Nurse anesthesiologist nonsense

[GaseousClay]

fight it here for those in CA

Inactive Campaign

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[Moose A Moose]

CRNAs in California are seeking use of the term “nurse anesthesiologist.”

They’re adorable.

 

[Dr. Rude]

fight it here for those in CA

Inactive Campaign

It is considered counterproductive for non state residents to weigh in on an individual state issue. Legislators tend to look unfavorably upon it. That said, I encourage all California state residents to respond and probably follow the recommendations of the state society.

 

[neutro]

We have lost the battle at state level

The battle is at individual hospital and facility level and at bylaws - this battle can be won and this is the battle that really matters.

As long as the local medical staff does not allow anyone without an MD, DO (and at times Psych D, podiatrist and OMFS), to call themselves a “doctor” - that’s what we need to strive for.

To be part of medical staff, there is an educational and training requirement - that is the discriminating factor, not what the AANA says.

Get involved in bylaws and credentials committee.

Also push for color coded badges with PHYSICIAN for docs only…

 

[Dr. Rude]

We have lost the battle at state level

The battle is at individual hospital and facility level and at bylaws - this battle can be won and this is the battle that really matters.

As long as the local medical staff does not allow anyone without an MD, DO (and at times Psych D, podiatrist and OMFS), to call themselves a “doctor” - that’s what we need to strive for.

To be part of medical staff, there is an educational and training requirement - that is the discriminating factor, not what the AANA says.

Get involved in bylaws and credentials committee.

Also push for color coded badges with PHYSICIAN for docs only…

Last line of defense.

 

[neutro]

well this is the only defense that’s under our control as anesthesiologists because it’s at a facility/ individual level and it’s controllable.

I can tell you from experience that it’s not easy to get rid of crna power especially when there are surgeons that have exclusive worked with CRNAs and the history of the anesthesia department is such that it had nonexistent or weak anesthesiologist leadership. Society or state mandates will not do anything…

It’s a local uphill battle that needs to be won over years strategically like a game of chess…it means presence and face time at credentials committees, bylaws, and med exec and using every single opportunity to advocate for all physicians without discriminating against midlevels but clearly communicating the differences

The biggest problem I find with majority of CRNAs compared to other midlevels is that they have this uninhibited and dangerous arrogance about their training, experience and knowledge just because “they can do anesthesia”. It can and truly does cause harm. In anesthesia, small issues uncorrected lead to big issues…

 

[Bryan O’Blivion]

Consider using the term “Real Anesthesiologist”.

 

[nimbus]

Consider using the term “Real Anesthesiologist”.

Look how well “physician anesthesiologist” turned out

 

[neutro]

Consider using the term “Real Anesthesiologist”.

Lol why should the original cave to the imitator?

 

[Bryan O’Blivion]

Lol why should the original cave to the imitator?

Well, I wouldn’t put that on my badge, but that’s where my mind goes when I read “nurse anesthesiologist”. And to be honest, I have no real beef with CRNAs. All of the anesthesia I’ve personally received has been administered by CRNAs, and I’ve had zero complaints. I agree with some of the complaints nurse anesthetists have with lazy anesthesiologists. I just think the term “nurse anesthesiologist” sounds corny, and well, fake.

 

[neutro]

Well, I wouldn’t put that on my badge, but that’s where my mind goes when I read “nurse anesthesiologist”. And to be honest, I have no real beef with CRNAs. All of the anesthesia I’ve personally received has been administered by CRNAs, and I’ve had zero complaints. I agree with some of the complaints nurse anesthetists have with lazy anesthesiologists. I just think the term “nurse anesthesiologist” sounds corny, and well, fake.

I mean I’m sure you would have received excellent anesthesia from anesthesiologists also…

The issue isn’t really about who can do anesthesia or hating CRNAs…the issue is privilege based on merit.

Merit being undergrad, MCAT, medical school, usmles, residency and boards…no one stopped the CRNAs to go through the RN to CRNA route but they chose that to practice anesthesia. However, it doesn’t make them equal now. How can it?

Yes it is sad to see many lazy anesthesiologists. There are plenty of lazy CRNAs too - you know the 235 pm exit crowd and ‘breakfast break must at 8 am’ and 50 minute lunches and ‘I can do only ASA 1-2 cases’ personnel

I don’t hate CRNAs - every single practice I’ve been in has had some crna involvement. CRNAs are as important to healthcare machine like any NP or PA…

At the same time I respect my license, credentials and experience. I understand what it took. So I don’t like it when it’s constantly tarnished and attempts are made to devalue it.

Recently, I sat through over 60 hours of bylaws meetings and some of it was very informative to hear the legal reasons why midlevels cannot be part of medical staff.

It essentially has to do with not being able to participate in peer review process and disqualification legally, based on different credentials and qualifications. They don’t meet the education, experience, and credentials criteria in case there is a lawsuit and professional equivalence needs to be established.

For instance, a hospital legally cannot use midlevel providers solely against MDs for peer review process or a difference in opinion to shed light on clinical matters as the qualifications aren’t equal…the converse is not true.

MDs can and do participate in midlevel peer review process given superior qualification.

There’s a lot more to it.

But essentially that’s what it comes down to. I know AANA is trying their hardest to somehow overcome this but this is where they will struggle - at the local hospital level, they will have the convince ALL the MDs in leadership that they’re equivalent to anesthesiologists. From internal medicine to surgery, to ER docs. There seems to be a very strong hard line on this particular issue unanimously as many of them are struggling with midlevel creep.

This is why it is so so so so crucial for anesthesiologists to take active roles in medical staff matters and build relationships. Because if you’re not on the table, you’re on the menu…

 

[Bryan O’Blivion]

I mean I’m sure you would have received excellent anesthesia from anesthesiologists also…

The issue isn’t really about who can do anesthesia or hating CRNAs…the issue is privilege based on merit.

Merit being undergrad, MCAT, medical school, usmles, residency and boards…no one stopped the CRNAs to go through the RN to CRNA route but they chose that to practice anesthesia. However, it doesn’t make them equal now. How can it?

Yes it is sad to see many lazy anesthesiologists. There are plenty of lazy CRNAs too - you know the 235 pm exit crowd and ‘breakfast break must at 8 am’ and 50 minute lunches and ‘I can do only ASA 1-2 cases’ personnel

I don’t hate CRNAs - every single practice I’ve been in has had some crna involvement. CRNAs are as important to healthcare machine like any NP or PA…

At the same time I respect my license, credentials and experience. I understand what it took. So I don’t like it when it’s constantly tarnished and attempts are made to devalue it.

Recently, I sat through over 60 hours of bylaws meetings and some of it was very informative to hear the legal reasons why midlevels cannot be part of medical staff.

It essentially has to do with not being able to participate in peer review process and disqualification legally, based on different credentials and qualifications. They don’t meet the education, experience, and credentials criteria in case there is a lawsuit and professional equivalence needs to be established.

For instance, a hospital legally cannot use midlevel providers solely against MDs for peer review process or a difference in opinion to shed light on clinical matters as the qualifications aren’t equal…the converse is not true.

MDs can and do participate in midlevel peer review process given superior qualification.

There’s a lot more to it.

But essentially that’s what it comes down to. I know AANA is trying their hardest to somehow overcome this but this is where they will struggle - at the local hospital level, they will have the convince ALL the MDs in leadership that they’re equivalent to anesthesiologists. From internal medicine to surgery, to ER docs. There seems to be a very strong hard line on this particular issue unanimously as many of them are struggling with midlevel creep.

This is why it is so so so so crucial for anesthesiologists to take active roles in medical staff matters and build relationships. Because if you’re not on the table, you’re on the menu…

I agree with you regarding the role physicians should have in medical staff. You will get zero dispute from me about that. I am an active member at my hospital.

I in no way support agenda of the AANA on this matter, and I have found strident AANA members to be among some of the least pleasant people I’ve ever worked with.

Conversely, I have worked with a lot of diligent and intellectually curious CRNAs that do excellent work, and that I learn from myself.

I think even the most juvenile CRNA propaganda like “Anesthesia Truth Blog” makes an excellent point about skill parity, especially when one witnesses anesthesiologists letting the CRNAs do all the work. If you haven’t seen this happening, you are intentionally being oblivious.

I think in addition to being a presence in committees, I think that a lot of anesthesiologists could stand to be more of a presence in the OR.

Anesthesiologists have excellent education and training, however there are many who will go to great lengths to avoid using these things.

 

[neutro]

I agree with you regarding the role physicians should have in medical staff. You will get zero dispute from me about that. I am an active member at my hospital.

I in no way support agenda of the AANA on this matter, and I have found strident AANA members to be among some of the least pleasant people I’ve ever worked with.

Conversely, I have worked with a lot of diligent and intellectually curious CRNAs that do excellent work, and that I learn from myself.

I think even the most juvenile CRNA propaganda like “Anesthesia Truth Blog” makes an excellent point about skill parity, especially when one witnesses anesthesiologists letting the CRNAs do all the work. If you haven’t seen this happening, you are intentionally being oblivious.

I think in addition to being a presence in committees, I think that a lot of anesthesiologists could stand to be more of a presence in the OR.

Anesthesiologists have excellent education and training, however there are many who will go to great lengths to avoid using these things.

I’m not sure what kind of anesthesiologists you’re talking about but the 60 hours of bylaws I attended was while doing cases on zoom and also managing workflow.

I also think that with CRNA compensation through the roof, more and more hospitals are opting for md staffing or anesthesiologists sitting own cases. At least that’s the trend I see in my area and it’s a good thing

 

[nimbus]

I’m not sure what kind of anesthesiologists you’re talking about but the 60 hours of bylaws I attended was while doing cases on zoom and also managing workflow.

I also think that with CRNA compensation through the roof, more and more hospitals are opting for md staffing or anesthesiologists sitting own cases. At least that’s the trend I see in my area and it’s a good thing

Good to hear. In what region of the country is this happening?

 

[neutro]

Good to hear. In what region of the country is this happening?

Dfw

Esp Many practices that specialize in asc work have realized that its more value to have an md staff rooms because ASCs are becoming mini hospitals and many cases are going past 3 pm

It essentially comes down to paying crna extra after asking them to stay longer plus having them supervised or just have rotating anesthesiologists that will finish out the day

 

[anbuitachi]

I mean I’m sure you would have received excellent anesthesia from anesthesiologists also…

The issue isn’t really about who can do anesthesia or hating CRNAs…the issue is privilege based on merit.

Merit being undergrad, MCAT, medical school, usmles, residency and boards…no one stopped the CRNAs to go through the RN to CRNA route but they chose that to practice anesthesia. However, it doesn’t make them equal now. How can it?

Yes it is sad to see many lazy anesthesiologists. There are plenty of lazy CRNAs too - you know the 235 pm exit crowd and ‘breakfast break must at 8 am’ and 50 minute lunches and ‘I can do only ASA 1-2 cases’ personnel

I don’t hate CRNAs - every single practice I’ve been in has had some crna involvement. CRNAs are as important to healthcare machine like any NP or PA…

At the same time I respect my license, credentials and experience. I understand what it took. So I don’t like it when it’s constantly tarnished and attempts are made to devalue it.

Recently, I sat through over 60 hours of bylaws meetings and some of it was very informative to hear the legal reasons why midlevels cannot be part of medical staff.

It essentially has to do with not being able to participate in peer review process and disqualification legally, based on different credentials and qualifications. They don’t meet the education, experience, and credentials criteria in case there is a lawsuit and professional equivalence needs to be established.

For instance, a hospital legally cannot use midlevel providers solely against MDs for peer review process or a difference in opinion to shed light on clinical matters as the qualifications aren’t equal…the converse is not true.

MDs can and do participate in midlevel peer review process given superior qualification.

There’s a lot more to it.

But essentially that’s what it comes down to. I know AANA is trying their hardest to somehow overcome this but this is where they will struggle - at the local hospital level, they will have the convince ALL the MDs in leadership that they’re equivalent to anesthesiologists. From internal medicine to surgery, to ER docs. There seems to be a very strong hard line on this particular issue unanimously as many of them are struggling with midlevel creep.

This is why it is so so so so crucial for anesthesiologists to take active roles in medical staff matters and build relationships. Because if you’re not on the table, you’re on the menu…

sounds related to why their malpractice is 10% the cost of ours

 

[neutro]

I agree with you regarding the role physicians should have in medical staff. You will get zero dispute from me about that. I am an active member at my hospital.

I in no way support agenda of the AANA on this matter, and I have found strident AANA members to be among some of the least pleasant people I’ve ever worked with.

Conversely, I have worked with a lot of diligent and intellectually curious CRNAs that do excellent work, and that I learn from myself.

I think even the most juvenile CRNA propaganda like “Anesthesia Truth Blog” makes an excellent point about skill parity, especially when one witnesses anesthesiologists letting the CRNAs do all the work. If you haven’t seen this happening, you are intentionally being oblivious.

I think in addition to being a presence in committees, I think that a lot of anesthesiologists could stand to be more of a presence in the OR.

Anesthesiologists have excellent education and training, however there are many who will go to great lengths to avoid using these things.

This is a weak response from you and highlights the apathy that is cancerous to our profession and current survival. I did not answer it well the first time so I will try again, in a more intelligent manner.

60 hours is not that much. Neither is 100 hours. That time is essential. Everyone is busy, but some things are more important than others. The same anesthesiologists who sit in the lounge and do pre-ops all day without stepping foot in the OR also complain about their 12 weeks off a year and having to take call. This is a work ethic and individual personality issue - not an anesthesiology as a profession issue. I was part of an anesthesia practice where the chairman took 6 weeks off between Thanksgiving to New Years and the rest of the group fought over PTO weeks. He refused to work during the busy season. Unfortunately, these type of malignant people exist. But we can learn from them and be better going forward. I do the schedule for our practice, and I ensure that I take on the toughest assignments every day. I would never tell anyone to do something which I wont do myself.

Typically we cannot find docs to participate in these matters. Anesthesia is usually absent or never invited so we can be targeted by surgeons behind our backs. Secondly, no one does meetings without multi-tasking these days.

On the flip side, it is very important that we remain relevant and involved. Our profession has a rich and beautiful history and we should respect that.

I am sorry that you chose an anesthesiologist over a CRNA for your anesthetic, but I will 100% use an anesthesiologist if I was to ever undergo surgery. I would find an MD only practice, and go there. Because I know when and IF s**t hits the fan, I would rather have a doctor than a nurse taking care of me. Its not even a question.

But that's me, and I respect your choice.

From my experience, MD only practices are the cream of the crop in terms of quality of work, their relationships with surgeons and overall routine, followed by MD - led private practice groups like USAP and then the rest are after. Working as an independent contractor is a great option too these days. I wont even consider anything besides that. Academics is a good option, but they have generally not kept up with compensation.

The minute you allow CRNAs in leadership roles, scheduling, and manage overall practice logistics, that is when it starts to go south. You start disenfranchising physicians. Tell me, will an orthopedic surgeon ever allow their midlevel to determine their assignments and take over complex surgical portions? Of course not. We have allowed this in our profession and its a big problem.
I won't name any groups - but you know the "practicing on top of my license" groups? Yes stay away.

 

[ambiturner]

I was part of an anesthesia practice where the chairman took 6 weeks off between Thanksgiving to New Years and the rest of the group fought over PTO weeks. He refused to work during the busy season. Unfortunately, these type of malignant people exist.

Not only do these people exist, they are EVERYWHERE in academics. I have yet to have a chairman who wouldn’t ghost from the OR schedule for the most trivial of meetings with no accountability to the rest of the group. Surgery chairs aren’t much different.

 

[GassYous]

Not only do these people exist, they are EVERYWHERE in academics. I have yet to have a chairman who wouldn’t ghost from the OR schedule for the most trivial of meetings with no accountability to the rest of the group. Surgery chairs aren’t much different.

The surgery chairs I know of are in their 60s and doing some of the most gnarly cases (open aaas, adrenalectomies)

 

[Volatile]

This is a weak response from you and highlights the apathy that is cancerous to our profession and current survival. I did not answer it well the first time so I will try again, in a more intelligent manner.

60 hours is not that much. Neither is 100 hours. That time is essential. Everyone is busy, but some things are more important than others. The same anesthesiologists who sit in the lounge and do pre-ops all day without stepping foot in the OR also complain about their 12 weeks off a year and having to take call. This is a work ethic and individual personality issue - not an anesthesiology as a profession issue. I was part of an anesthesia practice where the chairman took 6 weeks off between Thanksgiving to New Years and the rest of the group fought over PTO weeks. He refused to work during the busy season. Unfortunately, these type of malignant people exist. But we can learn from them and be better going forward. I do the schedule for our practice, and I ensure that I take on the toughest assignments every day. I would never tell anyone to do something which I wont do myself.

Typically we cannot find docs to participate in these matters. Anesthesia is usually absent or never invited so we can be targeted by surgeons behind our backs. Secondly, no one does meetings without multi-tasking these days.

On the flip side, it is very important that we remain relevant and involved. Our profession has a rich and beautiful history and we should respect that.

I am sorry that you chose an anesthesiologist over a CRNA for your anesthetic, but I will 100% use an anesthesiologist if I was to ever undergo surgery. I would find an MD only practice, and go there. Because I know when and IF s**t hits the fan, I would rather have a doctor than a nurse taking care of me. Its not even a question.

But that's me, and I respect your choice.

From my experience, MD only practices are the cream of the crop in terms of quality of work, their relationships with surgeons and overall routine, followed by MD - led private practice groups like USAP and then the rest are after. Working as an independent contractor is a great option too these days. I wont even consider anything besides that. Academics is a good option, but they have generally not kept up with compensation.

The minute you allow CRNAs in leadership roles, scheduling, and manage overall practice logistics, that is when it starts to go south. You start disenfranchising physicians. Tell me, will an orthopedic surgeon ever allow their midlevel to determine their assignments and take over complex surgical portions? Of course not. We have allowed this in our profession and its a big problem.
I won't name any groups - but you know the "practicing on top of my license" groups? Yes stay away.

This! In our group we are present for every induction/intubation. We do every spinal/ nerve block/ all labor epidurals/ all lines at our hospitals. We are present and have a great reputation. Many groups have given these things up but then complain about mid level creep :/ it’s laziness, they don’t want to be called for the 3am epidural. The more you give up the easier you’re replaced.

 

[2Fast2Des]

Not only do these people exist, they are EVERYWHERE in academics. I have yet to have a chairman who wouldn’t ghost from the OR schedule for the most trivial of meetings with no accountability to the rest of the group. Surgery chairs aren’t much different.

My chairman thinks he's above doing actual anesthesia, since he's too "busy" being a chairman and sending emails, looking to move up the ranks. He always has CRNAs, somehow also somehow only does the easy and productive rooms as well. Yet he makes all the rules that negatively effect the rest of us, without taking the pulse of the group or asking anyone's opinion about anything. Problem is everyone is afraid of him to confront him... Didn't realize this behavior is not out of the norm

 

[Bryan O’Blivion]

This is a weak response from you and highlights the apathy that is cancerous to our profession and current survival. I did not answer it well the first time so I will try again, in a more intelligent manner.

60 hours is not that much. Neither is 100 hours. That time is essential. Everyone is busy, but some things are more important than others. The same anesthesiologists who sit in the lounge and do pre-ops all day without stepping foot in the OR also complain about their 12 weeks off a year and having to take call. This is a work ethic and individual personality issue - not an anesthesiology as a profession issue. I was part of an anesthesia practice where the chairman took 6 weeks off between Thanksgiving to New Years and the rest of the group fought over PTO weeks. He refused to work during the busy season. Unfortunately, these type of malignant people exist. But we can learn from them and be better going forward. I do the schedule for our practice, and I ensure that I take on the toughest assignments every day. I would never tell anyone to do something which I wont do myself.

Typically we cannot find docs to participate in these matters. Anesthesia is usually absent or never invited so we can be targeted by surgeons behind our backs. Secondly, no one does meetings without multi-tasking these days.

On the flip side, it is very important that we remain relevant and involved. Our profession has a rich and beautiful history and we should respect that.

I am sorry that you chose an anesthesiologist over a CRNA for your anesthetic, but I will 100% use an anesthesiologist if I was to ever undergo surgery. I would find an MD only practice, and go there. Because I know when and IF s**t hits the fan, I would rather have a doctor than a nurse taking care of me. Its not even a question.

But that's me, and I respect your choice.

From my experience, MD only practices are the cream of the crop in terms of quality of work, their relationships with surgeons and overall routine, followed by MD - led private practice groups like USAP and then the rest are after. Working as an independent contractor is a great option too these days. I wont even consider anything besides that. Academics is a good option, but they have generally not kept up with compensation.

The minute you allow CRNAs in leadership roles, scheduling, and manage overall practice logistics, that is when it starts to go south. You start disenfranchising physicians. Tell me, will an orthopedic surgeon ever allow their midlevel to determine their assignments and take over complex surgical portions? Of course not. We have allowed this in our profession and its a big problem.
I won't name any groups - but you know the "practicing on top of my license" groups? Yes stay away.

I’m not sure if we are miscommunicating….

I serve on committees and at my hospital mid levels do not have leadership roles. I think that engagement is important. I don’t know how you misconstrued my response to understand otherwise.

I think you transposed anesthesiologist and CRNA in your response above. The point is I didn’t get to choose anything, a CRNA was assigned to me. If you think that I should insist on an anesthesiologist, I have some news for you, one typically isn’t available, and that would mean postponing an operation. That’s not an attractive option if you’ve been waiting 6 months. Honestly, most people aren’t going to do that.

I’m sorry you find it “weak” but I reiterate the point I was trying to make above: There are a lot of lazy anesthesiologists who are very content to have nurse anesthetists perform the bulk of the work. FYI, I’m not one of them.