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

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sloh said:
Haha, MLP’s on average probably aren’t as bright as us, but they aren’t that dumb
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True, but it Causes less animosity than telling them the truth.
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chocomorsel said:
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.
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I'd rather have an anesthesiologist any day. My hospital doesn't have crna.
 
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dr doze said:
Go through the motions of teaching them.
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I do not teach them a thing. At a shop I do locums, there are CRNAs which are technically their instructors. I don't say a single this to SRNAs other than "what do you see?" .
 
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nimbus said:
There’s no reason that a motivated CRNA couldn’t be very good at regional anesthesia. Why wouldn’t they be able to learn regional? I bet Jack Vander Beek, CRNA, can block with the best of us.

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Neuraxiom is powerered by MTSA and brings a new paradigm in perioperative ultrasound and acute pain management.
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Pecs II Catheter anyone?

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Agree that such technical skills aren't challenging to learn and certainly within the realm of what a crna could/would know. That being said, many of them have inadequate training in it. Given their limited clinical hours and even more limited hands on hours not surprising to see CRNAs with essentially no experience with this stuff.
 
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Lawpy said:
Why is there a lot of crap like this in the US healthcare system? There needs to be a massive overhaul
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It’s not just the US. There are shaman and faith healers all over the world. In California we have all kinds of woo woo healers, chakra aligners, sound bath healers, chiropractors, naturopaths, OMDs, etc with thriving practices.
 
nimbus said:
There’s no reason that a motivated CRNA couldn’t be very good at regional anesthesia. Why wouldn’t they be able to learn regional? I bet Jack Vander Beek, CRNA, can block with the best of us.

Neuraxiom | Ultrasound and Acute Pain Management

Neuraxiom is powerered by MTSA and brings a new paradigm in perioperative ultrasound and acute pain management.
www.neuraxiom.com

Pecs II Catheter anyone?

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My point is that it’s not part of their training. ACGME requires residents to do 40 blocks during residency and many do way more than that. Also, I’d argue that it’s not easy to find CRNA so motivated to learn and perform blocks regularly. Also, you yourself haven’t mentioned any personal experience of encountering this motivated crna. Are there any hospitals/practices that let allow CRNAs to perform blocks at such a volume that they become as good as an MD? And how many crnas are that ambitious to push for this?
 
Lashler9054 said:
My point is that it’s not part of their training. ACGME requires residents to do 40 blocks during residency and many do way more than that. Also, I’d argue that it’s not easy to find CRNA so motivated to learn and perform blocks regularly. Also, you yourself haven’t mentioned any personal experience of encountering this motivated crna. Are there any hospitals/practices that let allow CRNAs to perform blocks at such a volume that they become as good as an MD? And how many crnas are that ambitious to push for this?
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I don’t work with any CRNAs so of course I don’t have personal experience.

But 15 years ago, few anesthesiologists were doing USGRA. I did zero ultrasound guided blocks in residency and learned by attending a couple of weekend courses, watching my partners and Youtube. I wouldn’t hang my hat on the fact that not many CRNAs are doing ultrasound guided regional now. They will.

www.twinoaksanesthesia.com

Faculty — CRNA Conferences - Twin Oaks Anesthesia

Explore the Twin Oaks Anesthesia team that is made up of actively practicing regional anesthesia CRNAs and come together to make each of our conference experiences awesome!
www.twinoaksanesthesia.com www.twinoaksanesthesia.com
 
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nimbus said:
I don’t work with any CRNAs so of course I don’t have personal experience.

But 15 years ago, few anesthesiologists were doing USGRA. I did zero ultrasound guided blocks in residency and learned by attending a couple of weekend courses, watching my partners and Youtube. I wouldn’t hang my hat on the fact that not many CRNAs are ultrasound guided regional now. They will.

www.twinoaksanesthesia.com

Faculty — CRNA Conferences - Twin Oaks Anesthesia

Explore the Twin Oaks Anesthesia team that is made up of actively practicing regional anesthesia CRNAs and come together to make each of our conference experiences awesome!
www.twinoaksanesthesia.com www.twinoaksanesthesia.com
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I’d argue that CRNAs were around then and weren’t doing nerve stim blocks either. Just because you, MD/DO, has evolved, can you say the same about CRNA? Even if a CRNA watches YouTube, where will that CRNA do the block? I’m sure there are some motivated CRNAs out there but it seems like barriers are high for them to get enough reps to be good at them.
 
Lashler9054 said:
I’d argue that CRNAs were around then and weren’t doing nerve stim blocks either. Just because you, MD/DO, has evolved, can you say the same about CRNA? Even if a CRNA watches YouTube, where will that CRNA do the block? I’m sure there are some motivated CRNAs out there but it seems like barriers are high for them to get enough reps to be good at them.
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Repeat after me. The question that goes on in the boardrooms is and has been and will be “how few anesthesiologists can we get away with supervising/rubber stamping a bunch of CRNAs”?

Refusing to teach them or doing a deliberately incompetent job of teaching them a subset of technical procedures puts upward pressure on that number.

You fight with what you have.
 
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dr doze said:
Repeat after me. The question that goes on in the boardrooms is and has been and will be “how few anesthesiologists can we get away with supervising/rubber stamping a bunch of CRNAs”?

Refusing to teach them or doing a deliberately incompetent job of teaching them a subset of technical procedures puts upward pressure on that number.

You fight with what you have.
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Well, exactly. And since I don’t see CRNAs being taught or doing those technical procedures AND no one has mentioned this happening in significant numbers, I’m not worried. This is, until some anesthesiologists are stupid enough to include it in crna schools or actually allow CRNAs to do these procedures in PP
 
Lashler9054 said:
Well, exactly. And since I don’t see CRNAs being taught or doing those technical procedures AND no one has mentioned this happening in significant numbers, I’m not worried. This is, until some anesthesiologists are stupid enough to include it in crna schools or actually allow CRNAs to do these procedures in PP
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What you experience in your corner of the world is likely different than other parts of the world. The variability in culture, customs, and expectations in this field is pretty dramatic.
 
dr doze said:
What you experience in your corner of the world is likely different than other parts of the world. The variability in culture, customs, and expectations in this field is pretty dramatic.
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So, your experience is different in the US? I’m really just concerned about US and anyone actually seeing CRNA do these procedures. No interested in what could Or possibly be the case
 
CRNAs can already learn regional from other CRNAs who already know this stuff. Read the faculty profiles. Obviously they’re doing regional in their practices, especially the ones who practice independently since they too get money for blocks, just like us. Regional is not the thing that will distinguish us from CRNAs. CRNAs are also welcome at every single regional course run by anesthesiologists that I’ve seen.


www.twinoaksanesthesia.com

Faculty — CRNA Conferences - Twin Oaks Anesthesia

Explore the Twin Oaks Anesthesia team that is made up of actively practicing regional anesthesia CRNAs and come together to make each of our conference experiences awesome!
www.twinoaksanesthesia.com www.twinoaksanesthesia.com

Acute Surgical Pain Management Fellowship Faculty and Content Experts - MTSA

mtsa.edu mtsa.edu
 
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nimbus said:
CRNAs can already learn regional from other CRNAs who already know this stuff. Read the faculty profiles. Obviously they’re doing regional in their practices, especially the ones who practice independently since they too get money for blocks, just like us. Regional is not the thing that will distinguish us from CRNAs. CRNAs are also welcome at every single regional course run by anesthesiologists that I’ve seen.


www.twinoaksanesthesia.com

Faculty — CRNA Conferences - Twin Oaks Anesthesia

Explore the Twin Oaks Anesthesia team that is made up of actively practicing regional anesthesia CRNAs and come together to make each of our conference experiences awesome!
www.twinoaksanesthesia.com www.twinoaksanesthesia.com

Acute Surgical Pain Management Fellowship Faculty and Content Experts - MTSA

mtsa.edu mtsa.edu
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I guess we can agree to disagree. You can bring up one institution where CRNAs perform blocks, but this doesn’t constitute a trend I worry about if there aren’t many other places that do them. In the short term, admins will only care about the bottom line and placating surgeons who bring business to the hospital. And this certainly includes blocks. I don’t live near middle Tennessee and CRNAs don’t do blocks remotely close to where I practice, which is a state that allows independent CRNAs. And I’m not worried about my job at all
 
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okayplayer said:
www.ncbi.nlm.nih.gov

Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients

Background and study aims  The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
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The thing that struck me was that 73% of the study population was African American...weird.
 
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Shimmy8 said:
So which type of exec degree should I get? MBA, MHA?
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Doesn't matter. It's more about how much time you spend within 1 system, your connections, how much assz kissing you can do, and how much of a sychophant you become. Climbing the ladder is about nepotism and cronyism. That is all.
 
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nimbus said:
The thing that struck me was that 73% of the study population was African American...weird.
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I’d bet that you’re not going to see a lot of NPs do colonoscopies in the white, better insured population. Just a hunch here
 
Lashler9054 said:
I’d bet that you’re not going to see a lot of NPs do colonoscopies in the white, better insured population. Just a hunch here
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my social skills are lacking, but I’m sure that’s a “think it,” not a “type it.”

Freudian slip-ish.
 
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D P356 said:
my social skills are lacking, but I’m sure that’s a “think it,” not a “type it.”

Freudian slip-ish.
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No, I meant to type it. Saying it all with my chest here. Wonder who is going to get their feelings hurt by reading that
 
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Steve_Zissou said:
Hubris will be their downfall. Or perhaps not, perhaps human lives truly are worth so little.
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human lives vs bottom line

bottom line will win out every time in america, so long as the cost of doing business is < cost of lawsuits
 
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chocomorsel said:
I thought retirees went to the VA.
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Aren’t you former military??

Those that put in their 20 and retire are eligible to receive care at military hospitals (Walter Reed, Bethesda, Balboa, Trippler, etc.).

The VA is for those that have some form of disability resulting from their military service regardless of how long they served.

Obviously some people are eligible for both.
 
chocomorsel said:
Hmm, Baltimore. Hmm, poor. Hmm mostly minority population being “study” subjects.
What exactly is weird about that buddy?
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Since African Americans make up 13% of the US population, I haven’t seen many if any studies where 73% of the patients are African American. I just thought it was odd that they enrolled a disproportionate number of African American patients and didn’t mention the race/ethnicity of the rest of the study group.
 
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JiPo said:
Wow............................................................................................
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That’s pretty bad. Are you satisfied with the number of blocks you did in the same residency program? If not, then that’s a significant problem on two ends.
 
nimbus said:
Since African Americans make up 13% of the US population, I haven’t seen many if any studies where 73% of the patients are African American. I just thought it was odd that they enrolled a disproportionate number of African American patients and didn’t mention the race/ethnicity of the rest of the study group.
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I was being totally facetious buddy. I guess you didn’t get that.
 
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Shouldawouldacouldas said:
Wisconsin allows independent practice so the surgeons do not need to be on the record as supervising or directing.
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Wisconsin is an opt-out state. They don't have to have a surgeon supervising as far as billing under CMS.

Whether surgeons or CRNAs like it or admit it or not, surgeons can and will be held liable for errors of CRNAs working with them, whether they're "supervising" or not. You think that plastic surgeon in Colorado is going to be off the hook for the anesthesia death of the girl getting the breast aug? I think not.
 
Twiggidy said:
Quite honestly, a lot of the Navy CRNAs are pretty well trained because they seems to be mostly used in the military. @pgg can correct me if I'm wrong on this but I got wind from a Navy nurse that there was quite a shortage of anesthesiologist in the Navy.
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Because the Navy anesthesiologists fight the same battles with militant CRNAs as we do out in private practice.

And there is a HUGE difference anesthetizing young healthy male and female service members than there is anesthetizing older patients with 1/2 a dozen significant comorbidities.
 
jwk said:
Because the Navy anesthesiologists fight the same battles with militant CRNAs as we do out in private practice.

And there is a HUGE difference anesthetizing young healthy male and female service members than there is anesthetizing older patients with 1/2 a dozen significant comorbidities.
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HUGE? Not huge, bro...ASA 1 v. ASA 3? Not huge....anesthesia pretty safe...
 
chocomorsel said:
Yup. But I guess the old battle ax die hards a do age eventually. But if they are still active duty they have to meet some physical and health requirements unlike regular folk.
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We take care of retirees and dependents too. They don’t need to be the picture of health and many times aren’t. And despite what people seem to think, military docs can be sued. Dependents, retirees, and vets (if harmed at a VA hospital) can sue. So no, the healthy active duty soldier can’t sue you, but if you **** up his wife, she sure can.
 
Lashler9054 said:
No, I meant to type it. Saying it all with my chest here. Wonder who is going to get their feelings hurt by reading that
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Right on. When I read it, I automatically visualized it being said by a Karen from the HOA.
I’m aware that’s likely not you.
 
GassYous said:
At my residency program crnas were doing blocks, lines, neuraxial you name it
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At my residency program CRNAs were not allowed to even think about doing any regional or OB. They would do their own a-lines or spinals for their own OR patients, but that's it. Any patient sick enough to need a central line would be a resident case.
 
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