Salary drop from CRNA

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echod

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Assuming that CRNAs win the right to administer anesthesia in all but the most difficult cases and that CRNAs are hired readily because of worries about raising health care costs, what kind of salary drop would anesthesiologist be expecting? 10%, 20%, 30%, 40%, or 50%? Thanks a lot!
 
echod said:
Assuming that CRNAs win the right to administer anesthesia in all but the most difficult cases and that CRNAs are hired readily because of worries about raising health care costs, what kind of salary drop would anesthesiologist be expecting? 10%, 20%, 30%, 40%, or 50%? Thanks a lot!
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None. If you hire them and do the billing. Just make sure that you have an exclusive contract for all anesthesia services, than the hospital cannot hire them separately.
 
dr doze said:
Denial is not just a river in Egypt.
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If I'm wrong, I'll move or retire. If you're not going to pay for premium service, you're not going to get it. Not from me anyway. Good luck to the CRNA trying to keep the pedi liver transplant patient alive. Fellowships will aid with job security, unless you do one in Regional or OB.
 
IlDestriero said:
None. If you hire them and do the billing. Just make sure that you have an exclusive contract for all anesthesia services, than the hospital cannot hire them separately.
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Thanks for the replies. I admit that I don't know much about what I'm asking, but couldn't some shrew hospital owner decide one day that all easy cases would be handled by CRNAs independently while only the hardest/high risk cases go to anesthesiologists? If what I described does become reality, then I would image that either the demand or salaries for anesthesiologist to decrease. Then, how much salary decrease would this entail?
 
No one knows when that would happen, or what would happen to reimbursement. That is a separate issue from MaObama care cuts. Live well below your means and you'll be golden. If it gets really bad in 15 years, pack your very experienced bags and go somewhere where your expertise is appreciated, and fairly compensated. Also, if you can, don't take a job that's 100% supervision, especially right out of residency/fellowship.
 
All the anesthesiologists I know are making more than they ever have. Albeit, less than the lucrative periods of 80s and early 90s. Everyone in my group is doing well. Although medicare rates are low, our private payers have upped rates each year in the last few. It also helps to have very low overhead. Lots of jobs out there paying more than 350K to start. PS:My older partners tell me that the same issues with CRNAs have existed for year. Same fears when they graduated in the 1980s. FWIW.
 
sevo85288 said:
All the anesthesiologists I know are making more than they ever have. Albeit, less than the lucrative periods of 80s and early 90s. Everyone in my group is doing well. Although medicare rates are low, our private payers have upped rates each year in the last few. It also helps to have very low overhead. Lots of jobs out there paying more than 350K to start. PS:My older partners tell me that the same issues with CRNAs have existed for year. Same fears when they graduated in the 1980s. FWIW.
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-We are also just coming off a major shortage of anesthesia personnel, (docs and CRNAs)
-The economic pressures have never been stronger.
-In many cases, Much of our income is due to subsidies, not payments from third party payors.
-Docs are more and more functioning as employees of AMCs and hospitals, in effect surrendering many of the rights they had as private practitioners. NO BIG DEAL WHEN THERE IS A SHORTAGE. Watch out when there is a surplus, even a transient one. You will be amazed how bad things can get how quickly.
-When supply meets demand these pressures will reverse themselves with a vengence.
-many MD only departments are going to ACT models.
-Growing acceptance of midlevels in other specialties will only add to the acceptance of solo CRNAS.

Ask your older partners what the ratio of anesthesiologist to CRNA income was back in the day. It will never be 1:1 but IMO it will continue to get smaller as it has for a while now.
- also in the 80s, they made what they made supervising two rooms. Now in order to make what we make it is 3-4 rooms.
 
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echod said:
Assuming that CRNAs win the right to administer anesthesia in all but the most difficult cases and that CRNAs are hired readily because of worries about raising health care costs, what kind of salary drop would anesthesiologist be expecting? 10%, 20%, 30%, 40%, or 50%? Thanks a lot!
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First, Is the practice of Anesthesia Medicine or Nursing? If the Nurses/AANA are successful in their quest to restructure the field as one of DNAP CRNA and not one of MD/DO ANesthesiology then the "field" will reimburse accordingly.

IMHO, a DNAP solo practitioner is worth about $100-$110K per year. This represents about a 30% decrease from today's levels. But, since Anesthesiologists are performing a Nursing level duty the drop for them would be about 50% from today's levels. However, if the Physician level component remains intact (supervising 8 CRNAS or putting out fires ) then the decrease would be about the same as the DNAP CRNA.
 
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THE GREAT NURSE ANESTHETIST “OPT OUT” DEBATE

THE GREAT NURSE ANESTHETIST “OPT OUT” DEBATE

From the healthcare law blog

Under Medicare rules Certified Registered Nurse Anesthetists (“CRNAs”) must be supervised by a physician, typically an anesthesiologists or perhaps by a surgeon in rural areas where anesthesiologists are not available. Medicare has a state “opt out” provision which permits CRNAs to practice without supervision of a physician. To date, 15 states have chosen to opt out and others like Colorado are considering doing the same. Anesthesiologists are compensated for supervising CRNAs and can supervise up to 3 at a time because they are not required to be in the same room.


Anesthesiologists of course tend to favor the supervision requirement because they have a financial interest in the same and can also claim the mantel of patient safety, because of their more substantial professional education and experience. If you ask an anesthesiologists what differentiates his or her service from that of a CRNA, the answer that you are likely to get is that “I am a physician.” That is of course empirically true. There are occasions when having a physician capable of making medical decisions available to assist the surgeon in an emergency is a net plus. The problem is that in the overwhelming number of cases having both a “belt and suspenders” is an expensive luxury.



The delivery of anesthesia is a technical service. Over time the technical expertise in delivering the service is about the same as between physicians and nurses and frankly in some cases nurses do it better, particularly in the delivery of epidurals during delivery.

It is also true that anesthesiologists, although they are physicians, tend to get a little rusty in the medical department because they are delivering a technical service and to some extent operate in a routine that does not call upon their medical expertise margin as physicians, thus reducing the benefit of that superior education as a practical matter.



Looking at the issue from a cost/benefit analysis, absent a showing of clear and substantial benefit to patient welfare, which is a difficult statistical case to make, more and more states are likely to join the opt out crowd as the use of so called “physician extenders” increases in the cost containment/healthcare access movement picks up steam. The irony is perhaps the prospect that the growing alternative use of CRNAs will not only eliminate the supervision requirement, but also cut a competitive slice of anesthesia delivery out of the anesthesiologist’s economic pie - a legitimate cause for anesthesiologists’ concern ​
 
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FYI guys, today in the Denver Newspaper was a FULL PAGE ad spewing lies and mistrust. I was shocked that the ASA and Colorado Society of Anesthesiologists stooped to such fear mongering and total lies. It smells of desperation and insecurity on the part of the anesthesiologists.

All I can ask of EVERY CRNA in the US, not just Colorado...just write a note to the Governor of Colorado, Governor Ritter and simply explain how educated we are, how we are as safe as our colleagues, and we tend to allow more and better access in Rural settings. Please just drop a letter. Its easy to go to his web site and email the letter to him.

Thanks

Colorado CRNA
​
 
The AANA march to total destruction of the medical specialty of Anesthesiology continues albeit, at a slow pace. Next, Colorado's opt-out.

Imagine the propaganda once the DNAP starts hitting the work-force in 2015.
By 2025 the DNAP CRNA will be the norm and the AANA will be in the final phase of the equivalence/destruction of medical Anesthesiology. Since we are already "colleagues" per ex-military MD and many CRNAS why should hospitals and CMS keep paying for the MD/DO version of the anesthesia provider? Would patients actually pay DOUBLE the amount to get anesthesia from an MD/DO vs. a solo CRNA? What about "supervision" in the O.R.? How much is that worth to the average patient?

This field has 15-20 years left before it falls to the the marines of nursing. The DNAP CRNA will make ex-military MD's "colleagues" on par with him as far as the AANA and Joe Q. Public are concerned. Hospitals and CMS will likely follow-suite.

However, there will remain a salary difference between MD/DO and CRNA "anesthetists" as the former will be used to put out fires in the O.R. "Supervision" per se will no longer exist and the MD/DO will "facilitate" smooth function in the O.R.

Blade


http://www.dnap.com/DNAP,_CRNA,_Nurse_Anesthetist,.html
 
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sevo85288 said:
All the anesthesiologists I know are making more than they ever have. Albeit, less than the lucrative periods of 80s and early 90s. Everyone in my group is doing well. Although medicare rates are low, our private payers have upped rates each year in the last few. It also helps to have very low overhead. Lots of jobs out there paying more than 350K to start. PS:My older partners tell me that the same issues with CRNAs have existed for year. Same fears when they graduated in the 1980s. FWIW.
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Make hay while the sun shines. A Hurricane is coming circa 2025. It isn't 1980 anymore Toto. Nurses have gone from a Diploma in 1980 to a DNAP in 2015. They have gone from "yes doctor" to "I am a doctor and your equivalent."

Clinton put the crack in the dam and it will eventually break.
 
“In my judgment, the supervision rulings do not affect practice or the quality of anesthesia care,” said Sandi Peters, CRNA, former president of the Texas Association of Nurse Anesthetists. “I practice in three rural hospitals. In one practice site Im employed as a staff anesthetist; in the other two I independently contract. The physician who supervises me is usually a surgeon who likely has hd no advanced anesthesia training. Physician supervised or not, my practice is the same at all three hospitals.”
“Physician supervision of nurse anesthetists has absolutely nothing to do with practice or patient safety,” says Ira Gunn, MLN, CRNA, FAAN, who for nearly 50 years has practiced anesthesia and worked extensively with state legislatures, the Congress and administrative bodies regulating the nurse anesthesia profession. The 30,000-member American Association of Nurse Anesthetists (AANA) established a professional advocacy award in her name. “It has to do with politics, turf, control and income. It’s a holdover from the days of the ‘captain-of-the-ship’ legal doctrine, which became obsolete long ago in most jurisdictions.”
Gunn clarified a common misperception about who exactly “supervises” CRNAs. “People assume that physician supervision rulings are about anesthesiologists supervising nurse anesthetists. That isn’t true. Physician supervision rulings refer to any physician, including those without advanced anesthesia training. In practice it’s likely a surgeon,” said Gunn. “The American Society of Anesthesiologists (ASA) successfully campaigned to convince surgeons that they were liable for CRNAs. Nothing could be further from the truth. CRNAs carry their own medical malpractice insurance. Nurse anesthetists are trained by nurses, credentialed by nurses, and regulated by nurses. The profession is independent of medicine.”
 

2001 ​
The supervision rule was published in the Federal Register in the last days of the Clinton Administration and delayed by the new Bush Administration. A new rule was published in November that kept in place the Medicare requirement of physician supervision of CRNAs while establishing a process by which state governors could write to Medicare to opt out of the requirement.
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​
Iowa became the first state to opt out of the federal physician supervision requirement for nurse anesthetists.
The Ira P. Gunn Award for Outstanding Professional Advocacy was first presented to Ira Gunn, CRNA, MLN, FAAN.
 
Does the program run year around?
Yes, the 36-month nurse anesthesia program runs year around. Students register for classes during the fall, spring, and summer semesters. Students get a 2-week winter break, 1-week spring break, and 1-week summer break each year of




Nurse Anesthesia




Faculty Coordinator:
Kathryn White, CRNA, DNP
[email protected], (612) 625-3677
Specialty Area Information:
The University of Minnesota School of Nursing, Nurse Anesthesia Area of Study prepares Registered Nurses to become Certified Registered Nurse Anesthetists (CRNAs) who are prepared for nurse anesthesia practice at the highest level. Graduates will possess expertise in general and regional anesthesia techniques, and will be prepared to provide leadership in the practice setting. The Nurse Anesthesia Area of Study is fully accredited by the Council on Accreditation of Nurse Anesthesia Education Programs. In January of 2009, the University of Minnesota Nurse Anesthesia Area of Study received the maximum 10-year accreditation approval from the Council on Accreditation of Nurse Anesthesia Educational Programs. The program is the first nurse anesthesia program in the U.S. to be accredited to offer the entry-level Doctor of Nursing Practice
With the Minneapolis VA Medical Center serving as the primary clinical site for the program, the University of Minnesota nurse anesthesia students rotate to several urban and rural clinical sites, which offer a broad spectrum of practice experiences. Some of the clinical sites are required, and some are optional. All required clinical sites are within daily driving distance of the campus.
 
The bottom line is that as much "infighting" as we tend to do when mixing up the pot on this forum, we'll need to stick together like glue down the road.

Also, we must maintain our level of MEDICAL knowledge, which very often our surgical colleagues lose, and CRNA's never even have. I really think this will be important in the future.

Anesthesiology and Perioperative Medicine.....
 
cfdavid said:
The bottom line is that as much "infighting" as we tend to do when mixing up the pot on this forum, we'll need to stick together like glue down the road.

Also, we must maintain our level of MEDICAL knowledge, which very often our surgical colleagues lose, and CRNA's never even have. I really think this will be important in the future.

Anesthesiology and Perioperative Medicine.....
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There will always be a role for Perioperative Medicine and Consultants in Anesthesiology. But, the AANA is forcing our role as stool sitters to change or even be eliminated. Face the facts. This is a war and we are losing.
 
You make good points. Our model is a bit different and something you may want to get to know. We have a group which consists of anesthesiologists, surgeons and internists. We work for each other. And use our size as leverage. Very small % of our income is from subsidies. We don't like subsidizies. AMCs are big lies. Hospitals like at the beginning but 2 years later they hate them. (AMCs ask for huge subsidies) We have never had CRNAs and will don't forsee a need for them. We have a nice simple practice. Each of us is responsible for the complete care of each pt, including in the ICU. We provide acute and chronic pain service and provide a full range of anesthesia. We are not located in a high end area. Middle class.


dr doze said:
-We are also just coming off a major shortage of anesthesia personnel, (docs and CRNAs)
-The economic pressures have never been stronger.
-In many cases, Much of our income is due to subsidies, not payments from third party payors.
-Docs are more and more functioning as employees of AMCs and hospitals, in effect surrendering many of the rights they had as private practitioners. NO BIG DEAL WHEN THERE IS A SHORTAGE. Watch out when there is a surplus, even a transient one. You will be amazed how bad things can get how quickly.
-When supply meets demand these pressures will reverse themselves with a vengence.
-many MD only departments are going to ACT models.
-Growing acceptance of midlevels in other specialties will only add to the acceptance of solo CRNAS.

Ask your older partners what the ratio of anesthesiologist to CRNA income was back in the day. It will never be 1:1 but IMO it will continue to get smaller as it has for a while now.
- also in the 80s, they made what they made supervising two rooms. Now in order to make what we make it is 3-4 rooms.
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sevo85288 said:
You make good points. Our model is a bit different and something you may want to get to know. We have a group which consists of anesthesiologists, surgeons and internists. We work for each other. And use our size as leverage. Very small % of our income is from subsidies. We don't like subsidizies. AMCs are big lies. Hospitals like at the beginning but 2 years later they hate them. (AMCs ask for huge subsidies) We have never had CRNAs and will don't forsee a need for them. We have a nice simple practice. Each of us is responsible for the complete care of each pt, including in the ICU. We provide acute and chronic pain service and provide a full range of anesthesia. We are not located in a high end area. Middle class.
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Your model sounds like a good place to be during a period of oversupply.
 
What’s likely to be the result of IPAB’s efforts? The CBO, assuming that reduction targets will be hit, estimates Medicare spending reductions of $15.5 billion over five years, approximately 0.5 percent of projected costs. However, the CMS Chief Actuary has commented that history suggests that the target growth rates may be unachievable, while conservative economist (and former CBO director) Douglas Holtz-Eakin, writing in Health Affairs dismisses IPAB’s impact out of hand on the grounds that Congress will find its recommendations politically infeasible.
So, will IPAB cut costs at all? A more probable result than that forecast by the CBO or Holtz-Eakin is that IPAB will be optimistic in its forecasts of spending reductions, and that Congress will turn a blind eye to this optimism, while also occasionally loosening payment restrictions as beneficiaries find access to care increasingly difficult—a scenario likely to produce some savings, but probably only a fraction of the CBO estimate.
 
FindHappy said:
Blade:

I appreciate your posts! However, you never give us specifics as to what you would do with a solid future in medicine that seems to meet the criteria of "being worth the effort." Could you provide those? I

I can tell you I searched far and wide - and have not been able to find a model (maybe dermatology which is somewhat cash based ?). When I look on the pain message boards, some feel that anesthesiology will have better reimbursements. Cardiology - many pessimists. The list continues..I just don't think the insurance system is a good place to be at all.

As far as I can tell, this model is unsustainable for most fields. Insurance companies can't keep jacking their rates up like this forever. Medicare Part A,B,C,D is broke because the country is. It's only a matter of time before something like the IPAB gets rolling with no overturning SGR.

When I have spoken to people in all fields, no one is saying - oh yeah cardiologists will fine , or X Y Z will be fine.

I think the narrative I see is that medicine itself will not be an attractive profession at all - the hours, liability, stress, and declining reimbursements if this continues. I am a humble person, happy to serve - however I am not going to be "served" a continued case of "screw you" either.

Dentists surprassed primary care fields about 5 - 10 years ago. How long before they surpass most fields because their business model is more sustainable? Would I rather be a neurosurgeon making 400,000 a year or a dentist working 5 days a week 9-5 with much less stress making $200,000. My answer: dentist.

I am going to pay off my debt by my first year out, and have a decent amount of money saved 2 or 3 years after. At that point, I will consider going back to dental school or MBA school IF this nonsense continues. It sucks to have to live that way, but it is what it is.

It's not about the money - I just refuse to be a slave to bills like Obamacare which make no sense and force me into terrible patient care.🙂
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When Organized Medicine realizes that a Canadian system is better than Obamacare then where does that leave Anesthesiology? Will "Gas" be a Nursing level duty circa 2025? Or, will MD (A)s still be the predominant player in the O.R. suite? Obamacare was never designed to actually work; instead, this "temporary" system was designed to fail in order to usher in the true goal of Canadian style Medicine in the U.S. Obamacare is simply a transitional step to the final goal.

Unfortunately, the U.S. Anesthesia system will likely have the Solo CRNA as the cost effective provider (at around $100K Socialized Dollars per year) compared to the $400K Canadian Anesthesiologists earn. Canadian Cardiologists, Neurosurgeons, etc. are doing just fine in this system.
 
http://forums.studentdoctor.net/showthread.php?t=658036&highlight=canada



Average income is around $350k in the poorer provinces to $500k+ in the richer provinces (Alberta) - yes that is straight FFS - no salary/partnership crap). That and we don't (mostly anyways) have uninsured patients so you get paid for every case you do, only a single payer in each province (easy billing - can do without billing agents), a single country wide malpractice company (no issues of moving to another province/tail coverage), free (well included in taxes) healthcare, a tax rate around 34% once you incorporate, and a dollar that is close to par with the US and a banking system that has some effective bloody regulation to avoid the crap that is killing our and the worlds economy (ahem, sorry about that but I'm a little pissed looking at my retirement savings lose all my gains over the last 5 fricken years while the bast ards responsible get a bloody bailout, keep their CEO bonuses and go on nice company retreats to plan on how to say they are sorry for the mess but can they have some more money).

All you have to do is put up with our winters.

CanGas
 
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that the real numbers
it depends
whether you own a practice'
98% do and earn on average $300,000 on 3 days but the potential is limitless,
most ortho work 2.5 to 4 day
max potential is $5 mill gross with 50% overhead,
middle of career ( after 5-7 years)is $ 2.5 mil gross with 50-60% overhead
starting out is $400k to 500k gross with 60-65% overhead
 
John Canady said,


on October 13th, 2009 at 2:10 pm
As a CRNA with 12 years of independent-practice anesthesia experience, including 18 months in Iraq and 4 months in Central America, I too found the comments about “the greater training of the medical practice of anesthesia (anesthesiologists) over that of the nursing practice (nurse anesthetists)” to be misleading. I have always provided anesthesia personally; based on my own training, experience, and clinical judgment. I have never simply “assisted the anesthesiologist.” Further, the vast majority of my practice has been in settings with no anesthesiologist available at all; with no difference in patient safety, satisfaction, or quality outcomes.
In my practice, I frequently field questions from patients about what the difference is between anesthesiologists and CRNAs. I typically answer, with a chuckle, “about $150,000 per year” then follow with “actually, about 6 months training.” Is that the “greater training” that these comments refer too? The length of the average CRNA training program is 30 months while anesthesiology residency is 36 months. Six months more time as a student of anesthesia that the average CRNA. That’s it.
It’s tiresome hearing how anesthesiologists are better prepared to provide anesthesia because they “complete 4 years of residency and 4 years of medical school.” The first year of that “residency” is actually an internship, not anesthesia training. Four years of traditional or osteopathic medical school followed by a one-year internship is the same training that a dermatologist, allergist, or psychiatrist completes. And no, I’m not attempting to demean the training of those medical specialties. My point is this: Would you want your allergist performing your anesthesia, just because he or she went to medical school?
After completing our 30 months of training, CRNAs provide hands-on anesthesia every day, compared to the typical anesthesiologist who provides hands-on anesthesia care less than one day per week in some settings. The CRNA’s daily hands-on delivery of anesthesia care quickly erases any benefit, either imagined or real, that the anesthesiologist’s 6 months of additional training might have initially offered.
The first formal CRNA training program was established a full 50 years before the first anesthesiology residency training program, which didn’t occur until thousands of general medical officers returned home from World War II looking for work. Anesthesia was a recognized specialty of nursing for half a century before the first newly-minted anesthesiologists began claiming anesthesia as the practice of medicine and began their ongoing attempts to subvert CRNA practice.
I find it fascinating that so many physicians today chose to spend 3 years training to practice in a nursing specialty then spend so much time and energy constantly trying to undermine our history, professionalism, and clinical contributions to safe surgical and anesthesia care. You would think they would be more grateful for the opportunity we CRNAs have provided them.
 
It's saddening that nurses believe time outside of anesthesia isn't applicable to our practice (yet it is when they spend time outside of the OR in NA school). Is part of their 30 months spent sitting in a classroom learning, and sitting in a classroom taking tests? The SRNAs took pharm with me in med school (of course they didn't have to be there everyday, and of course they took different tests) so I know part of their training was spent sitting in a classroom.

Setting the CRNA vs. MD debate completely aside, all but the blindest, most narrow-minded, completely obtuse group of people should realize our training prepares us much better for independent practice.

A year of learning to diagnose and treat general medical conditions isn't applicable? Because why? Do patients in the OR not deserve someone able to treat any condition they may have? Is a physician who understands the pathophysiology of sarcoidosis and keeps it in the back of their mind not more important than someone pushing Labetalol 5mg IV b/c the systolic was a little high?

I guess by the same reasoning, time spent as a physician in the pain clinic and ICU isn't applicable either. Nor is a fellowship year learning interventional pain management, regional, critical care, TEE, hearts, etc.

I see two completely separate issues. Whether a CRNA is prepared for independent practice is one argument that'll never be solved (until we see a well setup study, which in my mind, based on what I see in practice, would be unethical to patients). But, for a CRNA to believe themselves to be as prepared for independent practice as an MD, or saying they train almost as long (6 months less), is lying to yourself, lying to your patients, and lying to everyone around you. Why can you just fess up, be honest, and say we're better prepared because we train longer, harder, with more diversity? Atleast be honest about that.
 
One of my co-fellows is from Canada. From what he says, being an anesthesiologist in Canada is a great gig. I think you need a total of 5 years of graduate medical education to work there.
 
BLADEMDA said:
John Canady said,


on October 13th, 2009 at 2:10 pm
As a CRNA with 12 years of independent-practice anesthesia experience, including 18 months in Iraq and 4 months in Central America, I too found the comments about “the greater training of the medical practice of anesthesia (anesthesiologists) over that of the nursing practice (nurse anesthetists)” to be misleading. I have always provided anesthesia personally; based on my own training, experience, and clinical judgment. I have never simply “assisted the anesthesiologist.” Further, the vast majority of my practice has been in settings with no anesthesiologist available at all; with no difference in patient safety, satisfaction, or quality outcomes.
In my practice, I frequently field questions from patients about what the difference is between anesthesiologists and CRNAs. I typically answer, with a chuckle, “about $150,000 per year” then follow with “actually, about 6 months training.” Is that the “greater training” that these comments refer too? The length of the average CRNA training program is 30 months while anesthesiology residency is 36 months. Six months more time as a student of anesthesia that the average CRNA. That’s it.
It’s tiresome hearing how anesthesiologists are better prepared to provide anesthesia because they “complete 4 years of residency and 4 years of medical school.” The first year of that “residency” is actually an internship, not anesthesia training. Four years of traditional or osteopathic medical school followed by a one-year internship is the same training that a dermatologist, allergist, or psychiatrist completes. And no, I’m not attempting to demean the training of those medical specialties. My point is this: Would you want your allergist performing your anesthesia, just because he or she went to medical school?
After completing our 30 months of training, CRNAs provide hands-on anesthesia every day, compared to the typical anesthesiologist who provides hands-on anesthesia care less than one day per week in some settings. The CRNA’s daily hands-on delivery of anesthesia care quickly erases any benefit, either imagined or real, that the anesthesiologist’s 6 months of additional training might have initially offered.
The first formal CRNA training program was established a full 50 years before the first anesthesiology residency training program, which didn’t occur until thousands of general medical officers returned home from World War II looking for work. Anesthesia was a recognized specialty of nursing for half a century before the first newly-minted anesthesiologists began claiming anesthesia as the practice of medicine and began their ongoing attempts to subvert CRNA practice.
I find it fascinating that so many physicians today chose to spend 3 years training to practice in a nursing specialty then spend so much time and energy constantly trying to undermine our history, professionalism, and clinical contributions to safe surgical and anesthesia care. You would think they would be more grateful for the opportunity we CRNAs have provided them.
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ask that same guy if he ever took a college level chemistry course with a lab.. ask him if he ever took a physics course in college. the one with a lab. I know his answer and his rebuttal. That stuff isnt important to understand in anesthesia.. yeah right OK....
 
Southpaw said:
... all but the blindest, most narrow-minded, completely obtuse group of people should realize our training prepares us much better for independent practice....
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It's difficult for a man to understand something if his salary depends on him not understanding it.

Few people (other than CRNAs) actually believe their position, but lots of people want to believe it, or need political cover to implement it.- thus bogus study after bogus study, saying their is no difference. Thus the DNAP. This will give some decision makers the cover that they need.
 
dr doze said:
It's difficult for a man to understand something if his salary depends on him not understanding it.

Few people (other than CRNAs) actually believe their position, but lots of people want to believe it, or need political cover to implement it.- thus bogus study after bogus study, saying their is no difference. Thus the DNAP. This will give some decision makers the cover that they need.
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Awesome post. Agree 100%.👍
 
90% of Gas MD/DO's are board certified. Make the requirement 100% within 3 years of residency completion.

If CRNA's want solo rights since they are "equal" to MD's/DO's, they can take the gas boards as well.

Same for every other specialty under turf threat. Sure, it will marginally suck for physicians, but there is no other way of showing that most CRNA's/DNP/ABCDEFGHIJKLMNOP's <<<<<<<<<<<< MD/DO in clinical capability, to the extent that they cannot handle many situations that may arise in the OR or in clinic.

CRNA's/DNP's/ABCDEFGHIJKLMNOP's have already won the basic science and non-specialty clinical skill exam argument under the guise of having a 'different' basic science background and 'different' non-specialty clinical skills (which of course, doesn't make sense either, but that's a battle already lost). Trying to make CRNA's/DNP's/ABCDEFGHIJKLMNOP's take Step I/II/III won't work: they claim equivalent testing in school, and equivalent knowledge through nursing school/clinical work and that forcing them to take Step I/II/III is forcing the evil medical model upon them which doesn't jive with their caring nursing model which taught them 'different' things yet somehow magically results in the same outcomes (which can't be tested apparently), and the argument has worked with legislators.

However, the board exam is taken after training ends, and is supposed to test clinical competency, which apparently the CRNA's/DNP's/ABCDEFGHIKLMNOP's have acquired through nursing, 30 month CRNA/DNP/ABCDEFGHIJKLMNOP programs and perhaps, smoking crack rock.

Close your eyes for a moment and imagine with me: Dr. Nurses running the ER, optometrists doing laser eye surgery, and CRNA fluoroscopy...
 
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Eugenie98 said:
90% of Gas MD/DO's are board certified. Make the requirement 100% within 3 years of residency completion.

If CRNA's want solo rights since they are "equal" to MD's/DO's, they can take the gas boards as well.

Same for every other specialty under turf threat. Sure, it will marginally suck for physicians, but there is no other way of showing that most CRNA's/DNP/ABCDEFGHIJKLMNOP's <<<<<<<<<<<< MD/DO in clinical capability, to the extent that they cannot handle many situations that may arise in the OR or in clinic.

CRNA's/DNP's/ABCDEFGHIJKLMNOP's have already won the basic science and non-specialty clinical skill exam argument under the guise of having a 'different' basic science background and 'different' non-specialty clinical skills (which of course, doesn't make sense either, but that's a battle already lost). Trying to make CRNA's/DNP's/ABCDEFGHIJKLMNOP's take Step I/II/III won't work: they claim equivalent testing in school, and equivalent knowledge through nursing school/clinical work and that forcing them to take Step I/II/III is forcing the evil medical model upon them which doesn't jive with their caring nursing model which taught them 'different' things yet somehow magically results in the same outcomes (which can't be tested apparently), and the argument has worked with legislators.

However, the board exam is taken after training ends, and is supposed to test clinical competency, which apparently the CRNA's/DNP's/ABCDEFGHIKLMNOP's have acquired through nursing, 30 month CRNA/DNP/ABCDEFGHIJKLMNOP programs and perhaps, smoking crack rock.

Close your eyes for a moment and imagine with me: Dr. Nurses running the ER, optometrists doing laser eye surgery, and CRNA fluoroscopy...
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I understand where you're coming from but I disagree that CRNAs should be allowed to take the test. So all I have to do is pass this test and everything else will be forgotten and we'll be considered equal? no way!!!

I guarantee you that give me a couple months and I'll be able to pass the bar, the professional engineer test, the "fill in the blank" test... does that mean I should be allowed to practice law and whatever else. no way!!!

Sorry, but there is already a path to independent practice of anesthesia. It's called med school and residency.
 
anesorbust said:
I understand where you're coming from but I disagree that CRNAs should be allowed to take the test. So all I have to do is pass this test and everything else will be forgotten and we'll be considered equal? no way!!!

I guarantee you that give me a couple months and I'll be able to pass the bar, the professional engineer test, the "fill in the blank" test... does that mean I should be allowed to practice law and whatever else. no way!!!

Sorry, but there is already a path to independent practice of anesthesia. It's called med school and residency.
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I hear you. I feel for you. But, the legislators and bean counters don't care.
It make come to this in a few years. Let's hope the ASA sponsored studies start happening this year or next. Otherwise this ABA certification looks like the last line of defense. This back-up parachute must be deployed with sufficient time or we still hit the ground and go splat.
 
anesorbust said:
I understand where you're coming from but I disagree that CRNAs should be allowed to take the test. So all I have to do is pass this test and everything else will be forgotten and we'll be considered equal? no way!!!

I guarantee you that give me a couple months and I'll be able to pass the bar, the professional engineer test, the "fill in the blank" test... does that mean I should be allowed to practice law and whatever else. no way!!!

Sorry, but there is already a path to independent practice of anesthesia. It's called med school and residency.
Click to expand...

Yes, but the political forces at hand mean THAT WILL NEVER HAPPEN, CRNA solo practice in some form or another is here to stay. If this rigorous board requirement isn't set and set soon CRNA's will gain the ability to do practice solo everywhere without even meeting basic clinical competency requirements.

If MD/DO's take the stance that there should be no such clinical testing requirements because CRNA's shouldn't be allowed to do solo practice, period, then CRNA's will couch their language in that of oppression (think of Braveheart where the Scottish = CRNA's and the English = MD's/DO's), after all they claim to have equivalent clinical competency and have "provided XYZ doses in BFE" and are the sole anesthesia providers in xxx BFE hospitals. AND THEY WILL WIN.
 
Eugenie98 said:
Yes, but the political forces at hand mean THAT WILL NEVER HAPPEN, CRNA solo practice in some form or another is here to stay. If this rigorous board requirement isn't set and set soon CRNA's will gain the ability to do practice solo everywhere without even meeting basic clinical competency requirements.

If MD/DO's take the stance that there should be no such clinical testing requirements because CRNA's shouldn't be allowed to do solo practice, period, then CRNA's will couch their language in that of oppression (think of Braveheart where the Scottish = CRNA's and the English = MD's/DO's), after all they claim to have equivalent clinical competency and have "provided XYZ doses in BFE" and are the sole anesthesia providers in xxx BFE hospitals. AND THEY WILL WIN.
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The libertarian in me is intrigued by your idea, but with a small caveat. They should take all the Steps (1, 2, and 3), and if they pass they can then take their equivalent-to-MD training, and then try their hand at the oral and written boards.

You might be thinking, "But none of them will pass!?". Yeah, probably right, but the public deserves the best trained, not just 'good-enough'.
 
Southpaw said:
The libertarian in me is intrigued by your idea, but with a small caveat. They should take all the Steps (1, 2, and 3), and if they pass they can then take their equivalent-to-MD training, and then try their hand at the oral and written boards.

You might be thinking, "But none of them will pass!?". Yeah, probably right, but the public deserves the best trained, not just 'good-enough'.
Click to expand...

Forget Step 1 and 2. We have a shot at Step 3 because they will get a DNAP and need basic practice skills. Also, forget the Orals as they will claim bias.

ABA certified CRNA passes Step 3 and the Writtens. This ABA certification isn't equivalence it means basic competence.

The ASA is going to need to choose a plan to defend the specialty against the CRNA mills. Either proceed with multiple academic backed studies or promote the ABA certified CRNA. The current plan of propaganda without evidence is doomed to fail.

Blade
 
I think it's idiotic for us to advocate letting non-physicians take licensure or certification exams. The message given is that the education leading to being qualified to sit for these exams doesn't matter. CRNAs aren't the same as anesthesiologists not because they didn't take a few tests, but because of the college, medical school and residency years of training. It's so much more than just a couple multiple choice questions.
 
BLADEMDA said:
Forget Step 1 and 2. We have a shot at Step 3 because they will get a DNAP and need basic practice skills. Also, forget the Orals as they will claim bias.

ABA certified CRNA passes Step 3 and the Writtens. This ABA certification isn't equivalence it means basic competence.

The ASA is going to need to choose a plan to defend the specialty against the CRNA mills. Either proceed with multiple academic backed studies or promote the ABA certified CRNA. The current plan of propaganda without evidence is doomed to fail.

Blade
Click to expand...

I think you've forgotten the importance of Step 1 and Step 2. Whether I'm conscious of it or not, I know that I use this knowledge daily. It's important to my patients, and it's important to me.

The CRNA mills are their own worst enemy. They have no standards...they're shooting themselves in the foot.
 
proman said:
I think it's idiotic for us to advocate letting non-physicians take licensure or certification exams. The message given is that the education leading to being qualified to sit for these exams doesn't matter. CRNAs aren't the same as anesthesiologists not because they didn't take a few tests, but because of the college, medical school and residency years of training. It's so much more than just a couple multiple choice questions.
Click to expand...

I love the Irony.

They practice Solo now.

They released new studies proving they are just as safe.

They have the legal right to administer anesthesia without an MD (A).

They get paid the exact same fee from Medicare as a Board Certified MD(A).

They do their "training" in the same locations as many Anesthesia Residents.

They learn from Academic Attendings and Faculty

Then, they take a water-downed exam and claim equivalence to you.

The horse is out of the barn here; the best you can hope for is Academic based studies "proving" more knowledge/skills and SOME HARD MULTIPLE CHOICE QUESTIONS called the ABA written exam.

Blade
 
BLADEMDA said:
I love the Irony.

They practice Solo now.

They released new studies proving they are just as safe.

They have the legal right to administer anesthesia without an MD (A).

They get paid the exact same fee from Medicare as a Board Certified MD(A).

They do their "training" in the same locations as many Anesthesia Residents.

They learn from Academic Attendings and Faculty

Then, they take a water-downed exam and claim equivalence to you.

The horse is out of the barn here; the best you can hope for is Academic based studies "proving" more knowledge/skills and SOME HARD MULTIPLE CHOICE QUESTIONS called the ABA written exam.

Blade
Click to expand...

sigh... how in the world did we let this happen?
I mean, how did we fall asleep at the wheel like this?
simply boggles the mind...

I think the first step is that all MD faculty should refuse to teach SRNAs! continuing to do this is plain ridiculous. If they think CRNAs are just as good, they can go learn from them. If we teach CRNAs everything we know, then what's the point!
 
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Southpaw said:
I think you've forgotten the importance of Step 1 and Step 2. Whether I'm conscious of it or not, I know that I use this knowledge daily. It's important to my patients, and it's important to me.

The CRNA mills are their own worst enemy. They have no standards...they're shooting themselves in the foot.
Click to expand...

I have to disagree.

First of all, you use that knowledge daily as a physician since you were trained in the physician model. A CRNA will say the nursing model is different and so the Step 2 and Step 3 tests are irrelevant to them since it is a fundamentally 'different' model.

Of course, this makes absolutely no frickin sense for Step 1 since Step 1 is a basic science exam. But then the nurses will argue that there is 'extraneous' science in Step 1 that is useless in the 'real world', i.e. book smarts not street smarts or warm fuzzy feeling smarts.

Second of all, the law profession has no standards for law schools, they now produce lawyers in a ratio of 3:1 to physicians, yet more and more law schools open every day (you can even earn your law degree over the internet). All this has done is increase the number of ambulance-chasers, torts, and malpractice rates. You see, as long as there is a pool of physicians performing ever-more complex procedures with an ever-sicker and ever-older population there is an ever larger pool of hosts (healthcare $) for the pathogen (lawyers) to live on.

Likewise, as long as our population becomes ever-sicker and ever-older, they can keep opening more and more CRNA mills. The key, as any good pathogen knows, is to NOT kill nor completely incapacitate your host.

MD anesthesiolgy's stupidity was that it took the infected patient and attempted to rehabilitate it without removing its virulence and capability to spread. By that I mean cleaning up CRNA programs, incorporating the programs into teaching hospitals, having attending physicians teach SRNAs, etc...

Now the infected patient is free to roam as a vector and advertise itself as a healthy individual meanwhile the pathogen spreads itself all over America. Of course, many individual view the infected patient with skepticism, and some areas are wise enough to quarantine the infected patient however, in many of those areas since the infected patients haven't shown any additional outward symptoms and are complaining about the injustice of being restricted and constantly point to the fact that many many years ago they were allowed to roam free, they are now indeed being allowed to roam free.

All I'm proposing is a viral load test. At least then we keep the infected patients who are definite transmitters quarantined.
 
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