Univ of Michigan Teaching CRNAs Pain & Regional!!

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mid|ine

Interventional Spine
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I just recieved a workshop invitation for:
"Advanced Pain Management Techniques and Regional Anesthesia Hands-On Workshop"
May 4-6
presented by:
Wayne State University and University of Michigan Schools of Med.

CRNAs ARE INVITED

I dont usually look at these flier often but this caught my eye. I dont know if this is standard practice, but SHOULD NOT BE.

I believe anyone that is involved with any professional societies should encourage strong statements against the teaching of intervention techniques to any non-physicians. This should include not granting any educational credits for attendance, revoking membership from presenters/teachers of the courses, and I would even support revoking board certification or eligibility from physician specialties.
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mid|ine said:
I just recieved a workshop invitation for:
"Advanced Pain Management Techniques and Regional Anesthesia Hands-On Workshop"
May 4-6
presented by:
Wayne State University and University of Michigan Schools of Med.

CRNAs ARE INVITED

I dont usually look at these flier often but this caught my eye. I dont know if this is standard practice, but SHOULD NOT BE.

I believe anyone that is involved with any professional societies should encourage strong statements against the teaching of intervention techniques to any non-physicians. This should include not granting any educational credits for attendance, revoking membership from presenters/teachers of the courses, and I would even support revoking board certification or eligibility from physician specialties.
Click to expand...

Is there a phone number and/or email address on the flier, so we might all voice our displeasure to the course organizers?
 
Members don't see this ad :)
flyer:
http://www.nysora.com/include/WAYNE_STATE_Anesthesia.pdf - shame on nysora as well for promoting/endorsing!
http://www.med.wayne.edu/anesthesiology/docs/AdvReg2006Brochure.pdf

Elie J. Chidiac, M.D.
Assistant Professor
Vice Chair for Education
Associate Residency Program
Director
Wayne State University
Co-Director, Anesthesiology
Michigan Orthopaedic Specialty
Hospital
Detroit, Michigan

Srinivas Chiravuri, M.B.B.S.
Director of Implant Program
Pain Management Anesthesiology
Department of Anesthesiology
University of Michigan
Ann Arbor, Michigan

John A. Dooley, Ph.D.
Clinical Assistant Professor
Department of Psychiatry and
Behavioral Neurosciences
Assistant Professor
Department of Anesthesiology
Wayne State University
Detroit, Michigan

Samir F. Fuleihan, M.D.
Clinical Associate Professor &
Vice Chair
Wayne State University
Chief of Anesthesiology
Harper University Hospital
Detroit Medical Center
Detroit, Michigan

Admir Hadzic, M.D., Ph.D.
Co-director, Regional Anesthesia
Deputy Associate Chairman
Anesthesiology
St Luke’s-Roosevelt Hospital Center
Columbia University
New York, New York

Naeem Haider, M.D.
Assistant Professor
Director of Regional Anesthesia
Interventional Pain Medicine
University of Michigan
Ann Arbor, Michigan

Mark Ireland, Ph.D.
Associate Professor
Department of Anatomy and
Cell Biology
Wayne State University
Detroit, Michigan

Todd E. Lininger, M.D.
Clinical Assistant Professor
Department of Anesthesiology
Wayne State University
Medical Director, NOMC Pain
Management
North Oakland Medical Center
Waterford, Michigan

H. Michael Marsh, M.B., B.S.
Professor & Chair
Department of Anesthesiology
Wayne State University
Specialist-in-Chief
Detroit Medical Center
Detroit, Michigan

Mitchell Marshall, M.D.
Associate Professor of Clinical
Anesthesiology
New York University Hospital for
Joint Diseases
New York, New York

Eugene Mitchell, M.D.
Assistant Professor of Anesthesiology
Medical Director of PACU
Director, Regional Anesthesia
Director, Orthopaedic Anesthesia
Interventional Pain Medicine Faculty
University of Michigan
Ann Arbor, Michigan

Samuel Perov, M.D.**
Associate Professor
Wayne State University
Chief of Anesthesiology
Detroit Receiving Hospital
Detroit Medical Center
Detroit, Michigan

Jovan Popovic, M.D., FRCPC
Assistant Professor & Attending
Anesthesiologist
Department of Anesthesiology
New York University Hospital
for Joint Diseases
New York, New York

Douglas Quint, M.D.
Professor of Neuroradiology and MR
Imaging
Radiology Department
Director of Resident Education
University of Michigan
Ann Arbor, Michigan

Liz Renaud, RN, MSN, OCN, NP
Pain Management Nurse Specialist
Department of Anesthesiology
Detroit Receiving Hospital
Detroit Medical Center
Detroit, Michigan

Setti Rengachary, M.D.
Professor and Associate Chair
Department of Neurosurgery
Wayne State University
Detroit Medical Center
Detroit, Michigan

Andrew D. Rosenberg, M.D.
Clinical Professor of Anesthesiology
and Orthopedic Surgery
Chair, Department of Anesthesiology
New York University Hospital
for Joint Diseases
New York, New York

Santhanam Suresh, M.D.
Co-Director, Pain Treatment Services
Children’s Memorial Hospital
Associate Professor of Anesthesiology
& Pediatrics
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

Ronald Wasserman, M.D.
Director
University of Michigan Center
for Interventional Pain Medicine
Chief, Pain Service
University of Michigan
Ann Arbor, Michigan

Jessie Wood, Ph.D., PT
Assistant Professor
Department of Anatomy & Cell Biology
Wayne State University
Detroit, Michigan
**Program Chair
 
Liz Renaud, RN, MSN, OCN, NP
Pain Management Nurse Specialist
Department of Anesthesiology
Detroit Receiving Hospital
Detroit Medical Center
Detroit, Michigan


^^^

WOW! WOW!
I envy her title.🙄
 
People, you’re making a big deal out of nothing. I am the Vice Chair at Wayne State University, and I am responding because a former and a current Pain Fellow noticed this web site and alerted me.

This course is offered annually. It’s primarily for our own residents. It includes lectures by anatomists, and acute and chronic pain anesthesiologists. It also includes guest Faculty with expertise in either chronic or acute pain. And in the afternoon, we go to the basement of the medical school building and work with predisected cadavers and fresh cadavers.

This is truly a great course. Outsiders who join us always send more people the following years. The U. Michigan Faculty came one year and loved it so much that they are now co-sponsors and they insist on sending their residents to the course. Same with our neurosurgery faculty and residents.

We are getting 60-100 people per year, mostly anesthesiologists and anesth. residents, plus a smattering of Acute Pain Nurses (our own three rounders who help us manage our enormous acute pain service – to whomever commented on Liz Renaud’s title, that’s exactly what she is), Neurologists, Neurosurgeons, etc… Over the past few years, I can only recall a total of 3 CRNA attendees, and they were all sent by a group of orthopedic surgeons and anesthesiologists who work in a stand-alone orthopedic surgery center.

RE. the brochure and invitation, someone here missed the point: If you look at the actual brochure at this web site http://www.med.wayne.edu/anesthesiology/docs/Anesthesia2007.pdf , you will see that under ‘target audience’, it only mentions “anesthesiologists, neurologists, neurosurgeons, residents and fellows.” It does not mention nurses or CRNAs. They are only mentioned on the page where people have to register and pay. I think that alone makes it clear to everybody: Both Wayne State and U. Michigan are sponsoring this course but are not supporting training CRNAs in regional or pain.

As you all know, nurses, medical students and CRNAs are always invited to anesthesiology conferences. Here, they are not on the list of ‘target audience’, but they are on the fee/registration list. I cannot think of any major anesthesiology conferences where they’re not invited. And this includes the annual A.S.A. meeting. As you may know, the A.S.A. is looking to offer membership to CRNAs.

So please don’t make a mountain out of a mole hill. Come join us for the course. Detroit is beautiful that time of the year, ONLY that time of the year ;-( ;-( ;-(

E.J. Chidiac
 
I guess that means I have to pull the pins out of the voodoo doll. Sorry about the testicular pain.
 
passgas said:
People, you’re making a big deal out of nothing. I am the Vice Chair at Wayne State University, and I am responding because a former and a current Pain Fellow noticed this web site and alerted me.

This course is offered annually. It’s primarily for our own residents. It includes lectures by anatomists, and acute and chronic pain anesthesiologists. It also includes guest Faculty with expertise in either chronic or acute pain. And in the afternoon, we go to the basement of the medical school building and work with predisected cadavers and fresh cadavers.

This is truly a great course. Outsiders who join us always send more people the following years. The U. Michigan Faculty came one year and loved it so much that they are now co-sponsors and they insist on sending their residents to the course. Same with our neurosurgery faculty and residents.

We are getting 60-100 people per year, mostly anesthesiologists and anesth. residents, plus a smattering of Acute Pain Nurses (our own three rounders who help us manage our enormous acute pain service – to whomever commented on Liz Renaud’s title, that’s exactly what she is), Neurologists, Neurosurgeons, etc… Over the past few years, I can only recall a total of 3 CRNA attendees, and they were all sent by a group of orthopedic surgeons and anesthesiologists who work in a stand-alone orthopedic surgery center.

RE. the brochure and invitation, someone here missed the point: If you look at the actual brochure at this web site http://www.med.wayne.edu/anesthesiology/docs/Anesthesia2007.pdf , you will see that under ‘target audience’, it only mentions “anesthesiologists, neurologists, neurosurgeons, residents and fellows.” It does not mention nurses or CRNAs. They are only mentioned on the page where people have to register and pay. I think that alone makes it clear to everybody: Both Wayne State and U. Michigan are sponsoring this course but are not supporting training CRNAs in regional or pain.

As you all know, nurses, medical students and CRNAs are always invited to anesthesiology conferences. Here, they are not on the list of ‘target audience’, but they are on the fee/registration list. I cannot think of any major anesthesiology conferences where they’re not invited. And this includes the annual A.S.A. meeting. As you may know, the A.S.A. is looking to offer membership to CRNAs.

So please don’t make a mountain out of a mole hill. Come join us for the course. Detroit is beautiful that time of the year, ONLY that time of the year ;-( ;-( ;-(

E.J. Chidiac
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I am afraid that I beg to differ. Anesthesiologists, especially academic anesthesiologists, frequently see "no harm" in training other physicians and nonphysicians ADVANCED INTERVENTIONAL techniques. You need to wake up and smell the coffee. You would never be able to enroll in a "hands-on" workshop that teaches diskectomy and spinal fusion. They would not let you even though you are a physician. Anesthesiologists are very good at attempting to make themselves extinct. Perhaps this only becomes clearer in private practice. You need to wake up.............
 
mille125 said:
I am afraid that I beg to differ. Anesthesiologists, especially academic anesthesiologists, frequently see "no harm" in training other physicians and nonphysicians ADVANCED INTERVENTIONAL techniques. You need to wake up and smell the coffee. You would never be able to enroll in a "hands-on" workshop that teaches diskectomy and spinal fusion. They would not let you even though you are a physician. Anesthesiologists are very good at attempting to make themselves extinct. Perhaps this only becomes clearer in private practice. You need to wake up.............
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This post was posted in surgical forums....
http://forums.studentdoctor.net/showthread.php?t=340752

I'm not sure whether this makes any sense...
 
I am anesthesia trained and I agree the anesthesiology departments are screwing up the future of their residents.
In the long run courses like the one in Michigan would be deadly to the profession (M.D.) just like anything else that today medicine is facing i.e. cheap unqualified labour of midlevel providers or outsourcing. Unfortunately this want affect the organizers of the above course- I wish it would.
I think the midlevel cost efective below par services will discourage the young generation to get into medical school-- these consequences will prove deadly to medicine in years to come in this country. It is not far when people will go to Canada to see a doctor because in US you will see only a nurse ,NP or a PA.

The leaders in academic programs should wake up and see outside the box.
 
I still see NO problem with my original post. While they may not be listed as the target audience they are clearly welcome. There is no disclaimer that the MAY NOT ATTEND WORKSHOPS! There is no reason to believe they will not be performing procedures at the meeting!
 
I agree. CRNAs are militant in this area, and given the opportunity to be "certified" by anyone who will give out any pain related certification, they will do so. The tacit acceptance of CRNAs to a workshop due to the lack of definition of qualifications for who may attend is an anathema to the profession of pain medicine. Course directors need to wake up and use just a tad of common sense when designing their course brochures.
 
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algosdoc said:
I agree. CRNAs are militant in this area, and given the opportunity to be "certified" by anyone who will give out any pain related certification, they will do so. The tacit acceptance of CRNAs to a workshop due to the lack of definition of qualifications for who may attend is an anathema to the profession of pain medicine. Course directors need to wake up and use just a tad of common sense when designing their course brochures.
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Absolutely correct. Pain medicine is the practice of MEDICINE. If there were a separate track for RN's or CRNA's that dealt with nursing care issues, as is some times offered at ASRA meetings or other organizations, that would be one thing, but this seems to blur the lines.
 
i wish that "passgas" or someone else in his position would respond to this forum. I hate one sided discussions (even though our side is correct in this case). Maybe this is why there is no response.
 
mille125 said:
i wish that "passgas" or someone else in his position would respond to this forum. I hate one sided discussions (even though our side is correct in this case). Maybe this is why there is no response.
Click to expand...

Maybe when the members of this forum stop describing the actions of someone in Dr. Chidiac's position as "screwing up the future", "deadly", "whoring out their profession", "cashing out" before the **** hits the fan", "greed", and advising them to "wake up", a sane, reasoned discussion might be held on the topic.

Until the level of our discourse is elevated above that of a schoolyard brawl, why would anyone in a position of authority bother to venture into our den of vipers?
 
paz5559 said:
Maybe when the members of this forum stop describing the actions of someone in Dr. Chidiac's position as "screwing up the future", "deadly", "whoring out their profession", "cashing out" before the **** hits the fan", "greed", and advising them to "wake up", a sane, reasoned discussion might be held on the topic.

Until the level of our discourse is elevated above that of a schoolyard brawl, why would anyone in a position of authority bother to venture into our den of vipers?
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Paz,


I cannot speak for all of the members on this forum. However, I would surmise that most if not all of us hold Mr. Chidiac (and others in his position) in high esteem. Educating and training residents are admirable aims and most anesthesia/pain management departments do a very good job at this. This is not what I take issue with. It does concern me that Mr. Chidiac and others like him our "letting down" our profession by training others on interventional techniques. If you want to give a lecture on a topic, I say invite MD's, CRNA's, MA's, AA,s and any other person who wants to attend. However, offering them training in interventional techniques is wrong, especially in today's environment. If you want to enroll in a lecture given by cardiologists on diastolic dysfunction, they would gladly let you in. If you want to enroll in a hands-on course on placement of intracoronary stents, there is ABSOLUTELY no way that they would let you in (even as an MD). This is the point that I am trying to stress to Mr. Chidiac and others like him because they can cause change. I actually hold him in high esteem.
 
Paz, the rant that you're referring to (whoring, etc) did not originate in this forum. It was quoted from the surgical forum, and the person who posted it here said "I'm not sure whether this makes any sense..."

I think we need to be very vigilant about this issue - not only with CRNAs, but with courses that crank out the "weekend wonders". As far as I'm concerned the weekend wonder courses do far more harm because they turn out high volumes of licensed physicians who are poorly trained in interventional techniques. Those guys can set up their own procedure room or get into a loosely governed ASC and do a lot of damage.

I don't know what the qualifications are for attending an ISIS course, but unless you're a resident/fellow or a trained pain doc looking for a refresher you shouldn't be allowed to touch a cadaver at one of those courses.
 
gorback said:
Paz, the rant that you're referring to (whoring, etc) did not originate in this forum. It was quoted from the surgical forum, and the person who posted it here said "I'm not sure whether this makes any sense..."
Click to expand...


That rant did not make any sense to me...but, i thought it was relevant to this thread and discussion. Anyway, that poster did not attack anyone personally. BTW...i deleted it and leaving the link.
 
gorback said:
Paz, the rant that you're referring to (whoring, etc) did not originate in this forum. It was quoted from the surgical forum, and the person who posted it here said "I'm not sure whether this makes any sense..."

I think we need to be very vigilant about this issue - not only with CRNAs, but with courses that crank out the "weekend wonders". As far as I'm concerned the weekend wonder courses do far more harm because they turn out high volumes of licensed physicians who are poorly trained in interventional techniques. Those guys can set up their own procedure room or get into a loosely governed ASC and do a lot of damage.

I don't know what the qualifications are for attending an ISIS course, but unless you're a resident/fellow or a trained pain doc looking for a refresher you shouldn't be allowed to touch a cadaver at one of those courses.
Click to expand...



my sentiments as well
 
passgas said:
People, you’re making a big deal out of nothing. I am the Vice Chair at Wayne State University, and I am responding because a former and a current Pain Fellow noticed this web site and alerted me.

This course is offered annually. It’s primarily for our own residents. It includes lectures by anatomists, and acute and chronic pain anesthesiologists. It also includes guest Faculty with expertise in either chronic or acute pain. And in the afternoon, we go to the basement of the medical school building and work with predisected cadavers and fresh cadavers.

This is truly a great course. Outsiders who join us always send more people the following years. The U. Michigan Faculty came one year and loved it so much that they are now co-sponsors and they insist on sending their residents to the course. Same with our neurosurgery faculty and residents.

We are getting 60-100 people per year, mostly anesthesiologists and anesth. residents, plus a smattering of Acute Pain Nurses (our own three rounders who help us manage our enormous acute pain service – to whomever commented on Liz Renaud’s title, that’s exactly what she is), Neurologists, Neurosurgeons, etc… Over the past few years, I can only recall a total of 3 CRNA attendees, and they were all sent by a group of orthopedic surgeons and anesthesiologists who work in a stand-alone orthopedic surgery center.

RE. the brochure and invitation, someone here missed the point: If you look at the actual brochure at this web site http://www.med.wayne.edu/anesthesiology/docs/Anesthesia2007.pdf , you will see that under ‘target audience’, it only mentions “anesthesiologists, neurologists, neurosurgeons, residents and fellows.” It does not mention nurses or CRNAs. They are only mentioned on the page where people have to register and pay. I think that alone makes it clear to everybody: Both Wayne State and U. Michigan are sponsoring this course but are not supporting training CRNAs in regional or pain.

As you all know, nurses, medical students and CRNAs are always invited to anesthesiology conferences. Here, they are not on the list of ‘target audience’, but they are on the fee/registration list. I cannot think of any major anesthesiology conferences where they’re not invited. And this includes the annual A.S.A. meeting. As you may know, the A.S.A. is looking to offer membership to CRNAs.

So please don’t make a mountain out of a mole hill. Come join us for the course. Detroit is beautiful that time of the year, ONLY that time of the year ;-( ;-( ;-(

E.J. Chidiac
Click to expand...



Dr. Chidiac,

I have to ask. You must truly believe that CRNAs like the woman on your service are equivalent to gas docs in the practice of pain medicine. Otherwise, why even allow them to get trained in these procedures?

If you believe CRNAs are equivalent to docs in terms of readiness to practice pain mgmt, just say so. I wont fault you for that.

So does the NP in your pain mgmt service truly function as an MDA equivalent? If so, then why even teach this stuff to residents? If a CRNA can do it with 1/3 the training of an MDA, it makes no sense to teach these things to residents. You dont offer workshops to the MDAs on drawing blood do you? No of course not, because its stupid to waste those resources on such a menial labor task that doesnt require the education/training level that a resident has.

I think you need to make a decision. If you need to be a doc to practice effective pain mgmt, then stop taking midlevels. If you dont need to be a doc to practice pain mgmt, then please stop wasting resources teaching these "lowly" skills to residents. If it doesnt require resident level training, then quit misleadnig people and just make this a CRNA training course.
 
If you need to be a doc to practice effective pain mgmt, then stop taking midlevels. If you dont need to be a doc to practice pain mgmt, then please stop wasting resources teaching these "lowly" skills to residents. If it doesnt require resident level training, then quit misleadnig people and just make this a CRNA training course.
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Just an FYI, but attending a little workshop isn't really training anybody to be a pain management specialist. CRNAs can and do perform regional blocks under the supervision of an anesthesiologist. Should they not be allowed to attend a workshop that might make them a little better at what they already do?

Nobody is going to be doing lumbar plexus, sciatic, interscalene, supraclav, etc. blocks/catheters for chronic pain management. It's all for use in the operating room. And if a CRNA happens to learn that OH MY GOD YOU CAN PUT STEROIDS IN AN EPIDRUAL!!!?!?!?!?!?, it isn't going to magically get them a job at a pain management clinic. Because they already know how to do epidurals quite well.

I'll spend more time worrying about the horrible Medicare reimbursement rates for anesthesiologists and why they only get 1/2 when supervising 2 rooms with residents while a surgeon can run 2 rooms all day and get fully reimbursed for each.
 
You must have skipped over the part in the brochure stating that the course would teach advanced procedures such as Spinal Cord Stimulator/Intrathecal Pump Implantation and RF Facet Denervation. You also fail to realize that most epidurals for chronic spinal pain are fluoroscopically guided and by the transforaminal approach.

And no, learning some interventional pain procedures isn't going to magically get CRNAs jobs at pain clinics, they'll just open their own and start practicing medicine.
 
Disciple said:
You must have skipped over the part in the brochure stating that the course would teach advanced procedures such as Spinal Cord Stimulator/Intrathecal Pump Implantation and RF Facet Denervation. You also fail to realize that most epidurals for chronic spinal pain are fluoroscopically guided and by the transforaminal approach.

And no, learning some interventional pain procedures isn't going to magically get CRNAs jobs at pain clinics, they'll just open their own and start practicing medicine.
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1) In which states will they be doing this?

2) Are you going to let somebody implant a SCS on you because they went to a workshop and practiced on a simulator? Would you refer a patient to somebody who's sum total of experience was that?


Give me a break. Mountain out of molehill. If a CRNA wanted to open a clinic and do some RF ablation, I suggest you worry about the laws of the state they are practicing in.
 
Mman said:
1) In which states will they be doing this?

2) Are you going to let somebody implant a SCS on you because they went to a workshop and practiced on a simulator? Would you refer a patient to somebody who's sum total of experience was that?


Give me a break. Mountain out of molehill. If a CRNA wanted to open a clinic and do some RF ablation, I suggest you worry about the laws of the state they are practicing in.
Click to expand...

It is comments/attitudes like this that contribute the erosion of the practice of medicine. In this day and age we need to be aware of multiple challenges to medicine including those originating from managed care and evolving federal/state laws. While most of us are busy focusing energy and money on these issues, insidious challenges from allied health professionals such as CRNAs performing pain procedures, DPT's calling themselves doctors; offering direct access and positioning themselves as providers of musculoskeletal care and chiropractors performing EMGs and spinal injections are mostly ignored as they slowly but surely erode our base and position themselves as cheaper alternatives to physicians. So I dont think this is overreacting. In order to make profit in the short term we are mortgaging our future and handicaping future medical graduates.
 
Mman said:
1) In which states will they be doing this?

2) Are you going to let somebody implant a SCS on you because they went to a workshop and practiced on a simulator? Would you refer a patient to somebody who's sum total of experience was that?


Give me a break. Mountain out of molehill. If a CRNA wanted to open a clinic and do some RF ablation, I suggest you worry about the laws of the state they are practicing in.
Click to expand...



you need to take your head out of the sand.....comments like this tell me that you have no idea of the fights and battles that are going on in the front lines (especially in private practice). If a CRNA or weekend warrior goes out and does radiofrequency ablation after a weekend course and a bad complication happens, it comes back on our whole specialty. Bottom line these courses should be open to fellowship trained interventional pain management physicians or physicians currently in fellowship. I do not have a problem with non fellowship trained anesthesiologists attending these courses as long as they provide detailed descriptions of their current exposure and experience in interventional pain management. I shouldnt be surprised by your comments. They reflect the general sentiments of most of our leadership in academic institutions. Sometimes I just dont understand the thinking of anesthesiologists. If we were interventional cardiologists, we would not be having this conversation (you cant enroll in their courses even as an MD). If we were interventional radiologists we would not be having this conversation. If we were spine surgeons or orthopedists we would not be having this conversation (good luck enrolling in a hand-on diskectomy/spinal fusion course). When is our profession at large going to "get it".
 
Mman said:
Just an FYI, but attending a little workshop isn't really training anybody to be a pain management specialist. CRNAs can and do perform regional blocks under the supervision of an anesthesiologist. Should they not be allowed to attend a workshop that might make them a little better at what they already do?

Nobody is going to be doing lumbar plexus, sciatic, interscalene, supraclav, etc. blocks/catheters for chronic pain management. It's all for use in the operating room. And if a CRNA happens to learn that OH MY GOD YOU CAN PUT STEROIDS IN AN EPIDRUAL!!!?!?!?!?!?, it isn't going to magically get them a job at a pain management clinic. Because they already know how to do epidurals quite well.

I'll spend more time worrying about the horrible Medicare reimbursement rates for anesthesiologists and why they only get 1/2 when supervising 2 rooms with residents while a surgeon can run 2 rooms all day and get fully reimbursed for each.
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Medicare reimbursement rates are definitely a big problem. A lot of time and energy is going towards this problem as well. However, you should not underestimate or belittle the issues that undertrained providers have on our specialty. Just look at the news bulletins: chiropractors performing sports physicals, optometrists doing eye surgery, podiatrists operating on the leg and hip, CRNA's doing interventional pain management. This is just the tip of the iceberg. Your response remind me of Neville Chamberlain in the 1930's (appeasement). Look at the results of his action (Nazi Germany dominating the entire European continent). Apathy and denial are not options. Wake up.......
 
CRNAs are performing vertebroplasty and SCS implants in New Hampshire, and are training for the same in Indiana. They are already performing RF in several states. The laws of the state do not necessarily apply since CRNAs couch their interventional pain practice for which they received no training in school, as a viable and legal chartered practice option for CRNAs since CRNAs according to their own AANA documents are capable of treating "pain". There is simply no law that specifically prohibits a CRNA from extending that line of thinking to performance of neurosurgery for pain, neuroablation, or ANYTHING related to pain.
Those who are naive and uneducated in the militant nature of CRNAs are as much a problem as the CRNAs themselves. I agree.....WAKE UP!!!!
 
Mman said:
1) In which states will they be doing this?
Click to expand...


Ahh yes, the "not my state" defense. Thats really worked well for you guys hasnt it? How many states have CRNA opt-outs now?
 
Mman said:
CRNAs can and do perform regional blocks under the supervision of an anesthesiologist. Should they not be allowed to attend a workshop that might make them a little better at what they already do?
Click to expand...

IMHO, it is outside the scope of practice to allow CRNAs to do ANY regional. This would include blocks and epidurals. Why do we insist on trying to give the practice of medicine away. The are more then willing to fight to take it. We should fight to keep it. I believe CRNAs serve a role as a physician extender in the OR. In general there are few complications and things tend to go well, even in complicated cases. The role of the doc is to be available to step in and help when things go wrong. CRNAs do not have the training and background for DDx or to fully understand disease processes. Again, this is the same reason they should be restricted to sitting the stool in the OR, not practicing medicine/performing procedures. Its a great gig anyway. Less then two years of graduate school and no post grad training and making more then alot of docs!!
 
Mman said:
Give me a break. Mountain out of molehill. If a CRNA wanted to open a clinic and do some RF ablation, I suggest you worry about the laws of the state they are practicing in.
Click to expand...


Your attitude is part of the problem. It takes over 9 years of dedicated training to become a competent pain physician. No short cuts should be tolerated. You cannot "protocol-ize" or dumb down the practice of pain medicine. It's a field whose scope spans at least 3 medical specialties. You REALLY think *ANY* mid-level can obtain that sort of breadth of training via on-the-job experience and attending weekend workshops?

The best way to counter this is to refuse to participate in any pain CME or conference activity that does not explicitly distinguish between training objectives for physicians, physicians in training, fellows and mid-level providers. In fact, I would like to encourage all readers active and influential in pain organizations to seriously consider instituting policies that make these distinctions in training objectives obvious.
 
We need to watch these issues wherever they crop up and support our colleagues in each instance, in each state. I guarantee that if the CRNAs were successful in LA they would have been wildly pumped up to try elsewhere. Instead, they took a hit but they are down, not out, and they have 49 more chances when they recuperate from the setback.

Opposing training CRNAs is not "making mountains out of molehills". To minimize contributing to our own destruction by training those who would supplant us is downright foolish.
 
gorback said:
Opposing training CRNAs is not "making mountains out of molehills". To minimize contributing to our own destruction by training those who would supplant us is downright foolish.
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Absolutely.It is not making mountains out of molehills. It is just givin' an inch now to let them take a yard from you very soon.
 
I sent a kindly worded letter to Dr. Chidiac telling of my dissatisfaction with his open invitation to CRNA's at his conference and he responded in kind.
Polite discourse to make the point that my fellows, myself, and anyone they can tell not to go- will not be in attendence nor support their efforts.
 
A very elegant approach Steve. Nice work. You got your point across without lynching him. I am very sensitized to this subject since I was on the other side a few years ago and did not recognize at that time the clear and present danger untrained uneducated mercenaries posed to patient welfare.
 
CRNAs are performing vertebroplasty and SCS implants in New Hampshire, and are training for the same in Indiana. They are already performing RF in several states. The laws of the state do not necessarily apply since CRNAs couch their interventional pain practice for which they received no training in school, as a viable and legal chartered practice option for CRNAs since CRNAs according to their own AANA documents are capable of treating "pain". There is simply no law that specifically prohibits a CRNA from extending that line of thinking to performance of neurosurgery for pain, neuroablation, or ANYTHING related to pain.
Those who are naive and uneducated in the militant nature of CRNAs are as much a problem as the CRNAs themselves. I agree.....WAKE UP!!!!


Algos,

Are CRNA's seriously performing these advanced interventional procedures independently and without DIRECT supervision of a pain specialist??? If so, :barf: :wow: ....you gotta be kidding me!! Friggin ridiculous!! 😡

PAINISGOOD
 
It is happening....and the knowledge deficit is far worse than you might think. The motivation is quite disturbing for non-physicians doing these things. In my state, there is a PA that is being supervised to do spinal blocks a hundred miles away by a unscrupulous MD pain doc. Recently, a non-physician met with a sales rep friend of mine and the only questions were: 1. which procedures will make us the most money and 2. where do we get training for spinal cord stimulation and RF? There were no questions about safety, efficacy, patient selection, appropriateness of their even considering doing the procedures, etc.
Be forewarned, this is a monumental problem that will come to battles in the court systems since the atty generals are sufficiently spineless to not enforce the medical practice laws of the states. However, you do not have to be spineless....join your state medical society, begin calling your legislatures even if you have never talked to them once....
 
I've been a PA for 7 yrs and a nurse for 10 prior to that. I just joined a Neuro group that also has a pain mangement clinic. They are training me to do cuadal and SI injections. This seems prefectly acceptable for a PA who has as much experience as I do.. CVOR, neuro surgery and trauma. I've also floated my share of IJs and A-lines, not to mention emergant trachs and chest tubes. I value my licence and would not do anything to lose it. I also remember that I am a physician extender, not a physician. I do not do anyting that my doc doesn't think that I'm qualified to do. also I have to get approval from our state medical board to do these things which requires logging of supervised procedures.
FYI: I live in a rural area were not too many MDs are jumping to set up practice. The patients that we take care of are very happy with the care that I provide and thankful to have someone to take care of their pain.
I don't think one weekend course would give the CRNAs the confidence to do things that might jeopardize their ability to work. No license=No work!

But what would I know- I'm just a PA
 
free2bpa said:
But what would I know- I'm just a PA
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. . . which is why you shouldn't be doing medical procedures.

But what do I know? I'm just a board-certified physician subspecialist with 20 years of formal education and 28 years of professional experience, which certain parties seem to think is the same as a bachelor's degree and a modicum of clinical exposure.

And a weekend course will, indeed, make a CRNA confident enough to try doing these procedures.
 
free2bpa said:
I've been a PA for 7 yrs and a nurse for 10 prior to that. I just joined a Neuro group that also has a pain mangement clinic. They are training me to do cuadal and SI injections. This seems prefectly acceptable for a PA who has as much experience as I do.. CVOR, neuro surgery and trauma. I've also floated my share of IJs and A-lines, not to mention emergant trachs and chest tubes. I value my licence and would not do anything to lose it. I also remember that I am a physician extender, not a physician. I do not do anyting that my doc doesn't think that I'm qualified to do. also I have to get approval from our state medical board to do these things which requires logging of supervised procedures.
FYI: I live in a rural area were not too many MDs are jumping to set up practice. The patients that we take care of are very happy with the care that I provide and thankful to have someone to take care of their pain.
I don't think one weekend course would give the CRNAs the confidence to do things that might jeopardize their ability to work. No license=No work!

But what would I know- I'm just a PA
Click to expand...

Free,

I'm sure that you are an intelligent, well-trained, competent, compassionate, and technically astute PA. Still, I do not think that Interventional Pain procedures are properly within the scope of practice of any mid-level provider. Interlaminar epidural steroid injections, caudals, and SI joint injections are not techically difficult and literally a "monkey" could do these procedures. There's a huge difference between what a person "can do" and what a person "ought to do."

Third and fourth year medical students also learn how to do IJ's, A-lines, chest-tubes, and many other minor surgical procedures. That does not mean that third and fourth year medical students SHOULD do these procedures without *DIRECT* one-on-one supervision no matter how gifted they may be.
 
Although it pains me to agree with the NRA, unfortunately the attitude of "if you give an inch, they will take a mile" applies to these situations. For every responsible practitioner, there are many others who believe that a minimum of training are an appropriate replacement for extensive schooling, training and experience.
 
But what would I know- I'm just a PA[/QUOTE]



Free,

You seem like a nice guy, but you have totally missed the point. There are many "practitioners" who perform procedures on patients after "weekend courses". They are endangering the public and make legitimate practitioners look bad when they have complications. I have absolutely no problem with extenders practicing within their scope. Interventional procedures are not within your scope. I don't blame you however. Your supervising doctors are the ones to blame. This is a big problem and shows you what greed has done to our profession. The only reason that they put you in this position is to satisfy their greed for money.

Let me give you an analogy. I have a good friend who is very much into flying small planes (he tries to get me to go with him but I am scared). I must admit that he is a good pilot. However, if he wanted to fly a 737 from Houston to Miami, he would be the first to admit that he was over his head. Even if he had intent, he would not be permitted to do it without the proper credentials and certifications (even though he is a good pilot). This is the same argument against mid levels performing invasive procedures.
 
free2bpa said:
I've been a PA for 7 yrs and a nurse for 10 prior to that. I just joined a Neuro group that also has a pain mangement clinic. They are training me to do cuadal and SI injections. This seems prefectly acceptable for a PA who has as much experience as I do.. CVOR, neuro surgery and trauma. I've also floated my share of IJs and A-lines, not to mention emergant trachs and chest tubes. I value my licence and would not do anything to lose it. I also remember that I am a physician extender, not a physician. I do not do anyting that my doc doesn't think that I'm qualified to do. also I have to get approval from our state medical board to do these things which requires logging of supervised procedures.
FYI: I live in a rural area were not too many MDs are jumping to set up practice. The patients that we take care of are very happy with the care that I provide and thankful to have someone to take care of their pain.
I don't think one weekend course would give the CRNAs the confidence to do things that might jeopardize their ability to work. No license=No work!

But what would I know- I'm just a PA
Click to expand...

why do you have to bold your comments..? geez
 
It is simply not possible to be supervised long distance to do interventional pain procedures. On the other hand, if the supervising physician is nearby, there is absolutely no reason for him to abrogate his responsibility to optimal patient care by not doing the procedure himself. You may mean well, but if you screw up or even if there is a perceived screwup by some angry patient, neither you nor your supervising physician would be able to withstand the tidal wave of condemnation by other pain physicians in the state or nationally, and the legal ramifications could be career ending. Your past experience in placing chest tubes or other emergency procedures has no bearing on the fact that you are not now, nor will ever be sufficiently trained and educated to perform interventional pain procedures.
 
I'm not trying to take anyones job or make tons of money for myself or supervising MD.

I would like to know how much experience everyone had prior to calling yourselves an Interventionalist and how many are board certified? Are you fellowship trained or a MDA.

Also how much surgical experience do you guys have...hands on in the trenched; not just holding a army-navy or pushing meds.

Are you aware of the training that a PA goes through...one year of PA school has been compared to 2.5 years of med school. This came from a Cardiac surgeon from Cleveland clinic that trained me, not from a PA.

I think you guys have put yourselves on a very high pedestal. You would rather have patients continue to be in pain while you fight over who should help them. Or is it that only patients that live in large metro area have pain that deserves to be addressed

Next you will be saying it's not OK for PAs to harvest for CABGs because a patient may bleed to death.

There's a big difference between what this course is offering and what happens in the real world. You are wanting to hang anyone and everyone that wants to get more education or just earn CMEs.

Also, sorry about the large font on previous post.
 
We really don't give a flip about what some cardiac surgeon might let you do...it is not relevant to our profession. The experience is not transferrable. PAs that persist in engaging in a field way outside their training, education, and scope of practice will find themselves in court...and so will their pseudosupervising MD.
 
free2bpa said:
I'm not trying to take anyones job or make tons of money for myself or supervising MD.

I would like to know how much experience everyone had prior to calling yourselves an Interventionalist and how many are board certified? Are you fellowship trained or a MDA.

Also how much surgical experience do you guys have...hands on in the trenched; not just holding a army-navy or pushing meds.

Are you aware of the training that a PA goes through...one year of PA school has been compared to 2.5 years of med school. This came from a Cardiac surgeon from Cleveland clinic that trained me, not from a PA.

I think you guys have put yourselves on a very high pedestal. You would rather have patients continue to be in pain while you fight over who should help them. Or is it that only patients that live in large metro area have pain that deserves to be addressed

Next you will be saying it's not OK for PAs to harvest for CABGs because a patient may bleed to death.

There's a big difference between what this course is offering and what happens in the real world. You are wanting to hang anyone and everyone that wants to get more education or just earn CMEs.

Also, sorry about the large font on previous post.
Click to expand...


Dude, chill, I think that surgeon was putting you up on a pedestal and blowing a lot of steam up your arse by comparing 1 year of PA school to 2.5 yrs of med school. Secondly, I don't think any of us (at least I don't) have a problem with PAs or even CRNA doing procedures, I DO have a problem when you guys compare your education and abilities to that of a physician and then think you are equivalent to that of an MD. So go ahead, be a technician, because that is what people who do procedures are, technicians and let the MDs take care of the rest.....unless you care to pay the malpractice premiums that we pay!!!
 
Please don't comment on something unless you've read the complete thread- especially my first comment. I think I made myself clear on were I stand about the the PA-MD relationship.

Have you every worked with a PA? Do you know what you're talking about?
Do even know about our training or what we have to do every 6 years to keep working?

Why hasn't anyone answered my previous questions?

You guys us "we" very loosely when you can't even agree on the debeat of the thread.

Gather your facts and than we'll talk!
 
Where many PAs stand on the MD-PA relationship:
1. they will do as much as they are allowed to do by the supervising physician whether it within their scope of practice or not
2. Some PAs see themselves not as their name implies, but as a substitute for physician care, and when left unsupervised by an ostensibly supervising physician, are doing just that. Such behavior cannot be justified regardless of the degree of trust the physician has in the PA, whether deserved or not. PAs should NEVER NEVER EVER be permitted to operate independently without the DIRECT supervision of a physician, period. The lack of DIRECT supervision in the realm of interventional pain means the PA is completely unsupervised. Unless the physician was physically present watching the needle placement and directing the procedure, the PA is operating unsupervised. If the physician were physically present, there would be no reason for the MD not to do the procedure themselves.
3. Some PAs believe because they have a little knowledge that they are equivalent to the education, training, and experience of a MD. Nothing could be further from the truth. The naivite of a PA does not bode well during malpractice proceedings.

You are stepping into a field of medicine in which you have no training, no education, no knowledge, and cannot be justified on the basis of whatever certification PAs have nor on the sloppy and completely inadequate supervision practices of their current and past employers.
 
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