O.R. cases for CRNA's vs. Anesthesiologists

Specialties CRNA

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You are reading page 3 of O.R. cases for CRNA's vs. Anesthesiologists

allnurses Guide

wtbcrna, MSN, DNP, CRNA

5,125 Posts

Specializes in Anesthesia.
The issue is liability. It has been a very nice dance around the issue in the past with CRNAs wanting independence but not wanting to tear down the shield that helps protect them. Perhaps that time has come. There are NO cases which I can find in which a MD in a team approach has not been named in a suit. Perhaps there are unscrupulous MDs that employ CRNAs but fail to provide assistance/supervision/direction/etc, and really don't give a flip about patient safety. I certainly agree that is often the case. However, this then gets into IRS regulations....it is not possible for a CRNA to bill independently of an employer. It will actually be interesting to see what transpires in the future, and I stand with CRNAs waiting for the unscrupulous anesthesiologists who employ gaggles? bevies? crowds? harems? (forgive me as I do not know what term is currently in use) of CRNAs to go down in flames.....

CRNAs have been around for over 150 yrs. It is anesthesiologists that are the newer profession in this country. If anything CRNA independence will go up, ACT jobs for MDAs will go down, overall rates for MDAs will go down, and there will be less MDAs overall.

Your post read like the ASA PAC statements. A lot of nonsense, misdirection, half-truth, with absolutely nothing substantial to back it up.

paindoc

169 Posts

I counter that if you have CRNAs that have been sued and lost in a team model when the anesthesiologist was dismissed, post it here, by all means. I agree, MDs are being self destructive with their continuance of the status quo but also believe the CRNA mills are equally as destructive with massive output of nurses from CRNA schools. CRNA independence will indeed increase, and so will the litigation against them- it is inevitable. Sorry, I have never been a member of the ASA, and I don't receive any of their literature.

allnurses Guide

wtbcrna, MSN, DNP, CRNA

5,125 Posts

Specializes in Anesthesia.
I counter that if you have CRNAs that have been sued and lost in a team model when the anesthesiologist was dismissed, post it here, by all means. I agree, MDs are being self destructive with their continuance of the status quo but also believe the CRNA mills are equally as destructive with massive output of nurses from CRNA schools. CRNA independence will indeed increase, and so will the litigation against them- it is inevitable. Sorry, I have never been a member of the ASA, and I don't receive any of their literature.

Read through the links I provided.

Specializes in Anesthesia, Pain, Emergency Medicine.

You have any studies showing patient safety is compromised by this? I can provide a few that show the exact opposite. Your credibility is at stake here.

If you accuse CRNAs as being less safe, which your statement certainly implies, back it up.

BTW, once again you are confused about medical directed and non medically directed. You can still be employed or contract with an MDA and do cases as non medically directed.

Perhaps there are unscrupulous MDs that employ CRNAs but fail to provide assistance/supervision/direction/etc, and really don't give a flip about patient safety. I certainly agree that is often the case.

paindoc

169 Posts

Actually you can only supply studies showing statistical but not relevant clinical significant differences... By definition an employee does not have completely independent decision making otherwise they would be either independent contractors or improperly supervised. You can't have it both ways much longer

allnurses Guide

wtbcrna, MSN, DNP, CRNA

5,125 Posts

Specializes in Anesthesia.
Actually you can only supply studies showing statistical but not relevant clinical significant differences... By definition an employee does not have completely independent decision making otherwise they would be either independent contractors or improperly supervised. You can't have it both ways much longer

So all the CRNAs that are independent contractors working without supervision are what exactly? Every anesthesia provider that works in a hospital works for someone in one fashion or another including MDAs.

400K+ anesthesia patients showed no difference in outcomes between anesthesia provider types I would call that statistically and clinically significant.

Specializes in Anesthesia, Pain, Emergency Medicine.

Ok, so you don't understand evidenced based medicine. That's ok.

S by your reasoning, an MDA who is employed is improperly supervised? You do realize many MDAs are employed? LOL.

It is very apparent that you really do not have a clue.

Even when provided with the differences between medical direction and supervision, you are unable to grasp the meaning.

I'm done. I feel like I'm arguing with my teen, LOL.

Have a nice life

Actually you can only supply studies showing statistical but not relevant clinical significant differences... By definition an employee does not have completely independent decision making otherwise they would be either independent contractors or improperly supervised. You can't have it both ways much longer

paindoc

169 Posts

Actually there are studies that demonstrate statistically significant differences, but not clinical differences in outcome. What does this prove: 1. anesthesiologists and CRNAs deliver virtually the same product 2. anesthesia has become so safe that it is virtually a technician's job unlike any other area of medicine that cannot duplicate the outcomes. The upshot of all of this is that given the expense of anesthetic delivery with the cost of the provider plus equipment plus drugs, it is probably overpriced and healthcare trends will seek out the low hanging fruit, replacing the technicians job with a real technician (2 year associates degree after high school) with supervision, whacking reimbursement, and cutting out the fluff devices being used that are not EBM. Both anesthesiologists and CRNAs will lose significantly if this is to occur. So we will have to wait and see what transpires.......

allnurses Guide

wtbcrna, MSN, DNP, CRNA

5,125 Posts

Specializes in Anesthesia.
Actually there are studies that demonstrate statistically significant differences, but not clinical differences in outcome. What does this prove: 1. anesthesiologists and CRNAs deliver virtually the same product 2. anesthesia has become so safe that it is virtually a technician's job unlike any other area of medicine that cannot duplicate the outcomes. The upshot of all of this is that given the expense of anesthetic delivery with the cost of the provider plus equipment plus drugs, it is probably overpriced and healthcare trends will seek out the low hanging fruit, replacing the technicians job with a real technician (2 year associates degree after high school) with supervision, whacking reimbursement, and cutting out the fluff devices being used that are not EBM. Both anesthesiologists and CRNAs will lose significantly if this is to occur. So we will have to wait and see what transpires.......

There are studies show exact same outcomes, mortality, adverse advents, length of stay in the hospitals etc. No matter what the comparison is you will find similar outcomes between the two types of providers.

1. The low hanging fruit as you call it would be the MDA that sits in the break room getting paid a double reimbursement to not do anything. The federal government is set to look at renewing the federal opt out, and at that point if it does get passed it won't be CRNAs that will have trouble finding jobs. It will be the aforementioned "supervising" MDAs.

2. Anesthesia is very safe, but the risk of anesthesia has recently increased. The reason for this is attributed to the increased age and comorbidities of anesthetic patients.

3. You basically post this same thing over and over. Do you really expect a different response? CRNAs won't be replaced by technicians in the foreseeable future. One day there maybe a machine that can safely do it all, but that time is in the very distant future.

4. What is the purpose of posting on here anyways? Per your own statements you do not even practice anesthesia anymore. You practice pain medicine.

bread angel

58 Posts

Specializes in Anesthesia.

Paindoc--you are sadly mistaken about the law of vicarious liability. Everyone involved gets named in a lawsuit, including the CRNA. There is a very important Washington case where an anesthesiologist who practice in a substandard fashion paid $1,000,000 settlement in a lawsuit and the CRNA had a jury rule against her to the tune of $6,000,000. Shoulder surgery under GA by CRNA. MDA decided to do a suprclavicular block and said he didn't care if patient was under GA. Patient got a total spinal and ultimately had her arm amputated.

paindoc

169 Posts

And you don't understand deep pockets. CRNAs may be named, but in a team model, even if the CRNA screws up badly and causes permanent injury or death, the anesthesiologist is ALWAYS NAMED. You can rarely find cases where the CRNA was found liable for malpractice in a team model while the anesthesiologist gets off scott free. This definitely is contrary to the assertion that even in a team model, the CRNA is capable of making completely independent decisions. If they are, then they should be sued independently of the anesthesiologist.....doesn't happen.

allnurses Guide

wtbcrna, MSN, DNP, CRNA

5,125 Posts

Specializes in Anesthesia.
And you don't understand deep pockets. CRNAs may be named, but in a team model, even if the CRNA screws up badly and causes permanent injury or death, the anesthesiologist is ALWAYS NAMED. You can rarely find cases where the CRNA was found liable for malpractice in a team model while the anesthesiologist gets off scott free. This definitely is contrary to the assertion that even in a team model, the CRNA is capable of making completely independent decisions. If they are, then they should be sued independently of the anesthesiologist.....doesn't happen.

That is because it has to be shown that the CRNA or MDA acted completely independently of each other, if the CRNA does something that the MDA neither consented to or knew about that was outside of normal/standard practice there is a chance that MDA can be found not liable.

MDAs put themselves in these situations, if they don't want to be held potentially liable for something that a CRNA or AA does while under their "supervision" then get a job doing anesthesia not "supervising.

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