Patient ability to opt out of non-physician anesthesia

[guanaco]

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We do pay malpractice - of course it's less than the MD. You'll have to find out from a CRNA about their's - I don't know.

It simply isn't possible for MD's to do every anesthetic in this country. There aren't enough numbers.

As for the rest of your ravings, they deserve little further comment. The MDA vs CRNA and/or AA debate has been worn out in several threads in this forum. Do a search of the threads and educate yourself. I don't feel like doing it for you.

As long as the midlevels are kept on a leash I say no problem. If they want to be MD/DO equals then I say make them pay the price.

 

[jwk]

As long as the midlevels are kept on a leash I say no problem. If they want to be MD/DO equals then I say make them pay the price.

We don't claim to be equals.

And you know what you can do with that leash.

 

[sethco]

Sorry to break up this argument, but I have a question for whoever can answer. What is the difference between the scope of practice between an AA and a CRNA, level of training, procedures, etc.? Also, why are the CRNAs and AAs at "war" with each other? Thanks for anybody that can answer. Appreciate it.

 

[jwk]

Sorry to break up this argument, but I have a question for whoever can answer. What is the difference between the scope of practice between an AA and a CRNA, level of training, procedures, etc.? Also, why are the CRNAs and AAs at "war" with each other? Thanks for anybody that can answer. Appreciate it.

Scope of practice is similar for both groups. Their scope of practice is determined by state law or regulation and their employer or hospital as to what they can or can't do. Both groups are involved with all surgical subspecialties. The primary difference is that AA's must practice with an anesthesiologist as part of an anesthesia care team, where CRNA's can work without an anesthesiologist, and in some states, without physician supervision. That of course is a huge brouhaha in it's own right.

AA's hold a master's degree. All CRNA programs are now master's programs, but that is a relatively recent thing. There are many CRNA's practicing with no degree - they have a nursing diploma and a nurse anesthesia certificate.

The CRNA organizations do not like AA's because they represent competition, plain and simple. Any other arguments they use against AA's don't stand up.

There are a number of threads on this topic on this board that will provide you with more than you want to know about the debate between these two groups. 🙂

 

[sethco]

thanks.

 

[gaslady]

I am a 4th year if that helps. How about you?
I think we should bring foreign MDs from india or elsewhere to fill the need instead of having nurses do a job that should really be done by a doctor.
Also, I bet they want to play doctor and they don't pay the same amount in malpractice insurance that an MDA pays. I understand that these folks work under an MDA's supervision so if something goes wrong, who gets sued? I am sure it'd be the supervising doc. Who in their right mind would want to take the responsability if one of these "doctor-wannabes" f*cks up?

No one has addressed your comment about bringing in foreign MDs so I will. Some foreign MDs are great, but there are many that are not. The deficiencies range from basic things such as language skills to clinical competency. Honestly, many US trained anesthetists are going to be better than some foreign MDs. It's no accident that residency programs with more US grads are more prestigious than ones with foreign grads. It's because the medical education in the US is superior to that of many foreign medical schools, by having established standards. In some places, it is fine, such as Europe. Nut in other countries a person who is upper class can essentially buy themselves a medical degree after going through some perfunctory classes. Then, combine that with poor language skills and it's not a winning combo.

 

[joshmir]

couple caveats regarding perceptions of FMGs in gas (fyi; i am an intern form a us med school);

1) Programs get more money to train US medical grads, that's the #1 reason they prefer them...medicare covers the resident's salary, malpractice insurance, and gives the hospital money

2) If an FMG passes with decent marks form a US intern year, I think they should be assumed to have the level of knowledge necessary to accelerate through a gas residency. beyond a certain point, medical knowledge is not needed to do gas well (ICU is a different story, but it is possible to go into the private world and not do any ICU)

3) Some FMGs are already attendings, and have much superior knowledge compared with my 25 year old intern arse

4) All of Harvard's gas programs continue to take badass FMGs as residents and hire them onto their staff. that is hard to question b/c they certainly don't *need* to.


Edit: reading back over my post, i just wanted to make sure i wasn't giving the impression that i was disagreeing with gaslady...just adding perspectives

No one has addressed your comment about bringing in foreign MDs so I will. Some foreign MDs are great, but there are many that are not. The deficiencies range from basic things such as language skills to clinical competency. Honestly, many US trained anesthetists are going to be better than some foreign MDs. It's no accident that residency programs with more US grads are more prestigious than ones with foreign grads. It's because the medical education in the US is superior to that of many foreign medical schools, by having established standards. In some places, it is fine, such as Europe. Nut in other countries a person who is upper class can essentially buy themselves a medical degree after going through some perfunctory classes. Then, combine that with poor language skills and it's not a winning combo.

 

[guanaco]

We don't claim to be equals.

And you know what you can do with that leash.

Good and yes I do know what to do with that leash.. put it around the junkyard dogs' necks and keep them at bay.

 

[guanaco]

No one has addressed your comment about bringing in foreign MDs so I will. Some foreign MDs are great, but there are many that are not. The deficiencies range from basic things such as language skills to clinical competency. Honestly, many US trained anesthetists are going to be better than some foreign MDs. It's no accident that residency programs with more US grads are more prestigious than ones with foreign grads. It's because the medical education in the US is superior to that of many foreign medical schools, by having established standards. In some places, it is fine, such as Europe. Nut in other countries a person who is upper class can essentially buy themselves a medical degree after going through some perfunctory classes. Then, combine that with poor language skills and it's not a winning combo.

I woudl have to disagree with the idea that only MDs educated in europe are capable to perform well in the US. Some of the brightest attendings out there are indian. I am sure not all of them are outstanding but the great majority do know their s*** and know it well. I say put them to the test and if they perform accordingly then I say use them instead of CRNA so that Anesthesiology does not get bastardized by mid-levels.

My 0.02 cents.

 

[jwk]

I woudl have to disagree with the idea that only MDs educated in europe are capable to perform well in the US. Some of the brightest attendings out there are indian. I am sure not all of them are outstanding but the great majority do know their s*** and know it well. I say put them to the test and if they perform accordingly then I say use them instead of CRNA so that Anesthesiology does not get bastardized by mid-levels.

My 0.02 cents.

Once again - you don't know what you're talking about. Now you think mid-levels "bastardize" anesthesiology. OMG, you're just a friggin med student. You've gotta finish med school and then residency before you even work in the real world. You better start realizing that everything in medicine is a team effort. If you think you're gonna be a one-man show and do it all, you are so sadly mistaken!

 

[jjjez]

IT seems wierd you know. In the UK the Royal College of Anaesthetists (who are your equiv to anaesthesiologists) did a small study into the possibility of whether non physician anaesthesia providers could be trained in the UK. (dont know where u guys could get on line report so just reading it as i understand it). they would prefer to train operating department practitioners (2 year course NVQ qual' at the end, nowhere near a degree or diploma, no entry requirements)(you know the guys that apply cricoid and maybe draw up the syringes) rather than degree trained ICU nurses with 5 years experience.
So in essence one can see that a smack decision of;
'Hmm, yes. not someone who can work without us, but someone who will need us to work, to keep us in the loop, someone who we could control...'
i think thats what the CRNA's gripe is. they are trained to work indep' at least to greater extent than AA's at least, right. can anyone really deny that? truthfully? im from UK and medicine as a profession has such control over healthcare that any advancements must come from them. u dont know how lucky you are to have three sets of anaesthesia providers. our problems are nowhere near the same i know. Our's are financial and our nurses have low morale, but trust me backwardness never helps.
BY the way the plan for our AA equiv's is that the anaesthetist (remember in UK they're the doctors!!) will start everything and then will duck out. seems like a cop out. why bother paying and trianing someone to do half a job???

 

[guanaco]

Once again - you don't know what you're talking about. Now you think mid-levels "bastardize" anesthesiology. OMG, you're just a friggin med student. You've gotta finish med school and then residency before you even work in the real world. You better start realizing that everything in medicine is a team effort. If you think you're gonna be a one-man show and do it all, you are so sadly mistaken!

I could care less whether you think I am mistaken or not. My beef is with people who try to lobby for independent practice rights who have no had the training or paid their dues. So whether you like or not, there will always be people like me who have a beef against CRNAs.
I may be a med student now but someday I may be your boss. Now that would be your worst nightmare, wouldn't it?

 

[jwk]

I could care less whether you think I am mistaken or not. My beef is with people who try to lobby for independent practice rights who have no had the training or paid their dues. So whether you like or not, there will always be people like me who have a beef against CRNAs.
I may be a med student now but someday I may be your boss. Now that would be your worst nightmare, wouldn't it?

How soon you forget - I'm an AA, not a CRNA. I'm not lobbying for independent practice rights. I won't have to worry about you being my boss - we only hire people who are respectful of their co-workers and employees, and you will never fit that bill.

 

[guanaco]

How soon you forget - I'm an AA, not a CRNA. I'm not lobbying for independent practice rights. I won't have to worry about you being my boss - we only hire people who are respectful of their co-workers and employees, and you will never fit that bill.

And I didn't say you were one again. So unless you are a CRNA, don't take offense. It does not apply to you.

 

[ultraconsrvativ]

I could care less whether you think I am mistaken or not. My beef is with people who try to lobby for independent practice rights who have no had the training or paid their dues. So whether you like or not, there will always be people like me who have a beef against CRNAs.
I may be a med student now but someday I may be your boss. Now that would be your worst nightmare, wouldn't it?

I've always been amused watching how fast the cockiness dissipates when the med student emerges from his cocoon into reality and finds out he has to coexist with the despicable nonconformist CRNA. In my town the CRNA 's own the group and the MDAs work for them. Maybe as a spectator of the egocentric I will even be fortunate enough to be the recipient of some good entertainment as I watch how your attitude changes as you engage in future threads.

 

[guanaco]

I've always been amused watching how fast the cockiness dissipates when the med student emerges from his cocoon into reality and finds out he has to coexist with the despicable nonconformist CRNA. In my town the CRNA 's own the group and the MDAs work for them. Maybe as a spectator of the egocentric I will even be fortunate enough to be the recipient of some good entertainment as I watch how your attitude changes as you engage in future threads.

Well you are assuming that my desire to not continue the argument signifies conformity. I am trying to be civil to the AA who is not a CRNA therefore not someone I would have a problem with. However, since some of the AAs tried to get independent practice rights in Louisiana, it shows that they also want to incur into the MDA turf. To those who want to do that I say "f*** them"

In my town the CRNA 's own the group and the MDAs work for them.

Well, in my town, the MDAs pimp out the CRNAs like cheap wh*r*s"

My attitude is not cockiness but anger to someone who wants to, yes, bastardize the profession by finding the loopholes and have access to something they never worked for. So, will my attitude change about CRNAs? I highly doubt it. So go ahead and keep on watching me but you may be dissappointed.

cheers, 😉

 

[jjjez]

'Oh my god, you guys are so weird!'

 

[grimace1900]

So here is my opinion about CRNAs compared to physicians:
I agree that CRNAs have all the skills to adminster anesthetics to most patients- the reason why they need to be supervised, I believe is because they are less trained to understand and implement changes in the field of anesthesia. Let me ask you- as a CRNA how would you make a change in how an anethestic is adminstered- either upon the realease of a new drug or even class of drug or a new procedure, or a chcnage in how a surgery is done. Wouldn't the most likely way you would find this out be via an anesthesiologist or from you institution (which means by physicians)- or do you claim to keep up on the literature? Now you can claim that these changes are infrequent, but in medicine and anesthesia they will occur. You can't be 90% able to take in and understand and evaluate these changes- you must be 100% able. Medical school and residency allow doctors to fully understand the why of things and not just the how. Even when I was a third year medical studnet and nurses thought I was an idiot because I don't have doses of meds or how to do an IV at the tip of my tongue, the understanding of the medical field I had was way more than any nurse. Most nurses did not realize this. They understood what they did everyday much better than I did, but how that fit into the field of medicine they were mostly clueless.
Also I don't know, but I doubt too many CRNAs do liver transplants, or Cardiac cases, pediatric hearts, complicated neuro cases, etc... There will always be those very infrequent times where something weird is going on- that you might do the same as normal, but it requires something different and you just don't even realize it. I know it hard to convince someone that that don't even know what they don't know.
I think CRNAs are really useful. They are well trained and deserve to paid well. Sometimes I think they get confused that because they can make almost as much as anesthesiolgist that they have almost the same skill set. It's not quite the case.
Anyway, I don't mean to be confrontational, but I think you should think about these issues.

 

[ultraconsrvativ]

So here is my opinion about CRNAs compared to physicians:
I agree that CRNAs have all the skills to adminster anesthetics to most patients- the reason why they need to be supervised, I believe is because they are less trained to understand and implement changes in the field of anesthesia. Let me ask you- as a CRNA how would you make a change in how an anethestic is adminstered- either upon the realease of a new drug or even class of drug or a new procedure, or a chcnage in how a surgery is done. Wouldn't the most likely way you would find this out be via an anesthesiologist or from you institution (which means by physicians)- or do you claim to keep up on the literature? Now you can claim that these changes are infrequent, but in medicine and anesthesia they will occur. You can't be 90% able to take in and understand and evaluate these changes- you must be 100% able. Medical school and residency allow doctors to fully understand the why of things and not just the how. Even when I was a third year medical studnet and nurses thought I was an idiot because I don't have doses of meds or how to do an IV at the tip of my tongue, the understanding of the medical field I had was way more than any nurse. Most nurses did not realize this. They understood what they did everyday much better than I did, but how that fit into the field of medicine they were mostly clueless.
Also I don't know, but I doubt too many CRNAs do liver transplants, or Cardiac cases, pediatric hearts, complicated neuro cases, etc... There will always be those very infrequent times where something weird is going on- that you might do the same as normal, but it requires something different and you just don't even realize it. I know it hard to convince someone that that don't even know what they don't know.
I think CRNAs are really useful. They are well trained and deserve to paid well. Sometimes I think they get confused that because they can make almost as much as anesthesiolgist that they have almost the same skill set. It's not quite the case.
Anyway, I don't mean to be confrontational, but I think you should think about these issues.

Yawn

Also I don't know, but I doubt too many CRNAs do liver transplants, or Cardiac cases, pediatric hearts, complicated neuro cases, etc...

Wrong again.

Anyway, I don't mean to be confrontational, but I think you should think about these issues.

knowledge deficit

 

[guanaco]

Loopholes? Access to something CRNAs never worked for?

Nurse anesthetists have been delivering anesthesia for over 100 years. When you return from your ego trip, please learn the facts before proclaiming that you really have no clue what you're talking about. Furthermore, I know of plenty of CRNAs who perform everything from liver transplants to pedi hearts who know the whys of what they're doing.

yeah it's always " I know someone who knows this and that". Too bad that you don't.

 

[ultraconsrvativ]

yeah it's always " I know someone who knows this and that". Too bad that you don't.

delusional

 

[jwk]

However, since some of the AAs tried to get independent practice rights in Louisiana, it shows that they also want to incur into the MDA turf. To those who want to do that I say "f*** them"

AS ALWAYS YOU DON'T KNOW WHAT YOU'RE TALKING ABOUT !!!
But that's nothing new!

1) There are NO AA's in Louisiana.
2) There have never been AA's in Louisiana.
3) We did not seek independent practice rights in Louisiana. We only sought the right to practice as part of the anesthesia care team WITH anesthesiologists, which is what we do in every state in which we currently practice.
4) We have not tried to get independent practice rights in ANY state.

You once again demonstrate that you have no understanding of the issues involved, very limited knowledge about CRNA's, and no knowledge whatsoever of AA's. Ya gotta know the facts to have an intelligent debate. Your strong suit appears to be using the **** to make a point, which of course you can't make since (everybody say it with me) you don't know what you're talking about!

 

[grimace1900]

My friend, you missed the crux of my opinion- in that as a CRNA you are not trained to analyze literature, understand the implications of advances and help a hospital decide which changes would be best. Now you can say you know some CRNA who can do this, and there probably is, but this is not the norm. Sure I'm sure some CRNA had an anesthesiologist train them how to do heart or a liver transplant, but this is not the norm. What teaching centers are you at that you routinely have such an excess of liver transplants and pedi heart cases that they would assign them to a CRNA over a resident? I'm not saying it's impossible, but it seems like that would be either one super great training program with so much volume it is crazy or it doens't exist.
On another note -Also, yeah a CRNA who has 20 years of experience is going to be more skilled than a resident with none. I hope to God so. But what about the skills of a CRNA with 1 year of experience acting completely unsupervised in a hospital with no anesthesiologists on staff- this is the implication of letting CRNAs work unsupervised. Most of the time stuff will go fine, but what happens that one day when somebody massively screws up and a 50 million dollar lawsuit is won against a CRNA. We live in a medical legal world where the supervisors take responsibility for the supervised. Don't you think insurance premiums would be higher for unsupervised CRNA? They may have the same skills, but in a court of law perception wins and I guarentee MD over no MD would win every time.
Anyway, you can coninue your arguments of "You don't know what you are talking about" or "you are just ignorant". You are winning a debate in terms of increasing annoyance amoungst- but your sources of "I know a guy.. " or "there is this hospital..." is simply ******ed.

 

[Gator05]

AAAAAAAARRRRRRRRRRGGGGGGGGGGHHHHHHHHHHHHHHH!!!!!

Boy do I miss the days when these threads were shut down...

 

[jjjez]

yeah but would they hire an mda with 1 years exp either???

 

[powermd]

Hmmm?let?s see. The last two teaching hospitals I?ve been at routinely assign their CRNAs to hearts, liver transplants, ect. So once again, guanaco, you have not a clue. 😎

I wonder if a CRNA ran President Clinton's anesthetic at Columbia last week? Given his support of independant practice rights for CRNAs I would hope Columbia assigned a CRNA to his case. Somehow I doubt it though. I guess when it *really* matters, only an MD will do. Not every patient has the luxury of VIP status where anesthesiology is concerned at some hospitals, like the "teaching institution" mentioned in ether_screen's post.

 

[Wahoowa]

IT seems wierd you know. In the UK the Royal College of Anaesthetists (who are your equiv to anaesthesiologists) did a small study into the possibility of whether non physician anaesthesia providers could be trained in the UK. (dont know where u guys could get on line report so just reading it as i understand it). they would prefer to train operating department practitioners (2 year course NVQ qual' at the end, nowhere near a degree or diploma, no entry requirements)(you know the guys that apply cricoid and maybe draw up the syringes) rather than degree trained ICU nurses with 5 years experience.
So in essence one can see that a smack decision of;
'Hmm, yes. not someone who can work without us, but someone who will need us to work, to keep us in the loop, someone who we could control...'
i think thats what the CRNA's gripe is. they are trained to work indep' at least to greater extent than AA's at least, right. can anyone really deny that? truthfully? im from UK and medicine as a profession has such control over healthcare that any advancements must come from them. u dont know how lucky you are to have three sets of anaesthesia providers. our problems are nowhere near the same i know. Our's are financial and our nurses have low morale, but trust me backwardness never helps.
BY the way the plan for our AA equiv's is that the anaesthetist (remember in UK they're the doctors!!) will start everything and then will duck out. seems like a cop out. why bother paying and trianing someone to do half a job???

You need to elaborate on your point. This ramble makes no sense.

 

[Wahoowa]

AAAAAAAARRRRRRRRRRGGGGGGGGGGHHHHHHHHHHHHHHH!!!!!

Boy do I miss the days when these threads were shut down...

Stay tuned--it will get even better than this.

 

[jjjez]

woulda thought doctor to be clever enough to follow gist.
BTW ostepath across the pond = quack medicine.

 

[Leukocyte]

I wonder if a CRNA ran President Clinton's anesthetic at Columbia last week? Given his support of independant practice rights for CRNAs I would hope Columbia assigned a CRNA to his case. Somehow I doubt it though. I guess when it *really* matters, only an MD will do. Not every patient has the luxury of VIP status where anesthesiology is concerned at some hospitals, like the "teaching institution" mentioned in ether_screen's post.

👍

 

[VentdependenT]

This pile of feces is still up and running. Amazing.

Off to practice my quackery! Lord help all those bones I'm a fixen.

 

[ultraconsrvativ]

AAAAAAAARRRRRRRRRRGGGGGGGGGGHHHHHHHHHHHHHHH!!!!!

Boy do I miss the days when these threads were shut down...

I agree