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

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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?
Yeah those two extra hands can be a tech or a good circulator. We have a "cardiac RN" who assists our hearts and things are much easier when I don't have to negotiate every part of the anesthetic and cater to personality disorders.
 
I am eager for CRNAs to have full practice rights. They can do their case and I can do mine. They can be responsible for their outcomes, and I mine. Although I will get a lot of flack for this comment, I do not see this as a threat to my job. You still need a 5th wheel that can do preops, blocks, handle PACU etc. Also, as long as CRNAs “must leave at 2:59 pm” our jobs are secure.
 
I hear the "I see 4 times the cases/airways/blocks/etc as solo docs" argument all the time, but is it really accurate? Yes, directing physicians are going to do more blocks than I, because I'm rarely put in ortho rooms anymore. But, I'm not seeing my colleagues intubate any more than I am. In fact, they're doing it less often. They may preop and sign four times the patients I am, but several of them will walk in for induction, run out, maybe pop in every hour or so to give a thumbs up, then see the patient in PACU to attest present at emergence. They are not actively managing all those extra patients. Is it really four times the experience, or is it just four times the liability exposure? Maybe some of my former partners are just lazy and the exception, however.
 
Wow your defensive because every time you sit that asa 2 gallbladder looking at your phone and trading stocks…knowing you aren’t doing anything a crna can’t…I get it
 
I hear the "I see 4 times the cases/airways/blocks/etc as solo docs" argument all the time, but is it really accurate? Yes, directing physicians are going to do more blocks than I, because I'm rarely put in ortho rooms anymore. But, I'm not seeing my colleagues intubate any more than I am. In fact, they're doing it less often. They may preop and sign four times the patients I am, but several of them will walk in for induction, run out, maybe pop in every hour or so to give a thumbs up, then see the patient in PACU to attest present at emergence. They are not actively managing all those extra patients. Is it really four times the experience, or is it just four times the liability exposure? Maybe some of my former partners are just lazy and the exception, however.
I’ll grant you the intubation piece. Although I’d say I do 4 times the difficult intubations the crna can’t get. But the rest..blocks, lines, codes, spasms, troubleshooting..easily 4 times. Preop and pacu issues 8 times probably. And before you go saying it’s the crna that causes the issues..hardly ever . It’s mostly the surgeon, the patient, or the situation. But keep telling yourselves otherwise.
 
Wow your defensive because every time you sit that asa 2 gallbladder looking at your phone and trading stocks…knowing you aren’t doing anything a crna can’t…I get it

Better than sitting in the lounge trading stocks liek you. People like you are exactly the reason CRNAs don’t think they need us and can replace us entirely. How can you guys be so short sighted
 
I’ll grant you the intubation piece. Although I’d say I do 4 times the difficult intubations the crna can’t get. But the rest..blocks, lines, codes, spasms, troubleshooting..easily 4 times. Preop and pacu issues 8 times probably. And before you go saying it’s the crna that causes the issues..hardly ever . It’s mostly the surgeon, the patient, or the situation. But keep telling yourselves otherwise.
It's true, I don't have to deal with spasms because they just don't happen (outside of peds).

I doubt you really deal with them either because you don't show up to extubation and your CRNAs aren't calling you anyway.
 
Wow your defensive because every time you sit that asa 2 gallbladder looking at your phone and trading stocks…knowing you aren’t doing anything a crna can’t…I get it


Plenty of time for that stuff whether you’re physician only or ACT. I prefer physician only because it’s easier and much less stressful. It’s bad enough dealing with my own f***ups, I don’t want to deal with other people’s f***ups too.

Do you ever medically direct CRNAs doing ASA2 gallbladders? In those cases what do you add that a CRNA working independently can’t do without you? Why are you there? One of my best friends covers hearts at a hospital with independent CRNAs. When they do an ASA2 gallbladder, he’s not even in the building and those patients do fine.
 
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I am eager for CRNAs to have full practice rights. They can do their case and I can do mine. They can be responsible for their outcomes, and I mine. Although I will get a lot of flack for this comment, I do not see this as a threat to my job. You still need a 5th wheel that can do preops, blocks, handle PACU etc. Also, as long as CRNAs “must leave at 2:59 pm” our jobs are secure.


The most efficient ways to staff are all MD, all CRNA, or a combination of MD+CRNAs all working independently and doing their own thing. It allows staffing the most sites with the fewest bodies. You really don’t need a “5th wheel”. Many places operate just fine without one.
 
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What if these nuts turn into DEEZ NUTS?

I’m honestly a fan of deez nuts jokes but this is the lamest deez nuts joke I’ve ever seen. Honestly just log off this site forever bro and go be a lazy attending sitting in the lounge letting the nurses do your work
 
I’m honestly a fan of deez nuts jokes but this is the lamest deez nuts joke I’ve ever seen. Honestly just log off this site forever bro and go be a lazy attending sitting in the lounge letting the nurses do your work
No sir! My presence seems to annoy you greatly so I will allow it to continue to do so. In the meantime, sit on that stool son and piss in the trash can if you must.
 
No sir! My presence seems to annoy you greatly so I will allow it to continue to do so. In the meantime, sit on that stool son and piss in the trash can if you must.


Why would I need the trash can? Unlike you I don’t have the bladder have a 60 year old post menopausal woman, I’m perfecting fine taking a piss in between cases in the men’s restroom.
 
Why would I need the trash can? Unlike you I don’t have the bladder have a 60 year old post menopausal woman, I’m perfecting fine taking a piss in between cases in the men’s restroom.
Ok boss. Figured you didn't have the time what with all the stool sitting.
 
No but they're surgeons.

Guess it goes back to my previous post. I don’t have the bladder of a 60 year old post menopausal woman.

And not sure why you call people who do their own cases “dinosaurs”. I finished residency in 2020. I didn’t go through all this training to become a preop monkey
 
Guess it goes back to my previous post. I don’t have the bladder of a 60 year old post menopausal woman.

And not sure why you call people who do their own cases “dinosaurs”. I finished residency in 2020. I didn’t go through all this training to become a preop monkey
Word.
 
The most efficient ways to staff are all MD, all CRNA, or a combination of MD+CRNAs all working independently and doing their own thing. It allows staffing the most sites with the fewest bodies. You really don’t need a “5th wheel”. Many places operate just fine without one.
No. The most efficient way is paying crnas solo for 400k and making them all work 45-50 hr full call schedule

Issue is 50% of crnas don’t want to be mandated to take a full call schedule even q10
Do you think the surgeon is leaving to take a piss during those 6 hours?
Yes. Surgeons eat and take bathroom breaks.
 
Never seen one leave in the middle of the case to take one but sure if you say so…
i had one who would take a 15 minute break in between a huge abdominal surgery/liver transplant during rewarming of the organ time
 
I’ve seen surgeons leave to take a **** after repairing a type A and leave me to manage the medical aspect of the hemostasis temporarily.. this is a stupid argument to be having
 
Never seen one leave in the middle of the case to take one but sure if you say so…
Happens as we all age. Hard to imagine 60 yo docs sit on the stool for 6 hour spine cases solo either. No breaks.

I’m not 60.

But recently did 6 hr plastics case solo tiva. No breaks. No one else in the building. Could barely hold it as I hit pacu

As for surgeons happens as they age. This is why on the general surgery side. Many old surgeons are trying to learn robotic surgery. So they can sit down as well.
 
Happens as we all age. Hard to imagine 60 yo docs sit on the stool for 6 hour spine cases solo either. No breaks.

I’m not 60.

But recently did 6 hr plastics case solo tiva. No breaks. No one else in the building. Could barely hold it as I hit pacu

As for surgeons happens as they age. This is why on the general surgery side. Many old surgeons are trying to learn robotic surgery. So they can sit down as well.
in residency my attending forgot about me during an awake crani (with intraoperative MRI), . I was solo 630am until 4pm with no bathroom or food breaks. That bathroom visit at the end was the Guinness book of records for how long a man can pee!
 
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

How is this any different from anesthesiologists monitoring remotely thru Epic right now?
 
How is this any different from anesthesiologists monitoring remotely thru Epic right now?
It's just scaled up even further, and more removed from the actual clinical situation, as the "ACTor" doesn't see the procedure or the room, just the EMR data. We all know all EMR data points are 100% accurate, right? No one ever leans on a BP cuff, flushes an art line, there's never electronic interference with the ECG, etc.
 
Just simple questions

How many 100% solo anesthesiologists in here

1. Average hours worked (including calls) per week
2. Average weeks off
3. Average pay (doesn’t have to be exact numbers plus minus 20% is fine with me)

I haven’t been 100% solo in 15 years. So solo pretty much my first 5-6 years. So salaries different obviously back than. But that’s the north. The act heavy model didn’t invade up there till 10-12 years ago.

But I have never been 100% supervision/medical direction act either. Usually 20-50% solo the last 14 years

As solo I probably averaged 60 hours/450-500k. Call q 5/6 and 6 weeks off private no amc overhead. Now that’s 14 years ago. I was always amazed to see the act docs make 750k-800k and working 55 hours back in 2010 when I was new to Florida. Like they were working less than me but making 50% more.

Now more recently when I worked act model with 30% solo I made 475k/11 weeks/36/38 hrs (that’s 2022/2023). Last year I went a little crazy with locums hours so I don’t consider that part of the normal work hours.
 
Just simple questions

How many 100% solo anesthesiologists in here

1. Average hours worked (including calls) per week
2. Average weeks off
3. Average pay (doesn’t have to be exact numbers plus minus 20% is fine with me)

I haven’t been 100% solo in 15 years. So solo pretty much my first 5-6 years. So salaries different obviously back than. But that’s the north. The act heavy model didn’t invade up there till 10-12 years ago.

But I have never been 100% supervision/medical direction act either. Usually 20-50% solo the last 14 years

As solo I probably averaged 60 hours/450-500k. Call q 5/6 and 6 weeks off private no amc overhead. Now that’s 14 years ago. I was always amazed to see the act docs make 750k-800k and working 55 hours back in 2010 when I was new to Florida. Like they were working less than me but making 50% more.

Now more recently when I worked act model with 30% solo I made 475k/11 weeks/36/38 hrs (that’s 2022/2023). Last year I went a little crazy with locums hours so I don’t consider that part of the normal work hours.
100% solo, 40 hours, $575k, Q12 weekday, Q6 weekend, 8-9 weeks off.
 
The most efficient ways to staff are all MD, all CRNA, or a combination of MD+CRNAs all working independently and doing their own thing. It allows staffing the most sites with the fewest bodies. You really don’t need a “5th wheel”. Many places operate just fine without one.

As long as the real doctors don’t have any responsibility for the fake doctors. Even in an emergency.
 
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

WashU is also so short getting anesthesiologist they started “importing” anesthesiologists from India.

No joke…..
 
Instead of "importing" anesthesiologists from India, why doesn't the university and other hospitals offer the current permanent anesthesiologists more compensation for additional work or do buy-back vacation. I've worked in hospitals where they did this and there was not a shortage of permanent anesthesiologists who wouldn't take extra pay for extra shifts. In fact all the extra pay shifts were snatched up as quickly as they were posted especially by new grads hungry for money to pay their student loans. The hospitals can put an ad online for locums anesthesiologists sponsored by the university or the hospital systems and cut out the locums agencies too to save money but they don't. There is not a shortage of US locums anesthesiologists who are willing to travel and stay at different cities if the price is right. Maybe it costs less to "import anesthesiologists" from other countries as labor. Again common sense seems to evade the C-suite administrators
 
Instead of "importing" anesthesiologists from India, why doesn't the university and other hospitals offer the current permanent anesthesiologists more compensation for additional work or do buy-back vacation. I've worked in hospitals where they did this and there was not a shortage of permanent anesthesiologists who wouldn't take extra pay for extra shifts. In fact all the extra pay shifts were snatched up as quickly as they were posted especially by new grads hungry for money to pay their student loans. The hospitals can put an ad online for locums anesthesiologists sponsored by the university or the hospital systems and cut out the locums agencies too to save money but they don't. There is not a shortage of US locums anesthesiologists who are willing to travel and stay at different cities if the price is right. Maybe it costs less to "import anesthesiologists" from other countries as labor. Again common sense seems to evade the C-suite administrators
Because if they import the anesthesiologist, they can trap them with a visa and work arrangements to their advantage. Typical scummy academic tactics instead of paying more.
 
India likely has a very deep pool of talented anesthesiologists who are proficient in English.
I think you may need to check that. I've worked with plenty of Indian anesthesiologists and MDs in general. Some excellent, some awful amongst the worst I've ever encountered. Very hard to decipher who is who until they're in your system... also proficiency in English is variable, and understand of US system, integration into western society may also be different
 
I think you may need to check that. I've worked with plenty of Indian anesthesiologists and MDs in general. Some excellent, some awful amongst the worst I've ever encountered. Very hard to decipher who is who until they're in your system... also proficiency in English is variable, and understand of US system, integration into western society may also be different


Sure it will be hard to figure out who is good and who is not, who will be a good match and who won’t, but I have no doubt that the country has an abundance of very good anesthesiologists. I’m sure most of them don’t want to move either. I sure as heck don’t want move.
 
I think you may need to check that. I've worked with plenty of Indian anesthesiologists and MDs in general. Some excellent, some awful amongst the worst I've ever encountered. Very hard to decipher who is who until they're in your system... also proficiency in English is variable, and understand of US system, integration into western society may also be different
What we consider “bad salary” here is top level salary for almost any physician is most other countries
 
WashU is also so short getting anesthesiologist they started “importing” anesthesiologists from India.

No joke…..
Their starting salary was sub 300k a few years back, declined them, was around in training when the control tower was initiated, i have mixed feelings about it, but if majority crna are in rooms, then this is needed to prevent patient harm
 
What we consider “bad salary” here is top level salary for almost any physician is most other countries
Everything is not apples to apples. German anesthesia docs are paid 1/2 (give or take ) docs in USA.

And they dont have the mid level encroachment. Neither the hospitals level admin level of pay.

Also many of those counties. If u F’d yup horsing around even at the high school level. You chances of admissions to colleges is severely hindered. Let alone even getting into medical school.
 
Instead of "importing" anesthesiologists from India, why doesn't the university and other hospitals offer the current permanent anesthesiologists more compensation for additional work or do buy-back vacation. I've worked in hospitals where they did this and there was not a shortage of permanent anesthesiologists who wouldn't take extra pay for extra shifts. In fact all the extra pay shifts were snatched up as quickly as they were posted especially by new grads hungry for money to pay their student loans. The hospitals can put an ad online for locums anesthesiologists sponsored by the university or the hospital systems and cut out the locums agencies too to save money but they don't. There is not a shortage of US locums anesthesiologists who are willing to travel and stay at different cities if the price is right. Maybe it costs less to "import anesthesiologists" from other countries as labor. Again common sense seems to evade the C-suite administrators
Not sure why more places don't do this. We pay both docs and anesthetists if they work on vacation days - totally voluntary. We've never used a locums anything in our group.
 
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