Vermont Opts-out of supervision of nurses

[NPJR]

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vermont opts out of crna supervision


AANA puts out a news blast of Vermont opting out of CRNA supervision. Whatever!!


I've been reflecting on this. I honestly dont think this angle that CRNAs have taken to shun supervision requirements will advance their agenda of increase utilization of solo nurses to deliver anesthesia. California is an opt out state for a number of years and there are more SOLO MD practices in california then anywhere. I dont see CRNAs making headway into california, I may be wrong.

I think the more effective move for the CRNAs would have been to embrace the Anesthesia Care Team model until every practice was ACT, then you pull out the "MDs are useless card" to get rid of us. Cant pull that card out when there are many solo md practices. They have revealed their cards (intentions), TOO SOON, which will limit their growth and now that we have a legit option AAs, PAs, that is the go to, They just could not help themselves to declare they are the Saviors of American Healthcare. Had Obama even saying that garbage

This is a non-issue since AAs have licensure of AAS. So we can just hire AAs in Vermont.

 

[cittykat]

vermont opts out of crna supervision


AANA puts out a news blast of Vermont opting out of CRNA supervision. Whatever!!


I've been reflecting on this. I honestly dont think this angle that CRNAs have taken to shun supervision requirements will advance their agenda of increase utilization of solo nurses to deliver anesthesia. California is an opt out state for a number of years and there are more SOLO MD practices in california then anywhere. I dont see CRNAs making headway into california, I may be wrong.

I’m in a solo MD group in California. Independent CRNAs have made headway. We used to staff a surgicenter that did podiatry/cystos/occasional plastics/cataracts/retina/minor gyn/pain cases. Easy work that most CRNAs can handle. Due to scheduling and payor mix, an FTE there would yield about $350-400k/year from collections only. While we were negotiating a stipend to bring the compensation there to be competitive with work elsewhere, the surgicenter signed with an all CRNA group. That CRNA group advertised the position for $350k. The problem is that CRNAs are happy to do easy daytime cases for $350k/year while no anesthesiologist would work for that.

 

[painquestions8989]

I’m in a solo MD group in California. Independent CRNAs have made headway. We used to staff a surgicenter that did podiatry/cystos/occasional plastics/cataracts/retina/minor gyn/pain cases. Easy work that most CRNAs can handle. Due to scheduling and payor mix, an FTE there would yield about $350-400k/year from collections only. While we were negotiating a stipend to bring the compensation there to be competitive with work elsewhere, the surgicenter signed with an all CRNA group. That CRNA group advertised the position for $350k. The problem is that CRNAs are happy to do easy daytime cases for $350k/year while no anesthesiologist would work for that.

So what's the answer? We also take those day time positions?

 

[NPJR]

I’m in a solo MD group in California. Independent CRNAs have made headway. We used to staff a surgicenter that did podiatry/cystos/occasional plastics/cataracts/retina/minor gyn/pain cases. Easy work that most CRNAs can handle. Due to scheduling and payor mix, an FTE there would yield about $350-400k/year from collections only. While we were negotiating a stipend to bring the compensation there to be competitive with work elsewhere, the surgicenter signed with an all CRNA group. That CRNA group advertised the position for $350k. The problem is that CRNAs are happy to do easy daytime cases for $350k/year while no anesthesiologist would work for that.

350K is not an awful salary. I do not make double that and I do crazy stuff (neuro, bad ENT, Trachs, Vascular, OB) and I do not make double that. 350K for a 4 day week with 8-10 weeks off Predictable clinical load is not far off from what is a decent deal as a doc.

 

[cittykat]

350K is not an awful salary. I do not make double that and I do crazy stuff (neuro, bad ENT, Trachs, Vascular, OB) and I do not make double that. 350K for a 4 day week with 8-10 weeks off Predictable clinical load is not far off from what is a decent deal as a doc.

In our market people who do “crazy” stuff do make double (mostly due to stipends and subsidies) which makes the easy low pay outpatient stuff less appealing. You’d have a hard time finding people who agree that $350k is a decent income.

 

[cittykat]

So what's the answer? We also take those day time positions?

No. I say let them have it.

 

[NPJR]

. You’d have a hard time finding people who agree they $350k is a decent income.

The answer is always, It depends! RIght?

If I am doing my job now for 350. No way. Its an insult.
But if I am doing an easy job with no zealous surgeons pushing the limit of their expertise, routine anesthetics solo out at a predictable hour sometimes noon, four days a week, 10 weeks off , i know everyone, lunch is catered everyday . I could be doing worse.

And of course I have to add: There are many people in this world who barely have a cot to sleep on. Just keep that in mind.

 

[dannyboy1]

350K is not an awful salary. I do not make double that and I do crazy stuff (neuro, bad ENT, Trachs, Vascular, OB) and I do not make double that. 350K for a 4 day week with 8-10 weeks off Predictable clinical load is not far off from what is a decent deal as a doc.

Will make close to double that working on average 45 hours a week. 350 is awful in today’s market.

 

[NPJR]

Will make close to double that working on average 45 hours a week. 350 is awful in today’s market.

Agreed, It aint good. But if I told you you would never have a BMI over 35 , can take bathroom breaks whenever you want, out by noon 3 out of your 4 days per week, surgeons are all friendly and you'd never get a curveball. All of a sudden it's not looking too bad. Am i right? As Aneftp says, " The devil is in the details."

I can give you a 700k job, heavy neuro, complicated ent,vascular, 4 weeks PTO, 10 hour days minimum surgeons and ancillary staff are all surly, never get a break etc etc.

Which job is better?

 

[cchoukal]

Agreed, It aint good. But if I told you you would never have a BMI over 35 , can take bathroom breaks whenever you want, out by noon 3 out of your 4 days per week, surgeons are all friendly and you'd never get a curveball. All of a sudden it's not looking too bad. Am i right? As Aneftp says, " The devil is in the details."

I can give you a 700k job, heavy neuro, complicated ent,vascular, 4 weeks PTO, 10 hour days minimum surgeons and ancillary staff are all surly, never get a break etc etc.

Which job is better?

You make some good points, but the either/or that you’ve presented isn’t necessarily reflective of people‘s reality. I wouldn’t take the outpatient job for 350 no matter how good the conditions because I simply need to make more than that, and the schedule as presented doesn’t really allow consistently doing other work (nobody’s looking for someone to show up in the middle of the day and pick up case cases).

 

[aneftp]

Let the surgery center pay the crnas 350k each for 42/44 weeks/40 hrs a week.

It’s the same as paying a crna $220/hr for those same hours give or take without the locums agency fees. If you use a locums agency add 30% maybe even 40% and costs can spiral out of hand.

Crna only models work up to a certain point.
1. Controlled hours (surgery centers) because crnas have always worked hourly
2. Hospital has way too many hours and sites to cover. Paying crna hourly at the hospital especially uncompensated beeper hours docs are stupid to keep taking. The hospifos going crna only models is rare in big cities. Hospitals know crna are not cheap staffing all those hours.

 

[dannyboy1]

Agreed, It aint good. But if I told you you would never have a BMI over 35 , can take bathroom breaks whenever you want, out by noon 3 out of your 4 days per week, surgeons are all friendly and you'd never get a curveball. All of a sudden it's not looking too bad. Am i right? As Aneftp says, " The devil is in the details."

I can give you a 700k job, heavy neuro, complicated ent,vascular, 4 weeks PTO, 10 hour days minimum surgeons and ancillary staff are all surly, never get a break etc etc.

Which job is better?

Why are people scared of neuro and vascular? It’s just bread and butter general anesthesia. Ent don’t bother me either. If the airway is hairy I just have the ENT residents do the awake fiber optic.

 

[NPJR]

Why are people scared of neuro and vascular? It’s just bread and butter general anesthesia. Ent don’t bother me either. If the airway is hairy I just have the ENT residents do the awake fiber optic.

It's not that I'm afraid of neuro or any of the aforementioned. They are just higher risk of bad outcomes and likely litigation that;s all. Steady diet of that **** increases your exposure considerably.

 

[NPJR]

You make some good points, but the either/or that you’ve presented isn’t necessarily reflective of people‘s reality. I wouldn’t take the outpatient job for 350 no matter how good the conditions because I simply need to make more than that, and the schedule as presented doesn’t really allow consistently doing other work (nobody’s looking for someone to show up in the middle of the day and pick up case cases).

ya got 10 weeks off, go find an 80k a week locums job or set up an online business with your free time.

 

[dannyboy1]

It's not that I'm afraid of neuro or any of the aforementioned. They are just higher risk of bad outcomes and likely litigation that;s all. Steady diet of that **** increases your exposure considerably.

I would tend to disagree. From what I’ve seen most anesthesia lawsuits arise from unexpected bad outcomes clearly attributed to anesthesia. Much harder to sue anesthesia when the problem was clearly surgical and the patient did not have that long of a life expectancy anyways. Just secure the airway and keep the vitals stable and it’s quite difficult to blame anesthesia for a poor neurological outcome when the procedure was neurosurgery.

 

[dannyboy1]

If you can make 80k a why would you bother with a 350k full time gig?

 

[aneftp]

ya got 10 weeks off, go find an 80k a week locums job or set up an online business with your free time.

It’s hard to hit 80k 1099 a week unless holiday pay is tied in.

50k is reasonable a week beeper plus the weekends off. Gotta pace yourself.

 

[dannyboy1]

It’s hard to hit 80k 1099 a week unless holiday pay is tied in.

50k is reasonable a week beeper plus the weekends off. Gotta pace yourself.

How does one hit 50k a week? Even at a rate of 500/hr that’s 100 hours per week? Let’s say you work 5 days/week. That’s only 120 hours (5x24). Would come out to a rate of 415/hr. If you are doing that 5 days in a row it can only mean there is significant downtime where you can sleep at night. Are people really finding gigs to pay them 415/hr to sleep??

 

[aneftp]

How does one hit 50k a week? Even at a rate of 500/hr that’s 100 hours per week? Let’s say you work 5 days/week. That’s only 120 hours (5x24). Would come out to a rate of 415/hr. If you are doing that 5 days in a row it can only mean there is significant downtime where you can sleep at night. Are people really finding gigs to pay them 415/hr to sleep??

The answer is yes to all your questions
Sleep at night. Most of the time. Daytime work is hard at most places to be honest.

I like to work 8 hr days (usually they let me leave at 12p/1pm early) or 24 hr. I don’t like 12 hr daytime. Cause I can’t do anything after I get home

But leaving work at 12/1pm. I can still run errands etc.

 

[dannyboy1]

The answer is yes to all your questions
Sleep at night. Most of the time. Daytime work is hard at most places to be honest.

I like to work 8 hr days (usually they let me leave at 12p/1pm early) or 24 hr. I don’t like 12 hr daytime. Cause I can’t do anything after I get home

But leaving work at 12/1pm. I can still run errands etc.

It’s just strange. If it’s mostly sleep at night they should not have to pay over 400/hr to cover it. Those shifts are highly desirable

 

[aneftp]

It’s just strange. If it’s mostly sleep at night they should not have to pay over 400/hr to cover it. Those shifts are highly desirable

Some places make their schedule too late. Say 32-35 days out. So that’s where I come. The professional locums all plan 60 days out and want to lock in their income stream as opposed to waiting for 30 days out.

Professional full time locums do not want to get caught with their pants down with no work lined up. So willing to work for 15-25k a week (which is still excellent money)

So some awesome running billable hours can be gotten with. 30-35 days.

But I can’t blame the professional locums. They gotta map out their schedule far in advanced.

Like I have no clue what I’m doing in September and I really don’t care but most locums do care what they are doing in 50 days.

 

[cittykat]

Latest MGMA puts 25th percentile income at $400k in academics and $500k in PP. Can’t see any situation where $350k would be considered good.

Anyway, CRNA opt out gives facilities a cheaper option especially in low acuity settings.

 

[aneftp]

Latest MGMA puts 25th percentile income at $400k in academics and $500k in PP. Can’t see any situation where $350k would be considered good.

View attachment 421812
View attachment 421813


Anyway, CRNA opt out gives facilities a cheaper option especially in low acuity settings.

Mgma data is always 3 plus years behind real time.

Those are crna income to be honest who do locums. Just pay the crna to work assuming 8-10 weeks off.

Crna w2 wages are surpassing 300k w2
4 days a week no calls no weekends plus sign on. For 42-44 weeks of work.

Any doc taking 450-500k plus calls for 42-44 weeks of work is not thinking smart.

 

[cittykat]

I’m in a solo MD group in California. Independent CRNAs have made headway. We used to staff a surgicenter that did podiatry/cystos/occasional plastics/cataracts/retina/minor gyn/pain cases. Easy work that most CRNAs can handle. Due to scheduling and payor mix, an FTE there would yield about $350-400k/year from collections only. While we were negotiating a stipend to bring the compensation there to be competitive with work elsewhere, the surgicenter signed with an all CRNA group. That CRNA group advertised the position for $350k. The problem is that CRNAs are happy to do easy daytime cases for $350k/year while no anesthesiologist would work for that.

So maybe I am wrong. Foot case gone bad.

Lawsuit alleges failure during routine surgery led to patient death at Mission Hospital • Asheville Watchdog

At 8:25 a.m. on Sept. 13, 2024, Noe Serrano Hernandez was put under anesthesia for a routine foot surgery at Mission Hospital. Over the next 51 minutes, the 64-year-old’s vital signs would steadily weaken while the nurse anesthetist supervising his care did not intervene until he suffered a...

avlwatchdog.org

 

[UscGhost]

So maybe I am wrong. Foot case gone bad.

Lawsuit alleges failure during routine surgery led to patient death at Mission Hospital • Asheville Watchdog

At 8:25 a.m. on Sept. 13, 2024, Noe Serrano Hernandez was put under anesthesia for a routine foot surgery at Mission Hospital. Over the next 51 minutes, the 64-year-old’s vital signs would steadily weaken while the nurse anesthetist supervising his care did not intervene until he suffered a...

avlwatchdog.org

Jesus.

Crna calls in the supervising physician 2 mins before the patient codes

A podiatry case no less.

 

[ItBurnsInMyHand]

I’m in a solo MD group in California. Independent CRNAs have made headway. We used to staff a surgicenter that did podiatry/cystos/occasional plastics/cataracts/retina/minor gyn/pain cases. Easy work that most CRNAs can handle. Due to scheduling and payor mix, an FTE there would yield about $350-400k/year from collections only. While we were negotiating a stipend to bring the compensation there to be competitive with work elsewhere, the surgicenter signed with an all CRNA group. That CRNA group advertised the position for $350k. The problem is that CRNAs are happy to do easy daytime cases for $350k/year while no anesthesiologist would work for that.

Are you kidding me? Thats my ideal job. And now since these jobs have been pawned off, I can only be a liability sponge, fire extinguisher, pre op, block, spinal, pacu, and break monkey, and work all the late, overnight, and weekend undesirable hours?

No thanks. I’ll take the 350… oh right. But that’s no longer an option.

 

[CopaceticOne]

So maybe I am wrong. Foot case gone bad.

Lawsuit alleges failure during routine surgery led to patient death at Mission Hospital • Asheville Watchdog

At 8:25 a.m. on Sept. 13, 2024, Noe Serrano Hernandez was put under anesthesia for a routine foot surgery at Mission Hospital. Over the next 51 minutes, the 64-year-old’s vital signs would steadily weaken while the nurse anesthetist supervising his care did not intervene until he suffered a...

avlwatchdog.org

That is horrible.

Side note - this is probably one of the most well written articles written describing intraop events in layman’s terms.

 

[amyl]

Jesus.

Crna calls in the supervising physician 2 mins before the patient codes

A podiatry case no less.

20 minutes*

 

[amyl]

Crna independent practice drags the whole market down for us…. And anyone who doesn’t think so has their head in the sand. Rural hospitals near me go crna only and I’m not even an opt out state…. That’s probably at least10 less anesthesiologist jobs just in my 20 miles radius. My own hospital lets the cardiologists supervise the crnas for tee’s…. A decision made before I joined or I would’ve made an issue of it. Giving up ground - any ground - is bad. Bad for patients and bad for our market.
Aneftp will tell you crna (technically surgeon supervised) are taking osc contracts in Florida. A bunch of my old Crnas have quit their jobs to do Locums and travel for premium rates and they only go to solo or surgeon “supervised” practices. These are jobs that would have had to employ an anesthesiologist in some way.
This is 100% less jobs for us, period.
If the surgery center can’t bill enough to pay for good safe anesthesia maybe they will have to dip into facility fees, remove admin positions or close…. That’s capitalism at work.

 

[UscGhost]

20 minutes*

At 9:14 a.m., Hunter texted Dziak to come to the operating room. Serrano Hernandez was not breathing and the oxygen levels in his blood had fallen to dangerously low levels. At 9:16 a.m. he went into cardiac arrest.

The article seems to say only 2 mins

 

[amyl]

Sorry other reports said vitals were abnormal at 850am. I’ll see if I can find it

 

[amyl]

“But beginning at 8:40 a.m., Serrano Hernandez’s vital signs began to display a worrying decline. His heart rate slowed to 30 beats per minute and his blood pressure fell to a level “inadequate for his underlying physiological status,” according to the board of nursing. Over the next 35 minutes, Serrano Hernandez’s breathing slowed to zero.”

Quote From the article above… crna also gave Narcan and started an epi drip before calling the anesthesiologist

 

[aneftp]

My buddy (yes I have buddies everywhere lol) says Asheville is still using cerner emr since the take over 6-7 years ago.

Guess crna didn’t know how to use cerner emr.

No Medaxion anesthesia emr. No meditech. Hca just switched to expanse recently.

 

[UscGhost]

“But beginning at 8:40 a.m., Serrano Hernandez’s vital signs began to display a worrying decline. His heart rate slowed to 30 beats per minute and his blood pressure fell to a level “inadequate for his underlying physiological status,” according to the board of nursing. Over the next 35 minutes, Serrano Hernandez’s breathing slowed to zero.”

Quote From the article above… crna also gave Narcan and started an epi drip before calling the anesthesiologist

Yea, seems like she didnt notify the MD until a couple mins before coding though.

I doubt he was informed of the barcan, epi drips. Etc.

Sounds like the crna was just throwing random stuff at the pt

 

[cittykat]

Crna independent practice drags the whole market down for us…. And anyone who doesn’t think so has their head in the sand. Rural hospitals near me go crna only and I’m not even an opt out state…. That’s probably at least10 less anesthesiologist jobs just in my 20 miles radius. My own hospital lets the cardiologists supervise the crnas for tee’s…. A decision made before I joined or I would’ve made an issue of it. Giving up ground - any ground - is bad. Bad for patients and bad for our market.
Aneftp will tell you crna (technically surgeon supervised) are taking osc contracts in Florida. A bunch of my old Crnas have quit their jobs to do Locums and travel for premium rates and they only go to solo or surgeon “supervised” practices. These are jobs that would have had to employ an anesthesiologist in some way.
This is 100% less jobs for us, period.
If the surgery center can’t bill enough to pay for good safe anesthesia maybe they will have to dip into facility fees, remove admin positions or close…. That’s capitalism at work.

Hospital stipends are so much better now that one surgicenter bought their own anesthesia group. They’ll send an anesthesiologist to the hospital to get in on the sweet hospital stipend. The anesthesiologist is a pawn used by the surgicenter. This is true for any employed job.

https://www.beckersasc.com/anesthesia/the-4000-a-day-anesthesia-stipend-bubble-and-when-it-pops/

“Rather than keep competing for stipend-driven coverage, Mr. Gipson bought an anesthesia group outright.

He credits the purchase with letting him redirect some of that same anesthesia capacity back toward hospital cases at the now-inflated market rate, rather than only absorbing the higher cost.

“To be quite honest, I’ll throw them over in hospital cases because we’re making those stipends now,” he said. “We pay our guys well, but it’s an exorbitant [amount] — more than twice of what we were paying anesthesia providers even three years ago.”

 

[cittykat]

Jesus.

Crna calls in the supervising physician 2 mins before the patient codes

A podiatry case no less.

Sad part is that the propofol infusion was continued while the patient was circling the drain. After the already neuropathic foot was numbed by local, patient likely didn’t need any additional anesthesia.


Oddly the CRNA wears a headlamp and loupes in his LinkedIn profile photo. Maybe he couldn’t see the monitor with his loupes on. 🧐

https://www.linkedin.com/in/andrew-hunter-40678b91?utm_source=share_via&utm_content=profile&utm_medium=member_ios

 

[UscGhost]

Sad part is that the propofol infusion was continued while the patient was circling the drain. After the already neuropathic foot was numbed by local, patient likely didn’t need any additional anesthesia.

Certainly no opiods...and then narcan?? Wtf

 

[ItBurnsInMyHand]

Crna independent practice drags the whole market down for us…. And anyone who doesn’t think so has their head in the sand. Rural hospitals near me go crna only and I’m not even an opt out state…. That’s probably at least10 less anesthesiologist jobs just in my 20 miles radius. My own hospital lets the cardiologists supervise the crnas for tee’s…. A decision made before I joined or I would’ve made an issue of it. Giving up ground - any ground - is bad. Bad for patients and bad for our market.
Aneftp will tell you crna (technically surgeon supervised) are taking osc contracts in Florida. A bunch of my old Crnas have quit their jobs to do Locums and travel for premium rates and they only go to solo or surgeon “supervised” practices. These are jobs that would have had to employ an anesthesiologist in some way.
This is 100% less jobs for us, period.
If the surgery center can’t bill enough to pay for good safe anesthesia maybe they will have to dip into facility fees, remove admin positions or close…. That’s capitalism at work.

I talked to a hospital in Morris IL. They want 7 day coverage. 4:1 during the day doing pre ops and blocks and then sit cases after hours and weekend coverage. 35k.

Guy said the CRNAs can go independent but prefer an MD. Yes. Why? So they don’t have to do any of the late or weekend coverage.

I’ll do it for 100k.

 

[aneftp]

I talked to a hospital in Morris IL. They want 7 day coverage. 4:1 during the day doing pre ops and blocks and then sit cases after hours and weekend coverage. 35k.

Guy said the CRNAs can go independent but prefer an MD. Yes. Why? So they don’t have to do any of the late or weekend coverage.

I’ll do it for 100k.

35k for the week. Must be some same course all these anesthesia companies attend. Literally 3 different hospitals offered me the same exact deal in Florida

The killer is the weekend. Not work it to be solo 48 hrs. I told them that’s another 20k charge.

35k for 5 days is fair if low call back. But it’s risky to be on 24/7 especially solo at night.

They are underpaying by at least 20k for the week. These are jobs that it’s best to tag team with friends. I tell everyone that being the long killer whale isn’t effective as being a pod of orcas working in unison on the same contract.

 

[NPJR]

Crna independent practice Bad for patients and bad for our market.
Aneftp will tell you crna (technically surgeon supervised) are taking osc contracts in Florida. A bunch of my old Crnas have quit their jobs to do Locums and travel for premium rates and they only go to solo or surgeon “supervised” practices. These are jobs that would have had to employ an anesthesiologist in some way.
This is 100% less jobs for us, period.
If the surgery center can’t bill enough to pay for good safe anesthesia maybe they will have to dip into facility fees, remove admin positions or close…. That’s capitalism at work.

Very short sighted of them. The chickens will come home to roost. They will have a catastrophic outcome. If you are getting a TEE, you are pretty ****ed up medically by and large. They will have to splain to the family or plaintiff's attorney why a real anesthesiologist was not involved. I'm sure all of those patients in your hospital believe they are getting an Anesthesiologist MD involved in their care. It really is unethical is what it is.

 

[ItBurnsInMyHand]

35k for the week. Must be some same course all these anesthesia companies attend. Literally 3 different hospitals offered me the same exact deal in Florida

The killer is the weekend. Not work it to be solo 48 hrs. I told them that’s another 20k charge.

35k for 5 days is fair if low call back. But it’s risky to be on 24/7 especially solo at night.

They are underpaying by at least 20k for the week. These are jobs that it’s best to tag team with friends. I tell everyone that being the long killer whale isn’t effective as being a pod of orcas working in unison on the same contract.

Agreed. 5 days 35k. Okay. Weekend? Hell no. Even tag teaming, it needs to be more than 35k.

You’re in institutional captivity for a week. For their cheaper labour to have a good life. This is Morris, IL. Theres nothing in the area or within callback range. They bought a house in the vicinity because the docs get lonely and want to bring their families.

Again, 100k. I’ll split that with someone for splitting one full week coverage.

 

[ItBurnsInMyHand]

Very short sighted of them. The chickens will come home to roost. They will have a catastrophic outcome. If you are getting a TEE, you are pretty ****ed up medically by and large. They will have to splain to the family or plaintiff's attorney why a real anesthesiologist was not involved. I'm sure all of those patients in your hospital believe they are getting an Anesthesiologist MD involved in their care. It really is unethical is what it is.

I had a colleague involved in an unfortunate case with a patient undergoing TEE who had ESRD and severe AS. She recognized that the patient was high risk and had specifically advised the CRNA to use Hurricane spray and give only minimal sedation.

Knowing the TEE was about to begin, she walked over to check on the case. When she arrived, they were coding the patient.

When she later spoke with the chief CRNA about what had happened, the response was: “There are always two sides to the story.”

The problem is. Most cases will be fine. It’s only the edge cases that are affected adversely, and I think the cost of that is calculated into the business model.

 

[NPJR]

Most cases will be fine. It’s only the edge cases that are affected adversely, and I think the cost of that is calculated into the business model.

It is unethical.

 

[amyl]

Truth. What does the hospital care if some Crnas and anesthesiologists get sued? Even if the hospital is named in the suit they’ll throw a little money at it to go away and leave the blame with the doctor and crna…. Cost of doing business… to them it’s better than paying enough and “setting the market.”
If I had a dollar for every time someone in my old PE group said we don’t want to set the market I could retire…

 

[UscGhost]

I had a colleague involved in an unfortunate case with a patient undergoing TEE who had ESRD and severe AS. She recognized that the patient was high risk and had specifically advised the CRNA to use Hurricane spray and give only minimal sedation.

Knowing the TEE was about to begin, she walked over to check on the case. When she arrived, they were coding the patient.

When she later spoke with the chief CRNA about what had happened, the response was: “There are always two sides to the story.”

The problem is. Most cases will be fine. It’s only the edge cases that are affected adversely, and I think the cost of that is calculated into the business model.

Yup.

The good anesthesiologists simply avoid creating the problems.

 

[narcotics999]

Agreed. 5 days 35k. Okay. Weekend? Hell no. Even tag teaming, it needs to be more than 35k.

You’re in institutional captivity for a week. For their cheaper labour to have a good life. This is Morris, IL. Theres nothing in the area or within callback range. They bought a house in the vicinity because the docs get lonely and want to bring their families.

Again, 100k. I’ll split that with someone for splitting one full week coverage.

I know people who works there. Horrible. 7 days/nights for 35K! Double it I will consider.

Let it go CRNA independent.

 

[narcotics999]

Very short sighted of them. The chickens will come home to roost. They will have a catastrophic outcome. If you are getting a TEE, you are pretty ****ed up medically by and large. They will have to splain to the family or plaintiff's attorney why a real anesthesiologist was not involved. I'm sure all of those patients in your hospital believe they are getting an Anesthesiologist MD involved in their care. It really is unethical is what it is.

The surgical center that I work at likes to push its limits. BMI 50, EF 35%. Not long ago I have a pt with BMI 48, mean aortic pressure gradient 58. Prep nurse just saw EF 45%, good to go, lol

 

[cittykat]

The surgical center that I work at likes to push its limits. BMI 50, EF 35%. Not long ago I have a pt with BMI 48, mean aortic pressure gradient 58. Prep nurse just saw EF 45%, good to go, lol

Why do you work there in a market like this? I quit a place because the medical director gave me pushback about using sugammadex.

 

[narcotics999]

Why do you work there in a market like this? I quit a place because the medical director gave me pushback about using sugammadex.

I don't go there often. As a matter of fact, the surgical center does not want me there because I am too expensive.

 

[aneftp]

I know people who works there. Horrible. 7 days/nights for 35K! Double it I will consider.

Let it go CRNA independent.

They know the crnas would demand 50k a week continuously billing while on beeper at $300/hr. Which is what one of my crnas friends did in the Midwest at semi rural hospital. Low ob coverage

So docs per hour are cheaper than cents per hours. And yes I count beeper and physical work hours the same.

Most Crnas are not dumb. Many Docs are dumb. Sticking to old style thinking that beeper is not worth much