Is the ASA still relevant?

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Based on https://www.opensecrets.org/pacs/lookup2.php?strID=C00173153 vs https://www.opensecrets.org/pacs/lookup2.php?strID=C00255752&cycle=2014, the ASA has so much more donations than the AANA. Why is it we are the group that seems flat-footed when things like Nursing Handbook comes out? Isn't that the whole point of lobbying, to affect the legislative process? I just feel less strongly at donating when money doesn't seem to be the rate-limiting step.

 

[deleted126335]

They have more allies.


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[vector2]

 

[deepstate2016]

well to be fair the ASA has to fight on several fronts. we see the primary front against mid level encroachment, but there are still issues regarding conscious sedation with ER, GI turf wars with hospitalists and pulmonology working the ICU, fighting to prevent decreasing reimbursements from medicare. There are so many things and I am quite sure NONE of them are getting the attention they deserve as far as the interested parties are concerned.

 

[deleted171991]

well to be fair the ASA has to fight on several fronts. we see the primary front against mid level encroachment, but there are still issues regarding conscious sedation with ER, GI turf wars with hospitalists and pulmonology working the ICU, fighting to prevent decreasing reimbursements from medicare. There are so many things and I am quite sure NONE of them are getting the attention they deserve as far as the interested parties are concerned.

Divide and conquer.

 

[Mman]

Based on https://www.opensecrets.org/pacs/lookup2.php?strID=C00173153 vs https://www.opensecrets.org/pacs/lookup2.php?strID=C00255752&cycle=2014, the ASA has so much more donations than the AANA. Why is it we are the group that seems flat-footed when things like Nursing Handbook comes out? Isn't that the whole point of lobbying, to affect the legislative process? I just feel less strongly at donating when money doesn't seem to be the rate-limiting step.

Nurses are like one big union. They stick together. You think your dollars and vote just compete with the AANA? Try every nurse in the country. It's also politically incorrect to say anything bad about nurses, yet doctors are fair game for getting ripped by anybody.

 

[GravelRider]

Nurses are like one big union. They stick together. You think your dollars and vote just compete with the AANA? Try every nurse in the country. It's also politically incorrect to say anything bad about nurses, yet doctors are fair game for getting ripped by anybody.

This is exactly it. In order to be relevant, the ASA and similar medical organizations would have to function more like a union and put out a real, no holds barred marketing campaign. Doctors rested on their laurels for way too long and now we are playing from behind.

 

[Consigliere]

The real question to ask is: Was the ASA EVER relevant?

 

[Doctor4Life1769]

Doctors don't ever stick together.
Cops do, nurses do. Hell even attorneys, politicians, and business folks do

 

[Ignatius J]

Lol. I love jaded anesthesiologists that act like they have gotten the short end of the stick. Trapped by their own warped reality.

 

[amLOLdipine]

Is the ASA any less relevant than the AMA? I thought this issue was far from being limited to anesthesia

 

[deleted126335]

Lol. I love jaded anesthesiologists that act like they have gotten the short end of the stick. Trapped by their own warped reality.

Said the guy who blames "dinosaur grandfathers"🙄 for the troubles in the field today.

 

[GravelRider]

Lol. I love jaded anesthesiologists that act like they have gotten the short end of the stick. Trapped by their own warped reality.

That's called resting on your laurels. Good will only lasts so long. Sit idle, say nothing, and watch medicine in the U.S. slowly erode into the lowest common denominator so the shareholders can maximize their margins.

 

[Ignatius J]

Said the guy who blames "dinosaur grandfathers"🙄 for the troubles in the field today.

Yeah, there is no excuse for an old to not now how to use an ultrasound and I am the one who has to do MOCA. I can look past that though. Great field.

 

[Ignatius J]

That's called resting on your laurels. Good will only lasts so long. Sit idle, say nothing, and watch medicine in the U.S. slowly erode into the lowest common denominator so the shareholders can maximize their margins.

I rarely see anyone who is a good dude and a good worker be left for dead. Frankly, they are a lot less common than the opposite. Roads are paved with bitter people who just don't think "they got a fair shake."

 

[pgg]

I think my ASA membership expired a few months ago. Not sure when.

I was an ASAPAC "Chairman's Council" donor for a few years too. Haven't donated recently.

Every now and then I think I should probably get around to paying my ASA dues and start donating to ASAPAC again, but to be honest I feel kind of apathetic about it. I was all motivated and optimistic ~7 years ago but in that time I haven't seen them make even an honest effort to counter the AANA propaganda machine. No ad campaign, no PR. Nothing. They haven't done ****. Some of the state chapters have done good work at the state level, but there's just nothing visible on a national level.

Too many anesthesiologists make too much money off too many CRNAs for the ASA to step on any toes.

The best defense of the specialty they've put up on my behalf is this PSH silliness. And I find that defense to be offensive.

Failure I could handle, but what we've got from them is apathy at best, and sometimes they even seem to be working against our interests.

I made a clean cut away from those wankers at the AMA years ago, but I'm finding it harder to give up on the ASA for some reason.

 

[GravelRider]

Too many anesthesiologists make too much money off too many CRNAs for the ASA to step on any toes.

And therein lies the problem.

 

[deleted171991]

I think it's not anesthesiologists who make the most money from the ACT model anymore; it's corporations, both AMCs and academia.

 

[hypnosMD]

Why can't the ASA issue a statement that, at a minimum, an anesthesiologist's involvement ranging from MD only to medical direction of no more than 4:1 for routine cases, is standard of care. Furthermore, we should be able to report offfending places (using only CRNA's, more than 4:1, AMC's such as Northstar, etc) anonymously to the ASA so they might send them a formal letter of standards of care and their potential exposure to liability. They could keep a file of these places so that when incidents occur they have evidence of them having been notified.

 

[GravelRider]

Why can't the ASA issue a statement that, at a minimum, an anesthesiologist's involvement ranging from MD only to medical direction of no more than 4:1 for routine cases, is standard of care. Furthermore, we should be able to report offfending places (using only CRNA's, more than 4:1, AMC's such as Northstar, etc) anonymously to the ASA so they might send them a formal letter of standards of care and their potential exposure to liability. They could keep a file of these places so that when incidents occur they have evidence of them having been notified.

Based on what evidence? Is there a study saying 4:1 is safer than 6:1?

 

[hypnosMD]

Based on what evidence? Is there a study saying 4:1 is safer than 6:1?

Based upon the very argument that an anesthesiologist is relevant to patient care. A prospective study to compare ratios for "safety" would never get IRB approval, and retrospective data has sample bias (smaller rural facilities using crnas only vs regional transfer high acuity centers with close supervision or MD only).
If the ASA won't argue for our relevance, they don't deserve any of our money.

 

[GravelRider]

Based upon the very argument that an anesthesiologist is relevant to patient care. A prospective study to compare ratios for "safety" would never get IRB approval, and retrospective data has sample bias (smaller rural facilities using crnas only vs regional transfer high acuity centers with close supervision or MD only).
If the ASA won't argue for our relevance, they don't deserve any of our money.

Why 4:1 and not 3:1 or 2:1? It's an arbitrary number and not backed by any data.

 

[hypnosMD]

Why 4:1 and not 3:1 or 2:1? It's an arbitrary number and not backed by any data.

So you are of the opinion that there is no supervisory ratio at which patient care is compromised?

 

[skypilot]

I think my ASA membership expired a few months ago. Not sure when.
The best defense of the specialty they've put up on my behalf is this PSH silliness. And I find that defense to be offensive.

Yep, makes me want to vomit. I didn't become an Anesthesiologist and hone my skills in General Anesthesia, Airway rescue, lines, blocks, obstetrics, Pediatric Anesthesia, and rapid differential diagnosis and treatment to work as a clerk in the PSH.

 

[skypilot]

Why 4:1 and not 3:1 or 2:1? It's an arbitrary number and not backed by any data.

Also so dependent on patient acuity and midlevel skill. Sometimes 2:1 is safe, sometimes 3:1.

 

[hypnosMD]

Also so dependent on patient acuity and midlevel skill. Sometimes 2:1 is safe, sometimes 3:1.

My opinion (for what little it is worth) is that the ASA should issue an expert opinion (low level of evidence, yet still recognized) on the maximum safe ratio. At least it is a starting point.
Meanwhile, standards of care are always changing and vary based upon region. However, most would hold a position that exceeding 4:1, much less independent mid-level practice, while possibly legal, is not standard of care. The ASA, if our advocates, could take that position.

 

[BLADEMDA]

My opinion (for what little it is worth) is that the ASA should issue an expert opinion (low level of evidence, yet still recognized) on the maximum safe ratio. At least it is a starting point.
Meanwhile, standards of care are always changing and vary based upon region. However, most would hold a position that exceeding 4:1, much less independent mid-level practice, while possibly legal, is not standard of care. The ASA, if our advocates, could take that position.

Just to play devil's advocate here, do you have any evidence that medical direction results in better outcomes than supervision? Similarly, any evidence that 4:1 is the correct ratio? From my person experience of covering 1-6 rooms with CRNAs is that 4 is a significant number at a major medical center while no big deal at an outpatient facility.

Standard of care based on what evidence?

 

[hypnosMD]

Just to play devil's advocate here, do you have any evidence that medical direction results in better outcomes than supervision? Similarly, any evidence that 4:1 is the correct ratio? From my person experience of covering 1-6 rooms with CRNAs is that 4 is a significant number at a major medical center while no big deal at an outpatient facility.

Standard of care based on what evidence?

Since the amount of time spent on any one patient is inversely proportionate to the number of patients overseen by necessity, it seems the overwhelming sentiment is that there is no correlation between the time of involvement of an anesthesiologist and the patients' outcomes.
Thus, as a partner in a private practice, perhaps my partners and I should just hire CRNA's in the future and allow them to solo, making us mere business owners henceforth.
Herein lies the future (ie the present).

 

[Consigliere]

Was the ASA EVER relevant?

 

[Crabbygas]

If I had three priorities for the ASA to fight they would probably be:

MOCA
Noncompetes
Big AMC takeover.

As far as I can tell the ASA is doing nothing about these things. The fact that they make lots of money off MOCA and the AMCs are big advertisers means they will likely never have an interest in addressing these issues. So to answer the OP question no they are not very relevant.

 

[Noyac]

Is anyone aware of ASA board members who also serve as AMC board members?