Nurse anesthetists aren't the same as anesthesiologists

KCG....ncmd trained at the best institution in the galaxy...do not feel the need to state the obvious to someone who attempts to play both sides.

Anesthesia Provider.
You can make fun of my institution (Duke University) all you want. You will not get a rise out of me. I am proud of my training and my experiences with those I have worked (anesthesiologists, surgeons, and nurse anesthetists). You are the one that questioned my abilities without knowing anything about me.
You have demonstrated that you wish not to engage in intelligent conversation. Let others answer for themselves, as it is clear that you wish only to agitate others while contributing nothing but rants to this discussion.
You are not an appropriate representative of nurse anesthetists.

WOW! WHAT A THREAD! I am a CRNA with thirty years of experience. I have worked in "care team" environments, "directed", "supervised", but mostly as an independent provider. I have seen it all! From cocky and inept Anesthesiologists to cocky and inept CRNAs. Face it there are good providers and bad providers. We should all work to rid both professions of the bad providers. If there are CRNAs that need "supervision" then by all means make sure they are supervised! Hell I have been in situations where the Anesthesiologist needed supervising by the CRNAs!! NCMD I must admit that you, of all the participants, are the most balanced. I respect that. Big egos always do more harm than good. To my CRNA colleagues, I agree that CRNAs that practice independently can be as skilled and safe as any Anesthesiologist. But bowing up and name-calling is immature at best and lends credence to the argument of less education. You want professional respect? Act professional in all arenas! STAND UP FOR YOUR RIGHT TO PRACTICE INDEPENDENTLY BUT, DO IT PROFESSIONALLY!

NCMD wrote:

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.

Omnicare,

I appreciate your comments, because I really believe most CRNAs and MDAs work very well together. Honestly in my practice it is like a family, and a requirement of being hired is that the prospective MD or CRNA must be more than willing to accept the anesthesia care team approach. Furthermore, I just couldn't complete my responsibilities appropriately without having anesthetists. For example some of our cardiac surgeons need us to monitor the patient with TEE for extended periods of time. Even more routine is that we are frequently in consultation with other physicians discussing/planning pre and/or post op issues. And all while managing any issues in the care of 3-4 patients at a time. And I do understand that my perioperative setting is quite acute and has a greater need for MD input, than in other settings. I have great respect for CRNAs, and will ask for their help at a moments notice. And I will never begrudge the compensation of CRNAs. Extensive training and responsibility deserve high compensation.

My only question is how independent practice will save the health care system (or patients) money. For example with CMS billing the service is split between the MD and CRNA. In independent practice the proceeds go all to the CRNA (ie same cost to the system). With private insurance, my understanding is that it is similar to CMS billiing (with only a marginally greater payment for the supervision component) structure (obviously to total compensation is greater). Just wondered if you had any thoughts on that?

Thanks again for your comments. I really believe anesthesia professions need to work together, because all of our compensation is about to get hammered. The only way we can fight it is together.

stanley wrote:

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

CRNA= rn + 2 YEARS NOTHING MORE

By opting out it removes the supervisory requirement, now in cases of Medicare/Medicaid both bill at the same rate, in cases of private insurance CRNA's bill at about 80%, so that can be a savings. In addition the stipends required to maintain the salaries of anesthesiologists would be removed, furthermore the cost of training an anesthesiologist is much more then a CRNA altogether these ca result in considerable savings, now who gets the money (hospital insurance company etc that will be decided in the marketplace but generally the less a service costs savings are passed on to the consumer.

stanley

Fair enough. I'm curious what percentage of patients in rural areas have Medicare/Medicaid? I'm guess pretty high, but I have no data on that.

I definitely see how CRNAs billing private insurance can say money (but I'm guessing the insurer doesn't lower the consumer's rates, it just keeps it for a higher profit).

I understand how CRNAs see the stipend issue. My group has a tiny stipend as a consolation for the millions of dollars of free care we do each year (I'm not exaggerating). I caution CRNAs who constantly question MD compensation with stipends, and salaries in general. Compensation of CRNAs is based on physician negotiation of anesthesia services over the last 30 years. CRNAs can make 3-6 times that of other nurses (in my opinion mostly deservedly so), I would suggest caution. You never know when your salary will be questioned. Unfortunately I believe for all of us (MDs and CRNAs) it will be very soon.

Ncmd...do you understand now?...thanks for your interest in CRNA only anesthesia ... Omni Care... you make a point but if you look back on the previous threads... You may realize that I do not feel the need, nor should any anesthetist, to prove anything to an md who comes on this post boasting about his/ her training as superior

You win Anesthesia Provider. I give up.