What the &*#$% is going on??

[dogbone65]

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http://www.nytimes.com/2010/09/07/opinion/07tue3.html?_r=1&ref=opinion

 

[lord_jeebus]

I sent them a letter regarding that editorial but I haven't heard back so it probably won't get published. The word limit is 150 so you have to really keep these to the point.

http://forums.studentdoctor.net/showpost.php?p=10116378&postcount=44

The ASA usually replies to this sort of thing and hopefully it would get published within a day or two.

 

[RussianJoo]

http://www.nytimes.com/2010/09/07/opinion/07tue3.html?_r=2&th&emc=th

so another editorial about CRNA's vs. MD anesthesiologists.. Why can't we just stomp this out? are MD's really that disliked and powerless? WTF!?

 

[cfdavid]

Dude, RJ, I agree we're going to have to address this problem. And, let's not f.ck around anymore. This is a serious problem.

I was paged by an attending in my department TODAY, regarding getting everyone in my program into the ASA-PAC. This will happen.

What's more interesting, and the nurses on here should pay attention to this, is that this "intitiative" came down from the Chairman of my department. To recruit us actively into the ASA-PAC.

The attending I spoke to just the morning (I'm in the CCU and he paged me, and then I went down to chat with him) was furious, but composed. This is a hybrid academic/private practice group, but they've trained CRNA's for many years, and only recently "ologists".

Point is, the gloves are coming off. I have a gathering on Sat. with my fellow residents and we'll be discussing this. It seems that the AANA is gaining the attention of the academics and/or hybrid's that make them possible in the first place.

We will win this. Support the ASA and spread the word.

Dr. Doze has stated correctly that a minority of highly motivated and organized individuals CAN (and for sure do) have a major impact. While I disagree with his intent with respect to that principle, I highly acknowledge this as FACT.

This battle is not lost. Rather it's just now beginning. The gloves are coming off at last.

cf

 

[cfdavid]

Because the fundamental assumptions upon which you were raised are in the process of being changed.
Because when money is tight, second best is good enough.
Everything else is just BS.

This is true as well.

See private forum for some ideas.

cf

 

[Southpaw]

Because the fundamental assumptions upon which you were raised are in the process of being changed.
Because when money is tight, second best is good enough.
Everything else is just BS.

Honestly, I don't see money as being that tight in healthcare. It's just Obama's issue and the media has latched on to the nurses.

If we really wanted to save healthcare dollars we should crack down on all the endless and often useless perioperative PCP/Cards 'surgical clearance' that goes on. I can't even fathom how much that'd save the gov't.

 

[sebsvenmdc]

Stupid CRNAs. So, what's the plan for those of us that will be practicing anesthesiologists 5-10 years from now? Will we have to accept equivalent job offers with CRNAs? But that's ******ed because no one would prefer to do have the same job with the same compensation with one easy road and one much much harder. So, that either leads us to a recalibration of our income so that we get what CRNAs get now, and they get half of what they get now. Or anesthesiologists are driven into extinction and only CRNAs practice? This really pisses me off. CRNA school is a freaking joke. You need like a 1100 on the GRE. Their education is embarrassingly easy compared to med school. Their students are also not as intense academically...so, they are competing with a much more average crowd. I think we need to destroy CRNAs and then rebuild our jobs.

 

[RussianJoo]

I am just upset that the specialty I love and finally have a chance to practice was taking this so litely and now are in such trouble, and that regular people actual think that a nurse is equivalant to an MD and aren't protasting abuot this issue as well.

 

[cfdavid]

I am just upset that the specialty I love and finally have a chance to practice was taking this so litely and now are in such trouble, and that regular people actual think that a nurse is equivalant to an MD and aren't protasting abuot this issue as well.

This game is far from over, my friend. Let us embrace this challenge and take it head on.

 

[aneftp]

This is getting serious. The AANA is basically paying for their own studies to win political and legal battles over the ASA. The scary part is 15 states and potentially Colorado will be the 16th State to OP out of CRNA supervision.*

AANA claims crnas have the same level of training. The question you have to ask is so many young students know how to game the system. You are talking about 25 year old newly minted CRNAs with maybe one year of ICU nursing on the job training and letting these 25 year old function independently vs at minimal a 30 year anesthesiologist with much broader knowledge.*

I am surprised the ASA doesn't mount a public campaign addressing whether they want to be treated by someone with less than one year of on the job ICU nursing training before going to CRNA school.*

 

[pgg]

Because when money is tight, second best is good enough.

If the American public made an honest cost/benefit analysis and made an educated, informed decision to accept lower cost or more readily available yet inferior midlevel care because it was good enough for themselves and their families, I'd be OK with that.

I really would.


But I guess that's too much to ask, given the ease with which the AANA lies to and manipulates an American public that, by and large, is made up of idiots who'll gladly spend $5/day on cigarettes while endlessly bitching about the $10 copay for the Name-Brand asthma medication they're entitled to.

 

[cfdavid]

If the American public made an honest cost/benefit analysis and made an educated, informed decision to accept lower cost or more readily available yet inferior midlevel care because it was good enough for themselves and their families, I'd be OK with that.

I really would.


But I guess that's too much to ask, given the ease with which the AANA lies to and manipulates an American public that, by and large, is made up of idiots who'll gladly spend $5/day on cigarettes while endlessly bitching about the $10 copay for the Name-Brand asthma medication they're entitled to.

Now that the gloves are off, we'll be playing TO the American public and politicians. This is SO up to us. Provided we get enough powerplayers to acknowledge that we can no longer play "status quo" and that different "methods" (get used to it) are necessary, then it makes me salivate at how easy this is in the REALITY that WE WILL CREATE. NOT the reality that our enemies (let's NOT mince words anymore) have attempted to create.

We should speak details in the private forum only, however...

cf

 

[sebsvenmdc]

I think physicians as a whole need to take on nurses on a whole. Other specialties are naive if they think they are immune to the kind of vocational erosion that CRNAs are incurring on anesthesiologists. This country is shifting in its stance on physicians...it's moving towards mid-level practitioners.

As cliched as the day without has become...I think the public needs to have a "Day without physicians." Then, maybe they will shut the hell up and care about us for a change. If true healthcare savings are the goal, going after tort reform and restructuring/shrinking defensive medicine is far superior than threatening our profession on the basis of salaries. Obama spews propaganda in the form of indicating that defensive medicine only accounts for about 2% of healthcare spending by accounting only for direct litigation costs instead of the majority of defensive medicine practices that never end up in court and end up generating the bulk or 30% of expenses.

 

[sebsvenmdc]

"Admissions - rotating imageAn application packet can be obtained from this website by clicking on Application under the Forms button above. Deadlines and other important dates related to admission are available on the website.

Applicants meeting the following criteria will be considered for admission:

* Bachelor of Science in Nursing, or an appropriate Bachelor degree from an accredited school or college
* Valid licensure as a registered nurse
* Official Graduate Record Examination (GRE) scores (verbal and quantitative > 1100, writing 4.0 or better)
* Weighted GPA 3.0 or greater
* A minimum of one year experience in adult critical care, or equivalent; two years recommended
* Certification as BLS, ACLS, PALS, CCRN
* Three strong professional references (one must be from current supervisior, the other two from professionals of your choice.)
* A short essay
* If English is not the first language, a score of at least 600 on the Test of English as a Foreign Language and a score of 6 on the institutional version of the Spoken English Test (SET)
* International applicants should refer to that section in the TCU Graduate Bulletin

Candidates who satisfactorily meet these criteria will be invited for an evaluated interview.

Application deadlines:

October 1st for class beginning the next year. Candidiates will be notified of admission status by February 1st . "

That is from a TCU CRNA school website. GRE > 1100. Geez, I think I could get an 800 on the quant and walk out half way through the verbal and still get 1100. 3.0 GPA?

This is ridiculous, guys! I didn't study my glutes off to be displaced by people with a subpar education and qualifications. As pretentious as that sounds, you have to admit, it pisses you off too...that someone can take your salary with 1/5 of the effort?

 

[Chloroform4Life]

Considering that anesthesiologists work longer hours, take overnight calls, do more complicated cases, and respond to codes, they should always have the leg up when salary is concerned. If people think they can pay us the even close to CRNA, they are out of their mind.

 

[sevo85288]

Guys,
I think this is good. We need a kick in the pants. Maybe our academicians need a wake up call.

 

[sebsvenmdc]

Considering that anesthesiologists work longer hours, take overnight calls, do more complicated cases, and respond to codes, they should always have the leg up when salary is concerned. If people think they can pay us the even close to CRNA, they are out of their mind.

And we deserve some reimbursement for educational sacrifices. I'm sorry, but I would be more than willing to take 150k only if all I had to do was get a 3.0 and an 1100 on the gre and not even attend med school!

 

[maceo]

Stupid CRNAs. So, what's the plan for those of us that will be practicing anesthesiologists 5-10 years from now? Will we have to accept equivalent job offers with CRNAs? But that's ******ed because no one would prefer to do have the same job with the same compensation with one easy road and one much much harder. So, that either leads us to a recalibration of our income so that we get what CRNAs get now, and they get half of what they get now. Or anesthesiologists are driven into extinction and only CRNAs practice? This really pisses me off. CRNA school is a freaking joke. You need like a 1100 on the GRE. Their education is embarrassingly easy compared to med school. Their students are also not as intense academically...so, they are competing with a much more average crowd. I think we need to destroy CRNAs and then rebuild our jobs.

listen, the studies are bogus. the article even stated who paid for the study.. Doing a study comparing crnas to MD would be unethical. you would have to take 2 level one trauma centers one staffed by just crnas, and one staffed by Mds only, or the anesthesia care model and see the results over a period of time. The study they did was completely bogus..

The answer is **** ing simple...

Physician Assistants in ANESTHESIA...

plain and simple

Nurses are nurses doctors are doctors. Next thing the nurses will say they can manage the ICU better.

PHYSICIAN ASSISTANTS IN ANESTHESIA

 

[maceo]

physician assistants in anesthesia

 

[sebsvenmdc]

listen, the studies are bogus. the article even stated who paid for the study.. Doing a study comparing crnas to MD would be unethical. you would have to take 2 level one trauma centers one staffed by just crnas, and one staffed by Mds only, or the anesthesia care model and see the results over a period of time. The study they did was completely bogus..

The answer is **** ing simple...

Physician Assistants in ANESTHESIA...

plain and simple

Nurses are nurses doctors are doctors. Next thing the nurses will say they can manage the ICU better.

PHYSICIAN ASSISTANTS IN ANESTHESIA

But Maceo, the new standard of nursing is going to be a doctorate in nursing by 2016. Nurses are going to be masquerading as physicians in the next decade. All of us need to step up and DOMINATE the nurses out there. I've had it with their attitude. Gentlemen, grab your balls and lets go balls to the wall. Ladies that are fellow physicians, grab your ovaries and lets go analogous internal genitalia to the wall.

If nurses want to be viewed as equally competent as physicians, that's fine...but go through med school and residency like the rest of us, first.

If you think about it, it's absurd to equate physicians and CRNAs...in the academic world, that's like equating a Ph.D. with a Masters...actually, more like Ph.D. with a Bachelors.

 

[jwk]

I am just upset that the specialty I love and finally have a chance to practice was taking this so litely and now are in such trouble, and that regular people actual think that a nurse is equivalant to an MD and aren't protasting abuot this issue as well.

It's not "the specialty" that takes it lightly. It's individuals who bury their heads in the sand and think either it's not their problem or that someone else will fight for them.

 

[jwk]

Considering that anesthesiologists work longer hours, take overnight calls, do more complicated cases, and respond to codes, they should always have the leg up when salary is concerned. If people think they can pay us the even close to CRNA, they are out of their mind.

You're in a small world. All this is group dependent, and unfortunately, many MD's abdicate their responsibilities after 3pm and on weekends and holidays.

Even in my strict ACT practice, our anesthetists also work long hours, take overnight call and/or stay in-house, do the most complex cases that we do, and even respond to codes.

 

[jwk]

listen, the studies are bogus. the article even stated who paid for the study.. Doing a study comparing crnas to MD would be unethical. you would have to take 2 level one trauma centers one staffed by just crnas, and one staffed by Mds only, or the anesthesia care model and see the results over a period of time. The study they did was completely bogus..

The answer is **** ing simple...

Physician Assistants in ANESTHESIA...

plain and simple

Nurses are nurses doctors are doctors. Next thing the nurses will say they can manage the ICU better.

PHYSICIAN ASSISTANTS IN ANESTHESIA

It's not simple, and yet you continue to beat this drum. The ASA doesn't support it. The AAPA doesn't support it. State law and Medicare/insurance regulations don't support it. And the AANA would go even more berserk than they already are.

200 AA's will graduate this year, finally getting into real numbers instead of the few dozen that graduated each year just 8 years ago. Support what's already there, already working, already in place. There are enough issues to deal with without trying to reinvent the wheel.

 

[desflurane]

I hope that this editorial does indeed wake the sleeping giant. It was a good swift kick in the arse for me.

I will be sending my first of many contributions to the ASA PAC. While it is important to make your voice heard on the local level the lobbyists and pr people do this for a living. If the health care debate taught me anything it was that lobbying works. Period. Remember the proposed cosmetic surgery tax? Axed by their lobby.

I've been using my blog to spread the message and I need your help. I accept all contributions as postings or comments. Any and all postings will be considered. Make your voice heard!

 

[maceo]

It's not simple, and yet you continue to beat this drum. The ASA doesn't support it. The AAPA doesn't support it. State law and Medicare/insurance regulations don't support it. And the AANA would go even more berserk than they already are.

200 AA's will graduate this year, finally getting into real numbers instead of the few dozen that graduated each year just 8 years ago. Support what's already there, already working, already in place. There are enough issues to deal with without trying to reinvent the wheel.

PAs are recognized and licensed in every single state. so there is no legislative battle there. AAs arent. Nobody knows what an AA is. So it would be easier to get PAs be our colleagues in the OR since they are recognized in every state. and every other specalty can use PAs . why not anesthesia?

I know your feathers are alittle ruffled but DONT THINK LIKE A CRNA>>

I fully support AAs.. I am going to join the quad a, and i dont think we should let Our fight go to have you licensed in every state.

 

[countingdays]

The PA idea is fatally flawed because PAs do not graduate ready to practice anesthesia, even heavily supervised. They graduate ready to work in other areas though. I doubt your are going to have PAs flocking to anesthesia training programs for an extra 2 years when they can go out and get jobs doing surgery or dermatology with a comparable paycheck and no crna problem.

 

[cfdavid]

But Maceo, the new standard of nursing is going to be a doctorate in nursing by 2016. Nurses are going to be masquerading as physicians in the next decade. All of us need to step up and DOMINATE the nurses out there. I've had it with their attitude. Gentlemen, grab your balls and lets go balls to the wall. Ladies that are fellow physicians, grab your ovaries and lets go analogous internal genitalia to the wall.

If nurses want to be viewed as equally competent as physicians, that's fine...but go through med school and residency like the rest of us, first.

If you think about it, it's absurd to equate physicians and CRNAs...in the academic world, that's like equating a Ph.D. with a Masters...actually, more like Ph.D. with a Bachelors.

This is giving me a headache already. I can just imagine. The "good" part is that this is NOT just the domain of anesthesiology. Sure, we can argue severity, but NP-->DNP is happening across many specialties. I'm sensing this will strengthen our position as other physicians begin dealing with this monster as well.

cf

 

[Laryngophed]

Gentlemen, grab your balls and lets go balls to the wall. Ladies that are fellow physicians, grab your ovaries and lets go analogous internal genitalia to the wall.

I certainly don't mean to cheapen the thought and emotion with which this post was made, but I just lost it. My lab group thinks I'm nuts because I'm laughing my butt off at this.

 

[maceo]

The PA idea is fatally flawed because PAs do not graduate ready to practice anesthesia, even heavily supervised. They graduate ready to work in other areas though. I doubt your are going to have PAs flocking to anesthesia training programs for an extra 2 years when they can go out and get jobs doing surgery or dermatology with a comparable paycheck and no crna problem.

they would do a 14 month residency with us.. with NO vacation.

2 months straight in didactics. 10 hour days of pharmacology, and intro to anes practice. acls and pals.

then 12 straight months in the Operating room at an approved anesthesia residency.. first 6 months general anesthesia, 2 months peds, 2 months ob, 2 months back in the general OR..

They would absolutely be ready for this.. I feel they would be more qualified then crnas because of their broad clinical exposure..

and anesthetists make 130-140 per year thatts like 50k more than a pa makes now. absolutely you would have PAs flocking..

 

[sebsvenmdc]

I certainly don't mean to cheapen the thought and emotion with which this post was made, but I just lost it. My lab group thinks I'm nuts because I'm laughing my butt off at this.

Yeah, it was an attempt at humor, but I am still furious with this situation. Someone introduced me to a person yesterday, and I looked down and saw, "CRNA" on the badge. I couldn't help frowning a bit and immediately labeling the person, "Enemy."

This shift in healthcare is just representative of the type of broader agenda that Obama represents. The physicians I work with have rightfully pointed out that Obama wants the US and the rest of the world to be the same, instead of us being ahead of the world as a superpower...this is why the world loves him. It's very sad when you consider the level of complacency that he endorses. Why should any of us be working hard when we can sit back and let everyone else pay for it.

The real annoying dimension to this nurse-MD issue is that it's politically correct to endorse bridging the gap. Nurses have turned their plight into a struggle for "equality" in terms of professional recognition. The reality is that they are inferior clinicians that do 3-4 12 hour shifts per week and they emphasize DOING things without understanding the WHY behind many of them. If medicine is to become 'de-cerebralized' and eroded into a waste-land of illogical thinking...everyone is in trouble.

 

[Mokki]

Maceo, the more I think I about it, the more I like the idea of supporting AA's and PA's in the OR. It's definitely worth starting up NOW, even though it's gonna take years to get a sufficient number trained to replace the CRNA's in circulation today. But the problem still remains - in rural areas, who's gonna supervise these folks? Are we going to expand residency training and train more folks who will go to rural areas?

It seems that's where the leech that is the AANA has started sucking on blood - in rural areas with high demand but no supply - they jump in pretending to solve the problem. These states aren't thinking straight, IMO, because they're so desperate and are taking any smarmy offers coming their way - and the AANA is throwing smarm galore and they're eating it up. But Colorado and California don't fit this pattern - I don't know, I'm so confused....

they would do a 14 month residency with us.. with NO vacation.

2 months straight in didactics. 10 hour days of pharmacology, and intro to anes practice. acls and pals.

then 12 straight months in the Operating room at an approved anesthesia residency.. first 6 months general anesthesia, 2 months peds, 2 months ob, 2 months back in the general OR..

They would absolutely be ready for this.. I feel they would be more qualified then crnas because of their broad clinical exposure..

and anesthetists make 130-140 per year thatts like 50k more than a pa makes now. absolutely you would have PAs flocking..

 

[Mokki]

So a quick (not funny, just amusing) story about this - today, I was the second guy out and went to relieve the first guy out. It was a peds case that would end in half an hour, with a plan to do a caudal at the end. Then, the attending walks into the room and says oh, the CRNA can relieve you both. Now, I love doing caudals and am thinking about Peds Anes and chose to stick around instead of letting some f----ng CRNA do it.

The CRNA walks into the room thinking she would relieve me - and I said no I want to stay and do this. She went and told another CRNA, I guess, and they both walk into the room and both were genuinely confused about why I'd choose to stay instead of leaving when I was scheduled to.

THAT is the mindset of a CRNA.

The reality is that they are inferior clinicians that do 3-4 12 hour shifts per week and they emphasize DOING things without understanding the WHY behind many of them. If medicine is to become 'de-cerebralized' and eroded into a waste-land of illogical thinking...everyone is in trouble.

 

[ProRealDoc]

So a quick (not funny, just amusing) story about this - today, I was the second guy out and went to relieve the first guy out. It was a peds case that would end in half an hour, with a plan to do a caudal at the end. Then, the attending walks into the room and says oh, the CRNA can relieve you both. Now, I love doing caudals and am thinking about Peds Anes and chose to stick around instead of letting some f----ng CRNA do it.

The CRNA walks into the room thinking she would relieve me - and I said no I want to stay and do this. She went and told another CRNA, I guess, and they both walk into the room and both were genuinely confused about why I'd choose to stay instead of leaving when I was scheduled to.

THAT is the mindset of a CRNA.

If everyone (residents and attendngs) did what we are supposed when we are supposed to do it, we wouldn't have this problem.
Most people want the money without doing any of the work. They think too high of themselves to 'sit' in an OR.

 

[countingdays]

they would do a 14 month residency with us.. with NO vacation.

2 months straight in didactics. 10 hour days of pharmacology, and intro to anes practice. acls and pals.

then 12 straight months in the Operating room at an approved anesthesia residency.. first 6 months general anesthesia, 2 months peds, 2 months ob, 2 months back in the general OR..

They would absolutely be ready for this.. I feel they would be more qualified then crnas because of their broad clinical exposure..

and anesthetists make 130-140 per year thatts like 50k more than a pa makes now. absolutely you would have PAs flocking..

If your assumption that PAs in anesthesia 'residency' would be paid similarly to a resident, then you may be correct that many PAs would train in anesthesia.

My assumption is that PAs would pay for 'anesthesia school' like student RN anesthestists. In that case, it would be much less appealing to PAs.

 

[bigdan]

I'd really like to see the ASAPAC launch an advertising plan in the Times and USA Today etc. to educate the public. The time is now, unless we plan on buying a few pro-anesthesiologist "studies" to counteract the nursing "studies".

You guys think the ASAPAC would go for it?

 

[cfdavid]

I'd really like to see the ASAPAC launch an advertising plan in the Times and USA Today etc. to educate the public. The time is now, unless we plan on buying a few pro-anesthesiologist "studies" to counteract the nursing "studies".

You guys think the ASAPAC would go for it?

They should go for it. We need to make them realize what their "constituents" desire. A full page ad in the WSJ would go a LONG way on many fronts. It would also make it clear to the AANA that we're no longer playing in the sandbox or climbingh monkey bars.....

cf

 

[Laryngophed]

They should go for it. We need to make them realize what their "constituents" desire. A full page ad in the WSJ would go a LONG way on many fronts. It would also make it clear to the AANA that we're no longer playing in the sandbox or climbingh monkey bars.....

cf

WSJ is a nice place to start, but I think we (who the %$*# am I to say we? ) need to convince the people who read USA Today more than the WSJ readers. Ultimately, if patients are demanding MD/DOs at the point of care as opposed to CRNAs, hospitals will staff MD/DOs, lest the patients go elsewhere. Further, if you get constituents fired up, they will apply the heat to the power/job hungry politicians. How many well publicized stories of x advanced practitioner killed my grandpa do you think it will take before people say, "Gee, I think more of my family than that! I don't want to put them in the hands of less than the best."

 

[Bertelman]

WSJ is a nice place to start, but I think we (who the %$*# am I to say we? ) need to convince the people who read USA Today more than the WSJ readers. Ultimately, if patients are demanding MD/DOs at the point of care as opposed to CRNAs, hospitals will staff MD/DOs, lest the patients go elsewhere. Further, if you get constituents fired up, they will apply the heat to the power/job hungry politicians. How many well publicized stories of x advanced practitioner killed my grandpa do you think it will take before people say, "Gee, I think more of my family than that! I don't want to put them in the hands of less than the best."

Your average patient could probably care less. The opinions of the country on the future of healthcare are across the spectrum You can expect the same broad spectrum of opinions on whether a physician or CRNA is best for delivering anesthesia.

The WSJ or Washington Post is exactly where we need to take this. This is a political battle, and policies adopted in the next few years may forever shape our future. There will never be a public outcry large enough to convince policy makers to take the reigns back away from CRNAs once they get in the driver's seat. With all that is wrong in this country right now, counting on a strong public voice to fend off CRNAs is hopeless. The average citizen cares much much more about immigration, foreclosures, unemployment, school budgets, taxes, etc.

As someone who reads the NYT routinely, I can say that articles about bedbugs outnumber articles about anesthesiology like 30:1. That's a window into the average daily concern of our citizens.

 

[maceo]

If your assumption that PAs in anesthesia 'residency' would be paid similarly to a resident, then you may be correct that many PAs would train in anesthesia.

My assumption is that PAs would pay for 'anesthesia school' like student RN anesthestists. In that case, it would be much less appealing to PAs.

being an anesthetist is a stable good job. you can work 30 years and not even think about being out of a job.. plus the pay is like 50-60k more per year then a PA makes now. i absolutely think they would come train in droves. seriously. If they can open and close chests alone in the room for the cardiac surgeons surely they can be our colleagues in the OR.

MOKKI mentioned who would supervise them in rural areas. I dont support unsupervised crna practice in rural areas. If they want to recruit people in bum **** nowhere.. they have to pony up the dough.. would you let a Nurse practitioner take out your gallbladder if there were no surgeon in bum **** nowhere?? you would take your ass to the nearest area with a surgeon..

 

[Southpaw]

would you let a Nurse practitioner take out your gallbladder if there were no surgeon in bum **** nowhere?? you would take your ass to the nearest area with a surgeon..

This doesn't make sense. Of course you wouldn't let an NP do the surgery. More importantly, the surgeons have been much more protective of their skill than us, and much more willing as a group to work harder.

The fact is, there are surgeons who operate in rural USA, where there are no anesthesiologists available. One reason for this is that rural access hospitals get increased Medicare funds by having CRNAs due to a political mishap. If there is a surgeon willing to operate, a competent anesthesia provider must be there to facilitate surgery. That's just a fact here in the grand ole' US of A. So first and foremost, we need to get Rural-pass through legislation passed so rural hospitals can financially attract Anesthesiologists.

As Bertelman suggested, taking the political fight to the big papers is important and necessary. Like he said, it's much easier to prevent an action than it is to take the result away after the action has already happened. You see this time and time again, just like you're currently seeing it with NPs supervising flouroscopy and diagnosing disease in Iowa. The BON, no surprise, said "Hell yeah, nurses can do this, we'll just have you take some BS (and that ain't Bachelor of Science I'm referring to, friends) radiation safety class, then go right ahead!!!". And of course, the BOM and others didn't fight it agressively enough to prevent it from starting. And now, after the fact, the ISA, the pain societies, and radiology societies, and the medical societies are fighting tooth-and-nail in the court system to try and stop nurses from practicing medicine in Iowa. You absolutely have to catch this cancer before it becomes metastatic, and if not, be prepared for a much, much tougher fight.

 

[BLADEMDA]

being an anesthetist is a stable good job. you can work 30 years and not even think about being out of a job.. plus the pay is like 50-60k more per year then a PA makes now. i absolutely think they would come train in droves. seriously. If they can open and close chests alone in the room for the cardiac surgeons surely they can be our colleagues in the OR.

MOKKI mentioned who would supervise them in rural areas. I dont support unsupervised crna practice in rural areas. If they want to recruit people in bum **** nowhere.. they have to pony up the dough.. would you let a Nurse practitioner take out your gallbladder if there were no surgeon in bum **** nowhere?? you would take your ass to the nearest area with a surgeon..

The analogy is not correct. CRNAs having been doing anesthesia SOLO in rural USA for decades. Decades. Safety does NOT appear to be a significant issue due to either very good CRNAs or low acuity cases. If NPs had 5 decades or more of hard data in rural USA of safely doing TWO types of operations (Gallbladder and Appendectomy) then the General Surgeons would be in the same boat as us.

Again, the Solo CRNAs in rural USA have, for the most part, been doing a good job. Perhaps, it is because experienced CRNAS fill those positions or, perhaps, the cases/patients are pretty simple. Regardless, the ASA won't win this battle; in fact, we lost it decades ago but you simply weren't told.

Blade

 

[RussianJoo]

well i looked through NYT website hoping to see a reply form the ASA like some people mentioned might happen. It's been a few days and no reply yet. Some how I don't think one will come... The ASA needs to be more public, maybe they should publish a study how CRNA's aren't equally trained to MD's, maybe publish a few case reports of CRNAs inappropriatly taking care of patients. We can't just fight this thing with political lobying. We need to bring this topic out to the lay people with editorials and research article published in health magazines that the lay public reads. What ever happened to that education compain the ASA had a few years ago? I don't think I saw a single ad, not at the hospitals I was rotating, no billboards on highways, no ads on tv.

What should lay people believe when everything is so one sided, the AANA is putting out all this press and making the news about how they're equal to MD's, and the MDs aren't doing anything, just sitting back and turning the other cheek.

 

[pgg]

So today I'm a shade more pessimistic about the whole CRNA world domination thing.


Background: Yesterday I took care of a person who went to Tijuana for a tummy tuck & liposuction to save a few bucks, with predictable results. She now has about a 20" x 8" piece of her abdominal wall completely missing. The guy who did the discount abdominoplasty also opened her fascia and closed it with a running suture of what looked like Vicryl - not sure what he did in her abdomen. (I checked the CT just to see if she still had both kidneys).

More on that in a second ...

Again, the Solo CRNAs in rural USA have, for the most part, been doing a good job. Perhaps, it is because experienced CRNAS fill those positions or, perhaps, the cases/patients are pretty simple. Regardless, the ASA won't win this battle; in fact, we lost it decades ago but you simply weren't told.

I've come to have a different view. Solo CRNAs in rural USA aren't doing a good job, but it doesn't matter.

You might be surprised at the kind of absolutely egregious medical errors that just slip by or are accepted as normal out here in rural America. It's not limited to anesthesia. There's just a passive, tacit acceptance that because we're out in BFE, expectations are lower. I'm not just talking about obvious resource limitations like not having a pediatric neurosurgeon on call 24/7. I mean basic stuff any hospitalist/surgeon/ER/ward/ICU should be doing, with actual avoidable bad outcomes.

A huge percentage of our patient population is, to put it politely, unsophisticated and uneducated (many don't even speak English) and when minor or major stuff is screwed up, they often don't realize they got substandard care. My point is just that even if some of the strip-mall-trained cowboy solo CRNAs out here were bumping people off right and left, I'm not sure anyone would notice or think it unusual.


Tijuana-tummy-tuck-girl wasn't the slightest bit interested in talking about anesthesia. She thought I was the nurse coming to help her poop and finished a long, drawn out cell phone conversation before even acknowledging my presence. Even after I convinced her that I was her anesthesiologist, and no I couldn't help her poop, I had to drag every last bit of medical history out of her. She cut me off and said she didn't want to hear about anesthesia risks. Her only concern - asked over and over again - was if I thought she'd have a noticable scar.

I guess maybe it won't be noticable from orbit.

The point of this sad tale of woe is simply this: even after a horrific complication, she still hasn't made the connection between discount surgery in Tijuana and her bad outcome. Expecting her kind to recognize and care about more subtle differences between CRNAs and anesthesiologists is asking a lot.

 

[deleted126335]

The analogy is not correct. CRNAs having been doing anesthesia SOLO in rural USA for decades. Decades. Safety does NOT appear to be a significant issue due to either very good CRNAs or low acuity cases. If NPs had 5 decades or more of hard data in rural USA of safely doing TWO types of operations (Gallbladder and Appendectomy) then the General Surgeons would be in the same boat as us.

Again, the Solo CRNAs in rural USA have, for the most part, been doing a good job. Perhaps, it is because experienced CRNAS fill those positions or, perhaps, the cases/patients are pretty simple. Regardless, the ASA won't win this battle; in fact, we lost it decades ago but you simply weren't told.

Blade

-Also expectations in much of rural America are different. More of a self reliant type of crowd. I bet that there is much less personal injury attorney work (not just medmal) in small town america than elsewhere.

-Also small town judges and juries are less willing to put a bullet in what is likely to be the one of the biggest if not the biggest employer locally (The hospital). Evidence for this is lower malpractice rates within states e.g. Philadelphia different than central PA, Detroit being different than the rest of MI, NYC being different than upstate, etc.

Ironic, the medmal plaintiff attorney might wind up being an indirect ally in this conflict.

 

[BLADEMDA]

-Also expectations in much of rural America are different. More of a self reliant type of crowd. I bet that there is much less personal injury attorney work (not just medmal) in small town america than elsewhere.

-Also small town judges and juries are less willing to put a bullet in what is likely to be the one of the biggest if not the biggest employer locally (The hospital). Evidence for this is lower malpractice rates within states e.g. Philadelphia different than central PA, Detroit being different than the rest of MI, NYC being different than upstate, etc.

Ironic, the medmal plaintiff attorney might wind up being an indirect ally in this conflict.

In a nutshell the CRNA is "good enough" for rural USA and don't look to the tort lawyers to save us.

 

[BLADEMDA]

You absolutely have to catch this cancer before it becomes metastatic, and if not, be prepared for a much, much tougher fight.


Really? So we don't have liver mets or lung mets yet? I think you need to Re-CT the patient and look again.

 

[NRAI2001]

well i looked through NYT website hoping to see a reply form the ASA like some people mentioned might happen. It's been a few days and no reply yet. Some how I don't think one will come... The ASA needs to be more public, maybe they should publish a study how CRNA's aren't equally trained to MD's, maybe publish a few case reports of CRNAs inappropriatly taking care of patients. We can't just fight this thing with political lobying. We need to bring this topic out to the lay people with editorials and research article published in health magazines that the lay public reads. What ever happened to that education compain the ASA had a few years ago? I don't think I saw a single ad, not at the hospitals I was rotating, no billboards on highways, no ads on tv.

What should lay people believe when everything is so one sided, the AANA is putting out all this press and making the news about how they're equal to MD's, and the MDs aren't doing anything, just sitting back and turning the other cheek.

I think the public is on board with the whole crna model because they believe the "impending doom" of the US HC system and they genuinely believe that this is a way to cut costs.. the thing they fail to realize is that using crnas cut costs for the hospital/surgery centers that employ them but crnas/NPs etc bill insurances/medicare at the same rate as do full fledged MDs.. hence why the hospital/surgi centers/anesthesiology groups can use crnas to increase revenue.... BASICALLY the public is paying for subpar care for the benifit of the administration's revenue. I think this should be emphasized👍

 

[NRAI2001]

The other thing I dont understand is why other non anesth physicians aren't more worried?

I ve noticed more and more with the emergence of NPs and PAs in primary care more Primary care physicians have begun to do specialist procedures in their offices. Driven by the fear of going out of business due to mid-level encroachment they switched their practice model to incorporate more specialist procedures and they ve actually managed to increase their incomes.

If I were a specialist (GI, cardiologist ..etc) I would be concerned as PCPs take over more and more of my bread and butter diagnostic procedures --> possibly forcing specialists to increase invasive procedures (ie the emergence of interventional cardiology and interventional radiology) which I would imagine would become more concerning to surgeons.

Point is that with greater mid-level encroachment no physician or no field of medicine is immune. Specialists are not immune, surgeons are not immune, PCPs are not immune. This should be stressed to our non-anesth. colleagues. All physicians should support this.

 

[DrJamrock]

In Brazil and most Latin American countries crna's do not exist,one surgery one anesthesiologist.

 

[countingdays]

In Brazil and most Latin American countries crna's do not exist,one surgery one anesthesiologist.

They'd have little incentive to train murses to be pretend doctors since the physician education is probably a lot cheaper in latin america since they don't waste most of your medical education dollars on administration salaries, professors who teach 1/6 of one class, teamwork seminars, simulators that cost millions but aren't worth sh##, tons of bureaucrats, hordes of secretaries, etc.