Short history of nurse anesthesia and future of anesthesia care (written by MD)

[aneftp]

https://www.linkedin.com/pulse/crnas-short-history-nurse-anesthesia-future-care-matthew-mazurek-md

Hmm, after reading the article (and supposedly he's from all MD anesthesia practice in Arizona).

The real question is wonder is whether his group is about to sell out to a management company soon??? Cause if they are from all MD group and he's promoting CRNAs. Those are tell tell signs they may be selling soon.

Just a hunch.

Cause Sheridan/Amsurg/Envision brought the other huge group in Arizona a couple of years ago.

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[Man o War]

He's more than welcome to get his anesthetic from one of the independent CRNAs, I sure as hell won't be!

 

[waterbottle10]

I think the issue isn't that they are nurses. But that their training is vastly shorter and less rigorous in terms of cases. That's basically saying the extra cases MD do are useless

 

[Wiscoblue]

So if they had a longer training and more cases you'd call them equivalent? The difference is that they are nurses and we are docs. We come from a different population of intelligence, critical thinking and knowledge. Just because a PA sits in with med students and read our books doesn't make them a doc. Same goes for CRNAs. They are nurses and they try to blur the difference with terms like anesthetist, provider and MDA.

 

[Consigliere]

And now I hate someone else.

 

[WholeLottaGame7]

Nauseating. Just like it's easy for the AANA to pretend like there aren't a bunch of CRNAs out there who don't want to be independent, it's easy for us to think that there aren't any MDs out there who are willing to sell us down the river as readily as this guy is doing.

 

[aneftp]

The true test of who is more qualify is new grad srna vs a new grad MD doing similiar high risk case.

That's the only way to to run a real study.

Have Asa 4e patient with new solo new grad crna and md. Run 1000 of these cases double blind. Who wants to volunteer?

Cause most of those experienced Crna's I argue with always use that "new" grad MD getting into trouble doing solo endo cases in private practice.

Yet we MDs protect the new grad Crna's and give them easy cases till we learn to trust them and as they gain experience let them do more

So most of what crna claim is equivalent training is really what many lean on the job in terms of technical skills. But fund of knowledge is lacking.

I go round and round with this argument. And their argument always is they wouldn't ever exposed a high risk patient to any new "provider"

 

[deleted126335]

1% of anesthesiologists agree with this guy. On the other hand, he just bought/earned the loyalty and support of every CRNA he will ever work with. Nothing like being a department chairman where the majority of employees support you personally.

 

[aneftp]

1% of anesthesiologists agree with this guy. On the other hand, he just bought/earned the loyalty and support of every CRNA he will ever work with. Nothing like being a department chairman where the majority of employees support you personally.

Like I said. Something sounds very fishy. He's the new "chief of staff elect" at his hospital.

It's either a setup for future use of Crna at their practice. Out west as we all know many of the groups are all MD and that's all surgeons are used to. So will look at Crna's with skepticism.

It's funny how some Crna's in the South I know say surgeons don't want MDs in the room and only Crna's. So it's who the surgeon is comfortable with.

 

[Man o War]

Like I said. Something sounds very fishy. He's the new "chief of staff elect" at his hospital.

It's either a setup for future use of Crna at their practice. Out west as we all know many of the groups are all MD and that's all surgeons are used to. So will look at Crna's with skepticism.

It's funny how some Crna's in the South I know say surgeons don't want MDs in the room and only Crna's. So it's who the surgeon is comfortable with.

The CRNAs tell you the surgeons don't want MDs in the room? I've never heard that. Do you believe them?

 

[aneftp]

The CRNAs tell you the surgeons don't want MDs in the room? I've never heard that. Do you believe them?

Yes, there are AMCs run hospitals that go through anesthesiologists like water. So the surgeons get used to the crna remaining. So the locums MDs who funnel through there are just rubber stampers/sign their names on the chart and leave. Than you get a few crazy locums MDs there looking for a paycheck and you get my drift. The surgeons start not trusting some of these new MDs who funnel through there.

They just want their cases done and get the heck out. They just want a warm body they recognize every day. So it's the surgeons who just want to push their cases through and don't want some new anesthesiologist cancelling their cases.

 

[Consigliere]

Yes, there are AMCs run hospitals that go through anesthesiologists like water. So the surgeons get used to the crna remaining. So the locums MDs who funnel through there are just rubber stampers/sign their names on the chart and leave. Than you get a few crazy locums MDs there looking for a paycheck and you get my drift. The surgeons start not trusting some of these new MDs who funnel through there.

They just want their cases done and get the heck out. They just want a warm body they recognize every day. So it's the surgeons who just want to push their cases through and don't want some new anesthesiologist cancelling their cases.

Very true. Plus, surgeons can bully CRNAs; any self respecting anesthesiologist (not the writer of the garbage above) will stand up to a surgeon and advocate for their patient.

 

[AdmiralChz]

surgeons can bully CRNAs

This times a million, and why it's so important we keep anesthesiologist-led care.

"Oh come on, I am sure we can do this BMI 70 patient at th ASC it's just a quick shoulder scope and all my equipment is there."

"The patient ate, but let's just split the difference and go in 4 hours so we can all go home earlier"

"You don't really think this is cardiac chest pain do you? Can't we just do the case, the patient really needs it."

All real examples at our shop the last couple months and the CRNA in each case advocated for going forward with the case, probably because the surgeon involved is a real pill (and two of them only have a month left anyway). They were overruled in each case, and told it isn't their decision to give a break.

 

[GA8314]

The key to some of the insightful, and true, posts above is low MD turnover. High performing MD's, and even in an ACT model, sitting rooms from time to time. Being a positive role in throughput and keeping things running on time, efficiently, and safely. In an ACT model, this is possible, but maybe harder. It is doable.

Seeing patients on time and keeping things moving are important. Get the patient to the block room early. Get the patient lined up or place the epidural on time or early, so it doesn't delay the OR.

It's easier to sit your own room from time to time in an ACT model when you employ your CRNA's. Find value regardless of your situation. It's possible. Be there, in the OR, during highly visible points in the case. Show a presence. It's not that hard but goes a long way.

And, never ever lose your ability to run a room yourself, fast and efficiently.......

 

[soorg]

What an ass. ABA should revoke his certification. Better, the AANA should make him an honorary member.

 

[aneftp]

What an ass. ABA should revoke his certification. Better, the AANA should make him an honorary member.

There is just some ulterior motive for him writing this article. Like I said. He's the "new chief of staff" at local hospital

1. Bringing in Crna's and increasing profit margin for MD group to remain private

2. Selling to highest offer AMC who will bring in Crna's themselves to maintain profit margin

I betcha one of those two situation will Or about to happen

 

[Man o War]

Well....here's your answer folks:

Quote from the the author, Dr. Matthew Mazurek:
"Just accepted a position with independent CRNAs as the main providers. Not a true medically directed model, but I am the medical director, so I will have oversight of operations"

BOUGHT AND PAID FOR.
Doctors who write stuff like this always have an ulterior motive.
I wonder if they wrote it in his contract that he must write and publish crap like this.

 

[aneftp]

Well....here's your answer folks:

Quote from the the author, Dr. Matthew Mazurek:
"Just accepted a position with independent CRNAs as the main providers. Not a true medically directed model, but I am the medical director, so I will have oversight of operations"

BOUGHT AND PAID FOR.
Doctors who write stuff like this always have an ulterior motive.
I wonder if they wrote it in his contract that he must write and publish crap like this.

Where did u find this.

 

[Man o War]

Where did u find this.

Comments section- scroll to the bottom of the article.

 

[deleted126335]

Well....here's your answer folks:

Quote from the the author, Dr. Matthew Mazurek:
"Just accepted a position with independent CRNAs as the main providers. Not a true medically directed model, but I am the medical director, so I will have oversight of operations"

BOUGHT AND PAID FOR.
Doctors who write stuff like this always have an ulterior motive.
I wonder if they wrote it in his contract that he must write and publish crap like this.

As my signature says:

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
― Upton Sinclair

 

[Robotic Wis-Hipple]

What a tool.

If Dr's and CRNAs are equivalent why do they need a Director?

I wonder if outcomes and complication rates will be tracked as closely as they were before going forward at his hospital....

 

[aneftp]

What a tool.

If Dr's and CRNAs are equivalent why do they need a Director?

I wonder if outcomes and complication rates will be tracked as closely as they were before going forward at his hospital....

Mainly these type of practices are all MDs. But they branch out and start hiring crnas in outpatient places

I betcha that's where they are starting at their outpatient places and non medically direct them. Increase profit margin. Why have 3-4 MDs solo at outpatient and pay them $400-500k? Cheaper to have 3-4 Crna's and pay them $150/200k

I am not jealous of him. It's his business and he's welcome to run it anyway he wants it.

But he's just got too much vested interested (financially ) it makes his article not worth anything.

I got into arguments with my crna friends over this article. They simple don't understand. Or maybe they do understand. They can practice "independent". That will make their ego bigger. But their paycheck ain't any bigger. It's not like this guy will pay them MD wages.

Notice he won't disclose ownership in the anesthesia practice. This is why these social media websites are all propaganda. Once u do research u can pretty much figure people out.

Does he or doesn't he not have a financial stake in the anesthesia billing?

 

[No_Pain]

They can practice "independent". That will make their ego bigger. But their paycheck ain't any bigger. It's not like this guy will pay them MD wages.

This is my understanding as well. Which is why I never understood why CRNA's try to equate us saying Anesthesia is so easy a nurse can do it. What they should be saying is: "anesthesia is so hard, MDA's deserve a raise!" since their salary is linked with ours

 

[GaseousClay]

the comments make me want to vomit. From MDs and CRNAs. what a joke

 

[aneftp]

I just have to get a good laugh at my crna friends who sent me this link originally. Plus a few of them HATE DONALD Trump. Trying not to get political but I tried to explain to them this MD who posted a pro crna article is playing them like a fool. Like trump!

Cause this guy playing them like a fool. He's not paying them any more. He's just recruiting Crna's to work for him and not paying them any more. And they will think he's crna friend has he takes their billing rights and profits from it.

And these guys will get even greedier. Most than start doing side pain procedures while acting as medical director to drive more income to the surgery center. While collecting crna "independent" billing rights at same surgery center.

This game has been played out so many times. Trust me. My buddy in Florida has done this before and explained this is the best way to maxmize profit.

But he's extremely careful not selecting brand new crna grads for "independent" practice. Cause new grads simply do not have the experience to function in many of these settings.

And that goes back to are brand new srna grads ready for independent practice.

 

[d9sccr]

The true test of who is more qualify is new grad srna vs a new grad MD doing similiar high risk case.

That's the only way to to run a real study.

Have Asa 4e patient with new solo new grad crna and md. Run 1000 of these cases double blind. Who wants to volunteer?

Cause most of those experienced Crna's I argue with always use that "new" grad MD getting into trouble doing solo endo cases in private practice.

Yet we MDs protect the new grad Crna's and give them easy cases till we learn to trust them and as they gain experience let them do more

So most of what crna claim is equivalent training is really what many lean on the job in terms of technical skills. But fund of knowledge is lacking.

I go round and round with this argument. And their argument always is they wouldn't ever exposed a high risk patient to any new "provider"

No IRB would ever approve that study nor should they.

I don't know why, but our interest groups fail to highlight simple things. They want to attack our profession, fine. Take the gloves off. Hit back for once.

- Discuss their non-inferior "studies". Respond in laymen's terms in our major journals to their papers comparing ASA I,II's taken care of by CRNAs to all comers by anesthesiologists and when the next VA bill comes around, take out ads and educate the public.
- Highlight that 1 year of residency is amounts to nearly double (SRNAs only work 3 days/week here) the training they receive before going out
- Maybe make an easy reporting system or push for reimbursement and therefore a paper trail whenever an anesthesiologist has to intervene in a case
- I don't know if it would be possible, but somehow splitting malpractice to give them skin in the game

 

[Iso4ane]

Just because a 5th grader and a 12th grader may get the same scores on an addition test does not imply they both have the same competency in mathematics.

And to be fair, just like with MDs/CRNAs, there probably are 5th graders whose math abilities exceed some of their 12th grader counterparts, but that is the exception, not the norm.

 

[AdmiralChz]

Did anyone see this?

Nurse Anesthetists Decry De Facto Medicare Exclusion

Looks like Medicare is trying to make chronic pain procedures reimbursable only if a physician is doing it.

 

[Man o War]

Did anyone see this?

Nurse Anesthetists Decry De Facto Medicare Exclusion

Looks like Medicare is trying to make chronic pain procedures reimbursable only if a physician is doing it.

This is amazing.

 

[WholeLottaGame7]

This is amazing.

"I know there are bullets flying everywhere, and your arm pain is probably the result of the shrapnel from the IED that just went off near you, but you're making it really hard to do this C-ESI with all the yelling and screaming and moving around all over the place..."

 

[Arch Guillotti]

I got into arguments with my crna friends over this article.

lol, why do you even have this discussion with them?

 

[Arch Guillotti]

I just made the mistake of reading the comments section.

The biggest troll of them all Mike M of course had to get his two cents in.

What a loser!

 

[soorg]

The feel-good story of the year. My heart is all warm and fuzzy.

 

[Man o War]

I just made the mistake of reading the comments section.

The biggest troll of them all Mike M of course had to get his two cents in.

What a loser!

Look up some of his past SDN posts. Funny stuff considering how much smack he talks now about his anesthesia proficiency on EVERY single internet post pertaining to anesthesia.

 

[AdmiralChz]

Good lord that comments section is a massive circle jerk, woof.

 

[deleted697535]

How about nursing surgeons? Supervised by an anaestheist?

 

[waterbottle10]

How about nursing surgeons? Supervised by an anaestheist?

They need to open nursing surgeon schools. Unfortunately surgeons egos are prob too big for them to ever teaxh nurses

 

[BLADEMDA]

This is amazing.

The decision to exclude CRNAs who bill Medicare for pain procedures won't hold up. I fully expect a reversal as that type of policy decision must come from CMS itself.

 

[Consigliere]

The decision to exclude CRNAs who bill Medicare for pain procedures won't hold up. I fully expect a reversal as that type of policy decision must come from CMS itself.

Me too. 0% chance of this holding up.

 

[deleted126335]

You fight on every front. You never know, you might get lucky. At least you make them spend resources. Just like they do to us. e.g., the recent attempt at an end run around the VA decision: American Society of Anesthesiologists - New House Independent Practice Legislation for VA Nurse Anesthetists

 

[Noyac]

I think the issue isn't that they are nurses. But that their training is vastly shorter and less rigorous in terms of cases. That's basically saying the extra cases MD do are useless

I disagree completely. The issue is that they are nurses and if you were to extend their training they still would never be as capable as someone who completed medical school.

Oops, I didn't see Wisco's response when I posted this but I'll leave it up anyway. It needs to be repeated.

 

[nimbus]

I disagree completely. The issue is that they are nurses and if you were to extend their training they still would never be as capable as someone who completed medical school.

Oops, I didn't see Wisco's response when I posted this but I'll leave it up anyway. It needs to be repeated.

I don't dispute that anesthesiologist training is superior to crna training and that on average anesthesiologists have a record of higher academic achievement and credentials than the average crna. However, in my career, I have encountered some crnas that I would choose to care for me over some anesthesiologists if the choice was between the 2. So there are exceptions.

 

[aneftp]

I don't dispute that anesthesiologist training is superior to crna training and that on average anesthesiologists have a record of higher academic achievement and credentials than the average crna. However, in my career, I have encountered some crnas that I would choose to care for me over some anesthesiologists if the choice was between the 2. So there are exceptions.

And that's the point. Crna's say they are just as safe.

Yet they want to blur the lines a day 1 new srna grad is the same as a day 1 new MD grad.

Many Crna's boast they do their own cases from Day 1. Sure where? Ain't in the big cities with ASA4 consistent cases Day 1 new grad.

Most go work out rural areas not busy places working "solo". If that.

Most work a few years essentially getting more on the job training under medical supervision model than bolt.

 

[Man o War]

I don't dispute that anesthesiologist training is superior to crna training and that on average anesthesiologists have a record of higher academic achievement and credentials than the average crna. However, in my career, I have encountered some crnas that I would choose to care for me over some anesthesiologists if the choice was between the 2. So there are exceptions.

The problem is nobody gets to choose though, unless you work at that hospital and have the option. By and large, a CRNA I'd take over a doc is the extreme exception and not the rule. Also depends on the surgery I'm having.
If you pick a random group of 100 anesthesiologists and 100 CRNAs, there is no doubt in my mind a patient would be safer with the doc group.
There are tons of CRNAs who don't do lines, don't do blocks, have never managed a cardiac case from start to finish, have never seen some of the weird stuff anesthesiologists do simply because they put enough time in during training to see them....it isn't possible for a patient to be safer with that provider.

 

[nimbus]

And that's the point. Crna's say they are just as safe.

Yet they want to blur the lines a day 1 new srna grad is the same as a day 1 new MD grad.

Many Crna's boast they do their own cases from Day 1. Sure where? Ain't in the big cities with ASA4 consistent cases Day 1 new grad.

Most go work out rural areas not busy places working "solo". If that.

Most work a few years essentially getting more on the job training under medical supervision model than bolt.

The problem is nobody gets to choose though, unless you work at that hospital and have the option. By and large, a CRNA I'd take over a doc is the extreme exception and not the rule. Also depends on the surgery I'm having.
If you pick a random group of 100 anesthesiologists and 100 CRNAs, there is no doubt in my mind a patient would be safer with the doc group.
There are tons of CRNAs who don't do lines, don't do blocks, have never managed a cardiac case from start to finish, have never seen some of the weird stuff anesthesiologists do simply because they put enough time in during training to see them....it isn't possible for a patient to be safer with that provider.

I'm talking about experienced CRNAs and it's the exception rather than the rule. On average I'd pick an anesthesiologist but there are some scary anesthesiologists out there and some excellent CRNAs.

 

[Wiscoblue]

Yes I'm sure there is a small overlap of two distinct bell curves where the mean of each curve is significantly far apart enough to make them two different populations.

I'm sure the Crna will do a lot more of the nursing stuff and be more diligent with covering your eyes or making sure the et tube tape is not cutting the lip and the elbow is padded and there is an ax roll for that 15 minute case. But will he or she have the knowledge or the expertise to do a blood gas, interpret it, and treat it in a 5 hour robotic bowel with the patient standing on his head? You put your best crna up against an average doc and I bet the crna will come up short.


Sent from my iPad using Tapatalk

 

[nimbus]

Yes I'm sure there is a small overlap of two distinct bell curves where the mean of each curve is significantly far apart enough to make them two different populations.

I'm sure the Crna will do a lot more of the nursing stuff and be more diligent with covering your eyes or making sure the et tube tape is not cutting the lip and the elbow is padded and there is an ax roll for that 15 minute case. But will he or she have the knowledge or the expertise to do a blood gas, interpret it, and treat it in a 5 hour robotic bowel with the patient standing on his head? You put your best crna up against an average doc and I bet the crna will come up short.


Sent from my iPad using Tapatalk

I'm not disputing this at all.

 

[deleted162650]

Yes I'm sure there is a small overlap of two distinct bell curves where the mean of each curve is significantly far apart enough to make them two different populations.

I'm sure the Crna will do a lot more of the nursing stuff and be more diligent with covering your eyes or making sure the et tube tape is not cutting the lip and the elbow is padded and there is an ax roll for that 15 minute case. But will he or she have the knowledge or the expertise to do a blood gas, interpret it, and treat it in a 5 hour robotic bowel with the patient standing on his head? You put your best crna up against an average doc and I bet the crna will come up short.


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That very graph has been posted here before.

 

[Modanq]

I also think we should step up to the plate. We should change the dynamics and understanding of what anesthesiologists do.
What are your thoughts on the following ideas...
1. We should have standard education in Echo both TEE and TTE.
All residents in anesthesiology should graduate with board certification in both surface and cardiac echo. You can use TTE as point of care. Instead of randomly giving fluids figure out how much a prepped-NPO-bowel obstruction patient needs. We can bill for ultrasound and it makes us indispensable.
2. Our residents/attending shouldn't be wheeling patients into the OR...really can't believe we still do that. We should be managing the OR managing the medical needs of the patient.
3. In our PA run pre-op anesthesiology clinic we can do our own TTE and manage pre-op medication management. What the hell is the MD degree for. Why do we need to send the patient to cardiology for B-Blockade titration pre-operatively. Or holding prils. Why does the PCP need to schedule patients for stress testing??? We can run our own TTE clinic and complete that in anesthesia clinic.
3. We should create education pathways for MD only in ultrasound blocks and catheter placements. This should be logged and more nuanced in the ACGME log book. That way it is stiffer for credentialing at the hospital level.
4. We should subsume ICU care into our standard of practice and core residency. Yes we may lose some $$ and not everyone is interested in ICU but our clout in the hospital will grow. At my institution the anesthesiologists run the ECMO service, the trauma transport team, and also the ICUs.
5. Why are we considered the PIV experts but never learn how to place PICC lines. We should supervise a line vascular service prob RN run but the tough cases should come to the MD.
6. The pain services should be hospital wide anesthesiologist run. It will initially be more work but in 15-20 years when we own methadone, PCAs, narcotics, ketamine etc... like we own propofol we can be leaders in all areas of the hospitals.
7. We let neuromonitoring slip right in front of us? I always wonder why we claim to be expert monitorists in the OR however when it comes to SSEPs the tech reports to a Neurologist. How did we let these folks into our own ORs???
I hate to admit but some older MDs got lazy. We should be billing for SSEP and MEP monitoring.
Its important to step up to the MD title.
Just some ideas that I think will broaden the scope and respect of the anesthesiologist. CRNAs should exist just like the ICU nurses, we need to broaden the things we do...We just can't sit in a chair for a 10 hour case and clock out.
Just my two cents.

 

[Nivens]

I also think we should step up to the plate. We should change the dynamics and understanding of what anesthesiologists do.
What are your thoughts on the following ideas...
1. We should have standard education in Echo both TEE and TTE.
All residents in anesthesiology should graduate with board certification in both surface and cardiac echo. You can use TTE as point of care. Instead of randomly giving fluids figure out how much a prepped-NPO-bowel obstruction patient needs. We can bill for ultrasound and it makes us indispensable.
2. Our residents/attending shouldn't be wheeling patients into the OR...really can't believe we still do that. We should be managing the OR managing the medical needs of the patient.
3. In our PA run pre-op anesthesiology clinic we can do our own TTE and manage pre-op medication management. What the hell is the MD degree for. Why do we need to send the patient to cardiology for B-Blockade titration pre-operatively. Or holding prils. Why does the PCP need to schedule patients for stress testing??? We can run our own TTE clinic and complete that in anesthesia clinic.
3. We should create education pathways for MD only in ultrasound blocks and catheter placements. This should be logged and more nuanced in the ACGME log book. That way it is stiffer for credentialing at the hospital level.
4. We should subsume ICU care into our standard of practice and core residency. Yes we may lose some $$ and not everyone is interested in ICU but our clout in the hospital will grow. At my institution the anesthesiologists run the ECMO service, the trauma transport team, and also the ICUs.
5. Why are we considered the PIV experts but never learn how to place PICC lines. We should supervise a line vascular service prob RN run but the tough cases should come to the MD.
6. The pain services should be hospital wide anesthesiologist run. It will initially be more work but in 15-20 years when we own methadone, PCAs, narcotics, ketamine etc... like we own propofol we can be leaders in all areas of the hospitals.
7. We let neuromonitoring slip right in front of us? I always wonder why we claim to be expert monitorists in the OR however when it comes to SSEPs the tech reports to a Neurologist. How did we let these folks into our own ORs???
I hate to admit but some older MDs got lazy. We should be billing for SSEP and MEP monitoring.
Its important to step up to the MD title.
Just some ideas that I think will broaden the scope and respect of the anesthesiologist. CRNAs should exist just like the ICU nurses, we need to broaden the things we do...We just can't sit in a chair for a 10 hour case and clock out.
Just my two cents.

A all-time great post