How are Crnas more cost effective?

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Because anesthesiologists hijack their (profession) in order to "employ" crnas doing the actual anesthesia getting paid 1/4-1/3 the pay. The farce is that crnas are cheaper, indeed the reimbursement is mostly the same. The way that crnas are more cost effective is that they take the same or slightly more pay without the stipends that their physician counterparts demand for call etc. Whereas the stipends can be =>7 figures.

My 9 colleagues and I make a great salary and provide every kind of regional anesthesia service. Our administration is adamantly apposed to bringing in even one anesthesiologist. Just too expensive and ZERO added value. If there is someone that thinks they can add to our practice,md or crna, I will give you administration's contact info.

Well folks, there have you it.
 
Because anesthesiologists hijack their (profession) in order to "employ" crnas doing the actual anesthesia getting paid 1/4-1/3 the pay. The farce is that crnas are cheaper, indeed the reimbursement is mostly the same. The way that crnas are more cost effective is that they take the same or slightly more pay without the stipends that their physician counterparts demand for call etc. Whereas the stipends can be =>7 figures.

My 9 colleagues and I make a great salary and provide every kind of regional anesthesia service. Our administration is adamantly apposed to bringing in even one anesthesiologist. Just too expensive and ZERO added value. If there is someone that thinks they can add to our practice,md or crna, I will give you administration's contact info.

Please post it. Would love to know which facility this is.
 
Huh? We get 40 hours per week plus at home beeper call once a week for total package of well under 200K per year for a CRNA. They get OT when they go beyond 40 hours, but still not even close to 200K per. And we could fill 10 extra spots tomorrow if we needed them. The waiting list for a job is growing, not shrinking.

Not where I live. Probably why there isn't a big cRNA presence.
 
Because anesthesiologists hijack their (profession) in order to "employ" crnas doing the actual anesthesia getting paid 1/4-1/3 the pay. The farce is that crnas are cheaper, indeed the reimbursement is mostly the same. The way that crnas are more cost effective is that they take the same or slightly more pay without the stipends that their physician counterparts demand for call etc. Whereas the stipends can be =>7 figures.

My 9 colleagues and I make a great salary and provide every kind of regional anesthesia service. Our administration is adamantly apposed to bringing in even one anesthesiologist. Just too expensive and ZERO added value. If there is someone that thinks they can add to our practice,md or crna, I will give you administration's contact info.

I've already closed one thread you posted this nonsense in today.

You have officially worn out your welcome. These forums, part of the Student Doctor Network, are not here for nurses to come in and assert that doctors add zero value. This is trolling.

Cool it, or begone.
 
I've already closed one thread you posted this nonsense in today.

You have officially worn out your welcome. These forums, part of the Student Doctor Network, are not here for nurses to come in and assert that doctors add zero value. This is trolling.

Cool it, or begone.
let this thread play it's course. Dont close it. This guy /gal is clearly looking for a reaction from us. The facts still remain AAs are better and cheaper than CRNAs
 
I've already closed one thread you posted this nonsense in today.

You have officially worn out your welcome. These forums, part of the Student Doctor Network, are not here for nurses to come in and assert that doctors add zero value. This is trolling.

Cool it, or begone.

i don't get how he isn't gone already. the murse is clearly trolling and has done what he has set out to do. i don't blame this murse for his feelings. i blame all anesthesiology programs that have physicians training these nurses to begin with. let them train their own without any physicians and lets see what happens. Unfortunately we have too many cowards in leadership positions in academia
 
I'll never forget the day my old group hired our first AA. The CRNAs wouldn't eat lunch with her, wouldnt speak to her when she said hello, I saw full on tantrums that would rival my 2 year old's when the decision was announced at our weekly meeting. It was truly the most unprofessional and sad display I think I've ever seen from adults. We never hired a CRNA after that.
 
let this thread play it's course. Dont close it. This guy /gal is clearly looking for a reaction from us. The facts still remain AAs are better and cheaper than CRNAs
I'll play... AAS are cheaper for whom? If you are the be all end all to deliver anesthesia... why delegate to a tech? Really,ed school prepared? Granted some of you h a d real undergrad degrees like biochem, ochem, but to the ones that had basket weaving with one ochem b- ? Whatever. We all get there right? Md, aa, crna, is anesthesia some secret only "doctors" know? Great you had a surgery rotation for three weeks and a week of anesthesia in med school. Wow a month in residency replacing potassium? I prevented residents from killing patients for three years before anesthesia. Aas, mdas, crnas, whatever. Bull****, less bull****, actually hands on. Tout your 16000 hours my hours before anesthesia were _life and death not doing physicals or med reviews. Take it or leave it
 
I'll play... AAS are cheaper for whom? If you are the be all end all to deliver anesthesia... why delegate to a tech? Really,ed school prepared? Granted some of you h a d real undergrad degrees like biochem, ochem, but to the ones that had basket weaving with one ochem b- ? Whatever. We all get there right? Md, aa, crna, is anesthesia some secret only "doctors" know? Great you had a surgery rotation for three weeks and a week of anesthesia in med school. Wow a month in residency replacing potassium? I prevented residents from killing patients for three years before anesthesia. Aas, mdas, crnas, whatever. Bull****, less bull****, actually hands on. Tout your 16000 hours my hours before anesthesia were _life and death not doing physicals or med reviews. Take it or leave it

Still waiting for the info you promised.
 
I'll play... AAS are cheaper for whom? If you are the be all end all to deliver anesthesia... why delegate to a tech? Really,ed school prepared? Granted some of you h a d real undergrad degrees like biochem, ochem, but to the ones that had basket weaving with one ochem b- ? Whatever. We all get there right? Md, aa, crna, is anesthesia some secret only "doctors" know? Great you had a surgery rotation for three weeks and a week of anesthesia in med school. Wow a month in residency replacing potassium? I prevented residents from killing patients for three years before anesthesia. Aas, mdas, crnas, whatever. Bull****, less bull****, actually hands on. Tout your 16000 hours my hours before anesthesia were _life and death not doing physicals or med reviews. Take it or leave it
You are just mad cuz AAs are better. They did not spend following orders in the icu providing bowel care.... read: wiping asses
 
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I've already closed one thread you posted this nonsense in today.

You have officially worn out your welcome. These forums, part of the Student Doctor Network, are not here for nurses to come in and assert that doctors add zero value. This is trolling.

Cool it, or begone.
He also claims to be a "resident." That alone is a ToS violation...
 
I'm more interested in real world solutions. Yes we think each other suck.... I respect physicians, more than anyone I respect physicians in anesthesia. I'm sorry that you feel bad that crnas do anesthesia in most rural places, that's me. That won't change as far as I think. Even though you may think you want that but would never work here.nlike I said, I mean Not threatened...
, I think I'm some where in between. Don't we all know both crnas and mda
 
I'm more interested in real world solutions. Yes we think each other suck.... I respect physicians, more than anyone I respect physicians in anesthesia. I'm sorry that you feel bad that crnas do anesthesia in most rural places, that's me. That won't change as far as I think. Even though you may think you want that but would never work here.nlike I said, I mean Not threatened...
, I think I'm some where in between. Don't we all know both crnas and mda
I'm upset that the only reason physicians can't do anesthesia rurally is because there is special legislation that only subsidizes midlevels. I'd love to be a rural anesthesiologist someday, but only CRNAs get that nice passthrough legislation, so no rural place can afford the doctors they realistically would rather have.
 
I'm more interested in real world solutions. Yes we think each other suck.... I respect physicians, more than anyone I respect physicians in anesthesia. I'm sorry that you feel bad that crnas do anesthesia in most rural places, that's me. That won't change as far as I think. Even though you may think you want that but would never work here.nlike I said, I mean Not threatened...
, I think I'm some where in between. Don't we all know both crnas and mda
YOU WILL BE AMAZED...

We make 300K as anesthetists, no subsidy, cover our own call and vacation. Sure id let you all know but none of you let anything told....
 
i don't get how he isn't gone already. the murse is clearly trolling and has done what he has set out to do.
The 2012 join date. People don't often abruptly start trolling 4 years after signing up. The usual MO is a newly registered, hours-old account that lets loose with the crap. When I see old accounts do things like this I leave more rope, on the off chance it's just a momentary lapse.

That said, he/she/it didn't take the hint.
 
The 2012 join date. People don't often abruptly start trolling 4 years after signing up. The usual MO is a newly registered, hours-old account that lets loose with the crap. When I see old accounts do things like this I leave more rope, on the off chance it's just a momentary lapse.

That said, he/she/it didn't take the hint.
I just loved the part about how CRNAs have been providing anesthesia independently for more than a century. Really nice trolling, and trying to rewrite history, a la AANA.

Here's the true version: http://www.psanes.org/home/tabid/37/anid/43/default.aspx . (Residents, know how to find that site even when woken up at night.)

"Returning to the question with which we began this discussion, the most relevant facts in 2012 are not who provided anesthesia care 150 years ago or for how long. If those were the relevant inquiries, barbers would be surgeons now as they once were. Instead, there are two centrally relevant questions. First, has the body of knowledge and skills necessary to care for patients changed? Second, has the practitioner’s education and training kept pace with those changes? When surgery progressed beyond bleeding patients to other forms of treatment, the barbers’ skills did not expand to keep pace, and their scope of practice reverted to its traditional role of cutting hair.

The history of modern anesthesia over the past 160 years begins with nurses assisting surgeons in the use of ether and then other gases. Anesthetics became increasingly more complex, from approximately the 1920s on. Surgical patients became sicker. Anesthesia outcomes initially worsened. These trends led to specially trained physicians – anesthesiologists – assuming responsibility for providing and directing anesthesia care, as well as performing the increasingly complex medical procedures associated with the perioperative care of surgical patients."
 
I just loved the part about how CRNAs have been providing anesthesia independently for more than a century. Really nice trolling, and trying to rewrite history, a la AANA.

Here's the true version: http://www.psanes.org/home/tabid/37/anid/43/default.aspx . (Residents, know how to find that site even when woken up at night.)

"Returning to the question with which we began this discussion, the most relevant facts in 2012 are not who provided anesthesia care 150 years ago or for how long. If those were the relevant inquiries, barbers would be surgeons now as they once were. Instead, there are two centrally relevant questions. First, has the body of knowledge and skills necessary to care for patients changed? Second, has the practitioner’s education and training kept pace with those changes? When surgery progressed beyond bleeding patients to other forms of treatment, the barbers’ skills did not expand to keep pace, and their scope of practice reverted to its traditional role of cutting hair.

The history of modern anesthesia over the past 160 years begins with nurses assisting surgeons in the use of ether and then other gases. Anesthetics became increasingly more complex, from approximately the 1920s on. Surgical patients became sicker. Anesthesia outcomes initially worsened. These trends led to specially trained physicians – anesthesiologists – assuming responsibility for providing and directing anesthesia care, as well as performing the increasingly complex medical procedures associated with the perioperative care of surgical patients."

Yeah whenever they bring up this talking point I'm always surprised. You started killing people in droves so they had to make it a medical specialty in order to make it safe.
Despite technology advances, this trend will return if there is widespread unsupervised CRNA practice.
Full circle!
 
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Great you had a surgery rotation for three weeks and a week of anesthesia in med school. Wow a month in residency replacing potassium? I prevented residents from killing patients for three years before anesthesia. Aas, mdas, crnas, whatever. Bull****, less bull****, actually hands on. Tout your 16000 hours my hours before anesthesia were _life and death not doing physicals or med reviews. Take it or leave it

I particularly love when RNs tout their year or two of ICU "experience" as having meant anything relating to anesthesia. Wow, you turned the dopamine drip down by 1 ml/hr every hour to wean it off? Congrats. Did you know that most RNs applying to anesthesia school have zero idea of the mechanism of action of any medication they give a patient? I mean none. They couldn't begin to tell you anything about epinephrine except it makes the BP and HR go up.

They go from knowing absolutely nothing about how to care for a patient except having experience in how to administer meds and how to check for decubs, to 12-18 months of clinical time (for less than 40 hours a week) of being ready to independently care for any patient that comes to any OR. Liver transplant? Bring it. Aortic dissection? Not a problem.




Wait... Did I just say they were ready to be independent? Nah. Go read that case requirements for SRNAs. The minimums. You know, the ones that MANY programs struggle for their students to hit. Go check the actual minimum requirements that today's CRNAs graduate with. Then get back to me. Because you don't want your sick loved one being cared for by a new grad CRNA.
 
YOU WILL BE AMAZED...

We make 300K as anesthetists, no subsidy, cover our own call and vacation. Sure id let you all know but none of you let anything told....

So how are you getting paid 1/4 to 1/3 of what anesthesiologists are paid?
Looking forward to that 7 figure salary
 
I particularly love when RNs tout their year or two of ICU "experience" as having meant anything relating to anesthesia. Wow, you turned the dopamine drip down by 1 ml/hr every hour to wean it off? Congrats. Did you know that most RNs applying to anesthesia school have zero idea of the mechanism of action of any medication they give a patient? I mean none. They couldn't begin to tell you anything about epinephrine except it makes the BP and HR go up.

You are overstating your case here, and that always hurts an argument.

One of the things that inspired me to go to medical school was when I watched a CRNA pimp a first year anesthesia resident about the mechanism of action of Precedex. Even when she gave him the hint about which specific receptors it worked on, he couldn't predict how it would most likely affect the vitals. He was just pushing it because the attending told him to, understanding that it was going to reduce agitation, but not able to predict side effects, even when provided with specific receptor affinities.

As just a 2 year diploma RN, I was biting my tongue to keep from answering for him. He had been pushing that drug into infants and children all day, but he didn't know its mechanism of action. It was drilled into me not to give a med if I didn't understand its mechanism, or at least understand it as well as the resources available to me. Anytime I was faced with a drug that I'd not given before, I reached for my reference before I administered it... as if I actually cared that I was doing something to a human being who might suffer from a mistake.

I'm not saying that there aren't lazy or incompetent nurses out there... and I know a few of them, some of whom are the kinds of CRNAs that provoke these discussions. But all nurses are taught to be better than that, whether or not they take it to heart. Maligning all nurses as knowing nothing at all gives them legitimate cause to accuse you of just being a nurse-hater, and that undermines the valid points you have to make about the superior quality of care that can be given by a fully trained physician.
 
You are overstating your case here, and that always hurts an argument.

I'm actually not. You might reread my post and note I said "most", not "all". I love nurses, I love CRNAs. I have family members that are CRNAs. I'm just telling you as somebody that actually participates in interviewing SRNA applicants what they know and what they don't know. It is disturbing how little a majority of them know as they apply to anesthesia school.

So then when a CRNA touts all the great experience they have prior to anesthesia school, it's hard for me not to laugh.

So please, keep in mind I'm about as friendly a face as you will ever see towards CRNAs. I fully support and participate in an ACT model of care and I think we do an outstanding job. So when I see the argument for independent practice, I like to remind that person that they are arguing that every CRNA in the country should be able to provide anesthesia to every possible patient in the country independently. And that isn't just scary, it's actually insane. Dead bodies would rack up every day if that were made true.

Could some CRNAs handle most of what they'd come across in a safe fashion? Sure. But not all of them. Not even most of them. So when the AANA argues that every CRNA in the country should be independent, well they are just being dangerous at that point. And you can go look at the case minimums to graduate for each CRNA nationally and see that it is clearly not safe for them to be independent.
 
You are overstating your case here, and that always hurts an argument.
I'm not saying that there aren't lazy or incompetent nurses out there... and I know a few of them, some of whom are the kinds of CRNAs that provoke these discussions. But all nurses are taught to be better than that, whether or not they take it to heart. Maligning all nurses as knowing nothing at all gives them legitimate cause to accuse you of just being a nurse-hater, and that undermines the valid points you have to make about the superior quality of care that can be given by a fully trained physician.

So I was on call the other night and was called to the MICU to intubate a guy with ESLD and septic shock who was about to go into respiratory failure. He's already on 0.9 mcg/kg/min epi and his MAP is 60, HR is 125 with ectopy. He's also on vaso at 0.04u/min. I tell the nurse to draw me a stick of vaso out of the bag and turn the infusion to 0.1 in preparation for induction. She actually stands there and fking argues with me for 30 seconds about how she would rather keep going up on the epi until I was forced to tell her to stop talking and just do what I say so we can get the tube in this guy.
 
Crnas independent practice I know makes $320-340k in rural North Carolina with 9 weeks off

One in Alabama 14 members group makes close to $400k taking 10 weeks off.

Crnas aren't cheap.

The Asa doesn't a very poor job comparing apple to Apple to the public.

It's a slam dunk public message "see crnas make the same and less educated". "Who do you want taking care of you".

So the aana will have to fight back and claim the stupid theory MDs are "over educated". That would never fly with the common public Joe/Jane person.
 
Crnas independent practice I know makes $320-340k in rural North Carolina with 9 weeks off

One in Alabama 14 members group makes close to $400k taking 10 weeks off.

Crnas aren't cheap.

The Asa doesn't a very poor job comparing apple to Apple to the public.

It's a slam dunk public message "see crnas make the same and less educated". "Who do you want taking care of you".

So the aana will have to fight back and claim the stupid theory MDs are "over educated". That would never fly with the common public Joe/Jane person.

Wow.
 
I'm actually not. You might reread my post and note I said "most", not "all".

Touche. I honed in on the absolutist assertion of "zero" knowledge and ignored the "most." So much for my own ability to avoid overstating my case. I guess that is one way to prove the point. =)
 
Crnas independent practice I know makes $320-340k in rural North Carolina with 9 weeks off

One in Alabama 14 members group makes close to $400k taking 10 weeks off.

Neither North Carolina nor Alabama are opt out states, so they are required to have CRNAs supervised by a physician.
 
Neither North Carolina nor Alabama are opt out states, so they are required to have CRNAs supervised by a physician.
Yes... supervised by the surgeons!
This by the way is one of the ASA's achievements: Conceding to the AANA long time ago that a CRNA can be supervised by any physician!
The same ASA who is now going to rescue anesthesiology by completely abandoning intra-op care.
 
The same ASA who is now going to rescue anesthesiology by completely abandoning intra-op care.

My thoughts exactly. All the skills, all the training, all the experience are preparing you to work in the Preop clinic in the Perioperative Surgical Home. The Physician organizations in medicine representing doctors have become corrupted by the Pharmaceutical sponsors, the Management Companies and pressures from CMS to the point where they no longer represent the Physicians.
 
I find it hard to believe that in the long run CRNAs or ACT models are more cost effective for any hospital. I tend to think that, when looked at from an all inclusive level, physician anesthesiologists are probably more cost effective when practicing solo. Didn't Howard recently get rid of all their CRNAs in favor of physician anesthesiologists for this very reason?

It may be that certain idiotic bean counters may not understand the physician-only cost savings (when not taking into account hours worked/available-on-call, CRNA overtime pay, CRNAs disappearing and leaving early, paying multiple CRNAs' FTE benefits, cost of CRNA induced complications, etc). I also bet that many of the bean counters are or are highly influenced by the vast armies of nursing bureaucrats that run hospitals these days.
 
I find it hard to believe that in the long run CRNAs or ACT models are more cost effective for any hospital. I tend to think that, when looked at from an all inclusive level, physician anesthesiologists are probably more cost effective when practicing solo. Didn't Howard recently get rid of all their CRNAs in favor of physician anesthesiologists for this very reason?

It may be that certain idiotic bean counters may not understand the physician-only cost savings (when not taking into account hours worked/available-on-call, CRNA overtime pay, CRNAs disappearing and leaving early, paying multiple CRNAs' FTE benefits, cost of CRNA induced complications, etc). I also bet that many of the bean counters are or are highly influenced by the vast armies of nursing bureaucrats that run hospitals these days.
You know without a doubt that CRNAs in an ACT model are cheaper because that is the model of the AMCs whose sole goal is to generate profit for the corporation. If all MDs were cheaper, that's what they would do to maximize profit.


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Il Destriero
 
All the skills, all the training, all the experience are preparing you to work in the Preop clinic in the Perioperative Surgical Home.
The good physicians are not the ones who end up at the preop clinic. You keep those in the OR. The opposite ones are sent to the clinic. That how a preop clinic improves outcomes.
 
You know without a doubt that CRNAs in an ACT model are cheaper because that is the model of the AMCs whose sole goal is to generate profit for the corporation. If all MDs were cheaper, that's what they would do to maximize profit.
That may or may not be true. There are costs the AMCs don't bear.

Imagine an AMC that hires the absolute dregs of the anesthesia "provider" world, strip mall puppy mill CRNAs, retread locums anesthesiologists who can't hold a job longer than two weeks, even something called an MDA whatever that is. They suck but manage to avoid sentinel events, mostly. Their patients spend 2x as long in the PACU and one in 30 has an unplanned admission. So much PONV that the vomit smell drives away paying customers in the plastic surgery clinic.

No skin off the AMC's back, their people moved on to the next billable units after dropping their last wreck off in PACU. But someone's paying for their complications.

A hospital that directly employs anesthesiologists and CRNAs needs to look at the whole picture. I have no trouble believing that an organization with the ability to track all the data, and the financial need to do so, might conclude that hiring just anesthesiologists is a better deal.
 
The good physicians are not the ones who end up at the preop clinic. You keep those in the OR. The opposite ones are sent to the clinic. That how a preop clinic improves outcomes.
So one keeps the most competent people, the ones who actually have a great medical knowledge, in the OR, and send the lazies, and those who know less than the former have forgotten, to "optimize" patients for stuff they are supposed not to know that much about. Because the divine presence of any anesthesiologist will improve outcomes. Yeah, that makes sense!

The CCM-trained people some centers use must have been chosen based on their OR incompetence. Why else would anybody want to work in the ICU, right?
 
You know without a doubt that CRNAs in an ACT model are cheaper because that is the model of the AMCs whose sole goal is to generate profit for the corporation. If all MDs were cheaper, that's what they would do to maximize profit.


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Il Destriero
Some AMC centers are still all-MD, in full ACT territory, years after takeover. There must be something about that, too.
 
A hospital that directly employs anesthesiologists and CRNAs needs to look at the whole picture. I have no trouble believing that an organization with the ability to track all the data, and the financial need to do so, might conclude that hiring just anesthesiologists is a better deal.

MSI with a strong interest in anesthesiology here.

Your last comment sounds like a wonderful scholarly project idea.

What would it take to get a project like this up and running?
 
So one keeps the most competent people, the ones who actually have a great medical knowledge, in the OR, and send the lazies, and those who know less than the former have forgotten, to "optimize" patients for stuff they are supposed not to know that much about. Because the divine presence of any anesthesiologist will improve outcomes. Yeah, that makes sense!

The CCM-trained people some centers use must have been chosen based on their OR incompetence. Why else would anybody want to work in the ICU, right?
It is getting certain people out of the OR that improves outcomes, not the actual preop evaluation.

And, I wouldn't let some CCM people I know take care of my dog, let alone a relative.
 
Yes... supervised by the surgeons!
This by the way is one of the ASA's achievements: Conceding to the AANA long time ago that a CRNA can be supervised by any physician!
The same ASA who is now going to rescue anesthesiology by completely abandoning intra-op care.

My point is those aren't the independent practice jobs that people reference. And supervised by a surgeon is not as bad as opt out, because 95% of surgeons will choose not to be legally responsible for the anesthetic complications. The small hospitals where I know this happens, the surgeons won't do anything but an easy case on a healthy patient at times when the anesthesiologist is not around. The surgeons liability goes way up.
 
My point is those aren't the independent practice jobs that people reference. And supervised by a surgeon is not as bad as opt out, because 95% of surgeons will choose not to be legally responsible for the anesthetic complications. The small hospitals where I know this happens, the surgeons won't do anything but an easy case on a healthy patient at times when the anesthesiologist is not around. The surgeons liability goes way up.
That's exactly the issue. 80-90% of the cases are the easy cases even in rural hospitals.

They will punt the more challenging cases. So if u do bread and butter 80-90% of the time. Who wouldn't want to do bread and butter.

If they paid u X amount and u get to do bread and butter all day getting paid the same X amount to do 30% complex patients at another place.

What would you choose? So they keep doing easy cases. Collect their pay checks. Low liability. And still get to claim they are just as safe as MDs.
 
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