So, I finally got to shadow an anesthesiologist, and I must say...

[johankriek]

YOU are a freaking resident.

YOU dont' cancell cases......YOU don't approve cases....YOU do what your attending tells you to do.

UNLESS of course your residency program is one of those where attendings drink coffee and residents run amuck....

Laugh away.........keep laughing....laugh all you want, but when the sun sets, you are STILL JUST A RESIDENT....doing anesthesia (not practice medicine) on someone elses credit card.

dude give it a rest military.. go find a hobby.... you are always in the middle of some controversy on this board..

as for conflicted... he is nitecap 100 percent... call baylor college of medicine and talk to them about this dude...

---

Members don't see this ad.

 

[johankriek]

YOU are a freaking resident.

YOU dont' cancell cases......YOU don't approve cases....YOU do what your attending tells you to do.

UNLESS of course your residency program is one of those where attendings drink coffee and residents run amuck....

Laugh away.........keep laughing....laugh all you want, but when the sun sets, you are STILL JUST A RESIDENT....doing anesthesia (not practice medicine) on someone elses credit card.

dude give it a rest military.. go find a hobby.... you are always in the middle of some controversy on this board..

as for conflicted... he is nitecap 100 percent... call baylor college of medicine and talk to them about this dude...

 

[Noyac]

we need to do MORE!!!!

Look at bottom table and tell me all of you are doing your best to contribute? This is a shame. Stop thinking someone else will do it for you, and send your contribution.

http://www.asahq.org/Newsletters/2006/12-06/becker12_06.html

I'm sorry Tough, but can you remind me what the ASA has done for us? Reimbursement continues to fall. The relationship with the AMA is **** and we can not count on them to help us in any way. crna's continue to gain ground. Blah blah blah. I'm not badgering you personally, just making a point. Maybe I'm wrong. Maybe they have doe lots for us. But these are big issues to me and my partners and we are getting noting from them. I think STSW's plan to bring the man in front of the members is great. I hope I can attend. I can't wait to hear the excuses. I sick and tired of the requests for money and the empty promises.

 

[Conflicted]

JK

You are just upset cause i have already proven you wrong about an ASC owned by a CRNA where the anesthesia is soley done by a CRNA. BTW, one would have to be in school to be at baylor, nitecap is still in school, i am not.

Moreover, the suggestion that you submarine someones career b/c of a forum board is not only dispicable but unprofessional and pathetic. What does that say about you and your character? Maybe its YOU who needs a hobby.

 

[Noyac]

Oh, I have worked with many many crna's of which most were very very good at their job. I have never seen one float a swan much less start a central line. TEE? Out of the question. The only regional I've seen them do is a Beir Block.

To reaffirm my position here. I am pro-crna but anti militant crna. I realize how fun this badgering must be for you conflicted but in actuality you are not doing yourself or your profession any good. Just imagine how many young (read future hiring anesthesiologists) you are influencing. I know there are jobs for crna's without anesthesiologist supervision. But those jobs aren't available to you unless you want to go to the rural setting. If so be my guest. And you will see why we aren't there. Can you say qualtiy of care?

 

[VolatileAgent]

If you are at a training program where one of the very few decisions are handed over to inexperienced trainees.......

who's "inexperienced" and what decision is "handed over"? i already told you that i've never cancelled a case. didn't you get that the first time? or, are you just trying to engage me in a rhetorical battle? pay attention, mil. i already said (but you have a hard time listening and getting things to sink in amidst all that mouthing off) that decisions should always be made in collaboration with the surgical team, and i have definitely been involved in the decision tree when a case has been cancelled... by the surgical team. i guess you just haven't yet learned the fine art of how to "help" them make such decisions.

 

[militarymd]

who's "inexperienced" and what decision is "handed over"? i already told you that i've never cancelled a case. didn't you get that the first time? or, are you just trying to engage me in a rhetorical battle? pay attention, mil. i already said (but you have a hard time listening and getting things to sink in amidst all that mouthing off) that decisions should always be made in collaboration with the surgical team, and i have definitely been involved in the decision tree when a case has been cancelled... by the surgical team. i guess you just haven't yet learned the fine art of how to "help" them make such decisions.

I guess you don't read too good....

Resident = inexperience

That's why YOU are a resident....that's why someone else HAS to sign your chart.

Hell....CRNA's don' need someone else to sign their charts.

I'll tell you again...you have NO authority to DO anything without an attending signing off on something.

 

[TheMightyAngus]

Do the non-MD anesthesia providers also have continuing education requirements or fellowship-like equivalents?

Who are teaching CNRAs to float swans and interpret TEE? Sounds like these are major liability issues to me.

 

[The_Sensei]

Who are teaching CNRAs to float swans and interpret TEE? Sounds like these are major liability issues to me.

Urban legend

 

[Conflicted]

I have never heard of a CRNA reading a TEE. CRNA do float swans and central lines. It is taught in CRNA school by CRNAs.

Yes CRNAs have CE requirements to renew their license.

Noy: i understand what your saying. I also understand this forum is designed for new physicians. However, i am simply telling the truth, nothing more and nothing less. From my perspective people like VA are putting out a militant-MDA message. You will notice the vast majority of my posts have been to reply to militant propaganda specific people spout. I am not, nor would i ever be, a militant anesthetist. My anesthesiologist friends reading this right now are laughing at the suggestion and the whole thread.

In anycase, I will try not to reply to those individuals anymore by placing them on ignore. Maybe you should (as a moderator) consider reading some of the posts VA has made and consider a warning for him. If not for his attacks on me and an entire profession, then for his attacks on attendings with experience (who are in short supply here).

I am not concerned about my employers or future employers. They will judge me solely on my skill and how I get along with the group.

Do the non-MD anesthesia providers also have continuing education requirements or fellowship-like equivalents?

Who are teaching CNRAs to float swans and interpret TEE? Sounds like these are major liability issues to me.

 

[Noyac]

Noy: i understand what your saying. I also understand this forum is designed for new physicians. However, i am simply telling the truth, nothing more and nothing less. From my perspective people like VA are putting out a militant-MDA message. You will notice the vast majority of my posts have been to reply to militant propaganda specific people spout. I am not, nor would i ever be, a militant anesthetist. My anesthesiologist friends reading this right now are laughing at the suggestion and the whole thread.

In anycase, I will try not to reply to those individuals anymore by placing them on ignore. Maybe you should (as a moderator) consider reading some of the posts VA has made and consider a warning for him. If not for his attacks on me and an entire profession, then for his attacks on attendings with experience (who are in short supply here).

I appreciate your cooperation here. The ignore button is a great tool.

I have read VA's posts and while I don't agree with everything he says, he is a physician and that is what this forum is for. I have stated that I will not get involved in arguments b/w members as long as they are not threatening. I think most here appreciate this.

Why don't your anesthesiologist friends join in then? This is a formal invitation.

 

[SleepIsGood]

I appreciate your cooperation here. The ignore button is a great tool.

I have read VA's posts and while I don't agree with everything he says, he is a physician and that is what this forum is for. I have stated that I will not get involved in arguments b/w members as long as they are not threatening. I think most here appreciate this.

Why don't your anesthesiologist friends join in then? This is a formal invitation.

Noyac...I am so glad that you stated what you just did. I think a lot of the mods on SDN do not realize thta this is a physician forum and physicians shouldnt be randomly kicked out or banned when CRNAs start quarrels. Kudos to you

 

[toughlife]

I'm sorry Tough, but can you remind me what the ASA has done for us? Reimbursement continues to fall. The relationship with the AMA is **** and we can not count on them to help us in any way. crna's continue to gain ground. Blah blah blah. I'm not badgering you personally, just making a point. Maybe I'm wrong. Maybe they have doe lots for us. But these are big issues to me and my partners and we are getting noting from them. I think STSW's plan to bring the man in front of the members is great. I hope I can attend. I can't wait to hear the excuses. I sick and tired of the requests for money and the empty promises.

Well this year they introduced many bills in congress to address the issues that have been mentioned here over and over such as the teaching anesthesiologist reimbursement rule, lobbied congress to change the unfair medicare rule and change the medicare part A rules. As you know, the AANA was also strongly lobbying against them as well, but they are actively trying to change things.

The CRNAs continue to gain ground because the residency program chairmen continue to train them and private practice docs keep hiring them.
The medicare payments that depend on SGR were averted but not those proposed by CMS so instead of a 13.9% cut in reimbursement, only an 8.9% will go into effect which (as the ASA article states) is more like 7% given the reimbursements for procedures like line placement and pain treatments were not affected as much and will partly offset some of the cuts. What really took the big hit is actually providing the anesthetic itself.


As far as Manuel Bonilla goes, I don't know what he has done but if he ain't doing crap, they need to fire him and get the best damn lobbyists money can buy. I always wondered why we don't have an attorney as a lobbyist.

So in short, the point is not to take on that pessimistic attitude that everyone here seems to have and forget about trying (or at least pretending) to want to change things. At least pretend that you give a **** and send your contribution. For someone like you who makes a lot of $$ how much would sending $100 bucks hurt your pocket anyways?

 

[johankriek]

JK

You are just upset cause i have already proven you wrong about an ASC owned by a CRNA where the anesthesia is soley done by a CRNA. BTW, one would have to be in school to be at baylor, nitecap is still in school, i am not.

Moreover, the suggestion that you submarine someones career b/c of a forum board is not only dispicable but unprofessional and pathetic. What does that say about you and your character? Maybe its YOU who needs a hobby.

Ok nitecap.. if you are not nitecap why do you have the same agenda and have very similar comebacks and writing styles... umm why dont you go debate your fellow crnas.. whycome in here? go to nursesarebetterthandocs.com im sure you will find people with simiar interests...

 

[Noyac]

I have been sending these blowhards my $$$ for 5 years now and as far as I can tell I have not received one thing from them. This year I decided to not send them anything and I will continue to not send them anything until they show that they deserve it. As soon as they fix something, one thing, anything, then I will send it in.

 

[toughlife]

"I have been sending these blowhards my $$$ for 5 years now and as far as I can tell I have not received one thing from them. This year I decided to not send them anything and I will continue to not send them anything until they show that they deserve it. As soon as they fix something, one thing, anything, then I will send it in."

And how do you propose they go about it besides lobbying to protect your livelihood? As far as the ASA and AMA go, the ASA has two of its members sit in the AMA board of trustees.

Ultimately, it is your choice whether you want to contribute or not. I feel for the specialty and it bugs me to see the lack of concern in many of its members. Sad to say the least.

 

[threepeas]

no study will ever show that new crna grads can practice competently in a autonomous setting like new MD grads, their training is not long enough to prepare them for all the settings, and situations that exist. someone may gain enough experience for this, but not as a new grad and that is how the professions are judged.

 

[Noyac]

The CRNAs continue to gain ground because the residency program chairmen continue to train them and private practice docs keep hiring them.
The medicare payments that depend on SGR were averted but not those proposed by CMS so instead of a 13.9% cut in reimbursement, only an 8.9% will go into effect which (as the ASA article states) is more like 7% given the reimbursements for procedures like line placement and pain treatments were not affected as much and will partly offset some of the cuts. What really took the big hit is actually providing the anesthetic itself.

I'm not talking about the crna's being trained and hired. We need them and they fill a void. And we all know that they can provide a service. I'm talking about the states that are opting out. I'm talking about the aana's attempts to remove the physicians role in anesthesia.

As far as the cuts. I don't benefit from the pain procedures any longer and therefore, I'm at nearly 9% in cuts. Also I rarely put a-lines or central lines in any longer, they are not necessary. Others get a raise from medicare. I'm tired of cuts. I want a raise that matches inflation. If you factor in inflation, our cuts are greater. Correct me if I'm wrong, I'm not an economist.

What about their relationship with the AMA? Is it any better? Why can't we combine efforts? Why can't the 2 work together? Don't you think that together they can pool resources and get something accomplished? The issues are not very different. Medicare cuts. Paraprofessionals moving in on healthcare to name a few.

PS: I respect your enthusiasm and hope that it works for you. That way we will all benefit.

 

[Noyac]

And how do you propose they go about it besides lobbying to protect your livelihood? As far as the ASA and AMA go, the ASA has two of its members sit in the AMA board of trustees.

Isn't that their job? I've given my grievances, its their job to work on it. Thats what we are paying for right?

I know that 2 members sit on the AMA board. What the hell are they doing?

 

[fakin' the funk]

I got the opportunity to chat with an anesthesiology chairman today. He said that in 5 years anesthesiologists won't be dripping propofol in the endoscopy suite (i.e., NAs would), and that the field would be moving toward the "perioperative medicine" end of things with preop, intraop, and postop medical management being done by anesthesiologists. He even suggested that some of the postop care on surgery floors would be done by anesthesiologists as surgeons become less and less interested in low-revenue postop care.

What do you guys think?

 

[toughlife]

I'm not talking about the crna's being trained and hired. We need them and they fill a void. And we all know that they can provide a service. I'm talking about the states that are opting out. I'm talking about the aana's attempts to remove the physicians role in anesthesia.

As far as the cuts. I don't benefit from the pain procedures any longer and therefore, I'm at nearly 9% in cuts. Also I rarely put a-lines or central lines in any longer, they are not necessary. Others get a raise from medicare. I'm tired of cuts. I want a raise that matches inflation. If you factor in inflation, our cuts are greater. Correct me if I'm wrong, I'm not an economist.

What about their relationship with the AMA? Is it any better? Why can't we combine efforts? Why can't the 2 work together? Don't you think that together they can pool resources and get something accomplished? The issues are not very different. Medicare cuts. Paraprofessionals moving in on healthcare to name a few.

PS: I respect your enthusiasm and hope that it works for you. That way we will all benefit.

To change those cuts requires that congress changes their messed up SGR rule. As long as the provision for payments is directly linked to GDP among others, it won't change. We need congress to change that and to do that we gotta lobby.

I am not sure about their relationship. I would surmise it is better given more anesthesiologists are in the committees. I think the problem with the AMA is how their decision-making body is organized. The board of directors + chairman call the shots and not the entire house of delegates as it is the case with the ASA. So even if the ASA has delegates in it, other specialties may have members that sit in the all-powerful board trying to get things accomplished for their own. And as we can see in these forum, getting doctors to agree on something is very difficult. They should be able to agree on the issues easily since the problem affects all doctors.

 

[2ndyear]

I got the opportunity to chat with an anesthesiology chairman today. He said that in 5 years anesthesiologists won't be dripping propofol in the endoscopy suite (i.e., NAs would), and that the field would be moving toward the "perioperative medicine" end of things with preop, intraop, and postop medical management being done by anesthesiologists. He even suggested that some of the postop care on surgery floors would be done by anesthesiologists as surgeons become less and less interested in low-revenue postop care.

What do you guys think?

5 years, I don't think so. That would be next years intern class. The residency would have to change enough to give more training in preop and post op medical management. Most of this could be done in a standardized PGY-1 year, however. IM Hospitalists are ready to move into the pre and post op care where they haven't already. And why not? They're available, qualified, and love that stuff. Besides if surgeons aren't interested in low revenue care, why should we be? I could see more aggressive post op pain services as regional techniques and catheters become more common. In the end what drives any specialty is reimbursement. As long as it is profitable to be in the OR that's where we'll be.

 

[Noyac]

hey Tough,
this is what I'm talking about. The Colorado society is at least close to getting results, unlike the ASA.

"GOOD NEWS!

Members of the legislature recognize the value of anesthesia care provided to our patients.

CSA Membership:

HCPF is recommending a 50% rate increase for Colorado Medicaid anesthesia services. If approved by the Joint Budget Committee, the legislature and signed by the governor, this will take the conversion factor from $14.33 to $21.49. The language they used in their briefing appears to be taken from the documents we provided.

HCPF is budgeting $14 million for targeted provider rate increases. Our increase will be 22% of this total.

Surprisingly, we have not heard of this from the department itself. I will work with Leslie Jameson, MD, CSA President, Carol Goddard, CSA Administrator, and Edie Busam, CSA Lobbyist, to write a letter of thanks on our behalf to the three top officials of the department that we have been conversing with. We will also send thank-you's to the members of the JBC.

There will be a lot of people that will want this money for other priorities so we will have a lot of work to do to protect this during the upcoming legislative session. Edie Busam has done a superb job of keeping our specialty on the HCPF and JBC horizon.

Randy Clark, MD
CSA Legislative Committee"

 

[toughlife]

hey Tough,
this is what I'm talking about. The Colorado society is at least close to getting results, unlike the ASA.

"GOOD NEWS!

Members of the legislature recognize the value of anesthesia care provided to our patients.

CSA Membership:

HCPF is recommending a 50% rate increase for Colorado Medicaid anesthesia services. If approved by the Joint Budget Committee, the legislature and signed by the governor, this will take the conversion factor from $14.33 to $21.49. The language they used in their briefing appears to be taken from the documents we provided.

HCPF is budgeting $14 million for targeted provider rate increases. Our increase will be 22% of this total.

Surprisingly, we have not heard of this from the department itself. I will work with Leslie Jameson, MD, CSA President, Carol Goddard, CSA Administrator, and Edie Busam, CSA Lobbyist, to write a letter of thanks on our behalf to the three top officials of the department that we have been conversing with. We will also send thank-you's to the members of the JBC.

There will be a lot of people that will want this money for other priorities so we will have a lot of work to do to protect this during the upcoming legislative session. Edie Busam has done a superb job of keeping our specialty on the HCPF and JBC horizon.

Randy Clark, MD
CSA Legislative Committee"

That's certainly a step in the right direction. Maybe the ASA can target each state individually since the federal gov't is not budging. They could also provide funds to each state anesthesiology society to lobby their state representatives. Either way, they should hear about this. Maybe an email to Gina Steiner would be in order.

I'm not sure if you heard/read this:

http://www.asahq.org/news/news121906.htm

"ASA is prepared to fight the Medicare payment battle on a number of fronts. We are moving forward with the following tactics:
1-Forming an allegiance with other hospital-based specialties, which also face huge cuts in Medicare payments
2-Seeking legislative relief from egregious payment disparities that unfairly penalize anesthesiologists and hinder patient access to expert anesthesiology medical care
3-Enforcing the “46% statute,” which holds that the anesthesia conversion factor must be at a level at least 46% of the conversion factor for the rest of medicine
4-Supporting antitrust legislation to provide relief for self-employed physicians, and to level the playing field in negotiations between physicians and third-party payers

 

[TaiShan]

I am doing surgery internship right now and I have noticed some difference between Surgeons/SA and MDA/CRNA.

First, both SA and CRNA are highly competent and most of them are doing better jobs in OR than junior residents.

However, in surgery, there is a firm boundary between Md/non-MD. You know who calls the shot at room (even as a PGY1 intern). No incision can be made without a MD. A lot of times SAs can be quicker, definitely more knowledeable and hold lap camera much better, but PGY1/2/3 are doing the abd exploration.

On the other hand, CRNA does almost all (intubation, lines) and sometimes MDA doesn't lift a finger other than push syringes. CRNAs sit through the whole case while MDA pops in once for 1 minute. There is relatively no difference between a resident and CRNA. Heck, sometimes, a CA1 resident was pulled out room because MDA thought an experiences CRNA is better to handle the complicated patient!!

I really believe MDA should have kept some invasive procedures to themselves (like intubation, lines). It is not saying CRNAs could not do it but you have to draw a line somewhere. As I said, most senoir SAs could do lap chole by themselves but they are holding retractors when a PGY1/2 is presented.

 

[Trisomy13]

I am doing surgery internship right now and I have noticed some difference between Surgeons/SA and MDA/CRNA.

First, both SA and CRNA are highly competent and most of them are doing better jobs in OR than junior residents.

However, in surgery, there is a firm boundary between Md/non-MD. You know who calls the shot at room (even as a PGY1 intern). No incision can be made without a MD. A lot of times SAs can be quicker, definitely more knowledeable and hold lap camera much better, but PGY1/2/3 are doing the abd exploration.

On the other hand, CRNA does almost all (intubation, lines) and sometimes MDA doesn't lift a finger other than push syringes. CRNAs sit through the whole case while MDA pops in once for 1 minute. There is relatively no difference between a resident and CRNA. Heck, sometimes, a CA1 resident was pulled out room because MDA thought an experiences CRNA is better to handle the complicated patient!!

I really believe MDA should have kept some invasive procedures to themselves (like intubation, lines). It is not saying CRNAs could not do it but you have to draw a line somewhere. As I said, most senoir SAs could do lap chole by themselves but they are holding retractors when a PGY1/2 is presented.

MDA?

 

[Noyac]

I am doing surgery internship right now and I have noticed some difference between Surgeons/SA and MDA/CRNA.

First, both SA and CRNA are highly competent and most of them are doing better jobs in OR than junior residents.

However, in surgery, there is a firm boundary between Md/non-MD. You know who calls the shot at room (even as a PGY1 intern). No incision can be made without a MD. A lot of times SAs can be quicker, definitely more knowledeable and hold lap camera much better, but PGY1/2/3 are doing the abd exploration.

On the other hand, CRNA does almost all (intubation, lines) and sometimes MDA doesn't lift a finger other than push syringes. CRNAs sit through the whole case while MDA pops in once for 1 minute. There is relatively no difference between a resident and CRNA. Heck, sometimes, a CA1 resident was pulled out room because MDA thought an experiences CRNA is better to handle the complicated patient!!

I really believe MDA should have kept some invasive procedures to themselves (like intubation, lines). It is not saying CRNAs could not do it but you have to draw a line somewhere. As I said, most senoir SAs could do lap chole by themselves but they are holding retractors when a PGY1/2 is presented.

Well there is a big difference b/w a SA and a crna. YOu have touched on some of the differences. But training is the biggest difference. Crna's and AA's are trained to do anesthesia while SA'a are trained to assist in surgery.
As far as procedures go. Intubations look like procedures but they are not big a deal after PGY 1 year. As Mil calls them "Monkey Skills". Lines are another thing. Still monkey skills but so groups restrict line placement and regional. My last job had may crna's and we didn't allow them to do anything but intubate and place IV's for many reasons. No spinals, no epidurals, no A-lines, no hearts, no cerebral anuerysms, and only a few could do major vascular. These crna's were very good and were capable of some of these tasks but it was a group decision that was made b/4 I arrived. Bottom line is that a lot of those things that look like great procedures just aren't as big a deal after some time.

About replacing a CA1 with an experienced crna is also not that big a deal if the attending can't be present for the majority of the case to teach the CA1. An experienced crna is just that experienced and the CA1 is learning. I would be pissed however if they replaced me in the middle of a case with a crna because of the case and not because of lectures or whatnot. I would expect to finish the case and have an attending around if it was beyond my experience level at the time.

 

[TaiShan]

Well there is a big difference b/w a SA and a crna. YOu have touched on some of the differences. But training is the biggest difference. Crna's and AA's are trained to do anesthesia while SA'a are trained to assist in surgery.

That is my point. Why is SNRA training almost as long as a residency? It used to be six months. I do not know about you, but if I were to do three years of ICU and three years of anesthesia training, I would think I am as good as the guy who doing one year of TY and three years of traning.

 

[fakin' the funk]

As I said, most senoir SAs could do lap chole by themselves

There's a reason why they aren't allowed to.

For the docs out there: is this kind of thinking prevalent among the techs, RNs, and midlevels that you work with? That they could do your job just as well?

The impression I've gotten from personal experience, as I head to the wards next year, is that this kind of thinking is very pervasive...

 

[2ndyear]

That is my point. Why is SNRA training almost as long as a residency? It used to be six months. I do not know about you, but if I were to do three years of ICU and three years of anesthesia training, I would think I am as good as the guy who doing one year of TY and three years of traning.

CRNA training is almost as long as residency because they spend about 12 months in the classroom learning basic and applied science. And it's not quite 3 years, more like 27-28 months. Even when you take off the time that we spend in the ICU and pain clinic (currently 3 months), residents have about double the time in the OR as a graduating CRNA. I'm not saying they're unqualified, but these are just the facts.

 

[juddson]

The Cleveland Clinic program for CRNA'ss (which is administered jointly by the department of anesthesiology at the Clinic and the school of nursing at Case Western Reserve University) trains CRNA's for 28 months. The claim to put them in the OR for at least 1800 hours during those 28 months.

As I understand it, an anesthesiologist trains for 36 months, just 8 months longer than a CNRA.

Something is going on here: If the scope of practice is the same, either the typical MD anesthesiologist with his four years of med school, year of medicine and three years of anesthesiology training is over-trained OR the CRNA is undertrained. Which is it?

Judd

 

[toughlife]

The Cleveland Clinic program for CRNA'ss (which is administered jointly by the department of anesthesiology at the Clinic and the school of nursing at Case Western Reserve University) trains CRNA's for 28 months. The claim to put them in the OR for at least 1800 hours during those 28 months.

As I understand it, an anesthesiologist trains for 36 months, just 8 months longer than a CNRA.

Something is going on here: If the scope of practice is the same, either the typical MD anesthesiologist with his four years of med school, year of medicine and three years of anesthesiology training is over-trained OR the CRNA is undertrained. Which is it?

Judd

OK? so they do 28 months of training. Is that supposed to be some sort of substitute for medical education and a full residency? You won't find ANY crnas working by themselves in the SICU at night taking call and managing sick patients. I am sure they do fine in the OR but remember you are a physician and are (or should be) functional in any area of medicine that anesthesiology deals with (pain clinic, ICU, OR) etc. That is what residency teaches you. That is the difference between you and a CRNA.

Always remember you are taught to think about the "WHY" of things. The how comes with practice. Therein lies the difference.

 

[threepeas]

The Cleveland Clinic program for CRNA'ss (which is administered jointly by the department of anesthesiology at the Clinic and the school of nursing at Case Western Reserve University) trains CRNA's for 28 months. The claim to put them in the OR for at least 1800 hours during those 28 months.

As I understand it, an anesthesiologist trains for 36 months, just 8 months longer than a CNRA.

Something is going on here: If the scope of practice is the same, either the typical MD anesthesiologist with his four years of med school, year of medicine and three years of anesthesiology training is over-trained OR the CRNA is undertrained. Which is it?

Judd

1800 clinical hours divided by 49 weeks/year equals just 36.7 hours a week. Residency clinical hours probaly average 60 hours a week plus hopefully 5-10 hours of didactics a week for 3 years which equals 8820 clinical hours and 1120 hours didactics. That's A big difference if you ask me.

 

[threepeas]

OK? so they do 28 months of training. Is that supposed to be some sort of substitute for medical education and a full residency? You won't find ANY crnas working by themselves in the SICU at night taking call and managing sick patients. I am sure they do fine in the OR but remember you are a physician and are (or should be) functional in any area of medicine that anesthesiology deals with (pain clinic, ICU, OR) etc. That is what residency teaches you. That is the difference between you and a CRNA.

Always remember you are taught to think about the "WHY" of things. The how comes with practice. Therein lies the difference.

This is a great point. I feel CRNAs are trained just enough to be very good dependent practioners. Some gain excellent experience on the job and become more independent but it is not expected and is individualized. The expectations on the physician are broader at time of graduation and that is why the training needs to be longer and more rigorous.

 

[threepeas]

That is my point. Why is SNRA training almost as long as a residency? It used to be six months. I do not know about you, but if I were to do three years of ICU and three years of anesthesia training, I would think I am as good as the guy who doing one year of TY and three years of traning.

A CRNA program can be as short as 24 months or as long as 36 months. You have to only consider the minimum though of 24 months. A CRNA applicant only needs one year of acute care nursing prior to application. Again this is the minimum. This one year in an acute care setting is not standardized in anyway and therefore doesnt mean much to me. It's just a job that could have an extrememe variety of clinical experiences. I dont think your post is accurate.

 

[EtherMD]

This is my first post to this gasforum. After 10 years or so in practice some CRNA's acquire the advanced skills and confidence to go it "alone" for ASA1 and ASA 2 patients. These CRNA's look for Outpatient centers and smaller hospitals to "cover." They form their own Groups and make money on par with some Anesthesiologists. I know a few who make $350,000 working 40 hours a week at a surgi-center. Some make $400,000 or more by covering OB at small hospitals, working at a plastic Surgeon's office, etc.
These facilities are sometimes in excellent locations/cities. Do not underestimate the competition experienced CRNA's pose to your future.

After finishing Medical School and a Top Ten Anesthesiology Residency Program I never would have imagined CRNA's would obtain through legislation what Anesthesiologists have to get through education. But, the fact remains that they can practice and bill without an Anesthesiologist. Those of you just entering the field need to realize the AANA is no friend of yours and believes the local Nurse Anesthetist has the skills and training to do what you do for less. If you say something loud enough and often enough people might just believe it.

 

[toughlife]

This is my first post to this gasforum. After 10 years or so in practice some CRNA's acquire the advanced skills and confidence to go it "alone" for ASA1 and ASA 2 patients. These CRNA's look for Outpatient centers and smaller hospitals to "cover." They form their own Groups and make money on par with some Anesthesiologists. I know a few who make $350,000 working 40 hours a week at a surgi-center. Some make $400,000 or more by covering OB at small hospitals, working at a plastic Surgeon's office, etc.
These facilities are sometimes in excellent locations/cities. Do not underestimate the competition experienced CRNA's pose to your future.

After finishing Medical School and a Top Ten Anesthesiology Residency Program I never would have imagined CRNA's would obtain through legislation what Anesthesiologists have to get through education. But, the fact remains that they can practice and bill without an Anesthesiologist. Those of you just entering the field need to realize the AANA is no friend of yours and believes the local Nurse Anesthetist has the skills and training to do what you do for less. If you say something loud enough and often enough people might just believe it.

All of that thanks to those who train them. Don't hire the b*tch*s.

 

[SleepIsGood]

All of that thanks to those who train them. Don't hire the b*tch*s.

The key here is to all the attendings out there: For the sake of our specialty, do not hire these guys. PLEASE. Sure you can pocket an extra buck, but where does the profession end up?

Anyone read the article in the ASA newsletter about the possibility of robotics, etc being introduced to help out with Anesthesia? The author was just introducing the concept. I dont know what I think about it. Basically he was stating that we can have robots etc administering meds etc, while the anesthesiologist sits in a room and monitors...sorta like how eICU does it. This would definitely rid the need of needing CRNAs,etc. However, there's always the possibility of this backfiring....

 

[EtherMD]

The key may be to hire AA's in the future. Anesthesia Assistants do not seek to compete with Anesthesiologists; instead, they must work under the direction of an Anesthesiologist at all times.

Do you realize that the number of CRNA's in practice is about the same as as the number of Anesthesiologists? So, not hiring CRNA's or firing your entire staff is simply not realistic. But, suppoting the AAAA (Ameican Academy of Anesthesia Assistants) makes sense. If only the ASA would have acted sooner on this issue (about 30 years ago) then the CRNA "independent practice" issue would not be as big as it is today.

Unfortunately, the CRNA does represent a threat to your job security as they promote themselves as "same quality of an Anesthesiologist at half the price."
Previous posters have pointed out that by allowing (legally in all 50 states) a CRNA to do everything that we do diminishes our profession and our training/residency.

How does the ASA and the academic community respond to the CRNA threat?
They want to lengthen the training again by one year. This is not the answer. The approach is to restructure the Residency to automatically include Critical Care Certification Eligibility as part of the program. Four years of Post Graduate Training is more than enough time to gain experience in Anesthesia and Critical Care.

After all, Medicare Reimburses CRNA's the exact same pay as an Anesthesiologist for a case. So, CRNA's with 27 months of training (some of which is non-clinical) receives the same amount of money as an Anesthesiologist with 48 months of training. Again, the answer is not to lengthen thetraining programs but restructure them.

 

[matt1234321]

The key may be to hire AA's in the future. Anesthesia Assistants do not seek to compete with Anesthesiologists; instead, they must work under the direction of an Anesthesiologist at all times.

Do you realize that the number of CRNA's in practice is about the same as as the number of Anesthesiologists? So, not hiring CRNA's or firing your entire staff is simply not realistic. But, suppoting the AAAA (Ameican Academy of Anesthesia Assistants) makes sense. If only the ASA would have acted sooner on this issue (about 30 years ago) then the CRNA "independent practice" issue would not be as big as it is today.

Unfortunately, the CRNA does represent a threat to your job security as they promote themselves as "same quality of an Anesthesiologist at half the price."
Previous posters have pointed out that by allowing (legally in all 50 states) a CRNA to do everything that we do diminishes our profession and our training/residency.

How does the ASA and the academic community respond to the CRNA threat?
They want to lengthen the training again by one year. This is not the answer. The approach is to restructure the Residency to automatically include Critical Care Certification Eligibility as part of the program. Four years of Post Graduate Training is more than enough time to gain experience in Anesthesia and Critical Care.

After all, Medicare Reimburses CRNA's the exact same pay as an Anesthesiologist for a case. So, CRNA's with 27 months of training (some of which is non-clinical) receives the same amount of money as an Anesthesiologist with 48 months of training. Again, the answer is not to lengthen thetraining programs but restructure them.

Too late in the game for the aa's to replace the crna and it wont solve the anesthesia provider problem in BFE where no anesthesiologist is willing to work. But, like a previous poster said an anesthesiologist is a medical doctor and his education is broad. The CRNA is a specialist, trained and educated specifically and only for providing anesthesia.