re: Wisconsin Hospital Replaces All Anesthesiologists with CRNAs

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They go to an online school. Let that sink in.

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They keep making arguments that in effect are arguing that physicians should limit the role of nurses going forward, reincorporating tasks rather than delegating them. Why can't I just hire scribes to do my paperwork, and then do more tasks that have been recently delegated to nurses, if the arguments are presented in an either/or manner?

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I mean no offense to y’all anesthesiologist but what do y’all exactly do day to day?

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Today I’m on the L&D floor and so far I’ve placed 3 epidurals, supervised a CRNA on 2 c sections, done 2 c sections by myself. Tonight I’m on call for epidurals and c sections until 7 am.

Yesterday I supervised 4 CRNAs from 7-3:30. Ortho, neuro, thoracic, general surgery cases. Saw every patient preoperatively (about 25), placed 4-5 nerve blocks for shoulder or knee replacements, was at induction for every anesthetic performed by a CRNA, helped CRNA on one airway where the CRNA put the breathing tube in the esophagus which caused the patient to desaturate to 11% (ELEVEN!!!) oxygen. We also made sure all the CRNAs were relieved at 3:30. This propaganda about them being present at all times is utter bullshite. Sure they’re in the OR with the patient at all times (with a physician immediately available) from 7-3:30 but once 3:30 comes they better get relief. Even offered overtime pay they will hardly ever stay to finish their current case.

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I work with 60 docs. 50% couldn’t sit a case. Fact.

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You work with 60 doctors, all of whom are anesthesiologists, and only 30 of them could do what you do? Is that what you are saying?

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This is true. And as a patient seems like a big deal to me.

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Sure they’re following a physicians orders to take care of a few patients at a time. During anesthesiology residency, the residents are in charge of making the orders for the entire ICU. Some anesthesiologists do a fellowship and are intensivists - running the entire ICU. Just one of many differences in training. They also train on the surgical teams during intern year prepping patients for surgeries and caring for them after.

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There are many CRNA only practices in Louisiana where no anesthesiologist is present

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is this you now accepting the fact a cRNA is not an anesthesiologist? bc if they were you wouldnt be saying crnas practicing when 'no anesthesiologist is present'

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You seem to really dislike them.

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I don’t dislike them. They are intelligent people. They have a role. Practicing independently or under the supervision of a non anesthesiologist is not it. That’s what has happened in Wisconsin.

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is this you now accepting the fact a cRNA is not an anesthesiologist? bc if they were you wouldnt be saying crnas practicing when 'no anesthesiologist is present'

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Yes, I know the difference. Many CRNA’s practice without anesthesiologist supervision. It happens throughout the US. The whole point to this thread was to alarm people to the fact that a facility went to an all CRNA practice. A fact that is already present in a lot of rural facilities. Tactics deployed to scare the public to thinking they are getting substandard care is what bothers me. Like I said earlier in a comment, I cover some work at a facility that fired 2 of their anesthesiologist because they were doing a poor job. Me and the other CRNA’s who now cover the work here have got nothing but praise for our care. Just because an anesthesiologist isn’t present, doesn’t make it substandard care.

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 Tactics deployed to scare the public to thinking they are getting substandard care is what bothers me.

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Well, you hate the truth. You are substandard compared to an anesthesiologist. That is the incontrovertible truth.

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As a non med person I agree. Idk whose fault that is but the high cost of healthcare seems to be a factor.

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There are multiple routes to decrease overall costs. Early orthopedic intervention in clavicle fractures has shown to be cheaper than going to the EM and waiting for a ortho consult, but the specific intervention I'm referencing required a specialty built orthopedic urgent care that isn't widespread yet. A radiologist I know insists you could see massive savings through primary care doctors knowing what imaging modality is the best to use for certain presentations, with (I think) his argument being that better and more specific use of imaging would have the same net effect as other cost-cutting measures, such as rationing, though he didn't specifically present numbers or data supporting his position.

I think any situation where there is less training overall, and more independence for these individuals who do not have the appropriate training is a race to the bottom, but people don't seem to realize that or care. There are multiple ways you could decrease overall healthcare costs, including opening more residency positions, and I've yet to see a legitimate reason presented as to why you should allow practioners with less training more independence.

Yes. That drama is currently happening at my practice.