Military Anesthesiologist pro and con

[CharleyVCU1988]

I am currently a CA-2 resident in my civilian program and we had a Grand Rounds presenter talk to us about bioinformatics - but he also happened to be in the Navy Reserves and had been recently deployed to Kandahar AFB in Afghanistan. I got to talk to him about his experiences and - while definitely intriguing, still leave me with some questions.

He stated that he did all of his own cases while deployed, his active duty partners were in the same situation as he but when they were stateside with ASA 1-2 cases they supervised CRNAs.

My chairman (no military experience) tells me that CRNAs could be my superiors should I enlist as an anesthesiologist. How true is this?

And on that note, anyone else want to chip in about their experiences in military anesthesia?

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[narcusprince]

Dr Ehrenfeld strikes again.......
https://en.m.wikipedia.org/wiki/Jesse_Ehrenfeld

 

[deleted171991]

My chairman (no military experience) tells me that CRNAs could be my superiors should I enlist as an anesthesiologist. How true is this?

Absolutely true. Not only that, but you even have to salute them, per one of my ex-colleagues, who used to be military. Imagine how nice is to "supervise" them.

 

[usma05]

I'd encourage you to check out the military board, a lot of your questions can be answered there. To briefly answer what you've asked here...yes you do have non-medical, nurse, and other specialty physician leadership that sometimes has a poor understanding of what exactly you do (reminiscent of the Bobs from Office Space). Yes, you usually end up doing your own cases while deployed, but it's probably not the "hooah, hooah, bang-bang scenario" most people have in their heads (more Jarhead than Saving Private Ryan). At the current moment, anesthesiologist deployments are hard to come by (as most anesthesia slots over there are CRNAs) so much so I was the only in country anesthesiologist for my branch during my deployment. With the other branches, I think you may add an additional 2 or 3 anesthesiologist in Afghanistan during the time between Bagram, Kabul, and Kandahar. Most of the stuff is routine emergency care with a sprinkling of trauma and other stuff. And yes, depending on where you are in the states it could be supervising crnas (meddacs or small community hospitals), but if you work at a medical center you supervise residents and work solo occasionally...a lot of asa 1/2 with a mix of 3,4, and 5s (trending to healthier patients vs the real world). Experiences may very.

 

[pgg]

We have a military medicine subforum that you should visit. Lots of tacked threads.

http://forums.studentdoctor.net/forums/military-medicine.72/

The practice environment with CRNAs has some nuances that are hard to give justice to a couple paragraphs. They are what I like to call "pseudo-independent" ... while they mostly do their own cases, the schedule is made by an anesthesiologist and cases are triaged appropriately. ASA 1-2 cases they generally do without our supervision or input; ASA 3 they are required to consult us and we lend help as needed, but they are still ultimately responsible.

A CRNA'smilitary rank can exceed any given anesthesiologist's rank but this really is an an administrative / dept structural issue. They don't direct anesthesiologists' medical care. I've never found it to be an issue.

I'm a Navy anesthesiologist. If you have other specific questions I can probably answer them.

 

[pgg]

Absolutely true. Not only that, but you even have to salute them, per one of my ex-colleagues, who used to be military. Imagine how nice is to "supervise" them.

As I wrote above, the relationship is more ... nuanced ... than that.

We don't supervise or direct them. Nether do they insert themselves in our cases, regardless of anyone's rank (which is totally irrelevant in clinical settingss).

Saluting is a red herring. Any officer of superior rank gets saluted, whether it's a pilot, infantry officer, lawyer, nurse, or anything else. In the real world 98% of us wear street clothes into the hospital and then change into scrubs. There isn't any saluting going on.

We've had this conversation before ...

http://forums.studentdoctor.net/threads/va-considering-independent-crna-practice.1040031/

 

[narcusprince]

I will say that departments in the Navy are run very differently from the large facilities versus smaller facilities as you get smaller the nursing power/bias gets bigger. You may have a CRNA who is the floor walker whom is called to the room when a emergency happens. Also at a smaller facility you may have a CRNA department head. This department head sit on boards and committees with other Department Heads of Surgery, Orthopedics, OBGYN. This department head argues policies and procedures with other services. Also the department head writes the evaluation of those in the department so yes a CRNA can write your evaluation. I would argue PGG that the DH role at least at the small command sets clinical policy as well as administrative policy. Pick your poison. Am I happy where I am yes. Is it perfect absolutely not.

 

[pgg]

I had a CRNA as my dept head for the first couple years out of residency. She handled a lot of administrative tasks and to be honest I was content to have nothing to do with any of that for a while.

She did "write my evals" which is really Navy-speak for "I wrote it myself" and she proofread it and sent it up the line to the director who then argued with the XO and other directors about where I should be ranked relative to other physicians. She had minimal impact on my job and career trajectory; none on my clinical practice.

We mostly got along quite well and we still keep in touch years later (she retired from the Navy a few years ago). That's not to say we never butted heads about anything.


Regardless, OP needs to read the milmed subforum.

 

[Consigliere]

Pros - it's the military. Cons - it's the military. Discussion complete.