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

[Bertelman]

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Re: Eliminate crna's

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

Is that a euphemism for killing them?

 

[yougotit]

Nothing is new under the sun. It's been since florence nightingale that nursing is trying to prove that it is a profession that's independent of medicine.

What is happening to anesthesia now is nothing but a result of the greed of those who wanted to be in 3 ORs at the same time and bill for it. Now, this is coming back to bite them. After all, you only reap what you sow. Still,I see some of you advocating for PAs in anesthesia. Are you seriously gullible enough to think that PAs won't be asking for independent practice in the future?

What's sad is that most of physicians are in denial of what's happening. Anesthesiologists expect the ASA to do something now when it never did. Heck, the ASA still invites CRNAs to their conferences for God's sake! if they want to be independent, why don't they do their own own discoveries and research?

Other physicians still think that this will never happen to their specialties. However, don't we all know that DNP programs already started residencies? What guarantees do cardiologists have that DNP cardiologists won't be asking to do catherizations in few years?

The problem is not with nursing. It's only human to want to advance your career and status. The problem is with medicine. We allowed this happen, we got infected by the 8-4 virus no one wants to work anymore, we allowed the 80 hours limit to take place and it's us who don't want to do our job. The short term gain you get by hiring a midlevel, will be nothing comparing to the loss you will get once that midlevel gains independent practice and offers to do your job for 40% of the price...after all that midlevel did not go through what all of us had to go through to become a MD, does not have our debt and would be more than happy to triple their salary by doing one extra year of training.

The solution?

1-We don't need midlevels. Medicine did without them up until 30 years ago. The rest of the world still does without them even now. Do not hire them!

2- Be as agressive as they are. Use litigation, dissect their studies, the outcomes they set and finally give hospitals ultimatums. US or them!

 

[lvspro]

Taking this profession back will take more than donating a few bucks, and crossing our fingers. You have to be a doctor, and outline the differences to your patients on every single encounter.
Donate!!! If you haven't, and don't plan on doing so, every year, then you are a part of the problem. I have been in touch with some political figures here in MI, and the MSA in particular. I would like to discuss more on this board, but since my identity is known, I have to use discretion in discussing any of the current tactics we are developing to combat this threat to our very existence.
Allow me to repeat, IF YOU ARE NOT DONATING, THEN YOU ARE CONTRIBUTING TO THE DOWNFALL OF THE PROFESSION RIGHT NOW!! NOT 10 YEARS FROM NOW, NOT EVEN 5 YEARS FROM NOW, THE NURSES ARE CURRENTLY PUSHING TO DESTROY YOUR SPECIALTY, AND ARE WINNING!!!

If you would like to find out more, we can talk in the private forum, or you can contact me and I will let you know where we are headed in terms of political moves.

I urge all of you to heed this warning, and think back to all the warnings and efforts by Blade. He was right, and they are extremely far ahead of us in terms of the political game. What he has been warning us about for so long is happening right now, and our viability is at stake.

Later on, I will post how I promote our specialty to every patient from the pre-testing period, to the PACU, and even after the pt is discharged home.I just got done talking to the president of MSA about this. TTYL all.

 

[Bertelman]

1-We don't need midlevels. Medicine did without them up until 30 years ago. The rest of the world still does without them even now. Do not hire them!

Actually, we do. There are simply not enough physicians in this country to cover the work that midlevels accomplish.

There are more than a few depts at my hospital which could not provide adequate staffing without midlevels, be it PA, NP or CRNA.

Anesthesiology. Surgery. Cardiology. CT surgery. GI.

Nurses filled a gap in the healthcare team, allowing more physicians to go home at a reasonable hour, or sleep at home instead of at the hospital. To think we have received no benefit from the creation of midlevels is denying a pretty obvious fact. To dream that we can erase them all from medicine medicine in the U.S. is completely foolish.

 

[DrJamrock]

Speak with a congressman/senator and ask them to author a federal law prohibiting crnas from practising independently thus invalidating the decisions of the states allowing them to do so.

 

[yougotit]

Actually, we do. There are simply not enough physicians in this country to cover the work that midlevels accomplish.

Well if you need them, then deal with the consequences and stop whining.
You can't have your cake and eat it too!

PS: By you, I mean the specialty of Anaesthesia and not you personally.

 

[Bertelman]

Well if you need them, then deal with the consequences and stop whining.
You can't have your cake and eat it too!

PS: By you, I mean the specialty of Anaesthesia and not you personally.

I'll try to compress the last few decades of history into an offensive analogy to help explain how we got here.

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CRNAs are like puppies. Nice and cute, and everyone loves them. Problem is, they're growing up. Now they have teeth, they growl, and occasionally lay a turd on the carpet. You've spoken to your friends about this problem, and they say that if you don't neuter your puppy soon, his behavior will get worse.

He will start sleeping in your bed, fighting his way in between you and the Mrs. He will jump on the counter and eat your roasted turkey. And he will roam around town, find another dog, and make more puppies.
------

We're just trying to neuter the puppies before they take our jobs.

 

[yougotit]

I'll try to compress the last few decades of history into an offensive analogy to help explain how we got here.

------
CRNAs are like puppies. Nice and cute, and everyone loves them. Problem is, they're growing up. Now they have teeth, they growl, and occasionally lay a turd on the carpet. You've spoken to your friends about this problem, and they say that if you don't neuter your puppy soon, his behavior will get worse.

He will start sleeping in your bed, fighting his way in between you and the Mrs. He will jump on the counter and eat your roasted turkey. And he will roam around town, find another dog, and make more puppies.
------

We're just trying to neuter the puppies before they take our jobs.

You can't neuter a rabid dog....Soon enough you and the rest of your friends will be reciting the medical version of Martin Niemoller's poem.

First they came for the anaestesiologists and I did not speak out because I wasn't an anaestesiologist...
Then they came for primary care providers and I did not speak out because I wasn't a pcp....

No one gives a hoot about what we did to get into med school, the hours we spend in the anatomy lab, the sleepless nights of residency....It's all about the economy and economy dictates that if they can pay half of what they pay you to someone else who can do most of your job, they will do it without blinking.

The recent stance of the NBME is only another proof about how serious the problem is within the medical community. If we don't stand for each other no one will stand for us. The only solution is to be as vicious as they are. They want to play doctor? let them go to medical school.

 

[lushmd]

FYI, Dr. Hannenberg (ASA President) submitted a letter to the editor which is now available on the NYT website.

To the Editor:

"Who Should Provide Anesthesia Care?" (editorial, Sept. 7) proposes allowing nurses to deliver anesthesia without the supervision of any doctor. Both of the studies cited to support this approach have been financed by the American Association of Nurse Anesthetists.

When did The New York Times start taking policy positions based on purchased research? If the editorial page is going to take a position, your readers deserve some degree of critical and impartial analysis.

The irony is that the remarkable safety of anesthesia underlying the assumption that anyone can do it is purely a result of physicians' innovation. Without physicians, patients are unpredictably put in danger, and further advances are impossible.

Alexander Hannenberg
President, American
Society of Anesthesiologists
Newton, Mass., Sept. 8, 2010

 

[GasEmDee]

The second letter is upsetting.

What exactly is the "science" that she is referring to? She is making total slop over the very term. Mind boggling.

On a side note, I wonder how many "purchased" studies were NOT publicized by the AANA because they did not have the desired outcome (i.e., a demonstration of equivalence between anesthesiologists and CRNAs).

 

[Apollyon]

On a side note, I wonder how many "purchased" studies were NOT publicized by the AANA because they did not have the desired outcome (i.e., a demonstration of equivalence between anesthesiologists and CRNAs).

You mean you didn't get this month's issue of The Journal of Negative Results?

 

[GasEmDee]

You mean you didn't get this month's issue of The Journal of Negative Results?

Nope. I haven't checked my mail. What did it say?

 

[BF2BC EMT]

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.

I was thinking this as I read, me, the average pt. would feel very uncomfortable with a CRNA unsupervised. Its only a matter of time before a CRNA goes rogue when things are going pear shape, and since they're unsupervised they will feel that they have to listen/answer to know one,and a pt. comes out hurt/dead.

MD-yelling at CRNA to correct situation-CRNA on high horse wont acknowledge-pt. dead.

 

[Bertelman]

I was thinking this as I read, me, the average pt. would feel very uncomfortable with a CRNA unsupervised. Its only a matter of time before a CRNA goes rogue when things are going pear shape, and since they're unsupervised they will feel that they have to listen/answer to know one,and a pt. comes out hurt/dead.

MD-yelling at CRNA to correct situation-CRNA on high horse wont acknowledge-pt. dead.

But you're not the average pt. You have an interest in medicine, are presumably completing your undergrad degree, etc.

The average patient has probably an associates at best, and is much more upset that they haven't eaten in 10 hrs than they are that a CRNA may be delivering their care. If they ask you how long the procedure will take, they immediately follow it up by saying the surgeon, you, or both of you must have a tee time to catch.

 

[maceo]

I wish the american society of anesthesiologist would embrace and start advertising for Physician Assistants in ANesthesia. and of course anesthesiology assistants

 

[BF2BC EMT]

But you're not the average pt. You have an interest in medicine, are presumably completing your undergrad degree, etc.

The average patient has probably an associates at best, and is much more upset that they haven't eaten in 10 hrs than they are that a CRNA may be delivering their care. If they ask you how long the procedure will take, they immediately follow it up by saying the surgeon, you, or both of you must have a tee time to catch.

Yes, your right. The general public needs to be further educated on the difference between the 2 professions. Its a shame that CRNA's are and will further take advantage of the economic state of most of the country to further push for being able to practice unsupervised. I think that's their best argument, 'we will save you money'. Who wouldn't want to save some cash? A Dangerous statement for a fresh CRNA, it should read 'we will save you money, but I may not save your life'. Nurses are needed, yes, but on a supervised level.

I've seen a few times in EMS, nurses of all levels on ego trips and to be honest its cringeworthy. I still think the outcome will end up bad for a pt. when the rouge CRNA turns up and answers to no one. With such limited education answering to no one = no good outcome.

 

[IDBasco]

ASA wasn't the only group to respond to the article. Funny these others weren't published, eh?🙄

http://www.asahq.org/news/responsetoNYTimeseditorial.htm

 

[ProRealDoc]

Letters to the Editor From Leading Medical Specialty Groups in Response to New York Times Editorial
In response to the NYT Editorial, Who Should Provide Anesthesia Care?, ASA President, Alexander Hannenberg, M.D., submitted this Letter to the Editor response, The American College of Surgeons and the American Academy of Family Physicians also submitted important Letters to the Editor which were left unpublished. Those letters are below.
Who Should Provide Anesthesia Care?
The editorial “Who Should Provide Anesthesia Care”* missed an important point: No operative procedure is “minor,” and the risk of anesthesia is never “minuscule.”
No one can truly predict what the risks of anesthesia are—or if they will materialize during an operative procedure. Patient safety is, and should be, the primary focus of all medical and health care professionals. As surgeons, we have a background in life support and management of vital signs and other possible risks associated with surgical procedures. We believe that having fully trained and qualified anesthesiologists as our partners in the operating room is essential to ensuring that all surgical procedures are as safe and effective as possible.
Advocating cost savings at the expense of patient safety and well-being is a penny wise and pound foolish philosophy that no one should be anxious to embrace.

A. Brent Eastman, MD, FACS, Chair, Board of Regents
LaMar S. McGinnis, Jr., MD, FACS, President
David B. Hoyt, MD, FACS, Executive Director
American College of Surgeons
*September 6, 2010

Dear Editor
The question of who should provide anesthesia care (“Who Should Provide Anesthesia Care? Sept. 6, 2010) misses an important point in discussing health professionals’ roles. That point is whether the patient receives the most appropriate care, given his or her health history, current health status and currently needed care. This, rather than the certification of the practitioner or cost of the care, should be the determining factor in whether a physician, advanced practice nurse or other health care professional should provide a health service to the patient.
In some limited areas of patient care, certified nurse anesthetists and physicians receive similar training. CRNAs’ two-and-a-half years of post-graduate training focuses on the “how” of anesthesia. Their skills comprise expertise in following protocol for anesthesia during uncomplicated procedures for patients with uncomplicated medical histories and straightforward pain control needs. As such, nurse anesthetists are valuable members of the patient care team. However, they do not have the medical knowledge that warrants working without the supervision of a physician, whose eight years of post-graduate training goes beyond following a recipe for anesthesia and includes expertise in the full range of medical conditions, management of coexisting diseases, and diagnosis and response to potential complications and interactions before, during and after a medical intervention.
Given the American Association of Nurse Anesthetists study’s finding that mortality rates rose among unsupervised CRNAs between 1999 and 2005 while mortality rates for anesthesiologists and anesthesiologist-CRNA teams went down, one must question why we would establish a public policy that denies patients access to the safer option of having an anesthesiologist or a physician-CRNA team.
Certainly it is not to save money. Medicare, Medicaid and private insurers pay the less-trained unsupervised CRNA the same as it pays the anesthesiologist.
Nurse anesthetists are an invaluable part of a patient’s health care team and are important to ensuring patient access to surgical and childbirth services, particularly in underserved areas.
This is not a territorial issue. It’s an issue of patient safety.
Sincerely,

Lori Heim, MD
President
American Academy of Family Physicians
Leawood, Kansas

 

[OB1🤙]

The FP response sounds better than the ASA's!

 

[Laryngophed]

Letters to the Editor From Leading Medical Specialty Groups in Response to New York Times Editorial
In response to the NYT Editorial, Who Should Provide Anesthesia Care?, ASA President, Alexander Hannenberg, M.D., submitted this Letter to the Editor response, The American College of Surgeons and the American Academy of Family Physicians also submitted important Letters to the Editor which were left unpublished. Those letters are below.
Who Should Provide Anesthesia Care?
The editorial “Who Should Provide Anesthesia Care”* missed an important point: No operative procedure is “minor,” and the risk of anesthesia is never “minuscule.”
No one can truly predict what the risks of anesthesia are—or if they will materialize during an operative procedure. Patient safety is, and should be, the primary focus of all medical and health care professionals. As surgeons, we have a background in life support and management of vital signs and other possible risks associated with surgical procedures. We believe that having fully trained and qualified anesthesiologists as our partners in the operating room is essential to ensuring that all surgical procedures are as safe and effective as possible.
Advocating cost savings at the expense of patient safety and well-being is a penny wise and pound foolish philosophy that no one should be anxious to embrace.

A. Brent Eastman, MD, FACS, Chair, Board of Regents
LaMar S. McGinnis, Jr., MD, FACS, President
David B. Hoyt, MD, FACS, Executive Director
American College of Surgeons
*September 6, 2010

Dear Editor
The question of who should provide anesthesia care (“Who Should Provide Anesthesia Care? Sept. 6, 2010) misses an important point in discussing health professionals’ roles. That point is whether the patient receives the most appropriate care, given his or her health history, current health status and currently needed care. This, rather than the certification of the practitioner or cost of the care, should be the determining factor in whether a physician, advanced practice nurse or other health care professional should provide a health service to the patient.
In some limited areas of patient care, certified nurse anesthetists and physicians receive similar training. CRNAs’ two-and-a-half years of post-graduate training focuses on the “how” of anesthesia. Their skills comprise expertise in following protocol for anesthesia during uncomplicated procedures for patients with uncomplicated medical histories and straightforward pain control needs. As such, nurse anesthetists are valuable members of the patient care team. However, they do not have the medical knowledge that warrants working without the supervision of a physician, whose eight years of post-graduate training goes beyond following a recipe for anesthesia and includes expertise in the full range of medical conditions, management of coexisting diseases, and diagnosis and response to potential complications and interactions before, during and after a medical intervention.
Given the American Association of Nurse Anesthetists study’s finding that mortality rates rose among unsupervised CRNAs between 1999 and 2005 while mortality rates for anesthesiologists and anesthesiologist-CRNA teams went down, one must question why we would establish a public policy that denies patients access to the safer option of having an anesthesiologist or a physician-CRNA team.
Certainly it is not to save money. Medicare, Medicaid and private insurers pay the less-trained unsupervised CRNA the same as it pays the anesthesiologist.
Nurse anesthetists are an invaluable part of a patient’s health care team and are important to ensuring patient access to surgical and childbirth services, particularly in underserved areas.
This is not a territorial issue. It’s an issue of patient safety.
Sincerely,

Lori Heim, MD
President
American Academy of Family Physicians
Leawood, Kansas

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