anesthesia programs with student CRNAs

[ecf1975do]

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i am currently on the interview trail.... i was wondering those who are interviewing or are current residents... what your views are in terms of the pluses and minuses of being at a gas program with a CRNA program as well..

thanks!

 

[Yogi Patel]

There are pluses to having CRNAs because they can relieve you for lunch, breaks, and late days. Plus, they can take the less educational cases on the schedule.

However, I would strongly advise against going to a program that has a nurse anesthesia school (i.e. SRNAs), because then you have to compete with them for cases. After all, they have educational requirements to fill as well.

Programs that have SRNA's competing with residents for cases include Duke, Wake Forest, Alabama, USC, Georgetown, Iowa, Mayo, Columbia, Pittsburgh, and Baylor. Be careful and keep your eyes open out on the interview trail.

 

[Beantown]

Avoid those programs like the plague (or SARS).....New England Med Cent (Tufts) also has SRNA's.

 

[shaz8901]

There are pluses to having CRNAs because they can relieve you for lunch, breaks, and late days. Plus, they can take the less educational cases on the schedule.

However, I would strongly advise against going to a program that has a nurse anesthesia school (i.e. SRNAs), because then you have to compete with them for cases. After all, they have educational requirements to fill as well.

Programs that have SRNA's competing with residents for cases include Duke, Wake Forest, Alabama, USC, Georgetown, Iowa, Mayo, Columbia, Pittsburgh, and Baylor. Be careful and keep your eyes open out on the interview trail.

Northwestern in chicago also has a SRNA program. Some of the residents I spoke to complained about them.

 

[Doctor4Life1769]

Yeah, more than half those programs are also considered upper-tier, nobody's gonna avoid 'em.

 

[Dejavu]

There are pluses to having CRNAs because they can relieve you for lunch, breaks, and late days. Plus, they can take the less educational cases on the schedule.

However, I would strongly advise against going to a program that has a nurse anesthesia school (i.e. SRNAs), because then you have to compete with them for cases. After all, they have educational requirements to fill as well.

Programs that have SRNA's competing with residents for cases include Duke, Wake Forest, Alabama, USC, Georgetown, Iowa, Mayo, Columbia, Pittsburgh, and Baylor. Be careful and keep your eyes open out on the interview trail.

Being an attending at one of the above named programs, I can assure you that, if the program is big enough, as ours is, you don't have to worry about competing for cases and whether you will get a quality education. Our grads have many times more cases and more regional experience than any program. Plus the benefits of relief and such, as stated above.

And here I get into trouble...but, at least in our institution, working in the same hospitals with SRNA/CRNAs is a small step toward learning how to get along, since both types of providers are here to stay (if my 34 years of experience (both as a CRNA and an MD attending) mean anything).

Please don't start any flame wars about that last part. I won't get sucked into that. It is pointless.

 

[Bertelman]

And here I get into trouble...but, at least in our institution, working in the same hospitals with SRNA/CRNAs is a small step toward learning how to get along, since both types of providers are here to stay (if my 34 years of experience (both as a CRNA and an MD attending) mean anything).

Please don't start any flame wars about that last part. I won't get sucked into that. It is pointless.

Agree, but it's also an early insight into how a few of the nurses believe they are our equivalents.

 

[Coastie]

dejavu,

I hope you're actively working with the ASA, given your experience, to destroy the AANA's political victories. That would definitely not be pointless. 👍

Being an attending at one of the above named programs, I can assure you that, if the program is big enough, as ours is, you don't have to worry about competing for cases and whether you will get a quality education. Our grads have many times more cases and more regional experience than any program. Plus the benefits of relief and such, as stated above.

And here I get into trouble...but, at least in our institution, working in the same hospitals with SRNA/CRNAs is a small step toward learning how to get along, since both types of providers are here to stay (if my 34 years of experience (both as a CRNA and an MD attending) mean anything).

Please don't start any flame wars about that last part. I won't get sucked into that. It is pointless.

 

[ProRealDoc]

CCF also has a SRNA training program.

 

[ctsicu]

personally i would avoid them...but you can go ask the residents in the program how it works. nurse students are in my experience, very aggressive with demanding the cases. definitely try and get a feel for how things are prioritized. i've def heard complaints that nurses will get preference in case mix.

 

[countingdays]

Even if residents get 3/4 of the good cases you are still missing out on 1/4 of the good cases. I don't think there is any positive to having srnas in your training institution. CRNAs are nice to have so you don't get put it weak cases just for coverage, but srnas add nothing. They should train in the countryside doing minor surgery in healthy patients, or they can apply to med school and good luck with that.

 

[Coastie]

personally i would avoid them...but you can go ask the residents in the program how it works. nurse students are in my experience, very aggressive with demanding the cases. definitely try and get a feel for how things are prioritized. i've def heard complaints that nurses will get preference in case mix.

Why would anyone give preference to a nurse for a medical case?

Sounds like some weak sauce attendings...on whom the nurses have a thing or two (or picture).

 

[Idiopathic]

personally i would avoid them...but you can go ask the residents in the program how it works. nurse students are in my experience, very aggressive with demanding the cases. definitely try and get a feel for how things are prioritized. i've def heard complaints that nurses will get preference in case mix.

I can only speak to my program but we train SRNAs and there has NEVER been a day since Ive been here where an SRNA got a good case that should have gone to a resident who was otherwise not involved in his/her own good case. Very occasionally there are just not as many residents available to do good cases (AAA, Whipple, etc.) and CRNAs will do them, but I dont see it at the expense of resident education. We train too many SRNAs, I think, but if anything, they support the education of residents (keeping us out of the eye room, ortho trash, belly case, occasional spine, etc) providing breaks, helping out with preops and what not.

Just two ways of looking at it. I think it would be a lot harder task for the residents and the programs to handle the work that we do without the extenders but I know that Ive said that elsewhere.

 

[Bertelman]

On a similar note, would you consider not applying to programs with a large number of residents, presumably because there are more residents than good cases?

 

[countingdays]

I can only speak to my program but we train SRNAs and there has NEVER been a day since Ive been here where an SRNA got a good case that should have gone to a resident who was otherwise not involved in his/her own good case. Very occasionally there are just not as many residents available to do good cases (AAA, Whipple, etc.) and CRNAs will do them, but I dont see it at the expense of resident education. We train too many SRNAs, I think, but if anything, they support the education of residents (keeping us out of the eye room, ortho trash, belly case, occasional spine, etc) providing breaks, helping out with preops and what not.

Just two ways of looking at it. I think it would be a lot harder task for the residents and the programs to handle the work that we do without the extenders but I know that Ive said that elsewhere.

You seem to be using crna and srna interchangeably.
The advantages you list apply to crnas not srnas.

 

[Engin]

As a 4th year med student, I have been pushed out of cases in preference of a SRNA. It is very infuriating. As it is my SubI, this did not get back to the attending (and this has happened with other med students).

 

[bullard]

Northwestern in chicago also has a SRNA program. Some of the residents I spoke to complained about them.

Northwestern does NOT have a SRNA program. SRNAs from Evanston Hospital (now known as North Shore, I guess) do rotate through, but I've never seen them in any kind of "big" case, i.e. neuro, cardiac, major vascular, etc. They do no blocks or epidurals at Northwestern; perhaps they do that stuff at the other hospitals they rotate through.

I get the feeling that the residents at Duke, Mayo, Columbia, etc aren't exactly fighting off SRNAs for good cases either. There's plenty of surgical volume to go around.

 

[yasawa]

There are pluses to having CRNAs because they can relieve you for lunch, breaks, and late days. Plus, they can take the less educational cases on the schedule.

However, I would strongly advise against going to a program that has a nurse anesthesia school (i.e. SRNAs), because then you have to compete with them for cases. After all, they have educational requirements to fill as well.

Programs that have SRNA's competing with residents for cases include Duke, Wake Forest, Alabama, USC, Georgetown, Iowa, Mayo, Columbia, Pittsburgh, and Baylor. Be careful and keep your eyes open out on the interview trail.

In general, I totally agree that you need to avoid programs that actively train SRNAs(USC, IOWA, Baylor). However, there are many programs like Mayo, Duke and Columbia where residents will always get the better cases. In terms of Columbia, only 1, possibly two SRNAs are allowed to rotate at the main CUMC campus. They send them to outside affiliate hospitals for their training where there are no residents. The ones that do come to CUMC for a month or two are placed in cysto, eye, and other off site cases. They are not allowed to do any regional at CUMC. Overall, our dept is very protective of the residency program and our leaders are constantly making changes/improvements.

 

[B-Bone]

As a recent grad from Dejavu's program I will attest that an SRNA program didn't take away from my education at all. In fact, by having to supervise SrNAs as well as CRNAs in my many hallway months, not to mention on call, I reinforced for myself the differences in our educations and prepared myself very well for my current private practice job where I supervise 95% of the time. Supervising is a skill just like any other and requires practice to do well and be comfortable. Programs without CRNAs/SRNAs just don't offer that experience, and most people will end up supervising at some time. As for competing for cases, neither CRNAs nor SRNAs were allowed to do lines, blocks, spinals or epidurals institution-wide so there wsa absolutely no competition for regional. Residents were always given priority over SRNAs,especially in cardiac, thoracic, big cases, etc. The SRNA program sends the students to tiny hospitals or even other states to get their "regional" experience. The benefits that come from a large CRNA/SRNA labor force are lots of reading time, home by 3 or 4 every day, no sitting butt pus cases at 3 am (cuz the nurses do it while you sleep or do a ruptured AAA), and experience supervising. I wouldn't go to another program in hindsight, and was very well prepared to start my job.

 

[ctsicu]

well, the above may be true...but i was an attending for a year at a place with both and i definitely feel like the nurses got some priority over the residents. so did the residents who were training. now, i'm going to a place with both (but i'm going to the icu) and i've heard complaints that nurses are taking cases from residents and its a big name midwest program. bottom line, ask the residents on your interview day what they think. it will give you a much better idea of how it works. have to say that i would never go somewhere and train beside a nurse.

 

[NotAMD]

i am a resident at one of the above mentioned programs with srnas

i honestly think they are overall a positive..from my perspective:

as a ca-1 you they make you look good because you can progress faster than them, your worker more, doing harder cases, etc.. so you look good compared to them..

as a ca-2 and beyond they are another able-bodied person to help with breaks, cases, preops, etc.. nothing advanced but basic stuff

i dont know about the other programs but out srnas arent doing many spinals, epidurals, basic nerve blocks, central lines, fiberoptic intubations, dlts, HIPECS, cabgs, pain consults, and by many i mean less than 5 if any in 2 yrs .. and we are a big program..its very basic bread and butter for them

so its not like they are stealing the good cases, they maybe steal a few D&Es mostly ... also.. the few days they do do a cardiac case or cover OB - you can take a break from a stressful rotation.. you still will more than exceed your numbers (prob similar for most of the other named programs too)

 

[leaverus]

as a ca-1 you they make you look good because you can progress faster than them, your worker more, doing harder cases, etc.. so you look good compared to them..

What does that mean? Make you look good in whose eyes - your attendings, the surgeons, other nurses??? Who cares about that? You're talking about an RN making an MD/DO looking good in comparison? Your statement confuses me 😕 because there shouldn't be a need to compare an RNs knowledge/skills to that of a PHYSICIAN.

 

[aredoubleyou]

My program, we did a lot of bs cases, trauma washouts, simple ortho. eyes, etc, etc. We worked, suposedly according to a reviewer, neat the 95+% of cases per resident in the nation. We had a couple crnas around to help with the load and they never came in late to get us out. We had no srnas. IT WAS WORTH EVERY 7 PM WASHOUT, EVERY MIDNIGHT LAP CHOLE, EVERY KNEE SCOPE TO NOT TRAIN OR SUPPORT THE MILITANT CRNA BS. If you want to be lazy and have a cush residency....you're no different than the jerks who came before us that thought supervising 4-6 crnas at once was a great idea. If youre a competitive med student send the message to the chairmans who train the CRNAs that you will not be part of it.

 

[dingleberry007]

I don't understand why anyone would be ok with training in a program that is shared by srnas. So in a few years they can say "hey, I did my training the same place you did bud!".
I'm getting the sense that there are a lot of excuses being given such as getting out early and not having to do bs cases. I agree with the previous poster that this is bordering on laziness. Why should you be expected to get out by 3 in residency? You're too good to do a lap chole as a resident?
I don't know how MDs let this happen! Doing residency side by side with nursing students trying to take our jobs! I thought this laziness permeated with the older docs that allowed for this influx of CRNAs, but I thought the new generation of docs are supposed to be more staunch in the defense of the profession. Guess not...

 

[doctor712]

.

 

[Southpaw]

My program, we did a lot of bs cases, trauma washouts, simple ortho. eyes, etc, etc. We worked, suposedly according to a reviewer, neat the 95+% of cases per resident in the nation. We had a couple crnas around to help with the load and they never came in late to get us out. We had no srnas. IT WAS WORTH EVERY 7 PM WASHOUT, EVERY MIDNIGHT LAP CHOLE, EVERY KNEE SCOPE TO NOT TRAIN OR SUPPORT THE MILITANT CRNA BS. If you want to be lazy and have a cush residency....you're no different than the jerks who came before us that thought supervising 4-6 crnas at once was a great idea. If youre a competitive med student send the message to the chairmans who train the CRNAs that you will not be part of it.

Couldn't have said it better myself. 👍

 

[ProRealDoc]

Wash U in St. Louis has a SRNA training program.

 

[Bertelman]

Wow. Now we've started to attack each other. You can go ahead and count me in the *lazy* group of residents that appreciate relief from my B.S. case from a CRNA. I'm so f'in lazy, I squeezed a chicken-fingers-and-bag-o-chips lunch into the extra five minutes of room turnover today while I waited for the circulator to lay out instruments. As I drained a Coke, a CRNA asked me if I needed a lunch break. I said no. In my mind, I was thinking, "My break starts in about 10 minutes once I slide the LMA into this pt. for a knee scope."

If you really feel strongly about ending all CRNA education, you should find a residency that doesn't have any CRNAs. Don't stop with residency. Limit your job search to MD-only practice. Embrace that 3 a.m. appy when you're 55 years old. You'll be doing it.

If you happen to have CRNAs at your program currently, stop accepting breaks from them. Petition your PD to eliminate CRNAs from the call pool. Residents only. Push the 80 hr week to its limit now, before the ACGME cuts it back next year. Hell, stay in the OR until your chairman drags you out kicking and screaming, stinking because you haven't showered in 3 days, because the showers they have for residents are shared by CRNAS, and bygod, you won't share shit with those hacks.

There's too much damn hyperbole on these boards recently. Whatever the future may hold for anesthesia, I hope it gets here soon. That way we can all just lie down and take it, instead of talking about it.










And yes, I voted for Obama. Along with most of the country. Sarah Palin disgusts me. I might regret my decision if McCain outlives Obama's term.

 

[Idiopathic]

SRNA students spend about 6 weeks of their however long clinical training at my hospital, so we "train" them but they do most of their training else where.

you all do whatever makes you happy, I guess. If you choose not to rank a program that trains nurses then great but what you have to realize is that THEY ARE NOT GOING ANYWHERE AND YOU ARE GOING TO HAVE TO WORK WITH THEM AT SOME POINT so wouldnt you rather get some experience supervising them as a resident since your first job is likely going to be supervising them?

 

[WholeLottaGame7]

A significant number of places I interviewed at had SRNAs, and at none of them did the residents feel threatened or competition. Most of the big academic places seem to have rooms/case loads far exceeding resident capacity, especially when non-OR sites are included. Residents universally told me that they are assigned to cases first with the CRNAs/SRNAs left to fill in the gaps.

 

[fakin' the funk]

Wow. Now we've started to attack each other. You can go ahead and count me in the *lazy* group of residents that appreciate relief from my B.S. case from a CRNA. I'm so f'in lazy, I squeezed a chicken-fingers-and-bag-o-chips lunch into the extra five minutes of room turnover today while I waited for the circulator to lay out instruments. As I drained a Coke, a CRNA asked me if I needed a lunch break. I said no. In my mind, I was thinking, "My break starts in about 10 minutes once I slide the LMA into this pt. for a knee scope."

Please teach me the ways of getting free time during room turnover. 😕 Seriously I'm busting my ass and always the last one ready.

 

[ProRealDoc]

Wow. Now we've started to attack each other. You can go ahead and count me in the *lazy* group of residents that appreciate relief from my B.S. case from a CRNA. I'm so f'in lazy, I squeezed a chicken-fingers-and-bag-o-chips lunch into the extra five minutes of room turnover today while I waited for the circulator to lay out instruments. As I drained a Coke, a CRNA asked me if I needed a lunch break. I said no. In my mind, I was thinking, "My break starts in about 10 minutes once I slide the LMA into this pt. for a knee scope."

If you really feel strongly about ending all CRNA education, you should find a residency that doesn't have any CRNAs. Don't stop with residency. Limit your job search to MD-only practice. Embrace that 3 a.m. appy when you're 55 years old. You'll be doing it.

If you happen to have CRNAs at your program currently, stop accepting breaks from them. Petition your PD to eliminate CRNAs from the call pool. Residents only. Push the 80 hr week to its limit now, before the ACGME cuts it back next year. Hell, stay in the OR until your chairman drags you out kicking and screaming, stinking because you haven't showered in 3 days, because the showers they have for residents are shared by CRNAS, and bygod, you won't share shit with those hacks.

There's too much damn hyperbole on these boards recently. Whatever the future may hold for anesthesia, I hope it gets here soon. That way we can all just lie down and take it, instead of talking about it.










And yes, I voted for Obama. Along with most of the country. Sarah Palin disgusts me. I might regret my decision if McCain outlives Obama's term.

So it would be OK for a 55-yr old CRNA to get up at 3am and do that lap appy but not you (assuming you were 55)? I am confused.

 

[Bertelman]

Please teach me the ways of getting free time during room turnover. 😕 Seriously I'm busting my ass and always the last one ready.

Maybe it depends on the hospital you're at. I work at a quasi-academic/private place, and I can say I easily have 5 min to chill between each case when the circulators and scrubs are fiddling. When I'm at the ASC, I don't have that window, but they rarely wait for me with turnover times.

1) Have all your drugs for the next case drawn up prior to emergence. Ditto for tube, blade, tape, etc.

2) Be very efficient in PACU handoff. There have been threads about this. You should make it back to your OR before they've opened the next case.

3) This is all contingent on your attending pre-op'ing the next pt.

Practice doing the simple stuff as quickly as you can, every single day. 95% of what we do, the mechanincs, preparation, etc., should be second nature, basically mindless.

 

[Bertelman]

So it would be OK for a 55-yr old CRNA to get up at 3am and do that lap appy but not you (assuming you were 55)? I am confused.

It was a rant. It wasn't supposed to make sense. 😉

My point was that if one feels so strongly about ending CRNA education, you shouldn't let your philosophy end when residency is over. If you're not willing to work beside SRNAs, you should commit to never accepting a job with CRNAs, either. Anything less is just thumping your chest.

I agree with Idio. If a large bloc of us choose not to rank programs with SRNAs, it's not like those programs will go unfilled. They'll still get anesthesia residents to do the work. If you choose not to rank a place because you feel your education may be compromised, so be it. Just don't think you're "sending a message" to the chairman by not ranking their program. They'll never get that message.

What do you think might happen if these programs do happen to go unfilled? I'd guess they would reach out to train more SRNAs with their empty ORs. They can squeeze them out twice as fast as a resident. Not exactly a good move for our future.

 

[PepperJusice]

If anyone is wondering why nurses are taking over anestheisa, they just need to look at this thread.

You guys are happy to let nurses to take the cases so you can "study' and "relax", and then you complain that CRNAs are taking your jobs...You are giving the specialty away!

Next time, when you are relived by SRNA/CRNA, please look at the other side of curtain. Your surgical colleages are staying, even for the BS cases. This is why they have at least a feasible future while you are fighting with CRNAs to survive.

 

[ProRealDoc]

If anyone is wondering why nurses are taking over anestheisa, they just need to look at this thread.

You guys are happy to let nurses to take the cases so you can "study' and "relax", and then you complain that CNRAs are taking your jobs...You guys are giving the specialty away!

Next time, when you are relived by SRNA/CRNA, please look at the other side of curtain. Your surgerical colleages is staying, even for the BS cases. This is why they have at least a feasible future while you are fighting with CRNAs to survive.

 

[Bertelman]

If anyone is wondering why nurses are taking over anestheisa, they just need to look at this thread.

You guys are happy to let nurses to take the cases so you can "study' and "relax", and then you complain that CRNAs are taking your jobs...You are giving the specialty away!

Next time, when you are relived by SRNA/CRNA, please look at the other side of curtain. Your surgical colleages are staying, even for the BS cases. This is why they have at least a feasible future while you are fighting with CRNAs to survive.

Let's get something straight. There is not a single CRNA at my program that works more hours in a week than I do. Not one. Even the ones that pick up "an extra shift", bringing them to a whopping 5-day work week, work fewer hours than each of our residents. As for the surgeon's perception of me- they can think what they want, because I'm in the OR 5-6 days per week. The busy ones manage 3 days.

Furthermore, when I get relieved from my room between 4 and 5, I don't exactly waltz my way into the locker room and head home. I head upstairs to do 2-3 pre-ops. That CRNA that "relieved" me often gets to the locker room about the same time I do. When they relieve me in a room, there's often some snide comment like, "I guess they're letting you out of here.". I quickly remind them I'd rather stay and finish my case, but someone's got to do the damn pre-ops, because our CRNAs aren't exactly rushing upstairs to pre-op the next day's AVR. There have been multiple occasions when, either because of the acuity of the case, or the capabilities of the CRNA coming in to relieve me, I have refused my relief.

I assure you that my 2+ years as a resident has had absolutely ZERO effect on the current status of CRNAs in this country. That path was laid well before I entered med school. Want a scapegoat? It's not me, or any of my resident colleagues. Furthermore, my hospital, which trains exactly 2 SRNAs per year, is not exactly the big threat you think it may be.

 

[pgg]

And yes, I voted for Obama. Along with most of the country. Sarah Palin disgusts me. I might regret my decision if McCain outlives Obama's term.

It amazes me that to this day there's a huge element of the Republican party that doesn't realize how poisonous she is. It just defies explanation.

 

[Idiopathic]

If anyone is wondering why nurses are taking over anestheisa, they just need to look at this thread.

You guys are happy to let nurses to take the cases so you can "study' and "relax", and then you complain that CRNAs are taking your jobs...You are giving the specialty away!

Next time, when you are relived by SRNA/CRNA, please look at the other side of curtain. Your surgical colleages are staying, even for the BS cases. This is why they have at least a feasible future while you are fighting with CRNAs to survive.

this is just ******ed logic. i worked just as hard as my surgical resident colleagues, while they were eating and having coffee and urinating etc, i was setting up their case prepping their patient, managing issues, etc. so if i take an f^ing lunch break at 230 while they are still trying to repair the bovie hole in the common bile duct so be it.

I think you are missing my point - having SRNA/CRNA providers allows me to work an extra month in the ICU, get that pain experience, do more cardiac and do research, ALL THINGS THAT WILL POTENTIALLY MAKE ME MORE COMPETITIVE in the long run, and more well rounded.

So, pick your program without nurses, get your experience and stand on your soapbox, but just remember, you will go out in private practice or academics and you will supervise these providers, at almost any job you take. No one has yet come up with a way to scale back the system, Im not sure that refusing to train at a place that trains SRNAs is a way to prevent their advancement goals. Seems like a way to sacrifice some element of your training, although I only went to one residency program

 

[cfdavid]

If anyone is wondering why nurses are taking over anestheisa, they just need to look at this thread.

You guys are happy to let nurses to take the cases so you can "study' and "relax", and then you complain that CRNAs are taking your jobs...You are giving the specialty away!

Next time, when you are relived by SRNA/CRNA, please look at the other side of curtain. Your surgical colleages are staying, even for the BS cases. This is why they have at least a feasible future while you are fighting with CRNAs to survive.

there's some truth to this......

That being said, I'm a big believer in having anesthesiology programs which actually allow residents to get out and read, thus do well on their board exams.

One very important opportunity for us is that while surgeons must master some widely variable and ever evolving surgical procedures, we can hone in on our MEDICAL knowledge base. We are freed up to do this, and must be the "internists of the OR".

 

[aredoubleyou]

Not trying to be too much of a d!ck, but seriously, if you need CRNAs to relieve you to be able to pass the boards, you should have been weeded out back at the MCATs. How do the surgeons pass their boards?

All points on the advantages of having the crna/srnas are valid...but justifying the manufacturing of an endless supply of these people to add to your three year education? Seems to me, in the big picture, the disadvantages outweigh the advantages. Lets reboot and start over.