Residencies To Avoid: Joint CRNA Training

[Aether2000]

CRNAs are no longer simply benign subservients but rather have every intention of promulgating to the public, state and national legislators, and hospital administrators that they are not only completely equal to physicians in capabilities but in fact are actually better. They have attempted to expand their scope of practice into surgical procedures in pain medicine and otherwise. The following is a list of dual programs with both anesthesiology residencies and CRNA schools offered at Universities where it is likely both will be trained side by side, sharing cases, competing for cases, taking over cases started by the other entity, or sharing OR space. Given the political ramifications of CRNA activism, residencies in these programs may entail effectively working side by side, or in adjacent ORs with CRNAs that will eventually be bidding for hospital contracts against anesthesiologists and openly competing with anesthesiologists in every way.
Below is a list of anesthesiology residencies that have programs at the same location as CRNA programs. The training at these institutions is excellent, but they are reported through ASA cross referencing of anesthesiology programs to CRNA programs to have both services in training simultaneously:
Univ Alabama Birmingham
USC
Loma Linda
Univ of Miami
Medical College of Georgia
University of Iowa
Rush Univ
Univ Kansas Medical Center
Univ Maryland
Mayo College of Medicine
University of Missouri-Kansas City Truman Med Ctr
University of Medicine and Dentistry UMDNJ
Albany Medical College
Columbia University
SUNY Buffalo
SUNY Brooklyn
Duke
Wake Forest
Cleveland Clinic
Case Western
Univ Cincinnati
Oregon Health Sciences University
Thomas Jefferson University
University of Pennsylvania
Univ of Pittsburg
Medical University of South Carolina
Univ Tennessee Knoxville
Univ Tennessee Memphis
Baylor
Univ Texas Houston
Virginia Commonwealth Univ.
Georgetown University

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[WholeLottaGame7]

UNC-Charlotte does not have an anesthesia residency program, FYI.

 

[Aether2000]

Excellent...I will remove it from the list.

 

[pd4emergence]

That's a pretty inclusive list. I think the bigger issue is not whether or not there is a srna school at a particular place but how that program affects an anesthesiology resident's education at that institution. Not choosing to go to a residency program solely because there are srna's there is a mistake.

 

[IlDestriero]

That's a pretty inclusive list. I think the bigger issue is not whether or not there is a srna school at a particular place but how that program affects an anesthesiology resident's education at that institution. Not choosing to go to a residency program solely because there are srna's there is a mistake.

That's very true. When I was at an SRNA training program in Navy, the residents got all the big cases and the sRNAs were assigned to the straightforward ones. The Peds surgeons didn't want to work with them at all. Their idea of a neuro day was 2 VP shunt revisions and a carpal tunnel release. They probably aided in resident education because they did the bulk of the ASA 1 patients. You have to look at how they are used and assigned.

 

[Aether2000]

It depends on your perspective of training along side the people that mean to replace you. As a long time physician, I have seen trends emerge, and there has been a significant change in the attitudes and actions of emboldened CRNAs that believe they are not simply as good as physicians, they are better. This attitude is like a pervasive cancer that grows with each hospital taken over by CRNAs and by each scope of practice victory. The only viable solution is to begin to recognize CRNAs and their profession, rapidly escalating in numbers, for what it is: the enemy. Of course when 1/3 of anesthesiology residencies are training physicians side by side with CRNAs, it gives the CRNAs the attitude that their training is no less than that of the physician. But there is no easy way out for the anesthesiology residency programs. However physicians that have choices of residencies can select those residencies that train physicians only or those that have SRNAs in one room and residents in the next, with the programs and hospitals using them interchangeably.

 

[pd4emergence]

It depends on your perspective of training along side the people that mean to replace you. As a long time physician, I have seen trends emerge, and there has been a significant change in the attitudes and actions of emboldened CRNAs that believe they are not simply as good as physicians, they are better. This attitude is like a pervasive cancer that grows with each hospital taken over by CRNAs and by each scope of practice victory. The only viable solution is to begin to recognize CRNAs and their profession, rapidly escalating in numbers, for what it is: the enemy. Of course when 1/3 of anesthesiology residencies are training physicians side by side with CRNAs, it gives the CRNAs the attitude that their training is no less than that of the physician. But there is no easy way out for the anesthesiology residency programs. However physicians that have choices of residencies can select those residencies that train physicians only or those that have SRNAs in one room and residents in the next, with the programs and hospitals using them interchangeably.

I can see where you are coming from. My opinion on this "trend" is that as a specialty we became lazy in the or. This is what happens after years of not showing up for inductions, not being there for emergence, not seeing the patient before going to the or, not doing your own lines and blocks,....etc, etc. As for srna vs resident training, my advice is to go to a place that uses crnas in the appropriate way (as an adjunct to your education).

 

[BLADEMDA]

With the cut in GME funding looming next year I doubt those programs with SRNAs are worried about whether a particular medical student decides to not to match there; the trends favor Anesthesiology Programs becoming more competitive as the number of Medical Students looking for a spot increases while available positions slightly decrease (due to cut in GME funding).

 

[Idiopathic]

yes by all means dont consider Duke, Wake Forest, OHSU, Cleveland Clinic, Iowa, etc...who cares if the training is excellent. We will be militant fundamentalists as well!!!

 

[Aether2000]

lol...the training is excellent at these institutions. The CRNAs that come from there will tell you so. The Cleveland Clinic pain medicine department in particular trains CRNAs in advanced pain procedures in cadaver workshops along side MDs...at least they are capable of signing up for this training for the Jan 2012 conference, and when brought to the attention of the course director, there was .............................silence.
The physician faculty at Iowa has long been a bastion of training of CRNAs, ultrasound workshops, regional anesthesia along side physicians. Apparently neither of these institutions feel there is any difference in CRNAs and physicians with respect to the training they make available.

 

[bigdan]

A few lesser known places, like MGH and Hopkins also list CRNAs on staff, or have nurse anesthesia schools, or both.

...better not train at those programs either.

 

[jwk]

That's a pretty inclusive list. I think the bigger issue is not whether or not there is a srna school at a particular place but how that program affects an anesthesiology resident's education at that institution. Not choosing to go to a residency program solely because there are srna's there is a mistake.

Several of the progams listed are very pro-anesthesiologist. Remember that residencies are run through the medical school, and CRNA programs through the nursing school. The Chairman of the Department still controls what goes on in the department, and that chairman is an anesthesiologist, and he/she does NOT work for the nursing school. I can tell you that several of the ones I know are more than happy to let SRNA's go elsewhere for part or most of their clinical education, especially when it conflicts with resident education.

Now - if you're talking about those academic anesthesia departments that allow SRNA's to run rooms by themselves, that's a different story.

 

[RussianJoo]

Wayne State University/Detroit Medical Center also has a CRNA school. If you're at a program with a CRNA school you can try changing things by telling the ACGME that you have to compete with SRNA's or CRNA's for cases.

 

[Nooblet]

.

 

[CrispDO]

Couple of details that are inaccurate:

1. University of Texas at Houston do not train CRNAs they train AAs which are under the Texas Board of Medicine, not Nursing. Also there are only 10 Student AAs where as each resident class has 20+ residents. Not an issue here.

2. University of Iowa does not allow SRNAs or CRNAs to do regional or epidurals. Iowa is such a strong program I just cannot see it being a problem.

3. There is no University of Tennessee Memphis Anesthesiology training program.

 

[deleted307836]

3. There is no University of Tennessee Memphis Anesthesiology training program.

Nor is there one at Boston College... it's a liberal arts college with no medical school/affiliated medical center even. Where are you getting this?

 

[Aether2000]

From the ASA: http://www.asahq.org/For-Students/For-Residents/Residency-Information-by-State.aspx They list Univ of Tennessee Memphis. The Univ of Texas Houston is listed under CRNA schools that list 111 currently active CRNA schools. Boston College offers CRNA training, per their website, Boston University offers anesthesiology residency training. That was my mistake....I found it difficult to believe a city would have both a college and university by the same name. As for the Univ of Iowa, I have had contact in the past through major society organizations querying the teaching of CRNAs in their regional anesthesia courses. They do. As for their teaching of CRNAs regional anesthesia during their training their, perhaps they do not, but they get their training in any case from their university professors of anesthesiology in courses taught by these professors.

 

[Southpaw]

There's no doubt you can get great training and some programs on the list. No doubt at all. There's also no doubt that you can get equivalent training at LOTS of programs NOT on that list. All else being equal, I'd choose not to be part of the SRNA/CRNA mess. Just me though.

 

[Aether2000]

When SRNAs and anesthesiology residents are trained side by side to do the same thing in the same ORs, it sends a strong message to hospital administrators and the surgeons in training that there really isn't any difference. You can have great training at all the above programs, but the profession itself is being harmed by fungible training of residents and SRNAs. The surgery residents in training remember the interchangeability of the what they are trained to call "anesthesia providers" and when they enter the jobs market, remember the equivalency that the university programs so promulgated. When credentialing issues arise regarding scope of practice, the surgeons are already institutionalized to think there is no difference between a CRNA and anesthesiologist. This is further hammered home when anesthesia groups hire CRNAs to do the technicians work and when inevitably the CRNA will at some point be functioning independently of the anesthesiologist. The surgeons and hospital administrators can't tell the difference.

 

[Idiopathic]

as an incoming resident, you should do whats best for you and your family, and not try to change the world that you dont even understand yet. buzzwords really have no meaning for you at this point, and you wont be hurting any program by denying them access to you. therefore, it behooves you to get the best training you can, and change the system from the inside, when you are ready.

 

[Aether2000]

True. And those anesthesiology residents that become used to working around CRNAs are later far more accepting of working with them in practice. But you are correct, that the ethics of mediocrity are being imposed by the university programs and it is really not your battle. Yet.

 

[BLADEMDA]

There's no doubt you can get great training and some programs on the list. No doubt at all. There's also no doubt that you can get equivalent training at LOTS of programs NOT on that list. All else being equal, I'd choose not to be part of the SRNA/CRNA mess. Just me though.

Ok. If a Med Student has the Step Scores, Grades, letters, etc to be selective then by all means do so. That said, most will have a tougher time this year matching into any program. That trend will only worsen over the upcoming years. My advice is to Match where it works for your family and you and where they are willing to train you.

Every one of those programs won't have any difficulty filling their slots.

I thought UT-Memphis was working on a Residency program. Do they have one yet?

 

[Idiopathic]

good luck trying to put the cat back in the bag. come up with a legitimate health care model that does not involve CRNAs and Ill be interested in hearing what else you have to say. otherwise, you are just encouraging people to not learn how to work in the major system there is.

 

[saratoga733]

A few lesser known places, like MGH and Hopkins also list CRNAs on staff, or have nurse anesthesia schools, or both.

...better not train at those programs either.

At MGH, the few CRNAs on staff often work the evening shift frequently relieving CA1s from routine cases so that they can attend lectures. Larger neuro, thoracic, vascular, etc cases residents stay and finish.

 

[floridaboy18]

This is ridiculous. I understand the intention behind the post politically, but there is a significant difference in training "side by side" (i.e. attending the same lectures and occupying OR's at the same time as CRNA's as if they were getting the same training) and training in a program that also has a CRNA program that trains seperately. CRNA's have an essential role in the current model and I don't really see any other way of doing it. I suppose anesthesiologists could supervise AA's...but we are going to have to supervise someone in order to fill the OR's.

That being said, Wake Forest definitely does not train CRNA's side by side. They do have a completely SEPARATE CRNA training program, but residents do not share rooms with CRNA's, do not attend lecture with CRNA's, and do not ever have to fight for rooms with CRNA's.

Also, at Wake the CRNA's are used to relieve residents for lecture so that they are out by 3pm daily. The CRNA's are used to help the residents, not hinder their education (which, by the way, is the purpose of a residency program).

CRNAs are no longer simply benign subservients but rather have every intention of promulgating to the public, state and national legislators, and hospital administrators that they are not only completely equal to physicians in capabilities but in fact are actually better. They have attempted to expand their scope of practice into surgical procedures in pain medicine and otherwise. The following is a list of dual programs with both anesthesiology residencies and CRNA schools offered at Universities where it is likely both will be trained side by side. Given the political ramifications of CRNA activism, residencies in these programs may entail effectively working side by side with CRNAs that will eventually be bidding for hospital contracts against anesthesiologists and openly competing with anesthesiologists in every way.
Below is a list of anesthesiology residencies to avoid in order to not have to train side by side with CRNAs.
Univ Alabama Birmingham
USC
Loma Linda
Univ of Miami
Medical College of Georgia
University of Iowa
Rush Univ
Univ Kansas Medical Center
Univ Maryland
Boston College
Mayo College of Medicine
University of Missouri-Kansas City Truman Med Ctr
University of Medicine and Dentistry UMDNJ
Albany Medical College
Columbia University
SUNY Buffalo
SUNY Brooklyn
Duke
Wake Forest
Cleveland Clinic
Case Western
Univ Cincinnati
Oregon Health Sciences University
Thomas Jefferson University
University of Pennsylvania
Univ of Pittsburg
Medical University of South Carolina
Univ Tennessee Knoxville
Univ Tennessee Memphis
Baylor
Univ Texas Houston
Virginia Commonwealth Univ.
Georgetown University

 

[saratoga733]

good luck trying to put the cat back in the bag. come up with a legitimate health care model that does not involve CRNAs and Ill be interested in hearing what else you have to say. otherwise, you are just encouraging people to not learn how to work in the major system there is.

Algosdoc raise some very good points re:CRNAs... especially informative for young/ future anesthesiologists. Although some of his suggestions may not sound practical given the enormity of the problem we currently face at least he is vocal and proactive. I respect him tremendously for giving forth the effort. It sounds like he's already had a long career. Most 'older' anesthesiologists can care a rats a**. Sad but true. Complacency has no place when dealing with the AANA propaganda machine. In my opinion we need more people like him.

The presence of CRNAs/SRNAs are an unfortunate reality at many institutions mostly because of staffing issues. The key is how they are utilized. Programs that train SRNAs along side residents... doing advanced procedures, attending same lectures, no case preferential/differentiiation... serve a major disservice to not only the residents they train but the specialty as a whole. I believe few on this board would disagree with this.

 

[Arch Guillotti]

The presence of CRNAs/SRNAs are an unfortunate reality at many institutions mostly because of staffing issues. The key is how they are utilized. Programs that train SRNAs along side residents... doing advanced procedures, attending same lectures, no case preferential/differentiiation... serve a major disservice to not only the residents they train but the specialty as a whole. I believe few on this board would disagree with this.

I doubt anybody on this board would disagree with this. Do programs like this really exist?

 

[saratoga733]

I doubt anybody on this board would disagree with this. Do programs like this really exist?

I can't say for sure because I don't know... but the fact that they can claim to 'train along side' future anesthesiologists at some of the most prestigious/ preeminent medical institutions in our country is already a major victory for them. Don't kid yourself if you don't think they are not trying to convince your local politician of this...

 

[Aether2000]

The post was FYI- it was meant to give you perspective that you don't have- that the surgeons in training, hospital administrators, other OR staff all do not know the difference given the SRNAs rotate in one room one day and residents the next day, and in some programs taking over cases started by residents. Some programs have anesthesiologists training CRNAs. Regardless of what entity is in charge of their training, they are being trained in the same system, dealing with the same attending surgeons, surgery residents, OR staff, and frequently do exactly the same cases. When you get into practice, don't be surprised if your perspective is that CRNAs are less educated, more of a worker bee, and in need of direction. The surgeons and hospital administrators and OR staff have a quite different perspective- that you are all just the same and interchangeable. This should give you all a slow burn. Hopefully you will have the good sense to seek out employment that doesn't employ these 2 year technicians that believe themselves fully capable of doing everything you do, and are increasingly convincing legislators and hospital administrators of the same.

 

[Nooblet]

.

 

[Arch Guillotti]

USC residents share cardiac cases with SNRAs each tuesday, and up until recently (the residents had to complain vehemently) they shared neuro cases as well.

That certainly is disturbing.

I wouldn't avoid a program just because there is an SRNA program. I don't necessarily like it but I think that it is dogmatic to shun these programs. These "sharing" programs are a different matter though.

 

[Idiopathic]

The post was FYI- it was meant to give you perspective that you don't have- that the surgeons in training, hospital administrators, other OR staff all do not know the difference given the SRNAs rotate in one room one day and residents the next day, and in some programs taking over cases started by residents. Some programs have anesthesiologists training CRNAs. Regardless of what entity is in charge of their training, they are being trained in the same system, dealing with the same attending surgeons, surgery residents, OR staff, and frequently do exactly the same cases. When you get into practice, don't be surprised if your perspective is that CRNAs are less educated, more of a worker bee, and in need of direction. The surgeons and hospital administrators and OR staff have a quite different perspective- that you are all just the same and interchangeable. This should give you all a slow burn. Hopefully you will have the good sense to seek out employment that doesn't employ these 2 year technicians that believe themselves fully capable of doing everything you do, and are increasingly convincing legislators and hospital administrators of the same.

I trained at one of these programs (ironically, not listed in the OP) and Ill tell you what, EVERYONE knows the difference. SRNA students rotate through for 6 weeks and then might not be seen again, even though probably 80 a year come through here. Our residents are here for four years and are well known to the attendings (surgical and anethesiology), nurses, board operators and techs. Im not sure of your experience, but mine was a positive one, all politics aside, which ive discussed before and would be happy to again.

 

[painstop]

lol...the training is excellent at these institutions. The CRNAs that come from there will tell you so. The Cleveland Clinic pain medicine department in particular trains CRNAs in advanced pain procedures in cadaver workshops along side MDs...at least they are capable of signing up for this training for the Jan 2012 conference, and when brought to the attention of the course director, there was .............................silence.
The physician faculty at Iowa has long been a bastion of training of CRNAs, ultrasound workshops, regional anesthesia along side physicians. Apparently neither of these institutions feel there is any difference in CRNAs and physicians with respect to the training they make available.

I applaud algosdoc for trying to shed some light on the slow (trickle...trickle....trickle...) bastardization of our field. I understand the impracticality of cherry picking your residency as a fourth year medical student (especially when other factors such as family have to be taken into account), but that does not justify the chairs and program directors looking the other way when it comes to teaching CRNA's advanced surgical techniques/regional techniques/invasive lines. Here's what I recently posted on the Pain forum about the Cleveland Clinic Pain Symposium next month:

I know...the CRNA mills that are currently producing an excess of graduating SRNAs so what do you think the market will look like for interventional pain in a few years if the nurses have their way and the state legislatures look the other way...every chiropractor in the continental US will hire a newly-minted CRNA that cannot get a job passing gas to do a "series of three" and the graduating SRNA will think to him/herself "since I can't get a job doing what I was TRAINED to do I might as well take no call and make some money doing epidurals"...there goes overutilization rates and our reimbursement (as well as inappropriate competition and a decrease in public sentiment when these procedures are not performed properly)...shame on Cleveland Clinic, which is an ANESTHESIOLOGY department and should obviously know better

 

[interleukin2]

I cannot speak for other programs but I can attest firsthand that the anesthesia program at the University of Pennsylvania does not have you competing for training with SRNA's. The involvement of CRNAs there is very minimal and residents do 98% of the work. Will you interact with CRNAs? Yes, about 3 of them that I have counted. Do I find myself competing with them for cases, no. I haven't even come across a SRNA. I dont know where you got your data but its definitely wrong when it comes to this program. The training you will receive will be second to none, in fact you work long hours because no CRNA will ever relieve you, your resident colleagues or attendings will. The moment I hear differently I shall amend this post.
Later
PS
I believe PENN has a CRNA school, however they do not train at HUP.

 

[Aether2000]

The data is cross referencing the location of CRNA programs with MD anesthesiology residency programs. "Side by side" does not mean necessarily in the same room but in adjacent rooms. Most residents really have no idea how many ORs have SRNAs, their length of training in the ORs, nor the cases they are doing because the residents are responsible for their own cases. CRNA programs now have between 24 and 36 months training with this time partially dispersed in the ORs. And yes, having been in practice for well over two decades now, I can attest to the not infrequent surgeons attitudes that there is complete interchangeability between CRNAs and anesthesiologists. My point is that there has been a major shift in CRNA activism over the past few years. Unfortunately the university programs are stuck training CRNAs and anesthesiologists side by side. Physicians in group practices feel stuck by having to continue hiring large numbers of CRNAs. Hospital administrators are emboldened by recently replacing physicians with CRNAs. My point: it will take a monumental effort to stop the tidal wave. The best place to start is with you guys. You are the future (and possibly salvation) of the profession. Far too many decades have passed with insouciant anesthesiologists making big bucks by hiring a bevy of CRNA technicians and abrogating their responsibility to assure good patient care.

 

[Idiopathic]

Far too many decades have passed with insouciant anesthesiologists making big bucks by hiring a bevy of CRNA technicians and abrogating their responsibility to assure good patient care.

yeah not to mention plenty of attendings on these very boards...i guess its easy for those of you "in practice for decades" to lecture those of us fresh out

 

[Bertelman]

yeah not to mention plenty of attendings on these very boards...i guess its easy for those of you "in practice for decades" to lecture those of us fresh out

 

[IlDestriero]

yeah not to mention plenty of attendings on these very boards...i guess its easy for those of you "in practice for decades" to lecture those of us fresh out

Yeah, and his last post pretty clearly suggests that he believes that the Penn resident/grad that posted before him didn't/doesn't know what's happening around him in HUP's own ORs, which is so ridiculous it made me laugh out loud. I've trained at and worked at some pretty big hospitals, and everyone knew what was going on, where it was happening, and who was in the room. (though not at the other affiliated hospitals where they're not assigned.). The schedules were posted everywhere and emailed out FFS.
My money's on no SRNA training's happening at HUP (because the guy actually at HUP says it's not), and that may be the case at many of the premier hospitals associated with some of the large programs noted on the list. It might be worth researching things a bit before you start lobbing grenades.
The sRNAs can say they got a "Penn" certificate, but it's really from the school of distance learning. What's a Penn certificate worth if you don't get to train with the faculty at HUP or CHOP and do the specialized and complex cases that make them what they are? They're probably better off training at a community hospital. I'm loving that little irony.

 

[Aether2000]

Keep your eye on the prize and don't get bogged down in trivia. Neophytes never value the opinions of those with decades of experience.....that is expected. But the whole point is not whether Penn residents or any resident believes themselves tacitly superior to the lowly CRNA ......the surgeons across the country do not. And btw, once you are in practice, no one gives a flip if you graduated from any particular residency, no matter the reputation. You are from that point on just a cog in a wheel. Your profession is under threat- keep your focus on what counts: the preservation of anesthesiology.

 

[interleukin2]

I think the OPs point that we need to protect our specialty and be aware of places that do have sRNA schools whose interests are in direct conflict with anesthesiology resident's educational goals is a valid one. However to come out and say to avoid all places that have a SRNA program and a anesthesiology residency is ludicrous as most large academic centers with nursing schools will. The point brought up by IlDestriero that it is difficult to know what goes on in affiliated hospitals is valid i.e. the UPHS (Penn health system) is composed of at least 3 hospitals, the bulk of training in anesthesia revolves around 2 of those and CHOP. Do sCRNAs train at the 3rd one? I frankly do not know, I do know they are cRNA heavy, and to be fair I dont think we have the manpower to staff that hospital with residents, but that is an educated guess I have no insight as to how those allocations get done. The truth is we need CRNAs, PA doesn't allow AA, to take the non-emergent 19 yo ASA 1 appy's at the affiliate hospital while residents deal with the ASA 4 CABG X3 coagulopathic 89 y/o hot case at HUP. The bottom line as I see it is this, as a specialty anesthesia must adapt to the changing times we need to become more involved in perioperative patient care, as has been echoed in this thread. We are physicians not techs, not chair warmers. Just like surgical PAs will never replace a surgeon ( although some think they can, I have witnessed that myself) a CRNA will never truly replace an anesthesiologist. Can a surgical PA go through the motions of a surgery and get it done, sure but when the case takes an unexpected twist can he rise to the occasion? Our training is different, its longer, of wider breadth, and more intense if surgeon's think we are the same as a CRNA, I say we need to show them the difference, in the OR, when their pt is actively trying to die on you. Most of the ones I have asked do understand, but we need to educate them about what we do I think we are one of the most misunderstood specialties out there, one that looks easy because we have made it so by instituting capnography, pulse oxymetry and many other advances that have given us one of the best safety margins across the board. We need to become advocates for ourselves, as many have stated here before, and adapt to a changing reality, while leaving the chair warming to the professionals!

 

[Aether2000]

Excellent points. In rural areas, CRNAs have replaced anesthesiologists for years without supervision or direction. In many busy city hospitals, CRNAs are used as worker bees due to lack of manpower, but it all depends. In the city where I live, population a bit over a million, there is a very very large anesthesiology group with 100+ anesthesiologists covering several hospitals and surgery centers. Zero CRNAs. Zero. They all make a very nice living and are professionally very happy with their jobs. There are four other anesthesiology groups in large hospitals that are all MD, zero CRNAs. They also financially do very well. At the fringes of the city are the lower tier hospitals that have CRNAs. They are used interchangeably with physicians A bit further out it is CRNA only. We need CRNAs at this time only because there are not enough anesthesiologists, but CRNAs are far more aggressive than you might imagine. Hospital exclusive contracts are now going to CRNA only groups because unlike anesthesiologists, they accept whatever contracts the hospitals made with insurers. The future is murky, and the resident anesthesiologists of today have the choice of practicing half assed anesthesia in a CRNA group filled with malcontents that would love to take over your job or practice quality medicine in all physician groups. Those choices will determine whether the profession survives as an entity or whether "anesthesia providers" become the norm, a generic for anyone that can pass gas, regardless of the qualifications, training, or expertise.

 

[foxtrot]

Add University of Nebraska to that list.

 

[cincincyreds]

Until people realize these cRNAs are a cancer, they will continue to hurt and maime the public. Notice when a congressman or woman has their surgery, they have an MD/DO Anesthesia provider. There is no arguing this. I refuse to work with them, and I don't.

 

[yappy]

Imagine the sweet justice if medical assistants started to grow a little in eduation and responsibility and threatened the RN degree lol. Maybe that would divert some of their attention towards what their real job is.

I dont know what your guys' experiences were in UG but most the would-be-physicians that could not cut it have been opting out of medical school and gearing towards nursing with the hopes of CRNA. This, after they've pulling D-C grades in the basic sciences

 

[saratoga733]

I have a hard time understanding some of the opposition to Algosdoc’s posts. Sure I realize many physicians on this forum work cordially side by side with CRNAs everyday. By all means continue to do your job... impossible to change overnight especially given the anesthesia delivery structure/limitations we have today. But please understand-- the next time you hire a CRNA or train a SRNA, appreciate this: ALL of them belong to a powerful NATIONAL society that works TIRELESSLY to legislate the expansion of their scope of practice in a concerted effort to devalue/marginalize Anesthesiologists.

Recent email from my state’s leadership…

------------------------------------------
Dear Colleagues,

Recently, the Medicaid Redesign Team's (MRT) Workforce Flexibility and Scope of Practice Workgroup submitted a proposal to expand the scope of practice of CRNAs.

This MRT Workgroup evaluated all of the proposals, scored them based on cost, quality and efficiency and then submitted the top 12 proposals to the full MRT. The proposal to expand the CRNA scope of practice was ranked 13, and therefore was not included in the final submission.

In the short-run we have been successful in preventing the MRT Workgroup in moving forward with the unwarranted expansion of the CRNAs’ practice. While it was an extremely close outcome, we triumphed. However, the bad news is that this fight is not going away.

Your leadership is prepared for the ongoing battle, and will continue to meet with the leadership in the State Education Department. Additionally, we will strongly advocate for more input from physicians on any future advisory group.

Again, thanks to all of you who acted during our time of need! Please remain vigilant and responsive, both in your practice, and on this issue.

-----------------------------------------------

Battles like this are playing out all over the country. Some are won, some are lost. This is REAL guys. The sooner we realize this the sooner we can do something constructive about it. The alternative is to pretend there is no threat and wake up one morning and realize it’s too late.

 

[Yangkower]

As long as SRNAs pay to cover cases (50-79k per year), programs are going to be very tempted to tap into this easy money. When the bottOm line of their department looks good, no one really cares how they did it and they will cont

 

[Yangkower]

As long as SRNAs pay to cover cases (50-79k per year), programs/department heads are going to be very tempted to tap into this easy money. When the bottom line of their department looks good, no one really cares how they did it and they will continue to get bonuses and promotions. This is a fight against greed and ambition.

 

[Mman]

FYI I know at least a few of the programs on this list have SRNA programs, but the SRNAs receive little to no training at the institution. They do their classwork at the nursing school and then go to other sites for their clinical rotations.

So having an SRNA program in and of itself means nothing unless you note where they are doing their clinical rotations.

Should medical students seek out residencies where there is no nursing school as well?

 

[lobelsteve]

As a non-Anesthesia doc, I do simple cases at the hospital and request MAC. I usually get a CRNA and on occasion the MD would come by to assist. I cannot tell the difference between the two in any way. I have not had any patient crump.

Algos is right- Our hospital just fired the current Anes team that was in place for 20 years and is replacing it with a few MD's and 30CRNA's that will rotate up from their home base. The Ortho/Uro/Gyn/ENT guys I eat lunch with are a little perturbed right now. They knew their Anes docs well, now they will get random CRNA to help them out.

 

[jwk]

As a non-Anesthesia doc, I do simple cases at the hospital and request MAC. I usually get a CRNA and on occasion the MD would come by to assist. I cannot tell the difference between the two in any way. I have not had any patient crump.

Algos is right- Our hospital just fired the current Anes team that was in place for 20 years and is replacing it with a few MD's and 30CRNA's that will rotate up from their home base. The Ortho/Uro/Gyn/ENT guys I eat lunch with are a little perturbed right now. They knew their Anes docs well, now they will get random CRNA to help them out.

Please set their minds at ease.