Fight for the profession

[size_tens]

I can understand the frustration of MDA's who have invested so much time and effort into learning a profession, only to see CRNA's with 2 years of specialized training doing more or less the same thing. It's understandable that MDA's would want CRNA's to function as assistants. However from a practical point of view it's evident to me that CRNA's can perform the vast majority of anesthesia tasks just as competently as MDA's. Why shouldn't CRNA's enjoy independence? There has not been a single significant and reputable source of medical literature that shows a meaningful difference in patient outcome. From a pragmatic point of view the arguement really is not about jobs or money. This is a question of ego and self worth.

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[toughlife]

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.

I can see your point in terms of working less for more money or if you have contracts with the surgeons to provide anesthesia services for all their surgeries. In the latter, you would need the manpower to cover all the sxs.

I guess I would favor hiring a physician over the CRNA if one is available.

 

[VolatileAgent]

not too interested in contributing to this thread... other than this.

please someone, pray tell, what is an "MDA"? i thought i was simply a doctor who studies, practices, and promotes the field of anesthesiology. and, then what do i call one of my osteopathic colleagues? a "DOA"? give me a break.

stop using this term "MDA" (as i have done), which was made-up by CRNAs and job recruiters. you are not an "MDA" or a "DOA" - you are a physician, first and foremost and above all else. don't let a bunch of nurses and/or recruiters make you co-opt a term that they invented. this is all part of the subtle psychological way they are slowly trying to chip away at the fact that we are indeed physicians and, at least in their minds, it lends creedence to their attempts to flatten out the field by bringing our far more extensive training and legal/ethical responsibility to our patients down to their level.

MDA is a made-up term - and never, ever forget who it was made-up by.

 

[militarymd]

I have always referred to myself and my colleagues as physicians, doctors, or anesthesiologist.

I don't even like the term "anesthesiologist".....implying we only study anesthesia.....

 

[militarymd]

I can understand the frustration of MDA's who have invested so much time and effort into learning a profession, only to see CRNA's with 2 years of specialized training doing more or less the same thing.

I'm not frustrated with the situation. I accept that anyone can learn the "monkey skills" needed to "anesthetize" a patient.

It takes a physician to direct the medical care of the patient in the perioperative period....only physicians do that.

Same thing applies in the ER. The emergency medicine attending makes a true difference in only selected cases.

The vast majority of clinic visits for Internists can be handled by a non-physician, but a physician is ultmately in charge and responsible.

 

[VolatileAgent]

I don't even like the term "anesthesiologist".....implying we only study anesthesia.....

hear, hear.

 

[jwk]

I don't even like the term "anesthesiologist".....implying we only study anesthesia.....

Hmmmm, that'll be a tough one to revise... Granted there are far too many syllables, but perioperative physician or something similar would be even longer. At least it's shorter than interventional neuroradiologist

 

[mountaindew2006]

The vast majority of clinic visits for Internists can be handled by a non-physician, but a physician is ultmately in charge and responsible.

Dude, whose side are you on? You're a MD right? You're pretty much trying to mess it up for all MD's out there by making such a statement.

Yo, a lot of what you do on a day to day basis may seem like run o' the mill 'monkey skills' because you know your $hit cold. You make it seem like an ease.

But remember you went through med school, residency training, etc. you know a whole heck of a lot more than teh random CRNA thats produced. give yourself more credit. if not for your sake, for the sake of the profession.

 

[jwk]

Dude, whose side are you on? You're a MD right? You're pretty much trying to mess it up for all MD's out there by making such a statement.

Yo, a lot of what you do on a day to day basis may seem like run o' the mill 'monkey skills' because you know your $hit cold. You make it seem like an ease.

But remember you went through med school, residency training, etc. you know a whole heck of a lot more than teh random CRNA thats produced. give yourself more credit. if not for your sake, for the sake of the profession.

The ASA is a proponent of the Anesthesia Care Team, which included anesthesiologists, AA's and/or CRNA's. As an organization, they have NO problem with an anesthesiologist providing supervision or medical direction to anesthetists.

As jet and others have said, it is not physically possible, now, or in the forseeable future, to have all MD anesthesia in every anesthetizing location in the country. And it's not economically possible either.

 

[stephend7799]

Dude, whose side are you on? You're a MD right? You're pretty much trying to mess it up for all MD's out there by making such a statement.

Yo, a lot of what you do on a day to day basis may seem like run o' the mill 'monkey skills' because you know your $hit cold. You make it seem like an ease.

But remember you went through med school, residency training, etc. you know a whole heck of a lot more than teh random CRNA thats produced. give yourself more credit. if not for your sake, for the sake of the profession.

i agree with you. Hes a lost cause.. He is gonna run for president of the ASA and he will prob win.. That last statement of his was just absolutely assinine. Military is the type of guy who has "low self esteem" so he screws his colleagues and sides with the opposition

 

[aredoubleyou]

i agree with you. Hes a lost cause.. He is gonna run for president of the ASA and he will prob win.. That last statement of his was just absolutely assinine. Military is the type of guy who has "low self esteem" so he screws his colleagues and sides with the opposition

Oh no, when we start to psychoanalyze its defenitely time to change the subject....anyone seem them Bears today - quite a game

 

[size_tens]

I'm not frustrated with the situation. I accept that anyone can learn the "monkey skills" needed to "anesthetize" a patient.

It takes a physician to direct the medical care of the patient in the perioperative period....only physicians do that.

Same thing applies in the ER. The emergency medicine attending makes a true difference in only selected cases.

The vast majority of clinic visits for Internists can be handled by a non-physician, but a physician is ultmately in charge and responsible.

If the role of the physician anesthesiologist were primarily to direct complex cases in times when non physicians can not handle the job, then the need for physician anesthesiologists would decrease quite dramatically. Our nation's medical system would be much more efficient by simply training tons of CRNA's. I'm not trying to marginalize the role of the physician anesthesiologist. It's just that if "anyone can learn the "monkey skills" needed to "anesthetize" a patient" then what's the need for such highly trained professionals to spend so much time working on the nuts and bolts of anesthetics?

 

[TXANESTHETIST]

i agree with you. Hes a lost cause.. He is gonna run for president of the ASA and he will prob win.. That last statement of his was just absolutely assinine. Military is the type of guy who has "low self esteem" so he screws his colleagues and sides with the opposition

That is just rediculous. Guys like military and Jet prop have just been around a while. They have lots of real world experience and usually present a very level-headed argument. They realize that we do all have to work together. A team approach is the best approach. Most of the negative comments about CRNA's or AA's come from young residents who don't really know what it's all about yet. I do understand that you may get a bad taste for some CRNA's who may try to make residents feel stupid when they first start a residency. I think it's all about how you treat people. If resident comes in acting like he knows everything he/she's probably not going to get a great reception from any of the staff. If a CRNA acts this way, same thing. If we all are just a little more humble and realize that we can learn something from everyone no matter what the initials behind their name all of our patients and the profession of anesthesia as a whole will be a lot better off.

 

[bell412]

The Anesthesiologist is the ultimate authority. As technology increases so will the demand for the ultimate authority. Perhaps limited positions. It will make your profession even more competetive. Salaries won't go down, they will go up.

 

[blocks]

If the role of the physician anesthesiologist were primarily to direct complex cases in times when non physicians can not handle the job, then the need for physician anesthesiologists would decrease quite dramatically. Our nation's medical system would be much more efficient by simply training tons of CRNA's. I'm not trying to marginalize the role of the physician anesthesiologist. It's just that if "anyone can learn the "monkey skills" needed to "anesthetize" a patient" then what's the need for such highly trained professionals to spend so much time working on the nuts and bolts of anesthetics?

There you go folks....that argument is also the party line of the nurse anesthetist organizations. I give props to guys like Military MD and Jet, who have the tremendous knowledge and experience and are quite concessionary to CRNA's. But with all due respect, you are not going to be around in the workforce when "the need for physician anesthesiologists would decrease" and we "should just train tons of CRNA's". You will be enjoying your retirement....and the future *physicians* who share your interest in this great field will have to contend with this increasingly aggressive encroachment on *our* turf by radicals.

Know what? Bring it on. I am all for the team based approach, am all for working well with midlevel practioners, giving props to the ones that have been in the trenches, and developed mad skills, and respect the younger CRNAs that have spent time training in ICU and have developed an excellent knowledge base. But you are not physicians and never will be, until you man up and go to medical school. Your medical training is inferior to that of MD's, period. That calls for a certain degree of division of labor, and it is not justification to claim that you are equal to a physician. Doing so would provide patients an inferior level of care, and that is not what reasonable people, including most CRNAs, want. It is time for the physicians practicing anesthesia to stand up, get political, and retake control of OUR field.

 

[toughlife]

The Anesthesiologist is the ultimate authority. As technology increases so will the demand for the ultimate authority. Perhaps limited positions. It will make your profession even more competetive. Salaries won't go down, they will go up.

what you are doing with that comment is trying to sell an idea that would benefit the influx of even more nurses into Anesthesiology. Having jobs only for a selected few is NOT good for the vast majority of MDs going into the field. We don't need more nurses, we need more doctors. Nurses are a dime a dozen.

 

[VolatileAgent]

It's just that if "anyone can learn the "monkey skills" needed to "anesthetize" a patient" then what's the need for such highly trained professionals to spend so much time working on the nuts and bolts of anesthetics?

to be available if/when the $hit hits the fan and, more importantly, take legal/ethical responsibility when it does. if you can convince me that CRNAs are capable of accomplishing the latter without jeopardizing patient safety, and the public is willing to accept that openly and without reservation, then you're right: medically-directed anesthesiology is dead.

 

[nitecap]

Come on guys, we all know that in both the Medical and Nurse Practice acts it plainly states that a MD is not liable for any independent decisions made by that CRNA or any other APRN and PA as long as the MD thought that the APRN or PA was competent. to make that call.

If the MD is always liable then why does the CRNA have to purchase at least 1/3 mill malpractice insurance, even when they work in a medically directed practice.

You guys act like an MDA is the only person in the entire OR suite that can intervene when the patient is crumping. Do you make a quick run to the phone boothe first and change into your superman out fit and fly to the rescue. So the patients coding in OR, are you guys the only peeps that know how to run a code. No offense but unless you did critical care medicine I probrably have participated in more instances of anal seepage hitting the fan" than most of you guys, while working in a large CVICU. That is unless you guys killed or nearly killed that many patients in your residency, which i doubt happened. What are you going to do crack the chest, I highly doubt that. Hell a CRNA can put in lines, push drugs and fluid rescitate, defib, pretty much every aspect you can do in these situations. Maybe not put in a IABP but then how many MDA's do. Hey I know you guys are medically educated but when the diarrhea is spraying like you say, its not always the most educated individual that does the right thing. Its the quick thinging, leader, that doesnt loose his cool, and is effective under duress. Sorry doubt your histology class will come in handy here. Physiology maybe but I use the same phys book that the med school does here, Boron and Boulpaep medical phys. Everyone knows its experience that counts when the crap starts flinging, screw memorization of facts.

 

[bell412]

Sorry it was a typo. I meant to say that your numbers will increase with more technology. You will take over your profession. CRNA's will be gone. The hospital will hire an assistant for you to do all of your tasks and your salaries will be over a half mil.

 

[nitecap]

Bell are you taking a few to many wiffs of gas in the OR?

 

[mountaindew2006]

Come on guys, we all know that in both the Medical and Nurse Practice acts it plainly states that a MD is not liable for any independent decisions made by that CRNA or any other APRN and PA as long as the MD thought that the APRN or PA was competent. to make that call.

If the MD is always liable then why does the CRNA have to purchase at least 1/3 mill malpractice insurance, even when they work in a medically directed practice.

You guys act like an MDA is the only person in the entire OR suite that can intervene when the patient is crumping. Do you make a quick run to the phone boothe first and change into your superman out fit and fly to the rescue. So the patients coding in OR, are you guys the only peeps that know how to run a code. No offense but unless you did critical care medicine I probrably have participated in more instances of anal seepage hitting the fan" than most of you guys, while working in a large CVICU. That is unless you guys killed or nearly killed that many patients in your residency, which i doubt happened. What are you going to do crack the chest, I highly doubt that. Hell a CRNA can put in lines, push drugs and fluid rescitate, defib, pretty much every aspect you can do in these situations. Maybe not put in a IABP but then how many MDA's do. Hey I know you guys are medically educated but when the diarrhea is spraying like you say, its not always the most educated individual that does the right thing. Its the quick thinging, leader, that doesnt loose his cool, and is effective under duress. Sorry doubt your histology class will come in handy here. Physiology maybe but I use the same phys book that the med school does here, Boron and Boulpaep medical phys. Everyone knows its experience that counts when the crap starts flinging, screw memorization of facts.

MDAs I'm glad that some of you are finally banning together w/ me on this issue.

But as one can see both NITECAP and TXANETHTIST (the CRNAs) are trying to imply that their quality of work is as equal to ours. NO offense MilMed but guys like you are giving them fuel. Furthermore, like someone else stated here you will be long gone and in retirement when this issue REALLY becomes an issue. I implore you to reconsider your previously made statements of 'non-physician' providers being in most instances equal to ours.

Look, both NITECAP and TXANE are doing what I said they would do. They are both trying to say that it's all about "delievering pt care". See this is the arguement that sways outside the MDA profession politicians. We know better than that. We know that the TRUE reason they state those above words are to gain sympathy for their cause and to fatten THEIR pockets.

Guys/gals they are literally robbing us. Listen, i realize that in the OR there is need for working together. Which reminds me, the coining of the word "team" is from business schools. When the word 'team' is used it mks the CRNAs and other auxillary staff feel like they are just as important and knowledgeable.,etc. In business, you learn that by making others feel just as important, they become more proficient. well guess wht, it's obvious that they are starting to get larger then what their pants can hold. So to all you CRNAs out there that feel you are part of a 'team', well guess what -as in any other team there's a captain. If you all played any sports in college or H.S. you will know that most times the captain is the smartest/best player on teh team. Guess who your captain is. That's right the more educated, MDA. And NITECAP i think it was you that brought up that histology doesnt have anything to do w/ anesth. Well i think that ppl that think that are just ignorant. I mean why not just do away w/ med school completely. After college if someone wants to go into gas why not just have 'anesthesiology school'. If you want to be a surgeon..."surgeon school'. A pathologist then have 'pathology' school. Why have med school? I'll tell you why. In some countries something similar to this happens. Guess what thsoe are the countries w/ the crappiest healthcare systems. The reason why AMERICA is so great when it comes to medical advances,etc is because physicians are better knowledgeable. Dont believe me? Why do prominent leaders of other countries come HERE for their cataract surgery or their cancer tx for lung cancer?

The reason this is the case is because as physicians you must comprehend the 'whole patient'. They do not just treat numbers and things that pop up on a screen. They realize and comprehend physio/pathology to a great degree. If you think you can do that, which you th ink you can by just reading the same physio book...I invite you to go to med school and take the USMLEs and various other tests. Come on tough guy, you can do it right? It's easy stuff? Go ahead try it.

Bottom line, MDAs are your superiors. It's not obligate of us to treat you w/respect (but most do because that's the kinda of ppl we are). Remember you all do not exist w/o us. We created your job. Realize that and RESPECT that. Snap out of your dream, you will never be equal to a MDA (which I realize is a hit to your over inflated Egos)...unless you go through med school. Earn your respect buying doing what we did. Those 'pesky' residents one day will be your boss one day.

 

[bigeyedfish]

Mountaindew brings up a good point about the value of medical training. If you want to sit in the captain's chair, you have to go to captain's school. If CRNA's ever did get equal footing with physicians it would set a dangerous precedent for other specialities and be a huge blow to the qualitiy of health care in this country.

I talked to someone from college the other day who had been trying to get into med school, then went to nursing school. She said she still wanted to go to med school but she couldn't bring herself to take the mcat again because it was "way too hard" so she was going to apply to CRNA school. (We didn't discuss spraying diarrhea.) This is a great example of the selection factor that medical school places on the profession, in addition to the increased training it offers.

 

[nitecap]

Moutain,

I said your histology would be useless when the shiznit is hitting the fan. Dont spin my statements.

I learn the same anesthesia things that the residents at my program do. I study the same texts. What I cant understand anesthesia texts because I didnt go to med school?

Look any one can learn anything if they truely want. People learn another language in a few years and are fluent if they are determined and practice.

With the theoretical knowledge that I learn from the same text books that you most likely learned from, add that with solid clinical experiece, the same that the residents at my program get though shorter and they do pedi hearts and we dont What you have then is a safe provider.

Not saying yor med school isnt valuable, just saying that someone else can do your job. Not going to even get into who is more safe or more effective because countless studies have been unable to do so. If CRNA's are so unsafe and incompetent like you dream then why do thousands of CRNA's practice outside of medical direction in most rural areas in this country. Why? Because we are safe, we have a history of providing safe care now for over 100 years.

And MDA's did not create the CRNA profession, surgeons did. And did so knowing that they would receive great care. I guess the CRNA's in the millitary that care for the soldier from your town that gets injured in IRAQ is incompetent huh?

Sure hope you or a family member of yours doesnt need any sort of unexpected emergent care in podunct rural america. Just dont know if you could handle a CRNA saving your life ir that of your family. Might hurt your pride to much.

Its such a joke when you say its all about the patient yada yada. No one is fooled, we all know its about you wallet man, you dont even have to be the medical field to see how obvious your actions are. Your cards are exposed and have been for a while, why dont you do something beneficial for your profession and play another hand man. You will never get anywhere with your Hitler type mumbo jumbo and blatently obvious insecurity.

Doctor or not when you are out of the hospital your just a man plain and simple. Put your medical degree aside and your no better than the bum that comes thru the ER wanting Demerol.

 

[nitecap]

Moutain,

I said your histology would be useless when the shiznit is hitting the fan. Dont spin my statements.

I learn the same anesthesia things that the residents at my program do. I study the same texts. What I cant understand anesthesia texts because I didnt go to med school?

Look any one can learn anything if they truely want. People learn another language in a few years and are fluent if they are determined and practice.

With the theoretical knowledge that I learn from the same text books that you most likely learned from, add that with solid clinical experiece, the same that the residents at my program get though shorter and they do pedi hearts and we dont What you have then is a safe provider.

Not saying yor med school isnt valuable, just saying that someone else can do your job. Not going to even get into who is more safe or more effective because countless studies have been unable to do so. If CRNA's are so unsafe and incompetent like you dream then why do thousands of CRNA's practice outside of medical direction in most rural areas in this country. Why? Because we are safe, we have a history of providing safe care now for over 100 years.

And MDA's did not create the CRNA profession, surgeons did. And did so knowing that they would receive great care. I guess the CRNA's in the millitary that care for the soldier from your town that gets injured in IRAQ is incompetent huh?

Sure hope you or a family member of yours doesnt need any sort of unexpected emergent care in podunct rural america. Just dont know if you could handle a CRNA saving your life ir that of your family. Might hurt your pride to much.

Its such a joke when you say its all about the patient yada yada. No one is fooled, we all know its about you wallet man, you dont even have to be the medical field to see how obvious your actions are. Your cards are exposed and have been for a while, why dont you do something beneficial for your profession and play another hand man. You will never get anywhere with your Hitler type mumbo jumbo and blatently obvious insecurity.

Doctor or not when you are out of the hospital your just a man plain and simple. Put your medical degree aside and your no better than the bum that comes thru the ER wanting Demerol.

And who said residents were pesky, I went out with 2 CA-2's this weekend and had a great time.

 

[rn29306]

.......Remember you all do not exist w/o us. We created your job.

This is an outright lie. It's good to be proactive in your stance, but lying in the process undermines your credibility.

 

[mountaindew2006]

This is an outright lie. It's good to be proactive in your stance, but lying in the process undermines your credibility.

last time I checked...CRNAs practiced under the MDA. I have never seen (although heard) a CRNA work for a surgeon. Personally, I think that's one of the most ridiculous things ever. A surgeon is not trained in anesthesia (or perhaps minimally), how in the heck would he know if a CRNA was doing a their job correctly. THat kind of set up is like having a MDA oversee a surgical assistant with the removal of a gallbladder....

hmmmm

So yes, you (CRNAs) do not exist w/o a MDA. As a student I've had several CRNAs allow me to intubate,etc and then as I was reluctant to just 'jump' in w/o knowing the 'correct' way of doing things....the CRNA proceeded to tell me, 'oh dont worry, just give it a shot, i dotn care, it's not my license that's at stake its the MDAs". So what does that *****ic statement tell me? They are not held accountable for their actions as much, and it is the MDA that oversees them.

Next nitecap, you stated why in the heck are CRNAs practicing by themselves supposedly in boo-foo. Easy...they're cheap. They're willing to be mercenaries to get the job done. Next, there was a relative 'shortage' of MDAs. I would still like to see if CRNAs will be practicing by themselves in say 10 yrs in boo foo. There will be soo many MDAs out there, that I doubt that will be the case. Most competent surgeons now request an ALL MDA group. Many groups use that as their 'sales pitch'...."All MDA, board certified,etc".

And NITECAP...lol ur twisting my words. I said that YOU ALL are the ones that state it's all 'about the patient' to gain sympathy. Let me ask you this. I figure you wanted to be in an 'intense envir, doing procedures, etc'. SO why didnt u just stay put as a ICU nurse? or a ER nurse?

reason...u wanted easy, fast $$$. So set your BSing 'patient' oriented speech aside.

 

[bigeyedfish]

Moutain,

I said your histology would be useless when the shiznit is hitting the fan. Dont spin my statements.

I learn the same anesthesia things that the residents at my program do. I study the same texts. What I cant understand anesthesia texts because I didnt go to med school?

Look any one can learn anything if they truely want. People learn another language in a few years and are fluent if they are determined and practice.

With the theoretical knowledge that I learn from the same text books that you most likely learned from, add that with solid clinical experiece, the same that the residents at my program get though shorter and they do pedi hearts and we dont What you have then is a safe provider.

Not saying yor med school isnt valuable, just saying that someone else can do your job. Not going to even get into who is more safe or more effective because countless studies have been unable to do so. If CRNA's are so unsafe and incompetent like you dream then why do thousands of CRNA's practice outside of medical direction in most rural areas in this country. Why? Because we are safe, we have a history of providing safe care now for over 100 years.

nitecap, I value CRNA's and their contribution, but don't say that the training is equivalent when it's not. Even aside from med school, internship, and USMLE exams, you said yourself that your training is shorter and you don't have the same cases. Also we are held to higher standard (ie our boards are more rigorous.)

 

[mountaindew2006]

nitecap, I value CRNA's and their contribution, but don't say that the training is equivalent when it's not. Even aside from med school, internship, and USMLE exams, you said yourself that your training is shorter and you don't have the same cases. Also we are held to higher standard (ie our boards are more rigorous.)

to piggy back on the rigorous training mentioned above.

let's not forget getting INTO medical school. I'll leave the talk about foreign medical schools for a different discussion. But just getting into medical school and then residency (esp these days) requires higher standards.

and as one of the previous posters pointed out there are nurses (shoot I have a few aunts) who are still trying to get into medical school. To this day i've never heard of a MD trying to go into nursing school (please correct me if I'm wrong)

So is our training better. Pure logic would tend to mk the case for it.

 

[size_tens]

I don't think anyone is trying to say that the the overall medical training of CRNA's is equal to MD's. The more important underlying question is how much training does it really take to be a competent provider of anesthesia for surgical procedures? The fact is that there are many CRNA's working around the country without MDA oversight. Unless you CRNA bashers can provide meaningful evidence demonstrating a lack of competence of these independent CRNA's, then I don't see how you can reasonably expect to keep them in a subservient position.

 

[VolatileAgent]

i think the '**** ratio has grown exponentially in the last 5-7 posts. mountain, you are definitely not a good advocate for our profession. and, nitecap you're not making a strong case as a good advocate for nurse anesthetists either. sorry. but, that's the way this is playing out to the rest of us. no sense going blow-by-blow because emotions are rapidly taking over. as expected, this thread is predictably devolving and should be closed posthaste.

 

[VolatileAgent]

I don't think anyone is trying to say that the the overall medical training of CRNA's is equal to MD's.

i think nitecap is. and he/she is grossly misinformed (as i'm recollecting overhearing a couple CRNAs, one with 20+ years experence, just today discussing how baffled they were with attempting to understand the "physics" [their words, not physiology] of the cardiac loop-flow diagram, something every medical student is extensively trained on throughout their four years of medical school, which is apparently something CRNAs are now expected to know for the CRNA boards - scary).

 

[rn29306]

last time I checked...CRNAs practiced under the MDA. I have never seen (although heard) a CRNA work for a surgeon. Personally, I think that's one of the most ridiculous things ever. A surgeon is not trained in anesthesia (or perhaps minimally), how in the heck would he know if a CRNA was doing a their job correctly. THat kind of set up is like having a MDA oversee a surgical assistant with the removal of a gallbladder....

hmmmm

So yes, you (CRNAs) do not exist w/o a MDA.

There is not one state in the union that says CRNAs must work under MDAs.
Hospital policy can superscede this and the hospital group / MD anesthesia group can make policies that state this. Perhaps you should look into the facts before going off like this.

 

[VolatileAgent]

There is not one state in the union that says CRNAs must work under MDAs.

that's because there's no such thing as an "MDA". and you know that this isn't true. they have to be supervised by a physician, and in most cases this is an anesthesiology trained physician.

Hospital policy can superscede this and the hospital group / MD anesthesia group can make policies that state this.

from a technical standpoint, this is not true. at the state level, the state has to "opt-out" first allowing medicaid reimbursement to individual hospitals if there is not going to be anesthesiologist supervision. this must occur first before anyone is going to get paid at the hospital level. so, if there's no reimbursement, it's unlikely a hospital is going to willy-nilly change their policy just to accomodate a squeaky wheel. these decisions are more often made out of economic necessity, not patient safety concerns (unfortunately).

Perhaps you should look into the facts before going off like this.

stop taking mountain's bait. and, perhaps you shouldn't overstate the facts as if they are common practice.

 

[rn29306]

that's because there's no such thing as an "MDA". and you know that this isn't true. they have to be supervised by a physician, and in most cases this is an anesthesiology trained physician.

You just proved my point that CRNAs don't have to work under anesthesiologists.

from a technical standpoint, this is not true. at the state level, the state has to "opt-out" first allowing medicaid reimbursement to individual hospitals if there is not going to be anesthesiologist supervision. this must occur first before anyone is going to get paid at the hospital level. so, if there's no reimbursement, it's unlikely a hospital is going to willy-nilly change their policy just to accomodate a squeaky wheel. these decisions are more often made out of economic necessity, not patient safety concerns (unfortunately).

You misread my post. While there is no law stating that a CRNA must work under an anesthesiologist, hosptial policy and anesthesia group policy CAN state that, in that environment, that CRNAs will, if they choose to work at that facility, work under the ATC guidelines.