Fight for the profession

SO just how do you suppose MD's or MDA's as you say fill this void by not working with CRNA's. Of course AA's are an option but CRNA's lobby against that aggressively. As well there are far to few AA's to replace the 30,000 CRNA's with only a handful of programs, that would take at least a decade.

Then you are saying replace them with a MDA I guess locums you are refering to. You can hire 2 locum crna's to one MDA, so then you take a huge hit on that.

As for a negativity toward attendings. Dude get over it, hey some attendings CRNA's and MDA's alike I love while some I cringe when I even see them. Not everyone likes everyone. Hey sometimes the attendings I respect the least actually teach me the most so get over it.

SO eliminate CRNA's, then what happens to the 50 rural Texas counties that only have CRNA anesthesia providers, screw them I guess hey.

Listen, though MDA's control most of the market you dont control it all. You must be a CA1 I assume, due to the way you sound. Bottom line is you cant replace every CRNA with a AA due to lack of, and cant replace with MDA because you will take a loss finacially. SO heres a suggestion, try to get along with all, trust no one, do your job, and lobby for your interest. In the end or at least for the next 20 years there should be plenty of work for all AA, CRNA, and MDA's. CRNA's will migrate to rural areas where opportunities are greater and MDA's will retain controll of the urban areas.

You do have a point however on the FMG issue and possibly their lack of aggressiveness and lobbying connections compared to a huge percentage of SRNA's being white males. No intentions of racial or sexual discrimination just stating a point).To compare the aggressivness between the 2, hey a mans a man and they will protect their livelyhood using and measure possible.

 

watch yourself MountainDew. Some day, you may be wishing that you had a well trained physician extender helping you out in a tough situation.

 

While it makes for an easier day, when people are thinking of doing fellowships in order to "differentiate" themselves from CRNAs, you gotta wonder what the profession's coming to, my friend.

 

I guess we have a difference in opinion. There is and always be a need for physician extenders. Internists need ward nurses. Intensivists need critical care nurses. Anesthesiologists will need CRNAs....in certain locales.

I will tell you this...there will NEVER be enough anesthesiologists to sit on ALL of the stools that need warming in the United States.

 

Our medical degrees, residency, and board certification differentiate us, my friend. The fact that we have medical licenses are another big distinguishing factor. It is a sad day when MDs and DOs, who are residency-trained and board certified clinicians;feel they must 'distinguish' themselves from RNs.

 

CHeck your history..."your profession". Nurses were the 1st to administer anesthesia besides for in the early days using the medical residents. If you actually look into the history of anesthesia and nurse anesthesia you will find that at the beginning anesthesia was not even a suitable hobby for a physician and that's why they let nurses do it, not to mention the nurses were great at it. I am not saying that MDA's are not great at it to, but all the bashing done to CRNA's is rediculous to those who don't even know the history of their "forefathers". Not until was there money and power involved in anesthesia practice did physicians think that CRNA's were incompetent! Come on.

 

Exactly! And make sure we look at what happened when those power & money hungry physicians become more involved with anesthesia....like research, quality assurance, and equipment and anesthetic development

Of course, the problem is that those pesky physicians sure made providing anesthesia pretty damn safe. Rats.

Oh! And lets not forget the other good old days when you used to be able to go to them thar barbers.. get a good shave and have your appendix taken out in one visit! Why'd those dirty stinking power and money hungry surgeons have to get involved and knock out the ol' two-for-one deal we used to have? I mean.... it used to be shave, haircut & gallbladder removal for two bits...

Yeah. Those were the days.

 

Dont forget the medical students were in on the action too. Anesthesiology has evolved into a medical speciality..sorry.

 

btw TXANESTHETIST do you know what the mortality rate secondary to nurses providing anesthesia in the old day was? PRETTY BAD..i heard when nurses were doing it in the 'old days' it was close to 50%.

next, if you peruse Morgan and Mikhail and check out the first chapter, one could easily read: "the task of anesthesia was usually delegated to junior surgical house officers or medical students .....later surgeons at both the mayo clinic and ccf trained and employed nurses.".

So..if you want to get technical, doctors were the FIRST to adminster anesthesia. Secondly, the advancement of anesthesia was ALWAYS made by physicians. Docs that readily come to mind are Drs Waters, Lundy, and Guedel during the turn of the century. These guys are who made/began providing anesthesia safely and actually began to understand respiratory physio,etc. Unlike the nurses, etc that just held the ether mask. As the profession of anesthesiology progressed the Long Island Society of Anesthetists was formed,etc etc.

I realize someone must have told you back when you in nursing school that nurses were the first to provide gas. Well it's quite evident from the literature that that is a misnomer. Dont believe me still, go look it up. [/QUOTE]

That is why I said except when they used residents for anesthesia before nurses, so technically residents were the first. That wasn't working out too well, so the docs started training nurses. (maybe i wasn't clear in my post on this). What I meant to say was nurses were the first officially trained Anesthesia providers. I believe those who trained the nurses noted that they were excellent at what they did. Anesthesia in general has come a long way since then. I do believe that when the mortality was 50% and I would dare to say it was worse, was the case no matter who was providing the anesthesia at that time.

I am very thankful for medicine advancing anesthesia. They had all the money and power then. Think about it, back then people thought physicians were next to God. I think we all know better now that they are still human like anyone. Think about this fact also. Most all nurses were women and most all doctors were women. That was a big factor. Nursing is still wayyyyy behind medicine in terms of research, etc. It will only get better with time.

It is just frustrating that we don't support eachother and encourage eachothers practice, provide great care, etc. I personally think a team approach is best for anesthesia. Instead we have to constantly put eachother down, defend our education, etc. Just walk the walk and prove it on both ends!

Well, Happy Thanksgiving to everyone!

 

Exactly, they trained nurses because if a med student was given the task of anesthesia it was a put down back then b/c you couldnt learn the surgeons technique. Thats why they trained nurses to do so. Nurses pretty much ran the show for quit a while.

I believe it was Dr. Mayo himself that was totally pro CRNA. By 1908 one CRNA (Magaw) had done over 14,000 drip ether cases for Mayo. Dude if you want to talk history bring it on.

Anyways whats the aurguement here about. Both CRNA's and MDA's understand the differences b/t the 2. Of course there are proveable differences like education, degrees, training. But Outcome differences have yet to have been proven. We are pretty much where we were politically in the early 1900's us wanting to maintain and expand or practice rights, and MDA's wanting to take them away and control the entire field. Now shouldnt that tell us something. That if politically things are near the same as they were 80yrs ago that in the future things are not going to change that much. Im sure CRNA's and MDA's felt the same way and said similar to the same things back in the day. So quit crying and face reality, CRNA's are here to stay like it or not. Another person can do your job, so get over it.

 

I think this is probably why CRNAs draw the heat they do...it seems a pretty prevalent attitude. Sad because you really do need them. But only in an assistant capacity. THe correct thing to say is that another person can do PARTS of your job. Never get too big for your briches.

 

Depends on what area you are implying. Of course most CRNA's arent gonna do pain, Critical care ect. But im talking mainstream your regular old community hopspital with general, ortho, OB and bread and butter cases. Intraop a CRNA can do all of what you do.

As for specialization then it all depends on experience. Of course a MDA that did a CT fellowship and works in the CV OR is going to be great and better than any CRNA and MDA with minimal CT experience. Hey I train at a CRNA program within an anethesia residency. When we work together we have the same role, same attendings, they do nothing intraop that we cant.

Now dont think Im on a high saying one is better than the other or one smarter. Im not even going there. Just stating that in many situations and cases CRNA's can do just as effective as a job as a MDA. Listen we need both professions to ensure the availabilty of quality care for our citizens. The 2 will continue to exist and butt heads Im sure. Its the same as interventional rads vs. Cardio, Intensivist crosing over and managing renal things and renal getting pissed, AA vs CRNA's, RN's vs LVN's, Janitors vs. professional maid yada yada.

Microsoft vs. Macintosh which is better, which is safer, which has more research put into it, which malfucntions more, which is more efficient which is more reliable. Everyone has their opinion and no one has proof to back it up, but the two continue to compete fiercly for the market, put each other down and campaign against each other and oh yeah ocassionally though rare work togther to accomplish something.

 

Mountaindew, WHY?


So much to learn!

Don't misunderstand me here, I like your enthusiasm.

But posts like this never accomplish anything and just piss everyone off.



Please, close the thread.

 

IF CRNAS wanted to practice independently, why dont they go to medical school.. Thats a physicians job to practice independently.. i mean when did they get privileges to prescribe medicine.. let alone narcotics? I just cant believe the set on the crna organization. I mean its harder and harder for me to get privileged at a hospital and the crnas come along and practice independently and make more than most internists with a RN degree. You dont see me trying to do a nurses job.. do you?

 

If I may reiterate




btw: I like the way you pulled off insulting DO's, IMG's, and CRNA's in one fell swoop. Quite effective.

 

Same old ****, different day. God I get tired of these threads.

Don't expect us "non-physician" anesthesia providers to apologize for our earnings compared to some physicians. It's all supply and demand when it comes to compensation. In a somewhat testy salary negotiation many years ago, one of my physician employers complained that we (the anesthetists) were making more than his wife who was a pediatrician. I just couldn't help myself when I said, "...then tell her to go to anesthesia school..."

We all have to live with the choices we make, right? Plastic surgeon grossing millions per year vs anesthesiologist in the mid-500k's? Internist at an HMO pulling in $150k salary for a 40hr week vs an anesthetist working 70hr weeks and making $200k or a rural CRNA covering 5 hospitals by herself in south Georgia and on call 24/7 for all of them and making $350k? No problem here. Simple supply and demand.

And dew - the prejudicial (looking for a nicer word) overtones of your rants about FMG's are a little startling for someone of your supposed education. I've been in anesthesia for a long time, and although I do know some FMG anesthesiologists and female anesthesiologists, I wasn't aware they represent the majority of practitioners in the field. You might find it shocking that some of them actually are competent providers and educators.

And here's a newsflash - if 50% of patients died from anesthesia in the "old days", those numbers applied to any type of practitioner, not just CRNA's. It took decades before anesthesia was safe by anyone's definition - and it's much safer now than it was 25 years ago when I started.

I know you young MS and CA-1 pups find this astounding, but folks like me and JPP and Mil and noyac and txanes get along just fine every day. The organizations are at each others throats, as well as some of the more politically active individuals in each group. But MD's and CRNA's and AA's get along great day in and day out in MOST practices around the country. We all have plenty of work to do, most of us make more than enough money to keep us happy, and we try not to kill or maim anyone and go home at the end of they day knowing that we've done the best job we can for our patients.

 

please, please not this again. close it, for the love of chocolate milk.

 

Its pretty sad that everytime this topic comes up the forum is quick to get shut down. This is one of the major issues facing our profession. Young pup MS4 or CA-1 or not, this site IS called student doctor network and we should be able to discuss this important issue and share information about the subject with our collegues without being shut down.

 

Mountindew, posted at the same time and you read my mind. Uhh kinda.
Let me add this...I get along with most of the CRNAs at my program, especially the older ones. My relationship is the younger ones and SRNAs is much more superficial. There is some underyling tension between them and residents. The way I see it, MDAs are here to stay and CRNAs arent going anywhere either. Their lobbing power is a huge advantage for them, one of the CRNAs here is friends with the presidents mother. How is that for lobbying power. Since it looks like we will both be around, we have got to come to some middle ground. Im not sure where that is....

I personally like the idea of the anesthesia care team, with the MDA leading the way with preop eval, anesthetic plan, intraop "event", and post op management. I agree with Mil i dont think an ologist needs to warm to stool for every MAC breast biopsy on a 22 year old ASA1. That model just seems win win for everyone, financially and intellectually.

 

Read my profile - I'm an AA, not a CRNA - 100% anesthesia care team every day - no starry dreams of practicing independently.

I just get tired of the attitude that physicians know it all and that non-physicians are generally less than pond scum. (I'm not sure where FMG's fall in your scheme of things since you have a problem with them as well.)

 

I could not agree more with this statement..

 

We need strong, aggressive and surgeon styly personalities in anesthesiology when it comes to dealing with the CRNAs.

 

Then you will have a big problem tough guy. All the CRNA's and AA's will quit your practice and go work else where in town. Your practice will shrink, you will be working your asss off and have no life, and your cool competitor across town will be reaping the benefits.

 

not if the guy across town is that same way.. you will have to move out of state.. maybe where its rural and nobody cares what you do

 

I think that alot of people on this forum are not so concerned about the fact that there are CRNA's. Rather, I think it is the fact that CRNA's want to practice independently without an Anesthesiologist. I would love to hear Military's thoughts on this and some of the other private practice guys who speak so highly of CRNA's. I defintely think that there is a need for CRNA's and I am coming around to the idea of the anesthesia team since CRNA's are definitely hear to stay. But I think it is concerning to many anesthesia residents who are at residencies where the younger CRNA's act like they know just as much about physiology and pharmacology as an Anesthesiologist. And have this chip on their shoulder thus perpetuating the idea that they should practice independently.
I am at a residency where there are alot of CRNAs. And I have to say, I really like the older ones. You can learn from them. It is the younger ones that concern me and they are the ones who make up the future AANA. These are also the same ones who have no bones about saying they should be able to practice independently which I completely disagree with. Perfect example is Military's thrombocytopenia case. Do they teach CRNA's about DDAVP is nursing school? I definitely think that threads like this should not be shut down and residents and medical students need to be informed about this argument because it is a serious one. There is no need to mud sling but this is an important topic that needs to be discussed.

 

You know what? CRNAs already practice without having anesthesiologists around.

It is allowed in all 50 states.

That's right....they do it already...it is nothing new.

Should they be allowed to? Well, they are allowed to already. Are we going to reverse that? I doubt it.

Unless, we start sending every new anesthesiologist grad to every podunk place where no one wants to go.

As for team practices, anesthesiologists need to behave like physicians....be able to make medical recommendations (like my ddavp thing) that decrease risk to patients...etc.

 

I agree that the younger SRNA/CRNA's are the more militant ones and that they too have alot to learn when they come out of training. And believe me they will have a difficult time if they continue to act this way because they will have much fewer jobs to choose from. I was not too different than some of the Residents posting on here when I was in training. I had CRNA's that were awful to deal with in my training and I had a real distaste for them because of the few that I had to be around for my 4 yrs. I came out thinking this was an awful thing having CRNA's that want independence. I thought the specialty was in trouble and that I might have 10 good years at best of practice. Its not that way at all. The CRNA's (sorry I have not worked with AA's since residency so I am not refering to AA's at all) that I met and working within private practice were quite different. They were seasoned and much less militant. They had no problems with their work environment and we never got into the competition issue. They called for help when necessary and if you were cordial when you came to help they called more often which made me feel secure with them in the room. I have been on vacation with some and socialize often with them. They are good people just as we are. When you bash CRNA's in general you are lowering yourself to the level of the few that you distaste. You are no different. I know your concerns with the issue and I have some of the same concerns but the majority of the work force out there is concerned with getting the cases done in a safe and effeicient manner. Your enthusiasm is healthy and beneficial to the specialty but your experience in this issue is limited to the few CRNA's that you have come in contact with. Believe me, I dislike the militant " I can do anything you can do" types as much as you do. But they will learn as we all do that you need others from time to time and if they don't they will be moving on to another job.

 

As I am not familiar with anaesthesiology in the US yet, I am not familiar with this CRNA issue but Noyac Good to see some common sense here.

 

I think you guys are looking at the independence thing all wrong. They want independence practice rights because they HAVE to practice independently. Thank God somebody is willing to go to some little **** town in SD,ND,IA. If you don't want em there practicing independently then YOU simply go there. This is how this whole independent thing got started. No godamn CRNA wants your job. If you think that way, your high on crack.

 

contrary to popular choice, I plan to work for my money and do not expect to make it off the backs of anyone else. I do not care to have a CRNA working for me. For once, money is part of the whole equation not the deciding factor on how I choose to practice.

 

good for you!! thumbs up!

 

Your ideas are understood, but they are not reality.

The reality is that everything in the anesthesia business is not based on egos and money.

The reality is there are not enough anesthesiologists to occupy every anesthesia site. And even if residencies doubled their matches, there still wouldnt be enough.

I'm not against all-MD practices...actually thought I was headed to one (Vegas) right outta residency...felt alot like alot of you on the MD CRNA thing.

But I can tell you from an efficiency standpoint there is no comparison. The team approach wins.

My buddies in Vegas are consulted by surgeons, much like a cardiologist consults a heart surgeon. They drive around to different hospitals...say following a spine guy who has 6 cases at three different hospitals.

Alot of wasted time.