The ASA is asking for your help....

[bchang74]

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Hello Everybody:

I got this e-mail from the president of the Missouri Society of Anesthesiologists, please read it, and follow the embedded link.

To those of you who are not able to read the entire message, here is a synopsis:

1. CMS (medicare) currently only reimburses physicians supervising residents 50% of what we bill for (i.e., medicare essentially gets 2 cases for the price of 1).

2. The ASA had been working for the past 3 years to correct this.

3. The AANA (amer. asscn nurse anesthestists) has lobbied against this, because they would like this disincentive for training residents to continue.

Anyway...here is the letter....if you have a few minutes, please send follow the link and write a letter to CMS.
*************

Urgent Email Communication from the MSA President
Dear MSA member:
The medical specialty of Anesthesiology is under attack and we need your help!
We have received an urgent communication from ASA leadership regarding their work over the past 3 years to correct the current inequity in reimbursement for teaching anesthesiology residents.
Use this link www.asahq.org/news/cmsproposal082405.htm to go to the ASA home page Action Alert on the anesthesiology teaching payment rule. The Action Alert will provide you a direct link to the easy to use CMS e-comment page and to our CAP WIZ page. A sample letter and bullet points are available on these sites to help you craft your message.
Currently teaching anesthesiologists are penalized by Medicare for supervising anesthesiology residents. The ASA has worked hard to correct this and had been on the verge on correcting this by Federal Rule.
The ASA learned just last month that the AANA has been working diligently through their political action committee to stop the correction in reimbursement for teaching anesthesiology residents sought by the ASA. The AANA recognizes that the current underpayment works as a disincentive to train anesthesiology residents. They do not want it corrected and have spent a great deal of energy to stop it.
The AANA lobby effort against anesthesiology teaching programs is full of the same rhetoric that was thrown around Washington a few years ago during the Medicare CRNA independent practice debate. The AANA believes strongly that there is no difference in anesthesiologists and CRNAs, except that it cost a lot more to educate anesthesiologists.
The ASA leadership is furious that the AANA worked behind their back to fight the ASA led effort to help anesthesiology teaching programs, despite the AANA promise to not oppose this effort.
There have been significant efforts to reach out to the AANA in Washington and the chapter here in Missouri. We have learned a great lesson. In the mean time we my work to counter the surprise attack against this important rule change. Please clink on the link below to help in our effort to save academic anesthesiology and residency training programs:
www.asahq.org/news/cmsproposal082405.htm
Sincerely,
John Menius, MD
MSA President

 

[lvspro]

OMG. Time to start playing catch-up b/c while we were sleeping the aana was slippin' it to us.

Can medical students get in on the action? This really underscores the fact that the ASA needs to constantly be on the move as opposed to reacting to jabs from the aana.

 

[jwk]

OMG. Time to start playing catch-up b/c while we were sleeping the aana was slippin' it to us.

Can medical students get in on the action? This really underscores the fact that the ASA needs to constantly be on the move as opposed to reacting to jabs from the aana.

Anyone can submit comments regarding this issue.

And do you really think the ASA has not been aware of this issue? It has been very well publicized within the ASA.

 

[UTSouthwestern]

Posted about twice previously, but still a good topic to keep up:

http://forums.studentdoctor.net/showthread.php?t=223491
http://forums.studentdoctor.net/showthread.php?t=224682

 

[MD Dreams]

Why is the aana against this? What do they have to gain from it?

 

[UTSouthwestern]

Why is the aana against this? What do they have to gain from it?

Getting reimbursed for two cases with residents instead of just one makes residents more financially viable in cash strapped hospitals. In other words, POTENTIALLY less jobs for CRNA's.

 

[toughlife]

Hello Everybody:
The AANA lobby effort against anesthesiology teaching programs is full of the same rhetoric that was thrown around Washington a few years ago during the Medicare CRNA independent practice debate. The AANA believes strongly that there is no difference in anesthesiologists and CRNAs, except that it cost a lot more to educate anesthesiologists.
The ASA leadership is furious that the AANA worked behind their back to fight the ASA led effort to help anesthesiology teaching programs, despite the AANA promise to not oppose this effort.

No surprise there at all. I sent my letter three weeks ago. We need other students to do the same. Hire AAs instead of CRNAs to teach the beotches a lesson.

 

[cfdavid]

No surprise there at all. I sent my letter three weeks ago. We need other students to do the same. Hire AAs instead of CRNAs to teach the beotches a lesson.

That's the exact action that should be done here. You guys need to get serious about promoting AA's (not over CRNA's, but simply promoting AA's)

But AA's won't be able to help if they aren't able to attain licensure at that particular state. So, perhaps a joining of forces is in order? I'm just a lowly pre-med, so what do I know. But, I am stayin in a HolidayInn Express tonight!! (have an AZCOM interview in the a.m)

Good luck with this issue. I'd like to follow it as it evolves.

 

[jwk]

That's the exact action that should be done here. You guys need to get serious about promoting AA's (not over CRNA's, but simply promoting AA's)

But AA's won't be able to help if they aren't able to attain licensure at that particular state. So, perhaps a joining of forces is in order? I'm just a lowly pre-med, so what do I know. But, I am stayin in a HolidayInn Express tonight!! (have an AZCOM interview in the a.m)

Good luck with this issue. I'd like to follow it as it evolves.

Why thank you! We AA's will take all the promotion we can get. 😉

 

[etherRN]

CMS (medicare) currently only reimburses physicians supervising residents 50% of what we bill for (i.e., medicare essentially gets 2 cases for the price of 1).

Has this always been the standard?

 

[jwk]

CMS (medicare) currently only reimburses physicians supervising residents 50% of what we bill for (i.e., medicare essentially gets 2 cases for the price of 1).

The inequity here is that surgery residents can be covered 1:4 with their attendings, while anesthesia residents can only be covered 1:2. Anesthesiology simply wants to be covered and compensated in the same equitable manner.

 

[Disse]

The inequity here is that surgery residents can be covered 1:4 with their attendings, while anesthesia residents can only be covered 1:2. Anesthesiology simply wants to be covered and compensated in the same equitable manner.

Actually, surgeons can get reimbursed for 2 rooms as long as the "key/critical" portions of the cases do not overlap (i.e. surgeon and resident work in room 1 while resident starts or finishes cases in room 2).

HOWEVER, the anesthesiologist supervising the anesthesia residents in those two rooms will only be reimbursed at 50%.

The 1:4 ratio refers to internal medicine and other such specialties who can oversee 4 residents performing clinic duties (but not for procedures).

This effort by the AANA, to me, reveals that they have absolutely no interest in cordial relations with the ASA. To actively lobby AGAINST a proposal that really has ABSOLUTELY no relevance to their profession at all other than perceived competition down the line sickens me. This isn't about "autonomy" or "outcomes"--it is simply an attempt to maintain a regulation that hamstrings the ability of academic programs to function.

Previously before hearing about this lobbying effort I had mostly positive things to say about CRNA's. At my program we have always had an excellent working environment with them. However, I now realize that the AANA has no interest in any sort of relationship with anesthesiologists in general--to them, we are all the enemy and, apparently, they will do anything to hurt our profession.

 

[jwk]

Actually, surgeons can get reimbursed for 2 rooms as long as the "key/critical" portions of the cases do not overlap (i.e. surgeon and resident work in room 1 while resident starts or finishes cases in room 2).

HOWEVER, the anesthesiologist supervising the anesthesia residents in those two rooms will only be reimbursed at 50%.

The 1:4 ratio refers to internal medicine and other such specialties who can oversee 4 residents performing clinic duties (but not for procedures).

My bad. But the surgeons get full fee, right? They're getting two full fees for essentially concurrent surgery while anesthesiology only collects 50% on each.

 

[Disse]

My bad. But the surgeons get full fee, right? They're getting two full fees for essentially concurrent surgery while anesthesiology only collects 50% on each.

Yep...even if those two surgical cases only overlap by 1 minute the anesthesiologist will only get reimbursed 50%.

 

[toughlife]

Has this always been the standard?

This person is a CRNA. Go away you hypocrite evil doer.

 

[etherRN]

This person is a CRNA. Go away you evil doer.

No, I'm not a CRNA, student. And no.

Haha! You edited your post, silly.

 

[toughlife]

No, I'm not a CRNA, student. And no.

"Hi, I'm a moderator on allnurses.com CRNA board"

you are the competition so why should we welcome you?

 

[toughlife]

No, I'm not a CRNA, student. And no.

Haha! You edited your post, silly.

I had to use a word more befitting of those who pretend to "want to learn" about anesthesiology by coming in here and asking questions, and yet, support the same organization (AANA) that is trying to destroy anesthesiology.

 

[etherRN]

You are making assumptions and personally attacking me with no merit. Last week I wrote to ASA Secretary Bob Wallace to ask if I could join. Primarily, I like to read the journals, but I like to learn about both sides (and was willing to pay money to ASA). I was interested in an educational membership. I'm not your competition. Haven't even been admitted yet. Why not play fair and read the rest of my profile to the others. Especially the part where it says "interested in candid dialogue about anesthesia."

Whatever professional organizations dictate to us does not mean that we must assent. Case in point.

And sorry about being sarcastic earlier. I want to be accepted by this forum without covertly choosing a screename, or ceasing to point out who I really am.

 

[toughlife]

You are making assumptions and personally attacking me with no merit. Last week I wrote to ASA Secretary Bob Wallace to ask if I could join. Primarily, I like to read the journals, but I like to learn about both sides (and was willing to pay money to ASA). I was interested in an educational membership. I'm not your competition. Haven't even been admitted yet. Why not play fair and read the rest of my profile to the others. Especially the part where it says "interested in candid dialogue about anesthesia."

Whatever professional organizations dictate to us does not mean that we must assent. Case in point.

And sorry about being sarcastic earlier. I want to be accepted by this forum without covertly choosing a screename, or ceasing to point out who I really am.

I will accept your apology if you promise to call 1-800-FUK-CRNA and leave a message stating how much CRNAs suck.

 

[Gimlet]

Alright now folks, let's play nice or Venty will be forced to close the thread.

 

[etherRN]

In the words of Vent, "TL, you are forcing me to read your peevish babble after having placed you on my ignore list. This is something I'd rather avoid doing if possible as it is quite exasperating.

For the curious and interested, the ignore function can be found in "User CP" (at the top o' your screen) under the 'Miscellaneous' tab. Use it."

I will.

 

[jetproppilot]

I will accept your apology if you promise to call 1-800-FUK-CRNA and leave a message stating how much CRNAs suck.

Alright Tough, ya gotta back off, bro. Yours was an unprovoked attack. I reread dude/dudettes post and there was no means for attack.

Back down, Lieutenant.

 

[toughlife]

Alright Tough, ya gotta back off, bro. Yours was an unprovoked attack. I reread dude/dudettes post and there was no means for attack.

Back down, Lieutenant.

Aight chief.

 

[OldManDave]

Alright Tough, ya gotta back off, bro. Yours was an unprovoked attack. I reread dude/dudettes post and there was no means for attack.

Back down, Lieutenant.

If I may officially echo JetProp's post - you're outta line my friend. Like it or not, EtherRN has just as much right to be here & participate as you do. The medical professional world would do so much better if we minimized all the internal squabble. Believe me, out here in the real world we have much larger threats to worry about than CRNA vs MD/DO anesth...or MD vs DO for that matter.

Long & short of it - play nicely! If you cannot be nice, just don't interact with EtherRN. These are basic people skills that we will all need to master to be successful professionals...and if you can't, Vent or I will have to stick you in time out. 😱

Thanks to everyone for their patience & understanding by not allowing this thread to turn into a mud-slinging festival!

 

[toughlife]

Believe me, out here in the real world we have much larger threats to worry about than CRNA vs MD/DO anesth...or MD vs DO for that matter.QUOTE]

Why don't you tell us about it?

 

[jetproppilot]

If I may officially echo JetProp's post - you're outta line my friend. Like it or not, EtherRN has just as much right to be here & participate as you do. The medical professional world would do so much better if we minimized all the internal squabble. Believe me, out here in the real world we have much larger threats to worry about than CRNA vs MD/DO anesth...or MD vs DO for that matter.

Long & short of it - play nicely! If you cannot be nice, just don't interact with EtherRN. These are basic people skills that we will all need to master to be successful professionals...and if you can't, Vent or I will have to stick you in time out. 😱

Thanks to everyone for their patience & understanding by not allowing this thread to turn into a mud-slinging festival!

I feel compelled to respond, Old.
This is a pretty self-regulating board with very few problems. Periodically, however, antagonism does arise in the form of some of us (me included) feeling like we have to defend our turf....with turf meaning the SDN, where people in the anesthesia world come to interact. Occasionally a poster will pop up with obvious ulterior motives, and in that scenerio, I'm locked-and-loaded. I'm not gonna put an ulterior-motive-poster on ignore. They're gonna hear from me.

That being said, yeah, Toughlife jumped the gun on this one, but as you can see he ceased-fire when asked. So IMHO your "official reprimand" was unnecessary.

Had this been a true "threat", however, I would've commenced support-fire. So I don't think its possible to play "nice" all the time. I agree this wasnt one of those times.

 

[Disse]

If I may officially echo JetProp's post - you're outta line my friend. Like it or not, EtherRN has just as much right to be here & participate as you do. The medical professional world would do so much better if we minimized all the internal squabble. Believe me, out here in the real world we have much larger threats to worry about than CRNA vs MD/DO anesth...or MD vs DO for that matter....

Just to reinforce that this thread is regarding a very large threat that ALL anesthesiologists need to worry about. Just because physicians and CRNA's at your place of business (like mine) may have a good relationship the AANA (which by and large most CRNA's support either directly or indirectly through membership fees) has decided to actively attack the ASA regarding funding for training--an issue that has no DIRECT impact on them.

It is in all our best interests realize this and support "our" political arm.

The deadline for comments to CMS regarding this policy is tomorrow (Sept. 30th). Please everyone do your part to support & protect our profession.

 

[jetproppilot]

Just to reinforce that this thread is regarding a very large threat that ALL anesthesiologists need to worry about. Just because physicians and CRNA's at your place of business (like mine) may have a good relationship the AANA (which by and large most CRNA's support either directly or indirectly through membership fees) has decided to actively attack the ASA regarding funding for training--an issue that has no DIRECT impact on them.

It is in all our best interests realize this and support "our" political arm.

The deadline for comments to CMS regarding this policy is tomorrow (Sept. 30th). Please everyone do your part to support & protect our profession.

Yes, this is an issue. But at least in the private world, there is a way around the constant worry of the one-anesthesiologist-to-4-crna-reimbursement-rule.

The powers-at-be wanna play hardball? Thats OK. We're just as smart as they are.

 

[nitecap]

Is it just this states particular association or the entire AANA. Though portions of AANA membership funding go to state associations the state association has their own leadership and is not controlled by the aana at all. What is on one states agenda may not be on anothers and may or may not be supported by the aana as a whole. The state associations are there to specifically handle local state issues. Sometimes their agenda is backed and futher funded by the aana and sometimes not. This is the first I hear of this and I believe it may be going a little to far. Its not like every hospital in the country can open an anesthesia residency just to not pay CRNA's, so I think it would effect us little in rural areas where we predominently practice anyway.

Though the AANA and ASA always have issues, dont think it is the agenda of the entire AANA to lobby against this bill.

 

[UTSouthwestern]

Is it just this states particular association or the entire AANA. Though portions of AANA membership funding go to state associations the state association has their own leadership and is not controlled by the aana at all. What is on one states agenda may not be on anothers and may or may not be supported by the aana as a whole. The state associations are there to specifically handle local state issues. Sometimes their agenda is backed and futher funded by the aana and sometimes not. This is the first I hear of this and I believe it may be going a little to far. Its not like every hospital in the country can open an anesthesia residency just to not pay CRNA's, so I think it would effect us little in rural areas where we predominently practice anyway.

Though the AANA and ASA always have issues, dont think it is the agenda of the entire AANA to lobby against this bill.

Unfortunately, it is the entire AANA and that has driven a major spike into the relationship between the ASA and AANA. There is simply no reason for the AANA to lobby against this issue and it just goes toward souring relationships between the two organizations and its memberships.

 

[nitecap]

dont tell my heart, my achy breaky hrt

 

[etherRN]

I myself do not support this particular state organizations direction, though I have not heard their side, nor the complete ASA side. ALL I know is what has been posted on this board.

Me too. I searched AANA and couldn't find anything.

 

[UTSouthwestern]

This isn't something that the AANA wants to proudly and vociferously espouse publicly. They know that this is a divisive issue that can only be construed as anti-physician when at the same time they are trying to put on a show of good will toward the ASA.

The unfortunate part of all of this is that in direct contrast to what they think will happen (less jobs/training opportunities for CRNA's/SRNA's), more income to cash strapped departments would actually allow the departments to bring in MORE CRNA's to help with ridiculous work loads. SRNA presence in these departments would not be reduced because they are already factored into the work load and aren't paid to begin with.

For example, if Parkland's anesthesia department could double the amount of money it takes in on supervised cases with residents, they would use that money to expand the total number of CRNA hours to help with coverage issues, weekend coverage issues, and most of all resident relief to attend educational conferences. More equipment could be brought in which would be used by both physician and nurse anesthesthetists. Pay for both physicians and CRNA's would both likely increase with that influx as well.

To argue that more income would mean less educational opportunities for SRNA's just doesn't hold water.

For the nurse anesthetists here, you should e-mail the AANA and ask them why they are trying to scuttle the legislation and what purpose do they think it will accomplish.

 

[maturner]

The AANA is not opposed to changing the repayment rules.

THe AANA is opposed to changing the repayment of residents to 100% for two simultaneous cases while leaving the reimbursement for SRNAs at the current 50% for the same two cases.

This in turn would potentially disincline clinical sites to accept SRNA students, when they could make double the money with Anesthesiology residents. Therefore potentially negatively impacting Nurse anesthesia schools and the training of nurse anesthetists.

The AANA agrees with the need for a change in reimbursement schedules but wants the reimbursement for SRNAs and Residents to be the SAME. Where attending anesthesiologists get reimbursed 100% whether an SRNA or resident is doing the case!

Why is the ASA trying to push the changes through without changes to the SRNA reimbursement schedule? Why not make the changes together alongside with the AANA?

I am not trying to bash the ASA, but WHY the push for a U N I L A T E R A L change?

Afterall, Changing BOTH Schedules is good for attending anesthesiologists and hospitals alike!

Thanks for reading

 

[toughlife]

The AANA is not opposed to changing the repayment rules.

THe AANA is opposed to changing the repayment of residents to 100% for two simultaneous cases while leaving the reimbursement for SRNAs at the current 50% for the same two cases.

Is the AANA lobbying to have this rule changed or is it just deliberately opposing any measures supported by the ASA?

This in turn would potentially disincline clinical sites to accept SRNA students, when they could make double the money with Anesthesiology residents. Therefore potentially negatively impacting Nurse anesthesia schools and the training of nurse anesthetists.

The AANA agrees with the need for a change in reimbursement schedules but wants the reimbursement for SRNAs and Residents to be the SAME. Where attending anesthesiologists get reimbursed 100% whether an SRNA or resident is doing the case!


Why is the ASA trying to push the changes through without changes to the SRNA reimbursement schedule? Why not make the changes together alongside with the AANA?

It is not the ASA's job to do the AANA's job. I could understand the AANA's position if the ASA was deliberately boycotting any attempts for full reimbursement on SRNA-run cases but is it?

I am not trying to bash the ASA, but WHY the push for a U N I L A T E R A L change?

Because the ASA is an organization that supports residents and physician anesthesiologists not nurses. Is that a surprise?

Afterall, Changing BOTH Schedules is good for attending anesthesiologists and hospitals alike!

Thanks for reading

Is the ASA opposed to allowing 100% reimbursement for SRNA-run cases? If so, then I would understand the AANA's interest in opposing full reimbursement in resident-run cases. Or is the AANA expecting the ASA to do all the leg work and get a free ride?

 

[maturner]

Is the ASA opposed to allowing 100% reimbursement for SRNA-run cases? If so, then I would understand the AANA's interest in opposing full reimbursement in resident-run cases. Or is the AANA expecting the ASA to do all the leg work and get a free ride?

By working for a unilateral change, apparently the ASA is opposed to 100% reimbursement for SRNA cases. WHy? You tell me. The AANAs position has been to work together and change the rules for both party's.

"Is the AANA lobbying to have this rule changed or is it just deliberately opposing any measures supported by the ASA?"

The AANA is for the rule change, so long as it is not unilateral.

The AANA stated their position in writing to the ASA during the "Thought bridge" meetings last spring regarding this issue. Their position was essentially, we will not support a unilateral change, but lets work together to change the reimbursements for both types of anesthesia students which is in the interest of both party's.

The AANAs position on the statemaent has not changed, the ASA is pushing their own agenda and refusing to work together. Why refuse to work together?

"It is not the ASA's job to do the AANA's job. I could understand the AANA's position if the ASA was deliberately boycotting any attempts for full reimbursement on SRNA-run cases but is it?"

Again, You tell me... The appearance is that the ASA does oppose equal reimbursement by refusing to work together. If the agenda is the same, why not unite both forces and work together?

The AANAs position has been lets do it together in both our interests. Instead of working together the ASA is insisting on doing it their way, in their own interest. Being that the AANAs members are the ones potentially hurt by a unilateral change it should be obvious as to why they oppose the legislation.

"Because the ASA is an organization that supports residents and physician anesthesiologists not nurses. Is that a surprise?

Same for the AANA with regards to CRNAs and SRNAs. The point being, the change is in the interestof both party's. Why not work together? ...unless there is some other agenda...

 

[toughlife]

By working for a unilateral change, apparently the ASA is opposed to 100% reimbursement for SRNA cases. WHy? You tell me. The AANAs position has been to work together and change the rules for both party's.

The AANA is for the rule change, so long as it is not unilateral. For the second time, is the ASA actively opposing equal reimbursement by requesting that SRNA-run cases not be reimbursed equally??


The AANAs position on the statement has not changed, the ASA is pushing their own agenda and refusing to work together. Why refuse to work together?

Wy do we have to work together? Why not say.. ok ASA you go and ask the CMS dudes to change the reimbursement rules and we will do the same"

Again, You tell me... The appearance is that the ASA does oppose equal reimbursement by refusing to work together. If the agenda is the same, why not unite both forces and work together?

The AANAs position has been lets do it together in both our interests. Instead of working together the ASA is insisting on doing it their way, in their own interest. Being that the AANAs members are the ones potentially hurt by a unilateral change it should be obvious as to why they oppose the legislation.

Same for the AANA with regards to CRNAs and SRNAs. The point being, the change is in the interest of both party's. Why not work together? Does working together mean my dues and donations to the ASA are supposed to be looking out for your kind as well as mine? ...unless there is some other agenda...

As long as the ASA is not actively blocking any efforts for equal reimbursements, your argument doesn't hold water. What you should be doing is calling the AANA and asking them why don't they go directly to the source and ask that they also be reimbursed equally for their cases

The AANA stated their position in writing to the ASA during the "Thought bridge" meetings last spring regarding this issue. Their position was essentially, we will not support a unilateral change, but lets work together to change the reimbursements for both types of anesthesia students which is in the interest of both party's.

I don't pay/donate money to the ASA to be pandering to CRNAs. What your organization is trying to do is benefit from the ASA's lobbying efforts and trying to derive a benefit that they feel they are entitled (i.e., equal reimbursement for your brethren, without making the effort and going directly to those who can help them.

Why does the AANA expect the ASA to do it for them or with them?? Are they incapable of doing it themselves that they feel the need to block any measure designed to receive appropriate and fair reimbursement of attending physicians for supervising residents?

Your organization's approach is nothing but obstructionist and speaks volumes about its principles and its unscrupulous character. Further, it shows that they will go to any lengths to erode the foundation of the specialty, and endanger the viability of residency programs and its future.

 

[jwk]

By working for a unilateral change, apparently the ASA is opposed to 100% reimbursement for SRNA cases. WHy? You tell me. The AANAs position has been to work together and change the rules for both party's.

"Is the AANA lobbying to have this rule changed or is it just deliberately opposing any measures supported by the ASA?"

The AANA is for the rule change, so long as it is not unilateral.

The AANA stated their position in writing to the ASA during the "Thought bridge" meetings last spring regarding this issue. Their position was essentially, we will not support a unilateral change, but lets work together to change the reimbursements for both types of anesthesia students which is in the interest of both party's.

The AANAs position on the statemaent has not changed, the ASA is pushing their own agenda and refusing to work together. Why refuse to work together?

"It is not the ASA's job to do the AANA's job. I could understand the AANA's position if the ASA was deliberately boycotting any attempts for full reimbursement on SRNA-run cases but is it?"

Again, You tell me... The appearance is that the ASA does oppose equal reimbursement by refusing to work together. If the agenda is the same, why not unite both forces and work together?

The AANAs position has been lets do it together in both our interests. Instead of working together the ASA is insisting on doing it their way, in their own interest. Being that the AANAs members are the ones potentially hurt by a unilateral change it should be obvious as to why they oppose the legislation.

"Because the ASA is an organization that supports residents and physician anesthesiologists not nurses. Is that a surprise?

Same for the AANA with regards to CRNAs and SRNAs. The point being, the change is in the interestof both party's. Why not work together? ...unless there is some other agenda...

Well said by toughlife on this one.

And as previously mentioned - anesthesia residencies are looking for some parity with reimbursements with other specialty residencies. It's not an issue that even involves CRNA reimbursement - that was never the intent.

Many people, myself included, think the ThoughtBridge process is pretty much a joke. Way too touchy-feely, let's all just get along kind of crap. And just because the AANA mentions their own reimbursement issues during this process doesn't mean the ASA is going to jump on board. Of course you then make the assumption that the ASA isn't cooperating with the AANA.

 

[UTSouthwestern]

By working for a unilateral change, apparently the ASA is opposed to 100% reimbursement for SRNA cases. WHy? You tell me. The AANAs position has been to work together and change the rules for both party's.

"Is the AANA lobbying to have this rule changed or is it just deliberately opposing any measures supported by the ASA?"

The AANA is for the rule change, so long as it is not unilateral.

The AANA stated their position in writing to the ASA during the "Thought bridge" meetings last spring regarding this issue. Their position was essentially, we will not support a unilateral change, but lets work together to change the reimbursements for both types of anesthesia students which is in the interest of both party's.

The AANAs position on the statemaent has not changed, the ASA is pushing their own agenda and refusing to work together. Why refuse to work together?

"It is not the ASA's job to do the AANA's job. I could understand the AANA's position if the ASA was deliberately boycotting any attempts for full reimbursement on SRNA-run cases but is it?"

Again, You tell me... The appearance is that the ASA does oppose equal reimbursement by refusing to work together. If the agenda is the same, why not unite both forces and work together?

The AANAs position has been lets do it together in both our interests. Instead of working together the ASA is insisting on doing it their way, in their own interest. Being that the AANAs members are the ones potentially hurt by a unilateral change it should be obvious as to why they oppose the legislation.

"Because the ASA is an organization that supports residents and physician anesthesiologists not nurses. Is that a surprise?

Same for the AANA with regards to CRNAs and SRNAs. The point being, the change is in the interestof both party's. Why not work together? ...unless there is some other agenda...

CMS specifically narrowed the reimbursement issue to resident physicians because it did not consider midlevel provider education in ANY field in this policy review. There was no support for doubling SRNA reimbursement because there was NO PROVISION IN THE ORIGINAL CMS GUIDELINES OR THE RESPONSE as this was a CMS determined physician issue and applies solely to physicians in this legislation.

Once again, let me review the shortsightedness of the AANA:

A doubling of physician resident reimbursement does not suddenly make it unattractive to train SRNA's. Each program has ACGME limits to the number of resident physicians it can train based on its ability to provide time for educational efforts, ability to limit total training time each week, and adequate case numbers, in particular subspecialty case numbers. A program has to apply to expand its class sizes but only gets reviewed for expansion/contraction every 2-4 years and only by 1-5 residents per class, NOT 100%. There are currently NO LIMITS on the number of SRNA's that a program can enroll to train and help with work issues.

Programs that have a significant number of SRNA's cannot suddenly replace all of that man (and woman) power with a resident pool that isn't as readily available as the AANA thinks, and if it were to try, it is likely that the CRNA's there would walk out in protest, leaving an academic program with even more shortages to deal with. Academics want to be academics and not have to run their own cases all day and all night and both physicians and nurses work to help the hospital, each other, and the academic physicians whose work allows our field to continue to evolve and refine itself.

IF the AANA wanted to espouse the SRNA reimbursement issue in earnest, it could have joined forces with the ASA, jointly espoused the need for fair reimbursement of physician resident training cases, hoped for a revision to the CMS policy for physicians, then pushed for SRNA reimbursement equality with the ASA side by side with the precedent already set in CMS policy for physician residents. A win-win situation for academic programs and the AANA, especially for programs that cannot meet ACGME training standards, but still train SRNA's as well as programs with dual training programs.

This was what the ASA had thought was agreed to since CMS would only review the physician training aspect of each specialty's reimbursement schedule. The AANA wanted to expand the issue to include SRNA's, but that additional package would have made it LESS appealing to CMS to alter the policy just by looking at how much more it would cost Medicare/Medicaid. What the ASA did not expect was a behind the doors attempt to subvert their efforts. In the worst, WORST case scenario for the AANA, the ASA would achieve its goal of doubling resident reimbursement, CMS refuses to reconsider SRNA reimbursement schedules, and the AANA could then go to court to argue that since SRNA's participate to the same degree in cases on rotations with physician residents, they are being unfairly discriminated against by CMS. This would force CMS to revise the SRNA reimbursement policy, with a precedent already set, and not knock physician resident reimbursement down to 50%, because the threat would then exist that the ASA would likewise file suit for discriminatory practice for its physicians in training compared to other specialties.

Why do we not just go to court now? We are trying to stay in good standing with CMS and not develop an acrimonious relationship that would lean CMS away from other anesthesiology related issues. Other specialties have a low threshhold for litigation and it has made CMS less pliable to their issues.

This isn't rocket science. This was discussed over and over by ASA and AANA reps and if the AANA decided to travel their own route to support its trainees and not support the ASA's residents, there was no need to try to sabotage the ASA's efforts. The general feeling I get from academic program reps is that enough is enough. They feel that they have worked hard to make the atmosphere as unified as possible, all the while the AANA, while rightfully pushing for its membership's goals, continues to try to reduce physician training and reimbursement issues.

Instead of accomplishing its goal of making CRNA/SRNA presence more attractive, the AANA has done exactly the opposite. Class sizes are being reevaluated by every program this fall and growth in trainee numbers will be looked at on the resident side in detail. The AANA has also provided an impetus for the utilization of AA's as a more viable alternative and this would have been/will be discussed at the ASA in Atlanta. Some programs are now providing locums contracts to private practice anesthesiologists with creative financing and insurance coverage that allows the hospital to pay the anesthesiologist a minimum stipend while still making it attractive for the physician to cover cases at these academic programs and now cheaper (to the hospital) than paying a CRNA. More alternatives to CRNA/SRNA involvement are being discussed that would have never received consideration had this final line not been crossed.

This wasn't an issue that should have been pushed by the AANA. All agree that academic programs are underfunded in general and reimbursement needs to increase. In trying to halt the progress that the ASA has made over the past several years on this issue (and this effort was SOLELY initiated and funded by the ASA yet could have yielded great benefits to the AANA), the AANA took a step towards trying to find the lowest common denominator for residents and SRNA's to train under. If the AANA is successful, it will keep academic programs underfunded, understaffed, and unattractive to strong physician candidates looking at academic practice whose knowledge, research, and teaching abilities would have directly benefitted both resident and SRNA education.

 

[jwk]

CMS specifically narrowed the reimbursement issue to resident physicians because it did not consider midlevel provider education in ANY field in this policy review. There was no support for doubling SRNA reimbursement because there was NO PROVISION IN THE ORIGINAL CMS GUIDELINES OR THE RESPONSE as this was a CMS determined physician issue and applies solely to physicians in this legislation.

Once again, let me review the shortsightedness of the AANA:

A doubling of physician resident reimbursement does not suddenly make it unattractive to train SRNA's. Each program has ACGME limits to the number of resident physicians it can train based on its ability to provide time for educational efforts, ability to limit total training time each week, and adequate case numbers, in particular subspecialty case numbers. A program has to apply to expand its class sizes but only gets reviewed for expansion/contraction every 2-4 years and only by 1-5 residents per class, NOT 100%. There are currently NO LIMITS on the number of SRNA's that a program can enroll to train and help with work issues.

Programs that have a significant number of SRNA's cannot suddenly replace all of that man (and woman) power with a resident pool that isn't as readily available as the AANA thinks, and if it were to try, it is likely that the CRNA's there would walk out in protest, leaving an academic program with even more shortages to deal with. Academics want to be academics and not have to run their own cases all day and all night and both physicians and nurses work to help the hospital, each other, and the academic physicians whose work allows our field to continue to evolve and refine itself.

IF the AANA wanted to espouse the SRNA reimbursement issue in earnest, it could have joined forces with the ASA, jointly espoused the need for fair reimbursement of physician resident training cases, hoped for a revision to the CMS policy for physicians, then pushed for SRNA reimbursement equality with the ASA side by side with the precedent already set in CMS policy for physician residents. A win-win situation for academic programs and the AANA, especially for programs that cannot meet ACGME training standards, but still train SRNA's as well as programs with dual training programs.

This was what the ASA had thought was agreed to since CMS would only review the physician training aspect of each specialty's reimbursement schedule. The AANA wanted to expand the issue to include SRNA's, but that additional package would have made it LESS appealing to CMS to alter the policy just by looking at how much more it would cost Medicare/Medicaid. What the ASA did not expect was a behind the doors attempt to subvert their efforts. In the worst, WORST case scenario for the AANA, the ASA would achieve its goal of doubling resident reimbursement, CMS refuses to reconsider SRNA reimbursement schedules, and the AANA could then go to court to argue that since SRNA's participate to the same degree in cases on rotations with physician residents, they are being unfairly discriminated against by CMS. This would force CMS to revise the SRNA reimbursement policy, with a precedent already set, and not knock physician resident reimbursement down to 50%, because the threat would then exist that the ASA would likewise file suit for discriminatory practice for its physicians in training compared to other specialties.

Why do we not just go to court now? We are trying to stay in good standing with CMS and not develop an acrimonious relationship that would lean CMS away from other anesthesiology related issues. Other specialties have a low threshhold for litigation and it has made CMS less pliable to their issues.

This isn't rocket science. This was discussed over and over by ASA and AANA reps and if the AANA decided to travel their own route to support its trainees and not support the ASA's residents, there was no need to try to sabotage the ASA's efforts. The general feeling I get from academic program reps is that enough is enough. They feel that they have worked hard to make the atmosphere as unified as possible, all the while the AANA, while rightfully pushing for its membership's goals, continues to try to reduce physician training and reimbursement issues.

Instead of accomplishing its goal of making CRNA/SRNA presence more attractive, the AANA has done exactly the opposite. Class sizes are being reevaluated by every program this fall and growth in trainee numbers will be looked at on the resident side in detail. The AANA has also provided an impetus for the utilization of AA's as a more viable alternative and this would have been/will be discussed at the ASA in Atlanta. Some programs are now providing locums contracts to private practice anesthesiologists with creative financing and insurance coverage that allows the hospital to pay the anesthesiologist a minimum stipend while still making it attractive for the physician to cover cases at these academic programs and now cheaper (to the hospital) than paying a CRNA. More alternatives to CRNA/SRNA involvement are being discussed that would have never received consideration had this final line not been crossed.

This wasn't an issue that should have been pushed by the AANA. All agree that academic programs are underfunded in general and reimbursement needs to increase. In trying to halt the progress that the ASA has made over the past several years on this issue (and this effort was SOLELY initiated and funded by the ASA yet could have yielded great benefits to the AANA), the AANA took a step towards trying to find the lowest common denominator for residents and SRNA's to train under. If the AANA is successful, it will keep academic programs underfunded, understaffed, and unattractive to strong physician candidates looking at academic practice whose knowledge, research, and teaching abilities would have directly benefitted both resident and SRNA education.

I'm sure glad there are other politically active and knowledgable out there. That was a SUPERB post.

 

[UTSouthwestern]

I have way too much time on my hands in private practice, jwk.

 

[Disse]

CMS specifically narrowed the reimbursement issue to resident physicians because it did not consider midlevel provider education in ANY field in this policy review. There was no support for doubling SRNA reimbursement because there was NO PROVISION IN THE ORIGINAL CMS GUIDELINES OR THE RESPONSE as this was a CMS determined physician issue and applies solely to physicians in this legislation.

Once again, let me review the shortsightedness of the AANA:

A doubling of physician resident reimbursement does not suddenly make it unattractive to train SRNA's. Each program has ACGME limits to the number of resident physicians it can train based on its ability to provide time for educational efforts, ability to limit total training time each week, and adequate case numbers, in particular subspecialty case numbers. A program has to apply to expand its class sizes but only gets reviewed for expansion/contraction every 2-4 years and only by 1-5 residents per class, NOT 100%. There are currently NO LIMITS on the number of SRNA's that a program can enroll to train and help with work issues.

Programs that have a significant number of SRNA's cannot suddenly replace all of that man (and woman) power with a resident pool that isn't as readily available as the AANA thinks, and if it were to try, it is likely that the CRNA's there would walk out in protest, leaving an academic program with even more shortages to deal with. Academics want to be academics and not have to run their own cases all day and all night and both physicians and nurses work to help the hospital, each other, and the academic physicians whose work allows our field to continue to evolve and refine itself.

IF the AANA wanted to espouse the SRNA reimbursement issue in earnest, it could have joined forces with the ASA, jointly espoused the need for fair reimbursement of physician resident training cases, hoped for a revision to the CMS policy for physicians, then pushed for SRNA reimbursement equality with the ASA side by side with the precedent already set in CMS policy for physician residents. A win-win situation for academic programs and the AANA, especially for programs that cannot meet ACGME training standards, but still train SRNA's as well as programs with dual training programs.

This was what the ASA had thought was agreed to since CMS would only review the physician training aspect of each specialty's reimbursement schedule. The AANA wanted to expand the issue to include SRNA's, but that additional package would have made it LESS appealing to CMS to alter the policy just by looking at how much more it would cost Medicare/Medicaid. What the ASA did not expect was a behind the doors attempt to subvert their efforts. In the worst, WORST case scenario for the AANA, the ASA would achieve its goal of doubling resident reimbursement, CMS refuses to reconsider SRNA reimbursement schedules, and the AANA could then go to court to argue that since SRNA's participate to the same degree in cases on rotations with physician residents, they are being unfairly discriminated against by CMS. This would force CMS to revise the SRNA reimbursement policy, with a precedent already set, and not knock physician resident reimbursement down to 50%, because the threat would then exist that the ASA would likewise file suit for discriminatory practice for its physicians in training compared to other specialties.

Why do we not just go to court now? We are trying to stay in good standing with CMS and not develop an acrimonious relationship that would lean CMS away from other anesthesiology related issues. Other specialties have a low threshhold for litigation and it has made CMS less pliable to their issues.

This isn't rocket science. This was discussed over and over by ASA and AANA reps and if the AANA decided to travel their own route to support its trainees and not support the ASA's residents, there was no need to try to sabotage the ASA's efforts. The general feeling I get from academic program reps is that enough is enough. They feel that they have worked hard to make the atmosphere as unified as possible, all the while the AANA, while rightfully pushing for its membership's goals, continues to try to reduce physician training and reimbursement issues.

Instead of accomplishing its goal of making CRNA/SRNA presence more attractive, the AANA has done exactly the opposite. Class sizes are being reevaluated by every program this fall and growth in trainee numbers will be looked at on the resident side in detail. The AANA has also provided an impetus for the utilization of AA's as a more viable alternative and this would have been/will be discussed at the ASA in Atlanta. Some programs are now providing locums contracts to private practice anesthesiologists with creative financing and insurance coverage that allows the hospital to pay the anesthesiologist a minimum stipend while still making it attractive for the physician to cover cases at these academic programs and now cheaper (to the hospital) than paying a CRNA. More alternatives to CRNA/SRNA involvement are being discussed that would have never received consideration had this final line not been crossed.

This wasn't an issue that should have been pushed by the AANA. All agree that academic programs are underfunded in general and reimbursement needs to increase. In trying to halt the progress that the ASA has made over the past several years on this issue (and this effort was SOLELY initiated and funded by the ASA yet could have yielded great benefits to the AANA), the AANA took a step towards trying to find the lowest common denominator for residents and SRNA's to train under. If the AANA is successful, it will keep academic programs underfunded, understaffed, and unattractive to strong physician candidates looking at academic practice whose knowledge, research, and teaching abilities would have directly benefitted both resident and SRNA education.

Well said UT.

 

[toughlife]

CMS specifically narrowed the reimbursement issue to resident physicians because it did not consider midlevel provider education in ANY field in this policy review. There was no support for doubling SRNA reimbursement because there was NO PROVISION IN THE ORIGINAL CMS GUIDELINES OR THE RESPONSE as this was a CMS determined physician issue and applies solely to physicians in this legislation.

Once again, let me review the shortsightedness of the AANA:

A doubling of physician resident reimbursement does not suddenly make it unattractive to train SRNA's. Each program has ACGME limits to the number of resident physicians it can train based on its ability to provide time for educational efforts, ability to limit total training time each week, and adequate case numbers, in particular subspecialty case numbers. A program has to apply to expand its class sizes but only gets reviewed for expansion/contraction every 2-4 years and only by 1-5 residents per class, NOT 100%. There are currently NO LIMITS on the number of SRNA's that a program can enroll to train and help with work issues.

Programs that have a significant number of SRNA's cannot suddenly replace all of that man (and woman) power with a resident pool that isn't as readily available as the AANA thinks, and if it were to try, it is likely that the CRNA's there would walk out in protest, leaving an academic program with even more shortages to deal with. Academics want to be academics and not have to run their own cases all day and all night and both physicians and nurses work to help the hospital, each other, and the academic physicians whose work allows our field to continue to evolve and refine itself.

IF the AANA wanted to espouse the SRNA reimbursement issue in earnest, it could have joined forces with the ASA, jointly espoused the need for fair reimbursement of physician resident training cases, hoped for a revision to the CMS policy for physicians, then pushed for SRNA reimbursement equality with the ASA side by side with the precedent already set in CMS policy for physician residents. A win-win situation for academic programs and the AANA, especially for programs that cannot meet ACGME training standards, but still train SRNA's as well as programs with dual training programs.

This was what the ASA had thought was agreed to since CMS would only review the physician training aspect of each specialty's reimbursement schedule. The AANA wanted to expand the issue to include SRNA's, but that additional package would have made it LESS appealing to CMS to alter the policy just by looking at how much more it would cost Medicare/Medicaid. What the ASA did not expect was a behind the doors attempt to subvert their efforts. In the worst, WORST case scenario for the AANA, the ASA would achieve its goal of doubling resident reimbursement, CMS refuses to reconsider SRNA reimbursement schedules, and the AANA could then go to court to argue that since SRNA's participate to the same degree in cases on rotations with physician residents, they are being unfairly discriminated against by CMS. This would force CMS to revise the SRNA reimbursement policy, with a precedent already set, and not knock physician resident reimbursement down to 50%, because the threat would then exist that the ASA would likewise file suit for discriminatory practice for its physicians in training compared to other specialties.

Why do we not just go to court now? We are trying to stay in good standing with CMS and not develop an acrimonious relationship that would lean CMS away from other anesthesiology related issues. Other specialties have a low threshhold for litigation and it has made CMS less pliable to their issues.

This isn't rocket science. This was discussed over and over by ASA and AANA reps and if the AANA decided to travel their own route to support its trainees and not support the ASA's residents, there was no need to try to sabotage the ASA's efforts. The general feeling I get from academic program reps is that enough is enough. They feel that they have worked hard to make the atmosphere as unified as possible, all the while the AANA, while rightfully pushing for its membership's goals, continues to try to reduce physician training and reimbursement issues.

Instead of accomplishing its goal of making CRNA/SRNA presence more attractive, the AANA has done exactly the opposite. Class sizes are being reevaluated by every program this fall and growth in trainee numbers will be looked at on the resident side in detail. The AANA has also provided an impetus for the utilization of AA's as a more viable alternative and this would have been/will be discussed at the ASA in Atlanta. Some programs are now providing locums contracts to private practice anesthesiologists with creative financing and insurance coverage that allows the hospital to pay the anesthesiologist a minimum stipend while still making it attractive for the physician to cover cases at these academic programs and now cheaper (to the hospital) than paying a CRNA. More alternatives to CRNA/SRNA involvement are being discussed that would have never received consideration had this final line not been crossed.

This wasn't an issue that should have been pushed by the AANA. All agree that academic programs are underfunded in general and reimbursement needs to increase. In trying to halt the progress that the ASA has made over the past several years on this issue (and this effort was SOLELY initiated and funded by the ASA yet could have yielded great benefits to the AANA), the AANA took a step towards trying to find the lowest common denominator for residents and SRNA's to train under. If the AANA is successful, it will keep academic programs underfunded, understaffed, and unattractive to strong physician candidates looking at academic practice whose knowledge, research, and teaching abilities would have directly benefitted both resident and SRNA education.

Outstanding insight. Thanks for shedding light on the current state of affairs and I truly look forward to being an active participant in this endeavor.

 

[UTSouthwestern]

No counterpoints?

 

[toughlife]

No counterpoints?

Still waiting myself. 😉

 

[kailiedu]

I'm a resident in a program w/o CRNA. During my prelim year I did a 2wk rotation in anesthsia department. What I saw the relationship between CRNA (>30 of them) and anesthsiology MD (~5) was shocking. The CRNA would be sitting at one end of table and MD would be at the other end during the conference. As out-numbered as they are, they didn't have much "vocal" power either. In another case, I saw a senior CRNA actually told the director of anesthsiology and me, the rotator to get out of her room because the teaching was too loud.

jetproppilot, I enjoy your post on this forum. You give us valuable insights on anesthesiology, in knowledge and practice. However, I have to point out one of biggest problem I see in your posts regarding CRNA:

CRNA are NOT your friends. They are your workers.

In general, anesthesiologists are most laid-back MDs. CRNA are most vocal (mostly female, in their prime years). When you have two groups of exactly opposite people like this, you are bound to have problem, especially when you are out-numbered like the one I mentioned.

I'm telling you, it's bad there. So bad that it's a shame to be a MD anesthesiologist.

True, CRNA are your colleagues, they do intubation, they sit in the case. However, they are NOT MDs, they are NURSES. Just like scrub nurse, circulating nurses assist surgeons. W/o them, surgeons can't do a case. Surgeons never consider scrub nurses equal, nor do scrub nurses ever DARE to ask for equalities to surgeons.

Why?

Two reasons stand out in my mind: 1st, I have mentioned, personality. Anesthesiologists are not aggressive enough, especially with older generation FMGs. 2nd, most importantly, anesthesiologists use CRNA to take more calls, to run more cases. Gradually, they lose their authority and RESPECT among people working for them because they get TOO LAZY and GREEDY.

In a private practice, as jetproppilot often mentions, CRNA works with or for anesthesiologists. Sure, it's because they get paid more when MDs get paid more as a group. Profit is aligned. As a whole, CRNA organization is vocal to get rid of MD supervision.

It's a constant battle. It's not a battle to be lost.

I say end it all, by eliminating CRNA participation of organized group. When a CRNA is hired, first thing on the contract, is forbiding any participation of CRNA organization, period. If they want to have a job, they have to be an obedient worker. If they refuse, hire someone. If there are no CRNA willing to take on the job, hire AA, or start to train different groups of "technicians". After all, MDs have hiring power, not CRNA.

Be vocal, fight this battle. Anyone who doesn't see the risk of CRNA with growing power, please email me. I'd be happy to forward you the hospital I rotated and you should go and check it out.

 

[toughlife]

I'm a resident in a program w/o CRNA. During my prelim year I did a 2wk rotation in anesthsia department. What I saw the relationship between CRNA (>30 of them) and anesthsiology MD (~5) was shocking. The CRNA would be sitting at one end of table and MD would be at the other end during the conference. As out-numbered as they are, they didn't have much "vocal" power either. In another case, I saw a senior CRNA actually told the director of anesthsiology and me, the rotator to get out of her room because the teaching was too loud.

jetproppilot, I enjoy your post on this forum. You give us valuable insights on anesthesiology, in knowledge and practice. However, I have to point out one of biggest problem I see in your posts regarding CRNA:

CRNA are NOT your friends. They are your workers.

In general, anesthesiologists are most laid-back MDs. CRNA are most vocal (mostly female, in their prime years). When you have two groups of exactly opposite people like this, you are bound to have problem, especially when you are out-numbered like the one I mentioned.

I'm telling you, it's bad there. So bad that it's a shame to be a MD anesthesiologist.

True, CRNA are your colleagues, they do intubation, they sit in the case. However, they are NOT MDs, they are NURSES. Just like scrub nurse, circulating nurses assist surgeons. W/o them, surgeons can't do a case. Surgeons never consider scrub nurses equal, nor do scrub nurses ever DARE to ask for equalities to surgeons.

Why?

Two reasons stand out in my mind: 1st, I have mentioned, personality. Anesthesiologists are not aggressive enough, especially with older generation FMGs. 2nd, most importantly, anesthesiologists use CRNA to take more calls, to run more cases. Gradually, they lose their authority and RESPECT among people working for them because they get TOO LAZY and GREEDY.

In a private practice, as jetproppilot often mentions, CRNA works with or for anesthesiologists. Sure, it's because they get paid more when MDs get paid more as a group. Profit is aligned. As a whole, CRNA organization is vocal to get rid of MD supervision.

It's a constant battle. It's not a battle to be lost.

I say end it all, by eliminating CRNA participation of organized group. When a CRNA is hired, first thing on the contract, is forbiding any participation of CRNA organization, period. If they want to have a job, they have to be an obedient worker. If they refuse, hire someone. If there are no CRNA willing to take on the job, hire AA, or start to train different groups of "technicians". After all, MDs have hiring power, not CRNA.

Be vocal, fight this battle. Anyone who doesn't see the risk of CRNA with growing power, please email me. I'd be happy to forward you the hospital I rotated and you should go and check it out.

Great post! We need more people to pay attention and to pass strict rules regarding CRNA participation.
Despite the fact that residents and students are more aware of the current state of affairs, I am still amazed as to how many med students are still ignorant as to what is going on. I have spoken with many of my classmates applying to anesthesia and all they are concerned about is just the decent paycheck and hours and seem to know crap about how much CRNAs are pushing for independence and how that can impact their future.

We need to realize that, although physicians are very respecful and avoid confrontations, this is not the time to be nice.

I personally think the ASA and American Board of Anesthesiology need to have tighter control over physicians who hire CRNAs. These could be done through reducing the numbers of CRNAs that a physician can supervise from 4 to 2, revoking board certification to those who break rules, monetary fines, push for increase involvement of AAs, or mandate that all departments hiring midlevels have an equal number of AAs as there are CRNAs on staff ( that would cut the number of CRNAs in half automatically), etc.

We need to get serious and mean business if we want to fix this broken system.

 

[jwk]

I'm a resident in a program w/o CRNA. During my prelim year I did a 2wk rotation in anesthsia department. What I saw the relationship between CRNA (>30 of them) and anesthsiology MD (~5) was shocking. The CRNA would be sitting at one end of table and MD would be at the other end during the conference. As out-numbered as they are, they didn't have much "vocal" power either. In another case, I saw a senior CRNA actually told the director of anesthsiology and me, the rotator to get out of her room because the teaching was too loud.

jetproppilot, I enjoy your post on this forum. You give us valuable insights on anesthesiology, in knowledge and practice. However, I have to point out one of biggest problem I see in your posts regarding CRNA:

CRNA are NOT your friends. They are your workers.

In general, anesthesiologists are most laid-back MDs. CRNA are most vocal (mostly female, in their prime years). When you have two groups of exactly opposite people like this, you are bound to have problem, especially when you are out-numbered like the one I mentioned.

I'm telling you, it's bad there. So bad that it's a shame to be a MD anesthesiologist.

True, CRNA are your colleagues, they do intubation, they sit in the case. However, they are NOT MDs, they are NURSES. Just like scrub nurse, circulating nurses assist surgeons. W/o them, surgeons can't do a case. Surgeons never consider scrub nurses equal, nor do scrub nurses ever DARE to ask for equalities to surgeons.

Why?

Two reasons stand out in my mind: 1st, I have mentioned, personality. Anesthesiologists are not aggressive enough, especially with older generation FMGs. 2nd, most importantly, anesthesiologists use CRNA to take more calls, to run more cases. Gradually, they lose their authority and RESPECT among people working for them because they get TOO LAZY and GREEDY.

In a private practice, as jetproppilot often mentions, CRNA works with or for anesthesiologists. Sure, it's because they get paid more when MDs get paid more as a group. Profit is aligned. As a whole, CRNA organization is vocal to get rid of MD supervision.

It's a constant battle. It's not a battle to be lost.

I say end it all, by eliminating CRNA participation of organized group. When a CRNA is hired, first thing on the contract, is forbiding any participation of CRNA organization, period. If they want to have a job, they have to be an obedient worker. If they refuse, hire someone. If there are no CRNA willing to take on the job, hire AA, or start to train different groups of "technicians". After all, MDs have hiring power, not CRNA.

Be vocal, fight this battle. Anyone who doesn't see the risk of CRNA with growing power, please email me. I'd be happy to forward you the hospital I rotated and you should go and check it out.

You're a little over the top with your opinions (the word "rambling" comes to mind) especially considering your EXTREMELY limited exposure to CRNA's. (wow, 2 weeks) Although I don't doubt your observations of this particular group, I can tell you that most anesthesia groups with MD's, CRNA's, and AA's work very well together. The group you describe is not typical in my experience, nor is your description of CRNA's (a bunch of old ladies? c'mon). I'm sure JPP would agree, and he and I together have seen a whole lot more than you have.

Do I have a problem with CRNA's as a professional organization? Absolutely. Do I have a problem with individual CRNA's in my group on a day to day basis? No I do not. Sure, the anesthetists are usually the employees (although there are MD's working for CRNA groups). But that doesn't mean that there can't be professional respect going both ways.

As far as your "hiring requirements" - good luck. "Obedient worker"??? Give me a break. Forbid participation in an organized group? Not even possible. You have no control over this, the requirement is probably illegal, and in order to maintain their certification and licensure, CRNA's need AANA-approved CME's. Guess what? You, and groups that might share a philosophy such as yours, will be standing around scratching your ass trying to figure out why you can't hire or retain good quality anesthetists, while groups that value their anesthetist employees will reap the benefits.

I fully understand most of the issues involved here, political, professional, or otherwise far more than you do, as does JPP. I know there are strong opinions on this board about CRNA's and MD's and even AA's. Unlike you, most of them are grounded in some EXPERIENCE from which to form those opinions.

And one last thing - as an AA, I would preferred to be hired by a group that values my services and capabilities. Hiring me as a backup or second choice because you're pissed off at CRNA's won't thrill me, and if your overall attitude of all non-physicians (nurses, CRNA's, technicians, AA's, or otherwise) is what you present on this board, good luck on your hiring. As long as you view anesthetists of either variety as just nurses or technicians, your list of employees/colleagues will be extremely short or non-existent.

 

[kailiedu]

First of all, you as an AA is welcomed to make a comment here. I have no problem with it. So feel free to express your anger/frustration/or whatsoever towards your SUPERIOR. Yes, you heard it right, MD anethesiologists are your SUPERIORS, respect it, and accept it. Medicine is a field of hierarchy. If you are a nurse, no matter how good you are at placing IV, a-line, intubate, you are a nurse, period. If you feel you deserve more respect than a MD, please go through 4 yrs of college, 4 years of medical school, 4 years of residency before you can make a sound argument, REGARDLESS how much experience you have in NURSING.

I'll respect you as a NURSE because you have the skill we need, not because the years of academic education you have. Know your limit, respect your superior, or you won't find a job.

As for as "while groups that value their anesthetist employees will reap the benefits", it is exactly the point I'm trying to make to my fellow future anesthesiologists. Work hard, know your trade, and be reasonable instead of greedy. It's not all about profit. It's also about respect among your fellow MD colleagues and your patients. Talk like a MD, act like one.

Join your organization, voice your opinions. No, I'm not being militant about this. We should all respect our colleagues, regardless of their position, MD, CRNA, AA, floor nurses. However, we won't tolerate bad employees, or employees in a lousy organization.

The stereotype of lazy, passive anesthesiologists are changing, especially, as more and more AMG getting into the field. If we didn't do our part, CRNAs as a whole (no, I didn't mean old ladies, I say, females in their prime, 30-50yrs with all the energy in the world to fight for their independent practice right) will.

My exposure with CRNA is short. Any longer I'd be ashamed to be a MD in the department even as a rotator. It reflects the disaster it could be heading to if anethesiologists aren't doing something about it.

You're a little over the top with your opinions (the word "rambling" comes to mind) especially considering your EXTREMELY limited exposure to CRNA's. (wow, 2 weeks) Although I don't doubt your observations of this particular group, I can tell you that most anesthesia groups with MD's, CRNA's, and AA's work very well together. The group you describe is not typical in my experience, nor is your description of CRNA's (a bunch of old ladies? c'mon). I'm sure JPP would agree, and he and I together have seen a whole lot more than you have.

Do I have a problem with CRNA's as a professional organization? Absolutely. Do I have a problem with individual CRNA's in my group on a day to day basis? No I do not. Sure, the anesthetists are usually the employees (although there are MD's working for CRNA groups). But that doesn't mean that there can't be professional respect going both ways.

As far as your "hiring requirements" - good luck. "Obedient worker"??? Give me a break. Forbid participation in an organized group? Not even possible. You have no control over this, the requirement is probably illegal, and in order to maintain their certification and licensure, CRNA's need AANA-approved CME's. Guess what? You, and groups that might share a philosophy such as yours, will be standing around scratching your ass trying to figure out why you can't hire or retain good quality anesthetists, while groups that value their anesthetist employees will reap the benefits.

I fully understand most of the issues involved here, political, professional, or otherwise far more than you do, as does JPP. I know there are strong opinions on this board about CRNA's and MD's and even AA's. Unlike you, most of them are grounded in some EXPERIENCE from which to form those opinions.

And one last thing - as an AA, I would preferred to be hired by a group that values my services and capabilities. Hiring me as a backup or second choice because you're pissed off at CRNA's won't thrill me, and if your overall attitude of all non-physicians (nurses, CRNA's, technicians, AA's, or otherwise) is what you present on this board, good luck on your hiring. As long as you view anesthetists of either variety as just nurses or technicians, your list of employees/colleagues will be extremely short or non-existent.