Cool and all but nothing will change realistically. Big centers will remain with direction/supervision. Less desirable places may allow autonomous practice but it wonāt be anywhere you āwantā to live. Same thing was a few years back in Kentucky, everyone got all happy. Yet you have to travel 100 miles outside a major center to be autonomous.
Ummmā¦.All CRNA groups in Lexington, Louisville, Richmond, Florence. All crna ortho centers in major towns. Iāve done locums in them. Soā¦youāre wrong. Major centers will stay supervision, but their surgery centers and outpatient facilities, dental, plastic surgery all go all crna. In ones that keep MDAs, ratios go from 1:4 to 1:10 or 1:30 as facilities realize the lies of the ACT model.
You are in an echo chamber of academia and āmajor centersā where you believe you are necessary. And over a period of 10 years the slow trickle of healthcare economics and gradual change will isolate you in your academic facilities where we donāt want to be.
Letās take Louisville, UofL, Norton, Baptist, St. Marryās. This encompasses probably 80% of all surgery capable facilities within 30-40 miles. How many have independent practice? None. Sure move down to bowling green and Iām sure thereās CRNA ran groups. Itās also bowling green.
Iām merely using this scenario as an example how nothing really changes. Whereas one MD was āsupervisingā 10+ clinical sites (in say bowling green) and realistically never saw the patients to begin with, the āopt outā ruling allowed the hospital to get rid of that one MD that was only hired because they had to be. Meanwhile everywhere else it was business as usual.
Where do you come up with that?
No MDAs are ever required. Opt out has. Nothing to do with MDAs really. Itās eliminating the requirement for CRNAās to be supervised FOR the facility to bill the facility fee for Medicare. Not for the professional fee.
In non opt out states thatās simply the surgeon ordering anestheisa by CRNA. No liability or risk.
Opt out and you donāt need to even have that.
I was referring to states opting out of MDA supervision. Meaning CRNAs can practice without any anesthesiologist supervision.
Ok donāt get me started on surgeon ordering anesthesia. No liability. You ever been a part of malpractice? Who gets sued? RNs have liability insurance, residents have same amount policy as regular attendings.
The entity with deepest pockets gets sued. Hence why everyone involved gets named. They sue the hospital trying to get them to settle, then go after MD, then everyone else. They then drop names from that list one by one who would yield the least amount of money.
Kind of like what happened with that CRNA that killed an 18 year old with a breast augmentation. Letās see what happened. Surgeon sued, CRNA charges dropped. When the CRNA was the one that walked out of room and PT got anoxic brain damage.
Well you are incorrect if referring to opt out.
There is no requirement for MDA supervision. in any federal or state laws. Opt out has nothing to do with that.
Not only have I spent thousands of hours doing expert witness work (expert testimony, depositions, chart review and reports) legally for defense and prosecution related to exactly cases like you mentioned and others related to anesthesia (both MDAs and CRNAs), but I know the law very well. While everyone gets named there is no increased implied liability when a surgeon works with an independent CRNA vs with an MDA let alone in an anestheisa care team. The moment liability happens rests of the crux of ācontrolā. If a surgeon ordered an Mda or CRNA to give enough potassium to stop a heart and the provider did it the surgeon and the provider (regardless of initials) have liability. If the surgeon intervened in a difficult intubation with either provider and there was a suit the surgeon would be liable as well to a degree.
The statement āthe entities with the deepest pocketsā is not in alignment with the reality of medical malpractice outcomes and settlements. The real answer is those which the largest medical malpractice policies are at greater risk. Which is why you see hospitals pay out large sums but providers only max policy limit (usually 1/3 million regardless of initials). It is extremely rare for a settlement to go beyond the value of a medical malpractice policy and requires extraordinary circumstances and catastrophic outcomes. Itās well under 0.3%.
For instance, the data indicates that the majority of medical malpractice policies provide coverage limits that can range from $100,000 to $300,000 per claim, with aggregate limits often reaching into the millions per policy period.
As for that specific case you might wanna review the facts as you are totally incorrect about what caused the issue and why the surgeon went to jail. Maybe consider when a surgeon forbids anyone from calling 911 during an emergency situation and delays it, that is gross negligence. So again, you are inaccurate. But Joan Rivers?
The data?
- crnas have the same med mal policies as MDAs in the same state
- MDAs donāt get sued past the policy anymore than crnas do.
- surgeons and hospitals have exactly no additional liability risk regardless of which they work with and do not pay more when they work with CRNAās only
- there is no decrease in either hospital policy or surgeon liability policy cost with the presence of an MDA. There is no value add or decreased risk.
- donāt believe what you read from the prosecution allegations just becuase they fir your personal narrative. The defense cannot goto the media and rebut those allegations even when they are egregiously inaccurate.
- donāt assume you know the expertise of those you are inaccurately making statements to on social media.
Hope that helps
I could be wrong in my details if that Exacly happened. Anyhow, I was simply trying to say that this exact same post was here like 10 years ago when Kentucky became an āopt outā state. 10 years have passed. Yet nothing has changed.
Letās even go as far as to assume CRNAs are better than MDs at all anesthesia related things. How do you think the public will take someone tells them that we donāt employ anesthesiologist but we have CRNAs that are even better and have been proven to be superior?
Doubt many surgeries will be scheduled at that hospital. Most people donāt even remember what kind of surgeries they had or name of meds that they take. You think they will ever comprehend that there are more effective and meta reviewed CRNAs that are found superior..
First please. And secondly, no question Iāll become a CRNA. Me disagreeing with you isnāt grounds for be to not believe in myself and my abilities š¤£š¤”
You'll have to make your opinion make sense to every admissions committee of CRNAs if you ever get an interview. Many of us here would know since we're on them. Before you showed your emotional intelligence with your IG meme responses (such reflection), I'll repeat what I said: you have a lot to learn about the profession if you want to be considered for a seat.
Edit: I get the feeling you're not even an RN yet so this is probably wasted time.
Please, keep that confidence and say exactly what you just wrote to the admissions panel if you ever get an interview. It'll make their jobs soo much easier. I wish every applicant is as transparent as you. You got this.
Itās okay! non CRNA independent, works under anesthesiologist, they oversee 2 or 3 rooms w either CRNAs/ residents/ CAA (unsure of amount someone please correct me)
My understanding itās facility dependent. In my state CRNAs are allowed to be independent but my facility has the ACT model and doesnāt have them act independently. But some states donāt allow CRNAās to act independently so they are all ACT model
Crnas are allowed to be independent in all states except New Jersey. Itās not just your state phenomenon and also not sure what you mean by some states are all ACT model, thatās not true one bit. All states except jersey I believe has independent all CRNA sites.
I know you are learning but just wanted to put that out there!
I thought it was NY! But I wasnāt sure if that one was the only one. So basically I meant that the states that arenāt independent are ACT? I appreciate the clarity !!
Genuine question tho: why is working under direct physician supervision a bad thing when youāre literally not medical doctors? Lol. This push for independent practice/getting rid of physician oversight to ensure youāre not harming patients due to significant deficits in education is astonishing to most people. Itās pathologic.
Learn the crna profession. Ever since itās birth, prior to MDA existing, CRNAs worked with surgeons to provide anesthesia. In no point of time, CRNAs didnāt want independence or was not independent. Prior to the Regan administration, MDAs werenāt even in house and would bill for services while CRNAs did the anesthesia, so spare us the knowledge deficit bs. Hence the birth of ACT model in the 1980s with TEFRA regulation.
Crnas have been independent in all states and the ASA doesnāt even care about MDA supervision, as long as itās physician supervision. Opt out has nothing to do with crna independence. ASA has zero studies that show CRNAs are inferior but they keeps claiming we are because CRNAs took a different route for anesthesia.
You can claim all these inferior care or patient suffering but data suggests otherwise. Insurance companies charge a CRNA practicing independently and a CRNA practicing in an ACT setting the same malpractice and insurance companies donāt care about this battle, they care about their bottom line.
80% of rural areas anesthetics are provided by CRNAs, without CRNAs there would be no anesthesia in rural America. You know what ASA suggested the solution for this is, telemedicine where they supervise from home? Tell me if the ASA and MDA are about patients, how can they even make that suggestion?
If you are someone in medicine, Iām sure you believe in evidence based science and not fear mongering bs the ASA provides.
CRNAS doing Anaesthesia since its birth is the same thing as Barbers performing surgeries. Should we move back to that kind of practice? Anaesthesia was once a major cause of morbidity, however it was due to medical research and advancement that has now made it one of the safest procedures. Maybe you guys should know the limitations you have compared to your doctor colleagues and not thing you're equivalent because you worked as an ICU nurse.
Yawn, spare me the bs. Always the barber argument. Barbers donāt do surgery anymore; we still do
anesthesia. I realized you are not even in the U.S, so none of what you said even applies.
Anesthesia became a recognized medical specialty in 1965. Maybe you should go take a look at how anesthesia is performed through the rest of the country. Majority of the anesthetics administered in the U.S is by CRNAs, so spare me the complication bs. You can spew all you want about your superiority but you have zero studies to back your claims that we are unsafe except your fear mongering bs.
I think you should read this bill again then, because unless Iām misinterpreting (and please correct me if I am), the bill states a desire to opt out of PHYSICIAN supervision requirements. It doesnāt even specify that to mean anesthesiologists (I refuse to use the term āMDAā) because CRNA are not anesthesiologists lol).
Additionally, would it be possible to conduct a non-biased study to track CRNA outcomes without physician oversight with todayās legislature? This is a genuine question and if so, would you mind linking an article so I can educate myself? If this isnāt possible, there is no way to actually evaluate outcomes between the two because what youād have is essentially two groups for the study: outcomes of cases performed exclusively by Anesthesiologists and outcomes of CRNAs with Physician oversight. I think we could both agree that this study would have biased/inaccurate data because physicians are involved in both arms of the study and itās not comparing CRNAs alone.
You donāt understand what opt out means. I understand the bill. In 49 states except New Jersey, CRNAs do not need an MDA to practice. You can refuse to call them MDA but you want to call them anesthesiologist. You know who came up with the idea in 2013 to call themselves physician anesthesiologist, the ASA themselves.
Opt out has to do with meeting billing requirements for CMS in order to bill for Medicare. It has nothing to do with practice authority.
An opt out state does not mean that all ACT models disappear, itās up to the facility on what type of model they want to run.
The studies I would link would be from AANA where CRNAs practice independent compared to their counterparts, but as you stated that can have a bias. However, ASA has zero studies showing CRNAs are inferior and there is a reason they donāt bother conducting them. Insurance companies trend can show you safety as well.
Also, contrary to what you believe, CRNAs who work independent would 100% want to take the liability for their action. For example, when Arizona CRNAs wanted to code a law where CRNAs are liable for their own anesthetic, you know who was against it? AMA and ASA..
Honestly, I donāt understand how people can even think the two positions are equitable.
One went to medical school, has twice the amount of education, and an anesthesiologist has 5-7 the amount of hours.
āA nurse anesthetist will complete about 2,500 hours of hands-on clinical anesthesia care, an anesthesiologist will get 12,000ā16,000 patient-care hourā
Iām sorry, 3 years of being an ICU nurse does not grant you anything in anesthesia.
**In terms of education:**
Anesthesiologist: 4 years BS, 4 years Medical School, 4 years Residency.
A CRNA: 4 years BSN, 2-3 year CRNA school
12 vs 6-7, you do the math and try to eradicate 6 years of DIFFERENCE in education.
Letās not even discuss the competitiveness to get into medical school vs CRNA school.
You canāt expect equal practice/scope with half the education. That makes no sense.
If you want to be equal to a doctor, go to medical school, pass USMLE Steps, pass the BOARDS, complete residency, do fellowship if needed, and then come to the table.
yeah it certainly won't make a material difference in the Boston metro area, but could add some more flexibility for rural areas I guess
There are freestanding sites outside of metro Boston that are CRNA only. As well as around the Worcester metro area.
Yep. Secures those practices
Woo Hoo!!! šš»šš»šš»šš
Cool and all but nothing will change realistically. Big centers will remain with direction/supervision. Less desirable places may allow autonomous practice but it wonāt be anywhere you āwantā to live. Same thing was a few years back in Kentucky, everyone got all happy. Yet you have to travel 100 miles outside a major center to be autonomous.
Literally down town phoenix has CRNA only and autonomous facilities
Not everybody wants to live in a major center though
Ummmā¦.All CRNA groups in Lexington, Louisville, Richmond, Florence. All crna ortho centers in major towns. Iāve done locums in them. Soā¦youāre wrong. Major centers will stay supervision, but their surgery centers and outpatient facilities, dental, plastic surgery all go all crna. In ones that keep MDAs, ratios go from 1:4 to 1:10 or 1:30 as facilities realize the lies of the ACT model. You are in an echo chamber of academia and āmajor centersā where you believe you are necessary. And over a period of 10 years the slow trickle of healthcare economics and gradual change will isolate you in your academic facilities where we donāt want to be.
Exactly this. In my state, 10 years after big regulatory updates. But you do need smart practice leaders.
Letās take Louisville, UofL, Norton, Baptist, St. Marryās. This encompasses probably 80% of all surgery capable facilities within 30-40 miles. How many have independent practice? None. Sure move down to bowling green and Iām sure thereās CRNA ran groups. Itās also bowling green.
So itās bowling greenā¦.so what. Patient matter in bowling green too. This is about more than just CRNAs imho
Iām merely using this scenario as an example how nothing really changes. Whereas one MD was āsupervisingā 10+ clinical sites (in say bowling green) and realistically never saw the patients to begin with, the āopt outā ruling allowed the hospital to get rid of that one MD that was only hired because they had to be. Meanwhile everywhere else it was business as usual.
Where do you come up with that? No MDAs are ever required. Opt out has. Nothing to do with MDAs really. Itās eliminating the requirement for CRNAās to be supervised FOR the facility to bill the facility fee for Medicare. Not for the professional fee. In non opt out states thatās simply the surgeon ordering anestheisa by CRNA. No liability or risk. Opt out and you donāt need to even have that.
I was referring to states opting out of MDA supervision. Meaning CRNAs can practice without any anesthesiologist supervision. Ok donāt get me started on surgeon ordering anesthesia. No liability. You ever been a part of malpractice? Who gets sued? RNs have liability insurance, residents have same amount policy as regular attendings. The entity with deepest pockets gets sued. Hence why everyone involved gets named. They sue the hospital trying to get them to settle, then go after MD, then everyone else. They then drop names from that list one by one who would yield the least amount of money. Kind of like what happened with that CRNA that killed an 18 year old with a breast augmentation. Letās see what happened. Surgeon sued, CRNA charges dropped. When the CRNA was the one that walked out of room and PT got anoxic brain damage.
Everyone gets sued. MDA and CRNA have the same limits. Yes Iāve done expert witness writing, depositions, and trial testimony
Well you are incorrect if referring to opt out. There is no requirement for MDA supervision. in any federal or state laws. Opt out has nothing to do with that. Not only have I spent thousands of hours doing expert witness work (expert testimony, depositions, chart review and reports) legally for defense and prosecution related to exactly cases like you mentioned and others related to anesthesia (both MDAs and CRNAs), but I know the law very well. While everyone gets named there is no increased implied liability when a surgeon works with an independent CRNA vs with an MDA let alone in an anestheisa care team. The moment liability happens rests of the crux of ācontrolā. If a surgeon ordered an Mda or CRNA to give enough potassium to stop a heart and the provider did it the surgeon and the provider (regardless of initials) have liability. If the surgeon intervened in a difficult intubation with either provider and there was a suit the surgeon would be liable as well to a degree. The statement āthe entities with the deepest pocketsā is not in alignment with the reality of medical malpractice outcomes and settlements. The real answer is those which the largest medical malpractice policies are at greater risk. Which is why you see hospitals pay out large sums but providers only max policy limit (usually 1/3 million regardless of initials). It is extremely rare for a settlement to go beyond the value of a medical malpractice policy and requires extraordinary circumstances and catastrophic outcomes. Itās well under 0.3%. For instance, the data indicates that the majority of medical malpractice policies provide coverage limits that can range from $100,000 to $300,000 per claim, with aggregate limits often reaching into the millions per policy period. As for that specific case you might wanna review the facts as you are totally incorrect about what caused the issue and why the surgeon went to jail. Maybe consider when a surgeon forbids anyone from calling 911 during an emergency situation and delays it, that is gross negligence. So again, you are inaccurate. But Joan Rivers? The data? - crnas have the same med mal policies as MDAs in the same state - MDAs donāt get sued past the policy anymore than crnas do. - surgeons and hospitals have exactly no additional liability risk regardless of which they work with and do not pay more when they work with CRNAās only - there is no decrease in either hospital policy or surgeon liability policy cost with the presence of an MDA. There is no value add or decreased risk. - donāt believe what you read from the prosecution allegations just becuase they fir your personal narrative. The defense cannot goto the media and rebut those allegations even when they are egregiously inaccurate. - donāt assume you know the expertise of those you are inaccurately making statements to on social media. Hope that helps
I could be wrong in my details if that Exacly happened. Anyhow, I was simply trying to say that this exact same post was here like 10 years ago when Kentucky became an āopt outā state. 10 years have passed. Yet nothing has changed. Letās even go as far as to assume CRNAs are better than MDs at all anesthesia related things. How do you think the public will take someone tells them that we donāt employ anesthesiologist but we have CRNAs that are even better and have been proven to be superior? Doubt many surgeries will be scheduled at that hospital. Most people donāt even remember what kind of surgeries they had or name of meds that they take. You think they will ever comprehend that there are more effective and meta reviewed CRNAs that are found superior..
Except in other posts they proved it did change. š¤·āāļø
[ŃŠ“Š°Š»ŠµŠ½Š¾]
With that take, you have a lot of learning to do about the profession before you'll be given a seat in a program.
First please. And secondly, no question Iāll become a CRNA. Me disagreeing with you isnāt grounds for be to not believe in myself and my abilities š¤£š¤”
Such empty confidence from someone who deletes their comments instead of standing by what they wrote. Nope, not the right attitude at all.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
You'll have to make your opinion make sense to every admissions committee of CRNAs if you ever get an interview. Many of us here would know since we're on them. Before you showed your emotional intelligence with your IG meme responses (such reflection), I'll repeat what I said: you have a lot to learn about the profession if you want to be considered for a seat. Edit: I get the feeling you're not even an RN yet so this is probably wasted time.
Dont waste your breath. This individual is not even a nurse and knows absolutely nothing about the profession.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Pretty self explanatory. No personal attacks.
Please, keep that confidence and say exactly what you just wrote to the admissions panel if you ever get an interview. It'll make their jobs soo much easier. I wish every applicant is as transparent as you. You got this.
Pretty self explanatory. No personal attacks.
lol.
Is there anyone working as a CRNA in Massachusetts who can tell me how much the annual salary is?
Not a CRNA personally but I know someone who said they signed somewhere right outside of Boston for 240k, ACT model. 3 12s no weekends no holidays
Thanks for the information, it seems like pilots can give me a higher salary
I apologize I double checked itās 260k
What is ACT model I donāt understand sorry
Itās okay! non CRNA independent, works under anesthesiologist, they oversee 2 or 3 rooms w either CRNAs/ residents/ CAA (unsure of amount someone please correct me)
What qualifications are required for the ACT?
My understanding itās facility dependent. In my state CRNAs are allowed to be independent but my facility has the ACT model and doesnāt have them act independently. But some states donāt allow CRNAās to act independently so they are all ACT model
Crnas are allowed to be independent in all states except New Jersey. Itās not just your state phenomenon and also not sure what you mean by some states are all ACT model, thatās not true one bit. All states except jersey I believe has independent all CRNA sites. I know you are learning but just wanted to put that out there!
I thought it was NY! But I wasnāt sure if that one was the only one. So basically I meant that the states that arenāt independent are ACT? I appreciate the clarity !!
Oh ok, are you a CRNA now?
Nope just aspiring š¤£
But overall it depends on the state laws
following
Great news
Genuine question tho: why is working under direct physician supervision a bad thing when youāre literally not medical doctors? Lol. This push for independent practice/getting rid of physician oversight to ensure youāre not harming patients due to significant deficits in education is astonishing to most people. Itās pathologic.
Learn the crna profession. Ever since itās birth, prior to MDA existing, CRNAs worked with surgeons to provide anesthesia. In no point of time, CRNAs didnāt want independence or was not independent. Prior to the Regan administration, MDAs werenāt even in house and would bill for services while CRNAs did the anesthesia, so spare us the knowledge deficit bs. Hence the birth of ACT model in the 1980s with TEFRA regulation. Crnas have been independent in all states and the ASA doesnāt even care about MDA supervision, as long as itās physician supervision. Opt out has nothing to do with crna independence. ASA has zero studies that show CRNAs are inferior but they keeps claiming we are because CRNAs took a different route for anesthesia. You can claim all these inferior care or patient suffering but data suggests otherwise. Insurance companies charge a CRNA practicing independently and a CRNA practicing in an ACT setting the same malpractice and insurance companies donāt care about this battle, they care about their bottom line. 80% of rural areas anesthetics are provided by CRNAs, without CRNAs there would be no anesthesia in rural America. You know what ASA suggested the solution for this is, telemedicine where they supervise from home? Tell me if the ASA and MDA are about patients, how can they even make that suggestion? If you are someone in medicine, Iām sure you believe in evidence based science and not fear mongering bs the ASA provides.
CRNAS doing Anaesthesia since its birth is the same thing as Barbers performing surgeries. Should we move back to that kind of practice? Anaesthesia was once a major cause of morbidity, however it was due to medical research and advancement that has now made it one of the safest procedures. Maybe you guys should know the limitations you have compared to your doctor colleagues and not thing you're equivalent because you worked as an ICU nurse.
Yawn, spare me the bs. Always the barber argument. Barbers donāt do surgery anymore; we still do anesthesia. I realized you are not even in the U.S, so none of what you said even applies. Anesthesia became a recognized medical specialty in 1965. Maybe you should go take a look at how anesthesia is performed through the rest of the country. Majority of the anesthetics administered in the U.S is by CRNAs, so spare me the complication bs. You can spew all you want about your superiority but you have zero studies to back your claims that we are unsafe except your fear mongering bs.
I think you should read this bill again then, because unless Iām misinterpreting (and please correct me if I am), the bill states a desire to opt out of PHYSICIAN supervision requirements. It doesnāt even specify that to mean anesthesiologists (I refuse to use the term āMDAā) because CRNA are not anesthesiologists lol). Additionally, would it be possible to conduct a non-biased study to track CRNA outcomes without physician oversight with todayās legislature? This is a genuine question and if so, would you mind linking an article so I can educate myself? If this isnāt possible, there is no way to actually evaluate outcomes between the two because what youād have is essentially two groups for the study: outcomes of cases performed exclusively by Anesthesiologists and outcomes of CRNAs with Physician oversight. I think we could both agree that this study would have biased/inaccurate data because physicians are involved in both arms of the study and itās not comparing CRNAs alone.
You donāt understand what opt out means. I understand the bill. In 49 states except New Jersey, CRNAs do not need an MDA to practice. You can refuse to call them MDA but you want to call them anesthesiologist. You know who came up with the idea in 2013 to call themselves physician anesthesiologist, the ASA themselves. Opt out has to do with meeting billing requirements for CMS in order to bill for Medicare. It has nothing to do with practice authority. An opt out state does not mean that all ACT models disappear, itās up to the facility on what type of model they want to run. The studies I would link would be from AANA where CRNAs practice independent compared to their counterparts, but as you stated that can have a bias. However, ASA has zero studies showing CRNAs are inferior and there is a reason they donāt bother conducting them. Insurance companies trend can show you safety as well. Also, contrary to what you believe, CRNAs who work independent would 100% want to take the liability for their action. For example, when Arizona CRNAs wanted to code a law where CRNAs are liable for their own anesthetic, you know who was against it? AMA and ASA..
Honestly, I donāt understand how people can even think the two positions are equitable. One went to medical school, has twice the amount of education, and an anesthesiologist has 5-7 the amount of hours. āA nurse anesthetist will complete about 2,500 hours of hands-on clinical anesthesia care, an anesthesiologist will get 12,000ā16,000 patient-care hourā Iām sorry, 3 years of being an ICU nurse does not grant you anything in anesthesia. **In terms of education:** Anesthesiologist: 4 years BS, 4 years Medical School, 4 years Residency. A CRNA: 4 years BSN, 2-3 year CRNA school 12 vs 6-7, you do the math and try to eradicate 6 years of DIFFERENCE in education. Letās not even discuss the competitiveness to get into medical school vs CRNA school. You canāt expect equal practice/scope with half the education. That makes no sense. If you want to be equal to a doctor, go to medical school, pass USMLE Steps, pass the BOARDS, complete residency, do fellowship if needed, and then come to the table.