Here's a question for all of you:
Why in the hell do we allow "nurse managers" and "nurse VP, CEO, etc" to even exist? Those who have management experience should be the ones holding these positions. Heck, allow a doctor to hold these positions (but, then one may argue conflict of interest....) then where's the argument for such against these nurses??
I, for one, am tired of psychotic attendings who cry and bitch over every little thing a resident does that isn't exactly what they ****ing do, and then make a giant stink about it. Not only do we residents have to deal with surgeons, every type of perioperative nurse, attendings (half of which, as YGP noted, have some sort of personality disorder), etc. but we are easy prey to getting bitched about constantly - especially if you have an off day with such an attending. The best thing is that these attendings laser beam on outta the OR to gossip or drink coffee or bs around with a CRNA or PACU RN or a secretary, rather than teaching something new. Some do, but some don't. It's funny that the ones who don't teach are the ones who have the personality disorders and are the biggest complainers. If I knew of all the shenanigans beforehand, I'd probably considered a different specialty. Quite frankly, I'm ready to be done with it. I love the specialty but, it's not worth me spending an extra year to gain certification in 2-3 extra subspecialties (including TEE) just to end up having to take 3 board exams (and PAYING for them) when I'm done. Then every 10 years I have to recert in all 3 plus the TEE recert. Kidding me??
I probably could take the exams and do ok on them. However, who is gonna fund me and every other broke resident to take all these exams?? It's easy to say it when you're no longer a part of the process. You have made your money. You are pretty much just making whatever on top to pad all you've made and saved.
It's like those conspiracy theorists who believe the Feds are plundering and saving the economy and then taking on the savior role to the public, expecting the public to do whatever they request, because it's in their best interest. Our past has plundered our future, and now we're to engage ourselves in further training to distinguish ourselves to the Nurse/MBA CEOs of hospitals to show our value with the upcoming ACO. Wonderful. Good thing I'll be done before this comes to fruition.
How about this Blade, and you know I like you - I actually agree with a lot of what you say - but this is going overboard. It's a good thing I'm looking to escape anesthesiology altogether. I wouldn't mind moonlighting in a surgicenter if I'm able, if I'm able to do my own cases. If I have to supervise, then I'll look for a gig where I supervise a few rooms. There's small centers out there. No big deal. I don't want to live in an over-saturated city or work in one. I like small towns and don't mind rural if it funds my F-U account. I'll take my ESCAPE cabin and my 100 acres and call it the day, explore the world and enjoy my life. I only have one life. I don't owe anyone anything, except those who helped me be where I am today. I'm not perfect, far from it, and I've certainly made my fair share of mistakes in life - but I've grown from them - so that is not to say I'm perfect and my word is gospel, but what you're saying shouldn't be made gospel either.
Heck, I get emails all the time of ASA 1-3 caseloads doing no chest cases (hearts, thoracic) all the time while taking q4 call supervising 3-4 CRNAs while having 8 weeks vacation all the time and making > 300K, and I'm not even done yet. Those gigs exist. No, not all of them are AMC-based, either. Some are partnership based and others aren't. Quite frankly, even if I make 350K with no partnership possibilities, at this point I'll be just fine with it, because I aim to find a job that I'll like. Anything is better than this thing called residency.
It's about being a major voice to the hospital administration. You have to show them you're not just a face. You can be triple boarded but if you don't have people skills and you're a push-over then it won't matter. The nurses are a loud bunch. If they have to stay late with a patient in the PACU, they're up in arms contacting heads of surgery and administration, anesthesia, etc. Anesthesiologists? They're more likely to lay back and not say anything. Half the time, they can't even get the SICU to admit a hemodynamically tenuous patient and instead we have to keep them longer in the PACU and then turf to a intermediate-step down unit where nurses are often times overseeing multiple tenuous patients at once. That's not good care. These patients then inevitably end up in the ICU due to further decompensation when a night float intern isn't able to properly care for these semi-critical patients and nurses are too busy shooting the **** or sleeping at nights. This stuff happens, folks. It's all about stepping up, being calm at all times, and not making an ass of yourselves clowning around the hallways or the cafeteria or office/lounge with all that free time y'all got with all those coffee breaks or monitoring stock options and then crying the sky is falling because nobody sees your worth. It's about making a push to ensure everyone understands your worth and what you can bring to the table. Nobody cares if you are IM, anesthesia, pedi/pain/cardiac, ICU boarded --- what are you gonna do with that?? Admit surgical patients? The surgeons would never allow that. So, what, help out the hospitalists and admit some of those medicine admissions?? Don't worry you won't be reimbursed extra for that with the bundled-payment plan because you're still anesthesia. Take care of patients in the OR and then round on these patients in the ICU? What's the point of a closed unit where patients are being overseen by an ICU attending? Cardiac? Are you gonna oversee CVICU patients?? Good luck with that - the cardiac NPs and surgeons will never allow that to occur. Let's say one does pain -- is one even going to ever use a lot of that extra training? This only potentially benefits those who want to do ICU after residency. The IM (or lack of it) and combination of anesthesia/cardiac/CCM/TEE certification (which, I imagine, would be the ideal goal if you're gonna go biggest bang for the buck) would likely benefit those who want to do CCM. Then again, where's the potential job market? IM and surgery have that market cornered - you can do academics or be lucky and find a gig like seinfeld, but it ain't easy. There's a thing called diminishing returns.
Like I mentioned before, there are combined CCM/cardiac trained anesthesiologists out there. I know of them. They were told when taking a job - choose cardiac OR ICU. Can't do both. So what was the point of doing CCM (or Cardiac) now? If you have no debt, great, pop off however many number of years you want because you'll be in your low-to-mid 30s being paid with no debt to pay back, go for it. Most of us aren't MD/PhDs, however.
