Here we go again...

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This is what happens when our economy is so desperate. Our huge unfunded liabilities are making it harder to maintain a 1st world standard of care.

As citizens we all share in this responsibility. The same "conclusions" might be considered in almost every aspect of medicine, and surely there will be editorials like these in primary care as well as many specialties.

I guess we just don't need doctors anymore.

Kidding aside (as if this is funny), we have an increasingly SICK population going to the OR. So, higher levels of expertise will be necessary. We need to work on PR in order to make this known to the lay public.

Bottom line is that our economy AS A WHOLE is in dire straights. We are seeing very predictable results of that, such as an increasingly desperate attempts to pair down costs. So, this should be of no suprise that these editorials are becoming more frequent.

This is what happens when we mismanage large social programs, leaving them wholely unfunded, and allowing our economy to become a "new, "modern", service oriented economy" (i.e. one in which it's just that much easier to offshore jobs such as IT etc.). Before, we were a world class exporter of manufactured goods. Now, we do a little of that, but not enough to create real wealth for a nation. So, we're subsidized by the producers of the world. What's more frightening is what happens when they stop the subsidy. Then, things really get desperate.

Cheers!

cf
 
OK, here is my prediction:
This medical specialty is dying and in the next 10-20 years it will seize to exist in the United States.
Our society is very susceptible to propaganda and BS which nurses are very good at.
We will lose this battle, the nurses will inherit the field of anesthesiology, and Americans will get the type of anesthesia care they deserve, cheap nurse anesthesia.
I am saying these things with tremendous pain and disgust because as an anesthesiologist who watched CRNA's perform for many years I know very well that they can not do what they say they can do without supervision, but my opinion will never be heard and the propaganda and BS will prevail.
 
I think the only thing that is certain is change. Our practice will be different twenty years from now just as it was twenty years ago. While nothing is impossible, the death of anesthesiology as a specialty is very unlikely.

More likely is that we will be paid differently than we are today. Instead of billing for start up units, time and sick patient modifiers, we will be paid for outcomes. Some of these outcomes will be silly and impossible to comply with (temperature) and some will be very reasonable (time outs, timely antibiotic administration).

Technology will change our practice. Forty years ago, anesthesiologists noted "bright red blood on incision" as part of the anesthetic record to document oxygenated blood. This is never done today because of the pulse oximeter. Unrecognized esophageal intubations are extremely rare due to end tidal CO2. There are technologies that have yet to be invented that will revolutionize our practice - we just don't know it yet.

Those of us who, for better or worse, embrace change will always be valuable and will always be compensated.
 
Nurses will be the ones to "embrace these new technologies" and comply with JACHO, ACHA....


gaspasser2004 said:
I think the only thing that is certain is change. Our practice will be different twenty years from now just as it was twenty years ago. While nothing is impossible, the death of anesthesiology as a specialty is very unlikely.

More likely is that we will be paid differently than we are today. Instead of billing for start up units, time and sick patient modifiers, we will be paid for outcomes. Some of these outcomes will be silly and impossible to comply with (temperature) and some will be very reasonable (time outs, timely antibiotic administration).

Technology will change our practice. Forty years ago, anesthesiologists noted "bright red blood on incision" as part of the anesthetic record to document oxygenated blood. This is never done today because of the pulse oximeter. Unrecognized esophageal intubations are extremely rare due to end tidal CO2. There are technologies that have yet to be invented that will revolutionize our practice - we just don't know it yet.

Those of us who, for better or worse, embrace change will always be valuable and will always be compensated.
Click to expand...
 
does anybody work with this chick at duke? someone needs to knock some sense into her.
 
Planktonmd said:
Nurses will be the ones to "embrace these new technologies" and comply with JACHO, ACHA....
Click to expand...

I honestly believe we ignore change at our peril.

I spoke to a very senior surgeon the other day and I asked him how he acquired the skills to do lap choles when he had been out of residency for so long. He explained the whole process of first watching videos, attending conferences and practicing on pigs. This took a lot of effort on his part to learn emerging technology but he did it because he wanted to keep his surgical practice relevant to what his patients expected.

For anesthesia, I think the MD-only practices will be a thing of the past in the not too distant future. Our value is not sitting with one patient at a time monitoring anesthesia, but rather as a perioperative consultant overseeing multiple patients, much like in the ICU.

As far as complying with JCAHO and other onerous organizations, the smart anesthesiologists/practices will figure out a way to do this efficiently while the other ones fall by the wayside. Think about the practices that are really good at documentation/billing/collections versus the ones that just muddle along.
 
Reading aan article written by a nurse on this issue is like reading a boozehounds memoirs on why they like booze. Of course they will paint themselves in a positive light and ignore the fact that nurses provide inferior care. It is journalistic masturbation on their part.
 
why do i see a million articles by nurses but none from anesthesiologists or the asa/
 
has anyone sent this to the ASA yet? What are the people at Duke saying about all of this? The ASA needs to start being more proactive. Deans and Chairpersons need to start writing similar articles in our defense. This is starting to get a little ridiculous.
 
yasawa said:
has anyone sent this to the ASA yet? What are the people at Duke saying about all of this? The ASA needs to start being more proactive. Deans and Chairpersons need to start writing similar articles in our defense. This is starting to get a little ridiculous.
Click to expand...

You mean the same deans and chairpersons that run the CRNA schools? 😎
 
haha, yeah dept heads are selling us out. However, since the dean of a nursing school is no longer playing the "politics game" of academics then why should our dept heads cont to support their endeavors to takeover our specialty. I think the chair at duke needs to set the tone and refuse to train any CRNAs.
 
yasawa said:
has anyone sent this to the ASA yet? What are the people at Duke saying about all of this? The ASA needs to start being more proactive. Deans and Chairpersons need to start writing similar articles in our defense. This is starting to get a little ridiculous.
Click to expand...

There have been a number of emails bouncing around, and I know the head of the hospital has been emailed about it. Not sure what, if anything, will happen as a result of it. We will see.

But yes, the nursing leadership seems to be much more coordinated and media-savvy. They know that, when it comes to publicity, you don't necessarily have to be right or accurate, just first. Then everybody else seems reactionary in comparison.
 
I'm curious - when a CRNA themself or their family member have surgery do they demand that NO physician take part in their anesthesia care? I doubt it.
 
Author:

Catherine L. Gilliss is dean of the Duke School of Nursing and president of the American Academy of Nursing.


Shocking. God, I love the way the CRNA/DNPs, etc, propagate this BS. Could you imagine if the rest of medicine and science worked this way:

This week in the NEJM, a 'scientifically proven study:' New Drug Awesome, Safe, and Better Than Stupid, Unnecessary, Money Grubbing Doctors,' By Pfizer.

Honestly, I really hope the average Joe is even smart enough to see something aint clean in an article, written by a nurse, that goes as far as to cite sources that state the training models are horrendously unequal, but nurses still rockzz and can do it just as well.

Pathetic.
 
xaelia said:
You say this sarcastically like it isn't the case the medical literature is corrupted by pharmaceutical and financial interests.
Click to expand...

It is influenced, highly in some cases, but a lot of the ones published in bigger journals usually reveal any conflicts. You honestly can tell me though that you think these articles where CRNAs/DNPs write the articles talking about how awesome they are and cite studies that THEY completed themselves aren't absurd??
 
physician assistant's in anesthesia.

The answer is staring us in the face.
 
leaverus said:
I'm curious - when a CRNA themself or their family member have surgery do they demand that NO physician take part in their anesthesia care? I doubt it.
Click to expand...

This is the question I have to. When a CRNA or a loved one is going under the knife, who would they want to do their anesthesia?
 
stargirl50 said:
Here's the response from the NC Society of Anesthesiologists.

http://www.newsobserver.com/2010/09/25/700746/assuring-the-safest-anesthesia.html
Click to expand...

👍 good thing the NC society of anesthesiologists is on top of their game. All we need now is for the ASA to start being proactive and stop simply reacting to these nurses. I really hope the Chair at Duke does something as well. There is no need to support a CRNA program when the agenda of the Dean of nursing is clearly counterproductive to the anesthesia care team model. Let the CRNAs train their own. No anesthesiologists should be involved in their education.
 
just a PM&R resident here. Why not stop training them? or better yet refuse to supervise. So if they can't get an airway it's sink or swim. like it is for the attendings.
 
Sanchik said:
just a PM&R resident here. Why not stop training them? or better yet refuse to supervise. So if they can't get an airway it's sink or swim. like it is for the attendings.
Click to expand...

If you stop training them, it makes crnas more expensive if supply decreases with no real benefit unless more docs, AAs, or PAs are trained to decrease the need for RN anesthetists.

If you refuse to supervise them, A you'd get replaced or B you would create an urgent perceived need by the government to give them independent practice rights to get the cases done, making matters even worse.

You don't let them go it alone, sink or swim, because patients deserve better.
 
Sanchik said:
just a PM&R resident here. Why not stop training them? or better yet refuse to supervise. So if they can't get an airway it's sink or swim. like it is for the attendings.
Click to expand...

It's a valid question. It should be looked at closer by programs, especially given today's political climate and the disrespect shown openly by nurses. I have no clear answer for you, but I've been asking a similar question for the past 2 years.
 
Physician Assistants in Anesthesia as anesthetists
 
Why not allowing independent CRNAs to consult with their fellow nurses when it comes to bad airway or sudden tachy or arrest. Patients should choose ahead of surgery if they want a nurse or doctor perfoming their anaesthesia care.

And louder voices should be heard from anaesthesiologists all over US. I'm not American, but l feel your fury and disgust when it comes to dealing with this kind of people.
 
ok i wont shout. PA anesthetists. We should start opening up schools and train them. The job of the CRNA is not to do our job which is design an anesthetic plan the job of a crna is to monitor the patient. If they no longer want to do this, I think PAs are poised to step up to the plate. what do you guys think??
 
I agree maceo. Get rid of these militant CRNAs.
 
A few comments/questions:

Is it possible to make it economically unwise to chose CRNA as an independent career? (Malpractice premiums at the same price as a anesthesiologist.) Since they think they can operate independently, shoulder them with the liability as well, instead of the MDs.

Otherwise, I like the idea of AAs. Seen them in a couple of hospitals.

Also, I remember a suit against an CRNA posted as a thread here. Is there any news on its progression/settlement?
 
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