Anesthesiologists being replaced by CRNAs???

[MONEJA783]

I was vacationing in the tropics a few weeks ago and met three handsome Anesthesiologists while sun bathing at the pool. We all chatted a little until the topic of our professions came up. I told them I was starting nursing school (ABSN Program) in a few weeks & how excited I was. I then proceeded further by saying I also hope to pursue a graduate degree as a CRNA or NP (note at this point I had no idea these guys were anesthesiologists). Why did I mentioned becoming a CRNA, b/c the stares I got from all three were nothing but pure EVIL STARES! By their looks I knew I said something wrong but had no idea what it was until they told me they were Anesthesiologists & fear that CRNAs were taking away their jobs at a cheaper price, and with the new health care laws just passed its going to get worst for them. This was totally unexpected 'cause all I planned to do that day was to relax by the poolside & sip pina coladas all day! However, they went on trying to convince me of all the reasons as to why I should not pursue a CRNA career & that eventually the national anesthesia board (not sure if this was the organization they mentioned) was no longer going to certify CRNA training and eventually they'll be no more training because there is no longer a shortage of Anesthesiologists. The shocker of this whole conversation was two of the anesthesiologists mentioned, with conviction, they wish they had pursue a CRNA career instead where they would have accumulated less debt with almost the same income or they wish they had chosen another specialty.

I was pretty shocked hearing these remarks & would love to hear your opinions :)

[NRSKarenRN, BSN, RN]

CRNA's have been providing unsupervised care for over 100 yrs in many settings, developing standards using common sense AND scientific knowledge to ensure favorable clinical outcomes.

World isn't flat anymore. :)

[backscatter]

"supervision is a billing formality"? that's the most arrogant statement that I have heard in a long time......

[wtbcrna, MSN, DNP, CRNA]

You can swim all day in the Sea of Knowledge and still come out completely dry. Most people do. ~Norman Juster

[srnamom]

"supervision is a billing formality"? that's the most arrogant statement that I have heard in a long time......

It may seem arrogant to you, but it is fact. The supervision 'requirement' is NOT a requirement for an anesthesiologist to supervise a CRNA, but for a physician (typically the surgeon) to supervise. This 'supervision' consists of deciding that anesthesia services are necessary or desirable for a procedure, and requesting them. The surgeon neither dictates how the anesthesia is performed nor is legally liable for the CRNA's actions. In every state in the U.S., many many anesthetics have been performed with this arrangement for many many years, over 60% of anesthetic cases every year. The federal government has allowed states to opt out of even this type of supervision. We are not 'unsupervised nurses', we are highly trained anesthesia providers with the same outcome rates and safety records as physician anesthesiologists. Legally, we are held to the same standards of care as physician anesthesiologists. We have to be able to handle crises on our own, but we are also highly trained to avoid them. When the *hit hits the fan, the anesthesiologist does not always come when paged, or does not always come in time. At many institutions, physician anesthesiologists never or rarely perform anesthesia themselves. Your faith in anesthesiologist supervision is but a false sense of security. You cannot win this discussion, because the facts are not on your side. Whether you choose to hold onto your prejudices despite the facts is your business--don't try to make it ours, you are in the wrong place for that.

[backscatter]

CRNA are nurses, nothing more, nothing less. Expecting a surgeon to safely supervise a CRNA is unsafe; ergo you have an unsupervised nurse doing anesthesia unless you have an anesthesiologist present.

[OrlandoFLNurse2b]

CRNA are nurses, nothing more, nothing less. Expecting a surgeon to safely supervise a CRNA is unsafe; ergo you have an unsupervised nurse doing anesthesia unless you have an anesthesiologist present.

Unfortunately, you're side of the discussion is based upon opinion. Support your opinion with evidence; otherwise, you're doing yourself and if you're a physician, your chosen profession a disservice. If you're not a physician than you must be really bored.

[oncall24/7]

CRNA are nurses, nothing more, nothing less. Expecting a surgeon to safely supervise a CRNA is unsafe; ergo you have an unsupervised nurse doing anesthesia unless you have an anesthesiologist present.

Having worked on both sides of this equation gives me a unique viewpoint. Surgeons do surgery and I haven't met one who knew beans about anesthesia. CRNA are useful providers, when properly supervised by an anesthesiologist they provide an invaluable service. Trying to "prove" which side is right (anesthesiologist supervised CRNA vs solo CRNA) is a waste of time; it's an opinion and it's a decision that should be left up to the patient.

[srnamom]

Having worked on both sides of this equation gives me a unique viewpoint.

So you are both a physician anesthesiologist and a CRNA?

[wtbcrna, MSN, DNP, CRNA]

oncall24/7

Did you ever work in an independent environment as a CRNA? Were you trained as an independent CRNA in school (such that you proficient in CVL, all Regional skills neuraxial/PNBs, allowed to do everything from pre-op assessments, PACU orders, f/u with patients, acute pain consults etc.)? From your posts I am guessing that you trained and only ever worked in ACT practices, but I could be wrong and I apologize if I am. It seems that your perspective might be a little biased from your CRNA training and CRNA work environment.

[subee, MSN, CRNA]

Having worked on both sides of this equation gives me a unique viewpoint. Surgeons do surgery and I haven't met one who knew beans about anesthesia. CRNA are useful providers, when properly supervised by an anesthesiologist they provide an invaluable service. Trying to "prove" which side is right (anesthesiologist supervised CRNA vs solo CRNA) is a waste of time; it's an opinion and it's a decision that should be left up to the patient.

How many patients understand the arcane debate in our internecine wars? Is is useful to "prove" which practice model is both safe and efficient, especially when we drift to more socialization in payment systems. I've worked both alone and currently work in the ACT model. I think it's a pure scam when an MDA is required to stand at the head of the bed while you're doing inductions in bread and butter cases...and don't even get me started about the eye rooms! So what is "proper supervision?" Try to define that for me..me with 29 years of experience. We need both providers, especially as the patients coming to the OR are frailer than ever. We just don't need so many MDA's. My off the cuff guess would be that MDA's are required for about 10% of the cases. All CRNA's understand that in most situations we have so many just so they don't get killed doing call.

[oncall24/7]

oncall24/7

Did you ever work in an independent environment as a CRNA? Were you trained as an independent CRNA in school (such that you proficient in CVL, all Regional skills neuraxial/PNBs, allowed to do everything from pre-op assessments, PACU orders, f/u with patients, acute pain consults etc.)? From your posts I am guessing that you trained and only ever worked in ACT practices, but I could be wrong and I apologize if I am. It seems that your perspective might be a little biased from your CRNA training and CRNA work environment.

wtb: yes I did work in an independent environment as a CRNA and was trained to do so. I felt increasingly uncomfortable doing so as my education progressed. This is my opinion only and I mean no disrespect to CRNA...I do not believe that "solo" CRNA practice is safe or desireable; again that is my opinion only. I try not to make abrasive comments about the capabilities (and limitations) of CRNA, but when I read that some CRNA claim professional parity with anesthesiologists I feel the need to give my opinion. One advantage of sitting on the fence watching both side of the debate is that I can take the high ground (advocate patient safety) rather than trying to protect some professional "turf" (CRNA or anesthesiologist). Interestingly enough, I do not see the "anesthesiologist being replaced by CRNA" issue anywhere except online. Best wishes for the holidays.

[FockerRN]

No, sitting on the fence essentially makes you holier-than-thou.... Patient safety? Research study after research study has shown that independent CRNA practice is as safe as ACT practice and MDA only practice, period. You were uncomfortable? Fine, don't work in that area if you don't feel qualified. CRNA's have been providing safe care (and economic as well) for quite a long time, as long as or longer than physicians. Physicians, historically, jumped into the anesthesia circle when the money showed up, not when they thought that it would benefit the patient.

As far as professional parity, if nothing else, inside the operating room there is parity in skill and ability. What really irks me in these arguements is the assumption that because someone went to med school that they are inherently superior in all things.

One final thing for another poster, supervision is all about billing. That is not opinion, nor arrogant, it is fact. The reason the wording is in federal law is to try to keep MDA's and hospitals from defrauding medicare. You see, historically doctors were "supervising" for the most difficult parts of a case (induction and emergence) but were not actually around. They billed as if they did something but in fact were doing nothing. This made the government angry so they said that for the doc to bill they actually have to be there. There is nowhere in federal or state law that says a CRNA has to work "supervised" by an anesthesiologist. It infuriates me that a question about fraud from one group (anesthesiologists) has been spun into a question of safe practice.

If anyone wants to find a real, evidence based and peer reviewed article that shows that independent CRNA's are less safe than their MDA colleagues please bring it forward. Otherwise those on the side of MDA's (docs or those carrying their water) are arguing a loosing battle based on their misguided and baseless opinions.