CRNA: We are the Answer - WTF????
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deleted126335
1st amendment.
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This is the first official communication that I’ve seen referring to themselves as “nurse anesthesiologists” - what a joke.
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Good lord. If only we had a society that had our best interests at heart. I'd call it something like the American Society of Anesthesiologists, with a mission to make sure to make sure that everyone from CEO to administrator to surgeon to nurse to patient knows the difference between an anesthesiologist and a lesser replacement (whether that replacement calls itself nurse anesthesiologist, nurse anesthetist, assistant anesthesiologist, assistant anesthetist or...) Why doesn't such a society exist??
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deleted171991
Much more than 75% of anesthesiologists are board-certified. If only just 75% were...
That association and their "board-certification" are an insult to medicine.
That association and their "board-certification" are an insult to medicine.
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ASA should sue them for fraud.
The solution is to go to state legislatures and lobby for the legal decredentialing of nurse anesthetists entirely. Eliminate their profession by legally merging them with AAs.
I just talked to the President of my state’s society. Apparently ASA and state bodies are aware and hard at work.
The solution is to go to state legislatures and lobby for the legal decredentialing of nurse anesthetists entirely. Eliminate their profession by legally merging them with AAs.
I just talked to the President of my state’s society. Apparently ASA and state bodies are aware and hard at work.
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If you train SRNAs, you are complicit. If you train CRNAs, you are complicit. If you let CRNAs do lines or blocks, you are complicit. Do your own cases.
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Please - my AA profession is happy as is - no "merging" is necessary or desirable.
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They don’t have an exam. I asked them.
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I don't think this is true at all.
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Huh. You mean the world isn't black and white?
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If you look at this example, grads from this program graduate with about 3700 hours of total clinical experience but the article inflates this number almost 3-fold. Not knocking crnas but thought I’d throw out numbers from an actual crna program to compare to the article posted here.
www.kumc.edu
Case Numbers
CASE NUMBERS: KU Nurse Anesthesia Program Graduates Compared to Requirements of the Council on Accreditation (COA)
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If you look at this example, grads from this program graduate with about 3700 hours of total clinical experience but the article inflates this number almost 3-fold. Not knocking crnas but thought I’d throw out numbers from an actual crna program to compare to the article posted here.
Case Numbers
CASE NUMBERS: KU Nurse Anesthesia Program Graduates Compared to Requirements of the Council on Accreditation (COA)
They usually count their critical care hours as their “clinical” hours.
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It’s not too late to change
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CRNAs take their certification exam once, right after they graduate. In some states, they can practice prior to passing their exam. They had started to require it to be taken every 10 years as a condition of maintaining certification, but their membership raised such a stink that it wasn't implemented. It's now essentially optional and loss of certification won't happen if one fails the exam. Contrast that to CAAs - exam every six years just prior to graduation - no pass=no certification=no work - and failure of the recert exam can lead to loss of certification. Trust me - our membership doesn't like it - but our certification board (NCCAA) as well as our program accreditation (ARC-AA through CAAHEP) is very deliberately wholly separate from our professional organization, so our membership has zero say into what's required to obtain and maintain certification. And as far as the ABA - I'll bet a fair number of those anesthesiologists that aren't board certified are board eligible, but haven't been in practice long enough to sit for their orals.
Don't know why this caught my eye - but 26 sitting position cases? Seriously? I haven't done that many sitting cases in my career, much less in two years of school, and I do a boatload of neuro cases.If you look at this example, grads from this program graduate with about 3700 hours of total clinical experience but the article inflates this number almost 3-fold. Not knocking crnas but thought I’d throw out numbers from an actual crna program to compare to the article posted here.
Case Numbers
CASE NUMBERS: KU Nurse Anesthesia Program Graduates Compared to Requirements of the Council on Accreditation (COA)
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Looks like "nurse anesthesiologist" is here to stay... Of course, the "nurse" part will go unmentioned frequently.
This is going to set a terrible precedent. What's next? Nurse cardiologist? Nurse endocrinologist?
This is going to set a terrible precedent. What's next? Nurse cardiologist? Nurse endocrinologist?
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Or counting beach chair position.
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deleted126335
I think that qualifies as lying...or honestly mistaken due to ignorance.
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I'll never get over the fact that their ICU years are counted as a worthwhile experience. Half my time in the ICU is spent preventing them from killing my patients with their negligence, laziness and ignorance. Yet somehow that turns into this sort of hubris:
"In addition to that there is a lot to be learned by a new physician about medicine and the basic portions of anestheisa and monitoring. Much of this a CRNA will come with from their critical care background. Reading ekgs, running codes and seeing thousands of patients with Thousands of diseases and on thousands of meds. That is not to say the MD does not catch up, they do and have a good foundation to do so (med school) but that is time often not spend as a CRNA."
(Taken from one of those reddit threads)
"In addition to that there is a lot to be learned by a new physician about medicine and the basic portions of anestheisa and monitoring. Much of this a CRNA will come with from their critical care background. Reading ekgs, running codes and seeing thousands of patients with Thousands of diseases and on thousands of meds. That is not to say the MD does not catch up, they do and have a good foundation to do so (med school) but that is time often not spend as a CRNA."
(Taken from one of those reddit threads)
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deleted500612
Look at the way they compare the various anesthesia care models... literally a joke. Highlights include accusing physician anesthesiologists of committing widespread fraud, of inflating their educational attainments, of being overpaid, draining hospital financial resources, and of being overall worse providers of anesthesia who only hold back CRNAs from delivering the ultimate anesthesia care (red text where i start gagging and dry heaving).
CRNA-only Model
In this model, the CRNA is the sole anesthesia provider. The CRNA-only model may vary by state. In some states, CRNAs work without physician supervision; in other states, they are required to be supervised by a physician. The physician could be, but is not required to be, a physician anesthesiologist. Often the supervising physician is a surgeon or other proceduralist. Currently, there are 17 states that have no physician supervision requirement for CRNAs whatsoever, meaning these states have opted out of the federal Medicare physician supervision requirement for CRNAs. Without any burdensome supervision requirement for CRNAs, healthcare facilities in these states can structure and staff their anesthesia departments to function as efficiently, cost-effectively, and safely as possible. Physician supervision of CRNAs is not and never has been a matter of patient safety. Its requirement has always been tied to the ability of a facility to receive reimbursement from the Centers for Medicare & Medicaid Services (CMS) for anesthesia care provided to Medicare patients.
Physician Supervision of CRNAs
Medical supervision is a billing term under Medicare which pertains to when one physician anesthesiologist oversees more than four CRNAs (or AAs) concurrently administering anesthesia to patients undergoing surgical or other procedures. In this model, the physician anesthesiologist doesn’t provide hands-on care, but is available in case he/she is needed to assist in any of the concurrent cases. Research has confirmed that patient safety is not enhanced by this anesthesia delivery model, and that the cost of having a physician anesthesiologist available “just in case” is often greater than the cost of adding two additional CRNAs to the anesthesia department
Physician Anesthesiologist Direction of CRNAs
Medical direction is a billing term under Medicare which pertains to when a physician anesthesiologist directs the anesthesia care of up to four CRNAs (or AAs) providing anesthesia for four different cases concurrently; however, for medical direction to be achieved legally and the physician anesthesiologist to be compensated, the physician anesthesiologist must meet seven requirements of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97–248 (TEFRA) for each case. For obvious reasons, medical direction, with its TEFRA requirements, is the model in which physician anesthesiologist billing fraud occurs most frequently. It is virtually impossible for a physician anesthesiologist to meet the seven TEFRA requirements in concurrent cases (regardless of whether there are two, three or four concurrent cases) without significant delays occurring in each of the cases as the physician anesthesiologist moves from room to room. In 2012, research by Epstein et al and published in the journal Anesthesiology examined this problem relative to delayed case starts (see Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics. - PubMed - NCBI). Aside from the potential for fraudulent billing practices, in most scenarios medical direction comes at an increased cost to the facility of at least one physician anesthesiologist for every four CRNAs. This translates to more than $1 million per year for an average-sized U.S. hospital with four operating rooms. The increased cost of the medical direction model is generally not sustainable, and typically the hospital subsidizes the anesthesia department to cover the cost which is then passed on to consumers of the hospital’s services.
Physician Anesthesiologist-only Model
In this model, the physician anesthesiologist is the sole anesthesia provider. The physician anesthesiologist provides hands-on patient care and stays with the patient throughout the procedure—exactly the way a CRNA functions all the time whether working solo or with a physician anesthesiologist. The physician anesthesiologist-only model is the least commonly used delivery model in the United States. While it is more 5 economical than the medical-direction and medical-supervision models, research has confirmed that it is far less cost-effective and no safer than the CRNA-only model
Some other pearls from the article...
"All CRNAs are board certified, while only 75 percent of physician anesthesiologists are board certified"
"CRNAs are the only anesthesia professionals required to attain clinical experience prior to entering an educational program"
"the American Society of Anesthesiologists (ASA) inflates years of schooling to 12-14 by including a four year bachelor’s degree attained prior to entering medical school, and a post-residency fellowship in an anesthesiology subspecialty such as chronic pain management, which many physician anesthesiologists do not pursue. The bachelor’s degree is typically not healthcare-focused. The ASA also inflates the number of clinical hours attained by residents to approximately 14,000-16,000, which is 2,000-4,000 hours more than the actual number of 12,120. An important difference between clinical education hours attributed to nurse anesthesia students and anesthesiology residents is that the hours claimed by SRNAs are those actually spent providing patient care, while the hours claimed by anesthesiology residents are all hours spent in the facility, including those hours not involved in patient care."
Talking down on AAs and saying their training is clearly inferior to CRNAs which is why they deserve to always be called "assistants" ... then in the very next sentence saying physician anesthesiologist training is closer to that of AAs, implying CRNA training is better than both.
"The education and training of an AA lags far behind that of CRNAs and physician anesthesiologists, hence the “assistant” title. It only takes two years of anesthesiology-focused education and approximately 2,500 hours of clinical training to attain a master’s degree as an AA prior to sitting for the certification examination. Unlike CRNAs, but exactly like physician anesthesiologists, AAs are not required to have any patient care experience before applying to an AA program."
Y'all will love this one.
"By carefully examining overcompensation of physician anesthesiologists for services that can be provided as safely and more cost-effectively by CRNAs, a substantial portion of this percentage can be realized."
CRNA-only Model
In this model, the CRNA is the sole anesthesia provider. The CRNA-only model may vary by state. In some states, CRNAs work without physician supervision; in other states, they are required to be supervised by a physician. The physician could be, but is not required to be, a physician anesthesiologist. Often the supervising physician is a surgeon or other proceduralist. Currently, there are 17 states that have no physician supervision requirement for CRNAs whatsoever, meaning these states have opted out of the federal Medicare physician supervision requirement for CRNAs. Without any burdensome supervision requirement for CRNAs, healthcare facilities in these states can structure and staff their anesthesia departments to function as efficiently, cost-effectively, and safely as possible. Physician supervision of CRNAs is not and never has been a matter of patient safety. Its requirement has always been tied to the ability of a facility to receive reimbursement from the Centers for Medicare & Medicaid Services (CMS) for anesthesia care provided to Medicare patients.
Physician Supervision of CRNAs
Medical supervision is a billing term under Medicare which pertains to when one physician anesthesiologist oversees more than four CRNAs (or AAs) concurrently administering anesthesia to patients undergoing surgical or other procedures. In this model, the physician anesthesiologist doesn’t provide hands-on care, but is available in case he/she is needed to assist in any of the concurrent cases. Research has confirmed that patient safety is not enhanced by this anesthesia delivery model, and that the cost of having a physician anesthesiologist available “just in case” is often greater than the cost of adding two additional CRNAs to the anesthesia department
Physician Anesthesiologist Direction of CRNAs
Medical direction is a billing term under Medicare which pertains to when a physician anesthesiologist directs the anesthesia care of up to four CRNAs (or AAs) providing anesthesia for four different cases concurrently; however, for medical direction to be achieved legally and the physician anesthesiologist to be compensated, the physician anesthesiologist must meet seven requirements of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97–248 (TEFRA) for each case. For obvious reasons, medical direction, with its TEFRA requirements, is the model in which physician anesthesiologist billing fraud occurs most frequently. It is virtually impossible for a physician anesthesiologist to meet the seven TEFRA requirements in concurrent cases (regardless of whether there are two, three or four concurrent cases) without significant delays occurring in each of the cases as the physician anesthesiologist moves from room to room. In 2012, research by Epstein et al and published in the journal Anesthesiology examined this problem relative to delayed case starts (see Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics. - PubMed - NCBI). Aside from the potential for fraudulent billing practices, in most scenarios medical direction comes at an increased cost to the facility of at least one physician anesthesiologist for every four CRNAs. This translates to more than $1 million per year for an average-sized U.S. hospital with four operating rooms. The increased cost of the medical direction model is generally not sustainable, and typically the hospital subsidizes the anesthesia department to cover the cost which is then passed on to consumers of the hospital’s services.
Physician Anesthesiologist-only Model
In this model, the physician anesthesiologist is the sole anesthesia provider. The physician anesthesiologist provides hands-on patient care and stays with the patient throughout the procedure—exactly the way a CRNA functions all the time whether working solo or with a physician anesthesiologist. The physician anesthesiologist-only model is the least commonly used delivery model in the United States. While it is more 5 economical than the medical-direction and medical-supervision models, research has confirmed that it is far less cost-effective and no safer than the CRNA-only model
Some other pearls from the article...
"All CRNAs are board certified, while only 75 percent of physician anesthesiologists are board certified"
"CRNAs are the only anesthesia professionals required to attain clinical experience prior to entering an educational program"
"the American Society of Anesthesiologists (ASA) inflates years of schooling to 12-14 by including a four year bachelor’s degree attained prior to entering medical school, and a post-residency fellowship in an anesthesiology subspecialty such as chronic pain management, which many physician anesthesiologists do not pursue. The bachelor’s degree is typically not healthcare-focused. The ASA also inflates the number of clinical hours attained by residents to approximately 14,000-16,000, which is 2,000-4,000 hours more than the actual number of 12,120. An important difference between clinical education hours attributed to nurse anesthesia students and anesthesiology residents is that the hours claimed by SRNAs are those actually spent providing patient care, while the hours claimed by anesthesiology residents are all hours spent in the facility, including those hours not involved in patient care."
Talking down on AAs and saying their training is clearly inferior to CRNAs which is why they deserve to always be called "assistants" ... then in the very next sentence saying physician anesthesiologist training is closer to that of AAs, implying CRNA training is better than both.
"The education and training of an AA lags far behind that of CRNAs and physician anesthesiologists, hence the “assistant” title. It only takes two years of anesthesiology-focused education and approximately 2,500 hours of clinical training to attain a master’s degree as an AA prior to sitting for the certification examination. Unlike CRNAs, but exactly like physician anesthesiologists, AAs are not required to have any patient care experience before applying to an AA program."
Y'all will love this one.
"By carefully examining overcompensation of physician anesthesiologists for services that can be provided as safely and more cost-effectively by CRNAs, a substantial portion of this percentage can be realized."
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deleted500612
They will basically introduce themselves as "I'm Dr. Smith, I'll be your anesthesiologist". Patients literally have no way of differentiating physicians from nurses any more. The obfuscation is relentless and deliberate. Already gave themselves a PhD in nursing so they can call themselves doctors. Now lets change the title from anesthetist to anesthesiologist to further blur the lines between nurses and doctors! I'm sure it's only a matter of time before they'll find some loophole allowing them to refer to themselves as physicians and put MD after their name ("ohh uhhh... yeah, that just means we are board certified in the state of Maryland")
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Don’t forget orthopedic shoulders. I’m sure that’s what they are counting.
“Cathopathic Nurses” or whatever that other joke thread is. I honestly think that is a satire website, though. Just not a funny one.
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With the push to make healthcare more transparent in terms of costs to patients by insurers and hospitals, can't physicians as a whole work create more transparency when it comes to who is actually administering care to patients?
Like if the pre-op evaluation service asks the patient if they want someone with a nursing school or medical school background responsible for their anesthesia? I'm willing to bet a very small number of patients would select the nurse over the medical doctor in this scenario.
Or have credentials and timelines listed for those administering care sent to patients a day or two before surgery?
Dr. Knotta Nerse, MD - ABA Certified 09-Present, (Insert name) Anesthesiology Residency '04-'08, (Insert Name) School of Medicine '00-'04
Again, I'm willing to bet patients would be reluctant to accept having an "(Nurse) anesthesiologist" without these types of credentials responsible for putting them to sleep and waking them back up.
Same can be done for ("D")NP, and PAs across the entire healthcare landscape. What drawbacks are there to this? Shouldn't patients have the right to know when they go to "the doctor" that they are actually going to see one that went to medical school and trained in a residency?
Like if the pre-op evaluation service asks the patient if they want someone with a nursing school or medical school background responsible for their anesthesia? I'm willing to bet a very small number of patients would select the nurse over the medical doctor in this scenario.
Or have credentials and timelines listed for those administering care sent to patients a day or two before surgery?
Dr. Knotta Nerse, MD - ABA Certified 09-Present, (Insert name) Anesthesiology Residency '04-'08, (Insert Name) School of Medicine '00-'04
Again, I'm willing to bet patients would be reluctant to accept having an "(Nurse) anesthesiologist" without these types of credentials responsible for putting them to sleep and waking them back up.
Same can be done for ("D")NP, and PAs across the entire healthcare landscape. What drawbacks are there to this? Shouldn't patients have the right to know when they go to "the doctor" that they are actually going to see one that went to medical school and trained in a residency?
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No, patients would just be impressed by all the letters after the crnas name. "rn bsn crna aprn cbc nbc jrsl idgaf"
AANA: 'Despite Having Much Less Training CRNAs Also Equivalent to Neurosurgeons, Fighter Pilots, and LeBron James' | GomerBlog
"Where is the research proving CRNA’s can't fly jets as well as fighter pilots? I haven’t seen it so we should be allowed to independently fly jets, drop bombs and stuff.
Gomerblog doing more to support anesthesiologists than the ASA lol
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deleted941485
The word Salad after the name works every time. Those clipboard carriers love it.
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AANA: 'Despite Having Much Less Training CRNAs Also Equivalent to Neurosurgeons, Fighter Pilots, and LeBron James' | GomerBlog
"Where is the research proving CRNA’s can't fly jets as well as fighter pilots? I haven’t seen it so we should be allowed to independently fly jets, drop bombs and stuff.gomerblog.com
Gomerblog doing more to support anesthesiologists than the ASA lol
Lol, so good.
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Let's just say that CRNAs become independent as they hope, I still don't see a scenario where they overcome the AMCs who will undoubtedly control their income. They will open themselves up to more liability, will be easily overruled by any surgeon and will have nothing to show for it. The hospitals will see them for what they are...nurses and will treat them as such. They do at my joint and don't want come near them with a 10-ft pole.
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I fully support CRNA independence. No decent surgeon will want to work with them. I once mentioned that to our surgeons, the answer was an absolute NO. I am in CA, an opt out state.
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I literally cannot believe my eyes. I feel like the AANA needs to be wholly rejected by their members, or, their profession needs to lose any credibility it has left.
My friend is in his fourth year of residency for anesthesia. I’m literally shaking in anger over how they claim superiority to the insanely long and arduous road he has gone through to earn the title of anesthesiologist. This isn’t right. I’m a PA student and this is horrifying to me.
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What is an opt-out state?
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Google is your friend. In short, they can practice independently in these states without anesthesiologists.
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Excellent, this needs to be expanded and acted on.
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Nursing led healthcare is the way this country is going... nurses doing IR procedures, working as hospitalists and intensivists and in the ED, seeing consults for all specialty services, starting to do procedures like caths and EGDs... it's not just anesthesia.
The set up of the healthcare system and insurance is driving this. There's too much work, too many patients and procedures, too expensive to have doctors do it alone. Have you ever met a doctor in the hospital that wasn't running around like a chicken with its head cut off and stretched too thin?
Changing the system requires addressing the underlying cause: how we deliver and pay for care. I don't think appealing to specialty boards, doctors, patients, or even nurses is going to change our trajectory. The system simply wouldn't function if nurses weren't expanding their scope. Let CRNAs practice independently so that we can absolve ourselves of their mistakes (if they make them). I don't think their independence will result in any less demand for MDs... just would let us get back to the ORs and not have to supervise. Like gomerblog says, just because someone claims to be Lebron doesn't make it true.
The set up of the healthcare system and insurance is driving this. There's too much work, too many patients and procedures, too expensive to have doctors do it alone. Have you ever met a doctor in the hospital that wasn't running around like a chicken with its head cut off and stretched too thin?
Changing the system requires addressing the underlying cause: how we deliver and pay for care. I don't think appealing to specialty boards, doctors, patients, or even nurses is going to change our trajectory. The system simply wouldn't function if nurses weren't expanding their scope. Let CRNAs practice independently so that we can absolve ourselves of their mistakes (if they make them). I don't think their independence will result in any less demand for MDs... just would let us get back to the ORs and not have to supervise. Like gomerblog says, just because someone claims to be Lebron doesn't make it true.
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AANA: 'Despite Having Much Less Training CRNAs Also Equivalent to Neurosurgeons, Fighter Pilots, and LeBron James' | GomerBlog
"Where is the research proving CRNA’s can't fly jets as well as fighter pilots? I haven’t seen it so we should be allowed to independently fly jets, drop bombs and stuff.
Gomerblog doing more to support anesthesiologists than the ASA lol
Touched a nerve.
https://mobile.twitter.com/aanawebupdates/status/1132030425533173767?s=20
I know people say they want the ASA to respond to things, but dear god please don’t become this. They come off as so desperate and childish. It’s not a good look.
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I replied on Twitter. I can’t help myself. Many CRNAs I work with are my good friends and to think this is the organization that represents them makes my blood boil.
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The AANA propaganda overlooks the fact that many CRNA's want to work with docs in a true team effort. The belligerent, pugilistic attitude of their political leadership is doomed to backfire. It is indeed childish and ignorant.
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Absolutely true. We employ several dozen CRNAs - but the percentage of them of our overall staff dwindles a little each year as more and more believe the independent practice mantra drilled into them literally from Day 1 of CRNA school.
Remember that they essentially coerce their members into membership in the AANA through cost incentives related to recertification.
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deleted126335
I don't think so. The leadership and a significant fraction of their membership has been just as belligerent for decades. No sign whatsoever of it backfiring. Over time,
The amount of MD-Anesthesia has declined.
The amount of solo CRNA anesthesia has increased.
Supervisory ratios have gone up.
It may be childish. It may be ignorant. But it is not failing.
BTW, with the exception of a few CRNAs who subsequently went to medical school and became Anesthesiologists, I have NEVER, EVER heard of a CRNA publicly taking a stand that anesthesiologist supervision of CRNAs improves quality of care. Not one.
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I've also never heard one criticize the AANA.
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Was playing some live poker last night and got to chatting with the table. After a couple hrs this guy asks what I do, I say physician. He asks what specialty, I say anesthesiologist. His next question? Did I become an anesthesiologist through the MD or physician assistant route.....
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HAH, to be fair I was sitting next to a dermatologist at a local charity event and someone asked her where she got her DNP from... she wasn’t exactly thrilled.
