Anesthesiologists being replaced by CRNAs???

[MONEJA783]

I was vacationing in the tropics a few weeks ago and met three handsome Anesthesiologists while sun bathing at the pool. We all chatted a little until the topic of our professions came up. I told them I was starting nursing school (ABSN Program) in a few weeks & how excited I was. I then proceeded further by saying I also hope to pursue a graduate degree as a CRNA or NP (note at this point I had no idea these guys were anesthesiologists). Why did I mentioned becoming a CRNA, b/c the stares I got from all three were nothing but pure EVIL STARES! By their looks I knew I said something wrong but had no idea what it was until they told me they were Anesthesiologists & fear that CRNAs were taking away their jobs at a cheaper price, and with the new health care laws just passed its going to get worst for them. This was totally unexpected 'cause all I planned to do that day was to relax by the poolside & sip pina coladas all day! However, they went on trying to convince me of all the reasons as to why I should not pursue a CRNA career & that eventually the national anesthesia board (not sure if this was the organization they mentioned) was no longer going to certify CRNA training and eventually they'll be no more training because there is no longer a shortage of Anesthesiologists. The shocker of this whole conversation was two of the anesthesiologists mentioned, with conviction, they wish they had pursue a CRNA career instead where they would have accumulated less debt with almost the same income or they wish they had chosen another specialty.

I was pretty shocked hearing these remarks & would love to hear your opinions :)

[sandmanpk]

wtb:.i do not believe that "solo" crna practice is safe or desireable; one advantage of sitting on the fence

fortunately, 70% or rural hospitals disagree with you. crnas are the sole providers in these facilities. sitting on the fence does nothing to advance our profession of anesthesia. remember: "the enemies you make by taking a decided stand, generally have more respect for you than the firends you make by being on the fence."

[oncall24/7]

Thabks for the replies; I tried to comment from a unique perspective, but it seems that this was a waste of time. Many patients want to know who is managing their anesthesia; and I'm often the one to answer the question. Docs, hospital administrators, people "in the know" want an anesthesiologist........I guess that my posting on a nursing board was a waste of time......I thought that the CRNA here would respond with a better response .. yep, I was wrong again (must be the nurse in me)..........STILL: BEST WISHES FOR ALL OF YOU FOR THE HOLIDAYS,

[oncall24/7]

No, sitting on the fence essentially makes you holier-than-thou.... Patient safety? Research study after research study has shown that independent CRNA practice is as safe as ACT practice and MDA only practice, period. You were uncomfortable? Fine, don't work in that area if you don't feel qualified. CRNA's have been providing safe care (and economic as well) for quite a long time, as long as or longer than physicians. Physicians, historically, jumped into the anesthesia circle when the money showed up, not when they thought that it would benefit the patient.

As far as professional parity, if nothing else, inside the operating room there is parity in skill and ability. What really irks me in these arguments is the assumption that because someone went to med school that they are inherently superior in all things.

One final thing for another poster, supervision is all about billing. That is not opinion, nor arrogant, it is fact. The reason the wording is in federal law is to try to keep MDA's and hospitals from defrauding medicare. You see, historically doctors were "supervising" for the most difficult parts of a case (induction and emergence) but were not actually around. They billed as if they did something but in fact were doing nothing. This made the government angry so they said that for the doc to bill they actually have to be there. There is nowhere in federal or state law that says a CRNA has to work "supervised" by an anesthesiologist. It infuriates me that a question about fraud from one group (anesthesiologists) has been spun into a question of safe practice.

If anyone wants to find a real, evidence based and peer reviewed article that shows that independent CRNA's are less safe than their MDA colleagues please bring it forward. Otherwise those on the side of MDA's (docs or those carrying their water) are arguing a loosing battle based on their misguided and baseless opinions.

wow, I have never asked anyone to "carry my water"........your comments and disrespect(?) speak volumes about this issue.......a "loosing battle"? I have no battles to fight and neither do most in the anesthesiology profession..........safe practice means an anesthesiologist managing each and every case; CRNA have a role and I respect that (I worked in that role).....your comments reinforce my opinion that unsupervised CRNA practice is unsafe.......

[srnamom]

Most of us were trained to handle whatever complications might arise in a case. If you don't feel safe practicing independently, don't. I fail to see how the previous poster's comments were disrespectful or reinforced your thesis that CRNAs need to be supervised by anesthesiologists. Can you elaborate? Are you still working as a CRNA?

[FockerRN]

Way to avoid the point all together and try to get out of it by taking the "high road".

You come and say that anyone in the "know" wants a MDA and that CRNA solo practice is unsafe. First, as the money gets tighter in healthcare all those hospital administrators that "prefer" a doctor providing anesthesia will start changing their tune when they look at the stipends that they have to pay their anesthesiologists to keep them around. Second, and more importantly, where is your proof that solo CRNA practice is unsafe? Journal article? AHRQ data? Anything? Do you have anything other than "I said so and people think doc's are super cool and smart so they are obviously superior"?

Your perspective is not unique it is just the party line of the ASA. So, when you find some data (evidence based and peer reviewed) that solo CRNA practice is unsafe then feel free to share. Until then I think this discussion is closed.

[Ackeem, BSN, MSN, RN, APRN]

These posts are very interesting, what debating arguments on both sides,but I would gladly have a skilled experience CRNA provide my anesthesia solo.

As it relates to who's more qualified it would most defiantly be the MDA's being they spent 7 plus years in medical school and so on . But that still doesn't make them better at administering anesthesia than a CRNA that's been practicing for over 20 years, opposed to a MDA that practiced for 10 years. with that being said I don't see the point for supervision of CRNA's. if its a less experienced CRNA I would strongly advice supervision from not only a MDA but a more experience CRNA as well.

CRNA's can never take the jobs of MDA's , and MDA's can't eliminate or deprive the CRNA's of their specialties just because they went to medical school and we went to nursing school.

CRNA critics if your going to start a war at least come with some useful weapons ( reliable facts and not personal knowledge and opinion )

Your on our turf just keep that in mind before you even attempt to draw your sword recklessly.

[oncall24/7]

These posts are very interesting, what debating arguments on both sides,but I would gladly have a skilled experience CRNA provide my anesthesia solo.

As it relates to who's more qualified it would most defiantly be the MDA's being they spent 7 plus years in medical school and so on . But that still doesn't make them better at administering anesthesia than a CRNA that's been practicing for over 20 years, opposed to a MDA that practiced for 10 years. with that being said I don't see the point for supervision of CRNA's. if its a less experienced CRNA I would strongly advice supervision from not only a MDA but a more experience CRNA as well.

CRNA's can never take the jobs of MDA's , and MDA's can't eliminate or deprive the CRNA's of their specialties just because they went to medical school and we went to nursing school.

CRNA critics if your going to start a war at least come with some useful weapons ( reliable facts and not personal knowledge and opinion )

Your on our turf just keep that in mind before you even attempt to draw your sword recklessly.

With all due respect, if a patient wants an unsupervised nurse (solo CRNA) performing his/her anesthesia, that's their choice; I just want to make sure that the patient understands who their anesthesia provider actually is. You are entitled to your own opinion. To be meaningful, supervision means anesthesiologist, nurses supervising other nurses flys in the face of safety as well as the ACT model. Comparing the depth, scope and tenor of an anesthesiologist's education to that of a CRNA is quite ridiculous......Been there, done that (both). I haven't seen anyone who went to med school try to compete with anyone who went to CRNA school and the reference to wars, weapons etc goes over my head entirely. And for your information, this IS my turf too.

[FockerRN]

Goodness, you starting to sound like a broken record. The whole "war" thing was saying that if you want to argue a subject such as this then you need to come armed with something other than "because I said so and I'm a doctor so I must be right" and "a doctor automatically makes it all safer".

I am fine with people knowing who their anesthesia provider is and the AANA is working so that the public knows who CRNA's are and how they are safe and exceptional providers of anesthesia; with or with out an anesthesiologist "supervising" them.

I didn't mean supervision in the sense that you mean it, I meant a collaborative environment where CRNA's work together (even with MD's *gasp* THE HORROR) and provide assistance to one another and the ability to...collaborate. Of course the ACT model is all about MD supervision, it is the pet of the ASA so it automatically is all about the doc being "captain of the ship" and all that BS. I'm sure there is a place for it, but in the economics of today's healthcare the number of places is dwindling. You see, there are multiple studies that show that CRNA vs. ACT vs. MDA solo are all equally safe and guess which one is the cheapest model?

There is not a comparison of the educations of MDAs and CRNAs, both very different but as studies show (most recent from Health Affairs) the outcome is not different.

You come around and say that it is obvious that having an MD involved in a supervisory role is automatically safer...prove it. That is purely an opinion that has been proven wrong by fact (peer reviewed studies in reputable journals).

I know this is going to make you mad, but the argument that the ASA has against CRNAs is not about safety. That is a losing argument, but it is all they have. The ASA and the MD's that agree with them can atempt to scare the public and smear CRNAs but the facts do not support their dictates of safety and superiority. It sounds like the Wizard from Oz "do not look behind the curtain!" The reason the ASA argues so hard is not altruistic love for their patients (not that docs don't care about their patients, so don't try to put words in my mouth) it's all about the all mighty dollar. As each healthcare dollar is scrutinized and it is seen that CRNA solo practice is safe and economical then the money to the MD's start disappearing. Stipends to support their salaries disappear, ACT practices where they can bill for half of the work that they had no part in disappear etc... In the end the argument is not at it's heart about safety it's about money. Do I blame them for trying to protect their pocket books? No, not really, but to try to put it in terms of safety is just dishonest.

Your turf? Fine, whatever you want but when you decide to start spouting your dictats on a website for nurses and CRNA's don't be surprised when you are challenged.

[BCRNA]

CRNA skills are not less than a MDA, I know the limitation of my skills. I would put them up against any MDA's. There are CRNA's who could not practice completely independantly, but then there are some MDA's who are the same. They stay in outpatient surgery centers or large practices where they have others to lean on. Do you actually know what the education a CRNA and a MDA is? Part of what physcians depend on to maintain there monoply is the opinion of many people to assume that "nurses" can't do their job safely. Or just assume that because they are physicians that automatically their clinical skills are better.

You give a crna and a mda the exact same case. Even though they both do exactly the same thing from beginning to end; what the mda does is called the practice of medicine and what the crna does is called the practice of nursing. Same thing with nurse practitioners. They are worried they are going to lose some of their cash cow so they try to diminish the public perceptions of what they see as their foe.

Out of curiosity, what are you basing your opinoins of crna's on? Have you worked closely with them? Or is it just your opinion that physicians are always captain of the ship, and that in any circumstance a nurse is less by very definition? How have you learned of the education process and skill sets of crnas and mdas? Instead of just saying one side is better because of common sense, what is your rationale?

[in2b8ix2b8]

First of all, I agree that possessing an M.D. degree doesn't make anyone inherently superior with regard to the administration of anesthesia. Really, how much cell biology, histology, biochemical pathways, etc. could a practicing anesthesiologist discuss in depth? Much of what we do is technical, requiring an opposable thumb and a good bit of practice. I worked with an MDA who was a fumble-**** with a spinal needle in his hand and I have worked with a CRNA who could do a SAB by braille. In anesthesia school, the SRNAs shared their cardiac rotation with the anesthesia residents. Let me tell you, the resident (yes, an MD) wasn't much smarter than a bag of rocks! He didn't know the drugs, didn't have a clue about managing the hemodynamic swings of going on/off pump and was a deer in head lights when one of our fresh hearts went into VT as we rolled in to CTICU. I guess he was over in the corner reciting Krebs cycle, or whatever it is that made him 'superior' to me, the SRNA, who promptly shocked the pt. back into a compatible-with-life rhythm. I did a locums assignment at a CRNA-only facility where one of the surgeons (very renowned orthopod) preferred CRNAs over docs! I work per diem at a facility where I cover for the anesthesiologists when they go on vacation! As far as the comment about 'people in the know want an anesthesiologist'...I did the anesthesia for an intensivist (someone 'in the know')at our hospital for an emergency appy. The anesthesiologist didn't do the case and she was actually free to do so...AND, later on, he told me how 'wonderful' he felt post-op. In anesthesia school, it was horrific listening to the residents having to present their 'screw ups' at grand rounds. It was quite scary some of the things they did to get themselves into such a bind. I have NEVER had a patient ask about the credentials of the person doing their anesthesia. I always introduce myself by first name, "I am your nurse anesthetist." If I didn't have the proper credentials, I am sure the physicians on the medical staff credentialing committee wouldn't have signed my paperwork, allowing me to work as an anesthesia provider. I think a lot of MDAs have an 'issue' with the fact that their field highly overlaps that of an advanced practice nurse. This could go on and on, both ways. The practice of nurse anesthesia, solo or ACT, is safe and the studies continue to affirm that. A degree is just that...a degree; it doesn't convey skill, superiority, vigilance, motivation, or personal ethics.

[in2b8ix2b8]

I don't feel the need to be or not be equal with anyone! An anesthesiologist is not the gold standard for an excellent anesthesia provider. I am a vigilant anesthesia provider and I can give just as good and safe of an anesthetic as the next anesthesia provider, be it a CRNA or a MDA. My outcomes are great and my data bank is squeaky clean! Afterall, isn't good patient outcome what is ultimately important and not the anesthesia provider's degree? Both MDs and CRNAs have bad outcomes...that's just the nature of what we do for a living. You seem to really be fighting for your 'doctor status'! You should have been a surgeon, a real doctor whose practice doesn't highly overlap with an advanced practice nurse, otherwise, you will forever be a physician practicing nurse anesthesia! I work per diem at a facility and I cover for the MDAs when they go on vacation! How bout that??!! I am credentialed medical staff, so says the credentialing committee of physicians!

[in2b8ix2b8]

Your comments stem from pure ignorance. Get out and see how CRNAs function solo...and check their outcomes...facts and data are something you haven't seemed to have checked. As a physician, shouldn't you have an 'evidence-based' way of approaching things? We are all credentialed members of the medical staff with the same priviledges as an MDA with regard to providing anesthesia and medical emergency services. Check the databanks of the thousands of CRNAs who work solo and compare with MDAs...why would the physicians on a medical staff committee sign off for CRNAs to work solo if we were so 'dangerous'? Go do another residency in another field so you can feel like a legitimate 'doctor' whose practice doesn't strongly parallel an advance practice nurse.