nitecap said:
So where is the financial incentive here for the facility to be able to hire 1 anesthesiologist to 2 CRNA's. If the issue at had is them not being able to afford anesthesia services then it only makes fiscal sense to get 2 anesthesia providers for the price of one. Hey we will let them duke it out in state capitals and DC. One or the other is going to lobby against each other for just about every issue they have. Its crazy that both prof. orgs spend so much money and resources on fighting over the same things year after year. I believe the ASA pack is 12th and AANA PAC 13th largest healthcare PACS today.
My statement earlier was merely to address the narrow mindedness of stephend comparing the entire CRNA work force to 15 CRNA's he works with.
Really doubt he has even worked with a AA. I took BIO chem and physics & calc as an undergrad and again as a grad student. The BIO chem and physics have helped. The calc on the other hand I fing was a waste. And please tell me how many people that took calc in undergrad at age 20 can do all those problems if needed at age 28 or older. Same thing with trig. Once thought about the engineering route. These classes were a waste for me.
So do the pre reqs that you mentioned above compensate that elementary education and psych graduate for the lack of ever even talking to or touching an actual pt. Many people take these classes whether they want a medical based profession, engineer, basic science degree, maybe psych, chem, envirnmental resource mgmt, dietetics. Does that mean that all that take physics, bio chem and calc can be MDs, CRNA's or AA's. Hell no these are classes that anyone with intellegence and determination can take and pass. So why does a med student have to relearn all these BIO chem pathways if they already took BIO chem undergraduate if I may ask. 9 months ago and could recite all these pathways but prob. couldnt now. Tts mere memorization JWK. These classes can be taken by anyone over a 4 month period so sorry this case just doesnt hold up.
Those few classes dont compensate that elementary ed. teacher for here clinical greeness and inexperience. young people that I have met in anesthesia groups have confirmed just what you and I discussed a while back.
Non-medical related professionals with non healthcare related undergrad degrees going to AA school with no patient exposure what so ever and in 26 months putting grandma to sleep.
In the case of that teacher we go from:
5+5 = 10 and please sit down little johnny its nap time to
1mg versed + 150mg of propofol + 100mcg fent = sleepy sleepy whether you like it or not.
Thats a large jump in just over 2 yrs. that sorry are not compensated by undergrad biochem, physics and calc.
Taking courses with the med students now and they too (MS-1 and 2) are green as hell to actual pt care. Now I know they will get tons of pt exposure as their schooling progresses but many times esp in neural science I am explaining to them many drugs ect that the profs mention in lecture.
OK. Jet has tried the sideline thing and it just doesnt work. Laud or criticize me, it doesnt really matter. I've gotta speak when I feel the need.
Here's Jet's perspective on the encroachment of non-MDs into what was previously all-MD turf....and this perspective applies to many specialties...anesthesia, peds, IM, family med, ER, ophtho, orthopedics (with non-MD rehab infiltration), etc.
Thirty years ago, a pre-med got accepted to med school, did a residency, then went into practice. Regardless of specialty, said practice encompassed a spectrum of cases, from very easy to very complicated. The pediatrician was reimbursed well for very easy cases (well-baby checkups, otitis media, etc) which took no time at all. This monetarily balanced the very time-consuming cases (meningitis, congenital anomaly) that, while still offering great reimbursement, required ALOT of time.
The anesthesiologist was reimbursed very well for easy cases (knees, gallbladders, etc) which took minimal time. Anesthesiologists also took care of very sick people (CABGs, ELAPs, fem-pops) which, although thirty years ago reimbursement was still great for these complicated cases, they still required more time and emotional investment than the ASA 1 knees/gallbladders.
Orthopedists thirty years ago could make money on the operation, then also benefit monetarily from the rehab.
Change course to current day, with infiltration of non-MDs into medicine.
Its all about money. And if you don't believe this, you are very naive.
Theres money to be made in medicine.
Nurse practioners can see the majority of a pediatrician's patient population without MD intervention. Assuring babies are appropriately on the growth curve, identifying an ear infection, giving phenergan to a rota-virus infected child, concominantly telling the mom to make sure she gives alotta pedialyte.
Physical therapists, now independent of physicians in many states, can provide rehab for post-op TKA THA ACL etc patients, and again, "skimming the gravy" off alotta orthopedist practices.
Same for internal med, family med, ophtho, etc.
And anesthesia.
In present day, non-MD professionals are profiting from the gravy that used to all go to the MD.
Lets face it. No matter what your specialty, theres alotta gravy. Easy stuff. Stuff that doesnt require alotta intervention/cerebral investment. Thirty years ago, the "gravy" used to counter-balance the cases that the physician was truly neeeded in.
No more.
Para-professionals are here to stay, like it or not. Are some of them capable of taking care of "physician-only" cases? Absolutely. But thats not really the point. In any professional-genre, one can identify subordinates that know more than their job scope. But that doesnt replace the standard. And the standard in medicine is that physicians administer medical care to patients, with para-professionals helping them. And that standard is in place for good reason...it is there so when the case comes along that exceeds the knowledge base of the para-professional, the physician is in place to fill in the gaps, if you will.
Physicians, from day-one of their training, are taught how to take care of patients from A to Z. Years and years of clinical experience during med school and residency produce an individual that can handle, albeit within the given specialty, anything that arises.
I think its naive for CRNAs to testify on this forum, and elsewhere, that the care they provide is similar in depth to the care provided by an MD.
As everyone knows here, I'm a CRNA advocate.
But we all have our place.
And leading the anesthesia forefront is not a CRNA's place.
Our practice is team-oriented...and very friendly at that.
But then again, I don't have any CRNA-terrorists in my group.
I realize that in, say, 75-90% of cases, a CRNA can provide an anesthetic very safely, without complications.
But its those few, but ever present cases that require a higher level of education/training that justify our existence...same with pediatricians, family practice, ophtho, ER, orthopedics, etc.
So back to the "gravy train". Paraprofessionals have figured this out. They've figured out that the majority of our practice is "gravy", i.e. very easy, regardless of specialty. And they are exploiting this. They are taking it away from us. Nurse practioners, optometrists, physical therapists. All profiting from what used to be all-MD turf.
But what happens in the minority-very-cerebral cases? That truly require physician intervention? Judicious interpretation of physical presentation and lab values, which lead to the appropriate going-on-with, or cancelling a case? Sure, my mom could identify an abnormal lab value and cancel a case because of it, but what good does that do if its a meaningless cancellation?
How about medically optimizing a patient who presents in the AM for surgery? Who presents teetering on the cancellation-line for whatever reason (asthma, COPD, DM) and, with a few hours of intervention from a peri-operative physician, could safely undergo surgery?
What about coming off bypass? How many CRNAs are there that can concominantly look at the RV, ECG, BP, HR, volume in the pump resevoir, temperature, Hb, ABG, and determine what intervention (if any) is needed to successfully separate the patient from bypass?
Treating myocardial ischemia in the OR? Identifying it?
Yes, we can all perform a general anesthetic. And we can all DEFINITELY perform a general anesthetic on the gravy cases. As can a NP see the gravy peds cases, a physical therapist can rehab the gravy orthopedic cases, an optometrist can treat the gravy ophtho cases, an ER PA can treat the gravy ER cases.
The truth in the pudding lies in the minority of cases that truly benefit from physician intervention. Problem is noone knows when those cases are gonna happen, so it pays to have a physician on payroll, if you are the patient or a familymember of the patient, when said situation arises.
But the paraprofessionals will not relent, since they've figured out our gig. Mostly gravy with the occasional I'm-glad-and-the-patient-is-glad-that-I-went-to-med-school-and-did-a-residency case.
Can CRNAs function independently most of the time?
Absolutely.
Can they function independently all the time, and give optimal patient care, independent of case variation?
Absolutely not. Beyond their training scope.
Hence the success of the team-model approach.
Same goes for nurse practioners, physical therapists, optometrists, PAs, etc.
