The beginning of the end?

[A Whole]

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With the recent opt-outs, the push for health care reform, and the recent court ruling in favor of independent clinical practice for CRNAs, I can't imagine anything positive in the future for anesthesiology. I'm beginning to think that anesthesiology as a medical discipline is on the verge of collapse.

I started my career in a highly competitive surgical subspecialty, where the notion of midlevel encroachment was a joke. Now it's a bona fide threat to my future livelihood as a physician. I enjoy anesthesiology in practice but the future of this specialty is in jeopardy. How on earth did things get so bad? Why did the ASA let this happen? It's absolutely infuriating and disheartening to watch the contest between the AANA and the ASA unfold (which we're clearly losing, BTW).

A few things from the CRNA vs. MDA polemic that really piss me off...

1. The education of a CRNA is essentially equivalent to the education of an anesthesiologist.

**Are you f*^&*#g kidding me? Let me get this straight. A bachelor's degree in nursing is basically the same thing as a bachelor's degree and a medical degree. The GRE and the NCLEX are essentially the same as the MCAT and steps I, II, and-III of the USMLE. Internship is the same as a few years of experience in the ICU as a nurse. And, last but not least, 3 years of residency +/- a fellowship is the same as 2.5 years of CRNA school. Master's degree=doctorate. Am I missing something here?

CRNAs could make the argument that MDs are overtrained, but don't tell me that our educational tracks are "equivalent."

2. There is no difference in patient outcomes between CRNAs practicing without supervision and CRNAs in an ACT setting.

**This statement may be true. Even so, the research to date (i.e., all the studies that CRNAs cite to support their political agenda) isn't proof of this statement. Even a person with rudimentary training in biostats (such as myself) can see that the studies are obviously flawed. WTF is wrong with the ASA and the AANA? Why don't they launch a collaborative study to put this issue to rest? If CRNAs truly are as safe and competent as MDAs, then for the love of god, publish a high quality study that definitively says so instead of relying on a bunch of dogs^&t studies.
😡

 

[cfdavid]

With the recent opt-outs, the push for health care reform, and the recent court ruling in favor of independent clinical practice for CRNAs, I can't imagine anything positive in the future for anesthesiology. I'm beginning to think that anesthesiology as a medical discipline is on the verge of collapse.

I started my career in a highly competitive surgical subspecialty, where the notion of midlevel encroachment was a joke. Now it's a bona fide threat to my future livelihood as a physician. I enjoy anesthesiology in practice but the future of this specialty is in jeopardy. How on earth did things get so bad? Why did the ASA let this happen? It's absolutely infuriating and disheartening to watch the contest between the AANA and the ASA unfold (which we're clearly losing, BTW).

A few things from the CRNA vs. MDA polemic that really piss me off...

1. The education of a CRNA is essentially equivalent to the education of an anesthesiologist.

**Are you f*^&*#g kidding me? Let me get this straight. A bachelor's degree in nursing is basically the same thing as a bachelor's degree and a medical degree. The GRE and the NCLEX are essentially the same as the MCAT and steps I, II, and-III of the USMLE. Internship is the same as a few years of experience in the ICU as a nurse. And, last but not least, 3 years of residency +/- a fellowship is the same as 2.5 years of CRNA school. Master's degree=doctorate. Am I missing something here?

CRNAs could make the argument that MDs are overtrained, but don't tell me that our educational tracks are "equivalent."

2. There is no difference in patient outcomes between CRNAs practicing without supervision and CRNAs in an ACT setting.

**This statement may be true. Even so, the research to date (i.e., all the studies that CRNAs cite to support their political agenda) isn't proof of this statement. Even a person with rudimentary training in biostats (such as myself) can see that the studies are obviously flawed. WTF is wrong with the ASA and the AANA? Why don't they launch a collaborative study to put this issue to rest? If CRNAs truly are as safe and competent as MDAs, then for the love of god, publish a high quality study that definitively says so instead of relying on a bunch of dogs^&t studies.
😡

When physician anesthesiologists get to the point where they are pissed enough to accept CRNA level pay (I know nobody wants to hear this), then the CRNA's will have reaped what they've sowed.....

Who knows how this will play out, but if anesthesiologist become the pediatricians of the future (in terms of pay), then it is what it is. We must fight to prevent this, but at that point, CRNA's will have absolutely pegged themselves to a more "reasonable" mid-level salary norm (like all other mid-levels). Personally, I feel they're shooting themselves in the foot.

That being said, with strong residents and future leaders, this is hugely salvageable. We should also get more involved in critical care, for sure. We need to be flexible as the general environment changes.

cf

 

[ASA6]

When physician anesthesiologists get to the point where they are pissed enough to accept CRNA level pay (I know nobody wants to hear this), then the CRNA's will have reaped what they've sowed.....

Who knows how this will play out, but if anesthesiologist become the pediatricians of the future (in terms of pay), then it is what it is. We must fight to prevent this, but at that point, CRNA's will have absolutely pegged themselves to a more "reasonable" mid-level salary norm (like all other mid-levels). Personally, I feel they're shooting themselves in the foot.

That being said, with strong residents and future leaders, this is hugely salvageable. We should also get more involved in critical care, for sure. We need to be flexible as the general environment changes.

cf

conversely, it will be interesting when CRNAs start commanding or attempting to get the same level of pay as physicians. What if CRNAs get independent practicing rights, as well as the ability to bill and collect the same reimbursements from private insurance and medicare? That seems like a possible outcome here, and once that happens, a hospital or practice now have the option of hiring a CRNA or a MD at the same cost. At that point, it would seem like CRNAs would have priced themselves out of competition, because if they are going to cost the same, wouldnt people rather have an MD?

 

[cfdavid]

conversely, it will be interesting when CRNAs start commanding or attempting to get the same level of pay as physicians. What if CRNAs get independent practicing rights, as well as the ability to bill and collect the same reimbursements from private insurance and medicare? That seems like a possible outcome here, and once that happens, a hospital or practice now have the option of hiring a CRNA or a MD at the same cost. At that point, it would seem like CRNAs would have priced themselves out of competition, because if they are going to cost the same, wouldnt people rather have an MD?

Yes. That would happen.

 

[Daredevil]

Thank you Obama for accepting mediocrity for the medical care of your citizens.

I'd like to see the medical care of Obama's two daughters and wife strictly by mid-level providers. Who needs doctors, right?

 

[Consigliere]

Thank you Obama for accepting mediocrity for the medical care of your citizens.

I'd like to see the medical care of Obama's two daughters and wife strictly by mid-level providers. Who needs doctors, right?

Yeah, like ole' slick Willy.....when Bill Clinton (whose mother was a CRNA) had his heart surgery, do you think there was a CRNA in his room? Sheeeeeeeeeeeeet, there wasn't a CRNA within a mile of that OR!