Physicians Advocacy Institute

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Copy of their open letter to Congress. Why isn’t the ASA doing this?

Physicians Advocacy Institute > Home

 

[Endee]

If you saw the fight in 2018 at the ASA annual meeting over changing the language to make it in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology" to allow an unlicensed SRNA to be alone in a room performing an anesthetic, you would understand why they aren't putting out things like this.

There is a strong pro-physician voice within the ASA. Unfortunately, many times, it's not the loudest. There are a lot of private equity-backed/corporate group interests in there that are at the very least, tacitly supporting the erosion of physician leadership, and at the very worst, actively lobbying for it.

Hopefully the pro-physician faction can win out, and hopefully, if they do, it's not too late.

 

[Drägerman]

If you saw the fight in 2018 at the ASA annual meeting over changing the language to make it in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology" to allow an unlicensed SRNA to be alone in a room performing an anesthetic, you would understand why they aren't putting out things like this.

There is a strong pro-physician voice within the ASA. Unfortunately, many times, it's not the loudest. There are a lot of private equity-backed/corporate group interests in there that are at the very least, tacitly supporting the erosion of physician leadership, and at the very worst, actively lobbying for it.

Hopefully the pro-physician faction can win out, and hopefully, if they do, it's not too late.

Any chance you could elaborate on the discussion?

How large is the PE voice in ASA? I would hate to see ASA go down the path of the EM advocacy groups.

 

[Endee]

Any chance you could elaborate on the discussion?

How large is the PE voice in ASA? I would hate to see ASA go down the path of the EM advocacy groups.

In 2018 there was a proposal to make the change I mentioned--changing language in the ASA's "Statement on the Anesthesia Care Team" to say that having unlicensed unsupervised personnel take care of patients is inappropriate and unethical and in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology". There was a huge backlash at the annual meeting and it led to one of the longest House of Delegates debates I've personally seen. Nearly all of the people I noticed speaking against the motion were people who had some connection to the corporate groups, for example I heard objections from people in large USAP groups that I know utilized a lot of SRNAs, people in leadership in Envision groups, people in Envision corporate level leadership positions, etc etc.

The motion passed, somewhat narrowly. There have been attempts since then to water it down.

Statement on the Anesthesia Care Team

www.asahq.org

Physician anesthesiologists who teach non-physician anesthesia students are dedicated to their education and to providing optimal safety and quality of care to every patient. The ASA “Standards for Basic Anesthetic Monitoring” define the minimum conditions necessary for the safe conduct of anesthesia. The first standard states, “Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and monitored anesthesia care.” By definition, non-physician anesthesia students are not yet fully “qualified anesthesia personnel”, and must be supervised to a greater degree than fully credentialed anesthesiologist assistants or nurse anesthetists.

Students are not qualified anesthesia personnel. Therefore, the use of students in place of qualified personnel is inappropriate as well as inconsistent with the ASA Guidelines for the Ethical Practice of Anesthesiology.

If you ask me, the single greatest threat to the future of anesthesiology is not the AANA, it's Envision/USAP/NAPA etc.

 

[deleted126335]

In 2018 there was a proposal to make the change I mentioned--changing language in the ASA's "Statement on the Anesthesia Care Team" to say that having unlicensed unsupervised personnel take care of patients is inappropriate and unethical and in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology". There was a huge backlash at the annual meeting and it led to one of the longest House of Delegates debates I've personally seen. Nearly all of the people I noticed speaking against the motion were people who had some connection to the corporate groups, for example I heard objections from people in large USAP groups that I know utilized a lot of SRNAs, people in leadership in Envision groups, people in Envision corporate level leadership positions, etc etc.

The motion passed, somewhat narrowly. There have been attempts since then to water it down.

Statement on the Anesthesia Care Team

www.asahq.org

If you ask me, the single greatest threat to the future of anesthesiology is not the AANA, it's Envision/USAP/NAPA etc.

Only as long as there is an excess of supply. The AMCs suffered multiple losses of contracts during the 2000s when the market for docs was really good. Anybody who could leave did. Anybody who stayed did as little as possible and provided [emoji90] service. Resulting in contract loss.

 

[GassYous]

In 2018 there was a proposal to make the change I mentioned--changing language in the ASA's "Statement on the Anesthesia Care Team" to say that having unlicensed unsupervised personnel take care of patients is inappropriate and unethical and in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology". There was a huge backlash at the annual meeting and it led to one of the longest House of Delegates debates I've personally seen. Nearly all of the people I noticed speaking against the motion were people who had some connection to the corporate groups, for example I heard objections from people in large USAP groups that I know utilized a lot of SRNAs, people in leadership in Envision groups, people in Envision corporate level leadership positions, etc etc.

The motion passed, somewhat narrowly. There have been attempts since then to water it down.

Statement on the Anesthesia Care Team

www.asahq.org

If you ask me, the single greatest threat to the future of anesthesiology is not the AANA, it's Envision/USAP/NAPA etc.

That's obvious. All you need to do is look at em. They needed to make a whole new society because acep was so in the pockets of cmgs.

 

[jwk]

In 2018 there was a proposal to make the change I mentioned--changing language in the ASA's "Statement on the Anesthesia Care Team" to say that having unlicensed unsupervised personnel take care of patients is inappropriate and unethical and in violation of the ASA's "Guidelines for the Ethical Practice of Anesthesiology". There was a huge backlash at the annual meeting and it led to one of the longest House of Delegates debates I've personally seen. Nearly all of the people I noticed speaking against the motion were people who had some connection to the corporate groups, for example I heard objections from people in large USAP groups that I know utilized a lot of SRNAs, people in leadership in Envision groups, people in Envision corporate level leadership positions, etc etc.

The motion passed, somewhat narrowly. There have been attempts since then to water it down.

Statement on the Anesthesia Care Team

www.asahq.org

If you ask me, the single greatest threat to the future of anesthesiology is not the AANA, it's Envision/USAP/NAPA etc.

The issue of using SRNAs as free labor has been going on for longer than the 40 years I’ve been in this profession. Many of the now-closed community hospital-based (and non degree granting) CRNA programs existed primarily to provide a steady supply of free labor to those hospitals, as well as a steady stream of newly minted CRNAs that they could hire.

It’s also one of the reasons that CAAs have a hard time getting into more states, and even getting hired in states that allow AA practice. AA students are not free labor like SRNAs are - they don’t run rooms by themselves.

 

[ryanjmy]

The issue of using SRNAs as free labor

Ethics aside this also speaks to how ****ty Medicare/Medicaid reimbursement is. You can’t bill for an sCRNA. These business types aren’t giving up the revenue from private insurance. I assume once the reimbursement drops below the cost of a CRNA ($100ish/hr) they’d rather just do the case for free if it costs them nothing.