Attention NC Residents - page 4

Okay guys, here we go again. We're the latest state in which the MDA's are trying to restrict our practice, as well as make it legal for AA's to work here. A bill is currently being introduced into... Read More

  1. by   jwk
    Quote from Maxs
    All you have to defend is a bill being supported by three people.
    It's being supported by a lot more than three people.
  2. by   Maxs
    I don't see the logic and the reason behind this bill. JWK, let's be fair to the females, your saying pass this bill without hesitation. Perhaps it's clear that i it pains you to practice under an MDA while CRNA's can function independently. If this bill is passed, it's just an exaggeration of the same conditions to you. You have to understand that these CRNA's will undergo through a major transformation. I call this bill simply "Bully" because your saying a nurse is indicated in title and it must be a sign of danger or incompetent. Let me rephrase what I said, show me or bring any evidence/research that suggests MDA's are safer than CRNA's. After all this is a matter of safety and forget the space fillers and the personal attacks. In order for me to believe in this bill, I want you to show me the neccessity of an MDA being present. You can even pull out researches or whatever. However, I can pull out how MDA's used to be unsafe by using the drugs themselves or being drug addicts, which is another whole topic. We both know this bill is unneccessary and It's for the sake of your master aka an MDA trying to secure their positions, but the outcome can be nasty. Here's a question I want you to answer to the best of your knowledge, what would happen if CRNA's left north carolina? What would happen than? Are you going to duplicate like bacteria with animal genes? face it, if MDA's fade, you fade along with them. To the best interest of the public, it's about competent and affordable, and that defines CRNA's because an equation has to be balanced from both ends. So, if it was up to me, there is no need for MDA's. They charge like heck and still do the same job, they feel threatened because of the CRNA rise, but if CRNA's were just politically as smart, by now, they would have pushed or migrated MDA's back to their orginal tags or MD's.

    Maxs
  3. by   jwk
    Quote from Maxs
    I don't see the logic and the reason behind this bill. JWK, let's be fair to the females, your saying pass this bill without hesitation. Perhaps it's clear that i it pains you to practice under an MDA while CRNA's can function independently. If this bill is passed, it's just an exaggeration of the same conditions to you. You have to understand that these CRNA's will undergo through a major transformation. I call this bill simply "Bully" because your saying a nurse is indicated in title and it must be a sign of danger or incompetent. Let me rephrase what I said, show me or bring any evidence/research that suggests MDA's are safer than CRNA's. After all this is a matter of safety and forget the space fillers and the personal attacks. In order for me to believe in this bill, I want you to show me the neccessity of an MDA being present. You can even pull out researches or whatever. However, I can pull out how MDA's used to be unsafe by using the drugs themselves or being drug addicts, which is another whole topic. We both know this bill is unneccessary and It's for the sake of your master aka an MDA trying to secure their positions, but the outcome can be nasty. Here's a question I want you to answer to the best of your knowledge, what would happen if CRNA's left north carolina? What would happen than? Are you going to duplicate like bacteria with animal genes? face it, if MDA's fade, you fade along with them. To the best interest of the public, it's about competent and affordable, and that defines CRNA's because an equation has to be balanced from both ends. So, if it was up to me, there is no need for MDA's. They charge like heck and still do the same job, they feel threatened because of the CRNA rise, but if CRNA's were just politically as smart, by now, they would have pushed or migrated MDA's back to their orginal tags or MD's.

    Maxs
    First - paragraphs are your friend.

    You've read a lot into my posts that I simply haven't said. Have I mentioned females? Nope. Have I said pass this bill without hesitation? Nope. I might think it, but I haven't said it. Of course I'm sure you think it should be defeated without hesitation, so that's really kind of a stupid argument to go with anyway.

    Let's see - drug use by anesthesia providers - I wasn't aware this was just an MD problem. It happens with CRNA's and AA's as well. There goes that argument.

    Half of the bill (dealing with CRNA's and supervision) seems to be moot, since the NC Supreme Court just affirmed that concept. There goes that argument.

    MDA's are not my massah - sorry to disappoint you.

    Somehow I don't think all the CRNA's would leave NC. "What if" is a stupid game to play. There goes that argument.

    Will MDA's fade? Nope. 70% of anesthetics involve CRNA's. 70% also involve MD's, either alone, or in care team practices.

    It's about competition. Simple as that.
  4. by   deepz
    Quote from jwk
    ....70% of anesthetics involve CRNA's. 70% also involve MD's, either alone, or in care team practices...........

    In your Massahs' dreams, 70%. Maybe 70% in Georgia, but then we all know what an abberation that State is.

    deepz
  5. by   jwk
    Quote from deepz
    In your Massahs' dreams, 70%. Maybe 70% in Georgia, but then we all know what an abberation that State is.

    deepz
    So you're telling me that 70% of all the anesthetics in this country are administered by CRNA's acting on their own without any involvement of an anesthesiologist?
  6. by   deepz
    Quote from jwk
    So you're telling me that 70% of all the anesthetics in this country are administered by CRNA's acting on their own without any involvement of an anesthesiologist?

    Read what I wrote.
  7. by   jwk
    Quote from deepz
    read what i wrote.
    i read well, thank you.

    let's try this again:

    certified registered nurse anesthetists (crnas) are anesthesia professionals who administer approximately 65% of all anesthetics given to patients each year in the united states.

    straight from the aana website. so tell me - how many of these anesthetics are administered by a crna, on their own, with no involvement of an anesthesiologist?

  8. by   URgettingsleepy
    Please, please quit responding to JWK maybe he will go away.
    I have said it before for every one worthwhile thing he posts on allnurses.com
    he posts twice as many flames on CRNA's on Studendoctor.net
    UR
  9. by   jwk
    Quote from URgettingsleepy
    Please, please quit responding to JWK maybe he will go away.
    I have said it before for every one worthwhile thing he posts on allnurses.com
    he posts twice as many flames on CRNA's on Studendoctor.net
    UR
    OK, quote me one.
  10. by   Maxs
    I did not want to get into this, but JWK I am not going to let you in here with that mask on. I will unveil your peculiarity and then probably show what kind of spectator you maybe. Now your here defending MDA's but you were there and let these statements go without a comment.

    Here I ran into medical students squabble the possibilities and the endanger of MDA's careers. In addition, here's how some medical students indeed feel.

    " posted orginally on student doctor by: driverabu 08-19-2004 02:59 PM
    Attention nitecrap, crna and all of you dipshts. Get the heck out of the MD forum and into your own. We chose to get our MDs and you chose to get your RN for whatever reason that may be. MDAs will always be worth more than CRNAs and that is final. Quit trying to throw in your crappy 2 cents worth to try and scare your future bosses (MDAs) and worry about holding your own. Bottom line, as a 4th year medical student, regardless of what you knuckle heads say, I am going into anesthesia because I love the field, I will make decent money and I will have a decent lifestyle. Did I say "cush?" NO, I said decent. You go ahead and make your 100-160 and I'll make my 200-250 and we'll both be happy. Quit trying to make yourselves feel more important than MDs because for one, you'll never be (although you all are a vital part of the medical team) and 2, the last I heard, an MD is superior to an RN. If it was sooooooo imperitive that you need to feel like you are at the top, you should have become an MD!!""

    And I Know that JWK is in this cult. Don't get me wrong, but some of these students have positive attitudes towards CRNA's. The ones in this cult obviously don't.

    ""home many crnas can a gas doc supervise at one time? i'm a little confused about this aspect of the job. i cant really tell if this supervising role is a drawback or not. i know i definitely liked what the cardiac anesthesiologist did.""
    As a matter of fact nobody (MDA's) offered an insight to this post."

    " when Money talks, BullS**T (=CRNA) walks. " posted by leukocyte

    for a minute I thought he was erythrocyte (red).
    All this that is going is just a moot, you're right about that, but no one has a right to talk about anyone's back like that.

    Maxs
    Last edit by Maxs on Mar 24, '05
  11. by   Maxs
    JWK I know you have nothing against CRNA's because I have seen your posts and you're a potential advocate for AA's, which is a professional courtesy. With that Said here is a post that gives an Isight and logical reasoning behind this blabblings.

    Orginally posted by Tenesma:
    ""I finally throw in my view of things:

    while I appreciate the fervor of some of the posters - it looks like you all have it wrong - and there is a serious misunderstanding both of the situation and of the issues....

    It is not uncommon for this to be a BIG topic of discussion for pre-meds, medical students and residents early in their training... they hear all of these things about CRNAs, and the automatic response is to become defensive.

    I hate to say this, but so far MacGyver actually has a good sense of what is going on with mid-level practitioners - and their possible effects on medicine and reimbursement as a whole.

    So here are a few things to clear up any issues

    1) CRNAs can practice independently of Anesthesiologists in ALL states ---- they can practice with a "physician" supervising in about 22 states, and in 33 states they can practice without any "physician" supervision at all.... and that "physician" supervision is primarily designed for them to be able to provide medications that they can't independently prescribe in those states....

    ---> So, in effect.... CRNAs can and do practice independently of physician supervision in most states. Don't confuse this with the "opt-out" rulings that have nothing to do with medical supervision, and are only designed to answer the question regarding Medicare Reimbursement.... one is a medical-legal issue the other is a billing issue

    2) CRNAs provide great anesthesia services.... while I find the AANA's statement that they provide 65% of anesthetics to be misleading (cause in reality they only provide "independent" anesthesia in 30-35% of anesthetics around the country - based on Medicare Data)... but still, they provide great services - especially to rural areas, as well as to the armed forces where they outnumber MDAs by 50 to 1.

    3) the argument of CRNA being equivalent to MDAs is an old issue - and most senior CRNAs (not the Student CRNAs or fresh out of school CRNAs who still don't have a clue) and most MDAs know that there is no equivalency. The act of administering anesthesia during a case can be done by both - and there is no data so far to show that a difference in outcomes (despite weak attempts on both sides). The act of administering anesthesia is based on a good understanding of physiology and pharmacology, and a lot of clinical experience... HECK, some of the best senior anesthesiologists I have worked with ONLY have a DDS degree and did a 2 year residency in the 60s.... but they have the clinical experience that would make your head spin.... So in the OR, we are highly trained technicians.... Just like anybody can be trained to do surgery (I know a Cardiac Surgery PA who opens the chest, takes down the LIMA, prepares the saphenous vein, and then assists with coronary anastomosis, then closes the chest --- that is a lot of stuff, considering that in academic programs ONLY the cardiac surgery fellow is ALLOWED to do that).... What makes a Surgeon a Surgeon isn't the operation, but knowing when to operate, knowing how to manage a patient pre-operatively, knowing how to manage complications post-operatively.... What makes a Surgeon a skilled Technician is exhaustive hands-on experience.... A similar analogy can be made as far as MDAs go, we are able to provide true peri-operative medicine - we can provide cardiac or medical clearance for a patient without requiring the surgeons to obtain extra consults for that patient - we play an extended role in the ICU, pain cliinic, pre-op. assessment clinic, PACU etc... In some areas and at some hospitals these things play a significant role and hence the continued demand for MDAs... In fact, if you look at the "opt-out" states where technically CRNAs can practice independently and bill medicare independently - MDAs still get great jobs and great pay for their added value to the hospital services and some of the cost savings they provide.

    My prediction for the future: CRNAs will gain the right to bill Medicare independently in almost all states, they will form more and more of their own groups - heck they might even own the local surgi-center..... As anesthesia becomes safer and safer by the day, MDAs will become more and more Peri-operative physicians with further expansion of their skills into the ICU world... Especially with the Leapfrog studies pushing for dedicated intensivists in ICUs there will be a greater demand, and I wouldn't be surprised if over time ICU care will have better reimbursement than OR reimbursement.

    So for those who say that we sold out the field.... I think there is some fallacy there. When no MDA was willing to work in rural Kansas, what are the surgeons or hospitals supposed to do? close their ORs?... the evolution of the CRNA was unavoidable... demand dictates care to some extent: in rural areas, FPs do c-sections, deliver babies and do appendectomies - they even run their own ICUS!!!!! in many rural areas, NPs and PAs are the only health care provider within 50 miles!!!

    Yes, our salaries aren't the same compared to the 80s --- but that has to do with our weakness as effective negotiators/lobbyists with insurance companies/hospitals... A surgeon will get 1200-1400 dollars for a CABG and 30 days of post-op care (and that includes a possible take-back, opening the chest in the ICU at 3 am, etc...).... which is a HUGE cut from what they got in the early 80s (8-12,000 then)... Whereas Hospitals can still charge 60-90 dollars PER MINUTE for OR time - the hospital association lobbying group is HUGE and has not let the government/insurance companies bully them into lower reimbursement...

    so for those who are going into anesthesia: it is a great field, with a lot of intellectual challenges, a lot of critical care, and very rewarding.... and once you are closer to being done with residency or actually practicing (like me or brachial plexus), then you will see what the difference is between an MDA and a CRNA."""

    Maxs
  12. by   URgettingsleepy
    Here you go, Sorry but If I see a two face I have to call them out.
    JWK posted on Studentdoctor.net
    This in reference to CRNA's eventually adopting a clinical Doctorate model.

    "Clinical doctorate or not, a CRNA will never be the equal to an MD, Professionally, legally, or otherwise"

    JWK probably even shines the MD's shoes before they head out of work on a Friday night.

    I wonder what he meant by "or otherwise"..

    I took me about two seconds to find this post, now you can picture what this
    TECHNICIAN really thinks. UR
  13. by   jwk
    Quote from URgettingsleepy
    Here you go, Sorry but If I see a two face I have to call them out.
    JWK posted on Studentdoctor.net
    This in reference to CRNA's eventually adopting a clinical Doctorate model.

    "Clinical doctorate or not, a CRNA will never be the equal to an MD, Professionally, legally, or otherwise"

    JWK probably even shines the MD's shoes before they head out of work on a Friday night.

    I wonder what he meant by "or otherwise"..

    I took me about two seconds to find this post, now you can picture what this
    TECHNICIAN really thinks. UR
    CRNA's won't be the equal of MD's. Not flaming - that's a simple fact.

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