Message From ASA President

[Hypnos Doc]

This forum is becoming a disgrace to the professionalism of our specialty. I personally do not condone or support slurs, epithets, threats or any type of soporific diatribe ascribed to our next generation of physicians. This site is a public forum that can be accessed or hacked by anyone outside of anesthesiology and should not be regarded as a backroom discussion opportunity to test ill-conceived ideas or make shock value declarations.

Did it ever occur to you that others opposed to your views can disguise themselves as militants to incite comments that can ultimately be used against the very ideas being germinated? It's a very effective form of counter-espionage.

ASA in no way supports or encourages topics that are designed to intentionally hurt others or to suggest actions that are in violation of federal laws.

Outrageous statements designed to hurt or denigrate those within or outside our specialty written under a pseudonym are frankly cowardly.

Discussions and debates are part of our culture and should be encouraged, but some of the stuff discussed here is absolutely mindless.

Please clean it up for all of our benefits. Stop the mob mentality. Educated, well-articulated concerns can be a force for change but not if the site is regarded a bogus.


Sincerely,
Mark J. Lema M.D., Ph.D.
(I do not routinely access this site so there is no need to reply)

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[toughlife]

I agree with your response and I am guilty of such behavior. I think it is important to continue this debate in a civilized manner and I encourage all of us that frequent this forum to join the private forum where ideas may be exchanged without fear of repraisal.

It will also help to avoid the many confrontations that have taken place when participants other than medical students, residents or attendings post inflammatory messages.

Remember you need an ASA membership and we need to be able to verity your identity.

 

[BLADEMDA]

I agree with your response and I am guilty of such behavior. I think it is important to continue this debate in a civilized manner and I encourage all of us that frequent this forum to join the private forum where ideas may be exchanged without fear of repraisal.

It will also help to avoid the many confrontations that have taken place when participants other than medical students, residents or attendings post inflammatory messages.

Remember you need an ASA membership and we need to be able to verity your identity.

What about Lema's opinion of the AANA? The DNAP issue? The militant AANA's desire for 100% Independence? I don't see the President of the AANA issuing a statement about the value/role of MD Supervision in any clinical situation.

We are in a war friends. Wake up and act before it's too late.

Join the Private Forum- Blade

 

[Taurus]

I believe in keeping it professional. I think my responses have been so.

With that said, I hope that the ASA is working hard to counteract the AANA surge. Years from now, I don't want to be looking back and thinking that they were all up in an ivory tower while they allowed their profession to decline.

 

[BLADEMDA]

I believe in keeping it professional. I think my responses have been so.

With that said, I hope that the ASA is working hard to counteract the AANA surge. Years from now, I don't want to be looking back and thinking that they were all up in an ivory tower while they allowed their profession to decline.

Now, I want you to review the FACTS:

1. Many Academic based Anesthesiology Programs have CRNA schools as well. The number of CRNA schools/slots has continued to increase over the past few years.

2. The ASA officially supports the AAAA yet there are only 4/5 AA schools in existence.

3. The ASA helps fight for the licensure of AA's in States like North Carolina (Florida before that)

The problem is that Number One far outpaces number 2. More CRNA schools/slots have been started with the support of Academic Chairs than NEW AA programs. Yet, the AANA has not issued any new statements about the value of MD Anesthesiology in the past few years. In fact, the AANA has embraced the DNAP degree and has NO plans of backing off 100% Independence for its membership.

Sorry, if anyone has been "unprofessional" in this battle it is the ASA and the Academic Chairs.

Blade

 

[Taurus]

Now, I want you to review the FACTS:

1. Many Academic based Anesthesiology Programs have CRNA schools as well. The number of CRNA schools/slots has continued to increase over the past few years.

2. The ASA officially supports the AAAA yet there are only 4/5 AA schools in existence.

3. The ASA helps fight for the licensure of AA's in States like North Carolina (Florida before that)

The problem is that Number One far outpaces number 2. More CRNA schools/slots have been started with the support of Academic Chairs than NEW AA programs. Yet, the AANA has not issued any new statements about the value of MD Anesthesiology in the past few years. In fact, the AANA has embraced the DNAP degree and has NO plans of backing off 100% Independence for its membership.

Sorry, if anyone has been "unprofessional" in this battle it is the ASA and the Academic Chairs.

Blade

That is why I'm somewhat skeptical of the ASA. They have an inherent conflict of interest. They don't want to rock the boat too much because a large group of stakeholders (academic chairs) are happy with the current resident/CRNA situation.

Does the ASA really represent the long-term interests of the private practice anesthesiologist? Is it possible for them to do so given their conflict of interest? Even if they do support us, they move sooo slowly. The AANA is running circles around them. If we fall in line with the ASA, we may be dooming the profession as we know it.

 

[BLADEMDA]

That is why I'm somewhat skeptical of the ASA. They have an inherent conflict of interest. They don't want to rock the boat too much because a large group of stakeholders (academic chairs) are happy with the current resident/CRNA situation.

Does the ASA really represent the long-term interests of the private practice anesthesiologist? Is it possible for them to do so given their conflict of interest? Even if they do support us, they move sooo slowly. The AANA is running circles around them. If we fall in line with the ASA, we may be dooming the profession as we know it.

No "may" in that last sentence.

Blade

 

[BLADEMDA]

That is why I'm somewhat skeptical of the ASA. They have an inherent conflict of interest. They don't want to rock the boat too much because a large group of stakeholders (academic chairs) are happy with the current resident/CRNA situation.

Does the ASA really represent the long-term interests of the private practice anesthesiologist? Is it possible for them to do so given their conflict of interest? Even if they do support us, they move sooo slowly. The AANA is running circles around them. If we fall in line with the ASA, we may be dooming the profession as we know it.

First,

Most of us work well with CRNA's. The average CRNA is easy to get along with and works well in the ACT model. The average CRNA doesn't hate AA's or seek conflict with anyone.

Then there is the AANA. Look at North Carolina and the battle over AA licensure. Which organization was unprofessional in bribing legislators?
Which organization lies about the qualifications of its membership and seeks 100% Independent practice rights for its membership of NURSES?
Which organization blocked the Medicare Teaching bill recently even though Academic centers are very CRNA friendly? Which organization wants to destroy the AA profession and tells BLATANT lies about AA qualifications UNDER OATH?

Sorry, but Lema has come to the wrong site. He must have meant to post on www.allnurses.com

Blade

 

[swpm]

Dr. Lema,

I'm a resident, and I haven't joined the ASA. So long as the organization you head does nothing to respond to the continuing AANA push for a widened scope of independent practice for CRNAs, I don't see any reason to join.

The ASA web site claims that "The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient."

How exactly, has the ASA raised or maintained the standard of care within our field by allowing nurses to get so close to independent practice?

Nero fiddled while Rome burned, but at least he got something done.

 

[SexPanther]

When Dr. Lema referred to violation of federal laws, does anybody have any idea what he was talking about?

I certainly agree that we need to keep it professional while we discuss the relevant issues to our specialty.

 

[poster]

To whom it may concern, I am the President of the United States and I approve of this message.

Pleeease, someone that important getting on a student forum to proclaim the unprofessionlism is unprofessional itself. DONT BELIEVE EVERYTHING YOU READ!

 

[BLADEMDA]

To whom it may concern, I am the President of the United States and I approve of this message.

Pleeease, someone that important getting on a student forum to proclaim the unprofessionlism is unprofessional itself. DONT BELIEVE EVERYTHING YOU READ!

While I agree not everything you read is true the poster claiming to be Lema does sound like him and fits his viewpoint.

Blade

 

[Taurus]

We should have checked his ASA # at the door.

 

[deleted9493]

To whom it may concern, I am the President of the United States and I approve of this message.

Pleeease, someone that important getting on a student forum to proclaim the unprofessionlism is unprofessional itself. DONT BELIEVE EVERYTHING YOU READ!

Can you not make the inference that whoever posted this is very highly educated? Can you give a motive for one such person posting on a site like this if he were anything but genuine? No, you cannot.


True, you can often sound smart by telling people to be skeptical concerning what their eyes see, but in this instance you've painted yourself to be very much the opposite.

 

[toughlife]

Just take everything with a grain of salt. It is obvious some of the ASA higher ups feel a certain way but others may not. We need leaders who listen to their constituents and do what the majority wants.

The mission of the ASA needs to be to protect the specialty of anesthesiology and aggressively deter any organization from encroaching into a field that has been advanced and developed by physicians.

I am afraid being meek and candid when faced with an organization like the AANA whose mission is to do away with an entire field of medicine and turning it into nursing for their own gain, is not going to work. I agree with etherMD when he stated that shutting down 10% of CRNA schools and replacing them with AA schools would send a loud and powerful message to the AANA that the ASA means business.

 

[poster]

Can you not make the inference that whoever posted this is very highly educated? Can you give a motive for one such person posting on a site like this if he were anything but genuine? No, you cannot.


True, you can often sound smart by telling people to be skeptical concerning what their eyes see, but in this instance you've painted yourself to be very much the opposite.

So you are telling me that a CRNA who wanted to stop a grass roots effort to stop the AANA would never do something like say they were the ASA president and wanted everyone to stop these actions now and continue the business as usual way of doing things.

 

[swpm]

While I agree not everything you read is true the poster claiming to be Lema does sound like him and fits his viewpoint.

Blade

I too think it's him. He's posted once before and we had no reason to doubt him then.

 

[BLADEMDA]

When Dr. Lema referred to violation of federal laws, does anybody have any idea what he was talking about?

I certainly agree that we need to keep it professional while we discuss the relevant issues to our specialty.

I have no idea what Federal law is being broken. Let me clear my posts up right now. There is NO PHYSICAL WAR with the AANA; the war is Political and pertains to Independent CRNA practice.

No individual CRNA is being targeted for anything. There is no threat of violence or physical harm. All my posts are METAPHORS and are not meant to be taken literally (Volatile definitely agrees with this ).

If the AANA wins the "war" for independence and we are no longer needed then Volatile can remember to always and I mean always substitute a salad for the large fries.

Blade

 

[CremeSickle]

Oh hello again EtherMD. I heard you were banned and had a new name! Didnt take long to guess who it was.....

 

[YupGypsy]

instead of a lecture on etiquette, why not discuss what the ASA game plan is

 

[mille125]

instead of a lecture on etiquette, why not discuss what the ASA game plan is

It is obvious that someone has complained (explaining Lema's presence). My money is that it came from someone in the CRNA/SRNA community. However, I must say that if you look through the hundreds of topics, there are certain themes and questions that many of us have. Some responses are more passionate than others. To my knowledge there have been no direct or indirect threats to any individual or group(so lets quiet that noise). I think that the following questions/statements sum up all of our frustrations


1) Why do the ASA continue the strategy of appeasement? This has obviously been the strategy for many, many years. Take a look where it has landed us. You cannot appease an aggressive foe no matter how good spirited you intentions are (just ask Neville Chamberlain).

2) Why do our academic departments continue to open more SRNA programs instead of focusing on AA programs? What is more not done to make AA practice available in all fifty states?

 

[Taurus]

It is obvious that someone has complained (explaining Lema's presence). My money is that it came from someone in the CRNA/SRNA community. However, I must say that if you look through the hundreds of topics, there are certain themes and questions that many of us have. Some responses are more passionate than others. To my knowledge there have been no direct or indirect threats to any individual or group(so lets quiet that noise). I think that the following questions/statements sum up all of our frustrations


1) Why do the ASA continue the strategy of appeasement? This has obviously been the strategy for many, many years. Take a look where it has landed us. You cannot appease an aggressive foe no matter how good spirited you intentions are (just ask Neville Chamberlain).

2) Why do our academic departments continue to open more SRNA programs instead of focusing on AA programs? What is more not done to make AA practice available in all fifty states?

Agreed. This sounds like typical CRNA modus operandi. They can't win the arguments with us, so instead they try to shut us up.

I think our discussions are waking up a lot of current and future anesthesiologists eyes and this makes the CRNA's nervous. They prefer us to be so busy and apathetic so that they can surprise us from behind.

*clangs pots and pans* C'mon people. We need to wake up the entire neighborhood!!

 

[poster]

Agreed! We need to make more waves not less in order to succeed. The being professional route has not worked till now. So as they say the definition of insanity is doing the same thing over and over and expecting a different result.

 

[Jeff05]

this is From the AANA site - in the section "For Patients"

Who administers anesthesia?
In the majority of cases, anesthesia is administered by a Certified Registered Nurse Anesthetist (CRNA).

CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist (physician anesthetist). CRNAs are advanced practice nurses with specialized graduate-level education in anesthesiology.

For more than 100 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered.

it does not state that the majority of those anesthetics are supervised by MDs.

dr. lema, in your ASA lecture you posed, and i quote “CRNA practice is here to stay. And the trend is toward independent practice …” I've read the ASA website front to back and it's a bit scary that there is not one paragraph that assuages my concerns. Something concrete that lets me know the ASA will do something to prevent this trend (the DNP seminar at the upcoming AANA meeting is disheartening. the upper extremity block workshop is truly alarming - why are CRNA's learning to do regional?!!?!?)

I love anesthesiology. I like being in the OR. I like the range of doing ASA1-ASA6 cases. I don't like the future vision of the "perioperative" physician. I don't want to round on the patients the night before surgery and make sure that the nurses draw the preop labs. I don't want to round on the patients after surgery. I DON'T WANT TO WORK IN THE ICU. There is a reason i chose not to be a hospitalist or an intensivist.

I have nothing personal against CRNAs. I think they are intelligent and capable individuals. But, they are directly competing for my future job. Their push towards independent practice will directly effect my marketability, my scope of practice, and my salary. So, I'm concerned. How will I ever compete with a Dr. Smith DNP, CRNA, DNP, MS who will work for half my salary and claims equivalent outcomes.

 

[BLADEMDA]

this is From the AANA site - in the section "For Patients"

Who administers anesthesia?
In the majority of cases, anesthesia is administered by a Certified Registered Nurse Anesthetist (CRNA).

CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist (physician anesthetist). CRNAs are advanced practice nurses with specialized graduate-level education in anesthesiology.

For more than 100 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered.

it does not state that the majority of those anesthetics are supervised by MDs.

dr. lema, in your ASA lecture you posed, and i quote “CRNA practice is here to stay. And the trend is toward independent practice …” I've read the ASA website front to back and it's a bit scary that there is not one paragraph that assuages my concerns. Something concrete that lets me know the ASA will do something to prevent this trend (the DNP seminar at the upcoming AANA meeting is disheartening. the upper extremity block workshop is truly alarming - why are CRNA's learning to do regional?!!?!?)

I love anesthesiology. I like being in the OR. I like the range of doing ASA1-ASA6 cases. I don't like the future vision of the "perioperative" physician. I don't want to round on the patients the night before surgery and make sure that the nurses draw the preop labs. I don't want to round on the patients after surgery. I DON'T WANT TO WORK IN THE ICU. There is a reason i chose not to be a hospitalist or an intensivist.

I have nothing personal against CRNAs. I think they are intelligent and capable individuals. But, they are directly competing for my future job. Their push towards independent practice will directly effect my marketability, my scope of practice, and my salary. So, I'm concerned. How will I ever compete with a Dr. Smith DNP, CRNA, DNP, MS who will work for half my salary and claims equivalent outcomes.

My message in a nutshell.


Blade- Welcome to the fight

 

[SleepIsGood]

this is From the AANA site - in the section "For Patients"

Who administers anesthesia?
In the majority of cases, anesthesia is administered by a Certified Registered Nurse Anesthetist (CRNA).

CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist (physician anesthetist). CRNAs are advanced practice nurses with specialized graduate-level education in anesthesiology.

For more than 100 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered.

it does not state that the majority of those anesthetics are supervised by MDs.

dr. lema, in your ASA lecture you posed, and i quote "CRNA practice is here to stay. And the trend is toward independent practice …" I've read the ASA website front to back and it's a bit scary that there is not one paragraph that assuages my concerns. Something concrete that lets me know the ASA will do something to prevent this trend (the DNP seminar at the upcoming AANA meeting is disheartening. the upper extremity block workshop is truly alarming - why are CRNA's learning to do regional?!!?!?)

I love anesthesiology. I like being in the OR. I like the range of doing ASA1-ASA6 cases. I don't like the future vision of the "perioperative" physician. I don't want to round on the patients the night before surgery and make sure that the nurses draw the preop labs. I don't want to round on the patients after surgery. I DON'T WANT TO WORK IN THE ICU. There is a reason i chose not to be a hospitalist or an intensivist.

I have nothing personal against CRNAs. I think they are intelligent and capable individuals. But, they are directly competing for my future job. Their push towards independent practice will directly effect my marketability, my scope of practice, and my salary. So, I'm concerned. How will I ever compete with a Dr. Smith DNP, CRNA, DNP, MS who will work for half my salary and claims equivalent outcomes.

That sums up everything. I disagree with those in our profession that say we should embrace CCM and those of us that do not are just being 'lazy'. As Jeff05 pointed out many of us chose to go into anesthesiology for certain reasons. We like variety, we like the OR, we like the brief but very meaningful interactions with patients, we like being the patients advocate right before surgery, we like being the consoler, etc.

CCM etc should be an option, not something we are FORCED into because we are kicked out of the OR.

Also as many have noted. There will be hospitals, pulmonologists, surgeons, pretty much EVERYONE MD in the hospital that will be competing for ICU work. Why not maintain our turf and expand laterally.

 

[rmh149]

- why are CRNA's learning to do regional?!!?!?)

Non-hostile CRNA here.....so dont think I am attacking. I am just educating.

As far as regional anesthesia......why not Jeff? Its not that difficult. Most of anesthesia I provide is regional. In fact, I do my best (without talking into) to convince my patients that regional is the way to go. I'm curious to why you question CRNA's running a workshop in upper extremety regional anesthesia.

Please keep in mind....not trying to start a fight here. Just providing input from a CRNA in a non-hostile way.

 

[The_Sensei]

Non-hostile CRNA here.....so dont think I am attacking. I am just educating.

As far as regional anesthesia......why not Jeff? Its not that difficult. Most of anesthesia I provide is regional. In fact, I do my best (without talking into) to convince my patients that regional is the way to go. I'm curious to why you question CRNA's running a workshop in upper extremety regional anesthesia.
.

Well let me think.......oh yeah, IT'S BECAUSE YOU'RE A NURSE!

 

[CremeSickle]

Ahh

exactly the unprofessional diatribe that Dr Lema is disowning us for. Nice way to prove his point Sensei.

Ive heard Dr Lema speak, have you?

 

[Jeff05]

i think that CRNAs can absolutely be trained to do EVERYTHING that MDs can do. like i said you are intelligent and capable. i think that a surgery PAs can be trained to do hernias, appys, choles, etc CRNAs are actively expanding the scope of their already lucrative and successful practice onto the turf of MDs. i find that professionally threatening, that is all.

 

[CremeSickle]

Perfectly and professionally said.

Thats EXACTLY the issue.

Thanks Jeff.

i think that CRNAs can absolutely be trained to do EVERYTHING that MDs can do. like i said you are intelligent and capable. i think that a surgery PAs can be trained to do hernias, appys, choles, etc CRNAs are actively expanding the scope of their already lucrative and successful practice onto the turf of MDs. i find that professionally threatening, that is all.

 

[BLADEMDA]

Perfectly and professionally said.

Thats EXACTLY the issue.

Thanks Jeff.

Okay,

Now that you have stated the problem in a politically correct fashion what are you going to do about it?

The current strategy (if there is one) is a failure. Hope you will join the private forum.

Blade

 

[JaLoMoWe]

There are other ways.

Think.

Politics may be important, but may be inefficient.

I've arrived.

A new enigma.

JLMW

 

[CremeSickle]

Sorry EtherMD

I would not risk myself by giving my real name to anyone on this site. That may well be professional suicide since i do not subscribe to the unprofessional acumen I've seen amongst your most vocal disciples. Not following the "hate CRNAs" mantra leads to one being called a CRNA and insulted at every turn.

Secondly, its clear that the ASA does not approve so why do it?

I am not a militant DO. If anesthesiology is trending away from OR (or less hands on) then I will as well. Medicine is a constantly changing enigma and one has to be flexible and change with it. There was a time when RNs were not allowed to start IVs, give certain meds or do certain procedures and now thats changed. Then, there were people like you who fought these changes and have been left behind because of their hubris.

Instead of research to show any differences, people like you take on terrorist-like propaganda tactics. Your quick to say "The AANA does it". Well, maybe they do but does that mean that we should? I think not. Your quick to tout pt safety, yet you have no proof for it. Quick to suggest that these CRNAs are going to kill pts (fear tatics) yet have nothing to backup your claim but your admonition that they are just "nurses" and we are mighty "Doctors". Historically, this tactic is a losing one.

Your big push is AAs and PR. Neither of which addresses the future defining issues facing anesthesiology, reimbursement & practice expansion. AAs = another person doing your job. Might not want independence now but its just ignorance of history to believe it wont happen in the future (look at the political pushes PAs have begun over the past 5 yrs). Why use resources creating another potential adversary? Its senseless. Money and resources should be spent on developing and expanding anesthesiology practice OUTSIDE the OR since even I (a mere resident) can see thats where the specialty is certainly heading.

Based on the AANAs OWN STATS they have less than 10% of their members practicing independently (in RURAL areas) and you think thats the big threat right now to anesthesiology? Come now, you cannot be that ignorant.

As opposed to yours, i think ill follow Dr Lemas lead, donate to the ASA-PAC and attend my local chapter meetings.

Okay,

Now that you have stated the problem in a politically correct fashion what are you going to do about it?

The current strategy (if there is one) is a failure. Hope you will join the private forum.

Blade

 

[Taurus]

Based on the AANAs OWN STATS they have less than 10% of their members practicing independently (in RURAL areas) and you think thats the big threat right now to anesthesiology? Come now, you cannot be that ignorant.

10% is just the beginning. Do you think that number won't rise in the coming years? 10% represents the aggressive, risk-takers. As it becomes more widely accepted and seen as less risky, more and more will go independent. Do you think that CRNA's prefer to practice in RURAL areas only? You don't think that they will want to live and practice in the same neighborhood as you? Come on, how naive can you be?

 

[mille125]

Non-hostile CRNA here.....so dont think I am attacking. I am just educating.

As far as regional anesthesia......why not Jeff? Its not that difficult. Most of anesthesia I provide is regional. In fact, I do my best (without talking into) to convince my patients that regional is the way to go. I'm curious to why you question CRNA's running a workshop in upper extremety regional anesthesia.

Please keep in mind....not trying to start a fight here. Just providing input from a CRNA in a non-hostile way.

i delivered fifteen babies and did scores of colonoscopies in my internship. Can I do these things? Absolutely....Should I do them? Absolutely not. What we can and should do are two different things. I have decided not to respond to CRNA's on this forum anymore (it is a waste of breath). If we all adopt this philosophy, they will leave and go back to CRNA land.

 

[BLADEMDA]

First,

Stop refering to me as EtherMD. My handle is Blade and you should show me the same respect as the CRNA posters on this site.

Second, I do not hate CRNA's and resent that statement. I simply wish that we, as a Group, would respond in a political fashion to the AANA threat to our specialty. You fail to see that threat or fully grasp its implications. I respect your decision to follow the established leadership and ignore the problem. That is your choice.

However, to call others like myself "terrorists" for wanting to mount a P.R. campaign and increase the political pressure against Independent CRNA practice is uncalled for and very unprofessional.

Your beloved AANA is a deceptive organization. On the private forum I prove that beyond beyond a reasonable doubt. The ASA has historically taken the
"high road" when dealing with the AANA and the CRNA's desire for Independent practice. But, politics and fighting for one's survival sometimes require a bit more substance and action than those like you are willing to do.
Fine. You can choose to change roads and do something else. Others may want to join the battle for the preservation of the specialty.

I hope you enjoy calling every CRNA "colleague" in ten years because this is where our current road leads. Some Physician Anesthesiologists out there think there is still time to mount an effective "counter-attack" against the AANA. I urge them to join us.

Blade

 

[rmh149]

i delivered fifteen babies and did scores of colonoscopies in my internship. Can I do these things? Absolutely....Should I do them? Absolutely not. What we can and should do are two different things. I have decided not to respond to CRNA's on this forum anymore (it is a waste of breath). If we all adopt this philosophy, they will leave and go back to CRNA land.

Mille, the difference here is colonoscopies and delivering babies has nothing to do with anesthesia. Upper extremety blocks is a form of anesthesia. So yes, a CRNA peforming regional anesthesia is within their scope of practice. My question to you is why a CRNA should not perform regional anesthesia?

 

[SleepIsGood]

FYI

When you enter the private forum and give one of the mods your personal info, it can not be shared with anyone. It's kept COMPLETELY confidential per SDN guidelines.

Sorry EtherMD

I would not risk myself by giving my real name to anyone on this site. That may well be professional suicide since i do not subscribe to the unprofessional acumen I've seen amongst your most vocal disciples. Not following the "hate CRNAs" mantra leads to one being called a CRNA and insulted at every turn.

Secondly, its clear that the ASA does not approve so why do it?

I am not a militant DO. If anesthesiology is trending away from OR (or less hands on) then I will as well. Medicine is a constantly changing enigma and one has to be flexible and change with it. There was a time when RNs were not allowed to start IVs, give certain meds or do certain procedures and now thats changed. Then, there were people like you who fought these changes and have been left behind because of their hubris.

Instead of research to show any differences, people like you take on terrorist-like propaganda tactics. Your quick to say "The AANA does it". Well, maybe they do but does that mean that we should? I think not. Your quick to tout pt safety, yet you have no proof for it. Quick to suggest that these CRNAs are going to kill pts (fear tatics) yet have nothing to backup your claim but your admonition that they are just "nurses" and we are mighty "Doctors". Historically, this tactic is a losing one.

Your big push is AAs and PR. Neither of which addresses the future defining issues facing anesthesiology, reimbursement & practice expansion. AAs = another person doing your job. Might not want independence now but its just ignorance of history to believe it wont happen in the future (look at the political pushes PAs have begun over the past 5 yrs). Why use resources creating another potential adversary? Its senseless. Money and resources should be spent on developing and expanding anesthesiology practice OUTSIDE the OR since even I (a mere resident) can see thats where the specialty is certainly heading.

Based on the AANAs OWN STATS they have less than 10% of their members practicing independently (in RURAL areas) and you think thats the big threat right now to anesthesiology? Come now, you cannot be that ignorant.

As opposed to yours, i think ill follow Dr Lemas lead, donate to the ASA-PAC and attend my local chapter meetings.

 

[CremeSickle]

Hi Sleep.

No offense intended, but an internet forum guidelines are hardly reassuring or secure. Just too dangerous to me but thanks.

 

[SleepIsGood]

Hi Sleep.

No offense intended, but an internet forum guidelines are hardly reassuring or secure. Just too dangerous to me but thanks.

No problems.

Hey not everyone's cup of java.

 

[poster]

Sorry EtherMD

I would not risk myself by giving my real name to anyone on this site. That may well be professional suicide since i do not subscribe to the unprofessional acumen I've seen amongst your most vocal disciples. Not following the "hate CRNAs" mantra leads to one being called a CRNA and insulted at every turn.

Secondly, its clear that the ASA does not approve so why do it?

I am not a militant DO. If anesthesiology is trending away from OR (or less hands on) then I will as well. Medicine is a constantly changing enigma and one has to be flexible and change with it. There was a time when RNs were not allowed to start IVs, give certain meds or do certain procedures and now thats changed. Then, there were people like you who fought these changes and have been left behind because of their hubris.

Instead of research to show any differences, people like you take on terrorist-like propaganda tactics. Your quick to say "The AANA does it". Well, maybe they do but does that mean that we should? I think not. Your quick to tout pt safety, yet you have no proof for it. Quick to suggest that these CRNAs are going to kill pts (fear tatics) yet have nothing to backup your claim but your admonition that they are just "nurses" and we are mighty "Doctors". Historically, this tactic is a losing one.

Your big push is AAs and PR. Neither of which addresses the future defining issues facing anesthesiology, reimbursement & practice expansion. AAs = another person doing your job. Might not want independence now but its just ignorance of history to believe it wont happen in the future (look at the political pushes PAs have begun over the past 5 yrs). Why use resources creating another potential adversary? Its senseless. Money and resources should be spent on developing and expanding anesthesiology practice OUTSIDE the OR since even I (a mere resident) can see thats where the specialty is certainly heading.

Based on the AANAs OWN STATS they have less than 10% of their members practicing independently (in RURAL areas) and you think thats the big threat right now to anesthesiology? Come now, you cannot be that ignorant.

As opposed to yours, i think ill follow Dr Lemas lead, donate to the ASA-PAC and attend my local chapter meetings.

Absolutely not true, please provide evidence for this statement. I think that is one of the misleading statements that is bought and paid for by the AANA.
They are not governed by a separate and "We stand alone" philosophy as the nurses are. I don't care if the ASA thinks that remaining calm and inactive is the answer, that is different than mine and will not support this route. I do believe in being civil as possible but if I TREAT these individuals as if they were as educated and made as much sacrifice as I have then that would put them at the same level which would give them more clout politically. I DO NOT UNDERSTAND why Dr. Lema chooses to do that but it is not the right approach and only gives them credibility.

 

[johankriek]

I DO NOT UNDERSTAND why Dr. Lema chooses to do that but it is not the right approach and only gives them credibility.

Because he probably has a choclate eclair for a spine.

 

[MacGyver]

The reason the ASA and academic chairs are selling out gas is simple. $$$$$$

Lets face it, academic gas docs make quite a bit less tahn their private practice counterparts. Their bitter about it, and they want it all, the research opps and prestige in addition to the $$$$

So what do they do? They actively encourage CRNAs to take over the field during the interim period when they can make a TON of $$$$ by supervising these punks. Most of these academic chairs are older and will be retired in 20 years time. They dont care if CRNAs expand by then, because they will be out of the game.

ASA leaders and academic chairs arent happy with their fat 250k salaries so they sell out theri field for an extra 75k per year.

 

[jetproppilot]

This forum is becoming a disgrace to the professionalism of our specialty. I personally do not condone or support slurs, epithets, threats or any type of soporific diatribe ascribed to our next generation of physicians. This site is a public forum that can be accessed or hacked by anyone outside of anesthesiology and should not be regarded as a backroom discussion opportunity to test ill-conceived ideas or make shock value declarations.

Did it ever occur to you that others opposed to your views can disguise themselves as militants to incite comments that can ultimately be used against the very ideas being germinated? It's a very effective form of counter-espionage.

ASA in no way supports or encourages topics that are designed to intentionally hurt others or to suggest actions that are in violation of federal laws.

Outrageous statements designed to hurt or denigrate those within or outside our specialty written under a pseudonym are frankly cowardly.

Discussions and debates are part of our culture and should be encouraged, but some of the stuff discussed here is absolutely mindless.

Please clean it up for all of our benefits. Stop the mob mentality. Educated, well-articulated concerns can be a force for change but not if the site is regarded a bogus.


Sincerely,
Mark J. Lema M.D., Ph.D.
(I do not routinely access this site so there is no need to reply)

This site is not regarded as bogus. As a matter of fact, DOCTOR, it is probably one of the most popular SDN sites.

We are priveleged to have several private practice clinicians that post regularly here.

Your well intended remarks about how-best to protect The Specialty are respected.

Your bow-tied, out of date, finger-wagging style is not.

Maybe you and your ASA-administrative colleagues should take a step back and recognize JUST HOW MUCH you have lost contact with real-life, non-academic, private practice anesthesia.

Do you, on a daily basis, fight-the-fight of efficiency vs patient care?

Are you comfortable with the fact that medicare reimburses my plumber more for a toilet de-clogging than I make for an AV graft anesthetic?

Are you comfortable with many of the useless, time-consuming guidelines/practices propegated by the ASA and residency programs?

Why are so many resident-physicians threatened by CRNAs, and why hasnt the ASA responded to their fear?

When is the last time you did a bring-back heart at 3 AM?

Are you truly ONE OF US? Physicians in the trenches, taking care of patients day-in-and-day-out, days, nights, weekends, holidays, insurance or no insurance, medicaid, self pay.......

Sorry, DOCTOR.....

coming onto a website full of med students and eager residents and delivering an arrogant, scolding message is not the answer to our problems.

If this is how the ASA handles controversial issues, the ASA may want to rethink how they handle controversial issues.

What a pompous, arrogant post.

 

[IN2B8R]

I admire your persistance. I am a Pain Physician MD. The answer to your question is simple: every profession on earth--especially medicine--protects its turf. Why? Because this is the source of an MD's income. An analogy: anyone can read a CXR, yet it takes a board certified Radiologist to render a "formal reading." Why? Because it is within that MD's turf, i.e., that individual went to medical school and residency in order to "qualify" herself for signing off on that simple reading of a CXR. The Radiologist did not count on Joe Schmoe, the x-ray tech, to render a reading for 50 percent of the Radiologist fee. One may say that a simple "workshop" can suffice in order to read a CXR, but the truth of the matter is that professional qualifications and ability to perform something are two separate things when it comes to one's turf. I am perfectly willing to allow an MD/DO resident to perform anything under my supervision. That person has worked hard enough to "qualify" herself and is not encrouching onto my field. I personally consider regional anesthesia and Pain management under the MD turf. Furthermore, the practice of anesthesiology in all of its forms, with all of its medical decision making, is an MD turf. Medical decision is an MD turf--point blank. While a nurse/CRNA can make a medical decision that is as sound as an MD (often, but not always), neither has gone to medical school and neither should encrouch onto MD turf. End of story--it is all about turf and money.

Mille, the difference here is colonoscopies and delivering babies has nothing to do with anesthesia. Upper extremety blocks is a form of anesthesia. So yes, a CRNA peforming regional anesthesia is within their scope of practice. My question to you is why a CRNA should not perform regional anesthesia?

 

[jetproppilot]

This forum is becoming a disgrace to the professionalism of our specialty. )

Yeah, OK Slim.

I am a board-certified anesthesiologist with eleven years experience who has contributed to, and witnessed the impact this forum has had on the future leaders of our profession.

There is NO OTHER INTERNET SITE where real-life practicing anesthesiologists routinely interact with pre-meds, med students, and residents about day-to-day life as an anesthesiologist.

Does the ASA post on the internet about what to expect in a real-life contract for emerging CA-3s?

Does the ASA routinely respond to posters about how to handle an abrupt surgeon? How to handle NPO status for an appendicitis patient at 7 pm? How a thoracic epidural contributes to an anesthetic? How to handle a scheduling conflict with a partner? How to weed through what is meaningful and what is banter in current residency teachings?

This forum is meaningful, Slim.

Sorry, DOCTOR Slim.

We reach out to pre-meds, med students, and residents every day. With real life info.

Does your ASA do the same?

Far from a disgrace, in my humble opinion.

 

[The_Sensei]

10% is just the beginning. Do you think that number won't rise in the coming years? 10% represents the aggressive, risk-takers. As it becomes more widely accepted and seen as less risky, more and more will go independent. Do you think that CRNA's prefer to practice in RURAL areas only? You don't think that they will want to live and practice in the same neighborhood as you? Come on, how naive can you be?

Words of wisdom

 

[jetproppilot]

Words of wisdom

Absolutely.

Just more reason to lobby your individual hospital.

Checkmate.

 

[The_Sensei]

Yeah, OK Slim.

I am a board-certified anesthesiologist with eleven years experience who has contributed to, and witnessed the impact this forum has had on the future leaders of our profession.

There is NO OTHER INTERNET SITE where real-life practicing anesthesiologists routinely interact with pre-meds, med students, and residents about day-to-day life as an anesthesiologist.

Does the ASA post on the internet about what to expect in a real-life contract for emerging CA-3s?

Does the ASA routinely respond to posters about how to handle an abrupt surgeon? How to handle NPO status for an appendicitis patient at 7 pm? How a thoracic epidural contributes to an anesthetic? How to handle a scheduling conflict with a partner? How to weed through what is meaningful and what is banter in current residency teachings?

This forum is meaningful, Slim.

Sorry, DOCTOR Slim.

We reach out to pre-meds, med students, and residents every day. With real life info.

Does your ASA do the same?

Far from a disgrace, in my humble opinion.

Thereby solidifying why I missed your presence so much on this forum.