I am trying to decide between my top 2 residency programs and a major difference between the 2 is the presence/absence of CRNA's. What are the pluses and minuses of training at a place that has CRNA's?
It depends on the culture of the residency program, and on the number of CRNAs versus the number of residents.
At some residency programs the CRNAs relieve you; at others, you relieve the CRNAs. At some programs it is clear the CRNAs are there to support you (the residents). At others, residents are there to support the CRNAs no matter what the program tells you during interviews. They cost more than you (3 times as much) and they stay longer than you (indefinitely versus your three years). So the motivation to make sure they remain happy is high. The motivation to keep you happy as a resident is usually not as high, although a good program will manage to do this anyway.
The number of CRNAs versus the number of residents also matters. If CRNAs outnumber residents then they take most of the cases, and you will get cases appropriate to your education -- which will include some vac dressing changes and some PEG tube placements from time to time. If residents outnumber CRNAs then residents will take most of the cases -- which will also include some vac dressing changes and some PEG tube placements.
No matter where you go, you will not get juicy cases all the time, nor will you always get the awake intubations or the epidurals or the major vascular cases. Sometimes a CRNA will get assigned a boring case like a knee arthroscopy only to find out right before the procedure that the patient needs an awake intubation. Most people will not then substitute the CRNA with a resident for that. It's luck of the draw, and it goes day by day.
So at our place we have like 80 residents and a couple dozen CRNAs. When the schedule is made the day before, the CRNA on the service usually gets the room with the simplest cases and the residents get the more complex ones. The presence or absence of CRNAs makes little difference to me, although they do the vast majority of the trach-pegs.
There is no such thing as a case that is not educational -- doesn't matter if it's a vac dressing change or a lung transplant. You want a residency that provides a wide range of cases that include everything from the very simple to the very complex. You also want a residency that provides a wide range of patient ASA classes from very healthy to death's door. This is why I think that "cherry picking" cases is unrealistic. There are residencies that are rumored to have "enough" CRNAs to allow you to do all "juicy" cases. This is unrealistic. In your first week of residency your staff may be more comfortable assigning you the ASA I and giving the CRNA the ASA III. So you're not getting a "juicy" case, you are only getting the appropriate case for you and the CRNA is filling in the gap. In your last week of residency, the cases you think are "juicy" and the cases you think are "routine" and CRNA appropriate will be completely different.
You cannot do all complex cases/patients all the time with no simple cases/patients and expect to get a well rounded education. You need to see a bit of everything and that includes some cases that are routinely assigned to CRNAs (but you can still be glad they're present to take these cases most of the time).
So many attendings from outside the states and they can only work at University, seems they're afraid to stand up to the CRNAs. Might get fired and have to go home. Screws the residents but great for CRNAs.
