How are CRNA supervision and academic attending different?

[GoodmanBrown]

---

Members don't see this ad.

So, as I've only been able to shadow academic attendings and residents, my view is obviously skewed, but it seems to me that supervising CRNAs and supervising residents are pretty similar. The attending is around for intubation and comes back for extubation and waking. Otherwise, he only comes around if there's a problem. Where's the difference between the two? Thanks!

-GB.

 

[ProRealDoc]

So, as I've only been able to shadow academic attendings and residents, my view is obviously skewed, but it seems to me that supervising CRNAs and supervising residents are pretty similar. The attending is around for intubation and comes back for extubation and waking. Otherwise, he only comes around if there's a problem. Where's the difference between the two? Thanks!

-GB.

One of the two being supervised will be supervising the CRNA someday.

 

[coprolalia]

So, as I've only been able to shadow academic attendings and residents, my view is obviously skewed, but it seems to me that supervising CRNAs and supervising residents are pretty similar. The attending is around for intubation and comes back for extubation and waking. Otherwise, he only comes around if there's a problem. Where's the difference between the two? Thanks!

-GB.

I have to disagree... at least at my institution. And, the reason annoys me to no end.

We have a couple of new CRNAs freshly-minted out of CRNA school. In both instances, they are in their mid-twenties. They went to BSN school, worked for a year (or so) in an "intensive care" setting (one in the ED and one in a step-down unit) before going to CRNA school. Both are intelligent, nice, easy to get along with, etc.

But, I have heard, from more than one attending, that they do "not have to worry as much about my 'other' room because, you know, a CRNA is in there and I need to focus more on my room with my resident."

Wait a minute! 😱

You have a nurse who went to a two-year training program after undergraduate BSN, worked the bare-minimum amount of time required to be eligible for CRNA-school before matriculating, and then is in their first post-graduate job - in one case less than six months - and they don't need to be supervised with the level of scrutiny that a CA-3 with four years of medical school and (going on) four years of post-graduate training managing all manner of complex OR and ICU cases does?

Give me a break. And, this is not unique to one individual or complexity of case at my institution. There is a perception by our attendings that the CRNA is "trained" and doesn't need as much oversight.

I have witnessed some of these very CRNAs not understanding basic things about giving an anesthetic. When I've had occasion to get them out for lunch or relieve them for the day (yes, we relieve them, not the other way around), I've seen some pretty questionable things going on. In one case, I had one of these CRNAs run a volatile anesthetic to a trach collar... yes, she did not plug the circuit directly onto the trach tube itself. In another instance, I had another junior CRNA come in the room to "help" me with a big case. I asked him to hang dopamine for me while I was busy doing other things. The result? He grabbed dobutamine, primed the line, and put it in the IV pump... still setting it up and labeling it dopamine. Fortunately, I caught the error before I hooked the line up to the patient and started the infusion.

This really pisses me off to no end. I don't know why this perception exists. Just because someone has "finished" their training doesn't mean they're competent and ready to practice independently. I'm fairly certain that the complexity of cases we see on a daily basis pales in comparison to the bulk of the cases they got during their training. Yet, the perception among some of our attendings is that they automatically get a longer leash than my vastly greater-trained resident colleagues, who in no uncertain terms still have more training in both depth-and-breadth of cases along with clinical complexity as well as time.

😡

-copro

 

[Coastie]

At my program, thankfully, the perception is exactly the opposite.

Amongst attendings, even the "seasoned CRNAs" compared with CA-1's at the end of their first year...well, the difference is stark. The attendings trust us far more than the CRNAs, and while there are exceptions within both groups, we get more clinical respect. Additionally, any procedure (central line, aline, spinal, fiberoptic, etc) within a case that a CRNA has (if they are assigned to such a room) is done by a resident.

I have to disagree... at least at my institution. And, the reason annoys me to no end.

We have a couple of new CRNAs freshly-minted out of CRNA school. In both instances, they are in their mid-twenties. They went to BSN school, worked for a year (or so) in an "intensive care" setting (one in the ED and one in a step-down unit) before going to CRNA school. Both are intelligent, nice, easy to get along with, etc.

But, I have heard, from more than one attending, that they do "not have to worry as much about my 'other' room because, you know, a CRNA is in there and I need to focus more on my room with my resident."

Wait a minute! 😱

You have a nurse who went to a two-year training program after undergraduate BSN, worked the bare-minimum amount of time required to be eligible for CRNA-school before matriculating, and then is in their first post-graduate job - in one case less than six months - and they don't need to be supervised with the level of scrutiny that a CA-3 with four years of medical school and (going on) four years of post-graduate training managing all manner of complex OR and ICU cases does?

Give me a break. And, this is not unique to one individual or complexity of case at my institution. There is a perception by our attendings that the CRNA is "trained" and doesn't need as much oversight.

I have witnessed some of these very CRNAs not understanding basic things about giving an anesthetic. When I've had occasion to get them out for lunch or relieve them for the day (yes, we relieve them, not the other way around), I've seen some pretty questionable things going on. In one case, I had one of these CRNAs run a volatile anesthetic to a trach collar... yes, she did not plug the circuit directly onto the trach tube itself. In another instance, I had another junior CRNA come in the room to "help" me with a big case. I asked him to hang dopamine for me while I was busy doing other things. The result? He grabbed dobutamine, primed the line, and put it in the IV pump... still setting it up and labeling it dopamine. Fortunately, I caught the error before I hooked the line up to the patient and started the infusion.

This really pisses me off to no end. I don't know why this perception exists. Just because someone has "finished" their training doesn't mean they're competent and ready to practice independently. I'm fairly certain that the complexity of cases we see on a daily basis pales in comparison to the bulk of the cases they got during their training. Yet, the perception among some of our attendings is that they automatically get a longer leash than my vastly greater-trained resident colleagues, who in no uncertain terms still have more training in both depth-and-breadth of cases along with clinical complexity as well as time.

😡

-copro

 

[coprolalia]

At my program, thankfully, the perception is exactly the opposite.

You're lucky. A "seasoned CRNA" at our institution recently did something so stupid that the knee-jerk reaction was to punish the entire department.

I cannot be done with residency soon enough... 50-some days and counting...

-copro

 

[badasshairday]

DOBUTAMINE INSTEAD OF DOPAMINE!!! 😱

Good thing you caught that.... damn.

 

[periopdoc]

I cannot be done with residency soon enough... 50-some days and counting...

-copro

52...


We should have a count down thread.

- pod

 

[smgilles]

At my program, thankfully, the perception is exactly the opposite.

Amongst attendings, even the "seasoned CRNAs" compared with CA-1's at the end of their first year...well, the difference is stark. The attendings trust us far more than the CRNAs, and while there are exceptions within both groups, we get more clinical respect. Additionally, any procedure (central line, aline, spinal, fiberoptic, etc) within a case that a CRNA has (if they are assigned to such a room) is done by a resident.

This is identical to my program as well.

 

[turnupthevapor]

Difference:

Residents listen to you! Do what you say with out arguing with ever decision you make and learn from you

CRNA'S do the opposite😡

 

[soonerfrog]

I will attempot to make this short, but first let me preface: Yes, I am aware this is a site for doctors and future doctors. I am neither. Secondly, try for just a brief minute to avoid the temptation to automatically prejudge my post before reading it, as it comes from a CRNA and not an MD/DO. I know that will be difficult because you have certain predisposed bias, but I think if you can be honest and reasonable, it will ultimately provide more insight.

It seems more often than not, when a CRNA makes a mistake in the operating room, it was because he/she has inferior training. More so in the DOBUTamine vs. DOPamine example listed above rather than the volatile via trach collar example (agree that is absurd in any circumstance). That being said, if an attending or resident made the same mistake, it seems you might be more tempted to say, "...well clearly the physician KNOWS the diffference between one vasopressor and another, this was just a mistake and we're all human and subject to error on occasion." Enter in the double standard. I appreciate this was an isolated incident, but it has every reason to be generalized into a larger glaring pattern. But I'm not naive. I know there will frequently exist a double standard amoungst our professions. I occasionally just grow weary of all this trivial bickering amoung two groups of people who seemingly got into the field for very similar reasons: earn a reasonable income, challenge oneself to learn, care for the sick/injured, ect. And there is clearly anger and rage on both sides, but when I read comments from individuals like TecmoBowl (a physician), "...CRNAs need to be squished like the bugs they are, all because, their political lobby has gone too far..." or even from SaladinMD (a med-student) "With regard to CRNAs, we need a solution. A final solution," it is no wonder why organizations like the AANA are so militant...they HAVE to be. There is an underpinning rage against them from the outset. I am not defending all of the AANA's stances/beliefs, but at the same time, I am troubled by the fact there appears to be no common ground with which to reason with betwixt the two parties. It's frustrating for both sides, no doubt. But the hate has got to stop. We're both just serving to ultimately demean the profession itself. I am aware of the arguments on both sides...ad nauseum. But if we cannot calm ourselves and find common ground with which to rationally and reasonable discuss our differences, we are doomed to repeat the last several decades worth of malevolence for each other.
As an aside, whether it means anything or not, I am grateful for this site as I feel it offers everyone a venue to learn valuable clinical information, knowledge pearls, ect. Sort of a "poor man's M&M" if you will. It may not matter to many, but to the few who care....simply, THANK YOU!!!

 

[soonerfrog]

Before I get banned...I just wanted to quote Jet:

"YOU DUDES/DUDETTES AINT STUPID. ME EITHER. WE'RE SOME SMART MO-FOs. PUT OUR THINKING AND TECHNICAL PROWESS TOGETHER AND YOU'VE GOT THE ULTIMATE ANESTHETIC MODEL."

I think he's the perfect example of ration and reason. And if we REALLY care about safety, I mean REALLY care, I think we could listen to him more, because 99.8% of the time, he's spot on.

 

[coprolalia]

I will attempot to make this short...

First off, thank you for your post. It has merit. And, it is appreciated.

Now, the reason why I posted my message was not as an assault against the nurse-anesthetist profession. It was in response to the perception about what level of supervision is expected, per the OP, in our institution. And, my de facto assertion is that, at least in my institution's case, I've heard echoed several times from a multitude of attendings across a broad sample of cases that our CRNAs don't need as much as the residents do.

Now, my institution's general practices might represent an isolated case. And, I'm sure that many residents, especially the junior ones, have made hare-brained mistakes (some well-known to me) that I could recount here in gory detail. That wasn't the issue on this thread, though. The issue was whether or not CRNAs, by default, get more or less supervision than residents. At my institution, if I haven't made it clear enough yet, the perception is that even the senior residents who may have more training both in terms of total clinical exposure time as well as complexity of cases require more supervision than our CRNA colleagues, including the fresh-outta-school ones.

Again, I am hoping (and am getting the impression) that this is mostly isolated to my institution. But, as was echoed - albeit representing a slight derailment of this thread - it seems that at least residents will listen to direction and criticism. Keep reading.

Now, with your aside and new direction of this thread duly noted, how do we change the perception among CRNAs that criticism and direction from their physician colleagues under whose supervision they operate should not immediately be met with argument and ensuing conflict? I guess that's the real question that you have (and at least one other poster has) raised.

As well, I have heard horror stories of cases going badly where the CRNA has said directly to the physician at the time "I don't need your help" when clearly they did. Again, I think this is an ongoing example of both hubris and "not knowing what you don't know". And, I have a feeling that many of my attending colleagues wrongfully feel that they don't need to supervise their CRNA counterparts because any direction that they give will fall on deaf ears, even with the most junior of CRNAs. This may be more of a throw-your-hands-up-and-hope-for-the-best attitude born out of frustration that any attempt to offer direction will be met with hostility based on a belief fomented by, in no small part, by the AANA that they are "equal" to their physician-trained colleagues. I surmise that attitude, on at least an individual basis, will change among those physicians the first time they find themselves in court defending a CRNA's actions with regards to their supposed direction under which the anesthetic was given.

So, for the "militant" posture that has created this situation, even if just at my institution and also among some of the recent grads, I wholly blame the AANA.

-copro

 

[BLADEMDA]

I wholly blame the AANA.👍👍👍👍

 

[coprolalia]

And, the AANA is the channel through which the local state affiliates take their direction...

"On May 2nd, the Pennsylvania House Insurance Committee met for testimony on Governor Rendell’s health plan. Representatives from the Pennsylvania Society of Anesthesiologists (PSA) and the Pennsylvania Association of Nurse Anesthetists (PANA) were present to testify. Dr. Erin Sullivan, President, PSA and Dr. Joseph Answine, President-Elect, PSA, testified that the anesthesia care team is time-proven and safe. Furthermore, they testified that the anesthesiologist is an acute care physician that diagnoses and treats illness during the peri-operative period. Dr. Arthur Zwerling (Doctor of Nursing Practice, DNP), President-Elect, PANA testified that the PANA seeks independent practice for Certified Registered Nurse Anesthetists and that an anesthesiologist is not necessary in most settings."

http://mkeamy.typepad.com/anesthesiacaucus/2007/10/should-mds-be-t.html

(And, note the comment at the bottom of the page at the end of the blog. I wonder if that was added by a CRNA... not! Gives one a great insight into how many of them think, though, whether they say it to your face in the OR or not... and most won't say it out loud.)

-copro

 

[ProRealDoc]

And, the AANA is the channel through which the local state affiliates take their direction...



http://mkeamy.typepad.com/anesthesiacaucus/2007/10/should-mds-be-t.html

(And, note the comment at the bottom of the page at the end of the blog. I wonder if that was added by a CRNA... not! Gives one a great insight into how many of them think, though, whether they say it to your face in the OR or not... and most won't say it out loud.)

-copro

from the same link:

"The evidence appears compelling that AANA is actively working against the efforts of the ASA to ensure the future viability of Anesthesiology. The AANA is a large society, and most of the nurse anesthetists we work with belong to it and thus can be assumed to support its activities, daily collegiality notwithstanding."

 

[pgg]

Before I get banned...I just wanted to quote Jet:

"YOU DUDES/DUDETTES AINT STUPID. ME EITHER. WE'RE SOME SMART MO-FOs. PUT OUR THINKING AND TECHNICAL PROWESS TOGETHER AND YOU'VE GOT THE ULTIMATE ANESTHETIC MODEL."

I think he's the perfect example of ration and reason. And if we REALLY care about safety, I mean REALLY care, I think we could listen to him more, because 99.8% of the time, he's spot on.

That's great. Glad to hear you agree CRNAs should be supervised and directed by anesthesiologists. Now go to the AANA and tell them that you want to preserve that ACT model and don't want independent practice.

We're waiting ...

 

[platon20]

Difference:

Residents listen to you! Do what you say with out arguing with ever decision you make and learn from you

CRNA'S do the opposite😡

Yet you attendings continue to hire them and sell out your own profession. The 250k you guys were making before CRNAs wasnt good enough, you wanted that half mil baby so you "supervise" all these CRNAs for extra cash.

Shame on you!

 

[jetproppilot]

That's great. Glad to hear you agree CRNAs should be supervised and directed by anesthesiologists. Now go to the AANA and tell them that you want to preserve that ACT model and don't want independent practice.

We're waiting ...

Your smart-a s s comment is recognized and ignored, Slim.

I've posted some on the nurse-anesthesia forum.

I've made my stance very clear there, as I have here.

Some agree, some don't, just like here.

Thats OK.

I'm comfortable with my opinion and my beliefs.

 

[GoodmanBrown]

So, I guess my question wasn't entirely clear. What's the difference for attendings btw. supervising the two. So far, I've got that CRNAs can be more resistant to certain instructions.

A more specific question. How many CRNAs does an MD usually supervise? It seems like it's usually about 2 residents (2 rooms in other words) from my academic experiences. I can't imagine you only do 2 CRNAs at once, right? (I'll save you the trouble... That's what she said.)

So, how does supervising 3 or 4 rooms make your job different? Busier, obviously, but anything else?

 

[coprolalia]

So, I guess my question wasn't entirely clear. What's the difference for attendings btw. supervising the two. So far, I've got that CRNAs can be more resistant to certain instructions.

A more specific question. How many CRNAs does an MD usually supervise? It seems like it's usually about 2 residents (2 rooms in other words) from my academic experiences. I can't imagine you only do 2 CRNAs at once, right? (I'll save you the trouble... That's what she said.)

So, how does supervising 3 or 4 rooms make your job different? Busier, obviously, but anything else?

The CMS reimbursement rules (followed by insurance companies) dictate that you can only supervise two residents to get full reimbursement.

At our institituon, at most 2 CRNAs are "supervised" (I use that in the loosest sense) by an attending... not 3 or 4. Call that a luxury of having adequate attending-staffing. They follow the same model as they do with the residents. The level of "supervision" is different. Otherwise, see my comments above.

-copro

 

[pgg]

Your smart-a s s comment is recognized and ignored, Slim.

Well Chunk, observe if you will, that my comment was not directed at you. I'm in 100% agreement with what soonerfrog quoted you as saying: that CRNAs + physicians make an excellent, safe, cost-effective team.

I was simply expressing my irritation with CRNAs who sing the "can't we all just get along" song and pay lip service to the ACT model, while paying dues with tithe-like diligence to an organization hell-bent on stamping out that ACT model in the name of reckless and irresponsible independent practice of medicine by nurses.

soonerfrog seems like very nice, reasonable person who favors the ACT model. He sounds a lot like all of the great CRNAs and SRNAs that I work with every day. I like them. They're my friends. I learn from them, they learn from me. And yet the organization made up of these very nice and reasonable CRNAs continues to work very hard to do things that all of these reasonable CRNAs (allegedly) disagree with.

I think soonerfrog is saying one thing to our face ("ACT model good!") and something quite different to the AANA ("ACT model bad - want independent practice now!") ... and you and I both know which way their money is flowing.

I'm glad you're comfortable with your opinion and beliefs. I'd be more comfortable if soonerfrog would spend the time it took to write that nice post above to write a nice letter expressing the same thing to the AANA.

 

[jetproppilot]

Well Chunk,.

THATS A GOOD ONE.....UHHHH......CHUNK..

I apologize for my misunderstanding you.

 

[pgg]

THATS A GOOD ONE.....UHHHH......CHUNK..

I'm apologize for my misunderstanding you.

I just figured I shouldn't call a bodybuilder slim.

 

[2win]

So, as I've only been able to shadow academic attendings and residents, my view is obviously skewed, but it seems to me that supervising CRNAs and supervising residents are pretty similar. The attending is around for intubation and comes back for extubation and waking. Otherwise, he only comes around if there's a problem. Where's the difference between the two? Thanks!

-GB.

Seems that you did your rotation in a second hand hospital. Time for a change and I know - "you can do it"!

 

[soonerfrog]

I believe the contention that CRNA's want independent practice is the very crux of what angers so many on this forum. I am somewhat torn on the issue personally. Firstly, I wholeheartedly agree with the ACT model. It's been discussed again and again, but clearly, the evidence points in favor of this direction. I think the vast majority of my colleagues would agree. Regrettably, I do not see how the ACT model is feasible in every venue anesthesia is involved in. Enter in the pink elephant. I think there are a reasonable number of docs that think we are out to replace them and a few that believe we think we are entitled to equal stature. This is simply unreasonable. However, I think there exists a subset of rural America where small hospitals REQUIRE CRNAs because MD's frequently find these sorts of communities "less than desirable" (generally speaking). So is it unreasonable to offer CRNA's solo practice in towns that would otherwise struggle with offering run-of-the-mill outpatient/mild inpatient procedures? *THIS IS THE IMPORTANT QUESTION* I know of several of these facilities that have frequently tried (unsuccessfully) to lure anesthesiologists in, but point of fact is that few people want to live in a town of <10,000 with frequent call. The 'rural gig' is unappealing for a variety of reasons. Again, we could go on forever with the supply and demand issue, but I think most CRNA's simply believe they have been adequately trained to do many ASA 1-3 cases in these sorts of scenarios. Many of us are also comfortable doing more challenging cases, and feel the addition of a physician only serves to improve outcomes. Most of us see this as a blessing, not a hindrance. I'm not sure where it all goes south, but clearly, this is not an issue that is new to the field. And likely, I'm falsely optimistic that we can weather a compromise anytime soon....but dare to dream, eh?

And on yet another aside, I get the impression that at least many of you have been as open and as unbiased as you can be in reading these recent exchanges. I admittedly know that it is frequently difficult to remain neutral and objective in discussing something so passionate. That being said, I would like to thank everyone for their candor and honesty. Emotions and beliefs frequently add impartiality and unnecessary fervor to an already volatile (pun intended) situation. I think it ultimately serves us best if we can have these sorts of open dialogue in this manner and keep civility in the forefront of our mind. Thanks again. Maybe it's been helpful...

 

[dhb]

I think the vast majority of my colleagues would agree.

The problem is that the organization that represents the vast majority of you does not.
So how do we interpret that?
The truth is most MD's have no beef with mid levels the problems arise when one groups claims equivalence although their training is clearly inferior.

 

[coprolalia]

Trying to stay on-topic...

I believe the contention that CRNA's want independent practice is the very crux of what angers so many on this forum.

Yes, this is part of it. And, some of them vociferously advocate, by attempted intimidation or outright refusal to adhere to the spirit of the ACT model, for this what-they-perceive-to-be "right" to it.

My contention is that there probably are some CRNAs who could practice independently. But, the issue regarding offering that is two-fold.

(1) Not all CRNAs are trained or have the level of expertise to practice independently. I've seen firsthand a much, MUCH wider variance in practice ability among CRNAs than I have among their board-certified physician colleagues. You can't offer independent practice to one group - or even the specter of independent practice - without offering it to all. Sorry, but you just don't have enough depth of training to cover all the responsibilities that a physician-trained anesthesiologist can cover.

(2) If you look at Art Zwerling's comments above, you'll see that he says specifically, "...an anesthesiologist is not necessary in most settings." Well, then what, pray tell, are the settings where an anesthesiologist is needed? You see, you can't easily quantify these on a day-to-day basis. Yet, the AANA and its affiliates would have the public believe that anesthesia is safe enough that a CRNA can effectively give it most of the time, but are unable to elucidate when exactly it isn't. This is the biggest problem with independent practice concept.

The ACT model works. Why then try to fix something that's isn't broken? And, potentially put the public at greater risk in doing so.

-copro

 

[ProRealDoc]

Trying to stay on-topic...



Yes, this is part of it. And, some of them vociferously advocate, by attempted intimidation or outright refusal to adhere to the spirit of the ACT model, for this what-they-perceive-to-be "right" to it.

My contention is that there probably are some CRNAs who could practice independently. But, the issue regarding offering that is two-fold.

(1) Not all CRNAs are trained or have the level of expertise to practice independently. I've seen firsthand a much, MUCH wider variance in practice ability among CRNAs than I have among their board-certified physician colleagues. You can't offer independent practice to one group - or even the specter of independent practice - without offering it to all. Sorry, but you just don't have enough depth of training to cover all the responsibilities that a physician-trained anesthesiologist can cover.

(2) If you look at Art Zwerling's comments above, you'll see that he says specifically, "...an anesthesiologist is not necessary in most settings." Well, then what, pray tell, are the settings where an anesthesiologist is needed? You see, you can't easily quantify these on a day-to-day basis. Yet, the AANA and its affiliates would have the public believe that anesthesia is safe enough that a CRNA can effectively give it most of the time, but are unable to elucidate when exactly it isn't. This is the biggest problem with independent practice concept.

The ACT model works. Why then try to fix something that's isn't broken? And, potentially put the public at greater risk in doing so.

-copro

$$$$$$$$

 

[ProRealDoc]

I believe the contention that CRNA's want independent practice is the very crux of what angers so many on this forum. I am somewhat torn on the issue personally. Firstly, I wholeheartedly agree with the ACT model. It's been discussed again and again, but clearly, the evidence points in favor of this direction. I think the vast majority of my colleagues would agree. Regrettably, I do not see how the ACT model is feasible in every venue anesthesia is involved in. Enter in the pink elephant. I think there are a reasonable number of docs that think we are out to replace them and a few that believe we think we are entitled to equal stature. This is simply unreasonable. However, I think there exists a subset of rural America where small hospitals REQUIRE CRNAs because MD's frequently find these sorts of communities "less than desirable" (generally speaking). So is it unreasonable to offer CRNA's solo practice in towns that would otherwise struggle with offering run-of-the-mill outpatient/mild inpatient procedures? *THIS IS THE IMPORTANT QUESTION* I know of several of these facilities that have frequently tried (unsuccessfully) to lure anesthesiologists in, but point of fact is that few people want to live in a town of <10,000 with frequent call. The 'rural gig' is unappealing for a variety of reasons. Again, we could go on forever with the supply and demand issue, but I think most CRNA's simply believe they have been adequately trained to do many ASA 1-3 cases in these sorts of scenarios. Many of us are also comfortable doing more challenging cases, and feel the addition of a physician only serves to improve outcomes. Most of us see this as a blessing, not a hindrance. I'm not sure where it all goes south, but clearly, this is not an issue that is new to the field. And likely, I'm falsely optimistic that we can weather a compromise anytime soon....but dare to dream, eh?

And on yet another aside, I get the impression that at least many of you have been as open and as unbiased as you can be in reading these recent exchanges. I admittedly know that it is frequently difficult to remain neutral and objective in discussing something so passionate. That being said, I would like to thank everyone for their candor and honesty. Emotions and beliefs frequently add impartiality and unnecessary fervor to an already volatile (pun intended) situation. I think it ultimately serves us best if we can have these sorts of open dialogue in this manner and keep civility in the forefront of our mind. Thanks again. Maybe it's been helpful...

Until the AANA stops blocking any attempts by the ASA to change the unfair rural pass-through rule that prevents rural hospitals from using Medicare Part A funds to pay anesthesiologists, but allows such funds to be used to pay CRNAs; until then, you have no argument.

Also, rural hospitals don't require nurse anesthetists, THEY SETTLE since no anesthesiologist is allowed to work there and be reimbursed fairly for his services.

So before you some here and spout your AANA rhetoric, check your facts.

 

[coprolalia]

$$$$$$$$

I.E., Greed.

(Of course.)

-copro