Question for Anesthesiologists

[rmh149]

Thinking about a dream opportunity....imagine a group of CRNA's and Anesthesiologists...and AA's for that matter. Not necessarily using exclusively the Anesthesia Care team model but have some flexibility. I have a vision of a grand group that covers multiple hospitals in a large city. In some settings the CRNAs and anesthesiologists practice as sole practitioners, some cases using the anesthesia care team model. Some places using exclusively anesthesiologist and some CRNA’s exclusively….depending on the needs of the hospital, clientel, stipends, etc. Also, since EVERY case does not need to be supervised by the anesthesiologist, more time can be freed for them to practice CCM improving the overall outcomes for the patients of that hospital. I would much rather see my family member in the ICU with an anesthesiologists managing their care than an intensivist (this comes from personal experience).

What I do miss is the input from other providers from different education and residency backgrounds (CRNA’s, DO’s, MD’s….east coast, west coast, military, etc.). I hope to get some of this from the clinical based posts on this forum. I also miss doing big cases such as thoracics, neuro, and transplants. Although an OB gone bad can be a pretty big case real fast.

One of the things I don’t like about most groups that use the Anesthesia care team model is the fact that I as a CRNA would be an employee and most likely never get to practice independently. Sorry, but waiting for the anesthesiologist to enter the room before I push my induction agents for a DX scope on an ASA-1 just for billing purposes is annoying. But for a AAA on a 72 y/o 20% EF…..two people behind that curtain is helpful.

Is it possible that changes that may occur in the future will take away restrictions and allow for more flexibility increasing the access to care and changing the restrictive billing requirements?

Anesthesiologists may see the DNAP as another threat. But can there be some positive points brought to the table considering the overall standards in anesthesia care provided to the citizens of this country continues to increase. Lastly, is it possible for a group as mentioned above ever exist? Could a group take advantage of the flexibility that comes from future changes?...instead of us trying to kill each others profession.

Your thoughts….

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[cfdavid]

Not really any input here as I'm still just a med student (but with a strong interest in antesthesiology). But, I'd like to commend you on keeping your cool and staying professional. Keep in mind that there have been other CRNA's that have come over to this forum to antagonize and weren't at all constructive. That's lead many of us to become rather defensive and cynical at first. However, as far as I'm concerned your posts have all been really good, with some nice ideas.

 

[BLADEMDA]

Not really any input here as I'm still just a med student (but with a strong interest in antesthesiology). But, I'd like to commend you on keeping your cool and staying professional. Keep in mind that there have been other CRNA's that have come over to this forum to antagonize and weren't at all constructive. That's lead many of us to become rather defensive and cynical at first. However, as far as I'm concerned your posts have all been really good, with some nice ideas.

The CRNA with DNAP will lead to the dumbing down of the profession. The AANA wants equality with MD's in pay and the work place. This means lower pay for Anesthesiologists and lower quality Residents.

While the patient gets a better CRNA he/she gets a "weaker" Anesthesiologist if any at all.

Blade

 

[BLADEMDA]

CRNA's can already push medications, start lines, do blocks, etc. without any Anesthesiologist present. The ACT model does not require a "physical" presence to be legal. TEFRA allows CRNA's to bill Independently and many Groups file the bill under the CRNA name. Thus, even in our current ACT model there is a lot of room for "Independent" practice.

What your AANA wants is something much more. The AANA wants NO RATIOS and no MD/DO needed at all in every situation. The CRNA would call the only MD/DO on duty for that shift even if there are 20 rooms running at the time.

Because of the AANA's stance on the issue the two professions are on a collision course. No offense but I want to take the AANA "out" with minimal damage to mine.

BLade

 

[Monty Python]

Also, since EVERY case does not need to be supervised by the anesthesiologist,

From a policy standpoint, hospital bylaws can mandate this. Bylaws can always be more stringent than state law or federal regulations.

Sorry, but waiting for the anesthesiologist to enter the room before I push my induction agents for a DX scope on an ASA-1 just for billing purposes is annoying.

Purely from a billing standpoint, only the TEFRA requirements for Medicare reimbursement requires this (the "7 steps").

 

[BLADEMDA]

From a policy standpoint, hospital bylaws can mandate this. Bylaws can always be more stringent than state law or federal regulations.



Purely from a billing standpoint, only the TEFRA requirements for Medicare reimbursement requires this (the "7 steps").

TEFRA allows a CRNA to bill independently. This means a CRNA can work for a Group and do his/her own case for that GROUP. The money from Medicare is the same whether Medical Direction occurs or the CRNA bills Independently.

The AANA wants much, much more than this and you know it.

Blade

 

[Monty Python]

TEFRA allows a CRNA to bill independently. This means a CRNA can work for a Group and do his/her own case for that GROUP. The money from Medicare is the same whether Medical Direction occurs or the CRNA bills Independently.

The AANA wants much, much more than this and you know it.

Blade

Thank you, please pardon my inaccuracy, and allow me to re-state more precisely. When an anesthesiologist is billing Medicare for CRNA supervision, he/she must meet the 7 steps. One of them is being physically present in the OR at induction, versus in the lounge/control desk/preop area.

If I'm understanding TEFRA .........

 

[rmh149]

CRNA's can already push medications, start lines, do blocks, etc. without any Anesthesiologist present. The ACT model does not require a "physical" presence to be legal. TEFRA allows CRNA's to bill Independently and many Groups file the bill under the CRNA name. Thus, even in our current ACT model there is a lot of room for "Independent" practice.

What your AANA wants is something much more. The AANA wants NO RATIOS and no MD/DO needed at all in every situation. The CRNA would call the only MD/DO on duty for that shift even if there are 20 rooms running at the time.

Because of the AANA's stance on the issue the two professions are on a collision course. No offense but I want to take the AANA "out" with minimal damage to mine.

BLade

The AANA may be mad at me for saying this..oh well. But even if they succeed in removing any ratio and no MD/DO needed by law, I still believe the individual hospitals will still choose to maintain their current Anesthesia Departments headed by anesthesiologists. I don’t see alot of change. And even if they say CRNA's are equal (in law), who's going to believe it? Law cannot force people to think a certain way.

The DNAP is a way we CRNA's can establish more credibility with the community and within our profession. But honestly...it still isn’t an MD/DO. The public will still view the education of the anesthesiologist to be more prestigious and superior than a DNAP (I think they are right). Can we still do the job, sure. But anesthesiologist will still be viewed as superior. I will never see a DNSc, JD, Pharm D, PhD...or any other D to be comparable to the MD/DO. The medical community has done a fine job maintaining this strong level of prestige with the public.

Now, the confusion of the introduction of "DR" with patients. I agree (as much as I don’t want to) that if I introduce myself as Dr. XXXX then they will think I am a physician. I agree that is wrong. When I acquire the DNAP degree I am sure that I will still introduce myself as XXXX, your anesthetist or CRNA. The main purpose for completing the DNAP would be for professional prestige with my collegues (CRNA's) and providing more confidence to the public.

What if I introduced myself as Dr. XXXX, nurse anesthetist? Would that still be OK? That way I can give credit for completing a doctorate without confusing someone into thinking I was a physician (honestly I would probably just use my first name...so much easier).

In the end, we may be a small threat, but I don’t think we can come close to where you as physicians are in the eyes of the public.

 

[BLADEMDA]

EtherMD

Do you just re-paste the BS from all of your posts over and over again? If you dont have anything new to say, please, dont bother posting.

BTW: how is it they allowed you a new account when you were banned and its obvious this is you again?

I am an ASA Member. I am a contributor of ASA PAC's (federal and state).
I have many years of private practice experience. If anyone needs to be banned it is you.

Blade

 

[BLADEMDA]

The AANA may be mad at me for saying this..oh well. But even if they succeed in removing any ratio and no MD/DO needed by law, I still believe the individual hospitals will still choose to maintain their current Anesthesia Departments headed by anesthesiologists. I don’t see alot of change. And even if they say CRNA's are equal (in law), who's going to believe it? Law cannot force people to think a certain way.

The DNAP is a way we CRNA's can establish more credibility with the community and within our profession. But honestly...it still isn’t an MD/DO. The public will still view the education of the anesthesiologist to be more prestigious and superior than a DNAP (I think they are right). Can we still do the job, sure. But anesthesiologist will still be viewed as superior. I will never see a DNSc, JD, Pharm D, PhD...or any other D to be comparable to the MD/DO. The medical community has done a fine job maintaining this strong level of prestige with the public.

Now, the confusion of the introduction of "DR" with patients. I agree (as much as I don’t want to) that if I introduce myself as Dr. XXXX then they will think I am a physician. I agree that is wrong. When I acquire the DNAP degree I am sure that I will still introduce myself as XXXX, your anesthetist or CRNA. The main purpose for completing the DNAP would be for professional prestige with my collegues (CRNA's) and providing more confidence to the public.

What if I introduced myself as Dr. XXXX, nurse anesthetist? Would that still be OK? That way I can give credit for completing a doctorate without confusing someone into thinking I was a physician (honestly I would probably just use my first name...so much easier).

In the end, we may be a small threat, but I don’t think we can come close to where you as physicians are in the eyes of the public.

You are wrong. The ratios will change as Lema and I predict. MD/DO Anesthesiology will no longer exist for us as the primary Anesthesia provider. Hospital ratios will increase from 4:1 to 6-7:1 or more. This is something I and others will fight hard against.

Blade- fighting against the AANA

 

[rmh149]

Question: Can a group bill private insurance more for Anesthesiologist supervising a CRNA compared to a solo CRNA or solo anesthesiologist?

I'm not a billing guru....

I did read an article stating in the state of TX CRNA's made 20% more than anesthesiologist for obstetric anesthesia covered by medicaid. Any ideas why this is?

 

[BLADEMDA]

Lema has asked for us to be professional. I intend to honor his request but some of our DO Junior Residents choose otherwise.

My handle is Blade. I ask to be called that when responding to my posts.
Please leave the name calling and accusations at the door.

Blade

 

[BLADEMDA]

Question: Can a group bill private insurance more for Anesthesiologist supervising a CRNA compared to a solo CRNA or solo anesthesiologist?

I'm not a billing guru....

I did read an article stating in the state of TX CRNA's made 20% more than anesthesiologist for obstetric anesthesia covered by medicaid. Any ideas why this is?

It is my understanding that Medicare reimburses a CRNA and Anesthesioogist the same amount of money for a case. If you do a case or Jet Medicare pays the same. Medicaid reimburses a CRNA 80% of the usual customary MD charges. BUt, since the reimbursement is so low ($20) the 20% reduction means very little in terms of $$$.

Hence, CRNA's are already "there" in terms of reimbursement from our Federal government. TEFRA allows a CRNA to bill Medicare and Medicaid with NO ANESTHESIOLOGIST SUPERVISION whatsoever.

Blade

 

[rmh149]

You are wrong. The ratios will change as Lema and I predict. MD/DO Anesthesiology will no longer exist for us as the primary Anesthesia provider. Hospital ratios will increase from 4:1 to 6-7:1 or more. This is something I and others will fight hard against.

Blade- fighting against the AANA

Ah, ! I understand.

 

[rmh149]

Hence, CRNA's are already "there" in terms of reimbursement from our Federal government. TEFRA allows a CRNA to bill Medicare and Medicaid with NO ANESTHESIOLOGIST SUPERVISION whatsoever.

So what big change would occur if all states OPTed out. I don’t get it. Our state has not opted out....but we are still independent. I guess the only thing that will change is the end of the medicare/medicaid requirement of documenting the supervising physician (which in our case is the surgeon).

It won’t change litigation much....its up to the jury to decide if the surgeon took control or not.

 

[rmh149]

Not really any input here as I'm still just a med student (but with a strong interest in antesthesiology). But, I'd like to commend you on keeping your cool and staying professional. Keep in mind that there have been other CRNA's that have come over to this forum to antagonize and weren't at all constructive. That's lead many of us to become rather defensive and cynical at first. However, as far as I'm concerned your posts have all been really good, with some nice ideas.

Thank you. I have to say that I was completely embarrassed to read those unprofessional non-productive posts. It was an insult to all CRNA's.

 

[Monty Python]

......TEFRA allows a CRNA to bill Medicare and Medicaid with NO ANESTHESIOLOGIST SUPERVISION whatsoever.

Blade

If that is true nationwide, then why was there so much hub-bub when Clinton signed the HCFA regulation giving CRNAs independence from supervision when billing Medicare, only to have Bush overturn it and create the opt-out issue? Or are you referring strictly to states which have opted-out?

Am I mixing apples and oranges?

 

[cfdavid]

The CRNA with DNAP will lead to the dumbing down of the profession. The AANA wants equality with MD's in pay and the work place. This means lower pay for Anesthesiologists and lower quality Residents.

While the patient gets a better CRNA he/she gets a "weaker" Anesthesiologist if any at all.

Blade

Blade, I hear that. I've said many times on this forum how ridiculous I feel the concept of a Doctor Nurse is. But, I'm happy to engage anyone that comes to this forum with a constructive, non-antagonistic attitude.

We've all pretty much agreed that the average CRNA is not a horrible human being. Rather, it's the AANA that needs to get the picture. And perhaps the AANA is as out of step with it's constituency as the ASA sometimes appears to be.

My view is that it's not personal. However, I'm happy to state on the record to any CRNA that it would be in their best interests to reign in their lobbying group, because we're ramping up our campaign. (I'll be over in the private forum in a month or so after I finish up this year. Then I'll be over to the anesthesiology dept. to get the PDs signature which I need as a med student.)

 

[Monty Python]

Blade, I hear that. I've said many times on this forum how ridiculous I feel the concept of a Doctor Nurse is. But, I'm happy to engage anyone that comes to this forum with a constructive, non-antagonistic attitude.

We've all pretty much agreed that the average CRNA is not a horrible human being. Rather, it's the AANA that needs to get the picture. And perhaps the AANA is as out of step with it's constituency as the ASA sometimes appears to be.

My view is that it's not personal. However, I'm happy to state on the record to any CRNA that it would be in their best interests to reign in their lobbying group, because we're ramping up our campaign. (I'll be over in the private forum in a month or so after I finish up this year. Then I'll be over to the anesthesiology dept. to get the PDs signature which I need as a med student.)

The absolute best thing which could happen is for ASA and AANA to work together, fighting the proposed continuing Medicare cuts.

 

[cfdavid]

Ah, ! I understand.

So, you can see how many of us see this as a major negative to hit our field (or the field we are interested in, if still med students). Like Blade, we WILL be fighting with gloves off to prevent this from occuring.

 

[cfdavid]

why dont you go back to your nursing forums and post over there. I know that you are nitecap..

you may recall nitecap's rather incoherent and TOTALLY adversarial approach. Even, if "nitecap" did a complete 180 degree turn, the spelling and grammar improvements would be unlikely....

I say we give this person the benefit of the doubt. He/She hasn't been causing trouble on this forum, though it's meant for doctors, residents, and med students. So, until he/she proves otherwise, so be it.

 

[BLADEMDA]

If that is true nationwide, then why was there so much hub-bub when Clinton signed the HCFA regulation giving CRNAs independence from supervision when billing Medicare, only to have Bush overturn it and create the opt-out issue? Or are you referring strictly to states which have opted-out?

Am I mixing apples and oranges?

"Opt-Out" refers to NO supervsion whatsoever from a Surgeon/Podiatrist, etc. as it regards billing and protocols. You can work "Inependently" under a protocol from an MD Anesthesiologist who is watching TV or playing golf in one of the NON OPT-OUT STATES; Or, you can work under the supervsion of a podiatrist.

You and I both know that a Podiatrist and the average Surgeon know NOTHING about Anesthesia. The AANA is just playing games with all this "we work under the surgeon" junk. The AANA wants to "end these games" once and for all with 100% Independent CRNA practice in all 50 states. Right now, the odds are heavily in your favor.

Blade

 

[BLADEMDA]

The absolute best thing which could happen is for ASA and AANA to work together, fighting the proposed continuing Medicare cuts.

This is where CRNA's like you come in. I like CRNA's as most of them are EXCELLENT Providers of Anesthesia. That said, the AANA needs to officially recognize the value of a Board Certified Anesthesiologist (if available) in the care of a patient. Your organization will not do that at this time.

This "war" doesn't have to happen at all. Your militant AANA can pursue another course and avoid the collision of our professions. You are not Physicians and need to recognize OFFICIALLY that the best care involves a BOARD CERTIFIED MD/DO PHYSICIAN ANESTHESIOLOGIST. Until the AANA does that the fight will continue.

In the 21st Century Anesthesia is the Practice of Medicine (despite what your Nursing Boards say). In the 19th and early 20th Century Anesthesia was Nursing. Once Joe public sees all the facts he will agree with me.



Blade

 

[johankriek]

This is where CRNA's like you come in. I like CRNA's as most of them are EXCELLENT Providers of Anesthesia. That said, the AANA needs to officially recognize the value of a Board Certified Anesthesiologist (if available) in the care of a patient. Your organization will not do that at this time.

This "war" doesn't have to happen at all. Your militant AANA can pursue another course and avoid the collision of our professions. You are not Physicians and need to recognize OFFICIALLY that the best care involves a BOARD CERTIFIED MD/DO PHYSICIAN ANESTHESIOLOGIST. Until the AANA does that the fight will continue.

In the 21st Century Anesthesia is the Practice of Medicine (despite what your Nursing Boards say). In the 19th and early 20th Century Anesthesia was Nursing. Once Joe public sees all the facts he will agree with me.



Blade

anesthesia was never nursing and never will be nursing its the practice of medicine and nurses dont practice medicine.

 

[jwk]

The absolute best thing which could happen is for ASA and AANA to work together, fighting the proposed continuing Medicare cuts.

One word as to why it won't happen - ThoughtBridge.

 

[Taurus]

Now, the confusion of the introduction of "DR" with patients. I agree (as much as I don’t want to) that if I introduce myself as Dr. XXXX then they will think I am a physician.

Degree inflation isn't isolated to just the DNAP. There's DNP, Pharm. D, DPT, DOT, etc. All of these professionals as well as physicians and surgeons will be working in the same hosptials and it will be very confusing to everyone. I think that eventually hospitals will mandate that only MD/DO can be called "Dr." or physicians and surgeons will use the titles "physician" and "surgeon". It would be nice if we had a national law to allow only MD/DO to use the "Dr." title in a clinical setting.

 

[lushmd]

One word as to why it won't happen - ThoughtBridge.

Care to expand on this JWK? All I know about it is that ThoughtBridge was a failed negotiation/mediation process between ASA and AANA.

 

[jwk]

Care to expand on this JWK? All I know about it is that ThoughtBridge was a failed negotiation/mediation process between ASA and AANA.

ThoughtBridge was indeed an attempt at communication between the two organizations with the assistance of a mediation company. The ASA withdrew after basically being stabbed in the back by the AANA when they opposed legislation dealing with the Medicare teaching rules after the AANA indicated they would support the proposal.

 

[toughlife]

Care to expand on this JWK? All I know about it is that ThoughtBridge was a failed negotiation/mediation process between ASA and AANA.

Read page 10 of this newsletter, that explains a bit more.

http://www.ncsoa.com/pdf/Issue 5d.pdf

 

[rmh149]

It is sad that Anesthesia in America is going to be ruined because the ASA refuses to cooperate and just do what the AANA tells them.

I am totally kidding....dont take that seriously, its a joke.

 

[BLADEMDA]

It is sad that Anesthesia in America is going to be ruined because the ASA refuses to cooperate and just do what the AANA tells them.

I am totally kidding....dont that seriously, its a joke.

Anesthesia will be "saved" because the AANA refuses to cooperate. It will force the BIG DOG/Sleeping Giant to FINALLY wake up and start fighting!

Blade

 

[Coastie]

Anesthesia will be "saved" because the AANA refuses to cooperate. It will force the BIG DOG/Sleeping Giant to FINALLY wake up and start fighting!

Blade

Not entirely sure of this.

They aren't waking up now. What will it take, and will it be too late?

Probably.

 

[mille125]

It is sad that Anesthesia in America is going to be ruined because the ASA refuses to cooperate and just do what the AANA tells them.

I am totally kidding....dont that seriously, its a joke.

all it takes is one catastrophic high profile case to derail the AANA's total agenda....rmh, you seem like a nice person (even though you continue to rove in a forum that is meant for MD's and MD's in training). I have nothing against you personally. However, this IS a war. More MD's are starting to see that. There will be casualties. There is absolutely NO CHANCE of things happening like your original post.

An analogy:

1) Lets say that I have a pilot's license and can fly small planes. I fly small planes therefore I should be able to fly 737's (even though I have much less training). How would you feel if you were a passenger on this 737? Should I be required to disclose my training? Could I say that I have never crashed any of my small planes therefore my safety rating is as good as the 737 pilots? Maybe I should be allowed to fly 737's that are leaving out of small rural areas. Maybe I should give money to my congressman who could pass a law on my behalf (instead of doing further training) Most people would tell me that "I am sure that you are a great pilot, but you are not flying my plane, alone". If the public was truly educated about CRNA's and MD's they would draw the same conclusion. What do you think rmh?



There is an easy solution to end this conflict with one blow. Academic chairman have to let go of their greed scared and close all existing CRNA schools and replace them with AA schools. This could be done and would immediately get the attention of the AANA. Is it likely? Not immediately. However, if we all put pressure on the right people it may swing the pendulum.

 

[rmh149]

all it takes is one catastrophic high profile case to derail the AANA's total agenda....rmh, you seem like a nice person (even though you continue to rove in a forum that is meant for MD's and MD's in training). I have nothing against you personally. However, this IS a war. More MD's are starting to see that. There will be casualties. There is absolutely NO CHANCE of things happening like your original post.

An analogy:

1) Lets say that I have a pilot's license and can fly small planes. I fly small planes therefore I should be able to fly 737's (even though I have much less training). How would you feel if you were a passenger on this 737? Should I be required to disclose my training? Could I say that I have never crashed any of my small planes therefore my safety rating is as good as the 737 pilots? Maybe I should be allowed to fly 737's that are leaving out of small rural areas. Maybe I should give money to my congressman who could pass a law on my behalf (instead of doing further training) Most people would tell me that "I am sure that you are a great pilot, but you are not flying my plane, alone". If the public was truly educated about CRNA's and MD's they would draw the same conclusion. What do you think rmh?
.

Mille, I do have a pilot's license. I am licensed to fly single engine private planes. I am only checked off on two types, Cessna 152's and Cessna 172's. As long as I follow the FAA guidelines for maintaining current, then my passengers should feel safe. I would never pilot a 737 because I am not qualified or have any experience in flying a 737.

The flaw in your anaology is that CRNA's are trained in all areas of anesthesia (small planes and big C-5's)...regional, thoracics, neuro, ortho, OB, trauma, general, etc. If a CRNA is checked off on it (as they are)...then their patient is safe.

I have a question for you. Do the CRNA's that practice with you act more as technicians...do they push the induction drugs, interview the patient, discuss the anesthetic plan with the patient, and make all decisions in the OR for the patient? If they dont, then your experience with the CRNA's you have worked with is limited. They are trained monkeys. Some prefer that...and I assume they are the ones that will continue to work in that capacity forever. I am not against it. I just dont want to practice that way. I would rather have complete control of my anesthetic.

I understand your point of view. But I truly believe that you dont completely understand the capabilities of CRNA's in this country. There are many out there that will be technicians forever...its their choice. But for those that are independent like me...you have to understand our position. There are many out there like me.

All this said....believe it or not. I have just checked in with one of the large groups in my area that is in need of CRNA's. I am going to moonlight with them to diversify my cases. I am looking forward to it...yes I am going to be supervised by anesthesiologists. I am looking forward to doing more neuro and cardiac. Trust me I will know my place as the Nurse Anesthetist. In fact, I have more respect and a better understanding for their position now that I have read the posts here on this forum. I do thank you for that.

" If the public was truly educated about CRNA's and MD's they would draw the same conclusion. What do you think rmh?"

I would agree that if someone had the choice of a board certified physician anesthesiologist they would prefer them over a master prepared CRNA. That does make sense. But what about the areas that do not have any anesthesiologists....like more than half of the counties in the state of Texas, or the large cities like Dallas, Houston, San Antonio where the physicians quit providing anesthesia at a hospital because of the percentage of medicaid patients? What choice does the community have. Thats why it is important to us nurses to keep raising our standards and keep pumping out damn good CRNA's that can take care of those problems. DNAP programs will be popping up all over the place in the near future. I think that will help in gaining confidence in the publics eye...although I still think MD/DO's will still be the leaders in the field.

I still believe that all CRNA's, MD's, DO's and AA's will have plenty of jobs for a long time.

 

[The_Sensei]

There are many out there like me

Ummmm.......not many.

 

[Planktonmd]

I don't know how many private practice groups out there would want to hire a Doctor CRNA !

 

[toughlife]

I don't know how many private practice groups out there would want to hire a Doctor CRNA !

That's where the independence practice rights movement comes in. Once they have the DNP and lobby to practice without supervision in all states, they will not need to ask you to hire them. They will directly compete with you for hospital contracts as they are doing already in some states.

 

[rmh149]

I don't know how many private practice groups out there would want to hire a Doctor CRNA !

I can understand how a group wouldn't want to hire a DNAP if that CRNA was pompous and arrogant...running around taunting that he/she is doctor and demanding respect. That would piss anyone off. However, I think that many CRNA's that achieve the DNAP will remain humble. We have lived our professional lives being called our first name. We are used to the tradition and probably will continue the tradition. We would be proud to hold a doctorate degree...but also think it would be weird to be called doctor all the time....except in formal settings.

I will definitely get a DNAP. Learning is always good...raising my own standard is always good.

I of course speak for the non-jackass, mature CRNA's?

I am curious though....I am going to post a question in the nurse anesthesia forum. "How would you introduce yourself to your patients if you held a DNAP"?

1. Dr. XXXXX
2. Your Nurse Anesthetist
3. Your Anesthetist
4. Your CRNA
5. Dr. XXXXX, your nurse anesthetist
6. Dr. XXXXX, your anesthetist

I believe selection 1 and 6 would be deceiving to the patients. Selections 5 would clearly identify us as a doctorate prepared nurse anesthetist.

Would you be interested in the results?

 

[cfdavid]

I can understand how a group wouldn't want to hire a DNAP if that CRNA was pompous and arrogant...running around taunting that he/she is doctor and demanding respect. That would piss anyone off. However, I think that many CRNA's that achieve the DNAP will remain humble. We have lived our professional lives being called our first name. We are used to the tradition and probably will continue the tradition. We would be proud to hold a doctorate degree...but also think it would be weird to be called doctor all the time....except in formal settings.

I will definitely get a DNAP. Learning is always good...raising my own standard is always good.

I of course speak for the non-jackass, mature CRNA's?

I am curious though....I am going to post a question in the nurse anesthesia forum. "How would you introduce yourself to your patients if you held a DNAP"?

1. Dr. XXXXX
2. Your Nurse Anesthetist
3. Your Anesthetist
4. Your CRNA
5. Dr. XXXXX, your nurse anesthetist
6. Dr. XXXXX, your anesthetist

I believe selection 1 and 6 would be deceiving to the patients. Selections 5 would clearly identify us as a doctorate prepared nurse anesthetist.

Would you be interested in the results?

It's kind of like if PA's in the operating room (many of whom are very involved and do a substantial amount of work during procedures) were lobbying for independence from surgeons. How would the surgeons react the that?? Ever see The Cider House Rules? Tobby McGuire plays an "apprentice" OB/GYN and has some good technical skills. He knows what to do for the most part. But the bottom line is that he didn't go to medical school!! Kind of a problem!

I really do think the U.S. is heading down a dangerous path with the sheer number of non-MD/DO practictioners out there. This seems to fly in the face of a high standard, and is very confusing to patients, whom are increasingly vulnerable to fraud as the complexity and # of options of medicine continues to increase. And leaving these decisions up to bean counters alone (and politicians) is not only irresponsible, but you'd get the low cost alternative every time (unless it's their family member).

 

[rmh149]

It's kind of like if PA's in the operating room (many of whom are very involved and do a substantial amount of work during procedures) were lobbying for independence from surgeons. How would the surgeons react the that?? Ever see The Cider House Rules? Tobby McGuire plays an "apprentice" OB/GYN and has some good technical skills. He knows what to do for the most part. But the bottom line is that he didn't go to medical school!! Kind of a problem!

I really do think the U.S. is heading down a dangerous path with the sheer number of non-MD/DO practictioners out there. This seems to fly in the face of a high standard, and is very confusing to patients, whom are increasingly vulnerable to fraud as the complexity and # of options of medicine continues to increase. And leaving these decisions up to bean counters alone (and politicians) is not only irresponsible, but you'd get the low cost alternative every time (unless it's their family member).

I see your point. But so far, the statistics paint a totally different picture. And as much as you and I hate statistics because you truly can make them say whatever you want, its what drives changes in this country.

Although, it is possible that we really are safe. Our standards continue to rise as well as the quality of care we provide (my opinion). I still dont think we are going to "take over".

There is nothing wrong with options and competition....it keeps us working harder to maintain turf. In the end, the patient wins.

 

[rmh149]

That's where the independence practice rights movement comes in. Once they have the DNP and lobby to practice without supervision in all states, they will not need to ask you to hire them. They will directly compete with you for hospital contracts as they are doing already in some states.

Very strong point. I dont think this way...but this is where the real threat is to MD/DO's. My eyes are open. It really is all about money and turf.

I understand your battle.

Question, did MD's have this same problem with DO's in the past?

 

[toughlife]

Very strong point. I dont think this way...but this is where the real threat is to MD/DO's. My eyes are open. It really is all about money and turf.

I understand your battle.

Question, did MD's have this same problem with DO's in the past?

DOs went to medical school. Did you?

 

[rmh149]

DOs went to medical school. Did you?

I wasnt trying to be a smart ass. One of the OB's that we work with is a DO. He told me (way back before my time) there were some turf issues.

I honestly was just asking a question. Does anyone have any information about the issues DO's had with MD's?

 

[The_Sensei]

I can understand how a group wouldn't want to hire a DNAP if that CRNA was pompous and arrogant...running around taunting that he/she is doctor and demanding respect. That would piss anyone off. However, I think that many CRNA's that achieve the DNAP will remain humble. We have lived our professional lives being called our first name. We are used to the tradition and probably will continue the tradition. We would be proud to hold a doctorate degree...but also think it would be weird to be called doctor all the time....except in formal settings.

I will definitely get a DNAP. Learning is always good...raising my own standard is always good.

I of course speak for the non-jackass, mature CRNA's?

I am curious though....I am going to post a question in the nurse anesthesia forum. "How would you introduce yourself to your patients if you held a DNAP"?

1. Dr. XXXXX
2. Your Nurse Anesthetist
3. Your Anesthetist
4. Your CRNA
5. Dr. XXXXX, your nurse anesthetist
6. Dr. XXXXX, your anesthetist

I believe selection 1 and 6 would be deceiving to the patients. Selections 5 would clearly identify us as a doctorate prepared nurse anesthetist.

Would you be interested in the results?

No. If any of my CRNAs EVER identified themselves as "Doctor" regardless of degree they would be fired on the spot for misrepresentation. They are all aware of this and none want to be referred to as doctor.

 

[Taurus]

I can understand how a group wouldn't want to hire a DNAP if that CRNA was pompous and arrogant...running around taunting that he/she is doctor and demanding respect. That would piss anyone off. However, I think that many CRNA's that achieve the DNAP will remain humble. We have lived our professional lives being called our first name. We are used to the tradition and probably will continue the tradition. We would be proud to hold a doctorate degree...but also think it would be weird to be called doctor all the time....except in formal settings.

I will definitely get a DNAP. Learning is always good...raising my own standard is always good.

I of course speak for the non-jackass, mature CRNA's?

I am curious though....I am going to post a question in the nurse anesthesia forum. "How would you introduce yourself to your patients if you held a DNAP"?

1. Dr. XXXXX
2. Your Nurse Anesthetist
3. Your Anesthetist
4. Your CRNA
5. Dr. XXXXX, your nurse anesthetist
6. Dr. XXXXX, your anesthetist

I believe selection 1 and 6 would be deceiving to the patients. Selections 5 would clearly identify us as a doctorate prepared nurse anesthetist.

Would you be interested in the results?

I don't care what they say now. Owing to human desire for respect, DNAP's will refer to themselves as Dr. XXXX, your anesthetist. This title is technically correct, although misleading. It won't stop most DNAP's from doing it.

 

[cfdavid]

I wasnt trying to be a smart ass. One of the OB's that we work with is a DO. He told me (way back before my time) there were some turf issues.

I honestly was just asking a question. Does anyone have any information about the issues DO's had with MD's?

Yes, there were issues for years, I believe. However, DOs increasingly embraced evidence based medicine and deemphasized (in practice) OMT. This happened over time. Their training is very similar to an MDs, in both content and length (even longer in some states with the additional internship year). And it's the depth of content that really sets MD/DO's appart from others. Even advanced practitioners (my aunt is an NP) and potentially "DNP's" will still lack the depth of scientific rigor in which we are trained. And, in reality this starts well before medical school, as the depth of science courses in UNDERGRAD far outweighs what most BSN programs require. I never had a nursing student in any of my science courses in college. They took the "other" science courses, more armchair, frankly. It's not a slam, and I really don't want to get personal. It's just different, that's all.

The same can not be said about any other healthcare provider. Our path is just so long and intense (at times) that it's kind of annoying to hear some mid-levels say "eh, we know it all", "who needs an MD??". It's really quite naive. Not that YOU are thinking that, but apparently, with this increased push for independence, the AANA does.

 

[Monty Python]

I am curious though....I am going to post a question in the nurse anesthesia forum. "How would you introduce yourself to your patients if you held a DNAP"?

1. Dr. XXXXX
2. Your Nurse Anesthetist
3. Your Anesthetist
4. Your CRNA
5. Dr. XXXXX, your nurse anesthetist
6. Dr. XXXXX, your anesthetist

?

I read somewhere that ~20% of the US population has a baccalaurate degree (or higher). That may be off by a few percentage points, but you get my drift. Most of the US population is getting by with a high school education, or less.

They will be totally confused by options 1, 4, 5, or 6. I believe option 2 covers all the bases in a clear and appropriate manner for the layperson patient.

 

[Monty Python]

That's where the independence practice rights movement comes in. Once they have the DNP and lobby to practice without supervision in all states, they will not need to ask you to hire them. They will directly compete with you for hospital contracts as they are doing already in some states.

All XYZ Hospital has to do is write "anesthesiologist required" in their bylaws.

 

[Monty Python]

There is an easy solution to end this conflict with one blow. Academic chairman have to let go of their greed scared and close all existing CRNA schools and replace them with AA schools. This could be done and would immediately get the attention of the AANA. Is it likely? Not immediately. However, if we all put pressure on the right people it may swing the pendulum.

There are 106 CRNA schools. About 1/2 are free-standing proprietary schools. The other 1/2 are university-based, mostly in Schools of Nursing. There aren't that many Chairperson arms to twist.

 

[rmh149]

Yes, there were issues for years, I believe. However, DOs increasingly embraced evidence based medicine and deemphasized (in practice) OMT. This happened over time. Their training is very similar to an MDs, in both content and length (even longer in some states with the additional internship year). And it's the depth of content that really sets MD/DO's appart from others. Even advanced practitioners (my aunt is an NP) and potentially "DNP's" will still lack the depth of scientific rigor in which we are trained. And, in reality this starts well before medical school, as the depth of science courses in UNDERGRAD far outweighs what most BSN programs require. I never had a nursing student in any of my science courses in college. They took the "other" science courses, more armchair, frankly. It's not a slam, and I really don't want to get personal. It's just different, that's all.

The same can not be said about any other healthcare provider. Our path is just so long and intense (at times) that it's kind of annoying to hear some mid-levels say "eh, we know it all", "who needs an MD??". It's really quite naive. Not that YOU are thinking that, but apparently, with this increased push for independence, the AANA does.

I totally understand your point. Honestly if I was a medical school graduate I would have the same opinion.