DetroitNews: "Don’t go under with only a nurse"

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As an intern who has spent the last five years of my life dedicated to studying and practicing the diagnosis and treatment of disease I was surprised to discover in the comments that everything I have done thus far before my CA-1 year was worthless and of no relevance to Anesthesiology.
 
But those simulations they use to get case numbers are very life like....
 
This guy is obviously a ***** to write about Joan Rivers as an example of anything, other than perhaps that emergencies happen unexpectedly and anesthesia is not as safe as is assumed. I still think that Joan's anesthesiologist was likely a flunky that couldn't perform under pressure and probably did this low risk office stuff for years pushing propofol and doing some jaw lifts. You don't want that person regardless of their degree or training. When I need a colonoscopy maybe I'll ask what percent of their practice is anesthesia vs MAC and how many patients they intubate a month.


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Il Destriero
 
It would've been far more effective to give examples of times the CRNA screwed up, couldn't secure an airway, or froze and he had to bail them out. Happens all the time.
 
IlDestriero said:
This guy is obviously a ***** to write about Joan Rivers as an example of anything, other than perhaps that emergencies happen unexpectedly and anesthesia is not as safe as is assumed. I still think that Joan's anesthesiologist was likely a flunky that couldn't perform under pressure and probably did this low risk office stuff for years pushing propofol and doing some jaw lifts. You don't want that person regardless of their degree or training. When I need a colonoscopy maybe I'll ask what percent of their practice is anesthesia vs MAC and how many patients they intubate a month.


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Il Destriero
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Some AMC models especially in the South where it is routinely 1:4 and besides being on call (solo vs with crna in house/trauma) u can go weeks without intubating yourself.
 
pgg said:
I thought that was an odd choice too.

The bigger question is why the ASA can't be bothered to write letters like this.
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Because the ASA is not led by hungry people, but by very well-fed ones, put there to defend the status quo. It's like expecting Wall Street to put Main Street first.
 
Logano2230 said:
As an intern who has spent the last five years of my life dedicated to studying and practicing the diagnosis and treatment of disease I was surprised to discover in the comments that everything I have done thus far before my CA-1 year was worthless and of no relevance to Anesthesiology.
Click to expand...

The new DNPs honestly believe they are equal to a new grad Anesthesiologist in most areas. They trubly believe "equivalency" exists in among both providers and see the MD route as just another pathway to becoming a "provider" of anesthesia. Yes, the AANA and DNP Crna believe your PGY-1 was "worthless" as was a lot of your medical education.

The current view among your younger CRNA "colleagues" is the CRNA DNP means equivalency with a general Anesthesiologist.
 
BLADEMDA said:
The new DNPs honestly believe they are equal to a new grad Anesthesiologist in most areas. They trubly believe "equivalency" exists in among both providers and see the MD route as just another pathway to becoming a "provider" of anesthesia. Yes, the AANa and DNP Crna believe your PGY-1 was "worthless" as was a lot of your medical education.
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It doesn't matter whether they are right or wrong. What matters is that the bean counters don't care about degrees. They want a cheap warm body in there, at a reasonable malpractice risk (that they budget for). The latest trend I see is to push down anesthesiologist salaries and have them work solo on the difficult cases, to achieve both.

We are just rounding errors for people who run this racket. I have so little respect for students who get into anesthesia nowadays.
 
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FFP said:
It doesn't matter whether they are right or wrong. What matters is that the bean counters don't care about degrees. They want a cheap warm body in there, at a reasonable malpractice risk (that they budget for).
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Yes. So, the salaries begin to decrease towards the cheaper provider who is winning this war for solo practice. If a CRNA can give anesthesia just as safely as a general anesthesiologist then why hire the more expensive provider? Hence, the trend is falling salaries especially in ASCs where the "owners" see anesthesia as a low level specialty.
 
Available solutions seem to be: prepare to take care of the sickest patients- and I don't mean routine cardiac anesthesia, I mean ICU trainwrecks "in need" of operations- via Cardiac/CCM, or get out of OR anesthesia entirely, via Pain.
 
Is it really game over for the specialty? Then why am I still seeing 400K gigs on gaswork in desirable locations.
 
Carbocation1 said:
Is it really game over for the specialty? Then why am I still seeing 400K gigs on gaswork in desirable locations.
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The pipe has a tiny leak in it. Drip..drip..drip... but eventually the leak becomes significant with a lot of water damage. Rather than fix the issue which can be expensive and very labor intensive due to the fact that the entire system must be changed the solution we have decided upon is expoxy, glue and a bucket to catch the water.

So, right now the water pressure in the home is good and there "appears" to be no immediate issue.
 
Nivens said:
Available solutions seem to be: prepare to take care of the sickest patients- and I don't mean routine cardiac anesthesia, I mean ICU trainwrecks "in need" of operations- via Cardiac/CCM, or get out of OR anesthesia entirely, via Pain.
Click to expand...

Do a fellowship - maybe two of them over 2 years. Do not allow your education to become "equal" to a CRNA. That's why I stress fellowships where nursing education is simply inadequate for the task. Those of you in Residency will ignore this advice at your own peril over the course of your career.
 
RNtoBSN_Highest_Salary2.png

CRNA SALARIES
 
Nivens said:
Available solutions seem to be: prepare to take care of the sickest patients- and I don't mean routine cardiac anesthesia, I mean ICU trainwrecks "in need" of operations- via Cardiac/CCM, or get out of OR anesthesia entirely, via Pain.
Click to expand...
I have been contemplating for months going 100% CCM (more and better jobs than combined). I just don't have the guts to give up my anesthesiologist career yet.
 
Nivens said:
Available solutions seem to be: prepare to take care of the sickest patients- and I don't mean routine cardiac anesthesia, I mean ICU trainwrecks "in need" of operations- via Cardiac/CCM, or get out of OR anesthesia entirely, via Pain.
Click to expand...
The problem is that these trainwrecks are a. not very common b.not all that complicated since they are usually all lined up with norepi already running and c.not money makers,
so if you rely on these type of cases for salvation good luck to you.
 
FFP said:
Because the ASA is not led by hungry people, but by very well-fed ones, put there to defend the status quo. It's like expecting Wall Street to put Main Street first.
Click to expand...

The ASA has a lot of agendas. They want to appear as fighting off the AANA when the reality is they need the nurses to keep the system working for them. The AMCs now run the show IMHO.
 
FFP said:
I have so little respect for students who get into anesthesia nowadays.
Click to expand...


That's interesting. Care to elaborate? I was active duty for 8 years and my last two years was the LPO of an Anesthesia department at a Naval hospital. This is where I truly learned a different side of medicine than my combat medic side knew. I ran a tight ship and my Corpsman were the best. We did all the difficult IV's in the hospital. I taught how to use U/S techniques for them as well. I learned and performed intubations, spinals, and some regional (femoral mainly with a few ISB and supraclavicular). My Docs were amazing mentors and I realized that I wasn't too old to pursue medical school because some of them have done it. So I got out finished undergrad and applied to DO schools. I start medical school in the fall and still have a love for anesthesia. I read all about the gloom and doom but I truly loved waking up everyday to go work in that department. Should I just give that up? Granted my views may change and I am going in with an open mind but I don't read too much into all the hype. Is it insane, coming from my perspective, to continue wanting to pursue anesthesia in the future?




Sent from my iPhone using SDN mobile
 
HMtoDO said:
That's interesting. Care to elaborate? I was active duty for 8 years and my last two years was the LPO of an Anesthesia department at a Naval hospital. This is where I truly learned a different side of medicine than my combat medic side knew. I ran a tight ship and my Corpsman were the best. We did all the difficult IV's in the hospital. I taught how to use U/S techniques for them as well. I learned and performed intubations, spinals, and some regional (femoral mainly with a few ISB and supraclavicular). My Docs were amazing mentors and I realized that I wasn't too old to pursue medical school because some of them have done it. So I got out finished undergrad and applied to DO schools. I start medical school in the fall and still have a love for anesthesia. I read all about the gloom and doom but I truly loved waking up everyday to go work in that department. Should I just give that up? Granted my views may change and I am going in with an open mind but I don't read too much into all the hype. Is it insane, coming from my perspective, to continue wanting to pursue anesthesia in the future?




Sent from my iPhone using SDN mobile
Click to expand...

It's rough out there these days. FFP is going through a hard patch right now. While Anesthesiology would not be my first choice these days I understand others will still want to match into the filed. As long as you understand all the issues the specialty faces going forward and are willing to do that extra year (fellowship is a must IMHO) then picking Anesthesiology is reasonable choice.

One last thing is to have a realistic view on salaries after fellowship. While I totally believe $400-$450K after a CT fellowship is realistic the salaries of general anesthesiologists have stagnated for many new grads being employed by management companies or hospitals. Those types of salaries are not going higher anytime soon.
 
Carbocation1 said:
Is it really game over for the specialty? Then why am I still seeing 400K gigs on gaswork in desirable locations.
Click to expand...
Don't focus on the $400k. Focus on how much you are working for that 400K.

Focus on what you are doing for that $400k and how many hours are u working
BLADEMDA said:
The ASA has a lot of agendas. They want to appear as fighting off the AANA when the reality is they need the nurses to keep the system working for them. The AMCs now run the show IMHO.
Click to expand...

Yup, go down the list of past and present list of ASA board of directors and it's a who's who have or are currently teaming up with AMCs. They are all in this bed together. Just collecting their paychecks and being double agents till they can retire.
 
BLADEMDA said:
RNtoBSN_Highest_Salary2.png

CRNA SALARIES
Click to expand...
Yup I know the DC area extremely well. That's 180-200K 4 days a week with NO WEEKENDS or calls (often times 7pm working lastest) and 6 (or 7 weeks) weeks paid vacation at most of the places for CRNAs.
 
Nivens said:
@FFP at this point you'd recommend CT alone over CT/CC?
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Pick your poison. If you love CCM, go for both. I just wouldn't recommend CCM-only.

Many academic anesthesia departments dominate the CTICU (financially more interesting), while being second fiddle to trauma surgeons in the SICU. Hence somebody with both CT and CCM will be way more interesting. Also, a CT-CCM person is interesting for PP, too, while a CCM person is definitely not.
 
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aneftp said:
Don't focus on the $400k. Focus on how much you are working for that 400K.

Focus on what you are doing for that $400k and how many hours are u working
Click to expand...
That is great advice, especially for fresh grads. I see so many of them jumping on a crappy package with many zeros, just because it's more than they have ever made. I have seen places paying 350+ in a 250 market, just to find out that there was no pay for overtime, no pay for extra calls, no clear provisions how much one has to work. Even most locums are better than that.

CRNAs are much savvier, as a group. There is a reason they have defined working hours and hourly pay, and we don't. 😉
 
FFP said:
That is great advice, especially for fresh grads. I see so many of them jumping on a crappy package with many zeros, just because it's more than they have ever made. I have seen places paying 350+ in a 250 market, just to find out that there was no pay for overtime, no pay for extra calls, no clear provisions how much one has to work. Even most locums are better than that.

CRNAs are much savvier, as a group. There is a reason they have defined working hours and hourly pay, and we don't. 😉
Click to expand...

It is a hangover from two things:

1. The historic commitment that medicine required.
2. The traditional owner v employee status. Physicians have traditionally been owners. Nurses haven't. Owners cherish their ownership stay till the work is done. Employees don't. As we become employees, plenty of docs are more than willing to consider an employee mentality. Unfortunately, the market is not allowing many of us to embrace it.
 
dr doze said:
It is a hangover from two things:

1. The historic commitment that medicine required.
2. The traditional owner v employee status. Physicians have traditionally been owners. Nurses haven't. Owners cherish their ownership stay till the work is done. Employees don't. As we become employees, plenty of docs are more than willing to consider an employee mentality. Unfortunately, the market is not allowing many of us to embrace it.
Click to expand...
If I have employee pay, you bet I will have a shift mentality. It's not like I am building my own business by staying longer. I usually stay to finish my cases, but I can't stand being taken for a sucker.
 
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BLADEMDA said:
Do a fellowship - maybe two of them over 2 years. Do not allow your education to become "equal" to a CRNA. That's why I stress fellowships where nursing education is simply inadequate for the task. Those of you in Residency will ignore this advice at your own peril over the course of your career.
Click to expand...

Best advice I've gotten in this forum since I became a member. Very happy to have sucked it up for another year and go the extra mile for the fellowship. It has paid off handsomely as well.
 
ProRealDoc said:
Best advice I've gotten in this forum since I became a member. Very happy to have sucked it up for another year and go the extra mile for the fellowship. It has paid off handsomely as well.
Click to expand...
Cardiac? It'd better.
 
One of the comments in that article made me snicker. A crna was touting his certified case log with a "huge" 1,000 cases.

Ive logged over 300 cases as a ca1 now, with majority being ASA-3 cases. I didnt even count our anesthesia intern month cases since technically youre paired with a senior.

Ive done a grand total of 8 asa-1 cases.

Just food for thought, but i guess our training is equivalent.
 
jthedestroyr said:
One of the comments in that article made me snicker. A crna was touting his certified case log with a "huge" 1,000 cases.

Ive logged over 300 cases as a ca1 now, with majority being ASA-3 cases. I didnt even count our anesthesia intern month cases since technically youre paired with a senior.

Ive done a grand total of 8 asa-1 cases.

Just food for thought, but i guess our training is equivalent.
Click to expand...


Nothing they say makes me snicker. It does elevate my blood pressure.


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BLADEMDA said:
It's rough out there these days. FFP is going through a hard patch right now. While Anesthesiology would not be my first choice these days I understand others will still want to match into the filed. As long as you understand all the issues the specialty faces going forward and are willing to do that extra year (fellowship is a must IMHO) then picking Anesthesiology is reasonable choice.

One last thing is to have a realistic view on salaries after fellowship. While I totally believe $400-$450K after a CT fellowship is realistic the salaries of general anesthesiologists have stagnated for many new grads being employed by management companies or hospitals. Those types of salaries are not going higher anytime soon.
Click to expand...
Any other ideas on what a DO who hates paperwork, rounding, notes, and likes procedures could do? Anesthesiology is really the only thing that remotely appeals to me at this point.
 
dr doze said:
Nothing they say makes me snicker. It does elevate my blood pressure.


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Click to expand...
Agree. Underestimating one's enemy is the surest way to defeat. Let's see first what president Trump and the republican Congress do with the VA.
 
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