VA Taking heat!

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Machinery

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http://www.foxnews.com/politics/201...ets-without-doc-supervision.html?intcmp=hpbt3



"The proposed rule is also meeting with political opposition. Rep. David Jolly, R-Fla., is outraged by the proposed change -- noting that at a March 2 hearing, he specifically asked VA Secretary Robert McDonald to "describe his position on it."

McDonald responded, "The thing we feel least comfortable about is anesthesiologists." But he left the door open to expanding their physician-like roles in the future, should the need arise"

Keep calling congress and Veteran organizations!It is time we make this a political fight this campaign cycle. I sent my opinion to the Trump, Clinton, Sanders, and Johnson(just in case) campaigns. I don't care if it never makes it to the candidates but I felt obligated. We need to bring this to limelight, and generate more public attention.

The message to the VA and Mr McDonald should be simple: If you want more physician services, HIRE MORE PHYSICIANS!
 
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Machinery said:
http://www.foxnews.com/politics/201...ets-without-doc-supervision.html?intcmp=hpbt3



"The proposed rule is also meeting with political opposition. Rep. David Jolly, R-Fla., is outraged by the proposed change -- noting that at a March 2 hearing, he specifically asked VA Secretary Robert McDonald to "describe his position on it."

McDonald responded, "The thing we feel least comfortable about is anesthesiologists." But he left the door open to expanding their physician-like roles in the future, should the need arise"

Keep calling congress and Veteran organizations!It is time we make this a political fight this campaign cycle. I sent my opinion to the Trump, Clinton, Sanders, and Johnson(just in case) campaigns. I don't care if it never makes it to the candidates but I felt obligated. We need to bring this to limelight, and generate more public attention.

The message to the VA and Mr McDonald should be simple: If you want more physician services, HIRE MORE PHYSICIANS!
Click to expand...

He should be uncomfortable with CRNAs unsupervised, every patient in this country should be. What the hell is a "physician- like role?" That's like saying you're kind of pregnant, you either are or aren't.
 
Dr. David Shulkin, undersecretary of health at VA

PowerPost: What does research say about the quality of care when it’s delivered by a nurse rather than a physician?

Shulkin: My assessment of the literature, which is vast on this subject in general, is that it has shown that nurses are able to deliver high-quality care, particularly when they are delivering care in settings that are within their competencies and scope of responsibilities. The literature shows very good outcomes.

PowerPost: The American Society of Anesthesiologists held a press conference on Wednesday to denounce the policy change to replace physicians with nurses who specialize in this area in surgery. They say this would be dangerous to patients.

Shulkin: I’ve looked at the data in the VA, and I do not assess that we have an access problem in anesthesia. We are using team-based approaches. I do not plan on implementing any change in current policy to our workforce [of advanced care nurses who administer anesthesia].

PowerPost: Okay, but the regulation, as proposed, does not exempt advanced-care nurses from acting independently in anesthesia care.

Shulkin: If at a later point in time, whether it’s me or another undersecretary, there becomes an access issue in anesthesia care, I don’t want another undersecretary [in my position] to have to sort through the issue again.
 
Carbocation1 said:
Dr. David Shulkin, undersecretary of health at VA

PowerPost: What does research say about the quality of care when it’s delivered by a nurse rather than a physician?

Shulkin: My assessment of the literature, which is vast on this subject in general, is that it has shown that nurses are able to deliver high-quality care, particularly when they are delivering care in settings that are within their competencies and scope of responsibilities. The literature shows very good outcomes.

PowerPost: The American Society of Anesthesiologists held a press conference on Wednesday to denounce the policy change to replace physicians with nurses who specialize in this area in surgery. They say this would be dangerous to patients.

Shulkin: I’ve looked at the data in the VA, and I do not assess that we have an access problem in anesthesia. We are using team-based approaches. I do not plan on implementing any change in current policy to our workforce [of advanced care nurses who administer anesthesia].

PowerPost: Okay, but the regulation, as proposed, does not exempt advanced-care nurses from acting independently in anesthesia care.

Shulkin: If at a later point in time, whether it’s me or another undersecretary, there becomes an access issue in anesthesia care, I don’t want another undersecretary [in my position] to have to sort through the issue again.
Click to expand...

What a slimy bureaucrat. What is it with the older generation of physicians going out of their way to screw everyone else? I got mine, f you seems to be the prevailing theme
 
Psai said:
What a slimy bureaucrat. What is it with the older generation of physicians going out of their way to screw everyone else? I got mine, f you seems to be the prevailing theme
Click to expand...
The older gen physicians are just weak pathetic worms who sold us out. its no wonder the nurses walk over them

Sent from my SM-N910P using SDN mobile
 
Carbocation1 said:
Dr. David Shulkin, undersecretary of health at VA

PowerPost: What does research say about the quality of care when it’s delivered by a nurse rather than a physician?

Shulkin: My assessment of the literature, which is vast on this subject in general, is that it has shown that nurses are able to deliver high-quality care, particularly when they are delivering care in settings that are within their competencies and scope of responsibilities. The literature shows very good outcomes.

PowerPost: The American Society of Anesthesiologists held a press conference on Wednesday to denounce the policy change to replace physicians with nurses who specialize in this area in surgery. They say this would be dangerous to patients.

Shulkin: I’ve looked at the data in the VA, and I do not assess that we have an access problem in anesthesia. We are using team-based approaches. I do not plan on implementing any change in current policy to our workforce [of advanced care nurses who administer anesthesia].

PowerPost: Okay, but the regulation, as proposed, does not exempt advanced-care nurses from acting independently in anesthesia care.

Shulkin: If at a later point in time, whether it’s me or another undersecretary, there becomes an access issue in anesthesia care, I don’t want another undersecretary [in my position] to have to sort through the issue again.
Click to expand...

I wish, just once, an interviewer would respond with: Gee, thanks for your canned answer. How about you answer the question I asked?
 
Googled Dr. Shulkin, found this gem:

Under-Secretary-David-Shulkin-Heisman-1024x606.jpg


http://www.disabledveterans.org/2015/07/20/new-va-health-chief-gives-veterans-the-heisman/

"Activist Ron Nesler, founder of the revolutionary VA accountability group VAisLying, reports that the new chief of the Veterans Health Administration (VHA), Dr. David Shulkin, will not speak directly with grieved veterans and family members. This serves as a complete deviation from the path taken by previous VHA chief Carolyn Clancy, MD. For those missing the football reference, the Heisman trophy shows a football playing giving opponents the stiff arm — which is what Shulkin will reportedly do when veterans seek help from him directly."
 
Fluffhead87 said:
I wish, just once, an interviewer would respond with: Gee, thanks for your canned answer. How about you answer the question I asked?
Click to expand...

Or "who sponsored that study you are quoting?"
 
That's the most knowledgeable and critical journalist I've seen address this issue, it's a start.

The lets just keep CRNAs included despite it not being an access issue in anesthesia just in case there's an access need in the future is irresponsible and lazy. How about you just grow a sack and commit to valuing and recruiting Anesthesiologists within the VA?
 
This move will not reduce wait times. Vets are waiting for specialist care and often get punted to outside hospitals. That can only be solved by hiring more specialists. Unless they plan on nurses performing surgery, delivering radiation therapy, and other highly specialized care (would not be surprised). They are being disingenuous when they try to use 'access' as an excuse to cave to ANA lobbyists. This is a political hit move designed for the sole benefit of the ANA. This has nothing to do with improving care or access for our Vets. Hence the need to take this fight to Congress and the campaign trail this cycle. The public sure as heck don't want this, and the ANA has made sure the public or the vets have no say in this. They need to!
 
Machinery said:
This move will not reduce wait times. Vets are waiting for specialist care and often get punted to outside hospitals. That can only be solved by hiring more specialists. Unless they plan on nurses performing surgery, delivering radiation therapy, and other highly specialized care (would not be surprised). They are being disingenuous when they try to use 'access' as an excuse to cave to ANA lobbyists. This is a political hit move designed for the sole benefit of the ANA. This has nothing to do with improving care or access for our Vets. Hence the need to take this fight to Congress and the campaign trail this cycle. The public sure as heck don't want this, and the ANA has made sure the public or the vets have no say in this. They need to!
Click to expand...
It's not hiring more specialists.

When GI docs only do 4-5 proceeded a day at the VA. Or when cardiologists do 4-5 Cathy all day. That's the problem. No incentive to do extra work at the VA.
 
aneftp said:
It's not hiring more specialists.

When GI docs only do 4-5 proceeded a day at the VA. Or when cardiologists do 4-5 Cathy all day. That's the problem. No incentive to do extra work at the VA.
Click to expand...
That's because of the salaries.

And the problem starts with the support staff, which is difficult to fire, not the physicians.
 
Psai said:
Thanks Obama
Click to expand...
One gets what one pays for. Good managers don't come cheap, definitely not at federal employee income levels. So you get career bureaucrats who are using the position either as a trampoline, or as a cushy job.
 
aneftp said:
It's not hiring more specialists.

When GI docs only do 4-5 proceeded a day at the VA. Or when cardiologists do 4-5 Cathy all day. That's the problem. No incentive to do extra work at the VA.
Click to expand...

True point, and FFP is also right about the support staff issues. Which further supports my argument that none of the true issues can be fixed by dangerously expanding mid-level autonomy.
 
Anytime you look at the comment section it's pro-nurse 10 to 1.
Letting them loose is your only option at this point.
 
As I said before, the general public does not understand much about their health care and as long as it stays free they don't care if the janitor is at the head of the OR table.
You can not make people smarter or more educated overnight, so they are going to get the kind health care they deserve no matter what we do.
 
dhb said:
Anytime you look at the comment section it's pro-nurse 10 to 1.
Letting them loose is your only option at this point.
Click to expand...

This is sad but possibly true. How have we gotten here? 100 years ago, or even 40-50 years ago doctors were literally the most revered members of their community, they were trusted. I have to think the media is partly to blame, stories of greedy doctors, or the exceedingly rare gross malpractice in addition to nurse PR/propaganda has somehow made the gullible entitled masses think it's common and nurses are going to be better. Sort of like how these days all police officers are racist shoot first scumbags...... :/
 
Robotic Wis-Hipple said:
This is sad but possibly true. How have we gotten here? 100 years ago, or even 40-50 years ago doctors were literally the most revered members of their community, they were trusted. I have to think the media is partly to blame, stories of greedy doctors, or the exceedingly rare gross malpractice in addition to nurse PR/propaganda has somehow made the gullible entitled masses think it's common and nurses are going to be better. Sort of like how these days all police officers are racist shoot first scumbags...... :/
Click to expand...
It was one simple thing: we allowed nurses to practice medicine. Day by day, year by year, we allowed them to do more, instead of putting them in their place. Do you see lawyers allowing paralegals to practice law?

Remember the outrage about the nurse who was ridiculed after she appeared on TV with her stethoscope? Until I immigrated here, I never saw a nurse with a stethoscope; that's a physician's tool by definition. And so on, the list is long.

Yes, it was also the greed and laziness and conflict-avoidance of our predecessors, may they die at nurses' hands.
 
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Mid levels are always pushing for expansion of services. I think especially with the ACA and now the VA wait times scandal. They feel it's another time to push "access" to care.

The ASA does a horrible job to denounce "access" claims by the AANA. We all know we have absolutely Zero access to care with anesthesia at the VA. In fact we know (and the AANA also knows) we are over staffed at most VA.

Come one. My buddy VA has at most 4 ORs running. Maybe cover out of OR (GI). They have 3 MDs 5 crnas daily plus 1-2 residents. It's a freaking joke. They have a dedicated "break MD and CRNA team".

No wants to disclose that. No one. And that's at most VAs.
 
aneftp said:
Mid levels are always pushing for expansion of services. I think especially with the ACA and now the VA wait times scandal. They feel it's another time to push "access" to care.

The ASA does a horrible job to denounce "access" claims by the AANA. We all know we have absolutely Zero access to care with anesthesia at the VA. In fact we know (and the AANA also knows) we are over staffed at most VA.

Come one. My buddy VA has at most 4 ORs running. Maybe cover out of OR (GI). They have 3 MDs 5 crnas daily plus 1-2 residents. It's a freaking joke. They have a dedicated "break MD and CRNA team".

No wants to disclose that. No one. And that's at most VAs.
Click to expand...

Agree about the ASA. The PR campaign is lackluster.
 
You know what the big problem is? That the new generations of young students and residents have been brainwashed into this "patient care team" bull****. They haven't been trained to function without all the support staff and consider everybody to be their equal colleagues (which is very nice and PC, but that's how our position gets eroded). So if you bring up the non-PC ideas, they immediately jump, without thinking.

As a medical student and resident abroad, I would have never been afraid of a nurse. They were there to help and support me, not to interfere with and judge me. This 360-degree PC crap should not exist for physicians, even in training. When was the last time an underling evaluated a manager?
 
This is true too. Literally every residency program these days has an orientation talk about respecting nurses and how they can make your life miserable so walk on egg shells etc. The nurses absolutely have figured out that they can be rude and condescending to us without any ramifications, it's worse actually, they can be rude every single day then finally when you're hangry or a ca-3 and just over it you give it back once and they right you up. It's this culture that has led to them having zero respect for us.
 
FFP said:
You know what the big problem is? That the new generations of young students and residents have been brainwashed into this "patient care team" bull****. They haven't been trained to function without all the support staff and consider everybody to be their equal colleagues (which is very nice and PC, but that's how our position gets eroded). So if you bring up the non-PC ideas, they immediately jump, without thinking.

As a medical student and resident abroad, I would have never been afraid of a nurse. They were there to help and support me, not to interfere with and judge me. This 360-degree PC crap should not exist for physicians, even in training. When was the last time an underling evaluated a manager?
Click to expand...

But they protect the patient from the doctor!
 
aneftp said:
Mid levels are always pushing for expansion of services. I think especially with the ACA and now the VA wait times scandal. They feel it's another time to push "access" to care.

The ASA does a horrible job to denounce "access" claims by the AANA. We all know we have absolutely Zero access to care with anesthesia at the VA. In fact we know (and the AANA also knows) we are over staffed at most VA.

Come one. My buddy VA has at most 4 ORs running. Maybe cover out of OR (GI). They have 3 MDs 5 crnas daily plus 1-2 residents. It's a freaking joke. They have a dedicated "break MD and CRNA team".

No wants to disclose that. No one. And that's at most VAs.
Click to expand...
I know for a fact that this is true.
 
How did we get here?

First off, it was bad business sense. Doctors rested on their laurels and figured they would always be respected members of the community. All you had to do was "show up." We all know the story of opening the door for midlevels and now they are on the cusp of being seen as equals. The difference lies in the fact that nurses marketed themselves aggressively...very aggressively. They are aggressive in lobbying politicians and they are aggressive in marketing themselves to the public. Doctors are not. We still have not figured out a PR campaign. We are too busy trying to be diplomatic because at the current moment, the midlevels are the hands that feed us. We are afraid to insult them. Yet they have no fear in insulting us.

Marketing is everything. Literally, any new internet startup that comes out has it's worth determined based on it's potential to market products to consumers. Marketing is such an enormous tool. Facebook, tweeter, instagram, and all that other nonsense exists solely to market products to you. Nurses have figured out the importance of aggressive marketing, but physicians are too busy trying to be nice to everyone. At this point, we cannot rely on our societies to take the lead in this. There needs to be some sort of grassroots groundswell of doctors fed up with having our education, training, and skills being minimized by nurses and administrators. However, I don't see that happening. There is such an inertia among physicians to demand change. Part of it is having no energy after having the life beaten out of you during residency and part of it still lies in the fear of insulting those who are working on your license. We would rather just assume the public understands the rigor of our training and then just complain under our breath when they don't.
 
FFP said:
You know what the big problem is? That the new generations of young students and residents have been brainwashed into this "patient care team" bull****. They haven't been trained to function without all the support staff and consider everybody to be their equal colleagues (which is very nice and PC, but that's how our position gets eroded). So if you bring up the non-PC ideas, they immediately jump, without thinking.

As a medical student and resident abroad, I would have never been afraid of a nurse. They were there to help and support me, not to interfere with and judge me. This 360-degree PC crap should not exist for physicians, even in training. When was the last time an underling evaluated a manager?
Click to expand...

Yeah but who is responsible for this? Ultra liberal academic attendings and administrators. Plus our society as a whole tends to be moving towards a " everybody is equal and special" mentality. Like I said before, every generation has its proportion of wolves and sheep, med school adcoms are doing a good job of filling classes with sheep who are glad to keep their head down and never speak up or get out of line. All the wolves of the hospitals - the MBAs, CEOs, Administrators and NURSES who use MDs as live stock will continue to do so and I'm actually afraid for the future of the profession.
 
GravelRider said:
How did we get here?

First off, it was bad business sense. Doctors rested on their laurels and figured they would always be respected members of the community. All you had to do was "show up." We all know the story of opening the door for midlevels and now they are on the cusp of being seen as equals. The difference lies in the fact that nurses marketed themselves aggressively...very aggressively. They are aggressive in lobbying politicians and they are aggressive in marketing themselves to the public. Doctors are not. We still have not figured out a PR campaign. We are too busy trying to be diplomatic because at the current moment, the midlevels are the hands that feed us. We are afraid to insult them. Yet they have no fear in insulting us.

Marketing is everything. Literally, any new internet startup that comes out has it's worth determined based on it's potential to market products to consumers. Marketing is such an enormous tool. Facebook, tweeter, instagram, and all that other nonsense exists solely to market products to you. Nurses have figured out the importance of aggressive marketing, but physicians are too busy trying to be nice to everyone. At this point, we cannot rely on our societies to take the lead in this. There needs to be some sort of grassroots groundswell of doctors fed up with having our education, training, and skills being minimized by nurses and administrators. However, I don't see that happening. There is such an inertia among physicians to demand change. Part of it is having no energy after having the life beaten out of you during residency and part of it still lies in the fear of insulting those who are working on your license. We would rather just assume the public understands the rigor of our training and then just complain under our breath when they don't.
Click to expand...

I think it's a secondary effect of giving away power in medicine. Doctors have slowly but steadily let their power erode. But we are the ones who make the hospital run. Why should we have to bow to the whims of an administrator or an insurance company? They need us and leech off of our education to make their huge profits. We don't need them, they need us. No one comes to the hospital to be seen by a vice president of marketing. Now we are becoming more and more superfluous by the midlevels that doctors are training and allowing to do more and more.

Can you imagine a doctor being labeled as disruptive 30 years ago? Or to have an insurance company tell you that you are required to see a patient within an arbitrary period of time to get a portion of the money that you earned? Or having nurses walk around dressed like doctors, calling themselves doctors while the real doctors are called providers? It's complete insanity. The older generation have been letting this slide as a select few got rich off of training our replacements. It's time to take back medicine and make it about the doctor and the patient. Every other person in healthcare is nothing more than support to foster that relationship and it's time for them to learn their place.
 
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