Should I be worried about this?

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As a med student considering anesthesiology should I be worried bout this?
Hospital Dumps Anesthesiology Group In Favor Of "Care Team".
Whether it's a pregnancy, planned surgery or trauma that brings Tulare County residents to Kaweah Delta Medical Center, it's important that patients have a complete understanding of the anesthesia care team that is there to care for them.
Starting Dec. 13, Somnia, a nationally recognized, physician-owned and led medical group will begin providing anesthesia services to patients at Kaweah Delta Medical Center. Under this group, the anesthesia care team model that has been used successfully at Kaweah Delta Medical Center in labor and delivery will be extended into other areas.
What is an anesthesia care team? It's a team model that is recognized by the American Society of Anesthesiologists as safe and effective and one that requires that every patient is the responsibility and under the care of an anesthesiologist. In addition to anesthesiologists, other members of the anesthesia care team include certified registered nurse anesthetists (CRNAs).
CRNAs have been members of the anesthesia care team at Kaweah Delta since 2002 and also provide anesthesia services to some of the providers named to the U.S. News and World Report's Best Hospitals' 2011-12 Honor Roll, such as Johns Hopkins (Baltimore), Massachusetts General (Boston), Mayo Clinic (Minnesota), Cleveland Clinic (Cleveland) and UCSF Medical Center (San Francisco). CRNAs are also commonly trained at and function as members of anesthesia care team models at major academic medical centers.
A CRNA is an advanced practice nurse who is specially trained in anesthesia. There are 42,000 in the United States delivering 32 million anesthetics a year. CRNAs are required to have an RN degree, spend a minimum of a year in a critical-care setting, complete 24 to 36 months of specialized training and pass a national accreditation exam. At Kaweah Delta, they will work with and under the supervision of an anesthesiologist when caring for a patient.
All disciplined national studies have conclusively demonstrated that use of the anesthesia care team model that includes CRNAs results in higher quality, safe and effective anesthesia services. In fact, for many years, Kaweah Delta's current anesthesia provider has had up to six CRNAs on staff providing exceptional and safe care to our patients.
At Kaweah Delta, this new anesthesia care team will evaluate each patient to determine when a physician anesthesiologist is medically required or when a specially trained and experienced CRNA is medically appropriate. For any patient, where the surgeon or physician anesthesiologist determines the need for a physician anesthesiologist, a physician anesthesiologist will directly manage that case.
While selection of Somnia represents a change in the leadership of anesthesia services at Kaweah Delta, people in the area should keep in mind that a number of anesthesiologists currently providing services at Kaweah Delta have decided to remain on the medical staff. That decision means they will be able to provide services under the Somnia agreement.
More here:
http://www.visaliatimesdelta.com/ar...ay-Mann-New-anesthesia-team-will-improve-care

Apparently the hospital now has 18 anesthesiologists and will be keeping a small number of them as Somnia employees after the care team starts.
I worry what this may mean for the anesthesiology job market if this spreads?
 
Wave of the future, my friend. Supervision ratios will increase to higher and higher levels and anesthesiologists will be utilized for only the sickest and most complex patients. The future looks dismal at best. Think long and hard before going into anesthesiology, and if you do, for God's sake do a fellowship.
 
My hospital works under the ACT model. With the pressure of 20 minute room turnover times, and the lack of medical due diligence done by surgeons, I just do NOT see patient safety standards being maintained without the presence of an anesthesiologist.

To the extent that if things do get too thin, there will for sure be massive increases in M&M. This for sure applies to high volume centers with productivity goals (who doesn't have them?). I don't know what happens in rural settings.

The only thing which allows that urologist to leave the room before a patient (morbidly obese, s/p 4 hours of full Trendelenburg, difficult airway, CAD and COPD/Asthma) is extubated is the presence of an anesthesiologist. If surgeons (or CRNA's) want to assume that level of responsibility/liability, then they will pay for it one way or another.
 
Consigliere said:
Wave of the future, my friend. Supervision ratios will increase to higher and higher levels and anesthesiologists will be utilized for only the sickest and most complex patients. The future looks dismal at best. Think long and hard before going into anesthesiology, and if you do, for God's sake do a fellowship.
Click to expand...

I agree withyou. there will be many displaced MDs in the future who are doing their own cases (me included) by crnas and the ACTand suddenly there wont be a demand for residency trained anesthesiologists. there will be still but not as much. My hospital already is looking to switch models. There are 10 of us doing our own cases. 2 on vacation at all times. so if that is the case there will be left 2 or 3 of us and 8 mid level anesthetists. so 7 of us are going to have to move on and find other jobs, Im lucky since my only daughter is in boarding school, and my wife works from the house so I am pretty mobile. But the others have 3 kids in school and heavily entrenched in the community. One of my partners said he should have done Medicine since he would be more in demand. everyone is looking for an internist
 
Maybe we'll just see more anesthesiologist moving to the boonies. Surely an easy value proposition can be made even if that "boonie" hospital hasn't seen an anesthesiologst, ever. ICU coverage, advanced cases, Rx priviledges, etc.
 
For certain qualifying rural hospitals or CAHs where the volume of cases requiring anesthesia services
is relatively light for a hospital, Medicare Part A offers a program for reasonable cost pass-through
payments for CRNA services. Under this program, a qualifying hospital may be paid on a reasonable
cost basis for one full-time CRNA providing 800 or fewer inpatient and outpatient anesthesia procedures.
Where the hospital qualifies for and receives such pass-through funding from the Medicare
program, neither the hospital nor the CRNA providing services at that hospital may bill Medicare Part
B for anesthesia services provided to Medicare beneficiaries at that hospital.
Finally, Medicare Part B and most public and private plans reimburse for certain medical and surgical
services provided by CRNAs that are not anesthesia services, so long as the CRNA is authorized to
furnish those services in the state where the services are being provided. The Medicare claims processing
manual identifies these services as insertion of Swan Ganz catheters and central venous pressure
lines, pain management, emergency intubation, and the preanesthetic examination and
evaluation of a patient who does not undergo surgery. These services are reimbursed under the
regular Medicare physician fee schedule, not the anesthesia fee schedule. Further, because the
concept of anesthesiologist medical direction applies only to anesthesia services and not to medical
and surgical services, when a CRNA provides these medical or surgical services Medicare reimburses
100 percent of the fee to the CRNA and anesthesiologist medical direction payment does not apply.
 
anynoise said:
I agree withyou. there will be many displaced MDs in the future who are doing their own cases (me included) by crnas and the ACTand suddenly there wont be a demand for residency trained anesthesiologists. there will be still but not as much. My hospital already is looking to switch models. There are 10 of us doing our own cases. 2 on vacation at all times. so if that is the case there will be left 2 or 3 of us and 8 mid level anesthetists. so 7 of us are going to have to move on and find other jobs, Im lucky since my only daughter is in boarding school, and my wife works from the house so I am pretty mobile. But the others have 3 kids in school and heavily entrenched in the community. One of my partners said he should have done Medicine since he would be more in demand. everyone is looking for an internist
Click to expand...

Except they'll probably end up with a FNP or PA, there, too. Very few fields are immune from mid-levels.
 
anynoise said:
I agree withyou. there will be many displaced MDs in the future who are doing their own cases (me included) by crnas and the ACTand suddenly there wont be a demand for residency trained anesthesiologists. there will be still but not as much. My hospital already is looking to switch models. There are 10 of us doing our own cases. 2 on vacation at all times. so if that is the case there will be left 2 or 3 of us and 8 mid level anesthetists. so 7 of us are going to have to move on and find other jobs, Im lucky since my only daughter is in boarding school, and my wife works from the house so I am pretty mobile. But the others have 3 kids in school and heavily entrenched in the community. One of my partners said he should have done Medicine since he would be more in demand. everyone is looking for an internist
Click to expand...

Yet somehow, academic medicine doesn't see any of this. Amazing.
 
foxtrot said:
Yet somehow, academic medicine doesn't see any of this. Amazing.
Click to expand...

What is academic medicine supposed to be doing? We work with them and know the score. Most of the CRNA mills are not at academic centers. The CRNA mills don't care about you or your future ($$$). I don't teach sRNAs. It will be a cold day in hell before CRNAs practice independently where I work, so no studies are going to happen here. Even if we looked at calls for help or other things and found some difference, it's not comparing independent CRNAs to physicians, so it wouldn't help the cause.
 
IlDestriero said:
What is academic medicine supposed to be doing? We work with them and know the score. Most of the CRNA mills are not at academic centers. The CRNA mills don't care about you or your future ($$$). I don't teach sRNAs. It will be a cold day in hell before CRNAs practice independently where I work, so no studies are going to happen here. Even if we looked at calls for help or other things and found some difference, it's not comparing independent CRNAs to physicians, so it wouldn't help the cause.
Click to expand...

yeah unfortunately some of the biggest CRNA mills are not in academic centers.
 
Yes. That's my answer to the OP. The future of this field is cost cutting which means lower salaries for midlevels (AA and CRNA) and Anesthesiologists. It also means the need for fewer Anesthesiologists to do their own cases (stool sitting).

Contrary to some on this board I see a Fellowship in a subspecialty like Cardiac, CCM, Pain or Peds to be a major plus for job security.
 
unemployed.jpg
 
The AANA has been pushing this 6 sigma nonsense for years. They want CEOs to buy into the propaganda and rhetoric . They are. We are losing. We have made anesthesia so safe that even a ____________ can do it.

But, the truth is anesthesia is only safe because of MD care and involvement.
 
In this issue of Anesthesiology, Arbous et al.1 provide a jolting report on the positive impact that anesthesia providers can have on their patients. How? Simple anesthetic management principles seem to have a major effect on perioperative mortality. The routine use of an equipment checklist (odds ratio, 0.61), direct availability of an anesthesiologist to help lend a hand or troubleshoot when needed (odds ratio, 0.46), the use of full-time compared with part-time anesthesia team members (odds ratio, 0.41), the presence of two members of the anesthesia team at emergence (odds ratio, 0.69), and reversal of muscle relaxants at the end of anesthesia (odds ratio, 0.10) had dramatic, positive effects that were associated with reduced perioperative mortality within 48 h after surgery and anesthesia.
This report is remarkable in several ways. First, it is one of the few that have shown anesthetic management processes to dramatically reduce perioperative mortality. Second, it reports perioperative mortality rates matching a number of recent reports. Importantly, it supports the recent insightful article by Lagasse2 about perioperative mortality and his suggestion that the US anesthesia community may have overestimated its impact on improving patient safety in the past two decades. Finally, the authors have used a unique and thoughtfully planned multiinstitutional survey and case-control methodology to evaluate this low (but not low enough)-frequency outcome.
It should not be surprising that perioperative anesthetic management processes can make a difference. The US Federal Aviation Administration has long required the use of pilot checklists for evaluating the airworthiness of aircraft and starting procedures, a requirement strongly supported by outcomes of real and simulated air flight. Why would our specialty, so often compared to piloting, be different? The Federal Aviation Administration also requires two pilots for most commercial aircraft operations, nicely matching the report's finding that the presence of two anesthesia providers at emergence is associated with lower perioperative mortality. The positive impacts of immediate availability of an anesthesiologist when needed and continuity of anesthesia providers in the care of individual patients likewise make sense but, until this study, rarely have been shown to be associated with reduced perioperative mortality.
Have we really overestimated our positive impact on patient safety? Clearly, a number of recent studies suggest that our oft-quoted estimate of 1:200,000 or more patients who have an anesthetic-related death may be flawed.2 The basis for this estimate is accurate but usually misinterpreted. Eichhorn et al.3 reported this low rate of anesthetic-related mortality in healthy patients, an important distinction occasionally neglected in anesthesia patient safety statements. This current study, like others, suggests that the anesthetic-related mortality rate is still too high. The good news is that we have room for improvement and, now, data to support anesthetic management changes that may help.
The study of rare medical events is extremely difficult; it often is extraordinarily frustrating to obtain numerators large enough or denominators that are sufficiently robust to allow calculation of frequencies of the events and subsequent analyses for potential risk factors. Arbous et al.1 have used a multiinstitutional study technique common to clinical research in other medical specialties, notably cardiology, but infrequently attempted in anesthesiology and the study of perioperative mortality. This process has provided the authors with (unfortunately) a sufficient number of perioperative deaths to allow case-control analyses, a good way to seek associations between rare events and potential risk factors.
In general, efforts to seek associations between rare medical events and potential risk factors follow a progression. First, case reports and small case series describe unusual outcomes. If enough of these unusual outcomes can be gathered (typically at least 20 are needed, assuming valid controls can be assessed), a case-control methodology can be used to seek possible but not proven risk factors. Subsequently, potential risk factors identified by case-control studies must be evaluated prospectively in large populations to ascertain their validity. Finally, potential interventions to decrease the frequency of these rare events can be tested in randomized, prospective trials. The current study's elegant methodology takes advantage of the large numbers of perioperative death reports that they collected in multiple institutions by creatively and prospectively seeking data from randomly selected controls within each of those institutions. This methodology is applicable to many rare perioperative events and should be a model often copied in the future.
Although conclusions from one study should not lead to wholesale changes in practice, the findings in this study support many plausible assumptions that improvements in anesthetic management processes can positively influence patient outcomes. The use of equipment checklists, immediate availability of anesthesiologists to help when needed, especially to provide extra assistance at emergence from anesthesia, and routine reversal of muscle relaxants are processes that should be seriously considered when seeking opportunities to improve the perioperative outcomes of anesthetized patients.
Mark A. Warner, M.D.
Mayo Clinic College of Medicine, Roches-ter, Minnesota. [email protected]

Back to Top | Article Outline
References

1. Arbous MS, Meursing AEE, van Kleef JW, de Lange JJ, Spoormans HHAJM, Touw P, Werner FM, Grobbee DE: Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology 2005; 102:257-68
Cited Here... | View Full Text | PubMed | CrossRef

2. Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97:1609-17
Cited Here... | View Full Text | PubMed | CrossRef

3. Eichhorn JH: Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 1989; 70:572-7
Cited Here... | View Full Text | PubMed | CrossRef
 
Our current original data suggest an overall perioperative mortality rate of approximately 1/500 anesthetics. This is consistent with the literature review, but the medical literature review offers a wide range of values. The wide range of perioperative mortality rates offered by the literature may be caused by differences in operational definitions and reporting sources. This is best illustrated by Pedersen (table 3), who described markedly different perioperative mortality rates in the same population depending on the timing of the patients’ deaths. 16 Our current data are consistent with the perioperative mortality rate recorded by the JCAHO (approximately 1/300 anesthetics), which used the same definition and similar mandatory reporting for participating hospitals. ‡
 
Based on these findings, the recommendations are quite simple. It is time to tell the emperor that he is not wearing any clothes. We must dispel the myth that anesthesia-related mortality has improved by an order of magnitude. Science does not support this claim. We must then begin our efforts to standardize our methodology of data collection and analysis so that we can share data worldwide. Large international data pools will allow us to develop risk adjustment models and identify best practices. Only then can anesthesia become a model of safe
 
The AANA and militant CRNAs spew lies about the safety of anesthesia. They claim 6 Sigma safety and their bogus studies claiming CRNAs are just as safe.

The FACTS Are very different and CEOs need to hear the truth. Perioperative deaths are 1/500! Go to Solo CRNA care and that number will climb.
 
Last edited:
BLADEMDA said:
In this issue of Anesthesiology, Arbous et al.1 provide a jolting report on the positive impact that anesthesia providers can have on their patients. How? Simple anesthetic management principles seem to have a major effect on perioperative mortality. The routine use of an equipment checklist (odds ratio, 0.61), direct availability of an anesthesiologist to help lend a hand or troubleshoot when needed (odds ratio, 0.46), the use of full-time compared with part-time anesthesia team members (odds ratio, 0.41), the presence of two members of the anesthesia team at emergence (odds ratio, 0.69), and reversal of muscle relaxants at the end of anesthesia (odds ratio, 0.10) had dramatic, positive effects that were associated with reduced perioperative mortality within 48 h after surgery and anesthesia.
This report is remarkable in several ways. First, it is one of the few that have shown anesthetic management processes to dramatically reduce perioperative mortality. Second, it reports perioperative mortality rates matching a number of recent reports. Importantly, it supports the recent insightful article by Lagasse2 about perioperative mortality and his suggestion that the US anesthesia community may have overestimated its impact on improving patient safety in the past two decades. Finally, the authors have used a unique and thoughtfully planned multiinstitutional survey and case-control methodology to evaluate this low (but not low enough)-frequency outcome.
It should not be surprising that perioperative anesthetic management processes can make a difference. The US Federal Aviation Administration has long required the use of pilot checklists for evaluating the airworthiness of aircraft and starting procedures, a requirement strongly supported by outcomes of real and simulated air flight. Why would our specialty, so often compared to piloting, be different? The Federal Aviation Administration also requires two pilots for most commercial aircraft operations, nicely matching the report's finding that the presence of two anesthesia providers at emergence is associated with lower perioperative mortality. The positive impacts of immediate availability of an anesthesiologist when needed and continuity of anesthesia providers in the care of individual patients likewise make sense but, until this study, rarely have been shown to be associated with reduced perioperative mortality.
Have we really overestimated our positive impact on patient safety? Clearly, a number of recent studies suggest that our oft-quoted estimate of 1:200,000 or more patients who have an anesthetic-related death may be flawed.2 The basis for this estimate is accurate but usually misinterpreted. Eichhorn et al.3 reported this low rate of anesthetic-related mortality in healthy patients, an important distinction occasionally neglected in anesthesia patient safety statements. This current study, like others, suggests that the anesthetic-related mortality rate is still too high. The good news is that we have room for improvement and, now, data to support anesthetic management changes that may help.
The study of rare medical events is extremely difficult; it often is extraordinarily frustrating to obtain numerators large enough or denominators that are sufficiently robust to allow calculation of frequencies of the events and subsequent analyses for potential risk factors. Arbous et al.1 have used a multiinstitutional study technique common to clinical research in other medical specialties, notably cardiology, but infrequently attempted in anesthesiology and the study of perioperative mortality. This process has provided the authors with (unfortunately) a sufficient number of perioperative deaths to allow case-control analyses, a good way to seek associations between rare events and potential risk factors.
In general, efforts to seek associations between rare medical events and potential risk factors follow a progression. First, case reports and small case series describe unusual outcomes. If enough of these unusual outcomes can be gathered (typically at least 20 are needed, assuming valid controls can be assessed), a case-control methodology can be used to seek possible but not proven risk factors. Subsequently, potential risk factors identified by case-control studies must be evaluated prospectively in large populations to ascertain their validity. Finally, potential interventions to decrease the frequency of these rare events can be tested in randomized, prospective trials. The current study's elegant methodology takes advantage of the large numbers of perioperative death reports that they collected in multiple institutions by creatively and prospectively seeking data from randomly selected controls within each of those institutions. This methodology is applicable to many rare perioperative events and should be a model often copied in the future.
Although conclusions from one study should not lead to wholesale changes in practice, the findings in this study support many plausible assumptions that improvements in anesthetic management processes can positively influence patient outcomes. The use of equipment checklists, immediate availability of anesthesiologists to help when needed, especially to provide extra assistance at emergence from anesthesia, and routine reversal of muscle relaxants are processes that should be seriously considered when seeking opportunities to improve the perioperative outcomes of anesthetized patients.
Mark A. Warner, M.D.
Mayo Clinic College of Medicine, Roches-ter, Minnesota. [email protected]

Back to Top | Article Outline
References

1. Arbous MS, Meursing AEE, van Kleef JW, de Lange JJ, Spoormans HHAJM, Touw P, Werner FM, Grobbee DE: Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology 2005; 102:257-68
Cited Here... | View Full Text | PubMed | CrossRef

2. Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97:1609-17
Cited Here... | View Full Text | PubMed | CrossRef

3. Eichhorn JH: Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 1989; 70:572-7
Cited Here... | View Full Text | PubMed | CrossRef
Click to expand...

.
 
Last edited:
Whenever I see a topic with 30 posts on it, I always know that I can count on Blade to have provided 20+ of them... in a row 🙂
 
IlDestriero said:
What is academic medicine supposed to be doing? We work with them and know the score. Most of the CRNA mills are not at academic centers. The CRNA mills don't care about you or your future ($$$). I don't teach sRNAs. It will be a cold day in hell before CRNAs practice independently where I work, so no studies are going to happen here. Even if we looked at calls for help or other things and found some difference, it's not comparing independent CRNAs to physicians, so it wouldn't help the cause.
Click to expand...


I know that most of the CRNA mills are not at academic centers; however, I know there are a number of anesthesia departments that allow CRNA's to do cases with supervision (not medical direction). And they do big cases and put in lines. I trained at a place that allowed them to do transplants! And it was a large academic center. A first step, would be to not let them do "big cases" and put in central lines by themselves. Academic centers along with the ASA (and ASAPAC) are the key to saving our profession. Do you think if the Cleveland Clinic put out a huge study on the economics of a CRNA only vs MD study, people wouldn't listen. Maybe rather than focusing all of our research on rat studies, more should be focused to the economics of anesthesia. As it is, at this point in time, if you are planing to go into anesthesia you pretty much have to do a fellowship in order to get a descent job. I don't place all of the blame on academics because it is not. But they can make a difference because most people respect the world of academia and look to academia for research and data.
 
foxtrot said:
I know that most of the CRNA mills are not at academic centers; however, I know there are a number of anesthesia departments that allow CRNA's to do cases with supervision (not medical direction). And they do big cases and put in lines. I trained at a place that allowed them to do transplants! And it was a large academic center. A first step, would be to not let them do "big cases" and put in central lines by themselves. Academic centers along with the ASA (and ASAPAC) are the key to saving our profession. Do you think if the Cleveland Clinic put out a huge study on the economics of a CRNA only vs MD study, people wouldn't listen. Maybe rather than focusing all of our research on rat studies, more should be focused to the economics of anesthesia. As it is, at this point in time, if you are planing to go into anesthesia you pretty much have to do a fellowship in order to get a descent job. I don't place all of the blame on academics because it is not. But they can make a difference because most people respect the world of academia and look to academia for research and data.
Click to expand...
I dont place the blame on academics. i place the blame on our ASA leaders who happen to be mostly academic big wigs at the centers. They sold out our specialty by not DELINEAting what was a PHYSICIANS turf and what was a crnas turf. There are many problem CRNAS in the academic departments who are actively practicing poorly who are not reprimanded for fear of political retaliation. The crnas are politically active.. you cross one of them might as well crossed all of them. Thats how they roll. Couple that with INVERTEBRATES who are chairman and you see why we are in the state we are in.. They dont wanna take this issue on, they are chicken **** of it. IF you have a problem with a crna.. its your problem.. its not your chairman's problem
 
anynoise said:
I dont place the blame on academics. i place the blame on our ASA leaders who happen to be mostly academic big wigs at the centers. They sold out our specialty by not DELINEAting what was a PHYSICIANS turf and what was a crnas turf. There are many problem CRNAS in the academic departments who are actively practicing poorly who are not reprimanded for fear of political retaliation. The crnas are politically active.. you cross one of them might as well crossed all of them. Thats how they roll. Couple that with INVERTEBRATES who are chairman and you see why we are in the state we are in.. They dont wanna take this issue on, they are chicken **** of it. IF you have a problem with a crna.. its your problem.. its not your chairman's problem[/QUOT

What political retaliation? Who cares if a CRNA tries to retaliate. But I agree with you, that is exactly how it was where I did my residency.
Click to expand...
 
Hello. I am a CRNA working in a rural hospital where our payor mix is composed of primarily Medicaid and Medicare...very little to no private insurance patients.... rather poor and underserved area to say the least. Our group does not have an anesthesiologist because the hospital simply cannot afford one.
 
CRNA 1996 said:
Hello. I am a CRNA working in a rural hospital where our payor mix is composed of primarily Medicaid and Medicare...very little to no private insurance patients.... rather poor and underserved area to say the least. Our group does not have an anesthesiologist because the hospital simply cannot afford one.
Click to expand...

I fear that may end being the case at more hospitals across the USA.
The ACT is in real trouble long term and will NOT be the primary model in about ten years; instead, loose supervision of 6:1 or 8:1 will become the norm.
 
OP, yes, you should be concerned. My advice, if you are way into anesthesia, stick to it. If you are an intern or medical student, stay away.
My group lost its contract years ago, so now I commute a long distance to work so that the family did not have to be uprooted again. I don't spend money because I never know what is coming next. Many groups are happy about the number of applicants trying to get in because they have great plans to lengthen the time to partnership and increase the buy in. Perhaps no partnership offers.
Nothing is permanent, but in the more rural areas when a group gets the boot, there are few options.
 
owie said:
OP, yes, you should be concerned. My advice, if you are way into anesthesia, stick to it. If you are an intern or medical student, stay away.
My group lost its contract years ago, so now I commute a long distance to work so that the family did not have to be uprooted again. I don't spend money because I never know what is coming next. Many groups are happy about the number of applicants trying to get in because they have great plans to lengthen the time to partnership and increase the buy in. Perhaps no partnership offers.
Nothing is permanent, but in the more rural areas when a group gets the boot, there are few options.
Click to expand...

what's the over/under on the number of usernames you think you'll make? At least now you're using punctuation and capitals, step in the right direction
 
foxtrot said:
I know that most of the CRNA mills are not at academic centers; however, I know there are a number of anesthesia departments that allow CRNA's to do cases with supervision (not medical direction). And they do big cases and put in lines. I trained at a place that allowed them to do transplants! And it was a large academic center. A first step, would be to not let them do "big cases" and put in central lines by themselves. Academic centers along with the ASA (and ASAPAC) are the key to saving our profession. Do you think if the Cleveland Clinic put out a huge study on the economics of a CRNA only vs MD study, people wouldn't listen. Maybe rather than focusing all of our research on rat studies, more should be focused to the economics of anesthesia. As it is, at this point in time, if you are planing to go into anesthesia you pretty much have to do a fellowship in order to get a descent job. I don't place all of the blame on academics because it is not. But they can make a difference because most people respect the world of academia and look to academia for research and data.
Click to expand...


I wouldn't count on the Cleveland Clinic doing any "negative" study about CRNAs. The Chief of Cardiac is a member of the NBCRNA and highly supportive of CRNA education.
 
Other team arrangements are more associative;
for example, in some models CRNAs are responsible for
their own cases with no physician involvement unless requested.


CRNA-Physician Collaboration in Anesthesia
www.aana.com/aanajournal.aspx AANA Journal ß December 2009 ß Vol. 77, No. 6

 
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