How bad is the CRNA problem. Will MDs always have a job

[happygilmore]

How bad is the CRNA problem? Will MD anesthesiologists always have a job?

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[BLADEMDA]

The Federal govt just ruled that CRNAs can practice independently at the VA. This really made the leadership at the ASA stand up and take notice. But, there isn't anything Fitch or the ASA can do about it.

Obama care leads to a federal opt out and socialized medicine. This means more CRNAs doing the job that an Anesthesiologist used to do pre-Obamacare.

AMCs are acquiring anesthesia practices at a rapid pace. Salaries are lower than at anytime I've seen since the late 1990s. Anesthesia will likely not offer lifestyle or high pay in 10 years but the high stress will remain.

I would not choose Anesthesiology as a career unless you plan on doing a fellowship where CRNA encroachment is less.

http://forums.studentdoctor.net/showthread.php?t=1033429

 

[happygilmore]

The Federal govt just ruled that CRNAs can practice independently at the VA. This really made the leadership at the ASA stand up and take notice. But, there isn't anything Fitch or the ASA can do about it.

Obama care leads to a federal opt out and socialized medicine. This means more CRNAs doing the job that an Anesthesiologist used to do pre-Obamacare.

AMCs are acquiring anesthesia practices at a rapid pace. Salaries are lower than at anytime I've seen since the late 1990s. Anesthesia will likely not offer lifestyle or high pay in 10 years but the high stress will remain.

I would not choose Anesthesiology as a career unless you plan on doing a fellowship where CRNA encroachment is less.

http://forums.studentdoctor.net/showthread.php?t=1033429

thanks for the info. As always your posts are great.

 

[BLADEMDA]

richard veal
09/11/13
Dr. Fitch is delusional. As a military trained CRNA I have often worked "unsupervised". In most locales supervision entails the Anesthesiologist signing his or her name to the anesthesia reimbusement documents and little else. Facts are facts , multiple states have decided to "opt out" of Anesthesiologist supervision of CRNA's with absolutely no negative impact on patient care, and indeed noted improvement in many cases. The day of the supervisor ( read computer solitaire playing ) Anesthesiologist are coming to an inevitable end. Patients, hospital administrations, insurance companies, and both state and federal governments demand fiscal accountability and will no longer pay the freeloading physician to "claim" supervision as an excuse not to do cases themselves. I suggest our good doctor hone her intubation skills and get back to work..
Richard L. Veal, DNP
09/11/13
I feel sorry for our so called concerned Anesthesiologist. The end is in sight for the freeloading physician who claims to be supervising yet remains "busy" on his or her computer searching google for the latest i-phone, or how much the new Mercedes costs. Truth be told, most supervision consists of the anesthesiologist signing his or her name to the reimbursement paperwork and little else. I suggest our good doctor brush up on her clinical skills and start doing cases herself..

 

[caligas]

I figure as an MD I can always get a job as a crna. Still make six figures AND get a lunch break!

 

[happygilmore]

I figure as an MD I can always get a job as a crna. Still make six figures AND get a lunch break!

Just don't tell them you're an MD!😉

 

[BLADEMDA]

I figure as an MD I can always get a job as a crna. Still make six figures AND get a lunch break!

Good attitude. The process of a Collaborative model where CRNAs practice as colleagues alongside Anesthesiologists will take a decade to become the norm. But, it is happening now at the Military and the VA. Some AMCs are promoting the collaborative model now in order to control costs and maximize their profits.

 

[BLADEMDA]

I figure as an MD I can always get a job as a crna. Still make six figures AND get a lunch break!

Under Obamacare the pay differential between MD (A) and CRNA will keep shrinking to the point that going to Medical School then a residency doesn't make fiscal sense.

The federal govt working alongside the AANA will do serious damage to the quality of those choosing to enter the specialty of Anesthesiology.

 

[WholeLottaGame7]

Under Obamacare the pay differential between MD (A) and CRNA will keep shrinking to the point that going to Medical School then a residency doesn't make fiscal sense.

The federal govt working alongside the AANA will do serious damage to the quality of those choosing to enter the specialty of Anesthesiology.

But this is true in many fields.

Why pay a cardiologist to manage heart failure when an NP can do the same job?
Why pay a family medicine doc to run a clinic when an NP can as well?
Why pay an EM doc when you can pay a PA?

The future is not far away when a surgical PA will be doing appys and choles.

It is the nature of medicine in general, not just anesthesiology.

 

[bigeyedfish]

As staff I am dumbfounded daily by the calls I get from crna's. Some of the things they say to me tie my brain in knots that they've made it this far. Things like, "he's a little tachy, I've been working in Esmolol but it keeps coming back up." My forehead is sore from smacking it so much. 10% of the crnas I work with are remotely capable of doing complex cases or getting themselves out of bad situations.

That's not to say I don't enjoy working with them or appreciate what they do. I do. And honestly I don't think most of them have any desire to work without us. The seem to have no interest in forming an anesthetic plan or making tough decisions.

I'll say the same thing I say to my residents. I, like them, underwent some handwringing over this issue as a trainee. If we woke up tomorrow and we were seen as interchangeable, what would happen? Who would the hospital fire? If cost and insurance were not concerns, what would happen? Md's would be sitting stools. So now you've got way more stool sitters than you need. Who do you fire? All things being equal, if I'm an administrator I'm firing nurses. So, md's would make a little less, and probably work less. That sucks. But hey, only one case at a time? Sounds much easier than what I do now.

A lot a lot of crnas would be out of work. That sucks worse. The crna mills will have to decrease their size and lower tuition. It sounds like they come out a lot worse. It baffles me that the aana doesn't see this. We should be combining our resources to preserve the status quo, which benefits both if us.

 

[Mman]

As staff I am dumbfounded daily by the calls I get from crna's. Some of the things they say to me tie my brain in knots that they've made it this far. Things like, "he's a little tachy, I've been working in Esmolol but it keeps coming back up." My forehead is sore from smacking it so much. 10% of the crnas I work with are remotely capable of doing complex cases or getting themselves out of bad situations.

That's not to say I don't enjoy working with them or appreciate what they do. I do. And honestly I don't think most of them have any desire to work without us. The seem to have no interest in forming an anesthetic plan or making tough decisions.

I'll say the same thing I say to my residents. I, like them, underwent some handwringing over this issue as a trainee. If we woke up tomorrow and we were seen as interchangeable, what would happen? Who would the hospital fire? If cost and insurance were not concerns, what would happen? Md's would be sitting stools. So now you've got way more stool sitters than you need. Who do you fire? All things being equal, if I'm an administrator I'm firing nurses. So, md's would make a little less, and probably work less. That sucks. But hey, only one case at a time? Sounds much easier than what I do now.

A lot a lot of crnas would be out of work. That sucks worse. The crna mills will have to decrease their size and lower tuition. It sounds like they come out a lot worse. It baffles me that the aana doesn't see this. We should be combining our resources to preserve the status quo, which benefits both if us.

Agree 100%. If the CRNAs manage to drive salaries down to complete equivalence and are no longer supervised, hospitals will simply fire CRNAs and replace them for equivalent cost MDs to sit on the stool. Higher quality care for the same price and then the CRNAs are out of jobs. There is no other outcome if they drive the salary to equivalence.

 

[secants]

But this is true in many fields.

Why pay a cardiologist to manage heart failure when an NP can do the same job?
Why pay a family medicine doc to run a clinic when an NP can as well?
Why pay an EM doc when you can pay a PA?

The future is not far away when a surgical PA will be doing appys and choles.

It is the nature of medicine in general, not just anesthesiology.

If my insurance gets billed the same and I have a choice, why would I go? Most employed by docs anyway in their office so I'd just request to see the MD.

 

[imfrankie]

Agree 100%. If the CRNAs manage to drive salaries down to complete equivalence and are no longer supervised, hospitals will simply fire CRNAs and replace them for equivalent cost MDs to sit on the stool. Higher quality care for the same price and then the CRNAs are out of jobs. There is no other outcome if they drive the salary to equivalence.

There are plenty of places where doc can't get a job even if he/she wanted one because CRNAs +/- supervising MDs have it locked up. It's not a free market where a doc can step up and say, "hey I'll do that for less."

 

[caligas]

Agree 100%. If the CRNAs manage to drive salaries down to complete equivalence and are no longer supervised, hospitals will simply fire CRNAs and replace them for equivalent cost MDs to sit on the stool. Higher quality care for the same price and then the CRNAs are out of jobs. There is no other outcome if they drive the salary to equivalence.

They dont want equal pay, they want to eliminate us and replace us at their current pay or moderately higher.

 

[IlDestriero]

Good attitude. The process of a Collaborative model where CRNAs practice as colleagues alongside Anesthesiologists will take a decade to become the norm. But, it is happening now at the Military and the VA. Some AMCs are promoting the collaborative model now in order to control costs and maximize their profits.

The military CRNA practicing independently is really an illusion. In the field dealing primarily with otherwise healthy trauma patients and in small military hospitals dealing primarily with stable ASA 1 and 2 patients having routine procedures, yes sure. A medical student could probably do those cases. At the big centers doing ASA 3,4 & 5 neuro, vasc, peds, cardiac? Unstable ICU players? No way Jose! Doesn't happen. NOT real independent practice.
I feel sorry for the Vets. They deserve better.
Maybe I can actively try to help with that? All of us .mil survivors should pick up the banner.
I wonder if the VA anesthesiologists even care, or if this affects the big centers affiliated with the big name universities?

 

[IkeBoy18]

Man reading these posts just sucks the air out of me. I really fell in love with anesthesia and wouldnt be done until 2019 with no fellowship. and seeing that all the predictions are centered around 10 years from now........

I just need to figure out a few things. Either I need to do a peds, CC or cards fellowship as Blade says... or I need to be interested in another specialty.

 

[BLADEMDA]

Man reading these posts just sucks the air out of me. I really fell in love with anesthesia and wouldnt be done until 2019 with no fellowship. and seeing that all the predictions are centered around 10 years from now........

I just need to figure out a few things. Either I need to do a peds, CC or cards fellowship as Blade says... or I need to be interested in another specialty.

Yes. I am telling the truth here. You don't want to be a physician in a nursing dominated field.
It won't be any better in ten years and will likely be far worse. Either plan on a fellowship for added job security or choose another specialty.

 

[digitox]

Every couple months someone starts thread like this. Honestly, it is becoming annoying. If you go back to 2001 and look at this form same exact dilemma was going on. Do what you like, that's all you can do and forget BS.

 

[BLADEMDA]

Every couple months someone starts thread like this. Honestly, it is becoming annoying. If you go back to 2001 and look at this form same exact dilemma was going on. Do what you like, that's all you can do and forget BS.

Ten years ago the CRNA threat was present but kept in check. Then, about 6 years ago the AANA began a heavy push into ASCs and Gi centers along with the formation of the DNAP.
IMHO, that push Has been successful in displacing Anesthesiologists from the low hanging fruit. When combined with the greed of AMCs and Surgicenter owners many Anesthesiologists lost good gigs throughout the country.

The next phase of the AANA plan started in 2010 with Obamacare. This socialized push into hospitals and anesthesia will result in pressure to hold down costs and cut subsidies. The result will be more CRNA independent practice, more Crna schools and lower salaries.
This next phase will take 5-10 years to begin gaining traction across the country.

Overall, the AANA master plan is taking longer to implement than they thought it would but the end result will be the same. Please feel free to " do what you like" but you have been warned that the CRNAs are winning ths war.

 

[digitox]

Yes which will eventually lead to more complications and increase healthcare cost.But assuming that's true so what do you recommend? Just give up and have nurses have it their way? This is pretty much what I am getting from this message. Everyone should just give up right now, before you even start residency, Just don't do it.

 

[masterchef]

Yes which will eventually lead to more complications and increase healthcare cost.But assuming that's true so what do you recommend? Just give up and have nurses have it their way? This is pretty much what I am getting from this message. Everyone should just give up right now, before you even start residency, Just don't do it.

Economically, it doesn't make sense for the AANA to pursue independent practice. We all know that the future of healthcare is heading towards healthcare professionals becoming employees of hospitals. Let's just do the math for a second:

Average CRNA being supervised in a 1:3 or 1:4 ACT model right now makes around 200k (including benefits) when employed by a hospital. In their own minds, if they pursue independent practice without supervision, they believe they can pull in an anesthesiologist salary (around 300k or so). However, if they do become independent practitioners, do you think the CEO of the hospital will just hand over the extra reimbursement (that had previously been given to the anesthesiologist) to the CRNA, or do you think the hospital CEO will just pocket the difference? We all know that medicare reimburses the same amount, whether the anesthesia is independently administered by a CRNA versus Anesthesiologist versus in a team model.

If CRNAs do in fact get their wish to practice independently, it would be a lose-lose situation: 1) They would have to do more work for the same salary, 2) patient safety would be compromised, as there would be no anesthesiologist present, and 3) the hospital would just pocket millions in profit at a time when the public is outraged at the concept of "for-profit healthcare".

So, why exactly would state and federal governments be fine with this?

 

[BLADEMDA]

Yes which will eventually lead to more complications and increase healthcare cost.But assuming that's true so what do you recommend? Just give up and have nurses have it their way? This is pretty much what I am getting from this message. Everyone should just give up right now, before you even start residency, Just don't do it.

Let me explain a few things:

1. It's harder to match into any residency these days. In a few years even Family practice will be competitive for the first time ever. This means Anesthesiology Residences will always get med students to sign up for 4 years. Any job is better than no job at all.

2. Anesthesiology is the only medical specialty to train advanced practice nurses right alongside their Residents. We can argue over the quality and the duration of that training but we can't argue they are exposed to all aspects of basic anesthesia care. No other field does this with advanced practice nurses and in such a large scale. I believe Emergency Medicine would be in the same predicament as us if they trained NPs in large numbers to do ER medicine for 24 months.

3. Fellowship in an anesthesia sub specialty does help to some degree with job security especially ten years from now. But, that specialty should be a far removed from general CRNA practice as possible. Thus, pain medicine, critical care, Peds, etc are all excellent choices. Because most CRNAs prefer the shortcut method for education and training the vast majority (99 percent) will not be at level in these areas required for independent practice

4. Basic Gas- those choosing to do a basic Anesthesiology residency 2016-2020 will find the job market for a new graduate "tight" with the vast majority of jobs looking for cheap emoloyee labor. The salary of such a job will be lower than the salaries of today. Yes, other specialties will suffer under Obamacare but the combined effect of the AANA and reduced salaries will brutalize this specialty.

5. Plan for the future- how long until residents rotating at the VA start seeing CRNA DNAPs doing their own cases unsupervised? What will the residents of the other specialties think of this independent practice at teaching facilities? Once it becomes the norm why not allow the CRNA this same practice at the local community hospital? Why not promote a CRNA DNAP to run the whole VA anesthesia department?

The small crack in the dam is leaking water and is now to the point that Anyone can see swift action Is required before the dam breaks. Alternatively, don't buy a home in the area where the dam is located.

 

[BLADEMDA]

Economically, it doesn't make sense for the AANA to pursue independent practice. We all know that the future of healthcare is heading towards healthcare professionals becoming employees of hospitals. Let's just do the math for a second:

Average CRNA being supervised in a 1:3 or 1:4 ACT model right now makes around 200k (including benefits) when employed by a hospital. In their own minds, if they pursue independent practice without supervision, they believe they can pull in an anesthesiologist salary (around 300k or so). However, if they do become independent practitioners, do you think the CEO of the hospital will just hand over the extra reimbursement (that had previously been given to the anesthesiologist) to the CRNA, or do you think the hospital CEO will just pocket the difference? We all know that medicare reimburses the same amount, whether the anesthesia is independently administered by a CRNA versus Anesthesiologist versus in a team model.

If CRNAs do in fact get their wish to practice independently, it would be a lose-lose situation: 1) They would have to do more work for the same salary, 2) patient safety would be compromised, as there would be no anesthesiologist present, and 3) the hospital would just pocket millions in profit at a time when the public is outraged at the concept of "for-profit healthcare".

So, why exactly would state and federal governments be fine with this?

The CRNA is a pawn in the AANA chess game. The AANA rallies the base the same way the democrat party rallies its base: propaganda and exaggeration of the truth.
This keeps the AANA liberals in power to promote its agenda. The AANA agenda isn't the agenda of the local CRNA.

 

[BLADEMDA]

In every war sacrifices must be made. The AANA views winning this war worth the sacrifices its membership and the public must pay in terms of blood and treasure. Nothing will stand in the way of AANA victory. For decades the AANA leadership has wanted independent practice regardless of the costs.

 

[jwk]

The CRNA is a pawn in the AANA chess game. The AANA rallies the base the same way the democrat party rallies its base: propaganda and exaggeration of the truth.
This keeps the AANA liberals in power to promote its agenda. The AANA agenda isn't the agenda of the local CRNA.

THIS is absolutely a tru-ism. Most CRNA's aren't practicing independently and have no desire to practice independently. Their own professional organization considers them just a little better than pond-scum much of the time. Unfortunately, most are still dues-paying members even though their organization ignores them and the fact that most CRNA's work in some sort of ACT practice.

 

[masterchef]

.

 

[BLADEMDA]

CRNA skill/competency on the Left vs MD(A) skill/competency on the right

 

[Mman]

They dont want equal pay, they want to eliminate us and replace us at their current pay or moderately higher.

But they can't. They don't have those cards in their hand. There is nothing they can do that I can't, so I can't be eliminated. And if they get rid of docs in the name of cost savings, they will have created a system where by the cheapest provider gets the job and they will make less money in the end.


If that is their ultimate goal, it's unreachable.

 

[BLADEMDA]

Yea. The AANA agenda is silly, and it's not watching out for the best interest of it's own constituents.

In my hometown, every single CRNA is directly employed and collecting salary from one of a very small group of monopolizing hospital chains. If the AANA somehow succeeded in convincing the government to let them practice independently, it would literally be the stupidest thing that could happen:

1. The hospital CEO would pay CRNAs the exact same salary as before when they were in the ACT model. They won't give them a sudden pay raise out of the "goodness of their heart." The independently practicing CRNA would have to do more work with newly added stress for the exact same salary. In fact, with the CRNA mills churning out thousands of grads every year, their incomes may even drop due to excess supply.

2. Anesthesiologists who have gone to 4 years premedical college, 4 years of medical school, and 4 years of residency partially financed by taxpayers would be sitting unemployed and unable to contribute to America's healthcare.

3. Patients would suffer as Anesthesiologists are not present anymore to watch over and direct their care.

and...

4. The hospital CEO would pocket an extra 5+ million dollars in profit by not employing anesthesiologists anymore. Hospitals around the country would start operating like Wall Street, trying to maximize profits instead of implementing the safest healthcare possible.

This "model for the future" is beyond asinine, and I would love to hear what the AANA says regarding it.

1. AANA doesn't care about individual CRNAs, their salaries or their work load. They are a pawn to be used for winning the chess game.

2. AANA would love to kill the medical specialty of Anesthesiology and install their DNAP, PhD CRNA as the new leadership of anesthesia. Anesthesia is NURSING afterall.

3. The AANA uses parlor tricks and voodoo statistics to show that a CRNA=MD(A) in all aspects of care. If in fact a few sick patients die as a result of their agenda then so what. A few more older farts croaking saves the system money. Maybe CRNAs save money buy letting Grandma die early and avoid that long ICU stay. Patients don't know any better and a good propaganda campaign is the AANA forte.

4. The hospital CEO doesn't care either but he would like the extra $5 million for his budget. I believe some hospitals do function like Wallstreet NOW putting profits ahead of patient care and safety.


The model for the future is the CRNA DNAP. These worker drones will be produced in mass by CRNA mills backed by the AANA propaganda machine. In turn, the drones will send millions back to the AANA in order to maintain Certification and keep the ASA from letting the public know the truth. The AANA spin machine is the best at what it does.

 

[BLADEMDA]

But they can't. They don't have those cards in their hand. There is nothing they can do that I can't, so I can't be eliminated. And if they get rid of docs in the name of cost savings, they will have created a system where by the cheapest provider gets the job and they will make less money in the end.


If that is their ultimate goal, it's unreachable.

The ultimate goal is Independent CRNA Practice where CRNAs do the same job as you do at the same pay level. Being equal means reducing the specialty to Nursing and leaving you with Nursing level pay and respect.

The AANA is winning the war for independent practice. That's obvious. The battle for respect and equally crappy pay comes in ten years. The AANA is willing to sacrifice everything for INDEPENDENCE and EQAULITY in the O.R.

For example, the majority of ASCs and GI centers (95% or more) that made the switch to CRNA from MD (A) resulted in zero savings to the system. The money went directly into the pockets of the ASC/Gi owners. The CRNA still earns the same pay but the Anesthesiologist got scalped or fired altogether.

Soon, the ACOs will put pressure on the hospitals to do the exact same thing as the ASCs/Gi centers. The sugeons are at the table while Radiology and Anesthesia are ON the table.

 

[Notanerd]

I pretty much feel the same way about liberals as I do a out crna's/AANA. They disgust me and I despise them. Medicine all over the place is being taken over by midlevels

 

[BLADEMDA]

Richard L. Veal, DNP
09/20/13
Never being one to leave well enough alone, I must issue an apology to both my fellow CRNAs, for being less than eloquent in my previous posts, but also to the thousands of dedicated Anesthesiologists who do work hard either as sole providers or as supervising physicians. Mine was a knee-jerk reaction to the not so subtle insult directed at CRNA practice by Dr. Fitch. The evolution of anesthesia care is ever ongoing and despite opinions to the contrary, supervision as a practice model is waning. As in all professions, there are practitioners of both camps, MDA and CRNA, of every skill level. Furthermore, neither camp can legitimately claim superiority of practice. Each group brings a wealth of assets to the table and both have performed to the benefit of our respective patients, personal reputations, and individual organizations. The paradigm is shifting. One of the true certainties of life is that change will occur. Evidence based data supports independent CRNA practice as both safe and economical. In todays environment that cannot be ignored..

 

[BLADEMDA]

Read the post above several times. Do you see his assumptions? This is the battle you are up against.

"Furthermore, neither camp can legitimately claim superiority of practice."

Welcome to the AANA

 

[Dejavu]

Every couple months someone starts thread like this. Honestly, it is becoming annoying. If you go back to 2001 and look at this form same exact dilemma was going on. Do what you like, that's all you can do and forget BS.

Hell, go back 37 years and the exact same conversations were going on. It hasn't changed.

There where no such threads because computers were still reading punch cards.

 

[happygilmore]

Hell, go back 37 years and the exact same conversations were going on. It hasn't changed.

The boy can mistakenly cry wolf a hundred times. Yet eventually he'll cry and the wolf will arrive.

 

[Dejavu]

Richard L. Veal, DNP
09/20/13
Never being one to leave well enough alone, I must issue an apology to both my fellow CRNAs, for being less than eloquent in my previous posts, but also to the thousands of dedicated Anesthesiologists who do work hard either as sole providers or as supervising physicians. Mine was a knee-jerk reaction to the not so subtle insult directed at CRNA practice by Dr. Fitch. The evolution of anesthesia care is ever ongoing and despite opinions to the contrary, supervision as a practice model is waning. As in all professions, there are practitioners of both camps, MDA and CRNA, of every skill level. Furthermore, neither camp can legitimately claim superiority of practice. Each group brings a wealth of assets to the table and both have performed to the benefit of our respective patients, personal reputations, and individual organizations. The paradigm is shifting. One of the true certainties of life is that change will occur. Evidence based data supports independent CRNA practice as both safe and economical. In todays environment that cannot be ignored..

As a CRNA, for a decade, who went back to med school and anesth residency, I can tell you for sure that when he says there is no difference in knowledge, background experience and competency, he is lying or is so ignorant of what he doesn't know that I feel sorry for him.

 

[BLADEMDA]

Hell, go back 37 years and the exact same conversations were going on. It hasn't changed.

There where no such threads because computers were still reading punch cards.

Wrong here Slim. Things have changed but you might be blinded by the big bucks at the Mayo. At your place 99 percent of patients have private insurance or pay out of pocket. Zero subsidies to the department so there is no CRNA problem. At most hospitals with a heavy CMS or no pay burden this issue is a real one and getting worse.

The world has changed over the past 3 decades. The CRNA is now emboldened with his or her DNAP and victories across the USA. Opt out didn't exist in your day slim. Neither did the DNAP. The new militant CRNA now runs his own anesthesia service at ASCs or Gi centers. I know of several CRNA run practices pulling in big dollars.

I have zero doubt that the majority of physician only practices in the USA won't exist in ten years and opt out will be the norm. I fully expect most hospitals to go medical supervision instead of direction.

But, since you practice at the most Ivory of all towers I doubt you will notice when the masses only have cake to eat.

 

[BLADEMDA]

Anesthesia residents coast thru 3 - 4 yrs of post grad "training" where they are mostly left alone to fend for themselves, and figure things out by trial and error. CRNAs undergo strict supervision, and are subject to daily written evaluations for a period of 27 months. Are the training experiences different? Yes. Is MDA training so obviously superior and resulting in a more skill provider? Not even close. In ten years of practice, I see no evidence of the average MDA having anesthesia knowledge or skills that exceed my own. All of this said, I will tell you that I love working with a good physician, but not for the reasons you might think. A physician is trained in a broad medical sense, and has experience and knowledge in areas that are helpful at times. There are plenty of times working up a difficult case with complex medical issues, that I will seek the input of a physician to gain perspective. However, nearly always that physician has specialty in something other than anesthesia - I just don't need that kind of help. And THAT is the real issue. Try as they might to justify their attempts to limit CRNA practice, and place themselves on a pedestal, it is becoming increasingly clear that the niche MDAs seek to profit from is somewhat artificial, and due to improved technology, any actual benefit from physician-run anesthetic management is harder to discern every day. Why waste our physician resources where we don't need them? Put them in primary care practices, where they are actually needed..

MREarl CRNA

 

[BLADEMDA]

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.

Of course, only governments can lose that much money and pretend they don't have to change. "Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."

In other words, the real Mayo story is that sclerotic Medicare is preventing more Mayos, and ObamaCare is paving the way for all of health care to operate like Medicare.
(Written in 2010)

 

[happygilmore]

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.

Of course, only governments can lose that much money and pretend they don't have to change. "Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."

In other words, the real Mayo story is that sclerotic Medicare is preventing more Mayos, and ObamaCare is paving the way for all of health care to operate like Medicare.
(Written in 2010)

It's amazing that medicare pays so terribly. When doctors in general lose autonomy, we're all in trouble.

 

[BLADEMDA]

Most hospitals can't drop Medicare and Medicaid. They also get stuck with no pay patients. These hospitals will get cut under Obamacare and will be searching for methods to save money.

The AANA and the VA model for anesthesia care delivery offers hospitals a method to shave millions from the anesthesia budget. Anyone who doesn't think this will eventually happen down the road must practice at a facility without significant CMS funds.

Even then they will still feel the sting of Obamacare once the public option becomes available to all.

 

[BLADEMDA]

The boy can mistakenly cry wolf a hundred times. Yet eventually he'll cry and the wolf will arrive.

And as I have said before nobody will believe him no matter how loud he screams.

 

[BLADEMDA]

I overheard this comment once when I walked by the CRNA lounge:

"Do you know the difference between a CRNA and an MDA?"

Answer: "about $150,000".

Welcome to the AANA

 

[pgg]

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Sure as the sun rises in the east, and opt-out is spreading, the day is coming when the government will force organizations to accept medicare. I don't htink Mayo will have the ability to refuse these patients forever.

Massachusetts already tried to tie medical licensure of physicians to forced acceptance of gov-insured patients. It didn't make it through, but one day it will.

 

[BLADEMDA]

Sure as the sun rises in the east, and opt-out is spreading, the day is coming when the government will force organizations to accept medicare. I don't htink Mayo will have the ability to refuse these patients forever.

Massachusetts already tried to tie medical licensure of physicians to forced acceptance of gov-insured patients. It didn't make it through, but one day it will.

PGG, you may be correct that the liberals will force hospitals and providers to accept Medicare or be denied all government funding. This means Mayo would lose its GME funds if it wouldn't accept Medicare.

I think Mayo will eventually be forced into the same health care model as the rest of us commoners. But, that may take another decade. In the meantime, Dajavu is well insulated from the medical supervision model I'm faced with or the collaborative model you see every day.

Being insulated in the ivory tower makes it hard to see the changes on the ground. I see them. Some have happened and more are just around the corner. Like it or not the AANA is winning this war for independent practice. Fitch and the ASA know it is true but will hold the line as long as possible.

The new paradigm won't affect you very much. You will be dealing with the same issues once you get out into private practice.

 

[badasshairday]

Sure as the sun rises in the east, and opt-out is spreading, the day is coming when the government will force organizations to accept medicare. I don't htink Mayo will have the ability to refuse these patients forever.

Massachusetts already tried to tie medical licensure of physicians to forced acceptance of gov-insured patients. It didn't make it through, but one day it will.

It is unconstitutional for the government to make us do do that. If they do I'm moving to Canada or Mexico.

 

[Silent Cool]

Sure as the sun rises in the east, and opt-out is spreading, the day is coming when the government will force organizations to accept medicare. I don't htink Mayo will have the ability to refuse these patients forever.

Massachusetts already tried to tie medical licensure of physicians to forced acceptance of gov-insured patients. It didn't make it through, but one day it will.

Yup, this is exactly what I have been saying. The only thing is that such ties to licensure enforced at the federal level would theoretically be unconstitutional unless, of course, you were merely "taxed" (sound familiar?) for not complying.

PGG, what happened to the attempted enforcement in Mass?

 

[Silent Cool]

It is unconstitutional for the government to make us do do that. If they do I'm moving to Canada or Mexico.

True, but it would be perfectly legal for state governments to do so.

If Harry Reid's intentions come to fruition and Obamacare does eventually yield to a single-payer system, then everyone will essentially be paid only by medicare.

 

[BLADEMDA]

How bad is the CRNA problem? Will MD anesthesiologists always have a job?

You will likely always have a job. I'm hesitant to say "always" because the AANA may join the AFL CIO and thus the democrats may pass a law requiring one to be a CRNA to actually administer anesthesia. All other groups must obtain permission from the Chief CRNA at the facility.

But, as long as the AANA claims Anesthesiologists have the proper credentials and education to be equal to a CRNA then you should have a job. Perhaps, you could work under the supervision of the Chief CRNA DNAP, PhD at your facility?

 

[BLADEMDA]

It is unconstitutional for the government to make us do do that. If they do I'm moving to Canada or Mexico.

Wrong. Once you accept even one dollar of government money then the government can dictate your practice.

Mayo would be forced to decline all government funding like the hundreds of millions it receives each year for residency training programs.