What US Senators think of CRNAs vs Anesthesiologists

[PinchandBurn]

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Members do not see this ad.

If you live in my state, myself and others have gotten this 'form' reply from our US Senator. If you go to the CAPWIZ website on the other thread, this is the reply that we got when telling our US Senator about stopping CRNAs from practicing Pain Medicine.

It's a window in how legislators think. It's utterly disgusting. CRNAs have brainwashed these legislators. Reportedly, they are 'cost effective and provide high quality". I wonder if he would want a CRNA taking care of his loved ones during a surgery🙄🙄.....

Those of you who think CRNAs are 'team players' and that the "ACT model" was a good idea, really need to wake up. Sorry.

____________________________________________




Dear Dr.XXXXXX:



Thank you for contacting me regarding Medicare coverage for services provided by certified registered nurse anesthetists (CRNAs). I appreciate hearing from you.



The Craig Thomas Rural Hospital and Provider Equity Act of 2011 (S. 1680), introduced by Senator Kent Conrad of North Dakota, contains a number of provisions to promote access to health care for Medicare beneficiaries in rural areas. This legislation includes an amendment to the Social Security Act to extend Medicare coverage to services provided by CRNAs.



CRNAs are advanced practice registered nurses who provide the majority of anesthesia care to rural and medically underserved Americans. Nurse anesthetists provide the most cost-effective method of anesthesia services, while providing high quality of care. Without CRNA services, many U.S. rural and critical access hospitals would not be able to offer many medically necessary services.



S. 1680 has been referred to the Senate Finance Committee. While I am not a member of this Committee, I will keep your views in mind should this bill come to the Senate floor.



I also encourage you to contact the Center for Medicare at the Centers for Medicare and Medicaid Services. It can be contacted by mail at 7500 Security Blvd. Baltimore, MD 21244.



Thank you again for contacting me. Please feel free to keep in touch.



Sincerely,



Richard J. Durbin

United States Senator

 

[polar403]

CRNAs are advanced practice registered nurses who provide the majority of anesthesia care to rural and medically underserved Americans. Nurse anesthetists provide the most cost-effective method of anesthesia services, while providing high quality of care. Without CRNA services, many U.S. rural and critical access hospitals would not be able to offer many medically necessary services.

I don't understand how they provide the most cost-effective method of anesthesia services if they get reimbursed the same as physicians from the government.

 

[chessknt]

I wish we could throw around words with no meaning or back-up, like "cost-effective" and "high quality." Also if rural care is being used to justify this why is it not restricted to that setting?

 

[yappy]

Isn't this becoming the norm in other expanded function nursing fields? I think that was the case in family care. It baffles me because essentially the government is buying an inferior product for the same price as physicians.

My cynical view is that D senators appeal to labor union or groups like RN's for political reasons. With one position you can secure a whole labor sector - nice.

EDIT: It's interesting because proposed mid-level dental providers use terms like "quality" "effective" "value" and "cost effective" too without any evidence to support those claims.

I don't understand how they provide the most cost-effective method of anesthesia services if they get reimbursed the same as physicians from the government.

 

[Mman]

Thread title is misleading. It isn't how senators think. It's how they are lobbied to think. They do whatever someone with money tells them to do. It's not like they are independent thinkers.

 

[D P356]

Thread title is misleading. It isn't how senators think. It's how they are lobbied to think. They do whatever someone with money tells them to do. It's not like they are independent thinkers.

True, which is unfortunate.

 

[seinfeld]

What have we done as a society of Anesthesiologists to increase access to ourselves in these rural communities?

Until we have a better answer to how to provide access to care for those rural communities we are unlikely to win theses debates. I realize part of the issue is that CRNA can bill through the rural pass through legislation and MDs can not.

 

[imfrankie]

What have we done as a society of Anesthesiologists to increase access to ourselves in these rural communities?

Until we have a better answer to how to provide access to care for those rural communities we are unlikely to win theses debates. I realize part of the issue is that CRNA can bill through the rural pass through legislation and MDs can not.

I have looked into a number of rural positions in the past--places that were CRNA shops. They wouldn't give me the time of day. This has to stop.

 

[PinchandBurn]

What have we done as a society of Anesthesiologists to increase access to ourselves in these rural communities?

Until we have a better answer to how to provide access to care for those rural communities we are unlikely to win theses debates. I realize part of the issue is that CRNA can bill through the rural pass through legislation and MDs can not.

There is no problem. THe problem may have existed back 20-30 years ago. That's the ruse that CRNAs are using.

For example, in polling the American Society of Interventional Physicians Members, there is a member atleast every 40-50 miles from each other. Now if you factor in pain MDs not part of this organization, there's probably one every 20-30miles.

So you can always find a Pain Physician and probably an Anesthesiologist every 20-30 miles now in America. So it's not an access issue any longer in my opinion.

 

[jwk]

What have we done as a society of Anesthesiologists to increase access to ourselves in these rural communities?

Until we have a better answer to how to provide access to care for those rural communities we are unlikely to win theses debates. I realize part of the issue is that CRNA can bill through the rural pass through legislation and MDs can not.

Why to you assume that anesthesiologists are the problem?

 

[jwk]

There is no problem. THe problem may have existed back 20-30 years ago. That's the ruse that CRNAs are using.

For example, in polling the American Society of Interventional Physicians Members, there is a member atleast every 40-50 miles from each other. Now if you factor in pain MDs not part of this organization, there's probably one every 20-30miles.

So you can always find a Pain Physician and probably an Anesthesiologist every 20-30 miles now in America. So it's not an access issue any longer in my opinion.

Maybe east of the Mississippi this is true, but not necessarily in the western half of the country. You can't just take the area of the country and divide it by the number of anesthesiologists and use that as your average distance to an anesthesiologist.

Clearly there IS a distribution problem.

 

[chessknt]

I have looked into a number of rural positions in the past--places that were CRNA shops. They wouldn't give me the time of day. This has to stop.

That would be a good counter-argument to the entire premise of their expanded power. If they are staffing rural areas because we won't, how can they justify it when rural areas wont hire us?

 

[RMortis]

It will expand from rural areas, they will set the cost efficiency status. Rural hospital A does procedure X for cheaper than hospital Y, hospital Y will adopt their model. This is just business sense. If anesthesiologists trained AAs or adopted them in their practice this would keep our position, as I see it, we have about 10 years until our salaries are dramatically decreased and we're not doing our own cases, and we're not supervising, we're competing with nurses for jobs. Thanks all those academics who are implicit in training CRNAs...welcome to an unsafe anesthesia future.
Just my humble opinion from a guy who sees the future

 

[PinchandBurn]

Maybe east of the Mississippi this is true, but not necessarily in the western half of the country. You can't just take the area of the country and divide it by the number of anesthesiologists and use that as your average distance to an anesthesiologist.

Clearly there IS a distribution problem.

I was primarily referring to Pain Mgt physicians, which a large majority are Anesthesiologists.

In terms of anesthesiologists. I still think the "gap" isnt as much as it was in the 90s or so. Tons of anesthesiologists are out there now, it's a very popular field nowadays. Additionally, as someone mentioned, aneshtesiologists who want to even find jobs in the rural areas arent finding them like they once did.

The "gap" in rural America for anesthesiologists is simply a ruse by CRNAs and the like. Also, if you have to drive 20-30 miles to a nearby hospital that's a Level 1, that's not a lot. There are enough 'smaller' hospitals in rural America nowadays to tk care of minor issues.

 

[gasattack3]

It will expand from rural areas, they will set the cost efficiency status. Rural hospital A does procedure X for cheaper than hospital Y, hospital Y will adopt their model. This is just business sense. If anesthesiologists trained AAs or adopted them in their practice this would keep our position, as I see it, we have about 10 years until our salaries are dramatically decreased and we're not doing our own cases, and we're not supervising, we're competing with nurses for jobs. Thanks all those academics who are implicit in training CRNAs...welcome to an unsafe anesthesia future.
Just my humble opinion from a guy who sees the future

This is why those in PP ACT models need to get some of their OR skills back. Even if this means sitting the stool at some off-site facility one day per week, as things play out. (many likely already have contracts where this is feasible).

In my opinion, we're fast approaching an environment where MD's will be competing directly with CRNA's. I don't think this is going to happen overnight, but slowly this will be the case. It could take on any number of forms, but we need to read the writing on the wall. Our system is buckling under financial pressure, and we're heading towards a despirate situation (though few sound the alarm that way). Thus, we'll see despirate decisions being made, with "trade-offs".

***Sooooo, hone those extra skills. Get back into the "flow" of the OR. MD/DO "providers" will still have inherent advantages with intrinsic value such as prescription rights (though I'm sure this will be included in Opt-Out legislation) etc. etc.

***For those successful (to date) PP ACT groups, start subsidizing your colleagues to allow them to sit a room, all day, solo. Work this into your practice. Not easy, and many of the old-timers will resist since, fankly, their time horizon is much shorter, and they may not really give a damn about what happens 5 years out. But, the younger partners need to push for this.

This will also send a clear message to the CRNA's at your institution, many of whom talk behind your back and don't really respect you in spite of what they may say to your face.

I'd be interested to hear from some of the experienced people (BladeMD for example) as to how this proposal might be feasable financially and from a billing perspective.

I don't believe that this needs to be fear driven either. We offer a unique skillset to society and even WHEN (not if) sh.t hits the fan, our skills will still command a good living. Just not super great, perhaps. But, even in the worst case scenario, it will still be a relatively good living.

Maybe start downsizing your lifestyle even? I feel MANY anesthesiologists will find it perhaps even refreshing sitting their own cases all day. More control, possibly less pressure (some might say MUCH less pressure), and perhaps more enjoyable and rewarding. Offering one on one care, just as may have been your interest when you were first finding interest in our wonderful profession.

And for god's sake. If you haven't already done so, start limiting the scope of the CRNA's practice within your institution while you still can (i.e. while you still have some control). Stop letting them do neuraxial anesthesia, no more lines (save perhaps A-lines). You need to limit their skills that they will indeed use against you down the road. Make them feel rusty when, soon enough, they will try "offering" those same skills to whichever future payer gains c n ontrol. If this means getting off your a.ss to place the epidural at 2 a.m. then do it. If you need to get in extra early to place a line or get something set up, then do it. The risk of NOT taking some initiative at this juncture is high, IMO.

Clearly society isn't going to place a premium on knowledge (not agreeing just saying). This seems somewhat obvious given the increasing frequency of responses such as that from Sen. Durbin. So, make sure you havd procedural skills over them. Be able to DO stuff they can not. This means running an OR start to finish among all the other skills we do, daily or weekly. Our economic and safety advantage over them, academically, has been, well, academic. Our despiration to cut costs out of the most expensive modern healthcare delivery system in the Western world will not tolerate this academic discussion, and will see it as, again, an "academic" discussion, difficult to "prove". So, it will be one of DOING. Can you OFFER an institution much more than a CRNA? We all know the answer, so we need to make it happen and take the necessary steps to ensure this.

Ofcourse we need to step up our lobbying efforts and maybe use tactics that some of the most successful lobbying groups do and which ours has not.

 

[Mman]

I'd be interested to hear from some of the experienced people (BladeMD for example) as to how this proposal might be feasable financially and from a billing perspective.

.

It isn't. It's a losing money proposition. What you are asking is for successful groups to stop making so much money and be less efficient and go have the MD sit in a room. Hard to persuade people to do that when it's a financial disincentive.

Also find it odd that you imply that someone in an ACT model supervising CRNAs has lost some sort of skill in the OR. When you take care of 4x as many patients, you deal with 4x as many difficulty airways and 4x as many difficult IV sticks etc. What I'm rusty at is intubating the Malampatti 1 slam dunk airway. Been a long time since I got to do that one. I only get to do the hard ones these days. But I'm pretty sure I could still get the easy tubes in if I had to.

 

[gasattack3]

It isn't. It's a losing money proposition. What you are asking is for successful groups to stop making so much money and be less efficient and go have the MD sit in a room. Hard to persuade people to do that when it's a financial disincentive.

Also find it odd that you imply that someone in an ACT model supervising CRNAs has lost some sort of skill in the OR. When you take care of 4x as many patients, you deal with 4x as many difficulty airways and 4x as many difficult IV sticks etc. What I'm rusty at is intubating the Malampatti 1 slam dunk airway. Been a long time since I got to do that one. I only get to do the hard ones these days. But I'm pretty sure I could still get the easy tubes in if I had to.

I'm suggesting working this into the schedule. One MD solo in a room every couple weeks. No big deal. You reference making so much money but my suggestion is based on the premise that this is coming to a likely end for many PP groups if things continue on their path.

imfrankie says he was turned down by a few rural areas already cost benefiting from CRNA independence. He would have needed to compete directly with them in that market. When that hits metropolitan areas it will be important for MD/DO's to be able to run cases solo as it's possible that we compete directly with them in the future.

If you have managed to maintain your OR finesse, then great. Not all have however.

 

[pgg]

If you have managed to maintain your OR finesse, then great. Not all have however.

Have you considered the possibility that the inept people you observe don't suck because they supervise/direct CRNAs ... but suck because, well, they've always sucked?

Ie, maybe those guys never had any OR finesse in the first place, and you're placing the blame for their suckiness in the wrong place?


I think a lot of us have seen some lousy anesthesiologists out in do-their-own-cases private practice. I don't work in an ACT model, but I can see some real upside to doing the thinking, planning, blocks, and crisis intervention for 3-4x as many cases.

 

[Mman]

I'm suggesting working this into the schedule. One MD solo in a room every couple weeks. No big deal. You reference making so much money but my suggestion is based on the premise that this is coming to a likely end for many PP groups if things continue on their path.

imfrankie says he was turned down by a few rural areas already cost benefiting from CRNA independence. He would have needed to compete directly with them in that market. When that hits metropolitan areas it will be important for MD/DO's to be able to run cases solo as it's possible that we compete directly with them in the future.

If you have managed to maintain your OR finesse, then great. Not all have however.

It is no big deal and it helps in no way. Do you want to know why an anesthesiologist might struggle to get a job in rural American compared to a CRNA? It's called the rural pass through and that small hospital gets paid cash money to help employ a CRNA for anesthesia, but they get squat to hire an MD. In other words, the government subsidizes the hiring of the CRNA instead of the MD.

Having a doc sit in a room "once very few weeks" is irrelevant to the problem or the solution. We do 30,000+ anesthetics a year. We do MD only in emergency situations when we don't have enough CRNAs to cover the stuff hitting the fan at night or on the weekend, but that's pretty rare.



You don't understand the problem.

 

[Mman]

I'm suggesting working this into the schedule. One MD solo in a room every couple weeks. No big deal. You reference making so much money but my suggestion is based on the premise that this is coming to a likely end for many PP groups if things continue on their path.

The gravy train for some groups coming to an end has nothing to do with CRNAs, it has to do with Obama care and reduced reimbursement.

 

[gasattack3]

Have you considered the possibility that the inept people you observe don't suck because they supervise/direct CRNAs ... but suck because, well, they've always sucked?

Ie, maybe those guys never had any OR finesse in the first place, and you're placing the blame for their suckiness in the wrong place?


I think a lot of us have seen some lousy anesthesiologists out in do-their-own-cases private practice. I don't work in an ACT model, but I can see some real upside to doing the thinking, planning, blocks, and crisis intervention for 3-4x as many cases.

Fair enough. I too see that advantage. A well orchestrated ACT model allows for the best efficiency, safety, and patient care IMHO. BUT, our "partners" in this model are stabbing us in the back around every corner.

 

[gasattack3]

It is no big deal and it helps in no way. Do you want to know why an anesthesiologist might struggle to get a job in rural American compared to a CRNA? It's called the rural pass through and that small hospital gets paid cash money to help employ a CRNA for anesthesia, but they get squat to hire an MD. In other words, the government subsidizes the hiring of the CRNA instead of the MD.

Having a doc sit in a room "once very few weeks" is irrelevant to the problem or the solution. We do 30,000+ anesthetics a year. We do MD only in emergency situations when we don't have enough CRNAs to cover the stuff hitting the fan at night or on the weekend, but that's pretty rare.



You don't understand the problem.

Thanks for the insite and clarification. What can we do then? How do we take some initiative?.

 

[Mman]

Thanks for the insite and clarification. What can we do then? How do we take some initiative?.

donate to ASAPAC

 

[gasattack3]

donate to ASAPAC

I do every year.

But, come on, I think our challenges are a little bigger than this. You have way more experience than I. So, what other things might we do in order to mitigate the agenda of the AANA. Grassroots type things that PP folks can do every day??

 

[doctor712]

Question: How many of these US Senators have anesthesia provided by CRNA's as opposed to BC Anesthesiologists when they go under the knife (or need a block in those states that allow CRNAs to do pain med)?

How many demand an anesthesiologist?

Just some thoughts... 🙄

d712

 

[imfrankie]

Question: How many of these US Senators have anesthesia provided by CRNA's as opposed to BC Anesthesiologists when they go under the knife (or need a block in those states that allow CRNAs to do pain med)?

How many demand an anesthesiologist?

Just some thoughts... 🙄

doctor712

This in my opinion, is exactly the solution. Anyone who votes for independent CRNA practice gets that, period. Where's the ASA on helping us with the Rural Pass through?

 

[Mman]

I do every year.

But, come on, I think our challenges are a little bigger than this. You have way more experience than I. So, what other things might we do in order to mitigate the agenda of the AANA. Grassroots type things that PP folks can do every day??

Grassroots things in day to day practice are essentially irrelevant to this issue. It's more in how a practice is setup. The MDs should be invaluable to the hospital. Take care of preop testing issues. Be proactive about being on hospital committees that are relevant to us (Blood conservation, patient safety, formulary issues, etc). Show the hospital that your training and knowledge are unable to be replaced by a CRNA sitting on a stool.

 

[usnavdoc]

This is what I got from my representative when I sent the asa email.
Obviously disnt read or didn't care with this auto response on the opposite side of the issue


Dear Friend:
**** Thank you for contacting me regarding the use of nurse anesthetists in our health care system. *I appreciate hearing from you.
*
**** I recognize the important services that Certified Registered Nurse Anesthetists (CRNA's) provide to their patients. *Particularly in rural and other underserved areas of Texas and other states, CRNA's provide critical services that might not otherwise be available to patients. *Should the Senate consider legislation regarding nurse anesthesia care, you may be certain I will keep your views in mind.
*
**** Thank you again for writing. *Please be assured that I will continue to support policies ensuring that all Americans continue to have access to safe and affordable health care.
*
Sincerely,
Kay Bailey Hutchison
United States Senator
*
284 Russell Senate Office Building
Washington, DC *20510
202-224-5922 (tel)
202-224-0776 (fax)
http://hutchison.senate.gov
*
PLEASE DO NOT REPLY to this message as this mailbox is only for the delivery of outbound messages, and is not monitored for replies. *Due to the volume of mail Senator Hutchison receives, she requests that all email messages be sent through the contact form found on her website at http://hutchison.senate.gov/?p=email_kay .
*
If you would like more information about issues pending before the Senate, please visit the Senator's website at http://hutchison.senate.gov . *You will find articles, floor statements, press releases, and weekly columns on current events.
*
Thank you.

 

[Mman]

I've heard from some people that an actual hand written letter to a congressmen (or woman) or senator is more likely to get to their eyes than an email that just gets an auto response generated.

Not sure on how likely that is and it probably depends on the member of congress you are writing to.

 

[W222]

I've heard from some people that an actual hand written letter to a congressmen (or woman) or senator is more likely to get to their eyes than an email that just gets an auto response generated.

Not sure on how likely that is and it probably depends on the member of congress you are writing to.

Unless that hand written letter is on the back of a check for about ten grand they won't even give it a passing glance. My former roomate was a top aid to a Senator, the only things that gets anyones' attention is if there are dollars attached to it or you threaten to kill someone.

 

[Mman]

Unless that hand written letter is on the back of a check for about ten grand they won't even give it a passing glance. My former roomate was a top aid to a Senator, the only things that gets anyones' attention is if there are dollars attached to it or you threaten to kill someone.

Senators are much different than Representatives. 2 senators per state and only up for election every 6 years. They don't need to care what an individual thinks. Representatives have a far smaller group of people to cater to and need to get re-elected every other year. They are far easier to get the attention of.

 

[PinchandBurn]

Senators are much different than Representatives. 2 senators per state and only up for election every 6 years. They don't need to care what an individual thinks. Representatives have a far smaller group of people to cater to and need to get re-elected every other year. They are far easier to get the attention of.

Mman



So one of the questions I pose, is that how can we as Anesthesiologists and Pain Practioners try to lift the CRNA 'rural pass"?


It seems that the ASAPAC should look into this. I donate every year to these fellas, but if this is the simple solution why arent they attending to this? Are they fully aware of it? Perhaps we should collectively contact our ASA leadership in regards to this.

Additionally, I think the ACT 'model' needs to be relooked at. CRNAs are just getting so comfortable with Anesthesia and now are getting so greedy they want to start doing independent Pain Mgt. ACT model implies a cohesive group working together. CRNAs are not trying to 'work' together, they are trying to work us out of the equation.

 

[gasattack3]

Mman



So one of the questions I pose, is that how can we as Anesthesiologists and Pain Practioners try to lift the CRNA 'rural pass"?


It seems that the ASAPAC should look into this. I donate every year to these fellas, but if this is the simple solution why arent they attending to this? Are they fully aware of it? Perhaps we should collectively contact our ASA leadership in regards to this.

Additionally, I think the ACT 'model' needs to be relooked at. CRNAs are just getting so comfortable with Anesthesia and now are getting so greedy they want to start doing independent Pain Mgt. ACT model implies a cohesive group working together. CRNAs are not trying to 'work' together, they are trying to work us out of the equation.

This is the problem. I agree. Many CRNA's believe they don't need an anesthesiologist. This is reflected by their support of the AANA, and it's agenda. I realize not all CRNA's feel this way, but clearly their leadership, followed by many many a CRNA does indeed.

This is why we need to push them back from thinking they are running the OR save induction and maybe emergence. This will necessitate more attending presence (not speaking as a resident either) in the OR. Not easy to do, I realize, but it can be done. It must be done.

Also, absolutely, we (as a profession) need to limit their scope (and I disagree with Mman in that such "grassroots" initiatives CAN'T have an impact) of practice IN YOUR home institution, assuming you still set anesthesia policy and protocol. This means, NO CRNA's doing neuraxial, lines, never solo for induction OR emergence etc. Limit their SKILLSET.

The value in this is that they WILL become rusty. They will look around at an already stagnating job market and bitch, but they'll stay on. Over time, they will become rusty if we simply do not expose them to the BREADTH of what it means to provide anesthesia in a modern practice using all of the latest technologies.

So, when their leadership lobbies for solo practice, the rank and file will not be so eager as they will realize they will then be expected to perform procedures and have skills which they simply do not have, even if they were trained to perform them, and perhaps once did. This can be done on an institutional level.

Obviously the ASA-PAC is important. But, it is equally obvious that it's simply NOT enough.

Ofcourse markets will become saturated to different extents and at different times. We might all agree that the CRNA market is becoming saturated. 5 years ago it was active recruitment and sign on bonuses. Today, I'm hearing a different story. This is when these policies can be more readily implemented, from a perspective of leverage. It takes leadership with balls to do this. Also, a group whose partners are willing to work quite a bit harder to secure a longer term solution to their problems AND ensure they will be compensated for their work not just now, but in the future as well.

 

[jwk]

So one of the questions I pose, is that how can we as Anesthesiologists and Pain Practioners try to lift the CRNA 'rural pass"?

It seems that the ASAPAC should look into this. I donate every year to these fellas, but if this is the simple solution why arent they attending to this? Are they fully aware of it? Perhaps we should collectively contact our ASA leadership in regards to this.

http://www.asahq.org/For-Members/Ad...ctivities/Rural-Pass-Through-Legislation.aspx

(Note - you may have to log in to read this online)

Of course they're aware of it.

If you haven't already done so, you need to attend the ASA Legislative Conference held each spring in Washington, DC. It's an eye opener into the legislative process, how things get done (or why they don't), and how to make your voice heard. Among other things, the Rural Pass Through is one of the main talking points each year as ASA members fan out and hit almost every congressional office on the Wednesday during the conference. I've been twice, and will probably go again in a couple years.

 

[lushmd]

PinchandBurn, the ASA/ASAPAC is well aware of the rural pass through issue. This is something that they lobby for on a regular basis but haven't made much headway on (despite an estimate that providing rural pass through funding for anesthesiologists would only cost ~$4 million). If you're going to contact/discuss this with someone, consider doing so with your members of Congress.

As regards the pros/cons of the ACT model, it's one way of dealing with an inadequate supply of anesthesiologists to provide direct 1:1 care for every patient undergoing surgery. It seems to me that most CRNAs are actually quite content to practice as part of an ACT, it's just that the minority of those that aren't are quite vocal in their opposition (as with extremists of any sort).

 

[Trailhead]

For what it's worth, I used to work as a legislative staff aide in the DC office of a US Senator and I can more or less guarantee that your letter (handwritten or not) does NOT make it to the eyes of the senator. Quite the contrary. All letters are screened by interns (i.e. undergraduates) who plug keywords (i.e. health care, health care providers, CRNA) into a computer. The intern will then write a response to you (such as what you quoted) which was then quickly run across the desk of a legislative aid and sometimes the communications director (to double check you don't generally endorse any specific position). It's then ran through the auto-pen machine and mailed to you as a response from the senator (gasp!). Even when we reached some sort of critical mass of letters pertaining to one topic (rare), the letters themselves will almost never, never, never ever be seen by the senator. Instead, it's a college student who reads it and writes back.

Same goes for when you "call your Senator."

 

[chessknt]

For what it's worth, I used to work as a legislative staff aide in the DC office of a US Senator and I can more or less guarantee that your letter (handwritten or not) does NOT make it to the eyes of the senator. Quite the contrary. All letters are screened by interns (i.e. undergraduates) who plug keywords (i.e. health care, health care providers, CRNA) into a computer. The intern will then write a response to you (such as what you quoted) which was then quickly run across the desk of a legislative aid and sometimes the communications director (to double check you don't generally endorse any specific position). It's then ran through the auto-pen machine and mailed to you as a response from the senator (gasp!). Even when we reached some sort of critical mass of letters pertaining to one topic (rare), the letters themselves will almost never, never, never ever be seen by the senator. Instead, it's a college student who reads it and writes back.

Same goes for when you "call your Senator."

Hurr durr I wonder why representative government is not representative.

 

[pgg]

Hurr durr I wonder why representative government is not representative.

Sounds like a pretty reasonable way for one person to handle 1000s and 1000s of emails and letters. Hire someone to sort them, collate the data, and summarize the general tone of the constituents. These are people whose schedules are blocked off in 15 minute increments.

Even if you can get their attention, you're not going to change their minds on a subject.


The rational approach is to elect people who agree with you on topics that matter, not try to convince people who are already elected that they should agree with you on something. If you fail at the former it's still worth attempting the latter ... but realistically it's a futile gesture.

I write to Feinstein and Boxer all the time but they'll never in 1,000,000 years do any of the things I suggest.

 

[chessknt]

Sounds like a pretty reasonable way for one person to handle 1000s and 1000s of emails and letters. Hire someone to sort them, collate the data, and summarize the general tone of the constituents. These are people whose schedules are blocked off in 15 minute increments.

Even if you can get their attention, you're not going to change their minds on a subject.


The rational approach is to elect people who agree with you on topics that matter, not try to convince people who are already elected that they should agree with you on something. If you fail at the former it's still worth attempting the latter ... but realistically it's a futile gesture.

I write to Feinstein and Boxer all the time but they'll never in 1,000,000 years do any of the things I suggest.

What are they doing in those 15 minute increments? How much of their day is spent actually listening to their constituents vs. lobbyists? The type of people who go in to these jobs should WANT to read as many of these emails as they can, not pawn it off to some intern the first day they take office.

 

[PinchandBurn]

What are they doing in those 15 minute increments? How much of their day is spent actually listening to their constituents vs. lobbyists? The type of people who go in to these jobs should WANT to read as many of these emails as they can, not pawn it off to some intern the first day they take office.

Money is the only thing that talks.

 

[Mman]

Money is the only thing that talks.

hence the importance of donating to ASAPAC. We also host fundraisers for local congressmen and senators to help educate them on the importance of issues we care about.

Money talks.

 

[pgg]

How much of their day is spent actually listening to their constituents vs. lobbyists?

A lobbyist is just a middleman representative of constituents who care enough about a topic to spend money on it ...


Again, you've got two reasonable choices
1) elect people that share your worldview so you don't HAVE TO buy their cooperation
2) failing that, donate in an organized way (eg ASAPAC) so you CAN buy their cooperation

The type of people who go in to these jobs should WANT to read as many of these emails as they can, not pawn it off to some intern the first day they take office.

If I held public office, I'd rather have an intern tell me "you got 782 emails last week urging you to vote no on SB249 and 181 urging you to vote yes" than mine 963 emails from the mass of V14GRA spam and death threats ...

 

[Socrates25]

Maybe east of the Mississippi this is true, but not necessarily in the western half of the country. You can't just take the area of the country and divide it by the number of anesthesiologists and use that as your average distance to an anesthesiologist.

Clearly there IS a distribution problem.

I agree with you in general.

However I have a side story to share:

Periodically some idiot journalist will publish an absurd article with a title like "No doctors available in rural Bushwack county Wyoming" or something like that. I'll write a response to the editor in which I can prove the entire article is a lie.

I've taken on several challenges by fools who commonly repeat this claim that there are no doctors within some large radius of a rural population. With a 5 second google search I can prove them wrong. So far I've done about 10 of these and I've ALWAYS been able to find a PCP within 30-40 miles who will take both Medicare and Medicaid. Doesnt matter how rural it is, either. Just a 5 minute google search and 1-2 phone calls.

We need to start calling out the press on these lies.

 

[imfrankie]

I think the ASA needs to spend some of its members' money and hire a real attorney who can take a case to the Supreme Court. The bush leaguers aren't cutting it.

 

[chessknt]

A lobbyist is just a middleman representative of constituents who care enough about a topic to spend money on it ...


Again, you've got two reasonable choices
1) elect people that share your worldview so you don't HAVE TO buy their cooperation
2) failing that, donate in an organized way (eg ASAPAC) so you CAN buy their cooperation




If I held public office, I'd rather have an intern tell me "you got 782 emails last week urging you to vote no on SB249 and 181 urging you to vote yes" than mine 963 emails from the mass of V14GRA spam and death threats ...

I agree with you that it is hypothetically supposed to work that way, however the reality is that interns shield them from real people and lobbyists make them feel like gods among men instead of public servants. We wonder how they get out of touch...

California has had democratic senators since 1992 by a wide margin, I have almost no belief that they will ever be dethroned as long as they run for re-election. Barbara Boxer will never vote against the party line since they control whether or not she can get re-elected, so spending money to ask her to deport illegals/lower taxes etc is a total waste. Hell even at the state level Republicans have no input whatsoever on the state budget farce anymore because it only requires a simple majority to pass without taxes. How does anyone not on the far left get representation under this system? Move?

 

[PinchandBurn]

I agree with you that it is hypothetically supposed to work that way, however the reality is that interns shield them from real people and lobbyists make them feel like gods among men instead of public servants. We wonder how they get out of touch...

California has had democratic senators since 1992 by a wide margin, I have almost no belief that they will ever be dethroned as long as they run for re-election. Barbara Boxer will never vote against the party line since they control whether or not she can get re-elected, so spending money to ask her to deport illegals/lower taxes etc is a total waste. Hell even at the state level Republicans have no input whatsoever on the state budget farce anymore because it only requires a simple majority to pass without taxes. How does anyone not on the far left get representation under this system? Move?

so basically lobbyists are the 'drug reps' for the politicians and grease them, take them out etc. However, politicians dont want drug reps to see physicians.

Hmmmm 🙄

 

[yappy]

check out this gem:

[YOUTUBE]http://www.youtube.com/watch?v=_65woayNegM&feature=related[/YOUTUBE]

 

[chessknt]

check out this gem:

[YOUTUBE]_65woayNegM[/YOUTUBE]

Yea I remember seeing that when it aired years ago. This guy is a living example of someone who has bought the nursing propaganda that nursing focuses on the "whole patient" while medicine focuses on "the disease." This garbage statement is absolutely meaningless of course, but it sounds really insightful to the lay-public and nobody ever presses the clowns that spew it out to give examples/contrasts between the two fields.

 

[Dawkter]

http://www.youtube.com/watch?v=i6kxm4tDXbk&feature=related

Found in related links to the above video.

 

[MD Dreams]

She may be ditsy, but she's cute 🙂. I wouldn't mind increasing her cortisol!