Lobbying against CRNAs is not acceptable at UNC

[Planktonmd]

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Just heard from a trusted source that the chief of anesthesiology at UNC has sent an official letter apologizing to the CRNAs for opinions expressed by one of the anesthesiologists in his department. Those opinions apparently were stated in a letter that anesthesiologist sent to the lobbying campaign against the the legislation proposed to allow advanced practice nurses independant practice in the VA system!
The CRNAs found out and made this chief of anesthesiology issue an official apology!
This is the current state of affairs of our specialty and these are the leaders we have!

 

[Carbocation1]

Seriously? I'm done.

 

[pgg]

Seriously? I'm done.

Bye?

 

[Spinach Dip]

Screw med school. I'm going to CRNA school. That's where the job security is.

At this rate, CRNAs will be supervising anesthesiologists in a decade or 2.

 

[Baller MD]

Why are your leaders so pathetic? Reminds me of them radiologists.

 

[Temeraire]

Ok, that rustles my jimmies. Like what the actual ****

 

[Mman]

The actual letter was pretty crass. It wasn't well written or professional. While I agree with the topic of the letter it was poorly written and didn't reflect well on physicians.

 

[fathead88]

Well thats no good, I just interviewed at UNC and got a good vibe, I guess the culture isn't as good as I thought.

 

[Consigliere]

Not surprised one iota. All anesthesia chiefs are invertebrates who will suck up to the CRNAs so their department can run.

 

[deleted171991]

Seriously? I'm done.

But this specialty has such a great future...

To get back on topic, young medical students should understand that the times of "yes, doctor" are gone. We are living in the times of political correctness, of blue collar people leading the former white collars. There are century-old frustrations and indoctrinations at work here.

Btw, the syndrome "we can do everything the more educated ones do, and much better" is typical of (marxist) revolutionary thinking, even if unconsciously. It's textbook class warfare, even if it's not politically correct to call it so. There is no us and them, like the cozy bigwigs would like us to believe. There is just us OR them. Just listen to the APRNs when they think you can't hear them. These are people who aim for independence and total equality, not supervision.

They envision a future where doctors and nurses will provide the same type of care, for the same pay, but because they are more numerous, obviously they will be the ones leading (which almost sounds like the present, doesn't it?). And then I guess we'll go the way of the dinosaurs (at least in the respective specialties), because nobody will waste a lifetime in medical training, if they can take the APRN shortcut to get to the same point. Or medical training will be dumbed down to the level where it can be done in fewer years, to compete with the lower costs of the nurse practitioner track. At which point we will be really at the same level of incompetence.

Also it's a matter of older doctor-preferring generations dying, and being replaced by the ones who are already used to seeing the friendly APRN their entire youth, for various minor ailments. Btw, if I were to work as little and be as rested as them, I would be very friendly, too.

 

[pgg]

Btw, the syndrome "we can do everything the more educated ones do, and much better" is typical of (marxist) revolutionary thinking, even if unconsciously.

There's more to it than that.

There's an anti-intellectual streak a mile wide in the Republican party, and I wouldn't exactly call them Marxists.

 

[Mad Jack]

There's more to it than that.

There's an anti-intellectual streak a mile wide in the Republican party, and I wouldn't exactly call them Marxists.

It's on both sides. I bilateral race to the bottom for different reasons- the right thinks education is a liberal tool and the more of it you have, the more brainwashed you are, while the left thinks that experts are protecting monopolies of power at the expense of people with less training that are "qualified" to provide the same services. This country is screwed.

 

[Man o War]

The actual letter was pretty crass. It wasn't well written or professional. While I agree with the topic of the letter it was poorly written and didn't reflect well on physicians.

I was thinking there was probably something more to this.

 

[criticalelement]

 

[G-Man82]

I do like my AAs at work. So much more pleasant to work with than the CRNAs I've had and in all honesty, no different.

 

[criticalelement]

all applicants should boycott UNC for that stance.......

 

[deleted171991]

all applicants should boycott UNC for that stance.......

Based on that logic, applicants should boycott any program that employs CRNAs. Because none of them will stand up against them, when needed. How many times have you heard the phrase "our CRNA colleagues", as if they were our professional equals? Same goes for "nurse colleagues", by the way.

That's the new reality in American healthcare. If one doesn't like it, one should find oneself another profession, or country.

 

[Shimmy8]

Proud to say my chair and other faculty lobbied just last week in the statehouse against independent CRNA practice.

 

[Impromptu]

Co-worker is probably the best way to call people that you work with at the hospital.

 

[ERRES2288]

Proud to say my chair and other faculty lobbied just last week in the statehouse against independent CRNA practice.

That's great. Would you mind sharing the program?

 

[Consigliere]

Co-worker is probably the best way to call people that you work with at the hospital.

I call them exactly what they are to me - employees.

 

[narcusprince]

Based on that logic, applicants should boycott any program that employs CRNAs. Because none of them will stand up against them, when needed. How many times have you heard the phrase "our CRNA colleagues", as if they were our professional equals? Same goes for "nurse colleagues", by the way.

That's the new reality in American healthcare. If one doesn't like it, one should find oneself another profession, or country.

I agree with the lobby. But in the end we have to eat. I like my job and I like the lifestyle my profession has afforded me. Unfortunately hospital administrators sometimes view crna=md it sucks thats why we have to attack from within get on your hospitals ecoms/mec/committees challenge bad practice with evidence. Our strength is in the repository of evidence based knowledge like blade or Sessler. We have lost the fight when our opening salvo is based on walking out. We must fight from within to remain strong. Also, if this VA initiative goes through practices will have to employ a floor walker model to put out the fires which in that sicker population would be very difficult for an anesthesiologist. Also our arguments have to start with and end with patient safety thats all those committes seem to understand..... Fight smart and strongly apply firm pressure.

 

[ryanjmy]

I heard this guy give a talk on the future of anesthesia. I wasn't impressed. He basically wanted to give up bread and butter cases to the crnas. He wanted to drastically cut residency spots and require a mandatory fellowship year. Basically giving up. I'm not surprised by the op.

 

[deleted171991]

I heard this guy give a talk on the future of anesthesia. I wasn't impressed. He basically wanted to give up bread and butter cases to the crnas. He wanted to drastically cut residency spots and require a mandatory fellowship year. Basically giving up. I'm not surprised by the op.

That IS the future of anesthesia. I am actually betting on it. Except that they will not cut the residency spots, because they need cheap labor (both during and after residency). 😉

 

[PainDrain]

I heard this guy give a talk on the future of anesthesia. I wasn't impressed. He basically wanted to give up bread and butter cases to the crnas. He wanted to drastically cut residency spots and require a mandatory fellowship year. Basically giving up. I'm not surprised by the op.

I have heard this from several "leaders" in our field. I don't know if it's out of sheer laziness or what but I suspect it's because higher powers want the money from CRNA programs.

 

[criticalelement]

I heard this guy give a talk on the future of anesthesia. I wasn't impressed. He basically wanted to give up bread and butter cases to the crnas. He wanted to drastically cut residency spots and require a mandatory fellowship year. Basically giving up. I'm not surprised by the op.

You heard which guy talk?

 

[deleted547339]

I agree with the lobby. But in the end we have to eat. I like my job and I like the lifestyle my profession has afforded me. Unfortunately hospital administrators sometimes view crna=md it sucks thats why we have to attack from within get on your hospitals ecoms/mec/committees challenge bad practice with evidence. Our strength is in the repository of evidence based knowledge like blade or Sessler. We have lost the fight when our opening salvo is based on walking out. We must fight from within to remain strong. Also, if this VA initiative goes through practices will have to employ a floor walker model to put out the fires which in that sicker population would be very difficult for an anesthesiologist. Also our arguments have to start with and end with patient safety thats all those committes seem to understand..... Fight smart and strongly apply firm pressure.

Disclaimer: not an anesthesiologist.

It seems like the motivation behind these issues is never actually patient safety, but all about the almighty dollar.

 

[Man o War]

Disclaimer: not an anesthesiologist.

It seems like the motivation behind these issues is never actually patient safety, but all about the almighty dollar.

How can you say that if you're not an anesthesiologist? The number of near misses I've seen in my career because of stupid CRNA mistakes is truly scary. I can see why someone on the outside looking in would say something like you just did because we are always there to bail them out.

 

[WholeLottaGame7]

The actual letter was pretty crass. It wasn't well written or professional. While I agree with the topic of the letter it was poorly written and didn't reflect well on physicians.

This. The leadership actually encouraged the rest of the faculty to write in to their politicians to lobby against the proposed changes. But not in the manner in which it happened. Making an emotional, name-calling, derogatory statement is counter-productive to the greater objective. Our arguments should be logical, reasoned, and professional, or otherwise it is going to weaken our argument and make theirs' stronger.

 

[Spinach Dip]

It seems like the motivation behind these issues is never actually patient safety, but all about the almighty dollar.

To the public, marketing should focus on safety and level of training.

To administration, focus should include the connection between safety and decreased lawsuits.

...But that's assuming someone actually wants to stand up and defend the specialty instead of abandon ship and swim for Peri-Operative Provider Island.

 

[narcusprince]

Honestly residency needs to shift its resources from intraoperative management to more ICU/preop evaluation of patients. How to manage and move sick patients from OR to ICU, and risk stratification of sick patients. Bread and butter cases can be learned from an efficiency standpoint in a short time. An additional year of 25% preop/75% ICU with a focus on evidence based medicine. Also some dedicated time to bio-informatics for CA2,CA3 students where they learn systems based approach to running an operating room and how different systems integrate to show us all the information that we need to sort out. Where do are monitors come from? Whats your Preop assessment scoring system? Whats our EMR? Strengths? Weaknesses? Competitors? Who supplies our machines? What type machines are used and strengths and weaknesses? How does the OR information get from the monitors to the provider? Informatics education. We need to inspire thinkers not stool sitters. Why can't we become the head Biomed guys for our machines? We can do much more then intraoperative management.

 

[deleted547339]

How can you say that if you're not an anesthesiologist? The number of near misses I've seen in my career because of stupid CRNA mistakes is truly scary. I can see why someone on the outside looking in would say something like you just did because we are always there to bail them out.

I think you misunderstood my statement. I was not at all saying anything positive about mid-levels. I was just saying that they are cheaper on paper to the people higher up. People like to talk about patient safety, patient flow, etc. The fact of the matter is this is just a way to save face - the C-suite only cares about money.

 

[Urzuz]

Also some dedicated time to bio-informatics for CA2,CA3 students where they learn systems based approach to running an operating room and how different systems integrate to show us all the information that we need to sort out. Where do are monitors come from? Whats your Preop assessment scoring system? Whats our EMR? Strengths? Weaknesses? Competitors? Who supplies our machines? What type machines are used and strengths and weaknesses? How does the OR information get from the monitors to the provider? Informatics education. We need to inspire thinkers not stool sitters. Why can't we become the head Biomed guys for our machines?

I humbly disagree and think this is a total load of ****, no offense. Being in the OR is where you learn intraoperative management. You can know Miller backwards and forwards, but when the time comes to actually step up to plate and perform, book knowledge will do you zero good. Having the book knowledge is what separates us from the nurses, and being able to use our hands and "get things done" is what separates us from other physicians.

Though "stool sitting" may seem like a waste of time, and oftentimes can be painful when there are long boring cases, that is the only way to expose yourself to rare problems during a case, and where you will learn how to deal with them. Why do you think we (anesthesiologists) are called to "put out fires" when CRNAs are choking under pressure? Knowing about the EMR is going to do squat in situations like that.

Rather than bending over and conceding the fight to the nurses, why not sack up and do something about it?

 

[criticalelement]

Honestly residency needs to shift its resources from intraoperative management to more ICU/preop evaluation of patients. How to manage and move sick patients from OR to ICU, and risk stratification of sick patients. Bread and butter cases can be learned from an efficiency standpoint in a short time. An additional year of 25% preop/75% ICU with a focus on evidence based medicine. Also some dedicated time to bio-informatics for CA2,CA3 students where they learn systems based approach to running an operating room and how different systems integrate to show us all the information that we need to sort out. Where do are monitors come from? Whats your Preop assessment scoring system? Whats our EMR? Strengths? Weaknesses? Competitors? Who supplies our machines? What type machines are used and strengths and weaknesses? How does the OR information get from the monitors to the provider? Informatics education. We need to inspire thinkers not stool sitters. Why can't we become the head Biomed guys for our machines? We can do much more then intraoperative management.

The above is
gob·ble·dy·gook

 

[teeva]

WTF? I'm supposed to get an electrical, mechanical, and computer engineering certificate too to figure out how the **** a monitor works and sends data to EMR?

Should I also learn how local anesthetics are synthesized for mass production by getting a certificate in chemical manufacturing during my third useless fellowship?

And more time penalty for learning evidence-based medicine? What are we doing now, voodoo and astrology guided practice?

 

[narcusprince]

Your not seeing the BIG picture. Can CRNA's push blue, yellow, and white just like we do for healthy patients? Undoubtedly yes. They study the same textbooks as we do. They quote Miller just like we do. Work in a environment where CRNA=MD and you will recognize the subtleties of their strengths and weaknesses. Using evidence to guide our practice is what we are strong at, therefore reinforcing a core knowledge of evidence based practice is key in distinguishing our practice from theirs. When Dr X uses X drug he can show some evidence that using approach X is better then Y drug and here is the evidence supporting it. As residents challenge your staff members ask them for evidence of why they practice a certain way. We have to expand the scope of residents education, look at the Brits much heavier emphasis on physics and informatics. Our preoperative evaluation is whats most important in our practice why not have residents spend more time doing that versus stool sitting.

 

[Planktonmd]

Honestly residency needs to shift its resources from intraoperative management to more ICU/preop evaluation of patients. How to manage and move sick patients from OR to ICU, and risk stratification of sick patients. Bread and butter cases can be learned from an efficiency standpoint in a short time. An additional year of 25% preop/75% ICU with a focus on evidence based medicine. Also some dedicated time to bio-informatics for CA2,CA3 students where they learn systems based approach to running an operating room and how different systems integrate to show us all the information that we need to sort out. Where do are monitors come from? Whats your Preop assessment scoring system? Whats our EMR? Strengths? Weaknesses? Competitors? Who supplies our machines? What type machines are used and strengths and weaknesses? How does the OR information get from the monitors to the provider? Informatics education. We need to inspire thinkers not stool sitters. Why can't we become the head Biomed guys for our machines? We can do much more then intraoperative management.

How about practicing medicine and taking care of patients? is that not needed anymore in your world of computers, machines, and administrators?
Most physicians usually study medicine because they like to take care of patients, Did that change now and the new medical grads want to be a mutant form of accountant/engineer/secretary/administrator?

 

[Planktonmd]

Your not seeing the BIG picture. Can CRNA's push blue, yellow, and white just like we do for healthy patients? Undoubtedly yes. They study the same textbooks as we do. They quote Miller just like we do. Work in a environment where CRNA=MD and you will recognize the subtleties of their strengths and weaknesses. Using evidence to guide our practice is what we are strong at, therefore reinforcing a core knowledge of evidence based practice is key in distinguishing our practice from theirs. When Dr X uses X drug he can show some evidence that using approach X is better then Y drug and here is the evidence supporting it. As residents challenge your staff members ask them for evidence of why they practice a certain way. We have to expand the scope of residents education, look at the Brits much heavier emphasis on physics and informatics. Our preoperative evaluation is whats most important in our practice why not have residents spend more time doing that versus stool sitting.

By the way all that stuff you are imagining to be your advantage over nurses can be done by a nurse for less money! And actually would be more welcomed by the administrators who are either nurses or nurse advocates!
Winning the war can not be by running to a new land and pretending that the war does not exist. If you you have no balls to fight for what you have and claim control over your territory, people will constantly challenge you and steal your lunch.

 

[Mad Jack]

That IS the future of anesthesia. I am actually betting on it. Except that they will not cut the residency spots, because they need cheap labor (both during and after residency). 😉

And PDs need to keep their gravy train rolling...

Path and radiology already had similar market changes for different reasons. Interesting how all of the places that have taken big hits are the fields that have the least facetime and continuity of care with patients.

 

[deleted171991]

Path and radiology already had similar market changes for different reasons. Interesting how all of the places that have taken big hits are the fields that have the last facetime and continuity of care with patients.

Bingo!

 

[Carbocation1]

And PDs need to keep their gravy train rolling...

Path and radiology already had similar market changes for different reasons. Interesting how all of the places that have taken big hits are the fields that have the least facetime and continuity of care with patients.

Is this a plug for primary care? LOL

 

[TeslaCoil]

Wooow. Strike UNC off my list.

 

[jl lin]

I call them exactly what they are to me - employees.

As a nurse, you may call me by my first or last name. That' is fine. I know the pluses of what I do as well as the limits. I am neither ashamed or haughty over what I know and do as an RN. I don't need to feel equal or superior. And there are many of us like this.

Please note: I am not for CRNAs having independent practice, and I will not go or be cool with my family going somewhere for a procedure where this is the case.

Remember please that not every nurse supports this initiative. There are many of us that think it is dangerous.

You have to work together so why be harsh w/ each other? I mean I call a housekeeper by their first name, if I know them. Nothing wrong w/ cordiality and general respectfulness. I don't think I am better than they are b/c my credentials and role are different.

UNC is just playing politics, b/c it saves them some $$$$ and peace in-house. (See below about CRNA job database.) I think what is needed is the opportunity to see independent practice and the negative outcomes compile over time. It's kind of like w/ the air traffic controllers, where they needed to see so many bad experiences before they made changes.

And really, is UNC in support of the independent CRNA initiative within their system?????

They should have made an intelligent reply as to why they are reticent to support it if, in fact, in-house, they do not. Whats more they should have stated that they also believe in physicians voicing their concerns and opinions. But again, that doesn't serve their bottom line.

Scrolling through job databases, I don't know how many CRNA jobs I saw posted--more than quite a few mind you.

But independent practice apart from sound medical anesthesia supervision is foolish. There will have to be a lot of crash and burns and publicity in order for things to change IMHO.

 

[jl lin]

Disclaimer: not an anesthesiologist.

It seems like the motivation behind these issues is never actually patient safety, but all about the almighty dollar.

Well, not for me, as a nurse and a person w/ family members w/ serious co-morbid issues that MUST be given very sound evaluation and thinking before the family member goes under the gas and knife. I completely believe there are HUGE safety concerns. No one really cares b/c it's all about tightening the money and preserving profit from investors/owners/health systems.


Also, if given independent practice, how many hospital and such will be totally OK with this from a risk management perspective?

 

[repititionition]

How about practicing medicine and taking care of patients? is that not needed anymore in your world of computers, machines, and administrators?
Most physicians usually study medicine because they like to take care of patients, Did that change now and the new medical grads want to be a mutant form of accountant/engineer/secretary/administrator?

No, but they may need to.

 

[pgg]

An additional year of 25% preop/75% ICU with a focus on evidence based medicine.

The entirety of MS3, MS4, internship, and residency, maybe even a bit of MS1 and MS2, can and should emphasize evidence based medicine.

Another year of residency to make everyone an intensivist also kind of follows the European model, but I don't know that we need to go there. This is a solution to a problem we don't have: we're not threatened by midlevels because we're not intensivists. If anything, this would push more US anesthesiologists away from bread & butter OR cases, i.e. the low hanging profitable fruit.

25% preop? I can't imagine 3 months of that being useful to a CA3 or fellow, but then, I'm not at all sold on the whole perisurgicaloperative scuthome idea. The answer to our collective woes (which I feel tend to be rather overstated on this forum) isn't to force everyone to do a CCM fellowship, much less one diluted with 3 months of pointless agony in preop purgatory.

 

[ph8]

Just heard from a trusted source that the chief of anesthesiology at UNC has sent an official letter apologizing to the CRNAs for opinions expressed by one of the anesthesiologists in his department. Those opinions apparently were stated in a letter that anesthesiologist sent to the lobbying campaign against the the legislation proposed to allow advanced practice nurses independant practice in the VA system!
The CRNAs found out and made this chief of anesthesiology issue an official apology!
This is the current state of affairs of our specialty and these are the leaders we have!

mods, could we move this discussion to the private forum?

 

[Planktonmd]

mods, could we move this discussion to the private forum?

Why?

 

[Psai]

This is sad. Nurses are not doctors. Nurses cannot replace doctors. Let them work on their own. If they don't like the letter, let them leave. It's not like there aren't a million new crna grads that would jump at the job. Train aas. Is this really that hard to do?

 

[jl lin]

mods, could we move this discussion to the private forum?

No need. Oh my. I'm out.