This will be fun

[gasman2014]

I’ll leave this here

Why Anesthesiologists Are Better Than CRNAs

This is just childish.

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[Man o War]

There is a truly shocking lack of professionalism in the CRNA community at large.
It’s like listening to my teenager and her friends. Except they’re supposed to be immature at their age.

 

[acidbase1]

I’ve never met one who thinks differently than the masses. They may act and say the right things, but deep down they’re all the same. CRNAs are hell bent on taking over the profession.

 

[gasman2014]

Here is a response to this from a CRNA (its long):

As long as the ASA and anesthesiologists continue to attempt to suppress CRNA full practice authority, as long as they continue to attempt to discredit the safety of CRNAs, as long as they continue to undervalue, undermine, and attempt to systematically suppress CRNA practice, you will continue to see these types of sites and articles. CRNAs have never attempted these things with anesthesiologists.

In fact, the AANA has always strived and driven for collaboration between anesthesiologists and CRNAs. The AANA has always held the belief that anesthesiologists provide safe, effective care. However, we have always believed that CRNAs do not need an anesthesiologists to direct anesthesia care from the confines of the break room. We have no desire to get rid of anesthesiologists. In fact, just the opposite. We want anesthesiologists earn their keep and prove their worth. We want you to do cases side by side with us, providing actual anesthetics instead of doing 5% of the work (if that much) and claiming 80-90% of the credit and profit. What other healthcare provider can you point to that does that? Now, I know anesthesiologists that do their own cases 100% of the time. Some that do them sometimes. And I know anesthesiologists that make 5-6x their CRNA colleagues and haven’t done a physical anesthetic in 20+ years. What are they contributing to the care of the patients? To the actual outcomes of these patients? Nothing. We do believe, and always have believed, that anesthesia providers should provide ACTUAL anesthetics to prove their worth, and not rely on other providers to do the work for them.

 

[DeadSpace]

Damn, they tricked me! I clicked on it wanting to be told how awesome I am. I guess we'll never get along. I give up on it.

At the bottom, it has a disclaimer saying the person who created the website is a relative of a CRNA and is tired of seeing the ASA slam them.

 

[Wiscoblue]

Damn, they tricked me! I clicked on it wanting to be told how awesome I am. I guess we'll never get along. I give up on it.

At the bottom, it has a disclaimer saying the person who created the website is a relative of a CRNA and is tired of seeing the ASA slam them.

I would love to see them compete with us. Not just the low hanging fruit. Let them do the ASA4 and 5 cases. Let them do the pediatric hearts. Let them do the transplants. And the TAVRs. The 350 pounder mom with twins for section in the middle of the night. Yeah. Bring it on. I do 100% of my own cases.

 

[GravelRider]

I would love to see them compete with us. Not just the low hanging fruit. Let them do the ASA4 and 5 cases. Let them do the pediatric hearts. Let them do the transplants. And the TAVRs. The 350 pounder mom with twins for section in the middle of the night. Yeah. Bring it on. I do 100% of my own cases.

More importantly, let them do the nights, weekends, and holidays. Let them work post-call. Let them stay late until all the rooms start winding down. Let them tell their spouses they don’t know if they’ll be home in time for dinner. They can have all of that.

 

[Man o War]

I would love to see them compete with us. Not just the low hanging fruit. Let them do the ASA4 and 5 cases. Let them do the pediatric hearts. Let them do the transplants. And the TAVRs. The 350 pounder mom with twins for section in the middle of the night. Yeah. Bring it on. I do 100% of my own cases.

Exactly.
I’ve seen enough of them in action to know it would be a complete train wreck. Titanic/iceberg is more like it actually.

 

[Stank811]

Same story different decade. CRNAs are unable to function independently straight out of training. Seen it to many times...”I don’t do regional, I am not comfortable in peds, I am not comfortable with spinals, epidurals, cvls etc....the list goes on.

Each case is also billed the same so the patient does not see an increased cost with MD vs CRNA so who do you want...solo CRNA?

As far as what other medical professionals use midleveles in the same fashion...I would answer most. Once ou get out of an academic center most ERs, hospital floors, ICUs etc are largely infiltrated with mid levels who appear to be doing a lot of the work. They function like residents in environments where residents are jut present.

 

[Stank811]

One last thing...if a CRNA or AA was going to make the same as an MD why would a group hire a mid level...

 

[coffeebythelake]

What a joke. So these CRNAs seem to think they are doing a lot of work sitting in the OR? Follow the recipe, no real consideration to the patient. Most of the time they are browsing the internet.

 

[deleted171991]

Here is a response to this from a CRNA (its long):

As long as the ASA and anesthesiologists continue to attempt to suppress CRNA full practice authority, as long as they continue to attempt to discredit the safety of CRNAs, as long as they continue to undervalue, undermine, and attempt to systematically suppress CRNA practice, you will continue to see these types of sites and articles. CRNAs have never attempted these things with anesthesiologists.

In fact, the AANA has always strived and driven for collaboration between anesthesiologists and CRNAs. The AANA has always held the belief that anesthesiologists provide safe, effective care. However, we have always believed that CRNAs do not need an anesthesiologists to direct anesthesia care from the confines of the break room. We have no desire to get rid of anesthesiologists. In fact, just the opposite. We want anesthesiologists earn their keep and prove their worth. We want you to do cases side by side with us, providing actual anesthetics instead of doing 5% of the work (if that much) and claiming 80-90% of the credit and profit. What other healthcare provider can you point to that does that? Now, I know anesthesiologists that do their own cases 100% of the time. Some that do them sometimes. And I know anesthesiologists that make 5-6x their CRNA colleagues and haven’t done a physical anesthetic in 20+ years. What are they contributing to the care of the patients? To the actual outcomes of these patients? Nothing. We do believe, and always have believed, that anesthesia providers should provide ACTUAL anesthetics to prove their worth, and not rely on other providers to do the work for them.

I think your "CRNA colleague" is full of crap.

 

[GA8314]

CRNA's use social justice/cultural marxist tactics against us. They play the role of the oppressed and claim that we are the ones oppressing them. This is a very effective strategy. If only the big bad anesthesiologists did not keep them down. If only the "MDA's" allowed them to do everything "they are capable of", such as lines of all sorts, US guided regional, TEE. ACT models which don't allow them to spread their wings are oppressive regimes which must be put down. Solo anesthesiologists that suggest they are better trained than a CRNA are victimizing the CRNA's with such a suggestion.

They will use marxist tactics such as attempts at inducing shame. We should feel guilty for not allowing certain practice "rights" be performed by a CRNA. That we oppress them by insisting we are there for induction even for "simple" LMA cases. Shame, and guilt. When all else fails they will call us names.

Consider the following analogy and why many people on the left find Donald Trump to be very frustrating. When accused as being a "wealthy billionaire", Trump essentially immunizes himself from shame. His response? "Yep, I'm REALLY wealthy. A lot MORE wealthy than those reports suggest I am". This eliminates the tool of shame from his opponents. This makes his opponents feel powerless in the sense that they lose a very effective tool.

Politics aside, do not allow yourself to fall victim to shame. See that technique for what it really is. Don't allow for the argument that "if only" the greedy anesthesiologists did not hold them back from reaching their true potential, then all would be just in this world.

 

[deleted171991]

More importantly, let them do the nights, weekends, and holidays. Let them work post-call. Let them stay late until all the rooms start winding down. Let them tell their spouses they don’t know if they’ll be home in time for dinner. They can have all of that.

Even more importantly, do all this while not having access to their smartphones!

 

[acidbase1]

“However, we have always believed that CRNAs do not need an anesthesiologists to direct anesthesia care from the confines of the break room. We have no desire to get rid of anesthesiologists. In fact, just the opposite. We want anesthesiologists earn their keep and prove their worth.”

Statements like this piss me off to no end...

 

[coffeebythelake]

The strategy of the AANA is to demoralize and make anesthesiologists so frustrated with their work that it doesn't become appealing as a medical specialty.

“However, we have always believed that CRNAs do not need an anesthesiologists to direct anesthesia care from the confines of the break room. We have no desire to get rid of anesthesiologists. In fact, just the opposite. We want anesthesiologists earn their keep and prove their worth.”

Statements like this piss me off to no end...

made by cocky CRNAs who think they know so much.
it's not because they're good.
it's because the patient isn't that easy to kill.

 

[deleted171991]

The strategy of the AANA is to demoralize and make anesthesiologists so frustrated with their work that it doesn't become appealing as a medical specialty.

And they are winning. This is not 100 years ago, when physicians were brought in because of all the CRNA butchers losing patients left and right; the technology (including access to OUR science) has caught up with their incompetence.

I see bad decisions on a weekly basis, even from the most experienced, but most wouldn't change outcomes.

The entire field of medicine is becoming nursing. The genie got out of the bottle when we let clipboard nurses run our hospitals.

Also, this is the age of *****s, for humanity. Nobody listens to the true experts anymore, because the population thinks they are smart enough to figure out almost everything for themselves, hence Trump, hence birtherism, hence global warming denial, hence antivaxxers, hence homeopathy etc. The many and noisy (and dumb) carry the day, science and truth be damned. Everybody is an expert, except for the real ones. It's the new marxism.

The current PC and populist movements were invented exactly to make all these people (read "voters") feel smarter than they actually are (politicians know that you catch more flies with honey than vinegar). Then they get manipulated into whatever brainwash the media and the politicians are paid for. Never mind the real experts; we'll just discredit them like all good profiteering authoritarians and special interests do (just look at Africa or Russia). One doesn't need to be a genius to see that we live in a f-ed up world, where common sense is not common anymore, where there is no more respect for the Truth. Why would anesthesiology be any different?

Make hay while the sun shines, then go retire in some sunny cheap place, even if it's just a semi-civilized developing country. You'll be happier than trying to change American medicine.

 

[Robotic Wis-Hipple]

And they are winning. This is not 100 years ago, when physicians were brought in because of all the CRNA butchers losing patients left and right; the technology (including access to OUR science) has caught up with their incompetence.

I see bad decisions on a weekly basis, even from the most experienced, but most wouldn't change outcomes.

The entire field of medicine is becoming nursing. The genie got out of the bottle when we let clipboard nurses run our hospitals.

Also, this is the age of *****s, for humanity. Nobody listens to the true experts anymore, because the population thinks they are smart enough to figure out almost everything for themselves, hence Trump, hence birtherism, hence global warming denial, hence antivaxxers, hence homeopathy etc. The many and noisy (and dumb) carry the day, science and truth be damned. Everybody is an expert, except for the real ones. It's the new marxism.

The current PC and populist movements were invented exactly to make all these people (read "voters") feel smarter than they actually are (politicians know that you catch more flies with honey than vinegar). Then they get manipulated into whatever brainwash the media and the politicians are paid for. Never mind the real experts; we'll just discredit them like all good profiteering authoritarians and special interests do (just look at Africa or Russia). One doesn't need to be a genius to see that we live in a f-ed up world, where common sense is not common anymore, where there is no more respect for the Truth. Why would anesthesiology be any different?

Make hay while the sun shines, then go retire in some sunny cheap place, even if it's just a semi-civilized developing country. You'll be happier than trying to change American medicine.

If you haven’t read this you should. Basically what you said exactly. So sad but true;

http://thefederalist.com/2014/01/17/the-death-of-expertise/

 

[GA8314]

I agree with FFP in many ways. We are experiencing this phenomenon in most of medicine. Make hay while you can and continue with our political efforts. Do not underestimate the power of a good PAC.

 

[dannyboy1]

I would love to see them compete with us. Not just the low hanging fruit. Let them do the ASA4 and 5 cases. Let them do the pediatric hearts. Let them do the transplants. And the TAVRs. The 350 pounder mom with twins for section in the middle of the night. Yeah. Bring it on. I do 100% of my own cases.

Hold on. Pediatric hearts, TAVR, and transplant ( I assume you mean heart lung and liver, not kidney). These are specialized cases that are not performed by the vast majorities of MD’s either. The CRNA’s do not want these cases and certainly not independently. They want to take over the role of “general anesthesiologist”. Unfortunately for us, technology has improved to the point where they can be safe enough...

 

[Man o War]

Hold on. Pediatric hearts, TAVR, and transplant ( I assume you mean heart lung and liver, not kidney). These are specialized cases that are not performed by the vast majorities of MD’s either. The CRNA’s do not want these cases and certainly not independently. They want to take over the role of “general anesthesiologist”. Unfortunately for us, technology has improved to the point where they can be safe enough...

Sure they do. They make no distinction. They are equal in every way according to them. I’ve seen them argue that they’re equivalent in the cardiac room. They have to say that, they can’t admit in public that there is any area they’re deficient in, although those of us involved know better.
It’s so absurd, of course.....hell it’s absurd to me to think they would do any case without MD backup, but as long as Medicare keeps paying rural hospitals only for CRNAs and not MDs, that will happen.

 

[chocomorsel]

Sure they do. They make no distinction. They are equal in every way according to them. I’ve seen them argue that they’re equivalent in the cardiac room. They have to say that, they can’t admit in public that there is any area they’re deficient in, although those of us involved know better.
It’s so absurd, of course.....hell it’s absurd to me to think they would do any case without MD backup, but as long as Medicare keeps paying rural hospitals only for CRNAs and not MDs, that will happen.

That sucks because I am one of those weird chicks that likes rural.

 

[Man o War]

That sucks because I am one of those weird chicks that likes rural.

Me too choco, unfortunately there’s not much heart surgery happening in rural America.
I love small town living, as does my wife. Planning to retire to the UP of Michigan or maybe the mountains of Tennessee.
But then I break out in a cold sweat thinking of being old and sick and winding up under the care of an independent CRNA.

 

[acidbase1]

That sucks because I am one of those weird chicks that likes rural.

They can still be beaten, even in the rural setting. I walked into thier territory and kicked ass, bc at the end of the day, theyre all talk and no product. Don’t be intimidated and keep donating to the PAC.

 

[RebelSandman]

I would love to see them compete with us. Not just the low hanging fruit. Let them do the ASA4 and 5 cases. Let them do the pediatric hearts. Let them do the transplants. And the TAVRs. The 350 pounder mom with twins for section in the middle of the night. Yeah. Bring it on. I do 100% of my own cases.

2 of our 4 anesthesiologists refuse to step foot in or be associated with any heart cases. 1 of our 7 CRNAs doesn’t do them. I did a 7 hour emergency heart on Easter a couple years back because the anesthesiologist refused to be involved “because I don’t do heart cases.” While I did this case placing all lines, floating a Swan, and doing a TEE that found previously undiagnosed 4+ MR, he did a colonoscopy case. His involvement included 2 minutes of “is everything ok in here, I’m going to get some lunch.” While we were on pump.

We do the 350 lbs OB patients. The PS 4 cases (we have no 5 cases, TAVRs, or transplants). I know plenty of CRNAs who do TAVRs, peds hearts, and transplants.

But hey, when the facts don’t matter and nobody will challenge you, you can just say whatever you want. Truth is irrelevant in echo chambers.

 

[dannyboy1]

2 of our 4 anesthesiologists refuse to step foot in or be associated with any heart cases. 1 of our 7 CRNAs doesn’t do them. I did a 7 hour emergency heart on Easter a couple years back because the anesthesiologist refused to be involved “because I don’t do heart cases.” While I did this case placing all lines, floating a Swan, and doing a TEE that found previously undiagnosed 4+ MR, he did a colonoscopy case. His involvement included 2 minutes of “is everything ok in here, I’m going to get some lunch.” While we were on pump.

We do the 350 lbs OB patients. The PS 4 cases (we have no 5 cases, TAVRs, or transplants). I know plenty of CRNAs who do TAVRs, peds hearts, and transplants.

But hey, when the facts don’t matter and nobody will challenge you, you can just say whatever you want. Truth is irrelevant in echo chambers.

Sounds like it’s a pretty small group. Is everyone in the group supposed to do hearts? Are they all fellowship trained? If this doc has not done hearts since residency I can’t fault him for not wanting to do the case. It’s called professionalism and knowing your limits. What you need is a dedicated cardiac call...

 

[Iso4ane]

2 of our 4 anesthesiologists refuse to step foot in or be associated with any heart cases. 1 of our 7 CRNAs doesn’t do them. I did a 7 hour emergency heart on Easter a couple years back because the anesthesiologist refused to be involved “because I don’t do heart cases.” While I did this case placing all lines, floating a Swan, and doing a TEE that found previously undiagnosed 4+ MR, he did a colonoscopy case. His involvement included 2 minutes of “is everything ok in here, I’m going to get some lunch.” While we were on pump.

We do the 350 lbs OB patients. The PS 4 cases (we have no 5 cases, TAVRs, or transplants). I know plenty of CRNAs who do TAVRs, peds hearts, and transplants.

But hey, when the facts don’t matter and nobody will challenge you, you can just say whatever you want. Truth is irrelevant in echo chambers.

Refusing to do a case is not a sign of weakness, its a sign of knowing your limitations. When your name is on the potential lawsuit, one becomes more risk adverse. It's the 'I can do anything attitude' that anesthesiologists are scared of. If a well-trained anesthesiologist knows he can't do everything well, why do you think he/she would believe a CRNA who says they can do everything well. The limits of my degree allow me to perform surgery, and technically I'm probably in the OR more than any surgical colleague of the same level, and arguably I could probably do a appendectomy if I was on LOST island, but that doesn't mean I can perform any surgery.

Also, just because I can drive a car fast, does not make me a NASCAR driver.

 

[Man o War]

2 of our 4 anesthesiologists refuse to step foot in or be associated with any heart cases. 1 of our 7 CRNAs doesn’t do them. I did a 7 hour emergency heart on Easter a couple years back because the anesthesiologist refused to be involved “because I don’t do heart cases.” While I did this case placing all lines, floating a Swan, and doing a TEE that found previously undiagnosed 4+ MR, he did a colonoscopy case. His involvement included 2 minutes of “is everything ok in here, I’m going to get some lunch.” While we were on pump.

We do the 350 lbs OB patients. The PS 4 cases (we have no 5 cases, TAVRs, or transplants). I know plenty of CRNAs who do TAVRs, peds hearts, and transplants.

And you wear this as some type of badge of honor? This is EXACTLY the problem with CRNAs. You have no business doing this case without significant input from an anesthesiologist. What exactly are your qualifications to do TEE? We routinely get referrals from our general group for patients they probably COULD do but don't because the cardiac group is much better equipped to handle it. You have illustrated beautifully the danger in letting CRNAs practice without supervision. Your judgment is highly suspect.
I seriously doubt the historical accuracy of this story. However, I'll give you the benefit of the doubt. Please post where this occurred so I can make a call. The cardiac community is small, I'm sure I know at least one of your attendings. This is terrible patient care IF it happened like this. I'm sure the hospital would like to know they have docs on cardiac call who you claim refuse to do the cardiac cases. The AANA is notorious for stretching the truth; I am sure this is just more of the same.

 

[Man o War]

And you wear this as some type of badge of honor? This is EXACTLY the problem with CRNAs. You have no business doing this case without significant input from an anesthesiologist. What exactly are your qualifications to do TEE? We routinely get referrals from our general group for patients they probably COULD do but don't because the cardiac group is much better equipped to handle it. You have illustrated beautifully the danger in letting CRNAs practice without supervision. Your judgment is highly suspect.
I seriously doubt the historical accuracy of this story. However, I'll give you the benefit of the doubt. Please post where this occurred so I can make a call. The cardiac community is small, I'm sure I know at least one of your attendings. This is terrible patient care IF it happened like this. I'm sure the hospital would like to know they have docs on cardiac call who you claim refuse to do the cardiac cases. The AANA is notorious for stretching the truth; I am sure this is just more of the same.[/QUOTE]

 

[usoggyojimbo]

I liked the conclusion of one the links that was given as support for MD/CRNA equivalency:

"Conclusion: As none of the data were of sufficiently high quality and the studies presented inconsistent findings, we concluded that it was not possible to say whether there were any differences in care between medically qualified anaesthetists and nurse anaesthetists from the available evidence."

I guess they're interpretting it as "the data is good enough to state that there is no difference" but I interpretted it as "the data is not good enough to make a judgement one way or the other."

 

[chocomorsel]

Congrats. You are the exception not the rule. Too many CRNA mills that are unregulated producing way too many inexperienced and undertrained nurses who can’t function on their own. And I am sure plenty don’t want to.

I don’t do hearts and hate hearts as well as most heart surgeons I have come into contact with. Majority of anesthesiologists don’t do hearts and neither do most CRNAs.

Whatever the case, you people need to stop acting like all we anesthesiologists are a bunch of lazy jerks who sit in the break room and sign charts. Plenty of people in ACT practice are running around like chickens with their heads cut off pre-oping, planning cases, lining up patients, taking care of emergencies out of the OR, preventing and putting out fires in the ORs, post oping and taking care of PACU emergencies and doing administrative work that you aren’t privy to. Not just playing soduku and stocks. And the rest of us are doing our own damn cases.

And stop lying that you are any more cost effective to the hospitals than anesthesiologists. That’s a damn lie and you all know it, but keep spewing that s hit to the public. Just cuz the hospital pays you half of what they collect from your services does not mean the patients get charged any less. The rural CRNAs who bill and collect for themselves are making more money than plenty of MDs. So cut the crap.

Which brings me to my next point. Rural pass through sure does make it easy for you to work wherever you want and then claim that “no anesthesiologist wants to come work out in the sticks”. That’s BS. I have called quite a few hospitals looking for jobs and they tell me “we only use CRNAs here”. Plenty of us are limited to working in the sticks by your damn AANA.

The ASA isn’t the problem. It’s the damned AANA that has mandatory membership, with huge lobbying power and attempts to brainwash even the greenest of nurses into thinking they are equal or better trained. Let’s be real, in this country it’s the people with the most money who sway the damn votes. And you guys have plenty of people in power who’s pockets you fill.

Whatever the hell happened to being proud to be a nurse instead of everyone and their damn mama playing doctor and trying to be something they are not? Oh yeah, that online DNP degree qualifies one to be a doctor. Seriously? Is this what’s best for the patients?

That’s why the f I am getting the hell out of this country and it’s big headed nurses who think they are equal or even more knowledgeable than we are when the vast majority of them couldn’t ever hack it in medical school. My class of 200 had two RNs in it. Wonder why? My back up plan was CRNA school if I didn’t get in.

GTFOOH.

2 of our 4 anesthesiologists refuse to step foot in or be associated with any heart cases. 1 of our 7 CRNAs doesn’t do them. I did a 7 hour emergency heart on Easter a couple years back because the anesthesiologist refused to be involved “because I don’t do heart cases.” While I did this case placing all lines, floating a Swan, and doing a TEE that found previously undiagnosed 4+ MR, he did a colonoscopy case. His involvement included 2 minutes of “is everything ok in here, I’m going to get some lunch.” While we were on pump.

We do the 350 lbs OB patients. The PS 4 cases (we have no 5 cases, TAVRs, or transplants). I know plenty of CRNAs who do TAVRs, peds hearts, and transplants.

But hey, when the facts don’t matter and nobody will challenge you, you can just say whatever you want. Truth is irrelevant in echo chambers.

 

[Man o War]

Congrats. You are the exception not the rule. Too many CRNA mills that are unregulated producing way too many inexperienced and undertrained nurses who can’t function on their own. And I am sure plenty don’t want to.

I don’t do hearts and hate hearts as well as most heart surgeons I have come into contact with. Majority of anesthesiologists don’t do hearts and neither do most CRNAs.

Whatever the case, you people need to stop acting like all we anesthesiologists are a bunch of lazy jerks who sit in the break room and sign charts. Plenty of people in ACT practice are running around like chickens with their heads cut off pre-oping, planning cases, lining up patients, taking care of emergencies out of the OR, preventing and putting out fires in the ORs, post oping and taking care of PACU emergencies and doing administrative work that you aren’t privy to. Not just playing soduku and stocks. And the rest of us are doing our own damn cases.

And stop lying that you are any more cost effective to the hospitals than anesthesiologists. That’s a damn lie and you all know it, but keep spewing that s hit to the public. Just cuz the hospital pays you half of what they collect from your services does not mean the patients get charged any less. The rural CRNAs who bill and collect for themselves are making more money than plenty of MDs. So cut the crap.

Which brings me to my next point. Rural pass through sure does make it easy for you to work wherever you want and then claim that “no anesthesiologist wants to come work out in the sticks”. That’s BS. I have called quite a few hospitals looking for jobs and they tell me “we only use CRNAs here”. Plenty of us are limited to working in the sticks by your damn AANA.

The ASA isn’t the problem. It’s the damned AANA that has mandatory membership, with huge lobbying power and attempts to brainwash even the greenest of nurses into thinking they are equal or better trained. Let’s be real, in this country it’s the people with the most money who sway the damn votes. And you guys have plenty of people in power who’s pockets you fill.

Whatever the hell happened to being proud to be a nurse instead of everyone and their damn mama playing doctor and trying to be something they are not? Oh yeah, that online DNP degree qualifies one to be a doctor. Seriously? Is this what’s best for the patients?

That’s why the f I am getting the hell out of this country and it’s big headed nurses who think they are equal or even more knowledgeable than we are when the vast majority of them couldn’t ever hack it in medical school. My class of 200 had two RNs in it. Wonder why? My back up plan was CRNA school if I didn’t get in.

GTFOOH.

I bet he/she is the rule when something goes wrong in these cases. This is no different than interventional cardiologists pushing the envelope on doing certain procedures on certain patients and then needing to get bailed out by a cardiac surgeon.....and they stand there floundering until the surgeon comes and fixes their eff up. They shouldn't even have done it in the first place because they can't competently handle the complications that can occur! This is absolutely shameful and I feel so sorry for the patients at this hospital if this really happened.

 

[chocomorsel]

I bet he/she is the rule when something goes wrong in these cases. This is no different than interventional cardiologists pushing the envelope on doing certain procedures on certain patients and then needing to get bailed out by a cardiac surgeon.....and they stand there floundering until the surgeon comes and fixes their eff up. They shouldn't even have done it in the first place because they can't competently handle the complications that can occur! This is absolutely shameful and I feel so sorry for the patients at this hospital if this really happened.

Yup. Agreed. When s hit hits the fan, they are gonna be just a nurse working under a physician.

If the anesiologist isn't comfy doing hearts he/she should not be supervising a CRNA in a heart room. What the hell kinda practice is this that allows it?

This really is what makes me feel like we should forget this whole ACT thing and give the public what it thinks it wants. Independent nurses, who are " cheaper" and no physician to save them. Then they can truly learn about being completely liable for a patient and not be so damn cocky. We then can see the percentage of CRNAs who can hack it.

 

[parcus]

I like the part about the AAs.

 

[AdmiralChz]

Sitting a cardiac case as an anesthetist or a resident is quite different from running the show as an attending, particularly for big heart cases. Anyone can sit the case - “do this, do that” of course most mid levels can do it. That being said, now that I’m almost done with fellowship, I totally see why a generalist wouldn’t be thrilled about running a pump case particularly if TEE is required.

Sites like this only hurt the nurses who are genuinely just trying to work the job they have as it breeds animosity. No one really benefits, so not sure what the point is.

 

[RebelSandman]

Sounds like it’s a pretty small group. Is everyone in the group supposed to do hearts? Are they all fellowship trained? If this doc has not done hearts since residency I can’t fault him for not wanting to do the case. It’s called professionalism and knowing your limits. What you need is a dedicated cardiac call...

There aren’t enough heart cases to have dedicated call along with general/OB call.

I agree with you, I don’t fault him for not doing something he isn’t comfortable with. In fact, I commend him. We should all have the same level of professionalism. However, the discussion was over complexity of cases and the suggestion that CRNAs are incapable of managing complex cases alone, without backup, and without an anesthesiologist to “bail them out” (if I had a nickel for every time I heard that lame retort). That suggestion is absolutely and unequivocally false. Am I staying ALL CRNAs are created the same and capable of doing the above? No. But neither are anesthesiologists. I’ve seen them quit because “weekend call was too hard,” seen them put 3.5 and 4.0 tubes in every. single. peds. patient. regardless of age. Ive seen them intubate every single patient because they don’t know how to use an LMA. I’ve seen them panic in the cath lab during an endo AAA screaming “where is the CRNA I can’t do this by myself.”

In the end, I think there is room for both of us. There is room for ACT practices and independent practices for both groups. There’s plenty to go around for all of us. I don’t ever want to see anesthesiologists eliminated. Instead, I want to work with and alongside you to provide the MOST patients with the BEST care both groups can provide.

 

[RebelSandman]

And you wear this as some type of badge of honor? This is EXACTLY the problem with CRNAs. You have no business doing this case without significant input from an anesthesiologist. What exactly are your qualifications to do TEE? We routinely get referrals from our general group for patients they probably COULD do but don't because the cardiac group is much better equipped to handle it. You have illustrated beautifully the danger in letting CRNAs practice without supervision. Your judgment is highly suspect.
I seriously doubt the historical accuracy of this story. However, I'll give you the benefit of the doubt. Please post where this occurred so I can make a call. The cardiac community is small, I'm sure I know at least one of your attendings. This is terrible patient care IF it happened like this. I'm sure the hospital would like to know they have docs on cardiac call who you claim refuse to do the cardiac cases. The AANA is notorious for stretching the truth; I am sure this is just more of the same.

[/QUOTE]


I’d love for you to explain why I have no business doing this case. I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist. I’ll wayt.

By the way, one of the anesthesiologists (now gone) that was hired out of residency right before I got here had between 6 or 7 heart cases in residency. I had well over 10x that in my training. Which one of us is more qualified?

 

[pgg]

 

[RebelSandman]

Sitting a cardiac case as an anesthetist or a resident is quite different from running the show as an attending, particularly for big heart cases. Anyone can sit the case - “do this, do that” of course most mid levels can do it. That being said, now that I’m almost done with fellowship, I totally see why a generalist wouldn’t be thrilled about running a pump case particularly if TEE is required.

Sites like this only hurt the nurses who are genuinely just trying to work the job they have as it breeds animosity. No one really benefits, so not sure what the point is.

You think managing 99% of the case without input from the “supervisor” is significantly easier than “running the show” from the break room or PACU and never being involved?

 

[Man o War]

I’d love for you to explain why I have no business doing this case. I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist. I’ll wayt.

By the way, one of the anesthesiologists (now gone) that was hired out of residency right before I got here had between 6 or 7 heart cases in residency. I had well over 10x that in my training. Which one of us is more qualified?[/QUOTE]

First of all, bulls@@t. I'll just direct you to the ACGME requirements for anesthesiologists to complete residency.
Second, still waiting for the name of the facility this supposedly occurred at.
What board certification? You're certified in nursing.

 

[RebelSandman]

Congrats. You are the exception not the rule. Too many CRNA mills that are unregulated producing way too many inexperienced and undertrained nurses who can’t function on their own. And I am sure plenty don’t want to.

I don’t do hearts and hate hearts as well as most heart surgeons I have come into contact with. Majority of anesthesiologists don’t do hearts and neither do most CRNAs.

Whatever the case, you people need to stop acting like all we anesthesiologists are a bunch of lazy jerks who sit in the break room and sign charts. Plenty of people in ACT practice are running around like chickens with their heads cut off pre-oping, planning cases, lining up patients, taking care of emergencies out of the OR, preventing and putting out fires in the ORs, post oping and taking care of PACU emergencies and doing administrative work that you aren’t privy to. Not just playing soduku and stocks. And the rest of us are doing our own damn cases.

And stop lying that you are any more cost effective to the hospitals than anesthesiologists. That’s a damn lie and you all know it, but keep spewing that s hit to the public. Just cuz the hospital pays you half of what they collect from your services does not mean the patients get charged any less. The rural CRNAs who bill and collect for themselves are making more money than plenty of MDs. So cut the crap.

Which brings me to my next point. Rural pass through sure does make it easy for you to work wherever you want and then claim that “no anesthesiologist wants to come work out in the sticks”. That’s BS. I have called quite a few hospitals looking for jobs and they tell me “we only use CRNAs here”. Plenty of us are limited to working in the sticks by your damn AANA.

The ASA isn’t the problem. It’s the damned AANA that has mandatory membership, with huge lobbying power and attempts to brainwash even the greenest of nurses into thinking they are equal or better trained. Let’s be real, in this country it’s the people with the most money who sway the damn votes. And you guys have plenty of people in power who’s pockets you fill.

Whatever the hell happened to being proud to be a nurse instead of everyone and their damn mama playing doctor and trying to be something they are not? Oh yeah, that online DNP degree qualifies one to be a doctor. Seriously? Is this what’s best for the patients?

That’s why the f I am getting the hell out of this country and it’s big headed nurses who think they are equal or even more knowledgeable than we are when the vast majority of them couldn’t ever hack it in medical school. My class of 200 had two RNs in it. Wonder why? My back up plan was CRNA school if I didn’t get in.

GTFOOH.

Most of your post is false, which isn’t surprising.

Never said all anesthesiologists are lazy jerks who do nothing all day. But some are. I have a lot of respect for the ones I work with because they sit cases from time to time, mostly weekends. They provide anesthetics, which is what they were trained to do. And I know quite a few who haven’t provided an anesthetic in decades.

AANA membership isn’t mandatory. Never has been.

Who said I’m not proud to be a nurse? I think that’s a vital part of who I am as a provider and how I treat patients daily. If I wanted to be a doctor I’d have gone to med school. But I wanted to be a CRNA, and I’m proud of it. And none of that has anything to do with my ability to provide excellent, safe anesthetics to all ranges of patients and complexities of cases.

 

[AdmiralChz]

You think managing 99% of the case without input from the “supervisor” is significantly easier than “running the show” from the break room or PACU and never being involved?

You won’t have that much liberty from me in a cardiac case. I’ll be in the room, doing the TEE you know nothing about and interacting with the surgeon about the necessary repairs. In fact, you wouldn’t be in the room at all or in the group with such attitude. Plenty of new CRNA grads next man/gal up!

 

[RebelSandman]

I’d love for you to explain why I have no business doing this case. I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist. I’ll wayt.

By the way, one of the anesthesiologists (now gone) that was hired out of residency right before I got here had between 6 or 7 heart cases in residency. I had well over 10x that in my training. Which one of us is more qualified?

First of all, bulls@@t. I'll just direct you to the ACGME requirements for anesthesiologists to complete residency.
Second, still waiting for the name of the facility this supposedly occurred at.
What board certification? You're certified in nursing.[/QUOTE]


Lol. I can only vouch for the words that came out of this person’s mouth. I didn’t look at their case log, but I assume they would have no reason to lie.

Wrong again. I’m licensed as a nurse. I’m board certified in anesthesia.

 

[RebelSandman]

You won’t have that much liberty from me in a cardiac case. I’ll be in the room, doing the TEE you know nothing about and interacting with the surgeon about the necessary repairs. In fact, you wouldn’t be in the room at all or in the group with such attitude. Plenty of new CRNA grads next man/gal up!

I have no problem with the anesthesiologist being involved. The anesthesiologists that do hearts here work well with the CRNAs as a team to make sure things run smoothly and in the shortest amount of time that is required for us to “delay” incision. And they know and respect us and our ability enough that they don’t feel the need to be present continuously or be called for and get permission to give a medication. But let’s not pretend that “supervising” a case is more intense or difficult than physically providing the anesthetic.

 

[AdmiralChz]

But let’s not pretend that “supervising” a case is more intense or difficult than physically providing the anesthetic.

This quote sums up so well exactly why independent practice remains so elusive for nurses. Dunning-Kruger in real life.

Anyways, this thread has gone about as well as predicted. Does it need to stay open?

 

[Dam272]

Coming from experience of anesthesiology from another country. It is shameful that there is even a discussion of nurses replacing MDs. Healthcare is eventually going to go down the drain in this country, and this is just the beginning.

 

[Psai]

This thread is insane. Really eye opening into how these people think.

 

[Consigliere]

I’d love for you to explain what part of my board certification disqualifies me from doing this case without an anesthesiologist.

Well, you aren't board certified....did you take a written and oral exam, both of which are very challenging to obtain board certification? No. You took a Mickey Mouse exam that 95% of anesthesia nurses pass on the first attempt which is offered 6-7 times a year. Don't ever tell me you are board certified because I will laugh in your face and tell you to take that garbage to St. Elsewhere.

 

[nimbus]

[QUOTE="RebelSandman, post: 19914507, member: 919793" But let’s not pretend that “supervising” a case is more intense or difficult than physically providing the anesthetic.[/QUOTE]


There are many people here who have done or currently do both. I have supervised in the past but currently do my own cases. It is easier and MUCH less stressful to do your own cases. There are few sensations worse than watching someone struggle through something you know you could easily do yourself. I would never go back.

 

[Man o War]

I’d bet a month’s worth of pay this a newish male CRNA(less than 10 yrs practice).
Helpful hint: If you are new to supervising, these are generally the ones you really need to watch in my experience. A legend in their own minds and too much ego.