re: Wisconsin Hospital Replaces All Anesthesiologists with CRNAs

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Would anyone honestly feel comfortable undergoing surgery knowing that the person responsible for keeping them alive during the operation is not a MD/DO?

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This is pretty much the standard in most hospitals. The CRNA is the one at the bedside during the entire procedure. If you actually get an anesthesiologist there during the procedure they most likely are only there for a short time

There’s tons of $$ involved with anesthesia and everyone wants their cut. The latest trend is, for example, an ambulatory surgery center opening and wanting an all CRNA staff, so the center can do the billing and pay us scraps. A CRNA doing their own billing, few and far between, can make absolute bank. But mostly we don’t bc it’s taken from us. MDAs, where I used to work-level I trauma center, are notorious for being lazy and absolutely taking advantage of the MD/CRNA supervision model. And don’t get me started on the rampant Medicare/insurance fraud from the MDAs. They are supposed to be present for induction/emergence and check in at whatever time duration. I can’t tell you how many cases I did solo and didn’t receive the proper billing. Broad brush, but MDAs are some of the most spoiled/entitled folks out there. They do whatever they can to protect their golden goose. At the hospital I referenced, the beans got spilled about their salary. They have a 500K base, and receive a QUARTERLY bonus of 100K and the CRNAS barely make 200K total package. All the while getting worked like a dog. There is no perspective from them, at all. Full disclosure, I haven’t worked with an anesthesiologist in almost 19 yrs. I’ve done everything solo but hearts. And CRNAs absolutely can place central lines, float a Swan, TEE, peripheral blocks.
Now, let me make it clear, not every CRNA is capable of working independently. The weak ones get weeded out in solo practice. There is a place for every model though. I’ve got no issues with the supervisory model, as long as it’s implemented properly. What I do have an issue with is the AAs

My wife is a NP,she had 20 years experience in ICU,Cath Lab before she went back for her Masters.She and other NP’s I know that followed a similar path don’t want to be Independent Practitioners,they realize what they know and what they don’t know.
These people that get a Bachelors,spend 1 year in ICU and then go for NP are no way prepared to work without supervision.

People in this thread acting like a CRNA went to community college

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That same hospital then had a patient die during a freaking colonoscopy less than one month after the CRNAs took over.

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What was the cause?

If you've ever gone in for surgery, chances are, you got a CRNA not an anesthesiologist.

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There’s no accurate way for someone in the field to convey this without sounding defensive, sadly. It’s quite true.

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I agree. This thread highlights that we as doctors are losing the PR war to the midlevels, with the biggest loser being patients and the biggest winners being corporate medicine.

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What I find particularly funny is that they have a HUGE role to fill in a tightly-focused, fairly repetitive task (above, for example) and are generally not prepared to take on the brunt of what people consider “general practice” without a lot of support.

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People think primary care is just refilling diabetes and HTN meds. It’s way harder than that, and some NPs can’t even do the basics correctly.

For the people in this thread who say midlevels do the same thing doctors do, I’m sure you will be fine letting Barbara manage you and your family’s health.

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I’m actually all for independent practice of mid levels under the condition they’re held to our standard-

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If they have to pass our boards, carry the same malpractice insurance, and I can testify against them in a court of law then I’m all for it.

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I think this is pretty common practice at most hospitals. Lots of CRNA’s work under supervision of MD. There’s generally an MD that reviews the cases also.

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this is not the same as replacing all MD/DO anesthesiologist. that means no supervison is happening.

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There is 100 percent an anesthesiologist in the building who is ultimately responsible.

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This is where you are wrong. There are plenty of practices in the US where CRNA’s are the only providers and are not required to work under any physician. To date, there are 19 states that have opted out of the CMS billing mandate that states CRNA’s have to have physician supervision. There is only one state in the US that requires a CRNA to be supervised by a physician anesthesiologist and that state is New Jersey.

Here in Louisiana, we have CRNA’s who practice independently and who carry malpractice insurance, much like any other medical specialty. Anesthesia claims are no greater in one provider over the other and when it’s a solo CRNA practice, the CRNA is responsible for any anesthesia liability, especially if the surgeon isn’t trying to dictated the anesthetic, which they rarely do.