CRNA's training residents

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Twiggidy said:
Residents making mistakes late in the year or late in residency has nothing to do with "MD vs CRNA instruction"....that's just residents being residents. Never think you don't need to supervise a resident. You'll learn which resident you can lengthen the leash on and which you literally have to stand at the door watching. (Same can be said for CRNAs)
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Yeah, this. I was once academic and wow, the variability in residents is amazing. We had CA1's who functioned at CA3 level (mostly attendings from overseas doing a 2nd residency so they could get a US credential) ... we also had CA3's who were more like 1's.

Trouble was, the schedulers didn't always know who was who... that's one thing I really don't miss about academics.
 
spacegun said:
Actually general surgery and EM look like they are more competitive than anesthesiology now. Results and data from the 2017 main residency match:

http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf
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Not sure what data in the referenced document you are using to make that determination. If using % positions filled by US seniors (which after looking at the document, I don't see which better metric one would use), we have Anes at 66%, EM at 78, and Surg at 78. IM at 45 and Ortho at 92 for further examples.

So by this metric you are probably correct. If I recall the avg step scores are about the same for IM, surg, don't remember about EM. Where Anes is loosing edge on its competitiveness is its large range. The low end of step scores is pretty low for Anes. I'd guess your average Anes resident has "achieved" in med school the same amount as your average EM and Surg resident however. I think it's that the most undesirable programs have trouble filling and so take who they can.

The pool of students interested in Anes is smaller than the number of spots (which isn't exactly a huge #, unlike IM for example). I think this is due in part to lack of generating interest in med school. My 3rd year 1 week rotation was spent mostly with an AA. Practically it was fine, and this person taught me a lot, but what message do you think that sends to med students? If our IM rotation was spent mostly working under NPs and PAs, vs docs for all other rotations, I bet there would be much less interest in the field.

I'm curious to hear what other peoples exposure was like in med school, and if mine was just a rare scheduling issue or this is more pervasive
 
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psychbender said:
I disagree with July being just an orientation month. Those basic tasks were generally taught during the med school rotation or the month in the OR as an intern where I trained. July was very important from a resident education standpoint. We went through all of Baby Miller in morning lecture during our first month, and were regularly questioned by our staff on the basics of anesthesia during our period of closest supervision. It ensured that we had a solid base and shared language on which to build for the coming months. Being paired with a nurse and just learning how to set up a room, start IVs, and intubate would have been a huge disservice.

Regarding being relieved at 3pm vs staying, yes there are benefits to both. While staying late and picking up sick add-ons is very beneficial, staying late and finishing a room of ASA1 lap choles is less so. I had staff that tried to use the argument that we needed to stay late to see more pathology, but really, they just wanted to keep us sitting stool late into the evening, rather than make sure we were relieved to prepare for the next day's cases or read. Not all time in the hospital is equal, and my education would have been better served if I had been able to leave a couple hours early those days and go home to read.

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People who really want to read will find the time
Twiggidy said:
Truth......

If you seek power and glory anesthesiology is NOT the path.
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power and glory?? Anesthesia is a field for the type B people who enjoy playing second fiddle to the surgeon and having a decent income and quality of life. Always has been.
 
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LunchMD said:
Not sure what data in the referenced document you are using to make that determination. If using % positions filled by US seniors (which after looking at the document, I don't see which better metric one would use), we have Anes at 66%, EM at 78, and Surg at 78. IM at 45 and Ortho at 92 for further examples.

So by this metric you are probably correct. If I recall the avg step scores are about the same for IM, surg, don't remember about EM. Where Anes is loosing edge on its competitiveness is its large range. The low end of step scores is pretty low for Anes. I'd guess your average Anes resident has "achieved" in med school the same amount as your average EM and Surg resident however. I think it's that the most undesirable programs have trouble filling and so take who they can.

The pool of students interested in Anes is smaller than the number of spots (which isn't exactly a huge #, unlike IM for example). I think this is due in part to lack of generating interest in med school. My 3rd year 1 week rotation was spent mostly with an AA. Practically it was fine, and this person taught me a lot, but what message do you think that sends to med students? If our IM rotation was spent mostly working under NPs and PAs, vs docs for all other rotations, I bet there would be much less interest in the field.

I'm curious to hear what other peoples exposure was like in med school, and if mine was just a rare scheduling issue or this is more pervasive
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Hey, yup I was looking at US Seniors % filled.

I worked with anesthesiology residents and attending, never got to work with AA’s.
 
LunchMD said:
I'm curious to hear what other peoples exposure was like in med school, and if mine was just a rare scheduling issue or this is more pervasive
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My rotation was mostly "attempt a couple intubations and go home". I got exposed to OB anesthesia while on OB/GYN where the senior resident (who was mostly on his own) doing a couple epidurals and otherwise not being bothered. Mind you, this was at a city hospital. I got PLAYED. The rotation at my school was only 2 weeks and the resident's only advice was "find a job where you make a lot of money and get a lot of vacation".

Surgery ran the show at my med school. They were literally the stars and were awesome at everything. I'm sure that led to some winners in the private world (God bless any of you who are working with them). Surprisingly, I'd argue the ER residents were the runner up stars in the hospital. Every other specialty was just in the way at this place. Looked into actually maybe doing surgery but honestly hated being in clinic so therefore it wouldn't have worked out.

My 2nd choice was radiology and my exposure was
1) Classroom
2) Looking at Xrays with the resident and attending where the attending was going on and on about how awesome the orthopedic surgeons were.
3.) Mammography where a lady was "uncomfortable with me in the room"

Therefore I said screw Rads and chose anesthesiology. There are many days I question that decision.
 
dannyboy1 said:
People who really want to read will find the time.
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That's a giant cop-out. If you are not being relieved from the OR until 7 or 8pm reliably, and the EMR is set up in such a way that you can't look up your cases for the next day (or even you assignment) while in the OR, and you have to call your attending to run through your plans after you've had a chance to look up your next day's patients, then no, there is no time to read. This was the situation that my residency class had for a while, until one resident called the PD around 10pm to run through the next day's patients. When he found out how bad things had gotten, he threatened to remove the privilege of working with residents (meaning that they'd have to sit stool themselves) from staff that kept us late for no good reason. Even then, it was normal to be kept in the OR until 6pm for basic cases, because the staff were too lazy to either get you out themselves, or didn't want to send their CRNA buddy who hadn't done anything since the start of their shift at 3pm into the room to get you out. That was a miserable year to be at the flagship, and we all looked forward to our rotations at civilian hospitals.
 
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Twiggidy said:
Therefore I said screw Rads and chose anesthesiology. There are many days I question that decision.
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It's interesting and a little disturbing how a handful of very brief, sort of random encounters as med students shape our paths.

My very first MS3 rotation was general surgery. The chief resident was a pathologically evil ass clown who was openly sarcastic and abusive to med students. We got screamed at one morning for getting breakfast before going to the OR on a late start day. He interrogated each of us about what we had to eat. I just thought this was the way surgery and surgeons were. Didn't have much interest in being a surgeon to start, and those six weeks cemented it for me. (About 1/2 way through the year, the complaints about him reached a level where they actually removed students from his team.)

My next rotation was 2 weeks of anesthesiology where everyone was nice. I'd always had some interest in it, but for a long time I thought I'd end up in IM (infectious disease) or neurology ... anyway, here I am.
 
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psychbender said:
That's a giant cop-out. If you are not being relieved from the OR until 7 or 8pm reliably, and the EMR is set up in such a way that you can't look up your cases for the next day (or even you assignment) while in the OR, and you have to call your attending to run through your plans after you've had a chance to look up your next day's patients, then no, there is no time to read. This was the situation that my residency class had for a while, until one resident called the PD around 10pm to run through the next day's patients. When he found out how bad things had gotten, he threatened to remove the privilege of working with residents (meaning that they'd have to sit stool themselves) from staff that kept us late for no good reason. Even then, it was normal to be kept in the OR until 6pm for basic cases, because the staff were too lazy to either get you out themselves, or didn't want to send their CRNA buddy who hadn't done anything since the start of their shift at 3pm into the room to get you out. That was a miserable year to be at the flagship, and we all looked forward to our rotations at civilian hospitals.
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Compared to the slaveship, has the flagship ever done anything besides half the work with twice the people?
 
Twiggidy said:
My 2nd choice was radiology and my exposure was
1) Classroom
2) Looking at Xrays with the resident and attending where the attending was going on and on about how awesome the orthopedic surgeons were.
3.) Mammography where a lady was "uncomfortable with me in the room"

Therefore I said screw Rads and chose anesthesiology. There are many days I question that decision.
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You would choose radiology over anesthesia today? No midlevels but i thought radiology (DR, not IR) has their own issues.
 
pgg said:
Compared to the slaveship, has the flagship ever done anything besides half the work with twice the people?
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I actually blame the Navy. When we had our own hospital, we had good cases, good teaching, staff actually did their own cases some days, and we got out at a reasonable time. It wasn't until we moved over to the President's Surgicenter that things really started going to ****.

The combined cesspool definitely had people falling over each other finding work to not do.

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psychbender said:
I actually blame the Navy. When we had our own hospital, we had good cases, good teaching, staff actually did their own cases some days, and we got out at a reasonable time. It wasn't until we moved over to the President's Surgicenter that things really started going to ****.

The combined cesspool definitely had people falling over each other finding work to not do.

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It's amazing how unmotivated people can get when you give them a timer. They leave at 3 on the dot no matter what, bye and **** the count and the nursing signout.
 
spacegun said:
You would choose radiology over anesthesia today? No midlevels but i thought radiology (DR, not IR) has their own issues.
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Reas their forum and then read this one again. Sure you may have to do about 30 fellowships to make yourself a little more marketable but no rads tech is taking their jobs anytime soon. Even the overseas stuff is a bit less of a threat then people thought and you still make good money. There’s a reason thats still one of the more sought after and competitive fields

But serious, compare thier forum topics to ours, even historically.
 
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FFP said:
It has already bit US. The one who will get bitten in the a$$ in the future is YOU.
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you may be right, but then you've had midlevels for a long time now. we're holding out pretty well, and nurses aren't making any progress because the only teaching they get is from other nurses.
 
Twiggidy said:
Reas their forum and then read this one again. Sure you may have to do about 30 fellowships to make yourself a little more marketable but no rads tech is taking their jobs anytime soon. Even the overseas stuff is a bit less of a threat then people thought and you still make good money. There’s a reason thats still one of the more sought after and competitive fields

But serious, compare thier forum topics to ours, even historically.
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One of my friends is in rads and told me AI is going to ravage the field before we all retire. There are already publications on it in major journals. Sure we will still need rads, and I have great respect for them. But we will probably need much less. They may make moves to all become more procedural over time. That kind of seems to already be happening.

AI is going to change everything in our lifetime. Just like the internet/computers have changed so much of what we do today. Anything that can be easily interfaced with a computer (ie images; re: rads, parts of pathology) is going to be ripe for some form of revolution, which probably isn't going to benefit the docs job market
 
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LunchMD said:
One of my friends is in rads and told me AI is going to ravage the field before we all retire. There are already publications on it in major journals. Sure we will still need rads, and I have great respect for them. But we will probably need much less. They may make moves to all become more procedural over time. That kind of seems to already be happening.

AI is going to change everything in our lifetime. Just like the internet/computers have changed so much of what we do today. Anything that can be easily interfaced with a computer (ie images; re: rads, parts of pathology) is going to be ripe for some form of revolution, which probably isn't going to benefit the docs job market
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Really think about it.......and try to be unbiased as possible.....once the IV is in and the patient is intubated, what's to keep a computer from doing what we do for the majority of cases up until extubation. People won't like this statement but most of what we do is computer programming inside our brain, or we've programmed another actual human to do it (residents/CRNAs). When x=y, then do z, otherwise null....or some junk like that. If the BP is below 90 then give x amount of neo, otherwise computer, sit and read the internet. That's the most simplistic example but that's why there are people working in Silicon Valley to come up with the more complicated version. This won't happen in our lifetime (and I'd argue AI in rads isn't either) but if our grandkids are going to be doctors they may want to reconsider.
 
Twiggidy said:
Really think about it.......and try to be unbiased as possible.....once the IV is in and the patient is intubated, what's to keep a computer from doing what we do for the majority of cases up until extubation. People won't like this statement but most of what we do is computer programming inside our brain, or we've programmed another actual human to do it (residents/CRNAs). When x=y, then do z, otherwise null....or some junk like that. If the BP is below 90 then give x amount of neo, otherwise computer, sit and read the internet. That's the most simplistic example but that's why there are people working in Silicon Valley to come up with the more complicated version. This won't happen in our lifetime (and I'd argue AI in rads isn't either) but if our grandkids are going to be doctors they may want to reconsider.
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There's a reason Sedasys didn't work out. It's quite fascinating how humans underrate their cognitive abilities and only realize it when trying to program a robot to do the same task.

There's something called The Frame Problem in artificial intelligence. Basically, while it's easy for us to think that you have to program a robot to give X amount of Neo for Y BP, there are a crazy amount of variables that our human intelligence processes without our knowing. Simple things like, the knowledge that the BP can't be fixed by just squeezing the cuff tighter or by turning off the display. Or more complex things like the relation to HR or stimulation or a myriad of other factors. The amount of information we omit only becomes clear when you sit down and think about everything it takes to program an AI to perform that task.
 
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Twiggidy said:
Really think about it.......and try to be unbiased as possible.....once the IV is in and the patient is intubated, what's to keep a computer from doing what we do for the majority of cases up until extubation. People won't like this statement but most of what we do is computer programming inside our brain, or we've programmed another actual human to do it (residents/CRNAs). When x=y, then do z, otherwise null....or some junk like that. If the BP is below 90 then give x amount of neo, otherwise computer, sit and read the internet. That's the most simplistic example but that's why there are people working in Silicon Valley to come up with the more complicated version. This won't happen in our lifetime (and I'd argue AI in rads isn't either) but if our grandkids are going to be doctors they may want to reconsider.
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While I agree with you to a certain extent, I think the mechanical challenges that full integration of an AI with drug infusion, feedback system I think provide more of a barrier. Further, the decisions are more dangerous, and give little time for a human to double check. While these obstacles are certianly not insurmountable, they will take much longer to implement than uploading Brain MRI.jpeg to the AI supercomputer and having a radiologist quickly double check a bunch of them later.

There is an upside, I think the first implementation of these technologies will probably take tedium out of work before they fully take over. Maybe we will hit the sweet spot for most of our careers.
 
Ronin786 said:
There's a reason Sedasys didn't work out. It's quite fascinating how humans underrate their cognitive abilities and only realize it when trying to program a robot to do the same task.

There's something called The Frame Problem in artificial intelligence. Basically, while it's easy for us to think that you have to program a robot to give X amount of Neo for Y BP, there are a crazy amount of variables that our human intelligence processes without our knowing. Simple things like, the knowledge that the BP can't be fixed by just squeezing the cuff tighter or by turning off the display. Or more complex things like the relation to HR or stimulation or a myriad of other factors. The amount of information we omit only becomes clear when you sit down and think about everything it takes to program an AI to perform that task.
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Just because it didn't work doesn't mean somewhere someone isn't trying to perfect it. I don't to turn this into an AI vs human thread because that's already been done but never rule out that someone isn't trying to make it happen. There are a lot ways in theory technology can infiltrate this field and dramatically reduce the workforce, it's just the implementation that would be the problem. That's why I said it's more of a worry for our grandkids or maybe even their kids.
 
LunchMD said:
While I agree with you to a certain extent, I think the mechanical challenges that full integration of an AI with drug infusion, feedback system I think provide more of a barrier. Further, the decisions are more dangerous, and give little time for a human to double check. While these obstacles are certianly not insurmountable, they will take much longer to implement than uploading Brain MRI.jpeg to the AI supercomputer and having a radiologist quickly double check a bunch of them later.

There is an upside, I think the first implementation of these technologies will probably take tedium out of work before they fully take over. Maybe we will hit the sweet spot for most of our careers.
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But playing devil's advocate (and this is how any pitch room works), why not just have the radiologist read them first and save money on the supercomputer, assuming it would likely be a multi-million dollar machine. I agree with you. Up front it would be a mess, but once it's perfected (likely with military trials) it would medicine interesting. I mean, look at telemedicine. I think It's still in it's early theory stages now, but once it gets going, who's gonna need a doctors office or even inpatients rounds?
 
Twiggidy said:
But playing devil's advocate (and this is how any pitch room works), why not just have the radiologist read them first and save money on the supercomputer, assuming it would likely be a multi-million dollar machine. I agree with you. Up front it would be a mess, but once it's perfected (likely with military trials) it would medicine interesting. I mean, look at telemedicine. I think It's still in it's early theory stages now, but once it gets going, who's gonna need a doctors office or even inpatients rounds?
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Or take it further, who’s going to be able to pay for the healthcare provided by all these machines? Or take it even further, once all the jobs are gone other than building and maintaining robots, what is everyone supposed to do to survive? Universal basic income? Sounds great but I don’t think the oligarchs that are going to own the robot factories will want to share.
 
nolagas said:
Or take it further, who’s going to be able to pay for the healthcare provided by all these machines? Or take it even further, once all the jobs are gone other than building and maintaining robots, what is everyone supposed to do to survive? Universal basic income? Sounds great but I don’t think the oligarchs that are going to own the robot factories will want to share.
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the idea i envision (hilarious. no pun intended) probably wouldn't cost as much as I'd imagine but i can't share my idea on the internet. someone might steal it. it's all just theory. me, you, and others and our kids, we'll be alright.
 
dannyboy1 said:
People who really want to read will find the time

power and glory?? Anesthesia is a field for the type B people who enjoy playing second fiddle to the surgeon and having a decent income and quality of life. Always has been.
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But also knows when to take over the situation. It doesn’t happen often but the sign of a stellar anesthesiologist is one that can lay low all day and night but also knows when to stand up.
 
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Twiggidy said:
Reas their forum and then read this one again. Sure you may have to do about 30 fellowships to make yourself a little more marketable but no rads tech is taking their jobs anytime soon. Even the overseas stuff is a bit less of a threat then people thought and you still make good money. There’s a reason thats still one of the more sought after and competitive fields

But serious, compare thier forum topics to ours, even historically.
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We are starting to catch up to them in terms of doing fellowship afterwards!
 
Ronin786 said:
There's a reason Sedasys didn't work out. It's quite fascinating how humans underrate their cognitive abilities and only realize it when trying to program a robot to do the same task.

There's something called The Frame Problem in artificial intelligence. Basically, while it's easy for us to think that you have to program a robot to give X amount of Neo for Y BP, there are a crazy amount of variables that our human intelligence processes without our knowing. Simple things like, the knowledge that the BP can't be fixed by just squeezing the cuff tighter or by turning off the display. Or more complex things like the relation to HR or stimulation or a myriad of other factors. The amount of information we omit only becomes clear when you sit down and think about everything it takes to program an AI to perform that task.
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+1

My old residency director would tell us the first thing we need to learn is to filter out and ignore the massive amounts of “white noise” we encounter in the operating room so that we can focus on the important stuff.

The robot will have trouble distinguishing hypotension caused by hemorrhage vs rhythm dysfunction vs contractile dysfunction vs vasoplegia vs anesthetic overdose vs embolus vs tension pneumothorax vs tamponade vs anaphylaxis vs a combination of any or all of the above. Robots will take over anesthesia just like they took over surgery:rofl::rofl:
 
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There are already robots in anesthesia. They are called CRNAs (not all of the latter, just some). As technology advances, the robots will be just nurses/techs.

Every time non-physician anesthesia takes another step, physician anesthesiology dies a bit more.
 
nimbus said:
The robot will have trouble distinguishing hypotension caused by hemorrhage vs rhythm dysfunction vs contractile dysfunction vs vasoplegia vs anesthetic overdose vs embolus vs tension pneumothorax vs tamponade vs anaphylaxis vs a combination of any or all of the above. Robots will take over anesthesia just like they took over surgery:rofl::rofl:
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Those issues aren't insurmountable. The larger barrier at this time is that anesthesia and surgery have mechanical tasks that are time sensitive and tightly coupled to the information processing. To give a trivial example, building a robot that can do a jaw thrust, correctly, effectively, immediately, in all patient sizes is orders of magnitude more difficult than programming a propofol pump to titrate the number on a Bis monitor.

It's the phycisians in fields that are digital-in, digital-out that will first get meaningful assistance, and will eventually be replaced, by machines in our lifetimes.
 
pgg said:
Those issues aren't insurmountable. The larger barrier at this time is that anesthesia and surgery have mechanical tasks that are time sensitive and tightly coupled to the information processing. To give a trivial example, building a robot that can do a jaw thrust, correctly, effectively, immediately, in all patient sizes is orders of magnitude more difficult than programming a propofol pump to titrate the number on a Bis monitor.

It's the phycisians in fields that are digital-in, digital-out that will first get meaningful assistance, and will eventually be replaced, by machines in our lifetimes.
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I’m not an expert in AI. I’m not even casually knowledgeable about AI, but I did listen to an interview of an AI expert a few weeks ago on npr. From what I gathered, AI is way more limited than people think. They can teach a computer to play chess because there are very limited possibilities of moves. Yes, there are very many possible games, but a limited number of pieces, they stay in their squares, no suprise pieces appear out of nowhere, etc. But they can’t teach a car to drive very well. They can teach it to stay between the lines, follow the speed limit, break for children, but it can’t extrapolate beyond it’s specific programming at all. Like it can recognize a child or a dog and break, but will it slam on the breaks for a small tree branch in the road, a kids sidewalk chalk art, a kid in a wheelchair, a kid in a ghost costume, a guy with an Abbey Road T-shirt on? Maybe, maybe not. Anyway the takeaway, for me was that computers do well with fixed rules and limited possibilities, but have never been able to deal with novel situations and are nowhere near being able to do so.
 
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Give me a call when someone figures out how to make our brand new monitors not alarm V fib nearly every time the surgeon turns on the bovie. Then we'll talk about robots taking over.
 
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I honestly don't know why people worry about AI. There is an ongoing flood of CRNAs on the market, which means that their salaries will keep dropping. If theirs drop, ours will follow.
 
FFP said:
I honestly don't know why people worry about AI. There is an ongoing flood of CRNAs on the market, which means that their salaries will keep dropping. If theirs drop, ours will follow.
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Maybe so but mine has gone up every year since I finished residency. Not once has it gone down. The national polls showed that anesthesiology went up 6% last year. Granted, I’m not in the mega bucks range but I’m above MGMA median. And that’s what my contract is based on.

The point is that we have all been saying that salaries are going to drop, and I believe they are. But I haven’t seen it yet. Here in Colorado we even managed to get an anesthesia funding cut removed from the legislature this year. Contributing to your PAC is one effective way of maintaining this.
 
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Noyac said:
Maybe so but mine has gone up every year since I finished residency. Not once has it gone down. The national polls showed that anesthesiology went up 6% last year. Granted, I’m not in the mega bucks range but I’m above MGMA median. And that’s what my contract is based on.
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Not everyone is as good as you though.

What is causing your salary to increase? Are you doing more cases or is insurance imbursing more?
 
anbuitachi said:
Not everyone is as good as you though.

What is causing your salary to increase? Are you doing more cases or is insurance imbursing more?
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MGMA. Yes are doing more cases but I believe everyone is doing more cases for the most part. I have mentioned it here before, I am employed by my hospital. They base our pay on MGMA median.
 
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Noyac said:
Maybe so but mine has gone up every year since I finished residency. Not once has it gone down. The national polls showed that anesthesiology went up 6% last year. Granted, I’m not in the mega bucks range but I’m above MGMA median. And that’s what my contract is based on.

The point is that we have all been saying that salaries are going to drop, and I believe they are. But I haven’t seen it yet. Here in Colorado we even managed to get an anesthesia funding cut removed from the legislature this year. Contributing to your PAC is one effective way of maintaining this.
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You are not in an ACT model (yet), are you? Plus you practice cardiac anesthesia, right?
 
Noyac said:
MGMA. Yes are doing more cases but I believe everyone is doing more cases for the most part. I have mentioned it here before, I am employed by my hospital. They base our pay on MGMA median.
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Wow which region of Us is this? I don't know of any hospitals around me that pay mgma median.
 
The only reason salaries are going down is because 3rd party middlemen are taking a bigger cut from more people’s paychecks. Actual reimbursrment rates (both government and private) are staying steady. Number of providers does not directly influence unit value. Do everything you can to work for a true PP and the worry of some suit arbitrarily cutting your paycheck drops significantly (albeit not to zero if the group relies on a significant subsidy).
 
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SaltyDog said:
The only reason salaries are going down is because 3rd party middlemen are taking a bigger cut from more people’s paychecks. Actual reimbursrment rates (both government and private) are staying steady. Number of providers does not directly influence unit value. Do everything you can to work for a true PP and the worry of some suit arbitrarily cutting your paycheck drops significantly (albeit not to zero if the group relies on a significant subsidy).
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Steady unadjusted for inflation though right
 
anbuitachi said:
Steady unadjusted for inflation though right
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Government pay for anesthesia actually has gone up slightly each time the rates have been adjusted over the last few years. Whether that keeps pace with inflation I do t really know. Most private payers base their rates on government rates to some extent but negotiating ability/power is way more important.
 
pgg said:
It's called CPB mode ... :)
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That unfortunately turns off the NIBP timed cycle; at least in my experience. Its nice to not hear the alarms, but a PITA to manually cycle the cuff every few minutes. Unless theres a way to time the cuff cycle while on CPB mode that I dont know about.
 
This happened at my residency program as well...

Another issue is that the crnas make the room assignments for the residents and crnas on the weekend instead of the attending
 
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