They will never stop seeking indy status

[OptionOffense]

CRNAs seeking permanent removal of supervision

Imagine the nutsack you have to have to be a nurse and say you dont need supervision.
You wonder why I say ASA should advocate for C-AA in all 50 states to replace the RNs.

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[Dr. Rude]

CRNAs seeking permanent removal of supervision

Imagine the nutsack you have to have to be a nurse and say you dont need supervision.
You wonder why I say ASA should advocate for C-AA in all 50 states to replace the RNs.

We know. Been that way for 40+ years.

 

[OptionOffense]

We know. Been that way for 40+ years.

Was it this bad 40 years ago?

 

[Dr. Rude]

Was it this bad 40 years ago?

In terms of intent...yes. In terms of behavior...no.

 

[anaesthetic]

CRNAs seeking permanent removal of supervision

Imagine the nutsack you have to have to be a nurse and say you dont need supervision.
You wonder why I say ASA should advocate for C-AA in all 50 states to replace the RNs.

That’s what they all seem to want in the end, including C-AAs, IMO. Look at PAs not wanting to be known as “physician assistants” anymore. I don’t buy the whole “we’re under the medical model so we’ll never push for independence” mantra. It’s already a conversation in certain circles.

 

[kidthor]

That’s what they all seem to want in the end, including C-AAs, IMO. Look at PAs not wanting to be known as “physician assistants” anymore. I don’t buy the whole “we’re under the medical model so we’ll never push for independence” mantra. It’s already a conversation in certain circles.

Yes “physician associates” are the sequel to “nurse anesthesiologists”.

 

[epidural man]

I really need help understanding why physicians are so against CRNA's practicing independently.....

I can't wrap my ahead around how an anesthesiologist wants to be totally and legally responsible for a less-trained pig headed stubborn adult.

If you got paid the exact same to supervise 4 CRNA's, or do your own case...you would rather supervise?

 

[OptionOffense]

I really need help understanding why physicians are so against CRNA's practicing independently.....

I can't wrap my ahead around how an anesthesiologist wants to be totally and legally responsible for a less-trained pig headed stubborn adult.

If you got paid the exact same to supervise 4 CRNA's, or do your own case...you would rather supervise?

You have to play the long game here and not just thinking about yourself. What do you think will happen to the quality of anesthetic care in this country if it is relegated to CRNAs?: which will happen once they equate nursing care with medical care. Once that is equalized in their minds , the pay disparity will go away, and medical anesthetic care will eventually disappear and die.
It is easy to say, yea just dont supervise them, which I dont, but eventually you wont have that option if you have that attitude.

 

[jwk]

That’s what they all seem to want in the end, including C-AAs, IMO. Look at PAs not wanting to be known as “physician assistants” anymore. I don’t buy the whole “we’re under the medical model so we’ll never push for independence” mantra. It’s already a conversation in certain circles.

It's not for CAAs. Hasn't been - won't be. I've been doing it for more than 40 years - it simply is not part of any discussions within our CAA professional organizations and I'm way up in the hierarchy.

 

[Dr. Rude]

It's not for CAAs. Hasn't been - won't be. I've been doing it for more than 40 years - it simply is not part of any discussions within our CAA professional organizations and I'm way up in the hierarchy.

Also, anesthesiologists are part of the governing board of the AA national professional organization. I suspect that changing the bylaws to remove this representation would require a supermajority and physician consent. Nothing is impossible, but Highly unlikely.

 

[epidural man]

You have to play the long game here and not just thinking about yourself. What do you think will happen to the quality of anesthetic care in this country if it is relegated to CRNAs?: which will happen once they equate nursing care with medical care. Once that is equalized in their minds , the pay disparity will go away, and medical anesthetic care will eventually disappear and die.
It is easy to say, yea just dont supervise them, which I dont, but eventually you wont have that option if you have that attitude.

You only think this way if you don’t believe the quality of care provided by Anesthesiologist isn’t superior.

 

[OptionOffense]

You only think this way if you don’t believe the quality of care provided by Anesthesiologist isn’t superior.

It doesnt matter what I believe. Dont make this about me or you. It is about what patients, decision makers, policymakers believe. And heretefore, I have not seen evidence that they believe we are that much superior to justify NOT having 20 states opt out and counting. If they want cheaper, we can give them a cheaper alternative to having every stool to be sat by a physician. One in which we are involved in training. Quality control

 

[epidural man]

It doesnt matter what I believe. Dont make this about me or you. It is about what patients, decision makers, policymakers believe. And heretefore, I have not seen evidence that they believe we are that much superior to justify NOT having 20 states opt out and counting. If they want cheaper, we can give them a cheaper alternative to having every stool to be sat by a physician. One in which we are involved in training. Quality control

I agree. It’s about what patients want ultimately.

I say let the patients decide. Let them have a baby in a hospital with a busy NICU with only CRNAs.

That will go bad quickly and people will quickly decide NOT to go to that hospital.

This only works if we not only allow CRNAs work independent but DEMAND they work independent and refuse to work with them in any capacity. We will not step foot in their hospital. They should get what they asked for.


I think it would take about 30 days for all CRNAs to loose their job in big hospitals, or come back begging to be supervised.

 

[OptionOffense]

I agree. It’s about what patients want ultimately.

I say let the patients decide. Let them have a baby in a hospital with a busy NICU with only CRNAs.

That will go bad quickly and people will quickly decide NOT to go to that hospital.

This only works if we not only allow CRNAs work independent but DEMAND they work independent and refuse to work with them in any capacity. We will not step foot in their hospital. They should get what they asked for.


I think it would take about 30 days for all CRNAs to loose their job in big hospitals, or come back begging to be supervised.

Do you honestly believe that would be good policy?

 

[coffeebythelake]

I agree. It’s about what patients want ultimately.

I say let the patients decide. Let them have a baby in a hospital with a busy NICU with only CRNAs.

That will go bad quickly and people will quickly decide NOT to go to that hospital.

This only works if we not only allow CRNAs work independent but DEMAND they work independent and refuse to work with them in any capacity. We will not step foot in their hospital. They should get what they asked for.


I think it would take about 30 days for all CRNAs to loose their job in big hospitals, or come back begging to be supervised.

They won't come begging. They are delusional. AANA.

 

[nimbus]

I agree. It’s about what patients want ultimately.

I say let the patients decide. Let them have a baby in a hospital with a busy NICU with only CRNAs.

That will go bad quickly and people will quickly decide NOT to go to that hospital.

This only works if we not only allow CRNAs work independent but DEMAND they work independent and refuse to work with them in any capacity. We will not step foot in their hospital. They should get what they asked for.


I think it would take about 30 days for all CRNAs to loose their job in big hospitals, or come back begging to be supervised.

Don’t know if I would go there.

Some patients decide to have their babies at home, in an inflatable spa.


We have a local hospital staffed CRNA only. About 300 beds, low volume OR and L&D (2000 cases and 1100-1200 deliveries). They have a very challenging patient population and seem to have been getting along fine for years. That said, I think all or most of their CRNAs are former navy so they have more experience than the average new grad CRNA.

 

[jwk]

I agree. It’s about what patients want ultimately.

I say let the patients decide. Let them have a baby in a hospital with a busy NICU with only CRNAs.

That will go bad quickly and people will quickly decide NOT to go to that hospital.

This only works if we not only allow CRNAs work independent but DEMAND they work independent and refuse to work with them in any capacity. We will not step foot in their hospital. They should get what they asked for.


I think it would take about 30 days for all CRNAs to loose their job in big hospitals, or come back begging to be supervised.

Although I agree with the general sentiment, OB is a bad example to use - a LOT of anesthesia groups, even those that are very well staffed, already fully cede their OB work to CRNAs simply because they never, ever, ever, want to do an OB anesthetic. Witness this thread that started yesterday...

I got offered a job straight out of residency in a Big OB/GYN hospital, should I accept?

CA3 here… so I got recruited to a big OB/GYN center starting in a couple of months. i did like 4 months there as a part of my training and I made a good impresion with the head of anesthesia, but I can’t help but be nervous about my first real job out there. I posted this elsewhere and the...

forums.studentdoctor.net

 

[nimbus]

Although I agree with the general sentiment, OB is a bad example to use - a LOT of anesthesia groups, even those that are very well staffed, already fully cede their OB work to CRNAs simply because they never, ever, ever, want to do an OB anesthetic. Witness this thread that started yesterday...

I got offered a job straight out of residency in a Big OB/GYN hospital, should I accept?

CA3 here… so I got recruited to a big OB/GYN center starting in a couple of months. i did like 4 months there as a part of my training and I made a good impresion with the head of anesthesia, but I can’t help but be nervous about my first real job out there. I posted this elsewhere and the...

forums.studentdoctor.net

Recently our group voluntarily left a hospital. We staffed it all MD when we were there. An AMC took over and their L&D will now be staffed with CRNAs only.

 

[epidural man]

Recently our group voluntarily left a hospital. We staffed it all MD when we were there. An AMC took over and their L&D will now be staffed with CRNAs only.

And the NICU surgical cases?

 

[epidural man]

Do you honestly believe that would be good policy?

As opposed to what?

Are things going in the right direction? Will that direction likely change?

If you take greed and laziness out of the equation, there is NO REASON anesthesiologists should supervise CRNAs. Zero.

 

[patriot6]

As opposed to what?

Are things going in the right direction? Will that direction likely change?

If you take greed and laziness out of the equation, there is NO REASON anesthesiologists should supervise CRNAs. Zero.

Pardon my ignorance, but I direct 3:1 typically, and I don't feel greedy or lazy. I work at a level 2 trauma, large community hospital. Our group probably has 15+ starts every day, along with a couple surgery centers around town. Am I to believe that it's realistic for our group in this small southern town to recruit probably 15 more anesthesiologists and go MD only? In my prior group, I did 50% of my own cases, which I really enjoyed. But the practice model here could not work like that. And despite what is often described on this forum regarding CRNA supervision, I'm very involved in each case.

 

[epidural man]

Pardon my ignorance, but I direct 3:1 typically, and I don't feel greedy or lazy. I work at a level 2 trauma, large community hospital. Our group probably has 15+ starts every day, along with a couple surgery centers around town. Am I to believe that it's realistic for our group in this small southern town to recruit probably 15 more anesthesiologists and go MD only? In my prior group, I did 50% of my own cases, which I really enjoyed. But the practice model here could not work like that. And despite what is often described on this forum, I'm very involved in each case.

Yes that should be the goal - MD only, or let the CRNAs do their own thing. You should NOT be held responsible for them.

AND make it very clear to the patients that CRNAs are not supervised and MDs will not bail them out. They asked for it and that is how they want it. Let’s see what the patient asks for then.

 

[voxveritatisetlucis]

I’ve noticed that most of the people who “like or prefer CRNAs/PAs/NPs” are almost always driven by ideology rather than perceived superiority of care

 

[nimbus]

And the NICU surgical cases?

Never did peds there.

They were transferred to a peds hospital. If they were diagnosed prenatally, they delivered either at the womens hospital adjacent to the peds hospital or at the university hospital. In either case, NICU cases are always done by a pediatric anesthesiologist.

 

[Southpaw]

Yes that should be the goal - MD only, or let the CRNAs do their own thing. You should NOT be held responsible for them.

AND make it very clear to the patients that CRNAs are not supervised and MDs will not bail them out. They asked for it and that is how they want it. Let’s see what the patient asks for then.

So I generally agree with your underlying sentiment. But it’s not as simple as you make it. It’s not like choosing Burger King or McDonalds. Patients generally have zero idea of what we do or our education. Most don’t know I’m a physician. If you told them they’re only getting a CRNA, most would nod and go along with it. Their surgeon after all told them to be there. They trust their surgeon.

Does laziness and greed play a factor? I dunno, certainly for some. For others, not at all. Some of us are just working in the model that occurs where we want to live. Anesthesia is a weird field and honestly its a big reason I regret choosing it and don’t recommend it. No one, and I mean NO ONE, asks me if I want to do my own work or supervise any day of the year. Ever. I either work in the model of my job, or I get up and go elsewhere. Now could I go elsewhere? Sure. But despite what many here say, moving all around when you don’t have to, for the sake of practice dynamics, generally isn’t worth the familial shakeup especially when kids are involved and they have their own social networks.

Does anesthesia take supervision too far? Absolutely. No question. Every anesthesiologist, for many reasons, should do their own cases some of the time even if they predominately supervise.

 

[voxveritatisetlucis]

It is interesting that despite these headwinds, anesthesiology is becoming more and more competitive. Like 10 people in my class have mentioned they want to pursue anesthesiology! Stanford had like 9 matches this past cycle

 

[Dr. Rude]

It is interesting that despite these headwinds, anesthesiology is becoming more and more competitive. Like 10 people in my class have mentioned they want to pursue anesthesiology! Stanford had like 9 matches this past cycle

Why do you rob banks?
Because that’s where the money is.

Willie Sutton

 

[voxveritatisetlucis]

Why do you rob banks?
Because that’s where the money is.

Willie Sutton

That’s true.

How much would a bill like this affect anesthesiology salaries? Doubt it will pass but seems like the crna orgs keep gaining more power

 

[IMGASMD]

Train more anesthesiologists. Look at the crashing EM market…..
The naysayers will tout that most ER now are staffed by midlevels. I then say, work like the midlevel too. 40 hrs a week and per diem somewhere else.

I personally would love to take a pay cut, so I don’t have to supervise. I would even be happier if I can do a 16 and 24 hr shifts a week, then get 4 days off. Just per-diem two days out of those 4, I would have it made.

I will look into that….

 

[OptionOffense]

I then say, work like the midlevel too.

Get paid like the mid-level too. What would you say then? You wouldn't say cuz' you would be Cryin'

 

[IMGASMD]

Get paid like the mid-level too. What would you say then? You wouldn't say cuz' you would be Cryin'

As far as I know, their rate is ~200/hr per-diem. 1099.

Which means if they’re good, then it’s overtime above 40 hrs.

On top of that, they’re playing on YOUR license.

I’d take $200/hr, with overtime, with the title of mid level, and I fuk up I just say I am only a mid level, any day.