opinion on the future

[lakersbaby]

---

Members don't see this ad.

During my rotation one of the attendings gave the residents and students a talk on where he thought the field was headed and what we needed to do to assure ourselves an actual future as an anesthesiologist. He said that we need to become perioperative care clinicians. Pre-op, intra-op, post-op were the main things that anesthesiologists need to take over because the days of CRNAs taking over most of the day to day anesthesia delivery in the OR are coming closer and closer. The only way to distinguish ourselves realistically is to take over perioperative care. What do you guys think?

 

[Narcotized]

Pre-op, intra-op, post-op were the main things that anesthesiologists need to take over.QUOTE]

You mean I should spend less time trying to take over dermatology and radiology, and focus on the things anesthesiologists already do, such as preop intraop and postop care?

On a side note, lakersfan, what do you think of the new anti-KobeCrybaby rule? I'm all in favor of it. I am so sick and tired of these friggin babies flailing the arms, making stupid faces, and running around the entire court every time a foul is called. I don't care who the crybaby is and for what team, I'm all in favor of it.

These type of crybaby antics in the picture in the following article need to go (regardless who the offender is). I completely disagree with the writer who wants to leave it as is.

http://sportsillustrated.cnn.com/2010/writers/ian_thomsen/09/24/technicals/

 

[Planktonmd]

He is partially right!
The nurses are going to inherit the intra-operative patient care but that does not mean they will stop at that.
The future of anesthesia in the U.S. is nurses doing protocol based patient care.
It is cheaper and more convenient to credentialing agencies, hospital administrators and insurance companies.
Whatever is cheaper will prevail since the American public is not educated sufficiently to distinguish between nursing and the practice of medicine.

 

[lakersbaby]

Pre-op, intra-op, post-op were the main things that anesthesiologists need to take over.QUOTE]

You mean I should spend less time trying to take over dermatology and radiology, and focus on the things anesthesiologists already do, such as preop intraop and postop care?

On a side note, lakersfan, what do you think of the new anti-KobeCrybaby rule? I'm all in favor of it. I am so sick and tired of these friggin babies flailing the arms, making stupid faces, and running around the entire court every time a foul is called. I don't care who the crybaby is and for what team, I'm all in favor of it.

These type of crybaby antics in the picture in the following article need to go (regardless who the offender is). I completely disagree with the writer who wants to leave it as is.

http://sportsillustrated.cnn.com/2010/writers/ian_thomsen/09/24/technicals/

sure there are a lot of annoying antics that ALL players do when they think there is a bad call but thats basketball. the refs mess calls up, they are human and a reaction to a bad call is also human. The NBA already lost the class it once had many years ago, this rule isn't going to change anything. regardless of this rule Lakers will 3 peat and you haters will conjure more things to hate about.

 

[Narcotized]

you haters will conjure more things to hate about.

Dude, grow up. Since about age 14 I stopped tying my identity to teams I don't belong to, or wasting time "hating" others. You act like you are an active teammate of a team that in reality couldn't care less if you even exist.

 

[lakersbaby]

Dude, grow up. Since about age 14 I stopped tying my identity to teams I don't belong to, or wasting time "hating" others. You act like you are an active teammate of a team that in reality couldn't care less if you even exist.

okay buddy enjoy watching sports while millions of other "14 year olds" actually have fun supporting teams they identify with. you are just way too mature for us.

 

[pgg]

You act like you are an active teammate of a team that in reality couldn't care less if you even exist.

Now, now. Be nice. Of course they care.

They care about the $ he spends to advertise their business on his clothing. 😀


Except for the 2006 World Cup and a handful of qualifying games, I don't think I've been to a pro sporting event in about 10 years. Minor league games are fun to go to though - the raw talent isn't there, but they're fun, cheap, and the players seem a bit more down to earth.

I can't even watch pro baseball or basketball on TV. I look at the NBA and I see gangsters; I look at MLB and see drug using freaks. The NFL has a bit of both but for some reason I still watch those games. It's a sickness I guess.

 

[bronx43]

Dude, grow up. Since about age 14 I stopped tying my identity to teams I don't belong to, or wasting time "hating" others. You act like you are an active teammate of a team that in reality couldn't care less if you even exist.

How is he acting like he's an active team member? He's defending his favorite sports team, from which he drew his moniker for an online forum. You baited him, then attacked him for responding. Cool stuff, dude.

 

[JLM]

Can someone explain to me how it saves the average patient A CENT to have their anesthesia provision by a CRNA vs. a physician. It seems to me that the hospital will be billing the exact same ammount for anesthesia care, but paying a CRNA less -- which unless elementary math is failing me, means more money in the pockets of the HOSPITAL (or whomever does the billing) and NOT THE PATIENT.

HEY ASA, I HAVE YOUR BIG AD CAMPAIGN: Tell the American public that they are paying hefty insurance premiums to ensure they have they best of care, but hospitals are substituting inferior providers in the operating room to expand their own bottom lines. I am a firm believer that the public is far too naive to care who their anesthesia provider is. However, if they think they are being swindled (which I believe they are) they will react with hellfire and damnation.

Until there is a true price difference in the reimbursement for CRNA vs. MD care (eg 50-60% discount) then there is not even a measurable cost savings to the patient themselves. AND WE MUST TELL THEM THAT !!


Am I wrong? Anyone? Is this not really what is going on? Is there really some discount for CRNA anesthesia care of which I am unaware?

 

[WholeLottaGame7]

How is he acting like he's an active team member? He's defending his favorite sports team, from which he drew his moniker for an online forum. You baited him, then attacked him for responding. Cool stuff, dude.

14 was the age Narc was cut from his Little League team, and forever scarred.

I don't really watch pro basketball all that much, though I will probably root for whoever's playing the Heat next year. I think it's a silly rule, but whatever. The refs shouldn't put up with that much crap in the first place. If they haven't liked it the past few years, it was within their right to T someone up already. This is the NBA's version of protocolizing medicine...

 

[BLADEMDA]

Can someone explain to me how it saves the average patient A CENT to have their anesthesia provision by a CRNA vs. a physician. It seems to me that the hospital will be billing the exact same ammount for anesthesia care, but paying a CRNA less -- which unless elementary math is failing me, means more money in the pockets of the HOSPITAL (or whomever does the billing) and NOT THE PATIENT.

HEY ASA, I HAVE YOUR BIG AD CAMPAIGN: Tell the American public that they are paying hefty insurance premiums to ensure they have they best of care, but hospitals are substituting inferior providers in the operating room to expand their own bottom lines. I am a firm believer that the public is far too naive to care who their anesthesia provider is. However, if they think they are being swindled (which I believe they are) they will react with hellfire and damnation.

Until there is a true price difference in the reimbursement for CRNA vs. MD care (eg 50-60% discount) then there is not even a measurable cost savings to the patient themselves. AND WE MUST TELL THEM THAT !!


Am I wrong? Anyone? Is this not really what is going on? Is there really some discount for CRNA anesthesia care of which I am unaware?

Let us review he FACTS one by one:

1. Inferior provider- DO you have any "proof" that a CRNA providing an anesthetic gives inferior care or an inferior anesthetic? In fact, the latest "evidence" sponsored by the AANA shows CRNA care is just as "safe" as MD superrvised care.

2. Cost- Not all insurance companies reimburse a CRNA only anesthetic the same amount of money as MD or MD supervised anesthesia. In fact, 60-80% reimbursement of the MD fee is the norm for CRNA only. Yes, Medicare pays the same but that is because the fee is exceptionally low (even CRNAS get twice the amount fom private insurance compared to Medicare).

3. Savings- Hospitals would "employ" CRNAs for a flat salary and cut/eliminate the anesthesia stipend. CRNAs would work harder/more hours but earn their current level of income.

4. Public- The average "Joe" is uneducated about anesthesia providers. If the surgeon tells the patient Nurse Betsy is great then the patient will say fine. The surgeon must "sell" the CRNA to the patient if the question about MD Anesthesiologist comes into play.

5. DNAP- The propaganda will only get worse once the CRNAS start getting Doctorates in Anesthesia. The patient will either get a Doctor of Nurse Anesthesia or a Doctor of Medicine Anesthesiologist. Per the AANA the care is equal and the service provided identical.

Circa 2020-25 the AANA will have Checkmate.

 

[halflife94]

Lets get back to the principles which anesthesia was founded on....we are the best critical care doctors in the world and that is something that nurses try as they might can not take away. Ask yourself does anyone really ever want to argue with an intensivist? We as a profession were the ones that started ICUs over half a century ago and got greedy. We left this to other areas of medicine and now it is theirs. By being a perioperative specialty you can truly protect yourself. Patients should be seen by a PHYSICIAN before during and after surgery. This is something they should expect. I agree with BLADE we must defend ourselves while we have something left to defend.

 

[IDBasco]

Time to change the name of the specialty to Anesthesia and Perioperative Medicine?

Just a thought. But it highlights the difference in depth of expertise between a CRNA and a physician.

 

[JLM]

Let us review he FACTS one by one:

1. Inferior provider- DO you have any "proof" that a CRNA providing an anesthetic gives inferior care or an inferior anesthetic? In fact, the latest "evidence" sponsored by the AANA shows CRNA care is just as "safe" as MD superrvised care.

The public could give two sh*ts about all of these crap studies put out by the AANA. What the patient hears is 'nurse' and 'doctor.' And if they think they are forking over the money for a physician, then damnit they will want a physician. THIS SHOULD NOT BE A SAFETY ISSUE !! We will never have well-powered studies to prove one safer than the other because its not ethical. So we need to take the argument in another direction - the fiscal direction.

2. Cost- Not all insurance companies reimburse a CRNA only anesthetic the same amount of money as MD or MD supervised anesthesia. In fact, 60-80% reimbursement of the MD fee is the norm for CRNA only. Yes, Medicare pays the same but that is because the fee is exceptionally low (even CRNAS get twice the amount fom private insurance compared to Medicare).

Does this in any way change how much the patient is paying for the service. Will there be a measurable discount to the out-of-pocket expense for the patient if the recieve MD vs. nurse anesthesia? And Im really asking, because maybe I just dont understand it. Seems to me that the patient will be paying the same ammount to their insurance company, but the insurance company only has to pay 60 to 80 % of the MD fee. Sounds like the insurance company is the winner here, not the patient.

3. Savings- Hospitals would "employ" CRNAs for a flat salary and cut/eliminate the anesthesia stipend. CRNAs would work harder/more hours but earn their current level of income.

Blade, this is my entire point. The winner in this game is the hospital. They continue to give anesthesia using a NURSE and save money because they dont have to hire a DOCTOR, hence making more money for THEMSELVES. If patients viewed this whole thing as a money-making scam for the hospitals (which really it is, in part) I think they would care a lot more than if we simply throw out the nurse vs. doctor safety bit which we will never really be able to prove. I know its a paradigm shift for our argument, but we are getting nowhere fast with the safety issue. Again, if the public thinks their hard-earned insurance premium money is supposed to buy them a doctor during anesthesia and they are only getting a nurse so some hospital CEO can line their own pockets, they will revolt.


4. Public- The average "Joe" is uneducated about anesthesia providers. If the surgeon tells the patient Nurse Betsy is great then the patient will say fine. The surgeon must "sell" the CRNA to the patient if the question about MD Anesthesiologist comes into play.

Unless they think they are paying for a physician to provide their care. There sholuld be no selling involved. If the patient saw an add on CNN telling them that insurance companies and hospitals were having nurses provide anesthesia rather than doctors so that they could line their own pockets they would care less how great nurse Betsy was. They paid for a doctor, they want a damn doctor.

5. DNAP- The propaganda will only get worse once the CRNAS start getting Doctorates in Anesthesia. The patient will either get a Doctor of Nurse Anesthesia or a Doctor of Medicine Anesthesiologist. Per the AANA the care is equal and the service provided identical.

Circa 2020-25 the AANA will have Checkmate.

,

 

[yasawa]

Lets get back to the principles which anesthesia was founded on....we are the best critical care doctors in the world and that is something that nurses try as they might can not take away. Ask yourself does anyone really ever want to argue with an intensivist? We as a profession were the ones that started ICUs over half a century ago and got greedy. We left this to other areas of medicine and now it is theirs. By being a perioperative specialty you can truly protect yourself. Patients should be seen by a PHYSICIAN before during and after surgery. This is something they should expect. I agree with BLADE we must defend ourselves while we have something left to defend.

I wonder if people would still choose anesthesiology if it were like europe where critical care was built into the training and it was 5 years as opposed to 4. I honestly would still choose this field. Maybe programs should do what OHSU is doing and have a critical care track that you can opt to match into. Maybe have like 1/4 of the spots with this track and over the years slowly inc the percentage until all the match spots are part of this track.

 

[maceo]

The future of anesthesia in the U.S. is nurses doing protocol based patient care.
It is cheaper and more convenient to credentialing agencies, hospital administrators and insurance companies.
Whatever is cheaper will prevail

until a few bad airways happens, and some intra operative deaths occur. See in anesthesia when bad **** happens.. bad **** happens. pretty dramatic.

 

[100101]

1. Orangutans will sit in for bread and butter procedures.

2. Robots will do nerve blocks.

3. CRNAs will be responsible for high-acuity cases and for disciplining/grooming the apes.

4. Anesthesiologists will be responsible for disciplining/grooming the CRNAs and greasing of robots.

5. Hospitals will be robots.