Net Cash flow

[militarymd]

---

Members do not see this ad.

.....convincing important people that you get paid too much and you are really not needed......

That's an interesting opinion.

About one year ago, we had many more rooms where the MDs did their own cases, and we all had a lower income.

The "important people" recognized that our group was not getting paid enough, and so we are moving to more supervision.

The "important people" would rather have the physicians available than sit in the room.

I personally would rather do my own cases....it is just SOOO much easier, but that is just a waste of resourses.

To each his own, d2700.....

 

[militarymd]

That's an interesting opinion.

About one year ago, we had many more rooms where the MDs did their own cases, and we all had a lower income.

The "important people" recognized that our group was not getting paid enough, and so we are moving to more supervision.

The "important people" would rather have the physicians available than sit in the room.

I personally would rather do my own cases....it is just SOOO much easier, but that is just a waste of resourses.

To each his own, d2700.....

Why would sitting in a room show that you ARE needed? Any semi-educated person can recognize that anyone can chart vital signs.

 

[davvid2700]

The "important people" recognized that our group was not getting paid enough, and so we are moving to more supervision.

....

Its all about the mighty dollar. Thats what is selling the specialty down the tubes. Thats what gave the crnas wings. one doc would hire 10 crnas and he would supervise all of them. He didnt give a rats ass what they were doing in there as long as he knew he was making 1-2 million dollars a year Hey, of course, his income is going to be more than a doc doing his own cases. that happened for years and years. Thats what we are trying to undo. so Please get off your "make more income" kick and get your ass in the room and chart vitals.. I wish i was your boss.

You heard it here folks.. military is selling the specialty for the almight dollar..


ANd you are talking to a guy who cares about where the specialty is going.

 

[militarymd]

Why are you so insecure about your specialty that you feel you HAVE to be there in the room, sitting there, doing a nurse's job?

I think YOU are selling out our specialty by advocating that we do nurse's jobs.

 

[davvid2700]

I think YOU are selling out our specialty by advocating that we do nurse's jobs.

I advocate that I do the job of an anesthesiologist.

 

[nitecap]

gotcha

 

[davvid2700]

Let me ask you one thing. In my CRNA program our texts are Miller Anesthesia 6th edition, Morgan and Mikal, barash, evers and Maze anesthetic pharm. Thats just to start. I understand your medical degree is a huge accomplishment, heres a pat on the back big dave.


Straight up I study from the same ****t the residents at my program do. What can only a MD/DO learn info and understand the INfo from the above texts?

Your medical knowledge is a mass of knowledge I understand that believe me. But anesthesia wise really as far as comparing the the things I study to that of what I have seen with the CA-1 and even 2's. We study the same stuff, same books, when we do our OB rotations we here the same lecutres in the same class room.

Dont tell me that you had way more experience in treating and titrating pain in med school.Dont tell me that you had way more experience with actual hands on fluid resucitation and hemodynamic management. Hands on not being standing behind an attending or writing an order and leaving. Tell me how many time as an intern in med school that you actually really gave a drug and saw how the patient responded and then changed your plan d/t the response you saw. Tell me how many times you stood at the bedside as an intern manipulating pressors with your hands actually on the drug and infusion pump. Tell how many times you really pushed a drug period and actually sat at the bedside long enough to see a response. Tell me how many times you took off your short coat to actually get in the freakin mix and pump on a chest, precord thump someone, defib someone. Tell me how many times as a med student you manipulated IABP settings other pressors to optimize a pt's status.

Sure as a resident you will do all these things. But face it as a med student you are green at best. JUst walking around with a brain full of memorized ****tt, but no experience or balls to put any of it to use.

SO what you will be a Anesthesiologist, I will be a CRNA and I will manage the patient just as well as you.

Hey if CRNAS bring the same thing to the OR than anesthesiologist, why is one called Doctor and the other one a nurse. You are absolutely clueless. I think CRNA school should be 8 more years then maybe we would be equal. I have seen new crnas come out. they are clueless just like you

 

[nitecap]

Hey if CRNAS bring the same thing to the OR than anesthesiologist, why is one called Doctor and the other one a nurse. You are absolutely clueless. I think CRNA school should be 8 more years then maybe we would be equal. I have seen new crnas come out. they are clueless just like you

Seems like you are pretty clueless about your profession yourself. You dont even know medical direction ratios for reimburstment and other CMS issues that you admit to knowing nothing about in past posts. Why is it that most other MDA's here dont even like your posts and agree that either you are clueless or have very narrow and limited experience. Hey I never discounted your education. Just saying maybe it doesnt take 8yrs to learn anesthesia. Doubt your histology class is going to help you in the OR.

We bring very different things to the OR, doesnt mean we cant both come out with the correct outcome does it?

 

[davvid2700]

Seems like you are pretty clueless about your profession yourself. You dont even know medical direction ratios for reimburstment and other CMS issues that you admit to knowing nothing about in past posts. Why is it that most other MDA's here dont even like your posts and agree that either you are clueless or have very narrow and limited experience. Hey I never discounted your education. Just saying maybe it doesnt take 8yrs to learn anesthesia. Doubt your histology class is going to help you in the OR.

We bring very different things to the OR, doesnt mean we cant both come out with the correct outcome does it?

DUDE,
i dont know crna ratios because i am in an all md practice.. we dont have crnas or aas. How would i know the ratios then??


Histology doesnt help me more or less then it helps the orthopedic surgeon, internists, podiatrists.. neither does most of the stuff we learn.. BUt you have to start somewhere. do you think we should just take someone off the street put them in the OR for 18 months and just teach them how to intubate and not teach them how things relate to one another on a cellular and gross level just like we do with CRNAs.. No.. there is a reason why we are called doctors and you are called a nurse.. You probably didnt even take a full physics course or chemistry course.. Prob took the physics course without the lab..

 

[militarymd]

My point exactly about the stuff in the OR. CRNA/AA/MDA...whatever ..A.... They all read the same books and do the same things in the OR.

Anesthesiologists are supposed to have extra breath of experience inside and outside of the OR.

If you spend all your time sitting on that stool, you'll take 4 times as long to gain your breath of experience.

I attend 4 times as many inductions and emergences than you. I put in 4 times as many blocks as you. I put in 4 times as many central lines, Swans, and Alines than you. I preop 4 times as many patients as you. I attend 4 times as many (name your complication) as you. I work with 4 times as many surgeons as you.....

Completion of residency only gets you ready to start the process of learning to become a fully trained anestheiologist. I'm hiring right now, and the folks I'm looking for need at least 5 years of experience after BC...there is a reason for that.

Each of those experiences, make the anestheiologist a better and better resource to the hospital and surgeon and CRNA/AA.

Sit on your stool all you want and say how great a doctor you are, but in the end, the physicians to see the most patients are the ones with the most experience.

 

[jetproppilot]

DUDE,
i dont know crna ratios because i am in an all md practice.. we dont have crnas or aas. How would i know the ratios then??


Histology doesnt help me more or less then it helps the orthopedic surgeon, internists, podiatrists.. neither does most of the stuff we learn.. BUt you have to start somewhere. do you think we should just take someone off the street put them in the OR for 18 months and just teach them how to intubate and not teach them how things relate to one another on a cellular and gross level just like we do with CRNAs.. No.. there is a reason why we are called doctors and you are called a nurse.. You probably didnt even take a full physics course or chemistry course.. Prob took the physics course without the lab..

David,

Youre wasting your breath.

Youre gonna get all pissed off, this dude is gonna keep coming at you telling you he's greater-than-or-equal-to-you.

You'll end up telling him to go f uck himself, and he'll say the same back.

Its a worthless arguement. I've been there before.

Dudes like a mini chihuahua that just wont quit biting your ankle.

Its aggravating, but its not worth your time to squash him.

 

[davvid2700]

Sit on your stool all you want and say how great a doctor you are, but in the end, the physicians to see the most patients are the ones with the most experience.

yeah ok.. you are much better than me becuase you have crnas do all of your work because you wanna prance around in the or. I know your type.. You cant do a case by yourself.. You need this and that and that and a tech and gloves and then you need the nurse to hold this and then you need the nurse to hold the tape and then you need someone to scratch your balls and then you need someone to get you another this or that.. another catheter, etc.. it goes on and on and on I know the type of somoene who hasnt done a case by himeself in a ... I mean ever..

Dude, I do thoracotomies, carotids, csections,AAAs, peds cases.. all on my own.. I dont call anybody,, i dont ask the nurse to get me anything. I scratch my own balls before i get to the hospital If i need help i enlist the help of the surgeon or one of my colleagues who is between cases.. We check on each other periodically and it works out.. I wouldnt want it anyother way.. IF you think Im inferior because I dont go in and out of rooms watching crnas push drugs so be it.. You are entitled to your opinion but i think its not the correct opinion

 

[jetproppilot]

You cant do a case by yourself..

This is not about egos. Congrats on being able to do a case yourself. And scratch your balls.

Do you truly think that because of where we ended up, where the MD/CRNA model thrives, that we cant do cases by ourselves?

I was headed to Las Vegas...I thought...in 1996 right outta residency, to practice with a cuppla buddies...all MD anesthesia...didnt work out because of hiring freeze concominant to my projected start date...

ended up staying in the southeast. Where I found the best job.

All that being said, in this cost cutting era, I can guarantee you that if my hospital has 40 cases on the board, and your hospital has 40 cases on the board, we will, with our MD/CRNA model, take care of our patients just as well as you, and we'll be done WAY before you.

And in between, we'll take care of OB too.

 

[nitecap]

True dat JPP.

Dave how long was your ball scratching residency, here those are hard as all hellll to match, but that the field is rather lucrative. Immediate satisfaction.

 

[militarymd]

Dude, I do thoracotomies, carotids, csections,AAAs, peds cases.. all on my own.. I dont call anybody,, i dont ask the nurse to get me anything. I scratch my own balls before i get to the hospital If i need help i enlist the help of the surgeon or one of my colleagues who is between cases.. We check on each other periodically and it works out.. I wouldnt want it anyother way.. IF you think Im inferior because I dont go in and out of rooms watching crnas push drugs so be it.. You are entitled to your opinion but i think its not the correct opinion

Who do you think does all the emergencies in the middle of the night when there is no CRNAs around? I do...the ruptured AAA, crash c-sections, blah, blah, blah...

They physician extenders are around during the day to extend ourselves....come nightime, when the sh it really hits the fan....I'm all by myself...

You need to look around man. There is more than one way to run an OR. I'm afraid you don't understand business.

 

[Disse]

I just enjoy doing my own cases.. I enjoy pushing my own drugs.. I have never had a job supervising crnas.. I chart my own vitals, i give my own fluid.. i waste awayin the room the whole day and so do my colleagues.. I take my breaks between cases.. Ive been at it for 2 years.... I do triple aaa my self.. I do thoracotomies myself.. The Or nurses step up and so does the anesthesia tech.. They are at out beckon call. damn the tech even takes our luncho orders and gets it.. Hey having 2 crnas doing my the work for me would be nice.. but wouldnt be as fun...

just my opinion.. call it dumass if you want jet

Where'd you do your residency davvid?

 

[davvid2700]

Where'd you do your residency davvid?

a no name program in the northeast... community hospital based farmed us out for major stuff...

 

[bogatyr]

Hey xmmd,

Could you comment more about only hiring docs with 5 years experience? Are you finding a large applicant pool? It would seem to me at that most people are already in a job they like at that stage of their career. Does your group have some type of amazing enticements to lure people away from other practices? Also, do you still make them wait x years until partner?

 

[militarymd]

Hey xmmd,

Could you comment more about only hiring docs with 5 years experience? Are you finding a large applicant pool? It would seem to me at that most people are already in a job they like at that stage of their career. Does your group have some type of amazing enticements to lure people away from other practices? Also, do you still make them wait x years until partner?

The pool isn't that big, I think that the average anesthesiologist goes through 2 to 3 jobs before settling, so there are definitely folks looking.

My rationale is this. Finishing your residency, although a big milestone, is just the beginning of an anesthesiologist's education. There is a lot of seasoning that needs to occur after you get board certified, and I find that, that is what my surgeons and the administration wants.

If you give the administration and the surgeons quality, then you have the makings of a happy and stable group.

We're not offering that much, just equal pay from day one, and partnership within a month or so.....we just want to weed out the personality disorders and lazy folks.....oops I just said a sensitive word....."lazy" ...oh well.

 

[davvid2700]

The pool isn't that big, I think that the average anesthesiologist goes through 2 to 3 jobs before settling, so there are definitely folks looking.

My rationale is this. Finishing your residency, although a big milestone, is just the beginning of an anesthesiologist's education. There is a lot of seasoning that needs to occur after you get board certified, and I find that, that is what my surgeons and the administration wants.

If you give the administration and the surgeons quality, then you have the makings of a happy and stable group.

We're not offering that much, just equal pay from day one, and partnership within a month or so.....we just want to weed out the personality disorders and lazy folks.....oops I just said a sensitive word....."lazy" ...oh well.

Good luck in your search for the guy/gal board certified, 5 years out. . You probably are having trouble recruiting anybody let alone with those two qualifications. You may be able to recruit somebody right out of residency and tell him all the bull**** that you are spewign on this board and he will sign on because he doesnt know any better. But somone who is board certified at least 2 years out (me), can smell the bull**** during the phone conversation and wont even bother coming to meet you. Ill go elsewhere. IM serious about this. Anybody who says you need 5 years experience after residency to do this job is a ******* ing B u l l s h i t artist who wants to take you for a ride.. ANybody disagree?

 

[militarymd]

Good luck in your search for the guy/gal board certified, 5 years out. . You probably are having trouble recruiting anybody let alone with those two qualifications. You may be able to recruit somebody right out of residency and tell him all the bull**** that you are spewign on this board and he will sign on because he doesnt know any better. But somone who is board certified at least 2 years out (me), can smell the bull**** during the phone conversation and wont even bother coming to meet you. Ill go elsewhere. IM serious about this. Anybody who says you need 5 years experience after residency to do this job is a ******* ing B u l l s h i t artist who wants to take you for a ride.. ANybody disagree?

Guess what? I have one guy joining me this spring with 4 years experience...not quite 5, but close enough.

Guess what again? I have another guy joining me sometime in the next few months with 9 years experience, like me.

I guess there are a lot of fools out there.

Doing anesthesia is easy....all these cases you're talking about (aaa, carotid, thoracotomies, etc.) are easy....they are challenging for new residents, but after you finish training, they are just part of your everyday life.

The rest of medicine, and the management of an efficient OR and business is hard....that consumes most of my energy.

I guess if you think you've mastered everything you need at 18 months after residency, then good for you.

I 'm definitely a slower learner, because I'm still learning things everyday.....some of it from CRNAs who have been doing this since before I was born.

 

[davvid2700]

I guess there are a lot of fools out there.

[/QUOTE


You said it not me

 

[davvid2700]

Doing anesthesia is easy....all these cases you're talking about (aaa, carotid, thoracotomies, etc.) are easy....they are challenging for new residents, but after you finish training, they are just part of your everyday life.

The rest of medicine, and the management of an efficient OR and business is hard....that consumes most of my energy.

.

I dont think anesthesia is easy at all. I think it is challenging. It may be easy to you because you are never in the frigiin room. Of course its easy when someone else is doing your work. And they are challenging for anybody. How can you say something like that?


I didnt go into medicine to manage an OR. You think thats why i went to school; that truly is the domain of a nurse. I went into medicine to treat my patients. period. I can tell the or nurses, manager what i want and she or he can implement it. plus, thats why they do not teach it in residency and thats why they dont ask about it on the oral boards..

Get a friggin life

 

[militarymd]

I guess there are a lot of fools out there.

[/QUOTE


You said it not me

It was sarcasm. I guess you missed it.

Anyways, what's up with the animosity? What's up with the name calling? What's up with the "there is only one way to do things....the Davvid2700 way"?

I hope you realize that a lot of what I say are things that the leadership of the ASA advocate.

 

[militarymd]

I dont think anesthesia is easy at all. I think it is challenging. It may be easy to you because you are never in the frigiin room. Of course its easy when someone else is doing your work. And they are challenging for anybody. How can you say something like that?

Did you read what I posted? I do cases also. Usually, the emergencies in the middle of the night when there is no one around except for the surgeon and me and the night OR crew. I know how to do cases, and compared to supervising....it is easier.

How can you compare when you've only done cases and not supervised?

And yes, I do find the physical act of doing the cases pretty easy compared to running the board and supervising nurses. After doing cases for a while, it gets to that.

 

[davvid2700]

I hope you realize that a lot of what I say are things that the leadership of the ASA advocate.

Well my point exactly. If the leadership of the ASA were on the pulse and were proactive instead of reactive then we would not have 14 states opting out of the supervision requirement and prob half the nation will follow along in the next 10 years.. You know where im getting at mr. im running the board?

Im getting at less jobs for us, less positions for us. This is a serious issue. Now is the time to be vocal about it since many many more americans are going into anesthesia vs general surgery, obstetrics and radiology. We are recruiting from the top of the classes now, not from the middle or bottom like years before. If you dont see my point your head is in the sand my friend. in the sand.

 

[militarymd]

Anyways, what's up with the animosity? What's up with the name calling? What's up with the "there is only one way to do things....the Davvid2700 way"?

Answer this one please.

 

[militarymd]

Well my point exactly. If the leadership of the ASA were on the pulse and were proactive instead of reactive then we would not have 14 states opting out of the supervision requirement and prob half the nation will follow along in the next 10 years.. You know where im getting at mr. im running the board?

Im getting at less jobs for us, less positions for us. This is a serious issue. Now is the time to be vocal about it since many many more americans are going into anesthesia vs general surgery, obstetrics and radiology. We are recruiting from the top of the classes now, not from the middle or bottom like years before. If you dont see my point your head is in the sand my friend. in the sand.

The leadership of the ASA is putting their heads in the sand? You, who trained at a no name program in the NE with a whopping 18 months of experience at one practice, know what's going on with the specialty, and the leaders of the ASA do not?

Where are you getting all your information?

Why the concern about jobs? and job security? Why are you so insecure about your specialty? Please answer those questions.

 

[mountaindew2006]

Well my point exactly. If the leadership of the ASA were on the pulse and were proactive instead of reactive then we would not have 14 states opting out of the supervision requirement and prob half the nation will follow along in the next 10 years.. You know where im getting at mr. im running the board?

Im getting at less jobs for us, less positions for us. This is a serious issue. Now is the time to be vocal about it since many many more americans are going into anesthesia vs general surgery, obstetrics and radiology. We are recruiting from the top of the classes now, not from the middle or bottom like years before. If you dont see my point your head is in the sand my friend. in the sand.

with all due respect mil med i think you have been a great asset to this forum w/o a doubt.

nevertheless, I do believe davvid has a pt here in so much as NOW, more US grads that are from the top of their classes are pursuing anesthesiology, something that has not occurred for quite some time until recently---if ever. Yes, many of us here maybe perceived as the 'surgeon' types but that's a good thing, we're here to secure the future (jobs,etc) for anesthesiologists from the rape and pillage from CRNAs. Look at the surgeons. You will never see a surgical assitant or tech talk to the surgeons the way CRNAs talk to us! How many times as a med student did I see/hear CRNAs and scrub nurses, etc treat Anesthesiologists like $hit. Guys, this is our profession, its a NOBLE profession...let's friggin make these mid-levels respect us. Yes, respect is earned, but some of these mid-levels have no cognition of what it is. Believe me, those CRNAs that seem to be getting along w/you are just 'playing the role'. Most, will snicker or tell the nurse next to them that they can do just as much. These CRNAs have their eye on bigger and better portions of the pie....dont believe me, just look at what their lobbying groups are doing.

Again...I'm all for them doing MAC cases. I really do not have a clue where these CRNAs get this idea that they are just as good or have just as good clinical expertise as us (I think it was this thread that that was addressed). Yes, we were med students and residents when u were a CRNA. But you know what, we dont just treat NUMBERS, we TREAT THE PATIENT. We have a better grasp of the physio and pharm of the patient. We know what questions to ask preop and we know what are considered 'red flags' in a pt's hx, etc. These valued points are not ascertained by doing a few years in nursing school. Medical school is the time where we indulge ourselves in these things, mk mistakes, learn from them, and move on to become doctors. IF you all (CRNAs) think you are just as good...then go back to med school! remember, the anesthesiologist is a clinical physiologist. Just because you read a few of the same books, we know how to CLINICALLY utilize the knowledge, which comes from med school/residency. Why else would med school/residency be 8+ years 🙄 🙄

Mil Med (not to call you out) but you of all people having been in the military should realize the importance of rank. I believe this rank needs to be better delineated in this fast growing field of anesthesia. In my opinion AAs are more benign and take up a more 'assisting mentality'.

my two cents

 

[mountaindew2006]

Why the concern about jobs? and job security? Why are you so insecure about your specialty? Please answer those questions.

concern for jobs---well if CRNAs take more positions, gues what we'll be forced out of the OR and must end up doing specialized (pain, CCM,etc) to mk a good living.

additionally, the compensation for your work will have to be halved because CRNAs will be more prominent. Yes, I did go ot med school for helping people etc...however, I also have 200K in loans, etc. Some midlevel CRNA that went to some community college, did a yr or two in ER, and then some yrs in nursing school will come out mking 200K. Doesnt that sound a little peculiar? does to me, especially if i wanted to do Gas because fo the OR aspect and not because I wanted to do pain,etc. I dont want to be forced into doing something I never had a passion for.

This is OUR specialty Mil Med. Look...the CRNAs coudl still be used, but I believe their pay (which is why they go into it....if they watned 'challenges' etc they coulda been a ICU, CCU, SICU nurse). THey are in it for the $$$$ and are literally robbing us. 😎

 

[militarymd]

Mil Med (not to call you out) but you of all people having been in the military should realize the importance of rank. I believe this rank needs to be better delineated in this fast growing field of anesthesia. In my opinion AAs are more benign and take up a more 'assisting mentality'.

my two cents

Your're absolutlye right about many aspects of our specialty, but you pointed out...we recognize the red flags, etc.

We recognize those flags before surgery, and we treat before surgery, and after surgery. Once your're in the OR.....things that you do are simple.

99% of the OR is charting vital signs, administer fluids, maybe vasoactive drugs......who does that everywhere else in the hospital? Nurses, not physicians.

I'm not in the OR to chart vitals and perform nursing duties. I come into the OR to do the things that you mentioned above. I do that also before the OR, in the PACU, and in the ICU.

I chart vital signs at night because it makes more economic sense for me to do it myself than to pay someone $100 per hour to do it.

 

[militarymd]

concern for jobs---well if CRNAs take more positions, gues what we'll be forced out of the OR and must end up doing specialized (pain, CCM,etc) to mk a good living.

Why would you ever be forced out of a job, if you are truly better than them?

If you, as an anesthesiologist, feel that you can do a much better job than a CRNA in the Or, then why would you ever be forced out of a job?

That would only happen if someone else can do the same for less money...so is everyone worried because everyone thinks that it can be done for less money?

 

[MedicinePowder]

Why would you ever be forced out of a job, if you are truly better than them?

If you, as an anesthesiologist, feel that you can do a much better job than a CRNA in the Or, then why would you ever be forced out of a job?

That would only happen if someone else can do the same for less money...so is everyone worried because everyone thinks that it can be done for less money?

The needed change in anesthesiology will happen within a decade, when the new crop or new generation of anesthesiologist put an end to the self-deprecating that has gone on too long by alot of the current anesthesiologists.

The thing with some CRNAs is that they want to make clear that they know as much as an MD/DO. Bottomline, they are certified nurses, while we are doctors or medicine. To the guy who claims that they read the same texts as anesth residents, I was studying at starbucks and saw a dude reading a radiology text, the same one I saw doing my radiology rotaion. Turns out he was studying to be a radiology tech at a community college. This dude would get laughed at if he flaunted to a radiologist that he read the same book he did. Just give up, if as a CRNA u want to be at equal level of an MDA, it just won't happen. Take time off, take the prereqs and get A's, then score high on the MCAT, then sacrafice four years of your life with endless stress, then you'll be at equal level.

 

[mountaindew2006]

Why would you ever be forced out of a job, if you are truly better than them?

If you, as an anesthesiologist, feel that you can do a much better job than a CRNA in the Or, then why would you ever be forced out of a job?

Mil Med, you seem like a reasonable guy and quite informative. As you should know by now, medicine is NOT run by pt care anymore, it's all about reimbursements and money...atleast that's what most hospital administrators feel. Hosp administrators are only concerned about numbers.

So does it matter who is better a MDA or CRNA? hell no. it's quite obvious that a MDA is better simply by virtue his status. but let's not even consider that. Let's take Davvid here....seems like he does most of his work by HIMSELF, so he's prolly a damn good MDA. But let's look from the hosp adminstration point of view. They see Davvid and then they see CRNA X. who is cheaper? hmmmm but who is better???


Furthermore, most MDAs I know always are in tune w/ the most recent research,etc. THey know what's in the forefront of medicine. CRNAs....well have you ever asked one to discuss diffusion hypoxia or even cardiac interdependence? most will be like, "well oh I know we gotta give O2 after each case". Thats it. they dont know the actual mechanism. or WHY.

So mil med, i would have to respectfully disagree w/ ur line of thinking. in this day and age when it's all about #'s, we MDAs/future MDAs must put our foot down and control this mess. pretty soon you'll see CRNAs trying to do CCM, Pain,etc. I mean most pain services already have these nurses prancing around w/ them. Man, I'm telling you the situation is GRAVE. Change must be made.

And like the last poster stated, I think it will take this NEW GENERATION (thank god) of MDAs. And yes, that means me. And to all you CRNAs out there, heck yah, things are going to be different.

 

[militarymd]

Mil Med, you seem like a reasonable guy and quite informative. As you should know by now, medicine is NOT run by pt care anymore, it's all about reimbursements and money...atleast that's what most hospital administrators feel. Hosp administrators are only concerned about numbers.

I AM trying to inform you. I AM in private practice. I AM aware of what the administrators want. I talk with them frequently about how to make our hospital and OR better.

That fact that it IS all economics IS what I'm trying to tell you less experienced folks.

The hospital and the surgeon actually doesn't care if you can discuss "cardiac interdependence"....even the cardiac surgeons.

I'll tell you what hospitals want. Maximum anesthetizing locations with the minimum cost.....how do you do that?

I'll tell you what surgeons want.....patients into and out of ORs without delay....they don't care if you can talk about "cardiac interdependce"....They probably care about efficiency more than about safety....how do you do that?

All by yourself??? Probably not.

I can turn a room around pretty damn fast by myself, but you know what, the turnaround is a lot faster when i work with a CRNA/AA....even with a slow CRNA/AA

 

[rs2006]

Hi all,
Happy turkey day!! With all due respect to all the wonderful attendings here who so willlingly answer all the questions that are asked on this website, I just wanted to ask the REAL QUESTION that has been raised by all of these posts above-- Given the REALITY of the future/present state of healthcare in this country (an aging population, medicare and medicaid that are financially cash strapped, a health insurance system that is hapless, etc), it seems as if CRNAs are an economical alternative to providing anesthesia services (they provide care at approx 1/2 cost of MDA-- heck, PAs now see alot of Primary care pts at a reduced cost as well, and the same movement is happening in other specialties-- psychologists vs psychiatrists, teleradiology vs radiologists, etc) why is it that the market has not moved in the same direction in Anesthesia (toward the cheaper CRNAs from the standpoint of decreased compensation for services, etc) when MOST other fields in medicine have received HUGE paycuts over the past few years-- is it just supply and demand that is keeping this going, or is there some other unseen force that I am unable to comprehend as a lowly medical student?? Any thougts-- also I do not want to start a war with this question-- would prefer only a gentleman's discussion regarding this issue. Thanks.

Mil Med, you seem like a reasonable guy and quite informative. As you should know by now, medicine is NOT run by pt care anymore, it's all about reimbursements and money...atleast that's what most hospital administrators feel. Hosp administrators are only concerned about numbers.

So does it matter who is better a MDA or CRNA? hell no. it's quite obvious that a MDA is better simply by virtue his status. but let's not even consider that. Let's take Davvid here....seems like he does most of his work by HIMSELF, so he's prolly a damn good MDA. But let's look from the hosp adminstration point of view. They see Davvid and then they see CRNA X. who is cheaper? hmmmm but who is better???


Furthermore, most MDAs I know always are in tune w/ the most recent research,etc. THey know what's in the forefront of medicine. CRNAs....well have you ever asked one to discuss diffusion hypoxia or even cardiac interdependence? most will be like, "well oh I know we gotta give O2 after each case". Thats it. they dont know the actual mechanism. or WHY.

So mil med, i would have to respectfully disagree w/ ur line of thinking. in this day and age when it's all about #'s, we MDAs/future MDAs must put our foot down and control this mess. pretty soon you'll see CRNAs trying to do CCM, Pain,etc. I mean most pain services already have these nurses prancing around w/ them. Man, I'm telling you the situation is GRAVE. Change must be made.

And like the last poster stated, I think it will take this NEW GENERATION (thank god) of MDAs. And yes, that means me. And to all you CRNAs out there, heck yah, things are going to be different.

 

[mountaindew2006]

Hi all,
Happy turkey day!! With all due respect to all the wonderful attendings here who so willlingly answer all the questions that are asked on this website, I just wanted to ask the REAL QUESTION that has been raised by all of these posts above-- Given the REALITY of the future/present state of healthcare in this country (an aging population, medicare and medicaid that are financially cash strapped, a health insurance system that is hapless, etc), it seems as if CRNAs are an economical alternative to providing anesthesia services (they provide care at approx 1/2 cost of MDA-- heck, PAs now see alot of Primary care pts at a reduced cost as well, and the same movement is happening in other specialties-- psychologists vs psychiatrists, teleradiology vs radiologists, etc) why is it that the market has not moved in the same direction in Anesthesia (toward the cheaper CRNAs from the standpoint of decreased compensation for services, etc) when MOST other fields in medicine have received HUGE paycuts over the past few years-- is it just supply and demand that is keeping this going, or is there some other unseen force that I am unable to comprehend as a lowly medical student?? Any thougts-- also I do not want to start a war with this question-- would prefer only a gentleman's discussion regarding this issue. Thanks.


Dude, that's what my posting is trying to prevent...both paycuts and downsizing.

rs2006...hopefully as a future MDA you'll see what i mean. We must all stand together in this fight against the CRNA (as they do united against us) to ensure that this 'paycut' and downsizing does NOT happen to our profession.

 

[bell412]

Mountain
I wanna help you out here. See in order to get rid of the CRNA you gotta get rid of nurses. Thats the root of your whole problem.

 

[militarymd]

...... to ensure that this 'paycut' and downsizing does NOT happen to our profession.

So, it's just about money? What are you trying to say? Fight the CRNAs so that you can get paid more to do the same job?

 

[mountaindew2006]

So, it's just about money? What are you trying to say? Fight the CRNAs so that you can get paid more to do the same job?

please refrain from just taking tidbits and then glorifying them.

yes, pay is certainly important. I mean you have said on here that you are not in it for the money, well thats nice, but heck you've already practiced for X number of years when the money was already good. You've already made your cash and like the gambler at the casino...either busted or is about read to cash out.

having said that...no its not just about money. If you read my earlier posts both here and on the other thread i made.....i believe MDAs provide a better qaulity of care. as a result of that yes they should be compensated better. Secondly, what you may think of just charting vitals, is exactly what is happening now. The CRNAs have gotten their foot in the door...and well you know what happens when the door is slightly opened....

it's about patient care mil.... its been my underlying argument all along. if you dont believe MDAs provide a better quality of care than CRNA, i must question your desire to pursue anesthesiology as a physician as opposed to a CRNA. It's my belief that you pursued the physician route for a reason. Dude, you are the one thats talking money here. You want to use CRNAs and maximize profits, which is just what the hosp adm is looking for.

dont u see...if we all worked together and all of us used ONLY MDA staff...yes perhaps 'turnover' rate may be slower but...
1)we're not selling out the professsion to mid levels
2)pt's get a better quality of care.


to the previous poster who said that u wanted to get rid of the nurses altogether i hope that was sarcasm. lol non-CRNAs are ok w/ me

 

[mountaindew2006]

happy T DAY!

 

[rn29306]

.......if they watned 'challenges' etc they coulda been a ICU, CCU, SICU nurse). THey are in it for the $$$.....

Critical care experience, be it ICU, CCU, CVICU, Neuro, Peds, MICU, or SICU, is what is required before CRNA school. ICU nursing isn't that hard after a while either. Frankly I was bored.

Rant all you want, but at least know the facts before oral garbage comes spewing forth...

 

[militarymd]

but heck you've already practiced for X number of years when the money was already good. You've already made your cash having said that...no its not just about money.

You know why my onscreen name is "militarymd"? It means I was in the military for 11 years.....Do you know what I made in the last 6 months of my military career? $36,000

The CRNAs have gotten their foot in the door...and well you know what happens when the door is slightly opened....

In case you didn't know, their foot was in the door before us....or at about the same time.

You want to use CRNAs and maximize profits, which is just what the hosp adm is looking for.

It's not about money, it's about efficency AND patient care. Do you really think you can do it better ALL by yourself? Over a team approach? Do you really think that one pair of hands is better than 2 pair of hands? If so, then there is an ego problem.

I'm always happy to have a second pair of hands when someone is going to sleep, when they're waking up...when there is excessive bleeding.

I'm seeing a lot of young bucks with a lot of excessive egoes.....same that is being said about the militant CRNAs.

 

[nitecap]

gone again

 

[bell412]

no sarcasm mountain. You need to get rid of nurses plain and simple. I think the AMA could start a grassroots agenda and start training medical assistants to replace nurses. All your problems would be solved. No more midlevels. The whole problem with anesthesia is that in 20 years the actual intraoperative phase is gonna be even easier. Hell just press a button and your anesthetic will be given for the entire case! You won't even have to chart vital signs, the computer will take care of it for you. The only thing you will have to do is dump pee and turn the bed every once and a while. Twelve years of intense education to just sit on your ass. Your a fool if you think its not going to happen.

 

[nitecap]

no sarcasm mountain. You need to get rid of nurses plain and simple. I think the AMA could start a grassroots agenda and start training medical assistants to replace nurses. All your problems would be solved. No more midlevels. The whole problem with anesthesia is that in 20 years the actual intraoperative phase is gonna be even easier. Hell just press a button and your anesthetic will be given for the entire case! You won't even have to chart vital signs, the computer will take care of it for you. The only thing you will have to do is dump pee and turn the bed every once and a while. Twelve years of intense education to just sit on your ass. Your a fool if you think its not going to happen.

Guess they could invent robots to take care of pt's on the floors as well. Hey you dont here much about an MD shortage, its a nursing shortage that has everyone spooked. So you launch your agenda,what will you call your med assistants low levels? Wake up from your dream bell, in twenty years all nurses will prob be making 70k base, 100k with overtime. Its all about supply and demand as is everything.

 

[powermd]

Could somebody please explain to me how a nurse can spend a few years in the ICU, bust through an anesthetist program, and all of a sudden feel competent to practice medicine? After four years of med school, a year of internship, and nearly six months of anesthesia residency I am still acutely aware of my limitations. Spend enough time listening to CRNA independance advocates and it's hard not to believe they managed to figure out a way to be a doctor - competently - without going to medical school. Maybe I just haven't spent enough time working with real world CRNAs to know their limitations. Or maybe anesthesiology is just a special case of a medical field that one does not actually need to be a doctor to practice competently. It makes me wince a little bit to think the time and energy I put into becoming a physician is irrelevant to my job. I think that feeling underlies a lot of the insecurity some anesthesiolgists feel where CRNAs are concerned. It's more than just concern over job security.

 

[2ndyear]

Just a couple of tidbits from "The Man" on what his opinion of the field may be in 20 years, since it was brought up:

"Credentialing will be based more on demonstrated competence rather than academic degree or board-certification. Turf wars will increasingly occur, with traditional boundaries for scope of practice being severely challenged. "

"With the advances in technology and pharmacology, how qualified will the future intraoperative anesthesia provider need to be?"

"Should the future of our specialty be nearly entirely based on operating room anesthesia? If the status quo persists, the answer is possibly yes. If the predicted changes in technology and pharmacology allow a lesser-trained individual to deliver anesthesia, then the answer is no. If the later prediction is correct, then diversification of practice paradigms is a more fundamentally sound basis for the future of anesthesiology. "

I think the whole talk sums up the notion that the care team approach is more likely to be what is used in the future, with sicker patients and more demand for MD's doing perioperative care, hopefully with better outcomes and shorter stays (like the Leapfrog study of intensivists). Who makes up that team? Who knows. MD's will have some role in selection of patients, preoperative workups, and modification of risk factors, but who will be 'warming the stool'? Could be the new 'Propofol Pushing RN's' that are making their way into the field, a CRNA trained at the current level, or some other new type of provider not yet defined.

I'm not sure where the doctorate level CRNA's will fit into the picture, the AANA will have to define where they want to be: in the OR or expanding out of it. If you were to believe Miller, then it could be argued that a doctoral level education will add little to intraoperative care with new technology (TCI, better BIS type monitors, etc.). Especially since the track record of Masters, and even less than Masters level CRNA's is too good to argue more education. Pain would be the only area I could see it being beneficial. As far as ICU and perioperative medical care, there are already mid-level pathways that will include standardized clinical doctorates for NP's in place, and many mid levels are already staffing ICU's and rounding on med/surg patients on the floors. Diluting the field with doctoral level perioperative providers leaves a big hole in the OR that the AANA won't want to give up.

But what do I know anyways, I'm just a CA1 who read the article I'll link here:
http://www.asahq.org/Newsletters/2005/10-05/miller10_05.html

 

[davvid2700]

Anyways, what's up with the animosity? What's up with the name calling? What's up with the "there is only one way to do things....the Davvid2700 way"?
QUOTE]

What anonymity? what are you talking about? do you want my full name first and last name? what does it matter to the discusiion at hand dude

 

[davvid2700]

99% of the OR is charting vital signs, administer fluids, maybe vasoactive drugs......who does that everywhere else in the hospital? Nurses, not physicians.

I'm not in the OR to chart vitals and perform nursing duties. I come into the OR to do the things that you mentioned above. I do that also before the OR, in the PACU, and in the ICU.

QUOTE]