Michigan CRNA's set up Go Fund Me page to raise money for lawyers!

[Stank811]

If there were no mid-levels, I predict that the max salary for the anesthesia physician would level out to around half of current levels.
I'm not sure it's in the best interest of all stakeholders to advocate for either 1:2 OR solo physician anesthesia care as the universal safest model.
If that's really true, why aren't physicians advocating for solo physician anesthesia? That's right, they are advocating for AAs.

Shouldn't we be trusting individual physicians/clinicians to decide what safe ratios of providers are in a particular practice and for particular cases?

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2442988

Looking at the most recent RAND study above it shows anesthesiologist supervise approx 30-40 percent of their cases and the use of CRNAs is decreasing most likely from the increase use of AAs. I can only speak for our group but if we went solo MD our compensation would decrease by 10 percent. Many of us do advocate for solo physician anesthesia practice.

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[deleted480308]

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2442988

Looking at the most recent RAND study above it shows anesthesiologist supervise approx 30-40 percent of their cases and the use of CRNAs is decreasing most likely from the increase use of AAs. I can only speak for our group but if we went solo MD our compensation would decrease by 10 percent. Many of us do advocate for solo physician anesthesia practice.

serious side question here.....if I join/start a surgery practice. What's the end cost differential to my patient if I shop for a doc only anesthesia provider? Is it the same cost to patient but the docs just make that 10% less?

 

[chocomorsel]

Aralc, what do you think Anesthesiologists would make if working solo without supervision? You said their salaries would be half of what they currently are. How much is that exactly? There is such variability in incomes.
I am with FFP, as in I like practicing independently. You tend to make less working solo, but not by too much. And really, it's all about peace of mind.
There are many docs out West who practice in physician only models and want to keep it that way. All the docs I spoke to did not want AAs working in my state when the bill was introduced because they don't like working with any type of mid levels. The docs advocating for AAs tend to be the ones who already work in an ACT setting. They like practicing in that model and or like the money they make off the nurses so they want to keep doing it with a little less attitude from the mid levels. I have worked with both AAs and CRNAs and in general, the AAs are more ok being in an ACT model and having the attending in charge do his or her thing with much less atitude and push back.
As far as working rural, yes it is less desirable. But I don't know why you think that more nurses than physicians want to go rural. The reason they (nurses) do is because they tend to make more money and are more independent. You better believe that if docs made more money out in the sticks than in the city, they would be running there. And there are docs on this board who are out there making more money in the country/smaller towns than in the cities and much prefer living out there. In fact they encourage young docs to go out to more unsavory places because you get more bang for your buck sometimes..
I am looking at a place in the sticks currently. They are looking specifically for a physician and for the size hospital it is, are paying pretty well. They aren't looking for a CRNA even though they could probably pay them half of a docs salary because it is an employee position. Why do they want a physician? The outgoing person is a CRNA.

 

[chocomorsel]

serious side question here.....if I join/start a surgery practice. What's the end cost differential to my patient if I shop for a doc only anesthesia provider? Is it the same cost to patient but the docs just make that 10% less?

There would be no difference in cost to your patient at all. If the docs are charging the insurance companies, they get whatever rate they negotiated with that said company. Same for the CRNA. So this whole arguments that CRNAs are cheaper is crap.
In a hospital, if they are salaried and work no overtime then yes they will be cheaper if working solo. Assuming the hospital pays them a smaller salary than a doc that is.

 

[deleted480308]

There would be no difference in cost to your patient at all. If the docs are charging the insurance companies, they get whatever rate they negotiated with that said company. Same for the CRNA. So this whole arguments that CRNAs are cheaper is crap.
In a hospital, if they are salaried and work no overtime then yes they will be cheaper if working solo. Assuming the hospital pays them a smaller salary than a doc that is.

well, if I ever go solo or become the tie breaker vote in a surgical practice, one of you gas docs gets a solo gig offered to them. if one of you is willing to make slightly less than you would be making by supervising a bunch of CRNAs/AAs then it's a clear win for my patients

 

[Psai]

There is indeed a lot of corruption in the world, and we need to fight against it as much as we can. But to say that solo physician anesthesia is the only way to deliver anesthesia safely is a huge insult to all the practices in this country that choose to employ CRNAs. The CRNAs and the physicians.

I will say it again, a well-qualified and competent mid-level who practices within their competence is not a threat to physicians or patients.

There is no way that you are a medical oncologist and you are not a physician so please stop playing nonsense games

 

[Man o War]

I agree with everything you said here. Except the implication that a CRNA can't work well with an MD

Did not mean to imply that....I've known plenty of CRNAs who were a pleasure. Unfortunately, their governing body tells them that they are ALL from day 1 good enough to practice independently and that anesthesiologists are just there to drink coffee in the lounge and line their pockets. Go read some of the comments on the Crains articles from some of them, and you will get a good glimpse of what we are dealing with. After you read some of those comments, ask yourself how you would feel if your APPs felt this way about you and how you think your working relationship with them would be as a result. Those militant attitudes most certainly translate into bad attitudes and insubordination in the work place.

 

[chocomorsel]

There is no way that you are a medical oncologist and you are not a physician so please stop playing nonsense games

Why, because he likes midlevels and wants them to practice at the top of their license and make him money? Believe it or not, there are plenty of docs out there like this. How do you think all these CRNAs proliferated? There are plenty of docs who like to use midlevels to maximize profit without thinking of the long term consequences and sounds like he or she is one of hose.

 

[Aralc]

.

 

[chocomorsel]

Choc and FFP, I have to admit that you have a position that has no impure motives that I can see.

Whether or not solo physician anesthesia is a feasible model in today's environment is unclear to me (are there enough of you? Is the system committed to training enough of you? Will the market sufficiently incentivize talent to go where the need is?).

I also don't know if choosing to work with a midlevel automatically makes a physician evil. I honestly don't have enough clinic openings to see all the patients referred to me (despite several recent MD hires). Oncology patients don't typically want to wait more than a week for an appointment. I also can't physically be everywhere and so rely on team members to help me take care of my patients. I thought that's how it might work in anesthesia but maybe I was wrong.

I don't want to dismiss your legitimate gripes regarding the relationships between MD and CRNA but don't throw everyone else under the bus.

I am not throwing any of my anesthesia colleagues under the bus. If they want to work in an ACT model I have no problem with that. No one is calling them all evil. Some though complain and gripe about how they are forced to work in an ACT model when in reality they are employing those nurses they so hate working with and making money off them. Just look at the comments of A Real Doc on this Detroit articles. Truth is, if you want to really work solo, there are plenty of those practices out there. You just have to move.
You however are coming here, telling us to embrace the CRNAs and encouraging us to train them when you really have no idea what we deal with. Most of us are fighting against independent practice for nurses.

Most docs including me have no problem with the ACT model. I don't want to work in one, so I don't. I personally have changed my mind about independent practice recently because I don't think docs should be held liable for anyone else's mistakes and stupidity. So I say, let them all fly free. Sure some of the public will pay, but give them what they want. Supposedly cheaper, more empathetic care.

 

[Aralc]

I am not throwing any of my anesthesia colleagues under the bus. If they want to work in an ACT model I have no problem with that. No one is calling them evil.
You however are coming here, telling us to embrace the CRNAs and encouraging us to train them when you really have no idea what we deal with.
Most docs here, including me have no problem with the ACT model. I don't want to work in one, so I don't. What people here are fighting against is independent practice for midlevels. I personally have changed my mind about that recently because I don't think docs should be held liable for anyone else's mistakes and stupidity. So I say, let them all fly free. Sure some of the public will pay, but give them what they want. Supposedly cheaper, more empathetic care.

As has been pointed out several times, and where I have not been listening - I think I am just underestimating the devastating effect of years of strife between your two groups.

I'm sorry. It makes me sad, I wish it didn't have to be like that.

 

[deltamed]

As has been pointed out several times, and where I have not been listening - I think I am just underestimating the devastating effect of years of strife between your two groups.

I'm sorry. It makes me sad, I wish it didn't have to be like that.

Aralac, you seem to be arguing from a pragmatic, cost "everyone cant have a doctor care for them" point-of-view.

Have you ever considered that oncology employs some of the most insanely expensive drugs and regimens in medicine for *often* a very small (months) survival benefit. Sometimes no survival benefit- just some possible months of quality of life for hundreds of thousands of dollars?

We could probably replace all the CRNAs with anesthesiologists 10 times over (and save a few young healthy patients) if we cut out practices like this in medicine. But we don't.

 

[Wiscoblue]

For an oncologist this guy knows too much about anesthesia. Almost like he might be a CRNA pretending to be a doc.


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[climbingak]

The greatest lie the AANA has been able to perpetuate successfully is that CRNAs are cheaper. The patient pays the same for anesthesia whether it's given by a doctor or a nurse. The price per unit is determined by market forces in that area, not by who gives the anesthesia.

Now sure hospitals can hire crnas cheaper than docs and pocket the extra cash, but the patient still sees the same bill. The only person who wins is the hospital by stealing the excess professional fee.

 

[WholeLottaGame7]

For an oncologist this guy knows too much about anesthesia. Almost like he might be a CRNA pretending to be a doc.


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Probably not, my guess is married to one.

 

[deleted480308]

Probably not, my guess is married to one.

the plot thickens! haha

 

[drmwvr]

Aralac, you seem to be arguing from a pragmatic, cost "everyone cant have a doctor care for them" point-of-view.

Have you ever considered that oncology employs some of the most insanely expensive drugs and regimens in medicine for *often* a very small (months) survival benefit. Sometimes no survival benefit- just some possible months of quality of life for hundreds of thousands of dollars?

We could probably replace all the CRNAs with anesthesiologists 10 times over (and save a few young healthy patients) if we cut out practices like this in medicine. But we don't.

What's this "we" business? While I can sympathize with frustration from apparent contradictions in objectives in excellent delivery of medical care to patients, a redistributive mentality cuts both ways.

 

[Wiscoblue]

Probably not, my guess is married to one.

Spouse of mi68 Crna, perhaps?


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[WholeLottaGame7]

.

I think the analogous situation would be some of your NPs or PAs going off on their own and opening up their own clinics and diagnosing/treating patients and claiming that they are equivalent because they read an oncology textbook and their nursing board says they can. While claiming that they can do an equal job for cheaper, because, hey, no studies showing a difference!

Meanwhile, the NPs or PAs that still report to you, see your patients but don't report changes in their condition, and come up with their own treatment plan even if it sometimes directly contradicts yours.

Not saying that all CRNAs are like that, or even most of them. The vast majority of them are team players, recognize their limitations, and work as a team to take care of patients. But there are enough militant ones out there that it's frustrating.

It's going to happen to every field at some point, it's just a matter of when. So far specialties like surgery and radiology are relatively well-shielded. But everyone else's time is coming. Hell, there are even derm NP "residencies." We've given the proverbial mouse the proverbial cookie, and now they are coming for the proverbial milk.

 

[WholeLottaGame7]

Spouse of mi68 Crna, perhaps?


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Yeah, or sibling, or somehow or another connected to the situation.

 

[SpartanWolverine]

Yeah, or sibling, or somehow or another connected to the situation.

Or something. To have their first SDN post on this thread (and then 80-90% of their other 100+ posts on this thread) is a little weird. Plus, it's clear that they're potentially from MI based on their post history. It's a little weird if a "medical oncologist" joined SDN and posted serendipitously on this thread without evidence of their affiliation or physician status. Not saying it's impossible for an interested MI physician to be pulled into SDN after searching about this case, but... something about it is a tad unusual.

 

[Consigliere]

The only way there is true peace and collaboration, when working with CRNAs, is if they are employed by the respective anesthesiologists. Probably this applies to other specialties, as well. Nobody bites or debates the hand that feeds him/her, even the militant kind.

An environment where CRNAs and anesthesiologists are both employees is dangerous, unless there are serious consequences for insubordination (which means at least having the same employer). Not to mention the situation in which the midlevels own the group and employ the anesthesiologist.

Absolutely true. I am so glad that this is our current situation; for several years it was not and the difference is enormous.

 

[Aralc]

I was debating as to whether or not to reply and put an end to all your speculation.

But just so that all this chatter stops- yes, I am married to one of the anesthesiologists involved in this situation. If anyone really cares enough, there is enough information to figure out who I am, and also seidnarb by the way.

Talking to the nurse mob was disheartening, but talking to the doctor mob equally so. The nurses have pretty much shut up, so please would you all too?

There are real lives at stake here. Thank you.

 

[GA8314]

Absolutely true. I am so glad that this is our current situation; for several years it was not and the difference is enormous.

I am convinced that my headaches are 50% less given that we employ the CRNAs......

 

[deleted480308]

I was debating as to whether or not to reply and put an end to all your speculation.

But just so that all this chatter stops- yes, I am married to one of the anesthesiologists involved in this situation. If anyone really cares enough, there is enough information to figure out who I am, and also seidnarb by the way.

Talking to the nurse mob was disheartening, but talking to the doctor mob equally so. The nurses have pretty much shut up, so please would you all too?

There are real lives at stake here. Thank you.

the fact that there are lives at stake is precisely why we should not stop talking about the mistake of CRNA independence. It is literally a life and death issue.

And just to note, your positions seem odd given that you are married to a physician...

 

[Aralc]

Look - regarding independent CRNA practice, if you remember, what I was saying is that most hospitals/ surgeons won't go for it, so DONT WORRY! STOP FREAKING OUT!
what I see here is fear driving anger.

In this situation, the hospital and surgeons now love the MDs. it's over there, and the CRNAs know it.
But just because they want the MDs, doesn't mean that they don't want the CRNAs too.

And thus, my position that a well-trained CRNA who practices within their competence level, and knows when to ask for help when needed, is an asset to any organization which chooses to hire them. They are not a threat to their employer, to physician anesthesiologists, or the patient. If you look at all the gripes that the MDs have regarding this situation, there are two main issues - clinical competence, and the inability to ask for help when needed. If you had a CRNA which was both, I'm sure you all would love working with them. I am trying to remind people that such CRNAs exist.

I was going to say something else about independent CRNAs, but I think I will skip it for the sake of peace.

 

[deleted480308]

Look - regarding independent CRNA practice, if you remember, what I was saying is that most hospitals/ surgeons won't go for it, so DONT WORRY! STOP FREAKING OUT!
what I see here is fear driving anger.

In this situation, the hospital and surgeons now love the MDs. it's over there, and the CRNAs know it.
But just because they want the MDs, doesn't mean that they don't want the CRNAs too.

And thus, my position that a well-trained CRNA who practices within their competence level, and knows when to ask for help when needed, is an asset to any organization which chooses to hire them. They are not a threat to their employer, to physician anesthesiologists, or the patient. If you look at all the gripes that the MDs have regarding this situation, there are two main issues - clinical competence, and the inability to ask for help when needed. If you had a CRNA which was both, I'm sure you all would love working with them. I am trying to remind people that such CRNAs exist.

I was going to say something else about independent CRNAs, but I think I will skip it for the sake of peace.

I think it's an important conversation to have...please say what you have to say about independent CRNA practice permission

 

[Aralc]

only if you and the rest of the board promise not to gang up on me.

 

[deleted480308]

only if you and the rest of the board promise not to gang up on me.

I feel like you are safe from injury on an anonymous message board. The discussion has been pretty issue based and while you are in the minority opinion here, it has been a reasonably adult conversation. I'm genuinely interested in your opinion and reasoning.

 

[nimbus]

And thus, my position that a well-trained CRNA who practices within their competence level, and knows when to ask for help when needed, is an asset to any organization which chooses to hire them. They are not a threat to their employer, to physician anesthesiologists, or the patient. If you look at all the gripes that the MDs have regarding this situation, there are two main issues - clinical competence, and the inability to ask for help when needed. If you had a CRNA which was both, I'm sure you all would love working with them. I am trying to remind people that such CRNAs exist.

Not me. Even good CRNAs sometimes do things that are cringe-worthy. Anesthesiologists too. I prefer to do everything myself which is why I practice in an MD only practice. If there's a f***-up, it's on me as it should be. I don't want to be responsible for anybody else's.

 

[Aralc]

thanks, and you're probably right but maybe now is not the right time or place. Ask me in a couple of weeks.

 

[Aralc]

Not me. Even good CRNAs sometimes do things that are cringe-worthy. Anesthesiologists too. I prefer to do everything myself which is why I practice in an MD only practice. If there's a f***-up, it's on me as it should be. I don't want to be responsible for anybody else's.

In the end, this is my argument about the independent CRNA. If they * up, it's on them.

 

[deltamed]

only if you and the rest of the board promise not to gang up on me.

So wait, you are a heme/onc physician married to one of the anesthesiologists, or are you married to one of the crna's? If the former, isn't your partner pissed about all the things the Crnas have said, and the smearing in the media?

In any case, I'm also in a different specialty with no connection to the situation so I have no horse in the game. BUT I find it hard to see why you are so sympathetic to the nurses.

In most specialties it's like 0.1% of midlevels that are militant and claiming complete equivalence. That makes it a mostly a collaborative and good environment for all. When you have 10% or even 5% making these claims (and their own organizations indoctrinating them) the environment becomes toxic for everyone. I'm not sure why you cant see that - to me it's clear 100% of the blame lies with the nurses.

 

[deleted480308]

In the end, this is my argument about the independent CRNA. If they * up, it's on them.

no, if they * up, it's a dead patient. And with a high risk to the patient, the government certifying they are competent for independent practice is inappropriate.

 

[Aralc]

no, if they * up, it's a dead patient. And with a high risk to the patient, the government certifying they are competent for independent practice is inappropriate.

Let's continue this argument later. It's not worth it now.

 

[Aralc]

So wait, you are a heme/onc physician married to one of the anesthesiologists, or are you married to one of the crna's? If the former, isn't your partner pissed about all the things the Crnas have said, and the smearing in the media?

In any case, I'm also in a different specialty with no connection to the situation so I have no horse in the game. BUT I find it hard to see why you are so sympathetic to the nurses.

In most specialties it's like 0.1% of midlevels that are militant and claiming complete equivalence. That makes it a mostly a collaborative and good environment for all. When you have 10% or even 5% making these claims (and their own organizations indoctrinating them) the environment becomes toxic for everyone. I'm not sure why you cant see that - to me it's clear 100% of the blame lies with the nurses.

read my first post again - married to doctor. Also, some of my posts about my experiences with midlevels likely reflect the generally good environment associated with 0.1% toxicity. I have so far never encountered an oncology APP who thought they were the equivalent of the physician. If you remember, I said it made me sad because I didn't know that this degree of toxicity existed and I naively thought that anesthesia was the same way. I think in the end, what I am saying, is that perhaps it is possible to recreate such an environment if those toxic elements are removed.

I don't really want to talk about blame, but remember there are 66 nurses. IIRC, 37 offers went out in December. And remember that reports from both sides suggested that the work environment was collaborative and good prior to this dispute.

 

[Psai]

Let's continue this argument later. It's not worth it now.

This is an anesthesiology board and you're the one coming in to stoke the fires

 

[Aralc]

This is an anesthesiology board and you're the one coming in to stoke the fires

correct, I apologize that I got carried away. I will be happy to have a discussion about independent CRNA practice at a future date should anyone care to discuss it with me. I suggest we start a different thread, in the midlevel forum.

 

[Consigliere]

. If you had a CRNA which was both, I'm sure you all would love working with them. I am trying to remind people that such CRNAs exist.

I was going to say something else about independent CRNAs, but I think I will skip it for the sake of peace.

You're right.....there are 2 of them.

 

[Aralc]

You're right.....there are 2 of them.

if that is true, then FFP is correct, solo MD anesthesia is the way to go.

I don't know why you get such pleasure out of disrespecting an entire profession. Honestly, it doesn't do your profession any favors.

But then, your statement seems to suggest that you don't disagree that if a CRNA was competent and teachable/respectful, the model would work...

 

[Consigliere]

if that is true, then FFP is correct, solo MD anesthesia is the way to go.

I don't know why you get such pleasure out of disrespecting an entire profession. Honestly, it doesn't do your profession any favors.

But then, your statement seems to suggest that you don't disagree that if a CRNA was competent and teachable/respectful, the model would work...

It does work IF your group employs the CRNAs and has hiring/firing power. That's the way my group is set up. Any CRNA that doesn't tow the line or do exactly as told is IMMEDIATELY TERMINATED with extreme prejudice.

 

[Aralc]

Look, you might be able to tell that I don't have any qualms about calling out bad behavior when I see it. Nurse or physician.

As far as I can tell (though I haven't searched exhaustively), the nurses have stopped. We should too.

 

[Aralc]

It does work IF your group employs the CRNAs and has hiring/firing power. That's the way my group is set up. Any CRNA that doesn't tow the line or do exactly as told is IMMEDIATELY TERMINATED with extreme prejudice.

Seems like PSJ will be in the same position.

 

[deltamed]

if that is true, then FFP is correct, solo MD anesthesia is the way to go.

I don't know why you get such pleasure out of disrespecting an entire profession. Honestly, it doesn't do your profession any favors.

So you didn't really answer the crux of the situation- if 10% of your APNs in oncology were claiming equivalence to you and saying they could practice independently, and another 10% didn't follow your plans when consulted, and their organization was running a campaign claiming equivalence to you.... Would you want to teach and work with the other 80%? Would you "respect" their profession?

Thank god this isn't (yet) a big issue in my specialty. I cant believe the anesthesiologists actually have to put up with this situation. It defies logic, really.

 

[Aralc]

So you didn't really answer the crux of the situation- if 10% of your APNs in oncology were claiming equivalence to you and saying they could practice independently, and another 10% didn't follow your plans when consulted, and their organization was running a campaign claiming equivalence to you.... Would you want to teach and work with the other 80%? Would you "respect" their profession?

Thank god this isn't (yet) a big issue in my specialty. I cant believe the anesthesiologists actually have to put up with this situation. It defies logic, really.

I don't know how I would handle it. I think that training AAs seems to be the best strategy, honestly. And what Consigliere said - to aggressively remove toxic elements from the workplace.
Clearly, each physician on the board has had to deal with the issue and has come up with their own coping mechanism - many of them choosing to work solo.

Another strategy is to get the non-toxic 80% in the fight as well. That is a large number of people.

 

[Aralc]

Ok, this last part of the conversation has been pretty civil. I need to take a break for my own mental health. Please police yourselves.

 

[pgg]

I was debating as to whether or not to reply and put an end to all your speculation.

Why did you go back and edit/delete so many of your posts in this thread?

That's ... rude.

But just so that all this chatter stops- yes, I am married to one of the anesthesiologists involved in this situation. If anyone really cares enough, there is enough information to figure out who I am, and also seidnarb by the way.

Talking to the nurse mob was disheartening, but talking to the doctor mob equally so. The nurses have pretty much shut up, so please would you all too?

You're not an anesthesiologist, you arrive at a forum full of anesthesiologists, join an ongoing thread, and feel you have some sort of weight or authority to tell us to quit talking about it? Really?

There are real lives at stake here. Thank you.

To be clear, which lives are you talking about?

The employment "lives" of 68 people who got a rude awakening to market forces, who turned out to be not quite as important or indispensable as they thought they were? Are their feelings at risk too?

Or are you referring to the lives of patients undergoing surgery?

 

[Aralc]

sorry to upset you by deleting my posts. Look, if folks want to use an open anonymous internet forum as an excuse to say things they would never say in public because they know they are shameful and embarassing to your profession, go ahead. From what I remember, I don't think you have so far, but some of your colleagues have. Tube monkey, baby sitter, incompetent, dangerous, etc. That is just as bad as the nurse mob.

Clearly, if you want to have a reasonable adult discussion without disparaging CRNAs as an entire profession, that is OK, but seriously, saying there are only 2 competent team-player CRNAs that exist? And then why would a physician ever work with a CRNA? The only reason would be to make money off of them. Again, it doesn't put your profession in a good light.

If you haven't figured it out yet, I am referring to the lives of seidnarb, his partners, their families, as well as members of the MI68 who unfortunately received bad advice from some toxic colleagues and are now unemployed.

Like I said, your colleagues should feel free to continue to abuse the CRNAs, but don't think people aren't reading and judging.

 

[deleted480308]

sorry to upset you by deleting my posts. Look, if you want to use an open anonymous internet forum as an excuse to say things you would never say in public because you know they are shameful and embarassing to your profession, go ahead. From what I remember, I don't think you have so far, but some of your colleagues have. Tube monkey, baby sitter, incompetent, dangerous, etc. You all are just as bad as the nurse mob.

If you haven't figured it out yet, I am referring to the lives of seidnarb, his partners, their families, as well as members of the MI68 who unfortunately received bad advice from some toxic colleagues and are now unemployed.

Like I said, feel free to continue to abuse the CRNAs, but don't think people aren't reading and judging.

I don't know about others, but I speak the same way in person

 

[Aralc]

The problem is that some folks dont.

Consigliere says he works with CRNAs. Do you think he would ever say something like this to their face?

If you look at all the gripes that the MDs have regarding this situation, there are two main issues - clinical competence, and the inability to ask for help when needed. If you had a CRNA which was both, I'm sure you all would love working with them. I am trying to remind people that such CRNAs exist.

You're right.....there are 2 of them.[/QUOTE]