you better play nice CNRA

[cfdavid]

---

Members don't see this ad.

Or else you WILL feel the wrath of the future of anesthesiology, which has had a change of "heart" towards you ladies (and murses just so the small d.cks don't feel left out). Just read these threads and know what you are up against. Actually, you are going to feel the wrath. This is a promise. We are no longer playing "nice". Good luck.

cf

 

[omniatlas]

Thank goodness I don't live in the United States.

 

[Idiopathic]

have you been drinking?

 

[CrazyJake]

The OP is 100% correct. Go and talk with residents and young attendings - we're excited to be doing Anesthesia and ready for the future. The days of Anesthesia apathy are over and CRNA's won't get anymore w/o a fight.

I think most younger generation don't mind CRNA's and we know they help cover cases and take care of pt's, but to say their equivalent - equal - same training -better...this crap campaign their pushing, ain't gonna fly. They'd be better off to realize how good they have it now b/c the more they fight, the more we will back...and unless Obama gets rid of trial lawyers, Anesthesiologist aren't going anywhere.

CJ

 

[cfdavid]

have you been drinking?

what about that statement shocks you to the point of such an accussation? are we supposed to sit back and take all of the crap coming out of the CRNA establishment without some counter threats? we have more clout than anyone truly realizes. and, yes, the future is more hostility towards this group, on our part. if you choose not to go that route, then that's your decision. playing nice isn't working so good, is it?

This is not going to become a "gentlemen's game".

 

[cfdavid]

The OP is 100% correct. Go and talk with residents and young attendings - we're excited to be doing Anesthesia and ready for the future. The days of Anesthesia apathy are over and CRNA's won't get anymore w/o a fight.

I think most younger generation don't mind CRNA's and we know they help cover cases and take care of pt's, but to say their equivalent - equal - same training -better...this crap campaign their pushing, ain't gonna fly. They'd be better off to realize how good they have it now b/c the more they fight, the more we will back...and unless Obama gets rid of trial lawyers, Anesthesiologist aren't going anywhere.

CJ

the gloves are off. 👍

 

[WaveEquation]

I was embarrassed the other day when a big-time IM doc introduced me to what -yes, not who (as they are not humans, but things)- I thought was an anesthesiologist, but what turned out to be a CRNA. I forced a 1/8 smile, wasn't very warm, and squeezed tight. Seriously, a CRNA is not my colleague. I know it's PC for us not to discriminate on the basis of educational background, but when you introduce me to a competitor that works half as hard and earns 2/3-3/4 as much and does it with 1/4 of the training, don't expect me to be warm and fuzzy. CRNAs need to go to medical school if they want to become anesthesiologists. Just like dentists have to get a MD to become an OMFS.

1) Why did previous generations of physicians let this garbage happen when they were graduating?
2) How are we going to ensure that we go over and beyond previous inadequate attempts to address this vicious, unjustified effort to create equivalence between two very non-equivalent levels of education and training?

 

[Idiopathic]

Just like dentists have to get a MD to become an OMFS.

this is not true

 

[Idiopathic]

1) Why did previous generations of physicians let this garbage happen when they were graduating?
2) How are we going to ensure that we go over and beyond previous inadequate attempts to address this vicious, unjustified effort to create equivalence between two very non-equivalent levels of education and training?

1) $

2) you cant. you can take a pay cut and provide a better service than a CRNA or you can make more money in supervision but its very unlikely that you will ever roll back the gains that CRNAs have made up until now. im very interested in how we keep things from getting worse but have no solutions for that

 

[darkmansaad]

Im curious about the timing of this thread....is this something discussed at ASA perhaps?

 

[Doctor4Life1769]

I was embarrassed the other day when a big-time IM doc introduced me to what -yes, not who (as they are not humans, but things)- I thought was an anesthesiologist, but what turned out to be a CRNA. I forced a 1/8 smile, wasn't very warm, and squeezed tight. Seriously, a CRNA is not my colleague. I know it's PC for us not to discriminate on the basis of educational background, but when you introduce me to a competitor that works half as hard and earns 2/3-3/4 as much and does it with 1/4 of the training, don't expect me to be warm and fuzzy. CRNAs need to go to medical school if they want to become anesthesiologists. Just like dentists have to get a MD to become an OMFS.

1) Why did previous generations of physicians let this garbage happen when they were graduating?
2) How are we going to ensure that we go over and beyond previous inadequate attempts to address this vicious, unjustified effort to create equivalence between two very non-equivalent levels of education and training?

I've never had an attending introduce me to a CRNA. That program must be dominated by CRNAs.
Also, while they are CRNAs, I don't think it's a good thing to malignant towards them as students. They do have some more experience than us. While I agree there may not be a WHOLE LOT of learning that can be had, I still tend to respect people with some sort of seniority. I'll leave the disrespect or looking down upon when I become a resident (not that I would at any rate). They are not "things," they are people too ...
I've had good and bad experiences with CRNAs. Yes, I am pissed about the militant AANA and the CRNAs claiming to be better than anesthesiologists; however, I know that not all claim to be and most tend to know their limits ... I have corrected a few CRNAs who tell patients they are "just like MD-As."

Malignancy just breeds more malignancy ... no need for that. We can play nice and still be assertive and command authority/respect.

 

[flashgordon]

1) $

2) you cant. you can take a pay cut and provide a better service than a CRNA or you can make more money in supervision but its very unlikely that you will ever roll back the gains that CRNAs have made up until now. im very interested in how we keep things from getting worse but have no solutions for that

My solution:

The ASA needs to grow some balls and take the offensive approach. The AANA juggernaut has intensified their agenda and continues to march towards 100% independence.

To win this war, we need to stop teaching CRNAs, unite with other medical specialties, donate to the ASAPAC, and ultimately, get the patients on our side... How? By exposing the fact that independent CRNAs bill the patient the same as a physician w/o any cost savings whatsoever. So you get an inferior product despite paying the same price. Patients don't like getting ripped off. And wait until they hear how much these nurses are making...

 

[ProRealDoc]

1) $

2) you cant. you can take a pay cut and provide a better service than a CRNA or you can make more money in supervision but its very unlikely that you will ever roll back the gains that CRNAs have made up until now. im very interested in how we keep things from getting worse but have no solutions for that

I disagree with that statement. There are jobs where you still get to do yuor cases and make more money than supervising nurses. A few of the posters here can attest to that.

 

[leaverus]

I disagree with that statement. There are jobs where you still get to do yuor cases and make more money than supervising nurses. A few of the posters here can attest to that.

Hell, i would take a paycut to work in a doc-only group. Sadly, there are none in this state and i've no desire to move.

 

[IlDestriero]

I disagree with that statement. There are jobs where you still get to do yuor cases and make more money than supervising nurses. A few of the posters here can attest to that.

There are jobs out there that are MD only and direct provider care, but the high pay is related to high insurance reimbursement deals and/or high hospital paid stipends/compensation for 24 hr call, trauma call, etc. I almost took one of these jobs. I'm not so sure of it's long term stability. Hospitals are always looking to decrease costs (subsidies), and insurance companies are going to want/need to cut payments, especially with the new changes and possible decreased Medicaid payments.
In the end, outside of hospital paid subsidies, you do a case and bill x dollars.
A group where the MD is supervising 3-4 CRNAs bills 3-4x for the same time period. They may give 1/2 to the CRNAs and earn 1.5-2x themselves, or they may pay a salary to the CRNA shift worker staff, and keep all the extra money generated for the partners. Supervision pays more when done properly, providing more service for less cost to the group, but NOT to the system. The hospital/AMC wins when everyone is staff, making you supervise 4:1, keeping the lions share of the profits and paying you a "partner" "bonus".

 

[Mman]

I disagree with that statement. There are jobs where you still get to do yuor cases and make more money than supervising nurses. A few of the posters here can attest to that.

I can assure you that is incorrect. At any gig doing your own cases, you'd be making more supervising in the same location. Now there are some places where people make more money doing their own thing than people supervising in a nearby location, but that's probably because of bad contracts or inefficiency.

0% chance you can make more doing your own cases than a well run ACT model. (or maybe you know where these guys pulling 7 figures for doing their own cases are hiding)

 

[Idiopathic]

I disagree with that statement. There are jobs where you still get to do yuor cases and make more money than supervising nurses. A few of the posters here can attest to that.

well there cant be many of them, so its unrealistic to expect to be able to make more money doing solo cases than doing 4 to 1 supervision, IMHO.

 

[sevoflurane]

Depends on your hospital and the circumstances surrounding said practice. If a hospital has already been burned due to it's inability to bring in quality CRNA/AMC's to it's system, a good group of anesthesiologists can realize very good compensation on said fact. This is especially true in certain states and outside major cities.

Our hospital tried going cheaper many, many years ago... The result = bad outcomes, bad reputation in the community and 2.6 million dollars to get out of the contract with the AMC/CRNA group at the time. That's not cheap to any hospital system, especially with those with only a 300 bed hospital. The hospital now receives excellent anesthesia care, our surgeons are happy, it's efficient, we have soaked up tons of ASC's and have re-established an excellent reputation... but most of all, WE DO OUR OWN CASES. Our hospital couldn't be happier with the way things are going.

There are many practices out there that are supervising for 375K and there are many solo MD practices that are making considerably more. You have to compare apples to apples however.

My practice is somewhat buffered because of it's location. I chose to not participate in the CRNA movement. I couldn't be happier for myself, my family or my contribution to our profession. Solo MD anesthesia is not dead and it should be supported, just like the rest of the world does.

ProRealDoc knows this: It comes down to salary vs lifestyle vs location. These days you get to pick 2 of them. Next week I get on a plane and arrive in Florida in no less than 2.5 hours, yet I practice in a small city. If things keep on heading down the path we are currently on (watering down our specialty), you will soon have the option to pick only one... or even less....

I love Colorado, but it's recent stance on anesthesia has left a very bad taste in my mouth. Solo CRNA practice is CRAZY. The american people are getting short handed. Small steps people... small steps...
Colorado is now uncertain territory. In my mind, at the very least, I know I had nothing to do with it and fought it all the way ‘till the end.

Someone recently said that they had observed central lines, swans and even blocks being placed by CRNA's while the anesthesiologist was in the lounge??? Ridiculous. They got their money and just didn't care about the the patient or the profession that gave them so much... Selfish, unsafe and again... watering down anesthesia.

Sorry guys.. If the above is going on, I'm on the other side. Sounds like some have already stopped fighting for M.D. only anesthesia... Not me.

After all, when I'm 85 y/o and go into an irregular wide complex tachycardia at 180bpm that eventually proves to be WPW, I would hope that someone had a thought about AV nodal blocking agents potentially worsening outcome instead of reflexively going to the cardizem (or not) before the anesthesiologist analyzed the situation.

-Sevo

 

[sevoflurane]

The USA does NOT have to go with the ACT model. It may be somewhat necessary, but not absolute.

 

[sevoflurane]

After all, when I'm 85 y/o and go into an irregular wide complex tachycardia at 180bpm that eventually proves to be WPW, I would hope that someone had a thought about AV nodal blocking agents potentially worsening outcome instead of reflexively going to the cardizem (or not) before the anesthesiologist analyzed the situation.

-Sevo

Do you think that it is possible when they ask you to "supervise" 6 or even 8 rooms? Cuz..... follow this trend... then, eventually..... that's where it's going.... IMHO.

 

[Mman]

Solo CRNA practice is CRAZY.

Not only is it crazy, it's stupid. Fortunately the vast majority of CRNAs do not think they should be practicing independently. A vocal minority wants this, but the smart ones don't. The know that there is vast knowledge gap and they appreciate having someone else there to help bail them out of potentially bad situations.

The most comical thing I've seen come of this are the SRNAs lured into the school because they think they can play doctor and do things independently. I enjoy working with them clinically and pointing out that they really don't know much of anything. I find it amusing.

 

[ProRealDoc]

I can assure you that is incorrect. At any gig doing your own cases, you'd be making more supervising in the same location. Now there are some places where people make more money doing their own thing than people supervising in a nearby location, but that's probably because of bad contracts or inefficiency.

0% chance you can make more doing your own cases than a well run ACT model. (or maybe you know where these guys pulling 7 figures for doing their own cases are hiding)

No one is talking about making a 7-figure salary. I do know many guys in PP gigs doing their own cases who are doing very well. They may not be in San Diego or Miami but are still able to pull in over $350K a year.

Now that may not be the preferred approach for those who prefer to sit in the lounge and "supervise" over a cell phone but that's another issue.

 

[cfdavid]

There are several ways of looking at the issues we face.

First, there's still time for current attendings, as well as PGY1's and even MS3/4's for that matter, to prepare for a reasonably worst case scenario.

That is, regardless of one's financial situation, you can pair down expenses and really focus on getting your financial ship in order. I think we can all agree that with "current" salary levels, this is feasible for even the most debt burdened medical student, or debt laden attending (perhaps through largess, for example). Whatever.

First, remember that the current shortage of anesthesiologists (not enough MD/DO's to do solo cases) is contingent upon a status quo in surgical volume. From what I hear and see, many elective procedures are being postponed by the underinsured/financially challenged. Can we count on the status quo for anything these days?? I don't think so.

So, it's entirely possible that after another 5 years or so of what many (I'm in that camp) feel will be continued economic stagnation, a worsening of our national debt, and a plummeting of Joe America's standard of living, surgical volume will be down even further, despite the Baby Boomers as a powerful demographic favoring expansion of healthcare.

These are a lot of "if's", and indeed, it paints a pretty grim picture. But, in such an environment, you can bet that surgeons will be competing fiercely for business as they strive to maintain their volume. Perhaps at that point there's a point in which surgical volume really challenges existing "provider" levels.

At this point, the CRNA's that are allowing their national organization to push vehemently for solo practice, would also become DIRECT competitors to physician anesthesiologists. They could finally achieve their greatest of all desires.

So, at this point and environment, "prices" for anesthesia are certain to come down (hence the preparation over the next 5-10 years). This, in an environment where surgeons are competing for business as well. So, if we were to allow market forces to prevail, with the help of some organized marketing, who do you thing the "consumer" will choose? Who do you think the surgeons will gravitate towards?? (this is where our own PR campaigns would come into play in order to force their hand just a tad which may or may not be necessary even).

If the majority (under such circumstances) of physicians were to be "willing" to compete in a "free market" for anesthesia services, directly, then we would be in a position to give the militant CRNA's what they're currently asking for, which is "efficiency".

No matter what, and even with the "DNP", at this point, the value of a licensed, prescribing physician, would be the go-to provider of anesthesia care, hands down. Surely, significant pay deductions would come to fruition to those in our profession, but there would be plenty of work to go around.

These are big hypotheticals, but I really think that the CRNA leadership is going to shoot themselves in the foot. Because, to me, it's much more of a probability that Nurse Anesthetists become a thing of the past, than a highly trained anesthesiologist (as some have suggested), and not the other way around. Probably, neither will happen and we'll just see a change in the acuity of what physician's are involved in (this is happening across most/many specialties), but if it HAD to come down to the above scenario(s), then we will prevail for sure.

This is why we will not lose and the viability of our profession can be sustained and even thrive under a "free market" for healthcare.

 

[jwk]

Not only is it crazy, it's stupid. Fortunately the vast majority of CRNAs do not think they should be practicing independently. A vocal minority wants this, but the smart ones don't. The know that there is vast knowledge gap and they appreciate having someone else there to help bail them out of potentially bad situations.

The most comical thing I've seen come of this are the SRNAs lured into the school because they think they can play doctor and do things independently. I enjoy working with them clinically and pointing out that they really don't know much of anything. I find it amusing.

👍👍👍

 

[cfdavid]

👍👍👍

I'll agree that it's likely a minority of militant CRNA's leading the charge. But, just as physicians have the obligation to demand that the ASA is more representative of their members (i.e. the MD/DO on the street, in PP), so do the rank and file of the AANA.

If in fact the average AANA member does NOT want essentially what their leadership is driving for in NO UNCERTAIN TERMS, then they have an obligation to make themselves heard. Otherwise, the average AANA member is guilty by association. We can't keep making excuses.

 

[Consigliere]

Not only is it crazy, it's stupid. Fortunately the vast majority of CRNAs do not think they should be practicing independently. A vocal minority wants this, but the smart ones don't. The know that there is vast knowledge gap and they appreciate having someone else there to help bail them out of potentially bad situations.

The most comical thing I've seen come of this are the SRNAs lured into the school because they think they can play doctor and do things independently. I enjoy working with them clinically and pointing out that they really don't know much of anything. I find it amusing.

A vocal minority is all it took for the state of CA to opt out and CA ain't exactly ND or SD.

 

[kmurp]

Or else you WILL feel the wrath of the future of anesthesiology, which has had a change of "heart" towards you ladies (and murses just so the small d.cks don't feel left out). Just read these threads and know what you are up against. Actually, you are going to feel the wrath. This is a promise. We are no longer playing "nice". Good luck.

I'm not too sure that you are in the mainstream. That view does not represent my views or the views of the anesthesiologists that I work with. We run our own practice and if we did not want CRNAs or realize a financial benefit from employing them, we would not do so. I suspect that our view is in the mainstream.

 

[Zoom-Zoom]

this is not true

Since when?

 

[ronaldo23]

I'm just a pre-med somewhat interested in the field, but the potential election of Andy Harris, a Hopkins anesthesiologist, to Congress seems like a big step for all you attendings/residents. RealClearPolitics has that Maryland District as "leans Republican," and having even one anesthesiologist in congress seems like it could make a world of difference in federal legislation regarding this issue. Contributing to his campaign is probably the best step any of you could do to protecting your interests.

 

[Idiopathic]

Since when?

the quote was

Originally Posted by WaveEquation View Post
Just like dentists have to get a MD to become an OMFS.

and this is not true.

DDS can enroll in a 6 year OMFS/MD or a 4 year OMFS program, but the second does not lead to an MD degree. (obv MD candidates can enter as well)

someone correct me if Im wrong, but ive worked with people in both tracks

 

[SomeGuy99]

I had to chime in just to give a diff perspective. I did pre-med for my first degree. Didn't work out. I'm trying to get my science GPA up to go for med school. Realistically though, at this point in my life, if that doesn't work out, I'll prob go for CRNA training at some point. It's my own fault if med school doesn't work out.

For the last few years, I've been working in surgery, yes as a nurse, at a teaching hospital at a university that has an anesthesiology training program. If I do get into med school...fantastic. If I go the CRNA route, I'd never practice without a supervising MD.

The case variety and volume I see is waaaaaaaaaaaaay to complex, and I really think the AANA needs their heads checked for pushing towards too much independence. I've seen simple cases go south real quick, and the support that comes in where I work is top notch b/c we have attending doctors with excellent clinical skills to back the residents.

I'd want to work with anesthesiologists out of respect for what I have learned, as well as what they would expect of me.

I'd have to agree with Blade on many of the posts I've read on the subject. Nothing wrong with protecting your own profession at all.

At the same time, cfdavid, I'm a male. I'm speechless at your first comments. I seriously seriously doubt you'd say that to anyone's face. I dare you to say it to mine. I could probably even arrange a job interview to provide the opportunity to do so if you want to pm me.

Good luck to everyone.

 

[Consigliere]

I had to chime in just to give a diff perspective. I did pre-med for my first degree. Didn't work out. I'm trying to get my science GPA up to go for med school. Realistically though, at this point in my life, if that doesn't work out, I'll prob go for CRNA training at some point. It's my own fault if med school doesn't work out.

For the last few years, I've been working in surgery, yes as a nurse, at a teaching hospital at a university that has an anesthesiology training program. If I do get into med school...fantastic. If I go the CRNA route, I'd never practice without a supervising MD.

The case variety and volume I see is waaaaaaaaaaaaay to complex, and I really think the AANA needs their heads checked for pushing towards too much independence. I've seen simple cases go south real quick, and the support that comes in where I work is top notch b/c we have attending doctors with excellent clinical skills to back the residents.

I'd want to work with anesthesiologists out of respect for what I have learned, as well as what they would expect of me.

I'd have to agree with Blade on many of the posts I've read on the subject. Nothing wrong with protecting your own profession at all.

At the same time, cfdavid, I'm a male. I'm speechless at your first comments. I seriously seriously doubt you'd say that to anyone's face. I dare you to say it to mine. I could probably even arrange a job interview to provide the opportunity to do so if you want to pm me.

Good luck to everyone.

Oh brother.......another internet tough guy.....🙄

 

[TecmoBowl]

I suppose you're just getting a glimpse of the strong emotions that are out there in the YOUNG Anesthesia community. The older Anesthesia guys... they don't care much. They're on their way out.

The senior AANA has caused much turmoil to us by attempting to completely devalue our education, training and quite literally, our hard work and top tier educational efforts.

What would you expect? A friendly hug and a handshake?

Realize what your leaders have done to you. You don't realize this, many Anesthesiologist don't realize this- the only way to go forward is really with the ACT model.

Obviously, if it comes down to it, we'll take pay cuts- we'll see you out of this field. It will be bad for both groups, but WE not CRNAs will ultimately survive- a pyrrhic victory but we will have it.

The best you can do is beat some sense into your "leaders".

They are ultimately harming your future- not to mention your kids/grandkids etc.

I'm sure you will all tell your kids to grow up, work hard and be Doctors... the American dream... work hard... be rewarded, at least respected!.....Right?!

I had to chime in just to give a diff perspective. I did pre-med for my first degree. Didn't work out. I'm trying to get my science GPA up to go for med school. Realistically though, at this point in my life, if that doesn't work out, I'll prob go for CRNA training at some point. It's my own fault if med school doesn't work out.

For the last few years, I've been working in surgery, yes as a nurse, at a teaching hospital at a university that has an anesthesiology training program. If I do get into med school...fantastic. If I go the CRNA route, I'd never practice without a supervising MD.

The case variety and volume I see is waaaaaaaaaaaaay to complex, and I really think the AANA needs their heads checked for pushing towards too much independence. I've seen simple cases go south real quick, and the support that comes in where I work is top notch b/c we have attending doctors with excellent clinical skills to back the residents.

I'd want to work with anesthesiologists out of respect for what I have learned, as well as what they would expect of me.

I'd have to agree with Blade on many of the posts I've read on the subject. Nothing wrong with protecting your own profession at all.

At the same time, cfdavid, I'm a male. I'm speechless at your first comments. I seriously seriously doubt you'd say that to anyone's face. I dare you to say it to mine. I could probably even arrange a job interview to provide the opportunity to do so if you want to pm me.

Good luck to everyone.

 

[Consigliere]

a pyrrhic victory

Nice.....I'm gonna use that today.