How to work with CRNA's effectivly

[Med4ever]

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Hello,

I am starting a new job that will be mostly CRNA supervision. My past employment has been in an MD only group. I wanted to know any tips from the Anesthesiologist's out there as well as any CRNA's on how to navigate this relationship in an safe manner for the patient. My concerns are 'encroaching' on a CRNA's autonomy when providing my input; how it will be perceived. I would like to know what techniques in this interpersonal situation have fared well. I don't want to start my new job and ' rock the boat' .

 

[M.Furfur]

.

 

[Mman]

I evaluate the patient and come up with a plan and then go over that with the CRNA. I try not to micromanage little things and let them stay within their comfort zone as long as I feel it is safe. If I feel there way of doing things for this patient isn't acceptable, I let them know.

Every now and then someone will ask me why about something and I explain my reasoning and that seems to satisfy their curiosity.

But for the vast majority of stuff in the OR, it doesn't matter. Sevo or Iso or Des? 99% of the time it doesn't really matter. Want to work in Morphine instead of Hydromorphone at the end of the case? I don't care. Rocuronium vs Vecuronium? Again, I don't care.

I worry about the big things and don't sweat the small stuff and we all seem to get along just fine.

 

[pd4emergence]

my 2 cents

1. Some CRNA's are very good, some are ok, some are dangerous. Figure out early the ones you can trust and which ones you have to hover over. Your new partners can help you with this.

2. Some CRNA's are better at certain anesthetic techniques, if it doesn't make a difference, go with the technique they more comfortable. You will have less headaches later.

3. Everybody has their way of doing things, try not to be overbearing unless you have a strong opinion that your way is going to make a difference in patient care or outcome. This also goes for institutional differences.

4. You will deal with headstrong CRNA's. Some of them are good and some are not. Don't get railroaded into doing something you don't wanna do.

5. Resolve conflicts promptly and face to face. If you are unable to resolve the problem ask your partners how to proceed.

6. Do your own lines and blocks. CRNA's have no business doing these.

7. Supervision or Medical direction is challenging. Your job is not only to keep your patients safe, but also to keep the schedule moving. Keep up with your surgeons, make sure patients are sent for when needed. Do what has to be done to get patient into the or and ready for the case (ie lines, iv's, epidurals). It takes some getting used to. Good Luck.

 

[SleepIsGood]

I think we as a profession need to set the CRNAs straight. Give them a taste of what they have been doing.

1) they are nurses, not doctors, not even residents. Think what would you do if you were supervising a resident? Atleast residents are physicians. For these CRNAs, you should come up with a plan and tell them to adhere to it. If you want sevo or roc or fent....tell them that. They should respect you and adhere to what YOU WANT. it's your license.

2)dont give them 'autonomy'.

3)you do the blocks, and lines, they watch the monitors.

4)They give you lipabout ANYTHING. WRITE THEM UP! (think back to when you were a resident, nurses didnt think twice about ratting you out...)

 

[IlDestriero]

it's your license.

I don't like the sound of this. I look at the kids as MY PATIENTS. Just like on the floor, the nurse, or CRNA, is watching them FOR ME. When something is happening with my patient, their job is to call me so I can determine an appropriate treatment plan.
I make a point not to micromanage as noted above. Lots of people try to micromanage. My days always seem to go much more smoothly.

 

[sevo85288]

Make sure your patients know that you are supervising them. You are the physician and they are the nurse. Also, make sure the surgeons know you and get to know them. It is important for them to see you with patients and taking good care of their patients.

 

[Jay K]

I think we as a profession need to set the CRNAs straight. Give them a taste of what they have been doing.

1) they are nurses, not doctors, not even residents. Think what would you do if you were supervising a resident? Atleast residents are physicians. For these CRNAs, you should come up with a plan and tell them to adhere to it. If you want sevo or roc or fent....tell them that. They should respect you and adhere to what YOU WANT. it's your license.

2)dont give them 'autonomy'.

3)you do the blocks, and lines, they watch the monitors.

4)They give you lipabout ANYTHING. WRITE THEM UP! (think back to when you were a resident, nurses didnt think twice about ratting you out...)

I say you go and encroach on their autonomy and if they don't like it. Fire them!
Time to put an end to all Dr wannabes

Both answers from individuals who haven't tried their hand at private practice with CRNA's. As much as I may, at one point during my training, thought the above would be the case, this will not ever happen "in real life."

It's VERY difficult to fire somebody, even with justification. Individuals file lawsuits. You have to document repeated poor performance, patient endangerment, etc. They'll still file a lawsuit claiming discrimation, unfair treatment, etc. Also, it's not as simple as that in "real life" logistics in keeping your OR running. Suddenly you're short 1 anesthetist - until who knows when. Credentialing new hires takes time. It might be 3 months before you get a replacement. In the meantime your ass/group's ass will be on the line to make sure the OR's continue to run, cases are done, patients are covered and everything continues to work like clockwork. You'll make no friends amongst your own partners (you probably won't even be a partner yet but on the track) if you provide them with more work and headaches.

As others have mentioned, as "the new guy," you are the unknown quantity. Everyone else has longer history, more allies and ties than you do. You show up and try to enforce your will with a "take it or leave it" "my way or the highway" attitude, and the only one hitting the highway will be you. Writing up everything is only going to earn you enemies, and as mentioned, THEY will have more friends than you amongst ancillary staff, other CRNA's, your own partners etc... and they'll all gang up on YOU to get YOU out the door. Your one "writeup," unless warranted due to actual patient harm, will simply result in an avalanche and backlash of ill will shunted your way.

The only place you might get away with such behavior is in academics, although probably not until you've attained some standing; Not to say the same ill will won't be directed towards you.

There's alot of good advice given in above posts from experienced practitioners on working effectively with CRNA's. I agree with all of the comments. Do your own lines, neuraxial and peripheral nerve blocks. Do your own preops and discuss the plan with the CRNA's. If the plan they have or nuances they have in running an anesthetic will not endanger the patient, don't feel that you have to impose a "better" method. If you do have input, place it in a collegial "discussion" format. I ask a lot of "why do you like this method" questions from CRNA's and from time to time will offer my own input backed up by "proof" if I can. If they feel like trying something new, they will. Those times that I "insist" on a certain anesthetic which may be better for patients with significant comorbidities I attempt to win the CRNA over with an effective anesthetic. The more times they see you offer "good input" and technique, the more they'll be likely to try your methods.

Good luck. When I first went looking for a job I was dead set on an MD-only practice, because I thought I wouldn't be able to work with CRNA's in an effective manner. I'll offer this twist to an old adage: "Necessity is the mother of adaptation." You'll adapt.

 

[Mman]

For these CRNAs, you should come up with a plan and tell them to adhere to it. If you want sevo or roc or fent....tell them that. They should respect you and adhere to what YOU WANT. it's your license.

If you try this tactic, I can assure you that they will almost never call you with a question during the case because they will not want to deal with you. You want them on your side so that they are comfortable asking for your help if they are worried about anything.

And when their is a bad outcome because they didn't call you, it is still "your license" on the line.

I strongly suggest letting people do things their usual way as long as it is safe. I guarantee you they can do it their way better than some other way that they've never done before. That's why I make sure I have a good reason for changing their usual recipe and I make myself more available in their OR to help them do it my way if they aren't comfortable with it.

 

[drccw]

I always evaluate the patient myself.
I never dictate the anesthesia plan.
I never let the CRNA dictate the anesthesia plan.

The plan is determined based on a discussion we have. Sometimes I have more input, sometimes the CRNA does. You can't bullhead someone into doing something the way you want, or vice versa. I do definitely tell them when I think something's a bad idea. And, let's face, some of you are too proud to admit it, but on occasion you can learn something from a CRNA. Though to be honest, I can't remember the last time I did....

Working with CRNAs isn't easy; it's definitely more work than working alone. Some are good, some are not, and some are downright dangerous. It's important to know the difference. Ask your colleagues; they'll let you know. Most important you want to be easy to work with; if you're difficult then yeah they won't want to call you or seek your input. So, don't burn any communication bridges; that's the most important thing...

drccw

 

[gaspasser2004]

There are two main keys I think of when working with CRNA's:

1. Pick your battles
Like with my wife in day to day life, I pick my battles with CRNA's. Some issues are way more important than others. Like other posters indicated, many decisions in the operating room don't lead to significantly better or worse outcomes. If a CRNA is going to do something unsafe, you have to speak up. If it is just a preference like the CRNA wants to use morphine instead of fentanyl, then let the CRNA do it. Remember, just as you were a resident once and had to do the "heavy lifting" by sitting in the room all day, the CRNA has to do that too. The CRNA's will work better with you and do a better job if they feel like they are allowed to have some input/decision making and are personally invested in the case.

2. Effective communication
You need to effectively communicate with CRNA's, particularly when there is a disagreement in patient management. For instance, when a CRNA wants to LMA a guy who's NPO but who has been hitting a PCA button all night, I explain the concept of delayed gastric emptying with opioids and how this patient is probably a full stomach. If not contraindicated, I will put an OG tube down after induction to demonstrate this point. CRNA's appreciate MD's taking the effort to communicate the "what" and "why" of what we are thinking instead of saying "Because I said so". A CRNA who feels that there is an honest two way communication is more likely to call you when they have a question and more willing to point out problems.

 

[kmurp]

The advice given above by all of the ATTENDINGS, is excellent and parallels my experience. The medical student and resident have much to learn. I'm thinking from my readings here that the worst situation is to work with CRNAs employed by the hospital. I may be wrong, but my impression is that many of those situations also involve >4:1 ratios.
Our current malpractice carrier won't even cover us at >4:1. I have read that working with hospital employed CRNAs is the most lucrative method of practice: don't know if that's true....

 

[aneftp]

There are two main keys I think of when working with CRNA's:

1. Pick your battles
Like with my wife in day to day life, I pick my battles with CRNA's. Some issues are way more important than others. Like other posters indicated, many decisions in the operating room don't lead to significantly better or worse outcomes. If a CRNA is going to do something unsafe, you have to speak up. If it is just a preference like the CRNA wants to use morphine instead of fentanyl, then let the CRNA do it. Remember, just as you were a resident once and had to do the "heavy lifting" by sitting in the room all day, the CRNA has to do that too. The CRNA's will work better with you and do a better job if they feel like they are allowed to have some input/decision making and are personally invested in the case.

2. Effective communication
You need to effectively communicate with CRNA's, particularly when there is a disagreement in patient management. For instance, when a CRNA wants to LMA a guy who's NPO but who has been hitting a PCA button all night, I explain the concept of delayed gastric emptying with opioids and how this patient is probably a full stomach. If not contraindicated, I will put an OG tube down after induction to demonstrate this point. CRNA's appreciate MD's taking the effort to communicate the "what" and "why" of what we are thinking instead of saying "Because I said so". A CRNA who feels that there is an honest two way communication is more likely to call you when they have a question and more willing to point out problems.

Great advice. That's what I've learned to do since relocating down to Florida. In Washington DC and California, I primarily worked my own cases. In most ways, that's the most simple ways to do things. You are responsible for your own actions.

But in Florida, I am often times in 2:1, 4:1. I have to be on top of things. Some CRNAs in Florida are used to independent practice. I let them have their space but always evaluate the patients myself first. Like the poster said, you pick and choose your battles.

Give little tidbits to the CRNAs here and there. Don't try to micromanage the patients (unless the CRNAs are doing something you are completely against).

Again, communication is key. Tell the CRNAs why you want things done a certain way. The reasoning is the most important part. You will get alone better with them.

I've never had a bad relationship with the CRNAs down in Florida. Maybe because we are on the same page. I work in a private practice surgery center these days as an independent contractor. I tell the CRNAs I got their back and they should have mind too. When I cancel a case, the surgeons will make some sly remarks (remember this is a private surgery center, no cases, means no $$$ for everyone). So the surgeons will try to get the CRNAs to tell them that they would do the case.

Since we are on the same page, the CRNAs always deferred to my medical decisions. And that's the way it should be. Because in a lawsuit, the surgeons are never your friend.

 

[SleepIsGood]

There are two main keys I think of when working with CRNA's:

1. Pick your battles
Like with my wife in day to day life, I pick my battles with CRNA's. Some issues are way more important than others. Like other posters indicated, many decisions in the operating room don't lead to significantly better or worse outcomes. If a CRNA is going to do something unsafe, you have to speak up. If it is just a preference like the CRNA wants to use morphine instead of fentanyl, then let the CRNA do it. Remember, just as you were a resident once and had to do the "heavy lifting" by sitting in the room all day, the CRNA has to do that too. The CRNA's will work better with you and do a better job if they feel like they are allowed to have some input/decision making and are personally invested in the case.
.

Hey I get your point. But the difference is tht the CRNA is getting PAID a TON of money to do this. Residents arent.

If I'm hearing everyone including the OP correctly, it seems like a lot of it has to do with new guy not wanting to 'rock the boat'. That's definitely a tough situation.

The burden should then perhaps be on the 'older' attendings. I understnd that in 'private practice', it's about effiency and making the bottom line.

I urge you attendings though to step back and see wht that has done to damage our profession. Look at what has happened to our profession. Many older guys have used CRNAs to generate revenue while cheapening the profession and giving CRNAs a false sense of entitlement and a false sense that they can do things on their own. These aren't the days of the 90s with that famous wall street journal article scaring people of doomsday. THIS is reality in light of Obamacare.

Attendings. Back up your young physician colleagues..please. If you '*****' out the profession there will be NOTHING left for you all and future generations of anesthesiologists. Think about what YOU would have wanted when you got out. What were YOUR expectations both economically, medically, and financially were. Cultivate the talent of young physicians in your group. You maybe making less with hiring more physicians. On the flip side, you maybe making SIGNIFICANTLY less or not working at all if CRNAs become indepedent practitioners.

It disgusts me when 'older' anesthesiologists sit in their lounges and say: " Gosh I'm so happy that I'm not coming out of residency these days. I made my cash. Sucks for you guys, but you guys deal with it, not my problem." To me this is selfish thinking. These guys dont care. On the other hand, "older' CRNAs are all about cultivating and proliferating their own. I think the older guys that think like this need to rexamine this attitude.

 

[soonerfrog]

I almost didn't respond to this post at least a thousand different times. But indeed, it needs a response, however meaningless.
CLEARLY...Sleep has had more than one bad experience with a CRNA and/or the AANA. We could turn this into that very political argument we all know too well and all equally loathe. We could highlight the transgressions that have been made on both sides but we all know what good that will ultimately serve. Rather, I'll simply stay on point and address the general sentiment here which is namely, how to supervise CRNA's effectively and safely. All reasonable points have been outlined above. Clearly, if it comes down to an MD vs. CRNA battle over the anesthetic plan, the MD will always win. But the question more likely should be, does there even need to be a battle in the first place. I'm genuinely sorry that Sleep has had his perceived world of anesthesia rocked by this whole MD-CRNA enigma. It is INDEED ugly. I would encourage current residents that fortunately, however bitter and sour it may be, this is happily a small sampling of most current ACT practices. Generally speaking,there are a great many examples of CRNA's and MD's working amicably well with one another. In fact, as you may or may not be surprised, there are still a great many of us (CRNA's) happy to work in the confines of the ACT model, perfectly content to provide anesthesia in whatever parameters your feel necessary, and are even MORE happy to be a valued and included component of the plan's formulation and execution. The very essence of what it means to have an ACT model requires this very sort of give and take discussion. I applaud the other attendings that have offered the OP valuable, helpful advice that is both safe and practical. There is a way to find amicable, genuine friendship amongst CRNA's and MD's despite what Sleep would have you believe.

And it's been said here before (ad nauseum no less) but here it is once last (millionth) time. For every bad CRNA out there, likely there is another congruent and analogous MD example. We could argue endlessly over the exact ratios, but the message stays the same: there are good and bad CRNA's and MD's out there. Find out which CRNA's you need to be concerned with and give them extra concern and yes, probably less lattitude. But there are indeed a great many of us who maintain that patient safety ultimately requires an individual that is steadfast in being constantly dedicated to the realm of anesthetic knowledge and entirely committed to the fact that one of the safest and most effective ways to deliver anesthesia is in the care team model. Yes, there are CRNA's that believe this, and NO, we did not all drink Blade's koolaid. Good luck in your future position. I hope it bodes well.

Adieu.

 

[gaspasser2004]

I have often times throughout my career felt insecure about my abilities and future. I remember starting my internal medicine internship and feeling a bit uneasy actually writing my own orders for the first time. I also remember interacting with nurses, especially older experienced ones, who seemed to know so much where I knew so little. It is only a natural defense mechanism to try to "prove" to everyone how bad a_$_$ of a doctor you are when you feel threatened.

During my residency, I had a couple militant CRNA's who worked at my hospital who would regularly approach us residents and straight up tell us how they could do anesthesia as good/better than us and what a travesty it was that they had to be medically directed. That certainly didn't make me feel good about my abilities or my future.

Having been out of residency for almost two years, I have come to realize a couple of things about anesthesia and MD/CRNA interactions.

The first is that there simply aren't enough providers for anesthesia to be provided by either only CRNA's or MD's. There also aren't enough MD's who are willing to go to rural/undesirable areas. I will be the first to admit that I don't want to practice in rural Montana. I also don't expect other physicians to go to rural Montana when I am not willing to do it myself. To their credit, our surgical colleagues have gone where we aren't willing to go. But again, there are not enough MD's to cover all the anesthetics in this country solo.

The second, as soonerfrog so eloquently stated, is that many CRNA's don't want to be independent and are very happy to be in an ACT model. These are the kind of CRNA's that are real "team players" who will do what is asked of them and also point out when you are doing something wrong (none of us are perfect). All these things contribute to great patient care.

I have great respect for with those who strongly believe in an MD only model and I sincerely hope those opportunities will continue to exist for those who want to pursue them. However, when deciding about whether or not you are going to work with CRNA's, I really think that you should take an "all or nothing" approach. If you are going to work with CRNA's, you need to treat them like valuable team members who can do the job they were trained to do. In return, the CRNA's should treat you with respect for your role in leading the anesthetic care team. If your attitude is that you need to put the CRNA's in "their place" or constantly keep them "under your thumb" then perhaps an anesthesia care team model is not the right fit for you.

 

[SleepIsGood]

I have often times throughout my career felt insecure about my abilities and future. I remember starting my internal medicine internship and feeling a bit uneasy actually writing my own orders for the first time. I also remember interacting with nurses, especially older experienced ones, who seemed to know so much where I knew so little. It is only a natural defense mechanism to try to "prove" to everyone how bad a_$_$ of a doctor you are when you feel threatened.

During my residency, I had a couple militant CRNA's who worked at my hospital who would regularly approach us residents and straight up tell us how they could do anesthesia as good/better than us and what a travesty it was that they had to be medically directed. That certainly didn't make me feel good about my abilities or my future.

Having been out of residency for almost two years, I have come to realize a couple of things about anesthesia and MD/CRNA interactions.

The first is that there simply aren't enough providers for anesthesia to be provided by either only CRNA's or MD's. There also aren't enough MD's who are willing to go to rural/undesirable areas. I will be the first to admit that I don't want to practice in rural Montana. I also don't expect other physicians to go to rural Montana when I am not willing to do it myself. To their credit, our surgical colleagues have gone where we aren't willing to go. But again, there are not enough MD's to cover all the anesthetics in this country solo.

The second, as soonerfrog so eloquently stated, is that many CRNA's don't want to be independent and are very happy to be in an ACT model. These are the kind of CRNA's that are real "team players" who will do what is asked of them and also point out when you are doing something wrong (none of us are perfect). All these things contribute to great patient care.

I have great respect for with those who strongly believe in an MD only model and I sincerely hope those opportunities will continue to exist for those who want to pursue them. However, when deciding about whether or not you are going to work with CRNA's, I really think that you should take an "all or nothing" approach. If you are going to work with CRNA's, you need to treat them like valuable team members who can do the job they were trained to do. In return, the CRNA's should treat you with respect for your role in leading the anesthetic care team. If your attitude is that you need to put the CRNA's in "their place" or constantly keep them "under your thumb" then perhaps an anesthesia care team model is not the right fit for you.

I hear you man..The thing is CRNAs don't want to go to Montana either.

Thats their ruse. They say they are there to 'fill the gap'. Well that's how it starts. Then they will/have said, "if we can be independent in Montana, why not in Pennsylvannia or NYC or Chicago or LA?"

See the problem. It's like drawing a line in the sand.

 

[2win]

I hear you man..The thing is CRNAs don't want to go to Montana either.

Thats their ruse. They say they are there to 'fill the gap'. Well that's how it starts. Then they will/have said, "if we can be independent in Montana, why not in Pennsylvannia or NYC or Chicago or LA?"

See the problem. It's like drawing a line in the sand.

The CRNA-s want to go to Montana - BUT the good places have NO CRNA-S... See Missoula.

 

[IlDestriero]

I urge you attendings though to step back and see wht that has done to damage our profession. Look at what has happened to our profession. Many older guys have used CRNAs to generate revenue while cheapening the profession and giving CRNAs a false sense of entitlement and a false sense that they can do things on their own. These aren't the days of the 90s with that famous wall street journal article scaring people of doomsday. THIS is reality in light of Obamacare.

Attendings. Back up your young physician colleagues..please. If you '*****' out the profession there will be NOTHING left for you all and future generations of anesthesiologists. Think about what YOU would have wanted when you got out. What were YOUR expectations both economically, medically, and financially were. Cultivate the talent of young physicians in your group. You maybe making less with hiring more physicians. On the flip side, you maybe making SIGNIFICANTLY less or not working at all if CRNAs become indepedent practitioners.

It disgusts me when 'older' anesthesiologists sit in their lounges and say: " Gosh I'm so happy that I'm not coming out of residency these days. I made my cash. Sucks for you guys, but you guys deal with it, not my problem." To me this is selfish thinking. These guys dont care. On the other hand, "older' CRNAs are all about cultivating and proliferating their own. I think the older guys that think like this need to rexamine this attitude.

Sleep et al.,
I understand what you are saying, BUT the cat's out of the bag.
In the 90's 2 things were happening. The partners were making HUGE $$$ and paying the new guys NADA. That was because there was a fear that there were too many anesthesiologists. The new guys were happy to get a job. They got 125 and billed 500, and the partners bought yachts. The CRNAs didn't care about saturation, or making $125K, they just wanted part of the market.
Than, everything changed. There are now more and more ASCs, clinics, etc. All needed providers. They are still increasing in numbers. There is no way they can be filled by MDs even if we wanted to. The future is clear. Supervision. The solo MD practice is on life support starting this year. It's only a matter of time. CRNAs will probably be independent everywhere eventually, but that does NOT mean that they will be at your hospital in your lifetime. If we get lucky, there will be some MORE data suggesting that the ACT model is safer. We all know bad CRNAs, so it's just a matter of time. Of course, bad outcomes don't exactly make the journals every day...
As an attending at an academic center, I can assure you that you will always be relieving CRNAs. It costs too much to keep them there for overtime. It's that simple, $$. They ARE also more difficult to replace than you, so do yourself a favor and ignore them. They are separate, and you should just accept that. You're there for one thing, to learn. You seem REALLY bitter about the CRNA issue, that WILL bite you in the ass if you're not careful, especially if you find yourself supervising in a couple of years.
I'm ALL for limiting their practice, etc. But groups are NEVER going to hire extra MDs when they can be using CRNAs. It's only going to get worse.
P.S. I don't train them, at least that's something.
P.P.S. If ANY CRNA or SRNA really says something to you about being able to do your job, being equal to you, etc. Tell the CHAIR! That's unprofessional and counterproductive and BAD FOR THE DEPARTMENT. I would be happy to hand them their ASS for breakfast, for quite some time.

 

[SleepIsGood]

Sleep et al.,
I understand what you are saying, BUT the cat's out of the bag.
In the 90's 2 things were happening. The partners were making HUGE $$$ and paying the new guys NADA. That was because there was a fear that there were too many anesthesiologists. The new guys were happy to get a job. They got 125 and billed 500, and the partners bought yachts. The CRNAs didn't care about saturation, or making $125K, they just wanted part of the market.
Than, everything changed. There are now more and more ASCs, clinics, etc. All needed providers. They are still increasing in numbers. There is no way they can be filled by MDs even if we wanted to. The future is clear. Supervision. The solo MD practice is on life support starting this year. It's only a matter of time. CRNAs will probably be independent everywhere eventually, but that does NOT mean that they will be at your hospital in your lifetime. If we get lucky, there will be some MORE data suggesting that the ACT model is safer. We all know bad CRNAs, so it's just a matter of time. Of course, bad outcomes don't exactly make the journals every day...
As an attending at an academic center, I can assure you that you will always be relieving CRNAs. It costs too much to keep them there for overtime. It's that simple, $$. They ARE also more difficult to replace than you, so do yourself a favor and ignore them. They are separate, and you should just accept that. You're there for one thing, to learn. You seem REALLY bitter about the CRNA issue, that WILL bite you in the ass if you're not careful, especially if you find yourself supervising in a couple of years.
I'm ALL for limiting their practice, etc. But groups are NEVER going to hire extra MDs when they can be using CRNAs. It's only going to get worse.
P.S. I don't train them, at least that's something.
P.P.S. If ANY CRNA or SRNA really says something to you about being able to do your job, being equal to you, etc. Tell the CHAIR! That's unprofessional and counterproductive and BAD FOR THE DEPARTMENT. I would be happy to hand them their ASS for breakfast, for quite some time.

Nice post.

Quick q. Why cant they just be salaried? Meaning they are there until the 'job is done'? This way no overtime has to be paid.

I believe perfusionists are paid in that manner.

 

[IlDestriero]

Nice post.

Quick q. Why cant they just be salaried? Meaning they are there until the 'job is done'? This way no overtime has to be paid.

I believe perfusionists are paid in that manner.

They're nurses first. Nurses are shift workers. Where I am, they are often done BEFORE their shift ends (outside of the summer) and we use them to take care of inpatient preops so the residents/fellows don't have to do them later.

 

[Jay K]

I'd just like to point out there's nothing wrong with Montana; If I could go to work and then fly fish moments from home at the drop of a hat, go kayaking, hiking, camping, etc... I'd be quite content. Southern Illinois, San Joaquin Valley, rural Nevada... THAT is BFE... Okay, had to get that off my chest. 😉

 

[JadamR15]

Nice post.

Quick q. Why cant they just be salaried? Meaning they are there until the 'job is done'? This way no overtime has to be paid.

I believe perfusionists are paid in that manner.

In many places, CRNAs are salaried, and don't leave until 'the job is done'.

 

[Consigliere]

In many places, CRNAs are salaried, and don't leave until 'the job is done'.

Where? I am not aware of any.

 

[IlDestriero]

Where? I am not aware of any.

Out where they're working independently without supervision!

 

[chocomorsel]

I'd just like to point out there's nothing wrong with Montana; If I could go to work and then fly fish moments from home at the drop of a hat, go kayaking, hiking, camping, etc... I'd be quite content. Southern Illinois, San Joaquin Valley, rural Nevada... THAT is BFE... Okay, had to get that off my chest. 😉

Hell I was thinking the same thing. If it wasn't cold as ****, and if there were more ethnic minorities, I certainly wouldn't mind practicing there. I have no problems with the rural communities as long as there's a nice percentage of black folk around. Somewhere like 7% for me so I'm not always the loner around.

 

[Consigliere]

Out where they're working independently without supervision!

Nice!

 

[pgg]

I'd just like to point out there's nothing wrong with Montana; If I could go to work and then fly fish moments from home at the drop of a hat, go kayaking, hiking, camping, etc... I'd be quite content. Southern Illinois, San Joaquin Valley, rural Nevada... THAT is BFE... Okay, had to get that off my chest. 😉

Yes, yes it is. 🙂

It's funny because I may leave the San Joaquin valley to go to Montana or Idaho or Wyoming ... if I can get over all that cold white stuff that covers those places in the winter. This place may be BFE but at least it's warm.