How do CRNAs/SRNAs benefit anesthesiology residents? - page 2
I was searching for information on the Wake Forest CRNA program and happened upon this information on the Wake Forest anesthesiology program. Dr. Royster has an interesting view on how CRNA's/SRNAs... Read More
Jun 12, '04Quote from jwkMy God, do you ever listen to yourself or read what you write? These are not the actions of a PROFESSIONAL, anesthesia or otherwise!
Opinions are like A$Aholes: everyone's got one.
BTW, Personal attacks do not advance your cause.
Jun 12, '04Quote from loisaneLoisana crna,Yes, it is an undisputed fact that the majority of anesthestics are provided by CRNAs and anesthesiologists working together.
But what is the nature of that team? This is where we have disagreement. TejasDoc, I ask you to examine your phrase "which involves an attending anesthesiologist supervising a nurse". That is YOUR definition of the team. It is NOT nurse anesthesia's definition. You assume that CRNAs need supervision, and we do not accept that assumption. Even when CRNAs work with anesthesiologists, the nature of that relationship does not need to include "supervision".
I believe I understand your major point. That there are benefits to residents if they choose an institution that employs CRNAs, and the original quote was a "marketing tool". I think it is a fair assessment of this picture.
So I have no issue with your major point. But some of the underlying philosophy/assumptions do strike a nerve with many of us. I do not know if you indeed hold these beliefs, or are simply repeating phrases you have heard. You say you are here for discussion, so I offer my insight in that spirit.
So I think we agree, that this webpage was trying to explain the responsibilities of CRNAs in the program and how that affects the opportunities for the residents. I don't think I would refer to CRNAs as "marketing tools" in this case, I'm sure they provide a value service to that department, but I think the Wake Forest webpage is trying to clarify how the CRNAs fit into the educational experience for prospective resident physicians, and that their existence within the program is a good thing, not a negative one.
As for the issue of the "anesthesia care team", we do not agree.
"Yes, it is an undisputed fact that the majority of anesthestics are provided by CRNAs and anesthesiologists working together."
So we agree on this, that CRNAs and anesthesiologists work together to provide the majority of anesthesia care in this country, but that's not the whole truth. My understanding, and please, someone correct me here if I'm wrong, I'll be the first to admit my inexperience, that when one says "anesthesia care team", that refers to an anesthesiologist (physician) medically directing and supervising a team of anesthetists (AAs and CRNAs). Work together, yes, same jobs and responsibilities, no.
I understand that you feel CRNAs do not need supervision, I disagree, but I think the definition of an anesthesia care team is pretty clear.
Jun 12, '04Quote from deepzDeepz,Because some animals (anesthesia providers) are MORE equal than others.
"Gaspasser.com consumer info about anesthesia" It's really a pro-CRNA / anti-anesthesiologist website, not consumer info. It's totally fine that it's a pro-CRNA website, but we have to call a spade a spade, so people looking for unbiased information can look elsewhere. Also, some of the information is not accurate and while there are many statistics quoted on that site, I cannot find any references.
"The Orwellian Inner Workings of American Anesthesia" ???? You kind of have to take the bias of the author into account before you read something like that and think of it as fact. "Orwellian", wow, you CANNOT make this stuff up. :>
Jun 12, '04Quote from TejasDocTD, there are many ACT that function as you describe-anesthesiologists directing or supervising CRNAs. Perhaps this is the only type of team structure you have been exposed to. But to assume it is the only type of team structure that exists, is an error ( a very easy error, that we all have been guilty of at one time or another. The SRNAs here will tell you I am just as apt to point it out to them, when they do the same thing.)My understanding, and please, someone correct me here if I'm wrong, I'll be the first to admit my inexperience, that when one says "anesthesia care team", that refers to an anesthesiologist (physician) medically directing and supervising a team of anesthetists (AAs and CRNAs). Work together, yes, same jobs and responsibilities, no.
Direction and supervision are terms that come from Medicare reimbursement. It is also possible to bill Medicare for CRNA care directly. Obviously, this is how it is done in CRNA only practices. But it can also be done when the practice and/or group includes anesthesiologists. These terms are all about billing. I am not an expert in billing, and it is an extreamely complicated subject.
The point I am making is that there are many different ways ACTs function. I do not know the particulars, it may even be true that the pattern you describe is in fact the predominate one. But I do know of situations where CRNA work with anesthesiologists, and they are not directed or supervised.
Jun 12, '04Quote from TejasDoc"Gaspasser.com consumer info about anesthesia" It's really a pro-CRNA / anti-anesthesiologist website, not consumer info. ......
Not consumer info? Looks like it to me. Perhaps as a doc you don't like to read that half the MDAs in America are not board certified, but otherwise how is this anti-anesthesiologist? Page two of the site clearly informs the reader that one side of the page is straight consumer information (the majority of the page, looks like), the other side labeled editorial "CRNAs Speaking Out." The Orwell quote comes from the clearly labeled editorial side of gaspasser.com, I believe.
Jun 12, '04deepz:
there are about 34,000 anesthesiologists in the U.S. According to the american board of anesthesia, there are 29,000 board-certified doctors, and about 3,500 board elegible doctors (meaning that they are in the process of getting certified - IE: they have finished residency but are waiting for their written exam results (done once a year in july) and readying for their oral exams which are only done twice a year (october and april) - so for most post-residency MDAs it takes between 1 and 2 years to become board certified). However, according to ALL state medical licensing boards, anybody who finishes a residency with statement of clinical competency can practice anesthesia. Most, if not all, Academic Centers require board-certification in order to become full staff (and allow 1-2 years of probationary hiring pending board-certification). And yes, since 2000, EVERY MD who gets their board-certification needs to be recertified every 10 years.
by the way, that website - written by somebody who after 40 years of anesthesia still has quite a few insecurities - is boring...
Jun 12, '04Removing this post, since it's clear it reached its intended audience.Last edit by Athlein1 on Jun 13, '04
Jun 12, '04athlein - you are absolutely right, i spend way too much time on this board (usually when i am on call between cases)... sometimes I see myself as the lone voice to correct a lot of misperceptions that are brandied about by CRNAs thus influencing SRNAs.
how is my comment incendiary? or personal? whatever....
this will be my last post
Jun 12, '04Quote from Tenesma.....by the way, that website ... is boring....
See message # 14 on this thread as to opinions.
Jun 13, '04Quote from Tenesmaathlein - you are absolutely right, i spend way too much time on this board (usually when i am on call between cases)... sometimes I see myself as the lone voice to correct a lot of misperceptions that are brandied about by CRNAs thus influencing SRNAs.
how is my comment incendiary? or personal? whatever....
this will be my last post
This board has become a nightmare.
Over half of the posts/threads have deteriorated into juvenile bickering. It is sad really, considering how good it was a year ago. This board has been taken over by knee-jerk zealots. The self-serving pontificating by first year SRNAs combined with radicalization of some the veteran CRNAs has become nauseating.
Tenesma has consistently been one the better posters here (regardless of the fact that he is a MDA). I am sad to see him go.
This board has become nothing but a source of negativity. I am embarrassed to be a member of it.
This will be my last post as well.
Jun 13, '04The self-serving pontificating by first year SRNAs combined with radicalization of some the veteran CRNAs has become nauseating.
Jun 13, '04Quote from jwkI would much rather wake up to a CRNA than an MD (mostly) because waking up to a nurse is much better than waking up to a doctor1In a practice where the ANESTHETISTS do all the cases (AA or CRNA) I'd much rather have the anesthetist be the one doing the case and staying in the room with me for MOST cases.