The future of anesthesiology

ReefTiger

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  1. Attending Physician
    I understand what you're saying, but I am not and never will be a "glorified CRNA" which is what you keep trying to perpetuate we are percieved as by a piece of paper.

    The fact that I have a piece of paper stating I am a graduate of an American allopathic medical school and that I have a piece of paper stating completion of preliminary internal medicine internship AUTOMATICALLY garners the legality of worth. Furthermore, the certificates provided to CRNA's are not the same as those from an physician anesthesia residency.

    The bottom line is attaining board certification. There are only two fellowships within anesthesia which will allow for extra "distinction", those being pain management and Critical Care.

    As a physician I am allowed all the rights of a physician in this country including doing surgery if a patient was willing to let me do it. Would anyone let me without proper credentials? Doubtful, which is how I see your original point. The extra-credentialling will not protect our jobs, informing patients will. Furthermore, it is a poor mindset in my opinion. By stating that we need further distinction, we are essentially agreeing that we and CRNA's are the same. We are perioperative physicians. Surgeons do not consult CRNA's to diagnose and manage post-op patients.

    It is the ASA/AMA's lack of a unified plan, physicians unwilling to work in underserved areas, and the initial Medicare reform disaster with its current forms (pay for performance) which has allowed the medical field (not just anesthesia) to slip. All of the documentation and red tape that we waste our time practicing defensive medicine has further allowed the increased scope and number of mid-level providers.

    Mid-levels have effective lobbying powers because they are taught about the importance of such political actions during their training. Most residencies are not, and that is perpetuated in part by a large amount of lazy attendings who are not active themselves and have already "made" their money.
    Furthermore, the mid-levels work significantly less hours, have significant income to donate with (which they do), all of which give them more time and vested interest in learning about and carrying out their efforts.

    We as physicians have let patients start to feel some sort of entitlement to health care. It is not a right. Nowhere in our constitution does it say so.
    Patients get in the habit of thinking medical bills cost a "co-pay". The mid-levels have always been supervised by physicians, or are employees of a hospital. This means they have never had to worry about overhead, collections, etc. They are actually screwing themselves and the people in America by trying to claim an equal level of care as a physician.

    They are behind the erosion of health care with us helping by not paying attention for far too long. There is a place for CRNA's just like there is a place for PA's doing the saphenous vein harvest on a CABG, or a Nurse pratitioner doing a well-woman exam. The problem is that the general public has no idea of their role and scope of practice and knowledge base.

    I personally feel we need to simplify it for people who are not involved with health care. It is as simple as wearing a long white coat.

    What? A long white coat? That's stupid you say? How many people in the hospital do you see wearing a long white coat? I see tons of them. Hell, we've got PA's, NP's, phlebotomists, dieticians, pharmacists, ECHO techs, physicians, physical therapists, occupational therapists. You name it. Meanwhile, John Doe from anytown USA sees so many people during his hospital stay he has no idea who the doctor was and wasn't. Furthermore, most people in the health field that I've seen don' t even introduce themselves properly. Just because we know they aren't physicians doesn't mean most people assume they are not doctors. I've seen it countless times myself. I've been fooled myself tons of times by someone who is my elder in a long white coat walking around all proud on the floor. It's not until you get up close to them to see their title hidden behind the pens in their pocket, or in tiny print on a picture ID that you need to be within 1.5 feet to read. Meanwhile, someone in scrubs in the ER is talking with a patient, and educating them about their complaint and the patient thinks this is doctor's orders, and potentially leaves the ER without ever having a physician lay eyes on them.

    This is one of the reasons for the new Bill being introduced to legislation concerning this misconception perpetuated by non-physicians charading around as one. Why can't we get back to simplicity. No one working in a hospital/clinic should be allowed to wear a long white coat except physicians.
    Then a patient can decide which physician they are talking to and there is less confusion. It may sound silly to some on this board, but uniforms are important. You go to Best Buy and you know someone in a blue shirt with Best Buy on it works there.

    Hell, if it is not such a big deal to wear the coat then why are medical students required to wear coats, or short coats at that? For IDENTIFICATION.

    There needs to be a MAJOR education of the public concerning the personnel in healthcare. It does not need to come across as physicians are all important and mid-levels are worthless. It needs to be done in the same way and with the same care that we educate patients about their illnesses. That is by placing the patient's best interest first.

    If it is done any other way, we will be percieved as greedy, pompous, and selfish. We became physicians to help people, be respected, and make money for our sacrifices, education and HARD WORK. We are the ones who need to fight for our patients now. We must unite under this premise which includes all specialties, because there is no way we lose the fight with this approach. If we keep trying to put out fires by winning small battles regarding reimbursement, and malpractice we will continue to perpetuate the wrong impressions.

    We need to reinforce the doctor patient relationship and put the patient back in control of his/her own care. They need to be able to have more choice in whether they are seen by an MD/DO instead of being told to by an HMO, or Medicare. Once we reinforce this and educate the public about the quality of care they are becoming limited to our stock will rise again. It is at this point when we can stand up to being told how to practice medicine by CEOs and other non-medically trained money hounds.

    Please forgive the long post.
     

    ReefTiger

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      This one:

      Rep. John Sullivan (R-OK) has introduced H.R. 5688, the “Health Care Truth and Transparency Act of 2006.” This legislation would strengthen FTC enforcement against limited-licensed health care providers and keep them from making deceptive misrepresentations as to their education, skills and training. It would also keep non-physicians from holding themselves out as medical doctors (MD), doctors of osteopathic medicine (DO), doctors of dental surgery (DDS) or doctors of dental medicine (DMD).


      :thumbup:
       
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      EtherMD

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        I understand what you're saying, but I am not and never will be a "glorified CRNA" which is what you keep trying to perpetuate we are percieved as by a piece of paper.

        The fact that I have a piece of paper stating I am a graduate of an American allopathic medical school and that I have a piece of paper stating completion of preliminary internal medicine internship AUTOMATICALLY garners the legality of worth. Furthermore, the certificates provided to CRNA's are not the same as those from an physician anesthesia residency.

        The bottom line is attaining board certification. There are only two fellowships within anesthesia which will allow for extra "distinction", those being pain management and Critical Care.

        As a physician I am allowed all the rights of a physician in this country including doing surgery if a patient was willing to let me do it. Would anyone let me without proper credentials? Doubtful, which is how I see your original point. The extra-credentialling will not protect our jobs, informing patients will. Furthermore, it is a poor mindset in my opinion. By stating that we need further distinction, we are essentially agreeing that we and CRNA's are the same. We are perioperative physicians. Surgeons do not consult CRNA's to diagnose and manage post-op patients.

        It is the ASA/AMA's lack of a unified plan, physicians unwilling to work in underserved areas, and the initial Medicare reform disaster with its current forms (pay for performance) which has allowed the medical field (not just anesthesia) to slip. All of the documentation and red tape that we waste our time practicing defensive medicine has further allowed the increased scope and number of mid-level providers.

        Mid-levels have effective lobbying powers because they are taught about the importance of such political actions during their training. Most residencies are not, and that is perpetuated in part by a large amount of lazy attendings who are not active themselves and have already "made" their money.
        Furthermore, the mid-levels work significantly less hours, have significant income to donate with (which they do), all of which give them more time and vested interest in learning about and carrying out their efforts.

        We as physicians have let patients start to feel some sort of entitlement to health care. It is not a right. Nowhere in our constitution does it say so.
        Patients get in the habit of thinking medical bills cost a "co-pay". The mid-levels have always been supervised by physicians, or are employees of a hospital. This means they have never had to worry about overhead, collections, etc. They are actually screwing themselves and the people in America by trying to claim an equal level of care as a physician.

        They are behind the erosion of health care with us helping by not paying attention for far too long. There is a place for CRNA's just like there is a place for PA's doing the saphenous vein harvest on a CABG, or a Nurse pratitioner doing a well-woman exam. The problem is that the general public has no idea of their role and scope of practice and knowledge base.

        I personally feel we need to simplify it for people who are not involved with health care. It is as simple as wearing a long white coat.

        What? A long white coat? That's stupid you say? How many people in the hospital do you see wearing a long white coat? I see tons of them. Hell, we've got PA's, NP's, phlebotomists, dieticians, pharmacists, ECHO techs, physicians, physical therapists, occupational therapists. You name it. Meanwhile, John Doe from anytown USA sees so many people during his hospital stay he has no idea who the doctor was and wasn't. Furthermore, most people in the health field that I've seen don' t even introduce themselves properly. Just because we know they aren't physicians doesn't mean most people assume they are not doctors. I've seen it countless times myself. I've been fooled myself tons of times by someone who is my elder in a long white coat walking around all proud on the floor. It's not until you get up close to them to see their title hidden behind the pens in their pocket, or in tiny print on a picture ID that you need to be within 1.5 feet to read. Meanwhile, someone in scrubs in the ER is talking with a patient, and educating them about their complaint and the patient thinks this is doctor's orders, and potentially leaves the ER without ever having a physician lay eyes on them.

        This is one of the reasons for the new Bill being introduced to legislation concerning this misconception perpetuated by non-physicians charading around as one. Why can't we get back to simplicity. No one working in a hospital/clinic should be allowed to wear a long white coat except physicians.
        Then a patient can decide which physician they are talking to and there is less confusion. It may sound silly to some on this board, but uniforms are important. You go to Best Buy and you know someone in a blue shirt with Best Buy on it works there.

        Hell, if it is not such a big deal to wear the coat then why are medical students required to wear coats, or short coats at that? For IDENTIFICATION.

        There needs to be a MAJOR education of the public concerning the personnel in healthcare. It does not need to come across as physicians are all important and mid-levels are worthless. It needs to be done in the same way and with the same care that we educate patients about their illnesses. That is by placing the patient's best interest first.

        If it is done any other way, we will be percieved as greedy, pompous, and selfish. We became physicians to help people, be respected, and make money for our sacrifices, education and HARD WORK. We are the ones who need to fight for our patients now. We must unite under this premise which includes all specialties, because there is no way we lose the fight with this approach. If we keep trying to put out fires by winning small battles regarding reimbursement, and malpractice we will continue to perpetuate the wrong impressions.

        We need to reinforce the doctor patient relationship and put the patient back in control of his/her own care. They need to be able to have more choice in whether they are seen by an MD/DO instead of being told to by an HMO, or Medicare. Once we reinforce this and educate the public about the quality of care they are becoming limited to our stock will rise again. It is at this point when we can stand up to being told how to practice medicine by CEOs and other non-medically trained money hounds.

        Please forgive the long post.

        Ah, to be young again and naive. In a few years you will see the truth and feel the pain economically. Right now, you are just playing into the hands of the current leadership which continues to lose ECONOMIC ground to your competition the AANA.

        How much good will your long white coat and M.D. label do for you when the AANA has obtained the legal right to practice Anesthesia without any supervision in 25 states? How about 40 sates? What will your label do for you when more and more CRNA Groups "outbid" you for contracts? If the AANA gets its way it is you who will want the Glorified CRNA label.

        I have no arguments with you. I just feel sorry for you.
         

        ReefTiger

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          It is not about stopping them from getting more states. They will continue to do that. There are still low total numbers of all anesthesia personnel available for jobs, hence the market. It still all lies on the consumer decision.

          Currently, people don't consider healthcare in the same fashion as paying for services like say, hiring a contractor. They have little say in what they are buying for their care. We as a profession must get back to dictating our own fees--which I know you will say is not possible. That's because too many of previous physicians sat spineless and let the govt and insurance companies swindle them into our current state of affairs.

          Anesthesia is made profitable and likely safer for patients when it is based on a care team model. Patients should know whether or not there is a physician involved in their anesthetic care or not. If they know there is NO board certified physician involved perhaps their perceptions are changed. Perhaps not. Perhaps they have no choice because of location. Whatever the reason, it is important for them to know that.

          Name one field of medicine where a mid level has replaced a physician. CRNAs are supposed to fill in gaps in areas that are underserved by physicians. This is one reason they have obtained the rural pass through legislation allowing them monies from medicare not allowed to physicians. The real issue is that new companies are contracting with hospitals to hire numbers of CRNAs and less anesthesiologists as it is shown to have a lower bottom line to the hospital. This is a problem, because it is another way the public is being less able to choose their healthcare options. This is also a problem for us also because we've let ourselves be dictated to about how we are allowed to practice and be compensated.

          What is your solution? Extra words on a piece of paper that distinguish us from CRNA? Give me a break. We have it already- Doctor of Medicine/Doctor of Osteopathy.

          And by the way, I have no problem with you either, but your plan is laughable.
           

          EtherMD

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            It is not about stopping them from getting more states. They will continue to do that. There are still low total numbers of all anesthesia personnel available for jobs, hence the market. It still all lies on the consumer decision.

            Currently, people don't consider healthcare in the same fashion as paying for services like say, hiring a contractor. They have little say in what they are buying for their care. We as a profession must get back to dictating our own fees--which I know you will say is not possible. That's because too many of previous physicians sat spineless and let the govt and insurance companies swindle them into our current state of affairs.

            Anesthesia is made profitable and likely safer for patients when it is based on a care team model. Patients should know whether or not there is a physician involved in their anesthetic care or not. If they know there is NO board certified physician involved perhaps their perceptions are changed. Perhaps not. Perhaps they have no choice because of location. Whatever the reason, it is important for them to know that.

            Name one field of medicine where a mid level has replaced a physician. CRNAs are supposed to fill in gaps in areas that are underserved by physicians. This is one reason they have obtained the rural pass through legislation allowing them monies from medicare not allowed to physicians. The real issue is that new companies are contracting with hospitals to hire numbers of CRNAs and less anesthesiologists as it is shown to have a lower bottom line to the hospital. This is a problem, because it is another way the public is being less able to choose their healthcare options. This is also a problem for us also because we've let ourselves be dictated to about how we are allowed to practice and be compensated.

            What is your solution? Extra words on a piece of paper that distinguish us from CRNA? Give me a break. We have it already- Doctor of Medicine/Doctor of Osteopathy.

            And by the way, I have no problem with you either, but your plan is laughable.


            A better certificate is part of the solution and not the entire solution. CRNA's would not be able to claim "equivalence" if Anesthesiologists were more than Consultants in Anesthesiology. You say were are more than that; I agree so why not get a certificate and Board Certification that "legally" backs up that statement.

            Medicare pays a CRNA the same as a Board Certified Anesthesiologist. Name one other Mid-Level provider whose parent organization makes the claim of "equivalency" to a Physician? The AANA states CRNA's can do everything an Anesthesiologist does for significantly less money. The number of graduating CRNA's continues to increase as does the number of new CRNA programs.

            Do you know of any other mid-level providers earning in excess of $300,000 on a routine basis. I know several CRNA's earning that amount of money. Some have their own Groups and contracts. The LAW allows them to practice without an Anesthesiologist. Even a Dentist can "supervise" a CRNA.
            Thus, providers with 27 months of training are taking business from Physicians with significantly more training and education.

            So, what is your solution? Display your M.D. name tag and wear a white coat? John Q. Public would better understand the term "Peri-Operative" Physician with expertise in certain areas. These credentials do matter to the public and the CRNA.

            One last question for you. How many years have you been PRACTICING as a Board Certified Anesthesiologist? How many CRNA's have you supervised or hired? 80% of Anesthesia Practices are non-academic and in the real world things are different. The current strategy of the ASA and Academic Chairs is not working at both the State and National Levels. You deserve better.
             

            EtherMD

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            1. Attending Physician
              Come now ether.

              My mother laughed reading this post.

              the average national CRNA income is 120K. The high end is 220K and that was less than 10%

              where are you getting your numbers?


              Average CRNA income is more like $130,000 a year. This is for a 40 hour work by a CRNA that is a Group/Hospital CRNA. At 45 hours a week (which reflects a more typical week) the pay is around $150,000 per year plus benefits of $40,000.

              Independent CRNA's that work in their OWN CRNA Group or have their own contracts make substantially more money. Tell your "mother" that I know a dozen or so CRNA's making in excess of $250,000 (or $300,000 as 1099).
              I know two who make more than $350,000 per year. How does that sound for a "Mid-Level" Provider? CRNA's are becoming more "creative" in bidding for contracts and providing services for surgi-centers, offices AND small hospitals.
              They really are "competitors" whether you believe it or not.


              The AANA/CRNA issue is a real problem and becomes WORSE each year. To ignore the problem or pretend that a label (M.D.) and a white lab coat solves it is naive. Those of you "sequestered" in an acadamic enivironment are probably thinking this issue will never affect you. Wrong. The AANA is going to make sure that every private practice in the country will be impacted by its members and its propoganda. It make take ten years for EVERYONE to feel this impact but it is coming to a neighborhood near you.

              For Ansthesiologists like myself (a decade or more in practice) this issue is less of a concern than for Medical Students and Residents just entering the field. While the leadership has ignored this issue for decades it is still not too late to mount a strong defense. Patient Education and a better Residency Certificate are good places to start. You deserve more from the ASA and the Academic Chairs: Start demanding it.
               

              EtherMD

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                Average CRNA income is more like $130,000 a year. This is for a 40 hour work by a CRNA that is a Group/Hospital CRNA. At 45 hours a week (which reflects a more typical week) the pay is around $150,000 per year plus benefits of $40,000.

                Independent CRNA's that work in their OWN CRNA Group or have their own contracts make substantially more money. Tell your "mother" that I know a dozen or so CRNA's making in excess of $250,000 (or $300,000 as 1099).
                I know two who make more than $350,000 per year. How does that sound for a "Mid-Level" Provider? CRNA's are becoming more "creative" in bidding for contracts and providing services for surgi-centers, offices AND small hospitals.
                They really are "competitors" whether you believe it or not.


                The AANA/CRNA issue is a real problem and becomes WORSE each year. To ignore the problem or pretend that a label (M.D.) and a white lab coat solves it is naive. Those of you "sequestered" in an acadamic enivironment are probably thinking this issue will never affect you. Wrong. The AANA is going to make sure that every private practice in the country will be impacted by its members and its propoganda. It make take ten years for EVERYONE to feel this impact but it is coming to a neighborhood near you.

                For Ansthesiologists like myself (a decade or more in practice) this issue is less of a concern than for Medical Students and Residents just entering the field. While the leadership has ignored this issue for decades it is still not too late to mount a strong defense. Patient Education and a better Residency Certificate are good places to start. You deserve more from the ASA and the Academic Chairs: Start demanding it.



                Look, I am not trying to be rude or abnoxious in my postings. I wish all the Residents and medical students choosing Anesthesiology as their chosen field a successful and lucrative career. I just want to point out where the "competition" was twenty years, ten years ago and last year. This may help show a greater general trend so you can "guess" where the AANA may be ten years from today. Perhaps, the AANA/CRNA issues reflects the overall general trend of PA's and NP's in Medicine. But, this is most likely not the case as the AANa really has started to move aggressively into areas they are not qualified to provide care.

                Ten Years Ago- "solo" CRNA practice was mostly seen in the rural areas of
                the USA. CRNA's income did not even come close to
                Anesthesiologist pay in any situation. Anesthesiologists
                were paid 150% of Medicare for medical direction of CRNA
                cases (up to four cases). CRNA's running their own Groups
                and covering outpatient centers/offices on their own were
                rare.

                Today- "solo" CRNa practices NOT limited to rural areas. Solo CRNA
                income exceeds Academic Anesthesiologist Pay. Income
                for all CRNA's "sky-rocketting" to levels above Family
                Practice Physicians. CRNA's are the highest paid Mid-Level
                Provides in the USA. Medicare now pays 100% of Medicare
                for medical Direction. CRNA's now get the same pay
                as an Anesthesiologist for doing a case. Medicare no longer
                pays an Anesthesiologist 'extra' for medical direction.
                Medicare pays 1/3-1/4 (about 30%) of typical commercial
                carrier. (Surgeons get 3/4 of typical commercial carrier).
                CRNA's ROUTINELY covering offices/outpatientcenters on
                their own.


                2017- ?? Just guessing but AANA makes even more progress in
                equivalency claims. CRNA pay now 80-90% of an
                Anesthesiologists. Academic departments begin to close
                in great numbers. The AANA claims "victory" to its
                members. Anesthesiologist now Routinely work for CRNA
                Groups as a "Consultant" for difficult cases. No Medical
                Direction rules or Supervision requirements. Medical
                Students stop choosing this specialty.


                OR: The ASA/ABA fights back aggressively. Residents
                mount a vigorous campaign to change the certificate
                to EXPERT IN PERIOPERATIVE MEDICINE. The ASA gets
                the government to require a PERIOPERATIVE PHYSICIAN
                be part of the anesthetic care of all Medicare Patients.
                The ASA gets Medicare to allow Anesthesiologists
                to bill patients for a "co-pay" Education program goes
                well and patients demand Anesthesiologists be involved
                in their care.:)
                 
                C

                CremeSickle

                  ether

                  I know 2 anesthesiologists making over 600K as well, they are statistical outliers. Also, including bennies means you have to do the same when comparing Anesthesiologists. Listen, im PRO-Physician (cause i am one) but I am Anti-Propoganda be it from the AANA, the ASA or you.

                  If we are going to start looking at numbers then the average anesthesiologist makes 300K a year. Now if you add in their malpractice, bennies etc etc.. its well over 400K. So, does it seem to unusual that a mid level makes 140K? I dont think it is. They make 1/4 the income orso for about 1/2 the education.

                  While i think the AANA are a bunch of propagandists, im not blind to the fact that the ASA is just as bad. Everyone is fighting for their piece of the pie, the $$$$ pie. When talking about the ASA vs AANA it has absolutely NOTHING to do with patients or education, it is 100% about dollars. They aren't fooling anyone.

                  Until the ASA produces a good peer reviewed solid study showing that anesthesiologists have better outcomes in anesthesia than CRNAs (which will never happen as its too late now), CRNAs will continue to gain ground. Adding CCM and TEE certs to my name will differentiate us OUTSIDE the OR. Tho i do not think it has any effect on my giving a good anesthetic (or a CRNA doing the same).

                  My personal feeling as someone who works with CRNAs is that their wages have stablized. They are happy with 140K and as they should be! Mid level wages for mid level education.

                  Again, I think that the vast majority of cases (90%) DO NOT need a physician as it has become JUST that "basic". Our role should be supervisory and our profession needs to branch out into REAL medicine (CCM Perioperative). Lets face it, most of anesthesia is B&B cases and isnt rocket science. Having a physician do these cases is like using a sledge hammer on a finishing nail, a waste of resources and highly advanced and skilled professional.

                  Here is what I see. I see a bunch of people who love their 'cake' job doing anesthesia and want badly to protect their 'lifestyle' specialty. This has nothing to do with pt saftey at all and it never has. The gravy train is coming to an end folks. As the economics of healthcare dictate 'cheaper services' (and they do/will) anesthesiologists will be used ONLY for high end CCM related anesthesia but mostly in an ACT supervisory role. Medicine and nursing has done this dance for a hundread years. Its not going to change.
                   

                  EtherMD

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                    ether

                    I know 2 anesthesiologists making over 600K as well, they are statistical outliers. Also, including bennies means you have to do the same when comparing Anesthesiologists. Listen, im PRO-Physician (cause i am one) but I am Anti-Propoganda be it from the AANA, the ASA or you.

                    If we are going to start looking at numbers then the average anesthesiologist makes 300K a year. Now if you add in their malpractice, bennies etc etc.. its well over 400K. So, does it seem to unusual that a mid level makes 140K? I dont think it is. They make 1/4 the income orso for about 1/2 the education.

                    While i think the AANA are a bunch of propagandists, im not blind to the fact that the ASA is just as bad. Everyone is fighting for their piece of the pie, the $$$$ pie. When talking about the ASA vs AANA it has absolutely NOTHING to do with patients or education, it is 100% about dollars. They aren't fooling anyone.

                    Until the ASA produces a good peer reviewed solid study showing that anesthesiologists have better outcomes in anesthesia than CRNAs (which will never happen as its too late now), CRNAs will continue to gain ground. Adding CCM and TEE certs to my name will differentiate us OUTSIDE the OR. Tho i do not think it has any effect on my giving a good anesthetic (or a CRNA doing the same).

                    My personal feeling as someone who works with CRNAs is that their wages have stablized. They are happy with 140K and as they should be! Mid level wages for mid level education.

                    Again, I think that the vast majority of cases (90%) DO NOT need a physician as it has become JUST that "basic". Our role should be supervisory and our profession needs to branch out into REAL medicine (CCM Perioperative). Lets face it, most of anesthesia is B&B cases and isnt rocket science. Having a physician do these cases is like using a sledge hammer on a finishing nail, a waste of resources and highly advanced and skilled professional.

                    Here is what I see. I see a bunch of people who love their 'cake' job doing anesthesia and want badly to protect their 'lifestyle' specialty. This has nothing to do with pt saftey at all and it never has. The gravy train is coming to an end folks. As the economics of healthcare dictate 'cheaper services' (and they do/will) anesthesiologists will be used ONLY for high end CCM related anesthesia but mostly in an ACT supervisory role. Medicine and nursing has done this dance for a hundread years. Its not going to change.



                    Then you see the AANA continuing to make more progress for its members?
                    This is the scenario I am describing for the year 2017. We are agreeing more than disagreeing on the likely continued success of the AANa and its members. This my point to the Residencys about where the specialty is going: The CRNA's are gaining ground every year. The more "lucrative" aspects of Anesthesia we lose (outpatient centers, offices, etc.) the more we become reliant on Medicare and poorly paid cases. The result is a gradual but steady increase of CRNA pay until it approaches 80-90% of an Anesthesiologist.

                    As for where CRNA pay is now, I was using "solo" CRNA income compared to Anesthesiologist income. Solo CRNA's really are making a lot of money these days. For the Residents and Students it matters more where the specialty is going than where it is today. Is Anesthesiology going to be worth the investment in tme and money for the MS-3 ? Or, for that matter the PGY-1 Intern?
                     

                    EtherMD

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                      ether

                      I know 2 anesthesiologists making over 600K as well, they are statistical outliers. Also, including bennies means you have to do the same when comparing Anesthesiologists. Listen, im PRO-Physician (cause i am one) but I am Anti-Propoganda be it from the AANA, the ASA or you.

                      If we are going to start looking at numbers then the average anesthesiologist makes 300K a year. Now if you add in their malpractice, bennies etc etc.. its well over 400K. So, does it seem to unusual that a mid level makes 140K? I dont think it is. They make 1/4 the income orso for about 1/2 the education.

                      While i think the AANA are a bunch of propagandists, im not blind to the fact that the ASA is just as bad. Everyone is fighting for their piece of the pie, the $$$$ pie. When talking about the ASA vs AANA it has absolutely NOTHING to do with patients or education, it is 100% about dollars. They aren't fooling anyone.

                      Until the ASA produces a good peer reviewed solid study showing that anesthesiologists have better outcomes in anesthesia than CRNAs (which will never happen as its too late now), CRNAs will continue to gain ground. Adding CCM and TEE certs to my name will differentiate us OUTSIDE the OR. Tho i do not think it has any effect on my giving a good anesthetic (or a CRNA doing the same).

                      My personal feeling as someone who works with CRNAs is that their wages have stablized. They are happy with 140K and as they should be! Mid level wages for mid level education.

                      Again, I think that the vast majority of cases (90%) DO NOT need a physician as it has become JUST that "basic". Our role should be supervisory and our profession needs to branch out into REAL medicine (CCM Perioperative). Lets face it, most of anesthesia is B&B cases and isnt rocket science. Having a physician do these cases is like using a sledge hammer on a finishing nail, a waste of resources and highly advanced and skilled professional.

                      Here is what I see. I see a bunch of people who love their 'cake' job doing anesthesia and want badly to protect their 'lifestyle' specialty. This has nothing to do with pt saftey at all and it never has. The gravy train is coming to an end folks. As the economics of healthcare dictate 'cheaper services' (and they do/will) anesthesiologists will be used ONLY for high end CCM related anesthesia but mostly in an ACT supervisory role. Medicine and nursing has done this dance for a hundread years. Its not going to change.



                      A CRNA makes a 1/4 of the pay of an Anesthesiologist. Really? This may have been true ten years ago but the fiugure is now 50% abd rising. Thus, my statement that an average CRNA makes 80% of an Anesthesiologist in 2017. 10% of CRNA's already earn "average" Anesthesiologist income today.

                      I respectfully disagree that my statements are "propoganda" in nature. They are "economic reality" and that is what has me concerned.
                       
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                      ReefTiger

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                        Ether,

                        How about we stop teaching nurses or AA's how to do anesthesia? Then they can no longer increase their numbers. Cut off the supply. That's the easiest way to protect it. But we won't/can't because the shortage for anesthesia personnel is too great. If you're so worried, why are you making so much bank from your ACT model at our specialty's expense?
                         

                        EtherMD

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                          Ether,

                          How about we stop teaching nurses or AA's how to do anesthesia? Then they can no longer increase their numbers. Cut off the supply. That's the easiest way to protect it. But we won't/can't because the shortage for anesthesia personnel is too great. If you're so worried, why are you making so much bank from your ACT model at our specialty's expense?


                          I don't teach Student Nurse Anesthetists. You want me to fire all my CRNA's?
                          I have 28 Full time employed people working for me. They have families and many are good people. Some of worked with me for years and done a good job. Is this your solution to our problem? Most on this board recognize this answer as "reactionary" and not realistic. A better solution is to stop the CRNA programs at University hospital (if even this is a good idea?)

                          Although I am Anti-AANA I am not anti-CRNA. Still, I understand your anger at guys like me who run a busy ACT model based practice. Remember, like you most of these things were already in place when I finished my residency years ago.
                           

                          cfdavid

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                            Average CRNA income is more like $130,000 a year. This is for a 40 hour work by a CRNA that is a Group/Hospital CRNA. At 45 hours a week (which reflects a more typical week) the pay is around $150,000 per year plus benefits of $40,000.

                            Independent CRNA's that work in their OWN CRNA Group or have their own contracts make substantially more money. Tell your "mother" that I know a dozen or so CRNA's making in excess of $250,000 (or $300,000 as 1099).
                            I know two who make more than $350,000 per year. How does that sound for a "Mid-Level" Provider? CRNA's are becoming more "creative" in bidding for contracts and providing services for surgi-centers, offices AND small hospitals.
                            They really are "competitors" whether you believe it or not.



                            The AANA/CRNA issue is a real problem and becomes WORSE each year. To ignore the problem or pretend that a label (M.D.) and a white lab coat solves it is naive. Those of you "sequestered" in an acadamic enivironment are probably thinking this issue will never affect you. Wrong. The AANA is going to make sure that every private practice in the country will be impacted by its members and its propoganda. It make take ten years for EVERYONE to feel this impact but it is coming to a neighborhood near you.

                            For Ansthesiologists like myself (a decade or more in practice) this issue is less of a concern than for Medical Students and Residents just entering the field. While the leadership has ignored this issue for decades it is still not too late to mount a strong defense. Patient Education and a better Residency Certificate are good places to start. You deserve more from the ASA and the Academic Chairs: Start demanding it.

                            Granted my sample size is pretty much n=1, but a resident in anesthesiology told me that the CRNAs at his hospital can earn up to 300K if they work "all the time". I took that to mean picking up as much call time and regular hours as possible, and also holidays etc. So, those higher numbers, while not representing 40 hrs (not that Ether suggested such) certainly seem possible.

                            Also, my ex gf (seriously, she was a materialistic beotch!!!!) started at 140K right out of CRNA school. She did a 4 year BSRN, ONE year in the ICU (that was the extent of her real world clinical experience) and then off to CRNA school. I will say she was a smart chick, but man....

                            That being said, I don't think ANY of us are against people making money. By all means.... It's just that we don't appreciate the competition and serious threat to our medical profession by yet another (perhaps the leaders of the pack) advanced practice nursing group overstepping their capabilities.

                            Cheers.
                             

                            johankriek

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                              So, what is your solution? Display your M.D. name tag and wear a white coat? John Q. Public would better understand the term "Peri-Operative" Physician with expertise in certain areas. These credentials do matter to the public and the CRNA.

                              One last question for you. How many years have you been PRACTICING as a Board Certified Anesthesiologist? How many CRNA's have you supervised or hired? 80% of Anesthesia Practices are non-academic and in the real world things are different. The current strategy of the ASA and Academic Chairs is not working at both the State and National Levels. You deserve better.


                              ether.. you are prolly one of those lazy ass attendings that gave crnas wings... Im sure you are .. I know the type


                              All reef was saying about the long coat thing.. was.. let the patient make the decision.. If patients say, we want an anesthesiologist dictating our anesthetic.. not some other physician who has no idea about any anesthesia supervising(what a joke)... otherwise im not having surgery here. Hospitals and groups will be forced to hire anesthesiologists and less and less crnas.. So patient education about credentials of anesthesiologists is a must.
                              . Im in california..been here for 2 years. I have yet to bump into a crna..
                              It is no longer profitable for anesthesiologists to supervise more and more crnas so that will also be a thing of the past as well. In fact a buddy of mine is on the east coast he refuses to supervise more than 2 at a time.. IF he does he complains and if it happens regularly he will quit.. I refuse to supervise even one..
                               

                              EtherMD

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                                ether.. you are prolly one of those lazy ass attendings that gave crnas wings... Im sure you are .. I know the type:smuggrin:


                                All reef was saying about the long coat thing.. was.. let the patient make the decision.. If patients say, we want an anesthesiologist dictating our anesthetic.. not some other physician who has no idea about any anesthesia supervising(what a joke)... otherwise im not having surgery here. Hospitals and groups will be forced to hire anesthesiologists and less and less crnas.. So patient education about credentials of anesthesiologists is a must.
                                . Im in california..been here for 2 years. I have yet to bump into a crna..
                                It is no longer profitable for anesthesiologists to supervise more and more crnas so that will also be a thing of the past as well. In fact a buddy of mine is on the east coast he refuses to supervise more than 2 at a time.. IF he does he complains and if it happens regularly he will quit.. I refuse to supervise even one..
                                :laugh:


                                Calling me names now? All I trying to do is post a few of my ideas in order to help Residents for the future. I work in a major Trauma center without Residents. Our CRNA's do not intubate any patients outside the operating room area and have regular hours. In order to keep the CRNA's from leaving WE cover many afternoon cases and weekend cases ourselves. Do you have any idea what it is like to cover four rooms in a major medical center WITHOUT Residents?
                                We also give breaks, see all the patients preoperatively, place all the blocks in holding and do Cardiac cases "solo". Those of us in the "real world" know covering four rooms is just as difficicult (if not more so) than doing your own room.

                                Not to mention the "in-house" call at night and on the weekends. I am looking forward to my retirement as an academic attending where staffing is NEVER a problem and the hours are much better.
                                :thumbup:
                                 
                                C

                                CremeSickle

                                  . Im in california..been here for 2 years. I have yet to bump into a crna..


                                  Huh?

                                  Have u ever heard of Kaiser? They have a TUN of CRNAs. Lets not forget anywhere not in the major cities, all filled with CRNAs. You just havent been many places im assuming.

                                  I will say i bet there are fewer CRNAs than most places simply because its desirable to live there in regards to "lifestyle" issues.
                                   

                                  johankriek

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                                    Huh?

                                    Have u ever heard of Kaiser? They have a TUN of CRNAs. Lets not forget anywhere not in the major cities, all filled with CRNAs. You just havent been many places im assuming.

                                    I will say i bet there are fewer CRNAs than most places simply because its desirable to live there in regards to "lifestyle" issues.

                                    I know there are crnas at ucla and usc.. just havent seen them in the pvt world.... I even have worked in the middle of the desert(undesirable) in cali and NO crnas..
                                     
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                                    sten biller

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                                      OK enough already. The ridiculous banter on this forum is shameful for any profession particularly physicians. Where is this specialty going? I don't see urologist arguing with their NP's over who provides safer more effective nephrectomies, or GI's trying to defend their domain of endoscopy, or even IM docs arguing their superiority for treating diabetes and HTN over the skill of a PA. Give me a break. The reason CRNAs believe they are as good as MD's is because they are being told this by their schools. CNRA schools are propaganda machines who use their students as minions for their message. The fact of the matter is CRNAs are not medical doctors, period. Must they be reminded to look at their certificate or diploma each mornig when they rise. I don't care what they are told or brainwashed to believe. They are nurses and they and should always be mindful of that. I can't stand the attitude of these people. They somehow believe graduation from crna school is tantamount to annointment. Come on, they even look down their noses on other nurses. Its amazing what a little education can do for someone with so little self worth. I don't know how much longer I can stand by and continue to be part of such a mindless and futile argument. I am considering leaving anesthesiology while I still have a chance!
                                       

                                      drusso

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                                        OK enough already. The ridiculous banter on this forum is shameful for any profession particularly physicians. Where is this specialty going? I don't see urologist arguing with their NP's over who provides safer more effective nephrectomies, or GI's trying to defend their domain of endoscopy, or even IM docs arguing their superiority for treating diabetes and HTN over the skill of a PA. Give me a break. The reason CRNAs believe they are as good as MD's is because they are being told this by their schools. CNRA schools are propaganda machines who use their students as minions for their message. The fact of the matter is CRNAs are not medical doctors, period. Must they be reminded to look at their certificate or diploma each mornig when they rise. I don't care what they are told or brainwashed to believe. They are nurses and they and should always be mindful of that. I can't stand the attitude of these people. They somehow believe graduation from crna school is tantamount to annointment. Come on, they even look down their noses on other nurses. Its amazing what a little education can do for someone with so little self worth. I don't know how much longer I can stand by and continue to be part of such a mindless and futile argument. I am considering leaving anesthesiology while I still have a chance!

                                        Unfortunately, this is what happens when greed takes over the agenda in organized medicine.

                                        Family practice *DOES* battle NP's and PA's
                                        Psychiatry *DOES* battle PhD/PsyD's
                                        Ophthamology vs Optometry
                                        PT's are developing "Doctor of Physical Therapy" programs with in direct competition with physiatry, rheumatology, and ortho.

                                        Anonymous payors could care less who's "turning the nobs." As the health care market becomes more competitive, the job will always go to the lowest bidder.
                                         
                                        C

                                        CremeSickle

                                          Not really

                                          It isnt just about the lowest bidder. It is about the lowest bidder who has the same endpoints. If CRNAs can show that they do the same thing on 90% of cases with similar outcomes (read: LESS or SIMILAR liability claims) then they will win. Right now, MD/DO or CRNA, 90% of cases are not at the physician level and it isnt long before the payors come right out and say it.
                                           

                                          foxtrot

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                                            ether.. you are prolly one of those lazy ass attendings that gave crnas wings... Im sure you are .. I know the type


                                            All reef was saying about the long coat thing.. was.. let the patient make the decision.. If patients say, we want an anesthesiologist dictating our anesthetic.. not some other physician who has no idea about any anesthesia supervising(what a joke)... otherwise im not having surgery here. Hospitals and groups will be forced to hire anesthesiologists and less and less crnas.. So patient education about credentials of anesthesiologists is a must.
                                            . Im in california..been here for 2 years. I have yet to bump into a crna..
                                            It is no longer profitable for anesthesiologists to supervise more and more crnas so that will also be a thing of the past as well. In fact a buddy of mine is on the east coast he refuses to supervise more than 2 at a time.. IF he does he complains and if it happens regularly he will quit.. I refuse to supervise even one..

                                            Well I have to say that if you goto anywhere in the midwest or the deep south you are going to find a ton of CRNAs practicing everywhere. Their training programs are located where residents train. They are out at private surgery centers and in private hospitals. Let's not even talk about rural america, where they have the majority of the anesthetic markets.
                                             

                                            foxtrot

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                                              OK enough already. The ridiculous banter on this forum is shameful for any profession particularly physicians. Where is this specialty going? I don't see urologist arguing with their NP's over who provides safer more effective nephrectomies, or GI's trying to defend their domain of endoscopy, or even IM docs arguing their superiority for treating diabetes and HTN over the skill of a PA. Give me a break. The reason CRNAs believe they are as good as MD's is because they are being told this by their schools. CNRA schools are propaganda machines who use their students as minions for their message. The fact of the matter is CRNAs are not medical doctors, period. Must they be reminded to look at their certificate or diploma each mornig when they rise. I don't care what they are told or brainwashed to believe. They are nurses and they and should always be mindful of that. I can't stand the attitude of these people. They somehow believe graduation from crna school is tantamount to annointment. Come on, they even look down their noses on other nurses. Its amazing what a little education can do for someone with so little self worth. I don't know how much longer I can stand by and continue to be part of such a mindless and futile argument. I am considering leaving anesthesiology while I still have a chance!

                                              Not talking about these issues is how this profession has gotten to be the way it is. The days where attending anesthesiologists sit in their office and drink coffee and play on the internet are numbered. Even though I still see it all of the time as a resident in the academic world. And it makes me sick because this type of laziness is how CRNA's have gained so much ground (sorry for the tangent).
                                              It is time to start talking about these issues and getting involved and demanding more from the ASA and residency programs. Quiting is not the answer. You need to stay in the field and channel your anger into ASAPAC and the ASA. I and many others agree with what you are saying about CRNA's but the fact is that they are not going away. And things are not going to get better if we don't speak out because unfortunately money is the bottom line. I think that EtherMD's posts are very realistic no matter how much we don't want to believe them. His predictions for 2017 are very realistic. It is very possible and plausible for Anesthesiologists to become consultants for difficult cases while CRNA's run the show. I think it is hard for some people to believe because they haven't had much experience with CRNA's. But when you start working more around them or you work where they train, you realize that this is highly plausible.
                                              Bottom line: don't leave the field, we need you.
                                               

                                              ReefTiger

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                                                :rolleyes: Ether said,

                                                "I don't teach Student Nurse Anesthetists. You want me to fire all my CRNA's?
                                                I have 28 Full time employed people working for me. They have families and many are good people. Some of worked with me for years and done a good job. Is this your solution to our problem? Most on this board recognize this answer as "reactionary" and not realistic. A better solution is to stop the CRNA programs at University hospital (if even this is a good idea?)

                                                Although I am Anti-AANA I am not anti-CRNA. Still, I understand your anger at guys like me who run a busy ACT model based practice. Remember, like you most of these things were already in place when I finished my residency years ago."


                                                Cry me a river, poor, poor Ether. 28 poor people, who make lots of money with better hours than you and are too nice to fire. Of course you can't fire them, you wouldn't even if you could. After all, you have to fund your lush retirement at our specialty's expense.

                                                Thank you for your bleeding heart concern for our specialty. Now you think residents should go through more rigorous training than you had to so we can become more credentialed. That way we can work harder to make as much or less than you do now.

                                                I've talked to private practice docs like you before. I've asked them what they thought about CRNA's. Their answer: "I love them. They are what allow me to make a lot of money." That is after all why you work with them isn't it?

                                                Ether, why don't you take your Consultant in Anesthesiology degree and ***** yourself into retirement on another message board rather than stir things up over here. All you offer is angst and work for others that you have no intention of enduring yourself.

                                                PS-thank you for your sympathy, but we already have enough. Maybe you could give it to your 28 employees as a end of the year bonus. That way you could give them something without having to give them any of your retirement pie.
                                                 

                                                EtherMD

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                                                  :rolleyes: Ether said,

                                                  "I don't teach Student Nurse Anesthetists. You want me to fire all my CRNA's?
                                                  I have 28 Full time employed people working for me. They have families and many are good people. Some of worked with me for years and done a good job. Is this your solution to our problem? Most on this board recognize this answer as "reactionary" and not realistic. A better solution is to stop the CRNA programs at University hospital (if even this is a good idea?)

                                                  Although I am Anti-AANA I am not anti-CRNA. Still, I understand your anger at guys like me who run a busy ACT model based practice. Remember, like you most of these things were already in place when I finished my residency years ago."


                                                  Cry me a river, poor, poor Ether. 28 poor people, who make lots of money with better hours than you and are too nice to fire. Of course you can't fire them, you wouldn't even if you could. After all, you have to fund your lush retirement at our specialty's expense.

                                                  Thank you for your bleeding heart concern for our specialty. Now you think residents should go through more rigorous training than you had to so we can become more credentialed. That way we can work harder to make as much or less than you do now.

                                                  I've talked to private practice docs like you before. I've asked them what they thought about CRNA's. Their answer: "I love them. They are what allow me to make a lot of money." That is after all why you work with them isn't it?

                                                  Ether, why don't you take your Consultant in Anesthesiology degree and ***** yourself into retirement on another message board rather than stir things up over here. All you offer is angst and work for others that you have no intention of enduring yourself.

                                                  PS-thank you for your sympathy, but we already have enough. Maybe you could give it to your 28 employees as a end of the year bonus. That way you could give them something without having to give them any of your retirement pie.
                                                  :scared:


                                                  What is your problem? Are you scared of the issues and your future so you call me names? What purpose does that serve except to make you look stupid.

                                                  That said, I gave my CRNA's their Christmas bonus this year and they were pleased. As for your little tirade
                                                  I will start with stating that my time spent in training was post 1988; thus, the ABA requirement for 48 months of Post Graduate Training.

                                                  I am on this board to discuss ideas for improving the profession and helping Residents get a chance at their piece of the American pie. Most private practice guys wouldn't bother posting on your board because they simply don't care. They feel no responsibilty to tell you what's going on in the private practice sector.

                                                  Do you realize the ONLY reason I even have a job anymore?
                                                  It is because the CRNA's need me. Yes, you read it right.
                                                  My hospital (a Major Trauma Medical Center) supports the Anesthesiology department with a large stipend. Without this stipend the hospital would be CRNA "only" as the revenue generation (No PAY, Medicaid, Medicare, etc.) is only sufficient to support the nurse Anesthetists and PERHAPS two Anesthesiologists.

                                                  The CRNA's told the administrators they needed us around for the trauma cases, ASA-4/5, Difficult intubations, OB, etc. Thus, the hospital maintains an ACT model.

                                                  So, in my world (and I know at least 5 hospitals in a similar state) the CRNA's keep me employed. With current laws the hospital does not LEGALLY need an Anesthesiologist any longer. They could hire only CRNA's and bill for their services.

                                                  The year is 2007 and not 2017. The generation before me (two generations prior to you) created the mess we are in today. They reaped huge profits by supervising CRNA's and avoiding work.

                                                  This is becoming much rarer and today's private practice Anesthesiologist is facing a different climate entirely. So, it is better for you to have people suspect you are ignorant fool than open your mouth and remove all doubt.:laugh:
                                                   

                                                  toughlife

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                                                    :rolleyes: Ether said,

                                                    "I don't teach Student Nurse Anesthetists. You want me to fire all my CRNA's?
                                                    I have 28 Full time employed people working for me. They have families and many are good people. Some of worked with me for years and done a good job. Is this your solution to our problem? Most on this board recognize this answer as "reactionary" and not realistic. A better solution is to stop the CRNA programs at University hospital (if even this is a good idea?)

                                                    Although I am Anti-AANA I am not anti-CRNA. Still, I understand your anger at guys like me who run a busy ACT model based practice. Remember, like you most of these things were already in place when I finished my residency years ago."


                                                    Cry me a river, poor, poor Ether. 28 poor people, who make lots of money with better hours than you and are too nice to fire. Of course you can't fire them, you wouldn't even if you could. After all, you have to fund your lush retirement at our specialty's expense.

                                                    Thank you for your bleeding heart concern for our specialty. Now you think residents should go through more rigorous training than you had to so we can become more credentialed. That way we can work harder to make as much or less than you do now.

                                                    I've talked to private practice docs like you before. I've asked them what they thought about CRNA's. Their answer: "I love them. They are what allow me to make a lot of money." That is after all why you work with them isn't it?

                                                    Ether, why don't you take your Consultant in Anesthesiology degree and ***** yourself into retirement on another message board rather than stir things up over here. All you offer is angst and work for others that you have no intention of enduring yourself.

                                                    PS-thank you for your sympathy, but we already have enough. Maybe you could give it to your 28 employees as a end of the year bonus. That way you could give them something without having to give them any of your retirement pie.

                                                    the bolded comment is hypocritical. He is against the organization but not its members. How is that possible?

                                                    Thet fact that he employs AANA members makes it possible for these cats to fund the same organization that wants to destroy his profession. Very smart :rolleyes:

                                                    How about some of us get together and create a CRNA training program in India and start importing them by the hundreds at a much lower rate than american CRNAs?

                                                    We can make some real money there.
                                                     

                                                    toughlife

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                                                      :rolleyes: Ether said,

                                                      "I don't teach Student Nurse Anesthetists. You want me to fire all my CRNA's?
                                                      I have 28 Full time employed people working for me. They have families and many are good people. Some of worked with me for years and done a good job. Is this your solution to our problem? Most on this board recognize this answer as "reactionary" and not realistic. A better solution is to stop the CRNA programs at University hospital (if even this is a good idea?)

                                                      Although I am Anti-AANA I am not anti-CRNA. Still, I understand your anger at guys like me who run a busy ACT model based practice. Remember, like you most of these things were already in place when I finished my residency years ago."


                                                      Cry me a river, poor, poor Ether. 28 poor people, who make lots of money with better hours than you and are too nice to fire. Of course you can't fire them, you wouldn't even if you could. After all, you have to fund your lush retirement at our specialty's expense.

                                                      Thank you for your bleeding heart concern for our specialty. Now you think residents should go through more rigorous training than you had to so we can become more credentialed. That way we can work harder to make as much or less than you do now.

                                                      I've talked to private practice docs like you before. I've asked them what they thought about CRNA's. Their answer: "I love them. They are what allow me to make a lot of money." That is after all why you work with them isn't it?

                                                      Ether, why don't you take your Consultant in Anesthesiology degree and ***** yourself into retirement on another message board rather than stir things up over here. All you offer is angst and work for others that you have no intention of enduring yourself.

                                                      PS-thank you for your sympathy, but we already have enough. Maybe you could give it to your 28 employees as a end of the year bonus. That way you could give them something without having to give them any of your retirement pie.

                                                      the bolded comment is hypocritical. He is against the organization but not its members. How is that possible?

                                                      Thet fact that he employs AANA members makes it possible for these cats to fund the same organization that wants to destroy his profession. Very smart :rolleyes:

                                                      How about some of us get together and create a CRNA training program in India and start importing them by the hundreds at a much lower rate than american CRNAs?

                                                      Anyone up for that?
                                                       
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                                                      EtherMD

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                                                        the bolded comment is hypocritical. He is against the organization but not its members. How is that possible?

                                                        Thet fact that he employs AANA members makes it possible for these cats to fund the same organization that wants to destroy his profession. Very smart :rolleyes:

                                                        How about some of us get together and create a CRNA training program in India and start importing them by the hundreds at a much lower rate than american CRNAs?

                                                        We can make some real money there.



                                                        Hypocrisy? What about YOUR training programs that educates the CRNA?

                                                        You may like a few Democrtats personally but that does not mean you support the Party does it? So, if you hire a Democratic Anesthesiologist does that make you a hypocrite as well?

                                                        What should my practice do? Replace 30 CRNA FTE's with MD/DO's? Where will the hospital find them? How will the hospital pay them (Not well by MD standards)? How much revenue from the cases will the hospital lose in the transition? (tens of millions because Medicare and Medicaid pay the HOSPITAL well). When the CRNA's find out you are trying to replace them they will "bolt" leaving the hospital in a dire state.

                                                        This happened to a hospital North of Us. It cost the facility about ten million dollars in lost revenue beacuse it took FIVE years to find enough SECOND rate Anesthesiologists to take that kind of position. My hospital is THREE times as large as that one.

                                                        So, maybe-just maybe- you should start importing more FMG's to fill those spots you want to create by firing the CRNA's.

                                                        Hypocrisy exists in the world. Open your eyes and deal with it.
                                                         

                                                        EtherMD

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                                                          EtherMD is fairly accurate in what's going out here in private practice land.

                                                          Just because reality is not what you want it to be does not make the messenger a bad guy.



                                                          I appreciate the comment. There is a hospital about one hour North of me that has MD/DO's only. This facility is extremely large but is not a trauma center or County Facility like my hospital. In other words, this facility I am describing has a much better payer mix than my hospital.

                                                          Yet, the very large Group of MD/DO's at this facility receives a stipend similar to ours: Why? Anesthesiologists demand more money in today's marketplace than a CRNA.
                                                          So, this facility pays a stipend to keep their "good" Anesthesiologists from leaving town. I am talking about a large sum of money (millions of dollars).

                                                          What would less funded hospitals do if they had to replace their CRNA's/AA's with ALL MD/DO's? I suspect they would need to hire Tough Life to train and import them. He would need to include a few English classes as well along with basic Spanish.:laugh:
                                                           
                                                          C

                                                          CremeSickle

                                                            Nicely said


                                                            CRNAs are NEEDED by both hospitals and patients who would not get anesthesia care otherwise. Im very PRO-CRNA. Im very ANTI-AANA propoganda. But lets be honest, the ASA employs the same tactics ona regular basis. Its a GAME thats fought with slander, lies and half truths all int he name of MONEY.

                                                            If you give a crap about pts, you dont want CRNAs to go away and you DONT want AAs to replace them. Rural hospitals would close all over the country. They cannot afford our wages and often survive by their OR with very simple cases. Its fine to be political and want to improve working conditions for the profession, but its NOT ok for all pts to suffer for it. Im from a Rural area and without CRNAs the 2 hospitals within 50 miles would close their ORs (if not entirely).
                                                             

                                                            cfdavid

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                                                              :

                                                              Thank you for your bleeding heart concern for our specialty. Now you think residents should go through more rigorous training than you had to so we can become more credentialed. That way we can work harder to make as much or less than you do now.

                                                              .

                                                              For the record, Ether never advocated more rigorous training, but rather being formally certified for the training that anesthesiologists already get during residency. I though that was a good suggestion.
                                                               

                                                              toughlife

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                                                                I appreciate the comment. There is a hospital about one hour North of me that has MD/DO's only. This facility is extremely large but is not a trauma center or County Facility like my hospital. In other words, this facility I am describing has a much better payer mix than my hospital.

                                                                Yet, the very large Group of MD/DO's at this facility receives a stipend similar to ours: Why? Anesthesiologists demand more money in today's marketplace than a CRNA.
                                                                So, this facility pays a stipend to keep their "good" Anesthesiologists from leaving town. I am talking about a large sum of money (millions of dollars).

                                                                What would less funded hospitals do if they had to replace their CRNA's/AA's with ALL MD/DO's? I suspect they would need to hire Tough Life to train and import them. He would need to include a few English classes as well along with basic Spanish.:laugh:

                                                                It just so happens that I am bilingual so that would NOT be a problem for me. :D

                                                                And in case you doubt it: No tendria ningun problema dando clases de espanol a aquellos/as que lo necesiten para llevar a cabo sus funciones.

                                                                Alguna pregunta Sr. Eter?
                                                                 

                                                                toughlife

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                                                                  Hypocrisy? What about YOUR training programs that educates the CRNA?

                                                                  do I look like a program chairman to you who has the power to decide whether to have a NA school or not?

                                                                  You may like a few Democrtats personally but that does not mean you support the Party does it? So, if you hire a Democratic Anesthesiologist does that make you a hypocrite as well?

                                                                  Is your democratic anesthesiologist going to fund an organization that will bankrupt you as well as him?[/I]

                                                                  What should my practice do? Replace 30 CRNA FTE's with MD/DO's? Where will the hospital find them? How will the hospital pay them (Not well by MD standards)? How much revenue from the cases will the hospital lose in the transition? (tens of millions because Medicare and Medicaid pay the HOSPITAL well). When the CRNA's find out you are trying to replace them they will "bolt" leaving the hospital in a dire state.

                                                                  Take a pay cut

                                                                  This happened to a hospital North of Us. It cost the facility about ten million dollars in lost revenue because it took FIVE years to find enough SECOND rate Anesthesiologists to take that kind of position. My hospital is THREE times as large as that one.

                                                                  So, maybe-just maybe- you should start importing more FMG's to fill those spots you want to create by firing the CRNA's.

                                                                  Can you read? I said open a CRNA school in india and train some there to import to the US. Who said anything about importing FMGs?

                                                                  Hypocrisy exists in the world. Open your eyes and deal with it.


                                                                  I am seeing it in you
                                                                   

                                                                  toughlife

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                                                                    Nicely said


                                                                    CRNAs are NEEDED by both hospitals and patients who would not get anesthesia care otherwise. Im very PRO-CRNA. Im very ANTI-AANA propoganda. But lets be honest, the ASA employs the same tactics ona regular basis. Its a GAME thats fought with slander, lies and half truths all int he name of MONEY.

                                                                    If you give a crap about pts, you dont want CRNAs to go away and you DONT want AAs to replace them. Rural hospitals would close all over the country. They cannot afford our wages and often survive by their OR with very simple cases. Its fine to be political and want to improve working conditions for the profession, but its NOT ok for all pts to suffer for it. Im from a Rural area and without CRNAs the 2 hospitals within 50 miles would close their ORs (if not entirely).


                                                                    OK let's say that I want more AAs so that more patients have access to anesthetic care. What would be the excuse to not open more AA schools then?

                                                                    If two AAs replaced the NAs, why would the hospital close?
                                                                     

                                                                    ReefTiger

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                                                                      The reason CRNAs are able to provide care in rural areas is because medicare appropriates money specifically for CRNAs that MD/DOs do not have access to.

                                                                      Ether,

                                                                      I don't know what you are talking about when you say I was calling you names. It does look like I struck a nerve though when your reply verified that you are in fact whoring yourself out and giving CRNAs more power, seeing as how they appear to be your boss.

                                                                      Again, your descriptions of the private sector may be accurate, but you are offering nothing of yourself to solve the issue. By the way, you sure seem to have a lot of time on your hands if you keep posting here.

                                                                      Until you tell us that you've personally donated a fair amount of money to a PAC or the ASA, or are involved in some level politically with the organizations I will view you as a hypocrite.

                                                                      Now I've called you a name.:thumbup:
                                                                       

                                                                      EtherMD

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                                                                        I am seeing it in you


                                                                        As an attending I have more spare time than most of you. Also, the way you respond to my posts is very immature and shows your lack of real word experience.

                                                                        My point about CRNA education is that many academic programs support it.
                                                                        Do you speak out about that issue? Have you discussed this with your PM.
                                                                        Your prgrams are producing the CRNA's who will work in the field regardless of your opinion.

                                                                        Democratic Anesthesiologists do vote against many issues central to our profession. This happens because many of those candidates support a Medicare type program which hurts our specialty the most. President Clinton (whose Mother was a CRNA) did a lot to advance the AANA's agenda.
                                                                        Still, should we fire all the Democratic Anesthesiologists because they diagree with you poltically? What if they vote for socialized medicine? HYpocrisy exists at many levels and disagreement on political/social issues is common.
                                                                        The AANA is a lobby and a poltical organization. They are not the KGB or EX-NAZI members.

                                                                        Do you read my posts. I stated a fact that it took FIVE years for a small hospital to replace their CRNA's with MD/DO's. The reason is that the hospital did reduce the average pay for an Anesthesiologist working at that facility. The marketplace spoke very clearly that young, graduating Residents are not intereted in low wages. My hospital would lose tens of million of dollars trying to change over to a MD/DO model. It will not hapen.

                                                                        With stupid responses like ToughLife I see no reason to continue to educate immature Residents on the facts. NO ONE takes a pay cut when they don't have to; not your attendings and not you. I guarantee that good, graduating Residents will not work in a facility with above average work for below average wages. Your "paycut" response is foolish and ignorant.

                                                                        I have donated funds to our political action committees and will continue to do so. Because unlike you I am interested in helping to improve our profession. Negative comments without any real helpful information is rubbish.

                                                                        Besides calling me a "hypocrite" what have you done for our field? How many cases have you supervised? What experience do you have with earning a real living and running a practice? Even all MD/DO practices have problems which is WHY THE ANSWER IS NOT TO BE REACTIONARY WHEN IT COMES TO THE ACT MODEL. CRNA's are here to stay and that is fact. How we deal with them is up to us (at least for now). By the way the majority of CRNA's (over 90%) work under the supervision of an ASA member.

                                                                        In the end, I predict people like "toughlife" will eat their words. I guarantee he won't like the taste.:rolleyes:

                                                                        For now quit with the stupid "bogus" comments that do not address the problems we face in our profession.
                                                                         
                                                                        C

                                                                        CremeSickle

                                                                          nice


                                                                          So i say something that dosent represent your opinion and now you turn on me calling me a CRNA? What a great "brothership" we have here.

                                                                          My current attending and i were discussing this veyr thread today (im a DO BTW). He said don;t be surprised if they turn on you, thats what residents do best.

                                                                          Could he have nailed it on the head better?

                                                                          You can call me Dr. Cremesickle BTW. Also, my mother is an Anesthesiologist who WAS a CRNA and my dad is a gen surg.

                                                                          EtherMD, i dont know why you bother to try and enlighten these idiots.
                                                                           

                                                                          toughlife

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                                                                            nice


                                                                            So i say something that dosent represent your opinion and now you turn on me calling me a CRNA? What a great "brothership" we have here.

                                                                            My current attending and i were discussing this veyr thread today (im a DO BTW). He said don;t be surprised if they turn on you, thats what residents do best.

                                                                            Could he have nailed it on the head better?

                                                                            You can call me Dr. Cremesickle BTW. Also, my mother is an Anesthesiologist who WAS a CRNA and my dad is a gen surg.

                                                                            EtherMD, i dont know why you bother to try and enlighten these idiots.


                                                                            You seem so CRNA-like. I could have sworn you were one. Regardless, why don't you answer my original question.

                                                                            Why would the hospital close if two capable AAs took over the CRNA jobs???
                                                                             

                                                                            toughlife

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                                                                              As an attending I have more spare time than most of you. Also, the way you respond to my posts is very immature and shows your lack of real word experience.


                                                                              I hope your spare time is while at home not at work. Otherwise that is part of the problem.


                                                                              My point about CRNA education is that many academic programs support it.
                                                                              Do you speak out about that issue? Have you discussed this with your PM.
                                                                              Your prgrams are producing the CRNA's who will work in the field regardless of your opinion.

                                                                              Yes. In some instances some CRNA schools were present before a residency program was instituted. As a resident, all I can do is bring it to the table and ask about it. Do I have the power to stop this? Obviously not. You on the other hand have control in the hiring. So who can effect more change on this issue? You or me?


                                                                              Democratic Anesthesiologists do vote against many issues central to our profession. This happens because many of those candidates support a Medicare type program which hurts our specialty the most. President Clinton (whose Mother was a CRNA) did a lot to advance the AANA's agenda.
                                                                              Still, should we fire all the Democratic Anesthesiologists because they diagree with you poltically? What if they vote for socialized medicine? HYpocrisy exists at many levels and disagreement on political/social issues is common.
                                                                              The AANA is a lobby and a poltical organization. They are not the KGB or EX-NAZI members.

                                                                              Physician support of the democratic party will affect medicine as a whole and this is an issue that needs to be addressed by the entire medical community. Medicare cuts reimbursements across the board not just for anesthesiology. Anesthesiology gets the biggest cut because CMS thinks that you as an attending are just a glorified CRNA so there's no reason to pay you more when the CRNA can do the same job.

                                                                              I am less concerned with the KGB or ex-nazi than I am with the AANA. The two former ones are not interested in anesthesiology as far as I know.

                                                                              Also, support of the democratic party is not the same as support of the AANA. The AANA advocates for your demise. You are their competition. The democratic party will screw all physicians over which is better than just anesthesiology being singled out. Last time I checked the AANA was not lobbying against surgeons


                                                                              Do you read my posts. I stated a fact that it took FIVE years for a small hospital to replace their CRNA's with MD/DO's. The reason is that the hospital did reduce the average pay for an Anesthesiologist working at that facility. The marketplace spoke very clearly that young, graduating Residents are not intereted in low wages. My hospital would lose tens of million of dollars trying to change over to a MD/DO model. It will not hapen.

                                                                              Yet another reason to advocate for more AAs to be trained. AAs have subscribed to the ACT model as one of their main tenets since their inception. ACT model should be in place when all parties involved are in agreement. In this case, the NAs have made it clear they want independent practice.

                                                                              With stupid responses like ToughLife I see no reason to continue to educate immature Residents on the facts. NO ONE takes a pay cut when they don't have to; not your attendings and not you. I guarantee that good, graduating Residents will not work in a facility with above average work for below average wages. Your "paycut" response is foolish and ignorant.

                                                                              So extrapolating your logic, we could say that all academic attendings must not be good because they do above average work for below average wages. Right?

                                                                              I have donated funds to our political action committees and will continue to do so. Because unlike you I am interested in helping to improve our profession. Negative comments without any real helpful information is rubbish.

                                                                              I am glad you donate. I do so myself and encourage everyone to do so. I am only an intern and I am learning as much as I can about the issues surrounding the field. If I wasn't interested in improve our profession, why would I bother learning about all the issues that are affecting it?

                                                                              Besides calling me a "hypocrite" what have you done for our field? How many cases have you supervised? What experience do you have with earning a real living and running a practice? Even all MD/DO practices have problems which is WHY THE ANSWER IS NOT TO BE REACTIONARY WHEN IT COMES TO THE ACT MODEL. CRNA's are here to stay and that is fact. How we deal with them is up to us (at least for now). By the way the majority of CRNA's (over 90%) work under the supervision of an ASA member.

                                                                              I should be asking you that question since I am just starting out and you have had plenty of time to be active and try to change things for the better. I never said I was against the ACT model. If I was, why am I advocating for the addition and training of AAs?

                                                                              I had plenty of jobs before medicine. Backbreaking jobs for that matter. So work is nothing new to me. Running a practice? No.


                                                                              In the end, I predict people like "toughlife" will eat their words. I guarantee he won't like the taste.:rolleyes:

                                                                              How do you know what I want to do?

                                                                              For now quit with the stupid "bogus" comments that do not address the problems we face in our profession.

                                                                              My comments are not hurting the profession. Your actions are.
                                                                               
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