Difference in residency training between SRNAs and MDs?

[DancingAstronaut]

What is really the difference in clinical training at an anesthesiology residency program where they train SRNAs and MDs and the attending never shows up in the room except for induction and extubation? Is it really just the rigor of the individual studying required in order to pass the ABA AKTs, ITEs, and Basic/Advanced exams? Is it that we have more advanced/higher # of cardiac, neuro, OB, Peds, and procedures required than SRNAs? Are we just integrating more together mentally with a similar clinical experience than they are given our medical knowledge? If someone could elaborate I would appreciate it. Thanks.

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[Man o War]

What is really the difference in clinical training at an anesthesiology residency program where they train SRNAs and MDs and the attending never shows up in the room except for induction and extubation? Is it really just the rigor of the individual studying required in order to pass the ABA AKTs, ITEs, and Basic/Advanced exams? Is it that we have more advanced/higher # of cardiac, neuro, OB, Peds, and procedures required than SRNAs? Are we just integrating more together mentally with a similar clinical experience than they are given our medical knowledge? If someone could elaborate I would appreciate it. Thanks.

Go to any CRNA school website and look at the bare bones standards they require for graduation- there's really no comparison. I've even been told by docs they can count simulations toward their required numbers. Frightening that this body of individuals thinks they should should be able to practice independently upon graduation.

 

[deleted162650]

:troll:

 

[Consigliere]

CRNA's are good at sitting on a chair, documenting vital signs, and doing what we tell them to do. That's about it.

 

[deleted171991]

CRNA's are good at sitting on a chair, documenting vital signs, and doing what we tell them to do. That's about it.

You probably also think that nurses should stand up in your presence. Also, that the year is 1970.

Times have changed, my friend. Most CRNAs I work with could do 95+% of our usual PP cases solo, well enough, i.e. with no measurable major bad outcomes (the human body is pretty resilient to provider incompetence/stupidity). And that's exactly what the bean counters are looking for: good enough, not perfection. (What they get away with, without us being able to measure the impact, is a completely different story and the main reason I would trust quasi none of them with my family's care.)

 

[caligas]

 

[DancingAstronaut]

:troll:

I'm not trolling. Attendings treat us the same and it's kind of disheartening because I would think they would discuss a topic or aspects of managing a case and integrate topics on a deeper level, but more often than not they treat you exactly like an SRNA or CRNA. Additionally, if a SRNA or CRNA comes to relieve you it makes you wonder does no one care or think that it matters the kind of medical management you provide vs a mid level provider.

 

[acidbase1]

I can tell you this, the hospital administration/surgeons can see a massive difference between me and independent CRNAs with 25 years experience in ONE WEEK.

 

[pgg]

I'm not trolling. Attendings treat us the same and it's kind of disheartening because I would think they would discuss a topic or aspects of managing a case and integrate topics on a deeper level, but more often than not they treat you exactly like an SRNA or CRNA. Additionally, if a SRNA or CRNA comes to relieve you it makes you wonder does no one care or think that it matters the kind of medical management you provide vs a mid level provider.

This is a lazy attending problem, not a physician vs nurse problem.

 

[deleted162650]

I'm not trolling. Attendings treat us the same and it's kind of disheartening because I would think they would discuss a topic or aspects of managing a case and integrate topics on a deeper level, but more often than not they treat you exactly like an SRNA or CRNA. Additionally, if a SRNA or CRNA comes to relieve you it makes you wonder does no one care or think that it matters the kind of medical management you provide vs a mid level provider.

Well if that's really the case, then I would strongly recommend trying to transfer to a non-POS residency program.

 

[Robotic Wis-Hipple]

I'm not trolling. Attendings treat us the same and it's kind of disheartening because I would think they would discuss a topic or aspects of managing a case and integrate topics on a deeper level, but more often than not they treat you exactly like an SRNA or CRNA. Additionally, if a SRNA or CRNA comes to relieve you it makes you wonder does no one care or think that it matters the kind of medical management you provide vs a mid level provider.

I apologize and mean no offense if I'm wrong here, but this reads like you're a CA-1. Which means you're in month 2, and yes, your medical knowledge is higher but in anesthesia you're a complete rookie and your staff is prioritizing the logistical aspect and making sure you don't off somebody. That stage will pass. However, if you're anything beyond a 3month CA1 and your attendings are doing that then I 100% agree with pgg and salty.

I just became an attending, and I trained at a place with SRNAs, and while it's annoying, I never felt they were treated like equals. And my personal strategy (obviously it's early) is to let the CRNA teach the SRNA while they sit in the rooms, I'll intercede when it's needed and on things like intubation/emergence strategy etc, but I'm not having the same physiologic discussions with the SRNA/CRNAs. Part of this is because I'm not trying to train my replacements, and I'm not a fan of initiating anything that resembles a discussion where they think their input is weighted equally. When it comes to overall case management and planning I don't plan on fostering a democracy.

 

[deleted171991]

Well if that's really the case, then I would strongly recommend trying to transfer to a non-POS residency program.

You mean the 10 or so remaining that don't prioritize money before education?

 

[AdmiralChz]

So glad I didn't train with SRNAs - by all accounts they are truly dreadful and terrifying. We have AA students at my fellowship though - we can't leave them alone in the room unsupervised under any circumstances as they have no license. I assume SRNAs are the same, their supervising CRNA can't leave right? If true that's a MAJOR difference there.

Otherwise, #troll.

 

[deleted171991]

So glad I didn't train with SRNAs - by all accounts they are truly dreadful and terrifying. We have AA students at my fellowship though - we can't leave them alone in the room unsupervised under any circumstances as they have no license. I assume SRNAs are the same, their supervising CRNA can't leave right? If true that's a MAJOR difference there.

Otherwise, #troll.

There are many who are motivated and pretty good, and that's what should be terrifying. Especially since nowadays they are trained in advanced anesthetic subspecialties and procedures, too, which used to be reserved for the MDs.

I am not sure they can be left alone, legally, by their supervising CRNA or MD. Regardless, don't hold your breath, especially in private practice.

 

[Temeraire]

We just started introducing CRNAs at our institution in an effort to relieve the case burden on the residents (there was a lot of low morale from being frequently stuck super late on non-call days, having zero breaks from morning until 2pm, etc). I hope they help take over the scutty cases and provide well-needed breaks during stable cases.

That said, I heard from one of my co-residents that during a quick chat about vent settings one of the CRNAs had asked: "what's compliance?"

 

[Hoya11]

There are many who are motivated and pretty good, and that's what should be terrifying. Especially since nowadays they are trained in advanced anesthetic subspecialties and procedures, too, which used to be reserved for the MDs.

I am not sure they can be left alone, legally, by their supervising CRNA or MD. Regardless, don't hold your breath, especially in private practice.

SRNAs are left alone, often.

I would think about SRNAs and Residents as training for different jobs.

SRNA training: easy cases selected for them, lots of room setup, charting, silly exams where everyone gets 90-100, multiple quick attempts at certification exam even if you fail, must be relieved right on time, no weekends or long shifts, trying to be proficient at LMAs, tubes, MAC, alines are a big deal. also ridiculous pre-ops where things are cut and pasted from the chart without any understanding of the content. A disconnect from the actual understanding of whats important in the case is mandatory...

 

[aneftp]

A lot of srna training is "on the job" training for 1-3 years AFER srna training.

I've stated many times. The real true test is to run double blind student with hospital and AMC executive love ones with Asa 4 patients with fresh grad srna and fresh grad MD doing similar high risk surgery cases.

 

[Silo004]

There are many who are motivated and pretty good, and that's what should be terrifying. Especially since nowadays they are trained in advanced anesthetic subspecialties and procedures, too, which used to be reserved for the MDs.

I am not sure they can be left alone, legally, by their supervising CRNA or MD. Regardless, don't hold your breath, especially in private practice.

On everything. After reading your posts, I want to quit medicine and start selling weed. Demoralizing is a word but not quite the right one.

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[deleted171991]

On everything. After reading your posts, I want to quit medicine and start selling weed. Demoralizing is a word but not quite the right one.

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Interesting that you quote a post that is pretty much true (from my own PP experience), not just my opinion.

Regardless how much you dislike me or my opinions, please realize that residency and academia are an ivory tower. You guys don't see 10% of what's out there once you become attendings. CRNAs doing spinals and epidurals in OB are just the frosting on the cake; we have way bigger problems. Private practices which run SRNA schools let them learn absolutely anything they want to; the school is a profit center for them, and the SRNAs are cheap workforce. They now insert A-lines, place DLTs; some even do cardiac cases once they become CRNAs. They try to learn everything they can; they are raised by CRNAs with the mentality that they should be able to perform independently. For example, they push their own induction drugs way more frequently than we ever did in residency. And PPs love them like that, because a quasi independent CRNA is one that allows the practice to run in 1:3-1:4 (or worse) mode. Once the public gets used to seeing mostly them and rarely us, it's just a matter of time until this specialty becomes a nurse-dominated one. Most patients already don't know that their anesthesiologist is a doctor, and are not able to appreciate the knowledge we bring to the table (good CRNAs have almost the same skills as us, or even better in ACT practices).

Like it/me or not, the lazy docs have sold out this specialty. It's just the law that hasn't caught up yet (thankfully).

 

[Consigliere]

FFP - I love ya' man but please, please reduce your use of the emoticon by 50%. Thanks.

 

[deleted171991]

FFP - I love ya' man but please, please reduce your use of the emoticon by 50%. Thanks.

For you, anything.

 

[Psai]

We just started introducing CRNAs at our institution in an effort to relieve the case burden on the residents (there was a lot of low morale from being frequently stuck super late on non-call days, having zero breaks from morning until 2pm, etc). I hope they help take over the scutty cases and provide well-needed breaks during stable cases.

That said, I heard from one of my co-residents that during a quick chat about vent settings one of the CRNAs had asked: "what's compliance?"

You don't need to know about compliance to give me a break for 15 minutes. Just call if something starts beeping.

 

[deleted171991]

You don't need to know about compliance to give me a break for 15 minutes. Just call if something starts beeping.

That's basically what the militant CRNA will tell you, post-residency, when you give her a break as her attending.

 

[Mad Jack]

That said, I heard from one of my co-residents that during a quick chat about vent settings one of the CRNAs had asked: "what's compliance?"

That CRNA should have been thrown out of the OR, omfg...

 

[2Fast2Des]

Interesting that you quote a post that is pretty much true (from my own PP experience), not just my opinion.

Regardless how much you dislike me or my opinions, please realize that residency and academia are an ivory tower. You guys don't see 10% of what's out there once you become attendings. CRNAs doing spinals and epidurals in OB are just the frosting on the cake; we have way bigger problems. Private practices which run SRNA schools let them learn absolutely anything they want to; the school is a profit center for them, and the SRNAs are cheap workforce. They now insert A-lines, place DLTs; some even do cardiac cases once they become CRNAs. They try to learn everything they can; they are raised by CRNAs with the mentality that they should be able to perform independently. For example, they push their own induction drugs way more frequently than we ever did in residency. And PPs love them like that, because a quasi independent CRNA is one that allows the practice to run in 1:3-1:4 (or worse) mode. Once the public gets used to seeing mostly them and rarely us, it's just a matter of time until this specialty becomes a nurse-dominated one. Most patients already don't know that their anesthesiologist is a doctor, and are not able to appreciate the knowledge we bring to the table (good CRNAs have almost the same skills as us, or even better in ACT practices).

Like it/me or not, the lazy docs have sold out this specialty. It's just the law that hasn't caught up yet (thankfully).

So let me get this straight.. a physician who is not cardiac trained cannot do cardiac even though they did enough cases in residency but a new grad crna can do a cardiac case no question? WTF

 

[Man o War]

So let me get this straight.. a physician who is not cardiac trained cannot do cardiac even though they did enough cases in residency but a new grad crna can do a cardiac case no question? WTF

No. I know of zero places where a CRNA does hearts without supervision.

 

[deleted171991]

So let me get this straight.. a physician who is not cardiac trained cannot do cardiac even though they did enough cases in residency but a new grad crna can do a cardiac case no question? WTF

They typically do it under the supervision of a cardiac anesthesiologist, or any anesthesiologist (if a cardiologist does the TEE). And they are not new grads, usually.

All I am saying is that they are infiltrating into everything, like cancer, because of the poor leadership of our departments. Everywhere I look (including PP), department chairs are pushing the "Anesthesia Care Team" model, because it's all about the money. The only things CRNAs don't do are the things they are not comfortable with, which are fewer and fewer as generations pass. Anesthesiologists are becoming firefighters, at a higher and higher malpractice risk, and at a much decreased income (per risky case).

 

[Gas you down]

the difference is enormous. i work at a place where there's a CRNA school. their education is laughable in comparison to what i went through. their didactics skim the surface. and the numbers of blocks, neuraxials, central lines, and just the caliber of good cases is abysmal.

that being said, if a crna does work long enough...we're talking many years, they eventually get up to a decent standard.

 

[Gas you down]

our SRNA's are NEVER left alone in a room, even as seniors.
that should tell you something right there

 

[likeaboss]

Where I trained, by the end of CA1 year most residents have surpassed 90% CRNAs in terms of clinical skills and medical knowledge (which shouldn't even be compared). That's 1/3 of the way through their anesthesia training.


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[deleted171991]

Where I trained, by the end of CA1 year most residents have surpassed 90% CRNAs in terms of clinical skills and medical knowledge (which shouldn't even be compared). That's 1/3 of the way through their anesthesia training.


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How would you know (since you were a resident, and not supervising those residents and CRNAs)? Also, PP CRNAs tend to be better and more independent than those who work in academia.

Extra medical knowledge is nice, but the bean counters couldn't care less about it, as long as it doesn't make a measurable ($$$) impact on their bottom lines.

 

[likeaboss]

We had a pretty collegial relationship with our CRNAs, and would sometimes work together, like on overnight call if there were too many simultaneous traumas / rooms running, sometimes I would work with a CRNA on a trauma while our attending was in the other room with the other tough case.

That, but also we would talk to CRNAs and SRNAs all the time, about interesting cases or just chit chat. Sometimes you give them lunch breaks or they give you lunch breaks, and you can really tell a lot about someone from the sign out they give or get.

Not to say that our CRNAs were not competent. But in general our residents were stronger, after a short period of training. This became pretty evident.

Maybe it doesn't change outcomes on a large scale. And even if it did affect outcomes and not affect the bottom line, the bean counters wouldn't care. But, for what its worth, residents get much better training, and start off at a much higher baseline, having done that whole med school thing.

 

[Man o War]

There's no difference documented because they're not let loose on a large enough scale to really wreck havoc. Been in PP my whole career and I'm 100% sure there would be outcome differences, even in PP cases. People are getting older, sicker, and fatter. PP isn't immune to that. There's just less room for error, and there's a lot of error with midlevels.

 

[likeaboss]

There's no difference documented because they're not let loose on a large enough scale to really wreck havoc. Been in PP my whole career and I'm 100% sure there would be outcome differences, even in PP cases. People are getting older, sicker, and fatter. PP isn't immune to that. There's just less room for error, and there's a lot of error with midlevels.

Of course. And let's just say they hire horribly incompetent anesthesia providers at a hospital and something goes wrong, patient dies. Often it's the provider who gets sued, so the costs of the resulting litigation is passed onto the provider and their insurance, not the hospital.

So for an unscrupulous hospital administrator, who cares if it's a CRNA or MD? CRNAs save them money and the costs are passed on to someone else....


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[Planktonmd]

I'm not trolling. Attendings treat us the same and it's kind of disheartening because I would think they would discuss a topic or aspects of managing a case and integrate topics on a deeper level, but more often than not they treat you exactly like an SRNA or CRNA. Additionally, if a SRNA or CRNA comes to relieve you it makes you wonder does no one care or think that it matters the kind of medical management you provide vs a mid level provider.

But you are a physician! You went to medical school, and you supposedly know how to think, diagnose, and formulate plans. You will be a consultant in this field, not a technician.
Your attendings don't give a shiit if you learn or not, and most of them all they want is to finish the day and go home preferably without complications.
It's too late now, you knew what this specialty was going through but you still decided to choose it! It's up to you now to learn everything there is to learn, and you should start by not expecting any one to spoon feed you knowledge or care about your feelings.

 

[likeaboss]

you should start by not expecting any one to spoon feed you knowledge or care about your feelings.

hear hear...

 

[Temeraire]

and you should start by not expecting any one to spoon feed you knowledge or care about your feelings.

I tend to have low expectations about residency in general (and it has served me well in the mental health department), but boy is it a real treat when I'm paired with an attending who likes to teach. Like, real socratic method and not just "I do things this way because xyz..."

 

[GA8314]

So let me get this straight.. a physician who is not cardiac trained cannot do cardiac even though they did enough cases in residency but a new grad crna can do a cardiac case no question? WTF

This issue is one which puts us in a bit of a quagmire. WE docs keep upping the ante. Fellowships. Certifications to do Peds. Pain.

Meantime, the CRNA's just keep pushing. This is why I say we should NOT be overly restrictive when our grads come out with good skills, lots of experience in a given subspecialty (and interest, motivation, and aptitude), and limit our grads. I don't think this is a case of 2 wrongs make a right either. We are going a little overboard on SOME of these issues. Again, in the meantime, the CRNA's are pushing into every subspecialty without (of course) fellowships. Indeed, by definition, without coming out with 1/3 or even less of our numbers in training or our medical training.

 

[NotFrankUnderwood]

On a separate but related note, I was looking up pay at my public university in a desirable city. There are CRNAs that make more in GROSS PAY than attending physicians. They not only get a higher hourly rate, but also a higher gross pay (263 vs 215 for the attending). This was confirmed by one of the attendings and is absolutely mind-blowing to me.

 

[leaverus]

we should print up caps that say "make anesthesia great again" and build walls to keep us separate from the inferior crna

 

[aneftp]

No. I know of zero places where a CRNA does hearts without supervision.

I do. And they make 400-450k crna only 10 weeks off.

For Valves usually mitral. They will have cardiology read the TEE.

 

[pgg]

This issue is one which puts us in a bit of a quagmire. WE docs keep upping the ante. Fellowships. Certifications to do Peds. Pain.

Well, it's not just we docs. Take cardiac - most of us on the anesthesiologist side will not only admit, but will argue, that any residency-trained anesthesiologist is absolutely capable of doing the great majority of cases involving CPB. It may take some extra effort to get the requisite TEE experience, but it's reasonable to expect a resident to get that training in initial residency, and to be able to hone it as an attending.

But what's happened?

NBE decreed (way back in 2009) that a 1-year fellowship dedicated to the perioperative care of cardiac surgical patients was needed to achieve board certification in TEE. The practice pathway to certification was slammed shut on July 1st, 2009. Oh, they'll still take your money and let you take the exam, but now you have to be content with the Testamur title.

Since about that time, more and more hospitals have gradually changed their policies to make it difficult or impossible to credential non-fellowship trained anesthesiologists to do hearts. So groups can't hire someone to do hearts if they don't have the fellowship. So anesthesiologists who want to do hearts, who aren't already entrenched into their current institution's heart program, need to do the fellowship.

My own hospital literally shut down its cardiac surgery program for a month because there was a gap between the loss of the last cardiac-credentialed anesthesiologist, and my arrival from fellowship. I'm a swell dude, but I'm not that special. Never mind that we've got a department of 30-something anesthesiologists, including some who did cardiac at other institutions before coming here. There's no reason at all that any one of them couldn't have stepped in and done the cases. Perhaps with a cardiologist stepping into the room to help with the TEE, but it could've been done. If not for the credentialing issue.


The only sense in which we docs keep upping the ante is our recognition that as the years go by medicine gets more complex, the care of a subset of complex patients benefits from physicians who've had additional subspecialty training. This is a good thing; this is a reflection of the fact that people in our profession are largely on the correct side of the Dunning-Kruger curve.

 

[pgg]

On a separate but related note, I was looking up pay at my public university in a desirable city. There are CRNAs that make more in GROSS PAY than attending physicians. They not only get a higher hourly rate, but also a higher gross pay (263 vs 215 for the attending). This was confirmed by one of the attendings and is absolutely mind-blowing to me.

Two issues -

It's human nature to keep score with money, but wages are always, always set by market forces. Supply and demand. Merit has little to do with it.

The CRNAs are in the OR every day, making it rain for their masters. Meanwhile, an attending at an academic institution may have a contract for something like 180 or 200 clinical days in a year, to leave room for research. Unless and until the grant money starts flowing in, the anesthesiologist is only making money for the place by being in the OR.


It is my impression that an academic career for an anesthesiologist is a financial dead end, unless they develop into strong researchers (ensuring promotion) and acquire other sources of income (book royalties, etc). That can be a great career path, and the kind of people who want it are willing to accept the initial lower paycheck in academics for the opportunity to do that kind of work and reach for those particular stars.


Last, if your sense of self-worth is based on what other people earn, you're in for a lifetime of heartburn.

 

[aneftp]

Well, it's not just we docs. Take cardiac - most of us on the anesthesiologist side will not only admit, but will argue, that any residency-trained anesthesiologist is absolutely capable of doing the great majority of cases involving CPB. It may take some extra effort to get the requisite TEE experience, but it's reasonable to expect a resident to get that training in initial residency, and to be able to hone it as an attending.

But what's happened?

NBE decreed (way back in 2009) that a 1-year fellowship dedicated to the perioperative care of cardiac surgical patients was needed to achieve board certification in TEE. The practice pathway to certification was slammed shut on July 1st, 2009. Oh, they'll still take your money and let you take the exam, but now you have to be content with the Testamur title.

Since about that time, more and more hospitals have gradually changed their policies to make it difficult or impossible to credential non-fellowship trained anesthesiologists to do hearts. So groups can't hire someone to do hearts if they don't have the fellowship. So anesthesiologists who want to do hearts, who aren't already entrenched into their current institution's heart program, need to do the fellowship.

My own hospital literally shut down its cardiac surgery program for a month because there was a gap between the loss of the last cardiac-credentialed anesthesiologist, and my arrival from fellowship. I'm a swell dude, but I'm not that special. Never mind that we've got a department of 30-something anesthesiologists, including some who did cardiac at other institutions before coming here. There's no reason at all that any one of them couldn't have stepped in and done the cases. Perhaps with a cardiologist stepping into the room to help with the TEE, but it could've been done. If not for the credentialing issue.


The only sense in which we docs keep upping the ante is our recognition that as the years go by medicine gets more complex, the care of a subset of complex patients benefits from physicians who've had additional subspecialty training. This is a good thing; this is a reflection of the fact that people in our profession are largely on the correct side of the Dunning-Kruger curve.

It's like health care executives. I think we need to dictate no one can run a hospital or be on the executive team including VP if they do not have an MBA with health care focus.

Half the people running hospitals are "grandfathered" and just get the job based on on the job training.

 

[Man o War]

I do. And they make 400-450k crna only 10 weeks off.

For Valves usually mitral. They will have cardiology read the TEE.

Where?

 

[nimbus]

Well, it's not just we docs. Take cardiac - most of us on the anesthesiologist side will not only admit, but will argue, that any residency-trained anesthesiologist is absolutely capable of doing the great majority of cases involving CPB. It may take some extra effort to get the requisite TEE experience, but it's reasonable to expect a resident to get that training in initial residency, and to be able to hone it as an attending.

But what's happened?

NBE decreed (way back in 2009) that a 1-year fellowship dedicated to the perioperative care of cardiac surgical patients was needed to achieve board certification in TEE. The practice pathway to certification was slammed shut on July 1st, 2009. Oh, they'll still take your money and let you take the exam, but now you have to be content with the Testamur title.

Since about that time, more and more hospitals have gradually changed their policies to make it difficult or impossible to credential non-fellowship trained anesthesiologists to do hearts. So groups can't hire someone to do hearts if they don't have the fellowship. So anesthesiologists who want to do hearts, who aren't already entrenched into their current institution's heart program, need to do the fellowship.

My own hospital literally shut down its cardiac surgery program for a month because there was a gap between the loss of the last cardiac-credentialed anesthesiologist, and my arrival from fellowship. I'm a swell dude, but I'm not that special. Never mind that we've got a department of 30-something anesthesiologists, including some who did cardiac at other institutions before coming here. There's no reason at all that any one of them couldn't have stepped in and done the cases. Perhaps with a cardiologist stepping into the room to help with the TEE, but it could've been done. If not for the credentialing issue.


The only sense in which we docs keep upping the ante is our recognition that as the years go by medicine gets more complex, the care of a subset of complex patients benefits from physicians who've had additional subspecialty training. This is a good thing; this is a reflection of the fact that people in our profession are largely on the correct side of the Dunning-Kruger curve.

Was it the hospital administration or the anesthesiologists (medical staff) who determined the credentialling requirements? In every hospital where I've worked, the existing anesthesiologists determine their own credentialling requirements. It is under the purview of medical staff. When we determined credentialling requirements for TEE and CS catheters, we made it up ourselves. The hospital admintration has no clue what is required or reasonable and had no input. And the chief of anesthesia is the one who ultimately signs off on privileges. At our institution, this position has significant discretion.

The changes in cardiac credentialling are physician driven everywhere I've seen.

 

[GA8314]

Was it the hospital administration or the anesthesiologists (medical staff) who determined the credentialling requirements? In every hospital where I've worked, the existing anesthesiologists determine their own credentialling requirements. It is under the purview of medical staff. When we determined credentialling requirements for TEE and CS catheters, we made it up ourselves. The hospital admintration has no clue what is required or reasonable and had no input. And the chief of anesthesia is the one who ultimately signs off on privileges. At our institution, this position has significant discretion.

Yes. This is how we do things. I suppose the entire Health SYSTEM of 10 hospitals (in our system) could set a TEE certified requirement, but I am aware of some sites within our system (not a major market system as a whole but not rural either) who can barely recruit a cardiac CAPABLE doc yet alone a fellowed guy/gal.

We have an anesthesiologist who sits highly on the credentialing committee at our hospital. He is a Practice Experience Pathway guy (thus certified) but we do not have that as a requirement and there are zero plans to do that at our shop. Again, the SYSTEM could do this but they will do what their hospital sites are able to do without interruption of work. For sure. Which clearly points to no advanced Cert needed for the foreseeable future.... It is what it is. I do hearts.

 

[Man o War]

Was it the hospital administration or the anesthesiologists (medical staff) who determined the credentialling requirements? In every hospital where I've worked, the existing anesthesiologists determine their own credentialling requirements. It is under the purview of medical staff. When we determined credentialling requirements for TEE and CS catheters, we made it up ourselves. The hospital admintration has no clue what is required or reasonable and had no input. And the chief of anesthesia is the one who ultimately signs off on privileges. At our institution, this position has significant discretion.

The changes in cardiac credentialling are physician driven everywhere I've seen.

It is the surgeons where I am. They've also told admin there will never be a heart case done with a CRNA, so that discussion never even gets initiated by administration anymore.

 

[Robotic Wis-Hipple]

My own hospital literally shut down its cardiac surgery program for a month because there was a gap between the loss of the last cardiac-credentialed anesthesiologist, and my arrival from fellowship. I'm a swell dude, but I'm not that special. Never mind that we've got a department of 30-something anesthesiologists, including some who did cardiac at other institutions before coming here. There's no reason at all that any one of them couldn't have stepped in and done the cases. Perhaps with a cardiologist stepping into the room to help with the TEE, but it could've been done. If not for the credentialing issue.

Sounds like a pretty good bargaining chip..... with lots of call.

 

[nimbus]

It is the surgeons where I am. They've also told admin there will never be a heart case done with a CRNA, so that discussion never even gets initiated by administration anymore.

That is appropriate. The surgeons should have a voice.