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re: Wisconsin Hospital Replaces All Anesthesiologists with CRNAs

Posted on 4/7/21 at 3:37 pm to
Posted by Big Block Stingray
Top down on open road
Member since Feb 2009
2090 posts
Posted on 4/7/21 at 3:37 pm to
quote:

I know a DO and she admits the DO part def carries a stigma.




Yep, valid or not it's the truth... Especially among older physicians.
Posted by MrSpock
Member since Sep 2015
5126 posts
Posted on 4/7/21 at 3:37 pm to
quote:

I would never trust my health or wellbeing to a DO.


Well, that's just stupid. There are several DO schools with higher MCAT and GPA averages than MD schools.
Posted by AMS
Member since Apr 2016
6537 posts
Posted on 4/7/21 at 3:38 pm to
quote:

Oh good lord ignore the dumb question then. I just have never experienced a setting like this thread is describing with an independent care NP.. I have stated I would not see one for specialized care either. So I don't understand the with problem with the physician led team model like I have always seen. Also it seems like most Physicians like their NPs/PAs and could give them the boot if they wanted.



lol yea thats the point. most of the public just isnt aware the gap in training. to be fair most midlevels are probably much better than that level of tweeted question.

midlevels can be very valuable to a physician led model, with supervision and consultation. but independently practicing while not held to the high standards of care a physician is, buyer beware. not trying to disparage midlevels but they may not know how the toilet flushes, and be out there plumbing independently.
Posted by Big Block Stingray
Top down on open road
Member since Feb 2009
2090 posts
Posted on 4/7/21 at 3:40 pm to
quote:

US Nurse Anesthesiologist.



What state is this term accepted?

I have never heard any CRNA introduce themselves as this...
This post was edited on 4/7/21 at 3:41 pm
Posted by greenwave
Member since Oct 2011
3879 posts
Posted on 4/7/21 at 3:41 pm to
Yeah I guess I am just naive but I do not see this NP Independent care as the case where I live. Maybe in a different state or something it is. But we as patients can choose who we would like to see so I don't see this as some major problem.
This post was edited on 4/7/21 at 3:42 pm
Posted by BeaumontBengal
Member since Feb 2005
2377 posts
Posted on 4/7/21 at 3:41 pm to
This was a nice read after a quick google search. From an LSU Law publication.

The Problems of Certified Registered Nurse Anesthetists

More than any other specialty, anesthesiology in the United States has blurred the distinction between physicians and nurse-practitioners. This confusion of roles has its roots in the late differentiation of anesthesiology as a specialty. There was a considerable period during which anesthesia delivery consisted of a paper cone and a container of ether, both held by a nurse. This created a perception that anesthesia was a nursing task. With the certification of registered nurse anesthetists (CRNAs), surgeons explicitly accepted that anesthesia could be practiced by a nurse, albeit under the supervision of a surgeon. This pattern of allowing nurses to practice a medical specialty did not pose a problem until anesthesia practice began to become much more sophisticated and technologically oriented.
Board certification in anesthesia now requires a medical degree, training in a formal residency, and passing a certification examination. This creates an enormous gulf between the knowledge base of CRNAs and physician anesthesiologists. It also creates a knowledge gap between board-certified anesthesiologists and physicians who practice anesthesia without formal training. Such physicians include family practitioners who provide anesthesia in rural hospitals, noncertified physicians who hold themselves out as anesthesiologists, and most surgeons who supervise CRNAs.
A major controversy between surgeons and anesthesiologists is the proper role of CRNAs. Few, if any, states allow the independent practice of anesthesia by nurses. The legal expectation is that the CRNA will be supervised by a properly qualified anesthesiologist. If the CRNA is not under the supervision of an anesthesiologist or if this supervision is too attenuated, the law will assign the surgeon legal responsibility for the CRNAs' actions. (See Chapter 15.)
Medical malpractice insurance rates for CRNAs are artificially low because the nurses do not bear primary responsibility for any negligent actions. When a CRNA injures a patient, the legal liability for that injury flows directly to the supervising physician--either the surgeon or the anesthesiologist. In some cases, the nurse is not even sued. In cases where the CRNA is not supervised by an anesthesiologist, the plaintiff's attorney focuses on the surgeon rather than the CRNA. The surgeon is a much less sympathetic target in front of a jury. As the licensed physician in charge, the surgeon is expected to know all aspects of anesthesiology practice. Plaintiffs' attorneys are able to make supervising surgeons appear negligent by forcing them to admit that they relied on the nurse's knowledge of anesthesia. This is ethically questionable and violates the medical practice act in most states because it is impossible to supervise care that one does not understand.
Posted by AMS
Member since Apr 2016
6537 posts
Posted on 4/7/21 at 3:42 pm to
quote:

and in some parts of the US Nurse Anesthesiologist.


colloquiially maybe. Recently states had supreme court cases outlawing nurses from falsely identifying as an anesthesiologist, which implies a level of expertise that cRNA does not have.
Posted by LC412000
Any location where a plane flies
Member since Mar 2004
16673 posts
Posted on 4/7/21 at 3:43 pm to
Doing ortho cases at that facility? How about Podiatry cases?
Posted by Success
Member since Sep 2015
1964 posts
Posted on 4/7/21 at 3:44 pm to
quote:

more like warm bodies in the room


You’re very confused.
Posted by Success
Member since Sep 2015
1964 posts
Posted on 4/7/21 at 3:46 pm to
quote:

AMS


I know exactly who you are. Not really. But you fit the bill.
Posted by Big Block Stingray
Top down on open road
Member since Feb 2009
2090 posts
Posted on 4/7/21 at 3:47 pm to
quote:

Yeah I guess I am just naive but I do not see this NP Independent care as the case where I live. Maybe in a different state or something it is. But we as patients can choose who we would like to see so I don't see this as some major problem.




Where you really see this in states with lower population and poor access to medical care. It's hard to recruit a MD to BFE and lower pay, a lot easier for a N P.

Some physicians get thier panties in a wad over this, but the NP is providing access to care to an area in need that they themselves want no part of working.
Posted by cwil177
Baton Rouge
Member since Jun 2011
29648 posts
Posted on 4/7/21 at 3:47 pm to
quote:

Yeah I guess I am just naive but I do not see this NP Independent care as the case where I live. Maybe in a different state or something it is. But we as patients can choose who we would like to see so I don't see this as some major problem.

You must not be in an independent state, yet. Regardless it will be your problem sooner rather than later. The nurse practitioner lobby is winning the fight to practice medicine without a license, legislating expertise, as another poster put it. There may come a day in the near future where your insurance forces you to see a mid-level prior to seeing or even in replacement of a physician. It is already happening in the military.
Posted by greenwave
Member since Oct 2011
3879 posts
Posted on 4/7/21 at 3:48 pm to
That is my understanding as well to some of these cases.
Posted by BeaumontBengal
Member since Feb 2005
2377 posts
Posted on 4/7/21 at 3:48 pm to
quote:

quote:
AMS


I know exactly who you are. Not really. But you fit the bill.


Yeah I think I know him too. A physician and patient advocate.
Posted by tigercross
Member since Feb 2008
5067 posts
Posted on 4/7/21 at 3:49 pm to
quote:

How does that work with people who wanna do general primary care, family doctor type stuff. Instead of doing residency at a hospital they work at different doctor offices or just bounce around different specialist areas of a hospital to learn as much as possible?


They would do a family medicine or internal medicine residency. A lot of clinic hours. Typically hospital based although they may do some rotations at satellite clinics. See the Duke family medicine residency curriculum below:

Posted by coondaddy21
Louisiana
Member since Oct 2012
3222 posts
Posted on 4/7/21 at 3:50 pm to
quote:

What state is this term accepted?

I have never heard any CRNA introduce themselves as this...


The AANA has approved it as a acceptable term to use. There is no legal claim over the use of the term anesthesiologist. The ASA more recently put the term physician in front of it. This past year there has been a grassroots push by members of the CRNA community to use the term Nurse Anesthesiologist because the term Anesthetist is difficult for non medical people to understand or say. The truth is, most non medical people don’t know the difference anyway. Some physician anesthesiologist organizations in certain states are trying to lay claim to exclusive naming rights to anesthesiologist but, to my knowledge, none have been successful.
Posted by cwil177
Baton Rouge
Member since Jun 2011
29648 posts
Posted on 4/7/21 at 3:50 pm to
quote:

My med mal carrier and my state board of medicine says it is absolutely correct where I practice...but carry

I would double check that, boss, before you need it. I’m serious.
quote:

Few, if any, states allow the independent practice of anesthesia by nurses. The legal expectation is that the CRNA will be supervised by a properly qualified anesthesiologist. If the CRNA is not under the supervision of an anesthesiologist or if this supervision is too attenuated, the law will assign the surgeon legal responsibility for the CRNAs' actions. (See Chapter 15.) Medical malpractice insurance rates for CRNAs are artificially low because the nurses do not bear primary responsibility for any negligent actions. When a CRNA injures a patient, the legal liability for that injury flows directly to the supervising physician--either the surgeon or the anesthesiologist. In some cases, the nurse is not even sued. In cases where the CRNA is not supervised by an anesthesiologist, the plaintiff's attorney focuses on the surgeon rather than the CRNA.
Posted by AMS
Member since Apr 2016
6537 posts
Posted on 4/7/21 at 3:51 pm to
quote:



Your own organization, the ASA, is the one who labeled you that because they felt there was a confusion in identifying who they were. Some people didn’t know an anesthesiologist was a physician and therefore the change. You do know there are also dental anesthesiologist?



nice try but a dentist is technically a physician, they practice dental medicine and have actually are educated at a higher level of physiology anatomy etc than a nurse. nurse anesthetists are not a physician and do not practice medicine.

but dont facts that get in the way of encouraging anesthetists from misrepresenting themselves as an anesthesiolgist. not that there is anything wrong with being an anesthetist, it just is not equivalent to an anesthesiologist no matter how hard you attempt to blur the lines
Posted by greenwave
Member since Oct 2011
3879 posts
Posted on 4/7/21 at 3:52 pm to
Yeah idk you seem to be fear mongering. Like I have a heart attack and then will be sent to NP Tonya for diagnosis cause there are no more cardiologists? Is your practicing state independent?

I mean I sure hope that's not that case and NPs don't want that either
This post was edited on 4/7/21 at 3:52 pm
Posted by BeaumontBengal
Member since Feb 2005
2377 posts
Posted on 4/7/21 at 3:52 pm to
quote:

grassroots push by members of the CRNA community to use the term Nurse Anesthesiologist because the term Anesthetist is difficult for non medical people to understand or say.


Yep that’s DEFINITELY the reason.
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