Does it bother CRNA's that MDA's get so much more...?

[ICU, RN, BSN, B.S.]

Hey guys,

I'm not a CRNA yet. I want to be. I just got hired in a MICU/SICU. I was just wondering if it bothered any CRNA's the fact that MDs who practice anesthesia get paid wayy more for doing the same thing? I know some hospitals/facilities require the MDA oversee the CRNA, but does that equate to a couple hundred K more?

I don't know...I just feel CRNA's are not compensated enough for the ENORMOUS amount of responsibility and knowledge they hold.

[wtbcrna, MSN, DNP, CRNA]

Commonwealth of MA.....244 CMR 4.05

http://www.mass.gov/Eeohhs2/docs/dph/quality/boards/nursing_244cmr4.00_task_force.pdf

Current regulation:

Supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of Massachusetts who

1) has completed approved ACGME training in the United States or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from MA department of health and the DEA

3) develops a mutually agreeed upon guidelines for the APN practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

The Board of Registration in Medicine's regulation 243 CMR 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the ACGME or RCPSC in a specialty area appropriately related to the nurse's area of practice, is Board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. This regulation includes advanced practice nurses who practice pursuant to MGL 112 sec. 80 H. A physician who is not an anesthesiologist may be a supervising physician for a CRNA as long as he/she complies with the requirements of 243 CMR 2:10.

............. There.

Lol.... That was hilarious and time consuming, and you showed absolutely nothing. This is what it takes for a physician to be able to supervise in that state. I found nothing that did not allow/requires physician supervision in your state. Specifically there was no requirement for a physician to be there during induction or emergence as you originally claimed. I stand by my original statement there are independent CRNAs in every state, but every state I know of still also has ACT practices. One is dictated by the state boards of nursing and one is dictated by hospital policy.

[wtbcrna, MSN, DNP, CRNA]

You do the entire nursing field a disservice with your incorrect, misguided statements. (see above ) Your inexperience shows in your rush to judgement and harsh statements......and I say that in the nicest way possible...

I agree....wtbcrna is very knowledgable and a great resource....no one questioned her integrity. The OP was talking about money and I said if you want to make that kind of money be a doctor...I knew I'd get flamed and that's ok. It it just what I experienced at a prominent hospital where I worked and have seen at other hospitals in my area. All areas of nursing are regulated differently in every state and some are more restrictive than others.

I type in peace.......*wine;) Flame on!!!!!!!!!!:flmngmd:

Ouch....I am the xy type of CRNA not the xx type.

[Esme12, ASN, BSN, RN]

Ouch....I am the xy type of CRNA not the xx type.

HaHaaaaa:lol2::lol2: I am soooooooo sorry! I apologize!!! Please forgive!

[pedimac]

So you gave a summary of what it takes to be a supervising physician, not the legal requirement for them to be present for induction/emergence.

From NHIC (the Medicare Administrative Contractor for Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), Medicare Part B, Anesthesia Billing Guide, effective October 2010. http://www.medicarenhic.com/providers/pubs/Anesthesia%20Billing%20Guide.pdf

"CRNAs and AAs may bill Medicare directly for their services or have payment made to an employer or an entity under which they have a contract. This could be a hospital, physician or Ambulatory Surgical Center."

"The physician and the non medically directed CRNA (or Anesthesiologist Assistant) are involved in one anesthesia case and the services of each are found to be medically necessary."

"The CRNA/Anesthesiologist Assistant should bill using modifier QZ, CRNA/Anesthesiologist Assistant services; without medical direction by a physician, and modifier 22, with attached supporting documentation."

So if the CRNA in Massachusetts can directly bill insurance companies using a QZ modifier (by the way, MDAs use an AA modifier to designate when they do the anesthetic) to designate there was no medical direction or supervision of a case, where is the law to show there must be a doc in the room for induction/emergence? Curious.

[lmdscd]

I'm a CRNA and love my job! Most days lol. The surgeon in OR looks over both MDA and CRNA during surgery but doesn't tell us what to do. As far as schooling I was tested with an MDA resident during my schooling and the director of the MDA was surprised how much we knew. We scored the same. So titles sometimes dont hold much water. Sorry I'm tired if any typo's please forgive me, oh p.s I love my independence

[wtbcrna, MSN, DNP, CRNA]

I'm a CRNA and love my job! Most days lol. The surgeon in OR looks over both MDA and CRNA during surgery but doesn't tell us what to do. As far as schooling I was tested with an MDA resident during my schooling and the director of the MDA was surprised how much we knew. We scored the same. So titles sometimes dont hold much water. Sorry I'm tired if any typo's please forgive me, oh p.s I love my independence

Please, explain how the surgeon looks over the anesthesia provider in the OR. I would say it was more the opposite since we keep the patient alive while the surgeon does things that would kill the patient without anesthesia.

[lmdscd]

It's just our hospital's by laws it says surgeon is to make sure we our competent to do our work that goes for MDA and CRNA, I agree we have the patient life in our hands. If I worded it to say something different ,sorry for the confusion.

[wtbcrna, MSN, DNP, CRNA]

It's just our hospital's by laws it says surgeon is to make sure we our competent to do our work that goes for MDA and CRNA, I agree we have the patient life in our hands. If I worded it to say something different ,sorry for the confusion.

Weird, but "who watches the watchers".....

[GM2RN]

A fairly large part of nurse anesthetist education focuses on the history of anesthesia and that of nurse anesthetists. CRNAs have NEVER been called assistant anesthesia RNs. Aside from anesthesiologists and CRNAS, the only other provider in the United States that is legally licensed to provide anesthesia is an anesthesiologist assistant. JWK would know this better, but I believe they first opened their doors to education in 1969 at Case Western Reserve. Again, how about taking a look at that book I recommended.

It doesn't matter that much to me to bother reading a book on the history of anesthesia. Again, I know nothing of the history of anesthesia or CRNAs, but I do know that there is much about history in general that never made it into books, and I think that someone who had been around during the time in question might know a little bit about it.

[I_See_You_RN]

commonwealth of ma.....244 cmr 4.05

http://www.mass.gov/eeohhs2/docs/dph/quality/boards/nursing_244cmr4.00_task_force.pdf

current regulation:

supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of massachusetts who

1) has completed approved acgme training in the united states or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from ma department of health and the dea

3) develops a mutually agreeed upon guidelines for the apn practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

-------------------------------------------------

the board of registration in medicine's regulation 243 cmr 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the acgme or rcpsc in a specialty area appropriately related to the nurse's area of practice, is board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. this regulation includes advanced practice nurses who practice pursuant to mgl 112 sec. 80 h. a physician who is not an anesthesiologist may be a supervising physician for a crna as long as he/she complies with the requirements of 243 cmr 2:10.

............. there.

........not there, lol

firstly lets look at number 4,.. now if i perform one surgery every 3 months,.. that would make sense to say that you directly and physically supervise me,.. but alas.. that is not the case. in massachusetts you are allowed to prescribe so one check every 3 months doesn't seem to be "supervision" in the usual sense. lets look at number 3... mutually. enough said.

and also, all that is up there is a criteria that a mda must follow in order to claim that he did supervise, it does not stipulate that crna's must be supervised. read the red bold sentence again. you are adding meaning to the phrase based on your belief. again, it says nothing about being present during intubation/extubation. thats a private independent group policy followed in some facilities for medicaid purposes, not legal state law purposes.

[I_See_You_RN]

commonwealth of ma.....244 cmr 4.05

http://www.mass.gov/eeohhs2/docs/dph...task_force.pdf

current regulation:

supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of massachusetts who

1) has completed approved acgme training in the united states or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from ma department of health and the dea

3) develops a mutually agreeed upon guidelines for the apn practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

the board of registration in medicine's regulation 243 cmr 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the acgme or rcpsc in a specialty area appropriately related to the nurse's area of practice, is board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. this regulation includes advanced practice nurses who practice pursuant to mgl 112 sec. 80 h. a physician who is not an anesthesiologist may be a supervising physician for a crna as long as he/she complies with the requirements of 243 cmr 2:10.

---------------------------------------------

a few points that you missed from that document:

* describes the physician-aprn relationship as collaborative and

consultative with a team approach to patient safety; and

* streamline and bring consistency, when appropriate, and available

between the practice/prescriptive guidelines and other existing

employer systems of privileging, credentialing, role descriptions, or

other business contracts.

* evidence demonstrates that aprn practice including prescriptive

practice has not resulted in an increase of board complaints.

[Zaphod, BSN, RN]

That is very possible, but I believe they include getting your MSN or Phd with your CRNA to then sit for the certification exam. If you see on my statement a straight masters program is 15-18 months and then anesthesia school another 2.5. quote] A CRNA is a specialized nurse. YOu have 4 years BSN, 15-18 months masters, I year critical care experience and 2.5 years CRNA school. end quote] and then whatever residency program that follows.

I am curious....why does it matter if we are students for CRNA's or not.

I see that you are new to AN and when you post, anyone including non medical people can comment on your posts, whether you say CRNA"S only or not. The forums are there so you may find information readily and contact your speciality directly. All forums are public domain and can end up in general nursing discussion if the moderators feel it would make a good discussion. There you will have CNA's, student nurses, people who want to be nurses, medical assistants, respiratorytherapists, the general public, and professional patients. SO your posts will gain a cross of education, experience and educational backgrounds.

I am not a CRNA nor am I a student. I am a registered nurse with 32 years as a critical care nurse/emergency nurse/trauma flight nurse experence. I rememeber when it was called Assistant Anesthesia RN and it was OTJT (on the job training). I think you need to get your critical care skill honed as you will need them in the OR and will go a long way towards making you an excellent CRNA. I understand your ambition and excitement....but if your peers think your are using them as a stepping stone.....isn't very endearing and you're in for a long haul.

Good luck to you!!!!! Peace:heartbeat

wrong...CRNA masters is at minimum 28 months in length and up(mine is 30). CRNAs DO NOT..have to be supervised by MD's and some DO provide anesthesia in Open Heart, Transplant etc.-independently. So yes-possibly they are gettinng cheated of some earning power. It definetely is not on the job training any longer, as the CRNA's need to be fully functioning independent providers of safe anesthesia. Peace.