Don't Go into Anesthesiology

[BLADEMDA]

For any anesthesiologist who has worked with CRNAs, the results should come as no surprise. Though we hate to admit it, most of them are every bit as competent as MDAs. I wonder though how much of this equivalency is the result of the evolving nature of anesthesia. Are anesthesiologists and the ASA, in our relentless pursuit of patient safety, devaluing our own work? It was not that long ago that the practice of anesthesia was a tedious, tiresome, hands-on drudgery. Back before automated sphygmomanometers, the anesthesiologist had to crouch under the drapes to measure the blood pressure by listening for distant Korotkoff sounds in a noisy operating room. Good luck if the patient was hypotensive or the arms were not accessible. In the days before capnography, anesthesiologists were literally tethered to the patient by a precordial or esophageal stethoscope to ensure the airway was patent. Nowadays with all the automated monitoring in the operating room, an anesthesiologist is free to walk around the OR to chat up the surgeons and the nurses or just to stretch his legs.

Anesthesia is so safe now that anesthesia attendings feel comfortable leaving a CA 1 resident in the OR by himself to do a case while he goes to another room nearby to teach a different resident. The safety profile of anesthesia is so high that it takes thousands of cases to find any meaningful rates of complications. Take for instance the recent quick demise of rapacuronium. The FDA tested this new muscle relaxant on thousands of patients before approving its use. It was not until millions of doses had been given that the FDA realized there were serious side effects of the drug and had it quickly pulled from the market. Succinylcholine would not stand a chance of approval today.

Is it any wonder that, despite the ASA's demagoguery of CRNAs, their work holds up just as well as anesthesiologists. I fear it will get more difficult in the future for anesthesiologists to justify our reimbursement levels when we can't prove that our skills are any more valuable than CRNAs', not when technology has leveled the playing field for everybody.

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[BLADEMDA]

My appeal to the ASA is to complete a study of their own. We need data to support the reality and well known fact that the majority of midlevels need help for a high acuity case. Hearts? Lungs? Brains? Aneurysms? The ASA knows these cases are beyond the practice scope of a solo CRNA. So prove it.

How about another study documenting Regional Anesthesia skills of new CRNA graduates? Nobody wants to do this to the AANA but we have no choice.

 

[maceo]

My appeal to the ASA is to complete a study of their own. We need data to support the reality and well known fact that the majority of midlevels need help for a high acuity case. Hearts? Lungs? Brains? Aneurysms? The ASA knows these cases are beyond the practice scope of a solo CRNA. So prove it.

How about another study documenting Regional Anesthesia skills of new CRNA graduates? Nobody wants to do this to the AANA but we have no choice.

forget the complex cases.. how about the asa 1 un anticipated difficult airway gone bad as we witnessed in kentucky at that endoscopy center. the crna was not supervised and supposedly medically directed by the gi doctor. outcome. the patient died. after a faile attempt at a cric. by the crna. How about the eye case that goes into vtach in the middle of the case. Blade these cases happen all the time everyday somewhere in america and an anesthesiologist is there dealing with the problem. its not necessarily the asa 3 o 4 patient that has problems. patient problems arise all the time.. how about explaining to those patients with bad outcomes that an anesthesiologist was too expensive. His/her medical knowledge and judgement was not needed. CRNAs are nurses. they are not medical professionals.

 

[InductionAgent]

What troubles me the most about Anesthesiology is that it is becoming more and more difficult for physicians to do their own cases. How am I suppose to practice and fine tune my skills and become a proficient provider after residency if I'm spending all day supervising CRNA's and doing pre-op evals?

This is an understandable concern. However, there are still physician-only groups that exist. If you limit your job applications to MD-only (or MD-heavy) groups, you will be able to do your own cases. This will necessitate excluding certain states from where you will live, as well as possibly accepting a lower income. The choice is yours.

In a worst-case scenario (in which CRNAs get universal independent practice rights and virtually every hospital is willing to credential them for such), anesthesiologists should still be able to earn as much as CRNAs. Groups already exist in which MDs and CRNAs practice in a "side-by-side" model independently. I believe there will also continue to be MD-only groups and CRNA-only groups, especially in larger cities.

I'm not 100% excited about the future of anesthesiology. I will continue to pay my ASA dues and contribute to ASA-PAC. However, I personally will be happier looking for ways to continue to be a competent anesthesiologist and to adapt to the poitical changes rather than expending an inordinate amount of time and money trying to fight the AANA and worrying about the future.

 

[Consigliere]

This is an understandable concern. However, there are still physician-only groups that exist. If you limit your job applications to MD-only (or MD-heavy) groups, you will be able to do your own cases. This will necessitate excluding certain states from where you will live, as well as possibly accepting a lower income. The choice is yours.

In a worst-case scenario (in which CRNAs get universal independent practice rights and virtually every hospital is willing to credential them for such), anesthesiologists should still be able to earn as much as CRNAs. Groups already exist in which MDs and CRNAs practice in a "side-by-side" model independently. I believe there will also continue to be MD-only groups and CRNA-only groups, especially in larger cities.

I'm not 100% excited about the future of anesthesiology. I will continue to pay my ASA dues and contribute to ASA-PAC. However, I personally will be happier looking for ways to continue to be a competent anesthesiologist and to adapt to the poitical changes rather than expending an inordinate amount of time and money trying to fight the AANA and worrying about the future.

Sounds great. I guess I'll stop supervising immediately.

 

[Sammich81]

So...in response to the thing I just posed with questions about practice...I should go work in a more remote area and bank more money?

 

[BLADEMDA]

forget the complex cases.. how about the asa 1 un anticipated difficult airway gone bad as we witnessed in kentucky at that endoscopy center. the crna was not supervised and supposedly medically directed by the gi doctor. outcome. the patient died. after a faile attempt at a cric. by the crna. How about the eye case that goes into vtach in the middle of the case. Blade these cases happen all the time everyday somewhere in america and an anesthesiologist is there dealing with the problem. its not necessarily the asa 3 o 4 patient that has problems. patient problems arise all the time.. how about explaining to those patients with bad outcomes that an anesthesiologist was too expensive. His/her medical knowledge and judgement was not needed. CRNAs are nurses. they are not medical professionals.

So, where are you studies? Anecdotal evidence is eactly what this specialty does not need at this time. While the AANA is busy spending money on promoting independent practice our eggheads are doing rat studies. There is a time for rat studies but not while your home burns to the ground. A full concerted effort from Academia is needed to refute the AANA claims. A dozens studies should do the trick and give the Trial Lawyers plenty of good evidence to use against Solo CRNAs. The way I see it is the ASA must stand for what is safest and Best for patient care. The studies must come soon or we are finished and rightfully so. If we add NO VALUE to patient care that can be proven in a study then we should be demoted to the field of Nursing.

If academia is too arrogant to bother with 6-12 such studies then we deserve to be buried by the AANA.
A war that is not fought can not be won.

Blade

 

[BLADEMDA]

The anesthesia care team is going away and with it many of the cush jobs these type of lazy MDAs are used to. I have no respect for those who would limit or otherwise control my practice because they do not want to compete. I have even less for those who spew the lies about pt safety (like blade) when they know full well what they are doing.

I believe it is entirely possible for CRNAs and MDAs to work together (in their OWN ROOMS) in a grp and benefit from each others experience. *gasp* yes there are many things CRNAs can teach full fledged MDAs, dont kid yourself. Oddly, this is exactly how I practice now. No stuporvision no medical direction and no controlling of my practice, simply a grp of CRNAs and MDAs who all run their own rooms. Welcome to the future.

Quote:
Originally Posted by drnurse
So you believe the Anesthesiology profession should be phased out, and replaced by CRNA's?

 

[sevoflurane]

The anesthesia care team is going away and with it many of the cush jobs these type of lazy MDAs are used to. I have no respect for those who would limit or otherwise control my practice because they do not want to compete. I have even less for those who spew the lies about pt safety (like blade) when they know full well what they are doing.

I believe it is entirely possible for CRNAs and MDAs to work together (in their OWN ROOMS) in a grp and benefit from each others experience. *gasp* yes there are many things CRNAs can teach full fledged MDAs, dont kid yourself. Oddly, this is exactly how I practice now. No stuporvision no medical direction and no controlling of my practice, simply a grp of CRNAs and MDAs who all run their own rooms. Welcome to the future.

Quote:
Originally Posted by drnurse
So you believe the Anesthesiology profession should be phased out, and replaced by CRNA's?

It is this type of overconfidence that kills people. Wow.

"Benefit from each others experience..." are you serious? Do a residency and then let's compare notes.

Geesh.. so glad I don't have to deal with this crap. Unbelievable.

 

[335230]

ok

 

[BLADEMDA]

Hey Blade:

Maybe I would be happier in primary care?

Doc, I have a pain here in my arm. My skin is blue. I am upset. Call my family members. How do we get these medications for free? Do you have samples ? Why did I see the sign saying that you won't take Medicare- you are "greedy"...

Doc, can you sign this form for disability? I have back pain and I need meds now ...

It could be worse man, that field is really important in my opinion but brutal. Running a fixed practice with increasing costs but decresing payments and then competing with "Ready Clinics" with NP's who don't know what they are doing at all and order scans on everything.

Thats help me put things in context Master Blade.

You are welcome. Wait until you finish Residency and see how the other Specialists really have it? That doesn't include Family Practice or General Internal Medicine. I hope you find true happiness, Dr. Find Happy.

Blade

 

[Bertelman]

So, where are you studies? Anecdotal evidence is eactly what this specialty does not need at this time. While the AANA is busy spending money on promoting independent practice our eggheads are doing rat studies. There is a time for rat studies but not while your home burns to the ground. A full concerted effort from Academia is needed to refute the AANA claims. A dozens studies should do the trick and give the Trial Lawyers plenty of good evidence to use against Solo CRNAs. The way I see it is the ASA must stand for what is safest and Best for patient care. The studies must come soon or we are finished and rightfully so. If we add NO VALUE to patient care that can be proven in a study then we should be demoted to the field of Nursing.

If academia is too arrogant to bother with 6-12 such studies then we deserve to be buried by the AANA.
A war that is not fought can not be won.

Blade

Instead of blaming this on academia, I think you should join an academic practice and conduct the studies yourself. A couple months ago you were looking for a new employer. Here's your chance.

 

[Ronin2258]

Hey Blade:

Maybe I would be happier in primary care?

Doc, I have a pain here in my arm. My skin is blue. I am upset. Call my family members. How do we get these medications for free? Do you have samples ? Why did I see the sign saying that you won't take Medicare- you are "greedy"...

Doc, can you sign this form for disability? I have back pain and I need meds now ...

It could be worse man, that field is really important in my opinion but brutal. Running a fixed practice with increasing costs but decresing payments and then competing with "Ready Clinics" with NP's who don't know what they are doing at all and order scans on everything.

Thats help me put things in context Master Blade.

This is what would make me want to open a major artery about the primary care specialties. Every experience I have had with IM, FP, etc. has been poor as both a student and dealing with as a housestaff. I would dread going to work in the morning to deal with long hours of social work, the neverending lectures given by people whose idea of lectures is to copy the whole book onto powerpoint slides, and dealing with billing issues. >.<

I know I would NOT be happy in primary care. FindHappy's examples have been more the rules in the clinics I worked with and not the exceptions

 

[BLADEMDA]

Over the past 90 days the AANA has put out 2 studies "showing" CRNAs can practice SOLO safely and cost-effectively. Where has the ASA been the past 5 years? Where are the refudiating studies? They are essential in repudiating the AANA propaganda. In fact, I would say we won't survive as a specialty without them.

The AANA studies are an "in your face" approach to challenging the very core of the specialty. What will the response be? A letter from the ASA President?
Please. WE need the BEEF behind the letter. We need Avademic studies PROVING Solo CRNAs are inadequately prepared for Solo practice. Will the AANA repudiate the data? Question the validity in rural setting? Absolutely. But, our studies will be essential in showing the medical staff. surgeons and administrators that Solo CRN practice has been PROVEN to be dangerous at University hospitals. This will give many administrators pause; even CMS may then be reluctant to turn over anesthesia care to the local anesthesia nurse.

THe time has come for the Specialty to put up or shut up in terms of evidence. We pride ourselves on well controlled studies to validate our practice. From U/S use to early extubation post CABG we have data. But, on the most important subject of all we remain silent. The AANA has put every Resident and Academic Attending on notice: Put up or shut up.

Blade

 

[BLADEMDA]

Instead of blaming this on academia, I think you should join an academic practice and conduct the studies yourself. A couple months ago you were looking for a new employer. Here's your chance.

This isn't a one man show. It will take a concerted effort by several major tertiary centers to conduct a sound study. Thanks for the career advice.

By the way, I don't blame academia- I blame myself and those who came before me.

Blade

 

[InductionAgent]

Sounds great. I guess I'll stop supervising immediately.

My point is that some anesthesiologists are more driven by non-work lifestyle factors and for that reason are reasonably content supervising. On the other hand, many anesthesiologists who are more driven by at-work lifestyle factors choose to supervise as little as possible.

No anesthesiologists have to supervise CRNAs. They just need to be realistic about the sacrifices involved if they choose not to work with CRNAs, and decide what will make them happy. Most residents were willing to relocate wherever they matched for residency. If they want to do solo anesthesia, they should be equally willing to relocate to areas where that is possilbe. Otherwise, they should take ownership of their decision to supervise CRNAs, because they wanted the location and salary it brings.

 

[BLADEMDA]

My point is that some anesthesiologists are more driven by non-work lifestyle factors and for that reason are reasonably content supervising. On the other hand, many anesthesiologists who are more driven by at-work lifestyle factors choose to supervise as little as possible.

No anesthesiologists have to supervise CRNAs. They just need to be realistic about the sacrifices involved if they choose not to work with CRNAs, and decide what will make them happy. Most residents were willing to relocate wherever they matched for residency. If they want to do solo anesthesia, they should be equally willing to relocate to areas where that is possilbe. Otherwise, they should take ownership of their decision to supervise CRNAs, because they wanted the location and salary it brings.

Supervising is much harder than doing your own cases. Try covering 4-5 rooms correctly (preop, blocks, induction, emergence, breaks, etc) and you will find out.

 

[BLADEMDA]

We can complain about the past and current situation all we want. But, going forward what are we going to fo about it? We have waited far too long to address the AANA cancer in anesthesia. While a cure may not be possible we must put it in remission. This requires pain, sacrifice and planning on our part.

Since the truth is on our side and patient safety used to be of paramount importance to the specialty the time has come to stop turning a blind eye to this plague on the USA. Academia must take the bull by the horns and tackle the problem. We still have the resources and manpower to do this; but, do we have the vision and the courage?

Without a concerted effort to address this cancer the patient has no long term viability.

Blade

 

[PL32]

The time has come to forget "political correctness" and take the fight to the AANA. The ASA needs to sponsor studies showing the number of "interventions" in CRNA cases at our major medical centers. Take ASA 3 and 4 cases and show the "problems" that the CRNAs fail to adequately address without attending intervention. From intubation, double lumen tube placement, lack of skill for line placement, bronchospasm, etc. the data exists which will clearly show that CRNAs lack the skill and knowledge as a group to practice solo.

The time has long past to "prove" in an ASA backed study that Solo CRNA is both dangerous and costly in terms of morbidity/consultations. The militant AANA must be countered or the war is lost.

As an ASA member I strongly encourage a "mock" administration of our past year's Written and Oral Boards to a select Group of 100 newly minted CRNAs. These CRNAs should have taken the AANA Union Board exam within the last 30-45 days so the anesthesia nurses can't say the CRNAs weren't prepared. Then, publish the results of that study. In addition, a study needs to be done using our computer data based listing "interventions" with CRNA care in anesthetics. I am begging those in power to take action now while there is still time for this specialty.

I hope there is still suifficient time and energy left to save this Medical Specialty from the Community College Graduate with a Bridge degree.

jesus christ can someone in charge please listen to people like Blade and do something before perception of reality drives government policy. Everybody knows that truth DOES NOT MATTER. Even in court, it's about WHAT YOU CAN PROVE! Because perception is reality these people at the AANA are going to make irrevocable damage to our field. So to all you impotent researchers out there publishing useless data, PLEASE, try to publish something that will actually save our jobs. WE ALL KNOW how much these people screw up, and how often. We now need to actively study it. Do it in the name of patient safety, couch the study that way, but get it done. I don't give a rat's ass about studies on IL1 or whatever. Study something worth MONEY and JOB SECURITY!

 

[PL32]

Sounds great. I guess I'll stop supervising immediately.

I'm not sure if you're being sarcastic or not here, but this is no time for jokes. If you're being coy about this because you like your job "supervising" then you are part of the problem and I have nothing but disdain for you. I think it's time for us to get angry and stop clowning around.

 

[IlDestriero]

I'm not sure if you're being sarcastic or not here, but this is no time for jokes. If you're being coy about this because you like your job "supervising" then you are part of the problem and I have nothing but disdain for you. I think it's time for us to get angry and stop clowning around.

Strong words chief, do you think we should all quit and work for MD only groups? Maybe we should just fire the CRNAs and close 1/2 the ORs? Someone's supervising your ass as well. I have time to teach residents and fellows because I can, usually, count on the CRNA to not assassinate the kids in my other room. Have disdain for me as well?

 

[Mman]

The militant Nurses are always claiming they are "equivalent" to a Board Certified Anesthesiologist. Let them enter the study and validate the claim.
Never underestimate the arrogance of a militant anesthesia nurse.

I would actually pay $$$ to watch a CRNA go through the ABA written and oral boards, but I'd want to film the entire process so we could show it to Congress (including the final results).

It would be priceless.

They could claim their training and knowledge base are equivalent, and I would die laughing at the end result.

 

[Consigliere]

I'm not sure if you're being sarcastic or not here, but this is no time for jokes. If you're being coy about this because you like your job "supervising" then you are part of the problem and I have nothing but disdain for you. I think it's time for us to get angry and stop clowning around.

Have all the disdain you want. I see that you are a resident; get some real life experience under your belt, cowboy then you can cast aspersions all you like. Until then, focus on passing the ITE and becoming board certified - then we can talk.

 

[InductionAgent]

Supervising is much harder than doing your own cases. Try covering 4-5 rooms correctly (preop, blocks, induction, emergence, breaks, etc) and you will find out.

I know. I supervise about 1 of 5 days in my current job. It is definitely more challenging. That's why I think the potentially increased income is about the only redeeming factor for supervision. Other people may enjoy the whole management/being in charge thing, but in my opinion it's overrated. I prefer having more complete control of the patient's anesthetic in a solo setting than partial control of multiple anesthetics while supervising.

 

[BLADEMDA]

I would actually pay $$$ to watch a CRNA go through the ABA written and oral boards, but I'd want to film the entire process so we could show it to Congress (including the final results).

It would be priceless.

They could claim their training and knowledge base are equivalent, and I would die laughing at the end result.

Quote:
Suggesting that this patient preference be pushed aside on the basis of flimsy analytics is irresponsible and is reminiscent of the “scientific studies” purchased by the tobacco industry to demonstrate the safety of tobacco. Americans understand the value of physician care, just as we saw through the false reports that promoted cigarettes.

"You mean like the Silber study by the ASA (which originally was NOT about anesthesia mortality whatsoever). Even Longnecker has discredited this study (which he participated in)."


"There is no evidence which shows improved outcomes in ACT practices or MDA only practices. None, nadda. You can be absolutely sure if there WAS any evidence for this or showing that there were more complications in ANYWAY with CRNA only practice the ASA would have long since published it. Not to mention hospitals and surgeons would have long since abandoned working with Solo/indep. CRNAs to protect their patients. Something else which has not happened and, in fact exactly the opposite is happening. There is MORE indy/autonomous CRNA practice than ever."



"ASA, I expected better but clearly you do not have anything solid to offer. Every study ever done shows no difference in ANYTHING. No study ever done shows MDA involvement changes ANYTHING".

You lose.

Militant CRNA

 

[IlDestriero]

:troll:

*CRNA troll deleted by mod*

:troll:

 

[cfdavid]

I don't want to get into too many specifics because I want to preserve my annonymity.

But, I can tell you at my institution, there are plenty of surgeons whom are getting mighty sick of CRNA's..... There's just SO much variability between them, some being pretty awful and others being very good at what they do.

I'm not making this sh.t up either. Just commenting on the overall "environment" from what I'm sensing thus far being a newly minted long-white coat.....

 

[BLADEMDA]

I don't want to get into too many specifics because I want to preserve my annonymity.

But, I can tell you at my institution, there are plenty of surgeons whom are getting mighty sick of CRNA's..... There's just SO much variability between them, some being pretty awful and others being very good at what they do.

I'm not making this sh.t up either. Just commenting on the overall "environment" from what I'm sensing thus far being a newly minted long-white coat.....

Your post is "dead-on" (pun intended). The CRNA "product" is inconsistent and can be quite shoddy. Any manufacturer that produced this type of product (some good and some really bad) wouldn't be bragging about quality. These Chinese made products have a long way to go before reaching parity with the real thing. The time has come to study and publish these disparities among CRNA staff plus show the VALUE we add to patient care.

If we fail to do so the militancy will only grow and the AANA will attract even more militants into the filed like they are doing now. The time for political correctness has ended and either defend the specialty, prove value in good studies or abdicate the field to the militant nurses. IMHO, there should be a study every month for the next 5 years on this topic. That type of published data would really hurt the militant AANA agenda.

 

[BLADEMDA]

jesus christ can someone in charge please listen to people like Blade and do something before perception of reality drives government policy. Everybody knows that truth DOES NOT MATTER. Even in court, it's about WHAT YOU CAN PROVE! Because perception is reality these people at the AANA are going to make irrevocable damage to our field. So to all you impotent researchers out there publishing useless data, PLEASE, try to publish something that will actually save our jobs. WE ALL KNOW how much these people screw up, and how often. We now need to actively study it. Do it in the name of patient safety, couch the study that way, but get it done. I don't give a rat's ass about studies on IL1 or whatever. Study something worth MONEY and JOB SECURITY!

 

[lakersbaby]

http://www.asahq.org/news/asanews080510.htm

my question is when the ASA puts out statements like these do they reach anyone who can actually make a difference in this fight? in the same way are any of the politicians even paying attention to these CRNA studies? I feel like its more the political power and money that the AANA has that advances the CRNAs rather than these meaningless studies and statements that keep coming out from either side.

 

[BLADEMDA]

http://www.asahq.org/news/asanews080510.htm

my question is when the ASA puts out statements like these do they reach anyone who can actually make a difference in this fight? in the same way are any of the politicians even paying attention to these CRNA studies? I feel like its more the political power and money that the AANA has that advances the CRNAs rather than these meaningless studies and statements that keep coming out from either side.

Uh, no. The studies do matter as they are the propganda tools of the AANA. The more bogus studies then the more propaganda to show legislators and administrators. Yes, their effectiveness is limited to a degree but the studies can be used to push for more opt-outs and the complete elimination of supervision. This will affect Anesthesiology. I guarantee it.

 

[lakersbaby]

Uh, no. The studies do matter as they are the propganda tools of the AANA. The more bogus studies then the more propaganda to show legislators and administrators. Yes, their effectiveness is limited to a degree but the studies can be used to push for more opt-outs and the complete elimination of supervision. This will affect Anesthesiology. I guarantee it.

yea you are right, im just saying that the statements the ASA makes should have some impact but the AANA just has a lot more political power to influence these people towards what they are trying to do with their crap studies.

 

[BLADEMDA]

yea you are right, im just saying that the statements the ASA makes should have some impact but the AANA just has a lot more political power to influence these people towards what they are trying to do with their crap studies.

Here is why going into 'Anesthesiology' is a gamble. The leadership doesn't want to anger a certain portion of the membership which makes a fortune off supervising CRNAs from home or the golf course. These Attendings like the status quo and quasi Independent CRNA practice; in fact, the AANA studies bolster the argument that all you need is one or two MD (A)'s and 20 CRNAs to run a hospital effectively and safely. Supervision need only be minimal.

Unfortunately, the ASA has largely ignored this issue due to the financial contributions of these multi-millionaires. Rather than face the issue of requiring in house supervision as part of ASA recommendations and peer reviewed studies (we don't have them yet) the ASA has largely side-stepped the issue or walked a narrow line.

However, the AANA attacks have been relentless and fierce. Academia doesn't see the issue or could care care less. The arrogance of "I don't care what happens to private practice Anesthesiology" will doom the specialty. Only a coordinated response from Academia and the ASA can alter the course we are on. I know where the road leads and you won't like the drop off the cliff.

Hence, until the ASA recognizes that playing nice with the AANA is a failed strategy and those who refuse to adequately supervise midlevels are a detriment to the profession I strongly caution against going into this field. If and when the coordinated response/effort begins by those in power the AANA doesn't stand a chance. The data will come from Academia in such large amounts that Solo CRNA practice will be exposed for what it truly is: Dangerous

 

[deleted339604]

Here is why going into 'Anesthesiology' is a gamble. The leadership doesn't want to anger a certain portion of the membership which makes a fortune off supervising CRNAs from home or the golf course. These Attendings like the status quo and quasi Independent CRNA practice; in fact, the AANA studies bolster the argument that all you need is one or two MD (A)'s and 20 CRNAs to run a hospital effectively and safely. Supervision need only be minimal.

Unfortunately, the ASA has largely ignored this issue due to the financial contributions of these multi-millionaires. Rather than face the issue of requiring in house supervision as part of ASA recommendations and peer reviewed studies (we don't have them yet) the ASA has largely side-stepped the issue or walked a narrow line.

However, the AANA attacks have been relentless and fierce. Academia doesn't see the issue or could care care less. The arrogance of "I don't care what happens to private practice Anesthesiology" will doom the specialty. Only a coordinated response from Academia and the ASA can alter the course we are on. I know where the road leads and you won't like the drop off the cliff.

Hence, until the ASA recognizes that playing nice with the AANA is a failed strategy and those who refuse to adequately supervise midlevels are a detriment to the profession I strongly caution against going into this field. If and when the coordinated response/effort begins by those in power the AANA doesn't stand a chance. The data will come from Academia in such large amounts that Solo CRNA practice will be exposed for what it truly is: Dangerous

Where does the road lead?

 

[BLADEMDA]

Where does the road lead?

 

[BLADEMDA]

Is this the ship you want to be on?

 

[igottaquestion]

But if we all agree it is true that CRNA solo practice is "dangerous", then the "data" to back this up will come from increased deaths/complications when they go solo on sick patients.

 

[BLADEMDA]

http://www.aana.com/AboutAANA.aspx?id=245

Read and Learn. You must understand the enemy to defeat him.

 

[BLADEMDA]

But if we all agree it is true that CRNA solo practice is "dangerous", then the "data" to back this up will come from increased deaths/complications when they go solo on sick patients.

No. I was thinking more along the lines of the following:

1. Documentation of attending intervention to save the CRNA's arse.

2. Documentation of inability to perform Regional Anesthesia in a timely manner

3. Documentation of inability to pass Resident exams/written Boards

4. Documentation of medical mistakes caught by the attending

I am sure our "braintrust" can come up with many more scenarios. Remember, the AANA isn't claiming CRNA equivalence to Residents but rather Attendings in all areas/scope of practice.

 

[BLADEMDA]

Here is an example:

All anesthesia providers regardless of degree will sit for annual exam to asses knowledge and competency in anesthesia. This exam is mandatory for employment at DA U.

There you go. Now we have data to asses CRNAS vs. Attendings vs. Residents and it is 100% legal plus required. Then, PUBLISH the data!

The Chairperson

 

[BLADEMDA]

Here you go:

100 senior SRNAS (final month of training) vs. 100 Residents (final month of training).

1. Successful intubation on first attempt

2. Successful Blocks on 1 or 2 attempts

3. Advanced Airway skills (use dummy)

4. Line placement (first or second attempt)

This data can be gathered rather easily at 1 or 2 large tertiary programs. The public deserves to know the results since the AANA is claiming EQUIVALENCY.

The Chairpersons should require such an exam for all Residents and SRNAs rotating at the institution. Now, publish the results.

 

[BLADEMDA]

Since the newly minted CRNA is basically barely competent in many instances the data would be quite refreshing to those of us who have seen the truth.

It is time the public and legislators get the truth as well.

Better get the team of lawyers in advance as the AANA will do everything possible to block/invalidate the study. They can't have the truth getting out as it damages the agenda.

 

[BLADEMDA]

I have no doubt that once academia puts its mind to getting the data on this very important "safety" issue in anesthesia the number of studies will be more than adequate to refute the AANA's junk science.


If the School of Nursing wants to use the Department's resources the Chairperson can demand certain
stipulations:

1. Testing of SRNAs by Attending staff

2. Documentation of safety at end of training

3. Skill level at end of training

Why agree to train SRNAs with Attending MDs and not get hard data for publication? For the *****s who don't want to damage relations between NUrsing and Medicine I have news for you: You are too late. All we can hope for is that Academia cares about the survival of the specialty and your future careers more than the free labor the SRNAS provide the institution.

 

[BLADEMDA]

 

[BLADEMDA]

So, Where is the data from Hopkins proving equivalency or better yet, lack thereof?

 

[BLADEMDA]

 

[BLADEMDA]

All warfare is based on deception



Sun Tzu 6th Century B.C.

AANA 2010

 

[Coastie]

Why is any institution training them in regional, adv airway, or line placement?

None of those (and more) are nursing.

Here you go:

100 senior SRNAS (final month of training) vs. 100 Residents (final month of training).

1. Successful intubation on first attempt

2. Successful Blocks on 1 or 2 attempts

3. Advanced Airway skills (use dummy)

4. Line placement (first or second attempt)

This data can be gathered rather easily at 1 or 2 large tertiary programs. The public deserves to know the results since the AANA is claiming EQUIVALENCY.

The Chairpersons should require such an exam for all Residents and SRNAs rotating at the institution. Now, publish the results.

 

[IlDestriero]

Why is any institution training them in regional, adv airway, or line placement?

None of those (and more) are nursing.

They don't do any of these things where I am faculty. I guess some staff may let them try an IV or Aline, but that's about it.

 

[lakersbaby]

Is this the ship you want to be on?

although this is a serious topic about all our futures, blade you are freakin hilarious