More CRAP from the AANA....

[MacGyver]

NEJM
Impact factor 44.0

ANESTHESIOLOGY
Impact factor 4.00

Nursing research
Impact factor 1.1

Yeah I know "nursing research" is a sham. EVery doctor knows its a sham. But thats not the point is it? As long as the legislators treat it as legit then you guys are in trouble and need to fight the AANA propaganda with research.

BTW, I want to look up the impact ratings for other journals. Where did you get that info?

---

Members don't see this ad.

 

[militarymd]

Yeah I know "nursing research" is a sham. EVery doctor knows its a sham. But thats not the point is it? As long as the legislators treat it as legit then you guys are in trouble and need to fight the AANA propaganda with research.

BTW, I want to look up the impact ratings for other journals. Where did you get that info?

I believe amgen made it up....but it IS funny......

 

[Amgen1]

use google

most journals will list their own IF under author info; also lots of other lists on the web

http://authors.nejm.org/Misc/AuthorFAQ.asp
http://library.med.ohio-state.edu/6873.cfm
http://www.nursingresearchonline.co...BbQTFF9ZcyH60y73!736553971!-949856145!8091!-1

 

[militarymd]

I stand corrected AND educated.

 

[Disciple]

By spending an extra year doing a pain fellowship (again you have to enjoy it, not just doing it for money) you can greatly expand the scope of services your anesthesia group can provide, and you can enter a field where CRNAs are not an issue.

You should check the Pain forum. There have been issues and concern regarding CRNAs performing interventional pain procedures (stims/pums/vertebroplasty) and being allowed to attend pain society cadaver workshops and even some workshops sponsored by Anesthesia pain departments.

http://gasforums.studentdoctor.net/showthread.php?t=365326

This is one thread of several on the issue.

 

[johankriek]

You should check the Pain forum. There have been issues and concern regarding CRNAs performing interventional pain procedures (stims/pums/vertebroplasty) and being allowed to attend pain society cadaver workshops and even some workshops sponsored by Anesthesia pain departments.

http://gasforums.studentdoctor.net/showthread.php?t=365326

This is one thread of several on the issue.

hey disciple
i just looked at that thread, the pain docs are getting heated over the militant crna orginization as well. rightfully so. I think we should reguarly email program directors and chairmen to voice our opinion as to the undermining of future anesthesiology graduates by training SRNAs. Encourage the adoption of more Anesthesiology Assistant schools instead.

 

[core0]

Stimulate says..."I was unaware that in the state of NY, NPs are allowed to practice critical care medicine independently of and without collaboration with physicians".

I inquired further into the matter and found that these APN's are actually employed by the anesthesia department at CUMC. They do work with a "high degree of independence" directing the care of their transplant patients. APN's do operate by a different set of rules v. CRNA's in that they agree to collaborate with a physician and subsequently, are not directed. FYI: the APN's do read x-rays for line placement/pathology. They do not place central lines. End of life decisions are made in a "team" construct. APN's can not pronounce.

APN's do operate in a manner very different from CRNA's. In a transplant setting they probably make very few independent decisions. This ideally is a collaborative model. In most academic programs ANP's and PA's take over many of the roles that were done by residents and interns prior to the advent of the work hours limitations.

Furthermore, they are part of a study being conducted by the university comparing outcomes (I do not know the variables) of APN directed v. MD directed care. I'm going out to get my subscription my Nursing Research today.

This is just a concrete example of what EtherMD has eluded to. The lines of distinction between health care providers is becoming increasingly more blurry. It raises a host of ethical issues in my mind. Who are all of these different care givers, with their different credentials, making bed side decisions? Is there no Captain of the ship? Is there somebody that a patient can point to as the director of his/her care. Can this director possibly be in tune with all of the big and small issues for a population of ICU patients?

This should be a collaborative model. Even if ANP's were allowed independent practice (in New York NP's must have physician collaboration and most hospitals require physician supervision). So the physician should be the captain of the ship.

The other issue that comes to mind, that is more immdiately pressing, is the Gastroenterologists pushing for RN's being allowed to administer propofol. We have gastro guys, with whom we currently work with, ready to have their office nurses do the cases. It's absolutly crazy.

What I have learned in my short career is that big money always trumps best practice.

I'm guessing you are in New York which has a relatively weird situation concerning endoscopy. There is an area from NYC to Boston where most endoscopy is done with MAC. This happen almost nowhere else in the US. In other areas insurance will only rarely pay for it. This means that the hospital or the endoscopy center has to pay the cost. This is the push from the Midwest for nurse administered Propofol. I have heard there will be a major effort to get rid of MAC for endoscopy since it gives more than a 50% increase to the cost. There is a novel concept in California. CRNA's and Anesthesiologists are doing MAC on a cash basis. Tell the GI you want MAC and they will arrange for anesthesia to show up. Around $400 cash only.

David Carpenter, PA-C

 

[core0]

You should check the Pain forum. There have been issues and concern regarding CRNAs performing interventional pain procedures (stims/pums/vertebroplasty) and being allowed to attend pain society cadaver workshops and even some workshops sponsored by Anesthesia pain departments.

http://gasforums.studentdoctor.net/showthread.php?t=365326

This is one thread of several on the issue.

Or take a look at the DNP plan for CRNA's which specifically mentions pain medicine and getting grandfathered CRNA's certified in pain management. The real question is should CRNA's be allowed to do outpatient medicine since they have no training in this and most nursing educators would say this is outside of their scope of practice.

David Carpenter, PA-C

 

[Disciple]

hey disciple
i just looked at that thread, the pain docs are getting heated over the militant crna orginization as well. rightfully so. I think we should reguarly email program directors and chairmen to voice our opinion as to the undermining of future anesthesiology graduates by training SRNAs. Encourage the adoption of more Anesthesiology Assistant schools instead.

What's concerning in that thread is the reply by the Associate Program Director/Vice Chairman at Wayne State (the sponsoring institution) Dr. Chidiak, who seems to think that objecting to allowing CRNAs into the cadaver course is "making mountains out of molehills".

C'mon, Dr. Chidiak, pums/stimulators are surgical procedures that are also performed by Neurosurgeons.

 

[SexPanther]

Or take a look at the DNP plan for CRNA's which specifically mentions pain medicine and getting grandfathered CRNA's certified in pain management. The real question is should CRNA's be allowed to do outpatient medicine since they have no training in this and most nursing educators would say this is outside of their scope of practice.

David Carpenter, PA-C

Ummm, no. They practice nursing, not medicine and they knew that when they chose their profession. Now they are trying to enter via backdoors that allow the blurring of the distinction between healthcare providers to continue to worsen.

 

[EtherMD]

I will say it again. Why are our academic programs training SRNA's? This is the root of the problem. WHen you have an infection you must teat the source. When you have a weed you must pull the root. IN this case, the answer is not just to stop CRNA's from attending weekend courses.

The AANA will pay overseas experts to come to the USA and teach them. They will find a way around your feeble attempts to block them. The answer is to pull the root now. Stop training your replacement.

 

[CremeSickle]

They continue b/c they dont have a choice in the matter. The hospital/institution they are associated with mandates it and HIRES people telling them UPFRONT they will be teaching CRNAs. Its NOT in our hands just like working for a hospitals that has CRNAs requires you to supervise. It is written RIGHT into the contract. This will never change.

I will say it again. Why are our academic programs training SRNA's? This is the root of the problem. WHen you have an infection you must teat the source. When you have a weed you must pull the root. IN this case, the answer is not just to stop CRNA's from attending weekend courses.

The AANA will pay overseas experts to come to the USA and teach them. They will find a way around your feeble attempts to block them. The answer is to pull the root now. Stop training your replacement.

 

[EtherMD]

No Choice? You are dead wrong. I know a top tier Anesthesiology Program that re-opened its CRNA school about 7 years ago. This same program closed the school in the late 1980's. Do you know why they re-opened the program? $$$$.

The academic chairs along with the ASA could close many academic CRNA programs. They could open AA schools instead. These Nurses could take a few more classes and go to AA school. Nothing prevents a Nurse from going to AA school. We as a specialty are encouraging the WRONG Mid-Level Provider in the operating room.

The time for action is growing short and the status quo in not an option.
Do you know why the leadership continues to help your enemy the AANA?
Greed and Fear. Two emotions that have NO PLACE in the Ivory towers of academia. Let the community hospitals train the CRNA's. The Anesthesiology Programs should train AA's.

In the end, the demise of the specialty will be caused by its leadership and academic programs. There is still time to effect change. It will only take a 10% market share by AA's to impact the AANA. The academic programs converting to AA programs would cause a "shock wave" in the Anesthesia world that would shake the foundations of the AANA.

 

[Disciple]

They continue b/c they dont have a choice in the matter. The hospital/institution they are associated with mandates it and HIRES people telling them UPFRONT they will be teaching CRNAs. Its NOT in our hands just like working for a hospitals that has CRNAs requires you to supervise. It is written RIGHT into the contract. This will never change.

Who says there's any mandate that institutions have to teach their CRNAs Pain Medicine and Regional Anesthesia?

 

[toughlife]

Who says there's any mandate that institutions have to teach their CRNAs Pain Medicine and Regional Anesthesia?

Don't waste your time talking to cremesickle. This dude either is a CRNA or is truly in love with CRNAs. Just look at the trend of his posts and you will see. I think it's nitecap undercover.

 

[toughlife]

No Choice? You are dead wrong. I know a top tier Anesthesiology Program that re-opened its CRNA school about 7 years ago. This same program closed the school in the late 1980's. Do you know why they re-opened the program? $$$$.

The academic chairs along with the ASA could close many academic CRNA programs. They could open AA schools instead. These Nurses could take a few more classes and go to AA school. Nothing prevents a Nurse from going to AA school. We as a specialty are encouraging the WRONG Mid-Level Provider in the operating room.

The time for action is growing short and the status quo in not an option.
Do you know why the leadership continues to help your enemy the AANA?
Greed and Fear. Two emotions that have NO PLACE in the Ivory towers of academia. Let the community hospitals train the CRNA's. The Anesthesiology Programs should train AA's.

In the end, the demise of the specialty will be caused by its leadership and academic programs. There is still time to effect change. It will only take a 10% market share by AA's to impact the AANA. The academic programs converting to AA programs would cause a "shock wave" in the Anesthesia world that would shake the foundations of the AANA.

Could not agree more. The leadership does not have to lose in the revenue by closing the CRNA schools. They can still maintain it with AA schools. They lack the most important thing to make changes...cojones.

 

[CremeSickle]

toughlife

You are nobody to me, and BTW, when you refer to me call me DOCTOR. Also, you can call me SENIOR resident since your NOT where I am in training.


Now that ive put that upstart kiddie back in his place let me answer the question. I talked to our PD/chief just to find out what the score was. Here is what he said:

1) The anesthesia dept in a university (or the med school for that matter) has absolutely no power over what the university decides to do with other programs. Dont pretend they do, its a fallacy and should be obvious.

2) the hospital/university isnt going to be reversing millions of dollars of funding/investment in a program and spend more to start a new one which to them, duplicates services already existing. Your far too full of yourself if you think they give 2 sh*ts about what our association thinks in the AA vs CRNA controversy.

3) The hospital isnt going to back our lobbying for AAs, EVER. Why? They have CRNAs now and to them, its a wash. Why put effort and resources into changing a system that works perfectly fine for them? The only problem is with national political organizations AANA vs ASA and that ISNT a hospital/academic problem.

4) To everyone but us and the AANA this is an absolute moot point. Why? b/c 90% or more CRNAs work in an ACT practice under the direct supervision of one of us. While you may hate to admit it, the 6-10% who dont work in places we NEVER would and provide services that wouldn't exist otherwise. This is a battle that can never be won with AAs which cannot fill those slots.

5) When the employer, lets say the hospital as it is the ultimate employer of EVERY anesthesia grp therefore anesthesiologist puts the anesthesia contract out for bid they say this "Will be responsible for training and supervising CRNA and CRNA students as well as residents". Do you think all the altruistic grps will just NOT BID for the betterment of the profession? HAHAHAHA. Never happen.

6) Lets say my residency program (which is at an academic institution) says they no longer want to mentor or train CRNA students. Now the facility which employees MANY CRNAs and wants to continue its CRNA training program so they have a well of applicants (plus the money) says "fine, find another place for your residents". Or they simply replace the program director. Its happened.

Dont think it can happen? Silly hubris is all that would be. The hospital/academic institution etc etc is vested in ONE THING The ALL MIGHTY DOLLAR. You put any of that dollar at risk via politics and you quickly find yourself escorted to the door where another anesthesia grp/program is walking in laughing at you.

Get real. This isnt as simple as the broken record i see here. AAs will never be the solution and neither will "refusing". The solution is political along with branching out practice and Lema is doing it the right way. This battle is over.

Don't waste your time talking to cremesickle. This dude either is a CRNA or is truly in love with CRNAs. Just look at the trend of his posts and you will see. I think it's nitecap undercover.

 

[Stimulate]

I am well aware of the efforts of CRNAs to break into pain medicine. So far they have been stopped (i.e. Louisianna's recent appellate court verdict) from expanding their scope of preactice via the creation of a rule by the State Board of Nursing.

I don't think that this problem is of the same magnitude as that which faces general anesthesiologists. I firmly believe that the future of physician-provided anesthesiolgy is in jeopardy within 10-15 years (both in terms of shrinking payment and of course the CRNA issue). Pain has similar issues but at least with pain management a patient or referring provider will have to be convinced that seeing a nurse is better than seeing a physician. CRNAs also have no ability to prescribe long-term narcotics, so what kind of a practice could they really build?

CRNAs will not be able to practice surgery (i.e. the implantation of spinal cord stimulators and intrathecal pumps) although I can see them eventually being able to perform very specific tasks like a straightforward lumbar ESI by order of a physician. However, they are not trained in radiology, nor can they diagnose and recommend treatment. Under a best-case scenario system for the CRNAs, they will be only able to perform a handful of procedures and only by a doctor order.

I may be optimistic or naive in this matter, however, I don't plan on sitting idly by with my thumb up my a** like many have before me. I contribute to PACs both ASA, AMA, etc. Although I may drop my ASA PAC support because I have heard that they aren't doing much to advocate for pain management (need to look into this more).

 

[toughlife]

toughlife

You are nobody to me, and BTW, when you refer to me call me DOCTOR. Also, you can call me SENIOR resident since your NOT where I am in training.

 

[Monty Python]

......I am well aware of the efforts of CRNAs to break into pain medicine. So far they have been stopped (i.e. Louisianna's recent appellate court verdict) from expanding their scope of preactice via the creation of a rule by the State Board of Nursing.

As an update:

In response to the lawsuit brought by physicians, the lower district court ruled against them, saying it was within the BON's authority to make the scope of practice ruling which supported the pain management CRNA's practice.

The apppeal court overturned the lower district court not on the merits of the case itself, but strictly because the BON inadvertently violated a procedural technicality in the state administrative code. The issue isn't dead.

 

[militarymd]

toughlife

You are nobody to me, and BTW, when you refer to me call me DOCTOR. Also, you can call me SENIOR resident since your NOT where I am in training.


Now that ive put that upstart kiddie back in his place let me answer the question. I talked to our PD/chief just to find out what the score was. Here is what he said:

1) The anesthesia dept in a university (or the med school for that matter) has absolutely no power over what the university decides to do with other programs. Dont pretend they do, its a fallacy and should be obvious.

2) the hospital/university isnt going to be reversing millions of dollars of funding/investment in a program and spend more to start a new one which to them, duplicates services already existing. Your far too full of yourself if you think they give 2 sh*ts about what our association thinks in the AA vs CRNA controversy.

3) The hospital isnt going to back our lobbying for AAs, EVER. Why? They have CRNAs now and to them, its a wash. Why put effort and resources into changing a system that works perfectly fine for them? The only problem is with national political organizations AANA vs ASA and that ISNT a hospital/academic problem.

4) To everyone but us and the AANA this is an absolute moot point. Why? b/c 90% or more CRNAs work in an ACT practice under the direct supervision of one of us. While you may hate to admit it, the 6-10% who dont work in places we NEVER would and provide services that wouldn't exist otherwise. This is a battle that can never be won with AAs which cannot fill those slots.

5) When the employer, lets say the hospital as it is the ultimate employer of EVERY anesthesia grp therefore anesthesiologist puts the anesthesia contract out for bid they say this "Will be responsible for training and supervising CRNA and CRNA students as well as residents". Do you think all the altruistic grps will just NOT BID for the betterment of the profession? HAHAHAHA. Never happen.

6) Lets say my residency program (which is at an academic institution) says they no longer want to mentor or train CRNA students. Now the facility which employees MANY CRNAs and wants to continue its CRNA training program so they have a well of applicants (plus the money) says "fine, find another place for your residents". Or they simply replace the program director. Its happened.

Dont think it can happen? Silly hubris is all that would be. The hospital/academic institution etc etc is vested in ONE THING The ALL MIGHTY DOLLAR. You put any of that dollar at risk via politics and you quickly find yourself escorted to the door where another anesthesia grp/program is walking in laughing at you.

Get real. This isnt as simple as the broken record i see here. AAs will never be the solution and neither will "refusing". The solution is political along with branching out practice and Lema is doing it the right way. This battle is over.

very accurate.

 

[EtherMD]

Don't waste your time talking to cremesickle. This dude either is a CRNA or is truly in love with CRNAs. Just look at the trend of his posts and you will see. I think it's nitecap undercover.

I agree very pro-CRNA but that in and of itself does not prove anything.
I admit that convincing universities to drop a nursing program and start another program in its place is a tough battle. But, an argument can be made at the top tier programs where the university and the hospitals are one and the same that this should happen. The CEO's are usually former academic chairs who are sensitive to "big" issues like Nurse Practitioners trying to take away the jobs from future Physicians.

The CRNA issue is a huge opportunity to make a statement by the academic community at large about the role of Mid-Level Providers: Over-step your boundaries and we will not train more of you.

This is a good message for the entire AMA. Why not start with the most militant Mid-Level Provider, the AANA? This Group does not want "solo" rights in just a few rural states; on the contrary the AANA wants full independent rights for its membership in every state. The ASA needs to make this the number one priority issue on its agenda. By the way, Pain medicine is next because the AANA views pain medicine as the ultimate proof its membership is equal to Physician Anesthesiologists. Once the AANA wins this battle (and they will in at least one state) the propoganda goes up one full notch.
The Doctor of Nurse Anesthesia will complete the AANA's agenda of "proving" its membership is fully equivalent.

Meanwhile, Academic Programs are going to pump out record number of CRNA's whose parent organization's MAIN goal is the destruction of the Specialty of Anesthesiology. NICE. This is like buying a gun and handing it to a serial killer. It gets worse. He then proceeds to kill your entire family with the gun you bought him. Then he shoots your neighbors for fun.
If the ASA and academic Chairs don't stand up for the specialty then who will? You might not be able to prevent serial killers but DON'T buy him the gun that shoots you!

 

[EtherMD]

toughlife

You are nobody to me, and BTW, when you refer to me call me DOCTOR. Also, you can call me SENIOR resident since your NOT where I am in training.


Now that ive put that upstart kiddie back in his place let me answer the question. I talked to our PD/chief just to find out what the score was. Here is what he said:

1) The anesthesia dept in a university (or the med school for that matter) has absolutely no power over what the university decides to do with other programs. Dont pretend they do, its a fallacy and should be obvious.

2) the hospital/university isnt going to be reversing millions of dollars of funding/investment in a program and spend more to start a new one which to them, duplicates services already existing. Your far too full of yourself if you think they give 2 sh*ts about what our association thinks in the AA vs CRNA controversy.

3) The hospital isnt going to back our lobbying for AAs, EVER. Why? They have CRNAs now and to them, its a wash. Why put effort and resources into changing a system that works perfectly fine for them? The only problem is with national political organizations AANA vs ASA and that ISNT a hospital/academic problem.

4) To everyone but us and the AANA this is an absolute moot point. Why? b/c 90% or more CRNAs work in an ACT practice under the direct supervision of one of us. While you may hate to admit it, the 6-10% who dont work in places we NEVER would and provide services that wouldn't exist otherwise. This is a battle that can never be won with AAs which cannot fill those slots.

5) When the employer, lets say the hospital as it is the ultimate employer of EVERY anesthesia grp therefore anesthesiologist puts the anesthesia contract out for bid they say this "Will be responsible for training and supervising CRNA and CRNA students as well as residents". Do you think all the altruistic grps will just NOT BID for the betterment of the profession? HAHAHAHA. Never happen.

6) Lets say my residency program (which is at an academic institution) says they no longer want to mentor or train CRNA students. Now the facility which employees MANY CRNAs and wants to continue its CRNA training program so they have a well of applicants (plus the money) says "fine, find another place for your residents". Or they simply replace the program director. Its happened.

Dont think it can happen? Silly hubris is all that would be. The hospital/academic institution etc etc is vested in ONE THING The ALL MIGHTY DOLLAR. You put any of that dollar at risk via politics and you quickly find yourself escorted to the door where another anesthesia grp/program is walking in laughing at you.

Get real. This isnt as simple as the broken record i see here. AAs will never be the solution and neither will "refusing". The solution is political along with branching out practice and Lema is doing it the right way. This battle is over.

You are assuming the "department" at a major university can be replaced.
This is not the case at the "better" departments as the have top-notch faculty and research. The community programs are a different matter. They will NOT be able to stop training SRNA's and don't need to.

The whole point about stopping 10-12 ACADEMIC TOP TIER Programs from training SRNA's is to make a point to the AANA and help the AA's. All it takes is for 10% of the work force to be AA's instead of CRNA's. This will have a major impact on the AANA's behavior.

There would still be vast numbers of newly graduated CRNA's to work in rural areas. But, by having more AA programs (at least 10-12) the Anesthesiologists in the community would have a choice who to hire in the operating room.

The AA issue is ONE measure to counter the AANA. The others include public education, better certificate for new graduates, mandatory subspecialty training, etc. All of these measures would have a "synergistic" effect on the survival of the specialty. The ASA and the academic chairs owe it to the next generation to at least try. The status quo is not an option. For those of you just starting training remember this point: The SRNA that you see may cause you to end up with a Nurse Anesthetist wage;or, even worse, replace you completely.

 

[Be a Pro]

EtherMD, I have to ask directly:
In addition to the plans you have laid out many times very clearly (and I do respect your energy -- being able to do this repeatedly without diminishing enthusiasm) -- how do you, or do you at all, feel that the ASA, anesthesiologists in training, or those newly in practice address the public in a way that helps defend the integrity and meaning of our licensure?
Specifically how should the issue of SUPERVISION be approached in the public arena? The public has to be a theater in the conflict doesn't it?
I appreciate any response.
Thanks
BaP

 

[jwk]

The anesthesia dept in a university (or the med school for that matter) has absolutely no power over what the university decides to do with other programs. Dont pretend they do, its a fallacy and should be obvious.

Maybe YOUR department doesn't have the balls, but others do. I have friend that's the chairman of an academic anesthesia department in a southern medical school. He refuses to allow nurse anesthesia students to perform/practice regional anesthesia within his hospitals. Such procedures are for residents only. The dean of the NURSING school had a cow - he told her too bad - he didn't answer to the dean of the NURSING school, and that HE was the chairman of the Department of Anesthesiology, and he decided what was allowed in his department and what wasn't. End of discussion.

My kind of guy.

 

[Gasboy07]

I'll post that article in another topic... titled

Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery: A Retrospective Analysis

You can read it for yourselves. Personally I can't be bothered as I have my anaesthetic primary exam on Monday. Lucky for us in Oz we don't have that problem.

I reckon there aren't articles by MDAs comparing themselves with CRNAs as we'd rather spend the effort doing articles that advance the science and practice of anaesthesia (or anesthesiology if I can ever managed to spell that)

In short - they admit that the patient profiles are different and the statistics have been fudged to get the result they want.

 

[EtherMD]

EtherMD, I have to ask directly:
In addition to the plans you have laid out many times very clearly (and I do respect your energy -- being able to do this repeatedly without diminishing enthusiasm) -- how do you, or do you at all, feel that the ASA, anesthesiologists in training, or those newly in practice address the public in a way that helps defend the integrity and meaning of our licensure?
Specifically how should the issue of SUPERVISION be approached in the public arena? The public has to be a theater in the conflict doesn't it?
I appreciate any response.
Thanks
BaP

How does this sound:


Whose in charge of your Anesthesia? Make sure it's a Board Certified Anesthesiologist. Your life Depends on it.


The Movie "Awake" presents the perfect opportunity to launch the ASA's campaign. The movie is due ot this year. The ASA needs to launch a public awareness campaign to coincide with the movie's release. Everyone is going to be talking about Anesthesia. Can you think of a better time?

 

[johankriek]

Maybe YOUR department doesn't have the balls, but others do. I have friend that's the chairman of an academic anesthesia department in a southern medical school. He refuses to allow nurse anesthesia students to perform/practice regional anesthesia within his hospitals. Such procedures are for residents only. The dean of the NURSING school had a cow - he told her too bad - he didn't answer to the dean of the NURSING school, and that HE was the chairman of the Department of Anesthesiology, and he decided what was allowed in his department and what wasn't. End of discussion.

My kind of guy.

awesome
we need more of this kind of chairman. Unfortunately, most chairmen or women are wishy washy andmore worried about if you exceeded your 15 minute break in the morning and pleasing the crnas then standing up for residents. and what ether md said is right.. the srnas that you see in your department are the same ones in 5 years who willl be saying that they are your equals.

 

[sirhumpsalot]

hopefully the university of florida will lead the way. I had read a few old articles via ASA.com by professors in the dept, Mackay?, about the ACT model and advocation of AAs, so I was hoping they would jump on board when florida got AA rights. Of course they have not, tho without a CRNA program they would seem to be a great candidate for the first public AA program in Fl.

Shands/UF have some CRNA jobs posted and when emailed they, via an HR person, said they have no plans for utilizing AAs for the open mid level , 100% medically directed positions.
My guess is that if anything happens with AAs gaining ground and MDAs holding ground vs CRNAs is that it will happen very S l o w .

 

[rn29306]

How does this sound:


Whose in charge of your Anesthesia? Make sure it's a Board Certified Anesthesiologist. Your life Depends on it.


The Movie "Awake" presents the perfect opportunity to launch the ASA's campaign. The movie is due ot this year. The ASA needs to launch a public awareness campaign to coincide with the movie's release. Everyone is going to be talking about Anesthesia.

Before you start advocating the movie and its positive publicity...does anyone has insider movie information on who specifically adminsters the anesthetic in the movie resulting in the pt being 'awake'?

Grey's Anatomy is bagging on anesthesiologists pretty bad and a movie about an awake patient with an anesthesiologist at the HOB will be a ASA PR nightmare.

Good luck turning that one around.

 

[fakin' the funk]

Grey's Anatomy is bagging on anesthesiologists pretty bad and a movie about an awake patient with an anesthesiologist at the HOB will be a ASA PR nightmare.

Meaning, the conclusion would be, you need someone with MORE training than an anesthesiologist?

Even if it was a doc who goofed, I don't see people walking out of the theater going "Ya know, since I'll be awake anyway, why not just go with the cheaper, less experienced provider?"

 

[rn29306]

Meaning, the conclusion would be, you need someone with MORE training than an anesthesiologist?

Even if it was a doc who goofed, I don't see people walking out of the theater going "Ya know, since I'll be awake anyway, why not just go with the cheaper, less experienced provider?"

It was a simple question as to if anyone knew the provider in the movie and a comment on current media portrayal of anesthesiologists.

Don't read into it or try to make it something it wasn't.

 

[toughlife]

I agree very pro-CRNA but that in and of itself does not prove anything.
I admit that convincing universities to drop a nursing program and start another program in its place is a tough battle. But, an argument can be made at the top tier programs where the university and the hospitals are one and the same that this should happen. The CEO's are usually former academic chairs who are sensitive to "big" issues like Nurse Practitioners trying to take away the jobs from future Physicians.

The CRNA issue is a huge opportunity to make a statement by the academic community at large about the role of Mid-Level Providers: Over-step your boundaries and we will not train more of you.

This is a good message for the entire AMA. Why not start with the most militant Mid-Level Provider, the AANA? This Group does not want "solo" rights in just a few rural states; on the contrary the AANA wants full independent rights for its membership in every state. The ASA needs to make this the number one priority issue on its agenda. By the way, Pain medicine is next because the AANA views pain medicine as the ultimate proof its membership is equal to Physician Anesthesiologists. Once the AANA wins this battle (and they will in at least one state) the propoganda goes up one full notch.
The Doctor of Nurse Anesthesia will complete the AANA's agenda of "proving" its membership is fully equivalent.

Meanwhile, Academic Programs are going to pump out record number of CRNA's whose parent organization's MAIN goal is the destruction of the Specialty of Anesthesiology. NICE. This is like buying a gun and handing it to a serial killer. It gets worse. He then proceeds to kill your entire family with the gun you bought him. Then he shoots your neighbors for fun.
If the ASA and academic Chairs don't stand up for the specialty then who will? You might not be able to prevent serial killers but DON'T buy him the gun that shoots you!

You don't have to shut down the CRNA program, just open an AA program right next to it. Case western reserve university in Ohio has done this. That way you can show them they are not special after all. The university hosting the program will be happy with more tuition money flowing their way. At the same time, SRNAs will be training along with their future competitor.

Here's the proof:
http://www.anesthesiaprogram.com/default.htm
http://fpb.cwru.edu/MSN/NA.shtm

 

[driverabu]

Meaning, the conclusion would be, you need someone with MORE training than an anesthesiologist?

Even if it was a doc who goofed, I don't see people walking out of the theater going "Ya know, since I'll be awake anyway, why not just go with the cheaper, less experienced provider?"

Uh, maybe because they would rather just be "awake" than awake and then dead, or permanently disabled, etc...

 

[apellous]

NURS 444C (Summer, Fall 2006, and Spring)
Health Policy Legislation and Legal Issues in Advanced Practice (1)
The focus of this course is the critical analysis of health policy and legal issues. Strategies for influencing the regulatory process will be explored.

Noticed this class. They teach them from the get go how to lobby.

 

[Disciple]

By the way, Pain medicine is next because the AANA views pain medicine as the ultimate proof its membership is equal to Physician Anesthesiologists. Once the AANA wins this battle (and they will in at least one state) the propoganda goes up one full notch.
The Doctor of Nurse Anesthesia will complete the AANA's agenda of "proving" its membership is fully equivalent.

You're absolutely right about the root of the problem being in the academic centers. The most prominent physician interventional pain medicine/spine organizations (ISIS, AAPM, ASIPP, NASS) allow only physicians to enroll in their cadaver workshops.

Anybody know the official stance of ASRA on this issue?

ASIPP recently blundered on the brochure for a spinal imaging/fluoroscopy interpretation course. The membership complained and the mistake was promptly corrected.

Thus far I have only seen open invitations for CRNAs to attend cadaver workshops for those courses sponsored by university programs.

 

[Stimulate]

You're absolutely right about the root of the problem being in the academic centers. The most prominent physician interventional pain medicine/spine organizations (ISIS, AAPM, ASIPP, NASS) allow only physicians to enroll in their cadaver workshops.

Anybody know the official stance of ASRA on this issue?

ASIPP recently blundered on the brochure for a spinal imaging/fluoroscopy interpretation course. The membership complained and the mistake was promptly corrected.

Thus far I have only seen open invitations for CRNAs to attend cadaver workshops for those courses sponsored by university programs.

I have been to cadaver workshops and although they are good, God help the patients if a CRNA or even an MD/DO is performing procedures on them with only a workshop as their training....

 

[Monty Python]

I have been to cadaver workshops and although they are good, God help the patients if a CRNA or even an MD/DO is performing procedures on them with only a workshop as their training....

To take this comment on a slight tangent ... a major dividing line between CRNAs and anesthesiologists is the board certification requirement (opinions of the CRNA board exam itself notwithstanding). A goodly percentage of practicing anesthesiologists are not board certified. Every CRNA is. Should board certification be required before a physician can refer to him/herself as an anesthesiologist, no matter what residency they completed?

 

[mocdoc]

To take this comment on a slight tangent ... a major dividing line between CRNAs and anesthesiologists is the board certification requirement (opinions of the CRNA board exam itself notwithstanding). A goodly percentage of practicing anesthesiologists are not board certified. Every CRNA is. Should board certification be required before a physician can refer to him/herself as an anesthesiologist, no matter what residency they completed?

The major dividing line between CRNAs and anesthesiologists is the four years of college, then four years of medical school, plus internship, plus residency, plus board certification, plus any fellowships, plus any subspecialty boards.

The issue of "grandfathering in" physicians with years of experience is a completely different issue all together and is not unique to anesthesiology.

Also, there are many anesthesiologists that are board eligible that have not yet taken their boards, as is the case in many other specialties.

Additionally, I don't see how you can compare non-boarded anesthesiologists to boarded CRNAs without considering the the inequities in training as well as in the board exams themselves.

Otherwise, you could argue that all non-boarded anesthesiologists are really boarded, since they have all passed the United States Medical Licensing Exam and have met the requirements to practice medicine in the United States.

 

[Monty Python]

The major dividing line between CRNAs and anesthesiologists is the four years of college, then four years of medical school, plus internship, plus residency, plus board certification, plus any fellowships, plus any subspecialty boards.

The issue of "grandfathering in" physicians with years of experience is a completely different issue all together and is not unique to anesthesiology.

Also, there are many anesthesiologists that are board eligible that have not yet taken their boards, as is the case in many other specialties.

Additionally, I don't see how you can compare non-boarded anesthesiologists to boarded CRNAs without considering the the inequities in training as well as in the board exams themselves.

Otherwise, you could argue that all non-boarded anesthesiologists are really boarded, since they have all passed the United States Medical Licensing Exam and have met the requirements to practice medicine in the United States.

Without meaning to cast dispersions on different cultures ......

This is where I'm coming from. On more than one occasion I've worked locums where the IMG/FMG physician(s) working as anesthesiologist(s) were from a foreign country with an accent so thick they couldn't be understood. Some hadn't completed an anesthesia residency. Others had completed a residency of dubious quality (in some country) but never "bothered" to take their boards. These folks couldn't intubate their way out of a wet paper bag, didn't know what an LMA was, etc, the list goes on. Yet they're qualified to supervise my anesthetic simply because they have MD/DO/MBBS after their name ???

One physician's first day in XYZ Hospital's OR was my first day there as a locums. This person honest-to-God didn't have a clue as to what an LMA was. We had an unexpected difficult airway, impossible to intubate, I reached for the LMA in my bag and I was FORBIDDEN to insert because Dr. ABC had never seen one and didn't trust it. The patient received a very ugly trach by an extremely irritated surgeon.

I have no problem recognizing the educational differences between CRNA and anesthesiologist. I likewise have no problem working with a properly trained BE/BC anesthesiologist. But I have a real problem working with generic MD/DO supervising me simply because of their academic degree, who may (or may not) have done an anesthesia residency, and who might be unable to pass their boards and never do.

How would you feel if your loved one was about to be slept by an "anesthesiologist" who continually was unable to pass boards? Would the simple fact that they possessed an MD degree pacify you? After all, what do they call the person who graduates last in their class from their med school? "Doctor."

The above derogatory comments are not intended to throw stones at physicians, but at double standards.

 

[Lumbago]

Hey trinity, you nurses train for 1.5 years ("clinically") and have the audacity to equate CRNA board certification with that of a physician's? Come on. The real dividing line between CRNA's and anesthesiologists is the fact that only one of the two is able to discern the difference.

 

[Monty Python]

Hey trinity, you nurses train for 1.5 years ("clinically") and have the audacity to equate CRNA board certification with that of a physician's? Come on. The real dividing line between CRNA's and anesthesiologists is the fact that only one of the two is able to discern the difference.

My original point (with apologies if it wasn't written clearly the first time) is that double standards are just that. If CRNAs are mandated to pass their boards before being allowed to pass gas, then physicians supervising CRNAs should be mandated to become BC within a certain time period. The BE timeframe should have a definite expiration date. Physicians wishing to practice as anesthesiologists should have to be boarded, IMHO, and should not be allowed to carry themselves as BE for decades.

I've seen instances where non-boarded physicians supervising CRNAs are a minus, not a plus, to good patient care.

 

[core0]

The major dividing line between CRNAs and anesthesiologists is the four years of college, then four years of medical school, plus internship, plus residency, plus board certification, plus any fellowships, plus any subspecialty boards.

The issue of "grandfathering in" physicians with years of experience is a completely different issue all together and is not unique to anesthesiology.

Also, there are many anesthesiologists that are board eligible that have not yet taken their boards, as is the case in many other specialties.

Additionally, I don't see how you can compare non-boarded anesthesiologists to boarded CRNAs without considering the the inequities in training as well as in the board exams themselves.

Otherwise, you could argue that all non-boarded anesthesiologists are really boarded, since they have all passed the United States Medical Licensing Exam and have met the requirements to practice medicine in the United States.

There is actually pretty good data that shows that non-board certified physicians have worse outcomes and higher claims rates almost accross the board. Most hospitals won't credential non-board certified physicians (or specify board certified within a time period for new physicians). This is a major area that the BME's are looking at and talk of requiring completion of a residency at the minimum for licensure.

David Carpenter, PA-C

 

[SleepIsGood]

Trinity--

First, I really cant believe your story because, no matter what country you graduated from you can't just come over to the US and start 'practicing'.

ON the otherhand there are folks that went to US med schools,etc that finished their residency in anesthesiology. These ppl may not all be board certified. Until recently being board certified was just a 'prestige'. No one cared if you were board certified or not. Times have changed. Nevertheless, any physician that finished an AMERICAN residency is day and night more qualified than any CRNA out there regardless of his board certification. Even now, getting board certified just makes you more marketable, it's not a necessity.

As someone pointed out above...a nurse can simply finish about 2 yrs of college (at a community college), then go into nursing schools 1.5-2 yrs (even at a community college)..then take an exam where they only have to get 72 questions right and then is automatically a RN. Sorry, but I dont know any community college type medical schools or residencies in the US. A physician goes 4 yrs college, 4 yrs med school (competitive), 4 yrs residency (competitive). Do the math..there's no comparison.

 

[johankriek]

To take this comment on a slight tangent ... a major dividing line between CRNAs and anesthesiologists is the board certification requirement (opinions of the CRNA board exam itself notwithstanding). A goodly percentage of practicing anesthesiologists are not board certified. Every CRNA is. Should board certification be required before a physician can refer to him/herself as an anesthesiologist, no matter what residency they completed?

as i mentioned in the previous post. CRNAs are NOT board certified. They may be certified but not BOARD CERTIFIED. Itis ILLEGAL to call yourself "BOARD CERTIFIED", if you are not by a recognized board of abms. YOu can go to jail. So while CRNAS may be certified by a 60 multiple choice question test, physicians are board certified by a written entance exam and a rigorous oral examination process.After going through this process, a crnas certification really pales in comparison. Board certification is the standard to which everyone is held. IF you are not you are not meeting standards.

 

[SleepIsGood]

BTW...certification in what? So a group of nurses get together and decide they want to create a certification process? So they have an exam which one passes and then is automatically a "certified nurse". The "certified" part in the certified nurse anesthesist is just a guise to make themselves "sound" mroe official.

Just to fill you in on something. A physician needs to pass about three national exams....USMLE 1,2,3. So if you're referring to the ability to pass a national exam to become "certified", then by all means all physicians are "certified"...infact "triple certified". And by the way are exams have about 300-900 questions per exam ..............

Realize this. A nurse's role is to work UNDER the supervision of a Physician regardless of whether he is board certified in anesthesiology or not since they have completed an anesthesiology residency. IF you or your colleagues are soo eager to work independently there is an easy solution....medical school

 

[johankriek]

My original point (with apologies if it wasn't written clearly the first time) is that double standards are just that. If CRNAs are mandated to pass their boards before being allowed to pass gas, then physicians supervising CRNAs should be mandated to become BC within a certain time period. The BE timeframe should have a definite expiration date. Physicians wishing to practice as anesthesiologists should have to be boarded, IMHO, and should not be allowed to carry themselves as BE for decades.

I've seen instances where non-boarded physicians supervising CRNAs are a minus, not a plus, to good patient care.

first of all numnuts, take your head from between your legs. and recognize that you cannot be board eligible forever. That eligibility expires after 3-5 years if you dont successfully complete your exam. Board eligibility is the same as certification because you need time to pass the exam. For me it was 9 months after graduating i was board certified. for others it takes a little longerand these docs ought not be penalized. But after like 4 years the eligibility expires and you are no longer board eligible andto call yourself that is illegal.

With respect to what you said about where you have seen instances where non boarded physicians supervising CRNAs are a minus to good patient care.. Give me an example! This ought to be interesting

 

[Monty Python]

as i mentioned in the previous post. CRNAs are NOT board certified. They may be certified but not BOARD CERTIFIED. Itis ILLEGAL to call yourself "BOARD CERTIFIED", if you are not by a recognized board of abms. YOu can go to jail. So while CRNAS may be certified by a 60 multiple choice question test, physicians are board certified by a written entance exam and a rigorous oral examination process.After going through this process, a crnas certification really pales in comparison. Board certification is the standard to which everyone is held. IF you are not you are not meeting standards.

My original comment of Should board certification be required before a physician can refer to him/herself as an anesthesiologist, no matter what residency they completed? was asked in order to stimulate an academic examination of the subject matter (pros and cons).

 

[johankriek]

My original comment of Should board certification be required before a physician can refer to him/herself as an anesthesiologist, no matter what residency they completed? was asked in order to stimulate an academic examination of the subject matter (pros and cons).

you truly need help..... can someone help this joker.. read my posts and you can answer the question yourself..

answer my question about non boarded anesthesiologist being a minus to care., You have steel ******

 

[Monty Python]

first of all numnuts, take your head from between your legs. and recognize that you cannot be board eligible forever. That eligibility expires after 3-5 years if you dont successfully complete your exam. Board eligibility is the same as certification because you need time to pass the exam. For me it was 9 months after graduating i was board certified. for others it takes a little longerand these docs ought not be penalized. But after like 4 years the eligibility expires and you are no longer board eligible andto call yourself that is illegal.

With respect to what you said about where you have seen instances where non boarded physicians supervising CRNAs are a minus to good patient care.. Give me an example! This ought to be interesting

1. As stated elsewhere the ability to diplomatically disagree without being personally disagreeable is a highly desirable professional attribute.

2. The list is long, courtesy of many years working locums in rural places where these non-boarded physicians are able to obtain employment.

Such as no versed allowed on any patient ("delays PACU discharge"), no fem/sciatic blocks allowed on ACL recons ("slows down room turnover"), the previously-mentioned "no LMA -> emergent trach" (yes Sleep is Good, it really happened).

And my favorite: being hustled from the lounge while on break, into the other OR where the other CRNA was in a verbal slugfest with the supervising physician. The supervising physician had wanted to intubate to "knock the rust off". The ETCO2 was flat. No BBS heard. The CRNA was telling the supervising physician that he had goosed the patient. The physician kept saying "just look at the pulse ox." (which was still in the low 90s). After he left the room I scoped, saw the tube in the goose and properly intubated.