The Most CRNA friendly States

KeithEMU · May 20, 2006

I dont mean this in a bad way to the Anesthesiologists, but isn't them coming in to push the induction a slap in the face of the CR NA? Its the least difficult part of the job.

The patient doesn't know that. It might make a patient feel like the doctor was doing the hardest part, and as far as they probably know, the MDA was there the whole time.

AmiK25 · May 20, 2006

The facility where the majority of my program's clinical portion is completed is an ACT and the MD does NOT push the induction drugs. They are present pre-operatively to discuss your plan (very rarely will they change it), induction (some will help with positioning, etc..), and emergence. They usually pop in once or twice to check on the patient or give the CRNA a break. Other than that, the RNSAs and CRNAs run the case. Obviously, they are available if an emergency arises but I haven't seen them called very often. For the most part, I think the CRNAs, RNSAs, residents, and MDs get along very well at our facility and it really is a team effort. We do rotate to several other facilities, which I haven't done yet so I don't know if the set-up is different there.

Ami

MmacFN · May 20, 2006

ami

Very nice. That sounds more like what im looking for. What part of the country do you work in?

Nitecap · May 20, 2006

For what reason would an MDA push the drug? Thats seems totally senseless to me.
Also, if yer at Ben Taub say hi to Dr. Ken Mattox. His brain is as big as 4 peoples even if his personality is as blank as a chalk board

For anesthesiologists to bill Medicare the must document that they are practicing using the TEFRA 7(Tax Equalization and Fiscal Responsibility Act).

1-Perform Preanesthetic Assessment

2-Prescribes Anesthetic plan

3-Participates in demanding portions - Induction/emergence ect

4-Ensure Anesthetic procedures done by qualified individual

5-Monitor course of anesthetic at intervals

6-remain physically present and available to assist with emergencies

7-Provides indicated PACU care

For an ACT group to bill under medical direction using a 4:1 Ratio they must document that they took some part in the above list.

Tranman · May 21, 2006

Generally States that are CRNA friendly are States that don't require MDA supervision.

Alaska, Idaho, Iowa, Kansas, Minnesota, Nebraska, Montana, New Hampshire, New Mexico, North and South Dakota, Oregon, Washington, Wisconsin.

deepz · May 21, 2006

Please, Tranman -- get it straight! Let's not give wannabees a wrong impression here. NO STATE *requires* MDA supervision of CRNAs. None.

Part of the COP for Medicare reimbursement does require MD supervision in those states you did not list, yes, as in surgeon supervision.

Welcome to the CRNA Forum.

deepz

Generally States that are CRNA friendly are States that don't require MDA supervision.
Alaska, Idaho, Iowa, Kansas, Minnesota, Nebraska, Montana, New Hampshire, New Mexico, North and South Dakota, Oregon, Washington, Wisconsin.

MmacFN · May 21, 2006

Deepz

You have been around for a long time like yoga. What has your experience been in this respect? Are there "places" where CRNAs get to practice to scope and have (typically) much better MDA CRNA relationships?

AmiK25 · May 21, 2006

ami
Very nice. That sounds more like what im looking for. What part of the country do you work in?

I am at the University of Cincinnati and the majority of our clinical education is completed at University Hospital.

deepz · May 21, 2006

Highly facility-specific and individual doc specific. In general, those rural one-holers (and two- and three- plus) are where the CRNA is fully appreciated, away from MDAs, i.e., CRNA-only shops. These places number about 1500, not including ASCs and office practices.

Deepz
You have been around for a long time like yoga. What has your experience been in this respect? Are there "places" where CRNAs get to practice to scope and have (typically) much better MDA CRNA relationships?

midwestsrna1 · May 22, 2006

Also, if yer at Ben Taub say hi to Dr. Ken Mattox. His brain is as big as 4 peoples even if his personality is as blank as a chalk board

Mike...what the hell is wrong with you??? Do you not realize how easy it would be to personally identify you off this message board (not to mention that your original screen name was your first/last name). Anesthesia is a very small community and you'll be lucky if this physician hasn't already seen this stupid remark you wrote that could have an adverse impact on any future you might have in anesthesia. Never underestimate how small the world of anesthesia is and save your smart ass comments for the time when you can back it up with four very important initials behind your name. :idea:

MmacFN · May 22, 2006

hey there

First off, it was a joke. I have both argued and learned from Dr. Mattox in the past as well as attended his conferences in Vegas. Clearly, the guy is a genious (hence the 4 brains comment).

As for people trying to effect my career in the future, that happens no matter what you say or do and is more often based on your actions than your words. My future in anesthesia is quite far off, at a minumum 3-4 years off in fact. Any comments made on this board will be long forgotten by then.

I am the person who is responsible for both what I say and do, not you. Why the sudden interest? Do we know each other?

Tranman · May 22, 2006

Please, Tranman -- get it straight! Let's not give wannabees a wrong impression here. NO STATE *requires* MDA supervision of CRNAs. None.
Part of the COP for Medicare reimbursement does require MD supervision in those states you did not list, yes, as in surgeon supervision.
Welcome to the CRNA Forum.
deepz

You're right. I should've said these states tend to be more CRNA friendly. Meaning that you can work independently from the MDAs. There's nothing quite like working with an all CRNA group or any group where there is mutual respect for your fellow anesthesia provider.

To find the states that are CRNA friendly. Goto www.gaswork.com. States with the highest salary positions tend to be more CRNA friendly IMO. Again this is all relative. It varies vastly from group to group.

Thanks for the welcome.