Friday, May 5, 2017

Proof CRNA's Don't Care About Patient Access To Anesthesia

This will finally put to rest the lie that CRNA's want to practice independently without supervision from physician anesthesiologists for altruistic reasons. They say nurse anesthetists should be able to work without anesthesiologists watching over their shoulders because they can increase the availability of anesthesia care since there are not enough anesthesiologists for all the cases that need to be done. It doesn't matter that studies have shown that states who opt out of physician supervision do not have more anesthesia cases than non opt out states.

Now we have this tweet from Juan Quintana, the immediate past president of the AANA. After the Department of Veteran Affairs denied CRNA's the right to practice without physician anesthesiologists in VA hospitals, he tweeted, "stick to your guns. In the meantime we will keep taking MDA jobs." For good measure he added a laughing so hard he's crying emoji.

Does this sound like he wants to give patients more access to expert anesthesia care? How can taking jobs from physician anesthesiologists lead to greater anesthesia access? All the propaganda from the AANA about CRNA's giving patients and surgeons more anesthesia choices have just been shown by their own society president to be a bunch of baloney. Their blatant bald faced lying would make even Hillary Clinton blush.

So next time you hear anything out of the AANA pushing their agenda for independent practice without physician anesthesiologist supervision, know that it is all fake news. Their real agenda is to prevent as many anesthesiologists as possible from observing and correcting their errors.

19 comments:

  1. LOL

    One study which was horribly flawed?! Want me to poke holes in it for you? Just look at how they determined the numbers. Elementary.

    Just so we are clear, if not for me and my CRNA colleagues there would be NO anesthesia in our rural towns. So it isnt an "agenda" nor are we talking anyones jobs (that would presume that an MDA ever had a job in our areas which is laughable), we are doing it when no one else would.

    Dr Quintana was referring to your jobs in metro areas as the collaborative model continues to explode. You know there was a summit with a number of large AMCs who want to remove 1:4 med direction and use a totally independent collaborative model right? Expect more every year. Every CRNA who works in these practices is one less MDA job and increased access to fiscally responsible care.

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  2. Mr Quintanilla is the Sarah Palin of anesthesiology.

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    1. And you're too ashamed to post your name for all of your colleagues to know how you really feel eh?

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    2. Standing for what is right and kicking bullshit square in the balls? Yeah, I agree.

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  3. So- your logic is that the CRNA initiative for independent practice (similar to most advanced practice nurses in this country BTW), is all an organized effort to prevent MDAs from observing and critiquing our work???!!! Is that the best you have to offer??? The fact is that most anesthetics (>65%) in this country are administered by nurse anesthetists- most without MDA oversight. Anesthesiology boasts an enviable safety record- in no small part due to the knowledge, skill and vigilance of the CRNAs who are actually doing the cases- you can't say that we are unsafe to practice, then boast about how safe anesthesia is today. Im another one of those independent rural CRNAs, I take care of the people that the MDAs won't take care of because of the paucity of well insured patients. If I wasn't doing what I and my colleagues do, patients would have no reasonable access to anesthesia care. If MDAs care so much about providing safe care to all, why are we not seeing them flock in droves to rural America? The MDA argument against CRNA independent practice is solely about INCOME, not outcome.

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    1. Why do CRNAs always seem to think physician anesthesiologists wouldn't practice in rural areas? Rural pass through legislation makes it so the hospital has monetary incentive to employ mid-level providers rather than an anesthesiologist. The option isn't even there, so it's a stupid argument to make.

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    2. Physicians do care about providing safe and competent care. That's why most of them spent the time and energy going to medical school.

      What I don't get is what CRNAs think they will get from their being "independent". To me it means they want to be respected as the equivalent of an anesthesiologist without having any other physician oversight, or going through a residency, while earning their income as a physician would.

      Perhaps what they don't understand is that in the end they will still ALWAYS be working for other physicians who will attempt pay them less for their services than they would if they were a physician. Interestingly, with a glut of anesthetic "providers" you are telling physicians that your services are worthless and ubiquitous.

      You can't make the argument that you want to lower the cost of anesthetic services while attempting to acquire the rights and privileges of being a physician (i.e., income, what this all really about). Instead, what will end up happening IF CRNAs acquire their independence is AA's will fill the void that CRNAs previously filled, and will argue for their role as part of the anesthesia care team. What amuses me to no end is CRNAs complain about how unfair and unlike a free market medical services are without their independence, but they also want to deny AAs that same ability--suggesting this IS all about income. What CRNAs argue for when they ask for independence is to have their jobs and roles replaced by others who will perform the role that physicians want and need.

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  4. First, CRNAs, are not taking any MDA jobs. As stated above, the MDAs do not want to work in the rural areas. Second, MDAs rarely work anyway--their so called 'supervision' involves never leaving the lounge where they can be on the internet all day. CRNAs are quite capable of doing anesthesia--hence why the MDAs are never anywhere to be found. We can't even get a bathroom break when we need it. If the MDAs truly believe they are 'correcting' our errors, one would think they would make their presence known in the OR. Botyom line: we never see them

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  5. Are you familiar with non sequitur?

    What a stupid conclusion to draw from a single tweet. One dude says CRNAs are taking MD jobs and you determine that all CRNA claims to wanting to improve patient access to care are baloney.

    You're a deep thinker, aren't ya?

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  6. Pull your underwear out of your ass and quit acting like bitchy little girls. There's plenty of anesthesia work to go around and CRNAs provide care that's on par with MDAs-it's a proven fact, so get over it. CRNAs work without supervision in many sections of the country that would not have anesthesia services if CRNAs weren't around-and let's not forget about the CRNAs working independently at this very moment under battle field conditions.

    Knock off the crap about "physician anesthesiologists" and their cerebral superiority because no anesthesia provider has clinical superiority over another and we all have to clean up each other's messes from time to time. If you've never needed some help, then you are both a fool and a liar.

    If you feel so f*&king strong about the supervision model, get your carcass down to the military recruiter's office, pledge to give your life for your country, and now all the injured soldiers and independent CRNAs providing care while getting shot at will have the luxury of your clinical brilliance and medical direction.

    I have to reply to this anonymously, because I've been thrown under the bus for exercising my 1st amendment rights

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    1. The studies that compare CRNAs and physicians with anesthesia care safety involve retrospective analysis using billing code QZ as an identifier for nurses practicing without supervision. It doesn't prove anything. Any study that would truly show safety would have to control for any physician oversight and would not be ethical. We supervise nurses and use QZ billing but practice in a medical direction oversight model so we don't have any chance of any fraudulent billing. Billing all goes to the same pool, so it doesn't matter. It's financially better than going from QK to AD if something happened.

      Nurses practice nursing. Physicians practice medicine. It won't ever be any other way, no matter how many letters you add to the end of your name or how much you pay to online universities. Different backgrounds and experience. It's not about being more cerebral. It's like comparing a paralegal to a lawyer.

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    2. Anesthesia IS nursing. Titration of medications, patient assessment. It was started by nurses and has been practiced by nurses since then.

      How many diagnoses are you making as a Physician Anesthesiologist?
      How many curative prescriptions are you writing?

      It's like comparing nurses to doctors-who-take-credit-for-the-work-and-safe-outcomes-of-nurses.

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    3. Started by nurses? Like in historically? Historically it began with surgeons and dentists anesthetizing patients.

      Anesthesiologists are perioperative physicians which encompasses more than administering anesthesia. At least outside your little US bubble.

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    4. Anesthesia is not nursing, not historically, nor in current times. I still do my own cases as a physician as well as supervise nurses. There is plenty of diagnosis and treatment of issues, especially in the ASA 3/4 level of morbidity. It's no different than ICU nurses who think they know more than physicians because they spend the most time with the patient and have followed enough orders to think if A happens B is always the answer. They don't have the background to understand the underlying reasoning. They don't know what they don't know.

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    5. If I had a dime for every time I had to convince an MDA of a really acute situation when he/she lacked the situational awareness to know what was going on, I'd be rich. The fact of the matter is that CRNAs have THE SAME level of education regarding physiology and pharmacology as MDAs do (he'll, we take the same board questions!) and it's simply impossible to manage an anesthetic from the coffee room safely and effectively. This common sense notion makes it clear that CRNAs are more relavent, safe, and effective anesthesia providers than MDAs.

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    6. Your anecdotal experience is worth a dime, too. The fact that you don't have any insight to the fact that you don't have the same level of education as a physician is evident of how little you know. Take the same board questions? Hardly. You take an easy written exam and that's it. That's hardly two written board exams and an oral exam.

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  7. Well, considering that an organization could pay two CRNAs (who will actually give anesthesia) in place of paying 1 anesthesiologist (who can't be bothered with actually doing a case), actually does increase access to patient care AND get the same outcome for the patient and for the surgeon, I think Doctor Quintana is on to something here.
    "It is difficult to get a man to understand something, when his salary depends on his not understanding it.' Upton Sinclair

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    1. Why pay 2 CRNAs, when you could pay 4 AA's.
      Why pay 4 AA's, when you could pay 8 janitors.....

      Argue for independence, or argue for the end of CRNAs and for Anesthesiologists to do their own cases, but why cheapen what you do? How does that serve your own future employment?

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    2. Hahahahaha! "Doctor" Quintana!! That actually made me spit my coffee out all over the lounge you think I hang out in all day. Now be a good little nursey and get back to stool sitting and charting.

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