Please support the ASAPAC and the ASA

[ThinkFast007]

As you all know, there is a heightened need to join or atleast support the ASAPAC.

It's about time as Anesthesiologists to be, that we really become more politically involved with the future of our profession. The CRNA association, AANA, is active.

Please PM me and I'll show you how to get involved. I would paste it on here, but some trolls and CRNAs (like nitecap et al) would take advantage of this since this is a 'public forum'.

Once i get enough requests, I'll try to mass PM those of you that are interested and direct you as to how to join.

Feel to put your name on this thread or PM me if you are interested.

Thank you doctors and soon to be docs


This is from the ASA newsletter:

------------------------------------------------------------------

SVR, SGR and You: Why You Need the ASAPAC

Warren K. Eng, M.D., Senior Co-editor
“Residents’ Review”


--------------------------------------------------------------------------------

VR versus SGR: Which is more critical to our future in anesthesiology? As we prepare for the 2006 in-training examination slated for Saturday, July 9, the systemic vascular resistance (SVR) equation, the arterial blood oxygen content equation and other formulae are among topics we must master in becoming successful practicing anesthesiologists.

However, one formula residents may not be aware of looms as a larger challenge to our future as anesthesiologists: Medicare’s Sustainable Growth Rate (SGR) formula. The SGR system was meant to control the growth of Medicare’s payments to physicians — yet in reality results in a 4-percent to 5-percent annual reduction in Medicare payments to anesthesiologists and other physicians, as it does not factor in increasing costs to provide services.

A complex formula based on gross domestic product, number of Medicare fee-for-service beneficiaries, input prices and various laws and regulations, the SGR has been criticized as flawed by ASA and other physician societies, the American Medical Association (AMA) and the Medicare Payment Advisory Commission. Its first implementation in 2002 resulted in a 5.4-percent reduction in physician payments.

Anesthesiologists in 2006 will not see their Medicare payments reduced — ASA and its allies have again successfully lobbied Congress this year to negate the cuts. Since 2003, Congress has passed one-year budget provisions restoring SGR-cut funds; however, these are temporary fixes that leave the SGR provision intact. Consequently, ASA, AMA and other physician groups are left to lobby representatives and senators on the same issue, every year.

What’s a busy resident to do? Between clinical duties, reading, the in-training examination and family life, how do we defend our specialty against external threats such as the SGR formula and the Medicare Teaching Rule reimbursement policy (see the October 2005 “Residents’ Review”)?

At a minimum, all residents should be aware of the ASA Political Action Committee (ASAPAC). ASA’s voice in Washington, ASAPAC was founded in 1991 as a bipartisan lobbying body. ASAPAC is one of the top 100 PACs in Washington, D.C., and was instrumental in orchestrating negation of the SGR fee reductions for this year.

While one notes with pride that ASAPAC is among the top 100 PACs in Washington, it also is noteworthy that other top 100 PACs include the American Association of Nurse Anesthetists, the Association of Trial Lawyers of America and the American Hospital Association. Only 10 percent of ASA members donate to ASAPAC — while already loud, imagine how much stronger our voice would be in Washington if that participation was simply doubled to a measly 20-percent participation rate (or even higher)!

---

Members don't see this ad.

 

[drRumi]

dude...ur box is full. clean the shiat up man. no pms goin thru

 

[ThinkFast007]

sorry about that. I just found out that the inbox actually contains 'sent' items as well, that's why I had a billion PMs.

It's clean now, so keep it coming.

 

[toughlife]

Opposition to Board of Nursing’s Proposed Conscious Sedation Rules


ASA
State Legislative and Regulatory Affairs


Over the past few years, the Florida Board of Nursing has solicited comments on its proposed Conscious Sedation Rules. The proposal was drafted in response to petitions for declaratory statements from registered nurses regarding the scope of practice of a registered nurse who is not a nurse anesthetist. Specifically the question was whether the administration of propofol and ketamine were within their scope of practice. The nursing board concluded that an R.N. could administer propofol under certain conditions but rejected petitions to administer ketamine. The R.N. could administer propofol pursuant to an order (written or verbal) if the patient is monitored and intubated. The R.N. must be trained in advance cardiac life support (ACLS) and must follow the policies and procedures of the facility.

Once the petitions for declaratory statements were heard, the nursing board published the proposed rules. The Florida Society of Anesthesiologists (FSA) and Florida Medical Association (FMA) submitted comments to the nursing board and Joint Administrative Procedures Committee (JAPC) expressing concerns. JAPC reviews agency rules to ensure that such rules do not exceed or conflict with the statutory authority delegated by the legislature to an agency.

Under the proposal, a R.N. qualified by training and education could administer limited medications to achieve conscious sedation pursuant to the order of a qualified anesthesia provider or physician. “Anesthesia provider” includes an anesthesiologist, physician or certified registered nurse anesthetist as authorized in a protocol agreement. The R.N. would be authorized and obligated to question orders and decisions that are contrary to standards of nursing practice and could refuse to administer medications that may induce general anesthesia or loss of consciousness. The R.N. would be required to have met the knowledge, education and competency requirements set forth in the rule, such as competence in patient assessment and the ability to administer medication through a variety of routes and to identify responses that are deviations from the norm. The R.N. or institution-based emergency response team would demonstrate skill in age-specific airway management and emergency resuscitation through ACLS, pediatric advanced life support, neonatal resuscitation program or equivalent training. The R.N. would have completed a program in conscious sedation developed by the institution or an approved continuing education provider. “Institution” includes a hospital, ambulatory surgery center, physician office setting, clinic or any other setting in which conscious sedation is utilized. The program would be, at a minimum, four hours in length and would contain information on drugs used during conscious sedation, assessment and monitoring of the patient receiving conscious sedation and recognition of emergency measures.

JAPC opposed the inclusion of nurse anesthetists as qualified providers who would be authorized to execute an order to an R.N. to administer anesthesia medications. Existing law does not extend such authority to a nurse anesthetist; their authority is limited to the prescription of pre-anesthesia medications. Moreover JAPC objected that the rule would not require supervision of the R.N. unless the purpose is to control the patient’s airway, such as rapid sequence intubation. JAPC questioned the rationality of requiring supervision of a nurse anesthetist but not an R.N. Lastly JAPC opposed the training requirements of an R.N. The comments expressed reservation that a four-hour program would be sufficient due to the acknowledged the complexity of the subject matter and that the proposal should list criteria for successful completion. JAPC, FSA and FMA all objected to the possibility that the program could be developed by any institution where the conscious sedation is administered.

Although the nursing board has not amended the conscious sedation rules to accommodate JAPC’s comments, it is unlikely that the current proposal would survive judicial scrutiny based on JAPC’s assessment.

 

[nitecap]

So whats the point here. Hey Im not for RN's pushing propofol or ketamine in a non intubated patient.

Its your pals the GI guys that are for it. Actually the ASA/AANA have made a joint statement regarding non anesthesia providers pushing anesthetics in non intubated pts. A rare aggreement b/t the 2.

 

[ThinkFast007]

bump

 

[jwk]

So whats the point here. Hey Im not for RN's pushing propofol or ketamine in a non intubated patient.

Its your pals the GI guys that are for it. Actually the ASA/AANA have made a joint statement regarding non anesthesia providers pushing anesthetics in non intubated pts. A rare aggreement b/t the 2.

The point had to do with politics and clout and the need to be involved, not the propofol debate. Obviously that point went right over your head. And much more often than not, the AANA and ANA are in 100% lockstep together.

 

[ThinkFast007]

hey everyone that PMd me...i got your PMs. keep it coming..i'll definitely PM you the link to the private forum, most likely by the end of the week, after I get more names.

Is it just me, or do you all feel passionate about this!! getting goosebumps here ....ok well no but..

 

[nitecap]

The point had to do with politics and clout and the need to be involved, not the propofol debate. Obviously that point went right over your head. And much more often than not, the AANA and ANA are in 100% lockstep together.

Not true on the 100% lockstep together, though on many issues like stated a unified front is the best way to go.

JWK sorry your profession lacks any politcal clout whatso ever. ITs ashamed that the very organization that you belong to and that promotes you will also hold you back and dictate all you do. Does the AAAA call the ASA daddy or what? IF it wouldnt be for ASA insecurity you wouldnt exist.

Like I said when the AA profession actually has more than 1000 AA's and we are really able to assess the overall practice of your entire profession we will really see who has data to back up all the trash talking you and I freq partake in.

Recently many CRNA programs have begun administering applicant evaluation exams assessing applicants clinical knowledge in areas such as hemodynamic value interpretation, ECG interpretation with clinical senarios, pharm exams ect We all know half of the AA's students entering these programs wouldnt be able to do this. Your profession is a joke and becomes even more hallarious as many students with non science Bach. degrees and no experience what so ever enter it. This will ultimatley lead to self implosion despite all the head you give to the ASA and I can promise you that I will exhaust all resources to lobby against your profession and the hipocracy of the ASA in claiming unsafeness of CRNA's while on the flip side promoting a less documented more servant like profession to increase control of and attempting to monopolize the market.

And Me trolling this forum? JWK you are the biggest troll around on the CRNA forums and are always stepping in, as I do here, when you feel something is stated that misrepresents what AA's are all about. Do they give you hipocrite seminars at your annual ASA meetings or what?

 

[HIIQ]

Nitecap is aggrevating, do you ever shut up?

 

[rn29306]

And the newly appointed forum Chicken Little aka Thinkfast isn't?

 

[ThinkFast007]

And the newly appointed forum Chicken Little aka Thinkfast isn't?

ah you're soo kind my friend. are you feeling a little scared now that some of teh docs and med students are actually AGGREGATING against the odds which your organization favor?

sadly for you it's happening.

 

[driverabu]

Not true on the 100% lockstep together, though on many issues like stated a unified front is the best way to go.

JWK sorry your profession lacks any politcal clout whatso ever. ITs ashamed that the very organization that you belong to and that promotes you will also hold you back and dictate all you do. Does the AAAA call the ASA daddy or what? IF it wouldnt be for ASA insecurity you wouldnt exist.

Like I said when the AA profession actually has more than 1000 AA's and we are really able to assess the overall practice of your entire profession we will really see who has data to back up all the trash talking you and I freq partake in.

Recently many CRNA programs have begun administering applicant evaluation exams assessing applicants clinical knowledge in areas such as hemodynamic value interpretation, ECG interpretation with clinical senarios, pharm exams ect We all know half of the AA's students entering these programs wouldnt be able to do this. Your profession is a joke and becomes even more hallarious as many students with non science Bach. degrees and no experience what so ever enter it. This will ultimatley lead to self implosion despite all the head you give to the ASA and I can promise you that I will exhaust all resources to lobby against your profession and the hipocracy of the ASA in claiming unsafeness of CRNA's while on the flip side promoting a less documented more servant like profession to increase control of and attempting to monopolize the market.

And Me trolling this forum? JWK you are the biggest troll around on the CRNA forums and are always stepping in, as I do here, when you feel something is stated that misrepresents what AA's are all about. Do they give you hipocrite seminars at your annual ASA meetings or what?

This is the first and probably last time I direct any comment towards you simply because it isn't worth my time. I have been reading a lot of your posts and honestly, what are you trying to prove? Coming to the Anesthesiology forum and calling our profession a joke? Who the he ll are you anyway to make that kind of remark? Look, I agree that almost anybody, with training can intubate and maintain a person under anesthesia for the duration of a relatively simple (i.e. lap chole, hernia, etc, etc) case. However, if you think for a second that that is all anesthesiology is about (and for the most part, that is what CRNAs and AAs are about), you probably need educate yourself a little more about what MDAs do, because you are clueless my friend. Until then, you really need to shut your word hole. I am sorry if you feel so damn insecure about yourself and your profession, but that gives you no right to bash somebody else's profession.

 

[nitecap]

This is the first and probably last time I direct any comment towards you simply because it isn't worth my time. I have been reading a lot of your posts and honestly, what are you trying to prove? Coming to the Anesthesiology forum and calling our profession a joke? Who the he ll are you anyway to make that kind of remark? Look, I agree that almost anybody, with training can intubate and maintain a person under anesthesia for the duration of a relatively simple (i.e. lap chole, hernia, etc, etc) case. However, if you think for a second that that is all anesthesiology is about (and for the most part, that is what CRNAs and AAs are about), you probably need educate yourself a little more about what MDAs do, because you are clueless my friend. Until then, you really need to shut your word hole. I am sorry if you feel so damn insecure about yourself and your profession, but that gives you no right to bash somebody else's profession.

Please tell me where I called your profession a joke. You are paraniod and putting words in my mouth. I have never said that, not even once. It is you that feels insecure the skew my posts into think I am some how saying your profession is a joke. It is you guys that do the profession bashing and me that rebukes, and aurgues these many times inaccurate BS comments that are dead wrong most of the times.

As you can see most of the actually attendings in the real world that know how things go many times defend the ACT, claim to get along well with the CRNA's within their practice and arent blabbing 24/7 about how we are trying to replace all MD's and about how all AA's should replace us ect. Why do they not make these statements? B/c they understand how things work, they understand the effectiveness of the ACT model, they understand that in the real world it not all fussing and fighting and bitterness like we have here. You residents and med students that have very narrow experiences and actually real world knowledge and practice jump to conclusion and are constantly foaming at the mouth with crap. That is when I jump in the mix, its not about bashing, merely defending and putting some in their place by calling out their lack of experience to make these bold and baseless claims upon.

 

[jwk]

Please tell me where I called your profession a joke. You are paraniod and putting words in my mouth. I have never said that, not even once. It is you that feels insecure the skew my posts into think I am some how saying your profession is a joke. It is you guys that do the profession bashing and me that rebukes, and aurgues these many times inaccurate BS comments that are dead wrong most of the times.

As you can see most of the actually attendings in the real world that know how things go many times defend the ACT, claim to get along well with the CRNA's within their practice and arent blabbing 24/7 about how we are trying to replace all MD's and about how all AA's should replace us ect. Why do they not make these statements? B/c they understand how things work, they understand the effectiveness of the ACT model, they understand that in the real world it not all fussing and fighting and bitterness like we have here. You residents and med students that have very narrow experiences and actually real world knowledge and practice jump to conclusion and are constantly foaming at the mouth with crap. That is when I jump in the mix, its not about bashing, merely defending and putting some in their place by calling out their lack of experience to make these bold and baseless claims upon.

Nitecap, remember that you're a student (that hasn't even gotten to clinicals as I recall), so you telling residents and med students that they're clueless is a pretty ridiculous.

 

[driverabu]

Please tell me where I called your profession a joke. You are paraniod and putting words in my mouth. I have never said that, not even once.

I'm done with you

 

[nitecap]

Nitecap, remember that you're a student (that hasn't even gotten to clinicals as I recall), so you telling residents and med students that they're clueless is a pretty ridiculous.

An an anesthesia provider your correct, i have little OR exp. AS far as being in the OR to observe interactions and how things work I have 2 yrs. The things we are discussing are about how things are, how people treat one another, work relationships, salary, reimburstment ect. I have just as much knowledge and more than any of these puusssy residents about these topics.

 

[rn29306]

ah you're soo kind my friend. are you feeling a little scared now that some of teh docs and med students are actually AGGREGATING against the odds which your organization favor?

sadly for you it's happening.

Actually I am quite comfortable in my future. You and everyone else can do a 3 man march up to the capitol and organize a grassroots political agenda if you so desire. I have no desire to argue with you about my job. I know what it is and what it isn't. I know how an efficient ATC practice works in both university level 1 centers (no anesthesia residents) and also how ATC works in smooth-as-glass private centers. Your constant lamenting has no effect on me whatsoever, sometimes I just wonder what rotation in the world you are on that allows you this much time on the internet. For God's sake, please start you anesthesia training already so you will STFU.
Although I am a student with 3 months to go at the end of my CRNA training, I have to admit I have more of a sense of how anesthesia runs than you do currently. And I can say that you have no idea. Perhaps you will, in the future, have a better sense. And when you do, you will see that CRNAs are more than IV startin', propofol-pushin', tube monkeys that actually run complex cases with minimal support. It is just that your pride may not allow this.
It is just funny to me that attendings here have said he or she has been where you are, have done what you have done, and ain't crap changed. CRNAs will not take over hospitals and force MDs out of a job.

I come here not to stir up trouble. You and your minions can believe what you want. I enjoy the cases presented by people that actually know WTF they are talking about, and this clearly does not include you in that group.

So have at it and bash away, it doesn't really matter.

 

[jwk]

An an anesthesia provider your correct, i have little OR exp. AS far as being in the OR to observe interactions and how things work I have 2 yrs. The things we are discussing are about how things are, how people treat one another, work relationships, salary, reimburstment ect. I have just as much knowledge and more than any of these puusssy residents about these topics.

Right.

Can you discuss the ramifications of the SGR and how it applies to anesthesiologists?

Can you discuss the problems of Medicare Part A passthroughs as they relate to anesthesiologists?

Are you aware of the ongoing debate with CMS regarding locked anesthesia carts?

Do you understand anesthesia resident reimbursement issues, particularly as to how they relate to surgical resident reimbursement?

If you answer no to any of these questions, then you really DON'T know WTF you're talking about. These and others are the issues that the ASA and ASAPAC deal with. I'm a member of the ASA - I would guess that you are not. No surprise there. Note the topic of this particular thread - "Please support the ASAPAC and the ASA". This doesn't relate to you in the least as a first year nurse anesthesia student.

 

[cloud9]

I'm done with you

Life can be beautiful, no?

This message is hidden because nitecap is on your ignore list.

 

[ThinkFast007]

yo JWK

i'm sure these CRNAs have no clue what the SGR is or any of the issues that are facing anesthesiology, why would they? They just wanta mk some $$$ and cash out. I'm actually quite glad that AA thing went through, certainly means great progress!

Man, I really am looking forward to getting involved with the ASAPAC.

you know what i love about Nurses Nitecap and RN90210, i love the fact that they are just student nurses already talking smack. It's hilarious, the guys claim they already know more than med students. Med students that have a better in depth knowledge about pharm, physio, and path...and of course some anesthesiology. See, the arrogance they have will follow through into when they are CRNAs.

See how arrogant theses STUDENT CRNAs are when they are just students, what mks ppl think they'll change when they become a CRNA. they'll still think they have the upper hand having sat around on a stool while we were doing other rotations outside the OR that give us a more wholisitic picture of the patient.

Yo nurses, do you guys really think we're that dumb? that we can't see through you? I cant wait to step inside the OR with one of you guys one day. The interaction will likely be like this, "hey nurse, I'm Dr.XX, go empty that urine. oh when you're done, get me some coffee". I suppose you all do serve some purpose.

 

[leopold stotch]

yo JWK

i'm sure these CRNAs have no clue what the SGR is or any of the issues that are facing anesthesiology, why would they? They just wanta mk some $$$ and cash out. I'm actually quite glad that AA thing went through, certainly means great progress!

Man, I really am looking forward to getting involved with the ASAPAC.

you know what i love about Nurses Nitecap and RN90210, i love the fact that they are just student nurses already talking smack. It's hilarious, the guys claim they already know more than med students. Med students that have a better in depth knowledge about pharm, physio, and path...and of course some anesthesiology. See, the arrogance they have will follow through into when they are CRNAs.

See how arrogant theses STUDENT CRNAs are when they are just students, what mks ppl think they'll change when they become a CRNA. they'll still think they have the upper hand having sat around on a stool while we were doing other rotations outside the OR that give us a more wholisitic picture of the patient.

Yo nurses, do you guys really think we're that dumb? that we can't see through you? I cant wait to step inside the OR with one of you guys one day. The interaction will likely be like this, "hey nurse, I'm Dr.XX, go empty that urine. oh when you're done, get me some coffee". I suppose you all do serve some purpose.

nitecap is just a student? wtf!!
i thought he was some old dude, practicing for like 10 years.

 

[Trauma Fluffer]

As you all know, there is a heightened need to join or atleast support the ASAPAC.

It's about time as Anesthesiologists to be, that we really become more politically involved with the future of our profession. The CRNA association, AANA, is active.

Please PM me and I'll show you how to get involved. I would paste it on here, but some trolls and CRNAs (like nitecap et al) would take advantage of this since this is a 'public forum'.

Once i get enough requests, I'll try to mass PM those of you that are interested and direct you as to how to join.

Feel to put your name on this thread or PM me if you are interested.

Thank you doctors and soon to be docs


This is from the ASA newsletter:

------------------------------------------------------------------

SVR, SGR and You: Why You Need the ASAPAC

Warren K. Eng, M.D., Senior Co-editor
“Residents’ Review”


--------------------------------------------------------------------------------

VR versus SGR: Which is more critical to our future in anesthesiology? As we prepare for the 2006 in-training examination slated for Saturday, July 9, the systemic vascular resistance (SVR) equation, the arterial blood oxygen content equation and other formulae are among topics we must master in becoming successful practicing anesthesiologists.

However, one formula residents may not be aware of looms as a larger challenge to our future as anesthesiologists: Medicare’s Sustainable Growth Rate (SGR) formula. The SGR system was meant to control the growth of Medicare’s payments to physicians — yet in reality results in a 4-percent to 5-percent annual reduction in Medicare payments to anesthesiologists and other physicians, as it does not factor in increasing costs to provide services.

A complex formula based on gross domestic product, number of Medicare fee-for-service beneficiaries, input prices and various laws and regulations, the SGR has been criticized as flawed by ASA and other physician societies, the American Medical Association (AMA) and the Medicare Payment Advisory Commission. Its first implementation in 2002 resulted in a 5.4-percent reduction in physician payments.

Anesthesiologists in 2006 will not see their Medicare payments reduced — ASA and its allies have again successfully lobbied Congress this year to negate the cuts. Since 2003, Congress has passed one-year budget provisions restoring SGR-cut funds; however, these are temporary fixes that leave the SGR provision intact. Consequently, ASA, AMA and other physician groups are left to lobby representatives and senators on the same issue, every year.

What’s a busy resident to do? Between clinical duties, reading, the in-training examination and family life, how do we defend our specialty against external threats such as the SGR formula and the Medicare Teaching Rule reimbursement policy (see the October 2005 “Residents’ Review”)?

At a minimum, all residents should be aware of the ASA Political Action Committee (ASAPAC). ASA’s voice in Washington, ASAPAC was founded in 1991 as a bipartisan lobbying body. ASAPAC is one of the top 100 PACs in Washington, D.C., and was instrumental in orchestrating negation of the SGR fee reductions for this year.

While one notes with pride that ASAPAC is among the top 100 PACs in Washington, it also is noteworthy that other top 100 PACs include the American Association of Nurse Anesthetists, the Association of Trial Lawyers of America and the American Hospital Association. Only 10 percent of ASA members donate to ASAPAC — while already loud, imagine how much stronger our voice would be in Washington if that participation was simply doubled to a measly 20-percent participation rate (or even higher)!

ThinkFast, perhaps you should think carefully.

Saw you spewing on the surgery board. Not cool.

 

[ThinkFast007]

ThinkFast, perhaps you should think carefully.

Saw you spewing on the surgery board. Not cool.

spewing?

surgeons are our colleagues and we have mutual interests....patients. I dont see a problem.

Trauma Fluffer, which one are you rn343234 or Nurse Nitecap, with a new username? Either way, doesnt bother me. I'm all for better patient care, collectively done by surgeons and anesthesiologists.

 

[ThinkFast007]

nitecap is just a student? wtf!!
i thought he was some old dude, practicing for like 10 years.

dude, so is rn22313 and the several other new posters with 1 post that's been popping up here and there. It's all good. they are just pist off that all of us going into anesthesiology are unifying.

 

[miamidc]

yo JWK

i'm sure these CRNAs have no clue what the SGR is or any of the issues that are facing anesthesiology, why would they? They just wanta mk some $$$ and cash out. I'm actually quite glad that AA thing went through, certainly means great progress!

Man, I really am looking forward to getting involved with the ASAPAC.

you know what i love about Nurses Nitecap and RN90210, i love the fact that they are just student nurses already talking smack. It's hilarious, the guys claim they already know more than med students. Med students that have a better in depth knowledge about pharm, physio, and path...and of course some anesthesiology. See, the arrogance they have will follow through into when they are CRNAs.

See how arrogant theses STUDENT CRNAs are when they are just students, what mks ppl think they'll change when they become a CRNA. they'll still think they have the upper hand having sat around on a stool while we were doing other rotations outside the OR that give us a more wholisitic picture of the patient.

Yo nurses, do you guys really think we're that dumb? that we can't see through you? I cant wait to step inside the OR with one of you guys one day. The interaction will likely be like this, "hey nurse, I'm Dr.XX, go empty that urine. oh when you're done, get me some coffee". I suppose you all do serve some purpose.

I agree and that last thing was funny . Even if things are smooth in the OR and everyone gets along now as some attendings truthfully say and observe. The fact that there are as much as a few student CRNAs trolling around our forum, talking smack, trying to find our weaknesses, telling us that they respect us but are really riding us to make themselves more money tells me that this is a mentallity shared by many more than those few invading our forum. We got to cut these suckers out before they cut us out. At least make sure they and everybody else (public) know whos boss. We got to have a voice, a strong voice, and one that isn't going to back down because some CRNAs or middle aged attendings want us to chill, and accept the market and our predicament bc there is nothing we can do about it (bullshtt). I live in DC, and I know they only way to change policy or to create policy is to speak up, in numbers on the hill, and MAKE things change, create legislation. Im with THINK here as should all you young, up and coming GAS folks. Its our turn to give our proffesion something it has been lacking for a long long time, noone elses.

 

[rn29306]

you know what i love about Nurses Nitecap and RN90210, i love the fact that they are just student nurses already talking smack. It's hilarious, the guys claim they already know more than med students. Med students that have a better in depth knowledge about pharm, physio, and path...and of course some anesthesiology. See, the arrogance they have will follow through into when they are CRNAs.

Show me where I said any of this, besides the anesthesia part. Have you ever been exposed to private practice ATC delivery? Simple yes or no will do.

And your semantic slight of hand does not go unnoticed BTW. We are not student nurses ahole. Actually, CRNAs were respected in your dual surgery posting BY surgery residents, probably much to your despair.

 

[toughlife]

I agree and that last thing was funny . Even if things are smooth in the OR and everyone gets along now as some attendings truthfully say and observe. The fact that there are as much as a few student CRNAs trolling around our forum, talking smack, trying to find our weaknesses, telling us that they respect us but are really riding us to make themselves more money tells me that this is a mentallity shared by many more than those few invading our forum. We got to cut these suckers out before they cut us out. At least make sure they and everybody else (public) know whos boss. We got to have a voice, a strong voice, and one that isn't going to back down because some CRNAs or middle aged attendings want us to chill, and accept the market and our predicament bc there is nothing we can do about it (bullshtt). I live in DC, and I know they only way to change policy or to create policy is to speak up, in numbers on the hill, and MAKE things change, create legislation. Im with THINK here as should all you young, up and coming GAS folks. Its our turn to give our proffesion something it has been lacking for a long long time, noone elses.

It is all about lobbying and schmoozing the politicians. Don't some say that we have the best congress money can buy?

 

[ThinkFast007]

It is all about lobbying and schmoozing the politicians. Don't some say that we have the best congress money can buy?

funny you brought this up. i dont want this thread to get side tracked, but dude you should check out this character, Rep. John Conyers Jr., D-Michigan. This guy apparently made his aides/lawyers babysit his kids, tk teh kids to the doc,etc. Apparently he's getting nailed for using congressional aides as 'servants'. atleast that's the allegation. You gotta love what goes on on the hill.

 

[miamidc]

Show me where I said any of this, besides the anesthesia part. Have you ever been exposed to private practice ATC delivery? Simple yes or no will do.

And your semantic slight of hand does not go unnoticed BTW. We are not student nurses ahole. Actually, CRNAs were respected in your dual surgery posting BY surgery residents, probably much to your despair.

dude you want to stop getting offended, and personally attacked, get off this PHYSICIAN forum, and I promise you will prob stop getting upset.

 

[nitecap]

yo JWK

i'm sure these CRNAs have no clue what the SGR is or any of the issues that are facing anesthesiology, why would they? They just wanta mk some $$$ and cash out. I'm actually quite glad that AA thing went through, certainly means great progress!

Man, I really am looking forward to getting involved with the ASAPAC.

you know what i love about Nurses Nitecap and RN90210, i love the fact that they are just student nurses already talking smack. It's hilarious, the guys claim they already know more than med students. Med students that have a better in depth knowledge about pharm, physio, and path...and of course some anesthesiology. See, the arrogance they have will follow through into when they are CRNAs.

See how arrogant theses STUDENT CRNAs are when they are just students, what mks ppl think they'll change when they become a CRNA. they'll still think they have the upper hand having sat around on a stool while we were doing other rotations outside the OR that give us a more wholisitic picture of the patient.

Yo nurses, do you guys really think we're that dumb? that we can't see through you? I cant wait to step inside the OR with one of you guys one day. The interaction will likely be like this, "hey nurse, I'm Dr.XX, go empty that urine. oh when you're done, get me some coffee". I suppose you all do serve some purpose.

JWK these issues are prob hammered into us more than they are hammered into residents. You can search past posts in which we all debated the resident reimbusrtment issues. Think you are getting old and seeing memory decline. On the contrary most residents here know very little about these things.

And Think see right through me? Surgery just saw right thru you on the other board. Thats hillarious. Others see thru you too.

AS far predetermining your interaction with your first CRNA that is totally unprofessional. You just continue to display your level of maturity. Doing that as a resident with no basis other than just to do it will most likely get you a face to face if not with your PD, then at least with the division chief and depending on who the CRNA is possible human resourses dept.

Its really time to step back to reality oh there goes rabit and oh...
I can assure you that as a resident you wont be saying these things to much, you will suffer the consequences man. Your attitude is piss poor man, I can believe you even said that. And you are going to be a MD in a few months? Guess that just proves 1 thing that MD does not = a professional professional.

As an attending sure go ahead and talk down on a CRNA. Your partners wont be happy when they cant retain staff b/c of your attitude and mistreatment. You prob wont be worth all the staff exiting. Also even as an attending within a group you still have to abide by hospital rules, regs and HR policies. You are in for a rude awakening man, your statement above just solidifies your maturity level and knowledge base. Your are a tool.

 

[ThinkFast007]

http://query.nytimes.com/gst/fullpage.html?res=9A05E3DF1238F936A25752C0A9649C8B63

I think the last line of the above link says it all

 

[cloud9]

We are not student nurses ahole.

???

rn29306
ATC SRNA
100+ Posts

So what does the "s" stand for?

 

[ThinkFast007]

???

rn29306
ATC SRNA
100+ Posts

So what does the "s" stand for?

good point. you crack me up Cloud

 

[nitecap]

http://query.nytimes.com/gst/fullpage.html?res=9A05E3DF1238F936A25752C0A9649C8B63

I think the last line of the above link says it all

Totally biased check what a quick google can find

Notice has been received of the death
of the following ASA members:

Quincy A. Ayscue, Sr., M.D.
Norfolk, Virginia
July 8, 2002

Figures the author is an Anesthesiologist, though god rest his sole has passed on.

 

[toughlife]

Totally biased check what a quick google can find

Notice has been received of the death
of the following ASA members:

Quincy A. Ayscue, Sr., M.D.
Norfolk, Virginia
July 8, 2002

Figures the author is an Anesthesiologist, though god rest his sole has passed on.

Were his shoes expensive or something?

 

[miamidc]

Fighting for surgical safety; Waukesha couple's daughter died during
Milwaukee Journal Sentinel, The, Dec 15, 2005 by SCOTT WILLIAMS
Waukesha Don Ayer has run a lot of marathons in his day, but never one like this.

The Waukesha man and his wife, Maureen, have spent two years fighting for a sense of justice in the death of a daughter who fell into a coma during plastic surgery.

Julie Rubenzer, 38, stopped breathing Sept. 25, 2003, while getting breast implants at a doctor's office in Florida. The 1984 graduate of Waukesha South High School never regained consciousness and died three months later at a Brookfield nursing home.

The Waukesha County medical examiner's office ruled that Rubenzer died from a lack of oxygen as an accidental complication of surgery.

The plastic surgeon, Kurt Dangl, lost his medical license and recently pleaded no contest to an unrelated felony charge of employing an unlicensed nurse.

But the Ayers, who hold Dangl responsible for the loss of their daughter, are not giving up. They have filed a wrongful death suit against him and are pushing to change Florida law to improve the safety of surgical procedures performed in doctors' offices rather than hospitals.

Continue article
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Don Ayer, a longtime marathon runner, said he is frustrated that investigators and other officials in Florida have "stopped short of the finish line."

Tougher standards sought

He and his wife are determined not only to establish responsibility for their daughter's death, but also to make sure that other men and women having plastic surgery are not subjected to the same hazards.

"I've never thought about quitting," Don Ayer said. "We'll take it to the wall."

Dangl, 44, who was given one year of probation on the unlicensed nurse charge, could not be reached for comment. The phone at his former Cosmetic Surgery Center in Sarasota, Fla., has been disconnected, and attorneys who have represented him in the past did not return calls for comment.

A prosecutor in the Sarasota County state's attorney's office said the investigation is closed, and officials have found no evidence that Dangl was intentionally negligent in Rubenzer's death.

Peter Lombardo, an assistant state's attorney, said he has gone over the evidence in detail with police investigators.

"I think everybody would agree that there was negligence involved," Lombardo said of Dangl's handling of the surgery. "But that's not a crime. You've got to have more than just negligence."

The prosecutor added: "It's very sad what happened."
Rubenzer, who had moved to Florida in 2001, stopped breathing near the end of breast-implant surgery for which she had paid $3,000.

Employees assisting with the operation later told investigators that Dangl became exasperated and forbade anyone from resuscitating the patient for several minutes.

Dual role questioned

Florida health investigators said Dangl tried to function as both surgeon and anesthesiologist and administered such high doses of anesthesia that it caused the patient to stop breathing.

Bruce Crow, an employee who assisted in the surgery, later resigned and contacted the Ayers to offer help in pursuing professional disciplinary action and criminal charges against Dangl. In an interview, Crow said he, too, is disappointed that the now ex- surgeon has not faced prosecution on tougher charges.

"I feel bad for them," he said of the Ayers. "I don't know if justice will ever come their way."

The unlicensed nurse charge had nothing to do with Rubenzer's death. It stemmed from another patient's complaint against Dangl. In addition to pleading no contest, Dangl agreed never to seek reinstatement of his medical license.

Don and Maureen Ayer said that although they are pleased that Dangl's plastic surgery career is apparently over, they worry about a lack of standards for other doctors offering quick, easy services in office settings.

Florida is more lenient than many other states on safety requirements for such businesses, the Ayers said.

"It has consumed our lives," Maureen Ayer said.

Maureen Ayer, 64, is a retired Waukesha schoolteacher, while Don, 68, is a real estate agent known for organizing marathons for charity in the Milwaukee area. They have been married 42 years and have two other children.

They are working with Florida medical professionals to craft tougher restrictions on office surgery. If a law can been passed, they hope it will be called "Julie's Law," after their lost daughter.

Hector Vila, a Florida anesthesiologist working with the Wisconsin couple, said their determination has been inspiring.

Vila said he is especially impressed that they realize the issue is bigger than the man they hold responsible for their daughter's death.

"They want to fix it for the rest of us," he said. "It well could be someone like Don and Maureen who make a difference."


Maybe these are the these we must use to educate the public about, and how things like this could have been avoided if a board certified Anesthesiologist would have been there.

 

[Gfunk6]

The plastic surgeon, Kurt Dangl, lost his medical license and recently pleaded no contest to an unrelated felony charge of employing an unlicensed nurse.

Call me crazy, but I'm quite certain that an "unlicensed nurse" is a far cry in terms of training and experience from a CRNA.

The unlicensed nurse charge had nothing to do with Rubenzer's death. It stemmed from another patient's complaint against Dangl.

Maybe you should read articles before posting them. This pretty much contradicts your entire argument.

Maybe these are the these we must use to educate the public about, and how things like this could have been avoided if a board certified Anesthesiologist would have been there.

Right . . .

My guess is that this could have been avoided if the plastic surgeon knew what he was doing. Not to mention the fact that he was a vindictive douchebag who put his own pride before patient safety.

 

[miamidc]

Call me crazy, but I'm quite certain that an "unlicensed nurse" is a far cry in terms of training and experience from a CRNA.



Maybe you should read articles before posting them. This pretty much contradicts your entire argument.



Right . . .

My guess is that this could have been avoided if the plastic surgeon knew what he was doing. Not to mention the fact that he was a vindictive douchebag who put his own pride before patient safety.

I assume that you are a nurse or a student nurse, funk.
Allow me to retort. I did not specifically single out a CRNA or nurse as a casue of the mishap, rather it was incidentaly mentioned in the article, and you chose to highlight it and try to gain ground on me somehow. This article was simply ment to show that there should be proper anesthesia professionals around to fix these calamities should they arise, peferably Board certified anesthesiologists. The SURGEON is at fault here, not the unregistered nurse, for HE was trying to play GasMan and Sticher at the same time. I was pointing out the surgeon's lack of respect for the pts life. Now that you have unnessicarily harrased me, I will point something else out. This goes to show that MD(meaning any MD) supervision of CRNAs is not enough, what the hell can a surgeon contribute if a pt is crashing right before his eyes, except hold pressure of fix a clipped artery. GI docs go along with this.

 

[jwk]

JWK these issues are prob hammered into us more than they are hammered into residents. You can search past posts in which we all debated the resident reimbusrtment issues. Think you are getting old and seeing memory decline. On the contrary most residents here know very little about these things.

You didn't answer my questions.

 

[Gfunk6]

I assume that you are a nurse or a student nurse, funk.

I find it hilarious how you assume that everyone who rains on your MDA/CRNA parade just HAS to be in the enemy camp. In my case, I'm just trying to unravel what I considered a flawed argument.

This article was simply ment to show that there should be proper anesthesia professionals around to fix these calamities should they arise, peferably Board certified anesthesiologists. The SURGEON is at fault here, not the unregistered nurse, for HE was trying to play GasMan and Sticher at the same time.

In this case, the surgeon was SO negligent, I don't think having an MDA would've helped. Probably, the surgeon and the MDA would've gotten into a fistfight while the patient died.

You are simply using an extreme example and are trying to make it sound like it is a trend. Maybe your original argument has weight, but this article does nothing to support it. That's all I'm saying.

 

[toughlife]

I find it hilarious how you assume that everyone who rains on your MDA/CRNA parade just HAS to be in the enemy camp. In my case, I'm just trying to unravel what I considered a flawed argument.



In this case, the surgeon was SO negligent, I don't think having an MDA would've helped. Probably, the surgeon and the MDA would've gotten into a fistfight while the patient died.

You are simply using an extreme example and are trying to make it sound like it is a trend. Maybe your original argument has weight, but this article does nothing to support it. That's all I'm saying.

What makes you think an MD/DO anesthesiologist would have let this patient become hypoxic/anoxic to begin with?

 

[miamidc]

I find it hilarious how you assume that everyone who rains on your MDA/CRNA parade just HAS to be in the enemy camp. In my case, I'm just trying to unravel what I considered a flawed argument.



In this case, the surgeon was SO negligent, I don't think having an MDA would've helped. Probably, the surgeon and the MDA would've gotten into a fistfight while the patient died.

You are simply using an extreme example and are trying to make it sound like it is a trend. Maybe your original argument has weight, but this article does nothing to support it. That's all I'm saying.

First off who/what are you? Please don't use MDA it undermines us as physicians. Second, I would have to disagree with you on this. I do think an anesthesiologist would have corrected this, very quickly. why? because we are not putzes and are not going to allow some stupid surgeon to compromise
our liscence because he doesn't know what he's doing, and just let him drag us down with him. Besides, the pt would never having gotten an overdose to begin with if the anesthesiologist was providing care. And I do think that these EXTREME examples are good to exploit, that is my opinion, i respect your as well. This article does do some service to what I am trying to say, although not as much as perhaps you would have wanted it too? If you want to help, then please find articles of your own that help our cause. If you don't then please go elsewhere. Thanks

 

[Gfunk6]

What makes you think an MD/DO anesthesiologist would have let this patient become hypoxic/anoxic to begin with?

Well, for one, this was not simply a case of negligence. It seems that while the medical staff wanted to help the patient, the surgeon aggresively told them to leave her be. Probably he was on a power trip. This is not a marginal case where the surgeon meant well but needed the services of an MDA. This surgeon willfully endangered that lady's life.

If you want to help, then please find articles of your own that help our cause. If you don't then please go elsewhere. Thanks

I see. You don't want your assertions challenged. Fair enough.

 

[nitecap]

First off who/what are you? Please don't use MDA it undermines us as physicians. Second, I would have to disagree with you on this. I do think an anesthesiologist would have corrected this, very quickly. why? because we are not putzes and are not going to allow some stupid surgeon to compromise
our liscence because he doesn't know what he's doing, and just let him drag us down with him. Besides, the pt would never having gotten an overdose to begin with if the anesthesiologist was providing care. And I do think that these EXTREME examples are good to exploit, that is my opinion, i respect your as well. This article does do some service to what I am trying to say, although not as much as perhaps you would have wanted it too? If you want to help, then please find articles of your own that help our cause. If you don't then please go elsewhere. Thanks

Any anesthesia provider, or you as a med student or me as a ICU RN would have intervened to do something. I would have told the MD to eat a dick and did anything within my power and knowledge to help. Sounds to me like here we just had a lack of confident people all the way around. Sure I wish an anesthesiologist would have been there, maybe this person would still be alive. But fact of the matter is that many different clinicians could have helped this patient out. You guys are good at what you do and would have managed the pt here, but so could many other clinicians.

 

[nitecap]

Are we really going to resort to posting malpractice cases here saying that one sucks more than the other. This is freaking highschool and pointless.

 

[jwk]

Are we really going to resort to posting malpractice cases here saying that one sucks more than the other. This is freaking highschool and pointless.

I agree. But let's get back to the OP and title of the thread, in which case, why are you here in the first place?

 

[ThinkFast007]

[.

 

[ThinkFast007]

... I would have told the MD to eat a dick ... .......

i would have loved to see you do that. You probably would've been either unemployed or woudl be back to your floor nursing job. You gotta love the professionalism of this nurse nitecap character.

In terms of this nurse nitecap guy. what have i noticed? every article/journal that we pull up and quote from, the nurse will attempt to dispute it's credibility. Of course when the article comes from a AANA backed journal, it's apparently the 'bible'. I'm just curious, since when did nurse journals become the standard of academic medicine. It's clear he's just trying to undermine every physician sponsered assertion. Laughable at best.

For the most part, 'standard of care' is determined by physicians or physicians working closely with PhDs. Thus, any credible resource will MORE likely be from the latter two. nice try though. I'm really getting the feeling that nursing student nitecap wants to be a physician deep down insdie.

 

[ThinkFast007]

......

The plastic surgeon, Kurt Dangl, lost his medical license and recently pleaded no contest to an unrelated felony charge of employing an unlicensed nurse.
....

I really hope the above plastic surgeon gets prosecuted to the fullest extent that the law allows. He should be held responsible for not having the proper personell on board, which eventually led to a patient's death. The very patients, that WE would have been vigilant towards and protected.

The Anesthesiologist quoted in the article is correct, there is a 'bigger' picture to worry about. I recently found this out. Most plastic surgeons try to offer the 'cheapest' rate on whatever procedure, "breast augm, nose job, etc". Their patinets are mostly individuals that pay cash. As such, some of these surgeons in an effort to be the 'least expensive' will attempt to cut corners. The issue is that he tried cutting corners via employing a CRNA. Surgeons are good at whatever they do, in terms of suturing,resecting, augmenting etc. When it comes to airway, breathing, circ and critical situations, the Anesthesiologist is the 'leader'...not a nurse.

It's very unfortunate for this patient. For her family's sake, I hope they find consolation. I hope this drives home the point that we've been making though. In this current state of medicine where managed care and a hospital or clinic's 'bottom line' is what's important, the standard of care is starting to become undermined. Cheaper labor (CRNA) does not mean BETTER results.