Tuesday, June 15, 2010

Turf Wars In Alphabet Soup Land; AA vs. CRNA vs. MDA

While my encounter with a crna was NOT amusing in the slightest bit, I find it hysterical that crna's are getting their comeuppance! I have dealt with their insufferable arrogance and mistreatment at their hands. They are not doctors and have limited capabilities. Paindoc from http://www.allnurses.com/ has some choice statements to make about them! Although Paindoc can be a pain himself, he is correct on many issues even though his irascible temperment can turn people off. Can't argue with the truth. I have some excerpts here in a compilation. (big surprise right?) These are from this discussion; CRNA Vs. MD - Page 2- Nursing for Nurses (Italics and bod face are mine)

Originally Posted by paindoc http://allnurses.com/certified-registered-nurse/crna-vs-md-464799-page3.html#post4249656

"It is so presumptious of superiority when one makes ridiculous statements about holding ones life in their hands.... Airline pilots make less than CRNAs and hold the lives of hundreds to over a thousand in their hands every day. Workers in nuclear power plants make only a small fraction of CRNA salaries but hold the lives of millions in their hands everyday. I think CRNAs (and doctors) need to get real about their presumed self importance and need to recognize: 1. a person off the street can be trained to give anesthesia in a couple of months and do it well 2. other countries doctors and nurses make less than factory workers (eg. Germany) 3. both doctors and nurses in this country are way way overpaid."

"Well, don't be mislead by those saying it is not about money...it is ALL about money. CRNAs make far more than any other group in nursing and more than many physicians. Their educational requirements are minimal....currently 6-6.5 years of training, and with an average salary of $185,000 per year, that comes out to around 30,000K per year of training. Anesthesiologists train for 12 years and have virtually the same income per year of training.
CRNAs have a very cushy lifestyle working an average of a little less than 40 hours a week (since most are employees, employers frequently don't enjoy paying an extremely high paid nurse time and a half for overtime). Therefore, the average CRNA makes around $92 an hour in salary alone, and then add on the benefits, and it puts them way over this amount. There are many times between cases when there are long turnover times, holes in the operating schedule due to improper scheduling or inefficiencies or cancellation of cases, etc, when CRNAs will frequently go out for smoking breaks or sit in the physician's lounge reading newspapers or hobnobbing in the cafeteria with the medical staff. Many hospitals have significant down time in the OR which frequently translates into free time (= not working time) for CRNAs. It is a life of luxury and bliss compared with most nurses who are slogging it out on the wards or having to listen to patients complain endlessly. CRNAs simply knock their lights out and voila! No more complaints! To quote a CRNA from another forum:" "...knock their lights out and voila! No more complaints!" This pretty much sums up my experience with Aaron my CRNA.
04-13-2008, 06:09 AM
"Do not get so worked up guys, we all know the salary is one thing that drew us. It is not what keeps year after year. It is no different in any profession, medicine sports business. Do not get upset, the lure of good pay way will interest the most motivated and education will winnow out those cannot do it."
CRNAs should be proud to make more than 97% of the American population working only 40 hours a week! It is a dream job everyone would aspire to. As much as CRNAs complain about their jobs sometimes, it ain't flippin' burgers, and they live in the privilege of wealth and power that few in our society achieve."

"It is useful to engage in self examination in order to produce cogent thought about one's life profession especially when there are those that have become so insouciant that they have developed their own self consistent set of ideas that are quite divergent from other professionals. Since most CRNAs are mere employees of others, the benefits they receive include salary and time off, which are hours that have to be worked in your stead while you bask on the beaches of your Florida second house or are on one of your IPG cruises. So with the whole package of salary and benefits, you are still in the 97th percentile of the population. Isn't that great! Isn't that something patients should understand about CRNAs, that a nurse would come with a pricetag each year that dwarfs what the patient's will earn over 5-10 years? Yes, CRNAs are overpaid. No, I have not been crying about the sky falling for a long period of time- fact is CRNAs make more than ALL other nurses, most lawyers, most primary care physicians, most PhDs who may work 60 hours a week to your 40, and have just as much responsibility. The sad fact is anesthetiizing and awakening a patient with no significant deviations in homeostasis could be done 99% of the time by a person with 6 months training out of high school. We need a less expensive alternative than CRNAs (and MDAs) considering the built in safety factors that come with modern monitoring and the relative paucity of significant homeostasis imbalance induced by modern medications.
The "experience" one needs for CRNA school is not educational training: it is a job requirement just as those going into medical school have some experience in the medical field on their resume before applying. Just as many lawyers have done some work in the legal or paralegal field before being accepted to law school. To count a job requirement as educational training is a farce and is disingenuous."

"It is futile to argue with facts. CRNA salaries have bloated to the point they should indeed become the focus of not only hospital administrators and anesthesiologists, but also the MDs that work twice as many hours per week as CRNAs, have substantially more education, and assume far more liability risk all for the same salary as a CRNA.Another little nasty fact is that there are many CRNAs practicing that have less than a BS RN, in fact have no 4 year college degree at all. They come from the 2 year or 3 year RN programs, some of which were hospital schools rather than colleges. In 1992 the predominate degree achieved by nurses matriculating into the CRNA programs was a 2 year RN, period. Many of these CRNAs continue to practice today and are paid the same as a MS + BSRN. Furthermore they are paid the same as a MD primary care physician that had requirements of 4 years college, 4 years medical school, and 3 years residency in 1992.
You are correct in assuming this message needs to be disseminated to other bulletin boards and I plan on doing exactly that, beginning with the primary care bbs and working my way up through hospital administrator bbs. Just the facts...just the facts...."
It is my sincerest hope that this Dr. does just what he threatens.

Crna's point to alleged studies which state that their skill is no less than an anesthesiologist's skill. No difference in statistical outcome between the two they claim. They both cost the same... (AA people claim that they make the same money as well, so this is not a cost savings at all.) But now, enter Anesthesia Assistants, the AA designation. THEY claim that THEIR skill set is on par with the crna's skill. Here's a link; The Ultimate site for the Anesthesiologist, Anesthesiologist Assistant, Anesthesia Assistant!

Here's an excerpt; How safe are Anesthesiologist Assistants compared to CRNA's? A four year study in Cleveland, Ohio's University Hospitals comparing Anesthesiologist Assistants and CRNA's
safety records showed that the two professions were virtually identical. The Medical Center conducted the
research study over four years (1999-2003) and studied more than 46,000 cases involving Anesthesiologist
Assistants and CRNA's (23,0000 cases each). They concluded by stating, "Complication rates were no higher
for Anesthesiologist Assistants than CRNAs." more information can be found at http://www.anesthetist.org/

So, while the crna's are strutting around claiming to be just as good as doctors and demanding that they be treated with deference by MDA's (and patients) they are also screaming bloody murder about the AA people. Well, now imagine that! Now these haughty crna's are getting a taste of their own medicine! (pun intended)

Here's what one AA applicant says. " Before any CRNAs decide to leave derogatory AA comments about this post be forewarned I am familiar with your biases and political indoctrination in school. My former girlfriend is a CRNA and we used to have many discussions regarding this specific topic. Also, her private opinion was that being an RN was also useless in preparation for being a CRNA, though I doubt you would get her to say that in public. As such, I believe that these CRNAs are basically scared and are extremely arrogant and misguided in their attempt to control the entire field of anesthesia."
This site has some very amusing squealing from crna's about the AA people. Anes. Assistants vs CRNA Facebook Of course you want some excerpts before you waste your time looking at what a bunch of nurses are upset over don't you? Here you go. CRNA Shop Started in response to the wall post regarding increased AA usage in the US. If anyone can enlighten: do they have different restrictions, why are they comparing themselves to CRNA's, and what's the AANA doing with AA? Boo hoo, these cretins are comparing themselves to us, and our exalted position! What is the AANA going to do about these people???!!!
You need to read this entire post by Gregory which follows. Can you believe the HUBRIS of these people?
Anne Response by Maryland Asso. of Nurse Anesthetists President:

President's Address

Gregory G. Taylor CRNA, MS

"To the newly elected MANA Board of 2009-2010, to past board members, to the past presidents of MANA, for whom I hope to continue your remarkable legacy, AND especially, to all the CRNA's in the state of Maryland, I humbly accept the position of President."

"We as a group, have faced many issues over the years: scope of practice issues; regulatory issues; the right to bill independently and practice independently. Last year we faced another challenge to our ability to practice in Maryland with the introduction of legislation to Open/Start a program at Johns Hopkins University for the training and ultimately the licensing of Anesthesia Assistants." I hope they do this. At the very least it would slap some of the arrogance out of CRNA's.

"As you are all aware, we defeated this first attempt with a coordinated attack lead by past president, Michelle Duell, our lobbyist, Bill Kress, past presidents Kathy Nugent and John Bing, your MANA Board and a host of dedicated CRNA's, who all stepped IN and UP at differing times to write, call and visit legislators, and to testify in Annapolis on behalf of MANA."
Yes, CRNA's dedicated to that easy money and dedicated to self aggrandizement.

"I wish I could tell you that was the end of it, but you all are astute and educated on this issue, and you know this will not die easily or quietly.
At present, MANA is actively continuing a dialogue with Maryland House and Senate members, both sympathetic to MANA and those supporting Johns Hopkins and the AA program. This is where our PAC money becomes so important. We need the money to support our efforts through donations to political fundraiser's etc. AND we need YOU, the CRNA's of MD, to speak to legislators in your respective districts and make your voice heard."
I also urge everybody in MD to contact your state legislators and demand that we break the strangle hold that crna's have on anesthesia so that we can get some price relief on health care. The AA's claim to be as good as the crna's who claim to be as good as the MDA's. So AA = Dr. Who is cheaper?

"Letters and emails are effective and noted, but nothing beats a face-to-face moment to introduce yourself, educate them about why an AA program is unnecessary and then ask for their support to defeat this onerous legislative initiative." Why is the AA program unnecessary? Don't you believe in a free market? The only reason you guys got where you are is because 1) Former President Clinton's mother was a crna and 2) there was a shortage of anesthesiologists (allegedly) and 3) crna's were supposed to save health care dollars. We want health care costs to go down. They are unsustainable... This means that we need to replace crna's with others who hopefully won't be so full of themselves and so demanding and so expensive. Are crna's starting to feel what MDA's have felt watching crna's try to take over anesthesia?

"This battle cannot be fought by just the MANA board and/or the University of Maryland School of Nurse Anesthesia, but must be fought by All practicing CRNA's in MD."

"A second issue facing CRNA's and our physician colleagues is the fast moving trend to take away "fee-for-service rights" in outpatient ASC's, GI centers, and even some plastic surgery centers by NON-anesthesia physician by creating a "legal" LLC Anesthesia Corp. pay the CRNA a flat daily rate, or hourly rate. Under their plan, the CRNA signs over billing rights to this "anesthesia corp.", which is then able to pocket the left over anesthesia gross." Well, yes, this would be a trend toward cost cutting. You guys are, after all, NURSES!!! What the hell? Pocket the left over anesthesia gross. Are you insane? What do you think my boss does? He pockets the left over gross from my work! I am paid an hourly wage which doesn't even begin to come close to what you get, and MY boss flies all over in his own jet, paid for with the sweat of my brow. Sigh. You guys should be paid around $30 an hour. Come back down to Earth...

"This model has been long established in hospitals, with a number of Nationwide and some local companies negotiating a fee for the company and then paying the CRNA a daily/hourly rate. What is troubling is that the CRNA's are not able to negotiate the " fair market rate " for their services. They must accept the "going rate" or their services are terminated. These non-physicians are making as much as a 50% profit from our anesthesia services. CRNAs take all the risk, and yet they get the profits. Is this "Smart Business or illegal Business"; at best, we know it is unethical." This is rich... You are talking about "unethical" behavior? YOU are talking about "illegality?" After what you arrogant wannabe doctors put your patients through in regards to informed consent, (lack of) not revealing that you are a mere nurse not a Dr., and assaulting patients with your control drugs in violation of the law? Fair market price for a crna should be about 30 dollars an hour. You are NOT taking "all the risk" your PATIENTS are taking all the risk. How often do you get sued for harming you patients? Plus, they are NOT taking the profits, YOU ARE! A six figure salary in the 97th percentile as Paindoc notes isn't enough for you people? Where do you get that they take 50% PROFIT! Jeez I wish I could make a 50% PROFIT and still over pay my employees like that. I don't hear any complaining about the profit the hospital makes on its other nurses. And I don't hear these other nurses getting militant and demanding that the hospital pay them ALL the profit for their work! HUBRIS!

"The Board of Nursing AND the Board of Physicians have jointly agreed to hear this issue. Stay Tuned!" Patients should call the Board of Nursing AND the Board of Physicians and tell them that crna's are not Dr.s, yet are making obscene salaries. Demand that a cheaper substitute be found for them, (AA's) just the way that the crna's in their turn were supposed to be cheaper substitutes for REAL doctors.

"The third and final point I'd like to highlight is dealing with the economics of a changing healthcare system. The landscape of the healthcare debate raging in our country presents many land mine's. We all have personal views as well as professional ones about the best outcome. However, it doesn't matter whether we are democrat or republican, supportive of this administration or not, the best approach is to have "a seat at the table". This is the approach the AANA has taken. It is better to be a "Player" in the healthcare debate than just cry "foul" from the sidelines. To that extent, we need to support our national organization with the same vigor and enthusiasm we give to our state. This means continuing to pay our dues, support our national PAC and give physical presence, letters, and emails when called upon." Typical union crap. As I've said before, health care MUST be the next bubble to burst. It simply cannot remain such a high cost and yet have less and less skilled people, such as yourselves, and now apparently AA's caring for us. Honestly an AA couldn't have been any worse than the creep crna who did my "anesthesia." Again I urge every patient to call, e-mail and make an appearance at the local office of your legislators, both state AND federal. Put a stop to these rich crna's controlling our health care AND OUR POLITICIANS and make them accountable to US!
I urge all of you who agree with me that these people need some kind of controls put on them to MAKE A DIFFERENCE! Call your state legislators, your Board of Health and Welfare, your Doctors Board, your Nursing Board. Say that we want cost savings and crna's aren't it. Ask them why we have to pay a little nurse the same salary as a doctor or MORE! If we are going to be treated by other than doctors shouldn't there be a savings?


  1. My wife is a physician (not an anesthesiologist) and my daughter is a CRNA. Anyone who equates the med school training of an anesthesiologist to the nursing school training of a CRNA is making a silly comparison. Nursing school for a CRNA (albiet 2 more years of nursing school) doesn't compare to medical school. It's an apples and oranges comparison. If you want safe anesthesia, you need an anesthesiologist. But lets stop and smell the roses (horsesh*t): if you get anesthesia, you are probably going to get it from a CRNA simply because they are cheap. Multiple CRNA's "supervised" (maybe) by single anesthesiologist. Not safe. Never has been. Physicians get anesthesiologists when they have surgery, but you won't. CRNA's usually chime in that they prefer fellow CRNA's, but then they can cherry-pick a certian CRNA....Bad CRNA's are terrible. Even my daughter the CRNA can't believe how much CRNA's can get away with; they basically practice medicine unsupervised because nobody gives a damn.

  2. Anonymous is very misguided in the whole practicing medicine comment... It's called practicing anesthesia .... Nurse anesthesia... Practicing medicine is what physicians call it to make it sound more important.

  3. What a load..I love the pilot analogy. I'm an experiened airline and I guess that I hold people's lives in my hand daily....I have a serious problem with a nurse (CRNA) performing my anesthesia; I want a physician (anesthesiologist).. My family includes advance-practice nurses (NP, one CRNA and several physicians)...and until I needed cancer surgery, I could care less about the initials follong the name.......BUT, MY SURGEON SAYS "I WON'T HAVE A NURSE ADMINISTER MY ANESTHESIA AND I WONT LET A CRNA ADMINISTER YOUR ANESTHESIA. Unfortunately the CRNA communits inclused "militant" members who think that nursing (CRNA) is the same as practicing medicine. This is a dangerous farce.....

  4. Let me direct anyone interested to an article in "The Hill" posted on 9/2/2010 in the healthcare blog titled Study: (Doc supervision of nurse anesthetists is expensive,ineffective and "irrational" )I don't think it will change the ranter's minds but may just educate and put to ease the general populace about CRNA,s!! Just cut and paste what is the between (parenthesis) above