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AA and CRNA Forum Talk!

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JCole View Drop Down
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Joined: 03 Oct 2007
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  Quote JCole Quote  Post ReplyReply Direct Link To This Post Topic: AA and CRNA Forum Talk!
    Posted: 17 Oct 2009 at 10:54pm
CRNA        VS        AA!



And the battle goes on.....

I respect the fact that you work in an environment with Anesthesiologists as a team. I don't know if the Anesthesiologist hired you and is your boss, but if you consider him to be, that's your prerogative. The problem comes when the Anesthesiologist considers your ability to provide anesthesia for the patient as subpar compared to his and when they continue to spread the propaganda that you're unable to provide anesthesia without him nearby. I hope your Anesthesiologist respects you as much as you say you respect him.

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To continue my rant-- Respect comes from within. I love my job and I feel fortunate be a Nurse Anesthetist. It is a very comfortable lifestyle.

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As a Nurse Anesthetist I meet the patient in the pre-op area, review the record and interpret lab results and other tests. I formulate a plan for the anesthetic and administer sedatives through the iv as we roll towards the operating room. Upon arrival I connect the monitors, administer oxygen assure the patient he will do well and give the induction drugs through the iv, once unconscious I perform a laryngoscopy inserting a breathing tube which I connect to the ventilator. During the operation I administer more anesthesia as I see fit and near the end I will get the patient spontaneously breathing. I will titrate narcotics iv so that the patient wakes up comfortably shortly after the surgeon is done.
I call my boss the Anesthesiologist and he or she is present at the start(induction) and end (emergence.) I respect and like our anesthesiologists and there are times with lives on the line when we work as a team quite effectively to provide the best possible care for our patients.

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If you anesthesiologists are so much more qualified, as implied by your ridiculous statements, why is it that one of the CRNA's working at my local hospital practices (and has for the past 17 years) under the supervision of HIMSELF? He has none of you arrogant, overbearing anesthesiologists to tell him what to do, when to do it or how to do it—and he must be doing something right! In those 17 years, he's lost only one patient, and that one was virtually dead before arriving to OR. Admittedly, I've met some very courteous anesthesiologists in my day. Not all have the attitude that their view on the science is superior to the CRNA's view. As Grant said, what textbook did you read that he didn't? Personally I'd like to know so that when I enter anesthesia school next year, I can grab a copy of that one text that was apparently different.

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In addition, I would like to ask you what exactly it is you can do as an Anesthesiologist that I can't do as a CRNA when it comes to anesthesia? What is it about your training that makes you think you can provide an anesthetic so much better? What different algorithm or special knowledge did you learn in your training that is going to make you the only one capable of bringing the patient with "complex issues undergoing a complex surgery" safely through the procedure and the only practitioner capable of bringing the crashing patient to life? What anesthetic textbook do Anesthesiologists read from that CRNAs don't read from? What about the EVIDENCE? What studies have you read that show better patient outcomes when an anesthesiologist is present? Have you read the Pine Study, the Bechtoldt study, Forest study, Minnesota Department of Health study, or the National Academy of Sciences study? All show no difference in care...only a difference in cost. That's why I'm proud to be a CRNA.

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The metropolitan hospitals where the Anesthesiologist shows up on induction to give the meds that the CRNA chose and drew up and then leaves to go do the same in another room or go drink coffee and schmooze with surgeons in the lounge talking politics while collecting half the profits from the case the CRNA is doing isn't done based on evidence that this is the best way to practice. It's done that way because Anesthesiologists enjoy having it easy and have paid big bucks to lobbyists to keep it this way. I recently met one anesthesiologist who owned the group that provided anesthesia for the hospital who said during a conversation "If I had to go before a court and defend my profession, I would be unable to...I admit that Anesthesiologists are unnecessary" In response to your question, I don't work with an anesthesiologist in my hospital. I'm one of those rural hospital CRNAs who just do "BASIC" cases.

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Grant...I m just beginning my learning and career in anesthesia, but your words express just how I a feel about anesthesia...thanks..

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Last time I post-a CRNA is a great MIDLEVEL PROVIDER-like NPs, PAs, etc. You would do a liver transplant on your own? Without the supervision of an anesthesiologist- the MEDICAL DOCTOR responsible for the perioperative care of a patient? That proves how dangerous it is when YOU DONT KNOW WHAT YOU DONT KNOW. The SURGEON is the MEDICAL DOCTOR for SURGERY. The ANESTHESIOLOGIST is the MEDICAL DOCTOR for ANESTHESIA. This IS NOT the 1800s anymore. Patients have complex medical issues and complex surgeries- this is what MEDICAL SCHOOL and RESIDENCY/FELLOWSHIP is for- to understand WHY AND HOW, not just WHAT- this is what saves a patient. I am very familiar with central Illinois-SIU-E? Will you have this conversation with the anesthesiologist who supervises you? No matter what- an anesthesiologist is the doctor who has MEDICAL training and practices MEDICINE, no amount of "board certification" in a nursing test will change the NURSING training and practice of NURSING for a CRNA. period.

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Joseph...I like how you highlight NURSE and PHYSICIAN and ANESTHESIOLOGIST and MEDICINE...You use these words to mislead people, which is extemely manipulative on your part. Anesthesia is not the practice of medicine as it pertains to the way you are using it. In anesthesia, you do not diagnose an illness and prescribe a treatment. You take into account patient's medical history/condition and utilize critical thinking skills to prepare a tailored plan for the patient to safely undergo anesthesia. You state that a "NURSE is a NURSE who provides an IMPORTANT role, but under the supervision of a DOCTOR." A CRNA is no ordinary "nurse"...they are board certified professionals trained in the administration of ALL ASPECTS of anesthesia for ALL CASES...not just the "BASIC" cases...unless you think open heart procedures and organ transplantation procedures and neuro cases are "BASIC"...and as far as "supervision" goes...the surgeon is a "DOCTOR". CRNAs guard the lives of their pts AT ALL TIMES.

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Simple FACTS continued: Multiple studies have attempted to show that care provided by or under the supervision of an anesthesiologist is safer. Despite multiple attempts, no legitimate peer-reviewed study has shown any difference in the quality or safety of anesthesia care provided by CRNAs practicing alone, CRNAs practicing with anesthesiologists, or anesthesiologists practicing alone. Training a CRNA costs significantly less than training an anesthesiologist (less than 1/3 in most cases). Additionally, facilities that use CRNAs practicing independently to provide anesthesia, as opposed to some variation of the “anesthesia care team,” do so at a significant cost savings. Given that there is no difference in quality or safety between CRNAs and anesthesiologists, and the significant cost savings realized with using CRNAs, calls for continued supervision of CRNAs by anesthesiologists are irresponsible given our current healthcare crisis. Thanks! John Canady, CRNA

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I've seen a variety of great comments and a variety of bad comments, either because they are inaccurate or simply rude. Unfortunately, I doubt any of the great comments will influence CNNMoney.com to correct their inaccurate article. Some simple FACTS: Anesthesia is rightfully and historically the practice of nursing. The 1st CRNA training program was established half a century before the 1st physician anesthesiology residency. While a small number of states require that CRNAs practice in coordination with a physician, no state requires that physician be an anesthesiologist. In the vast majority of hospitals and surgical centers in the USA, anesthesia is provided by CRNAs practicing independently with no anesthesiologist present or available. The “anesthesia care team” model mentioned in many comments is actually the LEAST COMMON and MOST EXPENSIVE anesthesia practice model used in the US today. Continued (John Canady, CRNA)

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Being a CRNA is a wonderful profession. I work with a group of CRNA's and MD's whom all strive for the same goal...pt safety. I encourage anyone who desires to pusrue this career to seek out for themselves what the job entails and also shadow someone. This is a very rewarding career with lots of autonomy.

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This isn't about promoting one agenda or another. I have great respect for the CRNAS- the NURSES- that I supervise and direct. This is about 5 pages below of a few CRNAs who went to NURSING school wanting to MEDICALLY manage a patient in a critical MEDICAL specialty. Can't do that. Can't let patients believe it because EVERY CRNA and PHYSICIAN I've come across had requested DIRECT anesthesiologist (MEDICAL DOCTOR) care for their own cases or for their families. We are SAFE when we know our limits- the problem is you don't know what you don't know. AND all that being said- CRNAs- awesome pay/ lifestyle/ and personal satisfaction from taking care of patients in a tangible way. Great field if you are not looking to have ultimate autonomy.

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stop it, a NURSE anesthetist is safe under the SUPERVISION of a PHYSICIAN..an ANESTHESIOLOGIST who practices MEDICINE. Due to FINANCIAL REASONS you have some areas allowing for NURSE anesthetists to do basic cases where there are no physicians. BASIC cases, because sick patients and complex surgeries get sent to major medical centers- ALWAYS under direction of an MD. Now nurses get "Ph.D's" in "philosophy of nursing" online and call themselves "Dr.s" to patients. so just STOP confusing the public. A NURSE is a NURSE who provides an IMPORTANT role, but under the supervision of a DOCTOR. Cause when it hits the fan, its the DOCTOR who has trained in MEDICINE who will save your life and assume FULL responsibility. CRNAs/ nurses will NEVER say this to patients or physicians in person- just online on their own nursing website. KNOW who is guarding your life during surgery at ALL TIMES! Ask! Who will take care of me?

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Just so you know - I have seen the same comment from Robert Haken on many of these top jobs. I think he is a prankster who enjoys getting people hot and bothered. Consider saving your righteous indignation (and it IS righteous indignation since what he said was rude - my husband is applying for a PharmD program and I was insulted) for something more worthwhile.

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Mr. Hacken is the dream team member of any hospital O.R.... He seems to know so much and will not stop telling you so.

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Your "What they do" implies that Nurse Anesthetist do not work autonomously and they do. Some work with Anesthesiologist and some do not. I work as the sole provider of anesthesia in my hospital which is in a rural setting. We learn from the same text books, use the same techniques when giving anesthsia. You should responsibly re-write this to be more accurate. It is misleading at best.

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As a graduate with science/engineering degree who didn't want to go immediately into med school, the other option for me was to attend an Anesthesiologist Assistant program. To catch me up with the CRNA's, I have to get 2600 clinical hours before I graduate, but working in a hospital is worth it. The only downside is that we are linked to an MD Anesthesiologists, but still have plenty of autonomy.

Mark below is advocating the CRNA profession, which is great, but CRNA's are just one piece of the puzzle. Free market economics suggest that there be multiple vendors, and MD's & AA's are the additional vendors to help avoid the existence of a cartel.

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CRNAs practice in every anesthesia specialty and, in many instances, provide the training to anesthesia residents who are physicians when they enter anesthesia training.
But please don’t just take the word of a CRNA or anesthesiologist. Research the truth about quality of care given by both providers. Learn about the cost to train an anesthesiologist versus a CRNA. Report on the salary difference between CRNAs and anesthesiologists and how the difference is justified. In today’s health care cost effectiveness, CRNAs fit the bill in cost containment based on salaries alone. What you will find is that CRNAs are the best kept secret in medicine and are deserving of an honest, truthful report. So, send a real reporter out to do an unbiased, extensive investigative story on CRNAs and report the truth.

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CNN/Money should really do an in-depth look at the profession of Certified Registered Nurse Anesthetists (CRNAs). We are not simply “assistants” to anesthesiologists, although they do have Anesthesiologist Assistants (AAs) who are their assistants. Rather, CRNAs are a separate, professional provider of all modes of anesthesia and analgesia care who practice independently and without the need for “assistants”.
It should come as no surprise that anesthesiologists will maintain that anesthesia is the practice of medicine and they would be correct when practiced by a physician. What is also correct is that anesthesia is the practice of nursing when practiced by a nurse who is educated and certified in anesthesia. It is mandatory that CRNAs be certified in anesthesia in order to practice. Not true with anesthesiologists who may practice without being board certified.

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The "What they do" statement is a little misleading. Nurse Anesthetists do often work with Anesthesiologists, however, I work as a CRNA in a rural hospital and there aren't any anesthesiologists working with me. Nurse Anesthetists do not require the presence of an Anesthesiologist and are perfectly capable of making all decisions regarding the care of the surgical patient on their own. The media and the public often don't understand this fact. Anesthesiologists as a group don't like the fact that we work independently and have fought over the years to restrict Nurse Anesthetists from working without their supervision. It's mainly a matter of politics and money rather than qualifications. CRNAs were the first anesthesia provider specialty and have been providing anesthesia for all types of surgical procedures for approximately 150 yrs.

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A great start for those of you who think that nurses, pharmacists and other healthcare practitioners were too sub par to go to med school, would be to check out the course requiremnets for any of those professions at your local university. I think you will find that you can't even pronounce some of the names. Good luck if you think you can manage them, you already fail at having "people skills." Without those you are pretty much a sub par business man as well.

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I think entrepreneurs are those who couldn't get into med school...wink

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Clearly there are some who are extremely uniformed about the various medical professions and willing to make ridiculous assumptions about why/how a person chooses a career. Those persons may consider a little introspective contemplation about linking self worth to a persons career or role in life. The truth is that we need all healthcare professionals to make the system function. Thanks God for all the mid-level care providers out there working hard, caring for their fellow man. Without them, millions would not have access to healthcare at all or specific services they need because there would physically be no one to provide it. I work in 100 bed NICU where 2-4 nurse practitioners work around the clock, making decisions about 600 gram babies titering on the brink of life and death while neonatologists sleep. In addition, the bedside nurse has to have the intellect to determine whether the pt even gets seen by a practitioner.
STL RN

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Dear Jay,
You're right. CRNAs are a glorified nurse. Glorified by their education and dedication. The US is very lucky to have them. If you think health care is expensive now; contemplate 65% of all anesthetics being paid at the rate Anesthesiologists are paid. Gee- is a dermatologist or a plastic surgeon just a "glorified" doctor? Not a "real" one, unworthy of respect because they are not a cardiac surgeon? Are you really only interested in gaining respect by virtue of a title? How about the quality of your work? Do you have "respect" for an Anesthesiologist who works in a large hospital "directing" 4 CRNAs while never actually performing an anesthetic themselves. Might you have "respect" for a lone CRNA providing the care for your loved one in a rural hospital? A hospital that the same Anesthesiologist didn't want to go, because he wouldn't make enough $$? Ask surgeons who have worked with CRNAs about who they respect
Maybe you should rethink the concept of respect.
Dave Harvey

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Dear Ben,
As in any walk of life, intellectual ability may determine success or what one can "handle". As you yourself become intellectually more mature, you will discover that many, many other factors determine what career choice one pursues: money, time, family issues, etc. . I'd like to think "respect" is generated from within no matter what you do for a profession. The fact is all too often people are educated well beyond their intelligence- some might even think a comment like yours is proof of that. No personal offense intended, of course.
Dave Harvey

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If one Anesthesiologist can bill for more than one anesthetic (often for 4 at once) while often doing nothing themselves; then I would think it would make it pretty clear to almost anyone that this is a financial expediency, not always one of medical safety. One also should not get the profession of Nurse Anesthesia confused with that of "Anesthesiology Assistant". CRNAs can practice independently and do in many parts of the country, especially where Anesthesiologists think they won't make enough $$. Anesthesiology Assistants cannot practice independently. CRNAS also save facilities a lot of money: They can do the same things as MDAs, but usually are only paid about 1/2 the $$. Keep in mind: the first established residency in anesthesia in the United States commenced in 1945, by this time nurses had been administering anesthetics for 100 years.
CRNAs: a great profession, I'm glad to be a part of it.
Dave Harvey, CRNA


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I am also a Certified Registered Nurse Anesthetist. I have been practicing 25 years in CA and MI. This is a fine job that I enjoy as much as when I started. Yes, it does take a minimum of 7 years to get there, but it is very rewarding both in terms of job satisfaction and money: I was earning 100k plus in 1984. If one doesn't mind traveling there is plenty of money to be made. I know plenty who make well over 200k gross. Legally there is virtually nothing an Anesthesiologist can do that a CRNA cannot. CRNAs provide more than 65% of all anesthetics in America. There is no definitive study that shows a difference in safety regarding who the anesthesia provider is. There is however some evidence that shows that Anesthesiologists practicing alone might be safer (less untoward incidents) if they had a CRNA helping them. It is true that many CRNAs practice with MDAs. By and large this is a billing issue, not a safety issue- to be continued-


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The ongoing turf war between Anesthesiologists and Anesthetists is driven, like most things, by money. Anesthetists are highly trained "midlevel" providers of healthcare to patients requiring surgery. like Nurse practioners and PA's in other specialties, Anesthetists can safely take care of most patients with little or no physician supervision. Likewise, physician Anesthesiologists can take care of patients without Anesthetists. The "Anesthesia Care Team" functions like a small ICU with a physician supervising/assisting 2-4 anesthetists that actually deliver the care to the patients in the same manner as an ICU nurse. The care team has been shown to be safer and effective, since having two professional from different backgrounds working together only improves patient care. Due to a shortage of personnel, Anesthetists work independently in rural areas of the country, but still have physician support from surgeons and other doctors. We need each other, why can't we just get along?

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