CRNA VS anesthesiologist MD - Page 10Register Today!
- Feb 6, '11 by NRSKarenRNasa response to ny times a-bomb editorial on crna supervision: paradigm shift
the law med blog
posted by lawmed on september 9th, 2010
...indeed ‘supervision’ and ‘medical direction’ are terms born of the insurance industry, not of the health care community. actual state practice laws vary in their requirements from total independent practice in iowa where crnas are considered equal colleagues with physicians under the law, to “collaboration” in maryland where crnas work independent of any physician but collaborate with a designated physician as needed, to states which require supervision but fail to define it in a meaningful way. such ‘supervision’ states fall short of the insurance definitions of supervision which generally spell out the activities of a supervising or medically directing physician. however only medicare requires physician supervision in order for a crna to get paid for their services (which the physician gets a percentage of), and only in states which have not opted out of the requirement. other insurance supervision requirements are used to determine whether a physician will be paid part of the anesthesia reimbursement or it will all go to the crna.
no state requires that a crna be supervised by an anesthesiologist.
...no study has been produced which supports the asa position convincingly, despite multiple attempts. the safety record of anesthesia is indisputable and no one has been able to show that anesthesiologist involvement is responsible for that safety. meanwhile crnas are the sole anesthesia providers in various surgical settings across the country absent any cries of alarm or indications of increased morbidity or mortality in patients….and this has been the practice for over 130 years. surely we would have seen some indication of a problem by now? or is the health care community part of a vast conspiracy supporting nurse anesthetists while ignoring patient safety?
aana - fact sheet: concerning state opt outsLast edit by NRSKarenRN on Feb 6, '11
- First, it bears stating that where a physician (MDA or otherwise) 'supervises' a CRNA whether by statute, insurance requirement or local institution policy they DO NOT become responsible for the negligent acts of the CRNA. Each provider practices under their own license and is responsible for their own actions. Supervision does NOT equate to 'assume responsibility for. On this the courts are clear. SEE:
Ware v Timmons
Symons v Prodinger
Institutions can create any policies and procedures they like. Often they create such policies thinking that they will limit liability by stating that an MDA must 'supervise' or be present for induction, or do a preop on every patient. The ONLY effect of such policies however is to create a 'local' standard to the hospital which if not followed allows for a lawsuit where one might not otherwise be possible. If an MDA is not present for an induction and the policy says he must be, then the hospital and the MD are now in violation of the standard of care at that institution....but not at the one across the street which has no such policy.
SEE:Hospital Policies Can Create a standard of Care and Surprise Liability
MDAs and CRNAs often work in the same hospital in a situation where each does their own cases and the MDA does NOT supervise the CRNA. By virtue of working or being present in the same institution, regardless of who pays them, the MDA is NOT responsible for the actions of the CRNA in ANY way. That is a fact, that is the law.
- Quote from SuperSixEightMDSimply put...you are WRONG.I’m going to get flamed or banned from the forum for saying this, but it must be said.
Anesthesiologists don’t “collaborate” with CRNAs. It never happens. In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role.
- Quote from SuperSixEightMDThat is an not unreasonable argument objectively. Fortunately CRNAs, medicare, the health care community at large, hospitals and patients do not rely on CRNAs to make the determination that CRNAs deliver safe, cost effective anesthesia care when working independently. They rely on over 100 years of safe practice, empirical and research evidence that this is so, as well as personal experience.I think there are some assumptions that can be safely made here.
1. An anesthesiologists training is broader than a CRNA’s. And an internists training is broader than a DNP’s.
2. There is no such thing as ‘knowing too much’ where skilled labor is concerned. The person delivering a baby who understands the pathophysiology of childhood brain tumors is just as good as the person who does not possess such knowledge. Their ability to practice, at very least, is every bit as good (....if not better).
As mid-level providers, CRNAs -- who have less education and training than anesthesiologists -- are taking the position that the information that they don’t have is useless anyway. It’s simply impossible to know the significance, or lack thereof, of knowledge you don’t possess.
So basically what I’m trying to say is that CRNAs and DNPs, being in possession of a narrow knowledge-base, are not in a position to make an accurate assessment of what knowledge is useful and what isn’t. I think this is a very reasonable argument.
- Quote from DEMARRTAA-CWHAT in the world are you talking about? None of what you say is true. An RRT cannot "do" anesthesia period. CoARC has nothing to do with determining who can be an AA-C. I have no idea what an AA-T is. An RRT can go to AA school like anyone else but they are given no special consideration. They are the same as the guy with a BS in English who does to AA school having never been in the same room with a sick person.Just to make it clear an RRT does not need to be a CRNA nor do they have to be a RN to do anethesia. RRT's per CoARC can be AA-T or AA-C's. The RRT as far as the AA-C is a lot more qualified than a CRNA and is considered a PA (they are PA's). AA schooling is a lot different than CRNA schooling and a lot more complex. The classes are far more advanced than that taken by a RN. '
Min Req. MCAT or GRE. MCAT score no lower than 27 GRE I do not remember. Upon completion you need to pass the PANCE exam. PLAIN and SIMPLE.
AS I SAID HUGE DIFFERENCE BETWEEN CRNA AND AA-C.
AA school is not more complex than CRNA school...that is absurd. Classes are not far more advanced. Upon graduation AAs are far less experienced than CRNAs, most having been exposed to health care for only the two years of AA school. The clinical ability differences are very noticeable.