Dear Charmains

[2win]

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Please let us know - how do you feel selling out our profession to CRNA-s?
Please let us know - how can you sleep when you KNOW that your residents ( yes - the one that have debt from their medical school, the one that are used as cheap labor, the one that have to pass a written and oral board and so on) are COMPETING for a job with the midlevels?
Please let us know - why do you still train CRNA-s?
Have you ever read their journal?
What do you think about it?
Please forget for few minutes about the academic politics and be sincere.
Thank you.
2win

forgive me about the typo...
my BP needs a drip.

 

[epidural2009]

i love it. good luck getting a response, but i love the questions. sadly most chairmen are P.C. and play nice with the CRNAs cuz they think they have to. i say f@#K 'em.

 

[Narcotized]

 

[Coastie]

My thoughts exactly?

Had to read that post 2-3 times.

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[Planktonmd]

Blade, we need to be a little bit realistic and stay attached to planet earth.
If you feel so strongly about your cause why don't you fire all the CRNA's that you employ and hire only physicians instead?
I know all the answers you are going to give to this question but these are the same answers these academic leaders are going to give you.

 

[countingdays]

Blade, we need to be a little bit realistic and stay attached to planet earth.
If you feel so strongly about your cause why don't you fire all the CRNA's that you employ and hire only physicians instead?
I know all the answers you are going to give to this question but these are the same answers these academic leaders are going to give you.

There is a big difference between firing all the crnas in your practice and allowing 'dnp' programs to exist in your department.

 

[Noyac]

There is a big difference between firing all the crnas in your practice and allowing 'dnp' programs to exist in your department.

Really? Are you sure?

Give it a try, then tell us what you think.

 

[Laryngophed]

This whole discussion is only serving to push me (and probably a boatload of others) to find a physician only practice when I'm out in the real world.

 

[Noyac]

This whole discussion is only serving to push me (and probably a boatload of others) to find a physician only practice when I'm out in the real world.

Then consider it, mission accomplished.

And you my friend will be one of the more content anesthesiologist of your time.

 

[Brian Fantana]

Then consider it, mission accomplished.

And you my friend will be one of the more content anesthesiologist of your time.

I am in a physician only group and I couldn't be happier. If I had to supervise a nurse for one day I would quit and find a job where I didn't.

 

[2win]

This is how I felt after an email was sent to a zillion chairmen - 0 answers so far.

 

[cfdavid]

I am in a physician only group and I couldn't be happier. If I had to supervise a nurse for one day I would quit and find a job where I didn't.

If enough physicians get fed up with CRNA's to the point where they're willing to take a significant pay cut to alleviate that headache or simply to have a more rewarding career, then the nurses are in serious trouble.

cf

 

[leaverus]

It isn't just the charmains who are selling out, what about all the academic anesthesiologists who are teaching these SRNAs?

 

[SleepIsGood]

It isn't just the charmains who are selling out, what about all the academic anesthesiologists who are teaching these SRNAs?

This is a huge problem. This is what needs to be stopped...cold turkey.

 

[cfdavid]

This is a huge problem. This is what needs to be stopped...cold turkey.

I just don't see this happening. These are money making endeavors for those institutions involved. I think this is above any individual department and goes all the way up to administration.

The only way it could be possible is to supplement that income with something else. More residents??

 

[Planktonmd]

I just don't see this happening. These are money making endeavors for those institutions involved. I think this is above any individual department and goes all the way up to administration.

The only way it could be possible is to supplement that income with something else. More residents??

Unfortunately, recruiting more residents requires more government funding which we all know is not going to happen.
Residents do not pay for their education and can not bill insurance or Medicare.
I am not defending academic leaders but we need to be realistic in our expectations.

 

[2win]

It isn't just the charmains who are selling out, what about all the academic anesthesiologists who are teaching these SRNAs?

The "academic anesthesiologists" are chickens.
They will never contradict the chairman.
They are out of the reality.
They don't know anything about billing. Ask them.
A lot of them are hippies happy to have a job and discuss endless about insignificant topics.
They care about membership in different societies IF is paid by the department.
If you wanna find a JCAHO aficionado - look at your attendings.
They struggle to publish - not because they care about science - it is because they have too.
They don't care about residents and their future - they care being politically correct. Keep the job, keep the name and the power.
You have more chances to stay in the academics if you are a mediocrity.
No balls and agreeing with everything.
If a CHANGE will not be made soon ....
What can we do about that?
Send them an email about your concerns. Show them that WE KNOW THAT THEY ARE WRONG!
Don't send the email to your boss. They will kill you - politically correct...
Send to others. Create another email address with a different name.
I don't know if we have a choice.
But we have to try.
2win

 

[Planktonmd]

The only thing we can do is establish the presence of an anesthesiologist in every anesthetic as a STANDARD OF CARE.
If we can't do that this specialty is going to become a nursing domain very soon.
We should not accept the soft language the ASA had adopted in the past where they were happy to only demand the supervision of a physician (not necessarily an anesthesiologist).
We can't eliminate CRNA's but we need to make it clear to everyone that an anesthetic without the supervision of an anesthesiologist is not acceptable and that the American public deserves the care of a physician that specializes in anesthesiology like the rest of the world.

 

[2win]

The only thing we can do is establish the presence of an anesthesiologist in every anesthetic as a STANDARD OF CARE.
If we can't do that this specialty is going to become a nursing domain very soon.
We should not accept the soft language the ASA had adopted in the past where they were happy to only demand the supervision of a physician (not necessarily an anesthesiologist).
We can't eliminate CRNA's but we need to make it clear to everyone that an anesthetic without the supervision of an anesthesiologist is not acceptable and that the American public deserves the care of a physician that specializes in anesthesiology like the rest of the world.

Plankton my brother 👍👍👍

 

[Narcotized]

If you work at a BS outpatient center doing mostly eyeballs or ASA1/2 endo, fact is you will be threatened by midlevels because it is more economical. The days of making 500,000 for doing basically nothing except being oncall for the 1 in 100,000 disaster are mostly likely coming to an end. It simply isn't good utilization of resources.

On the other hand, if you work at a major academic hospital or other major hospital setting where your patients are typically sick as crap and the surgeries are complicated, midlevels will NEVER... (NNNEEEVVVEEERRR)... go unsupervised. A few Michael Jackson anesthetics would end that debate forever.

I've worked at all of the above. Economics will dictate you won't keep get paid a fortune for basically nothing. While there will always be anethesiologist job security at the larger centers, competition for these jobs may significantly increase when the BS jobs start drying up from small center closure/consolidation and increased roles of midlevels at those centers. In fact, a lot of rear endoscopy is done by neither anesthesiologist nor anesthetist, so if you think anesthesiologists have a shot at holding on to all these minor procedures, you're fighting a losing battle.

 

[Noyac]

How many of you people are currently working with crna's right now?

If you want to put your money where your mouth is, then start heading towards eliminating crna's from your practice. Start hiring new grads in their place. We just hired 2. Lets get with the program.

Don't just send insulting letters to programs for training the nurses. Tell them you need doc's. Tell them you won't hire another nurse. Tell them to train doc's.

 

[IlDestriero]

How many of you people are currently working with crna's right now?

If you want to put your money where your mouth is, then start heading towards eliminating crna's from your practice. Start hiring new grads in their place. We just hired 2. Lets get with the program.

Don't just send insulting letters to programs for training the nurses. Tell them you need doc's. Tell them you won't hire another nurse. Tell them to train doc's.

I work with CRNAs in my academic practice. We don't train SRNAs.
That's good enough for me. If we fired them all and hired MDs instead, we would all be making CRNA salary. Something tells me that's not going to happen.

 

[Noyac]

I work with CRNAs in my academic practice. We don't train SRNAs.
That's good enough for me. If we fired them all and hired MDs instead, we would all be making CRNA salary. Something tells me that's not going to happen.

I understand.
And I am not calling for everyone to fire all their crna's. I'm just calling for more and more groups to start hiring MD/DO's instead of more crna's.

I also understand the need for crna's but if a group needs more members then I think they should go the MD/DO route.

 

[Laryngophed]

I understand.
And I am not calling for everyone to fire all their crna's. I'm just calling for more and more groups to start hiring MD/DO's instead of more crna's.

I also understand the need for crna's but if a group needs more members then I think they should go the MD/DO route.

I agree, but I insist they wait ~8-10 years to do so. 😀

 

[Voodoo]

I work in an all-anesthesiologist group and I couldn't be happier.

The day we even consider hiring a CRNA is the day I tender my resignation and move to greener pastures.

For those of you in similar practices to mine, please make your feelings known to your dept chair/group president/whatever method of group regulatorial body you have.

My $0.02

 

[Ignatius J]

I haven't met too many unemployed anesthesiologists.

Control what you can control, and don't worry about the rest.

Too many people in Medicine are Type A and think they can, should, and will control everything.

Just sit back, relax, and enjoy you career at face value. It's rewarding if you do.

 

[Mman]

How many of you people are currently working with crna's right now?

If you want to put your money where your mouth is, then start heading towards eliminating crna's from your practice. Start hiring new grads in their place. We just hired 2. Lets get with the program.

Don't just send insulting letters to programs for training the nurses. Tell them you need doc's. Tell them you won't hire another nurse. Tell them to train doc's.

My income would take a significant nose dive if we were doing MD only instead of 3 or 4:1 supervision. How much is it worth? I don't know. I'd probably cut at least $300,000 a year out of my pocket. That's a lot of money over a 10 or 20 year stretch (plus interest).

I get along fine with our CRNAs, or at least 95% of them. Maybe that's because we employ them. When I'm signing the paycheck (at least figuratively), there is a lot less dissent in the ranks amongst the whole CRNA/MD thing, or at least what is direct my way.

The safest and most efficient model of care is the ACT model.

 

[Engin]

I haven't met too many unemployed anesthesiologists.

Control what you can control, and don't worry about the rest.

Too many people in Medicine are Type A and think they can, should, and will control everything.

Just sit back, relax, and enjoy you career at face value. It's rewarding if you do.

Nope, but I've seen SRNA' w/ CRNAs given preference for big cases over residents. I've seen CRNAs take advantage of residents when they are on call, sleeping at an early hour and making the resident work into the night without even giving them breaks. At the hospital I am at, the doctors would let the CRNAs assign the board because they were to lazy to do it themselves and CRNAs would often give themselves the better cases (since corrected thank god). It's pathetic what our passivity has allowed.

 

[2win]

Nope, but I've seen SRNA' w/ CRNAs given preference for big cases over residents. I've seen CRNAs take advantage of residents when they are on call, sleeping at an early hour and making the resident work into the night without even giving them breaks. At the hospital I am at, the doctors would let the CRNAs assign the board because they were to lazy to do it themselves and CRNAs would often give themselves the better cases (since corrected thank god). It's pathetic what our passivity has allowed.

Agree with you.
When I was a resident I didn't know too much about the war between us and CRNA-S....Seemed strange though that the CRNA-s were treated much better than us (the residents)...
Recently i witnessed an intubation (academic center, me an observer) when the resident was pushed away by the attending for a CRNA.. I had to say something - though I was a guest...My remarkk wasn't welcomed - but the resident had his intubation!
I looked in the nurse eyes - to see if it is frustration or they understand that this is the normal hierarchy..
Guess what I saw?
Not only that.
Instead for the attending to reinforce the good job done by the resident - a second year (great guy) - he taped the CRNA back (in a way apologizing) and left the room.
WTF is wrong with them?
They are PAID to teach residents.
Our colleagues.
My buddies from PP.
The ones that I count on it.
Speechless.
2win

 

[Ignatius J]

Nope, but I've seen SRNA' w/ CRNAs given preference for big cases over residents. I've seen CRNAs take advantage of residents when they are on call, sleeping at an early hour and making the resident work into the night without even giving them breaks. At the hospital I am at, the doctors would let the CRNAs assign the board because they were to lazy to do it themselves and CRNAs would often give themselves the better cases (since corrected thank god). It's pathetic what our passivity has allowed.

No offense, but that sounds like an institutional problem.

 

[IlDestriero]

No offense, but that sounds like an institutional problem.

Absolutely.
What call attending would not run his/her own board at night. I want to sleep as much as the next guy, but when I'm on call, I run the board from the time I arrive until I leave, even if the 2nd call person is the one who ran the board during the day. We don't have the CRNA problem, but the surgeons and the OR nurses can be very manipulative. You need to manage all that yourself. Some people passively manage the board, it shows. You can't be pushed around by senior partners or slow surgeons. Don't even get me started on surgical residents.
The attendings at your program need to get some stones and step up to the plate. We had SRNAs when I was in the Navy. They didn't take much call, but when they did, I made sure that they protected the residents, not the other way around.

 

[leaverus]

Recently i witnessed an intubation (academic center, me an observer) when the resident was pushed away by the attending for a CRNA.. I had to say something - though I was a guest...My remarkk wasn't welcomed - but the resident had his intubation!

When i was a CA-1 on call one night, went to a code with CA-2, CA-3, and CRNA. During the code, there was a question about management and CRNA says "well, as the senior-most person here, i think we should do this..."

 

[Mman]

Absolutely.
What call attending would not run his/her own board at night. I want to sleep as much as the next guy, but when I'm on call, I run the board from the time I arrive until I leave, even if the 2nd call person is the one who ran the board during the day. We don't have the CRNA problem, but the surgeons and the OR nurses can be very manipulative. You need to manage all that yourself. Some people passively manage the board, it shows. You can't be pushed around by senior partners or slow surgeons. Don't even get me started on surgical residents.
The attendings at your program need to get some stones and step up to the plate. We had SRNAs when I was in the Navy. They didn't take much call, but when they did, I made sure that they protected the residents, not the other way around.

At my institution as a resident, residents were scheduled to rooms before CRNAs. All the good cases went to residents and the CRNAs filled in the gaps. Every day without exception. We also had a SRNA program, but they mostly rotated through other hospitals. It was a program based here in name (and classroom work) only.

 

[Coastie]

When i was a CA-1 on call one night, went to a code with CA-2, CA-3, and CRNA. During the code, there was a question about management and CRNA says "well, as the senior-most person here, i think we should do this..."

LOL, I'd love to be the CA-1 in that room..or 2..or 3...Last time that CRNA would have piped up.

 

[ProRealDoc]

When i was a CA-1 on call one night, went to a code with CA-2, CA-3, and CRNA. During the code, there was a question about management and CRNA says "well, as the senior-most person here, i think we should do this..."

Funny how less educated people equate time served with knowledge.

 

[dingleberry007]

LOL, I'd love to be the CA-1 in that room..or 2..or 3...Last time that CRNA would have piped up.

What would you have done if you don't mind me asking?

 

[ProRealDoc]

Agree with you.
When I was a resident I didn't know too much about the war between us and CRNA-S....Seemed strange though that the CRNA-s were treated much better than us (the residents)...
Recently i witnessed an intubation (academic center, me an observer) when the resident was pushed away by the attending for a CRNA.. I had to say something - though I was a guest...My remarkk wasn't welcomed - but the resident had his intubation!
I looked in the nurse eyes - to see if it is frustration or they understand that this is the normal hierarchy..
Guess what I saw?
Not only that.
Instead for the attending to reinforce the good job done by the resident - a second year (great guy) - he taped the CRNA back (in a way apologizing) and left the room.
WTF is wrong with them?
They are PAID to teach residents.
Our colleagues.
My buddies from PP.
The ones that I count on it.
Speechless.
2win

 

[bronx43]

My income would take a significant nose dive if we were doing MD only instead of 3 or 4:1 supervision. How much is it worth? I don't know. I'd probably cut at least $300,000 a year out of my pocket. That's a lot of money over a 10 or 20 year stretch (plus interest).

I get along fine with our CRNAs, or at least 95% of them. Maybe that's because we employ them. When I'm signing the paycheck (at least figuratively), there is a lot less dissent in the ranks amongst the whole CRNA/MD thing, or at least what is direct my way.

The safest and most efficient model of care is the ACT model.

Well, there you have it. The more attendings that think like this, the more power is given to the CRNAs. It seems like the field of anesthesiology has no one else to blame but the physicians themselves.

*There's nothing wrong with attendings wanting to leverage CRNAs to maximize their earning potential. It just sucks for the future generations that have to deal with the changing landscape of the specialty.

 

[Ignatius J]

Well, there you have it. The more attendings that think like this, the more power is given to the CRNAs. It seems like the field of anesthesiology has no one else to blame but the physicians themselves.

*There's nothing wrong with attendings wanting to leverage CRNAs to maximize their earning potential. It just sucks for the future generations that have to deal with the changing landscape of the specialty.

I disagree. I AM a future generation and I have no problem with it. So as a future anesthesiologist of the next generation, I ask you not to worry about me. In anesthesia, you can work with physician only or choose to work with cRNAs in hopes of earning more income for your family. There is no wrong or right. It's just a matter of preference.

But the bottom line is that currently there are not enough board certified anesthesiologists to fill the surgical cases that go on every day, so cRNAs are needed.

As a resident, I understand that the power will constantly shift and the field might not always be the same. But with that said, I do encourage ALL anesthesiologists to chill out, relax, and try and take every day for what it's worth. You'll be more of a pleasure to work with and you will enjoy your career more. At the end of the day, the sky isn't falling and there won't be any down and out anesthesiologists.

Behold, the power of optimism (and I'm a bitter, overworked resident).

🙂

 

[fakin' the funk]

Agree with you.
When I was a resident I didn't know too much about the war between us and CRNA-S....Seemed strange though that the CRNA-s were treated much better than us (the residents)...
Recently i witnessed an intubation (academic center, me an observer) when the resident was pushed away by the attending for a CRNA.. I had to say something - though I was a guest...My remarkk wasn't welcomed - but the resident had his intubation!
I looked in the nurse eyes - to see if it is frustration or they understand that this is the normal hierarchy..
Guess what I saw?
Not only that.
Instead for the attending to reinforce the good job done by the resident - a second year (great guy) - he taped the CRNA back (in a way apologizing) and left the room.
WTF is wrong with them?
They are PAID to teach residents.
Our colleagues.
My buddies from PP.
The ones that I count on it.
Speechless.
2win

I'm sorry but I don't speak Spanish.

 

[Socrates25]

My income would take a significant nose dive if we were doing MD only instead of 3 or 4:1 supervision. How much is it worth? I don't know. I'd probably cut at least $300,000 a year out of my pocket. That's a lot of money over a 10 or 20 year stretch (plus interest).

I get along fine with our CRNAs, or at least 95% of them. Maybe that's because we employ them. When I'm signing the paycheck (at least figuratively), there is a lot less dissent in the ranks amongst the whole CRNA/MD thing, or at least what is direct my way.

The safest and most efficient model of care is the ACT model.

This is where the true colors come out. MDAs started using this as justification to sell out their own field. You guys werent happy making 250k per year, you wanted that 450k so you sold out your field.

You guys deserve EXACTLY what you have coming to you.

 

[Mman]

This is where the true colors come out. MDAs started using this as justification to sell out their own field. You guys werent happy making 250k per year, you wanted that 450k so you sold out your field.

You guys deserve EXACTLY what you have coming to you.

What about the fact that an ACT model is as safe as using MD only for care? And it's more efficient (in terms of both time and money)?

Efficiency of care is very important.

Besides, I feel like sitting in a room during a hernia on an ASA 1 patient is a waste of my education. If I'm in the ICU, I can take care of 16 critically ill patients at once. But if I'm in the OR, I can only do 1? Sorry, my brain works far faster than that. In our practice, we divvy up the rooms so that nobody has multiple bad rooms at once. I might have one room with a big case, and then 2-3 far more straightforward rooms. We have more efficient room turnover than MD only, because I can put in all the blocks and lines I want in preop while the previous case is still ongoing. Or I can do all the blocks I want in PACU after the patient is dropped off and the CRNA is turning over the room.

It's as safe and more efficient. What's the downside?

 

[Green912]

Funny how less educated people equate time served with knowledge.

There's a difference between having 10years of experience vs. one year of experience ten times.

 

[Idiopathic]

Lots of dick swinging around here, huh.

 

[maceo]

Funny how less educated people equate time served with knowledge.

thats true.. You see 60 year old CRNAs saying how much experience they have.. and let me tell you... ALL of them have GLARING.. and i mean GLARING misunderstandings of how to approach anesthesia to the point where anything goes wrong they cant think their way out of it.. ITS REALLY SCARY FOLKS. Im serious and thats where the education of an anesthesiologist comes in.. its ****ing scary...