Should anesthesiologists and CRNAs stop fighting and join as one?

[GassYous]

Same. Im a young attending in my early 30s and work with some CRNAs that are in their 50s. A couple of times I let them attempt the spinal and they struggle so much I don't even understand the angles they're attempting and meanwhile the patient is uncomfortable from all the poking. I take over and get it within a minute. Now I don't even let them attempt anymore.

Man the other day I spent like fifteen mins trying to get a tough spinal for a total. Just couldn't get it at 3 different levels and called a partner. He's done thousands of spinal so I felt better when he couldn't get it either

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[Matthew9Thirtyfive]

Man the other day I spent like fifteen mins trying to get a tough spinal for a total. Just couldn't get it at 3 different levels and called a partner. He's done thousands of spinal so I felt better when he couldn't get it either

Now imagine a CRNA trying to do that. (Rhetorical as I know you don’t have to imagine.)

 

[jwk]

Most expertise at technical skills comes from experience. Anyone who says "I never miss a [X procedure]" is disingenuous at best. I've been doing anesthesia for more than 40 years. I still miss an occasional IV or A-line, and someone will invariably come behind me and get it. I have veins like pipes that are easily visible without a tourniquet and got stuck three times for my recent surgery by pre-op nurses that start IVs all day every day. All in a days work. Nobody looks down on anyone else.

 

[GassYous]

Most expertise at technical skills comes from experience. Anyone who says "I never miss a [X procedure]" is disingenuous at best. I've been doing anesthesia for more than 40 years. I still miss an occasional IV or A-line, and someone will invariably come behind me and get it. I have veins like pipes that are easily visible without a tourniquet and got stuck three times for my recent surgery by pre-op nurses that start IVs all day every day. All in a days work. Nobody looks down on anyone else.

Had a woman who exercises like a beast as a patient during ca2. Veins looked like they would take a foley catheter. Somehow my 20 gauge didn't even show a flashback. Embarrassing.

 

[2Fast2Des]

We all have our days... There's days when spinal or IV is a chip shot and then you get the ones that make you second guess yourself, especially when a 2nd pair of eyes\hands comes in and does it in 2 seconds after you struggle. The key is knowing when to be able to call it when you know you are not able to do something and ask for help. I still do it, it's humbling, and hope to heck my colleague struggles so I don't look like a dope

 

[stopthebs]

A paralegal is not a lawyer who is not a judge
A cadet is not a colonel who is not a general
A poly-sci freshman is not a PhD candidate who is not a tenured professor
A nurse is not a CRNA who is not an anesthesiologist

Like it or not, there is training, knowledge, experience, and testing that is missing at every lower rung. 95% of the time your average CRNA will function just as well as your average anesthesiologist. It's that 5% of the time, which influences outcomes, when the physician shines and makes the difference. Medicine has made some incredible leaps over time and has become increasingly safer. We now try to prevent and stave off the "never event" or salvage a ongoing disaster and this is where a physician versus a nurse makes the biggest differences.

CRNAs want the money and prestige without the hard work and higher level education and training. If they want that, they can take the MCAT, go through med school, complete a residency, and join me as an equal. Until then, they are not my equal.

Never forget than the best and the brightest coming out of high school want to become doctors. No valedectorian aims to become a nurse training at the top of their license. Everything else is marketing, propaganda, and spin.

When you do thousands of cases hands on while the MDA walks around doing PR and trying to convince others he/she is doing the case. There is a science and an art which only can be honed by doing cases.In 25 years I have listened to MDAs dismiss CRNAs but the absurdity of not giving credit to those actually doing the cases with great outcomes and zero contributions from them is a level of delusion unparalleled. In this day and age to think for a second an MDA has proprietary knowledge is ridiculous. Hopefully no one stopped learning after school but yet that is the tired argument. CRNAs do the cases and act as a buffer to displace blame if something goes wrong.Many Anesthesia departments restrict CRNAs needlessly to try and convince others that they can only do certain procedures.Procedures done in Anesthesia are a technical skill and takes minimal special knowledge. The bottom line MDSs need to stop the lie and be appreciative of having a job where someone else does 99% of their job but they still get all the respect and most of the money. It’s the most distorted relationship in medicine. I don’t subscribe to the belief that the less you do something the better you are at it.

 

[stopthebs]

A paralegal is not a lawyer who is not a judge
A cadet is not a colonel who is not a general
A poly-sci freshman is not a PhD candidate who is not a tenured professor
A nurse is not a CRNA who is not an anesthesiologist

Like it or not, there is training, knowledge, experience, and testing that is missing at every lower rung. 95% of the time your average CRNA will function just as well as your average anesthesiologist. It's that 5% of the time, which influences outcomes, when the physician shines and makes the difference. Medicine has made some incredible leaps over time and has become increasingly safer. We now try to prevent and stave off the "never event" or salvage a ongoing disaster and this is where a physician versus a nurse makes the biggest differences.

CRNAs want the money and prestige without the hard work and higher level education and training. If they want that, they can take the MCAT, go through med school, complete a residency, and join me as an equal. Until then, they are not my equal.

Never forget than the best and the brightest coming out of high school want to become doctors. No valedectorian aims to become a nurse training at the top of their license. Everything else is marketing, propaganda, and spin.

When you do thousands of cases hands on while the MDA walks around doing PR and trying to convince others he/she is doing the case. There is a science and an art which only can be honed by doing cases.In 25 years I have listened to MDAs dismiss CRNAs but the absurdity of not giving credit to those actually doing the cases with great outcomes and zero contributions from them is a level of delusion unparalleled. In this day and age to think for a second an MDA has proprietary knowledge is ridiculous. Hopefully no one stopped learning after school but yet that is the tired argument. CRNAs do the cases and act as a buffer to displace blame if something goes wrong.Many Anesthesia departments restrict CRNAs needlessly to try and convince others that they can only do certain procedures.Procedures done in Anesthesia are a technical skill and takes minimal special knowledge. The bottom line MDSs need to stop the lie and be appreciative of having a job where someone else does 99% of their job but they still get all the respect and most of the money. It’s the most distorted relationship in medicine. I don’t subscribe to the belief that the less you do something the better you are at it.

 

[GassYous]

How do people go around thinking like this? This kind of nonsense is how we get 9 frenches in the carotid and outpatients dying in the endo suite. MD only.

 

[coffeebythelake]

When you do thousands of cases hands on while the MDA walks around doing PR and trying to convince others he/she is doing the case. There is a science and an art which only can be honed by doing cases.In 25 years I have listened to MDAs dismiss CRNAs but the absurdity of not giving credit to those actually doing the cases with great outcomes and zero contributions from them is a level of delusion unparalleled. In this day and age to think for a second an MDA has proprietary knowledge is ridiculous. Hopefully no one stopped learning after school but yet that is the tired argument. CRNAs do the cases and act as a buffer to displace blame if something goes wrong.Many Anesthesia departments restrict CRNAs needlessly to try and convince others that they can only do certain procedures.Procedures done in Anesthesia are a technical skill and takes minimal special knowledge. The bottom line MDSs need to stop the lie and be appreciative of having a job where someone else does 99% of their job but they still get all the respect and most of the money. It’s the most distorted relationship in medicine. I don’t subscribe to the belief that the less you do something the better you are at it.

This is the kind of arrogant CRNA hubris that leads to injured and dead patients, because you equate anesthesia as a sum of simple procedures. You don't recognize your own knowledge deficits and think this is simply something you learn on the job. It's laughable that you think you have the same level of training and knowledge as a physician who has thousands of hours more clinical training than you, and the Kafkaesque and anti intellectual rants you use to support your position. Let me break it down to you simply. Its not a big conspiracy. Hospitals restrict CRNAs like you because patients need to be protected from your delusions of grandeur and self importance.

 

[OptionOffense]

When you do thousands of cases hands on while the MDA walks around doing PR and trying to convince others he/she is doing the case. There is a science and an art which only can be honed by doing cases.In 25 years I have listened to MDAs dismiss CRNAs but the absurdity of not giving credit to those actually doing the cases with great outcomes and zero contributions from them is a level of delusion unparalleled. In this day and age to think for a second an MDA has proprietary knowledge is ridiculous. Hopefully no one stopped learning after school but yet that is the tired argument. CRNAs do the cases and act as a buffer to displace blame if something goes wrong.Many Anesthesia departments restrict CRNAs needlessly to try and convince others that they can only do certain procedures.Procedures done in Anesthesia are a technical skill and takes minimal special knowledge. The bottom line MDSs need to stop the lie and be appreciative of having a job where someone else does 99% of their job but they still get all the respect and most of the money. It’s the most distorted relationship in medicine. I don’t subscribe to the belief that the less you do something the better you are at it.

Just replace these tools like this with the real anesthetists. AAs.
www.anesthetist.org

Merry Xmas

 

[nimbus]

We should stop fighting but we need 2 (or 3) willing parties to have peace.

 

[Southpaw]

@stopthebs went off to the extreme but to be honest they have a point that a lot of anesthesiologists refuse to acknowledge, or acknowledge but never admit. MD only anesthesia looks nothing like busy private practice supervision anesthesia. A MD only anesthesiologist would go into a busy supervision setup and not recognize or understand the role of the anesthesiologist. They definitely wouldn't like it. They'd have more in common with the CRNA (one patient at a time, in the OR the whole time, etc.). I don't fault CRNAs for begrudging anesthesiologists in the current setup, and I don't fault the AANA for fighting for their members. What should they do if not fight for their membership? I acknowledge that CRNA independence would lead to some very bad outcomes, morbidity, and mortality as some CRNAs can't operate independently. But some of them would be fine for your run of the mill straightforward cases if they had someone to bounce ideas off of every now and then.

I personally don't care if CRNAs get national independence and I say that only because I don't want to supervise them. They're professionals. They say their training prepares them for independence so fine, go be independent. I'd MUCH rather go do my own cases, wherever I want (not just the west coast or a few dots on a map here or there across the country), doing cases I want to do. That's what I was trained to do.

Anesthesiologists should routinely do their own cases through the entirety of their careers. Even academicians. An anesthesiologist should readily know where supplies and medicines are kept so they can easily grab them in an emergency, and they should never lose the hands on skill that absolutely occurs if they only supervise.

 

[BLADEMDA]

When you do thousands of cases hands on while the MDA walks around doing PR and trying to convince others he/she is doing the case. There is a science and an art which only can be honed by doing cases.In 25 years I have listened to MDAs dismiss CRNAs but the absurdity of not giving credit to those actually doing the cases with great outcomes and zero contributions from them is a level of delusion unparalleled. In this day and age to think for a second an MDA has proprietary knowledge is ridiculous. Hopefully no one stopped learning after school but yet that is the tired argument. CRNAs do the cases and act as a buffer to displace blame if something goes wrong.Many Anesthesia departments restrict CRNAs needlessly to try and convince others that they can only do certain procedures.Procedures done in Anesthesia are a technical skill and takes minimal special knowledge. The bottom line MDSs need to stop the lie and be appreciative of having a job where someone else does 99% of their job but they still get all the respect and most of the money. It’s the most distorted relationship in medicine. I don’t subscribe to the belief that the less you do something the better you are at it.

Displace the blame when something goes wrong? You have it arse backwards. I take all the blame when something goes wrong due to bad decisions by a CRNA. I carry their liability while they generally get off free. Why is it the supervisors pay 4 X more malpractice rates than the those actually doing the cases in my state? Is that because CRNAs are 4 X safer?

Arrogance combined with lack of knowledge kills patients. I have seen this time and time again with CRNAs even those with 5+ years of experience. They honestly think "cookbook" style which works most of the time but not all of the time. Routinely, the arrogant ones call me late in the process to save them from a disaster or they don't call at all until the OR nurse decides the "independent" CRNA needs help. The thing about anesthesia is the earlier the intervention the better the outcome. This is true for hypotension, airway issues, bradycardia, anaphylaxis, etc. yet many CRNAs simply prefer to let arrogance and pride prevent them from resolving the situation quickly.

I don't recommend anesthesia to med students with high step scores due to the CRNA issue. There is no point being top in your class then matching at a top 10 program to work with arrogant community college graduates. That is why AAs are better suited to the profession of midlevel provider rather than militant nurses.

As for "technical skill" that varies a great deal from provider to provider but not all providers get much better at it. Performing the anesthetic itself is quite simple but knowing the subtleties and what NOT TO DO and when you need help are essential to delivering a safe anesthetic to the sickest patients. I do agree that if you have Michael Jordan on the team having him supervise the water boy on the court just doesn't make any sense and no matter how much the water boy practices he/she will never be Michael Jordan.

 

[Straight2eight]

@stopthebs went off to the extreme but to be honest they have a point that a lot of anesthesiologists refuse to acknowledge, or acknowledge but never admit. MD only anesthesia looks nothing like busy private practice supervision anesthesia. A MD only anesthesiologist would go into a busy supervision setup and not recognize or understand the role of the anesthesiologist. They definitely wouldn't like it. They'd have more in common with the CRNA (one patient at a time, in the OR the whole time, etc.). I don't fault CRNAs for begrudging anesthesiologists in the current setup, and I don't fault the AANA for fighting for their members. What should they do if not fight for their membership? I acknowledge that CRNA independence would lead to some very bad outcomes, morbidity, and mortality as some CRNAs can't operate independently. But some of them would be fine for your run of the mill straightforward cases if they had someone to bounce ideas off of every now and then.

I personally don't care if CRNAs get national independence and I say that only because I don't want to supervise them. They're professionals. They say their training prepares them for independence so fine, go be independent. I'd MUCH rather go do my own cases, wherever I want (not just the west coast or a few dots on a map here or there across the country), doing cases I want to do. That's what I was trained to do.

Anesthesiologists should always routinely do their own cases through the entirety of their careers. Even academicians. An anesthesiologist should always readily know where supplies and medicines are kept so they can easily grab them in an emergency, and they should never lose their hands on skills that absolutely occurs if they only supervise.

You have a strange mix of opinions. Anesthesiologists should solo perform but some CRNAs can also solo perform?

Let me suggest to you why anesthesia requires an anesthesiologist. The average CRNA would be fine doing a run of the mill case solo… until something goes wrong. Anesthesia is easy when it’s easy and challenging when it’s not. If you are only competent when it’s easy then you’re not competent at all. Some select CRNAs may be competent when things hit the fan, but it’s <1% of CRNAs. It’s a low enough number to say that they are an exception upon which no rules should be based. I mean not to get on a soap box here but good grief there is a reason they went to nursing school instead of medical school and believe me it’s not because they wanted to enter a more self-sacrificial, hands-on field. Med school is an IQ filter pure and simple. And it shows in the inability of CRNAs to generate thorough differential diagnoses and to understand the physiologic variables that are at play in an emergency.

I hear lots of people say that CRNAs can probably do easy ASA 1 cases by themselves and I find this irritatingly obtuse. What they actually mean is that the CRNA will appear competent most of the time and that people won’t notice their incompetence leading to bad outcomes when complication rates are low. Having someone to “bounce ideas off of” really means being supervised which is what the patients need.

You are right that anesthesiologists should do enough solo work to remain facile with routine things like where the supplies are located and how to mix/hang the antibiotics. But 90% of what is done in the OR can be done by anyone and requires very little skill / attention (which is how incidentally we got the sudoku puzzle / stock checking stereotype). Our CRNA poster said “There is a science and an art which only can be honed by doing cases.” There’s also a science and an art to making a sandwich but it doesn’t make you special knowing how to throw some peanut butter and jelly on two slices of bread.

Just like the failing of the supervision model has been the detached MD who is just riding the efforts of the CRNA, the failing of the solo performing model is the anesthesiologist who thinks their value comes from sitting on that stool checking twitches.

 

[OptionOffense]

@stopthebs went off to the extreme but to be honest they have a point that a lot of anesthesiologists refuse to acknowledge, or acknowledge but never admit. MD only anesthesia looks nothing like busy private practice supervision anesthesia. A MD only anesthesiologist would go into a busy supervision setup and not recognize or understand the role of the anesthesiologist. They definitely wouldn't like it. They'd have more in common with the CRNA (one patient at a time, in the OR the whole time, etc.). I don't fault CRNAs for begrudging anesthesiologists in the current setup, and I don't fault the AANA for fighting for their members. What should they do if not fight for their membership? I acknowledge that CRNA independence would lead to some very bad outcomes, morbidity, and mortality as some CRNAs can't operate independently. But some of them would be fine for your run of the mill straightforward cases if they had someone to bounce ideas off of every now and then.

I personally don't care if CRNAs get national independence and I say that only because I don't want to supervise them. They're professionals. They say their training prepares them for independence so fine, go be independent. I'd MUCH rather go do my own cases, wherever I want (not just the west coast or a few dots on a map here or there across the country), doing cases I want to do. That's what I was trained to do.

Anesthesiologists should always routinely do their own cases through the entirety of their careers. Even academicians. An anesthesiologist should always readily know where supplies and medicines are kept so they can easily grab them in an emergency, and they should never lose their hands on skills that absolutely occurs if they only supervise.

You dont care if CRNAS get national independence until it's you getting the anesthetic. I wouldn't even move to a city with independenct CRNA practice. I would downgrade that city or locality. I'm with Blade, I've seen enough of the horror shows and bad decisions and the calls by surgeons to KNOW this is a horrible idea and the fact that they are making traction is emblematic as to how corrupt our politicians are including the organizations charged with protecting us and more importantly protecting patients.
The CRNAs dropped the title of anesthetists in their moniker. They are called Nurse Anesthesiologists! Further in 2025 all the graduates will graduate with a DNP. They argue that they are doctors and they are anesthesiologists just like us. Whats up with the different pay? And guess what, in this political climate, the politicians and policy makers will BELIEVE IT. I know, it's crazy but we have to be prepared.

www.anesthetist.org<-------- the true anesthetists... We should get behind this organization to ramp up AA training to compete with the CRNAs. MOreover, all the motivated paramedics, Respiratory Therapists, EMTs, current PAs that meet the pre requisite requirements should be encouraged to complete the designated AA training.

We cant keep kicking the can down the road and fighting for patients and continue losing. We have to do something different.

 

[Southpaw]

You dont care if CRNAS get national independence until it's you getting the anesthetic. I wouldn't even move to a city with independenct CRNA practice. I would downgrade that city or locality. I'm with Blade, I've seen enough of the horror shows and bad decisions and the calls by surgeons to KNOW this is a horrible idea and the fact that they are making traction is emblematic as to how corrupt our politicians are including the organizations charged with protecting us and more importantly protecting patients.
The CRNAs dropped the title of anesthetists in their moniker. They are called Nurse Anesthesiologists! Further in 2025 all the graduates will graduate with a DNP. They argue that they are doctors and they are anesthesiologists just like us. Whats up with the different pay? And guess what, in this political climate, the politicians and policy makers will BELIEVE IT. I know, it's crazy but we have to be prepared.

www.anesthetist.org<-------- the true anesthetists... We should get behind this organization to ramp up AA training to compete with the CRNAs. MOreover, all the motivated paramedics, Respiratory Therapists, EMTs, current PAs that meet the pre requisite requirements should be encouraged to complete the designated AA training.

We cant keep kicking the can down the road and fighting for patients and continue losing. We have to do something different.

If you think CRNAs are overly confident just wait until you're supervising paramedics, EMTs, and RTs.

AAs have been around a long time. They've been supported by the ASA for a long time. I can't tell you a lot of things, but I can definitively say CRNAs aren't going anywhere. I believe it was a massive misstep in them renaming their organization, but again, they did what their membership wanted. Now I personally think it speaks to an individuals insecurity to want to be called what someone more trained, or with more education, is called because its deceptive and everyone knows it. They should've always been proud to carry the nurse anesthetist title. Everyone should have pride in their profession - they chose it after all.

There are CRNAs practicing independently in GI, plastics, dental, surgery centers, and rural places all over the country. Screaming into wind or stomping your feet won't change it.

Maybe, just maybe, we should step into the OR and do the work ourselves. Lots of anesthesiologists do it, happily, and with pride. Primary care does that, and even with dumb studies showing NPs are just as good, the public at large will wait MONTHS to see a real doctor, knowing they could see a NP tomorrow. People can see and acknowledge the difference if we actually allow them to.

 

[nimbus]

If you think CRNAs are overly confident just wait until you're supervising paramedics, EMTs, and RTs.

AAs have been around a long time. They've been supported by the ASA for a long time. I can't tell you a lot of things, but I can definitively say CRNAs aren't going anywhere. I believe it was a massive misstep in them renaming their organization, but again, they did what their membership wanted. Now I personally think it speaks to an individuals insecurity to want to be called what someone more trained, or with more education, is called because its deceptive and everyone knows it. They should've always been proud to carry the nurse anesthetist title. Everyone should have pride in their profession - they chose it after all.

There are CRNAs practicing independently in GI, plastics, dental, surgery centers, and rural places all over the country. Screaming into wind or stomping your feet won't change it.

Maybe, just maybe, we should step into the OR and do the work ourselves. Lots of anesthesiologists do it, happily, and with pride. Primary care does that, and even with dumb studies showing NPs are just as good, the public at large will wait MONTHS to see a real doctor, knowing they could see a NP tomorrow. People can see and acknowledge the difference if we actually allowed them to.

It’s interesting that UK anesthetists with their typical 7-8 years of post medical school training have no problem being called anesthetist. It’s because they are not insecure. Maybe they’ll do a name swap next year to Royal College of Anesthesiologists


100% agree we should do it ourselves. Not doing it ourselves is how we created this mess.

 

[BLADEMDA]

It’s interesting that UK anesthetists with their typical 7-8 years of post medical school training have no problem being called anesthetist. It’s because they are not insecure. Maybe they’ll do a name swap next year to Royal College of Anesthesiologists


100% agree we should do it ourselves. Not doing it ourselves is how we created this mess.

"We should do it ourselves." Please explain to me how that is possible considering there are more CRNAs in the USA than Anesthesiologists. Even if I wanted to work for 25% more per year than a CRNA I probably couldn't find a job in the vast majority of practices across my state.

To make matters worse, I offered to do my own cases 18 months ago for $10 more per hour than the locums CRNAs at the hospital but was told "no thanks" because it would mess up the current model and "disturb the status quo." Fast forward to January 2022 and I can tell you for a fact that I would work for the total cost of a locums CRNA per hour and would be declined by the vast majority of AMCs, hospitals, etc.

Before anyone thinks "we should do it ourselves" the leadership needs to address the fact the ACT model actually promotes hiring CRNAs over Anesthesiologists even if it isn't cost effective to do so.

 

[nimbus]

"We should do it ourselves." Please explain to me how that is possible considering there are more CRNAs in the USA than Anesthesiologists. Even if I wanted to work for 25% more per year than a CRNA I probably couldn't find a job in the vast majority of practices across my state.

To make matters worse, I offered to do my own cases 18 months ago for $10 more per hour than the locums CRNAs at the hospital but was told "no thanks" because it would mess up the current model and "disturb the status quo." Fast forward to January 2022 and I can tell you for a fact that I would work for the total cost of a locums CRNA per hour and would be declined by the vast majority of AMCs, hospitals, etc.

Before anyone thinks "we should do it ourselves" the leadership needs to address the fact the ACT model actually promotes hiring CRNAs over Anesthesiologists even if it isn't cost effective to do so.

I’m sorry about the state of your state. Plenty of md only jobs in Texas, Nevada, Arizona, Oregon, California, Colorado, etc. Come join us! Everybody is hiring Clearly MD only is not the most lucrative model but we have people from across the nation because they want to do their own cases. Ultimately it’s a matter of will.

 

[BLADEMDA]

I’m sorry about the state of your state. Plenty of md only jobs in Texas, Nevada, Arizona, Oregon, California, Colorado, etc. Come join us! Everybody is hiring

My point was many of us are "forced" to supervise CRNAs if we want to live many areas of the USA.

 

[OptionOffense]

If you think CRNAs are overly confident just wait until you're supervising paramedics, EMTs, and RTs.

AAs have been around a long time. They've been supported by the ASA for a long time. I can't tell you a lot of things, but I can definitively say CRNAs aren't going anywhere. I believe it was a massive misstep in them renaming their organization, but again, they did what their membership wanted. Now I personally think it speaks to an individuals insecurity to want to be called what someone more trained, or with more education, is called because its deceptive and everyone knows it. They should've always been proud to carry the nurse anesthetist title. Everyone should have pride in their profession - they chose it after all.

There are CRNAs practicing independently in GI, plastics, dental, surgery centers, and rural places all over the country. Screaming into wind or stomping your feet won't change it.

Maybe, just maybe, we should step into the OR and do the work ourselves. Lots of anesthesiologists do it, happily, and with pride. Primary care does that, and even with dumb studies showing NPs are just as good, the public at large will wait MONTHS to see a real doctor, knowing they could see a NP tomorrow. People can see and acknowledge the difference if we actually allow them to.

Paramedics, RTs EMTs, wouldnt be those things when you supervise them. They would be AAs. Take it easy.
We have several options at this point:
1) Continue the D**K swinging contest with CRNAs. It will continue on in perpetuity and you will eventually lose ground and become more irrelevant and your salary will become that of a glorified CRNA. Do the same job but different titles. It has already been demonstrated that the political appetite to really win this is not embraced at the national level.
2) Embrace 1 MD, 1 patient at a time and train 5x more anesthesiologist that are currently in training. What this will need to succeed is, a majority of practices and health systems and employers to really appreciate and believe in the differences physicians bring to the table so much that they are willing to go ALL MD at their 30 OR hospitals, surgery centers, etc. I can tell you that some places (medium size) like mine will be happy to go ALL MD, but a majority will not. This will lead to a glut of physicians doing anesthesia and further limit employment opportunities and of course income, vacation, mobility etc etc.
3) Embrace AA training in all 50 states so qualified providers can train to become anesthetists since the former anesthetists are anesthesiologists. THis will maintain the integrity of the Anesthesia Care Team, limit the exodus of icu nurses into CRNA schools and bring people of diverse backrounds to anesthesia. Moreover and more importantly we would control the quality of the product by administering the AA training programs. This would be a win for the Anes. care Team, patients, physicians and anesthetists. Everyone wins.

There are many physicians like myself who do our own cases. I take 24 hour calls by myself. The problem is there is not enough of us. We broached the topic of getting crnas because of recruitment issues but we are so turned off with the current political climate we have fought against it.

 

[narcotics999]

I’m sorry about the state of your state. Plenty of md only jobs in Texas, Nevada, Arizona, Oregon, California, Colorado, etc. Come join us! Everybody is hiring Clearly MD only is not the most lucrative model but we have people from across the nation because they want to do their own cases. Ultimately it’s a matter of will.

Except Blade has to sweat for 2-5 years' partnership track.

 

[Zekchar]

I’m sorry about the state of your state. Plenty of md only jobs in Texas, Nevada, Arizona, Oregon, California, Colorado, etc. Come join us! Everybody is hiring Clearly MD only is not the most lucrative model but we have people from across the nation because they want to do their own cases. Ultimately it’s a matter of will.

No. It's a matter of getting the message out to the public. People choose their surgeons but don't choose their anesthesiologist. This has been a marketing failure of our societies or an intentional ommission if we are to believe the ASA is paid off and is in bed with AMCs and private equity etc.

A patient walks into a hospital, having scheduled a knee replacement with his orthopedic surgeon. In Pre-op they are offered the following coverage options:
1) Anesthesiologist
2) Anesthesiologist medically directing 4 CRNAs
3) CRNA only

I'd venture that 90% would say option #1 and 10% would say option #2. 0.002% would say option #3 - perhaps CRNA spouses to prove a point, but option #1 soon as it involves their children or a procedure of consequence. End of story.

Over time I suspect the coverage model will change and highlight physician only care as the selling point it should be. Those who has resources drive policy and change. The homeless person doesn't have much say because they dont have much financial influence on their surroundings.

In the non-medical fields, jobs that offer the 4 day flexible (at home vs in the office) workweek are going to cream the mandatory 9-5 in-office companies. So too will medicine undergo a transformation.

My prediction: Specialty private insurances that cost plenty but in return give you concierge physician only coverage and access. No physician extension bullshat. Would you sign your family up for such an option? I know I would in a heartbeat.

 

[GassYous]

I’m sorry about the state of your state. Plenty of md only jobs in Texas, Nevada, Arizona, Oregon, California, Colorado, etc. Come join us! Everybody is hiring Clearly MD only is not the most lucrative model but we have people from across the nation because they want to do their own cases. Ultimately it’s a matter of will.

Locums market seems pretty good too. People really need help

 

[Hork Bajir]

Problem with training more anesthesiologists is that it would dilute the training. In order for our training to really be meaningfully superior, anesthesia residents need frequent and repetitive exposure to the kinds of cases that you only see at tertiary/quaternary centers: complex CT, MCS, trauma, transplants, sick peds, high risk OB, etc. At most (not all) tertiary centers, these cases already go largely to residents or fellows. Opening more HCA-style community residency programs and accepting sub-par applicants will not create a generation of anesthesiologists capable of solving this problem.

(And by the way I mean no disrespect to those who trained at SOLID community programs, which do exist)

 

[IMGASMD]

My prediction: Specialty private insurances that cost plenty but in return give you concierge physician only coverage and access. No physician extension bullshat. Would you sign your family up for such an option? I know I would in a heartbeat.

I did. It was eye opening. After I signed up and paid my initial fee for the concierge medical service. I was literally contacted within 2 hours to set up my appointment with the doctor. He spent 1.5 hrs to take my history. His office staff proceeded to call and arrange all the consults that he and I discussed. Sure I feel a little guilty that healthcare is NOT a public good. I just don’t have the time nor the energy to see my doctor in 20 min increments and the first new patient appointment isn’t available until 3 months from now, unless I scream in the phone that I have crushing chest pain.

I agree with the rest of what you said too. It’s sad that everyone cannot get the same care, but when the choices are laid out plainly, I think most of the patient will choose anesthesiologists.

 

[IMGASMD]

Problem with training more anesthesiologists is that it would dilute the training. In order for our training to really be meaningfully superior, anesthesia residents need frequent and repetitive exposure to the kinds of cases that you only see at tertiary/quaternary centers: complex CT, MCS, trauma, transplants, sick peds, high risk OB, etc. At most (not all) tertiary centers, these cases already go largely to residents or fellows. Opening more HCA-style community residency programs and accepting sub-par applicants will not create a generation of anesthesiologists capable of solving this problem.

(And by the way I mean no disrespect to those who trained at SOLID community programs, which do exist)

I understand where you’re coming from; regardless how bad a residency program is ran or how few cases they get, it’s still far more superior than CRNA education or training. Or give those training opportunities to residents rather than sRNa’s (or they now call themselves as nurse anesthetist residents… GTFOH)Why the fuk a medical school or medical doctor training RNs for? Have seen them in CT cases, in neuro cases, peds cases….. why?

 

[narcotics999]

I did. It was eye opening. After I signed up and paid my initial fee for the concierge medical service. I was literally contacted within 2 hours to set up my appointment with the doctor. He spent 1.5 hrs to take my history. His office staff proceeded to call and arrange all the consults that he and I discussed. Sure I feel a little guilty that healthcare is NOT a public good. I just don’t have the time nor the energy to see my doctor in 20 min increments and the first new patient appointment isn’t available until 3 months from now, unless I scream in the phone that I have crushing chest pain.

I agree with the rest of what you said too. It’s sad that everyone cannot get the same care, but when the choices are laid out plainly, I think most of the patient will choose anesthesiologists.

how much money to get this service for a family? Do you pay medical services (lab, imaging, etc) with cash or through insurance?

 

[jwk]

I did. It was eye opening. After I signed up and paid my initial fee for the concierge medical service. I was literally contacted within 2 hours to set up my appointment with the doctor. He spent 1.5 hrs to take my history. His office staff proceeded to call and arrange all the consults that he and I discussed. Sure I feel a little guilty that healthcare is NOT a public good. I just don’t have the time nor the energy to see my doctor in 20 min increments and the first new patient appointment isn’t available until 3 months from now, unless I scream in the phone that I have crushing chest pain.

I agree with the rest of what you said too. It’s sad that everyone cannot get the same care, but when the choices are laid out plainly, I think most of the patient will choose anesthesiologists.

The catch is there are no concierge surgeons, endoscopists, or other specialists. Just primary care.

 

[Zekchar]

The catch is there are no concierge surgeons, endoscopists, or other specialists. Just primary care.

Not yet* At some point I imagine insurance will recognize the value of this and subcontract enough specialists to play this role. Or I can see a concierge multi-specialty group forming for this purpose. Perhaps I should pitch this to Goldman Sachs.

 

[OptionOffense]

Not yet* At some point I imagine insurance will recognize the value of this and subcontract enough specialists to play this role. Or I can see a concierge multi-specialty group forming for this purpose. Perhaps I should pitch this to Goldman Sachs.

I think you are on to something. Still way too early. Believe it or not, things have to get more screwed up, which it will, then it will be ripe for good ole pvt practice.

 

[IMGASMD]

how much money to get this service for a family? Do you pay medical services (lab, imaging, etc) with cash or through insurance?

The catch is there are no concierge surgeons, endoscopists, or other specialists. Just primary care.

@narcotics999. We paid an initiation fee, then a monthly subscription fee. I do have a commercial insurance for everything else. Yes, so specialist will be paid by “regular” insurance and some deductible on my end. Maybe someone will see that as paying twice for similar services. When you’re young and healthy, I suppose, there may not be a need to spend a few thousand dollars a year for something you may not use.

@jwk a “good” primary care physician really worth their weight in gold. I chatted him up during our initial 1.5hr intake appointment. He only has 200 patients on his panel. Regular insurance assigned PMD at least 10 times that. There are only 2 nurses right now, so I know their whole office. If I have a question, I expect either him or his nurses (not some random MA or NP) to get back to me. I don’t take any medications yet, but my partners who see him mentioned that even get him to call in for a refill is a breeze. They get my labs and referrals out right away. As a busy professional, I suppose I can spare an hour of my paycheck every month, to have a peace of mind.

As a physician, I’ve always been given the courtesy to cut lines or knowing the right answers get cut through a lot of bull****. For my SO, who is a lay person, I can see the frustration when they’re trying to get an appointment; She’s pretty intelligent and young enough to navigate through the minefield. I cannot imaging for some of our patients who are older and have no comprehension of what they’re doing for their own care.

Do I feel guilty, somewhat. Like I said before, we were always taught that healthcare is a public good, and people who are “poor” should have the same access. That just ain’t the reality.

To tie back the starting of this discussion. So maybe, when there are true tiered system for all specialties comes along, the anesthesiologists can command a better rate than CRNAs or patients are given a choice of how their anesthesia should be delivered or insurance/hospital/anesthesia groups actually publish their rate. Maybe a fee for service for what we used to do for plastics. Insurance is too damn high that covers essentially nothing. Something needs to disturb the current system.