Quote from TheLemur
...at this point in my career, I don't especially care about AA issues, supervision issues, or the expansion of CRNA responsibilities. Maybe I should.
Yes, you should. To sum it up, you don't know what you don't know. When you become more experienced in anesthesia, the bigger picture will become a lot more clear. What you have to understand is that anesthesia, as administered by CRNAs, is SAFE. An MD standing there as you intubate and extubate is not supervision. Supervision implicates a sense of responsibility on the part of the supervisor. If yo would break a tooth while intubating, cause a nerve injury while placing an epidural, or fail to recognize an esophageal intubation, who would be responsible? In a traditional job setting, the supervisor (MD). But in case law, it has been shown multiple times over, that the person responsible for mishaps is the one who administered the drug, placed the needle, or broke a tooth. If it is the CRNA, s/he is responsible. If the MD, s/he is responsible. [I am not sure about how it applies to AAs, so I can't comment on that]. Supervision as it applies to anesthesia has a purely financial/billing meaning. What if your supervising MD is a surgeon? Can s/he be responsible for that nerve injury you caused? Should s/he? NO. Just as YOU would not be responsible for the surgeon nicking the mesenteric vein. So you see, supervision issues ARE important.
What I think you will find as you begin your training is a much more friendly and collegial environment than you read about on SDN. Not all anesthesiologists subscribe to that way of thinking, nor all CRNAs. Also - the majority of ones who talk about silent treatments, backlash, etc are either medical students or interns/residents. They may very well sing a different tune when they really see how things work. What many of them know about CRNAs is what has been stated on that website, and we all know there are many misconceptions over there. Again, THEY don't know what they don't know. For all we know, they think that a CRNA is simply a nurse with a weekend course in anesthesia providing an anesthetic. I wouldn't place too much stock in what is said over there - nurse anesthesia is not their area of expertise. So why would you listen to what they have to say about it?
Those who choose to work in an anesthesia care team environment (with anesthesiologists supervising CRNAs) are typically not ones to spout off about supervision and billing issues at any given moment. As far as I know, most anesthesia schools provide clinical training in institutions that use the care team approach. You will find that you will learn a lot from both the CRNAs and the MDs, and most MDs will not begrudge you the education.
To address the issue of AANA undermining ASA's attempts th change reimbursement for resident education - are you fully educated on the issue? What the AANA was opposed to was to provide incentive to have a residency program instead of a nurse anesthesia program. It was not simply to prevent reimbursement for residents - there is more to it than that. Check it out on the AANA website.
What you will find is that many anesthesiologists are not even aware of some of the issues their national organization promtoes, as many CRNAs are not aware of the issues the AANA promotes. I think it is a bit premature in your career to form opinions about all this - wait until you are about a year into your program, and things will clear up quite a bit. You will learn all about billing, reimbursement, supervision, medical direction, etc. Don't jump the gun yet - you have to learn to administer anesthesia before you can argue about its political points.
Did that get too ugly for ya?