The American Association of Nurse Anesthetists makes a bold proclamation of their full practice, safety, independent capabilities, and economic advantage for our modern healthcare system.
Before we begin a discussion on the topic you should probably follow this link to the AANA's original statement.
Firstly, I have to disclose that I am in my third year of nurse anesthesia training preparing for graduation, so I am not a board certified CRNA yet. Anything I say is coming from the perspective of a new generation of CRNA DNP training which I've noted can be slightly different from those of older generations. I am also the elected political representative of my class throughout our program so I do stay more engaged and informed than some other anesthesia trainees. Last disclosure, I do serve the AANA and work on a committee that serves the board of directors.
Now, to understand where this new bold statement from the AANA came from I think it's necessary to understand it is in response to the ASA's statement about the Anesthesia Care Team last fall. Their statement unabashedly self-aggrandizes themselves and downplays CRNAs actual role as experts and independent anesthesia providers. In fact, they use wording that implies better education and training from their own assistants (AAs) than nurse anesthetists who has been providing safe competent anesthesia since the civil war.
Although, most CRNAs don't blame them for making a political statement like this promoting themselves and downplaying their competitors in the marketplace. That is the duty of a professional organization, to promote that organization. Anesthesia has been aggressively political since the early 1900s when physicians decided to start learning anesthesia and tried to make it illegal in California for a nurse anesthetist to continue practicing anesthesia. Who wants competitors if you think you can eliminate them, it just makes business sense.
After the political statement made last October by the ASA large amounts of CRNAs were outraged and demanded an immediate defending response from the AANA. The AANA is always careful and intentional in what it does, so they created a task force of influential and level headed CRNAs who would investigate the issue and come up with a diplomatic response. They spent 6 months discussing this and coming up with the response you are now reading. This statement was intentional and well thought out. It is supported and celebrated by a huge majority of CRNAs/SRNAs judging from responses in person and in private CRNA forums consisting of tens of thousands of CRNAs.
It's disconcerting that I have seen some negative comments online by people who aren't physicians. You would expect many physicians to react negatively to a non-physician provider talking about their education, training, and similar patient outcomes but it is odd to see some others ill-informed negativity.
The biggest confusing issue I see people have is that in the AANA's statement that is in response to the ASA's care team statement is that billing methods are often fraudulent. What many may not understand is that in a medical direction billing model (which is what the ASA is wanting everywhere) involves meeting 7 TEFRA requirements to bill for CMS. These requirements are very often not met even when physicians bill in medical direction, which is Medicare fraud. This is not just anecdotal. The ASA produced research they performed themselves that was published recognizing that a huge number of medical direction practices are not meeting the 7 TEFRA requirements. Medical direction benefits the physician because they can bill for 4 different cases at once while they are not providing the anesthesia but 4 different CRNAs are performing the anesthesia. You can see why they would want this to be a standard delivery method of anesthesia. Even when their own research shows they are fraudulently billing in many places they continue to push this model. This model is oftentimes the most restrictive and oppressive to CRNAs who choose to work with that anesthesia group. It is also one of the more costly models for hospitals to sustain, so it's not economically responsible or sustainable for many facilities.
CRNAs mention these issues with medical direction because it supports the movement nationwide for the collaborative model of anesthesia care. This model requires that both CRNAs and MDAs be independent full practice providers who work together on a team. They are equal partners and practice under their own license to provide safe high-quality anesthesia to their patients. In this model, there are no 7 TEFRA regulations so Medicare fraud is not an issue. The economic reason some in anesthesia will not like this anesthesia delivery model is that you can not bill for services of 4 CRNAs at once providing anesthesia. Each provider can only bill for their own anesthesia for a single case. It would do away with someone sitting in the break room drinking coffee while 4 other providers are working and earning you profit. You can see why certain people would not want this to happen.
I just wanted to clear that portion up about the AANA's statement so it had some context and people who are not in the anesthesia realm understand where that came from. Those of us in anesthesia are just so used to that issue I think we forget others are not informed about it.
I'm guessing you're an MS2 or MS3 from the passionate debate in favor of the robust clinical skill of medical students. I'm afraid any nurse working in the hospital when MS4's graduate and become residents know just how little clinical application ability is there in the beginning.
I'm not saying medical school is useless or med students are bumbling fools in the clinical arena so please lower your blood pressure. Although, If you believe that a medical student has the same expectations and performance of a third-year SRNA you're wildly delusional. In fact, on my first rotation as a second-year student, I had more responsibilities and expectations than the MS4 rotating with us. She at least had the sense to admit that and make polite conversation.
I did a med school internship and chose to do a CRNA DNP instead because I could see the changing of the tides in healthcare. As you say, physician anesthesiologists will make $400,000 a year where a CRNA may make $200,000 a year. The more economical option between two anesthesia providers who can perform the same role is exactly why the future is so bright for CRNAs.
No I finished med school several years ago kind sir. I know what most MS4s are capable of. Much more than SRNAs or at least the ones going into anesthesia are especially if they’ve already done a few anesthesia or cc rotations. If one is going to argue equality in anesthesia it’s better to say that physicians are often overtrained for it than to say physicians are morons and nurses are here to save the day with efficiency and intelligence. Nobody is going to buy into that argument
nurses have their place in health care as do physicians both are equally important but the command pole ends with the physician and it likely always will those who don’t lie it should have gone to medical school
Also im sure that med students come up to you on a daily basis and say “hey dr greenbolt why don’t you teach us things”
The tides will likely not change as much as you think if you seriously believe anesthesiologists will go out of business there are always cases that will require physician performance even if many cases can be done by a crna which nobody is arguing about
No I finished med school several years ago kind sir. I know what most MS4s are capable of. Much more than SRNAs or at least the ones going into anesthesia are especially if they’ve already done a few anesthesia or cc rotations. If one is going to argue equality in anesthesia it’s better to say that physicians are often overtrained for it than to say physicians are morons and nurses are here to save the day with efficiency and intelligence. Nobody is going to buy into that argument
nurses have their place in health care as do physicians both are equally important but the command pole ends with the physician and it likely always will those who don’t lie it should have gone to medical school
Also im sure that med students come up to you on a daily basis and say “hey dr greenbolt why don’t you teach us things”
The tides will likely not change as much as you think if you seriously believe anesthesiologists will go out of business there are always cases that will require physician performance even if many cases can be done by a crna which nobody is arguing about
eye roll
Your hyperbole and melodrama have made this an engaging conversation. I've enjoyed our discussion and wish you luck in your future endeavors.
Seems as if Bluebolt is attempting to explain things in a pretty neutral way people, twinsmom is citing her two twins as her source(how fitting) and hogger sounds like some sort of physician who never specialized in anesthesia. Let’s just stick to the research and leave the assumptions aside. Just because I’ve witnessed MS4 in action doesn’t make me an authority on the rigor which goes into their profession. I am sure that MDAs and CRNAs are both highly trained professionals and the practitioners all fall into a normal bell curve.
oh dear, my twins have nothing to do with much of this with the exception of what they went through in med school. I am speaking for the most part from my experience of a CVOR nurse with MD anesthesiologists. I did request an MD to provide my anesthesia mostly because that 's what I was most familiar.
oh dear, my twins have nothing to do with much of this with the exception of what they went through in med school. I am speaking for the most part from my experience of a CVOR nurse with MD anesthesiologists. I did request an MD to provide my anesthesia mostly because that 's what I was most familiar.
Med students touch patients from day one for four years. I do agree with the part you say though that for anesthesia training much of the knowledge gained in MD school is not required since excluding complications non pain fellowshipped MDA do not really diagnose chronic illness (but still need to know what they are for repercussions of the disease on giving anesthesio as you know. If you want to argue that all of medical school is not needed for safe distribution of anesthesia I will agree with you.
The amount of cases over 1-1.5 years of clinicals at most anesthesia schools is not equal to the three years of pure anesthesia/critical care of an anesthesia residency. I left out the intern year since it’s an intern year that probably does not need to exsist but does serve it’s purpose in understanding medicine in general.
Not all crna sxhools teach peripheral blocks
TBH though if CRNA want full autonomy go for it. If you think you can do heads and hearts day one out of CRNA school then be my guest but I’ll def will be referring any of my patients to centers that have MDA backup or MDA core for their own safety. I would bet many crna schools send students to facilities too small to even have heart lung marchines/ CTS ! What are you gonna do day 1 when you need to give anesthesia to that open heart even though you never saw one in school. Many places don’t even let non chest fellow MDA in those patients
Regional blocks are taught to ALL CRNAs
There are facilities where CRNAs independently do hearts/heads. Why do you think there isn't?
It’s simple CRNA/NP/PA can all practice at a independent level but for some challenging cases we need MDs! Periods! I know that there are exceptions, yes. Once we stop thinking we are better than each other and start thinking that we all work as a team to achieve the same goal, the health care world will be a better place!
It’s simple CRNA/NP/PA can all practice at a independent level but for some challenging cases we need MDs! Periods! I know that there are exceptions, yes. Once we stop thinking we are better than each other and start thinking that we all work as a team to achieve the same goal, the health care world will be a better place!
I wish this were the case, but CRNAs are the answer, clearly.
BoltRN!!! I have been following you on youtube since your days as a travel nurse. I want to congrats you on your recent career achievement. Now that's aside, some of the commentators are extremely rude. You contributed a lot to the CRNA social media community, for that, thank-you. I do not mind if a CRNA is my provider. When it comes to surgery, I imagine patients have other things to worry about than trying to figure out who will be their providers. For most people, it really doesn't matter. My roommate, who inspires to be a CRNA actually has a MD anesthesiologist recommendation of taking the CRNA route rather than through the medical school route. I too believe that the future will be in favor of CRNA.
This discussion reinforces something I’ve advocated in our state organization. CRNAs have to educate nursing about nurse anesthesia. We should not assume other nurses understand us. Of course there still will be nurses who don’t support independent CRNAs, but some just don’t understand us.
CRNAs are independent in my practice and it’s interesting to watch some travel RNs come into the OR as circulating nurses. Those who haven’t been exposed to independent CRNAs seem to fall into 2 camps. Those who are like “who knew” and ask questions and have an open mind. Others who are suspicious and are like “what’s going on here “ and seem to be resentful of the CRNAs autonomy.
Anesthesiologists and CRNAs can and do both work independently. There is nothing magical about anesthesiologist training that inherently makes them better or safer providers. There are good anesthesiologists and good CRNAs, and inversely there are bad providers in both of those professions.
I have supervised CRNAs and anesthesiologists. I have seen anesthesiologists and CRNAs make mistakes. The big difference is when a mistake/adverse event happens with an anesthesiologist it usually is glossed over and people will just say those things happen. When a CRNA makes a mistake people inherently blame it on being a CRNA.
I have worked all over the world as a USAF CRNA. I have done the worst trauma that you can get in Afghanistan (solo and in a mixed CRNA/MDA shop), all over the US to working in two person CRNA shop in a foreign country. There is no anesthesia case that CRNAs cannot do and do just as well as our MDA counterparts. Anesthesiologists tend to do certain speciality cases because of market protection where anesthesiologists get most of the large speciality cases at academic centers and anesthesiologists have fellowship trainings that are not offered to CRNAs.
hogger
26 Posts
No I finished med school several years ago kind sir. I know what most MS4s are capable of. Much more than SRNAs or at least the ones going into anesthesia are especially if they’ve already done a few anesthesia or cc rotations. If one is going to argue equality in anesthesia it’s better to say that physicians are often overtrained for it than to say physicians are morons and nurses are here to save the day with efficiency and intelligence. Nobody is going to buy into that argument
nurses have their place in health care as do physicians both are equally important but the command pole ends with the physician and it likely always will those who don’t lie it should have gone to medical school
Also im sure that med students come up to you on a daily basis and say “hey dr greenbolt why don’t you teach us things”
The tides will likely not change as much as you think if you seriously believe anesthesiologists will go out of business there are always cases that will require physician performance even if many cases can be done by a crna which nobody is arguing about
eye roll