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questions about MD vs CRNA 2015

Discussion in 'Anesthesiology' started by olivarynucleus, Jul 28, 2015.

  1. olivarynucleus

    olivarynucleus Membership Revoked
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    So, I've been following the whole thing since I was a freshman in college. Now that I am actually in med school and progressing through it, I have a few questions. With CRNA schools popping up everywhere, why haven't they saturated their market yet and when will that time come? I heard the average salary was 165k, I feel if their average salary dropped down to 110-120k not many of them would want to do it and they wouldn't be as much of a nuisance. Also, how are new anesthesiology MD grads doing as far as starting salary and job opportunities? I would love to believe the crnas don't compete for anesthesiology jobs but compete with each other, though it may not be that simple. If new grads are getting offered 250k, that's kinda sad, family medicine docs are being offered that. As far as the whole, employed vs PP thing, I have no idea how that affects new docs.
     
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  3. Consigliere

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    Oh God....
     
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  4. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay
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    This has been discussed ad nauseasum in the last few weeks/months. The search function is your friend. :slap: :beat:
     
  5. olivarynucleus

    olivarynucleus Membership Revoked
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    I haven't seen anything about CRNAs and how their unchecked proliferating affects their job market.
     
  6. Physio Doc 2 Be

    Physio Doc 2 Be Supratentorial problems
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    $45k to be an ICU nurse working 36-40 extremely hard hours or $110-120k to do 40 hours of anesthesia work (still work, definitely different and less physically taxing than acute nursing at the bedside in an ICU - most of the time) and you can't see how that math works out? o_O
     
  7. Carbocation1

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    Anyone notice any trends in the intellectual/technical abilities of new CRNA grads vs older CRNAs? I would suspect the average quality to be going down with the exponential increase in CRNA mills granting online degrees with minimal accreditation requirements.
     
  8. Carbocation1

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    So, in other words, eating you cake and having it too...
     
  9. olivarynucleus

    olivarynucleus Membership Revoked
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    That is horrible. I've seen what it takes to get into CRNA school, 3.o gpa in easy nursing classes, some schools require gre others don't, couple years of ICU experience and they are making 200k while simultaneously trying to bring down the profession that built them. Is there such ample work that 1:4 can exist and there is still a demand? If so how horrible was the shortage before CRNAs???
     
  10. Consigliere

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    Quality is decreasing. We have new grads that WE have to teach epidural placement.
     
  11. Carbocation1

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    Then don't allow them to perform epidurals. Their only role should be babysitting the patient in an ACT setting.
     
  12. Wiscoblue

    Wiscoblue ASA Member
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    You *have* to teach them?
     
  13. G-Man82

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    While I don't like teaching CRNAs much (hence me moving to an AA-friendly state by chance), I somehow don't think that showing them how to place a labor epidural would lead to the downfall of the specialty. It's a technical skill that doesn't really take much. APRNs and PAs place all sorts of central lines in the ICU, but knowing how to do that isn't going to lead to the fall of critical care.

    Big picture. Where I trained as a resident, CRNAs were not allowed to do anything that qualified as regional. Only MAC or GA. For ortho cases, the attending placed the block, the CRNA sat on the stool afterwards and titrated the propofol.
     
  14. Consigliere

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    You're obviously a medical student or something and have no idea how the real world operates. I'm not coming in at 0200 to put in a labor epidural; that's the CRNA's job. They are our employees and are paid well to do so. The way our practice is set up, my partner and I alternate taking call a week at a time. Having to put in even one after hours epidural would make it hard to work the next day. If you had several throughout the week, you would be unsafe.
     
  15. Consigliere

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    Yes I *have* to teach them since their skills are weak and they are our employees. Can't have our employees wet tapping the majority of the labor epidural population and have our satisfaction scores go down now can we?
     
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  16. pgg

    pgg Laugh at me, will they?
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    The Navy SRNA programs aren't filling any more. Lots of factors there (many parts of their $ and life calculations differ from civilians) but the job market on the outside is part of it.
     
  17. Man o War

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    CRNA quality decreasing. Look at it this way- when/if they finally get let loose, it is going to quickly become apparent that they need supervision. Patients are older, sicker, and fatter.
     
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  18. aneftp

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    There is the "holistic" "game plan" that the MD should do everything (epidurals, lines, blocks) and let the crnas baby sit.

    Unfortunately real world life vs what you guys think about protecting the speciality conflict each other.

    On paper, all MDs should do their own cases.

    With expanding surgical services it's just not possible unless you want to hire more MDs. Hiring more Mds costs even more money than hiring crnas.

    The way the ACT model is setup. It protects "weaker" "more inexperienced" crnas and to a smaller extent even "weaker MDs". We know there are weaker MDs in every group. But that's the way the ACT model works these days. The inexperienced crnas essentially get on the job training while they honed in their skills. The weaker MDs "get help" in an ACT model.

    I would advise any new grad not to join any 100% supervision model as well. You need 2-3 years doing mainly your own cases yourself. Not the same as a brand new Crna who lacks a lot of case loads. But you need those 2-3 years to gain judgement.
     
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  19. Consigliere

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    I would argue that you need at least 5 years; at least I did. Maybe I'm not as smart as everyone else...
     
  20. caligas

    caligas ASA Member
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    Yeah my curve was still going up at year 5, but I do pretty much everything but pain and premies. I never hurt anybody in those first years, but I learned a lot and got way slicker.
     
  21. IlDestriero

    IlDestriero Ether Man
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    Oh... You work in one of those practices.
    :(
     
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  22. FollowTheMoney

    FollowTheMoney ASA Member
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    Lets be honest here for a second. There are two types of anesthesiologists: the ones that are partners and run their respective groups and those that are employees of an AMC, University, PP group, etc. If I was the boss and was running my own group, my agenda would be to get everyone working for me to do as much work as possible and to be well trained while performing that work. Those Anesthesiologists that are employed see these midlevels as more of a threat than an asset because they aren't the ones calling the shots so it's in their best interest for them to be terrible, poorly trained, and limited in what they can do. I can't fault either perspective, but there's no doubt the first philosophy and model is threatening and undermining the profession.
     
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  23. Consigliere

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    Yes. Yes I do.
    :)
     
  24. jw3600

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    You can literally double that salary friend. Your point still may still stand but this is way off base.
     
  25. GaseousClay

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    Most nurses I know make upwards of 80-100k depending on overtime. Not a bad gig at all
     
  26. jwk

    jwk CAA, ASA-PAC Contributor
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    Two docs only? How many CRNA's?
     
  27. Consigliere

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    8. We also have a part time doc to cover our 24 weeks of vacation.
     
  28. jw3600

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    Um. Is that combined or each of you?
     
  29. Consigliere

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    We each take 12 weeks vacation.
     
  30. nycitygas

    nycitygas ASA Member
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    How often do you get called back in? Do the CRNA's perform cases at night without you or just basic labor epidurals?

    I am guessing you make close to 600k a year in BFE if not more.
     
  31. Twiggidy

    Twiggidy ASA Member
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    won't lie. a bit jealous.
     
  32. Twiggidy

    Twiggidy ASA Member
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    now i'm real jealous :)
     
  33. Consigliere

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    Call backs rare - can work until 1900-2000 when on call though. Weekends hit or miss. CRNAs do everything (except labor epidurals) under the strictest of supervision.

    Let's just say your guess is in the ballpark.
     
  34. Physio Doc 2 Be

    Physio Doc 2 Be Supratentorial problems
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    I know what a starting ICU nurse at my institution makes. I ballparked it, but YMMV.
     
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  35. jw3600

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    Your institution pays like ass. I know a dozen nurses that started on the floor at $35/hr which will certainly surpass $70k with OT. Vast majority of ICU nurses I know make $90-100k with all being >$80k. Like I said. I see the appeal of the CRNA transition, just don't feel the $ difference is as large as you suggested.
     
  36. jw3600

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    Dude you make >500k and have 12 weeks of vacation? I know anesthesia is dying but at least be a little happier when you come around these parts.
     
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  37. Consigliere

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    Oh, I'm very happy. You would not recognize the person I am beyond the world of SDN. SDN is where I vent and try to educate the young one's who need to know some of the downsides of anesthesiology.
     
  38. jw3600

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    Respect.
     
  39. Stank811

    Stank811 Junior Member
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    I argue half the people on SDN that are doom and gloom are attempting to "educate" young grads so they can hire them and pay them 1/4 of what they bill and give them minimal vacation. I work in a majority MD group, do 90% of my own cases, most of us take 8+ wks of vacation, and all do just fine financially. Anesthesiology is not dying....it is evolving...but will make us stronger in the end. I did not believe anesthesia was dead when I was in training and I defiantly do not feel anesthesiology is a dead field now that I am practicing.
     
  40. jw3600

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    Cool. Learn to spell "definitely" correctly then we can talk. Because you are 100% wrong about the field.
     
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  41. Twiggidy

    Twiggidy ASA Member
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    It's may not be close to death, but it MD anesthesiology may have some sort of long term maybe even terminal illness. I would not be surprised if the day comes where an entire OB floor is ran by nurses (nursing, CRNA, midwife, etc) and to be honest less call for me, more drama for them, and let's be real the patients would probably love it. I personally may not see that day, but that day will come. The safer anesthesia gets, the more nurse are going to want to do, the less need for an MD. I'm not sure if the current generation (or maybe even the next) of MDs need back up plans, but the teenagers and little kids who may have anesthesiology in the blood, may want to consider another specialty.

    And so while @Consigliere has some mad hilarious quotes on SDN, overall they are something for the future docs to take into consideration. I was a dumb med student. The minute I saw CRNAs intubating in the ICU and doing A-lines in the OR, I should've ran for the radiology fields (despite what they say, that field is fine. a bit saturated, but fine)

    I love anesthesiology, as it's challenging and allows somewhat of a lifestyle, but my gripes with the field are beyond CRNA vs MD. Another post, another time.
     
    #40 Twiggidy, Jul 30, 2015
    Last edited: Jul 30, 2015
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  42. chocomorsel

    chocomorsel Senior Member
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    Maybe he or she actually meant "defiantly " like it is written. Look it up. It is an actual word smarty pants.
     
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  43. Crayola227

    Crayola227 The Oncoming Storm
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    I don't have much place on this thread, but here will always be an OB on the OB floor, if only for the C-sections. Especially the stat ones. Sure, all the women want the midwife when it's coming out the vag, but once the placental abruption happens and they're unconscious and blue before your eyes in the span of 5 min, you better believe dad is going to grab the OB to wield the knife to slice dice them

    OBs will actually never be replaced by nurses or midwives. Never.

    If OB does make a big come back with C-sections, or the lay population comes around to caring about infant mortality, maybe you can convince them they want an MD sandwich for that, OB and anesthesia

    Luckily studies do still show that overall (outside of OB at least) people want MDs not RNs (if they can tell the difference in credentials which they often can't).

    Personally, I want nothing less an OB and a real anesthesiologist for my delivery
    Not that we always get what we want or that it even makes sense

    Just a shout out to all you anesthesiologists

    Come to think of it, I want my local and any epidurals to be MDs too
    I like people to be very careful when they bring sharp objects and my neural tissue into close proximity
     
  44. jwk

    jwk CAA, ASA-PAC Contributor
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    OMG, the sky is falling, the sky is falling!

    I like the quote from an earlier post - the field is evolving, not dying. I'm not sure how long you've been doing anesthesia, but anesthetists (AA and CRNA) have been doing ICU intubations and A-lines for many decades - this is not something new. If that's your measure, you need to gain some more perspective.

    OB will never be a nurse-only concept, if for no other reason that nurses of any level don't and won't ever do surgery. Sure there are birthing centers with no physicians (or ability to resuscitate mommy or baby) - I wouldn't let my dog have puppies there. The cavalier attitude towards OB anesthesia is a problem for a lot of anesthesiologists and one that CRNA's are more than happy to exploit to their advantage. You don't like it, don't want to do it, and are more than happy to let the CRNA's have it, especially on nights, weekends, and holidays. Sorry - that's not smart, and you have nobody to blame but yourselves when the CRNA's want to do even more or when they claim they don't need an anesthesiologist. Sorry, no offense intended, but CRNA's doing epidurals at night while the anesthesiologist sits at home doesn't jive with "under the strictest of supervision".

    We have one of the largest OB practices in the country. We have in-house coverage with docs and anesthetists at all our hospitals, including the one that's only 50 beds and only does 1000 deliveries a year. An anesthesiologist places every single epidural, period. Ditto for my previous practice that did about 3000 deliveries a year.
     
  45. Man o War

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    One of the biggest lawsuits in our area of the country involved an OB patient death. The anesthesiologist was asleep and unresponsive in his call room while the CRNA was in charge. If I ever had a cavalier attitude toward OB, that changed my thinking a lot. The award exceeded his malpractice coverage, complete disaster for him on many levels.
     
  46. Twiggidy

    Twiggidy ASA Member
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    The OB statement may be a bit of an overreaction, but I wouldn't be surprised if the field heads to sort of gray area of that type of practice. There will always be a need for anesthesiologist, but as things get safer and easier, our responsibilities may diminish
     
  47. olivarynucleus

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  48. Stank811

    Stank811 Junior Member
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    You will not talk to me...my career is over. :scared:
     
  49. acceptmeplease

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    That clown is all over SDN speaking like it has authority or knowledge of things as if anyone has any damn left to give or time to give it.

    It's a keyboard warrior who wouldn't have the testicular fortitude to say things as rudely to people in person more than a couple of times before being put in its place.

    If you, a practicing physician, believe your field is okay, I believe you have a little more authority and insight into the matter than a medical student.
     
  50. jw3600

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    Don't get your panties in a bunch because no one bought your nursing propaganda that nursing school is harder than medical school.

    As to the other point. That poster was literally saying that consig. expressed a negative outlook for anesthesia as a means to get newer grads to work for less....you're joking right?

    Reasonable people can debate the future of gas. But to deny that there are concerning changes is either dumb or disengenious.
     
    #49 jw3600, Aug 1, 2015
    Last edited: Aug 1, 2015
  51. chocomorsel

    chocomorsel Senior Member
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    Jwk, I was thinking the same thing. "Under the strictest of supervision" sounds questionable. At my last practice only the Docs put in epidurals and took care of all the OB needs. Yes we would wake up in the middle of the night and come take care of the patient. Yes, I hated it, but it was what was best for the patient.
    What happens if the patient or baby crashes after epidural and the doc is at home supervising in what turns out to be an emergency? Is there time to wait as doc drives in? I can see the doc being in house along with the CRNA but leaving him/her alone seems like asking for trouble.
    Strictest of supervision my ass!!! But hey, long as he is getting paid handsomely right?
     

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