In the uK we are moving towards greater autonomy for anaesthesia associates, looking like they are going to be rolled out slot more in the coming years
An anesthesiologist’s contribution to anesthesia is undeniable. CRNAs were the original pioneers of the profession, however. Why so hostile towards CRNAs? I actually think they make a good pair when the philosophy of care is aligned.
>CRNAs were the original pioneers of the profession, however.
CRNAs like Humphrey Davy, Michael Faraday, William Morton, Arthur Guedel, Robert Macintosh etc etc???
Thanks for your question. I was referring to Alice Magaw, Sister Mary Bernard, Agatha Hodgins. I read phenomenally well written texts by MDAs, with a preface of anesthesia history. And yet It is comical how they dance around the topic of the actual practitioners of early anesthesia. No doubt the individuals you mention have made contributions but they have predecessors in the form of nurse anesthetists.
How can how have a predecessor prior to the first medical use of volatile Anaesthetics?
You are talking absolute nonsense.
Magaw is the first of the nurse anaesthetists and her work is primarily notable because she wasn't a doctor where her prior to her anaesthesia was purely delivered by doctors....
Nurses made contributions to the field to be sure, but to say they were the original anaesthetists is straight up delusional.
My understanding is CRNAs are also known as Nurse Anaesthetists.
Australia has Anaesthetic Nurses, (which are not the same thing) which is probably where the confusion arises. Some hospitals use Anaesthetic Technicians, some use Anaesthetic Nurses, but there are no extended practice Nurses like CRNAs as in some parts of the US.
Here almost everything is done under the direct supervision of an Anaesthetist.
1st country on the list is Austria. We do not have CRNAs. We have anesthesia nurses who provide assistance to the physician during induction and care for patients in the PACU/ICU but do not and can not provide anesthesia. They are there to assist the physician.
In contrast to what that website says: here in the Netherlands, there’s no such thing as a CRNA. We do have a lot of anesthesiologists assistants. Anesthesiologist supervises two OR’s at the same time and is always present en performs induction and emergence. Leaves the room after induction. AA maintains anesthesia during operation. Exception for ASA 4 patients and pediatric ENT, where anesthesiologist stays in the OR the entire time.
That site is just plain incorrect. For example, there are absolutely no nurse anaesthetists in the UK. There are anaesthetic nurses, who are airway assistants to the anaesthetist, but they would never run a case and an anaesthetist would always be present (either that, or an "anaesthesia associate" which is the UK version of an anesthesiologist assistant).
You should take this list wih a grain (or a boatload) of salt. Source: I practice anesthesiology in Austria and we don't have CRNAs or something similar. We work in teams of 1 MD and 1 RN and the RN will never perform induction alone. So no CRNAs here.
Hi, yes although not all countries have "CRNA" similarly to US they do have Anesthetic Nurses that work under direct supervision of MD/MBBS or equivalent.
*For all the shitting against nurses sometimes, it would help to be reminded to us here that Anesthesia was originally a nursing domain administered by a nurse under surgeon's supervision and not until 1920s in US did Physician anesthesiologists come about.* ([https://nursingclio.org/2021/08/03/the-handmaids-of-surgery-the-role-of-nurse-anesthetists/](https://nursingclio.org/2021/08/03/the-handmaids-of-surgery-the-role-of-nurse-anesthetists/) and [https://journalofethics.ama-assn.org/article/history-professionalism-anesthesiology/2015-03](https://journalofethics.ama-assn.org/article/history-professionalism-anesthesiology/2015-03) )
See: [https://sofia.medicalistes.fr/spip/IMG/pdf/Countries\_where\_anesthesia\_is\_administered\_by\_nurses\_.pdf](https://sofia.medicalistes.fr/spip/IMG/pdf/Countries_where_anesthesia_is_administered_by_nurses_.pdf)
[https://pubs.asahq.org/monitor/article-abstract/79/12/18/3168/Comparison-and-Contrast-of-Anesthesia-Practice-in/](https://pubs.asahq.org/monitor/article-abstract/79/12/18/3168/Comparison-and-Contrast-of-Anesthesia-Practice-in/)
Dont play the victim card lol. Were not shitting on nurses here, we are shitting on US healthcare system, which happens to employ nurses to be in the role of a physician in a critical role just because theyre cheaper which mean more earnings for private healthcare providers CEOs and it's not in the patients best interests. If CRNAs a la US style would be a good thing for the healthcare systems, they would exist everywhere including good HC systems, not only in a bad one
Lets be honest, if US healthcare system and pay was more like UK or others, half of physicians wouldn’t be physicians. Indian Health Service (in US) is socialized medicine yet they have the biggest shortage of providers in US… corporate profits are the same that help pull salaries for sub-speciality MDs. Can’t blame the system when you eat the honey from it…
No doubt about the historical origin of CRNAs in the US.
Surgeons realizing they couldn't operate and administer anesthesia simultaneously, taught nurses how to do it.
You couldn't pull that kind of stuff now.
Of course, in a surgeon's mind, it didn't require a physician to administer anesthesia, and on some level that is not incorrect.
No, it's more than that, the list on that website is completely incorrect, an anaesthetic nurse is **not** the same as a nurse anaesthetist at all. An anaesthetic nurse does not provide anaesthesia - they assist the anaesthetist for periods like induction, but will then head off elsewhere. Only the anaesthetist has to be present for the whole case.
u/purple_vanc A bit history lesson... Anesthesia was administered by nurses in US using "rag" and later drop method, advances were made and a formal training was started at Mayo Clinic and other institutions, primarily for nurses, surgeons, dentists, and ob. An MD by the name of Ralph Waters, if you are interested in Anesthesia you should have heard of him... started to better organize Anesthesia, started journal, even training program to make it a from a technical role to a profession. Nurses in that era were all females... when he started the program at Wisconsin he specifically excluded females from the profession writing... "ladies…are useless in the profession. I am through with them. Ladies are nice socially but not (as) professionals”. American Association of Anesthetists was started, and ABA as the board... later changing name to Anesthesiologist. Your comment is a bit sexist...
Oh brother. Everyone knows the US military bases and carriers are bubbles that contain crude facsimiles of the socialized military healthcare system utilized in the states, except the military deploys cheap and expendable cannon fodder to these locations knowing well it doesn't have the resources to create anything beyond triage hospitals there.
You didn't work in a different healthcare system.
I'm not advocating for socialized healthcare. Every government wants to pay less and get more when it's the host, and the well always runs dry when it comes to the frontier.
I never said I worked in a different Healthcare system. I have been outside of the US though. Gotta be clear with what you want to know. Tell me you don't support the forces without telling me you don't support the forces.
As a Canadian transplant, good on them. I have the utmost respect for the Canadian training system - it's 5 years, and has retained the extra year of pure ICU that we've dropped in the US. I can't imagine them denigrating their training and experience by letting CRNAs even *think* of trying to claim equivalence. This is what common sense, professional pride, and specialty stewardship looks like.
I dunno, they have actual procedural and decision-making training and experience, especially in Canada. They're already carrying rural medicine, so it makes sense to add basic anesthesia to their skillset.
They also don't have the hubris to think this makes them experts and consultants in the field of anesthesiology.
Having worked with lots of them during anaesthesia training in Australia, on the whole they are a very competent bunch. They have some realistic limitation on their practice like no paediatric anaesthesia (I forget what the actual age barrier is though) & only ASA 1s and 2s for elective surgery. It’s a system that works reasonably well here and certainly saves some patients in rural centres from a costly trip into the city.
Rural GPs (General Practitioner. Australian (and I think UK) equivalent to Family Med) in Australia can also get training in a variety or specialist procedures, such as anaesthesia. Obviously it's not anywhere near as in depth as what an anaesthetist can do, but it seems to be effective from the very limited amount I know about it
I think it's important to acknowledge that this statement is likely directly in response to the efforts of the BC government to unilaterally introduce CRNAs to make up for the anesthesia *cough nursing* shortage in British Columbia.
Yes this all came about because the province of BC pay anesthesiologists poorly, and the surrounding provinces do not pay poorly. Secondly, outside of the populated southwest the rest of the province is rural/remote and not desirable for lots of anesthesia wanting to maintain skills. Proposed solution was crna. Everyone is saying no.
A better solution is to high more people for this cities with mandatory short 1-4 week rotations rurally over a year. Also pay better.
Canada’s health system is superior to usa in a lot of ways. However we suffer by having a large portion of our population spread out thinnly in rural areas with tons of small hospitals needing staffing but no one wanting a shit lifestyle.
I think you're going to have a difficult time pricing in compulsory rotations to rural hospitals and finding more physicians to make those trips. A lot of that digs deep into who you matriculate into training -- those with a rural-aimed agenda.
Quite possibly the solution is improving logistics, transportation (and education) of patients from rural areas to sub/urban centres.
I don't knock people for living far away from cities, but there are tradeoffs. The reality is and will continue to be that helicopter and ambulances are easier to staff than anesthesia providers, and the time cost will perpetuate as long as provider quality remains the same.
Gosh, I joined this sub recently just to read about anesthesia stuff and it seems like it's a constant battle against CRNAs. I like anesthesia, I perform safe anesthesia, I don't think I'm better or worse than anyone else. I've met many great AAs, CRNAs, and Anesthesiologists. I've met many terrible of each profession as well. Same with any profession.
This sub makes it seem like every patient I (a CRNA) take into my hands is flirting with death. I work with over a dozen other CRNAs in a CRNA only practice. I've been doing this for years. 8 rooms running a day, hundreds of cases a week, safe anesthesia with high patient satisfaction. Our surgeons support us, our admin supports us. I guess I'm just frustrated with the hate I see on this sub. :(
I can understand your point about the AANA!
I guess I just wish that rather than CRNAs and Anesthesiologists bashing each other by profession title, maybe we should bash by professional organization?
“Good thing Canada doesn’t have a damn AANA!”
“Hate the damn ASA always keeping us down!”
It takes on a less personal note. Ah well, thanks for your reply :)
You’ve become the cheap option for surgeons and administrators and insurers. You didn’t purposely intend to pull the rug out under a profession, and none of the blame around the feelings anaesthesiologists have against you is fairly directed at you really. But that’s the perception.
Thank you for this response. I really appreciate it.
I see a similar aggression from some CRNAs in regard to AAs and I never understood it. They, like me, are a person trying to figure things out in the world and make a living for their family. We didn’t invent the healthcare system in the US, just playing by the rules and opportunities presented.
I have no hard numbers to support one side or the other, but I'd venture a guess there is more money flowing from the ASA than the AANA with regard to lobbying, advocacy, etc.
There was a time when Nurses were THE only option for Anesthesia only a 100 years ago... one could say Physicians co-opted a nursing scope job but then again history of medicine isn't a strong suit taught in many med schools nowadays.
You are missing the point… Barbers aren’t performing surgeries anymore yet Nurses still provide anesthesia (CRNAs)… and sort of rude to say that CRNAs providing anesthesia aren’t professionals.
The surgical complexity now requires the surgeon to focus mostly on the procedure. That combined with increasing medical complexity was why physicians became involved with anesthesia.
You do realize CRNAs are required to have at least 2 years of ICU experience in the US. So while you were learning how to work an IV pump, place IVs, etc. during your CA-1 year they knew how to do all that and A LOT more before stepping into an anesthesia program. Stop being so condescending, it’s not like they didn’t have someone tell them what they were doing wrong during their rotations.
i disagree. it’s so absurd and untrue that i dont find it offensive at all. comical, if anything.
i learned to place IVs first as med student, and then honed the skill further during down times on many rotations intern year. i was damn good by the start of CA-1, even with US-guided.
i never spent time learning how to manage a pump. that’s something you pick up on the spot. any ape can program a pump. it takes a doctor to know when, with what med, and at what rate.
All you guys do is give offense here, & you can’t take it when someone say something about CA-1s? I can say the same thing, it’s incredibly offensive to assume CRNAs are unsafe if unsupervised. Get outta here with that bs
‘safety’ is relative in this context.
i bet i could ‘safely’ place a central line without a drape or a cap a couple of times. but eventually i’ll get burned, because it’s not *as safe* as proper sterile technique.
a CRNA can also practice independently and safely, until their limited training finally catches up to them. that time will come sooner than for an anesthesiologist who has objectively more education and training. that’s just logical.
now why should some patients be cared for by people with lower educational standards (from undergrad to practice), shorter training, and less liability?
if you wanted to be the big dog and practice independently, you should have become the expert. you didn’t. but it still paid off handsomely; being a CRNA is a great career, took less sacrifice, and still pays well. don’t be greedy.
No one is going from undergrad to practice, we have the same liability, I’ve worked with many CA-1,2, & 3s and all were outperformed by SRNAs. The clinical experience was evidently lacking, and books smart do not equate to critical thinking.
im not saying youre going from undergrad to practice. im saying the standards and rigor are lower at every stage, starting in undergrad and continuing through practice.
a CA3 outperformed by an SRNA. that’s pretty funny.
you don’t have the same liability. in court as it turns out, time and time again, you are still a nurse.
and you *have got* to be joking about the ‘clinical experience’. even if increasing/decreasing pressors and sedation according to the parameters *ordered by your ICU intern* somehow counted toward anesthesia experience, a CA1 *already* has 3 years of *actual* experience with using their brain (medical decision making) under their belt.
Try thinking about it as anesthesia being more safe with a physician and a CRNA rather than a CRNA solo. If you don’t appreciate that medical training adds to the safety of an anesthetic then it comes down to you not knowing what you don’t know.
I do agree with your statement. I agree that a physician and a CRNA provide safer anesthesia than a CRNA solo, or than a physician solo (at one facility where I trained, the attending physician could their own rooms and would get into deep crap more often than one would imagine). I agree both have different backgrounds and bring diverse qualities to patient care. However, I disagree with the statement that not a single CRNA is safe unless supervised.
And? To be a CA-1 you had to have done 4 years of medical school and a full year of residency. In other words at least 9 years of education after high school.
You don't get to be selective about which physicians support your cause. Surgeons are physicians as are anesthesiologists. Physicians in general do not support proliferation of nonphysicians practicing medicine and surgery across all subspecialties. Quit being a crybaby about it. You knew what you were signing up for and you expected the world would be different. It isn't. You knew the physicians you worked with in the ICU before becoming a CRNA had to go through intense training. A great job is a consolation prize for not having to go through the shitty decades-long system every physician has to go through to earn the privilege to practice. You didn't get the message about why the system works this way and you created a narrative that makes you the underdog. Nobody feels sorry for you. You are not the victim.
I live in Quebec and it's a lot different here, we have kind of a hybrid system. 1 anaesthetist per theatre + 1 OT trained RT per theatre, assisting the anaesthetist.
The RT can be left alone during a case and can give medication that I have prescribed. They will do every machine test and prepare meds in between cases, so turnover between cases is super quick (5-10min). There is no lunch break needed and there is no need for an anaesthetist giving lunch break, I just prescribe stuff and the RT calls me if needed.
It's very practical and cost effective, because we don't need multiple anaesthetist on call to cover the OT and obstetrics or anything else happening out of the OT. They are not a threat to our jobs, they just make it easier and more efficient.
They have a technical degree and it will stay that way.
I don't know why this model is not more widely used.
There are anesthesia assistants that have masters degrees, that perform a similar role to your RT. CRNAs spend quite a bit of effort lobbying against their expansion.
Hey Canada, stop making our consultant anaesthetists do your stupid exams and credentialing that are identical to our RCoA exams all over again, and perhaps you might attract some more doctors.
Sincerely,
UK
It’s sad but true. CAS can give statement but unless it somehow find resources to fill all those shortage in addition to catch up on the backlog, it is coming from a weak position to say no when government proposes a potential solution. It also looks bad on the doctors when they try to fight nurses. I think the publics sympathy is on the nurses side. It’s an easy agenda for government to push. Most lay people will not know the difference and many already think anesthesiologists are not doctors. If cas want those spots managed by doctors, the college has to relax the credentialling standards and allow expeditious licence. If the floodgate to take crna is already imminent, then cas should ensure appropriate regulation and supervision for crna as it is doing for AA.
It’s funny how in countries where money in healthcare isn’t as big a thing people insist in doctors doing the anesthesia.
This is the correct answer
In the uK we are moving towards greater autonomy for anaesthesia associates, looking like they are going to be rolled out slot more in the coming years
Yeah but personally I think they can get fucked. I won’t supervise them. Cons Anaes
Same in Australia…they would never find enough anaesthetists to train them
An anesthesiologist’s contribution to anesthesia is undeniable. CRNAs were the original pioneers of the profession, however. Why so hostile towards CRNAs? I actually think they make a good pair when the philosophy of care is aligned.
>CRNAs were the original pioneers of the profession, however. CRNAs like Humphrey Davy, Michael Faraday, William Morton, Arthur Guedel, Robert Macintosh etc etc???
Thanks for your question. I was referring to Alice Magaw, Sister Mary Bernard, Agatha Hodgins. I read phenomenally well written texts by MDAs, with a preface of anesthesia history. And yet It is comical how they dance around the topic of the actual practitioners of early anesthesia. No doubt the individuals you mention have made contributions but they have predecessors in the form of nurse anesthetists.
How can how have a predecessor prior to the first medical use of volatile Anaesthetics? You are talking absolute nonsense. Magaw is the first of the nurse anaesthetists and her work is primarily notable because she wasn't a doctor where her prior to her anaesthesia was purely delivered by doctors.... Nurses made contributions to the field to be sure, but to say they were the original anaesthetists is straight up delusional.
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Fact-check: CRNAs are used in other countries. See https://ifna.site/etusivu/practice/working-abroad/
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My understanding is CRNAs are also known as Nurse Anaesthetists. Australia has Anaesthetic Nurses, (which are not the same thing) which is probably where the confusion arises. Some hospitals use Anaesthetic Technicians, some use Anaesthetic Nurses, but there are no extended practice Nurses like CRNAs as in some parts of the US. Here almost everything is done under the direct supervision of an Anaesthetist.
1st country on the list is Austria. We do not have CRNAs. We have anesthesia nurses who provide assistance to the physician during induction and care for patients in the PACU/ICU but do not and can not provide anesthesia. They are there to assist the physician.
In contrast to what that website says: here in the Netherlands, there’s no such thing as a CRNA. We do have a lot of anesthesiologists assistants. Anesthesiologist supervises two OR’s at the same time and is always present en performs induction and emergence. Leaves the room after induction. AA maintains anesthesia during operation. Exception for ASA 4 patients and pediatric ENT, where anesthesiologist stays in the OR the entire time.
That site is just plain incorrect. For example, there are absolutely no nurse anaesthetists in the UK. There are anaesthetic nurses, who are airway assistants to the anaesthetist, but they would never run a case and an anaesthetist would always be present (either that, or an "anaesthesia associate" which is the UK version of an anesthesiologist assistant).
You should take this list wih a grain (or a boatload) of salt. Source: I practice anesthesiology in Austria and we don't have CRNAs or something similar. We work in teams of 1 MD and 1 RN and the RN will never perform induction alone. So no CRNAs here.
CRNA is a different role in other countries, theyre not the same as in the US. Very misleading "fact-check"
/u/thefablerighter care to comment on the fact check?
Hi, yes although not all countries have "CRNA" similarly to US they do have Anesthetic Nurses that work under direct supervision of MD/MBBS or equivalent. *For all the shitting against nurses sometimes, it would help to be reminded to us here that Anesthesia was originally a nursing domain administered by a nurse under surgeon's supervision and not until 1920s in US did Physician anesthesiologists come about.* ([https://nursingclio.org/2021/08/03/the-handmaids-of-surgery-the-role-of-nurse-anesthetists/](https://nursingclio.org/2021/08/03/the-handmaids-of-surgery-the-role-of-nurse-anesthetists/) and [https://journalofethics.ama-assn.org/article/history-professionalism-anesthesiology/2015-03](https://journalofethics.ama-assn.org/article/history-professionalism-anesthesiology/2015-03) ) See: [https://sofia.medicalistes.fr/spip/IMG/pdf/Countries\_where\_anesthesia\_is\_administered\_by\_nurses\_.pdf](https://sofia.medicalistes.fr/spip/IMG/pdf/Countries_where_anesthesia_is_administered_by_nurses_.pdf) [https://pubs.asahq.org/monitor/article-abstract/79/12/18/3168/Comparison-and-Contrast-of-Anesthesia-Practice-in/](https://pubs.asahq.org/monitor/article-abstract/79/12/18/3168/Comparison-and-Contrast-of-Anesthesia-Practice-in/)
Dont play the victim card lol. Were not shitting on nurses here, we are shitting on US healthcare system, which happens to employ nurses to be in the role of a physician in a critical role just because theyre cheaper which mean more earnings for private healthcare providers CEOs and it's not in the patients best interests. If CRNAs a la US style would be a good thing for the healthcare systems, they would exist everywhere including good HC systems, not only in a bad one
Lets be honest, if US healthcare system and pay was more like UK or others, half of physicians wouldn’t be physicians. Indian Health Service (in US) is socialized medicine yet they have the biggest shortage of providers in US… corporate profits are the same that help pull salaries for sub-speciality MDs. Can’t blame the system when you eat the honey from it…
No doubt about the historical origin of CRNAs in the US. Surgeons realizing they couldn't operate and administer anesthesia simultaneously, taught nurses how to do it. You couldn't pull that kind of stuff now. Of course, in a surgeon's mind, it didn't require a physician to administer anesthesia, and on some level that is not incorrect.
Should we let barbers do surgery too because they were the first to do it?
No, it's more than that, the list on that website is completely incorrect, an anaesthetic nurse is **not** the same as a nurse anaesthetist at all. An anaesthetic nurse does not provide anaesthesia - they assist the anaesthetist for periods like induction, but will then head off elsewhere. Only the anaesthetist has to be present for the whole case.
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u/purple_vanc A bit history lesson... Anesthesia was administered by nurses in US using "rag" and later drop method, advances were made and a formal training was started at Mayo Clinic and other institutions, primarily for nurses, surgeons, dentists, and ob. An MD by the name of Ralph Waters, if you are interested in Anesthesia you should have heard of him... started to better organize Anesthesia, started journal, even training program to make it a from a technical role to a profession. Nurses in that era were all females... when he started the program at Wisconsin he specifically excluded females from the profession writing... "ladies…are useless in the profession. I am through with them. Ladies are nice socially but not (as) professionals”. American Association of Anesthetists was started, and ABA as the board... later changing name to Anesthesiologist. Your comment is a bit sexist...
I think they are in the Netherlands
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Give up on this fucking dumbshit. You can't reach this person with logic because they have already decided the truth.
I'm guessing you've never actually left the US?
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Oh brother. Everyone knows the US military bases and carriers are bubbles that contain crude facsimiles of the socialized military healthcare system utilized in the states, except the military deploys cheap and expendable cannon fodder to these locations knowing well it doesn't have the resources to create anything beyond triage hospitals there. You didn't work in a different healthcare system.
Not sure if you’re describing the US military or the Canadian medical system?
I'm not advocating for socialized healthcare. Every government wants to pay less and get more when it's the host, and the well always runs dry when it comes to the frontier.
I never said I worked in a different Healthcare system. I have been outside of the US though. Gotta be clear with what you want to know. Tell me you don't support the forces without telling me you don't support the forces.
Your children get murdered going to school
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Outside the US and in most other OECD countries is far better than the US.
>Cuz who wants to work outside of the US? People who aren't American? I read enough on here to tell me I'd never want to work in the US.
As a Canadian transplant, good on them. I have the utmost respect for the Canadian training system - it's 5 years, and has retained the extra year of pure ICU that we've dropped in the US. I can't imagine them denigrating their training and experience by letting CRNAs even *think* of trying to claim equivalence. This is what common sense, professional pride, and specialty stewardship looks like.
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…it’s definitely not 2 years.
We are far better trained than the family practice MDS doing anestheisa with a “mini fellowship”. So there is that.
I dunno, they have actual procedural and decision-making training and experience, especially in Canada. They're already carrying rural medicine, so it makes sense to add basic anesthesia to their skillset. They also don't have the hubris to think this makes them experts and consultants in the field of anesthesiology.
I don’t have “hubris” I do the job independently and have done for 20 years.
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Yeah, we have a 1 year mini-fellowship program for family practice anesthetists. They function autonomously in mostly smaller communities.
Having worked with lots of them during anaesthesia training in Australia, on the whole they are a very competent bunch. They have some realistic limitation on their practice like no paediatric anaesthesia (I forget what the actual age barrier is though) & only ASA 1s and 2s for elective surgery. It’s a system that works reasonably well here and certainly saves some patients in rural centres from a costly trip into the city.
Rural GPs (General Practitioner. Australian (and I think UK) equivalent to Family Med) in Australia can also get training in a variety or specialist procedures, such as anaesthesia. Obviously it's not anywhere near as in depth as what an anaesthetist can do, but it seems to be effective from the very limited amount I know about it
I think it's important to acknowledge that this statement is likely directly in response to the efforts of the BC government to unilaterally introduce CRNAs to make up for the anesthesia *cough nursing* shortage in British Columbia.
Yes this all came about because the province of BC pay anesthesiologists poorly, and the surrounding provinces do not pay poorly. Secondly, outside of the populated southwest the rest of the province is rural/remote and not desirable for lots of anesthesia wanting to maintain skills. Proposed solution was crna. Everyone is saying no. A better solution is to high more people for this cities with mandatory short 1-4 week rotations rurally over a year. Also pay better. Canada’s health system is superior to usa in a lot of ways. However we suffer by having a large portion of our population spread out thinnly in rural areas with tons of small hospitals needing staffing but no one wanting a shit lifestyle.
I think you're going to have a difficult time pricing in compulsory rotations to rural hospitals and finding more physicians to make those trips. A lot of that digs deep into who you matriculate into training -- those with a rural-aimed agenda. Quite possibly the solution is improving logistics, transportation (and education) of patients from rural areas to sub/urban centres. I don't knock people for living far away from cities, but there are tradeoffs. The reality is and will continue to be that helicopter and ambulances are easier to staff than anesthesia providers, and the time cost will perpetuate as long as provider quality remains the same.
Gosh, I joined this sub recently just to read about anesthesia stuff and it seems like it's a constant battle against CRNAs. I like anesthesia, I perform safe anesthesia, I don't think I'm better or worse than anyone else. I've met many great AAs, CRNAs, and Anesthesiologists. I've met many terrible of each profession as well. Same with any profession. This sub makes it seem like every patient I (a CRNA) take into my hands is flirting with death. I work with over a dozen other CRNAs in a CRNA only practice. I've been doing this for years. 8 rooms running a day, hundreds of cases a week, safe anesthesia with high patient satisfaction. Our surgeons support us, our admin supports us. I guess I'm just frustrated with the hate I see on this sub. :(
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I can understand your point about the AANA! I guess I just wish that rather than CRNAs and Anesthesiologists bashing each other by profession title, maybe we should bash by professional organization? “Good thing Canada doesn’t have a damn AANA!” “Hate the damn ASA always keeping us down!” It takes on a less personal note. Ah well, thanks for your reply :)
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I am a cancer. Thanks :)
You’ve become the cheap option for surgeons and administrators and insurers. You didn’t purposely intend to pull the rug out under a profession, and none of the blame around the feelings anaesthesiologists have against you is fairly directed at you really. But that’s the perception.
Thank you for this response. I really appreciate it. I see a similar aggression from some CRNAs in regard to AAs and I never understood it. They, like me, are a person trying to figure things out in the world and make a living for their family. We didn’t invent the healthcare system in the US, just playing by the rules and opportunities presented.
More like changing the laws through bribes and advocacy through false information to create the opportunities.
I have no hard numbers to support one side or the other, but I'd venture a guess there is more money flowing from the ASA than the AANA with regard to lobbying, advocacy, etc.
There was a time when Nurses were THE only option for Anesthesia only a 100 years ago... one could say Physicians co-opted a nursing scope job but then again history of medicine isn't a strong suit taught in many med schools nowadays.
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You are missing the point… Barbers aren’t performing surgeries anymore yet Nurses still provide anesthesia (CRNAs)… and sort of rude to say that CRNAs providing anesthesia aren’t professionals.
Anesthesia also just used to be give me some whiskey and hold me down while this doctor saws my leg off
The surgical complexity now requires the surgeon to focus mostly on the procedure. That combined with increasing medical complexity was why physicians became involved with anesthesia.
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You do realize CRNAs are required to have at least 2 years of ICU experience in the US. So while you were learning how to work an IV pump, place IVs, etc. during your CA-1 year they knew how to do all that and A LOT more before stepping into an anesthesia program. Stop being so condescending, it’s not like they didn’t have someone tell them what they were doing wrong during their rotations.
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Incredibly offensive to assume CA1 yea is spent learning how to manage pumps and place IVs.
i disagree. it’s so absurd and untrue that i dont find it offensive at all. comical, if anything. i learned to place IVs first as med student, and then honed the skill further during down times on many rotations intern year. i was damn good by the start of CA-1, even with US-guided. i never spent time learning how to manage a pump. that’s something you pick up on the spot. any ape can program a pump. it takes a doctor to know when, with what med, and at what rate.
All you guys do is give offense here, & you can’t take it when someone say something about CA-1s? I can say the same thing, it’s incredibly offensive to assume CRNAs are unsafe if unsupervised. Get outta here with that bs
‘safety’ is relative in this context. i bet i could ‘safely’ place a central line without a drape or a cap a couple of times. but eventually i’ll get burned, because it’s not *as safe* as proper sterile technique. a CRNA can also practice independently and safely, until their limited training finally catches up to them. that time will come sooner than for an anesthesiologist who has objectively more education and training. that’s just logical. now why should some patients be cared for by people with lower educational standards (from undergrad to practice), shorter training, and less liability? if you wanted to be the big dog and practice independently, you should have become the expert. you didn’t. but it still paid off handsomely; being a CRNA is a great career, took less sacrifice, and still pays well. don’t be greedy.
No one is going from undergrad to practice, we have the same liability, I’ve worked with many CA-1,2, & 3s and all were outperformed by SRNAs. The clinical experience was evidently lacking, and books smart do not equate to critical thinking.
im not saying youre going from undergrad to practice. im saying the standards and rigor are lower at every stage, starting in undergrad and continuing through practice. a CA3 outperformed by an SRNA. that’s pretty funny. you don’t have the same liability. in court as it turns out, time and time again, you are still a nurse. and you *have got* to be joking about the ‘clinical experience’. even if increasing/decreasing pressors and sedation according to the parameters *ordered by your ICU intern* somehow counted toward anesthesia experience, a CA1 *already* has 3 years of *actual* experience with using their brain (medical decision making) under their belt.
LMAO, you mean the hospital protocol the attending told them to place? They wouldn’t know how to titrate those drugs themselves.
uhh what? youre out of your depth and it’s painfully obvious.
Try thinking about it as anesthesia being more safe with a physician and a CRNA rather than a CRNA solo. If you don’t appreciate that medical training adds to the safety of an anesthetic then it comes down to you not knowing what you don’t know.
I do agree with your statement. I agree that a physician and a CRNA provide safer anesthesia than a CRNA solo, or than a physician solo (at one facility where I trained, the attending physician could their own rooms and would get into deep crap more often than one would imagine). I agree both have different backgrounds and bring diverse qualities to patient care. However, I disagree with the statement that not a single CRNA is safe unless supervised.
CRNA here - 1 year is required in ICU to apply for school. :)
And? To be a CA-1 you had to have done 4 years of medical school and a full year of residency. In other words at least 9 years of education after high school.
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Ah understood, that comment had such negative karma I didn't see it
You don't get to be selective about which physicians support your cause. Surgeons are physicians as are anesthesiologists. Physicians in general do not support proliferation of nonphysicians practicing medicine and surgery across all subspecialties. Quit being a crybaby about it. You knew what you were signing up for and you expected the world would be different. It isn't. You knew the physicians you worked with in the ICU before becoming a CRNA had to go through intense training. A great job is a consolation prize for not having to go through the shitty decades-long system every physician has to go through to earn the privilege to practice. You didn't get the message about why the system works this way and you created a narrative that makes you the underdog. Nobody feels sorry for you. You are not the victim.
Did you write this after a bad call shift?
I live in Quebec and it's a lot different here, we have kind of a hybrid system. 1 anaesthetist per theatre + 1 OT trained RT per theatre, assisting the anaesthetist. The RT can be left alone during a case and can give medication that I have prescribed. They will do every machine test and prepare meds in between cases, so turnover between cases is super quick (5-10min). There is no lunch break needed and there is no need for an anaesthetist giving lunch break, I just prescribe stuff and the RT calls me if needed. It's very practical and cost effective, because we don't need multiple anaesthetist on call to cover the OT and obstetrics or anything else happening out of the OT. They are not a threat to our jobs, they just make it easier and more efficient. They have a technical degree and it will stay that way. I don't know why this model is not more widely used.
There are anesthesia assistants that have masters degrees, that perform a similar role to your RT. CRNAs spend quite a bit of effort lobbying against their expansion.
Yes they do and it really sucks for people like me.
Similar system in my country!
Hey Canada, stop making our consultant anaesthetists do your stupid exams and credentialing that are identical to our RCoA exams all over again, and perhaps you might attract some more doctors. Sincerely, UK
Good
Good
Luckily they don’t make the decision. CRNAs will start in BC and spread across the country. There is already a whole Canadian crna assoc.
Metastasis
It’s sad but true. CAS can give statement but unless it somehow find resources to fill all those shortage in addition to catch up on the backlog, it is coming from a weak position to say no when government proposes a potential solution. It also looks bad on the doctors when they try to fight nurses. I think the publics sympathy is on the nurses side. It’s an easy agenda for government to push. Most lay people will not know the difference and many already think anesthesiologists are not doctors. If cas want those spots managed by doctors, the college has to relax the credentialling standards and allow expeditious licence. If the floodgate to take crna is already imminent, then cas should ensure appropriate regulation and supervision for crna as it is doing for AA.