How much time do you spend supervising CRNAs?

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What percentage of your time is spent supervising CRNAs?

  • 1) 100% - I never do solo anesthesia care

    Votes: 4 12.5%

  • 2) 90% (or greater) - I may RARELY get my own room or day-cover OB by myself, etc

    Votes: 7 21.9%

  • 3) 70-90% - mostly CRNA supervision, but challenging cases or requests go to me solo

    Votes: 1 3.1%

  • 4) 50-70% - equally distributed with a fair amount of solo work

    Votes: 3 9.4%

  • 5) 20-50% - we have more docs than nurses, so I do a lot of solo cases

    Votes: 3 9.4%

  • 6) <20% - mostly docs, our CRNAs have a limited role and mostly serve endo/off-site

    Votes: 5 15.6%

  • 7) 0% - I am part of a physician-only practice

    Votes: 9 28.1%
  • Total voters
    32
  • Poll closed .
BuzzPhreed

BuzzPhreed

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I'm interested to know what your practice patterns are and, if you're interested, a general region you're practicing in such as the northeast, midwest, south, etc. in your comments if you're interested in sharing.

To come up with a percentage take a typical two-week period and average the amount of time you spend covering CRNAs. For example, if it's M-F x 2 and you only get one day by yourself in that timeframe, that's 90% (or greater). If you get 2-3 days, that's 70-90%. You get the idea.

Don't include your call duties. Just regular day duties.

Interested to hear. I'm at about 30%. Mid-Atlantic.
 
I'd guess I'm maybe 40-50% supervising residents, 40-50% solo, the rest being a consultant/helper/fireman for CRNAs. This is at a military teaching hospital.

CRNAs mostly get ASA 1-2s here and mostly do those cases independently; for 3+ they're required to consult with an anesthesiologist, who then can choose what level of involvement is needed to plan/conduct the anesthetic.

We're about 3:2 physician:CRNA and about 3:1 physician:resident ... so when we have residents it's always 1:1 and we have a lot of solo days as well.
 
pgg said:
I'd guess I'm maybe 40-50% supervising residents, 40-50% solo, the rest being a consultant/helper/fireman for CRNAs. This is at a military teaching hospital.

CRNAs mostly get ASA 1-2s here and mostly do those cases independently; for 3+ they're required to consult with an anesthesiologist, who then can choose what level of involvement is needed to plan/conduct the anesthetic.

We're about 3:2 physician:CRNA and about 3:1 physician:resident ... so when we have residents it's always 1:1 and we have a lot of solo days as well.
Click to expand...
Is this how the VA model works for anesthesiologists? Do you like it?
 
That was an active military base, though, not a VA. Btw, that's the side-effect of sovereign immunity from malpractice and every other kind of lawsuit.
 
Baller MD said:
Is this how the VA model works for anesthesiologists? Do you like it?
Click to expand...
Not sure how the VA works in general, though I do know there's a lot of variability between different VA hospitals.

I'm basically satisfied with the arrangement here. If you accept that "independent" CRNA practice exists and is here to stay, this is probably the most personally satisfying model for an anesthesiologist. The optimal arrangement for patient outcomes is going to be 100% directed/supervised ... but that just isn't in the cards long term. And, I don't particularly like that kind of work, and I definitely don't like being liable for what other people do. This way, they do their cases, subject to scheduling triage by an anesthesiologist, and I do my cases.



BuzzPhreed said:
I think the military, in general, is an "all bets are off" with regards to CRNAs. Much to the chagrin of anesthesiologists who work(ed) there.

http://forums.studentdoctor.net/thr...n-i-want-to-hear-from-this-guy-again.1075184/
Click to expand...
MedicalCorpse was an interesting character. This may sound like hairsplitting and rationalization from another guy in the military ... but he was in the Air Force. Each service (Army, Navy, AF) runs their own hospitals, with a couple of sorta-jointly run exceptions. There's good and bad to that. There are some cultural differences, for lack of a better phrase, between the services and the way hospitals get run, particularly when it comes to how much influence the administrators have over medical practice. The AF started making some policy decisions 10-15 years ago that really seem to have created a toxic, bureaucratic, lousy environment. They've gone down this aggressive downsizing/rightsizing path that hasn't been smooth. It ain't all roses on the Navy side, but we're certainly not as f'd up as the AF. This of course is just my personal opinion.


But again, if you're going to work with midlevels, I think the best possible arrangement is one in which you're not responsible at all for anything they do.
 
pgg said:
Not sure how the VA works in general, though I do know there's a lot of variability between different VA hospitals.

I'm basically satisfied with the arrangement here. If you accept that "independent" CRNA practice exists and is here to stay, this is probably the most personally satisfying model for an anesthesiologist. The optimal arrangement for patient outcomes is going to be 100% directed/supervised ... but that just isn't in the cards long term. And, I don't particularly like that kind of work, and I definitely don't like being liable for what other people do. This way, they do their cases, subject to scheduling triage by an anesthesiologist, and I do my cases.




MedicalCorpse was an interesting character. This may sound like hairsplitting and rationalization from another guy in the military ... but he was in the Air Force. Each service (Army, Navy, AF) runs their own hospitals, with a couple of sorta-jointly run exceptions. There's good and bad to that. There are some cultural differences, for lack of a better phrase, between the services and the way hospitals get run, particularly when it comes to how much influence the administrators have over medical practice. The AF started making some policy decisions 10-15 years ago that really seem to have created a toxic, bureaucratic, lousy environment. They've gone down this aggressive downsizing/rightsizing path that hasn't been smooth. It ain't all roses on the Navy side, but we're certainly not as f'd up as the AF. This of course is just my personal opinion.


But again, if you're going to work with midlevels, I think the best possible arrangement is one in which you're not responsible at all for anything they do.
Click to expand...


Seems like in the future all anesthesiology practices will adopt a similar model to the militay model. The pay will probably be similar also. I agree that independent CRNA practice and independent MD practice would likely be a more satisfying environment to work in than the supervision/direction model. Let CRNAs do their own thing and be liable for their own patients and get sued when things go wrong without the bailout or intervention of an MD. I have a feeling things would get really interesting politically if this were to happen. Let the cards fall where they may.
 
My perception is that most CRNAs don't want to work independently (on paper) as employees, only as partners. That's the main problem: they want the benefits, but not the risks. Even if self-employed, working independently, they want an MD to be there to take the fall. Hence many CRNA groups will hire a sucker "MDA" as a "medical director".

As pgg said: the best arrangement is one where you are not responsible for anything the midlevels do. And I would add "in the eyes of the law". Because you might think you are not responsible contractually, or even legally in case of helping out in an anesthesia emergency, but you can be held responsible legally (because you are the "more educated" provider, hence possibly the "captain of the ship"). There is a big difference between rushing to an emergency to lend a helping hand, and being expected to run the emergency in a patient you don't know much about.

Until there is legal precedent about this, I will steer clear of any arrangement involving work with unsupervised (not medically directed) CRNAs.
 
Last edited by a moderator:
pgg said:
But again, if you're going to work with midlevels, I think the best possible arrangement is one in which you're not responsible at all for anything they do.
Click to expand...

Man, I agree with that x1000.
 
My question is about this scenario:

Independent CRNAs working in the same place with MDs. There is an "anesthesia stat" in a CRNA room. The MD goes in, and sees the CRNA directing emergency efforts poorly/incorrectly.
1. Is he responsible if he doesn't take over the direction (just because he's present and "he should have known better")?
2. If he takes over directing the emergency efforts and, despite his best efforts, the outcome is still negative, can he be successfully sued for malpractice? (Because we know he will at least be named.)

I don't want to be in either situation. A group is as strong as its weakest link.
 
My question back is why would an anesthesiologist work in that arrangement in the first place?
 
That's the VA arrangement and the bean counters' dream (CRNAs doing the easy cases independently, MDs doing the complicated ones, solo or with CRNAs). Coming soon to a civilian hospital near us, I bet.
 
FFP said:
That's the VA arrangement and the bean counters' dream (CRNAs doing the easy cases independently, MDs doing the complicated ones, solo or with CRNAs). Coming soon to a civilian hospital near us, I bet.
Click to expand...

This already occurs in some opt out states. I'm actually considering a job in a group like this. I have no problem working with CRNA's. They do their cases independently and I do my own.


I have no interest in being a paperwork monkey. Someone can page anesthesiologist stat overhead all they want, but if you're in a room doing your own case you can't leave and abandon your patient. I probably spend 95% of my time in an OR on average. A care team anesthesiologist probably has a lot more time to be available for stat overhead pages.
 
kazuma said:
This already occurs in some opt out states. I'm actually considering a job in a group like this. I have no problem working with CRNA's. They do their cases independently and I do my own.


I have no interest in being a paperwork monkey. Someone can page anesthesiologist stat overhead all they want, but if you're in a room doing your own case you can't leave and abandon your patient. I probably spend 95% of my time in an OR on average. A care team anesthesiologist probably has a lot more time to be available for stat overhead pages.
Click to expand...
You might be the one anesthesiologist out and available between cases. Working solo does not protect you from being called to rescue a CRNA. In that situation, I am curious again who would the court consider "captain of the ship"?

When I was an intern and ran to a code, everybody expected me to run it if I was the only MD in the room.
 
FFP said:
You might be the one anesthesiologist out and available between cases. Working solo does not protect you from being called to rescue a CRNA.
Click to expand...

I agree, but it's much less likely if you're doing your own cases. I'd prefer this arrangement over running 4 rooms of "independent" practitioners.
 
I'm 80% solo. And 20% supervising Crna 1:1 so as to be available for epidurals and other fires around the hospital. Midwest.


Sent from my iPad using Tapatalk
 
you can also count on "case discussed with Dr. Kazuma preoperatively" to be written on the anesthetic record for every non routine case curbside consult to dilute out liability.
 
2/3 direction and 1/3 solo.
 
Interesting split in the poll so far.

About 37% are predominately CRNA-driven practices. And 43% are primarily physician driven. Not what I would've expected.

Next poll coming... how many do you regularly supervise?
 
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