Have Docs kept you out of an OR room b/c your a CRNA?

yoga crna · Apr 1, 2006

Mike,

It is not anti-trust, it is competition, which in encouraged in our capitalistic system. There have been several major anti-trust lawsuits won by CRNAs, but the facts were consistent with violations of anti-trust laws. In one, a hospital and anesthesiologists conspired to keep out a private practice CRNA (Bhan case). There was also a conspiracy proved in the Oltz case and a win for the CRNAs. The cases cost millions of dollars in legal fees and took years. The anti-trust legal route is not a practical way to maintain practice rights in a hospital. By the way, conspiracy is one of the components required, but hard to prove in anti-trust litigation.

When you look at competition, you will understand that there are two primary components--price and service. If CRNAs practice with competive prices and continue to provide quality care, which includes coverage, we will remain a viable profession. When you try to look into a healthcare economics crystal ball, you will see a place for nurse anesthetists for a long time.

Yoga

jwk · Apr 2, 2006

Mike,
It is not anti-trust, it is competition, which in encouraged in our capitalistic system.
Yoga

So CRNA's welcome competition? Hmmmmmmmmmmmm, let me ponder that one for a longgggggggggggg time................................................................................................................................

MmacFN · Apr 2, 2006

Thanks for the info

I did read those cases in the CRNA history book "watchful care".

So do surgeons ask not to have CRNAs? and is this a valid request? if so why?

Mike,
It is not anti-trust, it is competition, which in encouraged in our capitalistic system. There have been several major anti-trust lawsuits won by CRNAs, but the facts were consistent with violations of anti-trust laws. In one, a hospital and anesthesiologists conspired to keep out a private practice CRNA (Bhan case). There was also a conspiracy proved in the Oltz case and a win for the CRNAs. The cases cost millions of dollars in legal fees and took years. The anti-trust legal route is not a practical way to maintain practice rights in a hospital. By the way, conspiracy is one of the components required, but hard to prove in anti-trust litigation.
When you look at competition, you will understand that there are two primary components--price and service. If CRNAs practice with competive prices and continue to provide quality care, which includes coverage, we will remain a viable profession. When you try to look into a healthcare economics crystal ball, you will see a place for nurse anesthetists for a long time.
Yoga

athomas91 · Apr 2, 2006

So CRNA's welcome competition? Hmmmmmmmmmmmm, let me ponder that one for a longgggggggggggg time..............................................

+

jeez... must you always make it a crna/aa issue.. he actually said that "our capitalistic system" encourages competition - not crna's welcome competition...

however... if you must go there - please don't forget who started the practice of anesthesia - who stole it for monetary profit - and who is equating themselves with whom when the practices really aren't equal.

now...having said that - i like you, i enjoy your insight, have learned from your experience, and it wasn't personal.

jwk · Apr 2, 2006

+
jeez... must you always make it a crna/aa issue.. he actually said that "our capitalistic system" encourages competition - not crna's welcome competition...
however... if you must go there - please don't forget who started the practice of anesthesia - who stole it for monetary profit - and who is equating themselves with whom when the practices really aren't equal.
now...having said that - i like you, i enjoy your insight, have learned from your experience, and it wasn't personal.

Ah, so you're saying you DON'T welcome competition.

Which is it? You can't have it both ways. You can either welcome competition and let your profession stand on it's own merits and let the marketplace decide, or you don't welcome competition because of..................oh yeah - money. It all boils down to that.

As far as the original question, a surgeon can pick whomever he would like to perform anesthetics for his patients. If he wants an anesthetist, fine. If he wants an MD, fine. His choice. If he's not comfortable with a CRNA doing his case, that's his choice.

yoga crna · Apr 3, 2006

One of the issues related to competition is the "level playing field". That is where there are problems. Is it real competition when there are different education/licensure requirements in the two (three) groups? The reality is: a physician has an unlimited license and legally can do anything, from anesthesia to brain surgery. A nurse anesthetist has a separate license that allows anesthesia to be a nursing function, but the license is limited in that educational criterion must be met. I really don't want to get into the AA argument, because my knowledge is limited and there are no AAs in the state where I am in practice. That being said, I believe that AAs do not have a separate license and must practice in a supervised/medically directed environment. So, there is really not a level playing field as far as pure competition is concerned.

But, getting back to my orginial thesis, who administers anesthesia is now and will, in the future be more of an economic issue. If a hospital administrator wants only CRNA or only MD anesthesia, that will probably be the way it is. However, when anesthesia costs are calculated into the total surgical price, such as seen in HMOs and cosmetic surgery practices, the equation may change to whomever is the most cost-effective practitioner, as long as they can provide the care.

Stay tuned to future trends. The ones I see (1) every pregnant woman wanting an epidural, (2) post-op and chronic pain control and the issue of who will pay for those services.

yoga crna

PS. Competition is a major concern of myself and many other CRNAs. I have lost business to other CRNAs as well as anesthesiologists. And, I have sucessfully competed with both other nurse anesthetists and anesthesiologists, likewise. It is a two-way street.

y

MmacFN · Apr 3, 2006

very interesting stuff

Seems like it might not be a bad idea to take some Buisness classes or an MBA post grad eh?

jwk · Apr 3, 2006

That being said, I believe that AAs do not have a separate license and must practice in a supervised/medically directed environment. So, there is really not a level playing field as far as pure competition is concerned.
But, getting back to my orginial thesis, who administers anesthesia is now and will, in the future be more of an economic issue. If a hospital administrator wants only CRNA or only MD anesthesia, that will probably be the way it is. However, when anesthesia costs are calculated into the total surgical price, such as seen in HMOs and cosmetic surgery practices, the equation may change to whomever is the most cost-effective practitioner, as long as they can provide the care.
Stay tuned to future trends. The ones I see (1) every pregnant woman wanting an epidural, (2) post-op and chronic pain control and the issue of who will pay for those services.
y

Actually, AA's are licensed in most of the states in which we practice.

You're right - AA's practice exclusively in medically directed / supervised practices with anesthesiologists, just as most CRNA's do, including the president-elect of the AANA. 100% anesthesia care team.

Not every pregnant woman wants an epidural, but most do. That's not really a future trend - that's now, except for the ones who want to do bathtub births at home with a lay midwife. The question will be not only who does it, but who pays for it. Do you give an epidural to anyone who wants one without regard for their ability to pay for it? Will you be willing to be in-house managing those patients?

Post-op pain is easy with both PCA's and epidural pumps postop, but again, who pays for it and who manages it?

Chronic pain is a whole different ballgame. That's the next big fight coming down the pike - it's already arrived in a couple states.

MmacFN · Apr 3, 2006

hey jwk/yoga

You mentioned chronic pain, so im assuming pain clinics and management etc? So what are the politics and issues surrounding that? Ive read a few things here and there but nothing clear?

if you dont mind, i like learning about this stuff, regardless of differences b/t AA/CRNA im interested in experienced viewpoints from either.

jwk · Apr 3, 2006

hey jwk/yoga
You mentioned chronic pain, so im assuming pain clinics and management etc? So what are the politics and issues surrounding that? Ive read a few things here and there but nothing clear?
if you dont mind, i like learning about this stuff, regardless of differences b/t AA/CRNA im interested in experienced viewpoints from either.

Where MD's would prefer that CRNA's practice in a care team environment whenever possible as part of the usual perioperative positions we are all familiar with, the argument is being made that getting into the chronic pain management arena clearly crosses the line into the unlawful practice of medicine, and that simply because a state nursing board thinks it's OK does not mean it's legal. Complex pain procedures including things like spinal cord stimulators and such are surgical procedures, not nursing.

MmacFN · Apr 3, 2006

Interesting

However, NPs practice medicine on a regular basis. Its limitied practice to a specific scope, however, its medicine nonetheless. How is that any different from this then? Sounds like the exact same argument they lost in the beggining of the MDA profession?