Interesting job outlook perspective

Discussion in 'Anesthesiology' started by DrRobert, Dec 14, 2005.

  1. DrRobert

    DrRobert Day or Night
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    With the increased interest in anesthesiology among medical students these days generally revolving around money and lifestyle issues, I found some recent perspectives to be fairly surprising.

    In speaking with a couple CA-3 residents at a consensus top 10 program in the midwest, I asked how the job search was going. The best example that illustrates my point is the following:

    -> Large city in the midwest within a malpractice friendly state; population of ~3 million; this is the same city that these residents are training in.

    -> There are about 3-4 large private hospitals in this city that dominate the market when it comes to high volume surgery with a well-insured patient population; again, this is in the midwest, where physician salaries are known to be among the highest in the country (along with the south).

    -> The anesthesia groups that staff these hospitals have 40-60 MDAs each.

    -> Each hospital group offers similar packages to incoming MDAs.

    -> Starting salary is $180K/year. It takes three years to make partner, where your salary increases to $260K/year. This is the final number- there are no bonuses, etc.

    -> Vacation is 8 weeks. Benefits are standard with health/dental, 401K, etc.


    This is intersting because it stands in stark contrast to the $300K/year to start with $500K/year as partner figures (with 10-12 weeks vacation) that are commonly thrown around this forum.
     
  2. threepeas

    threepeas Senior Member
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    i am a med student but have a good friend who is an anesthesiologist in the des moine iowa area. they are part of a larger general physicain group (FP, surgeons, etc) and they are making $450K gross not including xyz benefits. i know money isnt supposed to be important, but i wouldnt do anything for nothing, and i would do just about anything for everything. (provided i enjoyed it)
     
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  3. joshua_msu

    joshua_msu Senior Member
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    I wouldn't call Illinois "malpractice friendly" either.
     
  4. fishtolive

    fishtolive Senior Member
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    i find it surprising being from the northeast (a relatively saturated market) where my good friend's brother just graduated nyu's program and got a job in conn. making 275k his first year, 6 weeks vaca. and partner in 2 years where salary goes to 400k. plus he's in a productivity based practice where he cleans up by taking calls for the senior partners. he seems happy from what i gather.
     
  5. bullard

    bullard Senior Member
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    I hear the market is tight in Chicago (if that's where we're talking about). The suburbs are a whole different ballgame.
     
  6. DrRobert

    DrRobert Day or Night
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    The city in question is St. Louis, MO
     
  7. Noyac

    Noyac ASA Member
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    Dr Robert, I think your numbers are more the norm than the others that are thrown around here. We all have stories of people getting those high income jobs and I think anything over 200K is high income (in general ) but the reality is that those jobs are few and becoming fewer. I joined a group right out of residency who's parnters were making over 650K and they required 3 yrs to partnership. By the time I was close to becoming a partner, they were below 400K (still great $$$). The point is that these jobs are few and if they haven't started to come down to earth, they will soon. The ones that are still making this type of money are also making it off of the new grads joining the group in most cases.
     
  8. jetproppilot

    jetproppilot Turboprop Driver
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    You've proved several points I've made in previous posts with your post:

    1) You spoke to residents at a consensus top 10 program... ...

    300+ jobs (starting) are out there...and you dont have to be from a top ten residency to get them.

    2) Anesthesia physician compensation is very variable, and depends on where you live.

    3)Typically (not always), superior physician salaries reside in smaller towns.

    The figures of 300K to start and 500K partner stats have been made with the above in mind. They have not been thrown around as you suggested.

    Wanna live where most people dont?

    Youre gonna make more cash.

    Wanna live where every else wants to live?

    Youre gonna make less cash.

    Pretty simple.

    If youre looking for cash, and you're burdened with debt, think of it as a military assignment, and search for the highest paying jobs regardless of location, and you'll find the numbers that are thrown around on this forum.
     
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  9. mountaindew2006

    mountaindew2006 Senior Member
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    Well...it goes back to the "FIGHT FOR THE PROFESSION" thread.

    of course guys like MilMD will say what they want about CRNAs etc. The fact of the matter is that now w/ the INCREASE in CRNA use the need for MDs is lower. I mean why pay a MD 300K when you can get away w/ 100K paying a CRNA? Simple supply and demand folks.

    Once again, this is why it's important to bring up the CRNA issue. The 'older' Anesthesiologists are willing to sell out the profession to CRNAs because they've made their loot. In fact theyre making more loot off of the CRNAs. The need to maintain the profession for future generations of anesthesiologists is not their top priority. It's simple..they want to line their pockets.

    It's unfortunate. THIS IS why its imperative for us YOUNG guys going into/starting anesthesiology to really step up.
     
  10. DrRobert

    DrRobert Day or Night
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    Points very well taken. I added the detail about the top 10 program just to solidify the point that this is a program that produces well-respected anesthesiologists. And it is particularly respected within its region.

    I was a little surprised with these figures because St. Louis really isn't a desirable place to live. People aren't exactly flocking to the city. The cost of living is dirt cheap, which is a marker for how desirable a location is. Also, with the passage of tort reform in Missouri, it is also a malpractice friendly environment. Combine all of this with the fact that the midwest is home to some of the highest salaries in the country (again, this is based on desirability).

    So on the surface it would seem to be a utopian place to practice; however, with regards to money it is clearly not.

    I can only imagine what the figures look like in desirable locations like the coasts.
     
  11. jetproppilot

    jetproppilot Turboprop Driver
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    You are very, very wrong, Dude.

    You are implying that us around-40-year-old anesthesiologists working in a team-approach practice have "sold out" the profession.

    You are showing how naive you are about this business.

    First of all, physician salaries are based on location more than anything else, not "older" anesthesiologists selling out the profession.

    Second, there arent enough anesthesiologists on this planet to occupy every needed anesthesia site in the US. SO, whats your solution, Slim?

    Your fantasy-lined aspirations of anesthesia being provided by MDs only is not realistic.

    And for the record, I have no desire to sell out the profession in order to line my pockets. I've got 10 years left in this business, and doing so would be cutting my own throat.

    I do not believe that CRNAs working autonomously is in the best interest of the patient.

    I do believe that the team approach is the best model, both patient-care wise and efficiency wise.

    In this efficiency-driven market, an all-MD model cannot hold a candle to a team-approach model.

    I do not envy my MD colleagues who are on their own for case after case. Yes, it sounds good ego-wise, and works well most of the time.

    But when the chips are down, and youve got a crashing patient for whatever reason (bad airway, blood loss, etc),

    TWO ANESTHESIA PROFESSIONALS ARE BETTER THAN ONE.

    Most all-MD models do not have a "float" MD who is immediately available to lend a hand in a true emergency. EVERY SINGLE team-approach model has a trained hand available for true emergencies.

    Ever been in a catastrophic emergency, all by yourself, with a patient who is about to bite it, Slim?

    Its a very, very lonely place.

    The MD/CRNA (or AA, jwk) model rules.
     
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  12. toughlife

    toughlife Resident
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    Man, there goes my aston martin.
     
  13. mountaindew2006

    mountaindew2006 Senior Member
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    if you havent noticed or there was a glitch on your screen...my screename on here is MOUNTAINDEW2006....as to "slim" ....I'm not certain of who you keep referring to .

    At any rate. Yes, anesthesiologists wotn want to work in PODUNK USA currently. But...if you havent noticed...there is a RISE in the applicant pool for anesthesiologists this year. I will be surprised if I see more than 10 unfilled spots this year (if that).

    Having said that...you are deeply incorrect in saying that Anesthesiologists will not want to work in places like PODUNK in the future.

    Do i think CRNAs can be helpful? Perhaps. Do I think they are equal to anesthesiologists liek many of the CRNAs have argued on this forum...HELL NO.

    Are you guys selling out the profession? Welll.....let's take Anesthesiologist "A" that must now go to PODUNK to practice in order to pay of his med school debts, buy a decent home in a decent area so that his wife, 3 kids (who are going to be college bound..required $$ these days ya know) are safe, he has a decent car, has to pay bills, pay malpractice,etc can pay these things off in a reasonable time must now go to PODUNK to make that $250-300K which you stated in an earlier post you will not work under (actually you said you wouldnt want to work under 300K) for. Is that fair? while CRNA "B" can just go to mainstream city USA and mk anywhere b/w 150-200 (esp if they work double), get the autonomy, etc.


    Why not hire that MD into your practice instead of having that CRNA? oh wait you're concerned about making YOUR ends meet now arent yoU? Cheaper to hire a CRNA right? OH by the way , not to mention you are indirectly helping to empower teh CRNA so that he/she can go their nearby lobby group to ask for even MORE.

    Wake up man. Serisouly, wake up.
     
  14. jetproppilot

    jetproppilot Turboprop Driver
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    Dude, where the f uck are you coming from?

    Reread my posts. There is no post that supports CRNAs working autonomously.

    I've been in this business almost ten years...and, contrary to your assumptions, I actually THOUGHT EXACTLY how you are thinking right now. And initially, I was aimed to an all-MD practice. That didnt work out, and I ended up in a team practice. And I quickly learned the benefits of same.

    I respect your perserverance.

    What I dont respect is your continuous propeganda on a subject you are not versed on.

    Again, there arent enough MDs to cover all anesthetizing sites, so we need paraprofessionals.

    And it turns out, in my opinion, that the team approach is better, both patient-safety wise and economical wise.

    And you havent responded to my TWO ANESTHESIA PERSONELL ARE BETTER THAN ONE POST.

    Whats your take on that?

    How many MD-ONLY practices have a float-MD to lend a hand in a true emergency?

    I worked in PODUNCT USA for 7.5 years. This specialty has seen rises-and-falls of residency applicants over the last 20 years. And despite the rises and falls, there are still many, many rural areas that continue underserved. SO, again, your posts are incorrect. Just because there is a current rise in applicants does not mean the rural areas will be teamed with anesthesiologists.

    Take the personal slashes out of your posts, Slim.

    I only fire when fired upon. You need to do the same.
     
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  15. militarymd

    militarymd SDN Angel
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    Slim,

    The vast majority of the CRNAs that I know about are NOT hired by the anesthesiologists. I don't hire CRNAS!!!

    My CRNAs are hospital employees, just like the OR circulators.

    slim, do you want that list of hospitals that I've been offerring???? They are looking for MDs to supervise their CRNAs....most of the patients won't have teeth...or just 1 or 2...

    Can't guarantee good pay either, but you WILL be putting your money where mouth is and start taking away CRNA autonomy.
     
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  16. mountaindew2006

    mountaindew2006 Senior Member
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    Slick x 2

    first of all....your spacing and covert swearing is quite unprofessional. Cut it out bud. you are being quite hypocritical here when you state that you are not taking things personal when clearly you are swearing, and 'firing' upon. let me repeat....SLICK, cut it out. C

    My take on TWO ANESTHESIA personel. I thought it was quite obvious...you are absolutely correct...two anesthesia personel are better then one, especially if it's TWO ANESTHESIOLOGISTS.

    if you really were thinking how I was thinkign back int he day, why dont you empathize? you can certainly see that NOW, more CRNAs are empowered then they once were in your day. It's quite evident. Doctors were much more respected in 'your' day then they are now. Put yourself in the shoes of YOUNG BUDDING anesthesiologists. All jokign aside, really try it. Think of the outlook. As stated earlier, we have MANY MANY more expenses nowadays. Many things to pay off.

    and Slick #2....as stated I dont need the podunct lists. i can google. but if you think that will mk me feel better or if you want to 'prove' a point, post them on here or PM me..whatever you prefer.
     
  17. DrRobert

    DrRobert Day or Night
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    oh no. what happened to my thread?
     
  18. militarymd

    militarymd SDN Angel
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    So will you be putting your money where your mouth is and do something about all these independent CRNAs?
     
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  19. mountaindew2006

    mountaindew2006 Senior Member
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    as soon as you put your money where your mouth is and work for free IN THE CIVILIAN sector because apparently money isnt an issue for you.
     
  20. jetproppilot

    jetproppilot Turboprop Driver
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    Again, your posts are wrong, Dude.

    I'm not that old. Maybe a generation ahead of yourself, but thats about it.

    I've never enjoyed the "doctor respecting" years, as you put it.

    And for all that are reading this, when I emerged from residency in 1996,

    THE SAME CONVERSATIONS WERE TAKING PLACE.

    "OH MY GOD, THE CRNAs ARE GONNA TAKE OUR JOBS!!!!"

    I'm living proof of the contrary.

    And, Slim, you dont like my posting style?

    I could give a s hit less.

    As MilMD previously said, trolls will come and go.
     
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  21. militarymd

    militarymd SDN Angel
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    Now that is just being silly and obnoxious.

    You are concerned about making more money and "not letting CRNAs drive down salaries" ....those are your words.

    I'm concerned about running an OR....and you translate that into working for free????

    You must be a democrat....you can't win an arguement based on facts, so you resort to emotional grandstanding.
     
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  22. jetproppilot

    jetproppilot Turboprop Driver
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    Geez, Slim, you dont know when to stop, huh?

    Are you looking for sympathy with your "WE HAVE MANY MANY EXPENSES TO PAY OFF NOWADAYS." ?????

    I emerged with 200K in student loan debt. I also had MANY THINGS TO PAY OFF, as you put it.

    Dude, your cries for empathy is falling on deaf ears. The women's stretching class is on the third floor, third door on the left.
     
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  23. mountaindew2006

    mountaindew2006 Senior Member
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    see next post of mine
     
  24. MedicinePowder

    MedicinePowder Senior Member
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    Seems like that practice isn't very efficient. Even in California, the market pays significantly better than 180,000/year out of residency.
     
  25. mountaindew2006

    mountaindew2006 Senior Member
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    sorry not a democrat.

    your words summed up were, "I'm not worried about money" (see other thread). so which is it? are you concerned about money or not? will you work for free or not?

    also thing about "trolling'. Slick #1...i've been onthis forum WAAAAAAAAAAAAAAY longer than you were. If i were trolling woulda been LONG gone.
     
  26. jetproppilot

    jetproppilot Turboprop Driver
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    Know what? Militant people (regardless of group) are bad for everybody. And from what I've seen, Slim, you are militant.

    I'll hire non-militant CRNAs (AAs) on a list a mile long before I'd consider you.

    Wait, I wouldnt even consider you.

    And yeah, even before you hit the reply button, I know what youre gonna post.

    Your post doesnt matter.

    I just wanna go to work, HAVE ALL ANESTHETIZING SITES COVERED (which, by the way Slim, your model, no matter how vivacious you are, is irrational), get the work done, and go home.
     
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  27. mountaindew2006

    mountaindew2006 Senior Member
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  28. Noyac

    Noyac ASA Member
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  29. Noyac

    Noyac ASA Member
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  30. jetproppilot

    jetproppilot Turboprop Driver
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  31. jetproppilot

    jetproppilot Turboprop Driver
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  32. Noyac

    Noyac ASA Member
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  33. fishtolive

    fishtolive Senior Member
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    :laugh: :laugh: :thumbup:
     
  34. davvid2700

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    hey im coming back from being on "ban" for a week for my fight with nitecap. if that guy comes back on here talking smack Im turning his posts in to baylor college of medicine department of anesthesiology (attention head CRNA).


    Im really busy tonite setting my record button for sterns last show tomorrow morning but just glancing at this thread I wanna add a few things and get back to y'all tomorow.

    I do my own cases. If i have an issue or an emergency the surgeon helps me, the anesthesia tech( awesome), and the nurses. My colleagues have no problems ducking out of a stable case to help me. We dont have a float, we dont need one. I have been in true emergencies by myself and have asked for my colleagues to help and they have. and vice versa. you dont have to envy me. I like what i do. I have a great relationship with the surgeons and nurses etc.

    I think military is lazy thats why he doesnt wanna do his own cases.. Its more work and its a pain for him. All this "doesnt make financial sense" is all hogwash. ANy one who knows the business,"knows" why he doesnt like to do his own cases day in and day out. MIlitary MD is "LAZY". Surprising because i thought asians were supposed to be hardworking. Doesnt fit the typical stereotype. Ill probably get another week "ban" out with that comment.

    see yall in a week if i get the BAN.
     
  35. mountaindew2006

    mountaindew2006 Senior Member
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    nice to see a REAL anesthesiologist back.
     
  36. heartICU

    heartICU Member
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    So your colleagues will leave an anesthetized patient alone in another room to come help you when you have a problem? Doesn't that go against the whole vigilance thing we pride ourselves on?
     
  37. militarymd

    militarymd SDN Angel
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    As I mentioned before, the team approach is the way to go. I've done it both ways....If I were lazy, I would park my ass in a room.

    When I get sick or don't feel well at my current job, I schedule myself in a room because it allows me to have an easy day on my butt.
     
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  38. zippy2u

    zippy2u Senior Member
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    David, so you're workin' with an orthopod and you're in the OR doing a case. The next case is a shoulder and he wants an interscalene with general and pt needs a central line due to poor IV access. The OR techs are settin' up another room to do this case. When ya going to put the central line in and do the interscalene? How long between cases? With team approach, I got the central line in and interscalene. Pt is asleep, prepped and positioned in other room ready to rock and roll while the CRNA is waking up the pt you're working on now. It's impossible to beat my times unless you have that MD "floater". That MD floater will make the same as you as each individual rotates in the floater spot. Your reimbursements probably will not be high enough to pay for the floater spot. Regards, ---Zip
     
  39. rn29306

    rn29306 Drugs are bad, m'kay?
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    Thanks for defining "patient abadonment" for me. You are a moron for leaving an anesthetized patient at any point. Who are you going to say in court was watching the patient? An OR nurse or the tech? That's laughable at best. Just sign a blank check bro.
     
  40. rn29306

    rn29306 Drugs are bad, m'kay?
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    You are such a tool. How about someone sends a link to your insurance carrier (attention mr insurance rep) just for posting something as stupid as what you describe above. Its a public board, don't make it personal.
     
  41. Noyac

    Noyac ASA Member
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    While I don't agree with abandoning a pt (at all), there are times when it is warranted. Those are times when you can save a life. Whether it is an airway issue, CV issue, or a serious case a diarrhea. :eek: You try to minimize the time away from the stable pt. For instance, I have had to go to another room to take over an airway while the provider of that room runs to my room were my pt is stable and asleep. Time away from the pt was minimal. I have not had to do this in my current (all MD practice) but I had to frequently in the team model, even with floaters, who were busy at the time. It is not ideal but it happens. I am not going to sit in my room while the pt next door dies just because I won't leave my pt. who is stable. What if the pt is under a block and wide awake? Is this still abandonment? Who cares, you gotta do the right thing.
    True case. I was on call the other night when I put an ICU pt to sleep for an ex. lap. The OB team runs to the OR without calling (at midnight) for an emergency c/s for abruption (they knew I was in house at the time). I ran next door induced and tubed the OB pt, had the supervisor call the 2nd call guy (takes 20 mins to arrive) placed a 14g PIV cranked the fluids wide open, ran back to the other room were I had the PACU nurse sitting with my ICU pt. Checked on things and ran back to the c/s. I left the doors open so that I could communicate with the PACU RN the whole time. MY partner arrives and is completely shocked at what is going on. I turn over the c/s to him and go to finish the ex lap. The mother, baby and ICU pt all did fine. Now, what would you guys have done?
     
  42. Noyac

    Noyac ASA Member
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    Hey Zip, we have 15 min turn overs and we get or blocks in btw cases with time to spare, for a central line even. Now not everyone can do it but I and a few others can, and its not to difficult. Interscalene takes less than 5mins and central line takes less than 10 mins, routinely.
    Not trying to be an a--hole, but just pointing out that it can be done. But I would much rather have a floater doing it with time to spare.

    PS: David, don't get the idea that I am on your side in this. I agree with some **** you have said but for the most part, you are dreaming. And your attacks are unwarranted.
     
  43. zippy2u

    zippy2u Senior Member
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    Well, I gotcha beat by 15 minutes. My pt. is asleep, prepped and surgeon just needs to start cuttin'. Once CRNA takes pt in other OR to the PACU, he comes and gets me out of the OR so I can repeat process. You will never beat me unless you have the floater. ---Zip
     
  44. zippy2u

    zippy2u Senior Member
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    Noyac, concerning your midnight call, Let the OB team call you and then you tell them to call the 2nd call guy as you are involved in a GA. That 2nd call dude better get his arse to the hospital and be ready to rock and roll within 30 minutes. You DO NOT under any circumstances give GA to 2 pts. Regards, --Zip
     
  45. Noyac

    Noyac ASA Member
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    I agree, I won't beat you with this model. Just pointing out that it can be done.
     
  46. Noyac

    Noyac ASA Member
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    Gonna have to disagree here. We may have lost a baby and even a mother if I hadn't. And I am not making lite of this one. This baby came out blue and we resuscitated it successfully.
    The ball was dropped when the stupid F'in OB brought the pt down without calling b/c he knew I was in the OR. We had a long talk with the a-hole and I guarantee it won't happen again. :mad:
     
  47. ultraconsrvativ

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    CRNAs are not gaining ground. They make occasional ground here and there in certain states but no large gains. Malpractice insurance drives some of how our future works and the insurance companies that insure not only us but the hospitals and CRNAs and surgeons prefer the team approach. Plus hospitals feel more legally secure when they have an MDA supervising so they write policies dictating that MDAs must do certain tasks (technically challeging procedures etc). MDAs are always needed and in demand.
     
  48. zippy2u

    zippy2u Senior Member
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    "WE may have lost..." no, the OB/GYN dude may have lost a baby. You stay put in your room doin' your case. Oh, the OB dude can't wait for the 2nd call guy. Throw em that that bottle of 1% lidocaine and tell em to start gettin' cowboy-- C/S with local. Make sure the dumb phuck OB nurse who wheeled the pt down has a tight grip on the OB dude's balls so they don't smack the ground. My viewpoint is brutal but legally, it does not pay to be a hero in any hospital facility. Regards, ---Zip
     
  49. Monty Python

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    Not to start a subjective debate, but to offer a true "what would you have done?"

    I was on a CABG and they were still harvesting saphenous, still 15-30 minutes before sternotomy. It's 1800, there's no floater, I'm the only CRNA there, and the only anesthesiologist is upstairs putting in a labor epidural. The senior SRNA across the hall is sitting on a trach/PEG placement on an ICU patient who came already intubated. (At this point I had had no involvement with this case - I had started my CABG prior to the trach's arrival).

    The circulator from the trach/PEG burst into my OR, begging me to help as the SRNA's pt had suddenly dropped their SaO2 (and their HR), the surgeon was screaming for anesthesia help, and the SRNA neck deep in alligators.

    I had two seconds to think, and decided to run across the hall based on these criteria:

    -- my patient had been stable as a rock since intubation
    -- the pt had a gallon of vec on board
    -- the perfusionist was already in the OR (reading a book, but there)
    -- there was an extra RN in my room (circulator in training) who I instructed to take my stool, and to immediately fetch me if any vital sign varied by more than 5%.

    I ran across the hall, took 10 seconds to diagnose and treat the airway problem (mainstem ETT), and ran back to my OR.

    Did I abandon my pt? I don't think so .... I didn't just nonchanantly walk away from my responsibilities, and I didn't leave my OR prior to employing a contingency plan. To me, technically, I was still immediately available (albeit now across the hall), with constant communication possible. It's not like I went to the cafeteria without first arranging another pair of eyes for my pt, with a means to contact me.

    We could debate this splitting of hairs for the next decade I agree. If my pt had been unstable, about to be cannulated, go on/off pump, etc, I wouldn't have left him. But I made an educated professional judgement (based on all the unique circumstances of that particular moment) and it was a win/win situation.
     
  50. Monty Python

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    I can't recall which text (Miller, Chestnut perhaps) but one famous author does say anesthesia's sole responsibility is to the mother. Difficult call, though, when the brown stuff is hitting the fan and you're there to see it all.

    Oh, the OB dude can't wait for the 2nd call guy. Throw em that that bottle of 1% lidocaine and tell em to start gettin' cowboy-- C/S with local.


    A little IV versed and ketamine as well, and hopefully there's a good outcome for everyone with minimal distress.
     

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