Nurse Anesthesiologist Name Change

I know... a rose by any other name...

but for those who care, what's your thoughts on the name change for CRNAs to nurse anesthesiologists? Is it good for the profession or just deceptive advertisement? Thanks!

Specializes in Adult Critical Care.

I'm happy to see you're not trying to defend any of the ASA's nonsense: 12,000 hours+, AA's are equal, etc.  Happier still to see your support for CRNA regional anesthesia.  That aside, your personal anecdotes from '2 anesthesia programs worth of teaching' aren't exactly compelling pieces of evidence.  I'm curious what the extent of your 'teaching' CRNAs encompasses.  

It's a shame you appear to restrict mentorship opportunities and case types at your sites based on provider type.  No doubt that greatly helps your recruitment of our graduates.  Luckily, our ~130 programs each have dozens of clinical sites so that our Nurse Anesthesia Residents get a good breadth of experience.  

It's nice you found a group of Nurse Anesthesiologists willing to stroke MDA egos, but I assure you that they don't speak for the vast majority of us.  We have the AANA for that.  There are CRNA-only groups all across the country doing hearts every day.  Nurse anesthesia residents do rotations at these places.  New grad CRNAs join those practices after graduation.

Thank you so much for taking time out of your busy day of stock trading and TEFRA fraud to share your wisdom with the group.

jfratian said:

I'm happy to see you're not trying to defend any of the ASA's nonsense: 12,000 hours+, AA's are equal, etc.  Happier still to see your support for CRNA regional anesthesia.  That aside, your personal anecdotes from '2 anesthesia programs worth of teaching' aren't exactly compelling pieces of evidence.  I'm curious what the extent of your 'teaching' CRNAs encompasses.  

It's a shame you appear to restrict mentorship opportunities and case types at your sites based on provider type.  No doubt that greatly helps your recruitment of our graduates.  Luckily, our ~130 programs each have dozens of clinical sites so that our Nurse Anesthesia Residents get a good breadth of experience.  

It's nice you found a group of Nurse Anesthesiologists willing to stroke MDA egos, but I assure you that they don't speak for the vast majority of us.  We have the AANA for that.  There are CRNA-only groups all across the country doing hearts every day.  Nurse anesthesia residents do rotations at these places.  New grad CRNAs join those practices after graduation.

Thank you so much for taking time out of your busy day of stock trading and TEFRA fraud to share your wisdom with the group.

Well...that escalated quickly. When a conversation becomes toxic and insulting, it's because someone that is wedded to a wooden ideologic position has become threatened. It also means that any further attempt at conversation is unlikely to result in productive ends. But just for people looking in...I'm well aware of those CRNA cardiac surgery groups as I belong to one. I don't deny for a minute that there are exceptional nurse anesthesia programs. It's just that there is no homogeneity across all groups of training programs for SRNA's like there is for MD residents.

Just taking the cardiac example, SRNA's very often have to travel to other states to get meaningful cardiac or transplant or tertiary peds training and experience while MD programs do not and have more time in the OR with these cases. To deny this fact is to surrender credibility.  

That the AANA and some of it's members want to die on this 'anesthesiologist' hill as opposed to correcting the problem of the wide variation in quality of training programs is beyond me. But have at it. I've been doing cardiac anesthesia for coming up on 30 years and am getting ready to leave. I've broken ground for CRNA's coming up behind me and left the profession better off than I found it. Ideologues that have made a religion out of their professions would disagree with that, but I'm interested to see how far they get being more concerned with what amounts to identity politics than training and experience. 

Specializes in Adult Critical Care.

Yeah, definitely nothing inflammatory about discrediting CRNA training in a CRNA forum.  And I get it....you're at retirement and don't like change.  However, this entire name debate is not trivial.  Words matter. This is about presenting our profession as one of highly trained, independent anesthesia providers distinct from AAs.   Without the AAs pretending to be 'anesthetists' and displacing CRNAs, we wouldn't be having this discussion. 

The AANA and NBCRNA are not prefect, but they are strong advocates for our profession.  They are absolutely strengthening program requirements all the time; each new cohort has more hours and cases required that its predecessor.  Of course there's always room for improvement.  I don't fixate on those things in public.

The point is that Nurse Anesthesiologists are just as safe as physician anesthesiologists practicing independently from day 1.  Every piece of literature out there says the same thing.  For whatever reason you're choosing to focus on imperfections and least common denominators in our profession.  Even if your intentions in doing so are good (I doubt it) doing that externally on a forum like this merely empowers those that seek to control us or eliminate us (an ASA stated goal).  And I think it's sad.

Specializes in CRNA, Finally retired.
offlabel said:

Well...that escalated quickly. When a conversation becomes toxic and insulting, it's because someone that is wedded to a wooden ideologic position has become threatened. It also means that any further attempt at conversation is unlikely to result in productive ends. But just for people looking in...I'm well aware of those CRNA cardiac surgery groups as I belong to one. I don't deny for a minute that there are exceptional nurse anesthesia programs. It's just that there is no homogeneity across all groups of training programs for SRNA's like there is for MD residents.

Just taking the cardiac example, SRNA's very often have to travel to other states to get meaningful cardiac or transplant or tertiary peds training and experience while MD programs do not and have more time in the OR with these cases. To deny this fact is to surrender credibility.  

That the AANA and some of it's members want to die on this 'anesthesiologist' hill as opposed to correcting the problem of the wide variation in quality of training programs is beyond me. But have at it. I've been doing cardiac anesthesia for coming up on 30 years and am getting ready to leave. I've broken ground for CRNA's coming up behind me and left the profession better off than I found it. Ideologues that have made a religion out of their professions would disagree with that, but I'm interested to see how far they get being more concerned with what amounts to identity politics than training and experience. 

I agree that the stock trading was snotty but the Tefra fraud accusation is a real, everyday occurrence. The criteria are unrealistic.  You can't work in a busy OR and complete the requirements at the same time.  I remember how these Tefra rules came into existence (to make the MDA's get into their  scrubs and look at the patients they were billing) but the designer of the new rules didn't address the realities of grueling OR schedules.  My old department added a residency program about 7 years ago and it's been a disappointment.  They help with the night call but don't work hard during the days.  They are not getting the experiences they need.  I had to LEARN how to get through 24 hour shifts.  It took time.  I'm not sure they are learning stamina or how to think on their feet.

subee said:

I agree that the stock trading was snotty but the Tefra fraud accusation is a real, everyday occurrence. The criteria are unrealistic.  You can't work in a busy OR and complete the requirements at the same time.  I remember how these Tefra rules came into existence (to make the MDA's get into their  scrubs and look at the patients they were billing) but the designer of the new rules didn't address the realities of grueling OR schedules.  My old department added a residency program about 7 years ago and it's been a disappointment.  They help with the night call but don't work hard during the days.  They are not getting the experiences they need.  I had to LEARN how to get through 24 hour shifts.  It took time.  I'm not sure they are learning stamina or how to think on their feet.

Not in supervision models/opt out states. TEFRA doesn't come into it at all. Can't speak to medical direction as I don't work under that model but as there have been several high profile fraud cases and subsequent intense emphasis on compliance across the industry, whatever the fraud situation is now, it is dwarfed by what it was 20 years ago. 

Specializes in Adult Critical Care.

TEFRA is absolutely relevant today.  The dominant model of anesthesia delivery in the U.S. is still 4:1 medical direction (QK billing code); supervision (AD billing code) and independent (QZ/AA billing codes) models are less common nationwide.  This is because, in most states that have 'opted out,' many of the healthcare organizations in that state still require medical direction for all anesthetics given in their facilities.

https://pubs.asahq.org/anesthesiology/article/116/3/683/13019/Influence-of-Supervision-Ratios-by

Above is Epstein's 2012 landmark study on TEFRA lapses within ACTs...published in Anesthesiology.   Summary (figure 2):  50% lapse at 2:1 ratio.  Nearly 100% lapse in meeting the 7 requirements of TEFRA if direction is 3:1 or greater.  

Modern ACTs and medical direction are inherently fraudulent.  Off the record, the DOJ says the sheer pervasiveness of it makes it practically unenforceable.  Physicians aren't 'supervising' from the golf course anymore as they were in the 1970s (prior to TEFRA), but there is still large-scale fraud in nearly every ACT.  From what I've seen, many physicians in ACTs have realized it's impossible to meet TEFRA rules and simply stick to the preops, blocks, and PACU discharges.  Rarely will you see them present on induction.  They of course still bill largely medical direction and of course commit fraud in doing so.

This is also a big reason why Certified Registered Nurse Anesthesiologists (CRNAs) are against AA licensure.  AA's can only operate under medical direction within an ACT.  The current state of medical direction is a joke and will not support these dependent providers properly.

The only ways to get rid of this fraud are: 1. delay surgery start times (not going to happen), 2. decrease ratios (not enough providers), or 3. have physicians and CRNAs independently bill and take care of their own patients.  

We do #3 where I am.  We cover way more rooms with the same number of staff.  I wish that's the way it was everywhere, but it's not.

Specializes in Oceanfront Living.
jfratian said:

And shadowing doctors treating patients (med school) isn't really medicine either.  Both are relevant clinical experience few AAs have.  The need to differentiate ourselves from them is the point here. 

If you take a hard look at the hours spent in the operating room in a 3 year doctoral CRNA program vs a physician anesthesia residency, there is not a massive difference.  Physician anesthesia residents have an intern year and a significant portion of their remaining 3 years outside of the OR in the ICU and doing research.  We train alongside one another and use many of the same textbooks.  In the OR we both get asked the same questions, we both do all types of cases (transplants, hearts, etc), and we do all types of procedures (peripheral nerve blocks, spinals, epidurals, central lines, a-lines, etc).  Based on the comparable time actually rendering anesthesia care, I believe both groups can fairly call themselves experts in anesthesia care and anesthesiologists.

I would point out that our 2nd year MD/DO anesthesia residents come in very green and are often trained by CRNAs for the first 6 weeks or so.  Our physicians don't want to deal with them, since they come to the OR with no idea how to work an IV pump, start an IV, or set up a ventilator to name a few.  No new CRNA student has that issue; CRNA students have a initial leg up on them in several areas.  However, I find the MDs have a initial stronger grasp of didactic content.  It really does even out by the end and you would not be able to tell the difference between one of our senior CRNA students and a 4th year MD/DO resident if you removed nametags.  I suspect a blind experiment would be quite revealing.

 

I don't think that much of this is correct.  My SIL is an MDA  and this was not the case in his residency.

Specializes in CRNA, Finally retired.
beachbabe86 said:

I don't think that much of this is correct.  My SIL is an MDA  and this was not the case in his residency.

In what respect?

Specializes in Oceanfront Living.
beachbabe86 said:

I would point out that our 2nd year MD/DO anesthesia residents come in very green and are often trained by CRNAs for the first 6 weeks or so.  Our physicians don't want to deal with them, since they come to the OR with no idea how to work an IV pump, start an IV, or set up a ventilator to name a few. 

My SIL was never "trained" by CRNAs .  He knew how to perform the afore mentioned skills as a med student.

Specializes in Adult Critical Care.

While sometimes a senior resident may do this training, I can think of numerous examples where I taught ultrasound IV insertion, IV pumps, and basic vent settings to  med students and junior residents.  I can assure you that it's often a CRNA, RN, or respiratory therapist who does this. 

Having interacted with many new CA-1s (2nd year physician anesthesia residents who just finished their intern year), I can confidently say very few of them have the above skills.

Specializes in Adult Critical Care.

And yes, all new CA-1s at my old institution spent their first 6 weeks 1:1 with a CRNA.  That is relatively common practice.  Attending physician anesthesiologist in academic practice very rarely personally administer anesthetics and are often supervising others.  They commonly delegate the training of anesthesia technical skills to CRNAs.

Specializes in CRNA, Finally retired.
beachbabe86 said:

My SIL was never "trained" by CRNAs .  He knew how to perform the afore mentioned skills as a med student.

Doubt that.  The brand new people don't know how to select drug doses except for textbook numbers which aren't always correct for actual humans.  Our  new residents were never safe to put in a room alone .  IF they were they would already be anesthesiologists.

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