Message From ASA President

[jetproppilot]

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Members do not see this ad.

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

AHHHHHHHHHHH, MASTA, such a phenomenal, manipulative, passive-aggresive ending!

Say your (bow-tied) stance at an internet site full of eager pre-meds, med students and residents, then end it with NO NEED TO RESPOND. I'M DONE WITH YOU.

Awesome marketing/recruiting tactics from our leadership at the ASA.

My job security is very safe with dudes like you at the wheel. Guess I should be thankful!

Drive on!

 

[jetproppilot]

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

Thanks. Really.

 

[morpheus md]

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Your bow-tied, out of date, finger-wagging style is not.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

*clap, clap, clap*

My thoughts exactly. After reading the OPs post, it is clear to me just how and why we are on the course we are on as a specialty. What is not clear is why I should financially support an organization whose president has such a blatant disregard for the concerns of its members.

 

[powermd]

*clap, clap, clap*

My thoughts exactly. After reading the OPs post, it is clear to me just how and why we are on the course we are on as a specialty. What is not clear is why I should financially support an organization whose president has such a blatant disregard for the concerns of its members.

If the ASA won't do the job, we'll have to create a new PAC that will.

 

[swpm]

My thoughts exactly. After reading the OPs post, it is clear to me just how and why we are on the course we are on as a specialty. What is not clear is why I should financially support an organization whose president has such a blatant disregard for the concerns of its members.

When is Dr. Lema's term up? What can we do to influence who replaces him?

 

[johankriek]

When is Dr. Lema's term up? What can we do to influence who replaces him?

doesnt matter,, next in line is moore(ROger) of the same

 

[Taurus]

Maybe it's time to create a new organization with no inherent conflicts of interests and that truly represents the interests of practicing anesthesiologists. We don't have much time to get this right before the window of opportunity for this profession shuts for good.

 

[BLADEMDA]

Maybe it's time to create a new organization with no inherent conflicts of interests and that truly represents the interests of practicing anesthesiologists. We don't have much time to get this right before the window of opportunity for this profession shuts for good.

Private Forum.

Blade

 

[lushmd]

 

[jetproppilot]

And the award for professionalism goes to... C'mon guys/gals, lets keep it civil.

We're in the United States.

You can kiss someone in public if you want. Ask Richard Gere.

You can also call someone a dickwad if you want.

I didnt make the rules.

Call Thomas Jefferson et al if you've got a beef.

 

[Trisomy13]

We're in the United States.

You can kiss someone in public if you want. Ask Richard Gere.

You can also call someone a dickwad if you want.

I didnt make the rules.

Call Thomas Jefferson et al if you've got a beef.

You sure can, and make yourself look unprofessional and immature in the process. It's a free country. 😉

 

[Taurus]

Cremesickle please stop trying to pass yourself as a resident in this forum. You and I know you are a CRNA.

I figured as much. Nobody in anesthesiology would be naive enough to believe that CRNA's just want to practice in RURAL areas.

 

[toughlife]

If the ASA won't do the job, we'll have to create a new PAC that will.

It is already in the works. As I stated in the past, I won't sit idly and watch the 'leaders' show me how to win at this game when they can't do it themselves.

I invite all of you to come to the private forum and continue this discussion. As you know and has been reiterated many times, this generation is anesthesiology residents is WIDE AWAKE at the wheel and will not let the specialty get taken over that easily.

Please join us!

 

[toughlife]

Maybe it's time to create a new organization with no inherent conflicts of interests and that truly represents the interests of practicing anesthesiologists. We don't have much time to get this right before the window of opportunity for this profession shuts for good.

PLease PM me to get you into the private forum.

 

[The_Sensei]

Thanks. Really.

Your welcome; I always have respected your insight/input since it so closely mimics my own. You have a much more eloquent and simplistic way of explaining things though.

 

[jetproppilot]

You sure can, and make yourself look unprofessional and immature in the process. It's a free country. 😉

Yeah, OK.

Calling some dude out and making a big deal out of an expletive he used...thus usurping the poignant message in his post.

Sounds like an uppity country club tea party to me.

Never been to one......do they have spitoons at those gigs?

 

[Trisomy13]

Yeah, OK.

Calling some dude out and making a big deal out of an expletive he used...thus usurping the poignant message in his post.

Sounds like an uppity country club tea party to me.

Never been to one......do they have spitoons at those gigs?

Never been to one either Jet. I'm about as blue collar as they come 😛 Just pointing out that one can easily undermine one's own credibility, unnecessarily. I felt that he usurped his own message that way, but otherwise agreed with his general sentiment.

 

[jetproppilot]

Never been to one either Jet. I'm about as blue collar as they come 😛 Just pointing out that one can easily undermine one's own credibility, unnecessarily. I felt that he usurped his own message that way, but otherwise agreed with his general sentiment.

Point well taken.

Although I did like the description of dic....

well you get the point.

 

[lushmd]

Yeah, OK.

Calling some dude out and making a big deal out of an expletive he used...thus usurping the poignant message in his post.

Sounds like an uppity country club tea party to me.

Never been to one......do they have spitoons at those gigs?

Just to clarify, I didn't take issue with the expletive so much as its target. Look, I think its great that Dr. Lema (and perhaps other ASA higher ups) may be on this site; even if he doesn't agree with us or all of our viewpoints, at least he is aware of us/them. Having said that, referring to Dr. Lema/ASA/Academic Anesthesiologists in a derogatory manner will likely only make it easier for him/them to marginalize our views. Not to sound trite, but this truly seems like a time to reach out/build a consensus and move forward with some meaningful action.

PS Sort of an aside (and I may well be flamed for this, whatever...), but to me (an MS3 very interested in Anesthesiology) it is difficult to believe that academics are actively selling out the field. They may well be out of touch with the situation/concerns of Anesthesiologists in private practice, and as such slow to react to the CRNA threat, but in my (admittedly limited) experience, academic physicians truly love/appreciate their respective fields and wouldn't actively contribute to a field's demise.

 

[cfdavid]

Just to clarify, I didn't take issue with the expletive so much as its target. Look, I think its great that Dr. Lema (and perhaps other ASA higher ups) may be on this site; even if he doesn't agree with us or all of our viewpoints, at least he is aware of us/them. Having said that, referring to Dr. Lema/ASA/Academic Anesthesiologists in a derogatory manner will likely only make it easier for him/them to marginalize our views. Not to sound trite, but this truly seems like a time to reach out/build a consensus and move forward with some meaningful action.

PS Sort of an aside (and I may well be flamed for this, whatever...), but to me (an MS3 very interested in Anesthesiology) it is difficult to believe that academics are actively selling out the field. They may well be out of touch with the situation/concerns of Anesthesiologists in private practice, and as such slow to react to the CRNA threat, but in my (admittedly limited) experience, academic physicians truly love/appreciate their respective fields and wouldn't actively contribute to a field's demise.[/QUOTE]


That's the point. It seems that many are out of touch with the realities of private practice and the fiscal concerns of the average anesthesiologist out there. Their focus is simply different, but that doesn't make our concerns any less valid. Academics have always been somewhat clueless of the realities that plague the average joe, so to speak. Just look at any university.

I agree that we must be diplomatic (to potential allies, that is), but it seems that the political lines are being drawn w/r/t the AANA with many med students, residents, and private practice dudes. The abosolute lack of value the AANA seems to place on an MD/DO anesthesiologist speaks volumes. So, why the academic departments are continuing to collaborate to the extent that they do with CRNA programs is beyond me. They still hold the leverage in terms of teaching and as being leaders of the field. So, they would have the leverage to drive home a message to their nursing colleagues that we're not comfortable with statements on the AANA website that "and sometimes an anesthesiologist (a physician anesthesia provider)" (not the exact quote, I think, but you get the point). And that we're not going to tolerate additional, directly threatening, legislative proposals made by the AANA.

Also, others have brought up the point that all fields evolve over time. That's true. But, the importance of advocacy is critical. You can never really let up. My personal view is that one must always be on the offensive. That way, any "changes" to the field will be CHOICES that we can make in the future, according to our best interests, rather than have change forced upon us by organizations that simply advocate/lobby better than we do.

 

[toughlife]

Just to clarify, I didn't take issue with the expletive so much as its target. Look, I think its great that Dr. Lema (and perhaps other ASA higher ups) may be on this site; even if he doesn't agree with us or all of our viewpoints, at least he is aware of us/them. Having said that, referring to Dr. Lema/ASA/Academic Anesthesiologists in a derogatory manner will likely only make it easier for him/them to marginalize our views. Not to sound trite, but this truly seems like a time to reach out/build a consensus and move forward with some meaningful action.

PS Sort of an aside (and I may well be flamed for this, whatever...), but to me (an MS3 very interested in Anesthesiology) it is difficult to believe that academics are actively selling out the field. They may well be out of touch with the situation/concerns of Anesthesiologists in private practice, and as such slow to react to the CRNA threat, but in my (admittedly limited) experience, academic physicians truly love/appreciate their respective fields and wouldn't actively contribute to a field's demise.[/QUOTE]


That's the point. It seems that many are out of touch with the realities of private practice and the fiscal concerns of the average anesthesiologist out there. Their focus is simply different, but that doesn't make our concerns any less valid. Academics have always been somewhat clueless of the realities that plague the average joe, so to speak. Just look at any university.

I agree that we must be diplomatic (to potential allies, that is), but it seems that the political lines are being drawn w/r/t the AANA with many med students, residents, and private practice dudes. The abosolute lack of value the AANA seems to place on an MD/DO anesthesiologist speaks volumes. So, why the academic departments are continuing to collaborate to the extent that they do with CRNA programs is beyond me. They still hold the leverage in terms of teaching and as being leaders of the field. So, they would have the leverage to drive home a message to their nursing colleagues that we're not comfortable with statements on the AANA website that "and sometimes an anesthesiologist (a physician anesthesia provider)" (not the exact quote, I think, but you get the point). And that we're not going to tolerate additional, directly threatening, legislative proposals made by the AANA.

Also, others have brought up the point that all fields evolve over time. That's true. But, the importance of advocacy is critical. You can never really let up. My personal view is that one must always be on the offensive. That way, any "changes" to the field will be CHOICES that we can make in the future, according to our best interests, rather than have change forced upon us by organizations that simply advocate/lobby better than we do.

My feelings exactly.

 

[lushmd]

That's the point. It seems that many are out of touch with the realities of private practice and the fiscal concerns of the average anesthesiologist out there. Their focus is simply different, but that doesn't make our concerns any less valid. Academics have always been somewhat clueless of the realities that plague the average joe, so to speak. Just look at any university.

I agree that we must be diplomatic (to potential allies, that is), but it seems that the political lines are being drawn w/r/t the AANA with many med students, residents, and private practice dudes. The abosolute lack of value the AANA seems to place on an MD/DO anesthesiologist speaks volumes. So, why the academic departments are continuing to collaborate to the extent that they do with CRNA programs is beyond me. They still hold the leverage in terms of teaching and as being leaders of the field. So, they would have the leverage to drive home a message to their nursing colleagues that we're not comfortable with statements on the AANA website that "and sometimes an anesthesiologist (a physician anesthesia provider)" (not the exact quote, I think, but you get the point). And that we're not going to tolerate additional, directly threatening, legislative proposals made by the AANA.

Also, others have brought up the point that all fields evolve over time. That's true. But, the importance of advocacy is critical. You can never really let up. My personal view is that one must always be on the offensive. That way, any "changes" to the field will be CHOICES that we can make in the future, according to our best interests, rather than have change forced upon us by organizations that simply advocate/lobby better than we do.

Agreed.

 

[powermd]

it is difficult to believe that academics are actively selling out the field.

At Columbia we have recently started using CRNAs for complex cardiac cases. It's great for lightening our workload, but clearly at the expense of the specialty.

Academic anesthesia is DEFINITELY selling out the field. We train SRNAs as our nursing program gears up to produce nurse "doctors" -

http://cpmcnet.columbia.edu/dept/nursing/programs/drnp_approved.html

Here is my favorite line from the description "The degree builds upon advanced practice at the master's degree level and prepares graduates for fully accountable professional roles in several nursing specialties. " How can they be any more accountable than they already are as advanced practice nurses? Nursing schools are gearing up for war with physician-based medicine.

 

[toughlife]

At Columbia we have recently started using CRNAs for complex cardiac cases. It's great for lightening our workload, but clearly at the expense of the specialty.

Academic anesthesia is DEFINITELY selling out the field. We train SRNAs as our nursing program gears up to produce nurse "doctors" -

http://cpmcnet.columbia.edu/dept/nursing/programs/drnp_approved.html

Here is my favorite line from the description "The degree builds upon advanced practice at the master's degree level and prepares graduates for fully accountable professional roles in several nursing specialties. " How can they be any more accountable than they already are as advanced practice nurses? Nursing schools are gearing up for war with physician-based medicine.

This quote from the same site says it all... "Built on evidence derived from over 10 years of increasing independence and scientific inquiry, including a randomized trial published in The Journal of the American Medical Association, Columbia University School of Nursing faculty developed the DrNP degree to educate nurses for the highest level of clinical expertise, including sophisticated diagnostic and treatment competencies.".

 

[BLADEMDA]

This quote from the same site says it all... "Built on evidence derived from over 10 years of increasing independence and scientific inquiry, including a randomized trial published in The Journal of the American Medical Association, Columbia University School of Nursing faculty developed the DrNP degree to educate nurses for the highest level of clinical expertise, including sophisticated diagnostic and treatment competencies.".

The specialty has 10-15 years (max) before it becomes dominated by the AANA and the CRNA with DNAP. You must fight now or forever hold your peace.

Blade

 

[johankriek]

The specialty has 10-15 years (max) before it becomes dominated by the AANA and the CRNA with DNAP. You must fight now or forever hold your peace.

Blade

we're trying.. at least im trying. but its hard with guys like lema et al. around.

 

[mille125]

we're trying.. at least im trying. but its hard with guys like lema et al. around.

i dont think that this was LEMA

 

[toughlife]

i dont think that this was LEMA

I believe it.

 

[Coastie]

Makes no sense to me.

At all.

At Columbia we have recently started using CRNAs for complex cardiac cases. It's great for lightening our workload, but clearly at the expense of the specialty.

Academic anesthesia is DEFINITELY selling out the field. We train SRNAs as our nursing program gears up to produce nurse "doctors" -

http://cpmcnet.columbia.edu/dept/nursing/programs/drnp_approved.html

Here is my favorite line from the description "The degree builds upon advanced practice at the master's degree level and prepares graduates for fully accountable professional roles in several nursing specialties. " How can they be any more accountable than they already are as advanced practice nurses? Nursing schools are gearing up for war with physician-based medicine.

 

[mille125]

Just to clarify, I didn't take issue with the expletive so much as its target. Look, I think its great that Dr. Lema (and perhaps other ASA higher ups) may be on this site; even if he doesn't agree with us or all of our viewpoints, at least he is aware of us/them. Having said that, referring to Dr. Lema/ASA/Academic Anesthesiologists in a derogatory manner will likely only make it easier for him/them to marginalize our views. Not to sound trite, but this truly seems like a time to reach out/build a consensus and move forward with some meaningful action.

PS Sort of an aside (and I may well be flamed for this, whatever...), but to me (an MS3 very interested in Anesthesiology) it is difficult to believe that academics are actively selling out the field. They may well be out of touch with the situation/concerns of Anesthesiologists in private practice, and as such slow to react to the CRNA threat, but in my (admittedly limited) experience, academic physicians truly love/appreciate their respective fields and wouldn't actively contribute to a field's demise.

Lush, when you graduate you will learn one thing. If there is something that doesnt make sense, it is about $$$$. Academic anesthesiologists/chairman get money from the school in the form of "slave labor". At my institution the higher ups secretly planned a SRNA school without informing the other faculty members. They also named several attendings as "teachers" of the SRNA's. They made many dollars for this title. This world is corrupt, pure and simple. Most of the chairman only have a handful of years remaining. The CRNA's could never hurt them because they are in the twilight of their careers.....I SPEAK THE TRUTH.....

Solution: Chairmen need to be pressured to close CRNA schools and open AA schools. This will drive the nurses to the bargaining table in a position of weakness..............

 

[jwk]

Dr. Lema's post is now noted on the ASA website, and is reprinted in it's entirety on the members only side.

 

[jwk]

This quote from the same site says it all... "Built on evidence derived from over 10 years of increasing independence and scientific inquiry, including a randomized trial published in The Journal of the American Medical Association, Columbia University School of Nursing faculty developed the DrNP degree to educate nurses for the highest level of clinical expertise, including sophisticated diagnostic and treatment competencies.".

There ya go

 

[Monty Python]

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




-- there is no anesthesiologist present, and .... the surgeons want a regional for the case or post-op pain control, the case is more appropriate for regional than GETA, field military anesthesia per CRNA in austere environments is always slanted towards regional if otherwise appropriate

 

[Monty Python]

AHHHHHHHHHHH, MASTA, such a phenomenal, manipulative, passive-aggresive ending!

Say your (bow-tied) stance at an internet site full of eager pre-meds, med students and residents, then end it with NO NEED TO RESPOND. I'M DONE WITH YOU.

!

No matter how effective JPP is when using his silver-tongued command of the English language, his physical acting skills are even more impressive. His hysterical impersonations of others' mannerisms would leave us gasping for breath.

If any of you get to meet him in person, have him impersonate a certain obgyn's emergency response to a stat c/section, as compared to his normal gait. I'm in tears just typing this.

 

[BLADEMDA]

Trinity,

Any comments on the DNAP requirement? What about your AANA's continued drive for Independence? What would you do if you were in our shoes? THe one thing we don't want to read is negotiate with the AANA. The AANA is like a despot/rogue nation in the fact they understand a stick much better than a carrot. It is time to use the sticks.

Blade

 

[mille125]

Trinity,

Any comments on the DNAP requirement? What about your AANA's continued drive for Independence? What would you do if you were in our shoes? THe one thing we don't want to read is negotiate with the AANA. The AANA is like a despot/rogue nation in the fact they understand a stick much better than a carrot. It is time to use the sticks.

Blade

i agree...read my above post...shutting down their programs would be a big stick and would bring them to the table in a position of weakness

 

[Heeed!]

i agree...read my above post...shutting down their programs would be a big stick and would bring them to the table in a position of weakness

Reminds me of a quote I once heard...something about negotiating with the enemy with your knee on his chest and your knife at his throat.

 

[Monty Python]

Trinity,

Any comments on the DNAP requirement?

Blade

I'm just an in-the-trenches workaday CRNA; I don't occupy any AANA office. My understanding is that the Am. Assembly of Colleges of Nursing (not AANA) decided the DNP would be the required entry-level for advanced practice nursing in the next decade (for midwives, FNPs, etc.). At first AANA wasn't overly crazy about it, but in the end they went along rather than fight a battle which wasn't really worth it. And it's the Schools of Nursing instituting the DNP requirement (in response to the AACN mandate), not necessarily the AANA making it happen.

The general membership is sharply divided into two camps. I have mixed feelings both pro and con. I'm always for continued higher education in principle. But I also wonder what will the increased length and expense of the curriculum do to the applicant pool?

I have asked and have yet to be informed of a study which demonstrates how the DNP translates into statistically significant improved patient care.

DNP students can only be taught by doctorally-prepared faculty. There aren't dozens of unemployed doctorally-prepared CRNAs out there looking for work. And you can't grow them overnight.

Trinity,

What about your AANA's continued drive for Independence? What would you do if you were in our shoes?

Blade

Probably the biggest complaint from CRNAs (and which is the foundation of all the angst and drive for independence) arises from those in the ACT setting where the anesthesiologists sit in the lounge all day, reading the paper, trading stocks on the internet all day long, supervising from the golf course, while the CRNAs are busting a@@ all day long in the OR. The ACT group bills for medical supervision, and the CRNAs take home pennies on the dollar for their efforts. I've been very fortunate to have worked in an ACT group which was at the opposite end of that particular spectrum. But I also think my group was in the minority based on conversations and internet forums I've kept up with.

A lot of CRNAs also chafe under the "1500 rule." From 0700-1500 we need supervision. But suddenly our intelligence and ability to give quality anesthesia independently goes up exponentially after 1500 (especially between 0001-0630), while the attendings are at such-and-such social function de jour or sound asleep at home. That was exactly my work setting prior to working with JPP.

The CRNA mentality is that if supervision (as described above) is a sham, then the CRNA should reap the full rewards of their efforts, thus giving rise to the independence issue. If the anesthesiologist wants to work hard right alongside the CRNA, then everyone's happy (as in my former group).

If I were in your shoes, I would make one simple rule: if you're on duty, don't be a lounge lizard.

 

[toughlife]

I'm just an in-the-trenches workaday CRNA; I don't occupy any AANA office. My understanding is that the Am. Assembly of Colleges of Nursing (not AANA) decided the DNP would be the required entry-level for advanced practice nursing in the next decade (for midwives, FNPs, etc.). At first AANA wasn't overly crazy about it, but in the end they went along rather than fight a battle which wasn't really worth it. And it's the Schools of Nursing instituting the DNP requirement (in response to the AACN mandate), not necessarily the AANA making it happen.

The general membership is sharply divided into two camps. I have mixed feelings both pro and con. I'm always for continued higher education in principle. But I also wonder what will the increased length and expense of the curriculum do to the applicant pool?

I have asked and have yet to be informed of a study which demonstrates how the DNP translates into statistically significant improved patient care.

DNP students can only be taught by doctorally-prepared faculty. There aren't dozens of unemployed doctorally-prepared CRNAs out there looking for work. And you can't grow them overnight.



Probably the biggest complaint from CRNAs (and which is the foundation of all the angst and drive for independence) arises from those in the ACT setting where the anesthesiologists sit in the lounge all day, reading the paper, trading stocks on the internet all day long, supervising from the golf course, while the CRNAs are busting a@@ all day long in the OR. The ACT group bills for medical supervision, and the CRNAs take home pennies on the dollar for their efforts. I've been very fortunate to have worked in an ACT group which was at the opposite end of that particular spectrum. But I also think my group was in the minority based on conversations and internet forums I've kept up with.

A lot of CRNAs also chafe under the "1500 rule." From 0700-1500 we need supervision. But suddenly our intelligence and ability to give quality anesthesia independently goes up exponentially after 1500 (especially between 0001-0630), while the attendings are at such-and-such social function de jour or sound asleep at home. That was exactly my work setting prior to working with JPP.

The CRNA mentality is that if supervision (as described above) is a sham, then the CRNA should reap the full rewards of their efforts, thus giving rise to the independence issue. If the anesthesiologist wants to work hard right alongside the CRNA, then everyone's happy (as in my former group).

If I were in your shoes, I would make one simple rule: if you're on duty, don't be a lounge lizard.

Do these supervising physicians even take call? If I had people making money for me like that, I'd be making their coffee and bringing them donuts every morning and making sure they all went home at the same time I did.

 

[Monty Python]

[/B]


Do these supervising physicians even take call?

In my particular instance, the anesthesiologist was always "on duty" as he/she received a straight monthly paycheck. One particular case sticks in my memory: I was in-house monitoring a labor epidural when an emergent appy was booked. This was around 0200. We hadn't yet instituted a back-up call CRNA. My only option was to call the anesthesiologist, who "relieved" me from home to supervise the labor epidural while I did the appy. He/she never got out of bed.

 

[toughlife]

In my particular instance, the anesthesiologist was always "on duty" as he/she received a straight monthly paycheck. One particular case sticks in my memory: I was in-house monitoring a labor epidural when an emergent appy was booked. This was around 0200. We hadn't yet instituted a back-up call CRNA. My only option was to call the anesthesiologist, who "relieved" me from home to supervise the labor epidural while I did the appy. He/she never got out of bed.

Again, laziness rearing its ugly head.

 

[Planktonmd]

In my particular instance, the anesthesiologist was always "on duty" as he/she received a straight monthly paycheck. One particular case sticks in my memory: I was in-house monitoring a labor epidural when an emergent appy was booked. This was around 0200. We hadn't yet instituted a back-up call CRNA. My only option was to call the anesthesiologist, who "relieved" me from home to supervise the labor epidural while I did the appy. He/she never got out of bed.

This is obviously a situation where the hospital employs the CRNA's and a physician or two to sign the charts, it's not entirely the Anesthesiologist's fault, it's the hospital that dictates how it works.

 

[Taurus]

The CRNA mentality is that if supervision (as described above) is a sham, then the CRNA should reap the full rewards of their efforts, thus giving rise to the independence issue. If the anesthesiologist wants to work hard right alongside the CRNA, then everyone's happy (as in my former group).

This is the great mistake of anesthesiology. They taught the technical aspects of giving anesthesia to CRNA's and became mere supervisors. CRNA's may not know the underpinning medicine, but they know how to deliver anesthesia. They're glorified technicians.

Other specialties will learn the mistakes of anesthesiology and never allow another midlevel group to assume the same level of success as the CRNA's.

If the CRNA's win this war, it will be a victory that they will regret. Anesthesiologists will move up the medical value chain where CRNA's cannot follow. They will leave delivering anesthesia to the CRNA's who will see their salaries plummet as field is seen as a nursing profession. I think that the CRNA's are hoping that the DNAP will help to maintain the prestige of the field in the eyes of CMS.

 

[jwk]

Probably the biggest complaint from CRNAs (and which is the foundation of all the angst and drive for independence) arises from those in the ACT setting where the anesthesiologists sit in the lounge all day, reading the paper, trading stocks on the internet all day long, supervising from the golf course, while the CRNAs are busting a@@ all day long in the OR. The ACT group bills for medical supervision, and the CRNAs take home pennies on the dollar for their efforts. I've been very fortunate to have worked in an ACT group which was at the opposite end of that particular spectrum. But I also think my group was in the minority based on conversations and internet forums I've kept up with.

A lot of CRNAs also chafe under the "1500 rule." From 0700-1500 we need supervision. But suddenly our intelligence and ability to give quality anesthesia independently goes up exponentially after 1500 (especially between 0001-0630), while the attendings are at such-and-such social function de jour or sound asleep at home. That was exactly my work setting prior to working with JPP.

The CRNA mentality is that if supervision (as described above) is a sham, then the CRNA should reap the full rewards of their efforts, thus giving rise to the independence issue. If the anesthesiologist wants to work hard right alongside the CRNA, then everyone's happy (as in my former group).

My large group is by-the-book TEFRA medical direction with a usual 1:3 mix. It works very well, and I guarantee you, they're not sitting on their butts. We have a very high volume practice, so while we're in the OR, they're seeing the pre-ops, placing blocks, coming in for every induction and emergence, etc.

Trin's right about the "1500 rule" in some practices. Most of the hospitals and large practices here utilize AA's and CRNA's. The few that don't use AA's are the ones most likely to use that "1500 rule", and those MD's have no intent of coming in at night unless all hell breaks loose. Their CRNA's do it all after hours.

 

[Monty Python]

............ If the CRNA's win this war, it will be a victory that they will regret......CRNA's .. will see their salaries plummet as field is seen as a nursing profession. .

Interesting perspective.

 

[toughlife]

This is the great mistake of anesthesiology. They taught the technical aspects of giving anesthesia to CRNA's and became mere supervisors. CRNA's may not know the underpinning medicine, but they know how to deliver anesthesia. They're glorified technicians.

Other specialties will learn the mistakes of anesthesiology and never allow another midlevel group to assume the same level of success as the CRNA's.

If the CRNA's win this war, it will be a victory that they will regret. Anesthesiologists will move up the medical value chain where CRNA's cannot follow. They will leave delivering anesthesia to the CRNA's who will see their salaries plummet as field is seen as a nursing profession. I think that the CRNA's are hoping that the DNAP will help to maintain the prestige of the field in the eyes of CMS.

Hell, CMS is even cutting reimbursements now even though it is considered a branch of medicine, let alone when it becomes a nursing field.

 

[Taurus]

[/B]


Hell, CMS is even cutting reimbursements now even though it is considered a branch of medicine, let alone when it becomes a nursing field.

Once the anesthesiologists move upstream, they won't fight with the govt to keep reimbursements up anymore. The CRNA's will be left fighting on their own. Be careful of what you wish for because you may just get it!

 

[VolatileAgent]

i hope many of you who speak anonymously on this forum have the stones to address your concerns directly and in person with the same candor to dr. lema at the next ASA meeting.

 

[poster]

Why? Is he the big bad wolf, going to eat me.

 

[YupGypsy]

The ASA should learn a thing or two from the AAO, they seem to have the ODs on a leash - halted their legislative efforts in numerous states and VA hospitals, successfully limited their scope of practice in certain places, banning them from AAO conferences, etc.

The AAO takes care of business. They aren't complacent and aren't afraid to make their tactics publicly known.