Utah surgeons against AA's - page 4

I found this to be very interesting. The docs on this site promote anesthesiologists and CRNA's, but is anti-AA. Many docs in Utah have been trying to get aa's here for several years. These... Read More

  1. Visit  srnamom profile page
    0
    You seem to come to this discussion with some preconceived ideas about how this all works and how it came about. I urge you to do some investigation into the history of nurse anesthesia and advanced practice nursing. History is replete with examples of APNs filling a need that physicians find less than lucrative. Nurse anesthetists were the first. ICU nursing is a prerequisite for a nurse anesthesia program not because ICU experience comes in handy occasionally or offers a back-up plan, but because anesthesia is the ultimate in critical care: providing loss of sensation and loss of awareness, while sustaining physiologic homeostasis as the surgeon cuts, manipulates and otherwise causes physiologic derangements during the procedure.

    Are you a would-be CRNA or an interested bystander?
  2. Visit  wtbcrna profile page
    0
    http://www.nursepostcard.com/S_4.JPG

    http://www.anesthesia-nursing.com/wina2.html

    Male nurses have been around as long or longer than female nurses. Male Nurse Magazine
    Female nurses during the early 1900's sought and effectively excluded most male nurses from being trained or working as a nurses. It has taken male nurses several decades to overcome this bias., and to again become significant contributors to the world of nursing.

    Male CRNAs have been actively trained by the military since 1961.

    The reason that nurses were picked to become anesthetists is because they were already trusted by the surgeons to take care of patients. It was a natural extension of nurse's duty to provide care for a patient during surgery while giving anesthesia.

    The reason that anesthesia didn't initially pay well is because it was considered part of the surgery and wasn't billed as a separate entity for several decades after the routine use of anesthesia during surgery.
  3. Visit  jjjoy profile page
    0
    Just interested! My university's nursing school encouraged pre-med students to consider nursing by touting "You don't have to be a floor nurse! You could be an NP or CRNA!" Some people choose CRNA and NP because they truly favor a nursing perspective to a medicine perspective. Still how many CRNAs who entered nursing school with the goal of becoming a CRNA, would've made that choice if it took significantly longer and/or cost significantly more to go through nursing school than medical school?

    Thanks for the links! Great pic of the male nursing class! Here's more info on Dixmont State Hospital. http://www.post-gazette.com/lifestyl...20dixmont2.asp
    It's interesting to note that it was a mental institution. I wonder how many acute care hospitals had nursing programs that accepted men. Just for the record, I noted the general concept nurse=woman "at that time", I was referring to the time surrounding the turn of the 20th century, what is generally considered the beginning of the "professionalization" of nursing. One of your links notes that "men were excluded [from the ANA] until 1930". Strict Victorian gender roles still had strong influence at that time.

    The link http://www.anesthesia-nursing.com/wina2.html notes

    One of the early accomplishments of the female nursing organizations was to exclude men from nursing in the military. In 1901 the United States Army Nurse Corp was formed and only women could serve as nurses. At this point in history military nursing which had been mostly males changed to being “exclusively female.”
    Would there have been any real reason to even create a separate US Army Nurse Corps if women could've officially served in the military before WWII? Would the Army have been allowed to train enlisted men as "real" nurses, instead of training them up as medics?

    I don't purport to be an expert. I'm just someone with a degree in nursing who finds professional nursing issues and the history of nursing very interesting! I have opinions based on my limited knowledge and experience; those opinions are subject to change with more knowledge and experience.

    I appreciate the civil discussion!
    Last edit by jjjoy on Oct 18, '10
  4. Visit  JacobSZ profile page
    0
    i believe healthcare to be a valued commodity, one which then becomes a calling in which anesthesia providers wish to make a life’s work of. where with economic change and competing global economies consuming technology and healthcare as a whole efficiency of care is paramount, not whom your provider is. practically handling patient care in a fashion that is sustainable, effective and proven sound and safe within it’s given costs is what the focus of anesthesia providers should be, which i’m sure many people feel is the case here. i believe however there to be ulterior motives when it comes to where the greater growth in mid level anesthesia care will be in the future, as opposed to where it historically has been.

    with crna’s practicing nursing anesthesia over the last century and demonstrating without question over the course of that time that they are in fact extremely skilled, educated and capable anesthesia providers it is obvious that they are a valued tool in the efficient and safe delivery of anesthesia care in this current economy more so then ever before, and the same can be said for anesthesia assistants also. to quote many other postings on this site i think it best to touch on a few common musings in regards to this debate…

    “no studies to date that have addressed anesthesia care outcomes have found that there is a significant difference in patient outcomes based on whether the anesthesia provider is a crna or an anesthesiologist.”

    and another favorite, less formal but still a favorite…

    “aa’s can do everything crna’s do, and they can do it just as safely.”

    back to my original point though, crna’s provide near equivalent care to their physician counterparts, indistinguishable alongside mda’s and in some respects i’m sure aa’s do the same. so with our commodity of healthcare being so scarce and at the mercy of our government to exchequer at any given point and time, why not work towards gradual removal of anesthesiologist from the anesthesia care team setting as a whole then? anesthesiologist can still choose to work and function as they always have, but it just seems to me that there should be a greater public demand for crna’s to work independently and autonomously by this reasoning alone.

    “multiple studies have attempted to show that care provided by or under the supervision of an anesthesiologist is safer. despite multiple attempts, no legitimate peer-reviewed study has shown any difference in the quality or safety of anesthesia care provided by crnas practicing alone, crnas practicing with anesthesiologists, or anesthesiologists practicing alone. training a crna costs significantly less than training an anesthesiologist (less than 1/3 in most cases). additionally, facilities that use crnas practicing independently to provide anesthesia, as opposed to some variation of the “anesthesia care team,” do so at a significant cost savings. given that there is no difference in quality or safety between crnas and anesthesiologists, and the significant cost savings realized with using crnas, calls for continued supervision of crnas by anesthesiologists are irresponsible given our current healthcare crisis.”

    and because of this i believe that aa’s should go by the wayside in favor of more crna's, for aa's are the asa’s solution to the costly management anesthesia care which still mirrors a system similar to what the above sited paragraph touches on. why should we continue to pay the overwrote salaries of anesthesiologist when we already can’t provide their costly services for over 55 percent of our nation’s healthcare population in regards to anesthesia care? anesthesia, as well many other physician specialties are being indirectly told by our government that their services are overpriced and impractical at large by way of reimbursement cuts and other government driven cost control measures. further more with healthcare reform, medicare and medicaid cuts in anesthesia reimbursement and nearly equivocal care being provided by autonomous crna’s and aa's (in part) for a fraction of the cost, the only natural progression would be the growth of mid level provider care which we as a country are already seeing throughout healthcare. with no real national interest in education reform in the way of medical education costs and tort reform to reduce the overriding liability of providers in all areas more and more doctors will simply say “why bother?” while the government pays out less and less to anesthesia providers each year.

    already you have the aana pushing fellow crna’s to pursue dnap degrees and advance their already amazing understanding and skill of anesthesia, and all of this incurrent time and cost of education, which by that point would be equal to that of a mda’s time and money spent on education (with exception that it is not subsidized by tax dollars by there being no paid residency period) only to still earn a fraction of the wage a mda generates. this system would vastly improve anesthesia care in terms of quality while still providing a reduction in cost. my only outstanding question is are aa’s pursuing to advance their education credentials and further their profession as crna’s have already done? to this i don’t know, but it seems aa’s continue to have the bare minimum of education and clinical experience (which even some aa’s on this site agree to when compared to their graduating crna counterparts, only stating that over the course of their combined career do they then posses comparable clinical skill related to anesthesia) before entering into the role of an anesthesia practitioner and provide the majority of the care with no incentive to evolve or grow as profession.

    i’m a radical in thinking that if things economically keep going the way they have been we might see a day when family practice md’s and internal medicine md’s disappear and are managed by apn and pa’s exclusively in and out of the hospital setting in hopes of cost control. and likening the above paragraph to another current facet of medicine why do podiatrist and dentist exist in their current capacity? why are surgeons not the only care providers in the world of procedural medicine, only to supervise dental assistants and surgical assistants? it’s because just like anesthesia these two unique areas of procedural medicine benefitted from specialty training of practitioners who rose to the level of an equivalency doctoral degree in that field to better serve the population as a whole, because it works. i openly would like to see a healthcare setting where you would find an overwhelming majority of dnap’s providing all anesthesia care for patients further justifying the unique and invaluable roles crna’s provide patients in need of anesthesia care within the dynamic of healthcare and medicine.
    Last edit by JacobSZ on Oct 29, '10 : Reason: More pithy
  5. Visit  loveanesthesia profile page
    1
    I am surprised to hear you are an RN in a Level 1 trauma center, several of the things you say don't reflect that experience.
    CPhT2RNstudent likes this.
  6. Visit  wtbcrna profile page
    1
    1. There are no studies that show AA's are just as safe as CRNA or MDAs. There are only studies that show AA's that are supervised by MDAs are as safe CRNAs in the same type of practice. To accurately show if there is a difference in AA and CRNA safety you would have to compare independent AAs (which is impossible since AAs cannot work without MDA supervision) versus independent CRNAs.

    2. It doesn't matter if nurse anesthesia training is 2yrs or 10yrs the cost will still be more to educate an anesthesiologist. What most people don't realize is that medical school and residency is highly subsidized by state and federal government. Nurse anesthesia is paid by the student with very little monies coming from state or federal monies. Also, during clinicals SRNAs are not paid by in many places provide free labor to hospitals. MDAs like all physicians are paid during their residencies.
    CPhT2RNstudent likes this.
  7. Visit  CPhT2RNstudent profile page
    0
    Wow. That was way too much to read. Whew. I would be interested in hearing how your interview went if you shared your opinion during your interview.
  8. Visit  JacobSZ profile page
    0
    as for my interview i only answered the questions i was asked, none of which dealt with my opinion. so i thought it went well (laughing). i'm still undecided about the whole experience, nerves got the better of me during my written test and then i settled down a bit during the interview. so we'll just have to wait and see. as always i learn something new about myself with experiences like these, and i feel more prepared for a next time if there should be one. so i'm glad to have been given the opportunity to interview, but anxiously awaiting their response.

    as for my point earlier, i just strongly feel our current physician driven healthcare system is not what's best for america/americans. everyone should really be looking at current practices and trends in healthcare and we should be asking ourselves how safe, high quality care can be delivered to maximum number of patients efficiently and in a cost effective manner. not, how can we proliferate tiered systems of medical bureaucracy. sometime less is more... except in the case of my prior post...

    sorry for any vision loss people might have developed after reading it.
  9. Visit  loveanesthesia profile page
    1
    Quote from jacobsz
    as for my point earlier, i just strongly feel our current physician driven healthcare system is not what's best for america/americans. everyone should really be looking at current practices and trends in healthcare and we should be asking ourselves how safe, high quality care can be delivered to maximum number of patients efficiently and in a cost effective manner. not, how can we proliferate tiered systems of medical bureaucracy. sometime less is more... except in the case of my prior post...
    " i would first and foremost wish to make my position clear in stating that i believe the best/most qualified/competent/skilled...etc... anesthesia provider would be that of an anesthesiologist."

    i can't believe the same person posted these two statements in the same week. and someone who is applying to a crna program. i would never give an anesthetic if i felt by doing so, by patient would receive care from a less "qualified/competent/skilled...etc... anesthesia provider" because i'm a crna. why are you applying to a nurse anesthesia program if you feel you would be second best to an anesthesiologist?
    wtbcrna likes this.
  10. Visit  jwk profile page
    0
    Quote from wtbcrna
    1. There are no studies that show AA's are just as safe as CRNA or MDAs. There are only studies that show AA's that are supervised by MDAs are as safe CRNAs in the same type of practice. To accurately show if there is a difference in AA and CRNA safety you would have to compare independent AAs (which is impossible since AAs cannot work without MDA supervision) versus independent CRNAs.
    As you are well aware, tens of thousands of CRNA's, including many without a degree of any type, work in anesthesia care team settings under the supervision or direction of an anesthesiologist, just like AA's, with the exact same job description and compensation package in departments that employ both types of providers. In those departments that employ both AA's and CRNA's, the malpractice insurance rates are identical, so the malpractice carriers are very satisfied with the quality and safety of AA's. If they weren't, the rates would be higher for AA's than CRNA's. They are not. Also, remember that the truly independent CRNA is a fairly small, but incredibly vocal, minority.

    Quote from wtbcrna
    2. It doesn't matter if nurse anesthesia training is 2yrs or 10yrs the cost will still be more to educate an anesthesiologist. What most people don't realize is that medical school and residency is highly subsidized by state and federal government. Nurse anesthesia is paid by the student with very little monies coming from state or federal monies. Also, during clinicals SRNAs are not paid by in many places provide free labor to hospitals. MDAs like all physicians are paid during their residencies.
    You are correct that physician education will cost more than CRNA education because it takes longer. However, you assume that tuition pays all the cost of a CRNA education, which would of course be incorrect. Many CRNA programs are in public colleges and universities, and even in private institutions, tuition rarely if ever covers teh actual cost of the education. That's why colleges and universities have endowments. You also imply that nursing education receives no state or federal subsidies, which would also be totally incorrect.

    Medical school students pay tuition for four years, and at the end of that four years, they have a medical degree. CRNA students pay for 2-3 years depending on the program, and have a master's degree at the end of that time. That's not earth-shattering news - you pay tuition to a school to get a degree or diploma. It's only during residency that physicians are paid, but at a rate that doesn't end up being much more than minimum wage consdering the hours worked. Again, you're trying to imply something that simply isn't true, that the cost of a medical education is minimal to the individual and borne mainly by the taxpayers - nothing could be further from the truth and you know it.
  11. Visit  wtbcrna profile page
    0
    Quote from jwk
    As you are well aware, tens of thousands of CRNA's, including many without a degree of any type, work in anesthesia care team settings under the supervision or direction of an anesthesiologist, just like AA's, with the exact same job description and compensation package in departments that employ both types of providers. In those departments that employ both AA's and CRNA's, the malpractice insurance rates are identical, so the malpractice carriers are very satisfied with the quality and safety of AA's. If they weren't, the rates would be higher for AA's than CRNA's. They are not. Also, remember that the truly independent CRNA is a fairly small, but incredibly vocal, minority.



    You are correct that physician education will cost more than CRNA education because it takes longer. However, you assume that tuition pays all the cost of a CRNA education, which would of course be incorrect. Many CRNA programs are in public colleges and universities, and even in private institutions, tuition rarely if ever covers teh actual cost of the education. That's why colleges and universities have endowments. You also imply that nursing education receives no state or federal subsidies, which would also be totally incorrect.

    Medical school students pay tuition for four years, and at the end of that four years, they have a medical degree. CRNA students pay for 2-3 years depending on the program, and have a master's degree at the end of that time. That's not earth-shattering news - you pay tuition to a school to get a degree or diploma. It's only during residency that physicians are paid, but at a rate that doesn't end up being much more than minimum wage consdering the hours worked. Again, you're trying to imply something that simply isn't true, that the cost of a medical education is minimal to the individual and borne mainly by the taxpayers - nothing could be further from the truth and you know it.
    1. I stated there are no actual studies comparing CRNAs to AAs which there isn't. You cannot compare Independent CRNAs to Independent AAs, because Independent AAs don't exist. There is no debate there. It is a simple fact. I would be surprised if malpractice rates were any different since anesthesia overall is very safe practice. What is interesting though is that no matter what the practice setting, independent or not, CRNA malpractice insurance is less than anesthesiologists. You would think that if anesthesiologists were so much better providers as some would suggest that their insurance rates would be less.

    2. The cost to train a CRNA is approximately 52,000. Which doesn't count the cost of a BSN, and is paid for almost exclusively by the CRNA. The cost to train an anesthesiologist is approximately 1,070,000. Which again doesn't count the cost of an undergraduate degree. AANA - Research
    (see bottom of page for link to the article on "Cost Effective Analysis of Anesthesia Providers") The cost of tution/fees etc. for four years on average for a medical student is 66K-133K. Those are reported figures from the AMA. Cost of Medical School - Get Prices and Information - CostHelper.com My math might not be the greatest in the world, but that leaves 900,000 dollars give or take that someone is paying for and it isn't the medical student/physician.
    ["I]The Congressional Budget Office's analysis of data from the Health Care Financing Administration indicates that for hospitals in the middle of the distribution in terms of subsidies per resident, an additional resident means that the hospital receives between $58,000 and $102,000 (in 1993 dollars) more in annual payments. About one-fourth of the teaching hospitals receive more than $102,000 annually for adding another resident, whereas about one-fourth of the hospitals receive less than $58,000 for one more."
    [/I] http://www.cbo.gov/doc.cfm?index=17&type=0&sequence=1
    There are simply no such public money backing CRNA education. The cost is almost exclusively born by the nurse anesthetist students themselves.

    3. Resident Salary and Benefits
    2010-2011 Academic Year
    PGY 1 - $45,175
    PGY 2 - $46,750
    PGY 3 - $48,350
    PGY 4 - $49,350
    Resident Salary Benefits - Graduate Medical and Dental Education

    4. Residents are mandated to work an average maximum of 80hrs week. Which if you do the math for PGY-1 is a little less than $11 dollars an hour. While it still isn't the greatest in the world, but 45-50K a year is hardly living in poverty. It also isn't half bad considering the amount of training that goes on especially in the first two years for intern/residents. It also is certainly not minimum wage as you would have some believe.

Must Read Topics


Need Help Searching For Someone's Comment? Enter your keywords in the box below and we will display any comment that matches your keywords.



Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top
close
close