Nurse anesthetists aren't the same as anesthesiologists

Sep 21, 2010 | Posted by: roboblogger | Full story: The Baltimore Sun

Catherine Gilliss's primary point in her op-ed is that nurse anesthetists are a less expensive alternative to physician anesthesiologists in providing anesthesia.

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CRNA are dangerous

Pittsburgh, PA

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#1
Sep 21, 2010
 

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CRNA are indeed cheaper than an anesthesiologist. Want cheap and dangerous anesthesia? Get a CRNA.
Anesthesia Provider

Winchester, VA

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#2
Sep 22, 2010
 

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CRNA are dangerous wrote:
CRNA are indeed cheaper than an anesthesiologist. Want cheap and dangerous anesthesia? Get a CRNA.
anesthesiologist are indeed more expensive to employ when compared to a Nurse Anesthetist... Want more expensive and over rated anesthesia ?... Have anesthesiologist pit you to sleep.
Wow

Chicago, IL

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#3
Sep 22, 2010
 

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Anesthesia Provider wrote:
<quoted text>
anesthesiologist are indeed more expensive to employ when compared to a Nurse Anesthetist... Want more expensive and over rated anesthesia ?... Have anesthesiologist pit you to sleep.
Having a physician who has trained for 12 years taking care of you while a surgeon operates is overrated, but having a nurse who has spent 2 years is a good idea?
That defies logic.
stanley

Louisville, KY

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#4
Sep 23, 2010
 

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more then 2 try 8 years of education, nurses have been performing anesthesia safley and solo in this country for over 100 years.
Wow

Chicago, IL

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#5
Sep 23, 2010
 

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Stanley,

You can become a nurse anesthetist with a 2 year associate's nursing degree from a community college, online bridge-RN, 1 year working as a nurse taking orders from doctors in an ICU, and then off to a CRNA-mill for education, where one year is spent in the classroom, and the last year is in the operating room.

That doesn't inspire much confidence in someone who is taking care of you during the intense stresses of surgery.

Sorry, but I am going to choose the doctor who survived the rigors of all 12 years of medical training versus the community college-trained nurse.
stanley

Louisville, KY

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#6
Sep 23, 2010
 

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You can be accepted into medical school without premed go to a Caribbean medical school (mill) have attended a three year anesthesia residency, never passed your boards and practice.

Within any group you can find people who have done the least and still get by does not make it the norm.

And for the record even if it were an ADN plus bridge and 1 year ICU and a CRNA mill (must be like an MD mill) that is 6 years school plus one year of practice. Far more then 2 years check your math, I can see you must be one of the Caribbean school graduates who never did boards.
Wow

Chicago, IL

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#7
Sep 23, 2010
 

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Stanley,

In order to practice anesthesiology in the United States, you need to do residency in the U.S.

Anesthesiology is a 4 year residency. After 4 years of medical school. After 4 years of undergraduate studies. With additional fellowships in pediatrics, cardiothoracic, pain, critical care.

The best and brightest from college take one of the most difficult examinations, just to get into medical school, called the MCAT.

To be a practicing physician in the U.S., you must pass Step 1, Step 2CK, Step 2CS, and Step 3 of the USMLE.

That's 12 years of training at the minimum, with many qualifying exams in between.

An anesthesiologist is a master of the full spectrum of anesthesiology. They run the critical care units, giving orders to the ICU nurses. They can handle all complications.

I don't understand how you can even try to argue equivalence between nurses and physicians. Anesthesiologist Assistants have the same amount of education as CRNAs, so do you think they are equivalent?
NCMD

Ahoskie, NC

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#8
Sep 23, 2010
 
Physicians are better trained to practice medicine, no question. We don't on average however perform a safer anesthetic than a CRNA. Is medical decision making involved in the care of the perioperative patient? Of course it is. The question is how often is it required for each type of surgical facility. The other issue is medical disasters do occur to healthy patients. What is the proper way to allocate MDAs in the perioperative setting? That question is unanswered. Those who argue with CRNAs about training and equivalence, just save your time. There will alway be the nurses that think they know more than the doctors. And in 100 years there will still be nurses who think the same thing. Who cares.
The dirty little secret that CRNAs don't want anyone to know is getting to the meat of the argument (for them at least, money). A patient will get the same exact bill (whether it is from most private insurers, or medicare/medicaid) whether a supervising doctor is involved (MDA or surgeon). Even more damaging to their argument is that the opt out saves the country no money. The professional/supervision fee is shifted either to the surgeon, the hospital, or most often (and especially in opt out states) the CRNA. In return the patient has no physician who is legally responsible for the patient.
Now if a CRNA is willing to collect the anesthesia fee, without any part of the professional fee (and pay for their health insurance and malpractice from their anesthesia fee), then I'll have a discussion with an anesthetist about this opt out topic. Otherwise I think a nurse getting paid 150k (who compensation is based on PHYSICIAN negotiation of anesthesia reimbursement over the last 30 years) may be part of the high cost of health care. Especially when in most situations, they just pick up the phone and someone else solves their problem.
stanley

Louisville, KY

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#9
Sep 23, 2010
 
Wow as I pointed out your 12 years of training can be very sub par or as you point out superlative (BTW there are many anesthesiologists practicing with a 3 year residency and non boarded), your description of CRNA education was disingenuous to say the least, with many loaded terms CRNA mills, etc, etc. I note you did not like it applied to your specialty golden rule golden rule.

I do not claim across board equivalence, just in delivering anesthesia, not CCM, pulmonology, etc. etc.

Please keep the discussion real and avoid the hyperbole, your credibility is fading fast.

As for billing I know what I bill and I pay for my salary and benies out of MEDICARE BILLING, no need for stipends for me that is the money saver.
Anesthesia Provider

Winchester, VA

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#10
Sep 23, 2010
 
AAs are supported by the ASA... This is the definition of greed and modern health care. Anesthesiologists are often homeopathic DOs that went to med school to say they are real doctors. Let us stop the banter of physician dominance and wake up to the reality that CRNA anesthesia is provided by very competent skilled professionals that provide a needed service to, not only rural America ( hence opt out states),but to thousands of patients daily. You can argue until your blue in the face... Facts are there about nurse anesthetist quality.... I ask once again docs... Where is your EBP proving anything remotely close to what you claim is superior practice?
NCMD

Ahoskie, NC

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#11
Sep 23, 2010
 
Anesthesia Provider.

You really don't have to be derogatory to physicians (MD and DOs) and AAs. It emphasizes your lack of confidence and strength of your argument. Furthermore it makes people laugh instead of listen to you. I would never be derogatory to CRNAs (actually I absolutely enjoy working with them, after all we have the closest physician-nurse interaction in medicine).

If you think provider quality studies contribute to evidence based medicine in a meaningful way, you need to smell what you are shoveling. They are biased, diluted, and inappropriately funded. They only attempt to state, with study design and statistics, what the financier wants it to say (and I'm talking both ASA and AANA, or any other physician/nursing organization). Physicians and physician groups have repeatedly attempted to contact the author Cromwell, with no response. This is not a robust piece of science to quote from.

I do have a couple questions since you seem to enjoy posting. How does the opt out PRECISELY save the patient and health care system money? And don't bother with stipends. It would be a yawn from me. I await your profound response.
Anesthesia Provider

United States

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#12
Sep 23, 2010
 
Profound response...actually not so profound... Rather elementary that an anesthesiologist's typical salary dwarfs that of a nurse anesthetist...hence rural hospitals shovel out unnecessary money to feed these salaries ... CRNA gets paid well but also well below what the hospital would be paying the Moneyologist...these savings to the hospital are in the hundreds of thousands of dollars... This cost can go instead towards other things such as better resources, supplies, facilities, quality of care, and yes...savings that trickle down to patients even...You are blinded by saving and justifying inflated physician salaries. If you are being honest with yourself and others you would admit this.
Anesthesia Provider

United States

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#13
Sep 23, 2010
 
NCMD...I would call 911 before most Anesthesiologists I work with in an OR emergency and I don't say that to be sarcastic but as a real response to your ridiculous post comments.
NCMD

Ahoskie, NC

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#14
Sep 24, 2010
 
I guess you have difficulty understanding the question. Oh well, I thought as much.
Instead of making sarcastic comments, discussing issues would serve you well. You don't put yourself in a good light. You are so militant and say so little that you don't even realize it.
Good luck.
Anesthesia Provider

United States

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#15
Sep 24, 2010
 
Way to go... Once again avoiding the issue at hand and pretending to be superior ... Your patients will need help with a mind set like yours... Great deflection to the issue at hand... Maybe you don't understand ideas outside of your own...think about the cost of paying twice the salary to any provider of any service ... This is common sense that money is saved by not doing this in healthcare and in any arena for that matter.
NCMD

Ahoskie, NC

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#16
Sep 24, 2010
 

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I was trained at one of the top anesthesia departments in the world. I am boarded in periop TEE, I have extra training in peds hearts, neonatal anesthesia, regional anesthesia (and catheters), and can do any regional or vascular procedure with ultrasound. Trust me, my patients need no help when I am taking care of them. But thanks for judging without knowing one thing about me. I didn't even say I was against independent CRNA practice in some locations (although at my hospital the surgeons never call a CRNA when there is a problem, they want the MD in the room).
I was simply asking how the opt out saves a patient or the health care system money. Your answer had to do with salaries and what a hospital would do with the extra money. Do you have any experience with how anesthesia services are billed? And by the way, I make a minimal amount more per hour than our CRNAs, and I carry most of the responsibility and liability (plus we pay their malpractice and insurance. Can you answer the question or not? And stop being derogatory. You have no idea who you are communicating with.
Anesthesia Provider

Winchester, VA

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#17
Sep 24, 2010
 

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Ncmd... Your arrogance knows no bounds...
NCMD

Ahoskie, NC

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#18
Sep 24, 2010
 
Thanks for the answer "Anesthesia Provider."
KCG

United States

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#19
Sep 24, 2010
 

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Anesthesiologist--you need to stop bashing CRNAs. As you know CRNAs have being administering anesthesia for the past 100 years. You are all so lazy always relying on the CRNA to do your cases and lie to patients that you do the case. Most of you sit in the office on the computer or on the the phone while the CRNA do the case. How do you live with yourselves. Give the CRNAs the credit they deserve.
NCMD

Ahoskie, NC

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#20
Sep 24, 2010
 

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KCG

I tell each patient that the anesthetist is with the patient at all times, and that I am immediately (about 15 seconds to be exact) available. I don't bash CRNAs, I work collaboratively with them, which I tell to each patient (and that I manage 3-4 locations at once).

Being derogatory doesn't strengthen your argument. When MDs see CRNAs in the lounge making 150K/yr, do you think we judge them to be lazy (or raise the cost of health care)? I don't. But there are always those individuals in any profession that are looking around saying "why are they making so much money sitting around." I'm sorry you have worked at places where the MDs haven't given you credit, that's pretty low. The place I trained at and where I work though is completely opposite. The MDs and CRNAs work as a unit an we are all very busy, but are providing different components to perioperative care.

Let me ask you KCG since Anesthesia Provider wishes not to engage in any meaningful conversation, how do you think the opt out PRECISELY saves patients or the health care system money?

No ill will and thanks for listening.

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