CRNA lead Cardic Anestheia Dept

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A hospital in my region recently laid off their cardiac anesthesiologists and are going to have their CRNAs run the program. They’re bringing in cardiologists for echo. I was a little caught off guard with the news. Is this common? Unbelievable imo

According to some in the know, they the CV anesthesiologist were too expensive and they’re paying the CRNAs 250k with 10 weeks vacation

 

[San Marzano]

Seems like you would need a lot of CRNAs working lots of hours to cover hearts 24/7... 250k sounds cheaper than a doc unless you need three of them to cover the duties that one body used to handle. And it sounds like some cardiologists are gonna be holding their sticky hands out for some $$$ now. I’d love to see the numbers on this to find out how much they think they are going to save themselves.

 

[Psai]

I don't get why we train these people

Would like more details on this situation. I find it hard to believe that the cardiac surgeons are okay with this.

 

[Twiggidy]

 

[acidbase1]

just not fair to the patients. I’ve worked with the CRNA who’s going to be covering these cases. He’s a good provider, but I wouldn’t feel comfortable with him performing my anesthetic solo

 

[deleted126335]

how many hearts do they do?

 

[acidbase1]

Think like 300-350/yr

 

[deleted126335]

that's why. It is a program that is little more than a backstop for interventional cardiology.

 

[Consigliere]

A hospital in my region recently laid off their cardiac anesthesiologists and are going to have their CRNAs run the program. They’re bringing in cardiologists for echo. I was a little caught off guard with the news. Is this common? Unbelievable imo

According to some in the know, they the CV anesthesiologist were too expensive and they’re paying the CRNAs 250k with 10 weeks vacation

What sort of horse's ass cardiac surgeon/administration/anyone is ok with this arrangement!? Remind me never to go to this "hospital."

 

[Man o War]

What hospital is this?
I’m trying to imagine the cost and logistics of keeping a cardiologist on standby 24/7 to do intraop echo. The units they can bill wouldn’t even be worth their time for that amount of call.
None of the cardiac surgeons i have ever worked with would even allow a supervised CRNA to do the cardiac cases, I’m trying to fathom their reaction if admin told them they were getting a solo one. Hell, the vascular surgeons at our sister hospital across town refuse to work with them anymore.

 

[IMGASMD]

Didn’t we have something similar that came up recently? Just have the hospital across town to advertise, we have board certified/fellowship trained cardiac Anesthesiologists doing all your Open Heart Surgery.

 

[Psai]

Didn’t we have something similar that came up recently? Just have the hospital across town to advertise, we have board certified/fellowship trained cardiac Anesthesiologists doing all your Open Heart Surgery.

These are "board certified" "fellowship trained" (nurse) "anesthesiologists"

 

[AdmiralChz]

A hospital in my region recently laid off their cardiac anesthesiologists and are going to have their CRNAs run the program. They’re bringing in cardiologists for echo. I was a little caught off guard with the news. Is this common? Unbelievable imo

According to some in the know, they the CV anesthesiologist were too expensive and they’re paying the CRNAs 250k with 10 weeks vacation

See how the CT surgeons feel about that after a few days, or weeks. The difference will be apparent, and CT peeps are the least tolerant of poor skills and knowledge.

That’s a very dangerous proposition. Hope I don’t need heart care there!

 

[nimbus]

Think like 300-350/yr

that's why. It is a program that is little more than a backstop for interventional cardiology.

That’s a good size program to be covered by a single anesthesiologist or CRNA. I would kill to do 300 hearts/ year. Even half that is a great number.

 

[chromuffin]

I really wonder how many lawsuits/medical errors it will take before the hospital administrators realize "saving" on cardiac CRNAs was a bad idea. Sure anesthesiologists make errors but its a lot harder to justify suing a fellowship trained cardiac anesthesiologist than a cardiac CRNA. Didn't even realize this was a thing.

 

[Twiggidy]

What sort of horse's ass cardiac surgeon/administration/anyone is ok with this arrangement!? Remind me never to go to this "hospital."

I wanted to know the same so I know where NOT to go

 

[acidbase1]

That’s a good size program to be covered by a single anesthesiologist or CRNA. I would kill to do 300 hearts/ year. Even half that is a great number.

It was two CV anesthesiologists. Typo

This is somewhat rural and they were asking for 550-650k/yr. hospital admin said thanks but no thanks, we have nurse anesthesiologists

 

[Twiggidy]

Think like 300-350/yr

That’s a solid amount of hearts. I wonder how much the Anesthesiologist wanted

 

[Twiggidy]

It was two CV anesthesiologists. Typo

This is somewhat rural and they were asking for 550-650k/yr. hospital admin said thanks but no thanks, we have nurse anesthesiologists

Yeah. RIP those surgeons and that hospital when....and I say WHEN a major complication occurs.

And let this be a lesson to any anesthesiologist teaching CRNAs A lines, CVPs, and echo

 

[Fpg1245]

Wow...so no anesthesiologist oversight. I honestly didn’t think they were demanding all the much for a rural area. 550K rural. Seems reasonable especially if undesirable locale. So admin played the crna card. Seems like something the ASA or even the state society should jump on.

 

[chromuffin]

What do the non CV anesthesiologist think?

 

[GravelRider]

Some parts of this story seem murky to me. They already have cardiac nurse anesthesiologists in place? These CRNAs are not asking for a raise for the increase in workload/responsibility? What were the anesthesiologists making before?

There won’t be many complications...at least not enough for this penny-pinching hospital to care about. I bet these are pretty routine cases and these cardiac surgeons are the type to tell you when to turn the Epi on. With the cardiologist doing the TEE, the remainder of the case is pretty routine. You have to remember that we think differently than the business-minded administrators. Where a bad outcome might sit with us for a while, the administration is looking at a macroscopic view. There is a tolerable amount of bad outcomes built into every cost-saving decision.

 

[sethco]

that's why. It is a program that is little more than a backstop for interventional cardiology.

I don't know. I'd call that moderate volume, certainly not low volume. Some Cardiac fellowships out there do about that kind of volume

 

[pgg]

There won’t be many complications...

Possibly. Some of these rural places work very hard to not notice complications.

 

[sethco]

It was two CV anesthesiologists. Typo

This is somewhat rural and they were asking for 550-650k/yr. hospital admin said thanks but no thanks, we have nurse anesthesiologists

That's a pretty fair number for two people covering 24/7

 

[ProRealDoc]

I say let them do it. I like to give people enough rope so they can hang themselves.

 

[Hamhock]

I think for all the chest pounding anesthesiologists do about this, there is little action when situations like this come up.
So far the hospital hasn't even been named!
Until that is the case and until more facts are released, this is all just a hypothetical that is getting emotional responses on the interwebs.
HH

 

[Man o War]

I think for all the chest pounding anesthesiologists do about this, there is little action when situations like this come up.
So far the hospital hasn't even been named!
Until that is the case and until more facts are released, this is all just a hypothetical that is getting emotional responses on the interwebs.
HH

Agree.

 

[sevoflurane]

What cardiologist wants to come in and do TEEs first thing in the morning and in the middle of the night? TEEs pay is negligible.

Cardiologist that sign up for this ridiculousness are getting a bad deal as well. RVUs generated for the availability is not worth it IMO.

Sounds like administrators poor decisions will lead to them being replaced at some point.

 

[jwk]

These are board certified fellowship trained (nurse) anesthesiologists

There is no such animal.

 

[Psai]

There is no such animal.

It was tongue in cheek. They take some simple multiple choice test and call it a board certification. They take a weekend course and call it a fellowship. They take their crap training and call themselves anesthesiologists. Everything that we do, they do something that doesnt even come close to resembling what we do but try to pass it off as the same thing.

 

[vector2]

Some parts of this story seem murky to me. They already have cardiac nurse anesthesiologists in place? These CRNAs are not asking for a raise for the increase in workload/responsibility? What were the anesthesiologists making before?

There won’t be many complications...at least not enough for this penny-pinching hospital to care about. I bet these are pretty routine cases and these cardiac surgeons are the type to tell you when to turn the Epi on. With the cardiologist doing the TEE, the remainder of the case is pretty routine. You have to remember that we think differently than the business-minded administrators. Where a bad outcome might sit with us for a while, the administration is looking at a macroscopic view. There is a tolerable amount of bad outcomes built into every cost-saving decision.

I can say this is the truth as someone who came on to a group where all the general guys were doing cardiac before I arrived. The surgeons in all honesty would rather have me sitting every case, but when I can't, the surgeon, perfusionist, and cardiologist essentially do the case (I.e they dictate drips, transfusion, heparin, protamine, echo findings etc). As terrible as it sounds, type A micromanaging surgeons probably aren't going to have a lot of complaints with the CRNA setup assuming we're talking about B&B hearts and not double valves and OPCABs on 20% EFs with pulm HTN.

 

[Arch Guillotti]

What cardiologist wants to come in and do TEEs first thing in the morning and in the middle of the night?

Ones that are employed by the hospital.

 

[chocomorsel]

Ok, this sounds crazy. My question is though, where do all these rural hospitals get all this money that they pay us and other specialists?
It's not like the rural population are a bunch of middle class or well to do people with good insurance.

And this is coming from someone who has an interview in a semi rural place coming up soon where I hear the money is really good. Gonna ride that gravy train till it stops producing!!

 

[Psai]

Ok, this sounds crazy. My question is though, where do all these rural hospitals get all this money that they pay us and other specialists?
It's not like the rural population are a bunch of middle class or well to do people with good insurance.

And this is coming from someone who has an interview in a semi rural place coming up soon where I hear the money is really good. Gonna ride that gravy train till it stops producing!!

I figured it was more that they had fewer self important suits sticking their hands in physician pockets

 

[ERRES2288]

What do the non CV anesthesiologist think?

This. They better start figuring out their exit plan, because if the bean counters will make this move for cardiac you can bet general is in the works.

 

[Twiggidy]

Some parts of this story seem murky to me. They already have cardiac nurse anesthesiologists in place? These CRNAs are not asking for a raise for the increase in workload/responsibility? What were the anesthesiologists making before?

There won’t be many complications...at least not enough for this penny-pinching hospital to care about. I bet these are pretty routine cases and these cardiac surgeons are the type to tell you when to turn the Epi on. With the cardiologist doing the TEE, the remainder of the case is pretty routine. You have to remember that we think differently than the business-minded administrators. Where a bad outcome might sit with us for a while, the administration is looking at a macroscopic view. There is a tolerable amount of bad outcomes built into every cost-saving decision.

Are you trying to tell me nothing bad has ever happened on a routine case? Let’s say the 60 year old AVR that decides to never wake up post op? (seen it) A malpractice lawyer could have a field day with a good ol’ American jury.

Edit: I do agree with you that someone just administration has probably weighed the risk vs reward and said let’s just take this chance and save a buck, but if they roll snake eyes...again RIP

 

[Twiggidy]

I think for all the chest pounding anesthesiologists do about this, there is little action when situations like this come up.
So far the hospital hasn't even been named!
Until that is the case and until more facts are released, this is all just a hypothetical that is getting emotional responses on the interwebs.
HH

I imagine the hospital is in a local where it’s a bit of a small world so I can understand OP wanting to be a bit incognito

 

[Twiggidy]

What cardiologist wants to come in and do TEEs first thing in the morning and in the middle of the night? TEEs pay is negligible.

Cardiologist that sign up for this ridiculousness are getting a bad deal as well. RVUs generated for the availability is not worth it IMO.

Sounds like administrators poor decisions will lead to them being replaced at some point.

Ive never seen a cardiologists come in after hours for a heart. They just read the report the next day.

 

[Hamhock]

I imagine the hospital is in a local where it’s a bit of a small world so I can understand OP wanting to be a bit incognito

If the OP was stating anything but facts, then I 'going incognito' makes sense.
Otherwise, it just more of the same.
HH

 

[Psai]

Ive never seen a cardiologists come in after hours for a heart. They just read the report the next day.

That's a good time to know that the MV needs to be repaired as well

 

[Twiggidy]

That's a good time to know that the MV needs to be repaired as well

And I’ll repeat......stop teaching CRNAs how to use the echo. I’m not even showing them how to turn on the machine. I would not be shocked if part of this decision was a nurse walking in the meeting and saying “I can get 20 views. *fill the blank* showed me how” or CV surgeon saying “Well that nurse can get the views so I’m good with this.....as a matter of fact, can I get some of the money saved via a pay bump or I take my patients elsewhere.”


Stop teaching nurses.

 

[GravelRider]

Are you trying to tell me nothing bad has ever happened on a routine case? Let’s say the 60 year old AVR that decides to never wake up post op? (seen it) A malpractice lawyer could have a field day with a good ol’ American jury.

Edit: I do agree with you that someone just administration has probably weighed the risk vs reward and said let’s just take this chance and save a buck, but if they roll snake eyes...again RIP

Would that 60 year old who didn’t wake up have had a different outcome if it had been an anesthesiologist vs CRNA? I’ll go one step further and say that it’s easier to explain a morbidity/mortality on an ASA 3, 4, or 5 patient than it is on a routine hernia repair on an ASA 1. You off grandma with critical aortic stenosis and maybe there’s a meeting amongst those involved the day after, but it’s pretty much forgotten a week later. You off that 23 year old with a back pimple and the lawyers are descending like vultures to fresh roadkill.

I’m trying to play devil’s advocate here, but the bottom line is that the suits in medicine don’t exactly think like us. It’s all about costs/expenses and risks/benefits in the name of turning a profit. It also goes back to my argument that doing a fellowship for reasons of job security is stupid. We’re not in charge of healthcare anymore.

 

[Twiggidy]

Would that 60 year old who didn’t wake up have had a different outcome if it had been an anesthesiologist vs CRNA? I’ll go one step further and say that it’s easier to explain a morbidity/mortality on an ASA 3, 4, or 5 patient than it is on a routine hernia repair on an ASA 1. You off grandma with critical aortic stenosis and maybe there’s a meeting amongst those involved the day after, but it’s pretty much forgotten a week later. You off that 23 year old with a back pimple and the lawyers are descending like vultures to fresh roadkill.

I’m trying to play devil’s advocate here, but the bottom line is that the suits in medicine don’t exactly think like us. It’s all about costs/expenses and risks/benefits in the name of turning a profit. It also goes back to my argument that doing a fellowship for reasons of job security is stupid. We’re not in charge of healthcare anymore.

I’ll agree with you and not to derail but I think in academics a fellowship will give you job security but not so much in private practice.

Sooooo there actually is doom and gloom in the future?

 

[Consigliere]

Ok, this sounds crazy. My question is though, where do all these rural hospitals get all this money that they pay us and other specialists?

4 words, g: rural pass through legislation

 

[Man o War]

4 words, g: rural pass through legislation

Yep. This is why you don’t see widespread solo CRNA use in non critical access hospitals. The day rural pass through applies to both CRNAs and anesthesiologists, things will start changing in the country. The CRNAs want to act like they’re the preferred provider in the country because of their super special nursing educations....

 

[gasman2014]

I know it's tongue-in-cheek on these boards, but we do ourselves no favors when we start using the AANA language of nurse anesthesiologist. That is not a term. Even when joking I suggest we don't give it any pseudo-legitimacy by utilizing the phrase.

 

[Twiggidy]

The CRNAs want to act like they’re the preferred provider in the country because of their super special nursing educations....

Just reading it makes me LOL

 

[Twiggidy]

I know it's tongue-in-cheek on these boards, but we do ourselves no favors when we start using the AANA language of nurse anesthesiologist. That is not a term. Even when joking I suggest we don't give it any pseudo-legitimacy by utilizing the phrase.

They’re nurses. Plain and simple

 

[sevoflurane]

Ones that are employed by the hospital.

Yup. In a malignant environment that might be the case. Any cardiology group that works for a hospital should have enough balls to say no. This is a VERY unusual setup.
I don’t think I’ve ever had a cardiologist in the CT room in 10+ years (probably since residency). I definitely have never seen a cardiologist at 3am during a Type A dissection. Good luck having a nurse identify a true and false lumen. Mess that up and you could easily kill the patient.