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deleted162650
That's still 10X.
That's still 10X.
You keep saying all of this, over and over, yet none of this has happened in places where right now they could fire every anesthesiologist and they have not done so. They could’ve been doing it years ago and didn’t.That's thoracic. Cardiac will probably be the same. Open vascular the same. And I am sure there are others, although not many I can think about. Although, in many places, all these are done with supervised CRNAs, even in a 3:1 model (one cardiac and two non-cardiac rooms per anesthesiologist).
Most cases are not like that. They are bread and butter, just ripe for takeover (and there are cases where outpatient surgeons/proceduralists hire their own experienced CRNA for anesthesia). They are also the biggest moneymakers: the simple elective (semi)outpatient procedures on ASA 1-3 patients.
I'd rather be "eat what you kill" in an endoscopy suite than in a thoracic or cardiac room. Even just an employee, because it's easier and because, sooner or later, some dumb bean counter will wonder why they are paying me more than a CRNA for a room that brings in less money.
Also, ask yourself: why do they rather pay YOU these rates, instead of hiring a permanent doc for the same money? Maybe because they don't want to pay anybody well enough, long-term, hence the reason for having a staffing problem in the first place. These places will always exist, in every country; there is usually a reason people don't want to work/live there. But I am talking about most jobs (which are where most people are, on the coasts and in metropolitan areas), not these outliers.
To those who disagree with me: let's just look again in a decade. Even the most optimistic of my friends agree that things are worse now than 10 years ago. Usually, when the sky is falling in a profession, people tend to not notice it until it's close, because that's when things speed up. See also my post above, about SLOWness in change. Leaders have been advised to do that at least since Machiavelli.
I only see practices which go from solo to ACT, or from ACT 2:1 to ACT 3-4:1, and never the other way round. All those changes are jobs lost for anesthesiologists. A lot of jobs. Hence some of us now work for various corporations.You keep saying all of this, over and over, yet none of this has happened in places where right now they could fire every anesthesiologist and they have not done so. They could’ve been doing it years ago and didn’t.
How is a CRNA going to be used interchangeably and be put in the call pool when they have done a handful of those cases, and possibly only ever watched them based on what I witnessed?
I brought up my locums offers because again, they could pay a nurse half what they pay me and they choose to keep paying me. And it’s not because they don’t have nurses willing to work there. I’m old enough that I only do locums in desirable areas or close to desirable areas that allow me to enjoy myself while I’m there, and see my kids at college. They pay me because they’re covering vacations/sudden illnesses and surgeries/family leave etc. Mix of PP groups and hospitals doing the paying.
I’ve been hearing the exact same thing for decades, and as a whole we are doing just fine- MGMA still looks great, job offers still look great...I mean, if you insist on living in certain pockets of the country you’re going to take a hit financially but what else is new, this is a different conversation than this supposed CRNA takeover that has been allegedly imminent for decades.
I only see practices which go from solo to ACT, or from ACT 2:1 to ACT 3-4:1, and never the other way round. All those changes are jobs lost for anesthesiologists. A lot of jobs. Hence some of us now work for various corporations.
I also see more anesthesiologists being "encouraged" to leave for not getting along with CRNAs than the opposite. When a CRNA gets into trouble, I usually see things being brushed under the carpet, or a slap on the wrist, because administrators know that going to war with one means going to war with all. Let's not mention "hurting their feelings" by actually telling them what to do, when medically directing.
This is all my subjective n=1. In my own geographical area (which is clearly one of the worst markets in the country), things are always getting only worse.
And, seriously, you're going to argue that the market is the same because you're still getting great locum offers? How many of us want to work as a locum tenens? Even in the middle of the Covid pandemic, New York hospitals were paying out-of-state locums much more than what they were paying the local temps, because they didn't want the income levels to "stick".
They would, if it's a doctor you're replacing on that stool. Some practices/surgeons just don't want CRNAs for certain cases (yet). That's why there are solo MD practices even in independent CRNA practice states.No, that’s not what I’m arguing. I’m arguing the market is good because every year I see a fresh class of residents who rotate through our sites and I know every one of their job offers. I see a very big picture.
The locums is being brought up because you seem to think nurses are actively replacing doctors, and if that were the case they wouldn’t be paying me times 2 to sit the stool.
Fair enough. We all have anecdotal evidence on both sides of this coin. But the job market as a whole is what we need to look at, and if you don’t limit yourself to a couple handfuls of super tight markets there are plenty of well paying jobs where you’re not a chart monkey praying a nurse doesn’t kill someone on your watch.They would, if it's a doctor you're replacing on that stool. Some practices/surgeons just don't want CRNAs for certain cases (yet). That's why there are solo MD practices even in independent CRNA practice states.
I'm glad that your program/market is so good that your residents still get good offers.
Believe me when I tell you: I have seen exactly one practice go almost solo MD from ACT (and that happened because they couldn't replace the CRNAs who left for various personal, not professional, reasons). It's almost always the other way round, so MD jobs are being lost. And working ACT for basically the same (or less) money as one used to do solo MD for, or covering more rooms, is a pay cut.
Fair enough. We all have anecdotal evidence on both sides of this coin. But the job market as a whole is what we need to look at, and if you don’t limit yourself to a couple handfuls of super tight markets there are plenty of well paying jobs where you’re not a chart monkey praying a nurse doesn’t kill someone on your watch.
You were asked this by a CRNA or MD?Exactly what I was told by a colleague who failed his oral boards, when I wanted to do gentle LMA for a 90 year-old with EF of 20% and ugly baseline EKG.
Etomidate is another marker of people who don't really know what they are doing, no offense. Same for phenylephrine for everybody (I was asked intraop why I preferred ephedrine first, at a HR of 50 and BP of 60/30). Etc.
Don’t hold your breath. The ASA’s response to the continuous erosion of anesthesiologists’ practice realm is akin to politicians’ responses to gun violence following a mass shooting.
“This is deeply concerning.” “Thoughts and prayers to the (anesthesiologists) who have lost their live(lihood)s.” “Keep sending us checks.”
Ask him/her what “when appropriately deployed” means. I agree with that, but “when appropriately deployed” to me does not mean unsupervised. I am genuinely curious. Isn’t that the heart of the whole matter? You might also ask if he/she is aware of how expensive CRNAs are for the hours they work and most don’t take call. If they made NP wages I could sort of understand that argument, but they don’t.Excerpt from the canned response to an email I sent one of my senators -
"I support policies that increase access, reduce cost, and provide for greater patient choice. I understand your concerns with respect to patient safety, and I believe that patient safety should always be our top priority when considering policy changes related to the delivery of patient care. At the same time, I do believe that when appropriately deployed, CRNAs operating at the full scope of their licensure can serve as a critical force multiplier, thereby increasing our health systems’ ability to provide timely and quality care to all patients.
...
I believe that taking care of veterans should be among our top priorities"
A lot of contradiction there and sadly, no support for actual quality care for our veterans.
Excerpt from the canned response to an email I sent one of my senators -
"I support policies that increase access, reduce cost, and provide for greater patient choice. I understand your concerns with respect to patient safety, and I believe that patient safety should always be our top priority when considering policy changes related to the delivery of patient care. At the same time, I do believe that when appropriately deployed, CRNAs operating at the full scope of their licensure can serve as a critical force multiplier, thereby increasing our health systems’ ability to provide timely and quality care to all patients.
...
I believe that taking care of veterans should be among our top priorities"
A lot of contradiction there and sadly, no support for actual quality care for our veterans.
We need to stop fighting the bull**** supervision argument. It’s very plainly clear where this is all heading. If the ASA said tomorrow we recommend all anesthesiologists do their own cases, CRNAs do theirs and all training of SRNAs by anesthesiologists stop completely, we may finally start a fight worth fighting.
As it stands we release statements and write letters and in the end it all amounts to nothing. The AANA does not want us supervising their SRNAs/CRNAs. Enough SRNAs/CRNAs do not want us supervising them. I personally do not want to supervise them. They go through their training. We go through ours. Let’s stop this bull**** supervision, start doing our own work, and let the dust settle. If they can stand on their own, so be it. They deserve what they get. But I’m confident in my training and my skills. I know the level of care I provide. I know patients benefit from anesthesiologists providing anesthesia.
The ASA would never say that though. They're too wishy-washy to even take an official stance on CRNAs, other than "stop being mean to us."We need to stop fighting the bull**** supervision argument. It’s very plainly clear where this is all heading. If the ASA said tomorrow we recommend all anesthesiologists do their own cases, CRNAs do theirs and all training of SRNAs by anesthesiologists stop completely, we may finally start a fight worth fighting.
As it stands we release statements and write letters and in the end it all amounts to nothing. The AANA does not want us supervising their SRNAs/CRNAs. Enough SRNAs/CRNAs do not want us supervising them. I personally do not want to supervise them. They go through their training. We go through ours. Let’s stop this bull**** supervision, start doing our own work, and let the dust settle. If they can stand on their own, so be it. They deserve what they get. But I’m confident in my training and my skills. I know the level of care I provide. I know patients benefit from anesthesiologists providing anesthesia.
Got the same response. I stopped trying to decipher it and figured they support independent NPs and CRNAs.Excerpt from the canned response to an email I sent one of my senators -
"I support policies that increase access, reduce cost, and provide for greater patient choice. I understand your concerns with respect to patient safety, and I believe that patient safety should always be our top priority when considering policy changes related to the delivery of patient care. At the same time, I do believe that when appropriately deployed, CRNAs operating at the full scope of their licensure can serve as a critical force multiplier, thereby increasing our health systems’ ability to provide timely and quality care to all patients.
...
I believe that taking care of veterans should be among our top priorities"
A lot of contradiction there and sadly, no support for actual quality care for our veterans.
all training of SRNAs by anesthesiologists stop completely, we may finally start a fight worth fighting.
But patients don’t get a choice when they show up to the hospital emergently ill. I have very little sympathy for people who choose midwives and NPs for their elective care. It terrifies me to think of myself or someone I love showing up for an emergent surgical procedure with nobody there but a nurse. Maybe it’s because I’m well into the second half of my life and I know my surgical needs will increase, but holy s@@t what a terrifying thought. So I continue to fight for that reason.
I agree we need to stop training them. Let them train each other.
Exactly what I was told by a colleague who failed his oral boards, when I wanted to do gentle LMA for a 90 year-old with EF of 20% and ugly baseline EKG.
Etomidate is another marker of people who don't really know what they are doing, no offense. Same for phenylephrine for everybody (I was asked intraop why I preferred ephedrine first, at a HR of 50 and BP of 60/30). Etc.
Etomidate is a drug of the devil. I see no good reason to use it over the plethora of other medications that could be given for intubation. There are several studies pointing toward increased mortality; although that is debated. Etomidate in my experience produces a jerky myoclonus and takes a few seconds longer to take full effect compared to other meds. And if you are so worried about dropping a septic or crashing patient’s pressure with propofol, here are some novel thoughts, give less propofol, use another drug or give a bolus of pressor preinduction.
I take the studies with a grain of salt but again if you can’t get a septic patient off to sleep and tube them without using without using etomidate then.....The studies on etomidate were flawed. Of course highly death rates but due to sicker patients being use with etomidate. I’ve read the studies.
Looks like you probably finished your training between 2006-2014 judging by your attitudes. Am I correct?
if it’s such a bad drug why don’t they just pull it? Like USA doesn’t use mivacurium any more.
you probably think chloroprep is superior to betadine as well.
Yep. They're the same ***** who claim they can "intubate anyone" with a Miller-3 blade and scoff at the use of the Glidescope.Anyone else tired of hearing how some people are such superior doctors because they dont use etomidate?
I don’t care if you induce anesthesia with a wooden mallet, do whatever works for you and gets the job done safely and efficient.
CA3 year was where I really fine tuned my ability to push the stretcher. By the middle of the year I could push an ICU bed while ambu-ing and bringing the pole with drips on it. It was very impressive and what surgeons would compliment me most on... my transport and turnover... FMLTough to do it safely with a wooden mallet. It’s a really fine line you have to walk there.
Definitely a CA-3 skill.
CA3 year was where I really fine tuned my ability to push the stretcher. By the middle of the year I could push an ICU bed while ambu-ing and bringing the pole with drips on it. It was very impressive and what surgeons would compliment me most on... my transport and turnover... FML
Dang I wish I rotated at Hopkins now instead of NIH.I still kick myself for not doing that stretcher driving fellowship at Hopkins.
Those skills are the first to atrophy when you become an attending.CA3 year was where I really fine tuned my ability to push the stretcher. By the middle of the year I could push an ICU bed while ambu-ing and bringing the pole with drips on it. It was very impressive and what surgeons would compliment me most on... my transport and turnover... FML
I came across this on gaswork.
CRNAs participate in all cases and have the opportunity to place all peripheral nerve blocks, double-lumen tubes, and invasive lines.
Love the Q3 second call too. You are always available to take the blame.Textbook firefighter and liability scapegoat job.
Love the Q3 second call too. You are always available to take the blame.
I came across this on gaswork.
CRNAs participate in all cases and have the opportunity to place all peripheral nerve blocks, double-lumen tubes, and invasive lines.