"Independent" CRNAs

[austintr]

It has always been my impression that CRNAs are supervised pretty much everywhere in the US, but I recently did some looking around at the anesthesia staff from a hospital back home and found there is no anesthesiologist (or at least evidence of one) to be found.

I'm a 3rd year med student but very interested in anesthesia and I understand that my interests may change. I'm somewhat familiar with pass-thru legislation but the specific word of law in my home state is that "CRNAs may function independently as part of a physician led team" and my interpretation is that this means the surgeon is filling this role, even though they aren't actually monitoring the anesthesia per se.

Is this common in other states? I would like to go back home if I end up pursuing an anesthesia residency, but what the hell do I do with this? It seems unlikely that I would be able to find a job within an hour of home, which is fine but not ideal for me.

I can't find a shred of evidence that there is a physician on staff doing anesthesia, and the two groups in town consist solely of CRNAs.

I did clinical rotations for a previous career at this hospital and actually learned from these CRNAs, but they seem to have the market cornered down there. Is it likely that such a broad swath of my home state is a desolate wasteland for anesthesiologists? I don't see this changing much in the future, but I also have approximately zero experience in this arena.

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[fittipaldi1of1]

What state?

 

[austintr]

What state?

Kansas

 

[deleted171991]

So, Dorothy, Kansas is an opt-out state. That means that CRNAs can work under the "supervision" of any physician or dentist. You should know this.

CRNA Practice

And here's your state low law:

65-1158

 

[Rich91]

It has always been my impression that CRNAs are supervised pretty much everywhere in the US, but I recently did some looking around at the anesthesia staff from a hospital back home and found there is no anesthesiologist (or at least evidence of one) to be found.

I'm a 3rd year med student but very interested in anesthesia and I understand that my interests may change. I'm somewhat familiar with pass-thru legislation but the specific word of law in my home state is that "CRNAs may function independently as part of a physician led team" and my interpretation is that this means the surgeon is filling this role, even though they aren't actually monitoring the anesthesia per se.

Is this common in other states? I would like to go back home if I end up pursuing an anesthesia residency, but what the hell do I do with this? It seems unlikely that I would be able to find a job within an hour of home, which is fine but not ideal for me.

I can't find a shred of evidence that there is a physician on staff doing anesthesia, and the two groups in town consist solely of CRNAs.

I did clinical rotations for a previous career at this hospital and actually learned from these CRNAs, but they seem to have the market cornered down there. Is it likely that such a broad swath of my home state is a desolate wasteland for anesthesiologists? I don't see this changing much in the future, but I also have approximately zero experience in this arena.

youd probably have to take a haircut on the pay, thats all, but i dont see a reason why both crnas and DocAs cant partner together if youre willing to take the same income

 

[chocomorsel]

youd probably have to take a haircut on the pay, thats all, but i dont see a reason why both crnas and DocAs cant partner together if youre willing to take the same income

And why should docs and CRNAs take the same income?
We are anesthesiologists. Not MDAs, not DocAs. Anesthesiologists. Physicians. Doctors of Medicine. Why do y’all always try to muddy the waters?

 

[Rich91]

And why should docs and CRNAs take the same income?
We are anesthesiologists. Not MDAs, not DocAs. Anesthesiologists. Why do y’all always try to muddy the waters?

supply and demand, and billing the same rates, youre a partner, not a employee, your own revenue minus expenses

 

[chocomorsel]

supply and demand

why should doctors be payed more than people with a PHD in engineering?

Market forces. Education. Why do CRNAs have such complexes and are always trying to pretend to be something they are not?

 

[Rich91]

Market forces. Education. Why do CRNAs have such complexes and are always trying to pretend to be something they are not?

education doesnt necessarily mean more value or more production

I guess its the same reason why pods after 7-8 years of specific F&A training make less then half as much as F&A orthos, simply because the orthos can take much higher value general ortho surgery

 

[nimbus]

Now we have DocA’s and NursA’s?

I’m so confused.

 

[Rich91]

Now we have DocA’s and NursA’s?

I’m so confused.

i dont want to offend the DOA's

 

[Urzuz]

Now we have DocA’s and NursA’s?

I’m so confused.

Mission accomplished.

 

[AdmiralChz]

DocA? That’s a new one, I sort of like it to be honest. Follow it up with NurseA, in practice with the AA. At least emphasizes that I’m a doctor.

Doesn’t matter, per our medical staff bylaws “doctor” is reserved for physicians only. The new NP clipboard letter gatherers hate it but don’t get a vote.

 

[austintr]

So, Dorothy, Kansas is an opt-out state. That means that CRNAs can work under the "supervision" of any physician or dentist. You should know this.

CRNA Practice

And here's your state low law:

65-1158

Thank you for the clarification. Coincidentally, those are the same pages I was looking at. But I wasn't connecting things to the opt-out thing I've heard so much about but was never clear on. Thanks to your reply, I now know a little more about it.

 

[Stank811]

Opt out means nothing. CRNAs where practicing independent before opt out and practice independent in non opt out states.

Most likely if the hospital has any volume or complexity at all they would love to have you on board but the arrangement might not be what you are wanting.

Many of the critical access hospitals have always had CRNAs only and the hospital still loses
Millions in their service which is why no anesthesiologist are present

 

[clubdeac]

Kansas has CRNAs that practice independently in pain Management doing epidurals, facet blocks, RFA and stimulators. It’s sad and sickening. Something really needs to be done to protect Anesthesiolgy and it’s subspecialties

 

[OneFellSwoop]

When armageddon hits and Medicare for all is king, we will likely be competing directly with CRNAs for jobs. There will be a mass exodus of retirees who won’t work for those rates, and for those of us too young to get out, we’ll likely have to downsize our life (myself included) but it is a livable wage and I’m not too concerned about my prospects of beating out CRNAs for jobs. This is likely worst case scenario, and while I’m not happy with it, particularly for patients, I’ve made my peace with that very real possibility.

Pro tip: get your debts paid off ASAP, invest for the long term with cheap index funds and don’t buy expensive toys with credit.

 

[clubdeac]

When armageddon hits and Medicare for all is king, we will likely be competing directly with CRNAs for jobs. There will be a mass exodus of retirees who won’t work for those rates, and for those of us too young to get out, we’ll likely have to downsize our life (myself included) but it is a livable wage and I’m not too concerned about my prospects of beating out CRNAs for jobs. This is likely worst case scenario, and while I’m not happy with it, particularly for patients, I’ve made my peace with that very real possibility.

Pro tip: get your debts paid off ASAP, invest for the long term with cheap index funds and don’t buy expensive toys with credit.

You see, it's passive whatever attitudes like this that got us into this mess. So you're happy making the same as a CRNA even though you have 4 more years of training and $100-200k more in debt? That's pretty weak

 

[Surfer]

To the original post, "Opt Out" means nothing. CRNA's practice independently in every single state in the union and have for years. "Opt out" only refers to medicare billing. Sadly, in many rural areas CRNA's get to use a higher billing base rate to actually bill more than Anesthesiologists which leads to CRNA's practicing in those areas and anesthesiologists wanting nothing to do with it.

 

[deleted480308]

To the original post, "Opt Out" means nothing. CRNA's practice independently in every single state in the union and have for years. "Opt out" only refers to medicare billing. Sadly, in many rural areas CRNA's get to use a higher billing base rate to actually bill more than Anesthesiologists which leads to CRNA's practicing in those areas and anesthesiologists wanting nothing to do with it.

I don’t think it’s true that they are independent everywhere

 

[deleted171991]

I don’t think it’s true that they are independent everywhere

That's correct. But that's what they tell everybody, that they have right to independent practice in ALL states. Which is a lie, probably coming from some AANA brainwash. Not even APRNs are allowed to practice independently in all states.

 

[Endee]

I would argue that QZ billing enables de facto “independent practice” in all states already. They may not have statutory independence but they’re basically there anyway. No state requires them to be supervised by an anesthesiologist.

That's correct. But that's what they tell everybody, that they have right to independent practice in ALL states. Which is a lie, probably coming from some AANA brainwash. Not even APRNs are allowed to practice independently in all states.

 

[OneFellSwoop]

You see, it's passive whatever attitudes like this that got us into this mess. So you're happy making the same as a CRNA even though you have 4 more years of training and $100-200k more in debt? That's pretty weak

Oh, don’t get me wrong. I’m fighting to maintain what is optimal care. I contribute to ASAPAC, I contacted my reps about surprise billing and have attended the legislative conference in the past. Unfortunately this independent practice stuff was out of the bag long before I started med school 15 years ago. I’m also in an opt out state so like it or not, independence is already a reality. On a more local level We are active in keeping our practice a true medical direction, we do all the procedures and push forth all initiatives, participate in hospital service lines and committees and In addition have had difficult conversations with chief CRNA and hospital admin about appropriate professional names (nurse anesthesiologist and MDA).

My whole point of the first post was to be ready for Armageddon and have a plan, because no matter what you do, you probably can’t stop the inertia that’s already started, you can only slow it’s acceleration.

 

[caveat87]

While there are many hospitals where crnas practice independently and bill qz, this is predominantly in critical access hospitals. I can tell you in a group that has a quality relationship with a hospital that is doing bigger cases, administrators know the value of physician led anesthesia care. This requires more than sitting stool and running for the door when the ORs are coming down (joining collaborative committees, working with the ICU to improve care, working with the pharmacy to establish policies, anticipating changes in case volume/accommodating new surgeons and ideas).

The minute you stop going above and beyond your hospital may lose faith in your group and may start to question why they don't go the cheaper route. Always remember to add value

 

[PieOHmy]

I would argue that QZ billing enables de facto “independent practice” in all states already. They may not have statutory independence but they’re basically there anyway. No state requires them to be supervised by an anesthesiologist.

NJ does

 

[chocomorsel]

You see, it's passive whatever attitudes like this that got us into this mess. So you're happy making the same as a CRNA even though you have 4 more years of training and $100-200k more in debt? That's pretty weak

Nope. It’s greedy old docs, now mostly dead, who started using and abusing CRNAs for maximum profits and marrying them (lol) that got us into this mess.

 

[ryanjmy]

If you want to practice in a small rural area do primary care.

These small hospitals don’t have the resource to do complex cases. It’s the same for outpt centers. This is where you usually find crna only practices. I feel that my knowledge and skill would be wasted in such a practice.

 

[Mman]

You see, it's passive whatever attitudes like this that got us into this mess. So you're happy making the same as a CRNA even though you have 4 more years of training and $100-200k more in debt? That's pretty weak

his attitude has nothing to do with "this mess", it's just personal happiness and financial planning and being ready for whatever.