Question regarding CRNAs and anesthesiologists

[24858]

Hello,
First off I am considering anesthesia as a career, with that being said, I am a little concerned. Where I am interning, during my surgery rotation, it appeared that the major day to day operation of the anesthesiologists was as a person to oversee the operations of the crnas. The crnas would sit in on most cases and the anesthesiologist would occassionally come into the room and ask if everything was OK or if the crna would like a coffee break.
Now I am sure that this isnt the same everywhere, but how prevalent is this type of work enviroment, I mean the type of enviroment where the anesthesiologist is more of a supervisor rather than the person that follows the case throughout?
Or maybe I am missing the role of the anesthesiologist?
I definitely would not be comfortable signing off on papers and floating to room to room or preoping patients all day long. Nor would I want to make sure that all the or's are covered by an anesthesiologist or crna, I dont want to be a supervisor, I thought anesthesiologists were more heavily involved in cases and not just intubating and making sure the crna is doing their job. Is this the way it is everywhere?
I would imagine at academic hospitals where there are residents the attendings barely ever do much at all, the residents and the crnas must do mostly everything, am I wrong? So where could one get the most hands on procedural work as an attending after residency, in a large community hospital?
Ive tried to make this post now inflammatory, so please answer the questions raised in my post and I dont want this to become a crna vs mda thread.

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[Tenesma]

meaculpa... a very good question

the role of the attending anesthesiologist is that of a peri-operative physician, and that includes pre-operative assessment, intra-operative management and post-operative management (especially in the critically ill). The role of supervisor exists in an environment w/ residents and CRNAs but still with a lot responsibility. You might have observed a few relaxed days with relatively stable patients (and that is what everybody aims to provide), but as the attending you are there to guide, and take-over if necessary to ensure top quality care.

However there are quite a few MD only practices in private practice with NO CRNAS and NO residents doing 1-on-1 anesthesia all day... I have a few colleagues who are doing that, and they enjoy it quite a bit...

 

[jwk]

Anesthesia practices vary tremendously from all-MD groups to all-CRNA groups and everything in between.

Many groups operate under an Anesthesia Care Team concept, where all the providers work together for the benefit of the patient. In those practices, some of the anesthesiologists provide supervision or medical direction to anesthetists (either AA's or CRNA's) who do many of the cases. Even in those practices, many anesthesiologists will still do their own cases. In my practice, we staff about 40 OR's daily, and there would normally be 4 OR's with MD's assigned to them. There are docs in my practice who love doing case, and some that don't. We have four docs who see chronic pain patients 80% of their time. We have docs that take call and work 60 hrs a week, and some that don't who work 35 hrs a week. We have enough variety in patients and caseload to keep everyone happy.

Each group also varies in their clinical responsibilities. Some do pain, some don't. Some do ICU work, some don't. Some do hearts, some don't. In some groups, the MD's do all the regionals and central lines, while in some groups those tasks will often fall to the anesthetists.

If you want to learn more, you need to do an anesthesia rotation, not just get glimpses of the specialty during a surgical rotation. You obviously have some misconceptions about how anesthesia practices work. Among them are your comments about CRNA's "sitting in" on cases and the anesthesiologist "just intubating and making sure the crna is doing their job". There's much more to a modern anesthesia practice than you have seen, as Tenesma has indicated.