New political subforum?

[Taurus]

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It doesn't seem like we can get away from the politics.

Did the Powers That Be agree to create a political subforum for anesthesia? I checked out that Topics in Healthcare forum and nobody goes there.

 

[BLADEMDA]

It doesn't seem like we can get away from the politics.

Did the Powers That Be agree to create a political subforum for anesthesia? I checked out that Topics in Healthcare forum and nobody goes there.

Anytime the moderators allow OPEN political discussion you can count on me to be there in full force.

Blade

 

[armygas]

Just a thought, but the moderators may want to consider subdividing the forum into focused areas based on the site's popularity.

I.E.

Politics
Cases
Regional Anesthesia
Pain
etc, etc
......................

 

[Trisomy13]

I see it this way - we have a political forum, i.e. the private forum. Plenty of good resourceful political discussion there. If the nurses want a political forum they can find it at allnurse. Anything in an open political forum, as amply evidenced by prior posts, would likely degenerate into nasty name-calling or sycophantic lip service, neither of which is helpful to anyone. So what's the point?


*edit * And to preemptively address the inevitable "why do you hate/fear free speech" post - this is a controlled forum with a designated purpose, not a soapbox on Main Street. Deal with it.

 

[armygas]

If the nurses want a political forum they can find it at allnurse.

That is actually one of the worst forums.......... floor nurses really have no clue about us. CRNAs are like the warrant officers of anesthesia, we are highly trained and specialized and can "fly the helicopter" but we don't fit in with the nurses or the MDs.

Still curious why you wouldn't want to have (non-name calling) frank discussions from both sides of an issue in a open political forum? It actually can enlightening both sides and possibly bridge gaps.

 

[BLADEMDA]

That is actually one of the worst forums.......... floor nurses really have no clue about us. CRNAs are like the warrant officers of anesthesia, we are highly trained and specialized and can "fly the helicopter" but we don't fit in with the nurses or the MDs.

Still curious why you wouldn't want to have (non-name calling) frank discussions from both sides of an issue in a open political forum? It actually can enlightening both sides and possibly bridge gaps.

Look,

Noy and JPP don't wany ANY politics in the public forum. Respect it or you will be WHACKED by JPP. As long as the AANA has its troops TESTIFY UNDER OATH blatant LIES there is no bridge to Gap. The Public forum is purely CLINICAL for now. But, the PRIVATE FORUM is a whole different matter.👍

Blade

 

[CremeSickle]

Gotta love the double-talk here.

Noy and JPP don't wany ANY politics in the public forum. Respect it or you will be WHACKED by JPP.

And then RIGHT afterward

As long as the AANA has its troops TESTIFY UNDER OATH blatant LIES there is no bridge to Gap.

You crack me up blade. Im waiting for your 'wack'.

 

[BLADEMDA]

Gotta love the double-talk here.



And then RIGHT afterward



You crack me up blade. Im waiting for your 'wack'.

What is your problem? Are you telling everyone here that ZWERLING wasn't
BLATANTLY LYING under Oath? The only Double talk here is your CRNA colleagues on SDN trying to reopen some old wounds.

Time for the MODS to close this thread! One last thing if it was up to me I would have you WHACKED by JPP.

Blade

 

[CremeSickle]

LOL

so.. you start the politic and im the one to blame. Yah, thats typical. Your actions in these types of threads dont make us look good as a profession. Keep it in the private forum where people who want to hear your rhetoric can kiss your a ss. I wont be one of them.

 

[toughlife]

What is your problem? Are you telling everyone here that ZWERLING wasn't
BLATANTLY LYING under Oath? The only Double talk here is your CRNA colleagues on SDN trying to reopen some old wounds.

Time for the MODS to close this thread! One last thing if it was up to me I would have you WHACKED by JPP.

Blade

His problem is that he is a CRNA. Why is it so hard for everyone to realize who this cat is? He doesn't contribute with any clinical cases, jumps on us at the first sign of CRNA bashing, and is always siding with the competition. Do we need any more proof??

Moderators, cremesickle needs to be banned.

 

[CremeSickle]

Toughlife.

Clearly you have not been reading my posts. I have contributed to many clinical posts as well as started a few of my own (i guess the hundreds of ppl who dont post on every clincal case but view them are all CRNAs?). Secondly, I only reply to the BS that comes from you and your lackies that sorely needs correcting. I certainly dont want CRNAs thinking you speak for all anesthesiologists as that simply isnt the truth. Just because everyone isnt militant like you dosent make them CRNAs.

In my opinion, you cant be trusted with my ASA number and name. Why would I after all the name calling and childish/unprofessional behavior Ive seen from you on this forum? Please, get a grip. Your position isnt the popular one among anesthesiologists nationally its fringe.

 

[BLADEMDA]

Toughlife.

Clearly you have not been reading my posts. I have contributed to many clinical posts as well as started a few of my own (i guess the hundreds of ppl who dont post on every clincal case but view them are all CRNAs?). Secondly, I only reply to the BS that comes from you and your lackies that sorely needs correcting. I certainly dont want CRNAs thinking you speak for all anesthesiologists as that simply isnt the truth. Just because everyone isnt militant like you dosent make them CRNAs.

In my opinion, you cant be trusted with my ASA number and name. Why would I after all the name calling and childish/unprofessional behavior Ive seen from you on this forum? Please, get a grip. Your position isnt the popular one among anesthesiologists nationally its fringe.

I agree you have clinical posts. But, any good CRNA could have done the same. You claim NO DOUBLE TALK, right? So, is ZWERLING LYING on the video, yes or no? If he is lying which any BSN could see then stop with your B.S.! Or, is that against your AANA membership rules?

Blade

 

[CremeSickle]

i watched the video. If Zwerling is the worst the AANA has to throw at us Im not concerned at all.

However, just to clarify, what part(s) do you think he was lying about and ill tell you what i think.

 

[proman]

i watched the video. If Zwerling is the worst the AANA has to throw at us Im not concerned at all.
.

I'm sure you meant to say "best", right?

 

[BLADEMDA]

i watched the video. If Zwerling is the worst the AANA has to throw at us Im not concerned at all.

However, just to clarify, what part(s) do you think he was lying about and ill tell you what i think.

PA Legislature:

Can you think of ANY scenario where an Anesthesiologist would be needed in the room?

ZWERLING:

No. Well, maybe in a teaching hospital where they are needed to train Resident Anesthesiologists.

CASE CLOSED! I have saved CRNA's many times my friend. Without me there would be dozens of dead patients in my area and probably thousands across the USA. This is the reality of the real world outside the political arena CREME. The FACT is your average community college graduate with a BRIDGE To BSN then 28 months at a community hospital becoming a CRNA CAN'T PRACTICE MEDICINE VERY WELL! This means they NEED supervision when working at the BIG medical centers across the USA.

Those of us like JPP and Mil MD work with CRNA's every day. We don't have a beef with the "average" CRNA who recognizes his/her limitations. We have a congenial realtionship with them and recognize each individual's skill set.
But, for any CRNA to claim that ANESTHESIOLOGISTS ARE NEVER NEEDED in the room is a blatant lie.

Anytime Mods please feel free to close this thread as CRNA's like Creme won't EVER admit the truth.

Blade

 

[BLADEMDA]

Now, I have posted enough comments to prove my point. The Mods don't want politics in the public threads so let us all just move on. But, FACTS ARE FACTS and not politics.

Blade

 

[CremeSickle]

ewps

yah 🙂

I'm sure you meant to say "best", right?

 

[armygas]

I have saved CRNA's many times my friend.

Blade, with all due respect, that role has been reversed on numerous occasions (i.e a CRNA being able to perform a procedure that the MD had difficulty). That doesn't mean anything, sometimes its just not your day but a good provider realizes it, isn't to proud to ask for assistance and another person is able to fix the problem.

I have helped people and people have helped me, the bottom line is patient safety, so again I would say your example is a reciprocal one.

 

[urgewrx]

CremeSickle, dude, we all know you are a CRNA. Your midichlorian level is non- existent.

 

[armygas]

Can you think of ANY scenario where an Anesthesiologist would be needed in the room?

Again, with all due respect, in my world as long as an oral surgeon/dentist or a surgeon is in the OR then the presence of an anesthesiologist is not required.

However on that note, if the case is an ASA 3 or greater and if an anesthesiologist is available then a consult with the anesthesiologist should (and if I am doing the anesthetic will) occur.

 

[toughlife]

Where Are You?? You Need To Ban These Nurses Stat!

Get Them Out Of Here.

 

[urgewrx]

(i.e a CRNA being able to perform a procedure that the MD had difficulty).

A high school student could do any procedure if he were allowed.

Ability to think clearly on your feet is what's important. I would be my ranch against any CRNA out-thinking me.

 

[Planktonmd]

Blade, with all due respect, that role has been reversed on numerous occasions (i.e a CRNA being able to perform a procedure that the MD had difficulty). That doesn't mean anything, sometimes its just not your day but a good provider realizes it, isn't to proud to ask for assistance and another person is able to fix the problem.

I have helped people and people have helped me, the bottom line is patient safety, so again I would say your example is a reciprocal one.

I have been working with CRNA's for 10 years and still haven't seen a CRNA bailing out an Anesthesiologist "with all due respect" !

 

[armygas]

I would be my ranch against any CRNA out-thinking me.

I am never trying to out-think someone in a time a crisis, I am trying to brainstorm with the CRNA/MD/Surgeon (whomever) so we can come to the safest conclusion for the patient. Its not an ego thing, you never know what experience other people bring into the OR.

 

[BLADEMDA]

Blade, with all due respect, that role has been reversed on numerous occasions (i.e a CRNA being able to perform a procedure that the MD had difficulty). That doesn't mean anything, sometimes its just not your day but a good provider realizes it, isn't to proud to ask for assistance and another person is able to fix the problem.

I have helped people and people have helped me, the bottom line is patient safety, so again I would say your example is a reciprocal one.

Not true. CRNA NEVER saved me and never will. My total experience (GROUP including partners) are in excess of 300,000 cases and NOT A SINGLE CASE did a CRNA save a Board Certified Anesthesiologist from anything LIFE threatening to a patient. The reverse is NOT the case. You clearly have little concept of care in our major medical centers and the skill set of the AVERAGE CRNA.

CRNA's are Midlevel Providers who provide a valuable service in the operating room. Some develop excellent skills in intubation, spinal, epidural, etc. ALMOST NONE become Physicians capable of Critical Care Medicine in the hospital. You confuse a procedure from saving a dying patient due to one reason or another.

Blade

 

[armygas]

I have been working with CRNA's for 10 years and still haven't seen a CRNA bailing out an Anesthesiologist "with all due respect" !

Cool, I only know what my experience has been.

 

[BLADEMDA]

Again, with all due respect, in my world as long as an oral surgeon/dentist or a surgeon is in the OR then the presence of an anesthesiologist is not required.

However on that note, if the case is an ASA 3 or greater and if an anesthesiologist is available then a consult with the anesthesiologist should (and if I am doing the anesthetic will) occur.

Look CRNA. I showed the video to some of my best CRNA's and even they couldn't believe Zwerling's lies. They know what we do for them day in and day out in the O.R. We don't Baby sit our CRNA's but we do bail them out of trouble more often than we would like. The BEST CRNA's know what AVERAGE really means. Unfortunately, the AANA and you don't! Giving an AVERAGE CRNA Independent practice rights is WRONG my friend and dangerous. The USA deserves better than that and many CRNA's know it.

Fortunately for all of us, the AVERAGE CRNA does not work solo, yet. That will all change if the AANA and CRNA's like Zwerling get their way.

Blade

 

[armygas]

ALMOST NONE become Physicians capable of Critical Care Medicine in the hospital.

Blade, I agree with you on this point.

Bottom-line, my job (because it is military and we are sent to non-average places) is to be prepared to perform a successful anesthetic on any type of patient undergoing a surgical/OB procedure in any type of environment with or without the presence of an anesthesiologist. It does not extend beyond the perioperative setting. I do not manage ICU patients.

 

[armygas]

CRNA's know what AVERAGE really means.

I am not disagreeing with you on this point one bit.

The civilian world is much different than the military. I guess my problem is that I truly don't understand what you mean by Independent Rights b/c that just will not work in our practice model, there are just not enough bodies to fill the needs of the Army.

Do I think the ACT is a bad thing? Absolutely not, but again I don't know how this can happen nationwide. There are just not enough bodies to fill the positions or not enough people willing to serve certain areas or just not enough money to make it all happen.

 

[BLADEMDA]

Blade, I agree with you on this point.

Bottom-line, my job (because it is military and we are sent to non-average places) is to be prepared to perform a successful anesthetic on any type of patient undergoing a surgical/OB procedure in any type of environment with or without the presence of an anesthesiologist. It does not extend beyond the perioperative setting. I do not manage ICU patients.

Sure, I will give you that point. But, think hard on my next statement and I mean hard.

If Zwerling gets his way the bottom 10% of your AANA membership is goint to be able to practice Independently. This means that 10% is going to be relying on the surgeon or dentist if anything goes wrong during the case.
Have you ever worked with your AANA's bottom 10%? Do you know how scary these people really are? Do you realize how long it takes these people just to function well in an ACT model with CLOSE supervision? I am talking about years if not a decade of experience for these people.

Now, Zwerling and you want to turn these people loose on the public SOLO?
With only an Oral Surgeon for back-up? Or, maybe the correct icon is 😱😱.

Blade

 

[CremeSickle]

Just for the sake of civil discussion here is what i think.

I know anesthesiologists (some of my attendings) that need someone in the room as well and cannot, apparently, practice medicine that well. That comment runs through ALL of medicine and every other profession in existence. How does this prove your point?

I have also saved one CRNA at my institution. 3 of them have saved me and ive seen them save a couple of attendings. Some of my attendings BOAST about how good some of the CRNAs are. One diagnosed a VAE when the attending was scratching his head and another caught a previously undiagnosed core pulmonale on and EKG just this week that a cardiologist apparently cleared and missed as did my attending AND me. This stuff happens all the time. Forgive me if i give them credit for being competent. You seem to choose a couple of bad experiences and decide thats the blanket for their profession, i disagree and its based on my personal experience.

I find Zerwling to be clumsy and comical in those videos (im sure thats why they were chosen to be placed on the PSA website) but what he says is not incorrect in MOST cases. Moreover ive read the issue in PA. It has nothing to DO with anesthesiologist in the room or not, its about the need for a PHYSICIAN of anykind signing the anesthesia record post op. That includes DPMs, DDS, DVMs and DO/MDs surgeons. As far as i can tell this has nothing to do with independence from anesthesiologists at all as they already HAVE IT. Its all about billing and the need for a physician to sign the chart. As it stands, they dont need anesthesiologists to practice in PA (or any other state) in the USA. So the cage rattling about "safety" is a total sham by the PSA since this dosent change the current practice setting in ANY way.

Now, who would i rather doing a big transplant or some complex separation etc? Id likely choose an anesthesiologist. The reason for this is b/c we tend to get MUCH more exposure to these types of cases and the management involved in them than CRNAs do. However thats where i see the main difference.

I believe (as does the rest of mainstream anesthesiology) that CRNAs can provide as good an anesthetic as I can in just about every other instance. We will ALWAYS run the large teaching institutions and the large city hospitals. That will never change. The ACT practice will be the reality in those places forever. I agree that ACTs are the best practice model b/c there will be those 1% cases where the medical knowledge i bring from my time in various rotations will allow me to make a difference in a case where the CRNA cannot. However, if im realistic, I also believe that the same thing would be true if in the case of PAs & NPs. If we were the ones doing everything hands on all the time (lets remove RNs from the ER and ICU as well) then we might make that 1% difference everywhere. Afterall, the PA or NP dosent have my training and all they need is for me to sign their charts ONCE every 6 months without EVER seeing the pt. Yet that isnt done because the difference is irrelevant.

Anyway, thats my personal belief as well as the belief at my institution. If you feel differently your entitled to that but respect the fact that not every anesthesiologist feels the same way as you.

PA Legislature:

Can you think of ANY scenario where an Anesthesiologist would be needed in the room?

ZWERLING:

No. Well, maybe in a teaching hospital where they are needed to train Resident Anesthesiologists.

CASE CLOSED! I have saved CRNA's many times my friend. Without me there would be dozens of dead patients in my area and probably thousands across the USA. This is the reality of the real world outside the political arena CREME. The FACT is your average community college graduate with a BRIDGE To BSN then 28 months at a community hospital becoming a CRNA CAN'T PRACTICE MEDICINE VERY WELL! This means they NEED supervision when working at the BIG medical centers across the USA.

Those of us like JPP and Mil MD work with CRNA's every day. We don't have a beef with the "average" CRNA who recognizes his/her limitations. We have a congenial realtionship with them and recognize each individual's skill set.
But, for any CRNA to claim that ANESTHESIOLOGISTS ARE NEVER NEEDED in the room is a blatant lie.

Anytime Mods please feel free to close this thread as CRNA's like Creme won't EVER admit the truth.

Blade

 

[BLADEMDA]

Just for the sake of civil discussion here is what i think.

I know anesthesiologists (some of my attendings) that need someone in the room as well and cannot, apparently, practice medicine that well. That comment runs through ALL of medicine and every other profession in existence. How does this prove your point?

I have also saved one CRNA at my institution. 3 of them have saved me and ive seen them save a couple of attendings. Some of my attendings BOAST about how good some of the CRNAs are. One diagnosed a VAE when the attending was scratching his head and another caught a previously undiagnosed core pulmonale on and EKG just this week that a cardiologist apparently cleared and missed as did my attending AND me. This stuff happens all the time. Forgive me if i give them credit for being competent. You seem to choose a couple of bad experiences and decide thats the blanket for their profession, i disagree and its based on my personal experience.

I find Zerwling to be clumsy and comical in those videos (im sure thats why they were chosen to be placed on the PSA website) but what he says is not incorrect in MOST cases. Moreover ive read the issue in PA. It has nothing to DO with anesthesiologist in the room or not, its about the need for a PHYSICIAN of anykind signing the anesthesia record post op. That includes DPMs, DDS, DVMs and DO/MDs surgeons. As far as i can tell this has nothing to do with independence from anesthesiologists at all as they already HAVE IT. Its all about billing and the need for a physician to sign the chart. As it stands, they dont need anesthesiologists to practice in PA (or any other state) in the USA. So the cage rattling about "safety" is a total sham by the PSA since this dosent change the current practice setting in ANY way.

Now, who would i rather doing a big transplant or some complex separation etc? Id likely choose an anesthesiologist. The reason for this is b/c we tend to get MUCH more exposure to these types of cases and the management involved in them than CRNAs do. However thats where i see the main difference.

I believe (as does the rest of mainstream anesthesiology) that CRNAs can provide as good an anesthetic as I can in just about every other instance. We will ALWAYS run the large teaching institutions and the large city hospitals. That will never change. The ACT practice will be the reality in those places forever. I agree that ACTs are the best practice model b/c there will be those 1% cases where the medical knowledge i bring from my time in various rotations will allow me to make a difference in a case where the CRNA cannot. However, if im realistic, I also believe that the same thing would be true if in the case of PAs & NPs. If we were the ones doing everything hands on all the time (lets remove RNs from the ER and ICU as well) then we might make that 1% difference everywhere. Afterall, the PA or NP dosent have my training and all they need is for me to sign their charts ONCE every 6 months without EVER seeing the pt. Yet that isnt done because the difference is irrelevant.

Anyway, thats my personal belief as well as the belief at my institution. If you feel differently your entitled to that but respect the fact that not every anesthesiologist feels the same way as you.

Creme,

You are a Resident (so you claim). This means you NEED to be saved periodically by experienced providers. The real world with FIRST RATE ANESTHESIOLOGISTS is very different. CRNA's rarely SAVE MD's in private practice. That doesn't mean they can't make tough calls, diagnose problems and treat patients. I never said that and you continually infer those things because of your agenda.

I like CRNA's and most are competent providers. But, INDEPENDENT PRACTICE for the average CRNA? No way. The best 5-10% can work alone safely with little help on ASA 1-3 cases. But, even this Group NEEDS MD/DO INPUT/HELP on tough ASA 4 cases at our major medical centers. My opinion is not based on politics but real world experience with hundreds of CRNA's throughout the years. Again, the AANA wants 100% INDEPENDENCE for ALL its membership and not just the top 10%. The public deserves better than that.

Blade

 

[armygas]

Now, Zwerling and you

Hey now, how in the world did I have anything to do with that legislation?

I am just presenting my perspective in this forum in a civil manner and trying to learn your perspective since I am in a unique practice environment. Like I said, overall it doesn't matter in my situation, I will be in the military until well into 2020.

 

[BLADEMDA]

Hey now, how in the world did I have anything to do with that legislation?

I am just presenting my perspective in this forum in a civil manner and trying to learn your perspective since I am in a unique practice environment. Like I said, overall it doesn't matter in my situation, I will be in the military until well into 2020.

I aplogize if you don't agree with Zwerling's stance. However, it appeared to me you support his statement of complete Independence for 100% of the AANA's Membership. That is wrong and dangerous. I think you recognize that fact as well. The system as it stands today works for everyone. Why can't the AANA leave well enough alone? The constant desire for more and more autonomy for EVERY MEMBER regardless of skill, knowledge or experience is blatantly wrong. Our patients deserve better than a brand new CRNA graduate with ZERO experience who barely passed his Board exam and who trained at a weak community program practicing INDEPENDENTLY in the USA.

Blade

 

[Taurus]

I have saved CRNA's many times my friend. Without me there would be dozens of dead patients in my area and probably thousands across the USA.

When outcome studies in the 14 states that have opted out come out, this is the hard data that I'm looking for.

 

[armygas]

I aplogize if you don't agree with Zwerling's stance. However, it appeared to me you support his statement of complete Independence for 100% of the AANA's Membership. That is wrong and dangerous. I think you recognize that fact as well. The system as it stands today works for everyone. Why can't the AANA leave well enough alone? The constant desire for more and more autonomy for EVERY MEMBER regardless of skill, knowledge or experience is blatantly wrong. Our patients deserve better than a brand new CRNA graduate with ZERO experience who barely passed his Board exam and who trained at a weak community program practicing INDEPENDENTLY in the USA.

Blade

I know the ACT team works well but honestly it just seems logistically that it can't happen in every situation but still in those situations CRNAs aren't independent, we still have requirements for the presence of a physician in the OR. With regards to PA legislation, what does it do or change in respect to those requirements?

 

[BLADEMDA]

Since I don't know, what does the legislation change?

That is not my point. My statements have to do with Zwerling's real agenda down the road. What does Zwerling and the AANA want? Come on now, you know the answer. If you step aside from politics and look at the real world situation even you would agree 100% Independence for every CRNA regardless of education, knowledge or experience is a BAD IDEA. If more CRNA's would just speak the truth perhaps the AANA would end this battle for Independence. Unfortunately, I seriously doubt anything or anyone will stop them. People like Tough and me are going to try like heck to at least slow them down.

Blade- Fighting Against the AANA and hoping you will join the Battle (purely political stuff here Creme).

 

[core0]

I know the ACT team works well but honestly it just seems logistically that it can't happen in every situation but still in those situations CRNAs aren't independent, we still have requirements for the presence of a physician in the OR. With regards to PA legislation, what does it do or change in respect to those requirements?

In theory the CRNA is working under the supervision of the surgeon (kind of hard to have surgery without a surgeon). In opt out states there is no supervisory need and the CRNA is an independent practitioner with no supervision (ie the physicians presence is still necessary for surgery just not the anesthetic).

David Carpenter, PA-C

 

[core0]

When outcome studies in the 14 states that have opted out come out, this is the hard data that I'm looking for.

You could probably do it now. The AANA has nicely identified a bunch of hospitals in Texas which do not have anesthesiology presence. Compare the anesthesia complications of those against those which use the ACT model and those that have no CRNA's. Even though complications are a rare event this should give you sufficient power. The real challenge is the multivariate analysis to adjust for patient condition. All of this data is available through medicare billing. You can also look at the operative morbidity and mortality rates for these hospitals for surgical patient when adjusted for patient condition. Once again Medicare has this data. There are good models for this and you should have sufficient numbers to give good power.

You could look at opt out states vs. non opt out states but you would have to differentiate the ACT practices from independent practices. I don't think you could control enough variables to look at this state vs. state. Also these are small states. I don't think that all of these states have the population of Texas.

David Carpenter, PA-C

 

[Planktonmd]

I didn't know that you could diagnose a core pulmonale from an EKG, I thought there is certain clinical criteria that need to be present before you say someone has core pulmonale!
But hey if a CRNA said it's core pulmonale and you and your attending didn't know it, then it must be core pulmonale!

 

[CremeSickle]

hehe

Yes and the presumptive Dx is often made based on pts clinical picture and EKG findings ie: the presence of a S1 Q3 T3 is suggestive of right heart strain and cor pulmonale. She caught the EKG and the dx and it was confirmed by the cards resident. Are you done berating now?

I didn't know that you could diagnose a core pulmonale from an EKG, I thought there is certain clinical criteria that need to be present before you say someone has core pulmonale!
But hey if a CRNA said it's core pulmonale and you and your attending didn't know it, then it must be core pulmonale!

 

[armygas]

In theory the CRNA is working under the supervision of the surgeon (kind of hard to have surgery without a surgeon). In opt out states there is no supervisory need and the CRNA is an independent practitioner with no supervision (ie the physicians presence is still necessary for surgery just not the anesthetic).

David Carpenter, PA-C

But that doesn't account for local hospital policies does it? Because I know it doesn't matter what the legislation says once you agree to a contract with a hospital or group. You have to abide by their by-laws, right?

 

[core0]

But that doesn't account for local hospital policies does it? Because I know it doesn't matter what the legislation says once you agree to a contract with a hospital or group. You have to abide by their by-laws, right?

To be a member of the medical staff you agree to abide by the by-laws. If you are an MD this applies. If you are a CRNA it depends if they credential you under medical staff or nursing.

David Carpenter, PA-C

 

[CremeSickle]

Hey man

No worries.

I know your just trying to do your best to protect our profession based on your 'take' of the situation. I dont blame you at all. I just see it differently.

I do agree that 100% independence for every CRNA is a mistake. I also believe that the AANA will lose that battle. They will win the Opt Out stuff, but that isnt independence. They will never have independence except in places that cant attract anesthesiologists or in GI labs that would bore me to death. To me, this is acceptable. In the major cities with the serious cases the ACT practice will be (and is) the only acceptable practice.

That is not my point. My statements have to do with Zwerling's real agenda down the road. What does Zwerling and the AANA want? Come on now, you know the answer. If you step aside from politics and look at the real world situation even you would agree 100% Independence for every CRNA regardless of education, knowledge or experience is a BAD IDEA. If more CRNA's would just speak the truth perhaps the AANA would end this battle for Independence. Unfortunately, I seriously doubt anything or anyone will stop them. People like Tough and me are going to try like heck to at least slow them down.

Blade- Fighting Against the AANA and hoping you will join the Battle (purely political stuff here Creme).

 

[armygas]

To be a member of the medical staff you agree to abide by the by-laws. If you are an MD this applies. If you are a CRNA it depends if they credential you under medical staff or nursing.

David Carpenter, PA-C

Thanks for that, when I work outside of the military I know that my practice situations change based upon the hospital or group where I work.

 

[armygas]

That is not my point. My statements have to do with Zwerling's real agenda down the road. What does Zwerling and the AANA want? Come on now, you know the answer. If you step aside from politics and look at the real world situation even you would agree 100% Independence for every CRNA regardless of education, knowledge or experience is a BAD IDEA. If more CRNA's would just speak the truth perhaps the AANA would end this battle for Independence. Unfortunately, I seriously doubt anything or anyone will stop them. People like Tough and me are going to try like heck to at least slow them down.

Blade- Fighting Against the AANA and hoping you will join the Battle (purely political stuff here Creme).

Hey Blade, more power to you, seriously.

Do I think 100% independence is the answer?....No...... I think that certain scenarios require CRNAs to be able to practice without an anesthesiologist, but I agree not all CRNAs are prepared (or want) to take on that kind of responsibility.

I just wish it wasn't an "all or none" political debate. That kind of fight makes brothers turn into mortal enemies.