repititionition

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Hi, I went to the RNC! We stayed up late!

I shook hands with AT LEAST 20 of the ~300 Republican members of congress, only 2 of which are on committees even peripherally related to health care.

Thanks to your enormous donations, ASAPAC is the largest physician PAC in the country.

Despite this, I can report no concrete action or progress or action on any issue relevant to Anesthesiologists in the United States.

Please give us more money.

- Mark Brady, MD, Chair of ASAPAC
 

Mman

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Hi, I went to the RNC! We stayed up late!

I shook hands with AT LEAST 20 of the 535 members of congress, only 2 of which are on committees even peripherally related to health care.

Thanks to your enormous donations, ASAPAC is the largest physician PAC in the country.

Despite this, I can report no concrete action or progress or action on any issue relevant to Anesthesiologists in the United States.

Please give us more money.

- Mark Brady, MD, Chair of ASAPAC
Lighten up Francis.

I'd say he spoke with some more important members of congress than stating "only 2 of which are on committees even peripherally related to health care". People like Paul Ryan, Mitch McConnell, etc.

What "concrete action or progress" would you have expected him to report back from Trump-mania 2016? It's a time for glad handing and making connections.
 
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repititionition

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Lighten up Francis.

I'd say he spoke with some more important members of congress than stating "only 2 of which are on committees even peripherally related to health care". People like Paul Ryan, Mitch McConnell, etc.

What "concrete action or progress" would you have expected him to report back from Trump-mania 2016? It's a time for glad handing and making connections.
If the best quote he had was that many members said "thank you so much for your support" while they pumped his hand, I'm simply not impressed.

A "thank you" is nice for the incredible amount of money we've poured into some of these candidates and campaigns, but I for one would prefer something a bit more. The connections should have been made long ago. With the VA nursing handbook coming out, this was a time to stay on message, not *begin* to cultivate relationships.
 
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repititionition

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Lighten up Francis.

I'd say he spoke with some more important members of congress than stating "only 2 of which are on committees even peripherally related to health care". People like Paul Ryan, Mitch McConnell, etc.

What "concrete action or progress" would you have expected him to report back from Trump-mania 2016? It's a time for glad handing and making connections.
My point is pretty simple: at this point, to me, donations to ASAPAC don't look like a great investment in the future of the specialty.
 
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Is the ASA-PAC really the largest physician PAC in the country?

What have they done for anesthesiologists in the last few years? (genuinely curious, not meant to be a snub).
 

Mman

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My point is pretty simple: at this point, to me, donations to ASAPAC don't look like a great investment in the future of the specialty.
I'm curious what better investment you have in mind?
 

Man o War

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Just going to throw this out there....
As long as we as a collective group agree to keep training CRNAs, what would we like them to do for us?
If you think about it, it's absolutely astonishing that we continue to train them. Every other specialty is looking at us thinking WTF.
Pissing in the wind.
 

Mman

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Just going to throw this out there....
As long as we as a collective group agree to keep training CRNAs, what would we like them to do for us?
If you think about it, it's absolutely astonishing that we continue to train them. Every other specialty is looking at us thinking WTF.
Pissing in the wind.

well if we all agreed to stop training all CRNAs, we wouldn't have enough anesthesiologists to meet the market demand for surgeries in the US. What would your solution be? Because surgeons and the public would be drastically against us.
 

d9sccr

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well if we all agreed to stop training all CRNAs, we wouldn't have enough anesthesiologists to meet the market demand for surgeries in the US. What would your solution be? Because surgeons and the public would be drastically against us.
Maybe that's why residency program are expanding. [sarcasm]
 

Mman

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Maybe that's why residency program are expanding. [sarcasm]
Far easier said than done, and you'd probably need to double the number of residency spots (and maybe more) to meet that level of demand.
 
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repititionition

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Just going to throw this out there....
As long as we as a collective group agree to keep training CRNAs, what would we like them to do for us?
If you think about it, it's absolutely astonishing that we continue to train them. Every other specialty is looking at us thinking WTF.
Pissing in the wind.
well if we all agreed to stop training all CRNAs, we wouldn't have enough anesthesiologists to meet the market demand for surgeries in the US. What would your solution be? Because surgeons and the public would be drastically against us.
AA's are the answer.
 

Man o War

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well if we all agreed to stop training all CRNAs, we wouldn't have enough anesthesiologists to meet the market demand for surgeries in the US. What would your solution be? Because surgeons and the public would be drastically against us.
1) AA legislation in all states (this obviously takes time). Change your hiring models to more AA heavy in states where this is possible. I noticed zero difference between them when I supervised.
2) Bare minimum teaching....I can't believe when I hear what some of us are teaching these people. Let's be honest with ourselves about why we are where we are today. Maybe not *you* necessarily but you know what I mean. I have no problem with physician extenders, you're right, at this point they're necessary. We need to change our attitudes toward them though because they have changed theirs toward us.
3) to piggyback on 2, those among us who use CRNAs as an excuse to sit around and do nothing, need to knock that off. They're emboldened when they don't see us at all. That kind of approach is seen by everyone else too, and makes the doc and CRNA interchangeable in their minds. See your own patients- that's another thing that makes me cringe. Manage perceptions.
I don't think this can happen overnight, but we can all do better I bet.
 

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Hi, I went to the RNC! We stayed up late!

I shook hands with AT LEAST 20 of the ~300 Republican members of congress, only 2 of which are on committees even peripherally related to health care.

Thanks to your enormous donations, ASAPAC is the largest physician PAC in the country.

Despite this, I can report no concrete action or progress or action on any issue relevant to Anesthesiologists in the United States.

Please give us more money.

- Mark Brady, MD, Chair of ASAPAC
You and I would get along very, very well my friend.
 

Noyac

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Lighten up Francis.

I'd say he spoke with some more important members of congress than stating "only 2 of which are on committees even peripherally related to health care". People like Paul Ryan, Mitch McConnell, etc.

What "concrete action or progress" would you have expected him to report back from Trump-mania 2016? It's a time for glad handing and making connections.
im gonna have to agree with Mman here.
What did you expect from the letter?
Here is a direct quote:
Ms. Matus introduced me as the Chair of the Anesthesiologists PAC. A few of these leaders said "Nice to meet you" and that was it. An overwhelming majority of them heartily shook my hand and with emphasis said "Thank you so much for your support".

That's about as much as you can expect to get from these guys these days.
 

pjl

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Would have wanted to see promises made for a wall around AANA headquarters. A yuuuge wall. That would be just terrific.
Perhaps we could get the CRNAs to build it.


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deepstate2016

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we shook hands, gave some BJ's and hoped
1. not in the mouth
2. we would still be loved
3. the check would be in the mail
Ahhh money well spent, gotta love politics!
 
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deepstate2016

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1) AA legislation in all states (this obviously takes time). Change your hiring models to more AA heavy in states where this is possible. I noticed zero difference between them when I supervised.
2) Bare minimum teaching....I can't believe when I hear what some of us are teaching these people. Let's be honest with ourselves about why we are where we are today. Maybe not *you* necessarily but you know what I mean. I have no problem with physician extenders, you're right, at this point they're necessary. We need to change our attitudes toward them though because they have changed theirs toward us.
3) to piggyback on 2, those among us who use CRNAs as an excuse to sit around and do nothing, need to knock that off. They're emboldened when they don't see us at all. That kind of approach is seen by everyone else too, and makes the doc and CRNA interchangeable in their minds. See your own patients- that's another thing that makes me cringe. Manage perceptions.
I don't think this can happen overnight, but we can all do better I bet.

Look francis these are not federal issues, but state and local issues. So how about a little reality M'Kay?
 

Man o War

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Look francis these are not federal issues, but state and local issues. So how about a little reality M'Kay?
What would you like them to do for you on a federal level when the problem has originated and proliferated on the local level?
Control what you can control. In our case, it's a lot more than we are taking advantage of.
Or you can continue to treat them as equals and sit on your butt in the lounge.
 

militarymd

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well if we all agreed to stop training all CRNAs, we wouldn't have enough anesthesiologists to meet the market demand for surgeries in the US. What would your solution be? Because surgeons and the public would be drastically against us.
You mean we would wind up in a situation where:

- if we show up late, no one cares, but everyone is just happy that you showed up.

- we actually decide which cases actually need to go to the operating room and when

- if we say that the patient needs additional workup, no one questions you.

- if a surgeon behaves inappropriately, we can just say we're not going to cover your cases.

- we decide what we should be paid for our services.

hmmm.......sounds awful.
 
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Mman

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You mean we would wind up in a situation where:

- if we show up late, no one cares, but everyone is just happy that you showed up.

- we actually decide which cases actually need to go to the operating room and when

- if we say that the patient needs additional workup, no one questions you.

- if a surgeon behaves inappropriately, we can just say we're not going to cover your cases.

- we decide what we should be paid for our services.

hmmm.......sounds awful.

you forgot the part that they would develop nationwide protocols to do cases without us involved in any way. The AANA would simply love it. We'd finish their job for them.
 

militarymd

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you forgot the part that they would develop nationwide protocols to do cases without us involved in any way. The AANA would simply love it. We'd finish their job for them.
Right.....surgery without anesthesia.

What I say applies to the AANA. There is an oversupply of anesthesiologists and nurse anesthetists. Don't let the government or any silly RAND corporation predictions fool you.

How do you think AMC's and "predatory private practice" groups do business?

You don't fall in line....we just get the next body to come and fill your shoes.

The solution is....don't have the next "body" available. Plain and simple.

As for the "demand for surgery"....look at your next OR schedule...tell me how many of those cases really need to be done. Tell me how many of those really are saving lives and preventing morbidity.

Then tell me how many of those are simply the means for money transfers from one pot (payor) to another (payee).
 

Mman

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Right.....surgery without anesthesia.

What I say applies to the AANA. There is an oversupply of anesthesiologists and nurse anesthetists. Don't let the government or any silly RAND corporation predictions fool you.

How do you think AMC's and "predatory private practice" groups do business?

You don't fall in line....we just get the next body to come and fill your shoes.

The solution is....don't have the next "body" available. Plain and simple.

As for the "demand for surgery"....look at your next OR schedule...tell me how many of those cases really need to be done. Tell me how many of those really are saving lives and preventing morbidity.

Then tell me how many of those are simply the means for money transfers from one pot (payor) to another (payee).

I'm not saying surgery without anesthesia, I'm saying without anesthesiologists. There is not an oversupply of anesthesiologists if you are arguing for MD only care. It's a mega under supply. Also, "demand for surgery" is by patients and surgeries, not listing which ones are emergent or not.

If you want to stand in the way of what patients and surgeons desire, they will find a way to do it without you.
 

militarymd

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I'm not saying surgery without anesthesia, I'm saying without anesthesiologists. There is not an oversupply of anesthesiologists if you are arguing for MD only care. It's a mega under supply. Also, "demand for surgery" is by patients and surgeries, not listing which ones are emergent or not.

If you want to stand in the way of what patients and surgeons desire, they will find a way to do it without you.

Where in the world did I say that I want to "stand in the way" of anything.

I said "There is an oversupply of anesthesiologists and nurse anesthetists" and once you correct that oversupply, there will be no more threads about how it's horrible working for AMC's and "predatory private practice" groups.

"Because surgeons and the public would be drastically against us." ...that's just silly. What are they going to do if there aren't any of us around?
 

Mman

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Where in the world did I say that I want to "stand in the way" of anything.

I said "There is an oversupply of anesthesiologists and nurse anesthetists" and once you correct that oversupply, there will be no more threads about how it's horrible working for AMC's and "predatory private practice" groups.

"Because surgeons and the public would be drastically against us." ...that's just silly. What are they going to do if there aren't any of us around?
If you are in favor of not training any CRNAs, we do not have enough anesthesiologists to provide care for all surgical patients. That will mean rationing surgical care until they come up with a way to do it without anesthesiologists (use solo CRNAs). They will do that. It isn't silly talk. We are a cog in the machine. While the machine runs far better with us in it, they'll drive a clunker without us if that's all they can get.
 

militarymd

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If you are in favor of not training any CRNAs, we do not have enough anesthesiologists to provide care for all surgical patients. That will mean rationing surgical care until they come up with a way to do it without anesthesiologists (use solo CRNAs). They will do that. It isn't silly talk. We are a cog in the machine. While the machine runs far better with us in it, they'll drive a clunker without us if that's all they can get.
If you have been reading what I have been typing, then you would know that I'm saying that we need to get rid of the clunkers also.
 

deepstate2016

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What would you like them to do for you on a federal level when the problem has originated and proliferated on the local level?
Control what you can control. In our case, it's a lot more than we are taking advantage of.
Or you can continue to treat them as equals and sit on your butt in the lounge.

Look AA legislation is not happening on a federal level. Not because we do not want it to but because they can't!
The training of CRNA'S depends on the bylaws of the hospital and the contractual agreements between hospitals and schools.
Seeing your own patients, that is individual.
So as I said Francis none of this is federal, so quit bitching about lack federal action.
bitch at the staff meetings about your peers, hitch at the medical staff meetings about scope of practice.
Hitch at the state level about AA's.
And do not worry about what I do, cause I sure as help am not worrying about you.
 

pgg

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I said "There is an oversupply of anesthesiologists and nurse anesthetists" and once you correct that oversupply
Welcome back.

In theory, I guess we could reduce the supply of anesthesiologists by cutting residency positions.

But how could we cut SRNA programs? They're growing like weeds. An SRNA program itself is profitable for the people running them, and they don't need us. CRNAs can teach SRNAs. And they're churning them out at a rate so high that they're hurting their own employment prospects. They won't stop, and we can't stop them.

So, given our inability to put the brakes on CRNA mills, how do you propose we correct the oversupply of CRNAs?
 

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militarymd

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Welcome back.

In theory, I guess we could reduce the supply of anesthesiologists by cutting residency positions.

But how could we cut SRNA programs? They're growing like weeds. An SRNA program itself is profitable for the people running them, and they don't need us. CRNAs can teach SRNAs. And they're churning them out at a rate so high that they're hurting their own employment prospects. They won't stop, and we can't stop them.

So, given our inability to put the brakes on CRNA mills, how do you propose we correct the oversupply of CRNAs?

It's called "teamwork".

One of the issues I have with many anesthesiologists and crnas is this >>>> them (MD or CRNA) versus us (CRNA or MD) attitude.

It is one specialty. It is "our" specialty...like it or not.

Whether it is MD only...CRNA only...or ACT model...or some other hybrid model dictated by economics or whatever circumstance.......does it really matter? It's about care of the patient while they are having some shi t done to them...wheither that s hit is needed, wanted, indicated, or not.

The first step in the solution to "our" problem is to get rid of the oversupply.

However, it appears that my stance is falling, for the most part, on deaf ears.
 

militarymd

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Welcome back.

In theory, I guess we could reduce the supply of anesthesiologists by cutting residency positions.

But how could we cut SRNA programs? They're growing like weeds. An SRNA program itself is profitable for the people running them, and they don't need us. CRNAs can teach SRNAs. And they're churning them out at a rate so high that they're hurting their own employment prospects. They won't stop, and we can't stop them.

So, given our inability to put the brakes on CRNA mills, how do you propose we correct the oversupply of CRNAs?
That there applies to residency programs also...and there lies part of the problem...our, so called leaders.

I've come 180 on the ASAPAC...and the numb nuts running all the training programs....MD and CRNA
 

dr doze

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It's called "teamwork".

One of the issues I have with many anesthesiologists and crnas is this >>>> them (MD or CRNA) versus us (CRNA or MD) attitude.

It is one specialty. It is "our" specialty...like it or not.

Whether it is MD only...CRNA only...or ACT model...or some other hybrid model dictated by economics or whatever circumstance.......does it really matter? It's about care of the patient while they are having some shi t done to them...wheither that s hit is needed, wanted, indicated, or not.

The first step in the solution to "our" problem is to get rid of the oversupply.

However, it appears that my stance is falling, for the most part, on deaf ears.
Your solution is simple and likely to be most effective, But it is highly unlikely to occur. It would require voluntary sacrifice from relatively few people who would be doing so for the collective good of the specialty. That type of behavior is a very rare bird except maybe in the military and religious organizations.
I think that my signature says it all.


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It's called "teamwork".

One of the issues I have with many anesthesiologists and crnas is this >>>> them (MD or CRNA) versus us (CRNA or MD) attitude.

It is one specialty. It is "our" specialty...like it or not.

Whether it is MD only...CRNA only...or ACT model...or some other hybrid model dictated by economics or whatever circumstance.......does it really matter? It's about care of the patient while they are having some shi t done to them...wheither that s hit is needed, wanted, indicated, or not.

The first step in the solution to "our" problem is to get rid of the oversupply.

However, it appears that my stance is falling, for the most part, on deaf ears.
I totally get what you are saying, but it is forces much larger than us that are driving this oversupply. The Wall Street suits don't care if it is CRNAs or MDs. They just want a "provider." Opening SRNA programs is a path of least resistance to flooding the market with "providers." There are no hoops to jump through to get more SNRA spots approved like there are for residencies, the training period is shorter, so you can control the supply a little bit more, and when the market truly becomes flooded, it does not create as much political turmoil to close SRNA programs as it does to close residencies. Once you have more "providers" on the market, you can continue to open up ASCs on every street corner and have a "provider" ready to plug in and give anesthesia, all while decreasing compensation to pocket more of the "provider" billing.
 
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"Teamwork" just takes a backseat sometimes for the negative feelings that I have for the AANA. No matter how much respect I have for individual CRNAs, the conduct of the AANA has effected and will continue to effect the way that I conduct my daily practice. It will continue to do so until I see individual CRNAs in large numbers publicly disavow their organization or their organization changes.

They want to be co-captains (or more) with anesthesiologists, but no matter how deserving an individual (rare) CRNA may be of that role, their position will always top out at first lieutenant in my mind until their organization changes its tune. What their organization does makes good people hate them as a profession. They need to accept this as the cost of doing business the way that they do. I have personally made decisions that have made my life harder to serve this particular agenda. All of us should.
 
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It all started when the ASA conceded that a CRNA can be supervised by a physician... any physician, not necessarily an anesthesiologist!
Agreeing to this horrible concept publically about 15 years ago was a terrible mistake that we will never be able to repair.
The ASA leaders thought that this was a compromise that will end the war with AANA, instead the AANA jumped on it and it helped them gain independent practice status in many states.
Now the ASA wants to take all that mess back and rename or rebrand anesthesiology with their stupid surgical home crap!
Unfortunately it's too late, this train has departed long ago!
 

cbrons

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I totally get what you are saying, but it is forces much larger than us that are driving this oversupply. The Wall Street suits don't care if it is CRNAs or MDs. They just want a "provider." Opening SRNA programs is a path of least resistance to flooding the market with "providers." There are no hoops to jump through to get more SNRA spots approved like there are for residencies, the training period is shorter, so you can control the supply a little bit more, and when the market truly becomes flooded, it does not create as much political turmoil to close SRNA programs as it does to close residencies. Once you have more "providers" on the market, you can continue to open up ASCs on every street corner and have a "provider" ready to plug in and give anesthesia, all while decreasing compensation to pocket more of the "provider" billing.
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