Enough Anesthesiologist vs CRNA threads, let's support AAs

[neusu]

Guys, I know this is true to your hearts.

1) CRNA under nursing board - trying to get independent practice. Preventing AAs from practicing

2) AAs under medicine board - happy to do whatever we want. Trying to get in to all states to help us

Why don't we take this up at the AAA. or AMA? I'm merely a surgeon but this is the obvious solution to the CRNA issue (much like PA is to NP).

Thoughts, criticisms. Personally, I'd like to see an action plan on our part, as physicians, to expand AA licensure. They really are the best replacement for our current system.

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[Spinach Dip]

I know! Let's just ignore the problem for another 10 years and hope it goes away!

[/sarcasm]

 

[Spinach Dip]

But seriously folks, there really needs to be some sort of effort to limit the scope of CRNA's practice. Restrict them to only ASA 1 and 2 patients, or only to the simplest of procedures.

Or, allow them to practice independantly, but ONLY IF they allow themselves/their employers to be sued for malpractice when the **** hits the fan.

 

[wjs010]

But seriously folks, there really needs to be some sort of effort to limit the scope of CRNA's practice. Restrict them to only ASA 1 and 2 patients, or only to the simplest of procedures.

Or, allow them to practice independantly, but ONLY IF they allow themselves/their employers to be sued for malpractice when the **** hits the fan.

are you saying they are completely immune to being sued? that sounds like a great gig lol

 

[007livesforever]

How do you determine the Asa class? Really it is so flexible I have seen many that I consider a 2 listed as a 3 and vice versa. As for being sued they can be and are.

 

[neusu]

I know! Let's just ignore the problem for another 10 years and hope it goes away!

[/sarcasm]

Not ignoring it. It's like introducing a new species to an environment to target a parasite. Let's face it. The CRNA business wouldn't be there without us. They're attempting to devour us. Let's culture the AAs, who want a symbiotic relationship, and they can fight eachother when the AAs are strong enough.

Outside Anesthesia, PAs have a strong presence. I much prefer PAs. They are much more flexible with respect to licensing and their individual personal restrictions on practice (e.g. there aren't separate licenses for pediatrics, OR training, etc.).

 

[wjs010]

Not ignoring it. It's like introducing a new species to an environment to target a parasite. Let's face it. The CRNA business wouldn't be there without us. They're attempting to devour us. Let's culture the AAs, who want a symbiotic relationship, and they can fight eachother when the AAs are strong enough.

Outside Anesthesia, PAs have a strong presence. I much prefer PAs. They are much more flexible with respect to licensing and their individual personal restrictions on practice (e.g. there aren't separate licenses for pediatrics, OR training, etc.).

Your idea is genius though. Don't PA have more rigorous academic standards too?

 

[neusu]

Your idea is genius though. Don't PA have more rigorous academic standards too?

Haven't looked in to this. Neither a PA nor an NP can replace an MD. Both should have to be supervised by an MD. Look at their clinical training, respective to an MD straight out of medical school, and you'll see a huge difference between MD and ancillary staff. That always begged the question in my mind with you guys, when I rotated on GAS. I wasn't interested in GAS, but I had co-M4s who were. You were more than comfortable letting an SNRA-1mo run a room, but an M4, no way! WTF!?

 

[wjs010]

Haven't looked in to this. Neither a PA nor an NP can replace an MD. Both should have to be supervised by an MD. Look at their clinical training, respective to an MD straight out of medical school, and you'll see a huge difference between MD and ancillary staff. That always begged the question in my mind with you guys, when I rotated on GAS. I wasn't interested in GAS, but I had co-M4s who were. You were more than comfortable letting an SNRA-1mo run a room, but an M4, no way! WTF!?

That's interesting. Yea no question PA or CRNA don't even come close to MD. I mean everyone knows that. They know what they are getting into by NOT going to med school and still trying to practice independently. I like spinach dips solution for that 😀

 

[neusu]

Spinach dip solutioun?

FWIW. All NP will be DNP in the future. There will be NP residencies. NP will advocate to apply to ACGME residency. This is coming..

 

[GaseousClay]

I don't understand all the institutions that have Anesthesia residents and SRNAs what a massive conflict of interest. Is it all motivated by money? Its shameful for our profession.

 

[wjs010]

Spinach dip solutioun?

FWIW. All NP will be DNP in the future. There will be NP residencies. NP will advocate to apply to ACGME residency. This is coming..

You're joking right? How could a NP possibly get into an ACGME residency? Yes, I have seen spinach dip ( a poster in this thread) say the best way to deal with CRNA is to let them practice independently and make them liable and able to be sued. That will weed them out pretty fast, hypothetically.

 

[neusu]

You're joking right? How could a NP possibly get into an ACGME residency? Yes, I have seen spinach dip ( a poster in this thread) say the best way to deal with CRNA is to let them practice independently and make them liable and able to be sued. That will weed them out pretty fast, hypothetically.

That is their goal. The writing is on the wall my friend, they are creating another "medical school." While DOs are acceptable, DNPs will never be, so far as I'm concerned, unless their curriculum dramatically changes.

That being said, no one has addressed the M4 vs SRNA issue.

 

[wjs010]

I noticed what you said about ms4 and I cannot believe it. Highly hypocritical. Good news is , you'll be a neurosurgeon so you won't have to worry about this, right?

 

[countingdays]

That is their goal. The writing is on the wall my friend, they are creating another "medical school." While DOs are acceptable, DNPs will never be, so far as I'm concerned, unless their curriculum dramatically changes.

That being said, no one has addressed the M4 vs SRNA issue.

It's safer to leave the srna in a room than the m4 because the srnas are trained in the basic tasks of managing an anesthetic. M4s obviously have a superior knowledge base but the practical stuff is learned later. Some places go further in training med students about the nob-turning and drug pushing, but most don't.

 

[neusu]

I noticed what you said about ms4 and I cannot believe it. Highly hypocritical. Good news is , you'll be a neurosurgeon so you won't have to worry about this, right?

I'll still have SRNAs in my room..

It's safer to leave the srna in a room than the m4 because the srnas are trained in the basic tasks of managing an anesthetic. M4s obviously have a superior knowledge base but the practical stuff is learned later. Some places go further in training med students about the nob-turning and drug pushing, but most don't.

This is a facility issue. There is no reason that you can't spend a day, or multiple days, training an MS4 SubI to turn the knobs/push the white stuff/call the attending. I, personally, was pretty offended that you guys gave these students who were essentially undergrads (if you want to count the 1st 2-years of med school as a masters so be it, I do) with a minimal understanding of the drugs they were using/anatomy they were dealing with the farm. WTF?

Perhaps a CRNA or SNRA can step in.. Anyone I've asked can not explain it

 

[chmd]

It's not allowed to staff multiple rooms with a medical student staffing one of them. SRNAs are treated as residents in this regard.

 

[pgg]

I don't understand all the institutions that have Anesthesia residents and SRNAs what a massive conflict of interest. Is it all motivated by money? Its shameful for our profession.

As in all things CRNA-related ... there's a wide, wide range of SRNA programs from the top rated schools to the downright scary strip-mall CRNA mills.

My residency program (military) has a SRNA program. There was never a conflict. None of the residents ever lost cases or procedures to them. Residents got scheduled first, weighted toward complex cases. There was sometimes a SRNA on the block team but the only time the SRNA drove a needle was if there were too many simultaneous blocks for the residents to do. SRNAs still did blocks though and most graduated with basic competence with the major PNBs. SRNAs didn't rotate through the pain clinic and never did interventional pain procedures. The SRNA program at my residency institution was actually pretty malignant. Some of that was probably just the usual nurse-eating-nurse abuse, but some was genuine shape-up-or-you're-out motivation.

I've never in my life seen a SRNA-1mo left to run a room alone. That's insane. Hell, in the military, new CRNA graduates are designated GRNAs (graduate-RNAs) for a while and are still supervised. The military is different though. As Blade mentioned in the other thread, the military CRNA programs are among the strongest in the country and produce really good CRNAs. Part of that is because there's no tuition and students actually can and do get kicked out for academic reasons. Part is because they're trained with the mindset that they'll be deployed to violent and austere places, alone, and future independence may be necessary.

I've posted about this before, and my feelings and misgivings haven't really changed. I think the military, and our practice of giving great training to CRNAs with the expectation that they'll be capable of full independent practice (albeit for managing trauma in young, healthy, prescreened military servicemembers overseas), is largely at fault for the independence problem in the civilian world. The AANA holds up the military as "proof" that unrestricted, unlimited, totally independent CRNA practice is safe, even though their implied premise is untrue - they don't get ASA 3/4 patients, or complicated surgeries, nothing in the chest, no heads, no complicated OB, case selection is triaged through an anesthesiologist scheduler, etc. I think the independent CRNA problem is our fault, mostly. But the military doesn't have enough anesthesiologists to meet its operational/deployment needs, so CRNAs fill the gaps. It's been that way for decades. The Navy isn't going to recruit and hire another 200 anesthesiologists to the tune of $80 million per year. The Army won't hire another 400-500. Maybe we should, but we won't. I don't know what the solution is, so I guess that makes me part of the problem.

 

[neusu]

As in all things CRNA-related ... there's a wide, wide range of SRNA programs from the top rated schools to the downright scary strip-mall CRNA mills.

My residency program (military) has a SRNA program. There was never a conflict. None of the residents ever lost cases or procedures to them. Residents got scheduled first, weighted toward complex cases. There was sometimes a SRNA on the block team but the only time the SRNA drove a needle was if there were too many simultaneous blocks for the residents to do. SRNAs still did blocks though and most graduated with basic competence with the major PNBs. SRNAs didn't rotate through the pain clinic and never did interventional pain procedures. The SRNA program at my residency institution was actually pretty malignant. Some of that was probably just the usual nurse-eating-nurse abuse, but some was genuine shape-up-or-you're-out motivation.

I've never in my life seen a SRNA-1mo left to run a room alone. That's insane. Hell, in the military, new CRNA graduates are designated GRNAs (graduate-RNAs) for a while and are still supervised. The military is different though. As Blade mentioned in the other thread, the military CRNA programs are among the strongest in the country and produce really good CRNAs. Part of that is because there's no tuition and students actually can and do get kicked out for academic reasons. Part is because they're trained with the mindset that they'll be deployed to violent and austere places, alone, and future independence may be necessary.

I've posted about this before, and my feelings and misgivings haven't really changed. I think the military, and our practice of giving great training to CRNAs with the expectation that they'll be capable of full independent practice (albeit for managing trauma in young, healthy, prescreened military servicemembers overseas), is largely at fault for the independence problem in the civilian world. The AANA holds up the military as "proof" that unrestricted, unlimited, totally independent CRNA practice is safe, even though their implied premise is untrue - they don't get ASA 3/4 patients, or complicated surgeries, nothing in the chest, no heads, no complicated OB, case selection is triaged through an anesthesiologist scheduler, etc. I think the independent CRNA problem is our fault, mostly. But the military doesn't have enough anesthesiologists to meet its operational/deployment needs, so CRNAs fill the gaps. It's been that way for decades. The Navy isn't going to recruit and hire another 200 anesthesiologists to the tune of $80 million per year. The Army won't hire another 400-500. Maybe we should, but we won't. I don't know what the solution is, so I guess that makes me part of the problem.

Thanks for your post.

 

[Spinach Dip]

Yes, I have seen spinach dip ( a poster in this thread) say the best way to deal with CRNA is to let them practice independently and make them liable and able to be sued. That will weed them out pretty fast, hypothetically.

Hi.

My basic idea is this: If they want to practice independantly like MDs can, let 'em! But then, they (or their employers) also have to be responsible for their actions.

I know. Crazy idea.

 

[wjs010]

Hi.

My basic idea is this: If they want to practice independantly like MDs can, let 'em! But then, they (or their employers) also have to be responsible for their actions.

I know. Crazy idea.

But why aren't they responsible for their actions now? I like your idea

 

[007livesforever]

They are, there are multiple examples.

 

[countingdays]

Academic chairmen aren't reading this thread. I'm not in a position to convert my srna program to an AA program because I don't have one. If you want useless proclamations of support for increasing the number of AAs in training, then I so proclaim.

 

[IlDestriero]

They need to make a bigger coordinated push to get licensed in all 50 States. There was talk about this it the highest levels of the ASA a couple years ago, but I've not seen any real progress. Another reason to question support of the ASA.
To those that would say that that's heresy and ludicrously suggest that is the equivalent of stealing from other anesthesiologists, you should determine for yourselves if they are good stewards of your hard earned money. I'd be better off giving to my state PAC. There's a reason I didn't donate anything for years. They were sitting in the corner sucking their thumbs and watching it all go south.
If they want more money from the rank and file they need to rally the troops behind specific battles and wage effective war. So many anesthesiologists aren't even members, let alone donors.
And if income drops significantly, that will be the one of the first expenses to be cut.

 

[jwk]

They need to make a bigger coordinated push to get licensed in all 50 States. There was talk about this it the highest levels of the ASA a couple years ago, but I've not seen any real progress.

All it takes is time and money. Getting anything through any state legislature is a royal PIA. Any of you who have been to the ASA Legislative Conference and made congressional visits, or are active politically in your home states, already know the wheels turn very slowly.

There is no national license for any medical profession - each and every license is a state issue. There are a number of states with proposed AA legislation this year. Sometimes, like Missouri, it gets through on the first try. NC and FL took three tries. If a legislature has a two year cycle, it can only be proposed once every two years.

And of course CRNA's fight any and all AA legislation. At the push of the "enter" key, 40,000 emails go out to every CRNA in the country letting them know about the latest AA expansion possibilities and to start their email train.

For those of you in states that have AA's that haven't started using them, and are still using solely CRNA's - what's the problem?

 

[IlDestriero]

If they (the ASA) are making progress they need to champion it better.

 

[gasdoc77]

Does anyone have a link to which states allow AA's?

 

[jwk]

Does anyone have a link to which states allow AA's?

https://aaaa.memberclicks.net/assets/map of aa work states january 2014 low rez.pdf

 

[likeaboss]

There was an AA licensure bill for California proposed by State Senator Leland Yee SB 410, proposed last year but it was killed on Feb 3, 2014 for some reason. Anybody know why / how?

Either way, It's a shame, passing this bill in a state as big as CA would probably get AAs one step closer to critical mass...

 

[MDforMee]

I'm just a masters student who wants to attend medical school in the near future, but I went to nursing school and saw what they're "teaching" there. I don't like saying it, but many nursing faculty and administrators harbor militant and occasionally hostile attitudes/opinions of doctors. I get along well with most nurses, and enjoy the practice of nursing, too.

But, I would be lying if I said that they don't want more money, and have built up resentments against physicians due to what they believe is a perpetuated patriarchy within medicine's culture that has leveraged inequities against women in the workplace. They think that this manifests as glass ceilings, sexual harassment, and discrimination. Many lectures I attended in nursing school, and many things nurses said to me follow this school of thought.

Really, though, the bigger issue with nurses, and what they're most unwilling to look at, is the fact that many (women, especially) entering nursing haven't pursued rigorous science majors, or are vocationally minded and/or not that smart to begin with, etc etc, and because of this, they don't have the educational backgrounds or skills to pursue higher paying fields. That's it.

Nursing unions should focus more on outreach toward underrepresented groups (men, minorities), on increasing the scientific rigor of prerequisites and in the coursework, itself, and addressing nursing faculty shortages (that fill those spots with real world flunkies); it is also known and well published that nursing academia is more negative and caustic than any other academic field (in nursing academics, the popular opinion is that there is a lot of bullying, "evidence based" pseudoscience, non-collegiality, and so on... google it to learn more, it's pretty shocking).

Added to which there are hordes of girls that did junk majors like human development, or in one way or another screwed themselves out of the premed track, or don't have an interest in going into competitive fields like sales, business, what have you and are kind of floundering. In these ways, nursing has become an easy fallback. Nursing unions should focus on addressing issues in these areas before pushing for expanded scopes of practice and inflating their NANDA diagnosis list to step on primary care doctor's toes. What nursing union's efforts tell me is that they are only trying to increase their pay at others expense. It's a cheap tactic that masks a larger problem, and stuffing giblet headed nurses into roles where they infringe on physician's prescriptive authority and medical decision making will never help solve it.

Long story short, I wanted to become a CRNA, but didn't feel prepared to manage complex cases with the science background I had at the time. I dropped out of nursing school with a 4.0 GPA after 1 year of a 3 year program; as I prepared to leave nursing school, I worked and built up money (bombed my final semester, lol), then jumped ship. I transferred to UCLA for a biochemistry degree and now I'm doing a pharmacology and toxicology masters at UCD.

 

[Consigliere]

Good for you, buddy. Going for the brass ring instead of the low-hanging fruit like the majority of dumb nurses.

 

[drmwvr]

Hi.

My basic idea is this: If they want to practice independantly like MDs can, let 'em! But then, they (or their employers) also have to be responsible for their actions.

I know. Crazy idea.

What do you mean by 'responsible for their actions'? Not trying to be flippant, but in a way that's different from physicians? Individual malpractice policies are as common as independent practice CRNA's in opt out states.

 

[steven.a.smith]

What do you mean by 'responsible for their actions'? Not trying to be flippant, but in a way that's different from physicians? Individual malpractice policies are as common as independent practice CRNA's in opt out states.

It means, NO PHYSICIAN BACK UP. NONE!!.. Have a problem? COnsult another NURSE... Your profession wants to be independent? I too say GO FOR IT!!. But anything complicated arises, dont look for assistance from the physicians. I just hope patients make the right choices and presented transparent choices.

 

[steven.a.smith]

I'm just a masters student who wants to attend medical school in the near future, but I went to nursing school and saw what they're "teaching" there. I don't like saying it, but many nursing faculty and administrators harbor militant and occasionally hostile attitudes/opinions of doctors. I get along well with most nurses, and enjoy the practice of nursing, too.

But, I would be lying if I said that they don't want more money, and have built up resentments against physicians due to what they believe is a perpetuated patriarchy within medicine's culture that has leveraged inequities against women in the workplace. They think that this manifests as glass ceilings, sexual harassment, and discrimination. Many lectures I attended in nursing school, and many things nurses said to me follow this school of thought.

Really, though, the bigger issue with nurses, and what they're most unwilling to look at, is the fact that many (women, especially) entering nursing haven't pursued rigorous science majors, or are vocationally minded and/or not that smart to begin with, etc etc, and because of this, they don't have the educational backgrounds or skills to pursue higher paying fields. That's it.

Nursing unions should focus more on outreach toward underrepresented groups (men, minorities), on increasing the scientific rigor of prerequisites and in the coursework, itself, and addressing nursing faculty shortages (that fill those spots with real world flunkies); it is also known and well published that nursing academia is more negative and caustic than any other academic field (in nursing academics, the popular opinion is that there is a lot of bullying, "evidence based" pseudoscience, non-collegiality, and so on... google it to learn more, it's pretty shocking).

Added to which there are hordes of girls that did junk majors like human development, or in one way or another screwed themselves out of the premed track, or don't have an interest in going into competitive fields like sales, business, what have you and are kind of floundering. In these ways, nursing has become an easy fallback. Nursing unions should focus on addressing issues in these areas before pushing for expanded scopes of practice and inflating their NANDA diagnosis list to step on primary care doctor's toes. What nursing union's efforts tell me is that they are only trying to increase their pay at others expense. It's a cheap tactic that masks a larger problem, and stuffing giblet headed nurses into roles where they infringe on physician's prescriptive authority and medical decision making will never help solve it.

Long story short, I wanted to become a CRNA, but didn't feel prepared to manage complex cases with the science background I had at the time. I dropped out of nursing school with a 4.0 GPA after 1 year of a 3 year program; as I prepared to leave nursing school, I worked and built up money (bombed my final semester, lol), then jumped ship. I transferred to UCLA for a biochemistry degree and now I'm doing a pharmacology and toxicology masters at UCD.

I am impressed with your ability to see through the agenda of rage of the nurses, crnas and nursing union.

 

[GasProspect]

I'm sure a study could be made and promoted by the ASA out of attendings documenting and categorizing every time they had to put out a fire experienced by a mid-level provider. Not hard to gather the data, would just take a few extra minutes out of each docs day to do and at the end of the year you'd have some interesting data to analyze. Theoretically these could be accounted for as adverse events without actually putting patients in harms way.

 

[Spinach Dip]

It means, NO PHYSICIAN BACK UP. NONE!!.. Have a problem? COnsult another NURSE... Your profession wants to be independent? I too say GO FOR IT!!.

Bingo.

 

[MomDoctor4]

I know this is an old thread, but I am looking into becoming an AA. I am currently pre-med. Also interested in a D.O. program. I used to want to become a CRNA, but was against nursing. Everything you guys are saying makes absolute sense! Why would someone like myself who has to complete all of the same pre-reqs/MCAT as a med school applicant not have the higher power position? Most nurses do not posses any science background. They only need micro, anatomy and a principles of chem class. I completed all of these as a part of my AA to transfer because I was originally going on the DNP path. Now, I want nothing to do with it.

 

[Baller MD]

I know this is an old thread, but I am looking into becoming an AA. I am currently pre-med. Also interested in a D.O. program. I used to want to become a CRNA, but was against nursing. Everything you guys are saying makes absolute sense! Why would someone like myself who has to complete all of the same pre-reqs/MCAT as a med school applicant not have the higher power position? Most nurses do not posses any science background. They only need micro, anatomy and a principles of chem class. I completed all of these as a part of my AA to transfer because I was originally going on the DNP path. Now, I want nothing to do with it.

Definitely consider going the PA or AA route. Both can be great gigs.

 

[tigers2007]

One need not focus on "power" but on gaining employment for the highest amount of money in the shortest amount of time all while having the most satisfaction. One of my MD friends tries to convince me to do a reality-check and strongly consider being a CRNA. I could get my RN somewhat quickly (paramedic for several years now) and there are a ridiculous amount of CRNA schools out there. My goals have swayed toward AA or CRNA at this time versus MD or DO due to the time issue. I could have my AA within five years (including prereq's) or MD/DO in at least ten years. If I quit my job now, I could probably enter CRNA school within 18 months.

 

[Man o War]

One need not focus on "power" but on gaining employment for the highest amount of money in the shortest amount of time all while having the most satisfaction. One of my MD friends tries to convince me to do a reality-check and strongly consider being a CRNA. I could get my RN somewhat quickly (paramedic for several years now) and there are a ridiculous amount of CRNA schools out there. My goals have swayed toward AA or CRNA at this time versus MD or DO due to the time issue. I could have my AA within five years (including prereq's) or MD/DO in at least ten years. If I quit my job now, I could probably enter CRNA school within 18 months.

I don't think I would do this....obviously nobody has a crystal ball, but with the huge amounts of CRNAs and AAs being pumped out, I am almost positive they are going to take a large haircut with regard to compensation in addition to experiencing a much tighter job market. You will have to get your RN, and then work in the ICU for a year before you can enter CRNA school. Not sure that's worth it with what I think is coming for them.