CRNAs - a blessing or a curse.... we have created a monster

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lotsapain

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The CRNA issue have long been discussed... and I am aware of all the counterpoints.... indeed it is great to have someone else
sit in the room while you are interacting with patients. That being said there is always:
A. issue of competency - varies a lot
B. making them indispensable
C. Cannot take a nurse out of a nurse

I have been to various practices some have excellent CRNAs who are both competent and step up when need be,
now most practices I see CRNAs just keep pushing the limits - I do not want to do this or that..... I do not want to take
call, I do not want to go to ASC, I can't stay late 5 minutes.

Fast to jump ship for 1 dollar higher rate and/or fewer shifts etc etc etc.... salaries are reaching $300 per hour for
locums and 300k+ for full timers, physicians are still few and far between and most would rather not sit in a room
(many threads here).... our laziness have created this monstrosity...

Mind you the reality of "I want to work independently" is "I want to work independently but I do not want the legal responsibility"
and most CRNAs shy from real independent practice. I am curious on opinions, seeing how things are going I would say
- go practice independently will see how long that last with outcomes.... on the other hand i know for a FACT that outcomes
are worse.... not sure what the ultimate outcome will be, I dread what happens in 10 years and who will be taking care of use
when we are old (that is not too far out for some of us).........
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I feel like the aggression levels of the new crnas has reached new heights. I'm seeing blatant disrespect nowdays. Even for simple things. Told one just use a glidescope looks a little challenging. Of course I walk in struggling with dl. It's like I told you man, why just blatantly disregard such a minor request? But that's how the new ones are. Also xovid shortage is getting them more and more empowered. Lots of places closing up md only shop and converting to supervision.
 
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Greenbayslacker said:
Source on these facts?
Click to expand...
Wouldn't be a big leap of logic to reach that conclusion.

Substantially less anesthesia training
Substantially less overall medical training
Significantly less average candidate baseline capabilities (MD pathway is vastly more difficult to enter than CRNA pathway)

Show me any specialty, NP, PA, etc where a less trained individual is equally capable. An easy example would be an ER doc. They are equal in terms of baseline qualifications (MD, college, etc) but much less specific training and experience in cardiology, orthopedics, nephrology, internal medicine, etc. would you expect their orthopedic complication rates to be equal to that of an orthopedic surgeon or would that be masked by the fact that they wouldnt generally handle major orthopedic issues

Would be challenging to prove though..as most CRNAs as supervised, and many don't take care of the same level of acuity. Would also be a challenging from an ethics perspective to do a double blinded study
 
Many new grads are taking the 75-100k 2 year sign on bonus plus the base 220k for 3 days a week with the 10% differential (3) 12s.

That’s close to to 300k for 26/27 yo with no life experience new grad.
They will stay for 2 years and move on and get more experience.

Like almost getting pgy 3/4 on the job training at 300k a year with no calls and no weekends and opportunities to work for more extra.
 
It's time for everyone to embrace independent practice. End supervision once and for all. I don't see how anyone could possibly enjoy "supervising" 4 locations at a time and derive any sort of professional enjoyment out of that. Young CRNAs coming out of school are abysmal. They frequently cannot get straightforward airways, have no idea how to handle anything outside of train tracks, etc. They want to be independent. It's a win win for all. I don't understand why we are fighting it. There are plenty of anesthesia jobs for us to do our own cases as anesthesiologists. ****ty hospitals with crappy surgeons will choose solo CRNAs to save a few bucks. Better hospitals that actually give a damn about patient outcomes will choose solo anesthesiologists.
 
Maz777 said:
It's time for everyone to embrace independent practice. End supervision once and for all. I don't see how anyone could possibly enjoy "supervising" 4 locations at a time and derive any sort of professional enjoyment out of that. Young CRNAs coming out of school are abysmal. They frequently cannot get straightforward airways, have no idea how to handle anything outside of train tracks, etc. They want to be independent. It's a win win for all. I don't understand why we are fighting it. There are plenty of anesthesia jobs for us to do our own cases as anesthesiologists. ****ty hospitals with crappy surgeons will choose solo CRNAs to save a few bucks. Better hospitals that actually give a damn about patient outcomes will choose solo anesthesiologists.
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This doesn't end the way you think it will

Even if you misguidedly think hospitals care about patient safety, you know damn well ASCs don't
 
gunnershow said:
This doesn't end the way you think it will

Even if you misguidedly think hospitals care about patient safety, you know damn well ASCs don't
Click to expand...
Continue fighting a misguided and inevitably losing battle. I will take my chances. There are plenty of jobs to go around. I have no interest in "supervising" people that have no idea what they are doing. The supervision model should not exist in the first place. We are meant to do our own cases. I didn't go into medical school to have other people do my work for me.
 
Maz777 said:
Continue fighting a misguided and inevitably losing battle. I will take my chances. There are plenty of jobs to go around. I have no interest in "supervising" people that have no idea what they are doing. The supervision model should not exist in the first place. We are meant to do our own cases. I didn't go into medical school to have other people do my work for me.
Click to expand...

I agree with both sides of this equation.... indeed we should let them go independent and see what happens as indeed physicians should be providing anesthesia. On the other hand most hospitals now are ran by talking heads who know only one thing - increase margin by cutting costs not how to run an actual safe operation which will in turn bring revenue...... as I said we have created a monster... nurses will remain nurses a long white coat does not make one a doctor, regardless of what they tell ya....
 
i was gung ho about doing solo anesthesia practice coming out of fellowship. Did that for about 7-8 years before forming the opinion that cases of a certain complexity/acuity deserve more than one experienced provider. There’s a reason ACLS tells you the person leading the resuscitation should not be the one trying to untangle the monitors and draw up drugs in an emergency.

I think extenders are needed for things like emergent CTS, interventional cardiology where the anesthesiologist is doing the imaging, etc. the problem is , how do we get this model ? In my state only CRNAs are allowed to practice (no AAs). Better than nothing though, I’m tired of being the one trying to de air the Belmont when the surgeon needs me to be looking at the echo.
 
half of my friends prefer supervising. They are all about 5 years out of training. They don’t like sitting in the room , talking to the surgeon , and it gives them a lot of free time during cases. They told me they prefer Crnas to residents and they also teach them blocks. I don’t get it and think it’s sort of lazy. Unfortunately I think there is a large amount of anesthesiologists who prefer to supervise. I hate supervising and my last three jobs have all been solo.
 
T-burglar said:
i was gung ho about doing solo anesthesia practice coming out of fellowship. Did that for about 7-8 years before forming the opinion that cases of a certain complexity/acuity deserve more than one experienced provider. There’s a reason ACLS tells you the person leading the resuscitation should not be the one trying to untangle the monitors and draw up drugs in an emergency.

I think extenders are needed for things like emergent CTS, interventional cardiology where the anesthesiologist is doing the imaging, etc. the problem is , how do we get this model ? In my state only CRNAs are allowed to practice (no AAs). Better than nothing though, I’m tired of being the one trying to de air the Belmont when the surgeon needs me to be looking at the echo.
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Rather than a CRNA, you could just use a good tech. Ours can prime and run the Belmont, per our direction, after nurses check the blood. Ours can also grab drugs, prime lines, set up pumps, etc. I don't see the need for a CRNA clamoring for independence.
 
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Yeah, huge difference in places with good techs, it takes a concerted effort and training by the anesthesia department but pays off when you have consistent people. I've been at places where the techs just stocked supplies and at places where you'd go to do a block and everything was set up and they knew which needle size almost 99% of the time, cardiac ones that knew how to set up a central line kit, at one place this superstar tech would have your preferred tube size, capped syringes, prop and roc vials all in the top drawer bc the night cases would bounce from room to room all night
 
Much prefer supervising. Still sit 25% of time or so…but much prefer. More cases. Stay busier. More procedures. Time for calls/eat/bathroom when want. It’s clear to everyone MDs aren’t needed to sit for 85% of routine surgeries. ASA 3 total knee under spinal…why do you need an MD to sit the case? Were there to facilitate OR throughout, put out fires, handle pre and pacu flow… if Good luck on the Md only. While the salaries of CRNAs are hitting 400k for those that work 5 days a week starting salaries for MDs are 6 and approaching 700 in many paces in Midwest/southeast. Until that gap narrows even further won’t change and even then many places will prefer an MD free -probably getting to 1:6 for mid to low acuity places,

I think 10-15 years still before Md only really disappears but it will
 
Howard888 said:
Much prefer supervising. Still sit 25% of time or so…but much prefer. More cases. Stay busier. More procedures. Time for calls/eat/bathroom when want. It’s clear to everyone MDs aren’t needed to sit for 85% of routine surgeries. ASA 3 total knee under spinal…why do you need an MD to sit the case? Were there to facilitate OR throughout, put out fires, handle pre and pacu flow… if Good luck on the Md only. While the salaries of CRNAs are hitting 400k for those that work 5 days a week starting salaries for MDs are 6 and approaching 700 in many paces in Midwest/southeast. Until that gap narrows even further won’t change and even then many places will prefer an MD free -probably getting to 1:6 for mid to low acuity places,

I think 10-15 years still before Md only really disappears but it will
Click to expand...
We all have colleagues like you, and we all know the underlying reason why you prefer supervision.
 
Some part is geographical, I don’t blame anyone who makes the choice to do one or the other. However if you’re not involved at all, don’t do procedures, don’t know how to triage who needs more watching, don’t stand up to pushback then good luck. I would say for new grads doing your own cases initially is invaluable for later on, I did my own cases for 5 years then did a stint of locums where I was supervising a lot…some of the things crnas said at smaller locations was poor clinical decision making, doing your own cases also lets you triage what actually matters in those scenarios. Going straight out of training into supervising will lead to faster skill atrophy than going into a straight endo center
 
Maz777 said:
We all have colleagues like you, and we all know the underlying reason why you prefer supervision.
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If you are happy grinding it out solo q5 calls 40 clinical in hours hrs a week for 550k clinically PLUS call hours meaning you are looking at close to 55 hrs a week at a large hospital. U can make 600-650k with overtime MD only. But that stuff gets old

Go for it solo by all means.

Hospitals would love it that 3-4 docs all stay to 7p solo instead of leaving 3pm and going 1:4 at 3pm.

So 4 docs all there to 7pm instead of one doc. Good luck with that. And yeah. I did that early on my career. I thought leaving at 6pm was good/normal. All solo. Work to 930p. Came right back at 630a for next day and worked to 1pm. It’s brutal day in and day out.

The MD only model only works at smaller places these days with strict cost control and room numbers going down to 1 by 5pm.
 
Md only model is dead in the southeast and getting there in Midwest. Just a matter of time. Couldn’t pay me enough to do it full time. MDs just aren’t necessary to sit cases and as someone on here already said the highest acuity cases are best served in team model with crna and Md -4 sets of hands.

Good luck to you Md only folks
 
Howard888 said:
Md only model is dead in the southeast and getting there in Midwest. Just a matter of time. Couldn’t pay me enough to do it full time. MDs just aren’t necessary to sit cases and as someone on here already said the highest acuity cases are best served in team model with crna and Md -4 sets of hands.

Good luck to you Md only folks
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I do think doing solo cases 20% of the time is good for everyone.

But full time Md only isn’t worth it unless it’s controlled ORs with very little chance for call back.

There is a really nice MD only place near my house. They have not had a single opening for 5 plus years even if no real pay raises.

None of the docs will leave even making low 450k
MD only 17 min from my house.

Why? The devil is in the details
1. 16 weeks off
2. 28 hr work weeks
3. Excellent hospital benefits including paid maternity/paternity and even general medical leave.
4. Sovereign immunity
5. Probably 10-12 more free days off when schedule is light
6. Call doc usually takes over around 1pm (means everyone is long gone)
7. Cases usually done by 4-5pm (90% of the time)
8. No ob, no peds, no trauma
9. Two trauma hospitals within 20 min either side of the hospital to ship any cases after hours. So very little call backs after 5pm and very little weekend cases

And I have privileges and have dinner with those guy there and have covered there for a very low $250/hr…..and I’d be glad do it again cause I get paid 8 hrs for working 4-5 hrs and the guys including the neuro rep are on the golf course by 1230pm on weekdays.

Those are the type of MD practices people 90% of docs would love to have. But there are certain docs who absolutely will not do solo cases anymore. They are out there. I’ve seen them. We all seen them. When they inquire about locums places. The first thing they ask me is, do you do calls? Do you do calls solo?
 
DG51 said:
Aka those of us who take pride in our work and prioritize the care of our patients over easily accessible bathroom and coffee breaks.
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Yeah you'll notice all the posts supporting ACT never mention patient care, it's always making excuses for their own laziness or inability to do the work.

And for what it's worth, I think there is a place for ACT... But setting it as a standard is a slippery slope, because it always degenerates into 4:1 covering hearts and peds and ceding OB to CRNAs entirely.
 
gunnershow said:
Yeah you'll notice all the posts supporting ACT never mention patient care, it's always making excuses for their own laziness or inability to do the work.

And for what it's worth, I think there is a place for ACT... But setting it as a standard is a slippery slope, because it always degenerates into 4:1 covering hearts and peds and ceding OB to CRNAs entirely.
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Try converting act model to all MD model. Just not enough bodies. That’s sorts of happening to some previously heavy act 1:4 models that lose crnas.

Docs solo and lucky to get out (1st out ) out by 5pm

Running 12 rooms at 3pm, 8 rooms at 5pm, 3 rooms by 7pm

How do you suggest to run doc only?

So some of these people are short crnas as they all go locums. So docs go solo. Getting. Suck late day after day. It’s miserable

So for all you docs here advocating solo MD. How many days a week are you willing to work to 7pm daily? 2? 4?

How many rooms are running after 5pm?
 
aneftp said:
Try converting act model to all MD model. Just not enough bodies. That’s sorts of happening to some previously heavy act 1:4 models that lose crnas.

Docs solo and lucky to get out (1st out ) out by 5pm

Running 12 rooms at 3pm, 8 rooms at 5pm, 3 rooms by 7pm

How do you suggest to run doc only?

So some of these people are short crnas as they all go locums. So docs go solo. Getting. Suck late day after day. It’s miserable

So for all you docs here advocating solo MD. How many days a week are you willing to work to 7pm daily? 2? 4?

How many rooms are running after 5pm?
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So you're saying CRNAs are capable of this "grind" and docs aren't? Pay me and give me enough vacation and I'll do it. If you just wanna sign charts and leave at 3, I don't know what to tell you.
 
gunnershow said:
So you're saying CRNAs are capable of this "grind" and docs aren't? Pay me and give me enough vacation and I'll do it. If you just wanna sign charts and leave at 3, I don't know what to tell you.
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Dude. I take my locums calls solo. That’s how I make the cash.

Crnas don’t even work more than 3-4 days a week w2 anymore. Most work 7 (24) these days w2.

U said it “pay me” “give me enough vacation”

That’s the bottom line. It’s idiotic to stay in MD only practice making even 700k if you are averaging 60 hours and 8—10 weeks off Working 2 weekends a month. Friday/sunday plus a Saturday the other weekend

Would you agree?

Those are the MD only groups folding due to increase demands for coverage from hospitals.

This is 2025. The 60 hr weeks /700k/8 weeks is the dinosaur from 2015
 
What are you taking pride in? Giving two antimetics, treating a BP of 90? To be fair I applaud you MDs doing solo hearts, trauma, or high acuity preds although I still think Md/crna better than Md only in those situations particularly if good working dynamic between the two. However, 90% of cases aren’t hearts, high acuity peds, or trauma…you’re flattering yourself.

Also previous post is spot on…not enough MDs. And you wouldn’t want to offer to replace CRNAs. The math is you would have to work 1.5-2 times as much to make 6-700k or more at places that currently supervise and you won’t want to do that. Go to a boutique practice that will die as the one advertised or go to California where CRNAs aren’t around YET and you can get hospital to pay you for what 5 years before this new crna legislation passes there?

Good luck
 
Howard888 said:
What are you taking pride in? Giving two antimetics, treating a BP of 90? To be fair I applaud you MDs doing solo hearts, trauma, or high acuity preds although I still think Md/crna better than Md only in those situations particularly if good working dynamic between the two. However, 90% of cases aren’t hearts, high acuity peds, or trauma…you’re flattering yourself.

Also previous post is spot on…not enough MDs. And you wouldn’t want to offer to replace CRNAs. The math is you would have to work 1.5-2 times as much to make 6-700k or more at places that currently supervise and you won’t want to do that. Go to a boutique practice that will die as the one advertised or go to California where CRNAs aren’t around YET and you can get hospital to pay you for what 5 years before this new crna legislation passes there?

Good luck
Click to expand...
This is like saying a cardiologist should only treat end stage heart failure and its equivalents and the "simple" referrals should be farmed out to NPs because, hey, it's "just" prescribing ASA and statin, right?

I already said that ACT has its place. But I can't get behind dancing on the graves of MD-only practices. I can only imagine an anesthesiologist doing this from a place of insecurity. From your posts, it seems like you're one of those who "needs" a CRNA to give anesthesia.

All I know is that when I changed from MD only to ACT, I started having a number of intraop and PACU issues I never had before. If you have no pride in your work and your duty to your patients, I suppose this is immaterial. But it makes no sense to denigrate those of us who do care.
 
gunnershow said:
This is like saying a cardiologist should only treat end stage heart failure and its equivalents and the "simple" referrals should be farmed out to NPs because, hey, it's "just" prescribing ASA and statin, right?

I already said that ACT has its place. But I can't get behind dancing on the graves of MD-only practices. I can only imagine an anesthesiologist doing this from a place of insecurity. From your posts, it seems like you're one of those who "needs" a CRNA to give anesthesia.

All I know is that when I changed from MD only to ACT, I started having a number of intraop and PACU issues I never had before. If you have no pride in your work and your duty to your patients, I suppose this is immaterial. But it makes no sense to denigrate those of us who do care.
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Crna quality can vary at different institutions.
 
Quality of care varies everywhere.

I used to “take pride” in my ability to do a 400 lb ruptured type A with a difficult airway by myself at night. Now I realize this is incredibly stupid and another experienced set of hands is better for everyone including the patient.

As for simpler cases - from a public health standpoint CRNAs are “good enough”. You’re insane to argue otherwise. Again quality varies but if you maintain competence standards and knowledge and clinical pathway standards it will be good enough. Video laryngoscopy will become standard, drugs will get safer, intra-OR command centers with full remote monitoring of all cases and AI assisted case guidance will be more widespread. Physicians will be overkill for sitting the stool.

here’s a glimpse of what’s coming

theanesthesiaconsultant.com

THE ANESTHESIA CONTROL TOWER: BIG BROTHER OR FRIEND? - The anesthesia consultant

Washington University in St. Louis is studying the Anesthesia Control Tower, a telemedicine-based intraoperative clinical support system.
theanesthesiaconsultant.com theanesthesiaconsultant.com
 

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University of Michigan I believe is the first big institution starting to use these ge machines. The machines exists so it’s really the software

www.fiercehealthcare.com

GE Healthcare gets FDA nod for software that automates anesthesia delivery

GE Healthcare has landed FDA pre-market approval for software that allows anesthesia providers to set targets for the end-tidal oxygen and anesthetic agents and reduces greenhouse gas emission | Inhaled anesthetic agents are costly and bad for the environment. GE Healthcare's software...
www.fiercehealthcare.com www.fiercehealthcare.com
 
aneftp said:
University of Michigan I believe is the first big institution starting to use these ge machines. The machines exists so it’s really the software

www.fiercehealthcare.com

GE Healthcare gets FDA nod for software that automates anesthesia delivery

GE Healthcare has landed FDA pre-market approval for software that allows anesthesia providers to set targets for the end-tidal oxygen and anesthetic agents and reduces greenhouse gas emission | Inhaled anesthetic agents are costly and bad for the environment. GE Healthcare's software...
www.fiercehealthcare.com www.fiercehealthcare.com
Click to expand...
This simply optimizes flows to minimize waste and cost. E.g., you change your vaporizer setting up it will temporarily increase FGF to reach equilibrium in a timely fashion. Then it will automatically minimize flows. Probably well under the "standard" 2 l/min that most folks cruise at.
 
T-burglar said:
Quality of care varies everywhere.

I used to “take pride” in my ability to do a 400 lb ruptured type A with a difficult airway by myself at night. Now I realize this is incredibly stupid and another experienced set of hands is better for everyone including the patient.

As for simpler cases - from a public health standpoint CRNAs are “good enough”. You’re insane to argue otherwise. Again quality varies but if you maintain competence standards and knowledge and clinical pathway standards it will be good enough. Video laryngoscopy will become standard, drugs will get safer, intra-OR command centers with full remote monitoring of all cases and AI assisted case guidance will be more widespread. Physicians will be overkill for sitting the stool.
Click to expand...
The patients are fatter, sicker, older and less well taken care of than ever before. Training is being skimped on for both CRNA students and residents from mid-tier programs and below. The A-list programs are still turning out great people.

T-burglar said:
here’s a glimpse of what’s coming

theanesthesiaconsultant.com

THE ANESTHESIA CONTROL TOWER: BIG BROTHER OR FRIEND? - The anesthesia consultant

Washington University in St. Louis is studying the Anesthesia Control Tower, a telemedicine-based intraoperative clinical support system.
theanesthesiaconsultant.com theanesthesiaconsultant.com
Click to expand...
If it works. Sedasys was touted as a way to reduce anesthesia personnel. Didn't work. Same with remimazolam. Also a bust.
 
Ok buddy. Progress has stopped, you’re right . Thanks for your ******* examples
 
T-burglar said:
Ok buddy. Progress has stopped, you’re right . Thanks for your ******* examples
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Touchy aren't we? I did say "if". Remember the eICU was all the rage for awhile. Seems like a valid parallel. Turned out that was mostly a bust and far less helpful than thought.

Work System Barriers and Strategies Reported by Tele-ICU Nurses: A Case Study author names and degrees - PMC

Tele-ICUs are a relatively recent innovation to deal with several issues such as ICU personnel shortage and improving care. In tele-ICUs, clinical teams monitor ICU patients remotely and support clinicians in multiple ICUs. The tele-ICU and ICU ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov
 
Dr. Rude said:
Touchy aren't we? I did say "if". Remember the eICU was all the rage for awhile. Seems like a valid parallel. Turned out that was mostly a bust and far less helpful than thought.

Work System Barriers and Strategies Reported by Tele-ICU Nurses: A Case Study author names and degrees - PMC

Tele-ICUs are a relatively recent innovation to deal with several issues such as ICU personnel shortage and improving care. In tele-ICUs, clinical teams monitor ICU patients remotely and support clinicians in multiple ICUs. The tele-ICU and ICU ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov
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TeleICU isn't really a bust. It's just not a full replacement for actual ICU physicians. We utilize teleICU overnight to manage the barrage of minor issue phone calls, and still have a physician and NP in-house to deal with admissions and critical issues. Without them, we'd likely either need to have another NP or physician on at night, or nights would just be a lot more painful for the in-house team.
 
Opponents of solo physician care always bring up that we don't have enough physicians to go full solo everywhere, but that's a strawman argument. It does not have to be 100% solo vs 100% ACT. There should be a mix of the two to find a balance between patient acuity, training, and availability of staff.

Regarding costs, why would we assume that a physician doing the case solo should be paid the same as a physician covering four rooms with CRNAs? Actual personnel cost per hour is CRNA rate plus 1/3 or 1/4 (depending on 1:3 vs 1:4) directing physician rate. And yet, I haven't seen practices in heavy ACT areas use this to recruit a handful of solo physicians to help with staffing shortfalls. Rather than forcing docs that don't want to work with CRNAs to choose between being unemployed or highly paid but miserable, offer the concession of solo work for less pay.
 
Howard888 said:
Much prefer supervising. Still sit 25% of time or so…but much prefer. More cases. Stay busier. More procedures. Time for calls/eat/bathroom when want. It’s clear to everyone MDs aren’t needed to sit for 85% of routine surgeries. ASA 3 total knee under spinal…why do you need an MD to sit the case? Were there to facilitate OR throughout, put out fires, handle pre and pacu flow… if Good luck on the Md only. While the salaries of CRNAs are hitting 400k for those that work 5 days a week starting salaries for MDs are 6 and approaching 700 in many paces in Midwest/southeast. Until that gap narrows even further won’t change and even then many places will prefer an MD free -probably getting to 1:6 for mid to low acuity places,

I think 10-15 years still before Md only really disappears but it will
Click to expand...

The reason they hit 400k is because of people like you
 
Howard888 said:
What are you taking pride in? Giving two antimetics, treating a BP of 90? To be fair I applaud you MDs doing solo hearts, trauma, or high acuity preds although I still think Md/crna better than Md only in those situations particularly if good working dynamic between the two. However, 90% of cases aren’t hearts, high acuity peds, or trauma…you’re flattering yourself.

Also previous post is spot on…not enough MDs. And you wouldn’t want to offer to replace CRNAs. The math is you would have to work 1.5-2 times as much to make 6-700k or more at places that currently supervise and you won’t want to do that. Go to a boutique practice that will die as the one advertised or go to California where CRNAs aren’t around YET and you can get hospital to pay you for what 5 years before this new crna legislation passes there?

Good luck
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I'm currently hospital employed, we are MD only, I am on the heart team. I work one weekend per month and nowhere near 60 hours per week. I am very happy with my setup, I'm sorry that solo cases aren't for you.
 
gunnershow said:
This is like saying a cardiologist should only treat end stage heart failure and its equivalents and the "simple" referrals should be farmed out to NPs because, hey, it's "just" prescribing ASA and statin, right?

I already said that ACT has its place. But I can't get behind dancing on the graves of MD-only practices. I can only imagine an anesthesiologist doing this from a place of insecurity. From your posts, it seems like you're one of those who "needs" a CRNA to give anesthesia.

All I know is that when I changed from MD only to ACT, I started having a number of intraop and PACU issues I never had before. If you have no pride in your work and your duty to your patients, I suppose this is immaterial. But it makes no sense to denigrate those of us who do care.
Click to expand...
As I’ve said multiple times I do my own cases around 20% of time. Zero insecurities in fact I’d argue doing 80% act has only strengthened my skills. I do 3-4 times the number of cases. Sure do CRNAs cause some issues yes but still most are caused by the surgeon or the situation and the increased number I deal with has only made me better.

My statements come from the truth as well
Stated on here…we aren’t needed to sit routine cases but facilitate throughout, put out fires, and optimize care for a larger population of patients in a cost effective way. 4 hands are better than 2 for the biggest cases or fires to put out. It’s really that simple
 
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Howard888 said:
As I’ve said multiple times I do my own cases around 20% of time. Zero insecurities in fact I’d argue doing 80% act has only strengthened my skills. I do 3-4 times the number of cases. Sure do CRNAs cause some issues yes but still most are caused by the surgeon or the situation and the increased number I deal with has only made me better.

My statements come from the truth as well
Stated on here…we aren’t needed to sit routine cases but facilitate throughout, put out fires, and optimize care for a larger population of patients in a cost effective way. 4 hands are better than 2 for the biggest cases or fires to put out. It’s really that simple
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what if 2 of those hands dont work properly? what if 2 of those hands are not trained appropriately? what if 2 of those hands will eventually replace the other 2 hands?
 
You probably need to do what’s being called “upskilling” these days if you’re doing cases where a CRNA can replace you .
 
T-burglar said:
Quality of care varies everywhere.

I used to “take pride” in my ability to do a 400 lb ruptured type A with a difficult airway by myself at night. Now I realize this is incredibly stupid and another experienced set of hands is better for everyone including the patient.

As for simpler cases - from a public health standpoint CRNAs are “good enough”. You’re insane to argue otherwise. Again quality varies but if you maintain competence standards and knowledge and clinical pathway standards it will be good enough. Video laryngoscopy will become standard, drugs will get safer, intra-OR command centers with full remote monitoring of all cases and AI assisted case guidance will be more widespread. Physicians will be overkill for sitting the stool.

here’s a glimpse of what’s coming

theanesthesiaconsultant.com

THE ANESTHESIA CONTROL TOWER: BIG BROTHER OR FRIEND? - The anesthesia consultant

Washington University in St. Louis is studying the Anesthesia Control Tower, a telemedicine-based intraoperative clinical support system.
theanesthesiaconsultant.com theanesthesiaconsultant.com
Click to expand...
I hope it’s made in Canada or Mexico
 
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