CRNAs fighting for complete removal of supervision

[VolatileAgent]

I don't know if he is somebody pretending to be somebody or whatever. I do however agree with a couple of his ideas no matter who he is. Public awareness, decrease helping the CRNA's, hire AA's ( I recently spoke with a couple of colleagues in MO that use them and have nothing but wonderful things to say about it), political strength, and making more Anesthesiologists aware of the situation about the DNAP.

please read the entire op-ed...

First and foremost, we must act like physicians in dress and decorum. Anesthesiologists, surgeons and internists need to remember that they are physicians — and being a physician comes with societal expectations that only we, by education and training, can fulfill. Like the orchestra, we must tune to the concertmaster and play the same music as a united orchestra, in proper concert attire. We cannot afford to argue, as many professional athletes have, that we did not ask for society to hold us in such high regard and therefore refuse to meet these expectations. For most of us, we aspired to become physicians and knew that there would be a lot of hard work, but we persevered because the rewards, among them the respect for the profession as a whole, were important. Quite simply the DNP might well be imitation, the very highest form of flattery and a quest by the nursing profession to be held in the same esteem as are physicians with similar responsibilities, including those related to liability.

http://www.asahq.org/Newsletters/2006/05-06/crowsNest05_06.html

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[BLADEMDA]

please read the entire op-ed...



http://www.asahq.org/Newsletters/2006/05-06/crowsNest05_06.html

Quite simply they want your job.

 

[BLADEMDA]

In the Private Forum. Blade invites you to join the discussion in the private forum.

BladeMDA

 

[VolatileAgent]

Quite simply they want your job.

never more true than the present.

chapstick and pucker up. the future is almost here. i gotta get at least another ten years out of this career. there will be no difference between scope of practice by when i retire.

 

[deleted126335]

never more true than the present.

chapstick and pucker up. the future is almost here. i gotta get at least another ten years out of this career. there will be no difference between scope of practice by when i retire.

All politics are local. The difference between the Anesthesiologist/CRNA dynamic between my first and second jobs was night and day.

 

[acidbase1]

I read this thread and started freaking out, then I noticed it was from 07

 

[Mr.S]

I read this thread and started freaking out, then I noticed it was from 07

so youre not freaked anymore that its not '07? You should be more freaked!!!!

 

[Mman]

so youre not freaked anymore that its not '07? You should be more freaked!!!!

this topic has been discussed since before this internet forum existed. We've been on the edge of impending doom as a specialty for more than 30 years. The fact it hasn't happened yet says something about something.

 

[Psai]

It's happening incrementally every day. Things that were inconceivable in the past are now reality.

 

[nimbus]

this topic has been discussed since before this internet forum existed. We've been on the edge of impending doom as a specialty for more than 30 years. The fact it hasn't happened yet says something about something.

It's happening incrementally every day. Things that were inconceivable in the past are now reality.

As Mman says CRNAs have been around forever. They are not the threat to our livelihood. Corporate ownership of anesthesia practices is. Some parts of the country like the greater NYC/Long Island/Northern New Jersey area were once places where you could make bank. CRNAs did not ruin things there. CRNAs are lowly, powerless, peon worker bees like us.

 

[Mr.S]

this topic has been discussed since before this internet forum existed. We've been on the edge of impending doom as a specialty for more than 30 years. The fact it hasn't happened yet says something about something.

You have to admit though there are a ton more crnas working independently now than ever before.

And it is anyone's guess where we will be in 15 years.

15 years ago. No one was doing fellowships. Not even pain folks. Icu was barely a thing. Nobody went into anesthesia with an interest in CC. If you were interested in CC you went into medicine.

Now people are doing Acute Pain Fellowships. You can learn how to do blocks reasonably well with an intense interest and youtube..

So we will see what happens.

 

[AdmiralChz]

You have to admit though there are a ton more crnas working independently now than ever before.

And it is anyone's guess where we will be in 15 years.

15 years ago. No one was doing fellowships. Not even pain folks. Icu was barely a thing. Nobody went into anesthesia with an interest in CC. If you were interested in CC you went into medicine.

Now people are doing Acute Pain Fellowships. You can learn how to do blocks reasonably well with an intense interest and youtube..

So we will see what happens.

15 years ago RRC requirements were much more lax and you could "load up" your CA-3 year (which was still somewhat new!) with subspecialty rotations to make you basically fellowship trained in a field (e.g. cardiac, CCM, peds). It was common for those folks to do 6 or more months of the year in their subspecialty. Now there is much less opportunities to do so since you have to fulfill more stringent requirements. Add in requirements of fellowship for board certification in peds/CCM and advanced echo certification and you have explained 50-75% of the increased interest in subspecialization.

In suburban or urban areas, good luck getting credentialed to do real deal subspecialty work without a fellowship as a new grad these days. Particularly in pain and CCM. Maybe not the case 15 years ago, who knows.

But continue the doom talk! Run for the hills!

 

[Stank811]

You have to admit though there are a ton more crnas working independently now than ever before.

And it is anyone's guess where we will be in 15 years.

15 years ago. No one was doing fellowships. Not even pain folks. Icu was barely a thing. Nobody went into anesthesia with an interest in CC. If you were interested in CC you went into medicine.

Now people are doing Acute Pain Fellowships. You can learn how to do blocks reasonably well with an intense interest and youtube..

So we will see what happens.

Why do you say there are a ton more CRNAs working independently?

 

[Beach bum]

As Mman says CRNAs have been around forever. They are not the threat to our livelihood. Corporate ownership of anesthesia practices is. Some parts of the country like the greater NYC/Long Island/Northern New Jersey area were once places where you could make bank. CRNAs did not ruin things there. CRNAs are lowly, powerless, peon worker bees like us.

Docs and nurses are fighting over scraps from Longshank's table!!

 

[jwk]

Why do you say there are a ton more CRNAs working independently?

There are a lot more outpatient centers and surgeon-owned single specialty shops where CRNAs frequently gravitate and anesthesiologists do not.

 

[Mr.S]

15 years ago RRC requirements were much more lax and you could "load up" your CA-3 year (which was still somewhat new!) with subspecialty rotations to make you basically fellowship trained in a field (e.g. cardiac, CCM, peds). It was common for those folks to do 6 or more months of the year in their subspecialty. Now there is much less opportunities to do so since you have to fulfill more stringent requirements. Add in requirements of fellowship for board certification in peds/CCM and advanced echo certification and you have explained 50-75% of the increased interest in subspecialization.

In suburban or urban areas, good luck getting credentialed to do real deal subspecialty work without a fellowship as a new grad these days. Particularly in pain and CCM. Maybe not the case 15 years ago, who knows.

But continue the doom talk! Run for the hills!

I think we're shooting ourselves in the foot by doing/requiring all these fellowships.
Its not doom talk. It is reality. You must look at all these factors and not stick your head in the sand.
how many CRNA opt out states were there 18 years ago. How many are there today?

 

[Stank811]

There are a lot more outpatient centers and surgeon-owned single specialty shops where CRNAs frequently gravitate and anesthesiologists do not.

Are the groups in your area not interested in covering these small surgery centers or are the surgery centers not interested in the groups covering them?

 

[d9sccr]

Are the groups in your area not interested in covering these small surgery centers or are the surgery centers not interested in the groups covering them?

From my limited experience it comes down to cost. The M.D. is always going to cost more than a nurse and from a financial standpoint, it makes sense to go the nurse route...until you have a major lawsuit and even then it may not be much of an influencing factor if the state has tort reform.

 

[Stank811]

From my limited experience it comes down to cost. The M.D. is always going to cost more than a nurse and from a financial standpoint, it makes sense to go the nurse route...until you have a major lawsuit and even then it may not be much of an influencing factor if the state has tort reform.

Anesthesiologist cost the same as CRNA unless you are going to employee them.

Which is why I asked the question. Are these small centers not profitable enough from a volume standpoint and OR utilization to support a physician salary so they have to hire CRNAs or are they trying to make extra money by hiring CRNAs and then skimming off the top of what is billed.

 

[psychbender]

or are they trying to make extra money by hiring CRNAs and then skimming off the top of what is billed.

This. Why let someone freely bill for his or her work in your center, when you can bill for them, and pay them a nominal salary? Then, why employee the physicians, when you can pocket more by employing nurses?


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[deleted103644]

never more true than the present.

chapstick and pucker up. the future is almost here. i gotta get at least another ten years out of this career. there will be no difference between scope of practice by when i retire.

You should be fine, ten years can go by in a single post.

 

[gasdoc77]

This. Why let someone freely bill for his or her work in your center, when you can bill for them, and pay them a nominal salary? Then, why employee the physicians, when you can pocket more by employing nurses?


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Bingo- perhaps the push is truly coming from behind the scenes via AMC’s through funding AANA and/or planting these ideas and creating these cultures. The same AMC’s then rent booths and line pockets of the anesthesia regulatory bodies as “hush money”. Ultimately, AMC’s want independence so they can staff with fewer (and maybe ultimately no) anesthesiologists, pay their CRNA’s no different, bill the full amount, capture more, and shoulder zero liability due to independence practice. They divide and conquer.

 

[Mr.S]

Bingo- perhaps the push is truly coming from behind the scenes via AMC’s through funding AANA and/or planting these ideas and creating these cultures. The same AMC’s then rent booths and line pockets of the anesthesia regulatory bodies as “hush money”. Ultimately, AMC’s want independence so they can staff with fewer (and maybe ultimately no) anesthesiologists, pay their CRNA’s no different, bill the full amount, capture more, and shoulder zero liability due to independence practice. They divide and conquer.

Absolutely.

It is very sinister.