AANA members

jwk · May 23, 2006

WITH THE ONE TO ONE REIMBURSEMENT THAT DERMATOLOGY, OPHTHAMOLOGY, GYN, SURGERY, MEDICINE, AND FAMILY MEDICINE RECEIVES, THANK GOODNESS ALL OF THOSE RESIDENCY PROGRAMS HAVE TRIPLED IN SIZE AND PREVENTED ANY TRAINING OF NP'S, NURSE MIDWIVES, OPTOMETRISTS, AND PA'S. (Sarcasm intended). So I ask anyone here still convinced that HR5246 will hurt CRNA's and trainees, do you think NP's, nurse midwives, optometrists, and PA's have suffered and watched their lateral practice residency programs even double in size?
In the end, HR5246, even if it passes, will likely not be enough to convince CMS to change the reimbursement rule. Remember it is not a mandate, only a very strong suggestion. CMS can do what it wants to do.

And there's the real issue - in comparison to other residencies in other specialties, anesthesia is treated differently. It has absolutely NOTHING to do with SRNA training programs. Apples and oranges - entirely different issues and circumstances.

The AANA and CRNA's are digging an ever-deeper hole in their relations with anesthesiologists, not that many of you necessarily care, but you should. Most of you practice in ACT practices, and most of you have a good relationship with the anesthesiologists with whom you work. That is changing, not for the better, but again, not that many of you care.

deepz · May 23, 2006

And when you write your letters, folks, don't forget to remind our legislators that for the price of ONE anesthesiologist we can train 8 to 11 CRNAs (depending whose figures one uses). And we PAY OUR OWN WAY.

deepz

MmacFN · May 23, 2006

This is an interesting discussion

After reading all the info from CRNAtoMD and everyone else as well as the bill proposal itself, i can see a case for both sides of the argument.

However, once im in school I will be vested in the CRNA profession. If there is one thing i have learned over the years is that solidarity is golden. Even if i were to disagree with the AANAs stance, I would support anything the association membership feels is salient to the future of all CRNAs. Some may call that blind following, but the history of all professions rely on solidarity of its members at all times. Just my opinion.

KeithEMU · May 24, 2006

OK, clear something up for me. Residency happens AFTER med school, right? Med Students are not paid, and do not get reimbursement for what they do. Is that correct? If that is true, why should we expect Medicare to reimburse for SRNA's.

Is this because in Med School there are no clinicals? I'm not trying to start a fight, just trying to understand all sides. I realize that is the bill covered both it would help both training programs, and therefore help have better anesthesia for patients regardless of from whom, and this would ultimately be best.

I hope one day to be a CRNA myself, but trying to look at this matter from a pretty neutral position is very hard. Both side have good points, but the outright hatred from some of the posts (no names) makes it hard to sort the angry statements, from what may be true, from the bull. I really hope that someday soon the anger between the two groups is resolved. It would be a HUGE benefit for the patients we serve, and will improve the workplace and teamwork among all.

MmacFN · May 24, 2006

Hey keith

In my understanding the situation would be seen this way:

Med school includes clinicals throughout the 4 years, they are often identified by MS1-4. Residents are often identified as PGY1-4 (post year graduate) during this time they work a max of 80 hours per week and are paid between 35-50 K per year and are also billable. The day a med student finishes med school they are officially Physicians. During the time they are in med school, including clinical time, they are not paid.

In comparison, Nursing school is also 4 years (if your a BSN which all CRNAs must be). This is time which includes clinicals and you are not paid (as you well know ). The RN wanting to be a CRNA then must work for a minimum of one year prior to applying to CRNA school. After that point, you go to your masters program CRNA school which is typically 27-30 months including clinical time. None of this is paid for.

The reason you see the AANA and CRNAs a bit frustrated stems from the physician residency being paid and the CRNA clinical time not being paid. From a superficial perspective, it is obvious that these are both graduate level education/training programs, include clinical training time and nessairy for each profession. So why is one paid and the other not?

While the AANA seems to have stopped fighting (at least to my limited knowledge) for SRNA residency pay, they are fighting against increased payment/residency slots and reimbursement for Physician anesthesia residencies. The stance is that the SRNA is already disadvantaged based on the fact that they are not paid during "residency". Why is it now OK to further spend public monies to add to the physician residency cause yet not address the glaring inequality already in existance.

The main argument for MDA residency slots does, and should, revolve around the fact that we are in an anesthesia provider shortage in the USA. What angers the AANA is that 4X the CRNAs (probably more) could be trained for the cost of one MDA. So, if the justification for the bill is public need and shortage, isnt the public money better spent (or at least equally spent) upon CRNA residencies which will increase providers much faster?

Yoga, Deepz, tam and the others, correct me if im wrong here, but this appears the thrust of the argument?

quote=KeithEMU]OK, clear something up for me. Residency happens AFTER med school, right? Med Students are not paid, and do not get reimbursement for what they do. Is that correct? If that is true, why should we expect Medicare to reimburse for SRNA's.

Is this because in Med School there are no clinicals? I'm not trying to start a fight, just trying to understand all sides. I realize that is the bill covered both it would help both training programs, and therefore help have better anesthesia for patients regardless of from whom, and this would ultimately be best.

I hope one day to be a CRNA myself, but trying to look at this matter from a pretty neutral position is very hard. Both side have good points, but the outright hatred from some of the posts (no names) makes it hard to sort the angry statements, from what may be true, from the bull. I really hope that someday soon the anger between the two groups is resolved. It would be a HUGE benefit for the patients we serve, and will improve the workplace and teamwork among all.

rayman · May 24, 2006

Nice work, Mike! Finally, a concise and coherent argument that makes a lot of sense. I'm not trying to get into a pissin match or go against the grain of our colleagues, but we are professionals, dammit, and should present ourselves thusly. Going nanny nanny boo boo like some nurses are apt to do is not the way to win friends and influence people. This is evident by the eloquence of our dear departed yoga. The man is well spoken and intelligent. MD's have lots of money, education and influence to swing around and we have to respond appropriately. Well done my friend.

MmacFN · May 24, 2006

hey Ray -> nanny nanny boo boo

I almost dropped the laptop when i read that!

Did yoga stop posting?

rayman · May 24, 2006

Right back at cha pal! Yeah, I think it was in the lidocaine thread. Looks like he doesn't like the way things are going and said he was going to resign. Hate that.

MmacFN · May 24, 2006

yup that sucks.

A loss like that is signifigant.

KeithEMU · May 24, 2006

Thanks Mike for helping to clear the mud a bit for me. I still have one thing that tickles the old brain. It's still in the comparison of CRNA to MDA training.

Our Nursing BSN is as Premed BS degree

CRNA's MSN including clinican Experience is as to Med School.

CRNAs then go to work and MDA's then have residency.

Now I know that MDA's make more after residency, and have slightly more entitlements. What I can't wrap my brain around is, unless CRNAs go back to include a residency following our MSN CRNA program, were is the justification of getting this upset? Again, not starting a contest with anyone, just trying to look at all sides. As SRNAs are going through 2-2.5 yrs of training, unpaid, Med students are going though 4 yrs of Med school unpaid.

Should hospitals not be paid more because they have to pay for residencies for MDAs? Sure it would be great if SRNAs got paid to go through the clinicals, being as they are providing services, but in all fairness I am having trouble understanding the equality we are fighting for here. It seems like we are trying to get a big upper hand over the MDA's.

Please, if someone can explain this point in a way I can understand. On a flowchart of training for CRNA vs MDA it doesn't quite seem to make sence in the scheme of this debate.

Would I love more money available for CRNA training and better equipment and so on? Heck yes! Might make it a lot easier for me to get into grad school later and get an even better education when I do. In fairness though it seems to me like it may be "like apples and oranges." Help me out guys.

MmacFN · May 24, 2006

Hey Keith

First off, im not an expert here. Im just giving opinion after reading the information. To answer your question i will give a little background info:

Im with you. The medical program is, in fact, graduate level in and of itself while the BSN ..... well isnt. The educational requirements do not compare between the CRNA and the MDA nor do the total cases in their respective "residencies".

The AANA feels that "time in school" is not really an indicator of competance in the field of anesthesia. Agree or not, the indicated proof of this (per the AANA) is evident in the large comparitive study of patient outcomes and saftey in the CRNA vs MDA study. Look at the evidence and draw your own conclusions. You can see, however, that this evidence makes a strong case for the AANA's position.

However, under the above assumption here would be the best answer i can think of for your second question. If it is true that each provider has similar patient outcomes and the CRNA can, in fact, practice the same scope in the OR, why spend more public money on what would essentially, be a bad return on investment?

So here is why the AANA might feel this is bad:

#1) The public interest is not best served by putting more money into MDA residency than already exists if, indeed, the goal is to increase anesthesia providers.

#2) By definition, increasing the reimbursement rates for MDA residency may well cause a hospital system to shed SRNAs in order to pick up greater reimbursement through MDAs.

#3) Anything which increases the numbers of MDAs is, by definition, bad for the CRNA profession.

#4) Any legislation which favors MDAs is, by defintion, bad for the CRNA profession as it may be seen as a "slippery slope".

#5) What message would a government approved, publically funded increase in MDA residencies send to CRNAs, MDAs, Other physicians and the public? It may be seen as saying "The governments chosen solution to the anesthesia shortage is enhancing MDAs numbers, NOT CRNAs".

I think the argument is less about getting payed residencies for SRNAs and more about not allowing MDAs to get more.

None of this is particularily my opinion, some i agree with some i do not. My personal opinions about the AANA or ASA statements are irrelevant as i am not "in the know", as it were. However, as an outsider looking in and reading all of the avaliable information, i think i can, unbiasedly, interpret the positions on the issue.

Does that make sense at all?

Thanks Mike for helping to clear the mud a bit for me. I still have one thing that tickles the old brain. It's still in the comparison of CRNA to MDA training.
Our Nursing BSN is as Premed BS degree
CRNA's MSN including clinican Experience is as to Med School.
CRNAs then go to work and MDA's then have residency.
Now I know that MDA's make more after residency, and have slightly more entitlements. What I can't wrap my brain around is, unless CRNAs go back to include a residency following our MSN CRNA program, were is the justification of getting this upset? Again, not starting a contest with anyone, just trying to look at all sides. As SRNAs are going through 2-2.5 yrs of training, unpaid, Med students are going though 4 yrs of Med school unpaid.
Should hospitals not be paid more because they have to pay for residencies for MDAs? Sure it would be great if SRNAs got paid to go through the clinicals, being as they are providing services, but in all fairness I am having trouble understanding the equality we are fighting for here. It seems like we are trying to get a big upper hand over the MDA's.
Please, if someone can explain this point in a way I can understand. On a flowchart of training for CRNA vs MDA it doesn't quite seem to make sence in the scheme of this debate.
Would I love more money available for CRNA training and better equipment and so on? Heck yes! Might make it a lot easier for me to get into grad school later and get an even better education when I do. In fairness though it seems to me like it may be "like apples and oranges." Help me out guys.

KeithEMU · May 24, 2006

Does that make sense at all?

Yes Mike, it does. It brings more questions, but more ones that maybe we should ask the lawmakers, and could support the ANAA's case.

Why should insurance pay more for MDAs instead of CRNAs in most cases since their success rate is about the same? I understand they have more training in other areas and may be more rounded in their knowledge, but they are used for the same areas as CRNAs, and the success rate there is about the same.

Why would a student pay more and go longer for the MDA education and have to go through residency when they could have been a CRNA? It would take a very long time to pay for the school and time you lose by choosing the MDA path with the difference in pay between the two. CRNAtoMD, I'd love to hear why you chose to go back to school for this.

Since so many more CRNAs can be trained for less and the success rate is similar will MDA continue to be a profession if looked at logically?

Do I want to see MDAs eliminated? NO, but I can see the argument that as CRNAs are more accepted and prove themselves it might be an option for the future. Instead some parties are fighting for CRNAs to be required to have a doctorate degree (PhD.) If the success rate is about the same, why push to make CRNA harder to obtain when if you look at the current stats they are operating at a level close to the MDA when they have the extra training and the residency?

If I keep this up people might start calling me Mike (to offense Mike) . Not trying to boil the pot over, but I am very interested in the CRNA profession. Still working on my BSN, but one day I hope.