Anesthesologist and CRNA collaboration

[GregRN]

i've been a lurker on this board for about a year now; not particularly active in participation, but more active in soaking up knowledge from others as i start my nursing career.

i'm interested in a career as a crna and it was the primary reason for pursuing my bsn, a second degree for me. over time i've read as much as possible about the trade, shadowed a number of crna's doing anything from epidurals at the bedside to or cases and have found it to be an excellent fit for what i do well. recently i made the mistake of reading posts on studentdoctor.net in the anesthesiology forum (gasforums.net) and find myself visiting regularly. oops. talk about a downer. the venom spit at crna's is remarkable. it seems every chance they get to bash, lobby against, pad their own pockets, etc., they take it and exploit it. therein lies my reason for this thread.

those of you who have experience as a crna i'm hoping you can provide some insight as to the collaboration and attitudes between mda's and crna's. i suspect that overall it's pretty solid and it's only a very minor group of people who hate crna's as much as they seem to on that "other" board. part of what is tainting my view is that the asa has a huge thumb on anesthesia here in colorado, going so far as to name the governor himself in a lawsuit brought about in response to the medicare "opting out" issue, putting crna's on unequal footing, so to speak.

are crna's respected by mda's or is there a relative lack of respect but both sides ignore it? any other insight you can provide? thanks much for your help.

[sawingzzzz's]

it all depends on the practice setting you are in. From what i have found the mda's who are used to working with crna's are fine with the situation. Over all i would say in MY experience there is collaborative effort.

[jwk]

the venom spit at crna's is remarkable. it seems every chance they get to bash, lobby against, pad their own pockets, etc., they take it and exploit it.

if you read through the posts on this board objectively, you'll have to agree that it goes both ways.

[GregRN]

If you read through the posts on this board objectively, you'll have to agree that it goes both ways.

Some. Though it does seem more CRNA's fight for a level playing field whereas more MDA's fight to keep their thumb on CRNA's. When comparing the two CRNA's say, "SAME". MDA's say, "BETTER".

It's those attitudes that have me wondering. Like I said, it very well may be that it's only a few who are sabre rattlers but I wanted to get a feel from those in the field already.

[deepz]

........ CRNA's fight for a level playing field whereas more MDA's fight to keep their thumb on CRNA's. ......

In a nutshell!

MDAs have no problem whatsoever with CRNAs and AAs, so long as the underlings kiss the ring and make the money while the overlords eat donuts and watch CNBC in the lounge Lazeeboy.

!

[paindoc]

I am certain AAs feel the same way about CRNAs. In some states, there is no requirement at all to administer anesthesia in a physician's office...RNs, MAs, or any other person off the street the physician selects to employ can do exactly the same job with the same outcome when trained properly and under the supervision of the MD....and for 1/8 of the price of a CRNA. One should continue to be mindful of the potential for replacement with others that are less expensive, no matter what the rank or profession. It would be very difficult for CRNAs to find statistical evidence they are in any way "better" than AAs.

[GregRN]

I am certain AAs feel the same way about CRNAs. In some states, there is no requirement at all to administer anesthesia in a physician's office...RNs, MAs, or any other person off the street the physician selects to employ can do exactly the same job with the same outcome when trained properly and under the supervision of the MD....and for 1/8 of the price of a CRNA. One should continue to be mindful of the potential for replacement with others that are less expensive, no matter what the rank or profession. It would be very difficult for CRNAs to find statistical evidence they are in any way "better" than AAs.

Weak. It would be difficult because none exists as it hasn't been studied, much like your "any person off the street" analogy hasn't been studied. Saying it would be difficult to find evidence is clever, but misleading, as it implies that that the subject has actually been studied, results verified and accepted, and the evidence shows there is no difference. Sorry, not kissing the ring, paindoc.

[airrn]

I am certain AAs feel the same way about CRNAs. In some states, there is no requirement at all to administer anesthesia in a physician's office...RNs, MAs, or any other person off the street the physician selects to employ can do exactly the same job with the same outcome when trained properly and under the supervision of the MD....and for 1/8 of the price of a CRNA. One should continue to be mindful of the potential for replacement with others that are less expensive, no matter what the rank or profession. It would be very difficult for CRNAs to find statistical evidence they are in any way "better" than AAs.

Interesting statement here. You imply that their is no statistical difference between AA's who have to be supervised by an MD and CRNA's who can and do practice independently. Sounds to me like you just admitted the ASA argument stating CRNA's should be supervised is totally invalid! Is this what you meant?

[jwk]

Outcome studies are difficult for all three providers because the incidence of major complications directly related to anesthesia is very low to begin with. All of the current published studies can be debated and picked apart ad nauseum with regard to design flaws and manipulation of statistics.

And of course all of us have our anecdotal stories about lousy providers of all three types, which prove nothing.

That being said, informal reviews have been done looking at AA's and CRNA's in ACT practices, and no differences in outcomes are apparent. Malpractice insurors are on board with this opinion as well, because malpractice rates for these two providers are the same.

[paindoc]

Ahhh...the nastiness of statistics. The numbers needed to find either statistical or clinical differences in outcomes would be huge when comparing any of the groups with one another. Therefore, we have no study large enough to demonstrate these differences. For AAs working under the direct supervision of a MD, there are not enough cases studied or available to demonstrate outcome differences. Neither are there enough outcome studies of RNs or MAs giving IV sedation or general anesthetics to conclusively demonstrate differences in outcomes compared to AAs or CRNAs, yet it is an extremely common practice to have RNs giving sedation and general anesthetics (yes, general anesthetics without protected airways) in various venues including the GI lab, ICU, ER, OR, ASCs, and physicians offices, all without the supervision or oversight of MD anesthesiologists or CRNAs. Therefore it is not clear in many circumstances CRNAs have any demonstrable benefit over RNs that do not have the "C" or "A" in their professionial title. Similarly, in most circumstances, there is probably no demonstrable benefit in having a MD anesthesiologist vs CRNA delivering the anesthetic. On the other hand, CRNAs, without valid statistics of sufficient discriminative power, may not claim either that they are equivalent to MDs in delivering anesthetics, nor that they are more valuable or capable than AAs, RNs, or others that deliver general anesthetics routinely. The belief of self worth within one's own profession is magnified by the myopic veil of self adulation while conveniently ignoring others that may be replicating their function with no less prowess, but for a small fraction of the cost.

[UTRN2005]

While the debate of CRNAs/AAs/MDAs is all fine and well, I'm interested to hear responses that are pertinent to the original question. Thank you.

[dfk, RN, CRNA]

MD anesthesiologist

hey paindoc, isn't this a bit "redundant"? just kidding.. i wish this banter among who's better who's best stuff would just blow over... as a practicing SRNA, i can vouch for both sides that some like eachother and some don't. that's gonna be around thru our lifetime, so far as i can see...