Surgery and Anesthesiology United

[mysophobe]

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Dude, I get your point with the NP doing surgery (which I've seen is a threat for you guys). See, teh point is this. As in the anesthesia world, the CRNA will come into the room and be like "hi, i'm the anesthesist , and I wil be providing the anesthesia this morning,etc". Do you really think the PATIENT knows the difference b/w an anesthesist or an anesthesiologists? in fact some of the nurses wont even say theyre an anesthesist, they'll just say "hi i'll be providing the anesthesia for you during the surgery".

what's my point? Well the NP can walk in and be like, "Hi Mr. Smith, I hope you are doing well. I'll be removing your gallbladder today...." When that nurse walks in with her LONG white coat (which most NPs are akin to already) and her stethoscope in her jacket, do you really think the PATIENT will know the difference? Nope.

Yes, but there is a difference in the way patients meet the anesthesia provider and the surgeon. At least in my experience, the surgeon meets the patient way earlier than the anesthetist. I just can't visualize an NP being able to hide the fact that they are NOT a surgeon from a patient. That seems like it would violate some sort of informed consent regulation. The CRNAs here always say "nurse anesthetist" and an MDA always looks at them before going back. I can't imagine an NP getting away with omitting the fact that they are a nurse and not an MD.

 

[ThinkFast007]

Dude..you are beating around the bush, and not going to the source of your problem:

-Anesthesiologists who are hiring CRNA's in their anesthesia groups (to increase their bottom line).

-The misinformed patient population.

Targeting surgeons will do you nothing. They have their own "crap" to worry about.

The core of your problem is that established Anesthesiologists want CRNA's.

You sould do what pharmaceutical companies do-

-Target the patient population with eduational ads (so that they request a MDA at the time when they schedule their surgery..days before their surgery)

-Be vocal/active in the ASA (and convince "your elders" to stop/limit the hiring of CRNAs.

You should be trageting the RICH Anesthesiologits who are hiring the CRNAs in their groups...NOT the overworked/poor surgeons!!!

You should go to the source of the problem, which is in your own backyard.

Point well taken my friend

Listen, us younger anesthesiology residents do intend to become more active in this issue, I can assure you of that. We do indeed desire to find out where the problems are and then go solve them.

Listen man, I think we ALL need to take a diversified approach the 'greater picture' of midlevels infiltrating our professions. Hey, I'll be just as busy and overworked as you next year, just like most residents are. HOwever, I still intend on becoming very involved with the ASA and the ASAPAC. But you all can help us out too by making sure that YOUR patients get the best care they can via physician providers. In turn when we are attendings and a lot of us will be atttendings in pain mgt, CCM, and just general OR anesthesia we will make sure that we refer patients ONLY to surgeons. Anesthesiologists are not always only in the OR, we do do a lot of outpatient medicine where we will have the ability to refer patients--and believe me I wouldnt trust anyone but a surgeon.

I think MacGyver had a point when he said that NPs were seen as not a huge threat in the primary care arena, but look what happened. Let's work together fellas.

The curtain only needs to be a barrier to prevent gases into the surgical field, it shouldnt be a barrier for a united surgery/anesthesiology front. 👍

 

[nitecap]

Point well taken my friend

Listen, us younger anesthesiology resident do intend to become more active in this issue, I can assure you of that. We do indeed desire to attack the problem wherever the 'root' of it is.

Listen man, I think we ALL need to take a diversified approach the 'greater picture' of midlevels infiltrating our professions. Hey, I'll be just as busy and overworked as you next year, just like most residents are. HOwever, I still intend on becoming very involved with the ASA and the ASAPAC. But you all can help us out too by making sure that YOUR patients get the best care they can via physician providers. In turn when we are attendings and a lot of us will be atttendings in pain mgt, CCM, and just general OR anesthesia we will make sure that we refer patients ONLY to surgeons. Anesthesiologists are not always only in the OR we do do a lot of outpatient medicine where we will have the ability to refer patients.

I think MacGyver had a point when he said that NPs were seen as not a huge threat in the primary care arena, but look what happened. Let's work together.

The curtain only needs to be a barrier to prevent gases into the surgical field, it shouldnt be a barrier for a united surgery/anesthesiology front. 👍

Think how do you know that CRNA's intro themselves to pt's ambiguously in the OR when you dont even work in the OR yet? You are big talk but bring little experience and knowledge about how these issues effect the real world. Like I said we didnt just come to life a few decades ago, we have been around about as long as your profession and are solid. Not any where in this country are anesthesiologist not getting jobs due to CRNA's. On the contrary we actually open up the job potential and increase anesthesiologists salaries drastically. Over 60% of the 33,000 CRNA work for MD run groups while less than 10% of the 33,000 CRNA's are indendent contractors that work in podunct North Dakota and a hand full of states. This is not a patient safety issue b/c we have 100yrs of documented safety under our belt. ITs about a money and market thing. And you guys are to green and inexperienced to realize that contrary to popular anesthesia resident belief we increase the salaries of most anesthesia groups while decreasing the hours they work, decreasing the call they take and increasing the number of cases they can bill for. The so called lifestyle that all you guys rant and rave about saying its why you chose anesthesia. Much of this lifestyle you desire is made possible by CRNA's which you can bill for and which cut many hours out of your work week had they not been there.

You claim you want to let the public know who does their anesthesia which is fine by me. So Let them know that you claim CRNA's unsafe yet promote a less documented, less proven, less available profession in Anesthesiologists Assistants that have no political clout or lobbying power. Believe me they will see right thru these tactics claiming a century old provider is less safe than a 30 yo provider that practices in a few states just b/c 2 of the 5 programs make them take the MCAT and one of those 2 says its optional.

Face it as a guy even before I was a RN as a Pt Care Assistant and hospital transporter the old men especially would many times refer to me a doc. I had not white coat, sometimes not even scrubs on and not once did I not correct them. It is unethical to impersonate and if CRNA's are really doing this which you have no clue b/c you are not in the OR yet then that facility should deal with those individuals accordingly. To generalize that all CRNA's want to call themselves MD is incorrect and misleading. Grow up fool.

 

[ThinkFast007]

nitecap: I think most of the residents/docs on here ignore your posts. People on the surgery forum can go to the Anesthesiology forum to see that you are not wanted on there at all by the resident/docs. I dont even read your posts much anymore.

Your ranting and raving just go to prove my point that non-physician providers are trying to acquire a bigger portion of medicine in general. The bottom line as you've been told MILLIONS of times by residents/anesthesiologists/med students on the Anesthesiology forum, your opinion isnt valid to any of us. You contrive little scenarios and stories attempting to cast sand in our eyes, yet we can still see through you. Your post about how you frequent these forums in order to see how physicians collaborate and exchange ideas about where we want our profession only to further your own agenda, tells us EXACTLY why you're on here.

Bottom line nitecap. All of us going into Anesthesiology really do not care about your opinions, which are usally tainted. Especially, all of residents. You as a non-physician provider can not sway OUR thinking. It doesnt matter if you have 20 or 50 years of clinical experience. If you truly want to contribute to Physician subject matters on this forum, go to med school for 4 years and then come back--then we'll welcome you with open arms. This place is called studen DOCTOR network for a reason. Until then, attempt to get converts to your thinking in forums for nurses such as www.allnurses.com

p.s. I would urge all surgeons here (who do not know nitecap) to also please skip over his messages as we do on the Anesthesiology forum

 

[mysophobe]

Word. 👍

 

[fishmonger69]

it's quite amazing how many individuals have absolutely no grasp of punctuation or spelling, yet are in charge of airways and anesthetic drugs for patients going under the knife.

case in point : "and not once did i not correct them". no double negatives please, it just hurts to read. some commas in that sentence would be great as well.

 

[KluverBucy]

it's quite amazing how many individuals have absolutely no grasp of punctuation or spelling, yet are in charge of airways and anesthetic drugs for patients going under the knife.

case in point : "and not once did i not correct them". no double negatives please, it just hurts to read. some commas in that sentence would be great as well.

sick...the vaunted "double negative". it is truly a gem in today's spoken word. it ain't not hard to never overlook it. (p.s. i don't know what i just said).

 

[Taurus]

Where do you guys find the time to fight back and forth? 😕

 

[Taurus]

Ooh, ooh. I can top your double negative. A quadruple negative! My eyes are going blind and my poor brain hurting after reading this.

I had not white coat, sometimes not even scrubs on and not once did I not correct them.

 

[mysophobe]

Mind...melting...

 

[cfdavid]

Would you go to a hospital and let an NP do your surgery? When the surgeon says, oh, I won't be doing your gallbladder, Nurse Mary will be doing it, you can bet your ass the patient will have something to say about that. No one in their right mind would let an NP/RNFA/PA/CST/CSA/XYZ do their surgery when they can have a surgeon do it.

NPs doing cases solo will never happen. Patients won't let it happen.

When I had my eye sutured up, it was by a PA. I was in the ED, and nobody asked me my preference. I just assumed it would be a doc. Midway through the procedure, I said "hey doc....", and she was like "actually, I'm a PA".........

The point is that patients are notoriously uneducated about who's actually providing their care. And without a massive public ad campaign, how would they ever really know who is yielding the knife? Especially, when nobody announces anything.

As for patients, I can guarantee you that most people don't know that they may not be brought under anesthesia by an MD/DO anesthesiologist. And if asked, what do you think their preference would be??

Do you really think the response would be that much different if it were announced, "Oh, we don't have an actual anesthesiologist on staff. But, "Nurse Mary" will gladly put you to sleep"??

And to suggest that mid-levels won't take on an increasing role in some of the more "bread and butter" surgeries as time goes on, seems exceedingly naive on your part.

Don't misunderstand some of our statements as if we're somehow against mid-level practitioners. That's not accurate, and I recognize the very important (critical even) role they play in healthcare. However, it's the legislature that decides, ultimately, who does what in medicine. And any mid-level group that lobbies for more and more autonomy from physician direction or supervision may become a very enticing option in an environment of higher and higher healthcare costs. And that's exactly what many of the mid-level provider professional organizations are doing, regardless of the more moderate attitudes of their members/constituents.

 

[Taurus]

I for one don't believe that mid-levels are happy to be where they are. They want more and more of our turf. Because they're more cost-effective, I doubt that we can do much to stop them from encroaching, no matter what some attendings may believe. The decision-makers may not have MD's behind their names, but instead MBA's. This genie ain't going back into its little bottle. In the future, I envision doctors ceding the low hanging fruit to mid-levels. Doctors will then be forced to move up the food chain, becoming more and more specialized. Mid-levels take on the easiest, common cases while doctors get the more complicated ones. It will be a world where mid-levels are the primary care providers and we depend on them for patient referrals. Tell me I'm crazy.

 

[mysophobe]

When I had my eye sutured up, it was by a PA. I was in the ED, and nobody asked me my preference. I just assumed it would be a doc. Midway through the procedure, I said "hey doc....", and she was like "actually, I'm a PA".........

This is WAY different than what we are talking about. The issue is PA/NPs doing entire surgeries solo, i.e., no doc. Having a PA suture you up in the e.r. or at the end of a procedure is nothing I have a problem with. I did it when I was a scrub tech. Suturing isn't that hard.

The problem comes when they start doing cases all on their own. We train for the better part of a decade to do these kinds of things, and when we get done, we are still wet behind the ears. You think people with 2 years of PA school and a year or two of experience as a PA first-assisting is going to be able to do what we do? THAT is naive.

The point is that patients are notoriously uneducated about who's actually providing their care. And without a massive public ad campaign, how would they ever really know who is yielding the knife? Especially, when nobody announces anything.

If the surgeon goes in the room and lets the PA cut and do the procedure, then they would never know unless they were told. But there is no way that a PA is going to see the patient, schedule them for surgery, see the patient pre-op, do the procedure, and provide post-op care without revealing that they are NOT a doctor. That's just ridiculous to think.

As for patients, I can guarantee you that most people don't know that they may not be brought under anesthesia by an MD/DO anesthesiologist. And if asked, what do you think their preference would be??

Do you really think the response would be that much different if it were announced, "Oh, we don't have an actual anesthesiologist on staff. But, "Nurse Mary" will gladly put you to sleep"??

It is different in the public eye. Most people think anesthetists just put you to sleep and wake you up. There is a difference between that and cutting you open to fix you up. Patients get introduced to the CRNAs here all the time with a "hey, I'm Bob, the nurse anesthetist that will be taking care of you". They never say anything. It may be because they don't care, don't know, or that an MDA always introduces himself as well. Who knows?

And to suggest that mid-levels won't take on an increasing role in some of the more "bread and butter" surgeries as time goes on, seems exceedingly naive on your part.

I never said they couldn't take on an increasing role. Once again, you are twisting words around. I have already stated that PAs/NPs do a lot during cases, and that they are invaluable. What we are talking about is doing cases solo with no MD.

Don't misunderstand some of our statements as if we're somehow against mid-level practitioners. That's not accurate, and I recognize the very important (critical even) role they play in healthcare. However, it's the legislature that decides, ultimately, who does what in medicine. And any mid-level group that lobbies for more and more autonomy from physician direction or supervision may become a very enticing option in an environment of higher and higher healthcare costs. And that's exactly what many of the mid-level provider professional organizations are doing, regardless of the more moderate attitudes of their members/constituents.

I'm not a mid-level provider, so why would I care what you think about them? They may have legislation giving them more autonomy, but there will never be a law that says an MD/DO can't do a case, and when presented with a choice between a surgeon and a PA/NP, no patient will choose the latter. Sorry, it's just a fact of life.

 

[cfdavid]

mysophobe. you made some good counterpoints. 👍

as a probable future anesthesiologist, myself and others agree that we need to do more to educate our customers both within healthcare (surgeons, administrators) as well as patients.

from what i see, we also should be marketing and developing the other skills that we have to offer, above and beyond what a mid-level anesthesia provider can offer. many of us have agreed that the only constant is change, and the new generation will be on top of it. we're getting organized and networking with one another to try and solve what we see as challenges to our profession. we will also be advocating strongly on behalf of our field.

cfdavid

 

[TheSleepMaster]

Obviously if the MD partner in the group has hired the CRNA/AA and is paying their malpractice insurance then they must be safe no?

 

[mysophobe]

mysophobe. you made some good counterpoints. 👍

as a probable future anesthesiologist, myself and others agree that we need to do more to educate our customers both within healthcare (surgeons, administrators) as well as patients.

from what i see, we also should be marketing and developing the other skills that we have to offer, above and beyond what a mid-level anesthesia provider can offer. many of us have agreed that the only constant is change, and the new generation will be on top of it. we're getting organized and networking with one another to try and solve what we see as challenges to our profession. we will also be advocating strongly on behalf of our field.

cfdavid

Yeah. CRNAs are a great resource, but you have to protect your turf. It's a shame that it's a war between mid-levels and MD/DOs, but I guess that's how it has to be. Fortunately for me, I think surgeons will have an easier time protecting it than MD/DOs in anesthesia.

 

[cfdavid]

Yeah. CRNAs are a great resource, but you have to protect your turf. It's a shame that it's a war between mid-levels and MD/DOs, but I guess that's how it has to be. Fortunately for me, I think surgeons will have an easier time protecting it than MD/DOs in anesthesia.

Yeah. But the burden of proof is on us. We'll be prepared, and it's not a zero sum game. We can create a win-win, which is the only way to go.

As for surgeons, I agree that it'll be a bit different for you given the full scope of patient interaction. But, paradigm shifts occur over time, and you just never know. If surgeons found themselves in the same place as some of their physician colleagues, they might be a bit more sympathetic.

Nevertheless, the onus is on us to redefine our role in this mosaic. We'll be up to it though, because the profession is worth fighting for, and an MD/DO level anesthesia provider will always have a significant role. We just need to be flexible enough to adapt to market conditions, which ultimately drives everything.

Good luck friend.

 

[mysophobe]

It's true. But, I am sympathetic to your situation. I understand that mid-levels encroach severely on anesthesia, and while we have our own issues, they aren't on the level of yours. I'm sure you'll be fine.

Good luck to you.

 

[lloydchristmas]

Personally, the infiltration of midlevels into medicine should be alarming to everyone. Look at what it's done to primary care.

Yeah, all us ***** NP and PAs out there in rural America are providing much needed primary care to people who love us for helping them. What a horrific situation!!! (oh, yeah, and my patients have better cholesterol, BP and HA1C than either of the docs I work in the general vicinity of) GOD HELP US AS THESE LAYPERSON-LIKE MIDLEVELS DESTROY AMERICA!!!

 

[TxMed]

Yeah, all us ***** NP and PAs out there in rural America are providing much needed primary care to people who love us for helping them. What a horrific situation!!! (oh, yeah, and my patients have better cholesterol, BP and HA1C than either of the docs I work in the general vicinity of) GOD HELP US AS THESE LAYPERSON-LIKE MIDLEVELS DESTROY AMERICA!!!

isn't lloyd christmas a character from dumb and dumber? hilarious movie. hope the name doesn't fit...for your patient's sake. (only jokes)

tm

 

[lloydchristmas]

isn't lloyd christmas a character from dumb and dumber? hilarious movie. hope the name doesn't fit...for your patient's sake. (only jokes)

tm

Lloyd is my hero. If the hospital would let me I'd chip my tooth and wear an orange tuxedo instead of scrubs.