The future of Anesthesia

[deleted162650]

I'm currently a 3rd year med student, and right now I'm very interested in pursuing a career in anesthesia. My question for the residents and attendings out there is where do you see the specialty going over the next say 30 years in light of the increaseing prevalence of CRNA's and ever changing healthcare environment. Will MD anesthsiologists maintain their intimate role in patient care or will they become managers overseeing a team of CRNA's? Will it become necassary to pursue fellowship training to ensure that you are in demand and able to pursue a good living? If you had it to do over again would still go into anesthesia or would look more closely at other specialties? Thanks.

P.S. I'm going to school in VA but I'm a native Californian, and I would eventually like to practice in CA. Can anyone tell me how CA is compared to other states as far as the use of CRNA's and any other pertinent info regarding anestheia?

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[InductionAgent]

Will MD anesthsiologists maintain their intimate role in patient care or will they become managers overseeing a team of CRNA's? Will it become necassary to pursue fellowship training to ensure that you are in demand and able to pursue a good living?

MDAs overseeing a team of CRNAs is not the worst-case scenario. The worst-case scenario which is unfolding is that CRNAs can practice unsupervised. There is an ever-increasing number of states in which CRNAs have secured the privilege to practice without us.

On the other hand, even in that worst-case scenario, we should still be able to make at least as much money as a CRNA, which is still a good living by most standards. I expect that things won't be quite that bad, but since I enjoy what I'm doing, I don't have to obsess over whether anesthesiology will continue to be quite as lucrative as it is now.

 

[deleted126335]

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[jwk]

MDAs overseeing a team of CRNAs is not the worst-case scenario. The worst-case scenario which is unfolding is that CRNAs can practice unsupervised. There is an ever-increasing number of states in which CRNAs have secured the privilege to practice without us.

They are pushing for independent practice, but there is not "an ever-increasing number of states in which CRNA's have secured the privilege to practice without us". If you're talking about the opt-out states, that number has not increased in a couple of years, and at least one attempt to move that direction was thwarted this year in Pennsylvania.

However, like it or not, CRNA's can already practice without an anesthesiologist in all 50 states.

 

[fakin' the funk]

I'm currently a 3rd year med student, and right now I'm very interested in pursuing a career in anesthesia. My question for the residents and attendings out there is where do you see the specialty going over the next say 30 years in light of the increaseing prevalence of CRNA's and ever changing healthcare environment. Will MD anesthsiologists maintain their intimate role in patient care or will they become managers overseeing a team of CRNA's? Will it become necassary to pursue fellowship training to ensure that you are in demand and able to pursue a good living? If you had it to do over again would still go into anesthesia or would look more closely at other specialties? Thanks.

P.S. I'm going to school in VA but I'm a native Californian, and I would eventually like to practice in CA. Can anyone tell me how CA is compared to other states as far as the use of CRNA's and any other pertinent info regarding anestheia?

1) Why didn't this OP get the standard "THIS QUESTION HAS BEEN ASKED A THOUSAND TIMES, DO A SEARCH, READ THE FAQS" response?

2) It isn't a "MD vs. CRNA" thread quite yet, but I do hope it gets closed if/when it becomes one.

 

[jwk]

1) Why didn't this OP get the standard "THIS QUESTION HAS BEEN ASKED A THOUSAND TIMES, DO A SEARCH, READ THE FAQS" response?

2) It isn't a "MD vs. CRNA" thread quite yet, but I do hope it gets closed if/when it becomes one.

Why do you care? If you don't like the thread, just don't read it anymore.

 

[InductionAgent]

They are pushing for independent practice, but there is not "an ever-increasing number of states in which CRNA's have secured the privilege to practice without us". If you're talking about the opt-out states, that number has not increased in a couple of years, and at least one attempt to move that direction was thwarted this year in Pennsylvania..

The opt-out number may not have increased in the past couple of years, but it certainly has not decreased, nor is it likely to. If one looks at the trend in the big picture, it is for ever-increasing "opt-out" and ever-increasing CRNA scope of practice, even if not overnight.

However, like it or not, CRNA's can already practice without an anesthesiologist in all 50 states.

I believe at present this is simply not legally true with regard to the administration of a general anesthetic. Some states still require physician supervision. The table in the following link, while outdated (2000) indicates that legally, CRNAs cannot practice unsupervised in all 50 states, not to say that it doesn't occur:
http://www.asahq.org/Washington/nurseanesscope.pdf

 

[jwk]

I believe at present this is simply not legally true with regard to the administration of a general anesthetic. Some states still require physician supervision. The table in the following link, while outdated (2000) indicates that legally, CRNAs cannot practice unsupervised in all 50 states, not to say that it doesn't occur:
http://www.asahq.org/Washington/nurseanesscope.pdf

There's a difference between practicing without an anesthesiologist and practicing without a physician. There is no state that requires a CRNA to be supervised or medically directed by an anesthesiologist specifically.

 

[Plead the Fifth]

For what it's worth, CRNA's at the relatively rural hospital I'm training at take call and can administer anesthesia during call hours without the oversight of an anesthesiologist (even though technically, I believe an anesthesiologist needs to be present). An anesthesiologist is always on backup call but does not necessarily have to be in house. On weekends, it's always locum tenens anesthesiologists or staff anesthesiologists.

 

[Coastie]

Dude, MDA? Come on.

For what it's worth, CRNA's at the relatively rural hospital I'm training at take call and can administer anesthesia during call hours without the oversight of an MDA (even though technically, I believe an MDA needs to be present). An MDA is always on backup call but does not necessarily have to be in house. On weekends, it's always locum tenens MDA's or staff MDA's.

 

[InductionAgent]

There's a difference between practicing without an anesthesiologist and practicing without a physician. There is no state that requires a CRNA to be supervised or medically directed by an anesthesiologist specifically.

True enough.

The stipulation of physician supervision of CRNAs in some states is still beneficial to us, as long as few surgeons remain willing to take medicolegal responsibility for supervising CRNAs.

 

[Plead the Fifth]

Dude, MDA? Come on.

I didn't realize it was a taboo acronym. My bad.

 

[fakin' the funk]

I didn't realize it was a taboo acronym. My bad.

What exactly is it an acronym for?!

 

[MacGyver]

Can anybody actually cite a case of a surgeon being sued for CRNA malpractice? That bogeyman gets thrown out all the time, but I think its a straw man because if it was really happening with any frequency at all the surgeons would have wised up to it a long time ago and refused to have CRNAs on their cases.

Based on the lack of outrage from surgeons regarding CRNAs, I have to conclude that they almost never get sued for what the CRNA does and therefore dont care who delivers the gas.

 

[core0]

Can anybody actually cite a case of a surgeon being sued for CRNA malpractice? That bogeyman gets thrown out all the time, but I think its a straw man because if it was really happening with any frequency at all the surgeons would have wised up to it a long time ago and refused to have CRNAs on their cases.

Based on the lack of outrage from surgeons regarding CRNAs, I have to conclude that they almost never get sued for what the CRNA does and therefore dont care who delivers the gas.

Well the AANA brief on this lists three cases. The two that you can look up easily support the fact that the surgeon was sued in both cases for the acts of the CRNA. Of course this is mixed in with the statement that surgeons can be sued for anesthesiologist acts also as part of the AANAs attempt to show they are just like physicians.
http://www.aana.com/Resources.aspx?...MenuTargetType=4&ucNavMenu_TSMenuID=6&id=2555

 

[InductionAgent]

Can anybody actually cite a case of a surgeon being sued for CRNA malpractice? That bogeyman gets thrown out all the time, but I think its a straw man because if it was really happening with any frequency at all the surgeons would have wised up to it a long time ago and refused to have CRNAs on their cases.

Based on the lack of outrage from surgeons regarding CRNAs, I have to conclude that they almost never get sued for what the CRNA does and therefore dont care who delivers the gas.

In a state that requires physician supervision of a CRNA, whoever is supervising the CRNA is directly responsible (i.e. sueable) for their actions. If the surgeon is the only physician on the case, then it would be quite natural to include him in a lawsuit. It seems logical that in states requiring physician supervision of CRNAs, surgeons would be more wary of allowing them to deliver anesthesia unless supervised by an anesthesiologist. At least they should be.

 

[Trisomy13]

getting back to the original topic.. the FUTURE of anesthesia... i would like to be the first anesthesiologist on a Mars mining colony, so when Schwarzenegger yells "GIVE THESE PEOPLE AIIIIRR!" i can step up with my ambu-bag and O2 cylinder and do my job.

now granted, that's probably more "future" than you meant, but it's better than a response about CRNAs.

 

[badgas]

getting back to the original topic.. the FUTURE of anesthesia... i would like to be the first anesthesiologist on a Mars mining colony, so when Schwarzenegger yells "GIVE THESE PEOPLE AIIIIRR!" i can step up with my ambu-bag and O2 cylinder and do my job.

now granted, that's probably more "future" than you meant, but it's better than a response about CRNAs.

Too late Trisomy, CRNAs have been adminstering anesthesia there since the civil war.

 

[OB1🤙]

Too late Trisomy, CRNAs have been adminstering anesthesia there since the civil war.

I hear they've been advancing the art and science of terraforming since then too.

 

[VentdependenT]

I hear they've been advancing the art and science of terraforming since then too.

BIODOME!