"To cut wait times, VA wants nurses to act like doctors. Doctors say veterans will be harmed."

[Carbocation1]

https://www.washingtonpost.com/news...-doctors-doctors-say-veterans-will-be-harmed/

"The American Society of Anesthesiologists, which represents 53,000 physicians, also opposed the proposed policy, saying that “removing anesthesiologists from surgery and replacing them with nurses” would be “lowering the standard of care and jeopardizing Veterans’ lives.”

The group said nurse anesthetists have half the education and a fraction of the training of physicians. The group plans to hold a press conference Wednesday to denounce the VA plan.

Asked at a hearing in March whether nurses would do the jobs of anesthesiologists under the change, McDonald and Shulkin assured House lawmakers that they would not. On Thursday, the lawmaker who asked the question, said he was misled.

“The secretary assured me, and I believed him,” said Rep. David Jolly (R-Fla.). VA officials could not immediately be reached for a response."

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[Chloroform4Life]

I hope mainstream media get a wind of this. It may get the public to understand the difference between crnas and anesthesiologists. Maybe people will start demanding that a doctor take care of them while they are unconscious.

 

[Carbocation1]

The comments section make me want to vomit.

 

[deleted171991]

The comments section make me want to vomit.

Then the practice of medicine in most American hospitals will. Because that's real life, that's how nurses think, that's what the population is being brainwashed into. And doctors are ****ed for the simple reason that it's very difficult to offer a better impression than the nurse who has half your workload and one tenth of your accumulated fatigue.

I personally would let nurse practitioners play their games, with one condition: a parallel health system, like naturopaths, chiropractors and the ilk. You are not practicing medicine, just "advanced nursing"? Fine. Then go open your advanced nursing practice or group. No referrals to doctors, no help from doctors, because, heck, you are their equal and you don't need supervision. I am ready to compete. If you don't want to be supervised, you should just get the heck out from between me and my patient already.

I am honestly fed up with supervising these people who just steal our knowledge and tricks, like some long-term medical/surgical residents, then claim equivalency. I am all for independence, even if short-term it will mean a huge inflation of physicians. But the genie is half out of the bottle, and won't go back, regardless of what we do. It's just a matter of time anyway. I would rather have this revolution while I am relatively young.

 

[Man o War]

Then the practice of medicine in most American hospitals will. Because that's real life, that's how nurses think, that's what the population is being brainwashed into. And doctors are ****ed for the simple reason that it's very difficult to offer a better impression than the nurse who has half your workload and one tenth of your accumulated fatigue.

I personally would let nurse practitioners play their games, with one condition: a parallel health system, like naturopaths, chiropractors and the ilk. You are not practicing medicine, just "advanced nursing"? Fine. Then go open your advanced nursing practice or group. No referrals to doctors, no help from doctors, because, heck, you are their equal and you don't need supervision. I am ready to compete. If they don't want to be supervised, they should just get the heck out from between me and my patient already.

I am honestly fed up with supervising these people who just steal our knowledge and tricks, like some long-term anesthesiology residents, then claim equivalency. I am all for independence, even if short-term it will mean a huge inflation of physicians. But the genie is half out of the bottle, and won't go back, regardless of what we do. It's just a matter of time anyway. I would rather have this revolution while I am relatively young.

I agree. Bring it. I feel sorry for the patients who will be affected, but this is so far gone I think the disasters will be the only thing that gets the attention of the people who think this is a good idea.

 

[Chloroform4Life]

Yeah, f*** the public who don't know any better. Maybe with trully independent practices, they will finally see the difference and demand to be cared for by physicians.

 

[Taurus]

VA patients are some of the most complex patients. If people are up in arms about long way times, what will the public and press think when our veterans start to die prematurely due to medical errors from NPs and CRNAs?

I say let them run wild and free in the VA system! I love it. I want the national press coverage when the dead bodies build up.

 

[WholeLottaGame7]

It's a race to the bottom, and we're all wearing weights.

Was talking to one of the MDs in my division the other day who is in charge of credentialing for our academic hospital. She said our CTICU was understaffed and they were hiring more NPs to cover the shortage. The head NP for the hospital wanted them to be credentialed to do central lines, PACs, chest tubes, etc, independently after TWO procedures. One for arterial lines.

There's no way this kind of irrational confidence doesn't hurt people. Sadly, this is usually paired with the attitude of "oh, this complication was unavoidable" when something bad inevitably happens.

Medicine is hard enough and complications are frequent enough with MD levels of training/experience. 100% sure it's not going to get any easier with less rigorous standards.

 

[Arantius]

It's a race to the bottom, and we're all wearing weights.

Was talking to one of the MDs in my division the other day who is in charge of credentialing for our academic hospital. She said our CTICU was understaffed and they were hiring more NPs to cover the shortage. The head NP for the hospital wanted them to be credentialed to do central lines, PACs, chest tubes, etc, independently after TWO procedures. One for arterial lines.

There's no way this kind of irrational confidence doesn't hurt people. Sadly, this is usually paired with the attitude of "oh, this complication was unavoidable" when something bad inevitably happens.

Medicine is hard enough and complications are frequent enough with MD levels of training/experience. 100% sure it's not going to get any easier with less rigorous standards.

This whole thing feels like the "wal-mart" ization of healthcare. Fill spots with lower quality "providers" for lower cost. It is frustrating that an NP can get signed off on a procedure after doing it 2 times when, as a resident, I am supervised doing that same procedure for 4 years and have to log each into my case log. Frustrating in the sense that could be my family member at the hands of that NP.


This is madness.

 

[BLADEMDA]

This is the USA and Obama health care system at work.

 

[BLADEMDA]

These threads are why I advocate for specialties without NPs/CRNAs or ones where they kept the leash on.

SRNA= Resident
CRNA= Attending

Just ask the AANA and Dr. Quintana

http://www.aana.com/newsandjournal/...-Juan-Quintana-Takes-Office-as-President.aspx

 

[deleted171991]

These threads are why I advocate for specialties without NPs/CRNAs or ones where they kept the leash on.

You can't keep the leash on forever. By working with midlevels, stupid and/or greedy docs have been training their replacements. If the VA experiment works, just watch it. Monkey see, monkey do, especially in the age of Google. To be honest, many things we learn after medical school are learned the same way. This is market economy at its best.

The main difference is that medical diploma, and the associated postgraduate training, which assures that we know what we don't know. But the public doesn't realize that, because most of them don't fully comprehend how vast and complicated medical science is and how easy it is to make a big mistake, especially when seconds count. My dad is an engineer, a very smart guy, and it took him a while to understand that I think in probabilities, not certitudes, because he doesn't think like that.

Most people don't know that medicine is an experimental science; we make it look precise and clear-cut. Patients don't see all the internal decision-making, the what-ifs. And when we share a small part of those with them, occasionally, they are generally overwhelmed. But this law suggests that we should share more frequently, so that they understand that a medical decision does not come from one book or smartphone app.

 

[WholeLottaGame7]

This whole thing feels like the "wal-mart" ization of healthcare. Fill spots with lower quality "providers" for lower cost. It is frustrating that an NP can get signed off on a procedure after doing it 2 times when, as a resident, I am supervised doing that same procedure for 4 years and have to log each into my case log. Frustrating in the sense that could be my family member at the hands of that NP.


This is madness.

Saw this on a T-shirt on a recent vacation to Utah. So very true.

 

[deleted126335]

Saw this on a T-shirt on a recent vacation to Utah. So very true.

The analogy is flawed, as it is the patient who suffers the consequences of "dumb guts"


Sent from my iPhone using SDN mobile app

 

[kidthor]

I read through the comments, vomited a little, and then laughed to see thoughtful insights from Ron Ray, ‎DNAP, CRNA, FNP-C, ENP-BC. Gotta love the alphabet soup.

 

[Carbocation1]

How do you guys suggest us young med studs have a chance to become wealthy? Medicine seems to be a sinking ship and is not worthy of the sacrifice nowadays... no respect from the public, politicians, Medicrap, etc. Perhaps work in Gas full time until loans are paid off, then transition to part time and use the cash to develop real estate? Open an ASC? I am talking a chance to own a 5M+ home, nice car, not worrying about children's education, etc.

@BLADEMDA

 

[jthedestroyr]

Do a CC fellowship and rotate through units run by different departments or even better rotate through a non academic hospital where the intensivist are only consulted for vent management or if it is time for palliative care. There is a lot of M and M that is occurring in such settings.

These threads are why I advocate for specialties without NPs/CRNAs or ones where they kept the leash on.

SRNA= Resident
CRNA= Attending

Just ask the AANA and Dr. Quintana

http://www.aana.com/newsandjournal/...-Juan-Quintana-Takes-Office-as-President.aspx

I already see "RN Resident" at one of the private hospitals we rotate at. It pisses me off every single time I see their badge as they mirror our, "Physician Resident." They're exact same color, font and size. You know that's intentional because all the other people with those specialty badges are differently color coded from the physician ones. First there was "Nurse Interns," now "RN Resident."

 

[chessknt]

Those comments really were nauseating. The **** quality studies being touted by supposed phds really raises some serious questions about the validity of any degree these political nurse clowns possess. We should do a rct on this and let them bully the Irb in to approving it and see how that goes with no backup.

Most srnas I met hated being nurses and just wanted a ton of money for few hours a week. Noble patient centered professionals is bull****.

 

[polar403]

Those comments really were nauseating. The **** quality studies being touted by supposed phds really raises some serious questions about the validity of any degree these political nurse clowns possess. We should do a rct on this and let them bully the Irb in to approving it and see how that goes with no backup.

Most srnas I met hated being nurses and just wanted a ton of money for few hours a week. Noble patient centered professionals is bull****.

They always want a study that will compare mid-level care to physicians. The only study that would ever reach a reasonable conclusion would be unethical. End of story.

 

[68PGunner]

Not surprising about this bs. I'm going to be a veteran and there's no way in hell I'm using the VA system when it comes to primary care or surgery for me and my family. I rather pay a 30% share to make sure that I and my family get the best care. You don't screw around and cut corners when it comes to health care since a minute mistake could leave me a vegetable.

Due to nurses pushing for independence, I'm all for opening the landscape up to open competition. That means no physician malpractice covering for nurses' mistakes. It's time for individuals to own up to their performances. Why should physicians cover for nurses' mistakes when the nurses themselves are making independent decisions that supposedly result in better care?

 

[Arantius]

How will the liability for crna's at the VA work? Are they included in the feres doctrine? Does it matter if they are a contractor or GS?

 

[68PGunner]

How will the liability for crna's at the VA work? Are they included in the feres doctrine? Does it matter if they are a contractor or GS?

There's no liability when it comes to the VA system. It's the same way in the military healthcare system. Consequently, you can't sue them if they mess up leaving you paralyzed.

 

[Arantius]

And if its like the .mil, im guessing you get good performance reviews if you generate lots of RVU's.. nevermind if you are competent or not. If you're a med student, hopefully in residency you will have an affordable health care plan through the hospital you're at and wont have to go to the VA.

 

[pgg]

There's no liability when it comes to the VA system. It's the same way in the military healthcare system. Consequently, you can't sue them if they mess up leaving you paralyzed.

Would it be too much trouble to at least look up Feres Doctrine on Wikipedia for saying things like this?

Feres Doctrine only applies to persons on active duty. There aren't many (any) of those at the VA. And actually ... the majority of patients at military hospitals aren't active duty either. They're mostly dependents and retirees.

 

[68PGunner]

Would it be too much trouble to at least look up Feres Doctrine on Wikipedia for saying things like this?

Feres Doctrine only applies to persons on active duty. There aren't many (any) of those at the VA. And actually ... the majority of patients at military hospitals aren't active duty either. They're mostly dependents and retirees.

Thank you for your corrections. Apology for the ignorance.

 

[Arantius]

Would it be too much trouble to at least look up Feres Doctrine on Wikipedia for saying things like this?

Feres Doctrine only applies to persons on active duty. There aren't many (any) of those at the VA. And actually ... the majority of patients at military hospitals aren't active duty either. They're mostly dependents and retirees.

This is what i thought but what is confusing is the status of contractors at the VA. Or thise who are active duty being treated at the VA. We have a fair number of those in our region due to "sharing"

 

[Noyac]

The comments section make me want to vomit.

I can't read those comments any longer. But in reality, we should and we should debunk their rhetoric and propaganda at every turn. It just makes me so mad that they are so blantantly disrespectful and willing to do anything for their agenda.

 

[deleted171991]

There's no liability when it comes to the VA system. It's the same way in the military healthcare system. Consequently, you can't sue them if they mess up leaving you paralyzed.

You are partially right. One cannot sue a VA employee, but for other reasons than the Feres doctrine. They can sue only the federal government.

The United States is the only proper defendant in an FTCA action. Agencies may not be named as parties eo nomine. If an offending federal employee or agency is named as a party in an FTCA suit, the United States shall be substituted as the sole defendant. 28 U.S.C. § 2679.

2. Other statutes prohibiting suits against federal employees:

b. Department of Veterans Affairs medical personnel (38 U.S.C. § 7316) (Remedy provided by the FTCA orother federal programs regarding claims “allegedly arising from malpractice or negligence of a healthcareemployee of the [Veteran’s] Administration in furnishing health care or treatment while in the exercise of that employee's duties in or for the [Veteran’s] Administration shall be exclusive of any other civil action or proceeding by reason of the same subject matter against the health care employee (or employee's estate) whose act or omission gave rise to such claim.”); Richardson v. Department of Veteran Affairs, 2006 WL1348392 (W.D.Wash.) (“all claims for willful or negligent conduct by DVA personnel are encompassed within FTCA and veterans-benefits statutes”)

http://www.joegriffith.com/THE FEDERAL TORT CLAIMS ACT 7-29-08 ds.pdf

 

[Planktonmd]

There's no liability when it comes to the VA system. It's the same way in the military healthcare system. Consequently, you can't sue them if they mess up leaving you paralyzed.

That's not entirely true!

 

[WholeLottaGame7]

I already see "RN Resident" at one of the private hospitals we rotate at. It pisses me off every single time I see their badge as they mirror our, "Physician Resident." They're exact same color, font and size. You know that's intentional because all the other people with those specialty badges are differently color coded from the physician ones. First there was "Nurse Interns," now "RN Resident."

You should see if you can bump that up the ladder. If they've gone to the trouble of distinguishing professions (pharmacy, medicine, nursing, etc) by color, that is obviously disingenuous.

 

[BLADEMDA]

When you are injured by a VA doctor or other employee of the Department of Veterans Affairs (VA), you have two legal remedies available to you. You can file a claim with the VA for disability compensation (commonly referred to as a Section 1151 claim), and/or you can seek money damages under the Federal Torts Claims Act (FTCA). The purpose of this article is to explain your rights under the FTCA.

Federal Torts Claims Act vs. Section 1151
You can file a lawsuit under the Federal Torts Claims Act (FTCA) when any employee of the VA acts negligently and causes you an injury. In contrast, Section 1151 is limited to claims of injury resulting from a VA hospital, outpatient clinic, medical examination or surgery. Under the FTCA, a negligent act by any agent of the VA (for example, even a janitor leaving a wet floor on which you slip and get hurt) can be the basis of a medical malpractice lawsuit. This means that the FTCA covers many more negligent acts than Section 1151 benefits do.

It's usually less complicated to get benefits under a Section 1151 claim than under an FTCA claim. The paperwork is easier to file, and the evidence required in a Section 1151 disability compensation claim is typically less than that required in an FTCA claim.

FTCA Damages
Unlike the VA rating system for service-connected disabilities, money damages under the FTCA are not based on an evaluation of how your disability impacts your ability to earn a living. Instead, the money damages you could win are calculated based on your suffering and the economic loss that has resulted from your injury. And unlike disability compensation, which is paid monthly over a number of years, you receive payment in one lump sum if you win an FTCA lawsuit.

It is important to remember, however, that these cases are difficult to win and can go on for many years.

 

[Man o War]

I already see "RN Resident" at one of the private hospitals we rotate at. It pisses me off every single time I see their badge as they mirror our, "Physician Resident." They're exact same color, font and size. You know that's intentional because all the other people with those specialty badges are differently color coded from the physician ones. First there was "Nurse Interns," now "RN Resident."

Take this to your Med Exec. Every place I've worked has had bylaws specifically written to prevent this type of line blurring. There's also been language preventing nurses from introducing themselves as "doctor" which a lot of them like to do after they receive their BS DNAP degrees.

 

[BLADEMDA]

Unlike the private sector, where survivors can file cases in state and federal court and often win large punitive damages, families of patients who die under VA care must exhaust a monthslong administrative review process before filing a lawsuit. Even if they succeed, families can win only actual and not punitive damages from the federal government.

As a result, lawyers are reluctant to take cases, and many families never file – or see a dime.

“The VA fights every case tooth and nail and so cases drag on for years,” said Cristobal Bonifaz, a Massachusetts attorney who in 2009 won a $350,000 settlement for the parents of Marine Lance Cpl. Jeffrey Lucey. Lucey was 23 when he hanged himself with a garden hose in his parents’ basement after being turned away from psychiatric care at the VA in Northampton, Mass. The payout came five years after his death.

Among Bonifaz’s current clients is Tracy Eiswert, who had moved into her car with her two young children after her husband, 31-year-old Iraq War veteran Scott Eiswert, shot himself in the head in 2008. The Nashville, Tenn., VA had denied his disability claim for post-traumatic stress disorder.



Three months after his death, the VA reversed itself, saying it was “clearly and unmistakably in error” for failing to grant Scott Eiswert’s disability claim, and the agency began sending Tracy Eiswert survivor benefits checks of $1,195 a month.

Despite the reversal, Tracy Eiswert decided to press ahead with a wrongful death lawsuit against the VA, in part because of the toll her husband’s suicide took on their children. “We’re still living with it today,” she said.

The VA declined to comment on Scott Eiswert’s death. In court, the VA has defended itself on a legal technicality, arguing that Tennessee law supersedes federal law in the case and that the Eiswert family failed to follow procedures prescribed in the state statute.

Filed in 2010, the case is still pending.


http://cironline.org/reports/va-pays-out-200-million-nearly-1000-veterans’-wrongful-deaths-6236

 

[lobelsteve]

How do you guys suggest us young med studs have a chance to become wealthy? Medicine seems to be a sinking ship and is not worthy of the sacrifice nowadays... no respect from the public, politicians, Medicrap, etc. Perhaps work in Gas full time until loans are paid off, then transition to part time and use the cash to develop real estate? Open an ASC? I am talking a chance to own a 5M+ home, nice car, not worrying about children's education, etc.

@BLADEMDA

Try CEO or professional poker. We all went into medicine to help people.

 

[BLADEMDA]

It's cheaper to fire all the Anesthesiologists and use Independent CRNAs at the VA even if mortality goes up by 10%. Most of the deaths won't result in any lawsuit and those that do would be settled for less than $150,000 each. These Veterans become "disposable items" if the VA allows CRNAs to practice Independently; the bean counters are hoping no one will notice and no one will care.


The median payment in VA wrongful death cases was $150,000.

 

[aneftp]

Question:

If nurses want to practice to the "fullest of their ability"

Than what does a physician do than? How do physicians practice to the "fullest of their ability?"

 

[BLADEMDA]

Question:

If nurses want to practice to the "fullest of their ability"

Than what does a physician do than? How do physicians practice to the "fullest of their ability?"

They try to be as good as their Advanced practice Nurse "colleagues."

 

[GravelRider]

This is my exact point. They have no problem disrespecting is, but our medical societies constantly take the high road and play the diplomatic game. We need to get aggressive and expose them for the butt-wipers they are.

 

[GravelRider]

A nurse is not a colleague. A nurse in any shape or form is a subordinate and that fact needs to be made clear as does the reason why.

My reason for this is selfish. When I get older and start needing to utilize health care then I want someone who is competent taking care of me, not someone who wipes butts and follows a protocol. (Although, I very well may need my butt wiped)

 

[jthedestroyr]

Take this to your Med Exec. Every place I've worked has had bylaws specifically written to prevent this type of line blurring. There's also been language preventing nurses from introducing themselves as "doctor" which a lot of them like to do after they receive their BS DNAP degrees.

In our state they can't introduce themselves as doctors in the hospital. We do have some laws preventing misrepresentation(one of the few) but I'm not sure how that works with "resident title."

Our main hospital, they don't have those badges, it's at an affiliated private that has a reputation for not listening to its own physicians.

 

[criticalelement]

butt wipers

 

[68PGunner]

...

 

[Planktonmd]

This is my exact point. They have no problem disrespecting is, but our medical societies constantly take the high road and play the diplomatic game. We need to get aggressive and expose them for the butt-wipers they are.

If by "medical associations" you mean the ASA then don't hold your breath!

 

[tartesos]

The comments section make me want to vomit.

There's an np that broke down the medical school years that made me want to create an account... But I didn't.


Sent from my iPhone using SDN mobile app

 

[tartesos]

Np in the va as primary care has been A pita.
They order a million tests that they don't know how to interpret. Consult all sub specialties for stupid questions.

Primary care in my opinion is one of the more demanding aspects of internal medicine, you need to be a good DOCTOR to do good primary care, catch on time and know when to refer.

Np education ( that can be had online) can't even come close.

Now I've seen np specialize in cards, Ortho, Icu and they can be very useful, but never in lieu of a physician.


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[Mad Jack]

I read through the comments, vomited a little, and then laughed to see thoughtful insights from Ron Ray, ‎DNAP, CRNA, FNP-C, ENP-BC. Gotta love the alphabet soup.

All that training and still lacking two letters that actually matter...

 

[Mad Jack]

Question:

If nurses want to practice to the "fullest of their ability"

Than what does a physician do than? How do physicians practice to the "fullest of their ability?"

Probably less than that of a nurse, since physicians can't care about a person holistically

 

[Planktonmd]

In the future they will mandate that medical students learn the "Nursing Theory" so they can be holistic and compassionate in their patient care!

 

[Laryngophed]

I already see "RN Resident" at one of the private hospitals we rotate at. It pisses me off every single time I see their badge as they mirror our, "Physician Resident." They're exact same color, font and size. You know that's intentional because all the other people with those specialty badges are differently color coded from the physician ones. First there was "Nurse Interns," now "RN Resident."

My hospital places nurses in a "residency" for those who have just graduated. It is a 12 month rotating orientation through multiple units. I get the idea, but I'm not a huge fan of it being called a residency. It seems deliberately misleading.

 

[criticalelement]

Tips on commenting from the regulations.gov website

Read and understand the regulatory document you are commenting on  Feel free to reach out to the agency with questions  Be concise but support your claims  Base your justification on sound reasoning, scientific evidence, and/or how you will be impacted  Address trade-offs and opposing views in your comment  There is no minimum or maximum length for an effective comment  The comment process is not a vote – one well supported comment is often more influential than a thousand form letters Detailed Recommendations 1. Comment periods close at 11:59 eastern time on the date comments are due - begin