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Michigan Senate Bill 1019

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siednarb

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In Michigan - Senate Bill 1019 (SB 1019) cleared the state senate. Here is the letter we got from the MSA:

This week, the Michigan State Senate ignored the voices of patients and physicians across the state who urged them not to remove physician involvement in anesthesia care. The Senate has passed Senate Bill 1019 which increases the scope of practice for nurse anesthetists and allows them to practice independently. It passed 22-15 and the breakdown of the vote is below.

You may recall that the last week of session prior to the summer break, the Senate introduced SB 1019, which is nearly identical to Senate Bill 320. The Michigan Society of Anesthesiologists and your lobbyist, GCSI, had been working for a year with members of the Senate Health Policy Committee on SB 320, having offered amendments that went unanswered, and demonstrating again and again to members of that committee how dangerous this legislation really is. As a result, committee members rightly refused to take action on SB 320.

In order to pass SB 1019, the nurse anesthetists and Michigan Health and Hospital Association needed to “committee shop” to put the legislation before a brand new Senate Committee. The Michigan Competitiveness Committee held a hearing on SB 1019, just one day after the bill was introduced, and voted it out after only 10 minutes of testimony.

Some supporters of SB 1019 may say that a physician will still be involved in anesthesia under the bill or “this doesn’t change much”. As it currently stands, SB 1019 states the nurse anesthetist is the “sole and independent anesthesia provider if he or she is part of a patient-centered care team.” The definition of a “patient-centered care team” under the bill states that it “MAY include, but is NOT REQUIRED to include, physicians”. Plain and simple, physician involvement is removed under the bill.

Michigan is currently one of 46 states that requires some level of physician involvement when it comes to the administration of anesthesia. With SB 1019 in its present form, Michigan will only be the fifth state which allows a nurse anesthetist to practice outside of the relationship of a physician. Montana, New Hampshire, Oregon, and Utah are the only four states currently that allow this. Supporters will argue that this bill puts Michigan in line with “40 other states” however, which is simply untrue.

Many Senators were denied the opportunity to offer amendments to the bill while it was being considered by the full Senate before the vote this week.

We thank all of the MSA members that had reached out to their lawmakers prior to the vote. I encourage you again to do this time thanking your lawmaker if they stood up for patient safety by opposing the bill or letting your Senator know your disappointment if they supported SB 1019. We will be sending out an action alert soon for MSA members to get in touch with their State Representative on this issue and we will be engaging in the rest of our PR plan. We have a long way to go on this still but wanted you to have the most up to date information on this issue. We encourage our members to stay engaged as we fight this to the end.
Senate Yes Votes on SB 1019
Ananich
Booher
Casperson
Emmons
Green
Hertel
Hildenbrand
Hood
Johnson
Knezek
Knollenberg
Kowall
MacGregor
Marleau
Meekhof
Nofs
Pavlov
Proos
Schmidt
Shirkey
Stamas
Warren
Senate No Votes on SB 1019
Bieda
Brandenburg
Colbeck
Gregory
Hansen
Hopgood
Horn
Hune
Jones
O’Brien
Robertson
Rocca
Schuitmaker
Young
Zorn
 
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DetectiveAlonzo

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What is the overall work ethic and knowledge base of nurse anesthetists? Won't hospitals feel they are putting their patients at risk?

Wtf man. I really was interested in gas too. Having to oversee some dingbat nurse do the same **** I could do with less liability and about equal $/hour is just downright infuriating and bull****.

How do we stop this?
 
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Man o War

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Besides that.

Do any of you guys currently work with or over CRNAs? What's ur experience been?

Take a look at states that have opt out. The vast majority of facilities require anesthesiologist presence.
So even in states where they can practice independently, for the most part they don't.
Worked with them for years and there's not a chance in hell I'd have surgery with just a nurse administering my anesthesia.
 

vector2

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Besides that.

Do any of you guys currently work with or over CRNAs? What's ur experience been?

On average, my interaction with CRNAs in real life has generally been pleasant and cordial. Most are there to clock in, get the job done, and clock out. About 1 out of 25-50 I would say are capable of doing a moderately complex anesthetic solo and dealing with the most likely complications (ironically, this set usually includes those who are real students of anesthesia and who want to work with physicians so they can continue learning).

That being said, another 1 out of 25-50 I wouldn't let anesthetize my dog even if I was in the room the entire time.
 

WholeLottaGame7

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Wtf man. I really was interested in gas too. Having to oversee some dingbat nurse do the same **** I could do with less liability and about equal $/hour is just downright infuriating and bull****.

How do we stop this?

Well then you should be all about this bill, then, because it removes you from having to supervise anyone. They will be doing it without you, now.
 
D

deleted50478

Take a look at states that have opt out. The vast majority of facilities require anesthesiologist presence.
So even in states where they can practice independently, for the most part they don't.
Worked with them for years and there's not a chance in hell I'd have surgery with just a nurse administering my anesthesia.

Yeah, these laws pass and crnas still work under anesthesiologist supervision, but then they claim the law as 'evidence' of the safety of independent crna practice even though the law had no immediate impact on practice.
Nursing research is easy because your study doesn't have to support your conclusions or even effectively examine the question of your study. You just gather irrelevant data and say it shows whatever you decided in advance it would show. You can't lose when only 1% of legislators know or care that all your claims are BS.
 
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dr doze

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Yeah, these laws pass and crnas still work under anesthesiologist supervision, but then they claim the law as 'evidence' of the safety of independent crna practice even though the law had no immediate impact on practice.
Nursing research is easy because your study doesn't have to support your conclusions or even effectively examine the question of your study. You just gather irrelevant data and say it shows whatever you decided in advance it would show. You can't lose when only 1% of legislators know or care that all your claims are BS.

The AANA is in it for the long haul. This is a siege. Not a timed match.
 
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DetectiveAlonzo

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Well then you should be all about this bill, then, because it removes you from having to supervise anyone. They will be doing it without you, now.

No ... I meant I am against the fact that CRNAs even exist.

What are your thoughts on this bill and has the presence of CRNAs affected your practice?
 

WholeLottaGame7

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No ... I meant I am against the fact that CRNAs even exist.

What are your thoughts on this bill and has the presence of CRNAs affected your practice?

You can be against their existence, but that cat is way out of the bag. That is not even the discussion we are having.

In an ideal world, total independence would be a good thing. Because then all the world would see the differences in outcomes. Unfortunately, that's not how it would work. Even if the outcome differences were signficant, hospital administrators and the CRNA lobby would sweep it under the rug. It's all politics, control, and money.

I'm not sure what you mean by "affected your practice." I mean, of course they do. So do residents and fellows. There are days when I have to keep CRNAs from hurting patients, and there are days when it's nice to have an experienced CRNA to minimize the drama in one room while I'm teaching or dealing with an issue in another room. I'm fortunate that most of the CRNAs I work with are solid, team-players.
 
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DetectiveAlonzo

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You can be against their existence, but that cat is way out of the bag. That is not even the discussion we are having.

In an ideal world, total independence would be a good thing. Because then all the world would see the differences in outcomes. Unfortunately, that's not how it would work. Even if the outcome differences were signficant, hospital administrators and the CRNA lobby would sweep it under the rug. It's all politics, control, and money.

I'm not sure what you mean by "affected your practice." I mean, of course they do. So do residents and fellows. There are days when I have to keep CRNAs from hurting patients, and there are days when it's nice to have an experienced CRNA to minimize the drama in one room while I'm teaching or dealing with an issue in another room. I'm fortunate that most of the CRNAs I work with are solid, team-players.

And you are not at all worried or fearful of the possibility they could replace you, a licensed anesthesiologist?
 

WholeLottaGame7

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And you are not at all worried or fearful of the possibility they could replace you, a licensed anesthesiologist?

As many other wiser and more experienced members of this forum have stated, nobody is irreplaceable, so yes. If it wasn't CRNAs it would be some other anesthesiologist or AMC or what have you angling for your job. Everyone is responsible for proving their worth or risk losing their job. If you think you're going to finish residency and then push propofol in some GI suite or place LMAs in ASA1s and 2s while working 40hrs/wk and making bank at an ASC and not expect someone to take that job, you're crazy.

You have to do something other people can't do or don't want to do, or do something better than other people do, or do something cheaper than other people do, or you're going to be on your bum.
 
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BLADEMDA

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As many other wiser and more experienced members of this forum have stated, nobody is irreplaceable, so yes. If it wasn't CRNAs it would be some other anesthesiologist or AMC or what have you angling for your job. Everyone is responsible for proving their worth or risk losing their job. If you think you're going to finish residency and then push propofol in some GI suite or place LMAs in ASA1s and 2s while working 40hrs/wk and making bank at an ASC and not expect someone to take that job, you're crazy.

You have to do something other people can't do or don't want to do, or do something better than other people do, or do something cheaper than other people do, or you're going to be on your bum.

Your post is the exact reason many should consider skills which are not run of the mill:

1. Fellowship at Chops followed by a second year at Chops doing only peds hearts (no CRNA will ever take your job)
2. Critical Care at MGH followed by Cardiac at MGH (great start to an academic career anywhere in the USA and one where no CRNA will ever take your job)
3. Pain fellowship with emphasis on interventional Pain (stimulators, pumps, etc). CRNAS will struggle to get privileges to take your job at most hospitals.

Ambulatory Fellowship followed by a job at an ASC. Good luck keeping the CRNA, DNP from taking your job.
 
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BLADEMDA

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This is the hat the AANA likes to wear at State Capitol buildings:

i_love_low_hanging_fruit_cap-rded4495a82e341d485c44c05791a9a08_v9wfy_8byvr_512.jpg
 
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DetectiveAlonzo

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Your post is the exact reason many should consider skills which are not run of the mill:

1. Fellowship at Chops followed by a second year at Chops doing only peds hearts (no CRNA will ever take your job)
2. Critical Care at MGH followed by Cardiac at MGH (great start to an academic career anywhere in the USA and one where no CRNA will ever take your job)
3. Pain fellowship with emphasis on interventional Pain (stimulators, pumps, etc). CRNAS will struggle to get privileges to take your job at most hospitals.

Ambulatory Fellowship followed by a job at an ASC. Good luck keeping the CRNA, DNP from taking your job.

I was planning on IF I enter anesthesiology, I would certainly plan on doing a fellowship, like Pain or Cardio and TEE.

CRNAs aren't allowed to specialize...? hmmm...

well yet. I guess.
 

GravelRider

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I was planning on IF I enter anesthesiology, I would certainly plan on doing a fellowship, like Pain or Cardio and TEE.

CRNAs aren't allowed to specialize...? hmmm...

well yet. I guess.

I think you inadvertently make a point. Technological advancements and protocols have evened the playing field in most specialties. Very few specialties are immune to midlevel encroachment. If you want to be more immune from midlevels, become a surgeon. Otherwise, you will constantly have to prove your value over another type of "provider" to whatever organization you end up working for.
 
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Consigliere

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****. So this is pretty much the future huh?
The future?!? It's the present. The future is working side-by-side with your so called "colleagues" as an employee of an AMC or hospital system. Eat plenty of crow during your residency, cuz you'll sure be eating a lot of it for the remainder of your career.
 
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Consigliere

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Besides that.

Do any of you guys currently work with or over CRNAs? What's ur experience been?
I do because it's a necessary evil. Let me emphasize though that THE CRNAS MUST BE YOUR EMPLOYEES. Any other supervision set-up is a prescription for unhappiness.
 
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DetectiveAlonzo

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I do because it's a necessary evil. Let me emphasize though that THE CRNAS MUST BE YOUR EMPLOYEES. Any other supervision set-up is a prescription for unhappiness.

I really value your opinion on these boards. I forgot if you mentioned to me whether or not you specialized or did a fellowship? Would you suggest doing that to avoid having to deal with CRNAs?
 

Consigliere

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I really value your opinion on these boards. I forgot if you mentioned to me whether or not you specialized or did a fellowship? Would you suggest doing that to avoid having to deal with CRNAs?
Didn't have to at the time but boy do I regret not doing one now. My winning personality (really) and work ethic have allowed me to excel for the last 15 years. I'm one of the lucky few though.
 
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DetectiveAlonzo

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Didn't have to at the time but boy do I regret not doing one now. My winning personality (really) and work ethic have allowed me to excel for the last 15 years. I'm one of the lucky few though.

idc how much people disagree with you on here or probably give you **** for being so honest.

But honestly...

I look up to you Consigliere.

I'm sick of so many people bitching and not being realistic. You are realistic and honest and the truth hurts sometimes. I wanna be like you!
 
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scudrunner

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idc how much people disagree with you on here or probably give you **** for being so honest.

But honestly...

I look up to you Consigliere.

I'm sick of so many people bitching and not being realistic. You are realistic and honest and the truth hurts sometimes. I wanna be like you!

4bf3a2d2cf5594c05bf31403925ab58c.jpg
 
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