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’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).
What if these nuts turn into DEEZ NUTS?
God, probably the lamest joke in the history of mankind. Glad you're not a comedian. snowflake much?
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.
Huh? What in tarnation is that supposed to mean?
Ok boss. Figured you didn't have the time what with all the stool sitting.
I'm referring to those 6 hour ex-laps with a ham-fisted surgeon.
No but they're surgeons.
Word.
Sure.
No. The most efficient way is paying crnas solo for 400k and making them all work 45-50 hr full call schedule
Yes. Surgeons eat and take bathroom breaks.
i had one who would take a 15 minute break in between a huge abdominal surgery/liver transplant during rewarming of the organ time
Happens as we all age. Hard to imagine 60 yo docs sit on the stool for 6 hour spine cases solo either. No breaks.
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!
www.beckersasc.com
How is this any different from anesthesiologists monitoring remotely thru Epic right now?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
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
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.
100% solo, 40 hours, $575k, Q12 weekday, Q6 weekend, 8-9 weeks off.
Thank goodness for federal tort reform.
WashU is also so short getting anesthesiologist they started “importing” anesthesiologists from India.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
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.
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.
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
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
Everything is not apples to apples. German anesthesia docs are paid 1/2 (give or take ) docs in USA.
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.
