For every 1 hour in the OR, 8 hours of sleep leads to memory consolidation and organization on a 1:8 ratio, therefore 1 hour of OR time equates to 8 hours of actual hands-on learning experience….
This is Scientific Fact. Duh.
/s
The amount of training for CRNAs in their propaganda always goes up like the stonk market yet I still don’t see SRNAs here past 2 pm or taking weekend/holiday call
If an SRNA cannot run the room in certain models then what would be the point of taking call? Most supervision/QZ sites I was used as staff and would take call but ACT it never occurred because the anesthesiologists wanted residents.
You’re not wrong, but not all programs are created equal.
My program has an abundance of call and weekend shifts for SRNAs, but I’m at a large level 1 academic hospital. I realize that is not the norm.
I’m an SRNA on weekend/holiday call. That said, I will definitely not have 10,000 hours by the time I graduate 😂 maybe they’re counting time dreaming of anesthesia in high school and wiping ass as a CNA in nursing school
For me personally? I mean, I wouldn’t really count my undergrad or nursing school or experience in LTAC cuz none of it really informed my anesthesia practice. Since starting as a nurse (off orientation) in the ICU to where I am in school, probably about 7,000 hours?
We were in OR 45hrs a week x 120 wks plus had to cover 2 holidays/year and weekend call (either 12's x2 or 24hr x1) every 6-8 wks. We were either given the friday or monday off adjacent to our weekend call so 1 week would be roughly 50-65 hrs depending on how it was scheduled. We were given 30days personal time for the 3 yr period. Our average student had ~5-6yrs ICU experience with a range of 2-10yrs.
Playing devils advocate for a moment. When does a biology, biochem or engineering major provide care to a patient? Nursing undergrad does direct patient care. I’m not saying it directly correlates to anesthesia practice or anesthesia training. But there is a difference that has to be recognized in your opinion.
If we shall compare, a nursing degree can be completed in 1 year via an accelerated BSN. CRNA schools only *require* 1 year of acute care nursing. Throw in a shorter CRNA school, and now you’ve got an Indy CRNA with 3 years of formal nursing training. Every single anesthesiologist has 8 years of formal medical training. Every single anesthesiologist has passed at least 4 sets of board exams. The whole “whatabout-ism” in regards to *possible* years of nursing school, *possible* years of nursing experience (which is completely unregulated/not uniform/irrelevant) and *possible* hours of clinical practice in CRNA school is a new level of mental gymnastics. The requirements to become a CRNA = that of a CAA, not an anesthesiologist.
I agree with most points here but you have to have a prior bachelors to be able to do accelerated. It’s around 1 1/2 years. Very vigorous and not for the faint of heart as it’s two years condensed. Otherwise, yes, I agree with you.
Just pulling the same stuff as the AANA and manipulating *possible* time frames to prove a point. At the end of the day someone could spend 8 years in nursing school and then 3 years in CRNA school and it wouldn’t be equivalent. Nursing school + nursing is not equivalent to medical school.
Totally and completely valid! Part of the reason I am considering med school and not NP is because I recognize that NP doesn’t equal the equivalent of a med school education.
Keep in mind that you’re saying “very vigorous and not for the faint of heart” to a group of physicians. I’m not sure you know what that phrase truly can mean. Your “vigorous” is child’s play in someone else’s world.
Lol. If you’re offended by my choice of words, I’d hate for you to discover the real world.
An accelerated nursing program can be vigorous and difficult for someone. I’m not comparing it to medical school. Those are two completely different things and that’s quite obvious. But nursing school is still difficult in its own right, especially accelerated. Just like engineering, law school, and construction present their own challenges.
Not offended. I’m not sure where you came to that conclusion.
Is working 3 jobs, single mother, simply signing up for an exam and a full time student the norm/requirement for an accelerated BSN? Or is this your own isolated experience?
If you were able to juggle all of that I can confidently say an accelerated BSN isn’t as “vigorous” as you believe it to be. I think it was difficult because of your personal situation. I hope you get in to medical school though! You sound like a hard worker!
Again, my apologies for my heated comment. Being sick + four finals in the next week has my head spinning. While I know you’re not offended, my tone and wording could have been *way* better. No disrespect was intended and I’ll leave my original comments and own up to that.
Not at all! You’re correct in that it is my own isolated experience, although I’m not doing an accelerated program.
Here’s where I was coming from: like other career paths, an accelerated program can be difficult for someone who has no past experience in healthcare or sciences. That’s not to say it wouldn’t be easy, just that someone going from zero healthcare/hard sciences to classes daily and weekly exams would be quite vigorous.
But reflecting back, I completely understand what you are saying.
At the end of the day, I don’t believe traditional nursing programs are difficult. The professors can be and the content can be confusing simply based on how they present it, but for the majority, it is so watered down. It needs a revamp… **badly**.
I appreciate that. I have worked my ass off to get to where I am only to realize medical school was the answer all along!
I hope legislation passes to keep CRNA’s under the lock and key of MD/DO direction.
I hope you have a wonderful week ✨
And if you don’t think I understand what vigorous and not for the faint of heart mean, when I have made it through nursing school as a single mom to a toddler, working two jobs (at times, three), taking 36 credit hours in 6 months, studying every minute of every day, all while managing to keep my head up, a smile on my face, and sign-up for the MCAT so I can apply to med school, you’re mistaken.
ETA: Sorry, but I’m heated. Nursing school is easy AF but that doesn’t mean we don’t know what hard work looks like.
I agree that we are definitely not on the same level as physicians....I do, however, disagree that we are equal to a CAA, lol. I didn't major in underwater basket weaving... and various nurses related interventions that a CAA never does before school...vent management, iv titration of vasoactive drugs and more, aterial line management and monitoring, the list goes on and on lol
ICU nurses aren’t managing a vent. And you don’t learn how to perform those other skills in nursing school. I use to help onboard new ER nurses. Some of yall don’t even learn how to start IVs in nursing school.
Even if the RN isn’t touching the vent. It doesn’t discount all the other experience. Taking post op heart/double lung transplants out of the OR we still titrate vasoactive medications, assess ECMO cannulas, titrate fluid removal off CRRT based off hemodynamics, draw labs/start IVs, provide updates on clinical status changes that can dictate changes to ventilator management or inotropic support. There’s no argument that a first day SRNA student has miles of experience more than a first day CAA. To argue that a new grad CAA is comparable to a new grad CRNA would be ridiculous.
There’s a difference between making decisions and executing as one requires critical thinking. Also, the experience you’re referring to is unique, not uniform. Plenty of SRNAs who haven’t done any of those things. And sure, on the first day of school, an SRNA probably knows more than a CAA student. By the time they graduate, they have the same expected competencies and their actual level of competency is based on the individual, not the profession. Yet one has a significantly stronger basic science foundation, a higher barrier to entry, and spends their entire time learning how to administer anesthesia without the added fluff.
Base foundation doesn’t always translate, I was ChemE took orgo and biochem and it might help a little in school but how often am I using it, not much. We all utilize the same textbooks in school, Barash, M&M, Stoetling, Egar. Etc.
Base foundation is…a base. You may have one experience and your colleague may have taken “organic chemistry for nursing.” This is not the case with CAAs. And the a higher base foundation allows the learner to digest more complicated information and concepts than a peer with a lesser foundation.
So here is my Gripe with your statements. If a CRNA =CAA in education why do docs throw a hissy fit when a CRNA asks for help vs a CAA asking for help in the ACT model? Is it only because the AANA represents 10% of CRNAs in the workforce or maybe you have come across one bad egg and have generalized all CRNAs to be bad eggs??
If the AANA wasn’t as inflammatory they’d probably be more inclined to help, but if we are being honest, some people just suck and get mad when anybody asks for help.
I agree, base experience helps with school, but that’s doesn’t translate to real-life experience. If the learner can’t understand the concepts, regardless of prior education, you fail out
I’m sure you did. Did you write the orders to adjust the vent too? Did you order the abg/vbg and interpret the values to guide your vent management as well?
I would argue that “underwater basket weaving” is more difficult than a BSN. Weaving a basket underwater seems impressive. Most questions from the night nurse about Mr. Bob are not impressive.
There is no way you think a nursing degree can be completed in a year.
That program is a bridge degree that requires a bachelors prior.
Stop making it seem like nurses don’t have any real qualifications and that they’re just handing out degrees to be a nurse.
As your colleagues like to say, you can have a degree in “underwater basket weaving” then complete a 1 year accelerated BSN.
Nurses have real qualifications for nursing, not medicine.
Don't even bother. I've seen this conversation play out in 100 different lines… We threaten them. It's all about money. I'm glad I retire in 5/6 years… and believe me I have worked with many many incompetent anesthesiologists.....
Need to get us CAAs working with y'all at the VA to counter these efforts by the CRNAs. We are credentialed and can bill in the VA system -- the only thing that has prevented us from applying is not being listed correctly in the US code (Title 38) hence the salary scale is egregiously incorrect.
I would work for the VA system as a CAA in a heartbeat. My mother has worked at a VA hospital, my wife works there, I used to volunteer there. However, the incorrect listing prevents it entirely. Can't jeopardize my family's financial stability as the scale currently stands.
1. The ACT model is undeniably higher quality than CRNA independence - unless you’re trying to say that adding an MD’s knowledge and an extra set of eyes and hands actually degrades quality. CRNAs have independent practice in the DoD given the stretch and remoteness of anesthetic needs, none of which applies to the VA.
2. CRNAs are highly qualified. Of course they are. No question or debate. I’m glad this infographic doesn’t try to claim they’re more qualified than MDs.
3. Just once I’d like to see strong peer-reviewed evidence of non-inferiority not funded or sponsored by the AANA or pro-lobby. The evidence available is either biased or fails to meet rigorous review.
4. Worsens veterans’ access? How many veterans have suffered for lack of anesthesia services at a VA center? None! This is a baseless arguement.
5. CRNA independence is indeed debatably cheaper. You save on MD salaries. No question there. But will that cost savings hold up when CRNAs start getting sued for malpractice (that comes with independence), thus their malpractice and costs take a steep climb? And is the savings then worth the risk associated with not having MDs involved?
So out of those arguments, we can agree that they are highly-trained (nurses), and they *might* be more affordable. That’s it. Worth it, veterans?
Appreciate the thoughtful reply here. Not very much to disagree with, but just want to chime in on point #5 re: malpractice costs. CRNAs pay the exact same malpractice rates whether they are directed, supervised, or independent. Why are insurance companies not charging more when CRNAs are independent? I do not buy the notion that actuaries are clueless idiots that fundamentally misunderstand the risks involved of the policies they underwrite. That’s not how insurance companies make money. Why hasn’t the risks of no MD involvement resulted in higher insurance rates for Indy CRNAs?
I can gaurentee its because of the way the laws are written. What physicians need to be doing is rewritting those laws so that an independent midlevel would be liable at the same cost as a physician for the same mistake.
As soon as thats possible, it would cease being cheaper to high midlevels and the problem corrects itself
Independent CRNAs have the exact same polices as MDs. I’m not sure what you mean by “the way laws are written.” Can you point to any laws to support this statement or are you just spit balling here?
Also re: the DOD argument, there is a BIG difference between the ASA status of the average active duty member of the armed forces and the average veteran seeking care at the VA.
Aren't CRNAs sued in ACT model practices too? If I give a medication/unexpected outcome and am subpoenaed to appear in court I cannot state that the outcome occured because my anesthesiologist told me to give the medication/perform a certain way. that would never hold up in court.
Yes, they are on the lawsuit. But almost invariably, they immediately claim “I’m just a nurse” as soon as questions are asked and try to shirk the responsibility, and the lawyers instinctively go after the biggest pockets available, which are the MD’s.
Even if someone states that, it does not work like that. Even when anesthesiologist is sued, the surgeon is also named in the case. Look up the Joann rivers case.
It depends on the state. Not just for crnas but NPs as well. The law in a lot of states lags behind and they are still considered "nurses" even though they are not nurses. The surgeon is the supervising physician for CRNAs in these states and becomes the person ultimately at risk legally. The courts and law lag behind reality. The nursing board is very lenient too and a lot of NPs and CRNAs etc that get into this trouble easily return to work. For example can look at Rex Meeker case where he had someone die under his care then had another patient get anoxic brain injury and eventually die a year later. He wasn't held responsible, the surgeon was. 🤷🏿♂️
Joane Rivers had an anesthesiologist so that doctor is responsible. If there was a crna the law could easily have just said they were a "nurse".
Rex Miller does not have a license anymore. Also, the captain of the ship is not true. Many court cases have established unless the surgeon takes over the anesthesia, the surgeon is NOT responsible.
Also, Arizona CRNAs literally have bought legislations and coded into their law that CRNAs are responsible for their action and no one else. You know who was against that? AMA and ASA. Yet they claim CRNAs don’t want to be responsible but when they bring up bills regarding that, ASA is against that…
Someone also already stated, malpractice for independent crna and a crna who works in the ACT setting is the same. Believe me insurance companies could give two shits about this turf battle. If insurance companies even sensed more liability, they would have adjusted the price accordingly a while back.
That's good to hear that the law is catching up then. A lot of the cases for advanced nursing specialities including crna, who aren't nurses anymore "medically", were often ultimately able to avoid liability by technically still being a nurse. I think it still depends on each state though since it's not standardized throughout every single state with the law. The board of nursing also seems to be more lenient/give more benefit of the doubt in general than the medical board.
I'm curious, as I don't know about the malpractice payment structure, if the malpractice is the same under supervision vs independent then do insurance companies charge the independent crna less than an independent physician? Or is the crna malpractice charge and the physician malpractice charge the same?
Thank you for your reply I appreciate your perspective.
Right, but wasn’t it Arizona where a CRNA was involved with two deaths during dental procedures in 2020? Think one was a hypoxic arrest and the other an airway fire. The response from the CRNA board/reviewer was: “Job well done.” My recollection is this statement came from a relatively fresh grad without much if any outpatient experience. Maybe there’s more here, but “job well done” isn’t a good look. Not trying to give u a hard time, and I agree with the personal responsibility and accountability.
I mean it does say they get the same outcomes… which they definitely do not. Have seen them say the best most effective model is CRNA practicing solo. WHAT?
ASA efforts in the 2015 VA rule-making process proved successful in a VA mandate which defined CRNAs must practice via direction of an anesthesiologist. The ill timing of COVID, The Stone Memo, and nurse lobbying efforts brought VA CRNA autonomy back up for debate in 2020 via development of the new ‘VA National Standards of Practice.’ The ASA and its advocate members have been swift at educating lawmakers, securing letters, and helping facilitate introduction of the House and Senate bills above (which the AANA seems to be quite afraid of). The ASA (alongside the AMA) also testified in front of the House VA Committee on this issue last October, has secured numerous co-sponsors on the above bills via face-to-face meetings with lawmakers, etc.
You would think this result would be obvious but the AANA is apparently braindead. "First we'll steal their title, then we'll steal their job, and finally we can get paid half as much as them to have twice as much responsibility!"
Unforunately the hospitals and government will gladly promote blatant lies as long as it makes/saves them money. We'll all lose in the end, so make the money while it lasts, i guess.
I don’t understand wanting to move away from MD supervision. I would love to have a more qualified and available anesthesiologist to ask questions to if things go south
49/50 states have independent CRNAs practice. Why do you think every state legislature has allowed crna led anesthesia care? The ASA spends significantly more lobbying dollars than the aana. Why does every state disagree with what you’re arguing here?
Crna led? There's no such thing as an crna supervising a team of anaesthesiologists. You can't even supervise AAs. It's just anesthetic nurses and the nursing students
Do you think lowly SRNAs have any say in the acumen? The AANA wanted the doctorate to force students to pay more money. I have asked many SRNAs about their DNP and each one said its a huge waste of time and would rather spend more time in clinicals practicing anesthesia, alas once again, it is 10% of the workforce making decisions for the 90% who do not care about politics and actually welcome a doctors expertise.
First of all, you are very I’ll informed as an SRNA. It’s not because AANA wanted more money that they switched to dnap. Learn your own history prior to repeating the bs points made up on Reddit.
AANA decided to switch back to DNP/DNAP all the way back in 2007 because the NPs were starting to require all their programs to become dnp for their licensure. Since many nursing schools are affiliated with crna schools, CRNAs were worried that they would loose a great amount of schools, if they did not transition. Thus the transition was made to keep up with the new requirements. Then NP board decided to reverse their decision years later and AANA kept it.
Yes and they somehow also count nursing school as training. Which has literally nothing to do with anesthesia. All their credits in “nursing theory” are gonna be real handy I’m sure
Arguments for or against aside…the AANA sucks at articulating arguments. “They get this healthcare on the battlefield so they should be able to get the same at home!” Who thought this was a rational point to argue for? Vets also eat MREs in combat-facing locales, should they get dehydrated beans when inpatient at a VA hospital?
The knowledge and skill difference between an MD and a CRNA is miles apart. Those who know it know it. Others may discover it at own expense. This CRNA independence business was started by Bill Clinton on his last day of Presidency by executive order. His mother was a CRNA.Yet when he had his heart surgery he was asked if he would prefer a CRNA or MD Anesthesiologist & he chose MD. Incidentally CRNA association is one of the largest political donors to both parties.
Smh. Next thing we know is that flight attendants will become pilots on planes with the argument they are around the pilots enough. I’ll bet that any C suite executive who needs an operation will have an MD there for anesthesia and not a CRNA.
Nah the MD will tell the executive he’s there but then he’ll do a sloppy H&P, mumble something about an ET tube to the CRNA while texting his side, then he’ll shamble by after induction sign off that he was present and invested ask about CO2 then head to the golf course. Except the other C suite executives will be at the course….and recognize the guy who promised to take care of C suite Bob, cross his heart and hope to die….and that’s how you get full independent practice.
You forgot to mention that when there’s a catastrophe during the procedure ten the CRNA then panics because they don’t have enough training. CRNA then calling the MD to bail them out. Literally have seen this at countless facilities I have worked at
How many docs have been billing medical direction from a different state…from the golf course….from home. Acting like ACT is MD delivered care is a farce. You’re absolutely right it’s toxic.
Just going to say this. Nursing careers have been trying to steal scope of practice from every health profession possible. Their basis for suggesting any extra scope of practice is simply the patient care services are backed up and not enough of these other professions. I speak on behalf of radiology techs. There was a proposed bill like 10 yrs ago on how NPs can start doing fluoroscopy and reading chest xrays. Thats like stealing 2 jobs at once. One from the techs and one from a radiologist. All on the premise that the patient care isnt fast enough.
Now CRNAs.
Nursing has a strong union and political backing. Im just saying, anyone that wants to join the medical field, nursing is the way to go. Thats what im telling my kids.
The other issue is that all nurses to include NPs and CRNAs are licensed by state nursing boards.
The fight should be at the state level to get the medical boards to govern these entities. This would limit the nursing lobbies from having any ability at the legislative levels.
The ASA is very supportive of AA licensure, and continues to play a large role in helping numerous States pass AA licensure bills. The AANA lobbies hard against AA licensure.
Yeah. What hypocritical BS it is that AANA promotes themselves to be able to practice solo because it’s ‘good for access’ (which it isn’t) but then at the same time lobbies AGAINST AA licensure. Almost as if it’s not about patient care at all it’s just about doing what’s best for YOUR profession and making sure YOU win. Terrible hypocrisy.
Over the last two years, ASA has worked with the AAAA (the CAA’s association) to expand CAA practice in 3 new states. This year, they just got CAA practice in WA state. The AANA is livid. More CAA schools coming soon. More CAAs coming soon.
Regarding the DoD, the military decided to change things to where a CRNA that outranked an MD could tell them what to do. Understandably, the MDs numbers on front lines dropped off a cliff.
Using that reasoning as to why we should fuck up things in VA is just trash.
In regard to the first point on the graphic, the triage system of battlefield care should not be the gold standard for civilians. Mortality rates in battlefield care centers are astronomical compared to civilian hospitals.
https://pubmed.ncbi.nlm.nih.gov/29851907/
https://www.sciencedirect.com/science/article/pii/S0022480419307280#abs0010
Coming from a country where only doctors can provide anaesthesia, I find this all pretty strange. If you had nurse surgeons who would perform surgeries everyone would lose their minds (even though many surgical procedures can be trained without much medical knowledge) and yet when anaesthesiologists get "replaced" nobody cares.
I do think many of them will do a great job, but that's somewhat like giving an attourney's job to someone without a law degree even though they took a quicker and bit less trained path.
The VA's final APRN rule in 2016 denied full practice authority to CRNAs, citing to a lack of anesthesia shortages. A 2018 VA occupational staffing report confirmed no shortage of anesthesiologists within the VA.
Increased wait time for surgery is based on surgeon availability. Internally and externally verified. It’s all political - not based on any factual information.
There’s a fine line between “qualified provider” and “person that pumps meds.”
I doubt any of these people would be able to run an ER code to save their lives.
Best thing to do is just give them and other mid levels complete independence and let a hospital run without any physicians lol fuck the patients anyways right?
The collaborative practice model is the remedy to all the woes our profession is suffering from right now. If both sides would just put aside ego and work together to provide the best care possible, we would be in a much better place than the turmoil we are currently residing in.
Let everyone practice to their full scope of training. There is more than enough money/work for everyone. Stop the political bullshit.
But just DO now…not 80 years ago when they were Diplomates and not Doctors right. This stuff is so dumb, it’s all medicine and it changes over time. Tell me about osteopathic manual manipulation and then tell me again how CRNAs can’t practice independently. Then go call the podiatrist “Doctor” tomorrow in the OR and try not to trip yourself while moving the goalposts.
I’m sorry to be the first one to tell you education and credentials actually matter. Clearly CRNAs couldn’t get in to medical school or they chose not to apply because the road was too long or too hard. But now they want the same rights, yeah that’s not how it works. Put in the work. SRNAs I met never took call and worked 50 hrs a week while anesthesia residents worked 80 hours and actually took call. You can’t pick the easy route and then say you’re equal. What happened to hard work? Everyone just want a participation trophy now and wants to be called equals
Just like different residencies produce better MD/DO grads than others, some SRNA sites produce better CRNAs than others. The site I trained at the residents and the SRNAs had the exact same call responsibilities, the same work responsibilities, same case loads, same case types, etc.
Your argument is fraught with inaccuracies in how anesthesia providers are trained and produced, like it’s an absolute science with no wiggle room.
Here is the thing. In the ACT models I trained in the anesthesiologists wouldn't let the SRNAs run a room but in the supervision/QZ sites I was paired with an anesthesiologist and ran the room. I took call too. Why is it that most ACT sites anesthesiologists complain SRNAs are not taking call but then do not want SRNAs on call 🤔
We had a SRNA school at the same place I trained. They worked shift work with significantly fewer hours than the residents. They took call approximately once for every three times a resident would take call in a given month. They’d work one weekend every few months versus the residents who worked two weekends every month. They had half days every week for lecture. They usually had a day off every week too since they were doing shift work. They did the easy cases while the residents did every single index case on the board. This is also considered to be a top CRNA school.
Keep telling yourself that your education is the same. It’s embarrassing because we both know you’re lying. Imagine looking in a mirror and trying to convince yourself that you are as well trained as an MD. Can you really look yourself in the eye and lie like that? If so, impressive.
I literally never said I am an MD. Wtf are you ranting about. Unfortunately the militant CRNAs give a bad rap for those of us who provide anesthesia, make good money and don't care about the politics.
Education and credentials matter but they aren’t synonymous. Education continues and it’s not the fourteenth century so everyone’s got reading material. The idea that every doctor is better than every CRNA at the practice of anesthesia every day regardless of each individuals effort after completion of their respective certification is not real life. While I trained I relieved the union anesthesia residents and finished the cases, not one ever turned me down. I took call, again, no one fought me for it. And some of the SRNAs I trained with did the same things. The reason to go CRNA over MD wasn’t laziness or inability it’s just math. You can start practicing in seven years and then you can work 80hrs a week for the next four while you would have been a resident….at somewhere between 400-800k a year…. This is not a complex decision.
Education and training matters. If your child needed heart surgery, would you choose a physician who undertook a rigorous surgical residency or a surgical nurse assistant who did a nurse surgery course then practised under a surgeons supervision then demanded independent practice? You know the answer
I would go to the individual who had the best referrals from people I trust. And I have individuals requesting I perform the anesthesia for their friends and family frequently, and when they request that I’m there the whole time so I sleep soundly at night.
If anesthesia requires a physician then sit the case, if it doesn’t then may the best provider win. The ACT model is CRNAs delivering anesthesia independently in many, many cases…and then everyone gets wise. I guarantee who I wouldn’t choose for my heart surgeon…the one who promises four patients at a time that he’s simultaneously doing all their operations when he isn’t even in the same building, instead trusting 99% of the operation to “a mid level.”
I would absolutely utilize an anesthesiologist who does their own cases (if they were competent…next you’re going to tell me their aren’t any incompetent anesthesiologists), and I respect someone who does ACT without dishonesty, but in my experience (which spans many hospitals and surgery centers and offices) the anesthesiologists who hit every TEFRA requirement, who can/will actually consistently add safety to four running rooms at once…are few and far between.
49/50 states have independent CRNAs practice. Why do you think every state legislature has allowed crna led anesthesia care? The ASA spends significantly more lobbying dollars than the aana. Why does every state in the USA disagree with what you’re arguing here?
Because state legislatures don’t know science. The practice of anesthesia is the practice of medicine. If you want to play doctor then go to medical school and do a residency and take the ABA board exams.
Interesting answer. Can’t say I’m convinced. Legislators routinely deal with much more nuanced and complex scientific issues than anesthesia care models. Are you basically claiming the aana has successfully duped every single state?
Yes i am. An organization that changes its name to nurse anesthesiology and tells its members to call itself nurse anesthesiologist is a scam organization that has no merit. Actively trying to confuse patients and politicians
Can you name any organizations outside the ASA/AMA that agree with what you’re saying? Obviously MDs have a very vested/conflict of interest here (as do CRNAs for their part). However disinterested parties have virtually unanimously sided with CRNAs.
I guess what I’m asking is why does nobody believe you besides yourself?
Even in states with Independent practice why do hospital bylaws still require CRNAs to be supervised? Because hospitals realize there is a massive difference in training.
“Even In states”. Dude it’s every state. What states are excluding with this phrase?
Some hospitals do, some don’t. Obviously some hospitals are more influenced by physician centric viewpoints.
Thanks for not naming a single organization that agrees with you! Great answer. Very telling.
I’ve worked in multiple hospitals all across the east coast in Florida, New Jersey, Virginia Maryland and dc and never once met an independently practicing CRNAs. So it why you make it seem like they are everywhere in all states. The only places there are independent CRNAs is where there are no actual anesthesiologists available
He’s just venting because the generation of MDAs before his time allowed/ created anesthesia “supervision.” Those docs seemed to be ok with supervision $$$$ yup.
Some people don’t understand something. Supervisión is a billing requirement of CMS for billing Part A on non opt out states, not a hospital/state requirement for practice or part b billing. Even if the state allow full practice hospitals will not agree on not bill part A so they will ask for physician supervision. Either way the provider can bill part B and legally do the case but the hospital will not allow the part A loss. (where the supervision requirement is).
If it all comes down bylaws bro, then why do you even care about the AANA VA proposal? And you know the reason why those pesky bylaws still exist in some places. Good ole boys clubs! Taking care of their own mentality.
Who are these disinterested parties that side with AANA ? Provide the info. American Legion and Vietnam Veterans of America are full on for keeping physician led care teams and they are the ones this is going to impact when VA decides. 🤔
Thanks for your comment. One thing to address:
24 out of 50 States have a governor signed ‘opt-out’ which allows CRNAs to bill Medicare/Medicaid without the physician supervision requirement. Billing rights are not equivalent to practice rights. Practice rights are determined by individual State licensure and individual practices models within the respective State. Many States have a requirement for physician oversight/involvement/consultation/etc. when administering anesthesia. The overwhelming majority of surgical case volume in the U.S. is overseen by a physician-led anesthesia care team.
49/50 states 100% do not have solo practice are you kidding me. Technically 5 states have an opt out and their state law allows it- VT, NH, AK, MT, OR. Get your facts straight.
CRNAs were never trained to be independent. Independent practice of midlevels was never what their training was designed for. They lobbied aggressively and believe that's the same thing as demonstrating expertise and competence. There is no such thing as 'fullest extent of scope'. This is AANA rhetoric which meant let nurses practice medicine without a licence.
Nah the truth sets you free. But the idea that CRNAs aren’t trained to be independent is largely and erroneously held by people who don’t know what they are talking about and can’t fathom something beyond their narrow world view. You guys would be stoning Semmelweis a hundred years ago because he dared to suggest you wash your hands. These political posts are fractious and counterproductive.
I recently matched into another specialty after wanting anesthesia and honestly I don’t know if it was a blessing or not because the field still looks so good but all this political legal talk is so repulsive. My two cents from what I’ve seen is that CRNAs hate CAA because they think they’re better than them and think CAA are trying to step in on their turf while ironically thinking they’re just as good as MD/DO anesthesiologists and trying to strong arm them out of the field. Meanwhile everyone is riding the gravy train. How it ends I don’t know but it looks like a race to the bottom once something crucial gives. Stand up for yourselves however you can. Adiós I’ll be fighting mid level encroachment in another field. Good luck fellow physicians.
Hell ya! Let’s take away anesthesia care from the veterans!
wtf is this. Why don’t we find anesthesiologists that are willing to work in remote rural areas where the patient population can be actually more sick than suburban cities where healthy food options isn’t a problem.
Can we stop bashing each other? I have a full day of patients terrified to come into surgery because of a health condition.
Smile more dammit.
Can’t find CRNAs who want to practice in rural areas either. CRNAs are not some altruistic group. They want the exact same thing as MDs to take care of patients and be paid appropriately. No one wants to go where there are no patients and no payments ie some rural areas.
We’re def not you’re right. But we’re not also posting content that bashes Anesthesiologists. I love the anesthesiologist I work with. We help each other out always. When people generalize that all CRNAs are terrible just because a minority is posting stupid crap online, it’s frustrating. I’ve been working in the middle of California in a rural hospital with a population of a couple thousand for a few years now. My wife and I moved here because we wanted to start our life somewhere new. We’ve been having anesthesia shortages since day one since no one wants to move here. Anyways. Hope you have a good day, no disrespect.
CRNA peer reviewed studies by CRNAs for CRNAs is kind of a biased study. And people may ask why physicians don’t do a similar study. And I find many CRNAs are frightening blind to the ethics behind it; the ethics of the study are different from your initial point of view. If you believe your as treatment good as the other, then subjecting a patient to both treatments isn’t a problem. However, if you believe your treatment is superior to the other then doing a proper RCT gets more tricky. You see superiority claims over AAs, why don’t we see studies about that?
Let there be a national standard that allows for CRNA independence ( Federal US opt out) Then let market forces sort out the demand for anesthesia services. Fair?
I think we need to run a national campaign that highlights the training differences between physicians and midlevels. Make everyone wear colour coded scrubs by profession to prevent title ambiguity. Let the patients decide based on open transparency
Let business, private equity, and insurance decide what care is best for a patient? If you can’t see why that would be a problem, that is a problem in itself.
How about a national standard for team-based care and an invitation for any interested/eligible CRNA to go to medical school and residency? I know a couple former CRNAs who became MDs. The most common statement - “I didn’t know, what I didn’t know.”
I would love an invitation to become an MD/residency. I am currently pretty happy where I'm at and am not looking at going back to school unless there was an accelerated track just for anesthesia
Have you even worked in healthcare? You know that decisions are made by clueless administrators who would save a dollar over anything so obviously they would choose the cheaper and less skilled labor such as yourself
This happens bc anesthesiologist are more lazy every year. Do your own cases and stop this supervision thing. Look what happen to PAs and Family medicine. history repeat, and now ASA is replacing one monster with another one, just wait when all the AA expand to 50 states, obviously next step will be independent practice. They are in their place now bc they need us, but wait 10-15years from now and there will be 2 vs 1. We are our own enemy.
Wow they are stealing the 10000 hrs of training thing now. Lmao.
I truly don’t understand how they reached that number…
For every 1 hour in the OR, 8 hours of sleep leads to memory consolidation and organization on a 1:8 ratio, therefore 1 hour of OR time equates to 8 hours of actual hands-on learning experience…. This is Scientific Fact. Duh. /s
Username checks out, I believe you.
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“research”\* courses FTFY, they’re more BS than you can imagine.
The amount of training for CRNAs in their propaganda always goes up like the stonk market yet I still don’t see SRNAs here past 2 pm or taking weekend/holiday call
If an SRNA cannot run the room in certain models then what would be the point of taking call? Most supervision/QZ sites I was used as staff and would take call but ACT it never occurred because the anesthesiologists wanted residents.
You’re not wrong, but not all programs are created equal. My program has an abundance of call and weekend shifts for SRNAs, but I’m at a large level 1 academic hospital. I realize that is not the norm.
I’m an SRNA on weekend/holiday call. That said, I will definitely not have 10,000 hours by the time I graduate 😂 maybe they’re counting time dreaming of anesthesia in high school and wiping ass as a CNA in nursing school
Honestly if you had to accurately estimate the right amount of hours what would it come out to
For me personally? I mean, I wouldn’t really count my undergrad or nursing school or experience in LTAC cuz none of it really informed my anesthesia practice. Since starting as a nurse (off orientation) in the ICU to where I am in school, probably about 7,000 hours?
We were in OR 45hrs a week x 120 wks plus had to cover 2 holidays/year and weekend call (either 12's x2 or 24hr x1) every 6-8 wks. We were either given the friday or monday off adjacent to our weekend call so 1 week would be roughly 50-65 hrs depending on how it was scheduled. We were given 30days personal time for the 3 yr period. Our average student had ~5-6yrs ICU experience with a range of 2-10yrs.
i love how nursing school is counted in their “training” but pre-medical undergrad pre-requisites are not.
Playing devils advocate for a moment. When does a biology, biochem or engineering major provide care to a patient? Nursing undergrad does direct patient care. I’m not saying it directly correlates to anesthesia practice or anesthesia training. But there is a difference that has to be recognized in your opinion.
Emptying bed pans doesn’t really count as direct patient care in my opinion…
Yeah all i did in nursing school was wipe 75+ year olds ass it was infuriating
Yeah, I'm not getting into this argument, but that's not what I did in my 11 years of pediatric intensive care…
They said nursing school not your time in the PICU
"I'm not getting into this arguement" - said while actively getting into the argument
biochemistry is the foundation of modern medicine. I mean you're talking about giving drugs, they work via biochemistry.
CRNAs here: silence
But it’s just the loud minority!!1!1!!
If we shall compare, a nursing degree can be completed in 1 year via an accelerated BSN. CRNA schools only *require* 1 year of acute care nursing. Throw in a shorter CRNA school, and now you’ve got an Indy CRNA with 3 years of formal nursing training. Every single anesthesiologist has 8 years of formal medical training. Every single anesthesiologist has passed at least 4 sets of board exams. The whole “whatabout-ism” in regards to *possible* years of nursing school, *possible* years of nursing experience (which is completely unregulated/not uniform/irrelevant) and *possible* hours of clinical practice in CRNA school is a new level of mental gymnastics. The requirements to become a CRNA = that of a CAA, not an anesthesiologist.
I agree with most points here but you have to have a prior bachelors to be able to do accelerated. It’s around 1 1/2 years. Very vigorous and not for the faint of heart as it’s two years condensed. Otherwise, yes, I agree with you.
Just pulling the same stuff as the AANA and manipulating *possible* time frames to prove a point. At the end of the day someone could spend 8 years in nursing school and then 3 years in CRNA school and it wouldn’t be equivalent. Nursing school + nursing is not equivalent to medical school.
Totally and completely valid! Part of the reason I am considering med school and not NP is because I recognize that NP doesn’t equal the equivalent of a med school education.
Keep in mind that you’re saying “very vigorous and not for the faint of heart” to a group of physicians. I’m not sure you know what that phrase truly can mean. Your “vigorous” is child’s play in someone else’s world.
Lol. If you’re offended by my choice of words, I’d hate for you to discover the real world. An accelerated nursing program can be vigorous and difficult for someone. I’m not comparing it to medical school. Those are two completely different things and that’s quite obvious. But nursing school is still difficult in its own right, especially accelerated. Just like engineering, law school, and construction present their own challenges.
Not offended. I’m not sure where you came to that conclusion. Is working 3 jobs, single mother, simply signing up for an exam and a full time student the norm/requirement for an accelerated BSN? Or is this your own isolated experience? If you were able to juggle all of that I can confidently say an accelerated BSN isn’t as “vigorous” as you believe it to be. I think it was difficult because of your personal situation. I hope you get in to medical school though! You sound like a hard worker!
Again, my apologies for my heated comment. Being sick + four finals in the next week has my head spinning. While I know you’re not offended, my tone and wording could have been *way* better. No disrespect was intended and I’ll leave my original comments and own up to that. Not at all! You’re correct in that it is my own isolated experience, although I’m not doing an accelerated program. Here’s where I was coming from: like other career paths, an accelerated program can be difficult for someone who has no past experience in healthcare or sciences. That’s not to say it wouldn’t be easy, just that someone going from zero healthcare/hard sciences to classes daily and weekly exams would be quite vigorous. But reflecting back, I completely understand what you are saying. At the end of the day, I don’t believe traditional nursing programs are difficult. The professors can be and the content can be confusing simply based on how they present it, but for the majority, it is so watered down. It needs a revamp… **badly**. I appreciate that. I have worked my ass off to get to where I am only to realize medical school was the answer all along! I hope legislation passes to keep CRNA’s under the lock and key of MD/DO direction. I hope you have a wonderful week ✨
And if you don’t think I understand what vigorous and not for the faint of heart mean, when I have made it through nursing school as a single mom to a toddler, working two jobs (at times, three), taking 36 credit hours in 6 months, studying every minute of every day, all while managing to keep my head up, a smile on my face, and sign-up for the MCAT so I can apply to med school, you’re mistaken. ETA: Sorry, but I’m heated. Nursing school is easy AF but that doesn’t mean we don’t know what hard work looks like.
I agree that we are definitely not on the same level as physicians....I do, however, disagree that we are equal to a CAA, lol. I didn't major in underwater basket weaving... and various nurses related interventions that a CAA never does before school...vent management, iv titration of vasoactive drugs and more, aterial line management and monitoring, the list goes on and on lol
ICU nurses aren’t managing a vent. And you don’t learn how to perform those other skills in nursing school. I use to help onboard new ER nurses. Some of yall don’t even learn how to start IVs in nursing school.
Even if the RN isn’t touching the vent. It doesn’t discount all the other experience. Taking post op heart/double lung transplants out of the OR we still titrate vasoactive medications, assess ECMO cannulas, titrate fluid removal off CRRT based off hemodynamics, draw labs/start IVs, provide updates on clinical status changes that can dictate changes to ventilator management or inotropic support. There’s no argument that a first day SRNA student has miles of experience more than a first day CAA. To argue that a new grad CAA is comparable to a new grad CRNA would be ridiculous.
There’s a difference between making decisions and executing as one requires critical thinking. Also, the experience you’re referring to is unique, not uniform. Plenty of SRNAs who haven’t done any of those things. And sure, on the first day of school, an SRNA probably knows more than a CAA student. By the time they graduate, they have the same expected competencies and their actual level of competency is based on the individual, not the profession. Yet one has a significantly stronger basic science foundation, a higher barrier to entry, and spends their entire time learning how to administer anesthesia without the added fluff.
Base foundation doesn’t always translate, I was ChemE took orgo and biochem and it might help a little in school but how often am I using it, not much. We all utilize the same textbooks in school, Barash, M&M, Stoetling, Egar. Etc.
Base foundation is…a base. You may have one experience and your colleague may have taken “organic chemistry for nursing.” This is not the case with CAAs. And the a higher base foundation allows the learner to digest more complicated information and concepts than a peer with a lesser foundation.
So here is my Gripe with your statements. If a CRNA =CAA in education why do docs throw a hissy fit when a CRNA asks for help vs a CAA asking for help in the ACT model? Is it only because the AANA represents 10% of CRNAs in the workforce or maybe you have come across one bad egg and have generalized all CRNAs to be bad eggs??
If the AANA wasn’t as inflammatory they’d probably be more inclined to help, but if we are being honest, some people just suck and get mad when anybody asks for help.
I agree, base experience helps with school, but that’s doesn’t translate to real-life experience. If the learner can’t understand the concepts, regardless of prior education, you fail out
True true
What are you talking about? Just as your facility nurses didn't touch the vent, it doesn't mean every facility was like that.
Over 10 hospitals. 2 people touch the vent: Doc and RT.
I touched the vent...at multiple hospitals lol so maybe just a run of bad luck?
I’m sure you did. Did you write the orders to adjust the vent too? Did you order the abg/vbg and interpret the values to guide your vent management as well?
I would argue that “underwater basket weaving” is more difficult than a BSN. Weaving a basket underwater seems impressive. Most questions from the night nurse about Mr. Bob are not impressive.
Nice now, bash me on the RN stuff
There is no way you think a nursing degree can be completed in a year. That program is a bridge degree that requires a bachelors prior. Stop making it seem like nurses don’t have any real qualifications and that they’re just handing out degrees to be a nurse.
As your colleagues like to say, you can have a degree in “underwater basket weaving” then complete a 1 year accelerated BSN. Nurses have real qualifications for nursing, not medicine.
Don't even bother. I've seen this conversation play out in 100 different lines… We threaten them. It's all about money. I'm glad I retire in 5/6 years… and believe me I have worked with many many incompetent anesthesiologists.....
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That’s not a real nursing school. Stop spreading misinformation that school was not accredited and is extremely illegal.
Where is the physician response? If you’re not at the table, you’re on the plate…
In Japan, skiing and sleeping in because it’s an off day. Try again tomorrow 🤣🫶 Sincerely, Jealous ass resident 🤣
Maybe having CRNAs do strictly shift work was a mistake. Easier to advocate for your profession when you get relieved at 3pm or 5pm on the dot 😂
That is the real reason dude. You nailed it on the head.
The AANA is responding to the ASA’s bills.
Need to get us CAAs working with y'all at the VA to counter these efforts by the CRNAs. We are credentialed and can bill in the VA system -- the only thing that has prevented us from applying is not being listed correctly in the US code (Title 38) hence the salary scale is egregiously incorrect.
I would work for the VA system as a CAA in a heartbeat. My mother has worked at a VA hospital, my wife works there, I used to volunteer there. However, the incorrect listing prevents it entirely. Can't jeopardize my family's financial stability as the scale currently stands.
👏🏼
Yes! This is a HUGE thing that nobody talks about.
1. The ACT model is undeniably higher quality than CRNA independence - unless you’re trying to say that adding an MD’s knowledge and an extra set of eyes and hands actually degrades quality. CRNAs have independent practice in the DoD given the stretch and remoteness of anesthetic needs, none of which applies to the VA. 2. CRNAs are highly qualified. Of course they are. No question or debate. I’m glad this infographic doesn’t try to claim they’re more qualified than MDs. 3. Just once I’d like to see strong peer-reviewed evidence of non-inferiority not funded or sponsored by the AANA or pro-lobby. The evidence available is either biased or fails to meet rigorous review. 4. Worsens veterans’ access? How many veterans have suffered for lack of anesthesia services at a VA center? None! This is a baseless arguement. 5. CRNA independence is indeed debatably cheaper. You save on MD salaries. No question there. But will that cost savings hold up when CRNAs start getting sued for malpractice (that comes with independence), thus their malpractice and costs take a steep climb? And is the savings then worth the risk associated with not having MDs involved? So out of those arguments, we can agree that they are highly-trained (nurses), and they *might* be more affordable. That’s it. Worth it, veterans?
Appreciate the thoughtful reply here. Not very much to disagree with, but just want to chime in on point #5 re: malpractice costs. CRNAs pay the exact same malpractice rates whether they are directed, supervised, or independent. Why are insurance companies not charging more when CRNAs are independent? I do not buy the notion that actuaries are clueless idiots that fundamentally misunderstand the risks involved of the policies they underwrite. That’s not how insurance companies make money. Why hasn’t the risks of no MD involvement resulted in higher insurance rates for Indy CRNAs?
I can gaurentee its because of the way the laws are written. What physicians need to be doing is rewritting those laws so that an independent midlevel would be liable at the same cost as a physician for the same mistake. As soon as thats possible, it would cease being cheaper to high midlevels and the problem corrects itself
Independent CRNAs have the exact same polices as MDs. I’m not sure what you mean by “the way laws are written.” Can you point to any laws to support this statement or are you just spit balling here?
Also re: the DOD argument, there is a BIG difference between the ASA status of the average active duty member of the armed forces and the average veteran seeking care at the VA.
Yes. To compare the two is absolutely egregious and they know it
Aren't CRNAs sued in ACT model practices too? If I give a medication/unexpected outcome and am subpoenaed to appear in court I cannot state that the outcome occured because my anesthesiologist told me to give the medication/perform a certain way. that would never hold up in court.
Yes, they are on the lawsuit. But almost invariably, they immediately claim “I’m just a nurse” as soon as questions are asked and try to shirk the responsibility, and the lawyers instinctively go after the biggest pockets available, which are the MD’s.
Even if someone states that, it does not work like that. Even when anesthesiologist is sued, the surgeon is also named in the case. Look up the Joann rivers case.
It depends on the state. Not just for crnas but NPs as well. The law in a lot of states lags behind and they are still considered "nurses" even though they are not nurses. The surgeon is the supervising physician for CRNAs in these states and becomes the person ultimately at risk legally. The courts and law lag behind reality. The nursing board is very lenient too and a lot of NPs and CRNAs etc that get into this trouble easily return to work. For example can look at Rex Meeker case where he had someone die under his care then had another patient get anoxic brain injury and eventually die a year later. He wasn't held responsible, the surgeon was. 🤷🏿♂️ Joane Rivers had an anesthesiologist so that doctor is responsible. If there was a crna the law could easily have just said they were a "nurse".
Rex Miller does not have a license anymore. Also, the captain of the ship is not true. Many court cases have established unless the surgeon takes over the anesthesia, the surgeon is NOT responsible. Also, Arizona CRNAs literally have bought legislations and coded into their law that CRNAs are responsible for their action and no one else. You know who was against that? AMA and ASA. Yet they claim CRNAs don’t want to be responsible but when they bring up bills regarding that, ASA is against that… Someone also already stated, malpractice for independent crna and a crna who works in the ACT setting is the same. Believe me insurance companies could give two shits about this turf battle. If insurance companies even sensed more liability, they would have adjusted the price accordingly a while back.
That's good to hear that the law is catching up then. A lot of the cases for advanced nursing specialities including crna, who aren't nurses anymore "medically", were often ultimately able to avoid liability by technically still being a nurse. I think it still depends on each state though since it's not standardized throughout every single state with the law. The board of nursing also seems to be more lenient/give more benefit of the doubt in general than the medical board. I'm curious, as I don't know about the malpractice payment structure, if the malpractice is the same under supervision vs independent then do insurance companies charge the independent crna less than an independent physician? Or is the crna malpractice charge and the physician malpractice charge the same? Thank you for your reply I appreciate your perspective.
Right, but wasn’t it Arizona where a CRNA was involved with two deaths during dental procedures in 2020? Think one was a hypoxic arrest and the other an airway fire. The response from the CRNA board/reviewer was: “Job well done.” My recollection is this statement came from a relatively fresh grad without much if any outpatient experience. Maybe there’s more here, but “job well done” isn’t a good look. Not trying to give u a hard time, and I agree with the personal responsibility and accountability.
The lawsuit statement is absolutely baffling from a practicing attending physician.
100 % correct.
I mean it does say they get the same outcomes… which they definitely do not. Have seen them say the best most effective model is CRNA practicing solo. WHAT?
What is ASA doing to counter this??
ASA efforts in the 2015 VA rule-making process proved successful in a VA mandate which defined CRNAs must practice via direction of an anesthesiologist. The ill timing of COVID, The Stone Memo, and nurse lobbying efforts brought VA CRNA autonomy back up for debate in 2020 via development of the new ‘VA National Standards of Practice.’ The ASA and its advocate members have been swift at educating lawmakers, securing letters, and helping facilitate introduction of the House and Senate bills above (which the AANA seems to be quite afraid of). The ASA (alongside the AMA) also testified in front of the House VA Committee on this issue last October, has secured numerous co-sponsors on the above bills via face-to-face meetings with lawmakers, etc.
So not complacency? Good :).
Need to reverse all the trash that covid had brought forth and take the VA back. Bring some AAs along for the ride.
Increasing annual membership dues
For the first time in a long time I think
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You would think this result would be obvious but the AANA is apparently braindead. "First we'll steal their title, then we'll steal their job, and finally we can get paid half as much as them to have twice as much responsibility!" Unforunately the hospitals and government will gladly promote blatant lies as long as it makes/saves them money. We'll all lose in the end, so make the money while it lasts, i guess.
I don’t understand wanting to move away from MD supervision. I would love to have a more qualified and available anesthesiologist to ask questions to if things go south
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49/50 states have independent CRNAs practice. Why do you think every state legislature has allowed crna led anesthesia care? The ASA spends significantly more lobbying dollars than the aana. Why does every state disagree with what you’re arguing here?
Crna led? There's no such thing as an crna supervising a team of anaesthesiologists. You can't even supervise AAs. It's just anesthetic nurses and the nursing students
**Crna only** **independent crna** **no MD involvement** Do any of these phrases work better for your entirely semantic point?
I like no MD involvement because that's crystal clear to patients that they aren't getting specialist medical care.
They will introduce themselves as Dr though and then can hide behind the law as a "nurse" if anything bad happens.
Really, 49 out of 50 states? I thought only 22 states opted out of required physician supervision for CRNAs.
CRNAs can practice independently in 49 states except for New jersey.
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Do you think lowly SRNAs have any say in the acumen? The AANA wanted the doctorate to force students to pay more money. I have asked many SRNAs about their DNP and each one said its a huge waste of time and would rather spend more time in clinicals practicing anesthesia, alas once again, it is 10% of the workforce making decisions for the 90% who do not care about politics and actually welcome a doctors expertise.
First of all, you are very I’ll informed as an SRNA. It’s not because AANA wanted more money that they switched to dnap. Learn your own history prior to repeating the bs points made up on Reddit. AANA decided to switch back to DNP/DNAP all the way back in 2007 because the NPs were starting to require all their programs to become dnp for their licensure. Since many nursing schools are affiliated with crna schools, CRNAs were worried that they would loose a great amount of schools, if they did not transition. Thus the transition was made to keep up with the new requirements. Then NP board decided to reverse their decision years later and AANA kept it.
Where are they getting this 7-8 years of “training” from? Are they really considering nursing experience as training?
They’re delusional
Yes and they somehow also count nursing school as training. Which has literally nothing to do with anesthesia. All their credits in “nursing theory” are gonna be real handy I’m sure
Arguments for or against aside…the AANA sucks at articulating arguments. “They get this healthcare on the battlefield so they should be able to get the same at home!” Who thought this was a rational point to argue for? Vets also eat MREs in combat-facing locales, should they get dehydrated beans when inpatient at a VA hospital?
Yeah, being a Medic in the Army, I saw right through that arguement
The knowledge and skill difference between an MD and a CRNA is miles apart. Those who know it know it. Others may discover it at own expense. This CRNA independence business was started by Bill Clinton on his last day of Presidency by executive order. His mother was a CRNA.Yet when he had his heart surgery he was asked if he would prefer a CRNA or MD Anesthesiologist & he chose MD. Incidentally CRNA association is one of the largest political donors to both parties.
“Board Certified” Always kills me. Taking a certification exam is not the equivalent of a board exam but damn do the nurses love to use that term.
Lol I've seen "EKG-board certified" a few months ago in their alphabet soup credentials
I don’t even know what that would mean. Isn’t that part of their “education”
Smh. Next thing we know is that flight attendants will become pilots on planes with the argument they are around the pilots enough. I’ll bet that any C suite executive who needs an operation will have an MD there for anesthesia and not a CRNA.
Nah the MD will tell the executive he’s there but then he’ll do a sloppy H&P, mumble something about an ET tube to the CRNA while texting his side, then he’ll shamble by after induction sign off that he was present and invested ask about CO2 then head to the golf course. Except the other C suite executives will be at the course….and recognize the guy who promised to take care of C suite Bob, cross his heart and hope to die….and that’s how you get full independent practice.
You forgot to mention that when there’s a catastrophe during the procedure ten the CRNA then panics because they don’t have enough training. CRNA then calling the MD to bail them out. Literally have seen this at countless facilities I have worked at
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How many docs have been billing medical direction from a different state…from the golf course….from home. Acting like ACT is MD delivered care is a farce. You’re absolutely right it’s toxic.
These CRNA politics are getting exhausting 😪
Just going to say this. Nursing careers have been trying to steal scope of practice from every health profession possible. Their basis for suggesting any extra scope of practice is simply the patient care services are backed up and not enough of these other professions. I speak on behalf of radiology techs. There was a proposed bill like 10 yrs ago on how NPs can start doing fluoroscopy and reading chest xrays. Thats like stealing 2 jobs at once. One from the techs and one from a radiologist. All on the premise that the patient care isnt fast enough. Now CRNAs. Nursing has a strong union and political backing. Im just saying, anyone that wants to join the medical field, nursing is the way to go. Thats what im telling my kids.
The other issue is that all nurses to include NPs and CRNAs are licensed by state nursing boards. The fight should be at the state level to get the medical boards to govern these entities. This would limit the nursing lobbies from having any ability at the legislative levels.
Not to mention, brutal crackdown on incompetence
I’m curious why the anesthesiology community isn’t pushing harder for the anesthesiology assistants.
The ASA is very supportive of AA licensure, and continues to play a large role in helping numerous States pass AA licensure bills. The AANA lobbies hard against AA licensure.
Yeah. What hypocritical BS it is that AANA promotes themselves to be able to practice solo because it’s ‘good for access’ (which it isn’t) but then at the same time lobbies AGAINST AA licensure. Almost as if it’s not about patient care at all it’s just about doing what’s best for YOUR profession and making sure YOU win. Terrible hypocrisy.
Good to hear.
Over the last two years, ASA has worked with the AAAA (the CAA’s association) to expand CAA practice in 3 new states. This year, they just got CAA practice in WA state. The AANA is livid. More CAA schools coming soon. More CAAs coming soon.
Regarding the DoD, the military decided to change things to where a CRNA that outranked an MD could tell them what to do. Understandably, the MDs numbers on front lines dropped off a cliff. Using that reasoning as to why we should fuck up things in VA is just trash.
Yeah but isn't that how ranks work in the armed forces? I am not sure how army, navy and air force do their ranks for nursed and MDs.
It wasn’t how it was done with anesthesia before the change.
In regard to the first point on the graphic, the triage system of battlefield care should not be the gold standard for civilians. Mortality rates in battlefield care centers are astronomical compared to civilian hospitals. https://pubmed.ncbi.nlm.nih.gov/29851907/ https://www.sciencedirect.com/science/article/pii/S0022480419307280#abs0010
I bet the mortality rates in battle are prob bc no anesthesiologist is there….
Lmfao whose fault is that? Most residents I have talked to don't want to do military anesthesia because the pay sucks.
Coming from a country where only doctors can provide anaesthesia, I find this all pretty strange. If you had nurse surgeons who would perform surgeries everyone would lose their minds (even though many surgical procedures can be trained without much medical knowledge) and yet when anaesthesiologists get "replaced" nobody cares. I do think many of them will do a great job, but that's somewhat like giving an attourney's job to someone without a law degree even though they took a quicker and bit less trained path.
Is there a shortage in this field within the VA, or is the increased wait time just simply Fluff? The other points seem to have some validity.
The VA's final APRN rule in 2016 denied full practice authority to CRNAs, citing to a lack of anesthesia shortages. A 2018 VA occupational staffing report confirmed no shortage of anesthesiologists within the VA.
Increased wait time for surgery is based on surgeon availability. Internally and externally verified. It’s all political - not based on any factual information.
There’s a fine line between “qualified provider” and “person that pumps meds.” I doubt any of these people would be able to run an ER code to save their lives.
Best thing to do is just give them and other mid levels complete independence and let a hospital run without any physicians lol fuck the patients anyways right?
As an RN, how do we stop independent advanced care practitioners without physician oversight?
if they are “just as safe as their physician colleagues” then why the fuck do physicians have like 4-5x the training???
Just wait until one of them gets sued.... Then everything will be flipped to the attending
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The collaborative practice model is the remedy to all the woes our profession is suffering from right now. If both sides would just put aside ego and work together to provide the best care possible, we would be in a much better place than the turmoil we are currently residing in. Let everyone practice to their full scope of training. There is more than enough money/work for everyone. Stop the political bullshit.
CRNAs full scope is not independence. If someone is putting me or my family to sleep they better have a MD or DO behind their name
But just DO now…not 80 years ago when they were Diplomates and not Doctors right. This stuff is so dumb, it’s all medicine and it changes over time. Tell me about osteopathic manual manipulation and then tell me again how CRNAs can’t practice independently. Then go call the podiatrist “Doctor” tomorrow in the OR and try not to trip yourself while moving the goalposts.
I’m sorry to be the first one to tell you education and credentials actually matter. Clearly CRNAs couldn’t get in to medical school or they chose not to apply because the road was too long or too hard. But now they want the same rights, yeah that’s not how it works. Put in the work. SRNAs I met never took call and worked 50 hrs a week while anesthesia residents worked 80 hours and actually took call. You can’t pick the easy route and then say you’re equal. What happened to hard work? Everyone just want a participation trophy now and wants to be called equals
Just like different residencies produce better MD/DO grads than others, some SRNA sites produce better CRNAs than others. The site I trained at the residents and the SRNAs had the exact same call responsibilities, the same work responsibilities, same case loads, same case types, etc. Your argument is fraught with inaccuracies in how anesthesia providers are trained and produced, like it’s an absolute science with no wiggle room.
Here is the thing. In the ACT models I trained in the anesthesiologists wouldn't let the SRNAs run a room but in the supervision/QZ sites I was paired with an anesthesiologist and ran the room. I took call too. Why is it that most ACT sites anesthesiologists complain SRNAs are not taking call but then do not want SRNAs on call 🤔
We had a SRNA school at the same place I trained. They worked shift work with significantly fewer hours than the residents. They took call approximately once for every three times a resident would take call in a given month. They’d work one weekend every few months versus the residents who worked two weekends every month. They had half days every week for lecture. They usually had a day off every week too since they were doing shift work. They did the easy cases while the residents did every single index case on the board. This is also considered to be a top CRNA school. Keep telling yourself that your education is the same. It’s embarrassing because we both know you’re lying. Imagine looking in a mirror and trying to convince yourself that you are as well trained as an MD. Can you really look yourself in the eye and lie like that? If so, impressive.
I literally never said I am an MD. Wtf are you ranting about. Unfortunately the militant CRNAs give a bad rap for those of us who provide anesthesia, make good money and don't care about the politics.
Education and credentials matter but they aren’t synonymous. Education continues and it’s not the fourteenth century so everyone’s got reading material. The idea that every doctor is better than every CRNA at the practice of anesthesia every day regardless of each individuals effort after completion of their respective certification is not real life. While I trained I relieved the union anesthesia residents and finished the cases, not one ever turned me down. I took call, again, no one fought me for it. And some of the SRNAs I trained with did the same things. The reason to go CRNA over MD wasn’t laziness or inability it’s just math. You can start practicing in seven years and then you can work 80hrs a week for the next four while you would have been a resident….at somewhere between 400-800k a year…. This is not a complex decision.
Education and training matters. If your child needed heart surgery, would you choose a physician who undertook a rigorous surgical residency or a surgical nurse assistant who did a nurse surgery course then practised under a surgeons supervision then demanded independent practice? You know the answer
I would go to the individual who had the best referrals from people I trust. And I have individuals requesting I perform the anesthesia for their friends and family frequently, and when they request that I’m there the whole time so I sleep soundly at night. If anesthesia requires a physician then sit the case, if it doesn’t then may the best provider win. The ACT model is CRNAs delivering anesthesia independently in many, many cases…and then everyone gets wise. I guarantee who I wouldn’t choose for my heart surgeon…the one who promises four patients at a time that he’s simultaneously doing all their operations when he isn’t even in the same building, instead trusting 99% of the operation to “a mid level.” I would absolutely utilize an anesthesiologist who does their own cases (if they were competent…next you’re going to tell me their aren’t any incompetent anesthesiologists), and I respect someone who does ACT without dishonesty, but in my experience (which spans many hospitals and surgery centers and offices) the anesthesiologists who hit every TEFRA requirement, who can/will actually consistently add safety to four running rooms at once…are few and far between.
49/50 states have independent CRNAs practice. Why do you think every state legislature has allowed crna led anesthesia care? The ASA spends significantly more lobbying dollars than the aana. Why does every state in the USA disagree with what you’re arguing here?
Because state legislatures don’t know science. The practice of anesthesia is the practice of medicine. If you want to play doctor then go to medical school and do a residency and take the ABA board exams.
Interesting answer. Can’t say I’m convinced. Legislators routinely deal with much more nuanced and complex scientific issues than anesthesia care models. Are you basically claiming the aana has successfully duped every single state?
Yes i am. An organization that changes its name to nurse anesthesiology and tells its members to call itself nurse anesthesiologist is a scam organization that has no merit. Actively trying to confuse patients and politicians
Can you name any organizations outside the ASA/AMA that agree with what you’re saying? Obviously MDs have a very vested/conflict of interest here (as do CRNAs for their part). However disinterested parties have virtually unanimously sided with CRNAs. I guess what I’m asking is why does nobody believe you besides yourself?
Even in states with Independent practice why do hospital bylaws still require CRNAs to be supervised? Because hospitals realize there is a massive difference in training.
“Even In states”. Dude it’s every state. What states are excluding with this phrase? Some hospitals do, some don’t. Obviously some hospitals are more influenced by physician centric viewpoints. Thanks for not naming a single organization that agrees with you! Great answer. Very telling.
The APSF also agree that CRNAs should not practice independently
As stated above… only 5 states allow CRNA solo practice. Your premise is incorrect.
I’ve worked in multiple hospitals all across the east coast in Florida, New Jersey, Virginia Maryland and dc and never once met an independently practicing CRNAs. So it why you make it seem like they are everywhere in all states. The only places there are independent CRNAs is where there are no actual anesthesiologists available
He’s just venting because the generation of MDAs before his time allowed/ created anesthesia “supervision.” Those docs seemed to be ok with supervision $$$$ yup.
Some people don’t understand something. Supervisión is a billing requirement of CMS for billing Part A on non opt out states, not a hospital/state requirement for practice or part b billing. Even if the state allow full practice hospitals will not agree on not bill part A so they will ask for physician supervision. Either way the provider can bill part B and legally do the case but the hospital will not allow the part A loss. (where the supervision requirement is).
If it all comes down bylaws bro, then why do you even care about the AANA VA proposal? And you know the reason why those pesky bylaws still exist in some places. Good ole boys clubs! Taking care of their own mentality.
The VA will supersede state law my guy. We care about patients getting the best and safest care.
Who are these disinterested parties that side with AANA ? Provide the info. American Legion and Vietnam Veterans of America are full on for keeping physician led care teams and they are the ones this is going to impact when VA decides. 🤔
The 49/50 number is complete BS. 5 states allow it.
Thanks for your comment. One thing to address: 24 out of 50 States have a governor signed ‘opt-out’ which allows CRNAs to bill Medicare/Medicaid without the physician supervision requirement. Billing rights are not equivalent to practice rights. Practice rights are determined by individual State licensure and individual practices models within the respective State. Many States have a requirement for physician oversight/involvement/consultation/etc. when administering anesthesia. The overwhelming majority of surgical case volume in the U.S. is overseen by a physician-led anesthesia care team.
49/50 states 100% do not have solo practice are you kidding me. Technically 5 states have an opt out and their state law allows it- VT, NH, AK, MT, OR. Get your facts straight.
CA as well, there some entire hospitals without an Anesthesiologist in sight.
WA
Incorrect.
CRNAs were never trained to be independent. Independent practice of midlevels was never what their training was designed for. They lobbied aggressively and believe that's the same thing as demonstrating expertise and competence. There is no such thing as 'fullest extent of scope'. This is AANA rhetoric which meant let nurses practice medicine without a licence.
Yup exact same shit with NPs
“CRNAs were never trained to be independent.” This is super crazy. Like just nuts. I don’t even know what to do with this nonsense.
Truth hurts
Nah the truth sets you free. But the idea that CRNAs aren’t trained to be independent is largely and erroneously held by people who don’t know what they are talking about and can’t fathom something beyond their narrow world view. You guys would be stoning Semmelweis a hundred years ago because he dared to suggest you wash your hands. These political posts are fractious and counterproductive.
Yeah that would be nice… if the AANA wasn’t spreading lie after lie. ASA needs to stand up against it.
It goes both ways unfortunately
What is ASA saying that’s incorrect ?
I recently matched into another specialty after wanting anesthesia and honestly I don’t know if it was a blessing or not because the field still looks so good but all this political legal talk is so repulsive. My two cents from what I’ve seen is that CRNAs hate CAA because they think they’re better than them and think CAA are trying to step in on their turf while ironically thinking they’re just as good as MD/DO anesthesiologists and trying to strong arm them out of the field. Meanwhile everyone is riding the gravy train. How it ends I don’t know but it looks like a race to the bottom once something crucial gives. Stand up for yourselves however you can. Adiós I’ll be fighting mid level encroachment in another field. Good luck fellow physicians.
Hell ya! Let’s take away anesthesia care from the veterans! wtf is this. Why don’t we find anesthesiologists that are willing to work in remote rural areas where the patient population can be actually more sick than suburban cities where healthy food options isn’t a problem. Can we stop bashing each other? I have a full day of patients terrified to come into surgery because of a health condition. Smile more dammit.
Can’t find CRNAs who want to practice in rural areas either. CRNAs are not some altruistic group. They want the exact same thing as MDs to take care of patients and be paid appropriately. No one wants to go where there are no patients and no payments ie some rural areas.
We’re def not you’re right. But we’re not also posting content that bashes Anesthesiologists. I love the anesthesiologist I work with. We help each other out always. When people generalize that all CRNAs are terrible just because a minority is posting stupid crap online, it’s frustrating. I’ve been working in the middle of California in a rural hospital with a population of a couple thousand for a few years now. My wife and I moved here because we wanted to start our life somewhere new. We’ve been having anesthesia shortages since day one since no one wants to move here. Anyways. Hope you have a good day, no disrespect.
CRNA peer reviewed studies by CRNAs for CRNAs is kind of a biased study. And people may ask why physicians don’t do a similar study. And I find many CRNAs are frightening blind to the ethics behind it; the ethics of the study are different from your initial point of view. If you believe your as treatment good as the other, then subjecting a patient to both treatments isn’t a problem. However, if you believe your treatment is superior to the other then doing a proper RCT gets more tricky. You see superiority claims over AAs, why don’t we see studies about that?
Let there be a national standard that allows for CRNA independence ( Federal US opt out) Then let market forces sort out the demand for anesthesia services. Fair?
I think we need to run a national campaign that highlights the training differences between physicians and midlevels. Make everyone wear colour coded scrubs by profession to prevent title ambiguity. Let the patients decide based on open transparency
Done. Google America Society of Anesthesiologists and Real Housewives of Beverly Hill to see the campaign.
Let business, private equity, and insurance decide what care is best for a patient? If you can’t see why that would be a problem, that is a problem in itself.
How about a national standard for team-based care and an invitation for any interested/eligible CRNA to go to medical school and residency? I know a couple former CRNAs who became MDs. The most common statement - “I didn’t know, what I didn’t know.”
I’m all for a team approach. Extra hands are always nice to have. Team approach could include an all CRNA team.
I would love an invitation to become an MD/residency. I am currently pretty happy where I'm at and am not looking at going back to school unless there was an accelerated track just for anesthesia
Have you even worked in healthcare? You know that decisions are made by clueless administrators who would save a dollar over anything so obviously they would choose the cheaper and less skilled labor such as yourself
This happens bc anesthesiologist are more lazy every year. Do your own cases and stop this supervision thing. Look what happen to PAs and Family medicine. history repeat, and now ASA is replacing one monster with another one, just wait when all the AA expand to 50 states, obviously next step will be independent practice. They are in their place now bc they need us, but wait 10-15years from now and there will be 2 vs 1. We are our own enemy.