Looking for some perspective on all the hate?

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FFP said:
Amazing role. Well-deserved Oscar.

I was actually alluding to his "We are Farmers" ad, in response to your "We are doctors" post. 🙂
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I had to look the guy up. Then coincidentally saw the film last night. Great film in my opinion. A terrifically told story and outstanding performances. Guy was channeling my old drill sergeant. And what jazz--wow!
 
If you liked that movie, don't miss Full Metal Jacket.



Or the first half from Band of Brothers, with David Schwimmer.

 
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Band of Brothers was excellent, the book as well as the movie. (Be forewarned: the movie has one very R-rated moment in the last episode).

It inspired me to start reading about WW2, which led me down a real literary rabbit trail of reading the memoirs of different vets. Seeing the war from that many different perspectives made me start to feel like I'd gotten a little glimpse into what army life was actually like back then - the terror and the boredom, the heroism and the bureaucracy.
 
I didn't know Anesthesiology started out as a nursing profession. So I guess CRNA's are the original providers
 
Brigade4Radiant said:
I didn't know Anesthesiology started out as a nursing profession. So I guess CRNA's are the original providers
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And surgery started out among barbers. So what?

Also, CRNAs were NOT the original independent providers. They did not practice anesthesia independently, but under a surgeon's supervision. And their big deal was administering ether and chloroform.

The original independent providers were physician anesthesiologists.

The history of modern anesthesia over the past 160 years begins with nurses assisting surgeons in the use of ether and then other gases. Anesthetics became increasingly more complex, from approximately the 1920s on. Surgical patients became sicker. Anesthesia outcomes initially worsened. These trends led to specially trained physicians – anesthesiologists – assuming responsibility for providing and directing anesthesia care, as well as performing the increasingly complex medical procedures associated with the perioperative care of surgical patients.

Indisputably, the nature of anesthetic practice as well as of surgery, have changed tremendously in the last two centuries, bringing with them dramatic changes in the necessary body of knowledge and skills. Medical training and medical research have transformed surgery and anesthesia into complex and inseparable medical disciplines. The answer to the first question – has the body of knowledge and skills necessary to care for patients changed – is a clear-cut “yes.”

Nurse anesthetists have continued to administer anesthetic medications and monitor many patients during surgery. Other nurses perform somewhat analogous monitoring tasks in intensive care units and procedure rooms. But a nurse anesthetist’s functions of administering medication on physician order, although it resembles what nurses routinely do, takes place in a very different and far riskier setting than its non-surgical counterpart. Treating it as akin to the bedside administration of medication in a medical-surgical ward, as some do, ignores these substantial differences. Moreover, actually administering medication is only a small part of the necessary functions included within the practice of anesthesia. There should be little doubt that ordering the panoply of medications used in providing anesthesia care and responding to developments arising in surgery lie far outside the normal scope of nursing practice.
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http://www.psanes.org/Home/tabid/37/anid/43/Default.aspx
 
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Mman said:
No, those places exist because of rural pass-through legislation. Basically the federal government will pay 100% of whatever is necessary for that rural hospital to be staffed by CRNAs so they can't lose a penny on it. It doesn't extend to MDs. It's a federal subsidy that encourages the hospital to employ CRNAs instead of MDs. If it was financially equivalent, they'd hire the MD every time. And I've had the discussion with the CEO of several such hospitals that invited us to bid on their anesthesia contracts.

On no planet is the small rural hospital making a decision that they'd rather have a CRNA than an MD, they are simply stuck by the bottom line and they can afford to pay more money to a CRNA than an MD. If/when that legislation changes, their will be a tidal wave of change in rural hospitals anesthesia departments. That's why the AANA spends so much money lobbying against changing it.
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Boom! Dropping the knowledge. So many people do not understand this concept.
 
amyl said:
What qualifies a location as rural and how much subsidy do they get?
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Critical access hospitals.

The key phrase is "Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.".

They don't get a subsidy. They simply send the bill to the government for whatever it costs and the government pays it. They are unable to lose money on CRNA services (amongst other things) so they can afford to pay higher salaries. The fact it covers CRNAs but not MDs would be comical if it wasn't so bad for patients.
 
Mman said:
Critical access hospitals.

The key phrase is "Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.".

They don't get a subsidy. They simply send the bill to the government for whatever it costs and the government pays it. They are unable to lose money on CRNA services (amongst other things) so they can afford to pay higher salaries. The fact it covers CRNAs but not MDs would be comical if it wasn't so bad for patients.
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That is some effed up stuff. Goodness. Thanks for sharing. I was unaware of this.
 
pgg said:
Just think of all the healthcare dollars that could be saved if ERs started referring patients to SuperCuts instead of general surgeons.
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The 'first surgeons' from supercuts charge the patient the same amount as a general surgeon but receive a lot less in salary with the difference going to administrators. Sending patients to supercuts is a terrible deal for patients but ceo's love it. Also, I'm pretty sure Obamacare defines treating surgeons and barbers differently as illegal discrimination.
 
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Late to the game -

My responses

@imfrankie - SHAME ON YOU. Watch it today (at least start). Incredible show. I haven't seen The Pacific, but heard it is good as wel.

@OP -
I personally understand the hatred on both sides. It is easily explained. First of all, most physicians on this board - had they found themselves a nurse, would likely become a CRNA (no brainer). And as a CRNA, we would all fight tooth and nail for our profession....especially if we saw ourselves doing the same thing day in and day out as our MD co-workers and getting paid way less with no evidence of outcome differences. It is easy for us to say that we would all be humble and play nice - but I really doubt that is the case. So that is understandable that CRNA's - with out evidence to the contrary, and with out knowing better (you don't know what you don't know) - would feel slighted. To make it worse, many MD's treat CRNA's very poorly - that just compounds the issue. We as physicians could do a better job understanding this perspective (walk in someone's shoes...all that jazz)

On the other hand, it isn't hard to figure out why physicians are so irked at the CRNA community since they so often claim that their training is the same. That is SOOO offensive. It also lends to CRNA's often speaking about how they are just as capable....again, very offensive. And as has been alluded by many....for some reason, many CRNA's have such incredible egos. I don't get it. I just don't. I have seen it 100 times. I have trained wonderful SRNA's who are a joy to train, to teach, to work with. They are teachable, lovely, humble people....but for some reason, a few years working as a CRNA - the attitude changes drastically - perhaps because of what I wrote above....but for whatever reason, it happens frequently.

Here is a great saying - a smart person learns from their own experience...a WISE person learns from the experience of others. We could all learn from the experience of those many people who have been a CRNA, and then decided to become a physician anesthesiologist. What is so amazing about this...is there isn't a single one (that I am aware of).. that has done both training experiences and claimed that becoming an anesthesiologist was a waste of time...that it didn't really add to what they already knew as a CRNA. THIS is VERY VERY telling.

I personally wish we would stop the debate. I have said this for years. CRNA's need to practice completely indepedent. But I mean COMPLETELY independent. Why debate? Why have this problem? We will make CRNA hosptials, and MD hospitals and make it a law that there can be no mixture. If a CRNA is caught using a textbook that an MD wrote, there would be a fine (how cool would that be if we could actually enforce this!) CRNA's need to come up with their own policies, guidelines, research, etc. (Because to me it seems very hypocritical to claim CRNA's are the same - yet most EVERYTHING CRNA's have learned and all the saftey guidelines and science has come from physician research.) The patients and society can decide who is better. What if it turns out that CRNA's are just as good? So be it - society will make that determination.
 
pgg said:
Just think of all the healthcare dollars that could be saved if ERs started referring patients to SuperCuts instead of general surgeons.
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Just think about the time and money that could be saved on vasectomies alone!!
 
Mman said:
Critical access hospitals.

The key phrase is "Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.".

They don't get a subsidy. They simply send the bill to the government for whatever it costs and the government pays it. They are unable to lose money on CRNA services (amongst other things) so they can afford to pay higher salaries. The fact it covers CRNAs but not MDs would be comical if it wasn't so bad for patients.
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The most messed up part is that it applies to CRNAs but not MDs. What's the ASA's lobbying division doing about this?

Seriously, if this was part of a novel, no one would believe it.
 
This is a never ending debate. The militancy never ceases to amaze me. A CRNA will never be equivalent to an MD no matter how many online DNAP degrees they get.

As an MD that practices in a care team model, but is considering going solo (to take advantage of that model while I can) I can appreciate the success that is achieved when the care team model works. The anesthesiologists I know, for the most part, support a well working, non-militant care team approach, especially with very sick patients. In my anecdotal experience, it is the CRNA that has a giant chip on their shoulder for having to practice within the care team model. The AANA has a true agenda to blur the lines as much as possible, hence "MDA" and SRNAs introducing themselves to patients as "Resident Nurse Anesthetists" and converting all the CRNA programs into "Doctorate" programs, to name only a few.

Forgive my horrible run-on sentence, but I honestly feel that if the CRNAs weren't religiously trying to ingenuously portray themselves as equal to physician Anesthesiologists in skill and training and stop acting as if the concept of an anesthesiologist was superfluous, while actively or passive-aggressively showing constant resistance to medical supervision and or direction...and work together in a true care team model... It could work. That's A LOT to ask and it's evidently not the AANA agenda.

I personally feel like I respect and appreciate the CRNA for their role in the care team, but I rarely feel the same respect. Honestly, I feel that the wedge and constant aggressive attitude comes from the nursing, not medical side of the team. It doesn't have to be that way.

It's a never ending debate, but one thing is for sure, I've never met an anesthesiologist that wants to be, or is okay being called an MDA. I didn't go to MD Anesthesia school. I went to medical school.
 
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DreamLover said:
The AANA has a true agenda to blur the lines as much as possible, hence "MDA" and SRNAs introducing themselves to patients as "Resident Nurse Anesthetists" and converting all the CRNA programs into "Doctorate" programs, to name only a few....

If the CRNAs weren't religiously trying to ingenuously portray themselves as equal to physician Anesthesiologists in skill and training and stop acting as if the concept of an anesthesiologist was superfluous, while actively or passive-aggressively showing constant resistance to medical supervision and or direction...
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As George Orwell said:
Thus political language has to consist largely of euphemism, question-begging, and sheer cloudy vagueness.

The great enemy of clear language is insincerity. When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms, like a cuttlefish spurting out ink.

Political language...is designed to make lies sound truthful...to give an appearance of solidity to pure wind.
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Spinach Dip said:
The most messed up part is that it applies to CRNAs but not MDs. What's the ASA's lobbying division doing about this?

Seriously, if this was part of a novel, no one would believe it.
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they lobby against it. But guess what, there are a lot more nurses than doctors in this country so they have more votes than we do.
 
Mman said:
they lobby against it. But guess what, there are a lot more nurses than doctors in this country so they have more votes than we do.
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This is one of our major problems. We are too busy going to school and completing residency and working in our jobs to have time to devote to defending our position. And while we were busy sacrificing our 20s and 30s for our careers and our patients, nursing lobbying groups have been successful in convincing congress that we are not necessary, with their biased "data" and clearly militant agenda. Our devotion and extreme work ethic dedicated to patient care Vs politics have made us our own worst enemies.
 
DreamLover said:
This is one of our major problems. We are too busy going to school and completing residency and working in our jobs to have time to devote to defending our position. And while we were busy sacrificing our 20s and 30s for our careers and our patients, nursing lobbying groups have been successful in convincing congress that we are not necessary, with their biased "data" and clearly militant agenda. Our devotion and extreme work ethic dedicated to patient care Vs politics have made us our own worst enemies.
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Just the other day I was working with a CRNA/SRNA combo, the patient needed a supraclavicular block for arm surgery so I get it all set up, do the block, and for the very last 5ccs I let the SRNA hold the needle and I injected while I held the ultrasound probe. The next week, I worked with the same SRNA, she is very enthusiastic about doing blocks and follow me to do another SC block, I said, so how many of these have you done? She said "I have done 3 so far and I'm getting pretty much completely independent, thanks for showing me how to do it the other day that was really helpful" Im not even confident this person can put on sterile gloves...
 
Spinach Dip said:
The most messed up part is that it applies to CRNAs but not MDs. What's the ASA's lobbying division doing about this?

Seriously, if this was part of a novel, no one would believe it.
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Go to the ASA Legislative Conference, meet with your congressman personally, and TELL THEM ABOUT IT. It's a key talking point every year.
 
Carbocation1 said:
Possible bad press for the specialty: http://q13fox.com/2015/03/12/portland-woman-reports-being-raped-under-anesthesia/
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If this is true, it's a tragedy, but I don't see how this fits the topic of this thread, whatsoever.

And to avoid unnecessary controversy, nowhere does this article even talk about an anesthesia provider assaulting the patient. It doesn't even delineate whether the pt had an anesthesia provider or received "conscious sedation" by the endoscopist.

Honestly, I've heard of this happening in a dental office setting, due to the autonomy of the dentist and provision of their own sedation. But having been involved with hundreds of colonoscopies, there are usually an endoscopist, an anesthesia provider and a nurse or assistant there to process biopsies etc--> then pt goes to an ambulatory recovery area...full of people. The logistics of such an atrocity seem far fetched...but never say never.
 
epidural man said:
by the way - no way that patient was violated. A patient gets raped and the nurse, GI doc, assistant - stood by and watched? And now are not saying anything? Oh brother-

More like the GI doc couldn't find the right hole for a while with his scope.
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That was my first thought as well. Have seen it happen. As was stated, too many people involved for no one to notice. At my place, never fewer than 4 people in the room and frequently 5-6 people. If an inexperienced GI fellow was involved, I would put this very high on the list of probable reasons. Just like I have seen inexperienced nursing students (and sometimes experienced nurses) put a foley in the vagina, this can happen fairly easily, especially if the patient has a large body habitus.
 
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This sums up the frustration. There's no way equivalence between the 2 fields can even be considered. A CRNA is not even 1/10 what an anesthesiologist is.
 
kzjb333 said:
View attachment 190252View attachment 190253

This sums up the frustration. There's no way equivalence between the 2 fields can even be considered. A CRNA is not even 1/10 what an anesthesiologist is.
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They really should have kept the units of measure consistent - comparing 450-550 cases to 12,000-16,000 hours doesn't make much sense [then again, maybe the marketing tool was the larger number].
 
amandaeleven said:
They really should have kept the units of measure consistent - comparing 450-550 cases to 12,000-16,000 hours doesn't make much sense [then again, maybe the marketing tool was the larger number].
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Intern year should be included and ICU should be included. And pain. Preanesthesia clinic. On and on and on...
 
FFP said:
MDA is a term invented by the AANA, so that it sounds like CRNA to the general public. It's about as offensive as the n word.
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Rapidresponsenurse as you can already see the bickering is petty and trite. I've been a nurse anesthetist for 26 years. I've heard this same bull**** for at least 25 years. The MDA crap is just one example of how petty this entire fight has become. I've worked with some wonderful anesthesiologists over the years. I've also worked with some that could not find their ass with both hands. The turf battle is only about money. These guys will not admit it. The most important advances in the practice were in pharmacology and technology. Anesthesiologists had nothing to do with either. None of what we do is new. Pulse oximetry had been used for years by fighter pilots before it was used in anesthesia. The advances in pharmacology were economically driven by big pharmaceutical companies. I've worked with anesthesia residents from the world renown Duke University Medical Center. Anesthesiology has the dubious honor of perpetrating some of medicines most notorious ethics violations in research. This must make you think that I dislike anesthesiologists. Nothing could be further from the truth, but what you are reading on this site is not all that representative of actual practice. The posts on here are filled vitriolic professional attacks. Go read about the case recently discussed involving a GI patient undergoing a colonoscopy. This is fodor for the immature and weak minded. This could have just easily have been on of them. They revel in a patient's demise without possessing any of the facts. They see it as a public relations opportunity. Read about the horrific murder of Ms Joan Rivers'. I am sorry, but the outright medical blunders perpetrated on Ms Rivers during her endoscopy are just as heinous as the scenario dreamed up by these weak minded anesthesiologists. These guys often preach about the great disparity in education in training then resort to fighting over regional blocks or intraoperative TEE as tools not possessed by most CRNAS. The fact is that these are nothing but technical skills that any idiot can learn and master. I urge you to go to anesthesia school. It is a wonderful career. Ignore the propaganda spewed by the physician bashing CRNAs and the money grubbing lazy ass anesthesiologists. Go to work do your best, and figure out the truth for yourself. If CRNAs were such poor care givers would we have survived over a 100 years in the profession. It is all about money.
 
Well there you have it OP. We are a bunch of money grubbing lazy, ass anesthesiologists who only care about money. Please go to anesthesia school and become a CRNA. They couldn't possibly care about making money. I mean, they were making 150K plus doing bedside nursing, critically thinking and carrying orders on sick ass patients right? Their motivation for going back to school had absolutely nothing to do with money. I am sure they would have gone back even if in the end they made 70K per year since they care so much about the patients and all we care about is the money.
 
ANRCMAN said:
The turf battle is only about money. It is all about money.
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Nice to see you admit that AANA only cares about money when they advocate for independent care. They don't give 1 **** about patients and patient safety. It's all about the benjamins for them.

I do find it convenient, however, that they don't admit this. Most of their argument centers on how much cheaper CRNAs are (which they make in a fallacious manner) and they don't mention how they want those same CRNAs to get paid a lot more to do what they are asking for.


Seems a bit disingenuous, no?
 
You see that phrase thrown about on the nurse anesthesia forums a lot: "it's all about the money." Yet somehow they are immune to it; apparently they don't realize the key word in that phrase is "ALL."
 
amandaeleven said:
They really should have kept the units of measure consistent - comparing 450-550 cases to 12,000-16,000 hours doesn't make much sense [then again, maybe the marketing tool was the larger number].
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But, some simple math will show you that even if those cases AVERAGED 10 hours each, thats only 5,500 still less than half of 12,000.
 
ANRCMAN said:
This is fodor for the immature and weak minded.
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Did you mean "fodder"? Ah... details, details, details. I guess when you have a "college education" that is actually a "BSN" they must not require coursework in English. Details matter. Even the little ones. Amazing how many times I've seen a CRNA miss those little details. Eventually they catch up to you.
 
A lot of good information here.

I had a question. I saw an anesthesiologist post that if they had a trauma case and ended up calling another anesthesiologist for help, the second anesthesiologist is not liable for the patient (unless there is malpractice).

As a resident or Anesthesiologist, is there any way for me to protect myself if a CRNA working on their own case calls me for help? I am open to stepping in and helping for the patients best interest, but I don't want to take responsibility for a CRNA's patient.
 
BW15 said:
A lot of good information here.

I had a question. I saw an anesthesiologist post that if they had a trauma case and ended up calling another anesthesiologist for help, the second anesthesiologist is not liable for the patient (unless there is malpractice).

As a resident or Anesthesiologist, is there any way for me to protect myself if a CRNA working on their own case calls me for help? I am open to stepping in and helping for the patients best interest, but I don't want to take responsibility for a CRNA's patient.
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Don't ignore the fact that your mere presence in any of these situations is a guarantee that you will be named as a defendant in a lawsuit, even if dropped later. (And that will do just wonders for your career.) Why? So they can depose you.
 
BW15 said:
As a resident or Anesthesiologist, is there any way for me to protect myself if a CRNA working on their own case calls me for help? I am open to stepping in and helping for the patients best interest, but I don't want to take responsibility for a CRNA's patient.
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Don't work at a place that has you supervise CRNAs. All MD or completely side by side is what you want.
Though I suspect the "fireman" model will spread with one MD covering many CRNAs that are functioning (almost) independently. That will be the worst arrangement as they will structure the system to share responsibility with the MD.
 
IIDestriero, I think he/she means, even if they CRNA's worked side by side and a CRNA had a crashing patient and the anesthesiologist was free and went in to help, would he be held liable if **** continued to go wrong and patient didn't do well? Kinda like where one goes in to help a fellow anesthesiologist.
I think the lawyers are gonna go for the deeper pockets quite frankly and that would be the MD/DO.
 
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