What is your stance on physician anesthesiologist?

[JiPo]

It's hard to take this seriously. I'm not trying to be dismissive.

I think your job has been certified by the FDA as the Worst Job In America, but you stay for reasons that matter to you.

If they started an SRNA program it's just hard to believe that would be the final straw.

To be fair, if I had his/her job AND had to supervise SRNA, I would leave the job too

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[anbuitachi]

To be fair, if I had his/her job AND had to supervise SRNA, I would leave the job too

exactly!

 

[chocomorsel]

sad that some of you have to be with SRNAs. if i had to do that at my work place, id either quit, or tell my boss i refuse to work with SRNA,

Do you work with CRNAs? Where do y’all think they come from?

 

[chocomorsel]

Everyone hates to “work with” them yet for some reason we still do it, I remember interviewing once at a napa site where they claimed it was a great feature to get to train srnas there. What a joke.

Why do we do this to ourselves?

Cuz we are stupid sheeple.

 

[anbuitachi]

Do you work with CRNAs? Where do y’all think they come from?

not from my training thats for sure.
i work alone and with residents way more than crna

 

[chocomorsel]

not from my training thats for sure.
i work alone and with residents way more than crna

Well, someone out there has to train them. And if you are ok with and or work with them, then ain’t no point in hating on the ones who train them.
I thankfully do not have to work with them or any midlevels at my FT gig.

 

[anbuitachi]

Well, someone out there has to train them. And if you are ok with and or work with them, then ain’t no point in hating on the ones who train them.
I thankfully do not have to work with them or any midlevels at my FT gig.

i dont get it. i work with admins and insurance. and i hate many of them

my colleagues in IM hate prior authorization calls and stuff. they still work with them

at this point in the northeast its hard to find a place with no CRNAs. but its not hard yet to find a place with no SRNA. now if you told me in 5 years we all be training SRNAs, its not like i'll just quit my job and change careers

 

[chocomorsel]

i dont get it. i work with admins and insurance. and i hate many of them

my colleagues in IM hate prior authorization calls and stuff. they still work with them

at this point in the northeast its hard to find a place with no CRNAs. but its not hard yet to find a place with no SRNA. now if you told me in 5 years we all be training SRNAs, its not like i'll just quit my job and change careers

They are likely in the same boat. Lots of crap they hate about their jobs including training SRNAs but they are tied to the community for whatever reason.
I don't know, I hated it when I had to do it occasionally in my old job. But I was not the Chairman that allowed it. Above our pay grade.
If there are heads of departments or real partners that make those decisions on this board that allow that ish... then that's another problem. Those are the ones we should have a problem with.

 

[POW16]

I have them sometimes in my ORs. I let them intubate and that's about it. I don't teach them anything, that's what the CRNA in the room is there for. It's really not a big deal.

 

[IMGASMD]

I have them sometimes in my ORs. I let them intubate and that's about it. I don't teach them anything, that's what the CRNA in the room is there for. It's really not a big deal.

Had an general ob case, three of us in the room for induction.
“Senior” SRNA proceed to intubate with glide. Couldn’t get a view. Patient start to desat. 80s, 70s….. ****ing CRNA just stood behind him. Still can’t get a view. I said something. Crna took over.
Probably a “teaching moment” for the SRNA, but not on my license nor on the baby’s expense. Not the fuking patient to do this on.
I had a moment like that when I was a resident, the attending trying to show me how little reserve parturients have. But he knew where I was in my skillset, and he chose to demonstrate that point at that particular time.

I didn’t fuking sign up for this bullsht.

 

[kidthor]

Well, someone out there has to train them.

But, do we? Or they can just train themselves in midlevel paradise hospitals.

 

[chocomorsel]

But, do we? Or they can just train themselves in midlevel paradise hospitals.

No, we obviously don’t. But I live in America and I know these colleges make the Anesthesia department money and America is about Money.
The Anesthesia department heads are allowing this BS.

 

[Precedex]

Everyone hates to “work with” them yet for some reason we still do it, I remember interviewing once at a napa site where they claimed it was a great feature to get to train srnas there. What a joke.

Why do we do this to ourselves?

Not me. I can't relate to these complaints. We have a SRNA program and I have always enjoyed working with them, find them motivated and hard-working. Sometimes they are better prepared than the residents. We have CRNAs too, many of whom are good friends and all of whom are competent at their jobs. I wouldnt hesitate having them give me anesthesia. I feel fortunate there is not animosity at my institution like the type I see here all the time. We all get along. No one is trying to undermine anyone. I'm sorry your experience has not been the same. I don't think it has to be adversarial.

 

[chocomorsel]

Not me. I can't relate to these complaints. We have a SRNA program and I have always enjoyed working with them, find them motivated and hard-working. Sometimes they are better prepared than the residents. We have CRNAs too, many of whom are good friends and all of whom are competent at their jobs. I wouldnt hesitate having them give me anesthesia. I feel fortunate there is not animosity at my institution like the type I see here all the time. We all get along. No one is trying to undermine anyone. I'm sorry your experience has not been the same. I don't think it has to be adversarial.

Dude you are brainwashed. Most of them if not all belong to the AANA whose mission is to be independent of docs and claim equivalency with less training.
Trust and believe most of them have other agendas and views.

 

[coffeebythelake]

Not me. I can't relate to these complaints. We have a SRNA program and I have always enjoyed working with them, find them motivated and hard-working. Sometimes they are better prepared than the residents. We have CRNAs too, many of whom are good friends and all of whom are competent at their jobs. I wouldnt hesitate having them give me anesthesia. I feel fortunate there is not animosity at my institution like the type I see here all the time. We all get along. No one is trying to undermine anyone. I'm sorry your experience has not been the same. I don't think it has to be adversarial.

Why are you a PHYSICIAN training a MIDLEVEL student?
Shouldn't they be training themselves?

 

[GassYous]

Not me. I can't relate to these complaints. We have a SRNA program and I have always enjoyed working with them, find them motivated and hard-working. Sometimes they are better prepared than the residents. We have CRNAs too, many of whom are good friends and all of whom are competent at their jobs. I wouldnt hesitate having them give me anesthesia. I feel fortunate there is not animosity at my institution like the type I see here all the time. We all get along. No one is trying to undermine anyone. I'm sorry your experience has not been the same. I don't think it has to be adversarial.

You're the problem

 

[anbuitachi]

attendings and crnas all get along in my department too at work. but we dont pretend they dont say stuff behind our backs.
there were several instances where crna were not happy attendings were telling them how to manage the patient

 

[IMGASMD]

You're the problem

TRUTH.

 

[IMGASMD]

Sometimes they are better prepared than the residents.

Then you guys are running a ****ty program.

How can these words even be true on “any” level is beyond me.

 

[chocomorsel]

My boyfriend from Fellowship preferred to work with the NPs versus the residents. Because the midlevels knew the system and had been there longer versus the “rotating” residents.
I told his ass he was part of the problem and stop worshipping these people who want to take over our jobs.

 

[MirrorTodd]

We don't have Srna's anymore, we have Rrna's at our hospital. I don't know how common that is, but you can guess what the R stands for.

 

[DrZzZz]

We don't have Srna's anymore, we have Rrna's at our hospital. I don't know how common that is, but you can guess what the R stands for.

Repulsive?

 

[chocomorsel]

We don't have Srna's anymore, we have Rrna's at our hospital. I don't know how common that is, but you can guess what the R stands for.

Rotating? ******ed? Redundant? Replacement?
Oh… I see. RESIDENTS!! Like physicians you mean?
Everybody want to play Physician but no one wants to work for it.
Y’all know this is a USA problem right? Where everything is about money and what lobbying you can buy with it.

 

[Precedex]

Dude you are brainwashed. Most of them if not all belong to the AANA whose mission is to be independent of docs and claim equivalency with less training.
Trust and believe most of them have other agendas and views.

You are probably right. It’s what happens After 15 years of working with crnas and srnas without any of the problems you seem to experience routinely. My condolences.

 

[Precedex]

Then you guys are running a ****ty program.

How can these words even be true on “any” level is beyond me.

Are you a resident?

 

[IMGASMD]

Are you a resident?

No.

Since we are in the question and answer section.

How much are you making off the CRNAs/SRNA’s back?

 

[hiyaman]

I would have serious concerns about a residency program if SRNAs are actually better. Most SRNAs i've talked to in residency have no clue the reasoning behind anesthetic decisions. They literally are just following a template that they get for x, y, z type case.

They can't adjust to different comorbidities of a patient to the surgery.
They don't concern themselves with surgical concerns to an anesthetic

That's the difference between CRNA and a physician

 

[GassYous]

I would have serious concerns about a residency program if SRNAs are actually better. Most SRNAs i've talked to in residency have no clue the reasoning behind anesthetic decisions. They literally are just following a template that they get for x, y, z type case.

They can't adjust to different comorbidities of a patient to the surgery.
They don't concern themselves with surgical concerns to an anesthetic

That's the difference between CRNA and a physician

That is a reflection on the attendings more than the residents. One or two bad residents is not your fault. If they suck as a group...

 

[anbuitachi]

We don't have Srna's anymore, we have Rrna's at our hospital. I don't know how common that is, but you can guess what the R stands for.

Repulsive?

Rotating? ******ed? Redundant? Replacement?
Oh… I see. RESIDENTS!! Like physicians you mean?
Everybody want to play Physician but no one wants to work for it.
Y’all know this is a USA problem right? Where everything is about money and what lobbying you can buy with it.

soon to be called PRNA. physician RNA

 

[IMGASMD]

soon to be called PRNA. physician RNA

They’re proud to be nurse. They will never stoop that low. They don’t want to be a physician, OTOH they do want to be called doctor.

Doctor Nurse Anesthesiologists. DNA…. I am vital to your existence, I Am D N A.

 

[chocomorsel]

You are probably right. It’s what happens After 15 years of working with crnas and srnas without any of the problems you seem to experience routinely. My condolences.

Like I said, I don't work with CRNAs. Can you read? I practice ICU and no midlevels except on the rare occasion of 1099 work of less than 14 days a year. Used to work with them. Haven't in a long time and my life is so much better without. The 1099 anesthesia work I do, I choose to do my own cases.
And, just because they smile in your face don't mean they aren't talking **** behind your back. Stop being naive. Actually, continue to bury your head in the sand.

 

[vm26]

Like I said, I don't work with CRNAs. Can you read? I practice ICU and no midlevels except on the rare occasion of 1099 work of less than 14 days a year. Used to work with them. Haven't in a long time and my life is so much better without. The 1099 I do I choose to do my own cases.
And, just because they smile in your face don't mean they aren't talking **** behind your back. Stop being naive. Actually, continue to bury your head in the sand.

It is difficult to get a man to understand something when his salary depends upon his not understanding it.

-Upton Sinclair

 

[We'llBeDoneIn15Minutes]

Well, someone out there has to train them. And if you are ok with and or work with them, then ain’t no point in hating on the ones who train them.
I thankfully do not have to work with them or any midlevels at my FT gig.

It's like the Fram oil filter commercial, you can pay me now, or you can pay me later. We can have the frustration early when they are SRNAs and teach them correctly then, or we can wait till they are frustrating CRNAs and teach them correctly after they are already working for you. So as long as we are ok with the anesthesia team model (Overall I am because I just can't sit the stool all day. Can't do it), I'm fine with somebody teaching SRNAs and breaking a lot of bad habits early rather than later.

 

[We'llBeDoneIn15Minutes]

I would have serious concerns about a residency program if SRNAs are actually better. Most SRNAs i've talked to in residency have no clue the reasoning behind anesthetic decisions. They literally are just following a template that they get for x, y, z type case.

I worked 5 years at a very good residency, not elite, but a top university and definitely a tier 2 if there are 5 or so tiers. Let me tell you, every single year there's a "physician resident" or two that SUCK. Suck in every way possible: work ethic, iq, personality. I'm sure even the tier ones have residents that everyone says, How in Hell did he/she slip through the cracks?

 

[We'llBeDoneIn15Minutes]

I'm a lot less bothered by Physician Anesthesiologist than MDA. That sounds more like the street drug Molly than anything associated with what I do. A lot of patients have no clue what's the difference between an anesthesiologist and an anesthetist, so since we can't just say, me doctor, him/her nurse, then at least they hear "Physician."

 

[nimbus]

Not me. I can't relate to these complaints. We have a SRNA program and I have always enjoyed working with them, find them motivated and hard-working. Sometimes they are better prepared than the residents. We have CRNAs too, many of whom are good friends and all of whom are competent at their jobs. I wouldnt hesitate having them give me anesthesia. I feel fortunate there is not animosity at my institution like the type I see here all the time. We all get along. No one is trying to undermine anyone. I'm sorry your experience has not been the same. I don't think it has to be adversarial.

I haven’t seen a CRNA in 25 years since residency but the relationships in that department were very collegial and some of the CRNAs were very good. No SRNAs at that program.

 

[anestronaut]

I would prefer:

anesthesia physician
anesthesia nurse
anesthesia assistant

 

[IMGASMD]

I worked 5 years at a very good residency, not elite, but a top university and definitely a tier 2 if there are 5 or so tiers. Let me tell you, every single year there's a "physician resident" or two that SUCK. Suck in every way possible: work ethic, iq, personality. I'm sure even the tier ones have residents that everyone says, How in Hell did he/she slip through the cracks?

It's like the Fram oil filter commercial, you can pay me now, or you can pay me later. We can have the frustration early when they are SRNAs and teach them correctly then, or we can wait till they are frustrating CRNAs and teach them correctly after they are already working for you. So as long as we are ok with the anesthesia team model (Overall I am because I just can't sit the stool all day. Can't do it), I'm fine with somebody teaching SRNAs and breaking a lot of bad habits early rather than later.

Are you judging/teaching your SRNA the same way as a resident? I hope not.

Even with the team structure, you’re supposed to be the leader. (Whatever that word means to you). You as a physician is leading the team, any tough decisions comes through you.
You’re training residents to become you, you shouldn’t be training SRNAs to replace you.

CRNAs will never be able to go head to head with a surgeon in any kind of “confrontation”. Hack, they can’t even have a conversation with our pharmacy, because they just don’t have the knowledge. Antibiotic choices, defer to surgeon.

Sure, train them if you want. Teach them to do things correctly. They will never think through a complex decision as a doctor.

 

[IMGASMD]

I haven’t seen a CRNA in 25 years since residency but the relationships in that department were very collegial and some of the CRNAs were very good. No SRNAs at that program.

I don’t know if the relationship changed throughout the last 25 years. I have to say, I worked with some old timer CRNAs, usually they’re much easier to work with. They were probably nurses for a while and really understood their job, as a nurse as a team member.

The new breed is different. Most of them have this mindset that being a ICU/ER/Whatever requirement nurse is means to an end. They just want to be a CRNA, so they can make the big bucks. It doesn’t really help now they’re tagging onto an extra year of “training” so they all can be DNPs, therefore doctor. More I think of it, more it depresses me.

The daily grind with them, is fine. It’s part of the “day”. Sure sitting on a chair all day and checking my stock prices can get boring (especially when I have most of my money on VTI). It’s the implications and long term deterioration of practice anesthesia that saddens me.

 

[Simba1711]

One of my friends works at a huge academic center. He told me he likes working with the srnas over the residents. Saids they’re better prepared and easier for him because they give each other breaks. He teaches them peripheral nerve blocks and neuraxial. My friend Didn’t understand when what he told me pissed me off.

 

[chocomorsel]

One of my friends works at a huge academic center. He told me he likes working with the srnas over the residents. Saids they’re better prepared and easier for him because they give each other breaks. He teaches them peripheral nerve blocks and neuraxial. My friend Didn’t understand when what he told me pissed me off.

Your friend sounds lazy and just wants to make his life easy. He’s too dumb to see the big picture. Or imagine what this means for our future.

 

[GassYous]

One of my friends works at a huge academic center. He told me he likes working with the srnas over the residents. Saids they’re better prepared and easier for him because they give each other breaks. He teaches them peripheral nerve blocks and neuraxial. My friend Didn’t understand when what he told me pissed me off.

Does your friend like dexmedetomidine

 

[OptionOffense]

One of my friends works at a huge academic center. He told me he likes working with the srnas over the residents. Saids they’re better prepared and easier for him because they give each other breaks. He teaches them peripheral nerve blocks and neuraxial. My friend Didn’t understand when what he told me pissed me off.

Your friend is YOU and you are a CRNA 100 percent. Thanks.

 

[Urzuz]

I worked 5 years at a very good residency, not elite, but a top university and definitely a tier 2 if there are 5 or so tiers. Let me tell you, every single year there's a "physician resident" or two that SUCK. Suck in every way possible: work ethic, iq, personality. I'm sure even the tier ones have residents that everyone says, How in Hell did he/she slip through the cracks?

I know a few orthopedic surgeons that are dumb as bricks and are awful surgeons. That can only mean we should start training PAs how to do surgery, right?

So as long as we are ok with the anesthesia team model (Overall I am because I just can't sit the stool all day. Can't do it), I'm fine with somebody teaching SRNAs and breaking a lot of bad habits early rather than later.

So you’re an anesthesiologist that can’t actually do anesthesia? And rather than finding something you can do, you want a brainless canary in the coal mine to scream when there’s a problem, all while making money from the little canary’s work? Got it.

I’ve read a lot of sad, pathetic posts on this forum but this series of posts by you and the other guy really take the cake. Right when I think there’s a glimmer of hope for the future of this field, someone like you will come along and remind me of why we will never be able to command the respect from our peers that the rest of us deserve. Really pathetic.

 

[nimbus]

I worked 5 years at a very good residency, not elite, but a top university and definitely a tier 2 if there are 5 or so tiers. Let me tell you, every single year there's a "physician resident" or two that SUCK. Suck in every way possible: work ethic, iq, personality. I'm sure even the tier ones have residents that everyone says, How in Hell did he/she slip through the cracks?

Clinically the worst anesthesiologist I’ve ever met was a DNA (doctor nurse anesthesiologist. She was a CRNA at an academic Mecca in nyc for almost 10 yrs), then went to medical school, then trained at a top 5 anesthesia program in Boston. How she graduated is unclear.

A pretty typical occurrence would be an anesthesia tech coming to get me while I’m between cases. “Dr DNA needs your help.” I’d go into her room and the crani would be finished. “Dr neurosurgeon would like an Aline for postop bp monitoring in icu.” I’d pull off the blankets and find 10 holes running up and down each arm where she had “attempted” an Aline. I put the ultrasound on the arm only to see a bounding 4-5mm radial artery. 1/1USG EZ. That was among many examples of basic procedures she couldn’t do. Thankfully she retired early a few years back.


Some anesthesiologists are terrible and some anesthesiologists are worse than some CRNAs which doesn’t help our cause.

 

[We'llBeDoneIn15Minutes]

I know a few orthopedic surgeons that are dumb as bricks and are awful surgeons. That can only mean we should start training PAs how to do surgery, right?



So you’re an anesthesiologist that can’t actually do anesthesia? And rather than finding something you can do, you want a brainless canary in the coal mine to scream when there’s a problem, all while making money from the little canary’s work? Got it.

I’ve read a lot of sad, pathetic posts on this forum but this series of posts by you and the other guy really take the cake. Right when I think there’s a glimmer of hope for the future of this field, someone like you will come along and remind me of why we will never be able to command the respect from our peers that the rest of us deserve. Really pathetic.

Good grief. Relax, have a cream soda. It's all going to be ok.

 

[anbuitachi]

Clinically the worst anesthesiologist I’ve ever met was a DNA (doctor nurse anesthesiologist. She was a CRNA at an academic Mecca in nyc for almost 10 yrs), then went to medical school, then trained at a top 5 anesthesia program in Boston. How she graduated is unclear.

A pretty typical occurrence would be an anesthesia tech coming to get me while I’m between cases. “Dr DNA needs your help.” I’d go into her room and the crani would be finished. “Dr neurosurgeon would like an Aline for postop bp monitoring in icu.” I’d pull off the blankets and find 10 holes running up and down each arm where she had “attempted” an Aline. I put the ultrasound on the arm only to see a bounding 4-5mm radial artery. 1/1USG EZ. That was among many examples of basic procedures she couldn’t do. Thankfully she retired early a few years back.


Some anesthesiologists are terrible and some anesthesiologists are worse than some CRNAs which doesn’t help our cause.

agree. there unfortunately are some very bad anesthesiologists out there which doesnt help our cause.

 

[coffeebythelake]

Clinically the worst anesthesiologist I’ve ever met was a DNA (doctor nurse anesthesiologist. She was a CRNA at an academic Mecca in nyc for almost 10 yrs), then went to medical school, then trained at a top 5 anesthesia program in Boston. How she graduated is unclear.

A pretty typical occurrence would be an anesthesia tech coming to get me while I’m between cases. “Dr DNA needs your help.” I’d go into her room and the crani would be finished. “Dr neurosurgeon would like an Aline for postop bp monitoring in icu.” I’d pull off the blankets and find 10 holes running up and down each arm where she had “attempted” an Aline. I put the ultrasound on the arm only to see a bounding 4-5mm radial artery. 1/1USG EZ. That was among many examples of basic procedures she couldn’t do. Thankfully she retired early a few years back.


Some anesthesiologists are terrible and some anesthesiologists are worse than some CRNAs which doesn’t help our cause.

how they hell is that even possible. to lack those basic technical skills after practicing so long.

 

[ValentineD]

Had an general ob case, three of us in the room for induction.
“Senior” SRNA proceed to intubate with glide. Couldn’t get a view. Patient start to desat. 80s, 70s….. ****ing CRNA just stood behind him. Still can’t get a view. I said something. Crna took over.
Probably a “teaching moment” for the SRNA, but not on my license nor on the baby’s expense. Not the fuking patient to do this on.
I had a moment like that when I was a resident, the attending trying to show me how little reserve parturients have. But he knew where I was in my skillset, and he chose to demonstrate that point at that particular time.

I didn’t fuking sign up for this bullsht.

Lol well why'd you let the SRNA intubate, seems like self-inflicted misery to me. Your room, your rules. CRNA should also have a bead on the relative skill level of the trainee and determined whether it was appropriate for them to have a role in the case. We get the entire spectrum of piss-poor airway abusers at my place (SRNA, SAA, various non-anesthesia residents). I always give them a chance. but only if it's appropriate based upon their skill-level. Although I usually take a more active role in their learning than some of my colleagues, start them with the trim patients and work them up to the ones who exert their own gravitational pull.

 

[IMGASMD]

Lol well why'd you let the SRNA intubate, seems like self-inflicted misery to me. Your room, your rules. CRNA should also have a bead on the relative skill level of the trainee and determined whether it was appropriate for them to have a role in the case. We get the entire spectrum of piss-poor airway abusers at my place (SRNA, SAA, various non-anesthesia residents). I always give them a chance. but only if it's appropriate based upon their skill-level. Although I usually take a more active role in their learning than some of my colleagues, start them with the trim patients and work them up to the ones who exert their own gravitational pull.

I appreciate your critique. SRNA was sold to me as a senior crna who has been rotating at our institution for a while. Covered OB a few times.

Certainly have other airway equipment available. IIRC, it wasn’t “supposed” to be a difficult one. I don’t think the patient selection was poor. My biggest grip was and still is the fact that the CRNA stood there even after the second try. But yes, ultimately I am on the hook, and I don’t like it.