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.

The Indiana Hospital Licensure Rules ("Rules") address the provision of anesthesia services in a hospital. 410 IAC 15-1.6-1 ( A LAW IN OUR STATE) states as follows: Anesthesia shall be administered by those privileged by the medical staff who are: i. An anesthesiologist; ii. A qualified physician with appropriate training, experience and privileges; iii. A dentist, oral surgeon or podiatrist who is qualified to administer anesthesia under state law; iv. A CRNA who is under the direction of the operating practitioner or of a qualified physician who is immediately available if needed. (Emphasis added). The Rules make it clear that a CRNA may practice either under the direction of the "operating practitioner" or, alternatively, under the direction of a qualified physician who is immediately available

Yes, RN schools have much lower standards for entering students than do MD schools. This is expected.

It is so presumptious of superiority when one makes ridiculous statements about holding ones life in their hands.... Airline pilots make less than CRNAs and hold the lives of hundreds to over a thousand in their hands every day. Workers in nuclear power plants make only a small fraction of CRNA salaries but hold the lives of millions in their hands everyday. I think CRNAs (and doctors) need to get real about their presumed self importance and need to recognize: 1. a person off the street can be trained to give anesthesia in a couple of months and do it well 2. other countries doctors and nurses make less than factory workers (eg. Germany) 3. both doctors and nurses in this country are way way overpaid.

It is useful to engage in self examination in order to produce cogent thought about one's life profession especially when there are those that have become so insouciant that they have developed their own self consistent set of ideas that are quite divergent from other professionals. Since most CRNAs are mere employees of others, the benefits they receive include salary and time off, which are hours that have to be worked in your stead while you bask on the beaches of your Florida second house or are on one of your IPG cruises. So with the whole package of salary and benefits, you are still in the 97th percentile of the population. Isn't that great! Isn't that something patients should understand about CRNAs, that a nurse would come with a pricetag each year that dwarfs what the patient's will earn over 5-10 years? Yes, CRNAs are overpaid. No, I have not been crying about the sky falling for a long period of time- fact is CRNAs make more than ALL other nurses, most lawyers, most primary care physicians, most PhDs who may work 60 hours a week to your 40, and have just as much responsibility. The sad fact is anesthetiizing and awakening a patient with no significant deviations in homeostasis could be done 99% of the time by a person with 6 months training out of high school. We need a less expensive alternative than CRNAs (and MDAs) considering the built in safety factors that come with modern monitoring and the relative paucity of significant homeostasis imbalance induced by modern medications. The "experience" one needs for CRNA school is not educational training: it is a job requirement just as those going into medical school have some experience in the medical field on their resume before applying. Just as many lawyers have done some work in the legal or paralegal field before being accepted to law school. To count a job requirement as educational training is a farce and is disingenuous.

The $185,000 figure is from the national press posted one week ago. Looking at the stats from several salary search sites including salary.com, one finds salary and benefits for the 50th percentile to be frequently over $200,000 in many locations. Salary plus time off is indeed $185,000. Perhaps you simply know the wrong CRNAs or need a more higher paid technicians job. I would suggest gaswork.com where there are 14 jobs in the first 3 pages alone paying over $200,000 with one paying $260,000 with call every 4th week only. CRNAs and MDAs are grossly overtrained and overpaid for what they do, so enjoy the gravy while you can....the end is coming. Soon.

Well, don't be mislead by those saying it is not about money...it is ALL about money. CRNAs make far more than any other group in nursing and more than many physicians. Their educational requirements are minimal....currently 6-6.5 years of training, and with an average salary of $185,000 per year, that comes out to around 30,000K per year of training. Anesthesiologists train for 12 years and have virtually the same income per year of training. CRNAs have a very cushy lifestyle working an average of a little less than 40 hours a week (since most are employees, employers frequently don't enjoy paying an extremely high paid nurse time and a half for overtime). Therefore, the average CRNA makes around $92 an hour in salary alone, and then add on the benefits, and it puts them way over this amount. There are many times between cases when there are long turnover times, holes in the operating schedule due to improper scheduling or inefficiencies or cancellation of cases, etc, when CRNAs will frequently go out for smoking breaks or sit in the physician's lounge reading newspapers or hobnobbing in the cafeteria with the medical staff. Many hospitals have significant down time in the OR which frequently translates into free time (= not working time) for CRNAs. It is a life of luxury and bliss compared with most nurses who are slogging it out on the wards or having to listen to patients complain endlessly. CRNAs simply knock their lights out and voila! No more complaints! To quote a CRNA from another forum: stanman1968 04-13-2008, 06:09 AM "Do not get so worked up guys, we all know the salary is one thing that drew us. It is not what keeps year after year. It is no different in any profession, medicine sports business. Do not get upset, the lure of good pay way will interest the most motivated and education will winnow out those cannot do it." CRNAs should be proud to make more than 97% of the American population working only 40 hours a week! It is a dream job everyone would aspire to. As much as CRNAs complain about their jobs sometimes, it ain't flippin' burgers, and they live in the privilege of wealth and power that few in our society achieve.

The wonderful thing about being in private practice, and not a technician chained to an anesthesia machine is that I can decide exactly which patients I will or won't see, what services I will or won't provide, how many hours I am willing to work and exactly what those hours are....I can vary them week to week or day by day through advanced scheduling, and how much vacation I will take. CRNAs are typically hospital employees, employees of an anesthesia group, or work in small hospitals where they must provide coverage for the surgeons. But you can't really select what your payor class mix is can you? What would your hospital do to you if you began to refuse to see Medicaid patients or refused to give anesthesia to Medicaid patients? You would find yourself booted out the door ASAP. So, yes, I will take a hit in income if I continue treating Medicare patients as I do now, however it depends on what services I provide, and I can elect to provide those services that generate the most revenue if Medicare cuts too deep. You effectively get paid the same no matter what you do for the patient....you bill by time units and have no way to generate more revenue. CRNAs will definitely take a hit if the SGF is not fixed, and it will be completely out of your control since you are financial slaves to your masters.

Its about time!

Oh, I understand the truth hurts, but there you have it. I have worked for years in programs that had MDAs only, CRNAs only, and combinations, and with 30 years experience in clinical medicine, I know exactly what I am talking about, and have the vast experience to prove it, far more than most CRNAs on this forum. I have been involved in the development of 3 drugs for clinical use, 2 implantable devices for clinical use, and was the first pain physician in the country to do minimally invasive endoscopic discectomy and foraminoplasty. I have published numerous articles, have performed several original research studies, and am very familiar with the CRNA literature. CRNAs should be proud to be fine technicians with limited patient interaction skills....just like anesthesiologists!

The responses to my post are predictable knee jerk reactions by those that feel threatened. The money is definitely a motivation based on my discussions with scores of CRNAs over the years, and when one considers they make make 200-500% of what a nurse practitioner makes and up to 10 times what a floor nurse makes, it is not surprising they gravitate to CRNA...who could fault them for that? The fact that they are chained to an anesthesia machine with very little patient interaction other than pleasantries before the patients are rendered unconscious is not a condemnation, but an observation of fact. Nurses that enjoy making a difference in the lives of their patients by serving as a friend or counselor or confidant are typically not CRNAs, who would rather avoid the messy emotional bonding that comes with dealing with real people and their real problems on a continuous or long term basis. CRNAs are technicians first, part of an OR team second, and way way down the line is the emotional bonding that exists between provider and patient. Oh, some would fool themselves via justification of their existence by occasionally patting the patient on the hand, squeezing their shoulder, or looking into their eyes before slamming their lights out, but that really isn't bonding, is it? Anyone could serve that very transient role including the OR night janitor. So lets not attempt to obfuscate the true role CRNAs play in real life. The attempt to divert attention to the greedy anesthesiologists sitting in the lounge is misguided, but nonetheless accurate. Anesthesiology departments that are not composed of greedy functionaries have only MDA working in them and do not utilize CRNAs as the hourly employees they frequently are. But back to CRNAs....they have a GREAT lifestyle compared to most nurses, and are in general quality technicians- they should be proud of that fact. They are not luminaries in the field of the advancement of anesthesia since virtually all advances in the field over the past 60 years were made by those other than CRNAs....they are not prolific in research compared to physicians, do not initiate many relevant prospective randomized clinical trials, and are not known for their cutting edge prowess. But they are wonderful technicians that are extremely well paid for their efforts.