SAD DAY FOR TENNESSEE CRNAS

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NicholasPavona

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aneftp said:
Good. I love it when the crnas try to practice to the fullest of their license crap motto. And look down on AAs.

Crnas mindset is
Crna=MD
Crna>AAs.
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Seems a bit like cutting off the nose to spite the face, no? I’m not celebrating any increase to anesthesia supply, especially not additional non-physician anesthesia.
 
Coffee PRN said:
Seems a bit like cutting off the nose to spite the face, no? I’m not celebrating any increase to anesthesia supply, especially not additional non-physician anesthesia.
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Physicians need to support AAs since AAs are under the Board of Medicine , unlike the rogue CRNAs who are under the Board of Nursing!

We should be working to support AAs in all 50 states, just like we currently support PAs in all 50 states.
 
FatKid said:
Physicians need to support AAs since AAs are under the Board of Medicine , unlike the rogue CRNAs who are under the Board of Nursing!

We should be working to support AAs in all 50 states, just like we currently support PAs in all 50 states.
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The same PAs that can be found to be arguing for independent practice?
 
Surprising factoid.


“9. Around 75% of CRNAs practiced independently with no collaborating physician in 2023.“


www.beckersasc.com

US to face shortage of 6,300 anesthesiologists: 12 stats to know - Becker’s ASC

By 2036, the U.S. is expected to be facing a shortage of 6,300 anesthesiologists nationwide, according to a white paper from Medicus Healthcare Solutions published May 21. The workforce management company’s report predicts that the U.S. will also face a shortage of 450,000 nurses by the end of...
www.beckersasc.com www.beckersasc.com
 
nimbus said:
Surprising factoid.


“9. Around 75% of CRNAs practiced independently with no collaborating physician in 2023.“


www.beckersasc.com

US to face shortage of 6,300 anesthesiologists: 12 stats to know - Becker’s ASC

By 2036, the U.S. is expected to be facing a shortage of 6,300 anesthesiologists nationwide, according to a white paper from Medicus Healthcare Solutions published May 21. The workforce management company’s report predicts that the U.S. will also face a shortage of 450,000 nurses by the end of...
www.beckersasc.com www.beckersasc.com
Click to expand...
I don't believe it.
 
nimbus said:
Surprising factoid.


“9. Around 75% of CRNAs practiced independently with no collaborating physician in 2023.“


www.beckersasc.com

US to face shortage of 6,300 anesthesiologists: 12 stats to know - Becker’s ASC

By 2036, the U.S. is expected to be facing a shortage of 6,300 anesthesiologists nationwide, according to a white paper from Medicus Healthcare Solutions published May 21. The workforce management company’s report predicts that the U.S. will also face a shortage of 450,000 nurses by the end of...
www.beckersasc.com www.beckersasc.com
Click to expand...
No where in the linked “white paper” which is cited as the source for that figure does that factoid appear.
www.beckersasc.com

75% of CRNAs practice with no physician oversight: Report - Becker’s ASC

As of 2023, 75% of certified registered nurse anesthetists reported practicing independently without collaboration from physicians, according to a white paper from Medicus Healthcare Solutions published May 21. CRNAs represent more than 80% of anesthesia providers in rural counties and...
www.beckersasc.com www.beckersasc.com
 
NicholasPavona said:
I don't believe it.
Click to expand...
I do...the only CRNA's that respond to these types of surveys are in indy practices and are very politically active. Prolly more precise to say that 75% of the CRNA's that responded to this company's survey practiced that way in 2023.
 
This doesn’t matter in the slightest to CRNAs until 10x more AA schools pop up. There aren’t enough AAs to make a dent in the crna market in TN. There just aren’t that many AAs. Not to mention they are paid the same as CRNAs and expect the same shift work/breaks/call outs etc

What you should be paying attention to is the number of AA schools CRNA’s have stopped from happening. That data isn’t published but I’ve heard it’s many via personal second hand stories
 
nimbus said:
Surprising factoid.


“9. Around 75% of CRNAs practiced independently with no collaborating physician in 2023.“


www.beckersasc.com

US to face shortage of 6,300 anesthesiologists: 12 stats to know - Becker’s ASC

By 2036, the U.S. is expected to be facing a shortage of 6,300 anesthesiologists nationwide, according to a white paper from Medicus Healthcare Solutions published May 21. The workforce management company’s report predicts that the U.S. will also face a shortage of 450,000 nurses by the end of...
www.beckersasc.com www.beckersasc.com
Click to expand...
Has to deal with qz billing. Not really independent practice.

This is what happens when idiots analyze data billing from computer rather than actually see what is going on in the hospital
 
aneftp said:
Has to deal with qz billing. Not really independent practice.

This is what happens when idiots analyze data billing from computer rather than actually see what is going on in the hospital
Click to expand...

To play devils advocate-

Is it possible that we (anesthesiologists) are not seeing this because we aren’t even in the county?
 
nimbus said:
To play devils advocate-

Is it possible that we (anesthesiologists) are not seeing this because we aren’t even in the county?
Click to expand...
Huh? I do my own cases and over see crnas.

now if I’m remotely managing crnas from remote location from home. Is that what you mean by not even the county?
 
aneftp said:
Huh? I do my own cases and over see crnas.

now if I’m remotely managing crnas from remote location from home. Is that what you mean by not even the county?
Click to expand...


I mean if there are CRNAs practicing independently in the vast underpopulated West and other rural areas, how would we as anesthesiologists even know about them? Those CRNAs wouldn’t ever cross paths with an anesthesiologist.

I’m in a densely populated west coast metro area and I know there are 2 hospitals in my county where CRNAs practice independently. I have no idea what’s happening in rural Nebraska.
 
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Howard888 said:
This doesn’t matter in the slightest to CRNAs until 10x more AA schools pop up. There aren’t enough AAs to make a dent in the crna market in TN. There just aren’t that many AAs. Not to mention they are paid the same as CRNAs and expect the same shift work/breaks/call outs etc

What you should be paying attention to is the number of AA schools CRNA’s have stopped from happening. That data isn’t published but I’ve heard it’s many via personal second hand stories
Click to expand...
How do CRNAs stop AA schools from happening?
 
nimbus said:
I mean if there are CRNAs practicing independently in the vast underpopulated West and other rural areas, how would we as anesthesiologists even know about them? Those CRNAs wouldn’t ever cross paths with an anesthesiologist.

I’m in a densely populated west coast metro area and I know there are 2 hospitals in my county where CRNAs practice independently. I have no idea what’s happening in rural Nebraska.
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75% of crnas practicing independently is a stretch.

If most of them live in urban or suburbs area like the rest of the USA. It’s hard to image 30k crnas independently practice.
 
The answer to crna encroachment is to pay crnas more money to practice in supervision model practices and provide a good quality of life breaks/lunches/time off/ fair practice.
 
AA is one of the worst things to happen to anesthesia. You have people who have even less training and science background than crnas doing our job. It cheapens our field even more. If you've ever worked with aa's, you'll know they are the same as crnas in terms of attitude. Some want to be supervised, but a lot of them are annoyed they aren't practicing alone and restricted by their license.
 
Ah let’s just add another group of midlevels to compete with for jobs. A group with even less training than the midlevels we were previously competing with. Perfect plan.
 
dabears505 said:
AA is one of the worst things to happen to anesthesia. You have people who have even less training and science background than crnas doing our job. It cheapens our field even more. If you've ever worked with aa's, you'll know they are the same as crnas in terms of attitude. Some want to be supervised, but a lot of them are annoyed they aren't practicing alone and restricted by their license.
Click to expand...
Embrace the suck!
 
The solution is to work your tail off now in youth and invest like crazy so you can reach FI sooner. Then you work for pleasure as your NW increases and walk around with FU money for things that are not to your liking. Not more call, wknds, admin bs once your in your 40s. Your field is booming with locums and side gigs right now. Who knows if 10 years from now it will be quite like that. The mid level encroachment is a slap in the face to docs in general. If all docs reached major milestones early than later maybe we can turn the tables a bit.
 
dabears505 said:
AA is one of the worst things to happen to anesthesia. You have people who have even less training and science background than crnas doing our job. It cheapens our field even more. If you've ever worked with aa's, you'll know they are the same as crnas in terms of attitude. Some want to be supervised, but a lot of them are annoyed they aren't practicing alone and restricted by their license.
Click to expand...
I disagree with this vehemently. Worked with crnas before. Current practice has AAs (and no crnas). I consider the AAs equivalent to crnas in every way from a knowledge and skills standpoint, but heads and shoulders better in agreeableness and attitude. They are SO much better to work with. Follow directions when you give them. Call for help readily, especially if I give specific instructions. I'm very happy with them and very happy to see their success.
 
caligas said:
Disagree. Current shortages drive independent CRNA practice. AA supply helps offset this.
Click to expand...
This current shortage has given us the most bargaining power and control over our schedules in recent times. Hospitals are finally paying the price when they refuse to negotiate in good faith with their anesthesia group and the group walks, because there are now options. I do not support diluting our labor supply with cheaper, lesser trained people.
 
I think it comes down to what your strongest beliefs are. If your priority is money, more AAs is bad. CRNAs are getting paid so much right now that it benefits our pay, once more AAs are around the pay for all will decrease. If you’re a MD only purist it’s a horrible thing to have more mid level creep. If you’re in a supervisory role I think more AAs is better because as stated above 99% of AAs don’t want independence and accept their role in the system and therefore much easier to work with. Just make our money the next 5-10 years and then chill out.
 
Howard888 said:
This doesn’t matter in the slightest to CRNAs until 10x more AA schools pop up. There aren’t enough AAs to make a dent in the crna market in TN. There just aren’t that many AAs. Not to mention they are paid the same as CRNAs and expect the same shift work/breaks/call outs etc

What you should be paying attention to is the number of AA schools CRNA’s have stopped from happening. That data isn’t published but I’ve heard it’s many via personal second hand stories
Click to expand...
You need better sources.

There are now 23 accredited AA programs with several more in the development stages. There will be over 400 new CAAs this year, 500 next year, and that number keeps increasing as program numbers increase. That's a far cry from 25 a year when I started my career.

I'm not aware of any AA programs being blocked by CRNAs. Of course they are constantly opposing legislation in any state in which it is proposed, but we've added three new states in the last 12 months (WA, VA, TN) and there is action in a number of other states as well.

It takes time to increase the CAA presence in any state and TN will be no exception. The best way to do that is to add new programs, and there is already a program in development in Nashville, the planning for which started well before the signing of enabling legislation by the governor a few weeks ago. We don't go into new states without there being interest in CAAs going there - there is and has been a Tennessee Academy of Anesthesiologist Assistants (TNAAA) for several years, laying the groundwork for CAA legislation and practice in TN, with plenty of support from the Tennessee Society of Anesthesiologists.

Master of Science in Anesthesiology (M.S.) | Lipscomb University

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lipscomb.edu lipscomb.edu

CAAs will indeed expect to be paid the same as CRNAs in the same practice doing the same work. Why wouldn't we? In medically directed practices there is not a single thing a CRNA can do that a CAA cannot. In my practice, the only difference in job descriptions is the title at the top of the form. Supply and demand is what sets compensation, as it does in all fields everywhere.

I'm guessing you've never personally worked with CAAs. I just retired after 44 years as a CAA. I took call all but the last three years of my career. Of course there are CAAs and CRNAs that are just interested in shift work and limited schedules, but that's true of anesthesiologists as well. My practice for the last 3+ decades has both anesthetists and anesthesiologists in-house 24/7/365 and does over 100k cases per year. We run 60% of our OR's after 3pm each day, and every one of them is covered by a CAA or CRNA. We are a fully medically directed practice.
 
aneftp said:
75% of crnas practicing independently is a stretch.

If most of them live in urban or suburbs area like the rest of the USA. It’s hard to image 30k crnas independently practice.
Click to expand...
You're absolutely correct.
 
nimbus said:
I mean if there are CRNAs practicing independently in the vast underpopulated West and other rural areas, how would we as anesthesiologists even know about them? Those CRNAs wouldn’t ever cross paths with an anesthesiologist.

I’m in a densely populated west coast metro area and I know there are 2 hospitals in my county where CRNAs practice independently. I have no idea what’s happening in rural Nebraska.
Click to expand...
The skewed numbers come from large private equity groups that billed QZ despite providing medical direction or supervision to avoid having to meet CMS requirements for direction. One of the biggest private equity groups in the country did this as the default. The data that is gathered picks up the QZ billing and marks it as CRNA independent practice (or under the supervision of a surgeon or proceduralist) so it greatly inflates the perception of CRNAs working on their own.
The great lie is that CRNAs are more willing to practice in rural areas than physicians. The rural pass through money incentivizes rural hospitals to utilize CRNAs because they get access to money that they cannot get if they utilize physicians. CRNAs want to work in urban and suburban settings just like anyone else. But money will drive decisions.
Florida, a few years ago, approved independent practice for primary care nurse practitioners, with the intent to increase access for rural areas. Instead, what they got was a flooding of NPs into the urban and suburban regions where they opened med spas for botox and filler injections. In addition, NPs from surrounding states of Georgia, South Carolina, and Alabama flocked to suburban Florida, thereby hindering the rural access to primary care for Florida and all of the surrounding states. The result was the exact opposite of the intent. If you have ever heard of the "cobra effect," this was an inverse cobra effect.

**Cobra effect-A name given to a situation based upon a possibly true tale of India's attempt to decrease the number of Cobras in the wild by offering a bounty for each dead cobra brought in. The intent was to decrease the number of cobras in the wild. But, through a perverse incentive, they actually made it worse. Cobra breeders sprouted up everywhere in an attempt to make money from the government for the dead cobras they could take in. I believe that Louisiana had a similar story about the invasive species of South American nutria that were imported into the area for their furs and because they kept the marsh grass under control. Huge releases of them into the wild resulted, either intentionally or during hurricanes, and they quickly got out of control and they began to destroy the fragile ecosystems. The government began paying for their skins to encourage people to kill them in order to control the population. This actually led to some people breeding them for the money they could make from the government. There are other examples out there of these types of perverse incentives that lead to the opposite of what was intended.
 
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jwk said:
CAAs will indeed expect to be paid the same as CRNAs in the same practice doing the same work. Why wouldn't we? In medically directed practices there is not a single thing a CRNA can do that a CAA cannot. In my practice, the only difference in job descriptions is the title at the top of the form. Supply and demand is what sets compensation, as it does in all fields everywhere.
Click to expand...
Interesting. I’ve never heard of AAs expecting to be paid the same. I thought the whole shtick was a cheaper alternative. If it costs the same why wouldn’t hospitals just use CRNAs with their new 3 year DNP degree esp if they can practice without MD supervision.
 
The effect of the QZ modifier on data sets

Here is the abstract, in case you don't want to read the whole thing:

We examined hospitals that exclusively used the billing modifier QZ in anesthesia claims for a 5% sample of Medicare beneficiaries in 2013. We used a national Medicare provider file to identify physician anesthesiologists and nurse anesthetists affiliated with these hospitals. Among the 538 hospitals that exclusively reported the modifier QZ, 47.5% had affiliated physician anesthesiologists. These hospitals accounted for 60.4% of the cases. Our results illustrate the challenges of using modifier QZ to describe anesthesia practice arrangements in hospitals. The modifier QZ does not seem to be a valid surrogate for no anesthesiologist being involved in the care provided.
 
Gern Blansten said:
The effect of the QZ modifier on data sets

Here is the abstract, in case you don't want to read the whole thing:

We examined hospitals that exclusively used the billing modifier QZ in anesthesia claims for a 5% sample of Medicare beneficiaries in 2013. We used a national Medicare provider file to identify physician anesthesiologists and nurse anesthetists affiliated with these hospitals. Among the 538 hospitals that exclusively reported the modifier QZ, 47.5% had affiliated physician anesthesiologists. These hospitals accounted for 60.4% of the cases. Our results illustrate the challenges of using modifier QZ to describe anesthesia practice arrangements in hospitals. The modifier QZ does not seem to be a valid surrogate for no anesthesiologist being involved in the care provided.
Click to expand...


That still leaves a good chunk of cases with no anesthesiologist involvement. I think the 75% number can be plausible if some of the CRNAs who primarily practice in medical direction of supervision models also have side gigs or locums practicing independently. I know some of the CRNAs at our local university (medical direction) also do independent side work in plastic surgery offices. One of my friends does locums in a mountain resort town. He says the hospital where he works also uses independent CRNAs in the weeks he is not there.
 
AAs have always been paid the same as CRNAs. I have heard of two AA schools planned that never made it in the Carolina’s due to pushback from CRNAs politically. Early stage planning but never got off the ground as a result.

In fact I believe in SC you can only direct 2 aas at a time. You can direct 4 rooms but only 2 being AAs. That’s complicated. Legislation crna politics got through.

I’m not against AAs at all. But the current practicing AA numbers just aren’t that large to make an impact. Not to mention I’ve seen several instances of practices who tried to bring in AAs and had a mast exodus of CRNAs as a result. With the current crna shortage facilities are too scared to try AAs and risk this as there just aren’t enough AAs to replace a mass crna exodus.

Maybe one day
 
CubsDynasty said:
Interesting. I’ve never heard of AAs expecting to be paid the same. I thought the whole shtick was a cheaper alternative. If it costs the same why wouldn’t hospitals just use CRNAs with their new 3 year DNP degree esp if they can practice without MD supervision.
Click to expand...
Why would I not want to be paid the same for the same work in the same practice?

Surely you know that the DNP is fluff - no additional clinical training or requirements than when it was a masters degree, no increased scope of practice or allowable procedures.

If you want a place with no MD supervision, then yeah, you won't find CAAs there. But don't believe the CRNA economic lies. They say they're cheaper but they're not. They bill the exact same amount. When they say they're "cheaper" they want you to also consider the cost of their education vs an MD/DO among other games.
 
Howard888 said:
AAs have always been paid the same as CRNAs. I have heard of two AA schools planned that never made it in the Carolina’s due to pushback from CRNAs politically. Early stage planning but never got off the ground as a result.

In fact I believe in SC you can only direct 2 aas at a time. You can direct 4 rooms but only 2 being AAs. That’s complicated. Legislation crna politics got through.

I’m not against AAs at all. But the current practicing AA numbers just aren’t that large to make an impact. Not to mention I’ve seen several instances of practices who tried to bring in AAs and had a mast exodus of CRNAs as a result. With the current crna shortage facilities are too scared to try AAs and risk this as there just aren’t enough AAs to replace a mass crna exodus.

Maybe one day
Click to expand...
South Carolina legislation was changed a few weeks ago as well - 1:4 is now allowed in SC.

You'd have to provide specifics where you've actually seen "mass exodus" of CRNAs because it doesn't happen. There are always CRNAs threatening to leave (never mind that those kinds of threats constitute illegal labor practices) but it's typically an idle threat because they don't want to uproot their families to make a stupid political statement.

There are shortages everywhere. Particularly for medically directed practices, adding CAAs into the mix should be a no-brainer. Will we ever have the numbers the CRNAs do? Probably not - but that doesn't mean we're not part of the solution to the extreme staffing shortages that a lot of areas face.
 
Seen multiple hospitals in southeast where AAs where hired and double digit CRNAs left. Several mednax facilities tried this 2017-2020. Failed terribly

Great to hear on the 1:4 for SC now. But…Right now in the Carolina’s large health systems are extremely short on CRNAs. Prisma, Musc, Atrium, Moses Cone, Mission, Novant, Duke, UNC. Why have they not hired AAs? Because just more CRNAs will leave and they’ve said that. Until enough AAs exist to replace a mass exodus it won’t be worth it for hospital administrations to apply.
 
jwk said:
Why would I not want to be paid the same for the same work in the same practice?

Surely you know that the DNP is fluff - no additional clinical training or requirements than when it was a masters degree, no increased scope of practice or allowable procedures.

If you want a place with no MD supervision, then yeah, you won't find CAAs there. But don't believe the CRNA economic lies. They say they're cheaper but they're not. They bill the exact same amount. When they say they're "cheaper" they want you to also consider the cost of their education vs an MD/DO among other games.
Click to expand...
I’ve worked several places with both and they were always paid significantly less. A quick search says average AA salary of 130-180 vs 205-250 for CRNAs. If AAs are getting paid the same then that changes the equation for me from a financial perspective.
 
CubsDynasty said:
I’ve worked several places with both and they were always paid significantly less. A quick search says average AA salary of 130-180 vs 205-250 for CRNAs. If AAs are getting paid the same then that changes the equation for me from a financial perspective.
Click to expand...
That’s also the exact same argument from the CRNAs saying they want to get paid like MDs
 
CubsDynasty said:
I’ve worked several places with both and they were always paid significantly less. A quick search says average AA salary of 130-180 vs 205-250 for CRNAs. If AAs are getting paid the same then that changes the equation for me from a financial perspective.
Click to expand...
Our AAs are making $250K before bonus or OT. Bonus pushes them close to $300K 40hrs. No nights, call, or weekends.
 
Howard888 said:
Seen multiple hospitals in southeast where AAs where hired and double digit CRNAs left. Several mednax facilities tried this 2017-2020. Failed terribly

Great to hear on the 1:4 for SC now. But…Right now in the Carolina’s large health systems are extremely short on CRNAs. Prisma, Musc, Atrium, Moses Cone, Mission, Novant, Duke, UNC. Why have they not hired AAs? Because just more CRNAs will leave and they’ve said that. Until enough AAs exist to replace a mass exodus it won’t be worth it for hospital administrations to apply.
Click to expand...
A success story

 
When I was an AA I was heavily involved in helping multiple groups across the country start up hiring AAs into an established ACT practice.

Number of groups where more than 2-3 CRNAs left after AAs were hired: zero. Typical initial tranche of new hire AAs: 2-5 people.

Number of groups happy ~1-2 years later when they are more able to be fully staffed: 100%.
 
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aneftp said:
Good. I love it when the crnas try to practice to the fullest of their license crap motto. And look down on AAs.

Crnas mindset is
Crna=MD
Crna>AAs.
Click to expand...
I never understood wtf “practice to the fullest of license” ever meant…
 
BLADEMDA said:
tennesseeconservativenews.com

Tennessee Needs Anesthesia Providers Who Are Highly Educated And Skilled! We Do Not Need A Lesser Option | Tennessee Conservative

Tennessee Conservatives Should Understand That There Is A Move Within The State Legislature That Aims To Introduce An Additional Anesthesia Provider To The State. This Provider Is Claimed To Be Available And Cost Effective. This Is Absolutely Not Accurate.
tennesseeconservativenews.com tennesseeconservativenews.com
Click to expand...
Wow! I am just an ophthal resident, but I dont see how MDA pay will not be adversly effacted in the long run by the passage of this bill. Serious encroachment.
 
dabears505 said:
AA is one of the worst things to happen to anesthesia. You have people who have even less training and science background than crnas doing our job. It cheapens our field even more. If you've ever worked with aa's, you'll know they are the same as crnas in terms of attitude. Some want to be supervised, but a lot of them are annoyed they aren't practicing alone and restricted by their license.
Click to expand...
I disagree as someone who was a RN and now a MD (hospitalist).

I don't know that much about AA grad study but if they have to take the MCAT, they probably have more science background than a CRNAs.
 
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GravelRider said:
Ah let’s just add another group of midlevels to compete with for jobs. A group with even less training than the midlevels we were previously competing with. Perfect plan.
Click to expand...
At least they won't be militants for the next 15+ yrs. Lol
 
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