..conversation that I had.. Don't go into anesthesia!

[criticalelement]

So I see an ad so i call it (not that I am looking immediately) but i'm curious. The ad reads

Looking for a doctor to collaborate with crnas. (the word collaborate got my attention)

3 crnas 1 md..

I ask the recruiter from a national company, " So Im supervising CRNAs?"

She: "No, you're doing your own cases"
Me: "great!! who is supervising the crnas?
She: Nobody they are independent
Me: Why do you wanna hire me then? Just hire another CRNA who is independent.
She: I know what you mean, but the hospital likes this model.

It went back and forth like this for awhile until I told her I wont be part of this. FIrst of all this was NOT an opt out state and I have no idea what lawyers told them this is ok. Or the surgeons may be signing off on their charts unbeknownst to the surgeons.

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Members don't see this ad.

 

[maxplankton]

So I see an ad so i call it (not that I am looking immediately) but i'm curious. The ad reads

Looking for a doctor to collaborate with crnas. (the word collaborate got my attention)

3 crnas 1 md..

I ask the recruiter from a national company, " So Im supervising CRNAs?"

She: "No, you're doing your own cases"
Me: "great!! who is supervising the crnas?
She: Nobody they are independent
Me: Why do you wanna hire me then? Just hire another CRNA who is independent.
She: I know what you mean, but the hospital likes this model.

It went back and forth like this for awhile until I told her I wont be part of this. FIrst of all this was NOT an opt out state and I have no idea what lawyers told them this is ok. Or the surgeons may be signing off on their charts unbeknownst to the surgeons.

Thanks, Alex! Let's stay in this category and go with 'things that didn't happen in real life' for $600.

 

[deleted171991]

Thanks, Alex! Let's stay in this category and go with 'things that didn't happen in real life' for $600.

They do happen. Just not so much in your alternate reality video game called med school, or residency.

 

[maxplankton]

They do happen. Just not so much in your alternate reality video game called med school, or residency.

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

 

[deleted171991]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

Somebody is signing those charts, most likely the surgeons. Which is exactly what criticalelement said. Nowhere does the law say that it must be an anesthesiologist.

 

[maxplankton]

Somebody is signing those charts, most likely the surgeons. Which is exactly what criticalelement said. Nowhere does the law say that it must be an anesthesiologist.

Fair point, but in which case I would bet the surgeons know what's up rather than signing off on solely CRNA led cases 'unbeknownst' to them.

 

[PainDrain]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

I guarantee what is going down here is the surgeon signs off on the chart and the CRNA is essentially acting independently, but with a catch. I bet somewhere deep down in the contract it says that you as the anesthesiologist must be available for emergent consults from the CRNAs, which I bet the hospital lawyers feel is enough to free them from liability. This is the ultimate F- you to the anesthesiologist who takes this job. They are supervising and don't even realize it until the **** hits the fan.

 

[maxplankton]

I guarantee what is going down here is the surgeon signs off on the chart and the CRNA is essentially acting independently, but with a catch. I bet somewhere deep down in the contract it says that you as the anesthesiologist must be available for emergent consults from the CRNAs, which I bet the hospital lawyers feel is enough to free them from liability. This is the ultimate F- you to the anesthesiologist who takes this job. They are supervising and don't even realize it until the **** hits the fan.

Ultimate F-you to the anesthesiologist who doesn't read or hire a lawyer to read his/her employment contract before signing on.

 

[gasp]

So I see an ad so i call it (not that I am looking immediately) but i'm curious. The ad reads

Looking for a doctor to collaborate with crnas. (the word collaborate got my attention)

3 crnas 1 md..

I ask the recruiter from a national company, " So Im supervising CRNAs?"

She: "No, you're doing your own cases"
Me: "great!! who is supervising the crnas?
She: Nobody they are independent
Me: Why do you wanna hire me then? Just hire another CRNA who is independent.
She: I know what you mean, but the hospital likes this model.

It went back and forth like this for awhile until I told her I wont be part of this. FIrst of all this was NOT an opt out state and I have no idea what lawyers told them this is ok. Or the surgeons may be signing off on their charts unbeknownst to the surgeons.

Wow, I was about to say not a bad gig until I saw the part about the non opt-out state. I would love to get a copy of that contract and read it VERY carefully. I bet there is a clause in there somewhere about being available and ultimately responsible for their f-ups..

 

[Spinach Dip]

I guarantee what is going down here is the surgeon signs off on the chart and the CRNA is essentially acting independently, but with a catch. I bet somewhere deep down in the contract it says that you as the anesthesiologist must be available for emergent consults from the CRNAs, which I bet the hospital lawyers feel is enough to free them from liability. This is the ultimate F- you to the anesthesiologist who takes this job. They are supervising and don't even realize it until the **** hits the fan.

This was my first thought as well.

 

[criticalelement]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

Well you better start buying it because that is reality. Everyone from your employer, hospitals, surgeons, CRNAs are desperately trying to eliminate your existence. And it is working. They dont give a rats arse whether is greater liability as long as they are saving money and they are eliminating YOU.

 

[chfo]

If you're not on the chart, it doesn't matter what your contract says, you're not responsible for their f ups.

 

[Arch Guillotti]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

Believe it.

 

[Consigliere]

Thanks, Alex! Let's stay in this category and go with 'things that didn't happen in real life' for $600.

This happens all the time. "Alex I'd like to change the subject to 'Asshats Who Are Clueless' for $800." This set-up is actually one where the CRNAs do their own cases and the anesthesiologist is there to either put out fires and act as a consultant or is actually the supervising physician. Either scenario is a potential lawsuit minefield. Avoid these gigs unless desperate.

 

[deleted126335]

On paper someone is supervising. Maybe it is in the policy and procedures manual.

"If after ten minutes at the poker table you do not know who the patsy is—you are the patsy."

POKER PROVERB

 

[criticalelement]

If you're not on the chart, it doesn't matter what your contract says, you're not responsible for their f ups.

That is true. And if there is no physician/patient relationship(as in preoperative interview) to establish duty difficult to establish malpractice case. However, if you are summoned in a difficult intubation case etc etc etc and the patient has a bad outcome you may be on the hook since it is COLLABORATIVE. By taking this job you agreed to collaborate they will argue.

I have no idea why these freakin numskulls put themselves in gray situations. There is a reason why anesthesia is so safe nowadays. It is like they have mickey mouse giving them legal advice

 

[Promethean]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

I walked away from a travel nursing assignment where they had unlicensed patient care techs obtaining the "informed consent" for procedures by shoving the consent into the hands of already semi-sedated patients just before the stick of propofol (all ready screwed into their IV tubing) was pushed by the apparently unsupervised CRNA. The patients never met the doc who was to do their procedure. Not in clinic beforehand. Not in the holding area. Not in post procedure recovery. The charting was all paper so that "you can fill most of the charts out for your cases for the day first thing in the morning, then all you have to do is go through and fill in the times as you get them done." You can guess how well the endoscope cart was cleaned in the 3 minutes (or less!) between cases. The disinfectant wipes weren't dry before the techs were setting up the next case.

I worked for two days, trying to figure out if there was a way to make their practice safer, before giving up and resigning the post. The travel nursing agency accused me of being unprofessional for refusing to risk my license for the full 12 weeks in that madhouse, and the hospital administrator who tried to put me in that position assured me that I'd never work for her hospital system again. That was fine by me, especially about 6 months later, when I noticed that GI lab mentioned in the news as a place that had done an procedure on the wrong patient and spread disease by using inadequately decontaminated endoscopy equipment.

When healthcare is business, and there is money to be made by squeezing margins, profit seeking will take precedence over patient safety, until lawsuits and/or regulators catch up. In the interim before that intervention, you can see some crazy things as a contractor.

 

[Psai]

I walked away from a travel nursing assignment where they had unlicensed patient care techs obtaining the "informed consent" for procedures by shoving the consent into the hands of already semi-sedated patients just before the stick of propofol (all ready screwed into their IV tubing) was pushed by the apparently unsupervised CRNA. The patients never met the doc who was to do their procedure. Not in clinic beforehand. Not in the holding area. Not in post procedure recovery. The charting was all paper so that "you can fill most of the charts out for your cases for the day first thing in the morning, then all you have to do is go through and fill in the times as you get them done." You can guess how well the endoscope cart was cleaned in the 3 minutes (or less!) between cases. The disinfectant wipes weren't dry before the techs were setting up the next case.

I worked for two days, trying to figure out if there was a way to make their practice safer, before giving up and resigning the post. The travel nursing agency accused me of being unprofessional for refusing to risk my license for the full 12 weeks in that madhouse, and the hospital administrator who tried to put me in that position assured me that I'd never work for her hospital system again. That was fine by me, especially about 6 months later, when I noticed that GI lab mentioned in the news as a place that had done an procedure on the wrong patient and spread disease by using inadequately decontaminated endoscopy equipment.

When healthcare is business, and there is money to be made by squeezing margins, profit seeking will take precedence over patient safety, until lawsuits and/or regulators catch up. In the interim before that intervention, you can see some crazy things as a contractor.

And if you whistleblow, they will find everything they can on you or just smear you with bs like child porn or rape to ruin your life

 

[Arch Guillotti]

Keep it professional please.

 

[urge]

So I see an ad so i call it (not that I am looking immediately) but i'm curious. The ad reads

Looking for a doctor to collaborate with crnas. (the word collaborate got my attention)

3 crnas 1 md..

I ask the recruiter from a national company, " So Im supervising CRNAs?"

She: "No, you're doing your own cases"
Me: "great!! who is supervising the crnas?
She: Nobody they are independent
Me: Why do you wanna hire me then? Just hire another CRNA who is independent.
She: I know what you mean, but the hospital likes this model.

It went back and forth like this for awhile until I told her I wont be part of this. FIrst of all this was NOT an opt out state and I have no idea what lawyers told them this is ok. Or the surgeons may be signing off on their charts unbeknownst to the surgeons.

I imagine the CRNAs will come trade cases with you once their patient went downhill. And you are probably on the hook night and weekends too.

No one should take a job like this.

 

[GA8314]

Sorry, but I'm not buying that hospitals/surgical centers are allowing CRNAs to practice independently in non-CRNA independent practice states. Too much risk from a legal liability perspective.

They absolutely are. This is happening for sure in my non-opt out state. I have no idea about the legalities (surely, the surgeons are signing for the CRNA's and maybe don't even realize it), but it is happening.

Usually, they will call this the "collaborative model".

That being said, this should free the MD up from any CRNA responsibility and you get to sit your own cases. So, it's not a horrible gig and I've seen decent salaries coming out of some of those ads.

I think it's ultimately a weak model, but it is what it is.

 

[GA8314]

If you're not on the chart, it doesn't matter what your contract says, you're not responsible for their f ups.

Good point. And "being immediately available" would never reasonably assume you were to abandon your own patient while doing the case. The hospital or surgeon (signing...) would take the fall for that, I have to think. Hospitals are powerful entities but so are good trial lawyers.

 

[GA8314]

And if you whistleblow, they will find everything they can on you or just smear you with bs like child porn or rape to ruin your life

This would be true on the national political level but unlikely at the hospital system level.... I think..........

 

[Promethean]

This would be true on the national political level but unlikely at the hospital system level.... I think..........

Those concerns are way out of scope for something like this. For one thing, no one needs to work nearly that hard to hurt you professionally.

All they really need to do to suppress whistleblowing is know that you need to get a job somewhere in this small world again. I'm an OR nurse. We are pretty specialized. If there are only two hospital systems in town, having one of them blackball me means losing out on 50% of opportunities, at least. If a national nurse staffing firm decides that I'm a problem, there goes access to their network of jobs.

I didn't call the Joint Commission. At the time, I was in pretty dire financial straits and needed a job. I probably could/should have done more than I did, but what I did do was provide a concise, yet thorough, accounting of my concerns to the hospital administrator and the recruiter. I wanted the hospital to have the opportunity to fix their problems internally. And to make the point that bringing in contractors who weren't accustomed to their broken culture had the potential to result in a more formal intervention if they didn't do something about it. In retrospect, probably I should have done more. But... like I said, 6 months after, I was hearing about the place on the news, with issues identified because of an internal review of procedures, so maybe refusing to participate and drawing their attention to my reasons was effective.

 

[PhysicianOnFIRE]

Yes, that collaborative model is common in rural America. If you run a hospital with 24-hour call and run 2 to 4 rooms, you can't have one doc on 24/7. You can go all CRNA (obviously not ideal), all MD (not affordable for many) or 1 MD and a few CRNAs sharing call. The MD will be the department head, responsible for more difficult cases, policy, etc... and may occasionally be called upon to aid a CRNA "in trouble."

It's certainly less than ideal, but in many cases, it's either that model or a CRNA-only model at small hospitals. Opt-in means nothing. Surgeons can be responsible for CRNAs without anesthesiologists on staff in all 50 states.