Expansion

Well, here is the headline:

Nurses Seek Expanded Role

This is a headline that you will see more and more in the future.  Sort of.  First of all, it is not factually correct.  This story is about CRNAs and not regular nurses.  They are the midlevels of the anesthesia world.   They started as a collaborative effort to work with doctors in that field but now are trying to compete with them:

A federal agency is weighing whether to reimburse a specialized type of nurse for giving chronic-pain treatments, a move opposed by some doctors and one that critics say could complicate the battle against prescription painkiller abuse By Nov. 1, the Centers for Medicare and Medicaid Services is expected to decide whether nurse anesthetists should be directly reimbursed by Medicare for evaluating, diagnosing and treating pain with epidural injections or prescription painkillers called opioids. The CMS rule, which would take effect Jan. 1, 2013, would reimburse nurse anesthetists on a par with doctors, signaling to private insurers and states that they are qualified to treat pain and may assume a more active role with such patients.

Does this sound familiar to anyone?  I have no idea why they would be given freedom in pain control but that is the power grab being launched by CRNAs.   It ceases to amaze me that doctors are afraid to speak up.   Remember this article, When The Nurse Wants To Be Called “Doctor”?

Wanting and deserving are two totally different things.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Expansion

  1. big picture doc
    October 18, 2012 at 1:34 pm

    Agree with our surgeon friend above, and look at the big picture. Most patients that get the epidurals do better with things like acupuncture and other complementary methods, and the recent disaster with contaminated injectables should give everyone pause no matter who is doing the procedure. Not only that, but steroids have lots of long-term nasty effects on the body. Also consider that there have been numerous other reports on contaminated parenterals because big business gets to do what ever they want to serve their bottom [a-hole] lines.

    • Doug Farrago
      October 18, 2012 at 1:47 pm

      That has nothing to do with the power grab I blogged about. Not everything is about the “evil big business monster”, which I guess are some fat, white guys, smoking stogies somewhere, right?

  2. arf
    October 17, 2012 at 4:41 pm

    The treatment of chronic pain is barely within the purview of anesthesiologists, let alone CRNA’s. Unless the anesthesiologist does a fellowship of course.

    If all I’m getting from the CRNA is a certain nerve block, I might as well refer to a neuroradiologist.

  3. Michelle Wolfe, MD
    October 17, 2012 at 4:00 pm

    I think the key phrase here is
    “would reimburse nurse anesthetists on a par with doctors”
    What is the point of having mid-level providers if they are going to charge as much as doctors? Or you could turn that around and say what is the point of being a doctor if you can charge as much with much less training as a nurse?

    • Doug Farrago
      October 17, 2012 at 4:31 pm

      Here is the reason: an employer (hospital) can pay the CRNA about 1/3 (not exact) of what they have to pay a doctor and save a ton of money.

  4. Anonymous Coward
    October 17, 2012 at 1:51 pm

    As a general surgeon, I have practiced in rural areas my entire career, and often had only CRNAs for providing anesthesia services. When I’ve had anesthesiologists, about half of them were as good as the CRNAs, but none better, and the other half were clearly inferior.
    In Africa, I didn’t even have CRNAs, and had to provide my own anesthesia with ketamine and a spinal for major abdominal surgery. Although it would have been safer to have an anesthesia provider, things can be done without them. My opinion that anesthesiologists have a much higher opinion of themselves than is warranted was reinforced. (I thought things were very wrong when I had a hernia repaired under local anesthesia (no sedation) and the anesthesiologist was paid as much as the surgeon, and the anesthesiologist was there only long enough to find out that I wasn’t going to have any anesthesia. The AA student sat there and watched the monitor. What a rip-off.)

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