CRNA Group hiring MD/DO’s

[chocomorsel]

Abnormal syntax appreciated.
Ban hammer on standby.

Ban hammer for what exactly? Having a differing view point? Are we no longer allowed to have that or speak our minds on this here forum?

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[chocomorsel]

Eh. You can make double that as a physician anesthesiologist..so I'd rather work a few more years to get double the salary.

Also, I prefer to make my own decisions, and the prestige that comes with being a physician.

That being said, crna is a great career. It just depends on what your preferences are. I would choose being an anesthesiologist if I had to do it all over again.

Prestige? There is prestige left in American medicine? Anesthesia specifically? 😛😆😆😆

 

[chocomorsel]

View attachment 366077

Who are you? Where have you been all my life? ❤️❤️❤️

 

[chocomorsel]

I get 5 weeks/year right now and it takes an act of congress to get more than two consecutive weeks anyway, so this seems nicer to me. And before you ask, yes, I'm in academics

I actually am just now seeing this and was going to ask where do you get such little vacation! Anyway let me see where I originally responded. Honestly in an Anesthesia practice where you don’t have to spend 12 hours a day in the hospital, this 26 weeks “off” may mean something.

 

[Anesthesia_Guy]

Ban hammer for what exactly? Having a differing view point? Are we no longer allowed to have that or speak our minds on this here forum?

Snowflakes. Feelings were hurt, repercussions need to occur.

 

[Anesthesia_Guy]

Prestige? There is prestige left in American medicine? Anesthesia specifically? 😛😆😆😆

Exactly. That's why there are 48,783 CVS/Walgreen Minute Clinics and more "urgent care centers" staffed by midlevel providers than Starbucks.

 

[GassYous]

I get 5 weeks/year right now and it takes an act of congress to get more than two consecutive weeks anyway, so this seems nicer to me. And before you ask, yes, I'm in academics

I take a consecutive 3 week vacation every year along with other vacations. Hard to do a good international trip otherwise

 

[2Fast2Des]

These days non cash psychiatrists are making good money. I find it disingenuous to go cash only in a field where the ones who need it most are poor and on Medicare. Like who are you truly helping? Well managed rich people only?

That's where the money is... Same way all those high power plastics people set up shop in the glitz and glamour areas

 

[gunnershow]

These days non cash psychiatrists are making good money. I find it disingenuous to go cash only in a field where the ones who need it most are poor and on Medicare. Like who are you truly helping? Well managed rich people only?

How is that "disingenuous"?

 

[Fpg1245]

How is that "disingenuous"?

I’ve literally had IM docs 4 years out of residency go concierge service for no other reason than to work less and make basically the same amount of money - nobody wants to grind and honestly more power to them!

 

[chocomorsel]

That's where the money is... Same way all those high power plastics people set up shop in the glitz and glamour areas

Plastics versus psych. Not the same thing. I doubt there are nearly that many reconstructive cases as there are regular old plastic cases. And I am suspect some of those docs still do reconstructive cases that are insurance covered. If simply for ego.😛😛
The state of mental health in the world these days…. I find it disingenuous. A chronic severe depressive or bipolar or shizophrwnic patient is more than likely poor.
Anyway, my take.

 

[DonFL]

Why would they hire MDs? Aren’t they happy doing their own thing? Or did the hospital force them because of bad outcomes?

Some of these guys are pretty astute on the business side too...they provide what the client requests

 

[DonFL]

According to him, there are only a few like 6-7 docs. Some old near retirement others freshly graduated that want only easy cases. Certain surgical centers don’t want CRNAs to come at all.

Is the reimbursement same for MD or CRNA when providing Anesthesia services?

Yes, reimbursement is the same unless some idiot agreed to a commercial contract that says otherwise

 

[DonFL]

Hospital ceos , even some are just regular RNs which zero advance business experience have been known to become ceo of hospitals and boss docs around.

So how is it any difference with CRNA bossing docs around.

As long as the paycheck clears and you are getting paid market rate and work load is reasonable. That’s all that matters in today’s environment.

Locums companies are run by non qualified non healthcare people as well hustling you.

Everyone is making money off the “providers”

We have to look in the mirror and realize we don't get any more business education than they do - any of them. If we're going to say we're better we have to be better.

 

[DonFL]

Arizona has a bill up to remove all physician supervision from CRNAs. I don't know what they'll do if it passes, which it probably will. They may continue hiring anesthesiologists because the hospitals want anesthesiologists around to make it look better.

We need to ask ourselves why it looks better and why we can't PROVE its better. For all the academics out there - this should be easy to prove in a study that doesn't involve obvious omissions or "modifiers". Its too easy for opponents to shoot holes in the current research

 

[DonFL]

What’s the rationale for bringing in docs?

Forget the dumpster fire crap. Sometimes a new client requests it, and the vendor provides what the client requires and is willing to pay for. Same way Envision went all CRNA in Wisconsin.

 

[DonFL]

Some hospitals require them. In the job I posted, I know Banner University requires "supervision" of CRNAs. The CRNAs don't think they need to be supervised though from my friends who worked there. I know working at the place in the thread about patient safety and the patient being coded after CRNA care, the surgeons didn't know they techincally were supervising "independent" CRNAs. I knew that a year ago, and I tried to point it out to the AZ Society. I was told there's nothing they can do since the surgeons were supervising even if they didn't know it.

If this is the case - total failure of the Med Staff Office

 

[DonFL]

Based on all of this, should I tell my friend to pursue becoming CRNA instead of the MD/DO, seems like all the perks with very minimal liability?

Why would anyone pursue becoming a physician nowadays?

Where does the "minimal liability" come from? I've done plenty of expert witness work and seen both anesthesiologists and midlevels excluded from cases where their actions weren't at issue. Everyone is liable for their actions if they have their own license and own limits.

 

[DonFL]

If someone knew they wanted anesthesia and nothing else, it isn’t a bad path.

The best path would be to get a degree in something cool like astronomy or music, then do one of those nursing master degrees that take something like 3 semesters, then work in ICU 1 yr, then on to CRNA school.

Cmon now - this is the crap they feed off of in their outreach. Do some research - this isn't even close to being true. We have to stop making stuff up if we're going to win the argument.

 

[DonFL]

Someone would pursue becoming a physician nowadays for one of 2 reasons: profound re_tardation or extreme masochism. CRNA all the way - done when you are 25-26, much less debt, minimal liability, $300k starting salary.

Cmon now - you should know better. The debt may be lower but very few CRNAs make $300k employed (not locums - employed), and the liability for their actions isn't lower if theyre independently licensed. Its just not true from a medical-legal standpoint

 

[aneftp]

We have to look in the mirror and realize we don't get any more business education than they do - any of them. If we're going to say we're better we have to be better.

As soon as administrators realize a 40 hour CRNA locums doing no weekends nights cost as much as full time w2 Md doc doing full time no nights and weekends.

Administration or most of them fail to realize that Paying CRNA locums $200/hr plus 30% or even 40% agency fees on top of that means it literally cost $500k or even 600k to use CRNA locums a year doing 40 hours.

 

[The kitchen sink]

Where does the "minimal liability" come from? I've done plenty of expert witness work and seen both anesthesiologists and midlevels excluded from cases where their actions weren't at issue. Everyone is liable for their actions if they have their own license and own limits.

2 scenarios:

a. Crna fully supervised by Anesthesiologist. Who takes the liability? Especially in cases where Crna did not act in accordance with supervising anesthesiologist.

b. Crna fully independent does case vs. Anesthesiologist does a similar case. Let’s say hypothetically a bad outcome occurs which would generally garner a similar $ payout. Which case pays out more, and why?

 

[vector2]

We need to ask ourselves why it looks better and why we can't PROVE its better. For all the academics out there - this should be easy to prove in a study that doesn't involve obvious omissions or "modifiers". Its too easy for opponents to shoot holes in the current research

It is impossible to get IRB approval to study this prospectively given how highly unethical it would be to have high ASA 3s and 4s getting anesthetized by CRNAs only.

 

[gulmohr]

 

[abolt18]

"How many hours are you working?"

"A lot.... Like 36-48"



Funny how I feel like anything less than 50 is a light week.

 

[Sug Knight]

It is impossible to get IRB approval to study this prospectively given how highly unethical it would be to have high ASA 3s and 4s getting anesthetized by CRNAs only.

Happens daily in outpatient facilities. Average patient 3.5 all day long. Granted, it's not TAVRs or robot cases.

 

[vector2]

Happens daily in outpatient facilities. Average patient 3.5 all day long. Granted, it's not TAVRs or robot cases.

Oh I'm not saying it doesn't already happen, I'm just saying no IRB would approve purposeful randomization to allow 3s and 4s to get true CRNA only care.

Just like we all know there's plenty of ICUs (esp the community kind) where the mid-level is running the unit (poorly) and the doc just signs the notes, but this is another situation where we'll never be able to prospectively study mid-level only care.

 

[UscGhost]

Oh I'm not saying it doesn't already happen, I'm just saying no IRB would approve purposeful randomization to allow 3s and 4s to get true CRNA only care.

Just like we all know there's plenty of ICUs (esp the community kind) where the mid-level is running the unit (poorly) and the doc just signs the notes, but this is another situation where we'll never be able to prospectively study mid-level only care.

I think you might be able to.

If we consider CRNAs to be stand of care...then shouldn't we be able to prospectively compare two models that are both considered standard of care?

I don't do research so I don't have much experience

 

[vector2]

I think you might be able to.

If we consider CRNAs to be stand of care...then shouldn't we be able to prospectively compare two models that are both considered standard of care?

I don't do research so I don't have much experience

Lol I don't think you can call it "standard of care" just because the AANA posters say it is. I also don't think a dozen some state legislatures approving opt outs make it a standard either, but that does raise a good question on what exactly determines the standard. The ASA certainly doesn't say it is..

Regardless, even if the ivory tower types on the IRB are pretty clueless, I don't think they're clueless enough to sign off on the ethics of "let's anesthetize the sickest patients....but without physicians present"

 

[BLADEMDA]

Cmon now - you should know better. The debt may be lower but very few CRNAs make $300k employed (not locums - employed), and the liability for their actions isn't lower if theyre independently licensed. Its just not true from a medical-legal standpoint

I disagree here. The liability is lower... a lot lower. If the cause of the injury is NOT directly related to the anesthetic the blame will lie with the physicians in the case. Any preop/postop event which results in morbidity or mortality will fall on the physicians. CRNAs are independent, midlevel practitioners who practice nurse anesthesia not medicine and that fact can't be ignored. Their standard of care is NOT the same in the perioperative setting as a physician anesthesiologist.

Final point of proof is the cost of the same $500,00 policy. CRNAs pay around $6-8,000 vs Anesthesiologists with rates 50-100% higher.

 

[BLADEMDA]

"How many hours are you working?"

"A lot.... Like 36-48"



Funny how I feel like anything less than 50 is a light week.

36-48 hours is a dream job for some of us here. We always bring up how EASY 36-40 hours would be as a day job.

 

[DonFL]

I disagree here. The liability is lower... a lot lower. If the cause of the injury is NOT directly related to the anesthetic the blame will lie with the physicians in the case. Any preop/postop event which results in morbidity or mortality will fall on the physicians. CRNAs are independent, midlevel practitioners who practice nurse anesthesia not medicine and that fact can't be ignored. Their standard of care is NOT the same in the perioperative setting as a physician anesthesiologist.

Final point of proof is the cost of the same $500,00 policy. CRNAs pay around $6-8,000 vs Anesthesiologists with rates 50-100% higher.

You are correct on the cost - but that gap is narrowing as practice models change everywhere. Most insurers can't just bump rates to where they need to be because of regulatory limits. The gross liability isn't lower in a case just because they're supervised - in my expert witness work I've seen plenty of anesthesiologists dropped from the suit because the CRNA did something stupid without them. And unfortunately the case law works the same if the surgeon is supervising - if they didn't direct the care they're generally not liable.

 

[DonFL]

As soon as administrators realize a 40 hour CRNA locums doing no weekends nights cost as much as full time w2 Md doc doing full time no nights and weekends.

Administration or most of them fail to realize that Paying CRNA locums $200/hr plus 30% or even 40% agency fees on top of that means it literally cost $500k or even 600k to use CRNA locums a year doing 40 hours.

They realize it. Locums CRNAs are being replaced with W2 physicians in many areas

 

[teacher2md]

in my expert witness work I've seen plenty of anesthesiologists dropped from the suit because the CRNA did something stupid without them. And unfortunately the case law works the same if the surgeon is supervising - if they didn't direct the care they're generally not liable.

Suuure you have….

You care to show us a single case where a supervised CRNA was found liable and the doc was dropped? Seriously, post some links.

 

[DonFL]

Suuure you have….

You care to show us a single case where a supervised CRNA was found liable and the doc was dropped? Seriously, post some links.

Thats cute - you should do some expert witness work sometime. Do you honestly think I'm free to post specific details of cases where I've served as an expert?

 

[teacher2md]

Thats cute - you should do some expert witness work sometime. Do you honestly think I'm free to post specific details of cases where I've served as an expert?

Respondeat superior--I'm sure you you know all about this legal principle.

Do you mean to tell us that the only cases in which anesthesiologists were excused from liability are the ones in which you personally participated?

 

[vector2]

Do you honestly think I'm free to post specific details of cases where I've served as an expert?

Um....yes? There's plenty of public presentations where speakers anonymized cases and presented specific details of expert witness work. Hell, my chairman is an expert witness and talks about cases all the time.

 

[DonFL]

Lol I don't think you can call it "standard of care" just because the AANA posters say it is. I also don't think a dozen some state legislatures approving opt outs make it a standard either, but that does raise a good question on what exactly determines the standard. The ASA certainly doesn't say it is..

Regardless, even if the ivory tower types on the IRB are pretty clueless, I don't think they're clueless enough to sign off on the ethics of "let's anesthetize the sickest patients....but without physicians present"

Seriously - everyone is forgetting the big picture: Nobody thats not a physician gives a crap about physicians. It all about outcomes: if we can't prove we're superior (should be easy) we'll keep having to fight scope creep

 

[teacher2md]

Seriously - everyone is forgetting the big picture: Nobody thats not a physician gives a crap about physicians. It all about outcomes: if we can't prove we're superior (should be easy) we'll keep having to fight scope creep

You're not fooling anyone here.

Suuure you have….

You care to show us a single case where a supervised CRNA was found liable and the doc was dropped? Seriously, post some links.

Still waiting on those cases.

 

[DonFL]

Um....yes? There's plenty of public presentations where speakers anonymized cases and presented specific details of expert witness work. Hell, my chairman is an expert witness and talks about cases all the time.

Ok nurse
I get asked regularly about whether a nurse will be involved in my patients' care as a lot of people are worried (appropriately) about anesthesia. MD only baby

Again, thats cute. And you all think every case reviewed by an expert is published with links able to be provided ? If you believe that & actually think I'm a damn nurse because I hold an opinion different from yours is part of the reason we need to be worried.

I've stated two facts that I'll stand by: 1) We must prove our outcomes are superior, and 2) case law precedent supports that the person that directed the anesthetic is liable, whether that be the anesthesiologist, the surgeon or the nurse.

 

[teacher2md]

2) case law precedent supports that the person that directed the anesthetic is liable, whether that be the anesthesiologist, the surgeon or the nurse.

You keep saying this yet you won't show a single example of it. Show us an instance where a supervising anesthesiologist was let off the hook for the actions of a nurse anesthetist.

 

[dannyboy1]

You keep saying this yet you won't show a single example of it. Show us an instance where a supervising anesthesiologist was let off the hook for the actions of a nurse anesthetist.

If you were on the chart you will certainly be sued. Keep in mind that your attorney is likely defending both you and the CRNA so it’s probably not in the interest of the case overall if both defendants get into a “he said, she said”.

 

[nimbus]

2) case law precedent supports that the person that directed the anesthetic is liable, whether that be the anesthesiologist, the surgeon or the nurse.

You keep saying this yet you won't show a single example of it. Show us an instance where a supervising anesthesiologist was let off the hook for the actions of a nurse anesthetist.

I think you and @DonFL agree. You are both saying the same thing.

 

[DonFL]

You keep saying this yet you won't show a single example of it. Show us an instance where a supervising anesthesiologist was let off the hook for the actions of a nurse anesthetist.

I've been involved with two cases dealing with this specific scenario, both involved outpatient procedures in which the supervision was loose collaborative (not medical direction), and both where the patient aspirated during the procedure where a nurse was in the room and the anesthesiologist was supervising 6-8 rooms. Both times we successfully removed the physician from the defendant list; one case was dropped completely and the other was settled for a cursory sum (against my recommendation) due to the terms of the policy.

 

[DonFL]

You keep saying this yet you won't show a single example of it. Show us an instance where a supervising anesthesiologist was let off the hook for the actions of a nurse anesthetist.

And regarding a surgeon not held liable because they didn't direct the anesthetic:


Glassman v. Costello, 267 Kan. 509, 523-524, 986 P.2d 1050, 1060-61 (1999)

Starcher v. Byrne, 687 So. 2d 737, 741-742 (Miss. 1997)

Parker v. Vanderbilt, 767 S.W 2d 412, 415-416 (Tenn. App. 1988) (rejecting “captain of the ship” doctrine and finding surgeon not liable for CRNA’s negligence.)

Vargas v. Dulzaids, 520 So.2d 306 (Fla. 3d DCA), review dismissed, 528 So.2d 1184
(Fla. 1988),

Fortson v. McNamara, 508 So. 2d 35, 37 (Fl. App. 1987)

Pierre v. Lallie Kemp Charity Hospital, 515 So. 2d 614, 620-621 (La. App. 1987)

Hughes v. St. Paul Fire and Marine Insurance Co., 401 So. 2d 448, 450 (La. App. 1981)

Foster v. Englewood Hospital, 19 Ill. App. 3d 1055 (1974).

Dohr v. Smith, 104 So.2d 29 (Fla. 1958)

Kemalyan v. Henderson, 277 P.2d 372 (Wash. 1954);

Sesselmon v. Mulenberg Hospital, 306 A. 2d 474, 475-477 (N.J. Super. Ct., App. Div. 1954)

Hudson v. Weiland, 150 Fla. 523, 8 So.2d 37 (Fla. 1942)].

What I'm trying to tell everyone is that the ASA isn't helping us in this regard. Blindly telling administrators that the surgeon is liable for supervision just isn't true. We cannot control the courts and the above is 80 damn years of precedent that contradicts our &$*%ing association.

 

[teacher2md]

And regarding a surgeon not held liable because they didn't direct the anesthetic:


Glassman v. Costello, 267 Kan. 509, 523-524, 986 P.2d 1050, 1060-61 (1999)

Starcher v. Byrne, 687 So. 2d 737, 741-742 (Miss. 1997)

Parker v. Vanderbilt, 767 S.W 2d 412, 415-416 (Tenn. App. 1988) (rejecting “captain of the ship” doctrine and finding surgeon not liable for CRNA’s negligence.)

Vargas v. Dulzaids, 520 So.2d 306 (Fla. 3d DCA), review dismissed, 528 So.2d 1184
(Fla. 1988),

Fortson v. McNamara, 508 So. 2d 35, 37 (Fl. App. 1987)

Pierre v. Lallie Kemp Charity Hospital, 515 So. 2d 614, 620-621 (La. App. 1987)

Hughes v. St. Paul Fire and Marine Insurance Co., 401 So. 2d 448, 450 (La. App. 1981)

Foster v. Englewood Hospital, 19 Ill. App. 3d 1055 (1974).

Dohr v. Smith, 104 So.2d 29 (Fla. 1958)

Kemalyan v. Henderson, 277 P.2d 372 (Wash. 1954);

Sesselmon v. Mulenberg Hospital, 306 A. 2d 474, 475-477 (N.J. Super. Ct., App. Div. 1954)

Hudson v. Weiland, 150 Fla. 523, 8 So.2d 37 (Fla. 1942)].

What I'm trying to tell everyone is that the ASA isn't helping us in this regard. Blindly telling administrators that the surgeon is liable for supervision just isn't true. We cannot control the courts and the above is 80 damn years of precedent that contradicts our &$*%ing association.

You've completely moved the goalposts. Your original claim was this:

in my expert witness work I've seen plenty of anesthesiologists dropped from the suit because the CRNA did something stupid without them.

To which I say: BS.

 

[DonFL]

You've completely moved the goalposts. Your original claim was this:


To which I say: BS.

I stated two specific cases in my experience where that claim is 100% true.

I've been involved with two cases dealing with this specific scenario, both involved outpatient procedures in which the supervision was loose collaborative (not medical direction), and both where the patient aspirated during the procedure where a nurse was in the room and the anesthesiologist was supervising 6-8 rooms. Both times we successfully removed the physician from the defendant list; one case was dropped completely and the other was settled for a cursory sum (against my recommendation) due to the terms of the policy.

 

[Anesthesia_Guy]

Cmon now - you should know better. The debt may be lower but very few CRNAs make $300k employed (not locums - employed), and the liability for their actions isn't lower if theyre independently licensed. Its just not true from a medical-legal standpoint.

I do know better and you are wrong - $300k is easy for a CRNA to make. They also rarely get sued.

 

[Sug Knight]

I disagree here. The liability is lower... a lot lower. If the cause of the injury is NOT directly related to the anesthetic the blame will lie with the physicians in the case. Any preop/postop event which results in morbidity or mortality will fall on the physicians. CRNAs are independent, midlevel practitioners who practice nurse anesthesia not medicine and that fact can't be ignored. Their standard of care is NOT the same in the perioperative setting as a physician anesthesiologist.

Final point of proof is the cost of the same $500,00 policy. CRNAs pay around $6-8,000 vs Anesthesiologists with rates 50-100% higher.

Standards of care (what would a reasonable provider do in similar situation) for the provision of Perioperative anesthesia services are not multi-level. False equivalency. SOC guidelines are quite similar. Now, if you are talking about payouts from settlements, well, deep pockets always get emptied first.

 

[Dr. Rude]

Other things that may be relevant when analyzing medmal premiums:

-Solo CRNAs tend to practice in rural areas that are less Plaintiff friendly.
-Solo CRNAs tend to practice in cosmetic surgery practices, cataract factories, etc. Other types of cases that solo CRNAs do are PS 1 and 2s for bread and butter procedures. I.e., lower risk of a bad outcome.
-Surgeons that hire solo CRNAs often try to cherry pick CRNAs that they worked with in a hospital setting and have had a chance to observe their skills. I.e., they try to cherry pick from the right side of the CRNA skill curve.