Cost of CRNA with 3:1 coverage

[skypilot]

So I am calculating the cost of a CRNA including the Anesthesiologist at 3:1. What I came up with is $300k for the CRNA including benefits, plus 1/3 of the Anesthesiologist including benefits $500k /3= $166k. So a total of $466k per year for a covered CRNA. Obviously the numbers change with the salaries but does anyone have a more nuanced view. $466k per year for the CRNA?

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[vector2]

So I am calculating the cost of a CRNA including the Anesthesiologist at 3:1. What I came up with is $300k for the CRNA including benefits, plus 1/3 of the Anesthesiologist including benefits $500k /3= $166k. So a total of $466k per year for a covered CRNA. Obviously the numbers change with the salaries but does anyone have a more nuanced view. $466k per year for the CRNA?

That math is probably in the ballpark, but you need to look at it from the hourly perspective.

3 CRNA*300k + 1 MD*500k = 1.4 mil.

3 anesthesiologists = 1.5 mil.

In either case you still get 3 anesthetizing locations covered, but with CRNAs a lot of them expect that salary for 36-40 hrs/week of work. With the latter, you have people who can do every kind of case, every kind of procedure, and who usually will work 40-50 hrs/week.

 

[aneftp]

That math is probably in the ballpark, but you need to look at it from the hourly perspective.

3 CRNA*300k + 1 MD*500k = 1.4 mil.

3 anesthesiologists = 1.5 mil.

In either case you still get 3 anesthetizing locations covered, but with CRNAs a lot of them expect that salary for 36-40 hrs/week of work. With the latter, you have people who can do every kind of case, every kind of procedure, and who usually will work 40-50 hrs/week.

That model only works with outpatient.

The issue is hospital call requirements

But correct on how much it truly cost a w2 CRNA these days. Around 300k for 40 hour work week w2 CRNA with benefits. and most won’t work 5 days. Most want to work 3-4 days max with no calls no weekends

A daytime doc with no calls or nights is still more expensive at 380-400k w2 plus benefits. So around 450k cost. Working 4-5 days a week

No easy solution these days except hospitals subsidy or good payor mix.

 

[vector2]

That model only works with outpatient.

The issue is hospital call requirements

But correct on how much it truly cost a w2 CRNA these days. Around 300k for 40 hour work week w2 CRNA with benefits. and most won’t work 5 days. Most want to work 3-4 days max with no calls no weekends

A daytime doc with no calls or nights is still more expensive at 380-400k w2 plus benefits. So around 450k cost. Working 4-5 days a week

No easy solution these days except hospitals subsidy or good payor mix.

I'm in a level I trauma center and we're paying CRNAs an arm and a leg to do nights and weekends. Likely probably more than many practices pay a doc if we look at it on an hourly basis.

The call issue does complicate things, but with what CRNAs are asking for nowadays I think the economics can still favor MD if you have a practice that regardless of CRNA presence requires an MD in house (due to trauma or OB etc). You're right, though- most practices do need a subsidy to recruit and prosper, but I think instead of us seeing this as a tenuous proposition with which we have to tiptoe around administration, the subsidy should just be part of the hospital's cost of doing business. Absent the small number of practices with a great payor mix, the question should never be whether there is a subsidy, but rather simply how much.

 

[nimbus]

Assuming you need an MD present for all cases, the MD only model provides a lot more MDs to dilute the call burden.

 

[narcotics999]

Dont forget crna is more likely to call out sick, especially on Monday and Friday.

 

[Hoya11]

That math is probably in the ballpark, but you need to look at it from the hourly perspective.

3 CRNA*300k + 1 MD*500k = 1.4 mil.

3 anesthesiologists = 1.5 mil.

In either case you still get 3 anesthetizing locations covered, but with CRNAs a lot of them expect that salary for 36-40 hrs/week of work. With the latter, you have people who can do every kind of case, every kind of procedure, and who usually will work 40-50 hrs/week.

But with 3 MDs you dont have an MD floating around taking care of issues outside the OR.

The main issue for my practice would be there is no one to do the preop blocks ahead of time and there is no one covering PACU with sleeping patients.

4 MDs = 2 Million vs 1.4 Million with one MD who can be in and out of all of the cases as needed, and be free to float outside the OR where needed.

 

[vector2]

But with 3 MDs you dont have an MD floating around taking care of issues outside the OR.

The main issue for my practice would be there is no one to do the preop blocks ahead of time and there is no one covering PACU with sleeping patients.

4 MDs = 2 Million vs 1.4 Million with one MD who can be in and out of all of the cases as needed, and be free to float outside the OR where needed.

Docs can just do their own blocks before or after the case in MD only practices. Takes 5 minutes if you have a block nurse. It's certainly not as efficient as having an ACT doc floating around all the time but I think the tradeoff is worth it.

As far as PACU, that can be a tricky one depending on the practice size. If you have 12-15+ anesthetizing locations, it's a near impossibility that at least one MD isn't between cases and able to respond to an emergency. Not to mention when you have MDs doing their own cases I think the likelihood of a patient having significant issues goes down tremendously. Almost everything else the PACU needs can be handled over the phone.

 

[UscGhost]

Docs can just do their own blocks before or after the case in MD only practices. Takes 5 minutes if you have a block nurse. It's certainly not as efficient as having an ACT doc floating around all the time but I think the tradeoff is worth it.

As far as PACU, that can be a tricky one depending on the practice size. If you have 12-15+ anesthetizing locations, it's a near impossibility that at least one MD isn't between cases and able to respond to an emergency. Not to mention when you have MDs doing their own cases I think the likelihood of a patient having significant issues goes down tremendously. Almost everything else the PACU needs can be handled over the phone.

Our practice doesn't have any CRNAs. We don't have any issues doing preop blocks. If it takes 30 mins to turnover, I can do a block in 5 mins so it's not an issue.

Extremely rare to have issues in pacu..and usually there is someone between cases anyways.

I haven't seen much reason to add CRNAs. They want almost as much money, far less versatile, take too many sick days, cancel cases, etc. And the monetary benefit is pretty small

 

[aneftp]

Dont forget crna is more likely to call out sick, especially on Monday and Friday.

Actually that’s incorrect.

They work 2-4 days a week. So if they work
16 Monday
16 Wednesday
8 Thursday

They will call out sick on Thursday and only take 8 hours leave. And they know they have Friday off already

They playing 4D chess with the schedule since they see the schedule as well.

 

[skypilot]

But with 3 MDs you dont have an MD floating around taking care of issues outside the OR.

The main issue for my practice would be there is no one to do the preop blocks ahead of time and there is no one covering PACU with sleeping patienBut with 3 MDs you dont have an MD floating around taking care of issues outside the OR.

The main issue for my practice would be there is no one to do the preop blocks ahead of time and there is no one covering PACU with sleeping patients.

4 MDs = 2 Million vs 1.4 Million with one MD who can be in and out of all of the cases as needed, and be free to float outside the OR where needed.

Doubtful that the 4th MD is just doing blocks and floating though. Probably covering OB and maybe even a fourth room. So I’m not sure the comparison is completely accurate. I guess it’s very dependent on the case mix for the hospital.

 

[Gern Blansten]

Dont forget crna is more likely to call out sick, especially on Monday and Friday.

Sadly true.

 

[Hoya11]

Doubtful that the 4th MD is just doing blocks and floating though. Probably covering OB and maybe even a fourth room. So I’m not sure the comparison is completely accurate. I guess it’s very dependent on the case mix for the hospital.

I thought we were talking about an ASC..

My point is there needs to be someone free and floating, whatever the model.. I think the idea that "nothing happens in the PACU due to physician given anesthesia" is not realistic and not satisfactory to the admins.. someone needs to be free and available for emergencies and not everyone in a room and depending on emergencies only happening when "someone is between cases".. i think all models should have one person free and roaming..doing blocks, covering OB, whatever.. you cant have everyone in a room doing cases and no one free - not a realistic model for a cost comparison

 

[vector2]

I thought we were talking about an ASC..

My point is there needs to be someone free and floating, whatever the model.. I think the idea that "nothing happens in the PACU due to physician given anesthesia" is not realistic and not satisfactory to the admins.. someone needs to be free and available for emergencies and not everyone in a room and depending on emergencies only happening when "someone is between cases".. i think all models should have one person free and roaming..doing blocks, covering OB, whatever.. you cant have everyone in a room doing cases and no one free - not a realistic model for a cost comparison

In an ideal world I'd also like someone free and floating no matter the model, but if I'm weighing the pro-cons then I'd still take MD only without a float vs supervising nurses with a float. I work in a place with sick patients and marginal CRNAs, and it's still a pretty damn rare occurrence that the call MD's physical presence is required to the bedside in PACU for a serious issue.

If you have a practice with enough ORs, then it becomes a near statistical impossibility that at least one person won't be between cases. And if you become more lax with post-op ICU admission criteria then there will almost never be a known tenuous pt just sitting in PACU waiting to detonate. But to deal with the rare times there is a PACU emergency and everyone is tied up, you can also ask admin to make sure the rapid response team or ICU/ED attending can respond when no anesthesiologist is available.


e: @nimbus , how does your practice handle trauma addons, PACU, blocks, etc?

 

[deleted1156848]

If it’s physician only, there likely won’t be many things requiring physician presence in PACU.

 

[skypilot]

I thought we were talking about an ASC..

My point is there needs to be someone free and floating, whatever the model.. I think the idea that "nothing happens in the PACU due to physician given anesthesia" is not realistic and not satisfactory to the admins.. someone needs to be free and available for emergencies and not everyone in a room and depending on emergencies only happening when "someone is between cases".. i think all models should have one person free and roaming..doing blocks, covering OB, whatever.. you cant have everyone in a room doing cases and no one free - not a realistic model for a cost comparison

I’m mainly thinking about cost here. If I’m willing to suck it up and do the job for $430k I can be $30,000 cheaper than a CRNA with 3:1 coverage by an Anesthesiologist.

 

[nimbus]

I thought we were talking about an ASC..

My point is there needs to be someone free and floating, whatever the model.. I think the idea that "nothing happens in the PACU due to physician given anesthesia" is not realistic and not satisfactory to the admins.. someone needs to be free and available for emergencies and not everyone in a room and depending on emergencies only happening when "someone is between cases".. i think all models should have one person free and roaming..doing blocks, covering OB, whatever.. you cant have everyone in a room doing cases and no one free - not a realistic model for a cost comparison

We staff all our hospitals and surgicenters without a designated “floater”….eg 4 room ASC gets 4 doctors, not 5. If we are running 17 rooms in the hospital, we have 17 people come to work. We don’t call in an 18th person from home to be a “floater”. It’s important to ensure the patients are tucked away well in PACU before moving on to the next case. May seem strange to people who have never worked in MD only practice but that’s the way it has been done for decades.

 

[nimbus]

In an ideal world I'd also like someone free and floating no matter the model, but if I'm weighing the pro-cons then I'd still take MD only without a float vs supervising nurses with a float. I work in a place with sick patients and marginal CRNAs, and it's still a pretty damn rare occurrence that the call MD's physical presence is required to the bedside in PACU for a serious issue.

If you have a practice with enough ORs, then it becomes a near statistical impossibility that at least one person won't be between cases. And if you become more lax with post-op ICU admission criteria then there will almost never be a known tenuous pt just sitting in PACU waiting to detonate. But to deal with the rare times there is a PACU emergency and everyone is tied up, you can also ask admin to make sure the rapid response team or ICU/ED attending can respond when no anesthesiologist is available.


e: @nimbus , how does your practice handle trauma addons, PACU, blocks, etc?

Answered above.

Traumas bump other cases if necessary. We match our staffing to the OR staffing so it’s never an “anesthesia only” issue. Circulator/scrub/anesthesia/room all get redirected to the trauma. We do all our own nerve blocks in preop. Fascial plane blocks are usually done with the patient asleep in the OR. Only time we block in PACU are rescue blocks and that is rare. Sometimes we do our own and sometimes we ask a free partner to do it.

 

[Mehd School]

Would love to do my own cases 90-100% of the time again. Preop monkey and fire-putter-outer gets old. And it’s way harder than just sitting in one room. The CRNAs where I’m at somehow disagree with me even though they have zero experience supervising.

 

[anaesthetic]

Would love to do my own cases 90-100% of the time again. Preop monkey and fire-putter-outer gets old. And it’s way harder than just sitting in one room. The CRNAs where I’m at somehow disagree with me even though they have zero experience supervising.

We do both. I would choose solo 100% of the time regardless of case time, length, or acuity. Maybe 95% depending on the surgeon.

 

[T-burglar]

Strictly monetary isn’t the way to think about ACT vs Physician only. You are really unimaginative if you can’t think of ways to utilize free roaming physicians to diversify revenue and add value

 

[skypilot]

Strictly monetary isn’t the way to think about ACT vs Physician only. You are really unimaginative if you can’t think of ways to utilize free roaming physicians to diversify revenue and add value

Agreed but it doesn’t have to be me. I love practicing Anesthesia not “adding value” or “diversifying revenue”. And I can make a good living and still be cheaper than a covered CRNA. 😃

 

[USCTrojan11]

Assuming you need an MD present for all cases, the MD only model provides a lot more MDs to dilute the call burden.

Depending on how busy your hospital is, this is not true. Let's say "on call" you can run up to 4 sites. You can either require 4 docs to be on call the whole weekend (rotating 1st, 2nd, 3rd and 4th call) or 1 doc and 4 APPs. With the latter model, you can see how 52 weekends can be covered as 4 weekends a year for a group of 18 docs with a large pool of APPs rather than each working 12 weekends per year for a group of 18 docs. Huge lifestyle difference there.

 

[nimbus]

Depending on how busy your hospital is, this is not true. Let's say "on call" you can run up to 4 sites. You can either require 4 docs to be on call the whole weekend (rotating 1st, 2nd, 3rd and 4th call) or 1 doc and 4 APPs. With the latter model, you can see how 52 weekends can be covered as 4 weekends a year for a group of 18 docs with a large pool of APPs rather than each working 12 weekends per year for a group of 18 docs. Huge lifestyle difference there.

But in a ACT model, how many doctors do you need to cover 18 weekday rooms? You don’t need 18 doctors. Maybe 6-10??

In an MD only model, you’d need 22-24 doctors to cover the rooms plus vacations, pre-call and postcall days.

Bottom line is that there are 365 nights/yr. You can divide that by a smaller number (ACT) or a larger number (MD only).

We run 3+trauma on Saturdays and 2+trauma on Sundays so I do see your point about weekends but overall we spend very few nights sleeping in the hospital.

 

[UscGhost]

Depending on how busy your hospital is, this is not true. Let's say "on call" you can run up to 4 sites. You can either require 4 docs to be on call the whole weekend (rotating 1st, 2nd, 3rd and 4th call) or 1 doc and 4 APPs. With the latter model, you can see how 52 weekends can be covered as 4 weekends a year for a group of 18 docs with a large pool of APPs rather than each working 12 weekends per year for a group of 18 docs. Huge lifestyle difference there.

Yea, but it's not quite the same. You would have a lot more than 18 MDs if you didn't have APPs.

Yes if the practice is large enough then you will eventually reach a number where it's efficient..but supervising 4 rooms sounds miserable

 

[skypilot]

Yea, but it's not quite the same. You would have a lot more than 18 MDs if you didn't have APPs.

Yes if the practice is large enough then you will eventually reach a number where it's efficient..but supervising 4 rooms sounds miserable

Hybrid model seems the way to go. Lots of docs, some solo in rooms, and some CRNAs. The responsibility for the care teams is handed around between the docs depending on the day. That leaves someone free when necessary.

 

[Gasworks]

Worked in many different places with everything imaginable from doc only to 4:1 supervision.. these days we tend to run most places 2:1 or 3:1 simply due to the fact that we can’t find enough docs to cover every room. If ur looking at this strictly from a $$$ perspective anything less than 3:1 is a money loser and the margin on 4:1 is rarely worth the headache. We also tend to use lots of crnas at our more remote sites so we at least have to option of QZ, but again this is not about the money but just a matter of not having enough bodies. Anywhere that either frowns on QZ or provides us with regular and predictable case loads we use AAs and never more than 3:1.

 

[Southpaw]

When people who haven’t seen or been in a MD only model say it can’t work because no one is ever available for PACU issues, or an extra set of hands, or to help with low volume OB when needed, they need to consider the following:

The more rooms that are staffed the more likely it is that someone is between cases, or on delay because of whatever reason (a lot of time it’s surgeon not available), or done for the day and is still around and would help if needed in a pinch. Also help in PACU is rarely needed in my opinion with MDs doing the case. And someone is always dropping a patient off in PACU to help.

The alternative is a lot of what is being discussed. Keeping a MD available to supervise 3-4 CRNAs, go to OB, go to PACU for rescue bc the CRNA did whatever you wouldn’t have done that led to an issue.

However, none of us did residency to ‘be available’ or supervise/watch CRNAs. The medical direction/supervision model is the sole reason this field gets squat on by other specialties in our daily interactions. It has also given unlimited ammo to the AANA to say they’re fine to be left alone in the OR.

All that said, I don’t expect anything said here to change anything in our field. It is worth pointing out though and having people coming to the realization that supervising CRNAs isn’t good for the field and it’s not good for anesthesiologists. You may not be able to change the model you work in, but acknowledgement that it’s good or bad is a decent first step.

 

[IMGASMD]

I was searching for something else but
came across this.

https://dhhs.ne.gov/licensure/Credentialing%20Review%20Docs/CRAACostAnalysisOfStaffingModelsOfAnesthesiaCare.pdf

 

[chocomorsel]

Docs can just do their own blocks before or after the case in MD only practices. Takes 5 minutes if you have a block nurse. It's certainly not as efficient as having an ACT doc floating around all the time but I think the tradeoff is worth it.

As far as PACU, that can be a tricky one depending on the practice size. If you have 12-15+ anesthetizing locations, it's a near impossibility that at least one MD isn't between cases and able to respond to an emergency. Not to mention when you have MDs doing their own cases I think the likelihood of a patient having significant issues goes down tremendously. Almost everything else the PACU needs can be handled over the phone.

Why are you stuck in an ACT practice that you seem to dislike? A lot a lot!

 

[vector2]

Why are you stuck in an ACT practice that you seem to dislike? A lot a lot!

Wife has a business in the city and my in-laws live 15 minutes away and watch my kid all the time.

 

[chocomorsel]

Would love to do my own cases 90-100% of the time again. Preop monkey and fire-putter-outer gets old. And it’s way harder than just sitting in one room. The CRNAs where I’m at somehow disagree with me even though they have zero experience supervising.

Do it. What’s stopping you? Kids?

 

[nimbus]

Wife has a business in the city and my in-laws live 15 minutes away and watch my kid all the time.

That is gold, especially if you like your in-laws.

 

[Hoya11]

When people who haven’t seen or been in a MD only model say it can’t work because no one is ever available for PACU issues, or an extra set of hands, or to help with low volume OB when needed, they need to consider the following:

The more rooms that are staffed the more likely it is that someone is between cases, or on delay because of whatever reason (a lot of time it’s surgeon not available), or done for the day and is still around and would help if needed in a pinch. Also help in PACU is rarely needed in my opinion with MDs doing the case. And someone is always dropping a patient off in PACU to help.

The alternative is a lot of what is being discussed. Keeping a MD available to supervise 3-4 CRNAs, go to OB, go to PACU for rescue bc the CRNA did whatever you wouldn’t have done that led to an issue.

However, none of us did residency to ‘be available’ or supervise/watch CRNAs. The medical direction/supervision model is the sole reason this field gets squat on by other specialties in our daily interactions. It has also given unlimited ammo to the AANA to say they’re fine to be left alone in the OR.

All that said, I don’t expect anything said here to change anything in our field. It is worth pointing out though and having people coming to the realization that supervising CRNAs isn’t good for the field and it’s not good for anesthesiologists. You may not be able to change the model you work in, but acknowledgement that it’s good or bad is a decent first step.

In all of medicine mid level expansion is obviously inferior to physician only care.

In my area of the country ACT is the mode not due to greed but due to necessity. That is an idea that is hard for the MD only folks to accept. It’s not greed, we know it’s inferior, there’s not enough bodies. Even with crna coverage there are facilities closing down due to shortages.

MD only is prevalent only where it can be. In less populated areas, and/or more affluent areas willing to pay subsidies for better care. MD only folks where do you practice ? Largely out west and in rural locations ..

 

[chocomorsel]

In all of medicine mid level expansion is obviously inferior to physician only care.

In my area of the country ACT is the mode not due to greed but due to necessity. That is an idea that is hard for the MD only folks to accept. It’s not greed, we know it’s inferior, there’s not enough bodies. Even with crna coverage there are facilities closing down due to shortages.

MD only is prevalent only where it can be. In less populated areas, and/or more affluent areas willing to pay subsidies for better care. MD only folks where do you practice ? Largely out west and in rural locations ..

Dude I practiced out in Vegas and I don’t know if you know Vegas, but it ain’t LA. It’s not known to be affluent. Pay per RVU was low and people made their money by busting their tail. And we didn’t make as much money. Indiana was and is known to have lots of Physician only groups all over.
Sorry, but in most ACT models it is and was about making more money off midlevels.

 

[ScarfTheVerb]

But in a ACT model, how many doctors do you need to cover 18 weekday rooms? You don’t need 18 doctors. Maybe 6-10??

In an MD only model, you’d need 22-24 doctors to cover the rooms plus vacations, pre-call and postcall days.

Bottom line is that there are 365 nights/yr. You can divide that by a smaller number (ACT) or a larger number (MD only).

We run 3+trauma on Saturdays and 2+trauma on Sundays so I do see your point about weekends but overall we spend very few nights sleeping in the hospital.

Ideally a lot of your weekday workload is ASC cases, which lets you increase your number of docs to further spread out your call burden.

 

[Southpaw]

In all of medicine mid level expansion is obviously inferior to physician only care.

In my area of the country ACT is the mode not due to greed but due to necessity. That is an idea that is hard for the MD only folks to accept. It’s not greed, we know it’s inferior, there’s not enough bodies. Even with crna coverage there are facilities closing down due to shortages.

MD only is prevalent only where it can be. In less populated areas, and/or more affluent areas willing to pay subsidies for better care. MD only folks where do you practice ? Largely out west and in rural locations ..

There’s nothing unicorn about committing to MD only or not. Or even MD mostly. There are some awful crappy payor mix hospitals in CA still MD only.

We could go round and round here but it isn’t worth it. I can look myself in the mirror and call the supervision model what it is. However, the reality is that it isn’t going to last. You can’t fight off angry nursing legislation forever.

The idea that you work in the only area with a poor payor mix or that has difficulty recruiting anesthesiologists isn’t new. Plenty of MD only practices have the same issues. Sorry not trying to be harsh. That’s just the reality of it.

 

[USCTrojan11]

Ideally a lot of your weekday workload is ASC cases, which lets you increase your number of docs to further spread out your call burden.

Dynamics and decision making change even more when anesthesia is tied in to the facility fee. All of a sudden, 3:1 or 4:1 cataracts and CTR makes sense

 

[USCTrojan11]

There’s nothing unicorn about committing to MD only or not. Or even MD mostly. There are some awful crappy payor mix hospitals in CA still MD only.

We could go round and round here but it isn’t worth it. I can look myself in the mirror and call the supervision model what it is. However, the reality is that it isn’t going to last. You can’t fight off angry nursing legislation forever.

The idea that you work in the only area with a poor payor mix or that has difficulty recruiting anesthesiologists isn’t new. Plenty of MD only practices have the same issues. Sorry not trying to be harsh. That’s just the reality of it.

Why does nursing legislation matter when AAs are expanding and (hopefully) moving towards being available in all states.

 

[nimbus]

Why does nursing legislation matter when AAs are expanding and (hopefully) moving towards being available in all states.

It matters because it’s also independent CRNA practice vs ACT.

 

[Southpaw]

Why does nursing legislation matter when AAs are expanding and (hopefully) moving towards being available in all states.

Well for starters I’m not seeing movement in AA legislation or AA availability.

On the legislation issue - my guess is most anesthesiologists fear what happens if crna independence happens everywhere and hospital admin is allowed to choose the anesthesia team. I have mixed feelings and thoughts here.

 

[IMGASMD]

Well for starters I’m not seeing movement in AA legislation or AA availability.

On the legislation issue - my guess is most anesthesiologists fear what happens if crna independence happens everywhere and hospital admin is allowed to choose the anesthesia team. I have mixed feelings and thoughts here.

Publish rates.
You want better product pay more. If mediocre is okay, then go right ahead.

Publicize the hospital and insurance companies are in cahoots…. Collect “diamond” level insurance premiums, you get bronze level care…..

 

[chocomorsel]

We do both. I would choose solo 100% of the time regardless of case time, length, or acuity. Maybe 95% depending on the surgeon.

Are there docs in your practice who refuse to sit in the room?

 

[chocomorsel]

Well for starters I’m not seeing movement in AA legislation or AA availability.

On the legislation issue - my guess is most anesthesiologists fear what happens if crna independence happens everywhere and hospital admin is allowed to choose the anesthesia team. I have mixed feelings and thoughts here.

I do too. I don’t think it would be complete doom like some docs think. We live in America. Bringing in a bunch of CRNAs to replace a bunch of docs in a high acuity hospital is going to take some balls from administration with the malpractice environment and overall poor health of this country. I for one would sit on the sidelines with my cup of tea and toast and watch the likely mayhem that would ensue.
And there are lots of CRNAs who want no part of independence.

 

[chocomorsel]

Well for starters I’m not seeing movement in AA legislation or AA availability.

On the legislation issue - my guess is most anesthesiologists fear what happens if crna independence happens everywhere and hospital admin is allowed to choose the anesthesia team. I have mixed feelings and thoughts here.

It’s slow but it’s happening.

 

[anaesthetic]

Are there docs in your practice who refuse to sit in the room?

Some refuse, some prefer it, some literally don’t know how to do a case by themselves.

 

[chocomorsel]

Some refuse, some prefer it, some literally don’t know how to do a case by themselves.

And the first and last anesthesiologists in your practice are what give us such a bad name and embolden the CRNAs to say that we aren’t needed.
I don’t get it. I have worked with some anesthesiologists who were scary AF who’d done years and years of ACT. This is so sad and pathetic.

 

[anaesthetic]

And the first and last anesthesiologists in your practice are what give us such a bad name and embolden the CRNAs to say that we aren’t needed.
I don’t get it. I have worked with some anesthesiologists who were scary AF who’d done years and years of ACT. This is so sad and pathetic.

Keep in mind some of these schmucks are in ASA leadership positions.