Difference in residency training between SRNAs and MDs?

[Arch Guillotti]

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

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

Where?

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[chocomorsel]

Where?

I would be interested in knowing as well. Wow.

 

[aneftp]

Where?

South. Deep South. Alabama.

 

[Man o War]

South. Deep South. Alabama.

Which hospital? I've never heard of anything this absurd.

 

[Psai]

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

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

Are they hiring?

 

[aneftp]

They also have crna only practices in Oregon, North Carolina that'

Which hospital? I've never heard of anything this absurd.

there are more than you know. Oregon, North Carolina, South Carolina. The USA is very large country and many semi "rural" areas population size 20k-100k.

Remember Crna's can practice "independently" in all states. It just comes down to hospital by laws. Cause surgeons can just sign off on all the paperwork regardless of "supervision" rules.

 

[Man o War]

They also have crna only practices in Oregon, North Carolina that'

there are more than you know. Oregon, North Carolina, South Carolina. The USA is very large country and many semi "rural" areas population size 20k-100k.

Remember Crna's can practice "independently" in all states. It just comes down to hospital by laws. Cause surgeons can just sign off on all the paperwork regardless of "supervision" rules.

Yes, I know all that.
What I want to know is which specific hospital is allowing CRNAs to do those cardiac cases independently and paying them 450k with 10 weeks off.
That's a better deal than some fellowship trained docs get who don't need a cardiologist to hand hold them through the case.
I feel like this may be one of those urban legends that gets passed around.

 

[deleted126335]

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

Probably a good reason that some of them didn't step up.

They also have crna only practices in Oregon, North Carolina that'

there are more than you know. Oregon, North Carolina, South Carolina. The USA is very large country and many semi "rural" areas population size 20k-100k.

Remember Crna's can practice "independently" in all states. It just comes down to hospital by laws. Cause surgeons can just sign off on all the paperwork regardless of "supervision" rules.

Not sure what the quotes mean. But In more than one state, CRNAs have to be supervised by a physician, dentist, or podiatrist as a matter of state law. That physician need not be an anesthesiologist. As you mentioned, Hospital bylaws and exclusive contracts are other "barriers" to independent practice of the carinas. I have practiced at more than one hospital where in order for a physician to supervise a midlevel, they must be credentialed in the procedure that they are supervising. So unless the surgeon has privileges in Anesthesiology, they can't supervise.

 

[epidural man]

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.

This is the second or third time I remember reading about the Dunning-kruger curve. It fascinates me every time (and I keep forgetting about it) -

So thanks for mentioning it again.

so fascinating.....

 

[epidural man]

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.

What is the difference?

None really. Duh....

 

[BLADEMDA]

 

[BLADEMDA]

 

[Iso4ane]

Honestly, I am definitely guilty of the 'too big for my britches' at times, and have kick myself down a peg every so often to keep myself out of trouble.