MacGyver

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The mantra on this forum is that they'll never expand their scope wider than it is now, and they'll always run 2nd place to MDAs.

You need to read this document, prepared by a consultant lawyer for the AANA (CRNA association).

http://firms.findlaw.com/lkarlet/memo4.pdf

Basically its a manual on how CRNA associations should file lawsuits against hospitals, forcing them to allow CRNAs equal rights/privileges as MDAs, including removing any regulations for doctor oversight.
 

powermd

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Originally posted by MacGyver
The mantra on this forum is that they'll never expand their scope wider than it is now, and they'll always run 2nd place to MDAs.

You need to stop being such a freaking troll! You run around these forums spreading fear of mid-level practitioners screaming "the sky is falling, the sky is falling!!" What is it you would like us to do, Mac? Relinquish our residency slots because of the threat YOU perceive to OUR job security? Please.. What exactly are you hoping to accomplish by spreading fear of mid-level practitioners? Shall we band together and kill them all? What do you suggest?

Most readers of this forum know there is an aggressive and vocal advocacy group for CRNAs, and that they want independant practice rights. It doesn't surprise me that they have a strategy and some devious tactics in their handbook.
 

antiadriani

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"respectfully submitted to the AANA" i.e. the lawyer realizes that there is big money in representing 95% of the CRNAs in this country....did you happen to notice it is 4 years old?

Dont know if AANA would support this proposal anyway...you are passing this Lawyers opinion as fuel to your fire....


dont believe the hype
 
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UTSouthwestern

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Those of you who are concerned need to contribute to our own organizations.

What the AANA is doing is what any organization should do for its members: fight for more opportunity for its members.

What you as MDA's can do is separate yourself as true specialists with multiple unique skill sets. I get tired of hearing residents saying that they only want to do "bread and butter" cases. Yes you make more money doing more of those cases and it's fine to do them per se but don't skimp on your training in the subspecialty areas and keep those skills updated.

Groups negotiating with different hospitals have the leverage they need when they can go to the bargaining table and say "we can cover EVERY service's need for anesthesia but you need to do business only/primarily with us if you want us to cover everything."

It's about business and you should have the most tools to stand out and the gumption to push when you need to push and not just be satisfied doing what you can get.

CRNA's have always filled needs where we couldn't/didn't want to be involved with and as such they have been able to negotiate themselves into a position of strength. We can combat that aspect by not ceding away those situations.

For example, the majority of us would probably not do off site anesthesia (ECT's, cardiac lab, GI lab, etc.) if we could avoid it. Anesthesia has to be provided by someone and if we aren't willing to do it, someone will fill that void.

In somewhat of a "turnabout is fair play" one anesthesiologist who fairly recently went solo in Nebraska decided to compete with a hospital's CRNA group for those "undesirable" cases and used his extensive, albeit dated knowledge of cardiology to argue the need for his presence, especially in the cardiac lab. He has now carved out a $250,000/year doing exclusively those cases and has no weekend or overnight call responsibilities. He has to bring in a locums guy to cover his vacation time because the CRNA group won't provide coverage, but so what.

This is not to say that we should hate CRNA's or view them as our nemesis. They have provided valuable manpower in times of severe shortage and continue to do so in underserved and undermanned areas. However, competition is competition and the punches don't need to be pulled by one side to be fair to the other. You are the physician with the skills to manages all crises, resuscitate (not just intubate), diagnose (not just treat), and treat (not just manage). You should leave your residency able to do the youngest to the oldest, the simplest to the most complex, the most to the least desirable and you should want to do AS MANY as you can to show that you WANT to provide the service not just that you can provide it.

The ASA will continue to lobby and negotiate on our behalf but we as its members need to contribute as much to it as the CRNA's contribute to their organizations and we need to truly separate our skills from theirs if we are to make a powerful argument to hospitals and other clinicians as to why they should do business with us. We are not just hired hands and we need to emphasize what the extra layers of education bring to the bottom line of the hospital or practice.
 

MacGyver

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Originally posted by powermd
Most readers of this forum know there is an aggressive and vocal advocacy group for CRNAs, and that they want independant practice rights.

Correction: They dont WANT independent practice rights, they already HAVE them.
 

juddson

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McGyver is only a kind of semi-troll. Much of what he says rings with some sort of truth.

The CRNA/MDA issue is a real one, which i think will drive some (many?) promising med students into other fields in the near furture. As I have said on some of the other threads, this is all going to come down to outcome studies. If the studies show that CRNA's can provide gas an effectively and no more dangerously than MDA's can, MDA's have a real problem. Training for MDA's in the future, then, may have to tend more towards the specialized cases in order to justify all the extra training and cost an MDA incurrs.

It's been said above on this thread - the evidence appears to suggest that an MDA is "overqualified" for the bread-and-butter cases - to the extent that a less qualified CRNA can do these cases just as well merely serves to prove this point. Where there is overqualification, there is inefficiency and "slack" in the market for gas services. A capitalist market (which the medical market is) simply will NOT tolerate it.

MDA's will need something OTHER than a mere political objection to an expanding scope for CRNA's. UNless the outcome studies are there, all the lobbying in the world won't help the ASA's position. It NEEDS the outcome studies. Look for the med mal insurance companies to provide those. Without the outcome studies, UTSouthwestern's advice is spot-on. It may ential a retraining of MDA's to handle more specialized cases.

in the end, I think MDA's have no-one to blaim but themselves. Who do you think runs the CRNA schools. I think MDA's thought this was a great deal when medicare permitted 120% billing on services. Not sure it is any good anymore.

BTW, can an MDA employ CRNA's, or are they always employed by somebody else. If an MDA can emply a CRNA, I suppose there is still money to be made.

Judd
 

juddson

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BTW, that was a poorly written memo. For somebody who (obviously) wants work from the CRNA groups, he should have proofread his memo better.

Judd
 

MacGyver

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Originally posted by juddson
MDA's will need something OTHER than a mere political objection to an expanding scope for CRNA's. UNless the outcome studies are there, all the lobbying in the world won't help the ASA's position. It NEEDS the outcome studies. Look for the med mal insurance companies to provide those. Without the outcome studies, UTSouthwestern's advice is spot-on. It may ential a retraining of MDA's to handle more specialized cases.

At least a dozen studies have already been done and they all show the same thing: CRNAs can do the same thing as MDAs, get similar outcomes, and have similar negative outcomes.

BTW, can an MDA employ CRNA's, or are they always employed by somebody else. If an MDA can emply a CRNA, I suppose there is still money to be made.

Sure they could. But the real question is WHY would a CRNA want to work for an MDA when they can make more money by working independently?

MDAs wont lose their jobs to CRNAs, but they are goign to see their incomes fall to the CRNA level.
 

NaeBlis

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Originally posted by juddson


BTW, can an MDA employ CRNA's, or are they always employed by somebody else. If an MDA can emply a CRNA, I suppose there is still money to be made.

Judd

90-95% of CRNA's are employs of MDA groups.
 

NaeBlis

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Originally posted by UTSouthwestern
Mac, please post all of the studies on this thread. I would like to read them.

:wow: You mean to tell me you don't accept Mac's random statements as divine truth. :p
 

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This stupid CRNA debate has been going on for so long. I don't understand that if they're such a big threat, why aren't any MDA's that I've worked with either private or academic feeling the heat? No one seems concerned about job security, pay, etc. They earn fat salaries, good benefits, and work with CRNA's who take the crappy cases that they don't want anyways. And studies have shown a higher mortality rate when CRNAs handle complex cases like hearts, vascular, neuro, t-plant. I think it comes down to the fact that the public will never be OK with a nurse putting them under for anything more complicated than a hernia, even if it saves them $50/year on health insurance, no matter what all the studies say. Just like I would never want an optometrist to fix my cataracts, or a PA to manage my hypertension, or a radiology supertech interperting my CTs.
 

Tenesma

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in response to all of this, I think it is a normal thought-process for medical students and junior anesthesia residents to go through... but once you are close to being done or actually in practice, you quickly see how this is a political issue over some extra dollars, and in the end won't truly affect the practice of anesthesia...

1) reimbursements: managed care/HMOs/etc... will always try to reduce provider reimbursements.... look at CT surgeons, they get 1200-1400$ for a simple CABG and that INCLUDES 30-60 days of free post-op. care (including ICU time), and that reduction had NOTHING to do with competition from mid-level practitioners. This reduction in reimbursement will continue over time no matter what we do, and it is only a matter of time before this country becomes a socialized system in order to financially be able to support the ever growing old people...

2) expertise: CRNAs are great at what they do, they provide safe anesthesia both in rural settings and urban settings... and this can be mainly attributed to the advances in anesthesia-safety practices/medications. Just like NPs and PAs provide great care to their patients.

3) our role: we will continue to be on the leading edge of anesthesia, providing care to the sickest and most complicated patients - or if we choose provide our medical knowledge in a supervisory role. Plus we still have the avenues of critical care, pedi, cardiac/TEE, pain, etc.... especially critical care, considering the LEAPFROG studies as well as the increasing old folks requiring more ICU time...

4) for the nay-sayers: yes, mid-level providers will accumulate more and more patient responsibility, all based on pre-set algorithms and protocols - and that is true for every specialty out there....

5) as far as the argument re: CRNA cheaper than MDs therefore hospitals/health-care-systems will hire CRNAs preferentially.... is a true misunderstanding of the situation. Will a plastic surgeon working on healthy patients requiring MACs/Sedation cases hire a CRNA over an MD - absolutely... and trust me, you aren't going to find many MDs with a desire for that kind of work. However, the bigger picture: an Anesthesiologist is still a doctor and therefore will be able to make pre-operative assessments without having to consult an internist or a cardiologist - which in turn, is actually a cost saving.

people have been worrying about the CRNA issue for a very long time - and yes, they can provide unsupervised care in 33 states and they can collect medicare dollars for unsupervised care in 13 states (the "opt-out" states).... but when you stop and look at salaries in those specific states for MDs, they are as strong as ever... I wonder why? maybe there is still a role for us :)
 
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NaeBlis

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LOLOL

For their size trolls can be surprisingly quiet at times.

:laugh:
 

MacGyver

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Tenesma,

Your post illustrates exactly why MDAs will have decreasing market share over the years. Slowly but surely, they will be relegated to only the super complex cases. "Complex" cases are a tiny fraction of the overall surgery load. If MDAs are used only for those kinds of surgeries, then it wont be long before a larage MDA surplus is going to take hold.

Your logic of "well we will always get to do the complex cases" is tremendously shortsighted for the MDA profession as a whole.

Besides, I propose that this wont be the case forever. You make it sound as if CRNAs are happy to just let MDAs do all the "hard" stuff when thats patently untrue. They are constantly expanding their scope. I guarantee you that I can find isolated examples of CRNAs running solo anes for every kind of surgery you can name. It may not be widespread practice yet, but its coming.
 

NaeBlis

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Hey UTSouthwestern, looks like we are being ignored. I feel hurt. :( :p
 

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end this misery of a topic please!!!!!!!!!!!!!!!!!!
 

NaeBlis

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Originally posted by apma77
end this misery of a topic please!!!!!!!!!!!!!!!!!!

It will just keep coming back. We should just choose one of these threads, close it, and post it as a sticky. Where is oldmandave, our moderator is asleep at the switch!
 

Tenesma

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macgyver.... you are absolutely right... there will be a time when all of medicine is provided by mid-level practitioners....
 

UTSouthwestern

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NaeBlis, it gets comical at times reading this topic over and over again. I think I'll abstain from future posts about this topic.

I would guess scaring away future candidates would be beneficial to us as it would mean less competition but also beneficial to the non-MDA's as they want to have more of a void to fill.

Bottom line, look at this from all points of view and don't do anesthesia unless you enjoy what you're doing.
 

NaeBlis

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Originally posted by UTSouthwestern
NaeBlis, it gets comical at times reading this topic over and over again. I think I'll abstain from future posts about this topic.

I would guess scaring away future candidates would be beneficial to us as it would mean less competition but also beneficial to the non-MDA's as they want to have more of a void to fill.

Bottom line, look at this from all points of view and don't do anesthesia unless you enjoy what you're doing.

I agree this topic gets comical, I always tell myself it's a waste to keep postinmg on this topic but I always get sucked back in. I guess it would be best to have less competition in the future, but I hate to think of the field I choose losing top notch candidates who love the field because of unfounded fears.
 
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MacGyver

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Originally posted by Tenesma
macgyver.... you are absolutely right... there will be a time when all of medicine is provided by mid-level practitioners....

Change "medicine" to "anesthesiology" and I agree. Until the MDAs start producing research to show that MDAs result in better outcomes for patients, then you are fighting a lost cause. The AANA pushes out dozens of studies every year showning that CRNAs are supposedly equivalent to MDAs. All we hear from the MDA side is..........silence.

Surgery is really the last bastion of MDs. As far as I know, there are no PAs or NPs who run their own surgeries (although they are first assistants).

Every single surgery that occurs in the United States has an MD/DO who oversees it and does the meat of the operation. For EVERY SINGLE OTHER PROCEDURE IN MEDICINE, THATS NOT THE CASE, and you can readily find nurses or PAs doing it.

Now that I've said that, I'm sure emedpa is going to come on this thread and proclaim that he knows a PA who is running heart transplant surgeries with no MD oversight. :rolleyes:
 

UTSouthwestern

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Please post those studies so we can all evaluate them objectively.

I'd love to see them. I'd love to see what criteria they use to make the comparisons, the endpoints of the studies, the direct comparisons I would hope they are drawing from, what exclusion criteria they employed and why they employed them, and what institutions agreed to "participate" in their studies.

As for surgery being the last bastion of MD/DO-hood, you make a good point. You neglect to mention the encroachment of other subspecialties into once fertile and proprietary surgical territory somewhat similar to the mid-level practitioners encroaching onto other services' territory.

In the past three years, how much has surgery suffered from the advances made by radiologists alone? It is a telling sign when you hear renowned neurosurgeons like Duke Samson talk about the loss of specific patients to interventional radiologists. Likewise, cardiologists have taken a significant chunk out of the CT surgeons paycheck. Even the general surgeons talk about the loss of bread and butter diagnostic procedures and many types of vascular procedures to interventional radiologists and gastroenterologists. This doesn't even begin to get into the competition between surgical subspecialties.

Competition is everywhere and if competition scares you, then run away or don't even try. That seems to be your message. However if you think that there is a field (especially a surgical field) devoid of competitors looking to undercut your bottom line, you are either very sheltered or very naieve.

Thankfully, this year's crop of anesthesia interview candidates has been among the strongest I and several of my colleagues at other institutions have ever seen or heard of. AOA, top board scores, top 10%, AND even transfers from neurosurgery, CT surgery, radiology, ophthamology, and internal medicine.

Unlike the 90's when the doom and gloom forecasters drove the best and brightest away from anesthesiology, naysayers of this decade have not put a dent in our recruiting efforts and the projected field for next year looks to be even stronger.

At my institution I have already received two dozen e-mails from prospective MS3's looking to get a leg up on the competition. All have asked about the projected future job market, but all have said that regardless, they want to enjoy what they are doing and anesthesiology is what attracts them the most.

For a field supposedly being squeezed out by cheaper competition, I am amazed by the types and locations of the job offers I and others have received. Even in the supposedly supersaturated Dallas market, I have already fielded 7 offers for job interviews at prestigious, desirable groups and hospitals almost all of whom are EXPANDING their groups to meet demands.

To the prospective student looking at anesthesia, I would say even in the lean years life was good and jobs were there. Be diligent, be aggressive, and make yourself stand out. Do those three things and it won't matter where the market is because you will set the market for yourself.
 

MacGyver

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Competing with other MDs for procedures is PROFOUNDLY DIFFERENT than competing with midlevels who cost 50-70% less than MDs.
 

UTSouthwestern

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To shorten my reply, what's the difference between an open crani and IR coiling? About 50%-60%. Competition is still competition so I guess prospective neurosurgery, cardiothoracic, and other surgical candidates need to look at Derm or Optho or Rads instead.

You still haven't posted those studies by the way.
 

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NaeBlis

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Originally posted by MacGyver
Do you have research showing them to be equivalent across the board?



http://www.aana.com/press/2003/073003_pine_talk.asp

http://www.aana.com/press/2003/041103_pine.asp

He posts the ONE study we all know about. I notice that you posted two links, but they are both sites on the same study, do you think we can't count? Where are the dozens, or even a half dozen you claimed exist? Could it be that they don't exist? Could it be that Macgyver is full of it?

Here is the ASA's analaysis of the pine study in case anyone has not yet seen it.

http://www.asahq.org/Newsletters/2003/07_03/warner.html


and, I posted this on another thread, but here it is again:

Silber JH, Kennedy SK, Even-Shoshan O, et al. Anesthesiologist direction and patient outcomes. Anesthesiology. 2000; 93:152-163

here is the study supporting improved outcome with MDA. Had trouble linking it, i'm sure you all have access to medline or something else, and can find it on your own.
 

MacGyver

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Taken from your link:

Type of in-room anesthesia provider is an interesting but relatively unimportant issue.

This is EXACTLY the position of the AANA. They arent arguing that CRNAs are superior to MDAs, they are arguing that they are equivalent.

Since CRNAs cost a lot less than MDAs, that casts the balance in their favor.

Is that really supposed to be a rebuttal? It doesnt address teh fundamental methodology or outcomes of the study, other than the validity of using Medicare data.

Very weak, IMHO.

Contrast that to the AANA critique of Silber:

http://www.aana.com/patients/hcfa/pastudy.asp

Unlike the ASA, they actually address the scientific makeup of the studies involved and give a detailed critique and analysis based on statistical grounds. You find NONE of this in the ASA critique.

Its truly embarrassing when a nurses organization shows more scientific prowess and critique skills than MDAs. Its obvious that the ASA just blew off the study and wrote their "critique" in 5 minutes, whereas the AANA analyzed the details of the study and came up with a statistical/scientific critique. I dont agree with all of their conclusions, but they kicked the MDAs asses on this one.

At any rate, EVEN IF THE RESEARCH BACKS YOU UP, you MDAs have obviously failed to get your message out to the decision makers, because they have ruled against you time and time again. I predict that in 10 years all 50 states will have opted out of the MDA supervision requirements of Medicare procedures.
 

NaeBlis

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CRNA's aren't cheaper, they make pretty much the same as MDA's once u account for hours.

Originally posted by MacGyver
.

Very weak, IMHO.


That can be said of most if not all of your posts, why don't we talk further once you post the other dozen studies you mentioned?
 

MacGyver

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Originally posted by NaeBlis
CRNA's aren't cheaper, they make pretty much the same as MDA's once u account for hours.

Bull****. Link please.
 

NaeBlis

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Originally posted by MacGyver
Bull****. Link please.

HAHAHAHA.
You made your claims first, so you post first.
If you had any actual clinical experience you wouldn't need proof, CRNA's work about 40hrs a week, and MDA's 60-80 depending on practice. The lowest CRNA salary I have seen is 130k, and they get benefits, and malpractice paid on top of that.
 

NaeBlis

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Sigh, I really need to stop feeding the troll. :p
 

juddson

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The AANA response DOES seem to have had a lot more thought put into it than the ASA response, though i suspect that the ASA response was not actually contained in that link given above. It seems to summary to me.

In any event, from the AANA response we have the following on death rates:

"Death Rates. The Pennsylvania study cites death rates that were many times more than the anesthesia-related death rates commonly reported in recent years, again leading one to conclude that the increase was almost certainly due to nonanesthesia factors."

The conclusion here is suspect (and goes to the heart of the matter). The "accepted" rate of death associated with Anesthesia administration prior to the study (1/240,000) is associated with MDA administration, NOT CRNA administration. Hence, IF the study suggests a death rate "several multiples" higher than the "accepted rate" it does NOT necessarily following that the higher rate is due to non-anesthetic post-operative care, as the AANA claim, but in fact may very well be the conclusion of the study itself, which is that non-MDA administration leads to death rates several multiples higher than MDA administration.

On TimeFraim, the AANA says:

"However, if one considered the study?s sample size (217,440) in relation to the widely accepted anesthesia mortality rate of one death in approximately 240,000 anesthetics given, which is recognized by ASA, AANA and cited in the Institute of Medicine report, To Err is Human: Building a Safer Health System (Kohn LT, Corrigan JM, Donaldson MS. Washington, DC: National Academy Press. 1999.), logic would dictate that less than a single individual in the entire database is likely to have died as the direct result of an anesthesia mishap!

What that leaves is this: Based on the 30-day time frame, it is clear that the study actually evaluates postoperative physician care, not anesthesia care."

Again, this conclusion does not follow. If the accepted death rate is 1/240,000 patients, and this study shows a death rate several multiples of that, the mere fact that it includes death rates after long post-operative care times does not mean that the type of provider is irrelevant UNLESS post-operative death rates are also elevated for MDA providers. After all, presumably the patient receives the same level of post-operative care over the following 30 days whether the provider was an MDA or a CRNA. True, the study asks this question outright (ie, whether non-MDA providers experienced, for whatever reason, lesser post-opperative care for thier patients than MDA providers did) - but assuming the post-operative care was the same, the ONLY variable in the study is MDA versus non-MDA provider in the OR.

And then from AANA:

"In a June 2000 press release about the Pennsylvania study, the ASA stated "that patient safety has greatly improved from one [death] in 10,000 anesthetics to one in 250,000 anesthetics." (This amounts to four deaths in one million.) In the same press release, the ASA stated that, "Dr. Silber?s findings show that for every 10,000 patients who had surgery, there were 25 more deaths if an anesthesiologist did not direct the anesthesia care." (The difference translates to 8,000 deaths in one million.) Thus, the difference in mortality rates that the ASA cited is 2,000 times the mortality rate ever attributed (including by the ASA) in the last decade to the administration of anesthesia. To attribute a difference of this magnitude solely to the supervision of CRNAs is ridiculous. In actuality, the large differences in mortality and failure-to-rescue are due to differences unrelated to the administration of anesthesia and outside the scope of practice of CRNAs, whether unsupervised, supervised by anesthesiologists, or supervised by other physicians."

ISN'T it possible that the study DID suggest a death rate 2000 times higher for non-MDA administration? After all, non-MDA administration acounts for a much larger percentage of administration than non-MDA, right? Still, the study would have to compare death rates for MDA's after a similar post-opperative period in order to make these numbers meaningful. I'm not sure the study does this. Still, one cannot ignore the "failure to rescue" factor. Presumably, a failure to rescue occurs in the OR, NOT during the post-operative period. Accordingly a difference in "failure to rescue" rates among MDA's and non-MDA' IS significant and CANNOT be dismissed by references to the long post-operative period.

THIS, however, is where the ASA needs to get on board:

"Failure to Rescue. For the most part, failure to rescue occurs when a physician is unable to save a patient who develops nonanesthesia complications following surgery. Therefore, it is not a relevant measure of the quality of anesthesia care provided by nurse anesthetists. It is a relevant measure of postoperative physician care, however."

Whoa whoa whoa. . .correct me if I am wrong, but, (1) don't failures to rescue occur in the OR or immedietly after surgery, and (2) isn't the anesthesia provider IN FACT and (presumably) necessarily the principle physician responsible for rescues (or failures to rescue)? As I understand it, the MDA is the only "internal medicine" doctor in the room, trained in airway management, crashing, etc. Defining "rescue" as outside the scope of anesthesia administration rather begs the question - IF the anesthesia provider is not responsible for rescue, just WHO exactly IS responsible for rescue in the OR (or immedietly after)?

And that's just the point, isn't it? an MDA is trained in quite a bit more than the mere "administration" of anesthetic. And while mere administration by CRNA's is as good as that by MDA's, the reality is that without an MDA in the room, death rates will necessarily rise due to a lack of care (in relation to rescue, etc.) as a result of the absence of the other skills that would normally be provided by an MDA OUTSIDE of his experitise in the mere administration of anesthetic.

That said, from what I can tell of the critique, the study has some gaping holes, particularly related to whether the patient was put in the MDA group or non-MDA group. The AANA did a MUCH better job than the ASA did in the critiques.

In any event, this issue is RIPE for some better studies on M&M rates. I think cardiologist mentioned in the critique is probably right - death rates associated with gas care will be much lower than complications. That is where the studies should focus. I would have though schools of public health would be all over this issue - not sure why it has not ben studied.

Judd
 

UTSouthwestern

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Excellent analysis Judd and given my background in public health, I may actually look into this, though with my added duties this year and next, I'd be pressing to get it out before I graduated.

Regarding the comparison of endovascular versus open craniotomy modalities, our institution is part of the ongoing trial directly comparing the modalities. Our interventional radiology department is exceptionally aggressive and the point of cost has been made to the cookie cutters trying to save a buck.

Endovascular coiling usually requires only MAC sedation and minimal post op ICU care and no burst suppression or hypothermia to complicate postop recovery time. Those are just the savings on the anesthsia side. Our neurosurgeons see the trend and are training themselves to do coils on their own. Again, COMPETITION.

Also, I noticed your post on the surgery BBS. Not so sure about mid level practitioners in surgery? Of course it's mostly outpatient surgery that they're involved with and you'll NEVER see a NP or PA in the OR by themselves right? They'll just do the basic stuff. Maybe they could do an appy. Maybe an open chole here and there. Maybe a simple fracture. Maybe . . . Hmmm wonder how long it will be before entrepreneurial surgeons decide to "supervise" NP's and PA's in separate rooms since they can already do office and simple outpatient procedures?
 

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Originally posted by UTSouthwestern
Also, I noticed your post on the surgery BBS. Not so sure about mid level practitioners in surgery? Of course it's mostly outpatient surgery that they're involved with and you'll NEVER see a NP or PA in the OR by themselves right? They'll just do the basic stuff. Maybe they could do an appy. Maybe an open chole here and there. Maybe a simple fracture. Maybe . . . Hmmm wonder how long it will be before entrepreneurial surgeons decide to "supervise" NP's and PA's in separate rooms since they can already do office and simple outpatient procedures?

There is a HUGE difference between PAs and NPs/CRNAs.

PAs scope of practice is governed by 1) their supervising MD; 2) the state medical board, which is controlled by MDs.

NPs and CRNAs, on the other hand, have ZERO MD control over them, and any arrangement they enter into with MDs is SOLELY by choice and not by regulation. Their scope of practice is controlled SOLELY by the state nursing boards. As you know, the state nursing boards are totally independent of MDs or state medical boards.

State nursing boards can do whatever the hell they want to, and the state medical boards have no say in the matter. This is a travesty, because it allows NPs and CRNAs to write their own scope of practice with no MD oversight or supervision.

PAs are still a threat, but not NEARLY as much of a threat as NPs/CRNAs. NPs and CRNAs can write their own scope--as of yet PAs can not do this.
 

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So surgery is not immune to the midlevel practitioner subject. NP = CRNA, PA = AA. Same difference. Will be interesting to see how NP's and PA's try to advance their priveleges.
 

beezar

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How about this whole AA issue, which I find to be interesting as well.

The ASA appears to be pushing for AA's while the AANA seems to be against it. It all seems hypocritical to me on both sides. Then again, not so hypocritical if you look at it from a money point of view...

What do you guys think?
 

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Originally posted by MacGyver
Now that I've said that, I'm sure emedpa is going to come on this thread and proclaim that he knows a PA who is running heart transplant surgeries with no MD oversight. :rolleyes:

What do you mean no oversight. PA Surgeons have an MD review of 1/10 of their charts at the end of the month, no? :laugh:
 

MacGyver

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Originally posted by eddieberetta
What do you mean no oversight. PA Surgeons have an MD review of 1/10 of their charts at the end of the month, no? :laugh:

Not only that, the chart reviews are over the internet and the MD never sets foot in the OR or clinic.
 

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BTW, I hate it when doctors get sued, but as for those docs who agree to such ludicrous arrangements with PAs, I hope they get sued out of the profession.
 
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