How do your programs do it?

[Idiopathic]

---

Members don't see this ad.

Just curious. Im at what I consider to be a moderate to large size training program. We have 35-40 "main" ORs, 4-6 cardiothoracic ORs, 15-18 Peds ORs, 3 GI labs, 2 radiology rooms, occasionally 1 dental room, 10 ambulatory ORs, a VA hospital with 10 ORs, modest delivery numbers (3500 deliveries, 1500 by c-section), a fairly large regional service with 25+ patients on each days census, a chronic pain clinic which sees 100 patients a week and does upwards of 30 procedures weekly, an ambulatory regional service and 4 ICUs that need staffing.

At least 75 ORs that need staffing daily, plus ancillary services.

We have 45 residents in the Ca1-3 classes

There are times when there might be 2 residents in the main OR, leaving >30 rooms that need staffing.

How do you do this without CRNAs (we have probably 70 full time) or SRNAs (we probably see that many each year). Do attendings solo that many cases? Do you find that you miss out on things like extra ICU/regional/OB time because you have to serve the operating rooms?

I feel like we have a good system, people get frustrated because of what they perceive peoples motives are (i.e. the SRNA/CRNA crowd think they are better than/equal to me) but for the most part, its collegial.

Id like to hear what some of the other setups are.

 

[Idiopathic]

109 views and no comments...interesting

 

[sevoflurane]

My residency program was structured very similarly. We used CRNA's and had SRNA's 🙁. More residents though. Overall, it was infrequent for our attendings to run their own rooms, but it did happen from time to time. Sometimes you would have to cover OB and interventional neuroradiology, which was a pain because it was in totally different places. Or... peds MRI day with peds cases going on in the main OR. Generally, the strong/senior residents would be doing off site sick patients ie. congenital heart/funny looking 6mo. old at offsite MRI.

If you have 30 rooms that need staffing, sounds like you need more residents (not CRNA's )

 

[sevoflurane]

Just curious. Im at what I consider to be a moderate to large size training program. We have 35-40 "main" ORs, 4-6 cardiothoracic ORs, 15-18 Peds ORs, 3 GI labs, 2 radiology rooms, occasionally 1 dental room, 10 ambulatory ORs, a VA hospital with 10 ORs, modest delivery numbers (3500 deliveries, 1500 by c-section), a fairly large regional service with 25+ patients on each days census, a chronic pain clinic which sees 100 patients a week and does upwards of 30 procedures weekly, an ambulatory regional service and 4 ICUs that need staffing.

At least 75 ORs that need staffing daily, plus ancillary services.

We have 45 residents in the Ca1-3 classes

There are times when there might be 2 residents in the main OR, leaving >30 rooms that need staffing.

How do you do this without CRNAs (we have probably 70 full time) or SRNAs (we probably see that many each year). Do attendings solo that many cases? Do you find that you miss out on things like extra ICU/regional/OB time because you have to serve the operating rooms?

I feel like we have a good system, people get frustrated because of what they perceive peoples motives are (i.e. the SRNA/CRNA crowd think they are better than/equal to me) but for the most part, its collegial.

Id like to hear what some of the other setups are.

Sounds like you need to let some go.

 

[IlDestriero]

Just curious. Im at what I consider to be a moderate to large size training program. We have 35-40 "main" ORs, 4-6 cardiothoracic ORs, 15-18 Peds ORs, 3 GI labs, 2 radiology rooms, occasionally 1 dental room, 10 ambulatory ORs, a VA hospital with 10 ORs, modest delivery numbers (3500 deliveries, 1500 by c-section), a fairly large regional service with 25+ patients on each days census, a chronic pain clinic which sees 100 patients a week and does upwards of 30 procedures weekly, an ambulatory regional service and 4 ICUs that need staffing.

At least 75 ORs that need staffing daily, plus ancillary services.

We have 45 residents in the Ca1-3 classes

There are times when there might be 2 residents in the main OR, leaving >30 rooms that need staffing.

How do you do this without CRNAs (we have probably 70 full time) or SRNAs (we probably see that many each year). Do attendings solo that many cases? Do you find that you miss out on things like extra ICU/regional/OB time because you have to serve the operating rooms?

I feel like we have a good system, people get frustrated because of what they perceive peoples motives are (i.e. the SRNA/CRNA crowd think they are better than/equal to me) but for the most part, its collegial.

Id like to hear what some of the other setups are.

I'm at a large Children's hospital. We use crnas, residents and fellows to cover rooms. The GI suite, ASCs, IR and some main OR rooms are direct provider (anesthesiologist only), the others are 1:2. At the end of the day, some of the providers will cover 1:3 to get people out. We don't have any of the CRNA silliness here. What they say behind closed doors I don't know, but there is no independent practice type stuff here. They follow our plan, and someone's there for every intubation and extubation. Disruptive influences would be given the chance to get in line or find another job. We treat them well and pay them fairly, so there's little incentive to cause trouble.

 

[pgg]

My program was relatively small, 6 residents per year. 23 ORs counting the in-house ASC, plus a few remote tasks. At any given time I think there were about 10 residents available for the OR due to out rotations, postcall, OB, busy pain clinic, etc.

We had a SRNA program but they were taught largely by CRNAs, who never supervised residents. Good cases went to residents first. Residents had first dibs on all blocks, though I sometimes got in trouble with CRNAs who tried to bend the rules to divert blocks to SRNAs. That said, it was the military and the CRNAs/SRNAs were being explicitly and deliberately prepared for independent practice. Since they were on an 18-month cycle with some overlap, about half the year we had 2x as many SRNAs, who were largely treated like residents when it came to scheduling.

Attending to resident was always 1:1 even through the CA3 year. They had some own-case days but that was the exception. MD-CRNA relations seemed pretty good for the most part, but since they were being prepared for independence, the shoulder chippiness was excessive and annoying at times. I assume they gave less lip to the the attendings than they gave to their inferiors (residents). Not much I could do as a resident except keep my head down though.

 

[SexPanther]

109 views and no comments...interesting

Maybe if you used apostrophes and correct capitalization, people would comment.

 

[sevoflurane]

Where I trained, the CRNA's/SRNA's put on a big fight to do blocks/epidurals, etc. Our Chair (interested in keeping them for cheap labor) didn't care one way or the other. The rest of us said: you have no business learning PNB's, especially at a residency program where residents need the experience.
The rest of the anesthesiologists united and made it so they were not taught these techniques, but they almost had it.

It amazes me how often our specialty tries to shoot itself in the foot.

 

[SexPanther]

Just curious. Im at what I consider to be a moderate to large size training program. We have 35-40 "main" ORs, 4-6 cardiothoracic ORs, 15-18 Peds ORs, 3 GI labs, 2 radiology rooms, occasionally 1 dental room, 10 ambulatory ORs, a VA hospital with 10 ORs, modest delivery numbers (3500 deliveries, 1500 by c-section), a fairly large regional service with 25+ patients on each days census, a chronic pain clinic which sees 100 patients a week and does upwards of 30 procedures weekly, an ambulatory regional service and 4 ICUs that need staffing.

At least 75 ORs that need staffing daily, plus ancillary services.

We have 45 residents in the Ca1-3 classes

There are times when there might be 2 residents in the main OR, leaving >30 rooms that need staffing.

How do you do this without CRNAs (we have probably 70 full time) or SRNAs (we probably see that many each year). Do attendings solo that many cases? Do you find that you miss out on things like extra ICU/regional/OB time because you have to serve the operating rooms?

I feel like we have a good system, people get frustrated because of what they perceive peoples motives are (i.e. the SRNA/CRNA crowd think they are better than/equal to me) but for the most part, its collegial.

Id like to hear what some of the other setups are.

When in the OR, we (residents) get 1st priority on cases - if we want it, we get it. The issue is that sometimes many of us aren't there b/c of other staffing responsibilities.

We do all the PNBs as part of the Acute Pain Service (some spinals are done in the OR by the primary anesthetic team - attending does it if with a CRNA/SRNA). SRNAs/CRNAs do some epidurals and spinals on OB.

I'd say 95% of our CRNAs are great to work with and want to be part of the ACT model. The other 5% can be militant but its usually passive aggressive or behind your back. We have a lot of SRNAs come through.

I don't foresee an increase in our residency size based on discussions I've had with the PD and former chair. So, what I think idio is getting at is that in our case (and many other cases) physician extenders are necessary to be able to get the work done (the caveat is that this should be under the umbrella of the Anesthesia Care Team with anesthesiologist supervision and not independent practice).

If you don't agree with the above statement, what else would you suggest to be able to provide staffing for everything?

 

[deleted126335]

Where I trained, the CRNA's/SRNA's put on a big fight to do blocks/epidurals, etc. Our Chair (interested in keeping them for cheap labor) didn't care one way or the other. The rest of us said: you have no business learning PNB's, especially at a residency program where residents need the experience.
The rest of the anesthesiologists united and made it so they were not taught these techniques, but they almost had it.

It amazes me how often our specialty tries to shoot itself in the foot.

Path of least resistance. Lack of long term vision. Short term benefit for potential long term loss. It's always nicer to say yes than to say no and avoid conflict. Makes sense from these points of view.

Take your pick.

 

[Southpaw]

Just curious.

Just a hypothetical question, if a surgery department foresaw an increase in demand for their services in a sicker, older population do you think they'd push to add more resident physicians to cover the demand, or hire more NPs?

In our field, we see increased demand and bring on more nurses rather than push for an increase in residency positions. It makes no sense whatsoever. On one hand we say we're needed for optimal patient care in a sicker population, and on the other hand we bring in nurses when forced to act.

My program is very resident dependent. I say this proudly, but unless all programs across the country act in a similar manner I honestly don't think it matters how just a few programs run.

 

[maceo]

www.anesthesiapa.org

 

[Daredevil]

Path of least resistance. Lack of long term vision. Short term benefit for potential long term loss. It's always nicer to say yes than to say no and avoid conflict. Makes sense from these points of view.

Take your pick.

There is a serious lack of leadership in our field.

 

[narcusprince]

SexPanther[/B] ;10030170]When in the OR, we (residents) get 1st priority on cases - if we want it, we get it. The issue is that sometimes many of us aren't there b/c of other staffing responsibilities.

We do all the PNBs as part of the Acute Pain Service (some spinals are done in the OR by the primary anesthetic team - attending does it if with a CRNA/SRNA). SRNAs/CRNAs do some epidurals and spinals on OB.

I'd say 95% of our CRNAs are great to work with and want to be part of the ACT model. The other 5% can be militant but its usually passive aggressive or behind your back. We have a lot of SRNAs come through.

I don't foresee an increase in our residency size based on discussions I've had with the PD and former chair. So, what I think idio is getting at is that in our case (and many other cases) physician extenders are necessary to be able to get the work done (the caveat is that this should be under the umbrella of the Anesthesia Care Team with anesthesiologist supervision and not independent practice).

If you don't agree with the above statement, what else would you suggest to be able to provide staffing for everything?

Something does not sit right with my bolded words. 😱

 

[seamonkey]

My Dept Chair does not believe in using CRNAs. We have maybe 6 or 7 who work in the electrophysiology rooms or our outpatient surgicenter. The rest of everything is all done by residents. We do all the cases. We are the workforce.

 

[Idiopathic]

My Dept Chair does not believe in using CRNAs. We have maybe 6 or 7 who work in the electrophysiology rooms or our outpatient surgicenter. The rest of everything is all done by residents. We do all the cases. We are the workforce.

Well then whats your volume of cases - ORs. Do you like being the service providers or would you rather be freed of some of that grind for a better learning experience?

 

[seamonkey]

We have an enormous case-load. Its frustrating at times because it is extremely rare to be able to leave before 5:30, and often are held later. I definitely wish I could get out of there to go read, and am jealous of my friends who are relieved by CRNAs at 3:30 to go to lectures or even home.


This program provides excellent clinical experience and cases, but pretty much no reading time.

 

[SexPanther]

Something does not sit right with my bolded words. 😱

I'm not sure I follow Narc. He was the chair of our dept. when I had the conversation, he's stepped down but is still faculty here. He remains very involved in education and is a resident and political advocate. I talk to him fairly often.