No need for CRNA bashing... but, do we honestly think this is a good idea?

[coffeebythelake]

Not a lawyer, but...

1. The CRNA....But, the question is are they truly acting independently? State Law is but one element of making that determination. Hospital bylaws, Employer contracts, Department Policy manual, "Informed" Consent all come into play in making that determination.

2. Depends on state law. Anesthesia is recognized as a practice of Medicine and a practice of Nursing. Regulated by different governing boards. Depending on the state, Anesthesiologists may or may not be able to give expert witness testimony against or for CRNAs. Likewise a CRNA may or may not be able to give expert witness testimony against or for an anesthesiologist.

Re: point 2, this is basically a setup for a 2 tier system. The standard of care for physician led anesthesia is not the same as CRNA solo anesthesia

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[deleted126335]

Re: point 2, this is basically a setup for a 2 tier system. The standard of care for physician led anesthesia is not the same as CRNA solo anesthesia

Again, not a lawyer, but I think that used to be the case. Courts have been moving away from that type of argument for a long time.

For example, if we resuscitate a newborn in the delivery room, the argument that the standard of care for anesthesiologists is different (lower) than that of neonatologists is almost certainly not going to fly.

Similarly, an independent CRNA is unlikely to successfully make the legal argument that s/he should be held to a lower standard than an anesthesiologist.

Does an independent NP who diagnoses calf pain as a muscle tear and misses a DVT when the patient dies a week later from a PE have a better chance of getting off because they are a nurse as opposed to being a physician? I don’t think so. Nor should they.

 

[vector2]

So who is ultimately liable when CNRAs are acting independently?

Also can MDs testify against non-MDs in trial?

Doesn't matter if the CRNA drew up some sevo in a syringe and accidentally mainlined it in the pt. Since there's no anesthesiologist the lawyers are going to go after the target who pays the biggest malpractice premium, i.e. the surgeon.

 

[deleted126335]

Doesn't matter if the CRNA drew up some sevo in a syringe and accidentally mainlined it in the pt. Since there's no anesthesiologist the lawyers are going to go after the target who pays the biggest malpractice premium, i.e. the surgeon.

They will go after them, but depending on state law, hospital bylaws, contracts, etc., The surgeon might be untouchable.

Sad that our most useful “ally” might be the blood sucking, bottom feeding, parasite lawyer. Enemy of my enemy is my friend.

 

[PikminOC]

Lifepoint health owns this hospital. The company is located in the same area as Envision. This is a VC experiment. Not a random place. The doctor works for lifepoint. Follow the money

 

[Splenda88]

With the glut of advanced nurses coming into the market, salary will eventually crash for many specialties.

The solution is to fix medical education by making it shorter: 2-yr prereq, 3-yr med school and 2-6 yrs residency. If one can become an anesthesiologist in 8 yrs and can command 200-250k/yr, that individual won't feel like they spend over a decade of their life and 300-400k just to compete with an inferior 'clinician.'

That might take care of many issues with system such as medical education being too long and expensive, and it will also decrease the incentive of nurses taking the shortcut to become anesthesia clinicians since you can be an MD in 8 yrs. Inn addition, if hospitals are paying both MD/DO and CRNA 200-250/yr, it's a no brainer that they will hire the better clinicians (MD/DO). Again, this will make CRNA less attractive to nurses since they will be competing with docs for the same job/salary.

Not counting on that to ever happen since most physicians believe the useless extra 2 yrs of undergrad and the prelim surgery yr they do for their advanced position in radonc, for instance, is what make them better than the advanced nurses.

Well, the MBAs in the C-suite have caught up with our BS medical education. We are doomed if we don't reverse courses!

 

[abolt18]

Doesn't matter if the CRNA drew up some sevo in a syringe and accidentally mainlined it in the pt. Since there's no anesthesiologist the lawyers are going to go after the target who pays the biggest malpractice premium, i.e. the surgeon.

Did you just come up with this idea (the IV sevo)? Or has this happened???

 

[deleted126335]

Did you just come up with this idea (the IV sevo)? Or has this happened???

We used to draw up 1-3 ml syringes of inhalational agent for closed system anesthesia during training.

Don’t think that it is possible given the way the inhalational agents are packaged today.

 

[aneftp]

It’s simple. The ACT has gotten surgeons comfortable with crnas. Especially ones where the docs hardly go into the room. Notice out west like California where it’s been opt out state. The state still remains MD only are most facilities even after 15 years opt out. Yes. There are a few crna mainly outpatient GI gigs. Some rural California places. But for the most part. It’s MD only. Because there are no cost savings with crna. A crna billing Medicare is the same as doc billing Medicare.

Now how much the crna actually keeps. That’s what the asa does not want to tell the public. The amc don’t care. They will still try to pay crna slightly higher with crna only model. And keep the rest of the profits just like private anesthesia practices that employ crna. ASA is in a catch-22.

blame the private act models docs super partners collecting 1 million plus working 40-45 hours. It’s near impossible to make 1 million plus without a 60-70% private insurance payor mix working 40-45 hours a week. So that money the super partners make is coming from somewhere. And it’s from the crnas.

Yes you can make 1 million plus MD only. But you gonna to be working 70 hours a week plus need good payor mix and working 2 weekends a month.

 

[chocomorsel]

It’s simple. The ACT has gotten surgeons comfortable with crnas. Especially ones where the docs hardly go into the room. Notice out west like California where it’s been opt out state. The state still remains MD only are most facilities even after 15 years opt out. Yes. There are a few crna mainly outpatient GI gigs. Some rural California places. But for the most part. It’s MD only. Because there are no cost savings with crna. A crna billing Medicare is the same as doc billing Medicare.

Now how much the crna actually keeps. That’s what the asa does not want to tell the public. The amc don’t care. They will still try to pay crna slightly higher with crna only model. And keep the rest of the profits just like private anesthesia practices that employ crna. ASA is in a catch-22.

blame the private act models docs super partners collecting 1 million plus working 40-45 hours. It’s near impossible to make 1 million plus without a 60-70% private insurance payor mix working 40-45 hours a week. So that money the super partners make is coming from somewhere. And it’s from the crnas.

Yes you can make 1 million plus MD only. But you gonna to be working 70 hours a week plus need good payor mix and working 2 weekends a month.

The greed in medicine is what got us where we are today. People feel like they “deserve” that 1 million just because they got lucky and are using the nurses.

 

[dannyboy1]

They will go after them, but depending on state law, hospital bylaws, contracts, etc., The surgeon might be untouchable.

Sad that our most useful “ally” might be the blood sucking, bottom feeding, parasite lawyer. Enemy of my enemy is my friend.

Problem is these CRNA’s are not independent practitioners. They are employees of large venture capital firms or large hospitals. These entities simply do not care about lawsuits. It’s the cost of doing business and they are insured. It also takes forever for any lawsuit to pay out and all the while they are racking up profits. An individual practitioner cares about lawsuits because it might hurt them personally if the judgment is over the malpractice limit and make it more difficult to get credentialed in the future. Envision has no such concerns....

 

[dannyboy1]

No. According to a surgeon (Ortho/spine) who works there, they are excellent. That said, they are not new grads. They are mostly former Navy.

Unfortunately this. Let’s be honest, plenty of experienced CRNA’s can practice independently to a reasonable standard. The key is experience. If you have a bunch of new grads working independently, better buy some body bags.

 

[Man o War]

Unfortunately this. Let’s be honest, plenty of experienced CRNA’s can practice independently to a reasonable standard. The key is experience. If you have a bunch of new grads working independently, better buy some body bags.

Yes, and there’s the problem. The quality is highly, highly variable. Especially now vs 20 years ago.
This is also dependent on the hospital. Better buy some too if you’re allowing nurses to practice independently in a hospital with any regular acuity.

 

[okayplayer]

The interesting thing that is not discussed in this debate is when hospitals have independent CRNAs and then decide to change their model to ACT or MD only.

Very prevalent example is OB anesthesia in my region. I can think of 4-5 hospitals in the past decade that used to be independent CRNA practice (for OB only) until the hospital approached the anesthesiologists who ran the ORs and asked them to take over OB anesthesia in some capacity. The reasons I’ve heard given are a string of bad outcomes or because the OBs were insisting on the change.

Just offering a counter argument to stories like this Wisconsin hospital.

 

[Man o War]

The interesting thing that is not discussed in this debate is when hospitals have independent CRNAs and then decide to change their model to ACT or MD only.

Very prevalent example is OB anesthesia in my region. I can think of 4-5 hospitals in the past decade that used to be independent CRNA practice (for OB only) until the hospital approached the anesthesiologists who ran the ORs and asked them to take over OB anesthesia in some capacity.

Just offering a counter argument to stories like this Wisconsin hospital.

Yes, I’ve also seen this. It doesn’t get any press coverage though.
My group has been approached to take some of these rural contracts where there are currently no docs. We don’t do it because frankly it’s not worth our time. The CRNAs working there take tons of call. These hospitals don’t pay near enough to make it worth it for us to send a doc out there every day, driving an hour or more each way.
It’s still not right for the patients, but these CRNAs aren’t taking these jobs for the altruistic “patient access” reasons they claim. That’s BS. Cut the pay out there to 150/160k like the city nurses and watch how fast they scatter. Those jobs are at the top of their pay scale, so they take them even though they’re among the worst jobs in anesthesia.
I think people are under the impression these hospitals preferentially choose CRNAs when the fact is often it’s literally all they can get.
I don’t know many docs who will live in those places, take Q2/Q3 call, and do both those things for 300-400k....we can make that kind of money in much better locations with less call. That’s just the truth, right or wrong and a huge advantage of being a doc vs a CRNA

 

[deleted126335]

Unfortunately this. Let’s be honest, plenty of experienced CRNA’s can practice independently to a reasonable standard. The key is experience. If you have a bunch of new grads working independently, better buy some body bags.

The top quartile or so skill wise who have at least five years experience can do plenty of stuff solo. The new grad and/or the CRNAs from the bottom quartile are horrific. How to work around this reality and cut down on the high priced help (us) is one of the dilemmas for the decision makers.

 

[Planktonmd]

The top quartile or so skill wise who have at least five years experience can do plenty of stuff solo. The new grad and/or the CRNAs from the bottom quartile are horrific. How to work around this reality and cut down on the high priced help (us) is one of the dilemmas for the decision makers.

The "decision makers" have figured out a way around it. If you compare outcomes based only on mortality, which is what the AANA has been advertising, then there is little or no difference between a solo CRNA and an anesthesiologist supervised CRNA. This is due to the fact that with current technology it is not easy to kill a patient, you actually have to put a serious effort into it.
Administrators are experts at interpreting data to fit their financial interest.

 

[linkin06]

The fact is you can start your CRNA career theoretically even from online nursing school. There is such a wide range of abilities for CRNAs and I’m pretty sure most hospitals dgaf to figure out who is actually good or bad.

 

[coffeebythelake]

The "decision makers" have figured out a way around it. If you compare outcomes based only on mortality, which is what the AANA has been advertising, then there is little or no difference between a solo CRNA and an anesthesiologist supervised CRNA. This is due to the fact that with current technology it is not easy to kill a patient, you actually have to put a serious effort into it.
Administrators are experts at interpreting data to fit their financial interest.

If their only outcome of interest is mortality, that is a pretty damn low bar. Imagine a hospital where the cRNa is told "Work here, doesn't matter what the **** you do as long as you don't kill anyone"

 

[chocomorsel]

Yes, I’ve also seen this. It doesn’t get any press coverage though.
My group has been approached to take some of these rural contracts where there are currently no docs. We don’t do it because frankly it’s not worth our time. The CRNAs working there take tons of call. These hospitals don’t pay near enough to make it worth it for us to send a doc out there every day, driving an hour or more each way.
It’s still not right for the patients, but these CRNAs aren’t taking these jobs for the altruistic “patient access” reasons they claim. That’s BS. Cut the pay out there to 150/160k like the city nurses and watch how fast they scatter. Those jobs are at the top of their pay scale, so they take them even though they’re among the worst jobs in anesthesia.
I think people are under the impression these hospitals preferentially choose CRNAs when the fact is often it’s literally all they can get.
I don’t know many docs who will live in those places, take Q2/Q3 call, and do both those things for 300-400k....we can make that kind of money in much better locations with less call. That’s just the truth, right or wrong and a huge advantage of being a doc vs a CRNA

What part of the country is this might I ask? How rural? How big are the hospitals? What kind of cases do they do? Would this be under an ACT model? PM if you don't want to put it out in the open.

 

[Man o War]

What part of the country is this might I ask? How rural? How big are the hospitals? What kind of cases do they do? Would this be under an ACT model? PM if you don't want to put it out in the open.

This has actually happened at both big groups I’ve worked for; regions are Midwest and south central. Hospitals were 50-100 beds. Gen surg, ortho, some OB, urology, ENT. Some of them did end up finding some doc coverage, I’m not sure how- possibly locums. These hospitals frequently ship/shipped their sick patients to us in the city so the actual acuity out there is not high....which makes it even more scary they’re looking for doc coverage.
I love the country, would love to live there, but there’s zero chance I am halving my pay and doubling or tripling my call to chase around some militant, salty CRNAs. I assume there’s some skill issues with the CRNAs too if they’re requesting a doc. No thanks.

 

[ZzzPlz]

We used to draw up 1-3 ml syringes of inhalational agent for closed system anesthesia during training.

Don’t think that it is possible given the way the inhalational agents are packaged today.

Anything is possible with an 18g needle and firm hands

 

[chocomorsel]

This has actually happened at both big groups I’ve worked for; regions are Midwest and south central. Hospitals were 50-100 beds. Gen surg, ortho, some OB, urology, ENT. Some of them did end up finding some doc coverage, I’m not sure how- possibly locums. These hospitals frequently ship/shipped their sick patients to us in the city so the actual acuity out there is not high....which makes it even more scary they’re looking for doc coverage.
I love the country, would love to live there, but there’s zero chance I am halving my pay and doubling or tripling my call to chase around some militant, salty CRNAs. I assume there’s some skill issues with the CRNAs too if they’re requesting a doc. No thanks.

I worked a job like this right out of residency. 99 beds and ACT model. Made 300K plus bennies and of course for me that was a lot of money for the work. Call wasn't bad at all. Got along well with most of the CRNAs but there were a couple of militant ones that made it difficult especially since I was the only woman.
Our acuity wasn't that high as in we didn't do CV/Spine/heads but did everything else so had a pretty decent mix of cases. Sometimes you have no time to ship people out if they end up at your doorstep and you gotta do what you gotta do because they won't survive the transfer. Like OB cases that turn to s hit, or the local trauma that is literally bleeding out in the ambulance, or an emergency airway, etc. I just wasn't up all night and weekend taking care of crashing patients with aneurisms/Traumas/high risk OB and that was fine w me. I was however not on call every 2-3 days. It was every 6 days and I was quite happy. If they want you to go there and work w/supervise militant CRNAs, that won't work. If they want you to go out there and do your own cases, that may work for some. Of course for me these days, I am more interested in the ICU. Some of those places do call one week at a time and I hear it's not bad. I love smaller towns myself but I would think they would want to pay you more in line with 400K plus bennies. Guess they "can't" afford it due to poor payer mix.

I see how hard some of these people who make 600K plus work and well, it isn't for everyone.

 

[sloh]

If their only outcome of interest is mortality, that is a pretty damn low bar. Imagine a hospital where the cRNa is told "Work here, doesn't matter what the **** you do as long as you don't kill anyone"

Seems like the way quality is measured in healthcare today, once the bar for “as long as you don’t kill anyone” is cleared, the next most “meaningful” metric is patient satisfaction—which does not require an MD/DO.

 

[Twiggidy]

Unfortunately this. Let’s be honest, plenty of experienced CRNA’s can practice independently to a reasonable standard. The key is experience. If you have a bunch of new grads working independently, better buy some body bags.

Quite honestly, a lot of the Navy CRNAs are pretty well trained because they seems to be mostly used in the military. @pgg can correct me if I'm wrong on this but I got wind from a Navy nurse that there was quite a shortage of anesthesiologist in the Navy.

 

[Wolverines83]

The fact is you can start your CRNA career theoretically even from online nursing school. There is such a wide range of abilities for CRNAs and I’m pretty sure most hospitals dgaf to figure out who is actually good or bad.

Dude...I know of a handful of CRNAs who did CRNA school online. So what I'm saying is...you can get your RN online, then become a CRNA online. Show up to a hospital and do some garbage clinicals with absolutely no accountability for your performance and boom, you're a CRNA. Unfortunately I'm at a center that has SRNAs and oh.....my.....god.....horrifying. Like want to give 8mg/kg of IV succinylcholine to a kid type of horrifying.

 

[coffeebythelake]

Dude...I know of a handful of CRNAs who did CRNA school online. So what I'm saying is...you can get your RN online, then become a CRNA online. Show up to a hospital and do some garbage clinicals with absolutely no accountability for your performance and boom, you're a CRNA. Unfortunately I'm at a center that has SRNAs and oh.....my.....god.....horrifying. Like want to give 8mg/kg of IV succinylcholine to a kid type of horrifying.

Training and education matters, despite what the AANA says

 

[secretasianman]

Quite honestly, a lot of the Navy CRNAs are pretty well trained because they seems to be mostly used in the military. @pgg can correct me if I'm wrong on this but I got wind from a Navy nurse that there was quite a shortage of anesthesiologist in the Navy.

If you have the Feres doctrine on your side you can try whatever you want and any medical disaster is just labeled as a military casualty. Also they are mostly young healthy patients so there is that.

 

[Twiggidy]

The field has just been made too easy therefore anyone feels like they can do it. The drugs are safer and everyone knows how to use a glidescope and quite frankly, it's us that have show them how to do everything. I've alway said we should be showing them how to do epidurals and parking them on L&D overnight and then see how much they want to take over the field. But it's not like this is breaking news and it's part of the reason fellowships have gained popularity. And before anyone preaches to me the CRNAs are making intraop echo decisions in CV ORs in Copperhead, Wherever, those are outliers.

 

[Man o War]

This is the future, folks. Lawyers are going to have a field day with midlevels. Hopefully the nurses are ready for this.
If you’ve ever been deposed, you know they normally start by going through your CV and qualifications. It’s going to be interesting to watch case law as more independent practice is granted to midlevels.

The unsupervised certified registered nurse anesthetist (CRNA) model threatens patient safety | Painter Law Firm Medical Malpractice Attorneys

Wisconsin hospital fired all anesthesiologist physicians and replaced them with less trained, cheaper CRNAs

painterfirm.com

 

[Man o War]

I worked a job like this right out of residency. 99 beds and ACT model. Made 300K plus bennies and of course for me that was a lot of money for the work. Call wasn't bad at all. Got along well with most of the CRNAs but there were a couple of militant ones that made it difficult especially since I was the only woman.
Our acuity wasn't that high as in we didn't do CV/Spine/heads but did everything else so had a pretty decent mix of cases. Sometimes you have no time to ship people out if they end up at your doorstep and you gotta do what you gotta do because they won't survive the transfer. Like OB cases that turn to s hit, or the local trauma that is literally bleeding out in the ambulance, or an emergency airway, etc. I just wasn't up all night and weekend taking care of crashing patients with aneurisms/Traumas/high risk OB and that was fine w me. I was however not on call every 2-3 days. It was every 6 days and I was quite happy. If they want you to go there and work w/supervise militant CRNAs, that won't work. If they want you to go out there and do your own cases, that may work for some. Of course for me these days, I am more interested in the ICU. Some of those places do call one week at a time and I hear it's not bad. I love smaller towns myself but I would think they would want to pay you more in line with 400K plus bennies. Guess they "can't" afford it due to poor payer mix.

I see how hard some of these people who make 600K plus work and well, it isn't for everyone.

Yes ma’am, it’s all relative. For us, the pain in the A factor wasn’t worth it. They asked some other groups in town too, who wanted nothing to do with it. Maybe someday it will be, but definitely not now.

 

[Urzuz]

I've alway said we should be showing them how to do epidurals and parking them on L&D overnight and then see how much they want to take over the field.

I wholeheartedly disagree. We should enthusiastically own all the aspects of this specialty, even the ****ty ones, because we saw what happens when we want to cherry pick the parts of it that we do and don’t want to do.

Granted I’m writing the above as if we got a do-over or a mulligan. The reality is that the flood gates are open and we all better grab a ****ing life jacket.

 

[gasdoc77]

I wholeheartedly disagree. We should enthusiastically own all the aspects of this specialty, even the ****ty ones, because we saw what happens when we want to cherry pick the parts of it that we do and don’t want to do.

Granted I’m writing the above as if we got a do-over or a mulligan. The reality is that the flood gates are open and we all better grab a ****ing life jacket.

That life jacket may in-part be the extra year's salary that many are foregoing for a fellowship 🤔 (especially when the employer (read AMC) can't bill a penny more for your certificate)).

 

[jthedestroyr]

Money, money money! I work with them often and I half the time can’t stand them. I found out they pay their ER docs more money to staff an ICU in my city than they do me. And I am full fledged fellowship trained ICU doc.
So I say F U and keep traveling to the smaller towns.

They pay Well for icu sometimes !

I get way more in icu than anesthesia rates for icu with envision/NAPA. If I remember napa only pays 200$ an hour for anesthesia.

I’m always surprised what envision sometimes will pay for locums ICU.

 

[jthedestroyr]

On

The AMCs want you all to be happy with any job they give you. The pay will be low and the call frequent but the alternative is unemployment. Combine the crna issue with the soon to be glut of new grads from community programs this field will become saturated. Again, this is good for the AMCs as it lowers wages. The AMC is paying in 2021 what it paid in 2014 to many of their employed Anesthesiologists. Fast forward 10 years and the salary Gap between “providers” will be less than 25 percent.

I honestly could see myself working for crna pay in 6-7 years if I could get their cushy work load to go with it. The irony is that even if I offered to work for crna pay the AMC would expect 2-3 x the amount of work.

In locums world, they’re commanding pay at almost 175$ an hour for crna.

a lot of places I’ve heard from a few recruiters have figured out, crna actually aren’t cheaper. That pay a little more and you’ll have the doctor do the case solo and minus a ton of other head aches.

 

[chocomorsel]

Dude...I know of a handful of CRNAs who did CRNA school online. So what I'm saying is...you can get your RN online, then become a CRNA online. Show up to a hospital and do some garbage clinicals with absolutely no accountability for your performance and boom, you're a CRNA. Unfortunately I'm at a center that has SRNAs and oh.....my.....god.....horrifying. Like want to give 8mg/kg of IV succinylcholine to a kid type of horrifying.

Stop teaching them.

 

[chocomorsel]

They pay Well for icu sometimes !

I get way more in icu than anesthesia rates for icu with envision/NAPA. If I remember napa only pays 200$ an hour for anesthesia.

I’m always surprised what envision sometimes will pay for locums ICU.

They do and they are all over Texas so it's so far the only one I work with in TX. They are trying to take over every field. Yeah, I like their money that's for sure. But I could never work with them full time. Just locums.

 

[coffeebythelake]

Quite honestly, a lot of the Navy CRNAs are pretty well trained because they seems to be mostly used in the military. @pgg can correct me if I'm wrong on this but I got wind from a Navy nurse that there was quite a shortage of anesthesiologist in the Navy.

You mean well trained in taking care of young healthy (ASA1 and 2) patients with acute illness or injury?

 

[chocomorsel]

Yup. But I guess the old battle ax die hards a do age eventually. But if they are still active duty they have to meet some physical and health requirements unlike regular folk.

You mean well trained in taking care of young healthy (ASA1 and 2) patients with acute illness or injury?

 

[Twiggidy]

I wholeheartedly disagree. We should enthusiastically own all the aspects of this specialty, even the ****ty ones, because we saw what happens when we want to cherry pick the parts of it that we do and don’t want to do.

Granted I’m writing the above as if we got a do-over or a mulligan. The reality is that the flood gates are open and we all better grab a ****ing life jacket.

The reality is you’re correct but another reality is it’s not like “we” make the decision. All of anesthesia practice could be MD only be we’re not deciding that. Maybe in a round about way we decide it all of us with MDs refuse to practice in rural areas (I acknowledge I’m one of them)

 

[Twiggidy]

Stop teaching them.

I hear what you’re saying but that’s also a quick way to find yourself unemployed

 

[Twiggidy]

You mean well trained in taking care of young healthy (ASA1 and 2) patients with acute illness or injury?

Again, PGG knows more about military medicine than most of us. It’s not like the only people they take care of are soldiers in war zones. How many young generals have you seen? And it’s not like a General doesn’t happen to need surgery for something

 

[deleted126335]

I hear what you’re saying but that’s also a quick way to find yourself unemployed

Go through the motions of teaching them.

 

[abolt18]

I hear what you’re saying but that’s also a quick way to find yourself unemployed

Just teach them the same thing every time you work with them. That way you can check your "I'm teaching them" box while also intentionally sucking at it.

 

[MirrorTodd]

Again, PGG knows more about military medicine than most of us. It’s not like the only people they take care of are soldiers in war zones. How many young generals have you seen? And it’s not like a General doesn’t happen to need surgery for something

Not to mention the significant amount of retirees and dependents we see daily. Theres plenty of people who are far more vulnerable than the 18 year old jarhead that needs a finger pinned cause he punched a door.

 

[Lashler9054]

I don’t know of any CRNAs that do PNB and I know our surgeons like them. They didn’t do them where I was trained. Not sure what everyone else’s experience is with this but this is one aspect that doesn’t make me worried. Also, has anyone compared salaries in those states that allow CRNA independence vs those that don’t? Nothing has indicated that those numbers are different. I could be wrong

 

[nimbus]

I don’t know of any CRNAs that do PNB and I know our surgeons like them. They didn’t do them where I was trained. Not sure what everyone else’s experience is with this but this is one aspect that doesn’t make me worried. Also, has anyone compared salaries in those states that allow CRNA independence vs those that don’t? Nothing has indicated that those numbers are different. I could be wrong

There’s no reason that a motivated CRNA couldn’t be very good at regional anesthesia. Why wouldn’t they be able to learn regional? I bet Jack Vander Beek, CRNA, can block with the best of us.

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[Status Sciaticus]

That life jacket may in-part be the extra year's salary that many are foregoing for a fellowship 🤔 (especially when the employer (read AMC) can't bill a penny more for your certificate)).

Could be useful if that fellowship is in pain and you need to jump ship from anesthesia when pay parity kicks in.

Go through the motions of teaching them.

+1. Not sure why you would want to teach them, especially if its not in your contract.

 

[deleted126335]

+1. Not sure why you would want to teach them, especially if its not in your contract.

Avoid the consequences of being perceived of as anti-CRNA. E.g., new doc, being an outlier, etc. Mattered to me when I was new and young and trying to establish my bona fides in the department.

 

[sloh]

Go through the motions of teaching them.

Haha, MLP’s on average probably aren’t as bright as us, but they aren’t that dumb