1) RNs are responsible for their actions when they screw up - but trust me, in a lawsuit everybody gets named (especially the doctors and the hospital) because of the amount of money involved - just look at RNs insurance premiums vs MDs premiums...
2) your logic that since Nurses provided anesthesia before there were Anesthesiologists - and thus anesthesiologists are encroaching on their field, is erroneous.... Dentists were the first to use anesthesia, followed by medical students - way before nurses were allowed to stand at the bedside and drip ether. So based on your logic CRNAs are encroaching on dentists and medical students???
3) Your next point is flawed as well... a higher proportion of ASA III and IV get done by anesthesiologists than CRNAs for two reasons 1) CRNAs are primarily distributed in rural/suburban environments where as MDAs are primarily in urban/academic environments - and most tertiary referral centers (where "harder" cases get done) are urban/academic. 2) level of training
4) your statement that CRNAs must have racked up enough experience before CRNA school was probably a typographical error - because CRNAs have absolutely NO anesthesia experience before CRNA school.... sure, after CRNA school and a few years of experience will make most CRNAs relatively competent at providing safe anesthesia for most patients. But i'll go back to my original point of CRNA=1600 clinical hours of anesthesia/patient care vs MD=10,000 hours of anesthesia care (plus another 4,000 hours of further patient care as interns, plus another (in my case) 3,200 of ICU patient management)... there is a discrpeancy in breadth and depth of training.
5) the reason there is a delay of patients getting into theaters (or ORs) has very little to do with the anesthesia provider deficiency, but rather with the miserably failing system of socialized medicine that exists in the UK.... the same system (or similar at least) is set up in CANADA, where for the most part there are more than enough Anesthesia providers, and they still have 6 month delays for elective surgeries...
6) as far as the cash that anesthesiologists make - it is well earned - and obviously insurance companies feel it is money well spent or else they would have contracts with CRNAs alone and would refuse to pay us way above CRNA salaries for the services we provide
This is a post from our friend Tenesma.
So what does everyone think? Are we second best and handmaidens to MDA's? I know that initially we can't be expected to do everything but are we still MDA's Bith*'s?
Maybe this is all true. I am just looking from CRNA experience to step in. I'm not trying to start a war or anything. Just interested in responses from experienced CRNA's
Most AA's work for MD anesthesia groups and are paid a salary by them. Unlike CRNAs they are not legally able to practice independently. As an independently practicing CRNA and a business person, I can compete with other anesthesia providers on price and service. AAs can't do that.
Just a thought on the big picture of this discussion...if you ask an MDA's opinion on CRNA's on a MD site, be ready for the answer.
With that said, it is BS to post one thing on student doctor.com, then come to a predominantly CRNA/SRNA/wannabe site and post something different. Although I value Tenesma's input very much, and his presence here has lent much saliency to a variety of topics, IMHO, it is bad form to post in such a manner.
I think the bickering is minor and only between a few people. All of the anesthesiologists I've worked with have been wonderful people, and it has been a pleasure working with them as part of a team.
IMHO....becasue of the anonymity of message boards, it is quite easy for one to say something that they would never say to someone's face. i.e. the bickering regarding CRNAs and MDAs I feel is somewhat inflated on message boards. I am not saying the ISSUE is inflated, but I feel the bickering is.
I realize that the post was not started here, but we should be better than this. I hate the stuff that goes on over at sd.com, but it happens. Those guys are insecure in their postions in life and it is a sad testament to what they will continue to do to their chosen profession. I am in no way criticizing you for cross-posting, but we have better ideas to talk about. Whenever sd.com comes up on this site, it is never a positive outcome.
I agree with Brett that the issues are inflated online because of the ability to hide behind an avatar, and they can get pretty rude over there, as I am sure he can attest, but the issues are the same online or in the OR. We as potential inheritors of this profession have to be better than all of this. As we move into the next ten years of this profession, we will see a bunch of changes, and I think alot will have to do with the nursing shortage we have now. I think the power of the ASA will only get stronger as the AANA loses it's older fighters. All the reason to get involved at whatever level possible, now as infants in the CRNA /SRNA world.
I don't if this makes any sense or not but I will step down off the soapbox and do what I am supposed to be doing---studying.
i just got back from vacation - and i am surprised to see a brouhaha about this posting from another forum site (the "dreaded" sd.net :) )
first of all - if you look back at all of my postings i have been very consistent (regardless of which forum you look at). The issues I was addressing were in specific response to a posting on the other website - so they do appear somewhat out of context... The hours i cited 1600 hrs of clinical exposure as a SRNA vs 10,000 hrs of clinical exposure as an Anesthesia resident did not include ANY hours from medical school... Otherwise all the other points that my very knowledgeable Kevin McHugh made, are very fair and i will let stand :)
by the way - CRNAs are nobody's *****es - they often know more about keeping somebody alive than anybody else in the OR... that knowledge should keep you satisfied for a long time...
I really hate to get into these discussions, but here I am.
3 years of @ over 10000 hours would require 10 hours a day every day of the year. Which is not what happens. I believe some of the difference in hours is related to what is counted toward hours in anesthesia.
As an SRNA we only count hours actually in the OR. So hours on call when there were no cases did not count. Post op visits did not count, journal clubs, classes etc., did not count. Periods waiting for the next case did not count.
My training was in a facility where anesthesiology residents were training, their hours were not much different than mine. They had one more year of clinical training so I am sure that the hours were higher, but nowhere near the 10000 vs 1600 number.
i don't want to get picky - or pedantic... as a resident we are in the OR from 6:30 am to 6pm every day (monday through friday) then we take call once to twice per week (which usually adds another 12 to 30 hours per week of OR work... and i am not including post-op checks, journal clubs = so that adds up to 70 to 85 hours per week - which averaged over 4 weeks is about 74 hours/week... we get 3 weeks of vacation per year... and one month per year is spent doing surgical ICU (which is q3 call about 90 hours per week = 360 hours per year - which i will NOT count) which adds up to 3330 hours per year spent in the OR ... times 3 years is 10,000 hours ... now i will admit that my program is probably busier than most programs (MGH), but these are all averages... the hours used to actually be a LOT longer until they implemented the 80 hour per work week maximum!!! because before that it wasn't unheard for us to do close to 100hours per week of OR time (not including post-op checks, etc...)...
I just visited the studentdoctor.net website because of some posts earlier about them...so I went to the anesthisia part and I have to say I was a little shocked.... I didn't know they were so worried about CRNA's just taking over their jobs completely. They sure seemed a little bit cynical about it. Not that this upsets me any but most of the comments mentioned their 8 years of school compared to a CRNA's education...so I guess they must think we're getting our degrees online in some 9 month program...that's nice. I wondered about how CRNA's were treated by the anesthesiologists...maybe this is just by medstudents, overall I'd heard that they worked well together. I was hoping so anyway.
I really liked this comment about CRNA's doing complex cases:
The nurses CANNOT do it..........what you are observing is simple cases that are within their realm..........give these glorified technicians something with an iota of complexity and see what happens.....
yep that's nice...well I guess I'll be staying away from these guys...have any CRNA's made any comments on their posts before? Not that it makes a difference but still....
this was good too...
An anesthesiologist I know in private practice uses his CRNA's to get to room ready for epidurals so he can roll out of bed, insert the needle and go back to bed when on call. Not too shabby.
uses "HIS" CRNA's?..ugh i can't read these anymore....
Yes, the commments are a bit much over there, thus, I find it easier to slap myself before heading on that website. I will tell you one thing, though, that website can be very motivational in the midst of a tough week at school, despite the self-imposed beatings. It can incite very fierce work ethic even in the laziest of mammals---me.
One word to Tenesma---thank you for returning despite the angst over your commments. The contributions Kevin M. and you make here are significant, and our discussions would not be the same. Later----S
just a quick note about studentdoctor.net... most of the people posting on the anesthesia forum (despite it being a "graduate" forum) are medical STUDENTS... they know about as much about Anesthesia as your average ICU nurse (and probably less than your average ICU nurse).... So any of their postings (unless it revolves around where they got an interview or not) are useless in the big scheme of things... Because trust me, once they start internship and realize how little they truly know - things change.... Very few residents or attendings write on that board (except for me and a select few).
The bottom line is that because of their lack of knowledge of anesthesia, they feel insecure about choosing a residency in anesthesia because of the concern w/ the CRNA vs MDA debate - and by voicing their "strong" opinions they feel that they strengthen their cause.... Those residents who are in the middle/end of their training and attendings know very well our role in anesthesia, and we also understand the role of CRNAs in anesthesia - and we know and understand the scope of our practice and what differentiates it from nurse anesthesia....
please don't let the postings on the studentdoctor board make you feel disenfranchised (is that a word?) - there is a great shortage of CRNAs, and many patients (especially in rural areas) need access to anesthesia...
i think what makes this board great is when there is discussion around techniques/difficult cases/difficult issues - that is where the learning and intellectual enjoyment of anesthesia starts...
yoga crna
530 Posts
Most AA's work for MD anesthesia groups and are paid a salary by them. Unlike CRNAs they are not legally able to practice independently. As an independently practicing CRNA and a business person, I can compete with other anesthesia providers on price and service. AAs can't do that.
YogaCRNA