No need for CRNA bashing... but, do we honestly think this is a good idea?

[CodeBlu]

Wisconsin Hospital Replaces All Anesthesiologists With CRNAs

The long-running battle over nurse anesthetists continues, with one hospital's action causing a flare-up on social media.

www.medscape.com

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[Taurus]

It was inevitable. The MBA’s will swing that pendulum as far to one side as they can and see what they can get away with. Maybe after a screw up and lawsuit, they will bring back some anesthesiologists but it won’t go back again to the way it was. New normal.

 

[Destalchemy]

Why would you not bash CRNAs when undoubtedly someone will get hurt or killed as a result of this decision despite "the literature [being] clear?"

All these anesthesiologists just lost their jobs, but hey let's be nice to the people that took them.

 

[DrOwnage]

Wow 80% of the comments gave me cancer

 

[deleted162650]

Why would you not bash CRNAs when undoubtedly someone will get hurt or killed as a result of this decision despite "the literature [being] clear?"

All these anesthesiologists just lost their jobs, but hey let's be nice to the people that took them.

The CRNAs didn’t take these jobs, the AMCs gave them these jobs. The docs gave their practices to the AMCs. This is largely self inflicted.

 

[secretasianman]

It was inevitable. The MBA’s will swing that pendulum as far to one side as they can and see what they can get away with. Maybe after a screw up and lawsuit, they will bring back some anesthesiologists but it won’t go back again to the way it was. New normal.

The mbas that made this decision won’t even be there for the fallout. They will take their bonuses and get better positions at hospitals elsewhere.

 

[secretasianman]

Wow 80% of the comments gave me cancer

Actually I’m surprised there are quite a few reasonable ones. I honestly hope the lawsuits start happening and the hospital takes a hit. Sad but the bottom needs to fall out in order to correct healthcare.

 

[C4C]

No surprise it was Envision that did this. None at all.

My only surprise regarding Envision is that some doctors still sign on with them. They have shown you time after time that they care about one thing and one thing only: eking out a staffing solution with the lowest-cost providers possible.

Why do physicians sign on with them? Why?

 

[Urzuz]

I’m surprised that rural Wisconsin had MDs to begin with

 

[chocomorsel]

No surprise it was Envision that did this. None at all.

My only surprise regarding Envision is that some doctors still sign on with them. They have shown you time after time that they care about one thing and one thing only: eking out a staffing solution with the lowest-cost providers possible.

Why do physicians sign on with them? Why?

Money, money money! I work with them often and I half the time can’t stand them. I found out they pay their ER docs more money to staff an ICU in my city than they do me. And I am full fledged fellowship trained ICU doc.
So I say F U and keep traveling to the smaller towns.

 

[chocomorsel]

I’m surprised that rural Wisconsin had MDs to begin with

Why is that? Do country folk not deserve real physcians?

 

[26B]

I'm surprised the surgeons at that hospital are so willing to take on the added liability of supervising CRNAs

 

[sevoflurane]

Lol... would never go there.
And the comment by the douchy surgeon is even worse.

 

[GassYous]

You'll never catching me working with a midlevel "surgeon"

 

[bronx43]

I’m surprised that rural Wisconsin had MDs to begin with

Metros are saturating in every specialty at ever increasing rates. Rural ANYWHERE has docs. And these docs are elated to be able to work there with reasonable pay.

 

[chocomorsel]

Metros are saturating in every specialty at ever increasing rates. Rural ANYWHERE has docs. And these docs are elated to be able to work there with reasonable pay.

I know. I don’t understand comments like that. They are so damn shallow. Everyone deserves MD care.
And people act like they can’t find good jobs that will treat you well and not like a cog in a wheel and be happy to have you there. And they are climbing over each other like crabs in a bucket for the big city life.

 

[chocomorsel]

I'm surprised the surgeons at that hospital are so willing to take on the added liability of supervising CRNAs

I feel honestly like there are so many surgeons who DGAF who’s behind the drape as long as the rooms keep getting turned over. And many prefer CRNAs that they can treat like crap.
I can however imagine, it’s a lot more difficult to start over as any type of doc who sees a patient panel than docs like us and rads and ER. If admin doesn’t budge, many suck it up and pray for the best.

 

[VisionaryTics]

Lol... would never go there.
And the comment by the douchy surgeon is even worse.

As a surgeon, it's infuriating. We need to close ranks and have support from the surgical societies supporting physician-lead anesthesia. I bet if Dr. Lachman was having a knee scope, he wouldn't want a solo CRNA providing his care. Or if his father was having a hip replacement.

As a surgeon I am totally uninterested in my patients getting below standard care so that a hospital administrator can take home a fatter bonus while exposing me to legal risk and exposing my patients to mortal risk.

 

[Agast]

How funny, Dr. Dachman very proudly lists his musical efforts on his LinkedIn page and will tell you where he did all his training up to medical school but conspicuously absent is where he did his surgery residency.

 

[gasdoc77]

And so the grand experiment begins. AMC's like $htstar have been lining up their pieces waiting for this day, intentionally "hobbling" their docs ("Misery" reference) while encouraging everyone else to do everything from blocks to airways to pushing meds. The more useless they can make their docs, the more desperate the doc will be for employment when this all comes to fruition. Why would anyone spend years in medical school and residency only to be the token pre-op secretary (read: expendable) for their career, which may as a result be shortened.

The CRNAs didn’t take these jobs, the AMCs gave them these jobs. The docs gave their practices to the AMCs. This is largely self inflicted.

 

[IlDestriero]

AMCs keep lowering the bar.
Good luck is all I can say.
They better have some damned fine CRNAs!
The surgeons will love it, until they don’t!

 

[Urzuz]

Why is that? Do country folk not deserve real physcians?

What? Where did I even suggest that?

I said I am surprised that there are anesthesiologists out there, not that 'country folk' don't deserve an anesthesiologist. Not that I ever believed it to begin with, but 'access to care' is the main talking point that the nurse anesthesia lobby brings up when talking about expanding independent practice rights. If anesthesiologists are willing to go to a place as BFE as rural Wisconsin, even that main talking point has zero merit.

 

[Southpaw]

notice they fired the physicians and kept the nurses, not vice versa. nice token quote by a surgeon. sweet 'equal outcomes' quote by the CEO, like a stab in the back as he kicks the anesthesiologists out of the hospital.

this isn't about quality care of care. if it was he'd keep the physicians and fire the nurses. this is about a few administrators shaving some bucks to sweeten their yearly bonus. let's keep things straight here.

no one should be shocked here. it may be rural WI, but a CEO is a CEO. an AMC admin is an AMC admin. the goals anywhere are the goals everywhere.

 

[Lecithin5]

What? Where did I even suggest that?

I said I am surprised that there are anesthesiologists out there, not that 'country folk' don't deserve an anesthesiologist. Not that I ever believed it to begin with, but 'access to care' is the main talking point that the nurse anesthesia lobby brings up when talking about expanding independent practice rights. If anesthesiologists are willing to go to a place as BFE as rural Wisconsin, even that main talking point has zero merit.

It’s been shown and well established that physicians are willing to go to these rural areas. However those hospitals aren’t incentivized to hire docs. “Access” is just another mendacious talking point from the crna lobby.

 

[Southpaw]

Also. This place is less than hour from Milwaukee. It isn’t that rural.

 

[We'llBeDoneIn15Minutes]

Let me state the obvious,
This is not good.
I've held off being a doom and gloomer that our field is screwed, but seeing horrendous news like this in Michigan and Wisconsin back to back... I'm transitioning to the Our field is screwed camp.

 

[We'llBeDoneIn15Minutes]

The CRNAs didn’t take these jobs, the AMCs gave them these jobs. The docs gave their practices to the AMCs. This is largely self inflicted.

True, but those docs that sold out the future anesthesiologists have already cashed out large to the AMCs and are reading this news slopeside in Aspen while preparing to spend the summer in Coronado.

 

[deleted875186]

I'm surprised the surgeons at that hospital are so willing to take on the added liability of supervising CRNAs

Surgeon has no idea that he is liable for any anesthesia complication.

 

[anbuitachi]

hopefully when im 60 and i need surgery, i'll still be able to find an anesthesiologist giving me care...

 

[deleted875186]

Also, news like this makes me grateful I did pain medicine. Disgusting to hear comments from a surgeon and CEO at the hospital like the ones I read. I never talk bad about other specialties or physicians, even if I think they stink, it’s just unprofessional and inappropriate, they have no idea what anesthesiooogy entails.

 

[Agast]

Also, news like this makes me grateful I did pain medicine. Disgusting to hear comments from a surgeon and CEO at the hospital like the ones I read. I never talk bad about other specialties or physicians, even if I think they stink, it’s just unprofessional and inappropriate, they have no idea what anesthesiooogy entails.

Lol why? They already came for us. There are CRNAs “supervised” by spine surgeons

 

[Cath Up]

Has there been any real effort by surgeons to insist on anesthesiologists? I had never even really considered that. A surgeon walkout movement for patient safety to insist on MD anesthesiology would go a long way given the revenue they generate. Surgeons don't care much about who is providing anesthesia?

 

[nimbus]

Has there been any real effort by surgeons to insist on anesthesiologists? I had never even really considered that. A surgeon walkout movement for patient safety to insist on MD anesthesiology would go a long way given the revenue they generate. Surgeons don't care much about who is providing anesthesia?

It probably depends on the practice. If there is a practice where anesthesiologists rarely show up in the room and the surgeons spend all day every day talking to CRNA’s, the surgeons could get the impression that anesthesiologists are superfluous.

 

[nimbus]

Lol why? They already came for us. There are CRNAs “supervised” by spine surgeons

In opt out states, CRNAs don’t need any physician supervision. The surgeons could be off the hook.

 

[deleted162650]

In opt out states, CRNAs don’t need any physician supervision. The surgeons could be off the hook.

“Opt-out” refers only to the ability to bill CMS without MD supervision. Has nothing to do with liability.

 

[Status Sciaticus]

How funny, Dr. Dachman very proudly lists his musical efforts on his LinkedIn page and will tell you where he did all his training up to medical school but conspicuously absent is where he did his surgery residency.

Botsford General Hospital (aka Beaumont).

 

[Lecithin5]

Has there been any real effort by surgeons to insist on anesthesiologists? I had never even really considered that. A surgeon walkout movement for patient safety to insist on MD anesthesiology would go a long way given the revenue they generate. Surgeons don't care much about who is providing anesthesia?

I’d like to think surgeons would have our back. And maybe in a good group with good working relationships they would. But don’t count on it. Yeah, they make protest for a little bit if they were to find out that their physician colleagues were replaced by an inferior product. But eventually the outrage would fizzle. Nothing will change. The MBAs would still win.

Why am I pessimistic? Because I’ve seen this exact scenario play out at various places that I’m familiar with.

 

[coffeebythelake]

It's all about the dollar bills, and this hospital has done the math and thinks that $$$ > patient safety. I heard people living in rural communities are much less likely to sue compared to city folk.

 

[coffeebythelake]

I've reach the point of realization that we cannot change the healthcare system in America and that midlevels are out of the bag. (The tragic thing is that these physicians were doing well and were fired as a pure financial decision.) MBAs control healthcare. But call midlevels for what they are. Less trained, less educated, and arguably worse outcomes.

Let's boil down the biased AANA studies which involve a combination of cherry picking propaganda from false assumptions (e.g., using a billing code to mark solo CRNA care) and a lack of understanding of basic statistics. The unbiased and independently conducted studies out there show physician led care is superior. The surveys of patients show they overwhelmingly favor physician led care.

The whole AANA propaganda about being "cheaper" is the eternal bait and switch. It is cheaper for the hospital, and hospital execs looking to pad their bonuses are complicit in this spiraling down of patient care. To be clear IT COSTS THE SAME FOR THE PATIENT (and maybe even more expensive because of added complications and unnecessary consults.)

So what we see from AANA propaganda is a strategy from multiple angles. 1. Make up laughably false studies to show equivalency to physicians and spread the propaganda like gospel, 2. Lure politicians with campaign contributions and under the guise of expanding access to care in rural populations, 3. Lure hospital executives and sycophant surgeons under the guise of cost savings. At the same time 4. Massively overinflate their credentials by claiming many more years and experience than they actually have. Finally 5. claim to be anesthesiologists and doctors to blur any name recognition distinction between NURSE and DOCTOR.

Disgusting. And it is working.

The public can choose safe and less safe options. They can drive a Volvo or they can drive a motorcycle without a helmet. But don't lie by saying the motorcycle is just as safe as the Volvo when you've never been involved in a crash. And don't go around calling the motorcycle a Volvo.

 

[circleK]

I’m from WI. This place is not that rural. 45mins from both Milwaukee and Madison.

Was Envision staffing their department prior to this or is this a new contract for them? I would assume this will be repeated in the near future by Envision in other opt-out state community hospitals that they staff.

I cannot imagine a surgeon at our hospital making a statement like this Dr Dachmann did. He’s either an incredible ***hole or has a bone to pick with the few anesthesiologists previously at that hospital.

 

[okayplayer]

I’m from WI. This place is not that rural. 45mins from both Milwaukee and Madison.

Was Envision staffing their department prior to this or is this a new contract for them? I would assume this will be repeated in the near future by Envision in other opt-out state community hospitals that they staff.

I cannot imagine a surgeon at our hospital making a statement like this Dr Dachmann did. He’s either an incredible ***hole or has a bone to pick with the few anesthesiologists previously at that hospital.

Probably CMO there or some similar corporate lackey.

 

[nimbus]

Local coverage.

Watertown hospital changes how it administers anesthesia

After what its leadership called, “careful consideration” and with the support of physician leaders and surgeons, Watertown Regional Medical Center has shifted to a comprehensive certified registered nurse anesthetist structure

www.hngnews.com

 

[Twiggidy]

Local coverage.

Watertown hospital changes how it administers anesthesia

After what its leadership called, “careful consideration” and with the support of physician leaders and surgeons, Watertown Regional Medical Center has shifted to a comprehensive certified registered nurse anesthetist structure

www.hngnews.com

I didn't even start to read the article, but when I read the sub-headline "support from surgeons", well that's a problem.

 

[D P356]

Local coverage.
“According to WRMC, it will continue to have an anesthesiologist on staff who works collaboratively with the CRNAs.”

the plot thickens...
Sounds like a high supervision model/firefighter.
or a doc doing their own (sicker) cases
doesn’t sound like hospital is putting all of its chips in to CRNA only care.

 

[Precedexx]

Looks like Envision is in charge of staffing at this hospital. They have quite the history of cutting staffing and scummy billing to squeeze money out of healthcare. They're backed by private equity, which personally makes my blood boil in medicine.

The Company Behind Many Surprise Emergency Room Bills (Published 2017)

A study by Yale researchers found that the rate of out-of-network doctor’s bills for customers of a big insurer jumped when EmCare entered a hospital.

www.nytimes.com

 

[BLADEMDA]

"This is a switch that has been occurring nationally, away from anesthesiologists who are exclusively medical doctors. It has been met, in some quarters, with opposition."

 

[chocomorsel]

I’d like to think surgeons would have our back. And maybe in a good group with good working relationships they would. But don’t count on it. Yeah, they make protest for a little bit if they were to find out that their physician colleagues were replaced by an inferior product. But eventually the outrage would fizzle. Nothing will change. The MBAs would still win.

Why am I pessimistic? Because I’ve seen this exact scenario play out at various places that I’m familiar with.

You aren’t a pessimist. You are a realist. Nothing wrong with that.

 

[chocomorsel]

I've reach the point of realization that we cannot change the healthcare system in America and that midlevels are out of the bag. (The tragic thing in this particular case is that there were physicians willing to work in this rural setting but they were fired.) MBAs control healthcare. But call midlevels for what they are. Less trained, less educated, and arguably worse outcomes.

The public can choose safe and less safe options. They can drive a Volvo or they can drive a motorcycle without a helmet. But don't lie by saying the motorcycle is just as safe as the Volvo when you've never been involved in a crash. And don't go around calling the motorcycle a Volvo.

Ha ha buddy. I am loving the Volvo analogy because guess what I drive?
But yes totally agree that this is a losing battle in this country.
On a positive note, my COO cousin out in California says he prefers dealing with physicians much more so than dealing with unionized nurses. He is so tired of those nurses. He says they are just way too damn needy and demanding compared to Physcians. This after I sort of heated conversation from my end about how we can’t stand the C suite and how they treat us.

 

[Man o War]

So....if the CRNAs are so safe, why do they still need an anesthesiologist around to “collaborate” with them?
Saying one thing, but actions demonstrate another.
But those of us who have supervised CRNAs know their limitations, and aren’t surprised they have elected to keep a physician around “just in case”

 

[chocomorsel]

So....if the CRNAs are so safe, why do they still need an anesthesiologist around to “collaborate” with them?
Saying one thing, but actions demonstrate another.
But those of us who have supervised CRNAs know their limitations, and aren’t surprised they have elected to keep a physician around “just in case”

I don’t think that physician is even in-house. I think he’s like operating from another state in the C suite. Just to make things legal.