paindoc

I completely agree. Supervising is non-sensical. I can't seem to get that across to my anesthesiology friends....they are more interested in the $$.

And you don't understand deep pockets. CRNAs may be named, but in a team model, even if the CRNA screws up badly and causes permanent injury or death, the anesthesiologist is ALWAYS NAMED. You can rarely find cases where the CRNA was found liable for malpractice in a team model while the anesthesiologist gets off scott free. This definitely is contrary to the assertion that even in a team model, the CRNA is capable of making completely independent decisions. If they are, then they should be sued independently of the anesthesiologist.....doesn't happen.

Actually there are studies that demonstrate statistically significant differences, but not clinical differences in outcome. What does this prove: 1. anesthesiologists and CRNAs deliver virtually the same product 2. anesthesia has become so safe that it is virtually a technician's job unlike any other area of medicine that cannot duplicate the outcomes. The upshot of all of this is that given the expense of anesthetic delivery with the cost of the provider plus equipment plus drugs, it is probably overpriced and healthcare trends will seek out the low hanging fruit, replacing the technicians job with a real technician (2 year associates degree after high school) with supervision, whacking reimbursement, and cutting out the fluff devices being used that are not EBM. Both anesthesiologists and CRNAs will lose significantly if this is to occur. So we will have to wait and see what transpires.......

Actually you can only supply studies showing statistical but not relevant clinical significant differences... By definition an employee does not have completely independent decision making otherwise they would be either independent contractors or improperly supervised. You can't have it both ways much longer

I counter that if you have CRNAs that have been sued and lost in a team model when the anesthesiologist was dismissed, post it here, by all means. I agree, MDs are being self destructive with their continuance of the status quo but also believe the CRNA mills are equally as destructive with massive output of nurses from CRNA schools. CRNA independence will indeed increase, and so will the litigation against them- it is inevitable. Sorry, I have never been a member of the ASA, and I don't receive any of their literature.

The issue is liability. It has been a very nice dance around the issue in the past with CRNAs wanting independence but not wanting to tear down the shield that helps protect them. Perhaps that time has come. There are NO cases which I can find in which a MD in a team approach has not been named in a suit. Perhaps there are unscrupulous MDs that employ CRNAs but fail to provide assistance/supervision/direction/etc, and really don't give a flip about patient safety. I certainly agree that is often the case. However, this then gets into IRS regulations....it is not possible for a CRNA to bill independently of an employer. It will actually be interesting to see what transpires in the future, and I stand with CRNAs waiting for the unscrupulous anesthesiologists who employ gaggles? bevies? crowds? harems? (forgive me as I do not know what term is currently in use) of CRNAs to go down in flames.....

If CRNAs are completely independent, then neither the surgeon in smaller hospitals nor the anesthesiologist in a team model would be found culpable at the end of litigation. Fact is, virtually 100% of the time the surgeon or anesthesiologist is named in a suit, and in a team approach, the anesthesiologist is always found liable if the CRNA is. You will have achieved complete independence in decision-making once CRNAs get sued independently of others and once the supervising anesthesiologists are dropped from the suits by the plaintiff without dropping the CRNA. But of course the rates for CRNA malpractice will rise substantially....many times what you pay now. I know some, such as wtbcrna are ready to go this direction, but I am not certain the entire profession is ready for this....

If the nurse is being employed by the anesthesiologist, then yes, the nurse has to get permission and typically in a team approach will discuss the case in advance. In a situation where the states are non-opt out and the anesthesiologists are in a team approach with the nurses, then yes, typically they require permission. In opt out states, a nurse can give a general anesthetic without the surgeon or anyone else having any idea what is being done...it is indeed a complete independent practice. So, it all depends, doesn't it?

It has been a "team approach" that is really a half baked approach to the delivery of anesthesia. I also think independent should rule....MDs should make themselves independent of the team approach, but in reality, most won't due to $$$$$.

I agree....the greedy lazy docs should go. But with CRNAs telling the surgeons, patients, and hospitals that they are at least as good as (if not better than) anesthesiologists, there will be some push back. As reimbursement by Medicare and linked insurers falls, there will be more pressure on the anesthesiologists to engage in self preservation. It will definitely be a war.

It is exactly the assertions by BCRNA that will cause MDs across the land to begin jettisoning their CRNAs, whether they have been with the group a long time, or not. The fact is, CRNAs have now engaged in terminology and rhetoric that places them squarely in competition with the anesthesiologists they may be working with. Physicians are not so dense that they cannot see the writing on the wall, and are beginning to take steps to eradicate CRNAs from their groups, either through attrition, or by overt housecleaning. Just FYI.

The anesthesiology groups that are simply operating off of greed by their partners and anesthesiologists will permit anyone, CRNA or AA, to do any case.

AAs are certainly a threat to CRNAs. As the CRNA political establishment becomes more militant about the independence of CRNAs and continues to equate their members to anesthesiologists in performance, training, etc, the physician anesthesiologists will do whatever it takes to preserve their specialty of medicine. CRNAs have fortunately awakened a sleeping giant, and AAs are part of the answer.

Whether you have broken a law is a matter for the attorney general of our state to evaluate. As for taking a person off the street and training them in anesthesia....I am dead serious. It has been done in Africa for decades and works quite well with limited monitoring capabilities. With our modern monitoring techniques, it is rare for an anesthetist (MDA, CRNA, AA) to get into any significant trouble since they are anticipating events. Writing a cookbook for the delivery of anesthesia for the 99% of the time things are routine is actually quite easy. It is really no different than an ACLS algorithm.

So, a CRNA in Indiana practicing independently without deference to the directing physician is violating State law. And freely admits it. Hmmmmm..... With respect to "5% sheer terror" giving anesthetics, that high of a percentage would be due to inexperience of the provider rendering the anesthetic. Even though I did cardiac and liver transplantation anesthesia in the past which are by far the most severe challenges for anesthesia, I did not experience 5% sheer terror even with those cases. Anesthesia is not just boring, it is extremely overpaid for what services are actually rendered. I could take a person off the street with absolutely no medical training, and within a few months have them giving a smooth anesthetic that would rival what MDAs or CRNAs could give. Emergency situations? That is where MDAs or CRNAs should be used to bail out the lower level providers who would be capable of handling 99% of cases without the continuous presence of a CRNA or MDA.