Survey for Residents-Politics of Anesthesia

[BLADEMDA]

I am curious as to what current Residents think about a requirement for a Politics in Anesthesia Course prior to completing Residency

---

Members don't see this ad.

 

[badasshairday]

Not a resident, but voted yes.

 

[RussianJoo]

I think a course like this should be given in all specialties not just anesthesia. every specialty has their issues, that just aren't talked about in med school.

Another great course would be on business and how to set up a practice and run a practice. besides being doctors a lot of us will be business man and although things are done one way in residency that might not be the case in the real world.

 

[QofQuimica]

I am curious as to what current Residents think about a requirement for a Politics in Anesthesia Course prior to completing Residency

Would this be an extra requirement on top of current training requirements, or would it be done instead of something else that is currently required? If it's the former, forget it. And even in the latter case, I'm skeptical. I've had plenty of proselytizing about getting involved in various medical organizations (some of which espouse things that I oppose) to last me a lifetime during med school. This is hopefully still a free country, and I should be free to not get involved in politics at all if I choose, or at least to pick which political battles I want to take on.

 

[badasshairday]

I think a course like this should be given in all specialties not just anesthesia. every specialty has their issues, that just aren't talked about in med school.

This is very true. To be honest, they should have a politics of medicine course in medical school. So many med students are clueless as to what the hell is going on with medicine these days.

 

[SleepIsGood]

maybe if not apart from Formal Residency training (although I think it should be)...it should be offered as a 'free' course at one of those ASA conventions.

 

[ProRealDoc]

Should be mandatory in residency.

 

[QofQuimica]

Hello to anesthesia la-la land, is no one going to step down off the anti-CRNA soapbox long enough to address my objections? Plenty of you folks flaunt your libertarian credentials about everything else under the sun, from what cars you can drive to all the guns you own to how this forum should be run. But somehow, no one sees any problem with forcing your future colleagues to put up with yet more bulls*** propaganda lectures during residency? I guess forcing a captive audience of residents to do anything is justified as long as it furthers the anti-CRNA agenda, huh?

 

[AK_MD2BE]

Q of Q...I don't think the topics of this forum are as much "anti-CRNA" as much as they are pro-anesthesiologist.
My major impression of the topics presented here suggest that most attendings believe that the ACT model is the best way to administer anesthesia. If that means that people on this forum are "anti-CRNA" to the point that they do not believe that CRNA's should be able to practice independently...well, I am with them.

 

[BLADEMDA]

Hello to anesthesia la-la land, is no one going to step down off the anti-CRNA soapbox long enough to address my objections? Plenty of you folks flaunt your libertarian credentials about everything else under the sun, from what cars you can drive to all the guns you own to how this forum should be run. But somehow, no one sees any problem with forcing your future colleagues to put up with yet more bulls*** propaganda lectures during residency? I guess forcing a captive audience of residents to do anything is justified as long as it furthers the anti-CRNA agenda, huh?

Excuse me? What objections do you have about spending a few hours learning about Nurse Anesthesia Practice in the USA? The point behind the POLITICS Course would be to explain the AANA agenda, Legal Practice Rights of CRNAs, Billing Equality of CRNA, etc. Most MDs at the end of the course should be enlightened as to what the specialty faces against the most militant Nursing Union in existence.

A few like you might decide that the AANA agenda and Independent CRNA is indeed the future of U.S. Anesthesia. Fine. Please feel free to donate to the AANA PAC. It is your right in this Country.

Blade

 

[Southpaw]

Bmore bulls*** propaganda lectures during residency? I guess forcing a captive audience of residents to do anything is justified as long as it furthers the anti-CRNA agenda, huh?

Well, what propaganda lectures are in place currently? Listen, I voted to have a class but make it voluntary, and it's strictly the libertarian in me that forced such a vote. The fact is though, I'm forced to listen to lectures on benefits, moonlighting, ID badges, confidentiality, and a load of other mess, and given the choice I'd appreciate a lecture on the politics of the field I'm investing my career in. Medicine has been passive far too long, so facing the facts and confronting a difficult future with an honest lecture on what we'll face politically should be anything but forced. It should be welcomed with open arms by every single anesthesiology resident across the country.

Also, as others have said, you need to understand the difference between pro-anesthesiologist and anti-CRNA.

 

[pgg]

Excuse me? What objections do you have about spending a few hours learning about Nurse Anesthesia Practice in the USA?

The same objections I'd have to spending a few hours of my residency "learning" about the Democrat (or Republican) agenda for health care. The content and tone of such a course would be wildly variable depending on who's teaching it.

I'm not interested in (for example) 6 hours of class time listening to a guy who, depending on my geographic location and the luck of the draw, might turn out to be a BLADEMDA clone (anti-CRNA), or maybe a jetproppilot clone (not anti-CRNA), a nitecap clone (pro-CRNA), or a Misterioso clone (isoelectric-EEG-clueless).

Required courses ought to have content that can be standardized and tested. "Politics In Anesthesia" is awfully nebulous.

 

[BLADEMDA]

The same objections I'd have to spending a few hours of my residency "learning" about the Democrat (or Republican) agenda for health care. The content and tone of such a course would be wildly variable depending on who's teaching it.

I'm not interested in (for example) 6 hours of class time listening to a guy who, depending on my geographic location and the luck of the draw, might turn out to be a BLADEMDA clone (anti-CRNA), or maybe a jetproppilot clone (not anti-CRNA), a nitecap clone (pro-CRNA), or a Misterioso clone (isoelectric-EEG-clueless).

Required courses ought to have content that can be standardized and tested. "Politics In Anesthesia" is awfully nebulous.

Your not having have a job in a few years won't be nebulous. When the CRNA obtains all the same practice rights as you have after Residency I doubt that will be nebulous either. One more thing I am not Anti-CRNA; I believe the CRNA has a valuable role as a midlevel provider in the operating room.

For the few that don't care what happens to this profession over the next few years PGG is a good role model.

 

[pgg]

Your not having have a job in a few years won't be nebulous. When the CRNA obtains all the same practice rights as you have after Residency I doubt that will be nebulous either. One more thing I am not Anti-CRNA; I believe the CRNA has a valuable role as a midlevel provider in the operating room.

For the few that don't care what happens to this profession over the next few years PGG is a good role model.

Oh for the love of god, way to totally miss the point. And for someone who's supposedly trying to recruit people to fight the good fight, there's nothing like taking the offensive and attacking me.

A class that is required for graduation from residency must have specific and standardized content and objectives. Your idea, such as it is, is far too vague for me to be willing to say Yep, let's add that to the list of all the other S H I T I've got to do to graduate.

I'm in the military, and I'm absolutely inundated on a weekly basis with mind-numbingly stupid "training" on everything from how not to infect government computers with porno-site virii, to how not to accidentally have sex with the enlisted folk, to how to combat human trafficking in 3rd-world countries. The last thing I need is another goddamn objectiveless, vague, "requirement" for graduation.

We're not talking about a class that would be helpful, or a good idea - and I agree that being taught something about billing, or the way the ASA represents or fails to represent us would be tremendously useful. You're talking about, to quote your words, "a requirement for a Politics in Anesthesia Course prior to completing Residency" ...

Just because I'm not blindly marching lockstep with you, eagerly lapping up everything you're trying to spoonfeed this forum, doesn't mean I don't agree with much of what you say. You're acting far too much like a zealous fanatic - anyone who isn't 100% in agreement with you is the enemy.

I'm not your enemy, and I'm not an enemy of your cause. I'm simply opposed to yet another vague, pointless time sink, which is what your idea sounds like to me.

Be a little more specific with what you'd like to see taught, and what you'd like to see accomplished, and maybe I'll muster up some enthusiasm. 'Til then, it's a bunch of unicorns and butterfly farts, and politics has enough of that already.

 

[BLADEMDA]

Oh for the love of god, way to totally miss the point. And for someone who's supposedly trying to recruit people to fight the good fight, there's nothing like taking the offensive and attacking me.

A class that is required for graduation from residency must have specific and standardized content and objectives. Your idea, such as it is, is far too vague for me to be willing to say Yep, let's add that to the list of all the other S H I T I've got to do to graduate.

I'm in the military, and I'm absolutely inundated on a weekly basis with mind-numbingly stupid "training" on everything from how not to infect government computers with porno-site virii, to how not to accidentally have sex with the enlisted folk, to how to combat human trafficking in 3rd-world countries. The last thing I need is another goddamn objectiveless, vague, "requirement" for graduation.

We're not talking about a class that would be helpful, or a good idea - and I agree that being taught something about billing, or the way the ASA represents or fails to represent us would be tremendously useful. You're talking about, to quote your words, "a requirement for a Politics in Anesthesia Course prior to completing Residency" ...

Just because I'm not blindly marching lockstep with you, eagerly lapping up everything you're trying to spoonfeed this forum, doesn't mean I don't agree with much of what you say. You're acting far too much like a zealous fanatic - anyone who isn't 100% in agreement with you is the enemy.

I'm not your enemy, and I'm not an enemy of your cause. I'm simply opposed to yet another vague, pointless time sink, which is what your idea sounds like to me.

Be a little more specific with what you'd like to see taught, and what you'd like to see accomplished, and maybe I'll muster up some enthusiasm. 'Til then, it's a bunch of unicorns and butterfly farts, and politics has enough of that already.

Slim,

You ain't my enemy. You may be apathetic but that will your problem not mine. As for what the "Course" should teach that is easy: the facts.

Do you know what a CRNA can legally do or not do in most States? What about billing? How would "opt-out" in every state affect private practice?
What is the actual AANA agenda these days and how does it impact your practice? Is supervision of ten CRNAs legal? Does it affect your billing/collection? Can you legally "supervise" from home and still collect your money? Should you be a 1099 Independent Contractor or W-2 employee? In what settings should you employ your CRNA/AA vs. pay them as Independent Contractors? Is this legal?

If and when the DNAP CRNA achieves opt-out in every state what is your back-up plan? What can you do to stop or slow the AANA agenda?

These are a few of the subjects for your course.

Blade

 

[pgg]

Slim,

You ain't my enemy. You may be apathetic but that will your problem not mine.

If apathy was my problem, I wouldn't have bothered arguing with you. My problem is that I find vague feel-good proposals viscerally distasteful, and I can't just click the little x and move on without saying something.

As for what the "Course" should teach that is easy: the facts.

That's my point - the "facts" in a politics class are usually debatable.

Do you know what a CRNA can legally do or not do in most States? What about billing? How would "opt-out" in every state affect private practice?
What is the actual AANA agenda these days and how does it impact your practice? Is supervision of ten CRNAs legal? Does it affect your billing/collection? Can you legally "supervise" from home and still collect your money? Should you be a 1099 Independent Contractor or W-2 employee? In what settings should you employ your CRNA/AA vs. pay them as Independent Contractors? Is this legal?

All of this should be part of every resident's education ... but most of these topics aren't politics, except perhaps tangentially so, and a politics class is what you initially proposed. FWIW, I would favor making most of these topics part of the required curriculum.

 

[BLADEMDA]

If apathy was my problem, I wouldn't have bothered arguing with you. My problem is that I find vague feel-good proposals viscerally distasteful, and I can't just click the little x and move on without saying something.



That's my point - the "facts" in a politics class are usually debatable.



All of this should be part of every resident's education ... but most of these topics aren't politics, except perhaps tangentially so, and a politics class is what you initially proposed. FWIW, I would favor making most of these topics part of the required curriculum.

Do you know why they are no longer politics now? Because the AANA got them to become LAW. THe same thing holds true for the "next round" of Politics of Anesthesia. If you don't know what the issues/agenda is then you are helpless to prevent them from progressing from "debatable" to public policy.

Blade

 

[pgg]

Just for grins, let's recall the post #1 proposal

a requirement for a Politics in Anesthesia Course prior to completing Residency

with the revised proposal

What is the actual AANA agenda these days and how does it impact your practice? Is supervision of ten CRNAs legal? Does it affect your billing/collection? Can you legally "supervise" from home and still collect your money? Should you be a 1099 Independent Contractor or W-2 employee? In what settings should you employ your CRNA/AA vs. pay them as Independent Contractors? Is this legal?

If and when the DNAP CRNA achieves opt-out in every state what is your back-up plan? What can you do to stop or slow the AANA agenda?

Politics:

• What is the actual AANA agenda these days and how does it impact your practice?
• What can you do to stop or slow the AANA agenda?

Not Politics:

• Is supervision of ten CRNAs legal?
• Does it affect your billing/collection?
• Can you legally "supervise" from home and still collect your money?
• Should you be a 1099 Independent Contractor or W-2 employee?
• In what settings should you employ your CRNA/AA vs. pay them as Independent Contractors? Is this legal?
• If and when the DNAP CRNA achieves opt-out in every state what is your back-up plan?

The latter six are great stuff, but it's more a "business of anesthesia" set of issues. As for the two under the politics header, I can all-too-easily imagine a tremendous amount of inconsistency, opinion, and anecdote-driven assertion in a class created to "teach" these issues. Which is not to say it's unimportant to discuss them, just that I'm skeptical that a mandatory class is the appropriate forum.

So, yes to a required class on the business & legal issues; no to a required class on whatever it is you're pretty sure the AANA is up to and what you think I ought to do to thwart their dastardly deeds.

And please note, that I'm absolutely with you in believing that the AANA is in fact up to no good and I'm all ears for hearing what you think I should do to oppose their half-educated ambitions. May their oily hides be acne-ridden, and may their forked tongues get burnt by too-hot pizza sauce.

 

[BLADEMDA]

Not Politics:

• Is supervision of ten CRNAs legal?
• Does it affect your billing/collection?
• Can you legally "supervise" from home and still collect your money?
• Should you be a 1099 Independent Contractor or W-2 employee?
• In what settings should you employ your CRNA/AA vs. pay them as Independent Contractors? Is this legal?
• If and when the DNAP CRNA achieves opt-out in every state what is your back-up plan?

Let us review/ When we have politics then we sometimes get LAW/Policy.
This happened in the late 1990's when Medicare cut Medical Direction from 150% per CRNA to 100%. Business? No. Politics. So, in the past you were PAID to "direct" 4 CRNAs and had every incentive to do it. The AANA lobbied to do away with that incentive. In addition, a CRNA is under no obligation to follow even one rule of TEFRA. This means a CRNA can bill in his/her name and collect the exact same fee as you do from Medicare. Supervision doesn't result in one additional cent. Politics? You betcha.

Politics determines TAX Policy which affects your business. This means Independent Contractor laws are greatly influed by politics. CRNAS know these laws and use them to establish their own companies and Groups to COMPETE for contracts.

DNAP CRNA "opt-out" is business? Absolutely not. This is Anesthesia Politics 100% and will affect your practice. How does it do so? Currently, the vast majority of states are non-opt-out. The AANA wants to change that very badly.

 

[DoctorPardi]

I think the problem is that you have an opinion that you believe in very strongly and you are assuming all other Anesthesiologists if given an opportunity would agree as well.

I have known a lot of anesthesiologists who are very happy to have CRNAs around. Maybe they are short sighted? Maybe they haven't been given all of the information? That's not my point. I don't intend to argue CRNA vs MD in the least.

My point is that your desire is to mandate a class with content that is up for debate and very political as some others have mentioned.

I wouldn't be opposed to a class about the politics of anesthesia if it was somehow taught from an unbiased perspective. MD's should be intelligent enough to make up their own minds if presented with the issues from both sides.

 

[BLADEMDA]

that's sparked one of the harshest turf battles in medicine.
The question is: have anesthesiologists advanced their science so far that they are no longer needed? Can it now be turned over to an army of Certified Registered Nurse Anesthetists, who will work for about a quarter the salary?
"It's a political turf battle,

 

[BLADEMDA]

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

 

[ProRealDoc]

I think the problem is that you have an opinion that you believe in very strongly and you are assuming all other Anesthesiologists if given an opportunity would agree as well.

I have known a lot of anesthesiologists who are very happy to have CRNAs around. Maybe they are short sighted? Maybe they haven't been given all of the information? That's not my point. I don't intend to argue CRNA vs MD in the least.

My point is that your desire is to mandate a class with content that is up for debate and very political as some others have mentioned.

I wouldn't be opposed to a class about the politics of anesthesia if it was somehow taught from an unbiased perspective. MD's should be intelligent enough to make up their own minds if presented with the issues from both sides.

You bring up some good, albeit idealistic points. The problem with medicine at large and anesthesiologists is the "me-first" attitude. This is a reflection of our societal views and principles.

When individuals in our ranks put themselves above the need to protect the specialty, you are opening the door to trouble. As you stated, there are many anesthesiologists who are happy to have CRNAs around. I would like to know whether the same individuals would still feel this way if they were fired and replaced with CRNAs.

Clearly, some do/say it out of ignorance of the facts, but it still does not make it right. Allowing rampant destruction of our specialty for the sole financial benefit of a few or because some of our brethren refuse to desist from practices that are bringing us closer and closer to the edge of the abyss, requires that new generations of trainees be educated in a consistent and compulsory manner about the issues.

The specialty belongs to all its members and we cannot allow a few feeble, lazy, uninformed or greedy souls to destroy it.

 

[AK_MD2BE]

The specialty belongs to all its members and we cannot allow a few feeble, lazy, uninformed or greedy souls to destroy it.[/QUOTE]

I am afraid that we may be too late.

 

[lvspro]

Wow
I thought it was standard at all programs, but our program gets 2-4 hrs of lecture on this very topic, as well as how to move into the political realm if one so chooses. I like this lecture b/c it gives us a type of "state of the union" address, as well gets the newbies involved.
The fact that not everyone gets this isthumbdown

Anyone going into this specialty needs to understand the stances of the major players, and how we got into the position we are in now.
Just my 2pence

 

[QofQuimica]

Excuse me? What objections do you have about spending a few hours learning about Nurse Anesthesia Practice in the USA? The point behind the POLITICS Course would be to explain the AANA agenda, Legal Practice Rights of CRNAs, Billing Equality of CRNA, etc. Most MDs at the end of the course should be enlightened as to what the specialty faces against the most militant Nursing Union in existence.

A few like you might decide that the AANA agenda and Independent CRNA is indeed the future of U.S. Anesthesia. Fine. Please feel free to donate to the AANA PAC. It is your right in this Country.

Blade

See below.

Q of Q...I don't think the topics of this forum are as much "anti-CRNA" as much as they are pro-anesthesiologist.
My major impression of the topics presented here suggest that most attendings believe that the ACT model is the best way to administer anesthesia. If that means that people on this forum are "anti-CRNA" to the point that they do not believe that CRNA's should be able to practice independently...well, I am with them.

Being "pro-anesthesiologist" is not how these discussion always come across, and I'd even go so far as to say they *often* don't come across that way. What good is a "political debate" if it attacks a straw man and is blatantly loaded so as to assure a guaranteed outcome? And if there's nothing to debate (i.e., CRNA = epitome of evil), why should we not take this idea to its logical conclusion? That is, why should we tolerate the existence of CRNAs at all? Why shouldn't we be working to outlaw CRNAs altogether? I don't think very many people would be willing to support such an extreme position, even if it were politically realistic to do so. What you've proposed (i.e., a discussion of the proper venue of CRNAs, which you seem to be suggesting is working under anesthesiologists rather than independently) is perfectly reasonable. I would agree with you. That did not appear to be the proposal for the class as outlined above. If I want to be "enlightened," I'll go get a freaking guru.

Well, what propaganda lectures are in place currently? Listen, I voted to have a class but make it voluntary, and it's strictly the libertarian in me that forced such a vote. The fact is though, I'm forced to listen to lectures on benefits, moonlighting, ID badges, confidentiality, and a load of other mess, and given the choice I'd appreciate a lecture on the politics of the field I'm investing my career in.

You've listed a nice number of them. Besides many of those, handwashing was another nuisance lecture. To be fair, it's an important topic. I just don't think an entire two hours had to be devoted to learning about its importance. I'm already OCD enough about avoiding microbes without it. Moving on to more "political" issues, I've had multiple one-sided lectures on the bright and upcoming future of universal health care (and even had one physician give me grief over refusing to fill out a goddamn voter's registration card for a state I'm not even a resident of). Oh, but my personal favorites of these required lectures are the ones deploring the evil of Big Pharma. I assure you that I don't go saying that I would consider working for Big Pharma too loudly around here.

Medicine has been passive far too long, so facing the facts and confronting a difficult future with an honest lecture on what we'll face politically should be anything but forced. It should be welcomed with open arms by every single anesthesiology resident across the country.

As others like pgg have already said more eloquently than I, the nature of these "facts" and "honesty" are certainly up for debate.

Also, as others have said, you need to understand the difference between pro-anesthesiologist and anti-CRNA.

You know, I'm a native speaker of English, and I dare say I have a pretty decent grasp of the language. Calling a position "pro-anesthesiologist" when it's actually "anti-CRNA" does not make it so. As my grandpa used to say, you can put earrings on a pig, but it's still a pig.

The same objections I'd have to spending a few hours of my residency "learning" about the Democrat (or Republican) agenda for health care. The content and tone of such a course would be wildly variable depending on who's teaching it.....And for someone who's supposedly trying to recruit people to fight the good fight, there's nothing like taking the offensive and attacking me.

I'm so turned off of this "fight" from reading SDN that I just roll my eyes and move on to a new thread every time I see another one about it. The only reason why this thread got my attention is that I strenuously object to being proselytized by people with an agenda.

Just because I'm not blindly marching lockstep with you, eagerly lapping up everything you're trying to spoonfeed this forum, doesn't mean I don't agree with much of what you say. You're acting far too much like a zealous fanatic - anyone who isn't 100% in agreement with you is the enemy.

I'm not your enemy, and I'm not an enemy of your cause. I'm simply opposed to yet another vague, pointless time sink, which is what your idea sounds like to me.

This is exactly where I'm coming from. Thank you for stating it more clearly than I did.