AANA members

sonessrna · May 11, 2006

Amen!!!!

MmacFN · May 11, 2006

is it something that cannot be discussed in public?

jwk · May 11, 2006

is it something that cannot be discussed in public?

Sure - who wants to start? :roll

heartICU · May 11, 2006

is it something that cannot be discussed in public?

No, definitely not something that cannot be discussed in public. But rather than start a MD vs CRNA sh*tstorm, I figured I would just have everyone do their thing on their own. This is what the email is about, and I am not trying to start a bunch of crap here - just trying to motivate CRNAs and SRNAs to be advocates for themselves.

HR 5246 has been introduced, and it would provide additional reimbursement for teaching anesthesiologists while supervising residents, but not for nurse anesthesia students. This could provide a financial incentive for institutions to train residents instead of SRNAs. Just looking to promote a little equity among all parties involved.

MmacFN · May 11, 2006

ah

Yes that seems unfair. Ill wait to see what deepz and yoga say

deepz · May 11, 2006

ah
Yes that seems unfair. Ill wait to see what deepz and yoga say

I wrote my letters to Congress already today.

z

BTW Harvard study announced today found 40% of malpractice lawsuits based on bogus claims. Do write those letters also!

https://allnurses.com/forums/f16/med-mal-reform-write-your-senator-155077.html

MmacFN · May 11, 2006

Is this something anyone might consider sending to me via email or pm so i can read it?

KeithEMU · May 11, 2006

To see the bill and track it's progress.

http://www.govtrack.us/congress/bill.xpd?tab=main&bill=h109-5246

If you click on the full text link you can see the bill. You can sign up for email alerts on the progress of the bill as well.

MmacFN · May 11, 2006

kethi and heart

Thanks alot for the info!

CRNAtoMD · May 15, 2006

Let me preface this by saying that I am a CRNA (Texas Weslyan, class of ancients) turned MD (UT Galveston School of Medicine) that has been on both sides of the argument.

I joined an academic institution after two years in private practice, in one of the most prestigious programs in Texas and the nation. One of my colleagues was sent this link and he in turn sent it to me because of his anger over it.

Having been on both sides, I would argue that the "HR5246 makes training residents more attractive/training SRNA's less attractive" argument is a false one. I am on the residency review committee and participate in the business committees of this program. It is similar to just about every other strictly academic practice.

The training of residents has been and will always be more expensive than the training of SRNA's. A resident makes an average of $40K in residency training on top of health, disability, 401K, book/education fund, and Liability Insurance coverage. SRNA's get no pay, limited on site health coverage, and liability. Still, it costs money to train both and we need more money to train both.

Even if we received a windfall of cash, we could never get rid of or even reduce our CRNA's and/or SRNA's because they are a vital component to the quality of health care provided at this institution. On top of that, we and any other training program can't just double the size of the residency. The ACGME and ABA require each resident to have a certain number of subspecialty cases in order to graduate, the most important being hearts, heads, pedi, and OB. heartICU, you probably know better than me that the number of heart cases is going into the toilet (haven't done hearts since residency and don't want to do any more) as are the number of heads now that radiologists are doing coils in the brain. When a residency expands, it is usually for expanded coverage of a new facility or new service (vascular, general, ortho, etc.).

It takes at least one year, plus submission of case loads and particularly subspecialty case loads, to get an approval to expand, and usually only one or two spots, almost never more unless a program doubles in size (four years ago one satellite academic program in Florida went from a two hospital system to a five hospital system, and even then only 4 spots were given to them because of the limits in heart and pedi numbers).

What bothers me is that all academic programs are having a hard time keeping and hiring great teachers. My program over the last year lost three young and bright MD's (guys that wanted to teach and do research, unlike some of my colleagues). On top of that, the hospital still had to cap CRNA work hours to make budget. Our chief CRNA is saint that juggles a full work and administrative slate yet still makes our CRNA's happy to stay here on at least a part time basis, but every year we lose one or two more great CRNA's to private practice in the city or suburbs.

Go ahead and oppose HR5246, but don't think you're just hurting MD's/residents and "levelling the playing field". This isn't a competition. A residency exists under its own restrictions and limits and on top of that more funding isn't going to make administrators all of a sudden want to spend MORE money on the benefits and extras it costs to train more trainees, i.e. the expensive residents. Once again, residency programs can't expand by more than one or two spots at most and only if the subspecialty numbers justify it, and top of that, Medicare ALREADY PAYS for the training of residents in EVERY field of medicine. HR5246 means we get to collect more on work the residents do, and more money means we get to hire or at the very least keep the best teachers and researchers in our programs, be they MD or CRNA.

By opposing HR5246, you're hurting everyone in an already underappreciated and underfunded academic community and it still won't make training SRNA's more attractive than they ALREADY ARE. It IS creating a tense environment for the CRNA's and a consequence is that more capping of work hours might happen as departments struggle to balance budgets and keep faculty salaries competitive enough to keep teachers on board (I make half of what I did in private practice but I can accept it because I'm given a little more time to spend with my family).

If HR5246 passes, the AANA can then make a similar proposal and argue discrimination on its behalf to increase reimbursement to 1:1 for supervised SRNA cases and that will then bring even more money to the academic programs and make everyone happy.

B.J.W., M.D., CRNA, RN, PFOT (soon to be proud father of twins)

MmacFN · May 15, 2006

CRNAtoMD

How nice it is to have someone who has seen both sides of the fence. I would hope you might be nice enough to stay on this board and post more. Experience with each side would be a golden asset here.

First, let me say I am NOT a CRNA but a hopeful (just had the interview) so my knowledge of the politcs is limited. However, im certainly used to politics. I had a couple of questions for you!

1) I understand the residency training issues and costs. What im wondering, however, is how this cashes out in politics. I have to say i cannot blame the feeling of the CRNAs and the AANA in regards to this bill. Here is the message (though maybe not the intent) that it appears to send:

We need more anesthesiologits. If we increase public spending for more then we are that much closer to displacing more CRNAs.

Im not saying that is, or isnt the actual plan. However, if you are the ASA and were interested in diminishing the CRNA populace in general, would this not be an excellent first step? It seems it would be.

2) I also agree with your ascertion that it is much cheaper to train a SRNA than any MD residency. Secondly, its a 4 year (or 3) residency for an MDA and so you could (theoretically) train 2:1 or 3:1 CRNAs for every MDA. So it easily appears that this should be of no threat to the CRNA population. I would ask, however, isnt this a slippery slope? Here is what I mean:

- Add more residents = less resources for SRNA training and increased competition for cases. In an MDA run hospital (the majority) it seems clear who will get prefrence in cases.

- Other hospital Anesthesia Depts see this success and also increase their MDA residency (or open one) based on the new bill and the funding. Now multiple hospitals decrease SRNA training resources in favor of MDA residency resources.

3) If your the AANA and you continually feel under attack based on the general ASA premise that "anesthesiology is the practice of medicine not nursing" wouldnt you be skeptical of the motives? Remember, it wasent that long ago that the ASA was attempting to turn the CRNA into a subserviant Physician Assistant type role with that very statement.

4) What does it say to the AANA/CRNA/SNRA when the government not only increases public funding for MDA residency slots, but is also paying them a stipend salary yet the SRNA is not paid and covers all their own expenses for similar free student labor? Med students already did it in their internship/med student days, nurses already did it in nsg school... why is that OK now? What message does that send to SRNAs? It wouldnt be a stretch to say that the message might be seen as this:

By increasing public funding for MDA training, yet not addressing the inherant costs of SRNA training the Government appears to value the MDA over the CRNA.

Afterall, is there really a difference in cost incurred by the SRNA or MD in training in a year? It would seem the government could put less than half that money into SRNA training and get twice the providers.

5) Does the hospital actually incur any expense for the MDA or the SRNA? Are there costs for each as it is and how much of that cost is absorbed by the public money?

6) This statement sounds good:

If HR5246 passes, the AANA can then make a similar proposal and argue discrimination on its behalf to increase reimbursement to 1:1 for supervised SRNA cases and that will then bring even more money to the academic programs and make everyone happy.

However, waiting until after the ASA gets what they want seems counter productive and possibly doomed to failure. What is wrong with suggesting amendments to this same bill for 1:1. Then everyone is happy and noone loses? Waiting until the ASA already gets what they want to make an attempt (which will most certainly be opposed by the ASA) seems a setup for failure?

In anycase, thatnk you for your posts. It was awesome. Do not take anything I say personal in anyway, im simply asking questions and trying to learn more about the dynamics between the two groups, political and otherwise. If any of my assumptions were incorrect its simply due to my lack of knowledge in regards to the processes.

Keep postin!

Mike

Let me preface this by saying that I am a CRNA (Texas Weslyan, class of ancients) turned MD (UT Galveston School of Medicine) that has been on both sides of the argument.
I joined an academic institution after two years in private practice, in one of the most prestigious programs in Texas and the nation. One of my colleagues was sent this link and he in turn sent it to me because of his anger over it.
Having been on both sides, I would argue that the "HR5246 makes training residents more attractive/training SRNA's less attractive" argument is a false one. I am on the residency review committee and participate in the business committees of this program. It is similar to just about every other strictly academic practice.
The training of residents has been and will always be more expensive than the training of SRNA's. A resident makes an average of $40K in residency training on top of health, disability, 401K, book/education fund, and liability insurance coverage. SRNA's get no pay, limited on site health coverage, and liability. Still, it costs money to train both and we need more money to train both.
Even if we received a windfall of cash, we could never get rid of or even reduce our CRNA's and/or SRNA's because they are a vital component to the quality of health care provided at this institution. On top of that, we and any other training program can't just double the size of the residency. The ACGME and ABA require each resident to have a certain number of subspecialty cases in order to graduate, the most important being hearts, heads, pedi, and OB. heartICU, you probably know better than me that the number of heart cases is going into the toilet (haven't done hearts since residency and don't want to do any more) as are the number of heads now that radiologists are doing coils in the brain. When a residency expands, it is usually for expanded coverage of a new facility or new service (vascular, general, ortho, etc.).
It takes at least one year, plus submission of case loads and particularly subspecialty case loads, to get an approval to expand, and usually only one or two spots, almost never more unless a program doubles in size (four years ago one satellite academic program in Florida went from a two hospital system to a five hospital system, and even then only 4 spots were given to them because of the limits in heart and pedi numbers).
What bothers me is that all academic programs are having a hard time keeping and hiring great teachers. My program over the last year lost three young and bright MD's (guys that wanted to teach and do research, unlike some of my colleagues). On top of that, the hospital still had to cap CRNA work hours to make budget. Our chief CRNA is saint that juggles a full work and administrative slate yet still makes our CRNA's happy to stay here on at least a part time basis, but every year we lose one or two more great CRNA's to private practice in the city or suburbs.
Go ahead and oppose HR5246, but don't think you're just hurting MD's/residents and "levelling the playing field". This isn't a competition. A residency exists under its own restrictions and limits and on top of that more funding isn't going to make administrators all of a sudden want to spend MORE money on the benefits and extras it costs to train more trainees, i.e. the expensive residents. Once again, residency programs can't expand by more than one or two spots at most and only if the subspecialty numbers justify it, and top of that, Medicare ALREADY PAYS for the training of residents in EVERY field of medicine. HR5246 means we get to collect more on work the residents do, and more money means we get to hire or at the very least keep the best teachers and researchers in our programs, be they MD or CRNA.
By opposing HR5246, you're hurting everyone in an already underappreciated and underfunded academic community and it still won't make training SRNA's more attractive than they ALREADY ARE. It IS creating a tense environment for the CRNA's and a consequence is that more capping of work hours might happen as departments struggle to balance budgets and keep faculty salaries competitive enough to keep teachers on board (I make half of what I did in private practice but I can accept it because I'm given a little more time to spend with my family).
If HR5246 passes, the AANA can then make a similar proposal and argue discrimination on its behalf to increase reimbursement to 1:1 for supervised SRNA cases and that will then bring even more money to the academic programs and make everyone happy.
B.J.W., M.D., CRNA, RN, PFOT (soon to be proud father of twins)