CRNA Threat - page 3
I read the following post on a student doctor's forum: "Agreed. CRNA's and nurses in general aren't the smartest group of people out there. The CRNA backlash has already begun. In response to... Read More
Mar 1, '11This all has been said on here time and time again, but I will make a general statement to some of the misconceptions on this thread.
1. CRNAs aren't trying to be physicians. CRNAs have been providing independent anesthesia care for over a hundred years, if anything physicians are trying to take over a nursing speciality. All the research shows that CRNAs are just as safe and effective as anesthesiologists.
2. PAs and AAs are not even in the same category. Physician Assistants were created to provide civilian crossover training for highly trained medics after serving in Vietnam, and to expand medical care. http://www.aapa.org/about-pas/our-history It was around this same time that NPs came into existence, but nurse anesthetist had been around providing the majority of anesthetics since the late 1800's. Nurse anesthetists are the United States oldest nursing speciality.
3. AAs were created for political reasons, and that reason was to give the ASA a political tool to help control CRNA practice with an anesthetic provider who can never increase access to care or compete against anesthesiologists. There are only about 2000 practicing AAs. AAs practice in approximately 16 states under the direct supervision of an anesthesiologist. http://www.anesthesiologistassistant.net/ CRNAs on the other hand practice in every state and every US territory that I know of. CRNAs can and do increase access to care, provide the majority of anesthesia care in the US, are the sole providers in many rural hospitals, and we currently number over 42K. CRNAs and anesthesiologists practicing independently is the most cost efficient type of practice. ACT practices are just behind only all MDA practices as the most expensive. It is often necessary for all MDA practices and many ACT practices to be subsidized by the hospital that employ them because they are too expensive to be economically viable on their own.
4. Physicians are an expensive commodity that the public helps fund. Medicare (the Department of Human and Health Services) provides all or the majority of all residents salaries, and many state/federal monies supplement medical student training costs. The way the physician training is set up physician's size numbers cannot increase in size very easily. CRNAs pay for all or the vast majority of their own training, and provide nearly identical/identical anesthetic care as anesthesiologist residents during their clinical phase which costs the public nothing and saves hospitals millions of dollars a year.
CRNAs are not fighting to gain independence. We are fighting to keep something that we have always had.
Mar 1, '11Quote from lckrn2paThe PA's I have met are really very smart. I've likewise met some NPs that have left me in awe too. PA school probably shouldn't be compared to nursing school though, because they aren't supposed to be on the same level. Sounds like PA school is pretty tough from your description.All I can say is wow, this is really what you think of PA's? You really need to research the role of a PA before you start calling us "little puppy dogs". The clinical rotations for PA's will usually be around 2000/hrs +/-, NP programs hover around 500 +/-and there is continued debate on where it should be for NP's. Then general consensus is minimum of 500hrs. PA students will have minimum 2000hrs HCE prior to entering a program, NP's require 2yrs as a RN which will average to little over 2000hrs. Most PA's applying for school will exceed the 2000hrs, my class average is around 7000 with my HCE at 35,000hrs. PA school is INTENSIVE, I studied more in the 1st 2 weeks of PA school than I did the entire time in. To me, nursing school was a joke compared to PA school and I went to a school with a >50% attrition and 99% first pass rate on boards. Out of my class of 62 only 1 did not pass 1st time. Most every NP worked in some capacity during school, VERY few PA's worked and nobody in my class works. I currently spend 36hrs per week physically in class, 3-5 hours per day studying and 10hrs each for Sat/Sun. I will spend 35-45hrs weekly studying. In nursing school, read notes about an hour before class.
Talk to some PA's before you call them puppies, that's pretty insulting and just really shows your ignorance.
Mar 2, '11[quote=samirish;4810720]I read the following post on a student doctor's forum:
"Agreed. CRNA's and nurses in general aren't the smartest group of people out there.
Well I hope whoever wrote this does not end up in a long term care. Nurses are the ones taking care of aging population in today's society. We have bigger roles than the doctors, so I do not think we should belittle ourselves. Just because we did not go to medical school does not make us less smart, I don't see how that correlates. Nurses are trained in their scope of practice and it's not like we can just go learn something in medical area to make us look "smarter" , i mean really, we went to to learn about nursing, so just because the "title" is less prestigious than a MD , it does not make us dumb.
Mar 2, '11Quote from lckrn2pa2000 hours per year (40 hrs x 50 wks, you do the math). a 5 yr rn would thus have 10,000+ hrs real world experience. my own are well over 30,000.all i can say is wow, this is really what you think of pa's? you really need to research the role of a pa before you start calling us "little puppy dogs". the clinical rotations for pa's will usually be around 2000/hrs +/-, np programs hover around 500 +/-and there is continued debate on where it should be for np's. then general consensus is minimum of 500hrs. pa students will have minimum 2000hrs hce prior to entering a program, np's require 2yrs as a rn which will average to little over 2000hrs.
Quote from lckrn2pagraduate school is more intensive than undergraduate. that's kinda the point. as for most np students working, in my experience, most of us have to. something about mortgages and kids to feed. with all of one exception, every single pa student i've seen in the last 3 years (doing clinical with us, term after term of them) has counted on mom & dads' $$$ to live on. the exception's husband was a retired military officer, i have to assume that her unemployment was not hurting them. given the choice, i wouldn't work full time, carry a full time class load, and study 30+ hours a week. i certainly won't have much time to sleep over the next couple of years.most pa's applying for school will exceed the 2000hrs, my class average is around 7000 with my hce at 35,000hrs. pa school is intensive, i studied more in the 1st 2 weeks of pa school than i did the entire time in nursing school. to me, nursing school was a joke compared to pa school and i went to a school with a >50% attrition and 99% first pass rate on boards. out of my class of 62 only 1 did not pass 1st time. most every np worked in some capacity during school, very few pa's worked and nobody in my class works. i currently spend 36hrs per week physically in class, 3-5 hours per day studying and 10hrs each for sat/sun. i will spend 35-45hrs weekly studying. in nursing school, read notes about an hour before class.
Quote from lckrn2payou know, you're right. i wish we could do without the jr high neener-neener between np/pas, because neither one has the market cornered on the propensity to be a jerk. i wasn't the one that posted the puppy comment, but i can see the insult in it; don't worry, you repaid the poster in kind.talk to some pa's before you call them puppies, that's pretty insulting and just really shows your ignorance.
Mar 2, '11Quote from medic7577That rule might just apply to competing CRNA sitesI have been informed not to place links in my posts. Kinda wondering how all these other folks seem be able to do it.
Mar 2, '11I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP.
Mar 4, '11Shrug, I have complete autonomy.
Quote from BabyLadyI'm sorry, if the CRNA wants complete autonomy, then he/she needs to go to medical school for upteen years and become an anesthesiologist.
Mar 5, '11Quote from Skip219This is not limited to rural settings. One also has to define what one means by 'complete autonomy'. If complete autonomy means providing an anesthetic from start to finish without any material involvement by any physician (material involvement meaning a physician making the ultimate decision as to what technique will be used, what medications, or physical involvement in the delivery of the anesthetic, or 'checking up' at regular intervals that the anesthetic is being delivered as they would like) OR if complete autonomy means a CRNA is no required to practice in ANY setting with an anesthesiologist available by law, then complete autonomy exists in each and every state in every anesthetizing location.I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP.
Independent CRNA practice has existed for over 100 years. Only 12 states require by law that a physician (and it can be ANY physician) 'supervise' a CRNA's practice of anesthesia. And here 'supervise' does not mean taking responsibility for or directing the anesthetic.
40 states do not have any physician "supervision" requirement for CRNAs in their nursing practice or medical practice laws or regulations. If one includes clinical "direction" requirements in addition to "supervision," 32 states do not have a physician supervision or clinical direction requirement for CRNAs. Including state hospital licensing laws or regulations, 33 states do not require physician supervision. Including state hospital licensing laws or regulations, 24 states do not require physician supervision or direction.
No state requires a CRNA be supervised or clinically directed by an anesthesiologist.
In states which do require physician supervision, the supervising physician is not required to have any training in the practice of anesthesia or additional qualifications with the exception of New Jersey and Washington D.C. (exception applies in D.C. only when a general anesthesia is given). What constitutes 'supervision' or 'direction' is generally poorly defined or not defined at all. Usually the term hangs in the air without any reference as to what it should mean and mere availability suffices. The surgeon meets the definition of 'supervision' when he does the surgery and ignores the CRNA and the anesthesia.
Mar 5, '11Quote from Skip219Drs like PA and AA because they are in control of them and can bill for their actions. Whereas, the CRNA is taking some of the money out of the MDAs pocket for each case. Do you know who does most anesthesia in the rural settings? Its CRNA where MDAs don't want to work. AA can"t work on their own in away of the opt-out states. In these states the AMA hasn't bought off the politicians with their PAC. There are 40-50,000 CRNAs and about 6000 AA. Its more cost effective for a hospital to employ CRNAs because they can work independently. MDAs stand there supervising inductions and emergences: then bill for it.
There are fewer than 2000 AAs practicing and they have been around for 20 years. Not a significant threat to CRNA practice.
Mar 8, '11Samirish
It is unfortunate, but it is another case of class warfare in healthcare.
RN's won't do bed baths because it is the CNA's job.
CRNA's and PA's won't help lift or toilet because it is the RN's job.
MD's won't do ... because it is someone else's job.
These young medical students took their myopic view of medicine and applied it to an entire population. They were probably referring to first year CRNA students who, to be fair, are wet behind the ears as well.
The CRNA/MD debate has been going on for some time and it is unfortunate because both disciplines have a lot to bring to the table. CRNA's have great training and MD's do as well. MD's can also bring an extra value to the OR through there post doctoral training and board certification and some have post doctoral fellowships in cardiac, peds, pain, etc.
To me it is sad to have these competitions because there are good and not so talented people in all levels of service.
Mar 22, '11My two cents; I have been a paramedic for 11 years in the Portland area. I'm not a nurse (yet) or a CRNA (but someday hope to be) but I think it's somewhat of an over-reaction to spell doom and gloom for the entire profession of CRNA's. Here in Portland, 1 hospital just this last year switched from the MDA-only Oregon Anesthesiology Group to anesthetix, a group based on the ACT model that incorporates CRNA's. I don't think it's likely that a whole career disappears when it has such a long history.
Mar 10, '12This whole debate regarding PA's vs. NP's funny. I'm a RN, going on 13 years. I've worked with many PA's and NP's in a varying capacities. Therefore, I believe I can make a pretty well informed opinion regarding the two. I believe that PA's are better prepared to practice compared to a NP. Their clinical experience while in school is much more intensive. There is no debate when you consider the minimum clinical requirement to graduate. The coursework is equally intensive and design to practice medicine, much like a doctor. NP school is a bit of a joke. (1) you can earn the degree online... Really? And, NP's wonder why they receive less respect. Personally, I think this is a slap in the face to physicians. (2) the coursework is quite similar to that of undergrad, just a bit more intensive. (3) too much time is spent on "nursing theories"! What a joke! Tell me, how is this going to save someone's life. How about eliminating all those stupid theories from the coursework and focus on more important topics.Just a few thoughts of mine.... I am pursuing a career as a CRNA because I believe it will provide me with happiness on many levels.
Mar 11, '12You obviously have no clue. First because you are not a NP or PA. Second, because you are showing you have no knowledge about the school.
BTW, I am a CRNA AND FNP. So please, finish one and come back and discuss the difference between what you finished and PA/MD>