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CRNA's getting a lot more bold
Started by GaseousClay
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Thats really ridiculous, people are always trying to up their status in this world without really earning it. It really is sad we even have to deal with it. But, Don't sweat it guys, I'm black and have patients asking me when the doctor is coming in...have even had some kids cry and say they want a doctor not "someone else." I don't let it bother me, in fact its understandable and I'm sure some females deal with the same thing. I had nothing but white docs growing up too, my mentor and inspiration was one in fact, so I can understand how some of the younger patients or old patients feel. I know that's not the issue, but sometimes you just have to let social interactions go.
I wish we could.
I don't know about your patient population, but mine right now is affluent suburbia. Among the frequent complaints we hear from administration through HCAHPS and Press-Ganey and the like is that "the anesthesiologist didn't adequately explain" whatever "to me." This is supplied with a seemingly magic percent of respondents to whichever questionaire they got where they specifically griped about one of us. There's a lot of heat at this job to make these numbers look good. You know what they say about the gravitational effects on the flow of fecal matter?
So I guess if you are presented with dumb patients you can dumb it down. Unfortunately our patients want that explanation. Apparently.
Residents, bottom line: in the real world, this kind of 'fecal matter' matters.
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Reminds me when I was a med student and was on a rotation with a black cardiology fellow. We were interviewing an elderly black female. He was asking all the questions. She would turn and answer to me. Finally he asked why she kept answering to me and she said, "He's the doctor, right?"
Umm, that was awkward. First time I saw that particular aspect of racism in person firsthand. Nothing else to call it.
I'll be honest with you, it really helps to laugh this stuff off. That sounds about right but as you mentioned, even blacks will say they want a white doc. I usually joke with them and say no problem, but you don't like me?
Another thing on this thread I have to mention, the whole MBA thing as some kind of designation. I also have an MBA but we had a running joke in our class that anyone that puts it after their name is totally trying too hard. People just love their geek tags! MD, CPA, CFA, MBA, MPH, MS, BS
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last year thanks to the hard work of volunteers at the asa, states such as maine, maryland, nevada and texas signed into law truth in advertising bills.
i know it is more constructive to most people to talk rather than do. i have become involved in many different ways in this war on our profession and against this aggressive monster known by the acronym aana. i plead any and all of you to join the war and become a foot soldier in the battle. contact you state anesthesia society and let them know you mean business and will volunteer to help. if you need help in that regard contact [email protected]
if you have interest on a national level contact [email protected]
this year we are fighting against the vha nursing handbook rollout, trying to gain aa practice rights in all states (let the ftc know who the real anti competitive individuals are)
at this point crnas feel extremely comfortable and remain passive about the aana, thats ok. when the reality of the situation catches up to them and they are begging for employment, we will see a major turn in their narrative. at that point they can call themselves doctor, nurse or whatever but it will be in the unemployment line or while changing a demented persons diaper in the nursing home.
i know it is more constructive to most people to talk rather than do. i have become involved in many different ways in this war on our profession and against this aggressive monster known by the acronym aana. i plead any and all of you to join the war and become a foot soldier in the battle. contact you state anesthesia society and let them know you mean business and will volunteer to help. if you need help in that regard contact [email protected]
if you have interest on a national level contact [email protected]
this year we are fighting against the vha nursing handbook rollout, trying to gain aa practice rights in all states (let the ftc know who the real anti competitive individuals are)
at this point crnas feel extremely comfortable and remain passive about the aana, thats ok. when the reality of the situation catches up to them and they are begging for employment, we will see a major turn in their narrative. at that point they can call themselves doctor, nurse or whatever but it will be in the unemployment line or while changing a demented persons diaper in the nursing home.
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deleted126335
Keep em flying.
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deleted171991
Today I went to an expensive restaurant to celebrate my wife's birthday. We were seated in a smaller room, just with 3 tables, with another pair that was chatting quietly like us.
After 20 minutes or so, in comes a group of 3 middle-aged people, looking like husband and wife, plus female friend. The two women talk loudly for the next one hour or so. We initially don't really pay attention, but then it becomes impossible not to overhear them. At one point the female friend, who is a mixture of dowager countess snobbery and O'Brien level trash, starts telling the pair about her expensive cruises, her $89 truffles, the Mercedes limousine service she used, and her expensive lifestyle in general. All this while being very noisy, and trash talking friends, completely insensitive to the people around her, specifically us sitting at a table 5 feet away.
The conversation reminds me literally of Sandra Bullock's snob friends in the restaurant in The Blind Side. My wife and I reach a common conclusion of nouveau-rich stay-at-home trash, and we ignore as much as we can, until the end, when while waiting for the credit card we overhear her mentioning her great decisions in life, namely becoming the a nurse anesthetist, working independently, and the first in her state to bill as a third-party (whatever that means), and how well she is doing blah-blah. Generally the kind of public grandstanding that would disgust anybody in a physician. Cheeky, arrogant, mediocre, but obviously very ambitious person, pretty insupportable even for my very tolerant wife, who rushes out of the restaurant, so the story ends here.
While all the stupid sucker anesthesiologists are becoming AMC and academic slaves, these borderline sociopath crnas are becoming the new business leaders in anesthesia, making the big money (especially those in private practice, especially if compared based on hourly wages and responsibility levels), and living the good life. Food for thought for all the salaried suckers, who are wasting their time on fellowships, instead of developing better business skills/degrees, better hospital contacts and administrative involvement, and taking over the initiative from midlevels, especially independent ones. Because nobody else can stop them, nobody else knows how little they know, and how dangerous they are; they are to physician anesthesiologists as subprime borrowers are to the 800+ credit-score holders.
P.S. I obviously don't have all the pieces of the puzzle (I really wanted to ignore Dr Trash, CRNA, DNP, MSN, BSN, ACLS, CCRN, FAANA, and focus on my wife), but the little I overheard makes me think seriously about becoming a modest but happy independent contractor rather than a slightly richer fully employed and overworked slave, while the crnas and corporations are laughing all the way to the bank.
After 20 minutes or so, in comes a group of 3 middle-aged people, looking like husband and wife, plus female friend. The two women talk loudly for the next one hour or so. We initially don't really pay attention, but then it becomes impossible not to overhear them. At one point the female friend, who is a mixture of dowager countess snobbery and O'Brien level trash, starts telling the pair about her expensive cruises, her $89 truffles, the Mercedes limousine service she used, and her expensive lifestyle in general. All this while being very noisy, and trash talking friends, completely insensitive to the people around her, specifically us sitting at a table 5 feet away.
The conversation reminds me literally of Sandra Bullock's snob friends in the restaurant in The Blind Side. My wife and I reach a common conclusion of nouveau-rich stay-at-home trash, and we ignore as much as we can, until the end, when while waiting for the credit card we overhear her mentioning her great decisions in life, namely becoming the a nurse anesthetist, working independently, and the first in her state to bill as a third-party (whatever that means), and how well she is doing blah-blah. Generally the kind of public grandstanding that would disgust anybody in a physician. Cheeky, arrogant, mediocre, but obviously very ambitious person, pretty insupportable even for my very tolerant wife, who rushes out of the restaurant, so the story ends here.
While all the stupid sucker anesthesiologists are becoming AMC and academic slaves, these borderline sociopath crnas are becoming the new business leaders in anesthesia, making the big money (especially those in private practice, especially if compared based on hourly wages and responsibility levels), and living the good life. Food for thought for all the salaried suckers, who are wasting their time on fellowships, instead of developing better business skills/degrees, better hospital contacts and administrative involvement, and taking over the initiative from midlevels, especially independent ones. Because nobody else can stop them, nobody else knows how little they know, and how dangerous they are; they are to physician anesthesiologists as subprime borrowers are to the 800+ credit-score holders.
P.S. I obviously don't have all the pieces of the puzzle (I really wanted to ignore Dr Trash, CRNA, DNP, MSN, BSN, ACLS, CCRN, FAANA, and focus on my wife), but the little I overheard makes me think seriously about becoming a modest but happy independent contractor rather than a slightly richer fully employed and overworked slave, while the crnas and corporations are laughing all the way to the bank.
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deleted171991
The militant ones are already badmouthing AAs at work, in my non-optout non-AA state, and hearing them bitch made my day last week.
I am looking forward to the day we replace the crna propofol infusers and monitor alarms with much cheaper AAs or almost regular RNs.
It is the under and inadequately trained or credentialed who think they can do the same job as you and are flaunting it like FFP said. And it is soon going to become a real problem. Being a sick patient isn't a 7-to-3 shift. They want all the same benefits you have without the knowledge or training or experience or dedication.
Great report found here
http://www.deloitte.com/assets/Dcom...ts/us_chs_2013SurveyofUSPhysicians_031813.pdf
Great report found here
http://www.deloitte.com/assets/Dcom...ts/us_chs_2013SurveyofUSPhysicians_031813.pdf
The militant ones have been badmouthing AA's for 40+ years.
Where does this concept of "much cheaper AA's" come from? In a group with both AA's and CRNA's, we get paid the same for the same job description. In an ACT practice, we don't get paid less than CRNA's just because we're AA's. Same job = same money.
Been talking to my "independent crnas and MDs".
This is what we do agree on. Wall Street and AMCs are monitoring these boards and other so called nurse anesthsists boards. And they are laughing to the bank.
Look at the big picture. We have discussed this in detail before.
These monopolistic groups (Sheridan, Mednax, Team Health, NAPA plus "newer partnerships" cough cough Resolute anesthesia (Goldman Sachs) US Anesthesia Partners with Welsh Carson Private equity funding (shifting risks over to private pension firms to hold the hot potato ) operating with impunity. Each anesthesia provider has a billing number attached to names. We are being scammed into organizations that are dealing in anticompetitive behaviors and taking our livelihoods for pennies on the dollar.
Selling services they don't own to Wall Street interest. In their employment contracts and people are signing this junk, you can not work for this hospital if our conglomerate loses our contract with them or you can't work with a "x" mile distance of this place. Can you say BS?
Now, ask yourself, why are they wanting to take so many privileges with our billing numbers and our licenses we worked so hard to obtain. They can sell their earning power and their licenses with income, but I would like to retain my freedom to work for whomever, where ever I want to work....."F" the supervision issues. These "F" ers are getting rich on the GATEKEEPER theory!
This is what we do agree on. Wall Street and AMCs are monitoring these boards and other so called nurse anesthsists boards. And they are laughing to the bank.
Look at the big picture. We have discussed this in detail before.
These monopolistic groups (Sheridan, Mednax, Team Health, NAPA plus "newer partnerships" cough cough Resolute anesthesia (Goldman Sachs) US Anesthesia Partners with Welsh Carson Private equity funding (shifting risks over to private pension firms to hold the hot potato ) operating with impunity. Each anesthesia provider has a billing number attached to names. We are being scammed into organizations that are dealing in anticompetitive behaviors and taking our livelihoods for pennies on the dollar.
Selling services they don't own to Wall Street interest. In their employment contracts and people are signing this junk, you can not work for this hospital if our conglomerate loses our contract with them or you can't work with a "x" mile distance of this place. Can you say BS?
Now, ask yourself, why are they wanting to take so many privileges with our billing numbers and our licenses we worked so hard to obtain. They can sell their earning power and their licenses with income, but I would like to retain my freedom to work for whomever, where ever I want to work....."F" the supervision issues. These "F" ers are getting rich on the GATEKEEPER theory!
Does anyone know if the ASA is going to help propose a piece of legislation that would actually license AAs at the federal (I.e., national) level?
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totally agree with your point here.
i am curious about your apparent double standard in previous posts though. why do you think it's ok for a general anesthesiologist to call himself a pediatric anesthesiologist but not ok for a CRNA to call himself equivalent to a Dr?
http://forums.studentdoctor.net/threads/pediatric-anesthesia-board-exam-2013.947808/#post-14936102
I'm all for people who deserve to get credentialed to get that credentialing. If you are a physician who provides safe pediatric care then you should be able to get that credentialing. I'm also not about putting yourself at personal risk for some vendetta against someone you perceive doesn't meet your standards. It's not your place to police our profession. That's the point.
I've worked with plenty of CRNAs who consider themselves "pediatric specialists" simply because they like kids. Most of them do a good job. An equal number of them are "cookie-cutter" and wouldn't really know what to do if the turds hit the fan.
I equally feel that there are some surgeons who don't want me to provide pediatric anesthesia simply because I don't have a tested-and-approved qualification. In residency, I did pedi hearts, I intubated neonates when the neonatologist couldn't get it, I did countless short-gut and plyloric stenosis and myelomeningocele cases, etc. Just because I don't have a qualification doesn't mean I don't know what's going on and can't take care of your kid.
Not that long ago a surgeon had an intussusception case that came in overnight when I was on call and he wanted me to call in one of the pedi anesthesiologists. The kid was an otherwise healthy 3 year old. I told him that if he wants to go now, we go now with me or you transfer him to the university program. I was perfectly capable of taking care of this kiddo and I was not about to bother a colleague in the middle of the night to satisfy his perception otherwise. The result? Suddenly this wasn't as much of an emergency and he waited until the morning to book it as an add-on. You can't win everyone over. Pick and choose your battles. Regardless I saved a colleague from an unnecessary and rude middle of the night phone call when she wasn't even on call.
There's no such thing. This is a state-by-state licensing issue. As such the battle has to be fought state by state.
There is no federal licensing of any health care profession.
HOWEVER - AA's can work in the VA, so technically they can work in any state for the VA as long as they have a license in one state. You could be licensed in Georgia as an AA and practice for the VA anywhere they'll take you.
AA's are also recognized providers by CMS and the TriCare system at the federal level.
this is the whole point - it is our place to police our profession, and to defend the value of our titles and certifications.
you continue to ignore the salient issue from the previous thread - i'll give it one more shot.
we're not talking about clinical competency. we're talking about being honest and representing yourself as who you are to the public. we're talking about attaining a title honestly - clinical experience follows.
a CA1 is less clinically competent on day #1 than a 40 year CRNA - the CA1 is still "doctor" and the CRNA is still "nurse". a CRNA working in a kids hospital is probably better at doing kids than an MD working at an adult GI center for the last 30 years. the guys in my practice who have been doing kids for years and used to do pedi hearts are undoubtedly better in pediatrics clinically than I am having just finished a pediatric fellowship - there is no substitute for experience. i realize this, and even though i have a pediatric fellowship under my belt and my partners do not, i still consult them when a tricky kid comes up on the schedule. here's the rub - clinical experience is not what we're talking about here, and wasn't what we were talking about in the other thread.
here, we're talking about CRNA's calling themselves "doctor". not our job to police this?
in the other thread, we were talking about a young general anesthesiologist lying about his pediatric experience to sit for the pediatric anesthesia boards in order to call himself a pediatric anesthesiologist - he could then tell your surgeon that he is qualified to do your overnight intussusception case and potentially get everyone into a lot of trouble, especially the kid. not our job to police this? sounds like a clear and present danger to patient safety to me.
again, we're not talking about relative clinical competency between individual anesthesia practitioners here. we're talking about honestly obtaining a title, and representing yourself for what you are, whether that be a nurse, doctor, generalist, specialist, or subspecialist.
to play the devil's advocate, maybe your surgeon was right to ask for a pedi anesthesiologist. could you have done a great job with that case? certainly - but how does your surgeon know that? how can he evaluate your clinical competency? if he doesn't know you from adam, how can he evaluate your clinical experience, short of looking at your case logs and asking other surgeons and anesthesiologists about your reputation? in the middle of the night? pediatric experience/competency is a mixed bag these days amongst generalist anesthesiologists - some are great and some are not. the shortcut to evaluating clinical competency/experience in the absence of other information (ie the middle of the night) is title, and certification.
if you want to call yourself doctor, go to medical school.
if you want to call yourself board certified in pediatric anesthesia, either do a fellowship and pass the (easy) exam, or obtain the required pediatric experience and pass the exam.
if you want to take care of complicated pediatrics in the future (and have the experience) but don't want to obtain the certification more power to you. just don't get into a huff when a new surgeon who doesn't know you or your experience asks for someone with the certification. you will have to increasingly prove yourself to surgeons in the absence of that certification if you want to continue to do those cases. it's the unfortunate reality of the way our practice is moving, and why I did the fellowship (even though I was pretty dang good at doing kids right out of residency)...
it will increasingly become our place to police our profession - we must be vigilant and active against malignant erosion of our value. at my previous hospital, SRNA's were given name badges saying "medical student" (just an oversight of the HR dept). I sent a number of emails to get it changed - but why was I the only one who did anything about this? I have an open dialogue with the ABA about credentialing the pediatric experience of those being grandfathered in to the peds anesthesia exam (probably won't change anything). passive acceptance isn't going to maintain our specialty, and with that comes risk, which we must accept.
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There are laws against this. You don't have to police it yourself.
http://beta.congress.gov/bill/109th-congress/house-bill/5688
Their lack of understanding of my ability to provide safe care to a child is a separate issue. I cannot be responsible for someone else's ignorance. I can only give choices: do the case now with me or transfer the patient to a tertiary center that has the capability of providing the care you think the patient needs. That is policing the situation.
Your issue is one of blowing the whistle on a colleague who may be misrepresenting his/her qualifications. I ask again, do you have all the facts? What's in it for you other than some sense of personal integrity or entitlement? If you do blow the whistle this becomes ultimately a credentialing issue. I am already credentialed to provide anesthesia to children without the sub-specialty certification or test. If someone doesn't want me to do it, that's the patient's and the person requesting the consult's problem - not mine. And the person preventing me from doing so faces their own liability if they delay the case and a bad outcome occurs. If I don't otherwise think I have enough training or qualification, I can always say so and state this. That is me policing myself. And that's okay.
You seem to want to be one of the gatekeepers of our profession. If the ABA says the guy/gal is qualified to take the test and they are not, they will have their own bed to lay in if/when something bad happens and they are called to the carpet. Again, not your problem. Don't try to save the world. Find the nearest wall and bang your head against it instead. You'll accomplish far more.
Like I said before, if you stick your neck out for a cause be prepared for you to be the one who gets it lopped off.
You do have to report it to the police/board. You don't have to know all the facts for this. Just report what truth or suspicion you do know.
We need fewer turtles in this specialty.
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deleted171991
That's not a law. It was just a draft that never passed even the subcommittee level.
What I don't understand is why anesthesiologists adopt the terminology that CRNAs want you to adopt (i.e. the term MDA). It's disgusting to me.
We don't. I've never heard an anesthesiologist refer to him/herself (or a colleague) as an MDA.
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deleted171991
Except for Blade. Beats me, because I have a ton of respect for the guy.
Nobody said anything about billing independently. Maybe you're not aware of how anesthesia billing is done.
I'm surprised that anesthesia is allowing it's specialty to be slowly commoditized. At least learn from Pathology and Radiology.
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deleted87051
You are correct. How would you prevent this?
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24858
mda is another worthless tactic by an inept group of greedy loathsome aana politicos
BladeMDA for President
Cute. What we really need are less internet warriors. My prediction is that you're just gonna gripe here and probably do nothing about this in the real world.
There are more important battles to fight in our profession right now instead of ratting on a colleague.
in my previous thread i gave 2 examples of my "real world" actions. just examples. hopefully you and others on here will be motivated to take action as well.
bah. everyone disrespects us. i'm rarely not called "anesthesia" except by or/pacu nurses. the other day, i met one of our ob/gyn docs for the first time, and even after i introduced myself by first name only, she says "i'm dr. hoity-toity". ugh.
I refer to all physicians as Dr X in front of patients, they almost always do the same. When they are anesthetized or away from patients, I use their first name. I don't care what the nurses call me, except in front of patients, where I am Dr. Destriero. I don't need adoring fans or accolades, but I expect respect.
Better to gripe here and get feedback to collect your thoughts than to go off uncocked at the wrong time or place. Especially for the residents or new anesthesiologists.
why is there so much tension between mdas and crnas? I think they equally want what is best for the patient.
I'm confused...so MDAs sit with the CRNAs in the room and watch over them? I thought CRNAs are independent licensed practioners.
There is sometimes tension between MDs and CRNAs because some CRNAs don't want what is best for the patient. They want to do it themselves rather than allow a physician with far more training than they have to participate in the care of the patient. They think they are good enough. But why settle for good enough when you can have the best?
Nice theory, but their powers that be are hell-bent. It's ridiculous to have to get a doctoral degree to do CRNA; but that's the way they are going, and can't see it being stopped. Doctoral is fine if you are going to teach the theory and practice of what you are doing as a CRNA, NP, whatever in nursing in the university. Other than that, it's expensive and nonsensical. But again, there seems to be no reasoning with these people.
Not a CRNA, but as a RN or whatever, I want all the help that I can get as my patients need it. It's not about me, it's about them. The patients have to come first, and I don't get pissy until there is clear evidence that they are not coming first.
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Solve this thing by making it a rule that if you are an advanced nurse practitioner of any sort, you must introduce yourself as a nurse practitioner--even if you are a CRNA, b/c you are a nurse practitioner of anesthesia. Hospitals and organizations need to say, if you are presenting yourself to a patient and/or pt's family, you must refer to your self as nurse practitioner--regardless of how many letters are after your name. Why are people getting letters after their name just to get them?
It's like these organizations and people do not really understand the true point of continuing your education. It's not for letters, it's supposed to be to increase your understanding and effectiveness or for leadership purposes. I partly blame this crap on the educational systems that promote this junk to get more tuition.
It's like these organizations and people do not really understand the true point of continuing your education. It's not for letters, it's supposed to be to increase your understanding and effectiveness or for leadership purposes. I partly blame this crap on the educational systems that promote this junk to get more tuition.
At my hospital (military) only physicians are allowed to introduce themselves as "doctor". The docs have big blue "physician" badges while the CRNAs have orange "provider" badges, RNs are red, PAs yellow, EMTs/LPNs green. Almost everyone except the RNs and EMTs wear the white coats and I've seen the active duty CRNAs introduce themselves by rank such as "Hi, I'm Captian/Major X and I'll be your anesthesia provider today." It's kind of misleading because by using their rank, they mask their actual healthcare profession. I've never seen active duty physicians introduce themselves by rank though.
While I don't really think it's dangerous that CRNAs are doing this, I think it's definitely misleading and wrong. I don't understand why they're trying to hide it. Nursing is a very noble and arguably prestigious profession that they should be proud of; especially being a nurse anesthetist which is very elite in the nursing world.
Patients deserve to know exactly who is treating them and who each member of the team is. Before I was in the medical field and didn't even know CRNAs existed, all I knew was EMTs, nurses, and doctors honestly. Back then if a CRNA introduced them self as doctor or captain/major or anesthesia provider, I'd totally assume they're an anesthesiologist.
So in the clinical setting, it should always be absolutely clear who everyone is and what they're job is. As for outside of the hospital, a DNP, PhD, or even a stupid honorary doctorate loser can introduce themselves as doctor X.
While I don't really think it's dangerous that CRNAs are doing this, I think it's definitely misleading and wrong. I don't understand why they're trying to hide it. Nursing is a very noble and arguably prestigious profession that they should be proud of; especially being a nurse anesthetist which is very elite in the nursing world.
Patients deserve to know exactly who is treating them and who each member of the team is. Before I was in the medical field and didn't even know CRNAs existed, all I knew was EMTs, nurses, and doctors honestly. Back then if a CRNA introduced them self as doctor or captain/major or anesthesia provider, I'd totally assume they're an anesthesiologist.
So in the clinical setting, it should always be absolutely clear who everyone is and what they're job is. As for outside of the hospital, a DNP, PhD, or even a stupid honorary doctorate loser can introduce themselves as doctor X.
Dr. Bill Cosby (hon):
He'll be "providing" your anesthesia today.
He'll be "providing" your anesthesia today.
Dr. Bill Cosby (hon):
He'll be "providing" your anesthesia today.
Dude, that's twice now. William H. Cosby, Jr, earned a substantive doctorate in education in 1976 from the University of Massachusetts - Amherst. He has a bunch of honorary degrees, but the Ed.D is the real thing.
The only other major actor with a graduate doctorate? Robert Vaughn, the Man from U.N.C.L.E., who earned his Ph.D. in communications from USC in 1970.
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