You guys should be allowed to practice in every state. Our hospitalist service can't stand when surgeons working with CRNAs calling us to take care of patients in the PACU with "bad heart rhythm". Is that supposed to be the on-call hospitalist problem? Why should we be involved in these mess?You need better sources.
There are now 23 accredited AA programs with several more in the development stages. There will be over 400 new CAAs this year, 500 next year, and that number keeps increasing as program numbers increase. That's a far cry from 25 a year when I started my career.
I'm not aware of any AA programs being blocked by CRNAs. Of course they are constantly opposing legislation in any state in which it is proposed, but we've added three new states in the last 12 months (WA, VA, TN) and there is action in a number of other states as well.
It takes time to increase the CAA presence in any state and TN will be no exception. The best way to do that is to add new programs, and there is already a program in development in Nashville, the planning for which started well before the signing of enabling legislation by the governor a few weeks ago. We don't go into new states without there being interest in CAAs going there - there is and has been a Tennessee Academy of Anesthesiologist Assistants (TNAAA) for several years, laying the groundwork for CAA legislation and practice in TN, with plenty of support from the Tennessee Society of Anesthesiologists.
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CAAs will indeed expect to be paid the same as CRNAs in the same practice doing the same work. Why wouldn't we? In medically directed practices there is not a single thing a CRNA can do that a CAA cannot. In my practice, the only difference in job descriptions is the title at the top of the form. Supply and demand is what sets compensation, as it does in all fields everywhere.
I'm guessing you've never personally worked with CAAs. I just retired after 44 years as a CAA. I took call all but the last three years of my career. Of course there are CAAs and CRNAs that are just interested in shift work and limited schedules, but that's true of anesthesiologists as well. My practice for the last 3+ decades has both anesthetists and anesthesiologists in-house 24/7/365 and does over 100k cases per year. We run 60% of our OR's after 3pm each day, and every one of them is covered by a CAA or CRNA. We are a fully medically directed practice.
SAD DAY FOR TENNESSEE CRNAS
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PCPs are crying seeing this post.
Can you explain?
The surgeon is calling the hospitalist? Or
The crna calling the hospitalist?
Or the surgeon is calling the anesthesiologist to the pacu? That is the job of the anesthesiologist to take care and try to stabilize the patient in the pacu than call the appropriate service line (hospitalist or icu) or in some weird hospitals if patient was outpatient , than we gotta call the ER from the pacu (there are smaller hospitals) where I had to call the ER from pacu because there their policy (for patients not scheduled for hospital admissions due to their outpatient surgery which turns out to be needing further work up and inpatient won’t take them directly)
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Why is an opthal resident lurking in a forum on AA legislation for TN?
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It was used in the attached document that BLADEMDA attached, which was written by a CRNA. It was easier for me to use it rather than spell out anesthesiologist. Didnt think anyone would take offense to it. My bad.
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It’s a subtle way that CRNAs minimize our medical training. The term MDA is not a real thing and is typically used as an insult. I understand if you were not aware and no harm done. But I would erase the term from your vocabulary.
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I wanted anesthesiology when I started med school, but switched to ophthal during my M1 year. I have lurked on this thread for many years. I was curious about the latest happenings with the whole CRNA thing.
Multiple times surgeons (not CRNAs) call us (hospitalist on call) for patient in the PACU (yes, the PACU) to stabilize. It happened to me once and it has happened to a few of my colleagues. When it happened to me, it was a patient that would not "wake up". I just gave the guy a higher dose of Narcan than the dose anesthesia was giving him.
Here is the call: Ortho surgeon .'I just operated on a guy that would not wake up. Anesthesia has been trying unsuccessfully to wake him up for about 30 mins.' I said in my mind "WTF. Why is he calling me?" I asked him for the patient medical history over the phone and he told that he did not know. That was someone they took straight from the ED to the OR.
S[ ]ht happens at my shop. I remember when I just started working there, a surgeon operated on a patient, and the patient was sick in the ICU after couple days. He just washed his hands and told the nurse 'call the hospitalist on call'. The nurse called me. Went there and patient was in shock. I told the nurse to call him and tell him to call me and if not, I will not see the patient. Small city/town BS, man.
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Unfortunately that’s medicine in 80% of the country these days.
We’ve become so disconnected with care.
Surgeons and even GI inpatient docs don’t even see their patient except shortly before their procedures and rarely have follow up They have the hospital employee PA or arnp see the patient before booking the procedure. So they aren’t even making the decision to book the original booking.
They don’t want to have to do anything with care outside of doing the procedures. Because procedures make money. Not follow up.
It's crazy that GI docs don't want to practice inpatient medicine anymore. The system seems to incentivize that kind of behavior.
For instance, my hospital has 2 outpatient GI docs and I was told thees guys are getting 800k+/yr. I am aware of someone they interviewed for inpatient (hospitalist GI) and they offered him 650k. Needless to say he rejected the offer.
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CAAs have been around more than 50 years, just not in TN.
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Simple supply and demand.
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Your averages for both are way low. I was heavily involved in recruiting until I retired. Average starting salary for new grad CAAs is easily $200k, and significantly higher in places considered less desirable (pretty much anything outside bigger cities).
But again - same job description, same practice. Why should a CAA be paid less than a CRNA?
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AAs need our support, every anesthetic delivered by an MD in US? This is why we need smarter people to deal in our specialty, know how to innovate/pivot, every group is different but it's not recreating the wheel, my previous group should've hired CRNAs, met the staffing needs, keep the contract, get more stipends in line with national averages, control the CRNAs; now it's PE QZ. Everyone should support AAs; pride goes before destruction, a haughty spirit before a fall. People don't see a bigger picture, PE/AMC do because they know hospitals only see a bottom line, I say this after a long conversation with my friend who's in EM, 5 years that could be us, EM was the hottest residency when I was matching and now it's terrible, we need to change our perspectives
- $525,000 Base Comp - 12 Weeks PDO
- $550,000 Base Comp - 10 Weeks PDO
- $575,000 Base Comp - 8 Weeks PDO
- + Extra Shift Pay
- $100,000 Recruitment Incentives
- $15,000 Moving Allowance
- $4,000 CME Allowanc
- 5 CME Days
- $1,600 Dues and Subscription Allowance • Malpractice Insurance Provided
- Benefit Guide & Retirement Plan
- Practice Details
- 6 Anesthesiologists
- 18 CRNAs
- 1 NP for PAT Clinic
- Dedicated CRNA OB Coverage Weeknights
- Call 1:6 @ Home Call; 5-6 Days/Month
- Weekday Call: 7 am - 7 am
- Weekend Call Friday, 7 am - Mon, 7 am
- Post-Call Days Off
- Weekend Coverage 1 MD; 2 CRNAs
- 8 ORs @ Main Hospital
- Main OR Runs 6-7 Rooms
- Available Upon Requests
- ~ 30 Cases/Day•
- 2 ORs @ Ortho ASC (1-2 CRNAs, 1MD)•
- 1 OR Urology ASC•
- 2 Endoscopy Rooms at Hospital, EGDs,
- Colonoscopies ~20-25/day•
- ~50 cases/day (OR, OB & Endo cases)
- • 40% Endo• 35% General Surgery
- • 20% Complex Ortho•
- 5% OB (C-section and Epidurals)
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Wrong thread for the question but that’s not a good offer anywhere. Pay is too low for that much call. 60x24hr calls/yr is insane. Each of those calls alone should be at least $8k.
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It’s way below average deal (100k recruitment bonus is likely 3 year commitment) taxed at 37%.
So I look it at
525k/33k (558k) and 12 weeks off
608k (8 weeks off)
This is old fashion way to run a practice
Problems I have with place
Vacation weeks needs to be at least 26 weeks off with the demand of 24 hr calls for 600k. You time is very valuable
The 1 room ASC and 2 room ASC plus hospital kill the staffing ratios.
Look at the HUGE RED FLAG 5% ob means 300 deliveries a year but the red flag is dedicated ob coverage for weeknights only with crna. Mean Md is on the hook for a weekend ob coverage plus on call 72 hr. Red flag.
That’s 72 hrs on the clock there. And to be in rural America. And being taxed at w2.
I get a similar deal 500k/26 weeks (md only ob call in house ) off package in downtown urban area or 510k/20 weeks off zero in house , 14 hr beeper call WITH A CRNA AND NO OB. 62hr (not 72 hrs) beeper call every 5 weeks for weekend with crna.
The days of the standard q5 24 hr calls plus 72 hrs beeper call weekend and 8-12 weeks off for even 550k-600k are over.
Look me and 4 other docs each have 4-6 weeks off for the summer for our kids due to our massive weeks off. No fighting for summer break weeks off. Kid finished school last Wednesday. I took off to London immediately
I have 3 weeks off. Now. Than 4 weeks off in July. (I traded a week with another doc who doesn’t care) so he will have more weeks off in December) but even if I didn’t trade. I’d still have a min 4 weeks off.
NicholasPavona
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Outstanding!
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The GI docs I know are clearing 7 figures easily. One wanted to move to socal and it would have been a 50% pay cut for more work and less vacation.
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thread should be titled GREAT DAY FOR TENNESSEE!!
nah its not. CRNAs independence is the worst thing to happen to anesthesia.
Their training is in the philosophy of medicine rather than nursing. That alone teaches them to understand and problem solve using critical analysis rather than just algorithmic 'if this, then that' workflow.
LOL where are they going to go? you think that they will uproot their life and make moves because they want to die on a political hill?
Its like us calling you an optometrist because its easier to spell than ophthalmologist.
7 figures means nothing without context of work load and weeks off.
My interventional cards buddy pulled 2.4 million (non ep) but he’s seeing 100 patients 2 weekends a month. On IR call 15 days a month. That’s a ton of work for 2.4 million hospital employed. And 8 weeks off.
So 2.4 million hospital employed sounds good but the work load is crazy.
Hospital executives sleep in their own bed for 2 plus million a year every night. Remember that boys and girls.
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Thats compiled from ChatGPT requesting as many references as possible. I agree the numbers are low realistically, but you can see the trend is that there are significant salary differences between the two.
But again - thats the exact same argument CRNAs make to be paid the same as anesthesiologists. I've heard many CRNAs say that time and time again. How long until AAs start saying the same in that case?
I've always been a proponent of AAs but if its true they expect to be paid the same as CRNAs than that's definitely going to drive down compensation across the board.
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You are confusing aggregate data with individual/local data. It's apples-to-oranges.
At the group level, in an ACT practice that employs AAs and CRNAs both, they make the same, and should make the same. As a national average, AA average salary and CRNA average salary will be different, but that is meaningless and factors in independent CRNA practice locations. This is the same fallacy as CRNAs saying they are "cheaper" because they show lawmakers the average CRNA salary and the average MD salary and say they do the same thing for less money. If they were independent, they would not be cheaper, they just want to make more money. If there is an independent CRNA out there, I'm sure they do make average physician money, because anesthesia billing is blind to the type of person billing it.
If you are in a hiring position as a physician and your group uses ACT practice and you employ CRNAs, you would not expect the CRNAs that work for you to make the same as a physician in your group, because that is not how your group is structured. You would expect all of the CRNAs to make the same (base, at least) as each other in your group, though. So if you brought in AAs, you (and they) would expect them to make the same as the CRNAs, because they are in the same pool as the CRNAs in your practice model, with the same scope of responsibilities. You're not going to pay the CRNA more than the AA more simply because they have the option of moving to Arizona and working independently and the AA cannot. You'll never bring in any AAs that way. If you're a group that cares enough to bring in AAs, you are also going to be someone that wants to encourage parity and goodwill between everyone that you employ like the good business leader that you are.
AA's will never expect to be paid like anesthesiologists are paid because AAs can never work outside of the ACT practice model. Sure, there will be plenty of people out there that want to work hard and grind the OT and have big numbers on their W2, but that is not the same thing as expecting your base compensation to be the same as the physicians you work for.
Bringing AAs into ACT practices is the best defensive bulwark groups have against CRNA encroachment/independent practice efforts.
What’s an MDA?
I meant to write: there’s no such thing as an MDA.
Are you talking about 1 wk on/off? You can't beat that schedule. I just don't get why there are a lot people who do not like it.
This is the future of w2 MD staffing.
2 weeks on. 2 weeks off. And not on call every day either. Many variations of these schedules. Not killing urself either with call generally q2 for 12 days and the rest of the month off if In house.
So 6 x 24 hrs calls in a month block. You can try to do it in 7 days if u want and take 3 weeks off. Or pace urself and do 6 calls in 12-14 days and than take the rest of the month off.
The one week (7 x 24 hrs calls ) with beeper is brutal in many places with 1 week off. That’s not worth 500-600k unless crna is primary call and Md is backup call. If Md is primary call, than the situation needs to pay closer to 1 million for 1 week on and one week off if u want Md to be essentially on the clock for 168 hrs and many places won’t pay that. And I certainly would not work for 500-600k to be tied to a pager for 168 hrs no matter how light the call is and have 26 weeks off. Just do the simple math. That average out to around $120/hr x 168 hr x 26 weeks of work for around 520k a year. That’s horrible.
Devil is always in the details.
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Does this mean CRNA does routine cases independently by themselves and MD comes in only for complicated cases?