A poll and question for everyone - the price of supervision

[Ignatius J]

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There are dysfunctional MD only groups just like there are dysfunctional ACT groups. I love my group. I almost never get to sit down during the day because I'm constantly busy doing things. It's physically very tiring, but it makes the time fly and that's what vacation is for to recharge from.

Based on my experience with both, you're an exception. Lounge-sittin' is much more common in ACT models. You can be lazy in physician-only groups, but the difference is you have to be in the OR. No exceptions to that.

 

[Mman]

Based on my experience with both, you're an exception. Lounge-sittin' is much more common in ACT models. You can be lazy in physician-only groups, but the difference is you have to be in the OR. No exceptions to that.

Being in the OR isn't exactly a tough part of the job and the dysfunctional MD only groups I've seen have problems with room turnover and responding to issues in PACU etc or even making room staff wait for them to get a case going.

I agree that physicians in any setting can have issues, it's just different issues that appear in different settings.

 

[Ignatius J]

Fair enough. Disagree on some points but different perspectives isn't a bad thing.

You sound like a good anesthesiologist so would love to have you in a MD only group. I think that's where good ones shine the most.

 

[Mman]

Fair enough. Disagree on some points but different perspectives isn't a bad thing.

You sound like a good anesthesiologist so would love to have you in a MD only group. I think that's where good ones shine the most.

I don't think I could be paid enough to sit on a stool all day. Doesn't stimulate my mind enough to only have 1 patient at a time. I respect those that can and do, but to me that's living the resident's life and I gave that up.

I just personally prefer to do lots of procedures and juggle patient responsibilities. I also like the ability to take care of my patients in PACU 30 or 60 or even 120 minutes after a procedure if the need arises and not be tied up in another case.

 

[Doctor4Life1769]

I love it when Consig gets most of y'all's panties in a wad. He may be trollin, but he is dishing out a hefty dose of reality.

 

[vector2]

This is why I don't want to be the guy sitting the stool

 

[Man o War]

HAAAAA. "Where is the anesthesiologist?"
"He left"

 

[TaoistDoc]

I see the costs and benefits of either model. Being a fresh attending 1 month out of residency in an ACT model, I was scared ****less my first week of work supervising 4 anesthetists. In my practice, we don't show up for extubations, so I kept thinking what if the patient laryngospasm, or what if they get over narcotized, or get too much muscle relaxants.... its all out of my control. So I was hovering quite a bit. Luckily, none of that has happened. One month in and I got to know many of the anesthetists better so I'm starting to feel more comfortable now. I do enjoy being able to leave the room after the interesting part of induction and intubation. If a patient is super sick, I'd check in more often and give pointers on how to optimize the case. I do think supervision is more intellectually challenging than doing your own case just from the sheer number of patients you're taking care of a day. But I do miss the good ole days of sitting my own case during residency though. Things seemed a lot simpler and less stressful back then.

 

[BLADEMDA]

I see the costs and benefits of either model. Being a fresh attending 1 month out of residency in an ACT model, I was scared ****less my first week of work supervising 4 anesthetists. In my practice, we don't show up for extubations, so I kept thinking what if the patient laryngospasm, or what if they get over narcotized, or get too much muscle relaxants.... its all out of my control. So I was hovering quite a bit. Luckily, none of that has happened. One month in and I got to know many of the anesthetists better so I'm starting to feel more comfortable now. I do enjoy being able to leave the room after the interesting part of induction and intubation. If a patient is super sick, I'd check in more often and give pointers on how to optimize the case. I do think supervision is more intellectually challenging than doing your own case just from the sheer number of patients you're taking care of a day. But I do miss the good ole days of sitting my own case during residency though. Things seemed a lot simpler and less stressful back then.

I'm glad you have a good job. Really. But, as a new attending doing your own cases is an important part of fully developing your skills. A few years in the OR or 25% solo anesthesia would make you a better supervisor and a better Anesthesiologist.

It's like going to war with the guy who is brand new vs one with 4 tours under his belt. The guy who has the training and the upfront, personal experience in combat is the one I would want by my side.

 

[TaoistDoc]

I'm glad you have a good job. Really. But, as a new attending doing your own cases is an important part of fully developing your skills. A few years in the OR or 25% solo anesthesia would make you a better supervisor and a better Anesthesiologist.

It's like going to war with the guy who is brand new vs one with 4 tours under his belt. The guy who has the training and the upfront, personal experience in combat is the one I would want by my side.

I would have liked to do my own cases too. But remember, I'm in the southeast so its not really an option.

I also think I honed my skills pretty well as a CA3 doing my own cases, albeit with "supervision" I.e. attending signed the chart.

 

[Ignatius J]

I would have liked to do my own cases too. But remember, I'm in the southeast so its not really an option.

I also think I honed my skills pretty well as a CA3 doing my own cases, albeit with "supervision" I.e. attending signed the chart.

I have learned almost as much doing my own cases on my own since residency. You perfect the science of it in residency, but doing your own cases in private practice, I think you get a feel for the art of it. JMO.

 

[GA8314]

Mostly agree with the above numbers. But I would change the supervision ratio to 1:2-3. 1:4 is rare and only when that 4th room is a sleeper, like a long stable case, or the eyeball room. And my call is 2-4 times per month for frequency. Salary is right on but partner track for those numbers. No partner track and I would think its a little low.

So I actually prefer supervising multiple rooms. Im sure every CRNA situation is different, but ours work for the group. So I do the pre-ops, communicate the plan, I am paged for induction, I stay and do the beginning of the case until it is stable and underway, then leave. Repeat and do the same in other rooms. Give breaks and lunches. Do blocks and lines myself. I honestly look at people doing their own cases and think, god how inefficient. Why should an MD be setting up suction and getting meds out of the pixis and watching stable vitals. I am called with problems and for extubations after I get the case rolling. I am happy with this arrangement and feel like I get all the action without the monotony because I can come and go in the case as I please. So i dont really see it as a a nuisance that would require more salary. Sure there are days when I am assigned to go solo, or cover the ICU and intubate solo, so there is always autonomy. I guess it depends on the gig, I wouldnt want to be supervising in a surgicenter all day just doing MAC cases, but in the right setting I dont feel Im missing out on what I consider to be the important parts of the case.

I feel very similarly on all aspects of what you said.