and CRNAs will worry about theirs. The ASA should really try to get all Anesthesiologists board certified before they attempt to certify CRNAs and AAs.
I agree w/Volatile on this. Not that my opinion matters much, but this is my main objection to Blade's proposal.
I of course like the "thousands of AA's" concept. 😉 It will be a much easier route.
The DNP will take 50 years to fully implement. You still have ASN/CRNA's giving anesthesia that still have 20 or more years to retirement. You then have tens of thousands of master's degree CRNA's either already in practice or in training. They're in it for another 35-40 years. The transition of programs to the DNP in and of itself, IF it happens, will take at least 15 years or more. Remember that to offer a doctorate degree requires doctorate-prepared faculty, and there just aren't that many doctorate CRNA's out there. That means hundreds of them will have to get their doctorate from a very small number of programs.
Like I said - thousands of AA's - much easier.
Sure JWK you want the AA route. I agree that is a logical approach.
The problem is the ASA and Academic leadership tell you they support AA's then go out and open a CRNA school (more correctly, agree to have SRNA's alongside Residents.) Where is the HONESTY is this debate? THe fact is the Academic and Private Practice communities are in the BUSINESS of training SRNA's. THe number of NEW CRNA programs over the last 5 years exceed ALL THE CURRENT AND PROPOSED AA programs across the USA.
Again, we say one thing but our actions show another. The AANA has been a terrible, unfaithful partner to the ASA. Regardless of the discussion here, the status quo isn't the long term answer. Those FAT AND HAPPY Chairpersons are training your competition and NOT your assistant as it pertains to the actual delivery of Anesthesia.
AS for BFE/rural USA my proposal is logical just not politically viable.
Blade
A CRNA is just a glorified and right now an overpaid technician.
From what I've seen, nurses are great at shooting themselves in the foot. They will keep opening more and more schools without much regard to market demand. This is an interesting thread from the nurses regarding that scenario with NP's.
http://allnurses.com/forums/f34/np-making-six-figures-40528.html
It's amusing how they even gripe that PA's are contributing to stagnant NP salaries. I predict that something similar will happen with CRNA's. More CRNA schools, more states licensing AA's, and more AA schools opening up. At some point, there will be more low-end anesthesia providers than demand. They will really realize that they are technicians when their attempts at scope expansion fails. They will then be stuck just delivering gas in a declining reimbursement and rising malpractice environment. As Blade said, anesthesiology will become more supervisory and it will be forced to move up the medical value chain.
From what I've seen, nurses are great at shooting themselves in the foot. They will keep opening more and more schools without much regard to market demand. This is an interesting thread from the nurses regarding that scenario with NP's.
http://allnurses.com/forums/f34/np-making-six-figures-40528.html
It's amusing how they even gripe that PA's are contributing to stagnant NP salaries. I predict that something similar will happen with CRNA's. More CRNA schools, more states licensing AA's, and more AA schools opening up. At some point, there will be more low-end anesthesia providers than demand. They will really realize that they are technicians when their attempts at scope expansion fails. They will then be stuck just delivering gas in a declining reimbursement and rising malpractice environment. As Blade said, anesthesiology will become more supervisory and it will be forced to move up the medical value chain.
While I do not advocate Independent CRNA practice the BEST CRNA's are more than technicians but less than Physicians. They deserve respect and as I have stated the BEST do their job very well.
AS for over production of CRNA's that is already occuring in my market. Two new CRNA schools and another two opening shortly. PLus, the existing schools all want to "enlarge" their numbers. While the National market place is still on the short side for supply the nicest local markets are becoming saturated.
Blade
Yes, some are very good at what they do, but they are few and far between. I'm looking at the average CRNA.
I'm not surprised that some markets are beginning to saturate. It will get worse for the CRNA's as more AA's come on line. But I think that CRNA's will overshoot supply even if you don't consider AA's. The nurses are just not that good at estimating supply and demand. Schools will keep pumping out more grads as long as they get more tuition money. Anesthesiologists will hold resentment against them for ruining their field and they will probably start to replace many CRNA's with AA's. This will in turn increase the number of available CRNA's on the market, further depressing the market. This is a good thing though. Anesthesiologists need AA's to keep CRNA's in check the way that PA's keep the NP's in check.
I think it's stupid for the CRNA's to piss off the anesthesiologists. They think we're just gonna sit here and take it. The CRNA's are really just shooting themselves in the foot. They should try to be cooperative to maintain the viability of their profession as they know it now, but their greed is making them blind. Both sides will be hurt by this war, but I would put my bets on the anesthesiologists to come out better than the CRNA's.
This is so funny
What is exactly "assessment skills"???
They don't teach those in medical school !
Did you ever perform a preoperative assessment? If not you cannot be supervising an anesthetic or performing one safely.
HE,HE An anesthesiologist who never performed an assessment.
What is exactly "assessment skills"???
They don't teach those in medical school !
Did you ever perform a preoperative assessment? If not you cannot be supervising an anesthetic or performing one safely.
HE,HE An anesthesiologist who never performed an assessment.
well said doctor!
I have an issue with how you are speaking of technicians. As a surgical assistant, I have seen some technicans that can run circles around the residents that come through surgery. and if you ask me, there are some anesthesiologist that need to learn the "technical" aspects of anesthesia before the end up killing somebody!!. It's not just about book knowledge. I was a surgical technician before becomming a surgical assistant. So, I take offense to that fact that you are stipulating that technicians are below average because we are not.
2) I hardly believe that a CRNA or an AA conciders themselves a LOW END provider. Are they cheaper, yes, but that hardly makes them low end. Just saying that is foul.....They are anesthetist that didn't make the choice to go to medical school. Medical school is a choice!! Not a Right! Not a need!Because you made that choice doesn't make you better it just gives you more perks😉
No offense, but how would you know? Look, I am of the opinion that I can learn (at least some things) from those w/different backgrounds/views, etc..., but with (inflammatory) posts like that you are doing a disservice to yourself as well as other CRNAs etc... wishing to post (constructively) on these forums.
hey queen
relax take some deep breaths baby.
surgical techs are just that.. techs.. they dont have any formal medical education except for what they get in tech school.. Surgical techs are my favorite people in the operating room. truly they are the people i get along with the most.
and crnas are not that much cheaper than physicians. lets face it. They have a lot of demands.. plus the issue at hand is when they say our education is un- necessary and they are just as good.. not only crnas but Nps also are waving that flag..
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The top 20-25% of CRNA's are excellent providers. Yes, they lack certain skills and/or knowledge of an MD that is why they are not Physicians.
But, calling this Group of CRNA's merely technicians is disrespectful.
My proposal has always stated "all CRNA's are not the same." I stand by that statement.
As for over-production of CRNA's we shall see about that one. BUt, I wouldn't count on the AA's because Academia has been mostly talk and no action on starting AA programs (compared to NEW CRNA schools).
Blade
You know, it's funny how non-physicians just assume that they "could have gone to medical school". Do you realize how naive that is?? If not, talk to some of the stellar RE-applicants to medical school. Each year, there are thousands of re-applicants to medical school of a very high caliber. I think you're using the term "choice" a bit too liberally.
Oh, and these are applicants that could easily slide right into ANY other allied health professional program.....
You know, come to think of it, you guys know this already. It's just too easy to talk a hard game.
Calm down Queen. Consider the following points:
(1) Realize that when comparing providers of any sort, you are almost compelled to compare means, not exceptions. Certainly, there are poor residents/physicians just as there are poor nurses/NPs. However, I think that we can all agree that, on average, a physician has superior medical training as compared to a nurse/tech.
(2) As far as medical school being a choice, yes it is a choice to apply...getting in is an entirely different story. Cream generally rises to the top and the typical med student is brighter than the average nurse/tech. The average physician is a superior overall healthcare provider as compared to the average nurse/tech (who can, after all, be proficient in certain aspects of a field) not because of the letters MD or DO, but rather because they are bright individuals that have undertaken rigorous training (this is not to say that others have not worked hard, but there is little comparison w/med school and residency +/- fellowship).
This post was not meant to initiate/prolong a pissing match. Just wanted to point out flaws in your reasoning and show that there's more to it than "more perks."
If I wanted to just take care of acute/critically ill patients I would have done IM/CCU. I went into anesthesia to administer anesthesia! I STRONGLY disagree with the run for the hills (perioperative) strategy. It is just giving up and saying "you win."
What I do is called History and Physical not "Assessment".
Assessment is what the recovery room nurse does when we bring her a patient, or what the nutrition service does to decide what to feed the patient.
If you read my post again you will CLEARLY see I present options. Perioperative Medicine is one strategy. Another is the training of a few thousand more AA's in order to bring competition to the market place.
What I don't understand is the total lack of a "plan" by the leadership.
On one hand they fight the AANA tooth and nail to block Independence while at the same time agreeing to train the next generation of CRNA with DNAP.
It gets better. The Academic departments are RUNNING To open more CRNA schools and train even more CRNA's.
Thus, the current strategy is more than just "giving up" it is actually "assisting" the AANA in its quest for Independence. Where are those AA programs? Again, all talk and no action while the AANA makes plans for several hundered more CRNA graduates per year.
Ridiculous strategy based on the here and now. I am glad you went into Anesthesia to be a stool sitter because so did the CRNA. Ultimately, who do you think is going to be more cost effective in that role? Your leadership is making sure there will be an ABUNDANT supply of CRNA stool sitters in the future some of whom will want complete Independence in the near future.
You really need to give serious thought to the future of the specialty and your job prospects. I wouldn't BANK your future as a stool sitter.
Blade
Jeez and miller calls it a preoperative assesment, look parse words if you like, I assess the patient get an H and P whatever so I can design an anesthesia plan. Remember I have no anesthesiologist here, someones gotta do it.
dont mean to sound smart assed but they call it preoperative assesment at umc lubbock texas.
dont mean to sound smart assed but they call it preoperative assesment at umc lubbock texas.
"total lack of a 'plan' by the leadership"? where are you getting this stuff??!??! seriously!
http://www.asahq.org/Newsletters/2006/08-06/washReport08_06.html
they are not! just because you say something doesn't mean it's true.
they are NOT! the ASA and academic departments have NOTHING to do with this. most new programs are being opened at community hospitals or ones that do not have anesthesia residencies! and, the ASA has absolutely no control over that! how could they? explain that. what do you expect the ASA to do, put on a superman cape and run roughshod over anyone and everyone who doesn't share their vision? you know what kind of PR damage that would do? do you understand anything other than your own delusions?
blah, blah, blah... you're deluded, dude. the worst part is that you probably actually believe your own hot-breathed rhetoric.
the rest of your post is so ridiculous that it doesn't bear a response.
anyone, that is, ANYONE can and should go to the ASA website (www.asahq.com) and read for yourself what is actually occuring at the national level concerning these issues. it's easy. you just have to do a search.
you should also be aware of what is occurring at your state level. be involved. know the issues from the authoritative perspective. try to learn about what is really happening, what your representatives are doing, and not get "educated" by the near-delusional rants of someone on an internet forum who's stirred himself into a frenzy with an intellectual boner that he doesn't know what else to do with.
please do this before you fall intellectual victim to the alarmist garbage posted here.
i write SOAP notes everyday. nurses are completely capable of coming up with a nursing assessment. they are not trained to develop plans. crna's can help develop plans, but they must be approved by a physician. them's the regulations. if you are not abiding by the regulations, you're breaking the law. pure and simple.
nurses, even crna's, do not develop H&Ps in the medical sense. despite what you may think, you're not adequately trained to do that. period.
Volatile,
You are a MAJOR problem to the future of the specialty because you suffer from ARROGANCE and DENIAL.
The FACTS speak for themselves. Yes, CRNA schools are started by Nursing Schools but ANESTHESIOLOGY departments must agree to go along with the idea. Recently, Univ. Miami and Harvard have started CRNA schools. Their numbers are on the RISE. This is FACT.
Second, when I state NO PLAN by our leadership I mean a logical, coordinated effort by the ASA leadership AND Academic Chairpersons. Columbia and MCV both have DNAP programs in the works and both are ACADEMIC programs.
Yes, the ASA is fighting the good fight against the AANA. But, where is the coordinated plan of attack? Where is the OFFENSIVE strategy?
People like you choose to ignore the threat posed to "stool sitting" in the near future by the CRNA with DNAP. You are just like those CRNA's on www.allnurses.com full of misleading statements and complete arrogance when it comes to understanding the complexity of this issue.
For those out there that care what else would you expect from an Attending with a whole ONE month of clinical experience? The SLOW encroachment by the AANA on our field is just starting to occur (relative terms). Over the next twenty years the primary role of "stool sitter" will belong to the CRNA. I guarantee it.
One last thing Volatile. My statements are accurate and truthful. The only RANTING going on in this thread is by you.
Blade
You are a MAJOR problem to the future of the specialty because you suffer from ARROGANCE and DENIAL.
The FACTS speak for themselves. Yes, CRNA schools are started by Nursing Schools but ANESTHESIOLOGY departments must agree to go along with the idea. Recently, Univ. Miami and Harvard have started CRNA schools. Their numbers are on the RISE. This is FACT.
Second, when I state NO PLAN by our leadership I mean a logical, coordinated effort by the ASA leadership AND Academic Chairpersons. Columbia and MCV both have DNAP programs in the works and both are ACADEMIC programs.
Yes, the ASA is fighting the good fight against the AANA. But, where is the coordinated plan of attack? Where is the OFFENSIVE strategy?
People like you choose to ignore the threat posed to "stool sitting" in the near future by the CRNA with DNAP. You are just like those CRNA's on www.allnurses.com full of misleading statements and complete arrogance when it comes to understanding the complexity of this issue.
For those out there that care what else would you expect from an Attending with a whole ONE month of clinical experience? The SLOW encroachment by the AANA on our field is just starting to occur (relative terms). Over the next twenty years the primary role of "stool sitter" will belong to the CRNA. I guarantee it.
One last thing Volatile. My statements are accurate and truthful. The only RANTING going on in this thread is by you.
Blade
So, you can work up abdominal pain in the ER? Know what to order, what to look for, when and when not to operate?
Oh, wait. Being able to close faster than a resident makes you a better surgeon....
Take a hike troll.
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