Howard University Hospital cuts nurse anesthetists, reorganizes nursing staff

[deleted480308]

The answer is a heck no to that. It may have been Mman who posted some study from the 70s, which just reading the date of publication raised specific concerns regarding the validity.

I had pretty much dismissed the claim after asking for a study and not getting one...but thank you very much for the confirmation

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[BuzzPhreed]

The answer is a heck no to that. It may have been Mman who posted some study from the 70s, which just reading the date of publication raised specific concerns regarding the validity.

No, no, no. This is an attempted resurrection of the ole Pine vs. Silber debate. Google it. Not the 1970's. Much later. It's what happens when self-proclaimed geniuses trumpeting their own particular agenda try to mine a CMS billing database post hoc and then call it "science". On both sides.

 

[Ignatius J]

No, no, no. This is an attempted resurrection of the ole Pine vs. Silber debate. Google it. Not the 1970's. Much later. It's what happens when self-proclaimed geniuses trumpeting their own particular agenda try to mine a CMS billing database post hoc and then call it "science". On both sides.

Not sure what you're speaking of, but the one study posted last week on another thread as evidence of the ACT model was most definitely from data in the 70s and prior. My interest is piqued in what you speak of, however.

 

[IlDestriero]

I come with years of experience. I command a senior salary.

Ok, $140, but not a penny more.
And no three 12s, you can do four 10s.

 

[BuzzPhreed]

Not sure what you're speaking of, but the one study posted last week on another thread as evidence of the ACT model was most definitely from data in the 70s and prior. My interest is piqued in what you speak of, however.

Silber (2000):

http://www.ncbi.nlm.nih.gov/pubmed/10861159

and, Pine (2003):

https://www.aana.com/newsandjournal/documents/109-116.pdf

 

[Ignatius J]

Silber (2000):

http://www.ncbi.nlm.nih.gov/pubmed/10861159

and, Pine (2003):

https://www.aana.com/newsandjournal/documents/109-116.pdf

Saw that. Googled it and it took me to some god-forsaken nursing blog with a link to the summary of the arguments. I'm going to go shower now.

 

[kzjb333]

I know y'all going to flip but try to see what I am saying. I'm flipping from the CRNA role to the DO/MD role in just another year so I really am trying to help (it would benefit me too). Here goes: many many many people do believe CRNAs are as safe or safer than the anesthesiologists. Whether or not you believe in the research is of no relevance. There are surgeons that don't respect the specialty and would go to bat for the CRNAs whether behind closed doors or right in front your face. Think of all the places that use CRNA only groups. It's not just rural areas either. Think of the surgery centers that refuse to use anesthesiologists at all. When I first started medical school, k interviewed with this surgeon that owned a few surgery centers in a very large metropolitan area. He told me he only uses CRNAs because the gasdocs are lazy, incompetent, and extremely entitled. He also told me he would hire me now but once I finished my training, he would cut me loose because he wouldn't want to upset the group of CRNAs he had in place already by bringing in a gasdoc. Even if I had been working there for a few years as a CRNA and he knew my work ethic. He said some of his friends that also owned or managed surgery centers held the same beliefs.
At some point, the discussion needs to be how anesthesiologists and ASA can change the public (and even some of the other specialties') views about anesthesiologists. That's what the CRNAs are doing. Whether or not you agree, they've proved their worth over and over again. Yes, the gasdocs won over HUH, for now. But everyday, CRNAs are digging their heels in further and further, taking over services all over the country. Their salaries are going up. As a new grad I made $140k with awesome benefits working just four days/wk. Halfway into that 1st year, I picked up a contract gig that added $25k to my income doing easy easy work. The year after that, I picked up another contract gig that took my income to well over $200k. My friend that just finished residency plus fellowship is currently making $250k with benefits that the group could have just kept (they are that horrible).
It's not the CRNAs that need to prove themselves. Until we can acknowledge that, revamp, and re-present the specialty, the CRNA takeover will be unavoidable.
I'm not here to argue. Just trying to help shed some light.

So you judge the legitimacy of the specialty off of what a surgeon says?

 

[Wolverines83]

sorry to side track but question for those of you who've been reading/critiquing studies for some time:

What do you guys look for when critiquing an article like this? I'm "ok" at critically reading these types of articles but want to get better.

I took a quick read (and I mean quick) through the aana website article referenced above and one thing that jumped out was the procedures that were included in the study. CEA, gallbladders, hemorrhoids, etc. I thought "how can there be a statistically significant difference in mortality when the mortality rates for those operations are so low to begin with?!?" Am I way off base here? What else did you guys see?

Thanks for the help

 

[anbuitachi]

Thats great and all... but CRNA market is still somewhat tied to anesthesiologist market I imagine. Some people might think haha CRNAs have fun with your lower salaries.. but if there are more CRNAS and their salaries are dropping, and more and more are willing to take lower salaries... that means anesthesiologist salaries will tank too, because now centers can hire more CRNAs for the price of one anesthesiologist, thus giving them more of a reason to hire CRNAs. this might help the established/partnered anesthesiologist, but i dont see how this will help the thousands of new grads

The problem isn't their salaries, its that in many areas, they can replace us in terms of employment. If they tank, i think we will tank as well, unless we truly differentiate ourselves to the hospitals and surgeons, which i'm not sure how that will be done. There are many medical fields with dropping salaries and poor job market, like radiology, but they usually aren't 'replaceable' to the employers by nurses

You've been brainwashed by the AANA.

1) CRNA salaries are dropping. Too many new grads. Supply>Demand. We used to have about 10-15 CRNAs a year leave for "greener" pastures. We've lost 2 in the last 3 years combined. There simply aren't jobs out there for them. And when we post a job? We get flooded with applicants.

2) what "many people" believe about the safety of CRNAs is relevant to a discussion of marketing, but isn't relevant to a discussion of actual safety. 100% independent CRNAs kill people every day. It's not just anecdotal stories either. They simply don't have the medical knowledge and training to deal with every possible situation they can find themselves in. And keep in mind, I'm pro ACT model. I have several family members that are CRNAs and in no way wish to try to denigrate them or their specialty of nursing. They are very valuable and do a good job within limits.

3) Some unintelligent surgeons dislike the medical training of anesthesiologists and like the fact that they can tell a nurse what to do where as another physician will fight back if appropriate. It's going for the yes man. They'd rather have a pawn there that they can pay less and will never tell them what to do or cancel their case. He was even honest with you that he liked you and felt you weren't "incompetent, lazy, or entitled" but wouldn't hire you as a physician for fear of upsetting the cheap, lazy CRNAs he already employs.

We hired the CRNAs who were previously hospital employees, dropped their salaries by $25k, fired 2 of them, and cut a week off their vacation. Know how many quit? Zero. Supply has far exceeded demand.

 

[Baller MD]

Thats great and all... but CRNA market is still somewhat tied to anesthesiologist market I imagine. Some people might think haha CRNAs have fun with your lower salaries.. but if there are more CRNAS and their salaries are dropping, and more and more are willing to take lower salaries... that means anesthesiologist salaries will tank too, because now centers can hire more CRNAs for the price of one anesthesiologist, thus giving them more of a reason to hire CRNAs. this might help the established/partnered anesthesiologist, but i dont see how this will help the thousands of new grads

The problem isn't their salaries, its that in many areas, they can replace us in terms of employment. If they tank, i think we will tank as well, unless we truly differentiate ourselves to the hospitals and surgeons, which i'm not sure how that will be done. There are many medical fields with dropping salaries and poor job market, like radiology, but they usually aren't 'replaceable' to the employers by nurses

Knowing this, why did you go into anesthesiology?

 

[anbuitachi]

Knowing this, why did you go into anesthesiology?

I liked the rotation lol. But im open minded so its not like I'm stuck in it. I can still switch out if anesthesiologists all get laid off in the next couple of years

 

[MikeMerk-MtS]

Silber (2000):

http://www.ncbi.nlm.nih.gov/pubmed/10861159

and, Pine (2003):

https://www.aana.com/newsandjournal/documents/109-116.pdf

Pine's study was funded by the AANA.... Seems like there's no conflict of interest there

 

[Psai]

Knowing this, why did you go into anesthesiology?

Being naive and hoping that the future will be better

 

[anbuitachi]

Being naive and hoping that the future will be better

yea its hard to predict the future. who knos when ww3 will happen and it might change everything

 

[urge]

Sure. We'd hire you in a second. Of course you probably wouldn't like the starting salary of 103K.

Ok, $140, but not a penny more.
And no three 12s, you can do four 10s.

Why are your guys being so cheap with me? Do you want to screw me because I'm an MD?

I'm looking for something like this (from another thread):

Honestly it's near impossible to find a job as anesthesiologist working 3 days a week (12 hour days) for 150-180k that I know many crnas make that includes many 3-4 days weekends plus vacation.

 

[Ignatius J]

Pine's study was funded by the AANA.... Seems like there's no conflict of interest there

Amazing that this particular type of unethical research is tolerated and even taken seriously in the medical community.

 

[Consigliere]

Why did you have to employ them?

Didn't HAVE to...we wanted to. We are expanding and wanted the flexibility of sending the nurses to other sites.

 

[deleted126335]

I would think

Amazing that this particular type of unethical research is tolerated and even taken seriously in the medical community.

It's not. It used as cover for administrators.

 

[Mman]

The answer is a heck no to that. It may have been Mman who posted some study from the 70s, which just reading the date of publication raised specific concerns regarding the validity.

I suppose you have better data? Didn't think so.

 

[aneftp]

Thats great and all... but CRNA market is still somewhat tied to anesthesiologist market I imagine. Some people might think haha CRNAs have fun with your lower salaries.. but if there are more CRNAS and their salaries are dropping, and more and more are willing to take lower salaries... that means anesthesiologist salaries will tank too, because now centers can hire more CRNAs for the price of one anesthesiologist, thus giving them more of a reason to hire CRNAs. this might help the established/partnered anesthesiologist, but i dont see how this will help the thousands of new grads

The problem isn't their salaries, its that in many areas, they can replace us in terms of employment. If they tank, i think we will tank as well, unless we truly differentiate ourselves to the hospitals and surgeons, which i'm not sure how that will be done. There are many medical fields with dropping salaries and poor job market, like radiology, but they usually aren't 'replaceable' to the employers by nurses

Only the top 5-10 anesthesiology partners of top heavy ACT groups make far much more than they deserve. Of course those are the same guys selling out to management companies the past 3-4 years. They see the writing on the wall.

But if you compare that worker bee MDs making $300-350k working 55-60 hours a week. Call 1:5-6. With weekend responsibility every 3-4 weekends. And I mean like a full weekend of call.

Compare that to Crna working daytime shifts making $150-170k 3-4 days a week. No calls no weekends. 40 hours.

The spread difference between CRNA salaries and worker bee MDs isn't that far off.

Like my sister all Md group pays week day MDs $210k. They don't even bother with crnas who don't even want to work 5 days a week. Most want 3 days a week. Or 4 at the most. Most want Friday's off as well.

If you were to poll crnas and their work hours. I bet 40% of them do not work 5 days week. I also bet 40-50% don't do nights or weekends.

And of the ones who work 5 days a week it's mostly at surgery centers with Asa 1-2 patients. Occasional ASA 3s.

 

[bronx43]

Only the top 5-10 anesthesiology partners of top heavy ACT groups make far much more than they deserve. Of course those are the same guys selling out to management companies the past 3-4 years. They see the writing on the wall.

But if you compare that worker bee MDs making $300-350k working 55-60 hours a week. Call 1:5-6. With weekend responsibility every 3-4 weekends. And I mean like a full weekend of call.

Compare that to Crna working daytime shifts making $150-170k 3-4 days a week. No calls no weekends. 40 hours.

The spread difference between CRNA salaries and worker bee MDs isn't that far off.

Like my sister all Md group pays week day MDs $210k. They don't even bother with crnas who don't even want to work 5 days a week. Most want 3 days a week. Or 4 at the most. Most want Friday's off as well.

If you were to poll crnas and their work hours. I bet 40% of them do not work 5 days week. I also bet 40-50% don't do nights or weekends.

And of the ones who work 5 days a week it's mostly at surgery centers with Asa 1-2 patients. Occasional ASA 3s.

That's not the point. The point he was trying to make is that anesthesiologists' salaries are now inextricably linked to that of CRNAs. The job markets are now intertwined to the point that as CRNAs flood the market and push down their salaries, it will invariably also push down salaries of anesthesiologists. When CRNAs are graduating into a tougher market, they will then offer to work more and take on more call/night shifts. They won't go back to being a floor nurse, even if salaries of floor nurses are going up. It's pathetic but midlevels view themselves as superior to floor nurses, and it would almost be shameful to return to that job when they took on "extra training." When that happens, then anesthesiologists will be fighting the same battle and will get dragged down as well.

 

[Ignatius J]

I suppose you have better data? Didn't think so.

I don't have data, nor did I make declarations. I do, however, have intuition and belief in my profession to think that a BC-anesthesiologist in the room the whole time is what I think is the safest and what I would want for my family member.

 

[Mman]

I don't have data, nor did I make declarations. I do, however, have intuition and belief in my profession to think that a BC-anesthesiologist in the room the whole time is what I think is the safest and what I would want for my family member.

And yet you almost can't find a major medical center that does that. We might do 60,000 cases this year at a 1000+ bed level 1 trauma center and our risk adjusted surgical mortality rates run in the 90th+ percentile (90th being low, not high) and yet we almost never have an anesthesiologist in the room for the duration of the case (with the exception of perhaps pediatric hypoplastic LV having repair). How is that?

Neither the ASA nor the majority of BC anesthesiologists agree with you nor do major medical centers operate in that fashion.

 

[Ignatius J]

And yet you almost can't find a major medical center that does that. We might do 60,000 cases this year at a 1000+ bed level 1 trauma center and our risk adjusted surgical mortality rates run in the 90th+ percentile (90th being low, not high) and yet we almost never have an anesthesiologist in the room for the duration of the case (with the exception of perhaps pediatric hypoplastic LV having repair). How is that?

Neither the ASA nor the majority of BC anesthesiologists agree with you nor do major medical centers operate in that fashion.

Yes, I can. I work in one.

I think there is a disconnect in the logistics between staffing all ORs with BCAs. It won't happen. Won't ever happen. There isn't enough to do that. I don't think the ACT model developed for safety measures so much as efficiency measures.

The logistics weren't the debate though. We are talking about safety. I don't think you'll find one physician-only anesthesia practice that wants to improve their safety by going to an ACT model. They go to it for the business. The bottom line. The logistics.

By the way, way too many confounders to attribute your patient outcomes solely to the ACT model. That would be extreme arrogance, IMO.

 

[Mman]

Yes, I can. I work in one.

Which one? I've never heard of one. Every top academic center in the country is ACT model because they have residents. Every big major private group I've ever seen is ACT model with CRNAs.

As for extreme arrogance, you are the one suggesting you know best about what is safe without offering any evidence to support it.

 

[Ignatius J]

Which one? I've never heard of one. Every top academic center in the country is ACT model because they have residents. Every big major private group I've ever seen is ACT model with CRNAs.

As for extreme arrogance, you are the one suggesting you know best about what is safe without offering any evidence to support it.

I've said I have an idea. This debate was not started regarding the superiority of physician-only practice. The initial debate was regarding the ACT being superior. That was the statement.

As far as where I work, PM and I'm happy to discuss where I work. It would be easy to figure out my group practice from the info, and wheras I stand by my comments from a personal standpoint, I do not want them to be reflective of my group at large. So I'd rather keep that private on an open public forum.

 

[BuzzPhreed]

As for extreme arrogance, you are the one suggesting you know best about what is safe without offering any evidence to support it.

It's because we haven't yet figured out a way to quantify "near misses". It's because the peer review system, even in 2015, is a complete joke. It's because we don't collect and analyze meaningful metrics (post-procedure pain, PACU length of stay, time from procedure finished until emergence and extubation, etc.) and use those metrics to improve performance and efficiency.

It's because no one -- besides us -- really knows or understands what we do.

 

[IlDestriero]

It's because we don't collect and analyze meaningful metrics (post-procedure pain, PACU length of stay, time from procedure finished until emergence and extubation, etc.) and use those metrics to improve performance and efficiency.

It's because no one -- besides us -- really knows or understands what we do.

We have been collecting data and developing best practice guidelines for both common and complex surgery for years. We also are looking at outcomes and change the recommendations to improve pacu stay, post op pain, inpatient opiate use, etc. We even look at turnover times and try to improve that. One thing we haven't been doing is publishing any of that data. My last academic job had extensive pathways as well, but it was on their intranet and not for distribution.

 

[chocomorsel]

Which one? I've never heard of one. Every top academic center in the country is ACT model because they have residents. Every big major private group I've ever seen is ACT model with CRNAs.

As for extreme arrogance, you are the one suggesting you know best about what is safe without offering any evidence to support it.

FYI,
San Antonio, most of Dallas, Phoenix, Las Vegas, and many, many groups out west (California) are all physician only groups. Just because you haven't heard about it, doesn't mean it doesn't exist. The groups in San Antonio and Phoenix are HUGE.
You must be practicing in the Midwest, South or Northeast. I left and moved to a physician only group out west and can tell you that we bust our asses and are a lot more respected as physicians. Stool sitting ain't easier and there are no lunch breaks/coffee breaks most of the time. I love it though, much better than ACT.

 

[anes]

Which one? I've never heard of one. Every top academic center in the country is ACT model because they have residents. Every big major private group I've ever seen is ACT model with CRNAs.

As for extreme arrogance, you are the one suggesting you know best about what is safe without offering any evidence to support it.

Cedars Sinai is a large physician only medical center. No act model. But it is neither a top nor an academic center. It is however a large private practice group.

That being said, See my previous posts regarding how I feel about Cedars.

 

[Mman]

FYI,
San Antonio, most of Dallas, Phoenix, Las Vegas, and many, many groups out west (California) are all physician only groups. Just because you haven't heard about it, doesn't mean it doesn't exist. The groups in San Antonio and Phoenix are HUGE.

You seem to be confusing the size of a group with the size of a hospital. I'm asking which major medical centers are using MD only anesthesia models. That excludes any hospital that uses residents or CRNAs.

 

[Ignatius J]

You seem to be confusing the size of a group with the size of a hospital. I'm asking which major medical centers are using MD only anesthesia models. That excludes any hospital that uses residents or CRNAs.

The answer to your question lies in his answers. I have privileges at app. 30 places, all of which use a physician-only delivery model.

 

[chocomorsel]

You seem to be confusing the size of a group with the size of a hospital. I'm asking which major medical centers are using MD only anesthesia models. That excludes any hospital that uses residents or CRNAs.

So you mean to tell me there are no major medical centers in any of the above mentioned cities I have told you about? Besides the University affiliated ones? Maybe you should try google. It's a search engine. You may have heard of it.
And what exactly is your definition of a "major medical center?" How many beds? What kind of services? In these cities like San Antonio and Phoenix where there is a residency program, all the other hospitals would then qualify for physician only models correct? I can assure you that there are plenty of those besides University affiliated ones.
Gonna stick with Ignatius on this one.

 

[Mman]

The answer to your question lies in his answers. I have privileges at app. 30 places, all of which use a physician-only delivery model.

And you don't have privileges at 30 mega hospitals. And there are major hospitals in the areas he listed that use CRNAs and residents so that excludes them from the point he is trying to make.

 

[Mman]

So you mean to tell me there are no major medical centers in any of the above mentioned cities I have told you about? Besides the University affiliated ones? Maybe you should try google. It's a search engine. You may have heard of it.
Gonna stick with Ignatius on this one.

No, I'm curious to which ones you refer.

 

[Ignatius J]

FYI,
San Antonio, most of Dallas, Phoenix, Las Vegas, and many, many groups out west (California) are all physician only groups. Just because you haven't heard about it, doesn't mean it doesn't exist. The groups in San Antonio and Phoenix are HUGE.
You must be practicing in the Midwest, South or Northeast. I left and moved to a physician only group out west and can tell you that we bust our asses and are a lot more respected as physicians. Stool sitting ain't easier and there are no lunch breaks/coffee breaks most of the time. I love it though, much better than ACT.

This is my model too. No guarantees of lunch breaks or coffee breaks, unless a partner wraps up or is waiting for their case to start and does a pro bono service.

I don't personally feel the "disrespect" for the profession that a lot of folks on here talk about, mainly because this model employs an anesthesiologist that is present from wheels in to wheels out. Face time matters. I'm the one usually calling the surgeon in the lounge from the OR telling them to get off their keester because we're prepped and ready.

It's a role reversal of sorts. It's credibility. In a physician-only model, you're viewed as in the trenches the whole time and I think OR personnel respond to that.

 

[Ignatius J]

And you don't have privileges at 30 mega hospitals. And there are major hospitals in the areas he listed that use CRNAs and residents so that excludes them from the point he is trying to make.

Not sure what you are arguing. There are 3 major private hospital networks in our city, all of which use a physician-only model, including the flagships in the medical center.

If you're trying to use academic places to defend your argument, then the debate is a non-starter because you have a built-in "out" you make for yourself. There is a University hospital in our medical center, but 30 other hospitals/surgery centers which deliver the large majority of healthcare and are all physician-only. Zero cRNAs. Hell, even the university sends surgery and primary care residents to the private hospitals for caseload. But no anesthesia residents. All physicians.

 

[chocomorsel]

Look up all the hospitals outside the UT system in San Antonio;(ie Santa Rosa, St Lukes, Methodist), Many of the hospitals in Dallas, most of the hospitals in Phoenix, Las Vegas. I interviewed at one in the middle of nowhere in Indiana.
They are out there. Some of us work in them. You are just not familiar with them.

 

[Mman]

Look up all the hospitals outside the UT system in San Antonio;(ie Santa Rosa, St Lukes, Methodist), Many of the hospitals in Dallas, most of the hospitals in Phoenix, Las Vegas. I interviewed at one in the middle of nowhere in Indiana.
They are out there. Some of us work in them. You are just not familiar with them.

There are of course plenty of them out there. I'm just looking for the name of a single major medical center. One. I'm not talking a 500 lb kinda sorta hospital. I'm talking 1000-2000 bed mega hospital, level 1 trauma center, etc. You know, the big ones.

 

[Mman]

If you're trying to use academic places to defend your argument, then the debate is a non-starter because you have a built-in "out" you make for yourself.

What "out" is that? We are talking about whether or not a board certified anesthesiologist is in the room 100% of the time at these places. Academic hospitals use the ACT model. It's not an "out", it's a fact.

 

[Ignatius J]

What "out" is that? We are talking about whether or not a board certified anesthesiologist is in the room 100% of the time at these places. Academic hospitals use the ACT model. It's not an "out", it's a fact.

Because the original premise was regarding the feasibility of physician-only care on a large scale. Do you think we're naive enough to not know most academic centers are the Level 1 trauma facilities? You are being stubborn to a fault here.

Can you just not admit that there are large scale hospital networks and communities out there that utilize a physician-only model?

 

[chocomorsel]

Many of us have never even worked in a 1000 bed hospital. Outside of academics, there are many hospitals that use physician only model. The only level one facility in Las Vegas only uses physicians, but it does not have 1000 beds. Many of the hospitals I know of are in the 300-600 bed range. And there are many academic centers out there that only use residents and not CRNAs. So your ACT model is only for training purposes which we all know is a necessity.
You also state that you have never heard of any large groups that are MD/DO only and I am giving you examples above. Greater than 50 partners is a large anesthesia group and the cities above mentioned have that.
Yes, the majority of models are ACT, but it does not make it a superior model. It is an efficiency model because we do all agree that there aren't enough of us to do the job in this country. At least not the elective surgeries anyway.

 

[Mman]

Can you just not admit that there are large scale hospital networks and communities out there that utilize a physician-only model?

Umm, I've pointed that out several times on these forums. That's not what I'm talking about in this particular thread.

 

[Mman]

You also state that you have never heard of any large groups that are MD/DO only and I am giving you examples above.

I originally asked about MD only practices in major medical centers. My later post said major groups. Sorry, meant to say groups covering major medical centers. I'm familiar with lots of "large groups" that are MD only covering multiple small facilities.

I don't care what happens in community hospitals and that's what I call a 400 bed hospital. They have healthier patients and better outcomes under any model. My point is that the ACT model is proven safe and effective in the biggest hospitals in the country and the sickest patients in the country having the biggest surgeries and I'm not familiar with ANY major medical center that is staffed MD only by anesthesiologists. And no, I'm not just referring to residency programs. I'm familiar with plenty of huge medical centers that are staffed by ACT model with MDs supervising AAs and CRNAs.

 

[deleted50478]

Blah ****ing blah

 

[chocomorsel]

Blah ****ing blah

Ha ha. Don't know if that was directed at me but it was funny.

 

[chocomorsel]

Size can be deceiving Mman. Bigger doesn't always mean better. LOL.
But really, plenty of midsize hospitals that are designated Level 1 centers or county hospitals were all kind of sick patients are taken care of. Where everything except major transplants happen.

But yeah, we all agree most of us work in ACT models. But most of us do not work in huge medical centers.

 

[deleted480308]

Size can be deceiving Mman. Bigger doesn't always mean better.

She lied to be nice

 

[Ignatius J]

I originally asked about MD only practices in major medical centers. My later post said major groups. Sorry, meant to say groups covering major medical centers. I'm familiar with lots of "large groups" that are MD only covering multiple small facilities.

I don't care what happens in community hospitals and that's what I call a 400 bed hospital. They have healthier patients and better outcomes under any model. My point is that the ACT model is proven safe and effective in the biggest hospitals in the country and the sickest patients in the country having the biggest surgeries and I'm not familiar with ANY major medical center that is staffed MD only by anesthesiologists. And no, I'm not just referring to residency programs. I'm familiar with plenty of huge medical centers that are staffed by ACT model with MDs supervising AAs and CRNAs.

Yet another myth. The patients in my private practice are generally as sick as they were in academics. If anything, moreso as we have a large referral basis from indigent areas. I know, tertiary care, smursiary care. You want a zillion beds.

My group covers every anesthesia case imaginable, including hearts, livers, lungs, neonates (actually staff pedi cases at the lone academic hospital in town), etc.

 

[IlDestriero]

There are plenty of large hospitals in California that, while perhaps not larger than an arbitrary 1000 beds, are full service facilities taking care of complex patients, and without a CRNA in sight. (No anesthesia residents either.) And that includes Level 1 trauma centers.
Perhaps you believe that anything short of a university hospital is some second rate glorified ambulatory surgery center full of hacks, but you will find out that it is not. It's often the opposite.
Are they doing transplants there or have billion dollar proton therapy units? No, but you don't need that to be a great hospital and care for challenging patients.
I wish I could do all my complex cases by myself.