re: Wisconsin Hospital Replaces All Anesthesiologists with CRNAs

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Does that phone have an app that connects you to your stocks? You should probably check your portfolio again.

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It sure does. But you’re the one that got paid so much today.

Gold star for you today doctor-nurse.

Think that surgeon just owned some physicians in here. What an interesting thread.

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anesthesiologist groups never pushed for independent cRNAs. that would be the nursing lobbyists. anesthesiologist groups pushed for supervised cRNAs and nurses groups were able to take a mile when given an inch.

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I never said they pushed for independent CRNA practice. I said they welcomed increasing CRNA involvement and independence. They gladly increased physician to CRNA ratios because the CRNA generates the exact same revenue and costs the group $200k instead of at least $400k. Greed started this and sure, the nursing lobby is taking it to its logical conclusion. But anyone with half a brain knew that was coming 10-20 years ago.

The substandard care part is interesting. I haven’t read any of those studies because it doesn’t affect me at all. I’m assuming you can link a few though? I find it odd that these large healthcare organizations who are incredibly risk averse would move to a 100% CRNA model of it was in fact significantly more risky. You know the first bad outcome at these facilities will result in big lawsuits. They know this too. I would assume they have crunched the numbers and figure negligence leading to lawsuits will be so rare that the salary difference will make up for the lawsuits one would expect with inferior anesthesia providers?

The only thing I don’t like about our CRNAs is that they are clearly inferior in medical management of the patient perioperatively. It’s not something that results in a lawsuit but their inaction when a diabetic patients glucose is significantly elevated likely leads to inferior outcomes (healing, infection). At least when I don’t catch those things and treat them myself. I do a lot of regional with sedation so I just don’t run across many cases where the CRNAs make my butthole pucker from an anesthesia administration standpoint.

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Recognizing possible cardiac risk factors that could be affected by either the surgery itself or the anesthesia that we know our patients will be placed under is 100% our responsibility.

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It’s a shame you feel responsible for the affect anesthesia has on your patients. How much anesthesia pharmacology and the resultant physiological changes that occur could you have? There are a million ways to anesthetize high risk patients, and I find it unfortunate a surgeon should understand not only how the surgery will affect the patient but also how all the anesthetic drugs alter physiology. Not to mention drug interactions between anesthetic drugs and drugs patients are already taking for other things. Also changes in patients’ disease states resulting in abnormal metabolism of drugs. That’s sad.

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And I got mother fricking paid!!!!

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Interesting day of the month to get paid

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if you’re not already in physicians for patient protection I think y’all should consider joining

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I’ve been in there long enough to watch the “admins” allow non-physician lawyers in the group, get found out, and cry about how lying to everyone in the group was in their best interest. I’d be careful about what I post in there if I were you.

It would also be wildly unpopular in that group to share my opinion from earlier which, again, I’ll state:
Let the doctors, APRN, LPN, and janitors all prescribe meds just the same. Just hold them all to one standard - that of a board certified physician in that specialty- if they want to practice in that field.


I talked to an old timer today. Doc had a handful of employed NPs. This one was fine. Not bad. Not exceptional. Gave plenty of notice when they wanted to leave the practice- about two months. NP started handing out cards at office visits for NP’s new practice before leaving. Doc fires NP, as you would expect.
I’ll pause this story to point out that one NP being a true dipshit of a human isn’t the point of this story at all. It just happens to be critical to the next point and a theme worth picking up on.
Again, doc fires NP. I live in a state where NP are not allowed to practice independently. NP opens new office where they (tried to) have old Doc patients, but most of them don’t go. NP basically turns into a pill mill using Doc’s DEA number. Doc calls state nursing board and reports this. Doc repeatedly gets calls from pharmacies and watches their DEA get used without consent for more than three months despite cease and desist letters and multiple nursing board complaints. NP still practices, just finally quits using Doc’s DEA number after several months, because apparently fraud, non consensual DEA license use, and independent practice after notification of collaboration dissolution isn’t really enough for LA’s state nursing board to take any meaningful action (Doc, in retrospect, thinks they maybe should have contacted the DEA or some other authority. Local pharmacies learned the pattern and picked up on the problem, and their refusal to fill scripts was probably more the reason they stopped being filled than anything that happened by the nursing board.



This is an anecdote that you won’t find in the PPP group. You’ll find a dozen or more similar ones. Generally speaking, state nursing boards aren’t used to dealing with NPs in general and won’t suspend/hold/investigate nearly as quick as a given state’s medical board (which acts with haste against complaints. Buddy of mine had a mentally ill family member of a patient contact the state board that included wild accusations that bordered on alien-invasion type delusions. The policy is to get a written statement for each complaint. I just can’t see a scenario where months of someone using an unauthorized DEA number flies DESPITE multiple complaints FROM THE OWNER of the license (to me, this holds a lot more weight than a patient complaint because it should take less than about two day’s to determine things like “lack of collaborative agreement” and “unauthorized use of license” vs poor/unethical treatment and things that are no less serious but far more subjective. Again, patient complaints are serious and every one of them given to the state medical board requires written response from Doc. Nursing board complaints have a track record of super slow and weak responses.)


This is why I advocate for fair access practice for all. These events are super rare and far between. Most are fine to do some work. But if we are going to let everyone practice, hold them all to the same standard. Lowering the current standard seems like a bad idea to me, as plenty of substantard medicine is being practiced to the detriment of the general public. So I feel we should go ahead and just hold anyone that wants to independently practice to the current, fairly high standard rather than lower it to accommodate the dipshits that have no business taking care of people.

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I would assume they have crunched the numbers and figure negligence leading to lawsuits will be so rare that the salary difference will make up for the lawsuits one would expect with inferior anesthesia providers?

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I think you’re overestimating the average hospital administrator.

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It’s a shame you feel responsible for the affect anesthesia has on your patients. How much anesthesia pharmacology and the resultant physiological changes that occur could you have? There are a million ways to anesthetize high risk patients, and I find it unfortunate a surgeon should understand not only how the surgery will affect the patient but also how all the anesthetic drugs alter physiology. Not to mention drug interactions between anesthetic drugs and drugs patients are already taking for other things. Also changes in patients’ disease states resulting in abnormal metabolism of drugs. That’s sad.

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Everything you just mentioned is stuff I learned in school. Nothing you just said is foreign to me. I am often altering my induction due to medications a patient takes, their age, or health status. I also take into account what receptors are activated when exposed to certain medications, such as non selective and selective beta blockers when needing to treat a patient with HTN who also has COPD/Asthma co-morbidities. Patients who are on nor epi depleting stores medications are also treated differently when needing to treat hypotension. Direct acting versus indirect acting medications. We aren’t just bumps on a log that turn a dial. I am often critical thinking when providing an anesthetic and using everything I have learned in school.

Doctors are to blame for a lot of these issues. I am a surgeon and do not have an NP/PA. I make less money than colleagues with an army of them but take pride in the fact that I see every patient and take ownership of their care.