shoving and pushing and such..

[epidural man]

---

Members don't see this ad.

My only goal ever on this forum was to start a post that made it to the second page, and this one was only one away.

Maybe I can respice this one up a bit....plus, I have got to say something. I would say it on the private forum but I don't know what my ASA number is. I paid the 25$ (resident's fee) and get the magazines that contain about 2 usefull articles in about 50 every month, but that's about it.....

So here it goes....will I get banned?

Here's what I think, and I would like an opinion on my conclusions.
(By the way, in my writing – MD=DO).
That video with the guy in front of a panel really got under my skin.
What has bothered me most in my medical career (and I guess you could say in life) is when people have a lack of humility and an understanding that the complexities of medicine are greater than us all. I have noticed that the more people are experienced and the more training they have, the more humble they are. I have seen anesthesiologist with oodles of talent and experience have no trouble asking others for help. I saw a pediatric cardiac anesthesiologist (subspecialty within a subspecialty) who was considered "the BOMB" not able to get an a-line on a kid and he had no problem quickly asking for someone to come help. The other person got the a-line fairly quickly – and this guy felt no ding to his ego at all. This is common among highly trained people and experienced people.

I was a General Medical Officer on a Navy ship. Part of my help in medical was with Idependent Duty Corspman. These guys have a high school degree and get a year or so of training so they can prescribe drugs and treat active duty sailors (got to love the Navy&#8230😉. They are very good at taking off ingrown toenails, treating rashes I'd never heard of, and other such things that I had no clue about. But they would not let me teach them a damn thing – because they "knew it all." One of my IDC's saw a guy with a crushed hand in the middle of the night and told him to come back 8 hrs latter in the AM for follow up with me. When we saw him, he of course had no feeling or motor strength because of the severe compartment syndrome he developed 8 hrs before. The IDC responsible, was he humbled? Absolutely not – and he still wouldn't let me teach him anything.

I say again, the more people are trained, the more humble they become – at least it seems to me to be the case. I work with many SRNA's and many are not teachable. On the flip side, the most competent and skillful CRNAs I know are also the ones who quickly say they don't want independence, and they are quick to call for help – yet they rarely need it. What bugs me about that guy saying that they don't need us – is this: I bet if you ask him what standard monitors he uses, he would corretly answer – "the ones that the MD's have defined for me." He, of course, would not say it like this, he would use the language "Standard ASA monitors…." My point is this – how can he say he wants independence when he is so dependant on the MD
anesthesiologist? If you don't agree with me, ask yourself this. "Who discovered what was causing post operative blindness? Who discovered the preoperative beta-blockers are helpful in a selective group of people? Who defined the CPP vs MAP curves?" You could ask thousands of similar questions. The answer is: not the nurses. The whole reason CRNAs can practice safe and do very well, is because of the rigourous science, studies, trials, and mishaps that MD's have done. It reminds me of those in this country who can safely get away without immunizing their kids. The reason is because I allow my kid to get immunization – along with all the risks known and unkown, and the unimmunized reap the huge benefit.

How can a CRNA really say they don't need us? (Asking for complete independence in my mind is saying you don't need us.) Also, once you find independence, are you going to continue with making anesthesia even safer by finding receptors that sevo work on? Are you going to discover new and safer paralytics and reversal agents? Are you going to answer questions about hypothermia and neurosurgical patients?

When I was in Puerto Rico for a few years, I could not believe that a small amount of people wanted PR to be their own nation. Let me remind you that 70% of Puerto Rican's are on welfare, and remember – they don't pay a bit of tax. Why in the world would someone want to get out of that deal? – yet a lot do. If the US said PR could be it's own country, the island would literally sink in the ocean in one day. Anyway, my point is that it was so unbelievable that Puerto Ricans wanted independence. I find a similar thing with CRNA's.

Now, I think I need to say that I really have no problem with CRNA's in a general sense. And as I have said before, I would do the same thing – I would fight to the death for my community, for more money, for more respect, etc. But in the same light, I need to do the same for my community currently.

Now here is my solution. I have always believed that cream (no matter how much you shake the bottle) will always rise to the top. Having said this – I think that if CRNA's want independence, we should give them absolutely 100% independence. They would need to understand that the two communities would be COMPLETELY separate. You would need to come up with your own guidelines for managing Obstructive Sleep Apnea perioperatively, or whatever. You can conduct your own studies and do your own discoveries and write your own journals.

I also believe in capitilism. I think hospitals should then advertise that your appendectomy surgery, or tetrology of Fallot would be cheaper because they have a CRNA doing the anesthesia. There would be full disclosure and MD hospitals would compete with CRNA hospitals. Capitilism would absolutely take care of the issue. Where are you going to take your dad who has CHF, diabetes, CAD, HTN, PVD, and ten other diseases that have three letter initials, and some unknown mitochondrial disorder discussed in this forum to get his hemipelvectomy because of a large invasive tumor that is wrapped around the iliac artery and vien?

The truth is, maybe it would be a hard pill for us medical doctors to swallow and perhaps the CRNA hospitals would do better (because outcomes would be the same and they do it cheaper.) If that were the case, we would bow our heads, say we were sorry, and look for another career – which we could easily find since we went to medical school.

 

[BLADEMDA]

Why should the largest study in the world be performed without approval by the public? Shouldn't the public (patients) know about this "study" comparing CRNA SOLO vs. MD/DO Board Certified Anesthesiologist outcomes with Anesthesia? Is such a study ethical? Would you enroll in this study?

The AANA says "Absolutely and Positively" this is a good idea. We have data from small states and tiny hospitals where CRNA's practice SOLO with good outcomes. Therefore, the ENTIRE USA is now fair game for the same "quality" care we provide in the SMALL TOWN USA.

As MERCK found out with VIOXX you can't extrapolate data. You can't assume SMALL TOWN USA is the SAME as BIG CITY USA. Major medical centers and ASA 3/4 patients are very different than the cases most SOLO CRNA's do every day ALONE. Like Merck the AANA won't accept that statement until patients die first.

We, as Physicians, must stand up against this unethical study in Anesthesia Providers. We can't let patients die to prove a point. It is our responsibilty to inform the public of the dangers in doing the world's largest study in comparing Nurse Anesthesia to Physician Anesthesiology. The AANA must be stopped and exposed before patients suffer the consequences.

Blade

 

[Gern Blansten]

“Who discovered what was causing post operative blindness?

urge, but he's not telling.🙂

 

[pd4emergence]

I think alot of our current problems with CRNA's and scope of practice fights are our own doing. The AANA wants to say that they can do everything we can do and just as well. They have so been successful in blurring the lines of CRNA's and MD's/DO to the lay public that most people do not know the difference between a residency trained board certified anesthesiologist and a CRNA. They say things like all of us are certified and only 60% of MD's/DO's are certified. They come up with studies done by CRNA's that compare their safety to ours. But unfortunately most of us just sit back and do nothing about it. Give to the ASA PAC, AMA PAC, and get involved with the ASA. Urge the ASA to be agressive about patient education re who is responsible for them in the OR. Finally, stop supervising and teaching CRNA's to do invasive procedures. They do not need to know how to do a CVL, PAC, or an epidural. I can and should be doing these procedures on all of my patients. This should be an ASA guideline. I feel that along with great patient care, continued research, and patient education we will win this fight. Given the choice, with all of the information, who would you pick as your anesthesia care provider.

 

[toughlife]

I think alot of our current problems with CRNA's and scope of practice fights are our own doing. The AANA wants to say that they can do everything we can do and just as well. They have so been successful in blurring the lines of CRNA's and MD's/DO to the lay public that most people do not know the difference between a residency trained board certified anesthesiologist and a CRNA. They say things like all of us are certified and only 60% of MD's/DO's are certified. They come up with studies done by CRNA's that compare their safety to ours. But unfortunately most of us just sit back and do nothing about it. Give to the ASA PAC, AMA PAC, and get involved with the ASA. Urge the ASA to be agressive about patient education re who is responsible for them in the OR. Finally, stop supervising and teaching CRNA's to do invasive procedures. They do not need to know how to do a CVL, PAC, or an epidural. I can and should be doing these procedures on all of my patients. This should be an ASA guideline. I feel that along with great patient care, continued research, and patient education we will win this fight. Given the choice, with all of the information, who would you pick as your anesthesia care provider.

Apathy kills.

Donating is the first step, contacting your reps is second, telling your colleagues about the problem is third.

Be aggressive, work harder, be knowledgeable and don't teach them anything. Give them hell.

 

[BLADEMDA]

Apathy kills.

Donating is the first step, contacting your reps is second, telling your colleagues about the problem is third.

Be aggressive, work harder, be knowledgeable and don't teach them anything. Give them hell.

So, you are saying SRNA's at Cleveland Clinic, Duke, Georgetown, Univ. of Miami, etc. aren't being taught anything by MD Attendings? I think not.
In fact, the odds are the better CRNA's (read this as the one's more likely to practice SOLO) attend and graduate the University Based Programs (or military ones).

Blade

 

[toughlife]

So, you are saying SRNA's at Cleveland Clinic, Duke, Georgetown, Univ. of Miami, etc. aren't being taught anything by MD Attendings? I think not.
In fact, the odds are the better CRNA's (read this as the one's more likely to practice SOLO) attend and graduate the University Based Programs (or military ones).

Blade

Obviously they're taught by attendings who, in my opinion, should not be doing it. My comment is directed to those senior residents who are already more knowledgeable than any SRNA and who may feel inclined to want to teach them.

I do not want to work in a practice that utilizes CRNAs (and I don't care if the paycheck is smaller) as I know I'd be miserable dealing with wannabes everyday. I want to be part of the solution and not contribute to perpetuate our current woes.

 

[pd4emergence]

I supervise just about everyday. Almost all of our CRNA's are very good and take good care of MY patients. I think the reality is that there are not enough MD/DO's to staff every OR. I think supervision in some places is unavoidable. More and more surgical cases are done every year and there is no way the current number of residency graduates can keep up. Our group does not allow them to do CVL, PAC, or epidurals. I am ashamed to say at my residency program they were allowed to do lines. There were some attendings that did not let them do them and I applaud those attendings. Our CRNA's in residency were not allowed anywhere near the OB floor. Unfortunately, it is in their their requirements to do a certian number CVL's and epidurals. We have SRNA's at the hospital where I currently work. Recently we were approached and asked if we would teach them lines and epidurals. Everyone in my group said no way. I wish there was this same attitude everywhere.

 

[johankriek]

I do not want to work in a practice that utilizes CRNAs (and I don't care if the paycheck is smaller) as I know I'd be miserable dealing with wannabes everyday. I want to be part of the solution and not contribute to perpetuate our current woes.

my sentiments exactly

 

[Noyac]

I supervise just about everyday. Almost all of our CRNA's are very good and take good care of MY patients. I think the reality is that there are not enough MD/DO's to staff every OR. I think supervision in some places is unavoidable. More and more surgical cases are done every year and there is no way the current number of residency graduates can keep up. Our group does not allow them to do CVL, PAC, or epidurals. I am ashamed to say at my residency program they were allowed to do lines. There were some attendings that did not let them do them and I applaud those attendings. Our CRNA's in residency were not allowed anywhere near the OB floor. Unfortunately, it is in their their requirements to do a certian number CVL's and epidurals. We have SRNA's at the hospital where I currently work. Recently we were approached and asked if we would teach them lines and epidurals. Everyone in my group said no way. I wish there was this same attitude everywhere.

This is a great way to do it.

My past group used crna's but we didn't allow them to do anything except GETA and PIV's. They didn't even do a-lines or spinals. This was a very effective way of practicing.

 

[rmh149]

This is a great way to do it.

My past group used crna's but we didn't allow them to do anything except GETA and PIV's. They didn't even do a-lines or spinals. This was a very effective way of practicing.

Thats too funny. At our hospital the anesthesia techs are able to do A-Lines and PIV's. Sounds like things are a little different in private practice.

Groups that limit CRNA's (A-lines, CVL, SG caths, epidurals,) generally get CRNA's that do not mind being limited...maybe lazy, maybe less committed to the practice (wanting off exactly at 3pm), or out of practice (and knowledge) in anything other than the technical side to general anesthesia....they may be the technicians....dependent on the anesthesiologist for everything. If thats what you want...then its not a bad thing. All I am saying is you get what you ask for. If it works for you group as you say...great. That is why I say there will always be the ACT model...because so many groups have created this type of CRNA...and they will always be happy in that environment.

 

[epidural man]

Why should the largest study in the world be performed without approval by the public? Shouldn't the public (patients) know about this "study" comparing CRNA SOLO vs. MD/DO Board Certified Anesthesiologist outcomes with Anesthesia? Is such a study ethical? Would you enroll in this study?

We, as Physicians, must stand up against this unethical study in Anesthesia Providers. We can't let patients die to prove a point. It is our responsibilty to inform the public of the dangers in doing the world's largest study in comparing Nurse Anesthesia to Physician Anesthesiology. The AANA must be stopped and exposed before patients suffer the consequences.

Blade

Blade, I was going to say, "don't you get it?", but I know you do get it because you are the one that tried to get me to "get it."

But I don't think you understood my point - or maybe I don't understand the point of what I am saying - but I am not asking for an experiment AT ALL.

If you kick your 16 y/o out of the house - are you experimenting to see how outcomes will be? No, not at all. You are finally making a decision based on how the 16 y/o is acting and decided that enough was enough. Does this mean that you don't love your kid, or that you wish things were different? Absolutely not, but sometimes kicking them out is the right thing to do.

This would not be, as you say, an unethical study. We, as consumers pick products all the time that hurt our health because we believe in freedom to choose our destiny. Capitalism - a wonderful concept in my mind - would take care of the problem. It isn't a "study" to see who is better. And I really think that CRNA's would be out of a job in a short time. As you have said, maybe some will get hurt - but it sounds like we are in a war, and in war - their are causualties. Your arguement - although sound in many ways - is hard for me to swallow. I know of people that will spend over $15000 to treat their dog's cancer, yet thousands of kids go unimmunized or hungry. (we have all seen those commercials that say...for only a dollar a day...). That $15000 and millions of other dollars that are spent could be considered unethical because in a sense, there are many that are hurt because that money was not used for them.

 

[BLADEMDA]

Blade, I was going to say, "don't you get it?", but I know you do get it because you are the one that tried to get me to "get it."

But I don't think you understood my point - or maybe I don't understand the point of what I am saying - but I am not asking for an experiment AT ALL.

If you kick your 16 y/o out of the house - are you experimenting to see how outcomes will be? No, not at all. You are finally making a decision based on how the 16 y/o is acting and decided that enough was enough. Does this mean that you don't love your kid, or that you wish things were different? Absolutely not, but sometimes kicking them out is the right thing to do.

This would not be, as you say, an unethical study. We, as consumers pick products all the time that hurt our health because we believe in freedom to choose our destiny. Capitalism - a wonderful concept in my mind - would take care of the problem. It isn't a "study" to see who is better. And I really think that CRNA's would be out of a job in a short time. As you have said, maybe some will get hurt - but it sounds like we are in a war, and in war - their are causualties. Your arguement - although sound in many ways - is hard for me to swallow. I know of people that will spend over $15000 to treat their dog's cancer, yet thousands of kids go unimmunized or hungry. (we have all seen those commercials that say...for only a dollar a day...). That $15000 and millions of other dollars that are spent could be considered unethical because in a sense, there are many that are hurt because that money was not used for them.

Allowing the AANA to gain 100% Independence for ALL its membership means there is considerable risk that patients will die as a consequence of that action. This is very different than kicking a teenage kid out of the house for a while. Some of the deaths will be covered up by the preexisting condition of the patient (ASA 4 with many medical problems). Other deaths will be more obvious and result in lawsuits.

The AANA propoganda machine wants to FOOL THE PUBLIC that its membership is equal to a Board Certified Anesthesiologist. Let the people decide and vote with their lives and the lives of their loved ones. But, first we must INFORM and EDUCATE the citizens of the USA.

Blade

 

[The_Sensei]

Groups that limit CRNA's (A-lines, CVL, SG caths, epidurals,) generally get CRNA's that do not mind being limited...maybe lazy, maybe less committed to the practice (wanting off exactly at 3pm), or out of practice (and knowledge)

Blatantly false. In my group, we a have a hard-working, stay till the work is done, dedicated, competent groups of CRNAs. They just don't do CVPs, epidurals, SG catheters or PNBs. We as a group feel very strongly that these are the realm of a PHYSICIAN not a NURSE. The CRNAs all agree.......

 

[rmh149]

Blatantly false. In my group, we a have a hard-working, stay till the work is done, dedicated, competent groups of CRNAs. They just don't do CVPs, epidurals, SG catheters or PNBs. We as a group feel very strongly that these are the realm of a PHYSICIAN not a NURSE. The CRNAs all agree.......

Its not a matter of true or false. It is an opinion. Obviously you and I have different ideas of what makes a good CRNA. No biggie.

Realm of a physician...or a way to keeping a CRNA in their place? Its all a game....I just dont want to play. Which is why CRNA's like myself would never work for a group that limits the CRNA for a stupid reasons (again, an opinion). Dont worry though. Their are plenty that will still work for you....and agree with you.

 

[pd4emergence]

Its not a matter of true or false. It is an opinion. Obviously you and I have different ideas of what makes a good CRNA. No biggie.

Realm of a physician...or a way to keeping a CRNA in their place? Its all a game....I just dont want to play. Which is why CRNA's like myself would never work for a group that limits the CRNA for a stupid reasons (again, an opinion). Dont worry though. Their are plenty that will still work for you....and agree with you.

I too work in a practice where we have excellent CRNA's. Many of which practiced indepently for a number of years. It all comes down to responsibility. I do not feel nurse's should be able to do invasive procedures period. How many chest tube's has the average CRNA placed? Are you able to deal with the complications that will arise (no matter how good you are). I just don't think so. Is it a way to keep nurses in their place? You bet. Nurses have no business performing invasive procedures. Similiarly, they have no business practicing medicine and neither does anybody but a licensed physician. Who do you go to for your medical care? You go to licensed physician who can take care of your problem. You don't go to an PT/OT, Optometrist, DNP, DNAP, or a CRNA. If people don't wake up that is what they will be relagated to. They will go to a technician who can only see their scope of the problem. Sure, keep fighting for your own piece of the pie and see where it gets you. It'll get you more responsibilty, about the same or less pay, and huge malpractice premiums. Good luck with that. Also, if you do screw up there will be a line out the door of people who have better credentials, done real research, and have written respected books who will nail your A** to the wall. It will end in higher malpractice premiums, less pay, more responsibility and in the end of the day you will long for somebody for you to ask what the plan is.

 

[CremeSickle]

Im laughing at the fact that somehow these monkey skills (CVPs, epidurals, SG catheters or PNBs) mean anything.

Where i am the CRNAs run the OB service, place CVPs, spinals and do blocks. Im glad because i cant be bothered (nor am i interested) in putting in a bazillion epidurals/spinals/lines/blocks in all day long with how busy it is. Stop kidding yourselves. "skills" are nothing more than a motorfunction, I could teach the janitor to place an epidural inside 30 minutes and have him aware of all the things to look for and when to call me in another 30.

There is where you need to focus. When things go wrong whoya gonna call? The DOCTOR.


In anycase, this thread needs to be closed since its in violation of the new rules.


PS toughlife. Its illegal for anesthesiologists, the ASA or a hospital to do anything which impedes the teaching/education or hiring of CRNAs. Its an antitrust decision that happens YEARS ago. If you choose a job in a facility where SRNAs are taught and consistently refuse to be apart of the education or treat them with anything less than the respect they deserve as students trying to better themselves you may well find yourself out of a job.

 

[toughlife]

Im laughing at the fact that somehow these monkey skills (CVPs, epidurals, SG catheters or PNBs) mean anything.

Where i am the CRNAs run the OB service, place CVPs, spinals and do blocks. Im glad because i cant be bothered (nor am i interested) in putting in a bazillion epidurals/spinals/lines/blocks in all day long with how busy it is. Stop kidding yourselves. "skills" are nothing more than a motorfunction, I could teach the janitor to place an epidural inside 30 minutes and have him aware of all the things to look for and when to call me in another 30.

There is where you need to focus. When things go wrong whoya gonna call? The DOCTOR.


In anycase, this thread needs to be closed since its in violation of the new rules.


PS toughlife. Its illegal for anesthesiologists, the ASA or a hospital to do anything which impedes the teaching/education or hiring of CRNAs. Its an antitrust decision that happens YEARS ago. If you choose a job in a facility where SRNAs are taught and consistently refuse to be apart of the education or treat them with anything less than the respect they deserve as students trying to better themselves you may well find yourself out of a job.

I think you are looking for www.allnurses.com and www.aana.com

 

[johankriek]

Thats too funny. At our hospital the anesthesia techs are able to do A-Lines and PIV's. Sounds like things are a little different in private practice.

tell me which hospital.. lets anesthesia techs do a lines or Ivs for that matter..

 

[epidural man]

We, as Physicians, must stand up against this unethical study in Anesthesia Providers. We can't let patients die to prove a point.

Blade

I wanted to say something else about this.

Chiropractors are sometimes very dangerous and can cause serious morbidity. I think everyone knows (the patient knows) what the difference is between a chiropractor, a DO, or even a physical therapist. The patient mostly know the level of understanding and education of the provider, yet the patient often willingly will choose the less trained who doesn't believe in the scientific method - for whatever reason.

The same can be said about many "providers", faith healers, naturalists, accupuncturists, or whatever. Some of these are dangerous - but the system has somewhat of a check and balance on it. Maybe it isn't perfect but it kind of works. Birthing centers are common that have no MD support, as are home births. Patients understand the risk, and so far midwifes (trained and untrained) have not run OB docs out of town.

Why couldn't it work the same way with different hospitals that have different models?

 

[rmh149]

tell me which hospital.. lets anesthesia techs do a lines or Ivs for that matter..

I know...its odd. It just goes to show that things are different everywhere you go. The techs are trained and certified to do them here...I personally do my own a-lines.

 

[rmh149]

I too work in a practice where we have excellent CRNA's. Many of which practiced indepently for a number of years. It all comes down to responsibility. I do not feel nurse's should be able to do invasive procedures period. How many chest tube's has the average CRNA placed? Are you able to deal with the complications that will arise (no matter how good you are). I just don't think so. Is it a way to keep nurses in their place? You bet. Nurses have no business performing invasive procedures. Similiarly, they have no business practicing medicine and neither does anybody but a licensed physician. Who do you go to for your medical care? You go to licensed physician who can take care of your problem. You don't go to an PT/OT, Optometrist, DNP, DNAP, or a CRNA. If people don't wake up that is what they will be relagated to. They will go to a technician who can only see their scope of the problem. Sure, keep fighting for your own piece of the pie and see where it gets you. It'll get you more responsibilty, about the same or less pay, and huge malpractice premiums. Good luck with that. Also, if you do screw up there will be a line out the door of people who have better credentials, done real research, and have written respected books who will nail your A** to the wall. It will end in higher malpractice premiums, less pay, more responsibility and in the end of the day you will long for somebody for you to ask what the plan is.

Ok, I will be sure to call you when I have a problem.

 

[CremeSickle]

Originally Posted by BLADEMDA

We, as Physicians, must stand up against this unethical study in Anesthesia Providers. We can't let patients die to prove a point.

Blade

Blade. While i do understand and respect your drive and motivation to do something, lying does not become you. It is not appropriate for us to point the finger at other healthcare providers (regardless of who they are) and say they "let pts die" without proof. In this case, there isnt any proof and yet, there you say it as if its established fact. Its tantamount to slander/libel.

 

[CremeSickle]

As ive come to expect, you have nothing of any substance in your replies. All you do is beat your own drum and ignore the facts and reality of the situation. When you have no intelligent reply, like a teenager you resort to insults. Love the professionalism and maturity you display here on a daily basis.

I think you are looking for www.allnurses.com and www.aana.com

 

[johankriek]

I know...its odd. It just goes to show that things are different everywhere you go. The techs are trained and certified to do them here...I personally do my own a-lines.

yeah ok pull the other leg, it plays jingle bells. What is the housekeeper certified to do, do a whipple?

 

[toughlife]

As ive come to expect, you have nothing of any substance in your replies. All you do is beat your own drum and ignore the facts and reality of the situation. When you have no intelligent reply, like a teenager you resort to insults. Love the professionalism and maturity you display here on a daily basis.

Ditto. Look people will respect you more if you just admit who you are.

 

[BLADEMDA]

Blade. While i do understand and respect your drive and motivation to do something, lying does not become you. It is not appropriate for us to point the finger at other healthcare providers (regardless of who they are) and say they "let pts die" without proof. In this case, there isnt any proof and yet, there you say it as if its established fact. Its tantamount to slander/libel.

You, like the AANA, have taken my sentences out of context. You have chosen to ignore the meaning behind my post: The outcome of letting every CRNA practice SOLO across the USA is unknown. While data exists in small town USA little or none exists for SOLO CRNA practice in major medical centers.

Thus, this large clinical study MAY cost patients their lives. MidLevel Providers are not qualified to practice Medicine SOLO in our major medical centers.

Blade

 

[CremeSickle]

Ditto. Look people will respect you more if you just admit who you are.

uh huh.

Im not the one who constantly berates another profession or threatens them. Or who slanders other physicians when they dont agree with his ignorant rants and immature posturing.

Grow up.

 

[rmh149]

You, like the AANA, have taken my sentences out of context. You have chosen to ignore the meaning behind my post: The outcome of letting every CRNA practice SOLO across the USA is unknown. While data exists in small town USA little or none exists for SOLO CRNA practice in major medical centers.

Thus, this large clinical study MAY cost patients their lives. MidLevel Providers are not qualified to practice Medicine SOLO in our major medical centers.

Blade

Look in Texas. No supervision required in Texas....many CRNA's fly solo. But, I dont think you will find the results you are looking for as far as more patients dieing under the hands of a solo CRNA because there wasnt a doctor to help.

 

[toughlife]

uh huh.

Im not the one who constantly berates another profession or threatens them. Or who slanders other physicians when they dont agree with his ignorant rants and immature posturing.

Grow up.

And how are we to take the comments of your beloved leadership?

 

[CremeSickle]

Sorry blade

I did that that out of context from the post above where they quoted it.

Your right there, its a crapshoot as to what would happen if all midlevels (PA,NP, CRNA) were to practice independently. Oh, hold it now they mostly DO practice independently. Lets review, shall we?

PAs: Only have to have physicians review their charts every 6 months to meet the supervision requirement, thats WELL after the case is done and delt with. (no mortality increase documented)

NP: See PAs. Additionally, they can bill and practice without any physician supervision in many states but they seem to only be able to bill at a lower rate? (no mortality increase documented and many studies published to show the opposite)

CRNAs: Can work indy and bill indy yet well over 90% of them do not and thats because well over 90% of them work in big hospitals where all the jobs are. Either as employees of the hospital or us.(No mortality increase documented and studies to show the opposite)

If there was a significant mortality risk with these providers why isn't it documented by now with how long all 3 have been working?

I doubt big hospitals will ever have solo CRNA practice. BUT, you cant argue that its OK to do it in little town America and then say its NOT ok to do it in big cities. Either its OK or it isnt. Many people talk about larger cases and ASA scores being an issue, but lets call a spade a spade. ASA score RARELY matters in practice. In fact, all the worst things that happen do so with ANY patient. Last i checked the closed claims it was hypoxia due to lack of ventilation that was killing patients not lack of knowledge due to huge case.

But I do agree, there is no need for solo CRNA practice in large hospitals.

You, like the AANA, have taken my sentences out of context. You have chosen to ignore the meaning behind my post: The outcome of letting every CRNA practice SOLO across the USA is unknown. While data exists in small town USA little or none exists for SOLO CRNA practice in major medical centers.

Thus, this large clinical study MAY cost patients their lives. MidLevel Providers are not qualified to practice Medicine SOLO in our major medical centers.

Blade

 

[CremeSickle]

Buddy

Your insulting ME. Not to mention talking about berating and disrespecting a whole group of people (SRNAs) because of what someone else says? Thats just unprofessional and immature.

you have alot to learn about how the world works. Im glad i came to medicine later in life, im past being a 'know it all' about things i have no experience with.

And how are we to take the comments of your beloved leadership?

 

[toughlife]

Buddy

Your insulting ME. Not to mention talking about berating and disrespecting a whole group of people (SRNAs) because of what someone else says? Thats just unprofessional and immature.

you have alot to learn about how the world works. Im glad i came to medicine later in life, im past being a 'know it all' about things i have no experience with.

I don't consider myself a know-it-all but I do read enough to stay abreast of the issues at hand.

What you need to realize is that you are preaching to a group of people who do not agree with your view of CRNAs. Yet you continue to flap your yap about how great they are.

Let me break it down for you. This is the student-DOCTOR forum and no one cares how great you think they are. You will always find antagonism in folks like myself who believe that anesthesiology is the practice of medicine and should not be bastardized by a group of midlevels who think otherwise.

When and only when your CRNAs go through the proper educational pathway and pay their dues, will you find full recognition in the eyes of many, myself included. In the meantime, their existence will only be seen as an attempt by your beloved AANA to deceive the public as to their true credentials and training.

In the meantime, as long as your expect to use this forum to further your AANA propaganda, you can expect a lot more antagonism.

 

[stanleykristian]

Look a lot of unpleasantness going around here. I have to wonder, what happens at these rural hospitals? A CRNA is often the only anesthesia provider at hands. So no spinal anesthesia in a rural hospital? No Blocks, no epidurals?
I realize there are groups who prohibit CRNA's from these basic tasks routinely, but I at a rural hospital must perform them routinely, or do you think that only patients in large urban settings deserve anything except GA. The hospital I am working in is looking for an MDA, but surprise no one wants to take call every other day and work. Not when there are so many jobs "supervising".
In the operating room we all perform the same task using the same information. I certainly did not develop the ASA scoring system but neither did toughlife or blade or any one us. Does that mean we cannot use it.
Most of our lives all of us are technicians, rarely if ever do we do anything truly original, and if you think that is not so just look at what you do every day. You apply established procedures to a particular case, just like me or I do just like you.
There will always be a need for doctors in anesthesia as far as I can see. It is due to a great deal of research and effort that anesthesia is as safe as it is and for the foreseeable future it will be doctors who do the research. But the application of this knowledge can be performed by anybody with the right training and motivation.
It all comes down to money and power, who has it and who wants it. I want to take care of my patients give them the best anesthetic possible and keep them from pain. I will accept knowledge on how to so from any person who will teach it.
And yes anesthesia performed by CRNA's independently is safe for in small town America the vast majority who go under the knife have good outcomes even if cared for by a mere nurse.

 

[The_Sensei]

Dont worry though. Their are plenty that will still work for you....and agree with you.

Thank God, because you are one of those overly confident nurses who think they can do everything a physician does. I pray that when you get in over your head (which you will) that the patient is some ASA 5 gomer who is about to die anyway. 😡

 

[VolatileAgent]

The whole reason CRNAs can practice safe and do very well, is because of the rigourous science, studies, trials, and mishaps that MD’s have done.

yes, it's true: we are a victim of our own successes. it's easy - for all of us - to stand on the shoulders of giants....

 

[The_Sensei]

If you choose a job in a facility where SRNAs are taught and consistently refuse to be apart of the education or treat them with anything less than the respect they deserve as students trying to better themselves you may well find yourself out of a job.

Well then, I guess my ENTIRE group should start looking for a job. We were blindsided by the inclusion of an SRNA training program at my institution. Trust me, the only learning they get is via passive observation and osmosis. They certainly DO NOT deserve my respect in the least.

 

[VolatileAgent]

If you choose a job in a facility where SRNAs are taught and consistently refuse to be apart of the education or treat them with anything less than the respect they deserve as students trying to better themselves you may well find yourself out of a job.

not true.

our training is very different - and very separate. despite the fact that we have many CRNAs and SRNAs, the only time i interact with them is in the break room... and the rare occassion where they get me out of a case.

i certainly don't "consistently refuse to be a part of their education" because i'm not involved in their education.

 

[toughlife]

Look a lot of unpleasantness going around here. I have to wonder, what happens at these rural hospitals? A CRNA is often the only anesthesia provider at hands. So no spinal anesthesia in a rural hospital? No Blocks, no epidurals?
I realize there are groups who prohibit CRNA's from these basic tasks routinely, but I at a rural hospital must perform them routinely, or do you think that only patients in large urban settings deserve anything except GA. The hospital I am working in is looking for an MDA, but surprise no one wants to take call every other day and work. Not when there are so many jobs "supervising".
In the operating room we all perform the same task using the same information. I certainly did not develop the ASA scoring system but neither did toughlife or blade or any one us. Does that mean we cannot use it.
Most of our lives all of us are technicians, rarely if ever do we do anything truly original, and if you think that is not so just look at what you do every day. You apply established procedures to a particular case, just like me or I do just like you.
There will always be a need for doctors in anesthesia as far as I can see. It is due to a great deal of research and effort that anesthesia is as safe as it is and for the foreseeable future it will be doctors who do the research. But the application of this knowledge can be performed by anybody with the right training and motivation.
It all comes down to money and power, who has it and who wants it. I want to take care of my patients give them the best anesthetic possible and keep them from pain. I will accept knowledge on how to so from any person who will teach it.
And yes anesthesia performed by CRNA's independently is safe for in small town America the vast majority who go under the knife have good outcomes even if cared for by a mere nurse.

OK, let's see if you put your money where your mouth is.

Here's the link from the ASA website where you can easily send an email to congress asking them to change the rural pass-through rule so that anesthesiologists who want to work in rural areas are allowed to receive medicare part A funds and receive fair compensation on par with midlevels.

http://www.asahq.org/news/news041907.htm

When you are done sending the email, post the reply here so we can all see it.

 

[CremeSickle]

What you need to realize is that you are preaching to a group of people who do not agree with your view of CRNAs. Yet you continue to flap your yap about how great they are.

Ahh, but thats not true. The majority of anesthesiologists see CRNAs the way I do. Many are on this very board.

 

[toughlife]

Ahh, but thats not true. The majority of anesthesiologists see CRNAs the way I do. Many are on this very board.

So are you going to admit you are a CRNA?

 

[pd4emergence]

Im laughing at the fact that somehow these monkey skills (CVPs, epidurals, SG catheters or PNBs) mean anything.

Where i am the CRNAs run the OB service, place CVPs, spinals and do blocks. Im glad because i cant be bothered (nor am i interested) in putting in a bazillion epidurals/spinals/lines/blocks in all day long with how busy it is. Stop kidding yourselves. "skills" are nothing more than a motorfunction, I could teach the janitor to place an epidural inside 30 minutes and have him aware of all the things to look for and when to call me in another 30.

There is where you need to focus. When things go wrong whoya gonna call? The DOCTOR.


In anycase, this thread needs to be closed since its in violation of the new rules.


PS toughlife. Its illegal for anesthesiologists, the ASA or a hospital to do anything which impedes the teaching/education or hiring of CRNAs. Its an antitrust decision that happens YEARS ago. If you choose a job in a facility where SRNAs are taught and consistently refuse to be apart of the education or treat them with anything less than the respect they deserve as students trying to better themselves you may well find yourself out of a job.

I tried to keep quiet but just can't. I teach SRNA's often. I enjoy it. I do my best to help teach them to be good CRNA's. I respect the fact that they need to learn and that there is enough work to go around. I draw my line at invasive procedures. Some of our CRNA's probably could put a line in with their eyes closed. But some have not done many at all. For this reason, I trust my own hands when it comes to procedures that can cause potential harm. Now you may say "do you intubate all your patients" and the answer is no. I have confidence that this can be done and done well by all of our CRNA's. Recently we were asked as a group to help our SRNA's meet thier requirements for CVL's and epidurals (5 of each). Now if your wife, sister, husband, son, daughter, brother needed one of these procedures done would you trust it to someone who has only done 5. I had a night in residency when I did 18 central lines. It was awful but after that night and many more like it I was ok at lines. As for legality of my approach, the short answer is I just don't give a ****

 

[CremeSickle]

So are you going to admit you are a CRNA?

No. Are you going to admit your childish?

 

[CremeSickle]

Thank you pd4.

I tried to keep quiet but just can't. I teach SRNA's often. I enjoy it. I do my best to help teach them to be good CRNA's. I respect the fact that they need to learn and that there is enough work to go around. I draw my line at invasive procedures. Some of our CRNA's probably could put a line in with their eyes closed. But some have not done many at all. For this reason, I trust my own hands when it comes to procedures that can cause potential harm. Now you may say "do you intubate all your patients" and the answer is no. I have confidence that this can be done and done well by all of our CRNA's. Recently we were asked as a group to help our SRNA's meet thier requirements for CVL's and epidurals (5 of each). Now if your wife, sister, husband, son, daughter, brother needed one of these procedures done would you trust it to someone who has only done 5. I had a night in residency when I did 18 central lines. It was awful but after that night and many more like it I was ok at lines. As for legality of my approach, the short answer is I just don't give a ****

 

[stanleykristian]

I simply stated in my post that I can and do perform these procdures safley and frequently and that I will accept knowldge from anyone that can provide it.
No where did I state that I feel the need to suppoet the further subsidy of anesthesia. Put your money where your mouth is take the big pay cut and work in a rural hospital.

 

[rmh149]

Thank God, because you are one of those overly confident nurses who think they can do everything a physician does. I pray that when you get in over your head (which you will) that the patient is some ASA 5 gomer who is about to die anyway. 😡

right, um....OK 🙄

 

[BLADEMDA]

Sorry blade

I did that that out of context from the post above where they quoted it.

Your right there, its a crapshoot as to what would happen if all midlevels (PA,NP, CRNA) were to practice independently. Oh, hold it now they mostly DO practice independently. Lets review, shall we?

PAs: Only have to have physicians review their charts every 6 months to meet the supervision requirement, thats WELL after the case is done and delt with. (no mortality increase documented)

NP: See PAs. Additionally, they can bill and practice without any physician supervision in many states but they seem to only be able to bill at a lower rate? (no mortality increase documented and many studies published to show the opposite)

CRNAs: Can work indy and bill indy yet well over 90% of them do not and thats because well over 90% of them work in big hospitals where all the jobs are. Either as employees of the hospital or us.(No mortality increase documented and studies to show the opposite)

If there was a significant mortality risk with these providers why isn't it documented by now with how long all 3 have been working?

I doubt big hospitals will ever have solo CRNA practice. BUT, you cant argue that its OK to do it in little town America and then say its NOT ok to do it in big cities. Either its OK or it isnt. Many people talk about larger cases and ASA scores being an issue, but lets call a spade a spade. ASA score RARELY matters in practice. In fact, all the worst things that happen do so with ANY patient. Last i checked the closed claims it was hypoxia due to lack of ventilation that was killing patients not lack of knowledge due to huge case.

But I do agree, there is no need for solo CRNA practice in large hospitals.

While your concluding statement is correct the reasoning process is flawed.

1. CRNA vs. MD/DO- We do have a two level system in the USA. The rural hospitals and the less desirable locations get CRNA only. The better "gigs" get MD/DO or ACT model. Those 14 states that "opted-out' represent a small percentage of the USA's total population. This statement is FACT and not opinion. We can argue over the causes for the two levels of care and whether it should be permitted (you say yes and I say NO) but it is reality.

2. CRNA does not equal MD/DO Anesthesiology. This doesn't mean they are not "safe" or that patients are guaranteed to die as a result of CRNA only care. But, CRNA's don't have the formal education or formal training of the MD/DO Board Certified Anesthesiologist. I am not debating skills or street smarts here just FORMAL education and training. Thus, MD/DO is FIRST TIER and CRNA is SECOND TIER in terms of these parameters.

3. The public is generally unaware of points one and two. In fact, most don't know the difference between Anesthetist and Anesthesiologist. But, John Q. Public does know the difference between NURSE vs. Doctor. This is the key element that must be hammered home in any public education campaign.

4. The AANA is part of the problem and not part of the solution. The ASA has continually tried to reach out to the AANA in peace and seek an amicable solution to our differences. Instead, the AANA like most militant Groups use deceit and treachery to further its own agenda for 100% Independence.
While the ASA is talking peace the AANA is busy taking care of business (see Zwerling's video for proof).

Blade

 

[core0]

Sorry blade

I did that that out of context from the post above where they quoted it.

Your right there, its a crapshoot as to what would happen if all midlevels (PA,NP, CRNA) were to practice independently. Oh, hold it now they mostly DO practice independently. Lets review, shall we?

PAs: Only have to have physicians review their charts every 6 months to meet the supervision requirement, thats WELL after the case is done and delt with. (no mortality increase documented)

This varies state by state. A SP can always dictate more stringent requirements. In most hospitals the orders have to be reviewed within 48 hours. There are very few states where the charts are reviewed every six months. There are no studies that look at mortality in relation to physicians.

NP: See PAs. Additionally, they can bill and practice without any physician supervision in many states but they seem to only be able to bill at a lower rate? (no mortality increase documented and many studies published to show the opposite)

The lower rate is from medicare supposedly because of lower education and practice costs. There are no well done studies that show better or worse outcomes to practicing physicians.

CRNAs: Can work indy and bill indy yet well over 90% of them do not and thats because well over 90% of them work in big hospitals where all the jobs are. Either as employees of the hospital or us.(No mortality increase documented and studies to show the opposite)

Not my area of expertise, but I have yet to see a properly powered study. The N is huge here because the mortality risk is low. Also is mortality the best measure here?

If there was a significant mortality risk with these providers why isn't it documented by now with how long all 3 have been working?

I doubt big hospitals will ever have solo CRNA practice. BUT, you cant argue that its OK to do it in little town America and then say its NOT ok to do it in big cities. Either its OK or it isnt. Many people talk about larger cases and ASA scores being an issue, but lets call a spade a spade. ASA score RARELY matters in practice. In fact, all the worst things that happen do so with ANY patient. Last i checked the closed claims it was hypoxia due to lack of ventilation that was killing patients not lack of knowledge due to huge case.

But I do agree, there is no need for solo CRNA practice in large hospitals.

For NPs and PAs there will probably never be a study showing a difference because the vast majority of NPs and almost all PAs work for physician practices. CRNAs are the only group where there is a significant presence outside of physician practices. This is the only group where you might be able to show a difference.

David Carpenter, PA-C

 

[VolatileAgent]

While your concluding statement is correct the reasoning process is flawed.

1. CRNA vs. MD/DO- We do have a two level system in the USA. The rural hospitals and the less desirable locations get CRNA only. The better "gigs" get MD/DO or ACT model. Those 14 states that "opted-out' represent a small percentage of the USA's total population. This statement is FACT and not opinion. We can argue over the causes for the two levels of care and whether it should be permitted (you say yes and I say NO) but it is reality.

2. CRNA does not equal MD/DO Anesthesiology. This doesn't mean they are not "safe" or that patients are guaranteed to die as a result of CRNA only care. But, CRNA's don't have the formal education or formal training of the MD/DO Board Certified Anesthesiologist. I am not debating skills or street smarts here just FORMAL education and training. Thus, MD/DO is FIRST TIER and CRNA is SECOND TIER in terms of these parameters.

3. The public is generally unaware of points one and two. In fact, most don't know the difference between Anesthetist and Anesthesiologist. But, John Q. Public does know the difference between NURSE vs. Doctor. This is the key element that must be hammered home in any public education campaign.

4. The AANA is part of the problem and not part of the solution. The ASA has continually tried to reach out to the AANA in peace and seek an amicable solution to our differences. Instead, the AANA like most militant Groups use deceit and treachery to further its own agenda for 100% Independence.
While the ASA is talking peace the AANA is busy taking care of business (see Zwerling's video for proof).

Blade

this is the first Blade post i 100% agree with. it's clear you've been paying attention to my posts. 😉

 

[fakin' the funk]

this is the first Blade post i 100% agree with. it's clear you've been paying attention to my posts. 😉

I second that.

For any students (like myself) who ever doubted that MD/DO care is different than CRNA care, just take a listen to the conversation behind the curtain (attending-resident, attending-attending vs. CRNA-CRNA) next time you're scrubbed in for surgery and judge for yourself.