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

[MmacFN]

So this sortof came up the other day.

Is it the surgeons right to request NOT to have a CRNA? Is that legal? It seems that CRNAs and MDAs compete for the exact same jobs and have near identicle outcomes. Wouldnt it be an antitrust issue to preclude one group from working with you?

I dont know, but i figured i would ask.

[jwk]

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?

Perhaps because they're specifically allowed to by statute - like you said, limited and specific scope of practice. The problem is that chronic pain services (particularly the specialty blocks, spinal cord implants, etc.) are not within the usual recognized scope of practice of nurse anesthetists. There has to be a line somewhere between what constitutes the practice of nursing and what constitutes the practice of medicine. I think those are the arguments that will be used against CRNA's on this issue. As I recall, it's already the subject of litigation in at least one state.

[MmacFN]

hmm

Growing pains. Will be interesting to see how this cashes out.

[jwk]

hmm

Growing pains. Will be interesting to see how this cashes out.

Hey, it's nothing if not interesting.

[yoga crna]

Mike,

CRNAs are very much involved with chronic pain. Visit this website http://napeseminars.com/. This is from a group of very respected CRNAs and, while I have never attended one of their seminars, I understand they are excellent.

Those CRNAs gave me excellent advise when I had a ruptured disc. They know their business.

Also, I heard an excellent lecture last year from a CRNA who runs the pain clinic at Walter Reed Medical Center. She talked about what they are doing for chronic pain control for the casulties of the Iraq war. Outstanding work. Makes me proud to be in the same profession.

Yoga

[MmacFN]

cool

thanks for the info

[rayman]

hmm

Growing pains. Will be interesting to see how this cashes out.

There's a great pun there whether intentional or not...lol

[MmacFN]

hehehe intentional, was wondering if anyone would notice. Maybe i should have said ca$h.

[ivpush]

I find it interesting.......

The practice of nurse anesthesia is to relieve pain. What is the difference between pain relief for an acute process (surgery) and a chronic process (herniated disk)? In both scenarios, we are relieving pain-in other words, we are doing our jobs.

[MmacFN]

IVpush

The difference is who makes all the money. Chronic pain is big billable bucks. For the same reason MDs all the sudden jumped into anesthesia, they are now working to control chronic pain with the exact same argument. Ive read a couple of lawsuits recently.

MONEY. plain and simple.

Now are the CRNAs doing it for the same reason? Of course. However, the cost is severly less. So then, whats best for the patient?

Hard questions.

[WntrMute2]

Actually, most of the time the surgeons ask why do we have MDAs when the CRNAs do all the work. There are moments where a surgeon may ask if the MD can step into the room. That's happened exactly twice. Both times to yell at them for a decision made in pre-op BTW. The scariest thing is to watch how quickly things turn bad when the MDA gives me a bathroom break in the heartroom. Most surgeons realize we provide excellent care and quickly learn to trust us.

[MmacFN]

Wntr

That is very good to hear! I bet it makes your day!

[Tenesma]

Your position is that CRNAs can do Chronic Pain and the interventional aspects of it - since you guys contend it falls under the practice of nursing - and since you have some superficial exposure to pain intra-operatively and post-operatively.

Why don't CRNAs do Nephrology and Dialysis, or Pulmonology and Bronchoscopic Biopsies, or Intensive Care, or Pediatrics and vaccinations, or Cardiology and Interventional Caths w/ stent placement? You could argue that superficially you are exposed to renal management, bronchoscopies, vasopressor management, pediatric cases, intra-op MIs during your cases - so therefore those fields should become the practice of nursing...

that argument is weak - I implant spinal cord stimulators on a regular basis, but it doesn't mean that I will start doing Motor Cortex Stimulation. The acquisition of knowledge is necessary and so is the appropriate training.

A CRNA who is trained to do a physical exam is geared towards pre-op eval (ie: airway, cardiac, pulmonary, and checking if the pupils are dilated) - the finer findings of a non-crossing patellar reflex and positive ipsilateral babinski in a patient with loss of proprioception wouldn't mean much to you unless you had the fundamental knowledge of the proper functioning of the lateral corticospinal tracts with interruption of the lateral spinothalamic tracts - so that you could diagnose Brown-Sequard syndrome.

Somebody who treats chronic pain really should be a physician, and have both the background anatomical/physiological/neurological understanding of how to diagnose, and how to treat based on mentored experience (ie: residency or fellowship). Can you teach somebody to do a fluoroguided injection? Sure, I can teach my mother how to do that - is it appropriate (other than she will make good money)? no...

chronic pain is soo much more than understanding narcotics and sticking needles into somebody's spine based on MRI findings.