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I learned this the first week of residency.
Lobbying against CRNAs is not acceptable at UNC
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I learned this the first week of residency.
Did you see the actual letter?
Here's the chairs response:
To Our Physician Anesthesiologists and Certified Registered Nurse Anesthetists,
I am proud to be a member of the anesthesia care team at the University of North Carolina at Chapel Hill. The care our physician anesthesiologists and CRNAs render our patients is exemplary. The collaboration, trust and respect we have fostered at UNC results in extraordinary care for all of our patients. My confidence in our physicians and our CRNAs is unwavering.
Recently, a letter was sent as part of a lobbying effort by one of our physician anesthesiologists expressing a personal opinion regarding a legislative issue involving CRNAs in the VA system. I want to be clear that the opinions expressed regarding our CRNAs are hers alone. I found the characterizations of our CRNA colleagues to be inappropriate, unprofessional, inaccurate and offensive. Our CRNAs are among the most gifted and well trained anywhere in the nation. The trust, respect and working relationships we have between our CRNAs and our physician anesthesiologists exemplify the very best in healthcare. Regardless of ones opinion on the legislative issue, I stand behind each of you and the high quality of care you deliver every day.
In closing, I want to thank each of you for your commitment to the health and wellbeing of our patients. I look forward to each day at UNC as I know that my efforts and those of my physician and CRNA colleagues make a difference in the lives of others.
To Our Physician Anesthesiologists and Certified Registered Nurse Anesthetists,
I am proud to be a member of the anesthesia care team at the University of North Carolina at Chapel Hill. The care our physician anesthesiologists and CRNAs render our patients is exemplary. The collaboration, trust and respect we have fostered at UNC results in extraordinary care for all of our patients. My confidence in our physicians and our CRNAs is unwavering.
Recently, a letter was sent as part of a lobbying effort by one of our physician anesthesiologists expressing a personal opinion regarding a legislative issue involving CRNAs in the VA system. I want to be clear that the opinions expressed regarding our CRNAs are hers alone. I found the characterizations of our CRNA colleagues to be inappropriate, unprofessional, inaccurate and offensive. Our CRNAs are among the most gifted and well trained anywhere in the nation. The trust, respect and working relationships we have between our CRNAs and our physician anesthesiologists exemplify the very best in healthcare. Regardless of ones opinion on the legislative issue, I stand behind each of you and the high quality of care you deliver every day.
In closing, I want to thank each of you for your commitment to the health and wellbeing of our patients. I look forward to each day at UNC as I know that my efforts and those of my physician and CRNA colleagues make a difference in the lives of others.
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Ok, now let's see the original letter....
The Chair, David Zvara also basically forced her to write a letter of apology to the whole department JUST for expressing her views in a CONFIDENTIAL letter to her congressman that was purposefully LEAKED by, most likely, an aide in the Congressman's office. How ANYONE could work in such a department is beyond me.
hang tight - i'm figuring out how to post it
Also, it looks like the CEO at UNC may have forced the chair to write this letter... http://www.nurse-anesthesia.org/con...empts-to-Obstructs-Veteran%92s-Access-to-Care
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deleted171991
The CRNAs say something very true there: “It is hard to convince someone of something when their salary depends on them NOT being convinced of it.” It applies beautifully to the CEO, the chair, the politicians, and all the bean counters who put CRNAs on (more than) equal footing with anesthesiologists.
I am so tired of this charade, and of having CRNAs practice under our good names. Let them sink or swim on their own, no anesthesia care team, no MDs involved, no firefighters, no preop monkeys, no safety net. It would take just a few months before they would have to rescind the legislation, and they know it; that's why they are afraid to get completely rid of doctors.
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I agree with you - and that statement also applies to the multitude of AANA journal articles they posted without the accompanying analysis that shows how weak those studies are. The ASA website does a beautiful job of looking at the evidence that is out there at this time (both pro and con). And at the end of the day, lets just look around - I don't spend a day a week on average in an operating room rescuing my MD colleagues....I don't need to. They don't get into the same kind of hot water.
Harshly written, but maybe we need more of that.
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deleted171991
I hope everybody here understands that this is because the anesthesiologist gets to pay the brunt of any malpractice damages, even when the mistake belongs to a CRNA, even if the anesthesiologist was not called promptly.nurse-anesthesia.org said:
In the eyes of malpractice law and juries, CRNA = anesthesiology resident. In the eyes of most CRNAs, CRNA = anesthesiologist, hence the attitudes. Good luck finding the fine line to walk in your daily practice.
That whole page proves again, if it was even necessary, that militant CRNAs don't know what they don't know.
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This is HILARIOUS - read what nurses think of doctors 🙂 http://www.nurse-anesthesia.org/showthread.php/2944-Why-didnt-you-goto-Medical-school?highlight=ross
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deleted171991
I love that they start by quoting copro. That post is an evergreen.
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But I wish copro had added to the laundry list the number of paraprofessiona
This is probably going to be the most negative post I have ever written to potential applicants to CRNA schools. While I will admit that there may be some subliminal, selfish, personal reasons for writing this, that isn’t my real goal. I’m trying to do what I have always done. Be up front and honest about the profession and your chances for becoming not just a CRNA, but a happily employed CRNA. Things have changed in the profession, and you need to be fully aware of what you are pursuing.
Let me start by telling you that I have been a CRNA for 10, almost 11 years, and I love what I do. I love the interaction I have with patients, and to a more limited extent, with their families. I love the daily challenge of anesthesia, and I love learning new techniques, I love the variety in my day to day employment. That said, I’ve seen some troubling developments in the last several years. Let’s start with the realities of schools. I’m not going to talk about any specific schools, and when I talk about things I’ve seen, I won’t reveal what schools I’m talking about, so don’t ask.
There has, in the last few years, been an explosion in the number of schools that offer CRNA programs. There are a couple of reasons for this. When I started school in 1999, there were far fewer schools, and our profession was facing a critical shortage of CRNA’s. Competition for the few school seats was tight, and schools were able to select only the best candidates. That situation has completely reversed. Now, the schools are competing for candidates to fill the seats. As a result, many folks who would not have even made it to the interview stage 12 years ago are being accepted into schools. This isn’t meant to be nearly as elitist as it sounds. The fact is, both the students and the profession are being done a great disservice in the overall process. Let me explain:
First, there are “CRNA mills” that accept as many as 120 students per class. If they could graduate that many (which they can’t), they would long ago have completely killed the job market in a wide radius around their location. So, how do they avoid doing that? Well of course, they accept students from other areas, knowing these students are likely to go “home” after graduation. But there is another built in safeguard. I’ve heard of more than one of these mills that accept more students to start the class than they have clinical sites to support. In other words, while they may initially accept 120, they have only 80-100 available spots with the didactic phase ends and the clinical phase begins. That means in the intervening time between acceptance and clinicals, they must lose (i.e. flunk out) 20-40 students. Think about that for a minute. This means that the school has no incentive to help the struggling student, the student who is just not getting it. In fact, these schools have a strong incentive to not help these students in any meaningful way. Get into one of these programs, and you are competing with 120 other students for a professor’s “office hours.” And the closer a class gets to the clinical phase, the less incentive the school has to help the struggling.
This leaves a number of RN’s, forced to return to jobs paying RN salaries, with anywhere from one to three semesters of CRNA school debt. So, why would they accept more students than they can train? Well, no one has ever come out and said it to me, but I have my own opinion. CRNA education is expensive. Very expensive. The more students the school takes in, the more money they can make, which is the school’s ultimate aim. So, if they can get 120 students, knowing they will have to drop 20-40 students, that’s OK. They will at least get up to half the program’s tuition out of those students they are “forced” to flunk out.
But the smaller schools have their problems, too. The explosion of schools has greatly increased the COA, the body that certifies CRNA graduate programs. While members of that board my say differently, I contend that the increased workload has created a situation whereby weak schools are able to get by with little or no notice. Right off the top of my head, I can think of two programs that have opened since I started practicing whose students I have trained have just been weak across the board. Every student, in every situation. I know of more than one case where these students have graduated, passed boards, then had difficulty keeping a job because they simply could not keep up, could not practice independently enough, even in an ACT environment. And while I have no evidence, I think there is a great potential for these folks to get sued.
The job situation isn’t great, either. A changing economic climate, coupled with the increased number of seats available has vastly changed the employment landscape. When I started, it was projected that as many as 50% of active CRNA’s were going to retire in the next 10 – 15 years. That, coupled with the low number of graduates that were coming out yearly, meant a CRNA could “write their own ticket.” Jobs were plentiful, anywhere one wanted to work. Salaries were climbing fast, and sign on bonuses of $20,000 or more were common.
But, owing to huge losses of retirement savings in the economic crash, most who were projected to retire have stayed in the work force. Couple that the increasing number of people coming out of school, and the employment picture has turned 180 degrees around. Salaries have stagnated, and are falling in some places. Look around this board. There are very few to no jobs to be had in California, Colorado, and other states. Look at just one example (you might not expect).
In Tennessee and Arkansas, when I first moved to the area in 2004, jobs were literally everywhere. Now, there are no fewer than 8 schools in the area producing CRNA’s. Jobs in both states have almost completely dried up. I’ve even heard a rumor that CRNA’s have been laid off in Chattanooga. I just now checked Gaswork, and there are three jobs available in Tennessee, one for a Chief CRNA. There was only 1 in Arkansas, at an endoscopy center in Little Rock. I work with a CRNA in Texas now who is a new graduate from Little Rock. She did not want to leave the area, but there just weren’t any jobs available.
Salaries, as I’ve said, have stagnated. In many urban areas, salaries have even gone down, particularly for new graduates. Raises are non-existent. I make exactly the same base pay now as I made in 2004, but other forms of compensation (i.e. overtime, call pay, etc) have decreased pretty dramatically. If you want to be a CRNA, don’t plan too much on finding a job where you go to school or do your clinicals.
The upshot is this: if you want to be a CRNA for the challenge, for the increased knowledge, then I encourage you to go for it. But if, upon graduation, you will be tied to a particular spot, especially if that spot is where you are going to school, or where you are going to do your clinical rotations, do your due diligence. Make sure there will be a job for you. Get a commitment, if you can (unlikely). Think long and hard. I know more than one CRNA who feels stuck in a suck job because they can’t (or won’t) move. I know others (some on this board) who simply cannot find a job in a place they want to live.
Last edited by kmchugh; 03-17-2012 at 10:07 AM.
Heres a post by a CRNA about becoming a CRNA:
This is probably going to be the most negative post I have ever written to potential applicants to CRNA schools. While I will admit that there may be some subliminal, selfish, personal reasons for writing this, that isn’t my real goal. I’m trying to do what I have always done. Be up front and honest about the profession and your chances for becoming not just a CRNA, but a happily employed CRNA. Things have changed in the profession, and you need to be fully aware of what you are pursuing.
Let me start by telling you that I have been a CRNA for 10, almost 11 years, and I love what I do. I love the interaction I have with patients, and to a more limited extent, with their families. I love the daily challenge of anesthesia, and I love learning new techniques, I love the variety in my day to day employment. That said, I’ve seen some troubling developments in the last several years. Let’s start with the realities of schools. I’m not going to talk about any specific schools, and when I talk about things I’ve seen, I won’t reveal what schools I’m talking about, so don’t ask.
There has, in the last few years, been an explosion in the number of schools that offer CRNA programs. There are a couple of reasons for this. When I started school in 1999, there were far fewer schools, and our profession was facing a critical shortage of CRNA’s. Competition for the few school seats was tight, and schools were able to select only the best candidates. That situation has completely reversed. Now, the schools are competing for candidates to fill the seats. As a result, many folks who would not have even made it to the interview stage 12 years ago are being accepted into schools. This isn’t meant to be nearly as elitist as it sounds. The fact is, both the students and the profession are being done a great disservice in the overall process. Let me explain:
First, there are “CRNA mills” that accept as many as 120 students per class. If they could graduate that many (which they can’t), they would long ago have completely killed the job market in a wide radius around their location. So, how do they avoid doing that? Well of course, they accept students from other areas, knowing these students are likely to go “home” after graduation. But there is another built in safeguard. I’ve heard of more than one of these mills that accept more students to start the class than they have clinical sites to support. In other words, while they may initially accept 120, they have only 80-100 available spots with the didactic phase ends and the clinical phase begins. That means in the intervening time between acceptance and clinicals, they must lose (i.e. flunk out) 20-40 students. Think about that for a minute. This means that the school has no incentive to help the struggling student, the student who is just not getting it. In fact, these schools have a strong incentive to not help these students in any meaningful way. Get into one of these programs, and you are competing with 120 other students for a professor’s “office hours.” And the closer a class gets to the clinical phase, the less incentive the school has to help the struggling.
This leaves a number of RN’s, forced to return to jobs paying RN salaries, with anywhere from one to three semesters of CRNA school debt. So, why would they accept more students than they can train? Well, no one has ever come out and said it to me, but I have my own opinion. CRNA education is expensive. Very expensive. The more students the school takes in, the more money they can make, which is the school’s ultimate aim. So, if they can get 120 students, knowing they will have to drop 20-40 students, that’s OK. They will at least get up to half the program’s tuition out of those students they are “forced” to flunk out.
But the smaller schools have their problems, too. The explosion of schools has greatly increased the COA, the body that certifies CRNA graduate programs. While members of that board my say differently, I contend that the increased workload has created a situation whereby weak schools are able to get by with little or no notice. Right off the top of my head, I can think of two programs that have opened since I started practicing whose students I have trained have just been weak across the board. Every student, in every situation. I know of more than one case where these students have graduated, passed boards, then had difficulty keeping a job because they simply could not keep up, could not practice independently enough, even in an ACT environment. And while I have no evidence, I think there is a great potential for these folks to get sued.
The job situation isn’t great, either. A changing economic climate, coupled with the increased number of seats available has vastly changed the employment landscape. When I started, it was projected that as many as 50% of active CRNA’s were going to retire in the next 10 – 15 years. That, coupled with the low number of graduates that were coming out yearly, meant a CRNA could “write their own ticket.” Jobs were plentiful, anywhere one wanted to work. Salaries were climbing fast, and sign on bonuses of $20,000 or more were common.
But, owing to huge losses of retirement savings in the economic crash, most who were projected to retire have stayed in the work force. Couple that the increasing number of people coming out of school, and the employment picture has turned 180 degrees around. Salaries have stagnated, and are falling in some places. Look around this board. There are very few to no jobs to be had in California, Colorado, and other states. Look at just one example (you might not expect).
In Tennessee and Arkansas, when I first moved to the area in 2004, jobs were literally everywhere. Now, there are no fewer than 8 schools in the area producing CRNA’s. Jobs in both states have almost completely dried up. I’ve even heard a rumor that CRNA’s have been laid off in Chattanooga. I just now checked Gaswork, and there are three jobs available in Tennessee, one for a Chief CRNA. There was only 1 in Arkansas, at an endoscopy center in Little Rock. I work with a CRNA in Texas now who is a new graduate from Little Rock. She did not want to leave the area, but there just weren’t any jobs available.
Salaries, as I’ve said, have stagnated. In many urban areas, salaries have even gone down, particularly for new graduates. Raises are non-existent. I make exactly the same base pay now as I made in 2004, but other forms of compensation (i.e. overtime, call pay, etc) have decreased pretty dramatically. If you want to be a CRNA, don’t plan too much on finding a job where you go to school or do your clinicals.
The upshot is this: if you want to be a CRNA for the challenge, for the increased knowledge, then I encourage you to go for it. But if, upon graduation, you will be tied to a particular spot, especially if that spot is where you are going to school, or where you are going to do your clinical rotations, do your due diligence. Make sure there will be a job for you. Get a commitment, if you can (unlikely). Think long and hard. I know more than one CRNA who feels stuck in a suck job because they can’t (or won’t) move. I know others (some on this board) who simply cannot find a job in a place they want to live.
Last edited by kmchugh; 03-17-2012 at 10:07 AM.
D
deleted171991
Seriously??? Do we really need to ask every anesthesiologist whether they have ever had to rescue a patient from imminent death or brain damage because the CRNA decided that there was no need to call the physician? Haven't we all seen this before?nurse-anesthesia.org said:
And the nerve to make this out into the big bad anesthesiologist versus the poor CRNA who only cares about the patient.
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here it is: As you know, I recently submitted comments regarding the necessity of physician led anesthetic care to
my United States Senator. I submitted these comments with the naïve understanding that they were private comments between myself and someone who represents me in the United States Senate. Given the nature of current political discourse, I felt compelled to use strong language to get my position across. Unfortunately, my comments were fed into the public domain. I am truly sorry that the words I chose hurt the feelings of many of you.
I want to state, without reservation, that I value all the members of our care team and that I have tremendous respect for nurse anesthetists and the important contributions they make to the anesthesia care team. However, I feel very strongly that the level of safety and quality that the team based model of care affords is superior to that proposed by current legislation and that the best level of care should be provided to every patient, particularly our nation's Veterans. My conviction is based in large part on experiences with my two grandfathers, both of whom served in the military and receive medical
care in the VA system. I want my grandfathers to have the best care possible and I believe an anesthesia team benefiting from the unmatched training and education of a physician anesthesiologist is
the best way to deliver that care.
I am proud to stand with my nursing colleagues at UNC in delivering exceptional anesthetic care to our patients. Unfortunately, my passion for this issue and the resultant messaging used a few words which I wish I could take back. I understand how these words could have been interpreted as calling into question the important work that you do each and every day in the care of our patients. I am sorry if you felt devalued. This was not my intent. I think we share the goal of working in an anesthesia team that provides patients the synergistic benefits of the different education and skills
delivered when nurse anesthetists and physician anesthesiologists work together cooperatively.
my United States Senator. I submitted these comments with the naïve understanding that they were private comments between myself and someone who represents me in the United States Senate. Given the nature of current political discourse, I felt compelled to use strong language to get my position across. Unfortunately, my comments were fed into the public domain. I am truly sorry that the words I chose hurt the feelings of many of you.
I want to state, without reservation, that I value all the members of our care team and that I have tremendous respect for nurse anesthetists and the important contributions they make to the anesthesia care team. However, I feel very strongly that the level of safety and quality that the team based model of care affords is superior to that proposed by current legislation and that the best level of care should be provided to every patient, particularly our nation's Veterans. My conviction is based in large part on experiences with my two grandfathers, both of whom served in the military and receive medical
care in the VA system. I want my grandfathers to have the best care possible and I believe an anesthesia team benefiting from the unmatched training and education of a physician anesthesiologist is
the best way to deliver that care.
I am proud to stand with my nursing colleagues at UNC in delivering exceptional anesthetic care to our patients. Unfortunately, my passion for this issue and the resultant messaging used a few words which I wish I could take back. I understand how these words could have been interpreted as calling into question the important work that you do each and every day in the care of our patients. I am sorry if you felt devalued. This was not my intent. I think we share the goal of working in an anesthesia team that provides patients the synergistic benefits of the different education and skills
delivered when nurse anesthetists and physician anesthesiologists work together cooperatively.
I can't believe that they have to apologize for what should have been a private message to someone that represents them. The leadership needs to grow a goddamn backbone, nothing she says is untrue.
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deleted171991
She is junior faculty. She finished her residency in 2012, and her fellowship one year later. She is a small fish, and the big sharks don't give a crap about her.
Watch and learn, because this is exactly what happens if you piss against the wind in any anesthesia group, not just an academic one. Free speech is for rich people who don't need a job.
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deleted171991
From http://www.klevinelaw.com/wp-content/uploads/2015/04/6-500-000-SETTLEMENT-IN-ANESTHESIA.pdf
Whenever a CRNA screws up, they can come for the anesthesiologist at least for "failure to supervise".
Visited recently.
SUPER friendly atmosphere. Turns out, a few of the CRNAs are very active politically and advocate for independent practice regularly.
I asked about it but didn't get great answers..
"Wouldn't you do the same if you were in their position?" ..
..I'm curious how these CRNAs haven't been eliminated.
SUPER friendly atmosphere. Turns out, a few of the CRNAs are very active politically and advocate for independent practice regularly.
I asked about it but didn't get great answers..
"Wouldn't you do the same if you were in their position?" ..
..I'm curious how these CRNAs haven't been eliminated.
Elizabeth Ross for president of ASA
I hope Dr Ross realizes her career there is over and she will never make professor. She should print out the letter she wrote along with the back story and use that as a CV for PP groups. Assuming she's competent, I'd vote to hire her just based on that. Even in her "apology letter" she stuck to her guns, I like it.
I have her email address and photo.. Not sure if I should post it here. Pm me for email address so you can write her and tell her how awesome she is. She is cute too.
I don't care if I was junior faculty. There are other jobs and I am sure she would be hired because of, and not in spite of, her opinion. If the chair asked me to write the letter I would have simply walked out and the only letter they would get was my resignation.
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1) The letter could maybe have been worded better.
2) I'd like to know the circumstances of it being made public, and if she has any possibility of legal action. Her current and future career without question will be effected, and she obviously had no desire to make it available to her department head, much less everyone else.
2) I'd like to know the circumstances of it being made public, and if she has any possibility of legal action. Her current and future career without question will be effected, and she obviously had no desire to make it available to her department head, much less everyone else.
This apology and the crushing of this junior attending is a huge victory to the CRNA's propaganda machine.
The worst part is that the ASA president actually sent a letter to all members indirectly referencing this situation, and asking for civility when Lobbying!
He has the audacity to mention civility while the AANA banners are everywhere, calling themselves the future of anesthesia, and openly claiming that physicians are not needed and not necessary!
This is why the ASA is so useless!
The worst part is that the ASA president actually sent a letter to all members indirectly referencing this situation, and asking for civility when Lobbying!
He has the audacity to mention civility while the AANA banners are everywhere, calling themselves the future of anesthesia, and openly claiming that physicians are not needed and not necessary!
This is why the ASA is so useless!
Mine too. Multiple times in the last year. Multiple leaders.
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