Whats going on with Pediatric Anesthesiology Match?

[dchz]

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Why are there so few high acuity pure pedi jobs available? Most major pediatric centers have CRNAs who do peds in a low supervisory ratio. CHOP alone has 23 CRNAs. More programs are hiring CRNAs for Pedi cardiac cases (Lurie, UCSF, etc). If the reason we need CRNAs is because there's a shortage of anesthesiologists, couldn't all those practices convert to physician only with improvement in patient care?

Those practices leverage attendings with CRNAs for easy rooms that generate revenue and will supervise CRNAs and trainees 1:1 for high morbidity cases (cardiac, neonates). Thus adding cardiac CRNAs is to gain extra hands rather than supervise at high ratios (or if you’re cynical, to free up attendings to sit in their offices on cath/EP days).

WTF right? Today i was doing a subaortic resection and some rando SRNA came in my room and took my airway and caudal... WHAT THE F??

I guess in many ways i'm lucky i've been sheltered from this BS in residency. If there is no resident in a good big case I was often able to get in there (sometimes attendings even come looking). But my residency was thinking about getting SRNAs right as I finished. Glad I got done before I had to deal with that BS.

Also what is the role of the CARDIAC CRNA at your facility? From what i'm seeing they just literally sit there while the attending needs a break, other times the attending does everything. Wonder how long before we have pedi cardiac CRNAs.

 

[ambiturner]

There are hordes of academic attendings at high acuity centers who have literally never done a case solo. If there’s not enough trainees around to do their case with, they will have no shame asking for a CRNA to work 1:1 with. These people are now senior enough to be in leadership positions and can then force this practice on everyone else. Administrators at children’s hospitals love it bc most of them are alphabet soup nurses.

every academic place I have ever worked had pedi cardiac CRNAs. At none of those places were they the primary drivers of management though.

 

[WholeLottaGame7]

Enlighten my ignorance. What skills are required in the wilms tumor case besides a volume line of some sort.

Epidural? A-line? Possibly central line (unlikely). How many non-peds people do those things routinely? (Genuinely asking, I only have experience at academic places).

Probably not a great example anyway, I doubt many Wilms' tumors are being done at non-children's hospitals. They need heme/onc, cards, VIR, etc.

 

[WholeLottaGame7]

WTF right? Today i was doing a subaortic resection and some rando SRNA came in my room and took my airway and caudal... WHAT THE F??

Did they dart you with sux before they did it? Did they duct tape you to the wall? Did they wedgie you and hang you from the IV pole? Did your attending threaten you with a bad eval if you didn't let them do it?

 

[skankhunt42]

Enlighten my ignorance. What skills are required in the wilms tumor case besides a volume line of some sort.

Wow....so it took only about 20 responses for this thread to turn form a very specific question about current outcomes in a fellowship into a classic SDN exchange about how private practice people walk on water and academic folks are slow pretentious overly cautious people that 'just don't get it.' Thanks for this valuable contribution.

All I meant to say is that there are cases where Peds Anesthesia is needed. I agree that in many ways peoples thinking have shifted that all children need peds anesthesia. This is course not appropriate. But come on man...sheesh....

 

[abolt18]

Wow....so it took only about 20 responses for this thread to turn form a very specific question about current outcomes in a fellowship into a classic SDN exchange about how private practice people walk on water and academic folks are slow pretentious overly cautious people that 'just don't get it.' Thanks for this valuable contribution.

All I meant to say is that there are cases where Peds Anesthesia is needed. I agree that in many ways peoples thinking have shifted that all children need peds anesthesia. This is course not appropriate. But come on man...sheesh....

Overreaction much? You just put a lot of words in his mouth that were not there.

 

[IlDestriero]

There are hordes of academic attendings at high acuity centers who have literally never done a case solo. If there’s not enough trainees around to do their case with, they will have no shame asking for a CRNA to work 1:1 with. These people are now senior enough to be in leadership positions and can then force this practice on everyone else. Administrators at children’s hospitals love it bc most of them are alphabet soup nurses.

every academic place I have ever worked had pedi cardiac CRNAs. At none of those places were they the primary drivers of management though.

We have pediatric cardiac CRNAs at my shop and while they are nice people, they don’t really do much of anything at all. They’re not placing lines, they don’t make any decisions, etc. They primarily chart and are a second set of hands.

 

[dchz]

Did they dart you with sux before they did it? Did they duct tape you to the wall? Did they wedgie you and hang you from the IV pole? Did your attending threaten you with a bad eval if you didn't let them do it?

The attending GAVE IT to the SRNA... I was standing there about to do the caudal, the attending took the SRNA's hand and made her do it.

I was like
WHAT
TEh
F?

 

[IlDestriero]

The attending GAVE IT to the SRNA... I was standing there about to do the caudal, the attending took the SRNA's hand and made her do it.

I was like
WHAT
TEh
F?

We get a handful of SRNAs that rotate through. We are not a primary training program for them. They are always paired with a CRNA and never take procedures, or anything from the residents or fellows. That’s some BS you’ve had to deal with there.
Maybe ask the attending why he’s giving away your procedures? Have you done 50 of them? You can’t learn anything else? A different approach, etc.?

 

[WholeLottaGame7]

The attending GAVE IT to the SRNA... I was standing there about to do the caudal, the attending took the SRNA's hand and made her do it.

I was like
WHAT
TEh
F?

That is just gross. I'd report that s*** to the fellowship director. You have more power than you think you do. Especially with the match the way it is now, the prospect of a few bad anecdotes like that in front of applicants could really be detrimental.

Our relationship with SRNAs is similar to @IlDestriero. I've switched fellows into an add-on room with a neonate gastroschisis or what not and pushed the SRNA out. Didn't make the CRNA coordinator happy, but whatever, I'm not getting paid to train SRNAs.

 

[chocomorsel]

All the comments above are spot on.
The fellowship craze is doing a disservice to everyone.
I do cover a large hospital where I take all comers and did not do a fellowship .
fellowship is for suckers who have no confidence in themselves in my opinion

That’s your opinion. Tell me what ICU is gonna let me work there without a fellowship. There are fellowships that are mandatory and ICU is one of them.
Whatever the case, I had a crappy experience in my residency ICU rotations and it had been six years so was needed.

 

[deleted171991]

Wow....so it took only about 20 responses for this thread to turn form a very specific question about current outcomes in a fellowship into a classic SDN exchange about how private practice people walk on water and academic folks are slow pretentious overly cautious people that 'just don't get it.' Thanks for this valuable contribution.

All I meant to say is that there are cases where Peds Anesthesia is needed. I agree that in many ways peoples thinking have shifted that all children need peds anesthesia. This is course not appropriate. But come on man...sheesh....

Yes, there are cases where peds anesthesia is needed, just much fewer than the number of pediatric anesthesiologists being produced. That was the point. Nothing arrogant in that concept. Doing an inhalational induction and calculating the proper doses of medications for a T&A or similar is not rocket science.

Outside of children's hospitals, it really shouldn't matter whether one is peds-certified or not.

@chocomorsel, critical care is a different story. It's the one fellowship where one year may not be enough. (Funny thing: I hated ICU during residency so much that I had sworn not to step in one ever again. Isn't it ironic, don't you think?)

 

[PieOHmy]

That’s your opinion. Tell me what ICU is gonna let me work there without a fellowship. There are fellowships that are mandatory and ICU is one of them.
Whatever the case, I had a crappy experience in my residency ICU rotations and it had been six years so was needed.

You are correct. If you want to do ICU ( I dont know why), but fellowship is required..
Pain and ICU really the only ones that are really required.

 

[btbam]

I do pedi hearts (AA). Attendings are nice and let us do lines, but yea I’m mostly there as a second set of hands and just to help get cases going. No one is ever asking my input on anything.