Jonathan Slonin, an anesthesiologist and past president of the Florida Society of Anesthesiologists, believes that lawmakers should not allow the administration of anesthesia without a physician in the room. Although he works with and respects Certified Registered Nurse Anesthetists (CRNAs), they are not physicians.
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They have years of training, but they are not trained in medical diagnosis and treatment, and while they are highly skilled and a vital part of the medical care team, they should never be the lead of that team.
While the American Association of Nurse Anesthetists are advocating for a proposed bill that would allow CRNA’s to practice without the supervision of a physician, some see this as a dangerous and costly move.
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...safety should be the primary goal and that is why physician-led care must remain the standard. If CRNAs were given complete independence to practice complex medicine, costly mistakes will happen. And when they do, we all pay for those mistakes through increased healthcare costs.
Agree to disagree. We have crnas and MDAs who truly cannot do anything but bread and butter. We have crnas and MDAs who do RFAs/pain procedures, exotic blocks, and hearts without any help/supervision. Your title shouldn't define your limits. I think the healthcare industry automatically assumes competence for physicians until proven otherwise; it's the reverse for crnas and I think that's misguided.
As I live in an area with a heavy kaiser presence, I wouldn't consider kaiser crnas a beacon for independent practice. I would expect crnas working there to be generally more sympathetic to physician oversight.
Again, devil's advocate...look at the clinical discussions in anesthesia professional forums. How do you rate the quality and sophistication of one v. the other? Not a randomized DB study, but for sure a very strong indicator of clinical sophistication. Blocks and lines shouldn't impress anyone, btw....
Again, devil's advocate...look at the clinical discussions in anesthesia professional forums. How do you rate the quality and sophistication of one v. the other? Not a randomized DB study, but for sure a very strong indicator of clinical sophistication. Blocks and lines shouldn't impress anyone, btw....
Not sure how one would objectively evaluate the quality of a discussion forum. I doubt any unbiased stakeholder would find that arguement compelling. Although, to that end I would consider several of the CRNA discussion forums I participate in to be of high quality.
The available literature doesn't support physician supervision of CRNA practice. The widespread success of hundreds of CRNA anesthesia groups across decades of practice doesn't support it either. As reimbursement decreases and group subsidies become an increased burden, I suspect we'll see a lot more CRNA success in unsupervised models, and the evidence for my position will continue to grow.
Not sure how one would objectively evaluate the quality of a discussion forum. I doubt any unbiased stakeholder would find that arguement compelling. Although, to that end I would consider several of the CRNA discussion forums I participate in to be of high quality.
Professionals wouldn't be able to look at conversations on clinical topics and determine their level of sophistication and relivancy? That would be pretty weak if true.
Professionals wouldn't be able to look at conversations on clinical topics and determine their level of sophistication and relivancy? That would be pretty weak if true.
I think the percieved quality of anonomized online discussion forums are pretty weak evidence of anything. We shouldn't be making healthcare decisions on that level of evidence.
I think the percieved quality of anonomized online discussion forums are pretty weak evidence of anything. We shouldn't be making healthcare decisions on that level of evidence.
This discussion was almost exactly the same when I graduated in 1984. Tit for tat. If you don't like the team concept, move on. We have more MDA's in bigger centers because we need an assortment to take call to a variety of ICU's as well as the OR. The residents are there to train. Of course they are doing a lot of bread and butter. Most of the cases are. It's not going to change. I started taking call solo 2 weeks after graduation in a community hospital as did others in small hospitals across the country. This is nothing new.
This discussion was almost exactly the same when I graduated in 1984. Tit for tat. If you don't like the team concept, move on. We have more MDA's in bigger centers because we need an assortment to take call to a variety of ICU's as well as the OR. The residents are there to train. Of course they are doing a lot of bread and butter. Most of the cases are. It's not going to change. I started taking call solo 2 weeks after graduation in a community hospital as did others in small hospitals across the country. This is nothing new.
I certainly never bought into the ACT concept and certainly won't change any minds already working in the field (which are generally already made up). My purpose in participating in this exchange of ideas up to this the point was to ensure that the next generation of RNs and healthcare leaders passing through these forums aren't sucked into this idea of "CRNA supervision is needed for safety" without rebuttal. When I was working as a nurse aide or nurse long ago, I never once heard this perspective. I'm paying it forward.
I certainly never bought into the ACT concept and certainly won't change any minds already working in the field (which are generally already made up). My purpose in participating in this exchange of ideas up to this the point was to ensure that the next generation of RNs and healthcare leaders passing through these forums aren't sucked into this idea of "CRNA supervision is needed for safety" without rebuttal. When I was working as a nurse aide or nurse long ago, I never once heard this perspective. I'm paying it forward.
And the AANA has been aggressive in the mission to drop MDA supervision requirements. Especially after Covid. There was a surge in opt-out states, including mine. This conversation has been re-hashed for decades. Getting legislators to understand that Tefra is a billing requirement, not a practice requirement is a complex argument to make. Most of the CRNA's I worked with over the years weren't politically active and got what they what they reaped. Maybe your generation will do better but so far, the two biggest meaningful changes that have affected us in the past 50 years is 1. The Minneapolis lawsuit and 2. Covid which nudged many states into opting out. State associations have paid lobbying lawyers millions of dollars to get where we are now. Millions. I also delivered many PAC checks to legislators for their campaign funds. Change us slow but feel free to become active in getting rid of Tefra which makes liars out of all of us.
Agree to disagree. We have crnas and MDAs who truly cannot do anything but bread and butter. We have crnas and MDAs who do RFAs/pain procedures, exotic blocks, and hearts without any help/supervision. Your title shouldn't define your limits. I think the healthcare industry automatically assumes competence for physicians until proven otherwise; it's the reverse for crnas and I think that's misguided.
Same can be said for AA's? PA's are now rattling their cages for more (if not complete) independent practice and it's not outside the realm of possibility that AA's could try it as well down the road. The arguments the AANA uses for their position can easily be used for AA's. And 'trained to be independent' means absolutely nothing as that phrase is completely undefineable.
Same can be said for AA's? PA's are now rattling their cages for more (if not complete) independent practice and it's not outside the realm of possibility that AA's could try it as well down the road. The arguments the AANA uses for their position can easily be used for AA's. And 'trained to be independent' means absolutely nothing as that phrase is completely undefineable.
But I think that our critical care requirement stands for something since experience is so critical to learning. We come to school with a skillset that no other groups has. I wish they would change the mininum ICU experiene to 3 years instead of 1. I've personally only worked with 1 person who started classes after 1 year experience. Her father was an anesthesiologist in the same hospital which gave her an advantage.
Same can be said for AA's? PA's are now rattling their cages for more (if not complete) independent practice and it's not outside the realm of possibility that AA's could try it as well down the road. The arguments the AANA uses for their position can easily be used for AA's. And 'trained to be independent' means absolutely nothing as that phrase is completely undefineable.
Independent obviously means providing the entire scope of anesthesia care without any supervision or direction from anyone else. When I go to work every day it's just me and the surgeon in the building. If an anesthesiologist is around, they're doing their own cases.
PAs have no anesthesia training in their programs; I know of no hospital where a PA is credentialed to deliver general anesthesia. AAs have a fraction of the prior experience and anesthesia training; none are working independently.
The median person starting a CRNA program had 4 years of prior ICU experience. With the 36 month DNPs, the average person is now graduating with close to 3000 anesthesia clinical hours. In their programs, crnas train in independent practice settings (see above). Crnas in training are often in a 1:2 ratio with a physican or CRNA.
An AA student typically starts with no clinical skills, their programs are 2 years long, and they generally start with zero clinical experience. They only train in ACTs. Their AA supervisor or physician is always in the room during training; they are never left alone.
Independent obviously means providing the entire scope of anesthesia care without any supervision or direction from anyone else. When I go to work every day it's just me and the surgeon in the building. If an anesthesiologist is around, they're doing their own cases.
PAs have no anesthesia training in their programs; I know of no hospital where a PA is credentialed to deliver general anesthesia. AAs have a fraction of the prior experience and anesthesia training; none are working independently.
The median person starting a CRNA program had 4 years of prior ICU experience. With the 36 month DNPs, the average person is now graduating with close to 3000 anesthesia clinical hours. In their programs, crnas train in independent practice settings (see above). Crnas in training are often in a 1:2 ratio with a physican or CRNA.
An AA student typically starts with no clinical skills, their programs are 2 years long, and they generally start with zero clinical experience. They only train in ACTs. Their AA supervisor or physician is always in the room during training; they are never left alone.
Every single point, besides our ICU requirement, is a broad generalization. Out of the 141 accredited CRNA programs in the US, there is no way anyone could make the claim that the training is as homogeneous as laid out above, nor the relative experience of the trainees. There superlative nurse anesthesia programs and there are superlative AA programs, but the difference is that AA's don't have the politics surrounding getting their blocks, lines, hearts etc...Non physician anesthesia training is a mixed bag and to say that every single nurse anesthesia training program adequately prepares their graduates for independent practice is just not true. I say this not to trash independent practice but to pressure the AANA/NBCRNA to make programs way less heterogeneous than they are or close them. You really have no idea what your getting with any given new grad CRNA until they show you, and that's not the exception, its the rule.
But I think that our critical care requirement stands for something since experience is so critical to learning. We come to school with a skillset that no other groups has. I wish they would change the mininum ICU experiene to 3 years instead of 1. I've personally only worked with 1 person who started classes after 1 year experience. Her father was an anesthesiologist in the same hospital which gave her an advantage.
Yeah, I don't disagree. I was looking at a reddit thread and someone asked how much folk's ICU experience impacted their anesthesia job...Mine did tremendously, but I did liver transplant, tons of congenital cardiac repairs, tons of inner city morbidity and penetrating trauma....6 years worth. Less than 2 years in a neuro-ICU like several of my students? Not so much. We can't claim superior training and experience if all we do is point to an average. It needs to be a hard, non-negotiable line of at least 3 years. But that would limit the pool of applicants and that doesn't meet the AANA/NBCRNA production goals. Yeah, if it sounds like I'm pretty jaded it's because I am.
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Again, devil's advocate...look at the clinical discussions in anesthesia professional forums. How do you rate the quality and sophistication of one v. the other? Not a randomized DB study, but for sure a very strong indicator of clinical sophistication. Blocks and lines shouldn't impress anyone, btw....