VA to remove anesthesiologists

[clubdeac]

So now the VA is going to remove anesthesiologists?!?! WTF??

http://www.safevacare.org/

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Members don't see this ad.

 

[deleted480308]

So now the VA is going to remove anesthesiologists?!?! WTF??

http://www.safevacare.org/

I hate the proposal but I don't think allowing independent crna is the same as removing anesthesiologists...am I missing something ?

 

[GA8314]

This hasn't happened yet. Go to the site http://www.safevacare.org and send out your letter. Then have 5 family members do the same. You don't like it? Then do something about it.

 

[Wiscoblue]

No they are not removing Anesthesiologists. The VA will continue to have docs and CRNAs. The CRNAs will now practice at the 'fullest scope of their license'. The docs will end up getting the Asa 3 and up. CRNAs will get the Asa 1&2 and will claim better outcomes and better service. They will be working 'side by side with their MDA colleagues'.


Sent from my iPad using Tapatalk

 

[secants]

When I did month at the VA, majority of the patients were ASA 3 and 4s

 

[pgg]

No they are not removing Anesthesiologists. The VA will continue to have docs and CRNAs. The CRNAs will now practice at the 'fullest scope of their license'. The docs will end up getting the Asa 3 and up. CRNAs will get the Asa 1&2 and will claim better outcomes and better service. They will be working 'side by side with their MDA colleagues'.

This is how the military works today.

The silver lining is that once you accept that the voting public has chosen to allow CRNAs to practice independently (however poorly informed that choice was), the best possible outcome is for them to be working under the "fullest scope of their license" ... not your license.

In a perfect world all patients get doctors directing their care, but that ship has sailed. Make peace with the low hanging ASA 1-2 fruit going to the nurses while the sick patients come to us.

 

[Planktonmd]

This is how the military works today.

The silver lining is that once you accept that the voting public has chosen to allow CRNAs to practice independently (however poorly informed that choice was), the best possible outcome is for them to be working under the "fullest scope of their license" ... not your license.

In a perfect world all patients get doctors directing their care, but that ship has sailed. Make peace with the low hanging ASA 1-2 fruit going to the nurses while the sick patients come to us.

There is a huge difference between the patient population military CRNAs deal with and the VA population!
The VA population is the sickest most fragile population we have in this country, and unsupervised nurse administered cookie cutter anesthesia will certainly kill a higher percentage of them. The question is what percentage of veteran casualties is acceptable to politicians and to veteran advocates???

 

[pgg]

There is a huge difference between the patient population military CRNAs deal with and the VA population!
The VA population is the sickest most fragile population we have in this country, and unsupervised nurse administered cookie cutter anesthesia will certainly kill a higher percentage of them.

Oh, I agree. It's an awful idea.

But they're going to do it. Maybe not this time, but they'll keep trying.

I'm just saying, that as an anesthesiologist working in such a facility, it's better for your sanity if the nurses are working under their licenses and not yours. That's all.

The question is what percentage of veteran casualties is acceptable to politicians and to veteran advocates???

The outcomes will be measured in a way that validates the decision they made. The politicians will never admit a problem or even have to look at data suggesting higher M&M. The veteran advocate groups will probably be misled by statistics showing better access, shorter waits, etc.

Everyone will declare victory.

 

[Planktonmd]

Oh, I agree. It's an awful idea.

But they're going to do it. Maybe not this time, but they'll keep trying.

I'm just saying, that as an anesthesiologist working in such a facility, it's better for your sanity if the nurses are working under their licenses and not yours. That's all.




The outcomes will be measured in a way that validates the decision they made. The politicians will never admit a problem or even have to look at data suggesting higher M&M. The veteran advocate groups will probably be misled by statistics showing better access, shorter waits, etc.

Everyone will declare victory.

Agree... that is exactly what's going to happen sooner or later... more vets are going to die as a result and the actual cause will never be addressed. They will make up metrics that will show that everything is wonderful as usual!
It's not right... but it is another direct result of the unforgivable disaster the ASA had inflicted on us when they conceded that a CRNA can be supervised by a physician not necessarily an anesthesiologist!!!
What professional organization on earth accepts that it's members are not needed but then claims to represent their interests???

 

[narcusprince]

This is how the military works today.

The silver lining is that once you accept that the voting public has chosen to allow CRNAs to practice independently (however poorly informed that choice was), the best possible outcome is for them to be working under the "fullest scope of their license" ... not your license.

In a perfect world all patients get doctors directing their care, but that ship has sailed. Make peace with the low hanging ASA 1-2 fruit going to the nurses while the sick patients come to us.

PGG
I challenge your position that independent practice = practicing under the CRNA's license. As floor walker/con/ board runner don't you get a call to come to a room into an airway/CV disaster? As soon as you arrive to the room you become liable and that case is excluded from any independent statistics since now an anesthesiologist is involved. Even though you had no hand in preop or induction of said anesthetic. A truly independent practice would not allow an anesthesiologist rip cord, pull when you do not want to be independent.

 

[criticalelement]

PGG
I challenge your position that independent practice = practicing under the CRNA's license. As floor walker/con/ board runner don't you get a call to come to a room into an airway/CV disaster? As soon as you arrive to the room you become liable and that case is excluded from any independent statistics since now an anesthesiologist is involved. Even though you had no hand in preop or induction of said anesthetic. A truly independent practice would not allow an anesthesiologist rip cord, pull when you do not want to be independent.

You are not obligataed to respond to any emergencies in the O.R. unless it is YOUR patient that you entered a physician/patient relationship with.

A crna that I am not supervising in a cannot ventilate situation is not my fu c king problem.. It is the patient's problem, the crna's problem and the operator's problem. If i am on my way to lunch. Im continuing on my way..... That is the way they want it.

 

[pgg]

PGG
I challenge your position that independent practice = practicing under the CRNA's license. As floor walker/con/ board runner don't you get a call to come to a room into an airway/CV disaster? As soon as you arrive to the room you become liable

No. Not just "no" but "absolutely not" no.

You're no more liable for their complications than you are for an internists' complications if you respond to a code blue elsewhere in the hospital.

Now ... our current .mil setup, in which they're required to "consult" with one of us for ASA 3-4 patients may expose the consulting anesthesiologist to some liability, if the CRNA documents that consulting. Maybe. I think it would depend on the actual case and the actual error.

But in the circumstance in which a CRNA's case goes south when they've managed it independently from the start, the mere act of calling for help (and getting it) doesn't put the responding parties on the hook for errors and complications that arose prior to their arrival.

and that case is excluded from any independent statistics since now an anesthesiologist is involved. Even though you had no hand in preop or induction of said anesthetic. A truly independent practice would not allow an anesthesiologist rip cord, pull when you do not want to be independent.

Sure, the statistics are skewed, but that's no different from how things are now.

 

[criticalelement]

What professional organization on earth accepts that it's member are not needed but then claims to represent their interests???

An organization that does not deserve anyone to pay any dues.... Everyone should unjoin the asa..

 

[criticalelement]

But in the circumstance in which a CRNA's case goes south when they've managed it independently from the start, the mere act of calling for help (and getting it) doesn't put the responding parties on the hook for errors and complications that arose prior to their arrival.




Sure, the statistics are skewed, but that's no different from how things are now.

Tell that to the other anesthesiologists who got sued in the joan rivers case. They were not the ones managing the case. They heard code blue and responded. But they settled for a few million.

BUt that's not the point. The point is that crna independent practice is RIDICULOUS. At the very least there should be the anesthesia care team which i oppose as well but its better than crna independent practice.

 

[pgg]

You are not obligataed to respond to any emergencies in the O.R. unless it is YOUR patient that you entered a physician/patient relationship with.

Well, if you're hired for a "fireman" job you should probably respond as a fireman.

But firemen aren't liable for arson.

 

[pgg]

Tell that to the other anesthesiologists who got sued in the joan rivers case. They were not the ones managing the case. They heard code blue and responded. But they settled for a few million.

A fireman who negligently pours gasoline on a fire instead of water may be held liable. Acts of malpractice that occur after one's involvement are still malpractice.

 

[deleted171991]

.

No. Not just "no" but "absolutely not" no.

You're no more liable for their complications than you are for an internists' complications if you respond to a code blue elsewhere in the hospital.

Now ... our current .mil setup, in which they're required to "consult" with one of us for ASA 3-4 patients may expose the consulting anesthesiologist to some liability, if the CRNA documents that consulting. Maybe. I think it would depend on the actual case and the actual error.

But in the circumstance in which a CRNA's case goes south when they've managed it independently from the start, the mere act of calling for help (and getting it) doesn't put the responding parties on the hook for errors and complications that arose prior to their arrival.




Sure, the statistics are skewed, but that's no different from how things are now.

How do you prove what was prior? You can't. If they mess up big time, all your excellent care won't bring the patient back. Why did the other anesthesiologists get sued in the Joan Rivers case? Why was it their fault? As long as we are not protected for emergencies the same way ED docs are in certain states (extension of first responder doctrine), they can wait till I help somebody who's not my friend.

As an intern, I never knew why all the attendings tended to walk away from a code as fast as possible, and let the residents run it.

 

[deleted171991]

Well, if you're hired for a "fireman" job you should probably respond as a fireman.

But firemen aren't liable for arson.

They are, in the medical world.

Ask juries how they feel about firemen, then ask them how they feel about doctors.

 

[pgg]

I think it's pretty silly to fixate on fireman risk for prior events in the context of the overall risk we accept as physicians. It's like driving your car every day and worrying about drunk truck drivers.

And if you disagree and don't think that risk is acceptable ... don't take a job as a fireman.

 

[pgg]

To be honest, I haven't really followed the Joan Rivers debacle, but from what little I recall, didn't the responders fail to act appropriately too? As in, no attempt at a surgical airway?

Also, pointing to a nationally publicized case involving a celebrity probably doesn't say a lot about the actual malpractice risk we face in our normal lives.

 

[deleted162650]

There is a huge difference between the patient population military CRNAs deal with and the VA population!
The VA population is the sickest most fragile population we have in this country

Sick yes, fragile no. Those guys are all sick as chit but they're damn near impossible to kill . . . No matter how hard one tries.

 

[clubdeac]

Make sure you go to the link, sign and send to all of your colleagues, friends and family to sign. This needs to but nipped in the bud...
http://www.safevacare.org/

 

[chocomorsel]

Tell that to the other anesthesiologists who got sued in the joan rivers case. They were not the ones managing the case. They heard code blue and responded. But they settled for a few million.

BUt that's not the point. The point is that crna independent practice is RIDICULOUS. At the very least there should be the anesthesia care team which i oppose as well but its better than crna independent practice.

Do we know for a fact that the other two anesthesiologists who were sued, came in to help during the code?
Is it possible they were part time owners of the center or some other connection?
Are we doing a lot of speculation here or what?

 

[GravelRider]

We have to stop being a bunch of pansies about this. Just don't practice at a place that allows CRNAs to practice independently. Period.

This is a game of marketing and they are winning big time. We have to be willing to get nasty as they are doing to win this fight. We have to had real ad campaigns stating exactly why an anesthesiologist is more desirable. The public has to be educated and demand this. The problem is there are too many groups that rely on crnas for the labor and too many old washed-up anesthesiologists who couldn't do a case alone on a bet. If you start and support a campaign like this then all of a sudden that care team model feels a little awkward.

 

[IlDestriero]

Do we know for a fact that the other two anesthesiologists who were sued, came in to help during the code?
Is it possible they were part time owners of the center or some other connection?
Are we doing a lot of speculation here or what?

That was my guess. Owner(s) and or medical director(s). Someone knows, hopefully we find out eventually. But as PGG pointed out, if you commit malpractice and/or offer care below the standard of care after you arrive as an emergency responder, you are at risk. If I go to a code or trauma and the whole house of cards is burning down, I just place my airway or line and GTFO.


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Il Destriero

 

[criticalelement]

That was my guess. Owner(s) and or medical director(s). Someone knows, hopefully we find out eventually. But as PGG pointed out, if you commit malpractice and/or offer care below the standard of care after you arrive as an emergency responder, you are at risk. If I go to a code or trauma and the whole house of cards is burning down, I just place my airway or line and GTFO.


--
Il Destriero

The problem with that argument is that hypoxic brain injury couldl set in before you get to the emergency. So by the time you get there no matter what you do will be " below the standard of care" according to a jury. So it is best to stay the F away..

 

[chocomorsel]

We have to stop being a bunch of pansies about this. Just don't practice at a place that allows CRNAs to practice independently. Period.

This is a game of marketing and they are winning big time. We have to be willing to get nasty as they are doing to win this fight. We have to had real ad campaigns stating exactly why an anesthesiologist is more desirable. The public has to be educated and demand this. The problem is there are too many groups that rely on crnas for the labor and too many old washed-up anesthesiologists who couldn't do a case alone on a bet. If you start and support a campaign like this then all of a sudden that care team model feels a little awkward.

Quite frankly I would rather work side by side with them, let them practice independently, not ask for my input than supervise them. That is not what I went to school for nor trained for. I like doing my own cases, but if I had to chose between ACT and a model working side by side with CRNAs, I would rather the latter.
The ship has sailed, for independent practice, and I highly doubt we are going to reverse, or even slow down what is happening. CRNAs have way more lobbying power and are way more brainwashed against us than we are against them.

 

[amLOLdipine]

I barely see any anesthesiologists at the VA as is. 80% of the cases seem to be done by CRNAs and SRNAs from start to finish

So while I'm hopeful about this safevacare effort, I'm not really sure what positive effect it'll have in the long run for anesthesiologists.

 

[Twiggidy]

We have to stop being a bunch of pansies about this. Just don't practice at a place that allows CRNAs to practice independently. Period.

This is a game of marketing and they are winning big time. We have to be willing to get nasty as they are doing to win this fight. We have to had real ad campaigns stating exactly why an anesthesiologist is more desirable. The public has to be educated and demand this. The problem is there are too many groups that rely on crnas for the labor and too many old washed-up anesthesiologists who couldn't do a case alone on a bet. If you start and support a campaign like this then all of a sudden that care team model feels a little awkward.

truth

 

[criticalelement]

Quite frankly I would rather work side by side with them, let them practice independently, not ask for my input than supervise them. That is not what I went to school for nor trained for. I like doing my own cases, but if I had to chose between ACT and a model working side by side with CRNAs, I would rather the latter.
The ship has sailed, for independent practice, and I highly doubt we are going to reverse, or even slow down what is happening. CRNAs have way more lobbying power and are way more brainwashed against us than we are against them.

Anyone who works s ide by side with them without directing them is conceding their equivalence.. might as well have gone to nursing school. Dont give up as long as you are practicing...

 

[criticalelement]

I barely see any anesthesiologists at the VA as is. 80% of the cases seem to be done by CRNAs and SRNAs from start to finish

So while I'm hopeful about this safevacare effort, I'm not really sure what positive effect it'll have in the long run for anesthesiologists.

Again i swear you are a nursing student.

Again, the turning of the dials can be done by a chimp. The higher order stuff requires an anesthesiologist.

 

[chocomorsel]

I barely see any anesthesiologists at the VA as is. 80% of the cases seem to be done by CRNAs and SRNAs from start to finish

So while I'm hopeful about this safevacare effort, I'm not really sure what positive effect it'll have in the long run for anesthesiologists.

I did some of my training at the VA. There were six anesthesiologists on staff. The other VA I know of has docs as well. I know one of them. They are there. Obviously they are outnumbered by the nurses, just like most ACT models.

 

[chocomorsel]

Anyone who works s ide by side with them without directing them is conceding their equivalence.. might as well have gone to nursing school.
Dont give up as long as you are practicing...

I did go to nursing school about 20 years ago.
I hate supervising and dealing with CRNA attitudes. It's a lot easier for men to supervise nurses than women. Don't get as much crap and pushback from them. As a woman, you stand up to them you get labeled as a bitch and disruptive.
Sure as physicians we shouldn't give up, but we shouldn't have to be forced to supervise either if we want to live in certain places.
Where the hell did this whole idea of supervising CRNAs come from anyway?

 

[GravelRider]

The CRNAs have no problem putting out ad campaigns stating their education is equivalent to ours, their skills are just as good as ours and because they are nurses, they are more compassionate...oh and they are more cost effective because the rich doctors are bankrupting the healthcare system. Meanwhile the ASA puts out some sissy ad campaign saying the care team model is the safest. The problem is they won't say why because that is where you have to get a little nasty.

First things first, when we are talking about anesthesia to a patient, we have to stop saying we are going to make you go off to sleep. There is nothing remotely resembling sleep when you are under anesthesia. It is a medically induced coma. If we finally give what we are doing it's appropriate respect then maybe patients will start to think more about who their anesthesia "provider" is. You tell patient to trust you because it is safe and you trained intensely for many years to learn how to get the patient through that coma despite all of his or her comorbidities.

I envision an ad where you have some bubble gum snapping nurse wearing one of those old fashioned nurses uniforms with the words "Do you want a nurse inducing a coma for your surgery?" Then at the bottom: "Choose doctor when it matters most."

 

[Twiggidy]

sounds like people are making the case for doing fellowships.....heck, im considering a second

 

[chocomorsel]

I never tell my patients they are going to sleep unless it's a child. Even then, I tell them it's a lot deeper than regular consciousness. I tell patients, they are going to be completely unconscious.

 

[drmwvr]

Make peace with the low hanging ASA 1-2 fruit going to the nurses while the sick patients come to us.

Can't tell if this is tongue-in-cheek or not....Staffing based ASA status? It's hard enough based on who has a kids football game at 4. Smaller VA's would have a difficult time parsing 3 ASA 3's to one physician and 2 nurses...unless of course it magically became more difficult to be classified as an ASA 3

 

[criticalelement]

The problem with that is.. is that bad things happen to asa 1 as well..

 

[drmwvr]

I never tell my patients they are going to sleep unless it's a child. Even then, I tell them it's a lot deeper than regular consciousness. I tell patients, they are going to be completely unconscious.

At the VA, that's just another Saturday night.

 

[Taurus]

VA patients are some if the biggest trainwrecks out there. Let the CRNAs practice independently under their own licenses. Don't intervene when the **** hits the fan. They will be exposed so fast. I can't think of a better way of demonstrating the differences between anesthesiologists and CRNAs than using trainwrecks. You could never do this outside of the government without risking a reprimand from the hospital. Create a national database to collect cases. Then, go to the media and politicians. In hindsight, this change could be a blessing in disguise.

 

[Planktonmd]

Why don't anesthesiologists who are currently employed by the VA just threaten to walk if this is passed?

Because if you threaten to walk they might just say don't let the door hit you!

 

[deleted171991]

Why don't anesthesiologists who are currently employed by the VA just threaten to walk if this is passed?

Because they will say: thank you for leaving voluntarily, so we can hire an independent CRNA instead.

Do you guys think all these doom and gloomers here have generalized anxiety disorder and imagine things? Most of us have personally experienced at least one of the things we describe. At my last job, they knew that I was geographically restricted to the bad local market, so they renewed my contract at a lower effective hourly rate than the previous one. Why? Because the market had worsened and they had 5 other people lining up for the job.

Anesthesiology is approaching the Great Depression. It will be a jungle out there in 10 years.

 

[Shouldawouldacouldas]

So now the VA is going to remove anesthesiologists?!?! WTF??

http://www.safevacare.org/

Be ready. Nurse practitioners can practice independently of doctors in about 22 states. Nurse practitioners are not primary care doctors; CRNAs are not anesthesiologists.Yet, this horrible trend can not be stopped because of the cost of medical care of this country's aging population.

We use the ACT model, because we can't afford to staff every room with an anesthesiologist. Only one of our CRNA's has a slight understanding of the difference between CRNA training and MD training. Her daughter became a doctor, and she saw what her daughter had to endure from 3rd year of medical school until the end of her residency. Most CRNA's and the public will never understand the difference.

 

[deleted171991]

I think it would be a FANTASTIC thing for our profession if the VA told anesthesiologists to take a walk. I look forward to the day that a group of politicians and administrators decide that independent CRNA practice is as good as hiring an anesthesiologist. Let CRNA's have every case, ASA I-IV, without us there to save them. Can you imagine the outcomes in the VA? That is the only way we win this war.

And when they come crawling back to us, ASA should say anesthesiologists + AA's, no CRNA's.

The problem is exactly that we don't walk. To be precise, we don't all walk, like ever, the way CRNAs walked out on their group. So there is always somebody remaining to take over the extra work.

And even if we were to walk out en masse, where would we go? The market sucks. This is not a specialty where one can just open one's own private practice. Again, remember the Michigan CRNAs.

The only way one can walk is a la Consigliere: get your F-you money in the bank and, when fed up, give them the finger until the next good job comes around, a month or a year later, or never.

 

[Wiscoblue]

The va anesthesiologists are not going to let go of their pensions and walk out. They will have to stay. They will end up doing the asa 3 and 4 cases.

 

[deleted171991]

You hit the nail on the head.
The nurses are unified in a way that doctors aren't. They are also smart in ways doctors aren't. It makes me sad.

It takes a special kind of loser, and definitely not a businessperson, to invest at least 8 of his best years in post-college education, for hundreds of thousands of dollars in loans, which will require slaving away for more years until they are paid back, plus many other years working for the man, all for future promises based on the industry's current performance.

There is a reason the wealthy and/or powerful don't send their kids to medical school, but rather to business or law.

 

[amLOLdipine]

There is a reason the wealthy and/or powerful don't send their kids to medical school, but rather to business or law.

Of all the things you could have picked, you picked law school to use as a counter-example?

LOL.

Graduate from a non top-20 med school and you're still a fully licensed MD and can get a job just about anywhere. Graduate from a non top-20 law school and...good luck finding a job that doesn't involve being a paralegal.

 

[Shouldawouldacouldas]

It takes a special kind of loser, and definitely not a businessperson, to invest at least 8 of his best years in post-college education, for hundreds of thousands of dollars in loans, which will require slaving away for more years until they are paid back, plus many other years working for the man, all for future promises based on the industry's current performance.

There is a reason the wealthy and/or powerful don't send their kids to medical school, but rather to business or law.

If your kids are driven and smart, then make them do anything but medicine. If your kids are smart but not driven, then a doctor is probably their best option.

 

[GravelRider]

I'm not convinced that if anesthesiologists walked out, outcomes would all of a sudden be that much worse...at least not appreciably so. We have to change perception instead.

 

[pgg]

You hit the nail on the head.
The nurses are unified in a way that doctors aren't. They are also smart in ways doctors aren't. It makes me sad.

It worked out so well for those 68 GoFundMe'ers in Michigan ...

No one is immune to market forces. Not even unified hero-worshipped media "savvy" nurses.