Nurse anesthetists aren't the same as anesthesiologists

Sep 21, 2010 Full story: The Baltimore Sun 119

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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Anesthesia Provider

Winchester, VA

#21 Sep 25, 2010
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.
NCMD

Cary, NC

#22 Sep 25, 2010
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.

Since: Sep 10

Location hidden

#23 Sep 25, 2010
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.
NCMD

Cary, NC

#24 Sep 25, 2010
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.
MATH SKILLS

Pittsburgh, PA

#25 Sep 25, 2010
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
stanley

Louisville, KY

#26 Sep 25, 2010
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.
NCMD

Cary, NC

#27 Sep 25, 2010
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.
Anesthesia Provider

Winchester, VA

#28 Sep 26, 2010
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
NCMD

Ahoskie, NC

#29 Sep 26, 2010
You win Anesthesia Provider. I give up.
Kendra

Barbourville, KY

#30 Jun 30, 2012
Go to http://www.nurse-anesthesia.org/ If you ever wondered how much regard anesthesia nurses have for their patients, look at what they say on the thread Crazies Following are some truly horrifying excerpts.

"So I am curious to see what does everyone else do when you wake a patient up and they are crazy as hell and don't know what is going on. Do you give some propofol, narcs, put them back down, or smack them in the head? What is everyone's plan with this happens?"

"a nice soft pillow.... " The red X marks the spot for the smiley face icon laughing.
"held TIGHTLY over their face .......... Lord forgive me and bleess [sic] all the little pygmies in New Guinea!)" The red X marks the spot for a little praying smiley face icon.

"You must have one amazing patient population to never have a patient wake up even slightly nuts. But for me I will use a cc or two of propofol and/or give a little extra narc. Today I had a 50ish lady for hysteroscopy (20min case) that woke up after 100 of fent with a deer in headlights look and was going bannanas. Gave another 50 of fent and a cc of propofol and when she came to in the PACU she couldn't stop thinking me.(I think he/she meant to say "thanking me") God I HATE these patients!" Look at the last line "God I HATE these patients!" "Duct tape.
Actually, Midazolam...but I fantasize about duct tape." Again, the red X marks the smiley face icon.

These quotes are from a variety of nurses and CRNA's. They are in the 'PUBLIC Section' for us all to see! OMG! when I found this site and began reading what these medical 'professionals' say about what should be very serious life and death matters.

I was reminded of a CRNA who injected Versed into me without my consent in 2007. I had not signed consent for surgery when injected due to the wrong surgical procedure being listed on the conent. I was waiting to speak with my doctor when the CRNA injected me with Versed. The CRNA knew this! He did not care. My last waking memory was of the CRNA injecting my IV. My next memory was of a nurse telling me I was in recovery and that all of my healthy sex organs had been rmoved.

I realize now, much to my horror, that the CRNA probably thought it was funny what they did to me. They were probably all laughing in the O.R. as I was strapped down and then gutted like an animal. If you go through their responses, you will see how they love giving patients this amnesia-causing drug 'Versed'. Most people would be shocked to know what truly goes on behind those surgical doors.

My advice to anyone after what happened to me would be to never ever allow a 'nurse' to provide anesthesia to you. They do not appear mature enough, sane enough or educated enough to perform such serious duties as putting people under and then waking them up. Judge for yourself after reading some of their blogs. I'm sure the average person has no earthly idea that 'nurses' are the ones sedating them and waking them up and I'm positive they have no idea how these nurses truly view them, make fun of them and even talk about wishing they could kill them. It's beyond sickening. These people are depraved... I will never agree to any type of surgery again. I would rather die than be abused, violated and mocked. For those of you who do chose to undergo surgery, I stronly suggest that you chose to have an M.D. sedate you.

On a final note... I can remember years ago when my father (who taught vocational education) used to say that the kids who can't read or do well in school are directed to vocational school. He also said that one day these kids would be the people working on your bodies. Very scary prediction that has come to be...

Thanks for this post. People need to know the truth about who they are entrusting their very life with and/or the life of someone they love.
CRNA or MDA

Mount Juliet, TN

#31 Jul 16, 2012
CRNA=in the room giving the anesthetic, maintaining hemodynamics.
MDA(or DO=usually in holding doing pre-ops (or in the lounge drinking coffee).Don't be offended, this is just the experience I have had.(VA,KY,TN)
Anethesiologist are definitely trained well in their profession. I have no doubt most could run a room. It has been my experience that most don't. Who could blame them. They are paid twice as much without having to do the actual labor. Unfortunately, over time, they lose their skills. I would chose a CRNA any day due to more in the room experience.
As to the education...minimum of a Master's degree (soon to be a doctorate), one year in an ICU, very high GPA (usually 4.0) to be considered. You have to be the cream of the crop. The school is very hard. Training is approximately 2.5-3 years in th O.R. while in anesthesia school. These are no dummy's.
Countless studies have shown no difference in outcomes between doctors or nurses giving anesthesia.
CRNA or MDA

Mount Juliet, TN

#32 Jul 16, 2012
Kendra, I am very sorry to hear about your experience. CRNAs and Doctors are human beings and make mistakes. As for the character punches try going to http://forums.studentdoctor.net/forumdisplay.... . This is a student doctors forum. The first post I saw was "How would you incubate this patient?". Just for the record, anesthesia providers intubate, we do not incubate. I don't believe judging someone's intelligence on a keystroke error is fair.
If you think doctors do not talk about their patients, think again.
Annoyed by ignorance

Port Saint Joe, FL

#33 Jul 27, 2012
CRNA are dangerous wrote:
CRNA are indeed cheaper than an anesthesiologist. Want cheap and dangerous anesthesia? Get a CRNA.
ok so is that why CRNAs have been providing SAFE anesthesia for over 150 years? Gets your facts straight!
yopt

Phoenixville, PA

#34 Jul 30, 2012
CRNA is no match for an MD. suck it up and shut up CRNAs
HumanSpirit

Gainesville, FL

#35 Jul 31, 2012
What is next, the local carpenter using a Black-n-decker 3/4 inch drill bit to do a cranial opening for brain surgery.
the truth is in the detai

Latrobe, PA

#37 Aug 15, 2012
Wow wrote:
<quoted text>
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.
Find a physician that actually sits in a room and does anesthesia... good luck. What defies logic is how many CRNA's handle anesthesia for docs every day and it is safe and perfectly fine, but the minute price becomes an issue and docs are questioned, they are suddenly dangerous. I guess that is why the ACTUAL numbers are almost identical for sentinel events and there are SO many facilities that go with the doc only model of care. If your words were true, you wouldn't really be in this situation would you?
research med

Pittsburgh, PA

#38 Dec 2, 2012
nurse (crna) anesthesia is NOT as safe as anesthesiologist (MD/DO) anesthesia..to argue otherwise ignores common sense. I have a medical degree. Do I think that crna are dangerous and useless? no. Properly supervised, they are useful assistants to an anesthesiologist for certian tasks not requiring a medical degree.
stanley

Washington Court House, OH

#39 Dec 5, 2012
I am pl3ased that you have a medical degree, unless it is followed by an anesthesia residency your opinion is is just that, however many studies performen by people with medical degrees contradict your opinion, so i will accept the data that matches the real world that has been generated and interpiated by someone with a medical degree, no difference in outcomes.
ICU Nurse

Arlington, TX

#40 Dec 6, 2012
Wow wrote:
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?
Are you kidding me? I've been an ICU RN for over twenty years, working from coast to coast and not one of you "ran" the ICU!!! You are so full of yourself! Depending on the potential complication, I call the surgeon. The main doc also sets the vent settings. You must come from a tiny hospital with a 2 bed unit. Hope you let some air out of that ego.
crna are nurses

Brooklyn, NY

#41 Dec 24, 2012
CRNA are nurses and as such can have a support role in the provision of anesthesia care, but they should never function as independent "anesthesia providers". I don't care what the "opt-out" regulations may say..if a patient wants safe anesthesia, chose a physician (anesthesiologist)..if not choose a nurse with 20 months of CRNA training. Just hope that nothing goes wrong.

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