What do you think (if anything) MDA's will do...

Specialties CRNA

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to protect their turf? If there's one thing I learned in my short thirty three years on this planet it is that interest groups always TEND to seek for ways to maximize THEIR interests (nothing wrong with this of course but politicians should keep this in mind when considering their input on issues). It doesn't matter if you are talking about government workers, teachers, Dr's or CRNA's. One need only to witness some of the caustic things that were put out by the AMA during the debate concerning "opt out" provisions for Medicare of direct physician supervision of CRNA's.

Without regard to whether or not this is actually THE CASE MDA's PERCEIVE CRNA's as something of a threat. My question is what will their LONG TERM strategy be for dealing with this threat. Possibilities that I can think of might include:

I. Working to increase the standards of education for CRNA's. Perhaps, getting CRNA schools to introduce an additional semester or two of courses like gross anatomy, and or pathophysiology. This would be an interesting approach since it would probably garner the support of many CRNA's who would benefit (at least in the short term) by the even greater shortage it would facilitate. The decrease in graduating CRNA's might encourage the common use of CRNA's to "go out of common practice" in many locales.

II. Another route they might follow would be to seek regulation AT THE STATE LEVEL which would make it more difficult for CRNA's to effectively practice. Perhaps mandating A CERTAIN TYPE of liability insurence (not availible from CRNA associations) that would make it less viable for CRNA's to practice.

III. Yet another tactic would be to fight the EXPANSION of existing CRNA educational facilities with a result similar to #I above in the long term.

My question is are CRNA organizations anticipating such action and even more importantly what are they doing to fight back?

Tenesma-

I think you have made some very valid points and agree with what you say for the most part.

However, I wonder if it possible that some of you have misinterpreted what Kevin had to say about not trusting some MDA's or CRNA's to "watering his lawn." The way I interpreted that was to mean that even though both types of professionals obviously have had the required education does not mean they have the common sense or bedside clinical skills to provide good care. They may be able to answer any question correctly on paper, but translating that knowledge into application of clinical skills is another thing. In my experience, I have on more than one occasion met a nurse who was very intelligent, but couldn't apply her knowledge to bedside care. In other words, hands on clinical skills and application of knowledge at the bedside is very different than reading a book and taking a test. Critical thinking skills must be present and must be utilized very effectively at the bedside and not all people have as strong critical thinking skills as others. So, just because someone has achieved the education requirements doesn't always mean they are adept at providing hands-on care to patients. I know there are clinical requirements for graduation, but it is very different doing clinicals in a learning environment than actually practicing autonomously on your own license. As far as the MDA vs CRNA controversy, I think there will always be a controversy. It's just like the controversy with MD's and PA's and FNP's. I have heard some PA's argue that they were trained by MD's, took the same A &P's with MD students etc., and can treat patients the same, but they can't work independently. Some PA's don't feel FNP's have had equal training to the PA and feel that it is unfair to allow FNP's to work independently. In my personal opinion, I believe that the root of the controversy surrounding all of these issues is not a question of safe, effective patient care provided by Advanced Practice Nurses, but a desire of the medical community to control nursing as maybe it once was. Again, the training and requirements for the MDA vs the CRNA are different;but, nevertheless, both provide excellent care to patients with safe outcomes. I think there is a lack of respect for each profession on both sides of the spectrum-most MDA's don't like having a "nurse" work independently and then some CRNA's think their education is equivalent to that of the MD and it's not. Bottomline is the MD receives a much broader knowledge base on general medicine than the CRNA typically does and I can see where that knowledge can come into play when providing anesthesia care to some difficult to manage patients. Don't get me wrong, I am not saying that CRNA's with a lot of experience can't manage the same patients that were mentioned above by Tenesma as being patients not typically managed by CRNA's because I disagree with that point. I think that some CRNA's who have a lot of clinical knowledge and experience can provide care to the equivalence of some MDA's, that is true and I hope one day to be one of them, but the fact still remains if a CRNA wants to be considered an equivalent provider to the MDA in the eyes of society, then they should go to medical school. In addition, I think is acceptable for CRNA's to work independently in most situations. I also think that MD students who piss and moan about how much money CRNA's earn and that they shouldn't be able to practice independently should take another look at the career choice they have chosen because I think it is more of a jealously thing than anything else.

are a very good way to protect CRNA interests. However, I am speaking to strategy and tactics. In other words WHAT things can those groups do to effectively combat equally effective interest groups on the "other side". Perhaps, this is an excessively conflict orientated perspective, but I believe it to be a valid portrayal of the situation as it exists. It might be possible to ameliorate this situation via some sort of trans CRNA/ MDA organization that looked at the problem as something OTHER than a zero sum game. However, such an ideal no matter how noble doesn't seem to be in the cards presently (at least I'm not aware of it if it is).

Instead, we have a situation where MDA organizations seek to further limit the scope of CRNA practice, and CRNA organizations are seeking to expand their mandate (or at least maintain the purview which they currently enjoy). A good (albeit imperfect) analogy would be the situation which exists between Handgun Control Inc. and the NRA. Each organization seeks an outcome completely unacceptible to the other and there is very little room for negotiation. The issue of gun control will likely ultimately be decided by the group which can most effectively muster resources in the most efficient manner so as to sway public opinion in their direction or the side which displays superior intellect and cunning in furthering their cause.

CRNA's MAY be outgunned in terms of financial resources, but it doesn't mean they can't prevail if they utilize superior tactics. I have already suggested the funding of studies to further demonstrate the safety, efficacy, and cost effectiveness of CRNA's. In addition, I would submit that aggressive public relations campaigns might be useful. Alliances with HMO's, insurance companies and hospitals, motivated by their desire to control costs would also be logical. Such alliances could be used to push for even greater independence for CRNA's than they currently enjoy (even if the real goal is only to maintain the status quo). Aggressive offense is often more effective at protecting one's turf than even the best defense.

roland... i was scratching my head about what you said in your last post: i wish i could come up with a good concrete resolution to the issue, but the truth is I am just as frustrated with the whole process and I don't think there is going to be a good answer for a while... i think it would be interesting to see what would happen if the AANA and ASA merged and became an anesthesia-provider organization (think of the possibilities!!!). however, i doubt that would happen for a long time to come.... too bad.

i hope everybody has a great labor day weekend

""and Chigirl which studies/claims by the AMA/government do you refer to regarding seasoned CRNAs? and regarding reasearch - how many CRNAs are actively seeking grants for research? I would argue that most CRNAs don't become CRNAs to do research... ""

1) I haven't seen any studies so far in my search that CRNA's are causing deaths in large numbers.

2) CRNA's and research, I think the possibilities of all specialists in this field have a great opportunity to use the clinical research process and contribute. In the end I think people should give back in the form of viable research that will help both AMA, and CRNA's do their jobs better. Don't know who else but a seasoned AMA, or CRNA that would be the best choice for this. And if I choose to become (someday) a CRNA then the goal will be from the beginning to eventually go into research to:

perfect the art,

contribute to the process,

and make the job easier........

for me personally, my background in Engineering coupled with being a Nurse will prove to be very fruitful whatever I decide to do, just gotta decide. You have all been very helpful, again thanks.

best regards,

Chigirl:D

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