One year CRNA program?

paindoc · Feb 18, 2010

I agree the 4th year is not necessary in anesthesiology residency. Much of residency is redundant and that in and of itself is of the old school philosophy that repetition makes good practitioners. As a contrarian, I believe excess repetition creates brain dead practitioners. They simply go through the motions of drawing up the same drugs without really thinking about the exact amount of drugs they render, nor all the nuances that should influence their decision to use one drug over another. But in a way that is the point...anesthesiology is so safe that the therapeutic index is huge, and even if one does screw up and give too much muscle relaxant or narcotic or benzodiazepine that there are always contingency plans available to handle these situations. 99% of anesthestics could be done with 3 or 4 drugs and an 18 month training program.

foraneman · Feb 18, 2010

CRNAs are denigrating their profession by having such enormous differences in training ranging all the way from a 2 year RN plus minimal certificate program being granted the same certification as those with a 4 year or more BSN plus MSN with up to 33 month training in NA school. The American College of Surgeons would never consider certifying the inferior...why would CRNAs as a national entity do so?
Yes, anesthesiologists are vastly overpaid for what they do.

Theoretically I understand what you are saying, however the term 'denigrating' seems inappropriate and does not equate to some measurable adverse affect on quality of care and would imply a 'downward' progression in professional standards. Since the absolute opposite is true I am not sure what, if anything, you are proposing. CRNA educational requirements have steadily increased, not decreased, over the last 100 years with the greatest changes in minimal requirements over the last 30 or so. For about the last 20 years the graduating MS degree has been mandatory. As you know entrance requirements steadily increased prior to that eventually making a BS mandatory. That has been some 25+ years, i am not sure exactly. Regardless, once in anesthesia school the same core cirriculum of chemistry, anatomy, biochem, physics, etc. had to be completed, but not every program had the ability to offer it as an MS. anesthesia schools do not determine the curriculum they may teach. It is manddated by the Council on Accreditation of anesthesia programs. So regardless of whichever era one attended anesthesia school, one received standardized training. This IS precisely the same as the progression of anesthesia residency programs. I entered anesthesia school when anesthesia residencies were 3 years and populated by failed surgery residents. As you know, anesthesia residency training only gets more thin prior to that, before disappearing all together. Let's not pretend there is some irregularity in the way CRNAs have progressed.

Another consideration is that any 2 year RN's who went to CRNA school now have 25+ years of experience. Certainly you are not suggesting that these providers are less prepared than a new graduate to administer an anesthetic. Certainly you are not suggesting that they are less prepared than an Anesthesia Assistant to administer an anesthetic.

If we were to accept your premise that CRNAs are 'denigrating' their profession based on your statement above, and even without asking you to define what denigrate is to mean and then why that even matters, what would you propose and, from an evidence based practice model, why?

paindoc · Feb 19, 2010

The anesthesiology curriculum has increased in length by 33% over the past 25 years. The CRNA curriculum has increased by between 67% and 150% depending on how you do the math. The pre-anesthesiology training has increased by 0% over the past 25 years; the pre-CRNA training has increased by 100%. So my point is: the combined pre-CRNA training plus CRNA training of today is vastly increased from the past while pre-anesthesiology +anesthesiology training is virtually unchanged. The denigration of the CRNA profession is the fleecing of the public by the universal designation "CRNA" to fit everyone, making them believe the still practicing ancient relic CRNAs are even in the same league as the currently trained CRNAs. If they are equal, then what is the point of the extra training since the earlier trained CRNAs had much less training. If they are not equal, then why designate them as equal to the public, insurers, and government agencies?

foraneman · Feb 19, 2010

The anesthesiology curriculum has increased in length by 33% over the past 25 years. The CRNA curriculum has increased by between 67% and 150% depending on how you do the math. The pre-anesthesiology training has increased by 0% over the past 25 years; the pre-CRNA training has increased by 100%. So my point is: the combined pre-CRNA training plus CRNA training of today is vastly increased from the past while pre-anesthesiology +anesthesiology training is virtually unchanged. The denigration of the CRNA profession is the fleecing of the public by the universal designation "CRNA" to fit everyone, making them believe the still practicing ancient relic CRNAs are even in the same league as the currently trained CRNAs. If they are equal, then what is the point of the extra training since the earlier trained CRNAs had much less training. If they are not equal, then why designate them as equal to the public, insurers, and government agencies?

I am sure you would agree that the technology and science of anesthesia has increased almost immeasurably during the past 25 years. While the length of anesthesiology curriculum for anesthesia residents has increased in length by 33% (which is not 'virtually unchanged' though I understand the point you are trying to make compared to CRNA training), the anesthesia specific content of that curriculum has increased significantly more in scope as a result. There is no evidence to suggest that a CRNA practicing for 30 years is any less qualified or skilled compared to a new graduate. Certainly 30 years of experience counts for a great deal, especially since the delivery of anesthesia is as much an art as a science. If one was to compare the 30 year CRNA when they were a new graduate to the new graduate of today they would be woefully less qualified obviously. However this is true of ANY health care professional. Certification and training requirements and standards continue to increase in all specialties. Saying that the more drastic such changes are correlates to a decline in the abilities of established professionals comparatively has never been true in medicine. Surgeons are an excellent example. The training of the 60 year old chief of surgery was arguably laughable compared to his 5th year residents. Even today the 5th year resident will not spend nearly the clinical time treating patients that his counter part did prior to the changes in allowed hours per week.

The idea that various designations of licensure or board certification for CRNAs (CRNA-1, CRNA-2...whatever) based on when they went to school should be created is one that would be created absent any science. No data, anecdotal or otherwise, supports such a scheme. It has to be said that any claims that the public is being hoodwinked and placed at risk based on these ideas must be viewed as having their genesis in agendas which place anesthesia provider politics, rather than any actual concern over patient care as claimed (in this instance at least) or science.

paindoc · Feb 20, 2010

The tacit response of CRNAs to a challenge is that "there is no data to support....whatever". But shouldn't there be data to support the contrary? Why should the public have to accept the assumption of equivalency of skills and training of generations of CRNAs that continue to practice in spite of vastly different length of training? Why is it not the CRNAs that would test this premise that their knowledge and skill sets are equivalent? After all, it is really about public safety rather than failing to address an uncomfortable issue while hiding behind the "there is no evidence" statements? It is your profession, so why is it up to anyone else other than CRNA organizations to prove the equivalency of skills and capabilities? The lack of data simply means CRNA organizations are not doing their job in assuring public safety.

stanman1968 · Feb 21, 2010

For gods sake this is insane. EVERY SINGLE ASPECT OF MEDICAL CARE HAS ADVANCED IN THE LAST 20 YEARS!!!!! Every one, the training and education I received is superior to my fathers and CRNA's training and education will be better still 20 years from now. It is no different for anesthesiologists, I have worked with brand new grads and anesthesiologists who have been practicing 20 plus years, I will say it now those new grads know their stuff, does this mean those who completed residency 20 years ago need to retire or go back are they unsafe? How about a surgeon? RT, PT pharmacist?

This lack of data is across the board in nursing medicine everything....I guess the whole medical profession is letting the public down. Now can we stop this game, or should we start a conversation about ohhh interventional pain and how those practicing now MUST be safer then those 10 years ago, I mean more education and all, what no data? Shame letting the public down like that clearly Doctors cannot be trusted letting all of those less trained and qualified practitioners to continue.

For gods sake.

foraneman · Feb 21, 2010

You have not answered any of my questions or commented on the fact that training in all specialties increases over time, and never has a need been identified to do what you are suggesting.

Sorry, but this is NOT an uncomfortable issue. In fact, it is not an issue at all. Until you mentioned it here I never heard anyone broach the subject. To design and implement a study to gather data (a nearly impossible study, with endpoints and marker which would be subjective and imprecise in there relevance) in this area, without any reason whatsoever to beleive such a study is needed, seems pointless. Obviously anyone who is a proponent of what you are suggesting is welcome to do such a study. There are plenty of things broken in health care that need fixing. Nothing broken here however.

paindoc · Feb 22, 2010

Actually, medicine began "fixing" this situation 10-20 years ago, depending on the specialty, with MOC testing and time limited certifications, something that CRNAs seem to have missed. Once a CRNA, always a CRNA...just pay your money. No testing required, no demonstration that your skills are equal to those of current graduates. Medicine realized this was a problem decades ago, but not CRNAs. It ain't broken, so lets not fix it appears to be the operational philosophy....but perhaps it IS broken. Medicine discovered it WAS broken years ago and has taken steps to correct this. Not easy to test the thesis for CRNAs? BS! With the next certification year, simply mandate all CRNAs take a real competency test, not the silly 2 hour exam you take now for certification, but a test similar to that of medical specialties lasting 6-8 hours, then compare the results from the older CRNAs to the newer grads. It would be readily evident if there were a problem. Nurses want to play in the big leagues? Then start acting with the responsibility needed to assure the public all CRNAs are competent.

stanman1968 · Feb 22, 2010

let me get this strait, an exam in which there is a 99% pass rate is really a means of maintaining competency? Wow either 1. anesthesiologists are just well there is no other word...AWSOME, I mean otherworldly in there ability to recall the minutiae that is required to pass boards.

or 2. The test does not test a thing and is just a PR ploy

Well I am sure it must be #1 ROFL

Well you can take the MOCA exam an unlimited number of times and still practice, forgot to mention that hmmmm? You can practice NEVER taking the boards.

CRNA's are not perfect but guess what no boards no practice, try 3 times your out not unlimited, not a chance to practice while we study as cases are "supervised".

Give it up will you?

foraneman · Feb 22, 2010

Ah yes. Pass a 200 question exam (NOT some 6-8 hour exam regardless of your representation) once every 10 years and you are deemed a competent anesthesiologist and board certified for another 10 years. Oh, and you must practice anesthesia at least 104 days out of those 10 years and obtain 21 hours of CEs for each of the 10 years. The idea that this in any way ensures clinical competency is absurd. However, if original board certification was gained prior to 2000, then certification is life long and participation in MOC testing voluntary. To claim your profession requires ANY testing of anesthesiologists who were trained below the standards which existed in 2000 is a blatant falsehood.

SO,,,,despite your attempt to claim otherwise, anesthesiologists are not tested for competency in any meaningful way for their board re-certification (and there has been plenty of discussion in your circles as to what a test failure really should mean), and older anesthesiologists are not tested at all. Anesthesiologists and CRNAs are required to obtian the same number of CEs per year, although CRNAs must complete them every two years when they re-certify whereas the anesthesiologist has 10 years. The very first MOC testing for anesthesiology was offered in starting in 2007 for the 2000 certificates so let's not act like you have been doing this for 'decades'. It has not even been three years.

Let's not forget that a CRNA cannot work unless they are re-certified, since their state license is predicated on their currently being certified. Should an anesthesiologist fail their MOC test, they go about their anesthesia practice and take it again. There is NO effect on their license to practice medicine and anesthesia, even should they lose their board certification. With so little to lose, and with a 10 year recert cycle, why not have that 6-8 hour test you like?

CRNAs have been, and will continue to be, playing in the 'big leagues' DESPITE, not because of suggestions spawned by ulterior motives from members of organizations who would rather we did not think for ourselves. We need no lecture on responsibility from such quarters.

aCRNAhopeful · Feb 23, 2010

Honestly, wow. I finally took the time to read this thread and am wishing I didn't. I couldn't even be convinced that paindoc believes his own rationale for that argument. I actually believe that he was probably posting those things for his own enjoyment, testing his debating skills if you will. If he could win an a debate with an argument so weak it would speak volumes about his wit. Of course it was an almost impossible debate to win but he still made a strong attempt. I'm guessing he is just entertained by the entire thing. This thread was truly a waste of time. Maybe he does believe it but I've never met anyone that actively engages in debate with zero sense behind their argument, on the other hand, I am somewhat new to the healthcare world so maybe I'm just naive.

foraneman · Feb 25, 2010

Honestly, wow. I finally took the time to read this thread and am wishing I didn't. I couldn't even be convinced that paindoc believes his own rationale for that argument. I actually believe that he was probably posting those things for his own enjoyment, testing his debating skills if you will. If he could win an a debate with an argument so weak it would speak volumes about his wit. Of course it was an almost impossible debate to win but he still made a strong attempt. I'm guessing he is just entertained by the entire thing. This thread was truly a waste of time. Maybe he does believe it but I've never met anyone that actively engages in debate with zero sense behind their argument, on the other hand, I am somewhat new to the healthcare world so maybe I'm just naive.

Since paindoc has not responded for 5 days, and 1 day is his usual, he likely does NOT beleive his own argument. Paindoc has been vocal on CRNA issues in the past on this board, and since misinformation should always be challenged, the thread was not entirely a waste of time. Certainly it was for some reading it!!!