Crna = Mda?!

versatile_kat · Oct 22, 2003

Can't we all just get along? Whenver I read these type's of post's the same things are reiterated a million times over. And all it does is get everyone in a bad mood (not to mention decreasing the morale for new SRNA's who don't have the experince of dealing with MDA's in the OR like seasoned CRNA's). Maybe instead of debating which came first, and who's brain is bigger, we should take the calmer road and try to work TOGETHER instead of AGAINST each other.

my 2 cents.

alansmith52 · Oct 22, 2003

where did this come from.

sounds like a post from student doctors.net. which has proven to hold no value in the past.

dreamon · Oct 22, 2003

I hate going on studentdoctor.net...sometimes it can really drag morale down, the way they talk about nurses.

meandragonbrett · Oct 22, 2003

Originally posted by dreamon
I hate going on studentdoctor.net...sometimes it can really drag morale down, the way they talk about nurses.

I agree! I no longer visit the site due to the ignorance of many people on the site!

Brett

kmchugh · Oct 22, 2003

Coug

First, don't be too hard on Tenesma. He's not changing faces, and I don't see a whole lot different in this post compared to some of the things he's said here. Also, he provides good insight into many aspects of anesthesia care. Unfortunately, he suffers from MDA syndrome:D where nurse anesthetists are concerned.

But, to answer your question, no, CRNA's are not the "bi***s" of MDA's. There are some things Tenesma says in that post that are quite true, while others appear true on the surface, but need a little deeper examination. Let's look at each point he made:

1. True, with a proviso. Generally, lawyers and plaintiffs see the hospital and the physician as having the "deep pockets." You don't sue poor people, there's no money in it. However, I've never seen any data to suggest that awards for malpractice are higher in cases involving MDA's over cases involving CRNA's. CRNA's insurance premiums are lower, however. Much of that is due to MDA's doing things that are outside the scope of practice of CRNA's (prescriptions, pain management surgical procedures, etc), and therefore there are more things an MDA can be sued for.

2. True on it's face. However, nurses were the first to perform anesthesia as a specialty. Prior to nurse anesthetists, anesthesia was not performed by fully certified physicians, because the surgeon is the head cheese in the OR, and no doctor wanted to play second fiddle to another doctor. So, initially, medical students were tried out as anesthesia providers, but morbidity and mortality rates were too high. Nurses were then trained specifically to administer anesthesia. M&M rates dropped significantly. In my mind, this was the first proof that anesthesia needed to be a separate discipline. However, none of this is proof that one group is infringing on the turf of the other.

3. Well.... I work in a very rural hospital, and we have no MDA's. (And rest assured, I am no one's bi***!) We do what are considered to be big general surgery cases (including whipples), and I do anesthesia for ASA III and IV patients routinely. As to the tertiary centers, what Tenesma said would be true if the cases were being done by MDA's. In many, if not nearly all of those tertiary centers, the anesthetic for nearly all cases, from endoscopy to open heart procedures is actually done by a CRNA under MDA supervision. Often, that supervision means the MDA is in the room only for induction. Where I was before, I did a large number of cases, including open heart and intercranial procedures essentially by myself. The supervising MDA sat in the corner while I induced the patient, inserted the necessary lines, then left to mess online with his stocks, while I did the anesthetic. Unless I paged the MD so I could go to the bathroom, the next time I saw the MDA was often in the physicians lounge after I had dropped the patient off in the PACU or ICU.

4. True enough. But then, before beginning their residency in anesthesia, new graduate doctors don't have experience with anesthesia, either. As to the hours of education, I'm presuming Tenesma is including hours in medical school. Most medical schools offer no classes in any specialty, but rather teach a general medicine curriculum. Prior to beginning an anesthesia residency, most medical students contact with patients has been very limited and highly supervised. Nurse anesthetists, on the other hand, have had at least a year of experience working directly with critically ill and injured patients. And its difficult to compare the education received by MDA's to that received by CRNA's. The education received by CRNA's is highly focused on providing anesthesia, which MDA's get none of until they actually begin a residency.

5. Exactly correct.

6. This would be true if and only if MDA's could bill at a higher rate than CRNA's. In other words, if a CRNA could bill $X for anesthesia provided for procedure A, while an MDA could bill $X + $Y for the same procedure, then Tenesma could make this statement. However, the truth is that for any procedure, the amount that Medicare or insurance companies will pay for the anesthetic for that procedure is always the same, regardless of whether the anesthetic is performed by an MDA, a CRNA, or a CRNA under MDA supervision. In other words, insurance companies and Medicare don't care who does the anesthetic.

The fact that MDA's make more than CRNA's has nothing to do with insurance companies, it has to do with what MDA run groups are willing to pay CRNA's. That's why most anesthesia groups want to hire a larger percentage of CRNA's. The last figures I read said that an anesthesia provider, working full time, could expect to bill about $200,000 - $250,000 for their services. If you ran an anesthsia group, and had to pay $150,000 to employ a CRNA, versus $225,000 for an MDA, which provider would you hire?

However, there is an interesting counterargument spawned by Tenesma's last statement. Since insurance companies pay the same for an anesthetic, regardless of who does it, perhaps they are aware that an anesthetic performed by an MDA is no safer than one performed by a CRNA. Otherwise, they would reimburse at a higher rate for MDA's, and would demand that MDA's perform the anesthetic for certain procedures.

Kevin McHugh, CRNA

CougRN · Oct 22, 2003

Thanks Kevin. I just wanted an opinion on some of these statements and you did a great job of doing that for me. I didn't want to start an arguement with anyone. I appreciate the time you took to respond.

yoga crna · Oct 23, 2003

Sorry guys, we will never just get along. Both groups will be practicing in this country and crnas will be seen all over the world. The reason is ECONOMICS. Don't forget that--this country is rapidly moving towards some kind of national health insurance and CRNAs will play a major role in anesthesia delivery in such a system.

When I am teaching anesthesia, law and health care economics, my motto is: "Always look for an economic motive--it is usually there in some form'"

YogaCRNA

Cynthiann · Oct 23, 2003

Originally posted by yoga crna
"Always look for an economic motive--it is usually there in some form'"

YogaCRNA

That is sooo true.

smogmatt · Oct 23, 2003

But.....

My ?? is if economics is the biggest factor than wouldn't the market turn to AA's??

just a thought

CougRN · Oct 24, 2003

Originally posted by smogmatt
But.....

My ?? is if economics is the biggest factor than wouldn't the market turn to AA's??

just a thought

Well isn't that what the ASA wants? More money for MDA's makes them happy. Plus more control.

Cynthiann · Oct 24, 2003

AA's wouldn't necessarily be cheaper to employ if you need more MDA's to supervise. I tend to think the the cost is about the same either way. (Keep in mind I'm still an undergrad student, so my statement is based on what I've been reading here for the past year).