What’s the real deal with crnas?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Destalchemy

Full Member
2+ Year Member
Joined
Sep 28, 2019
Messages
64
Reaction score
98
Ok so if you’re an absolute prick and have this idea that nurses aren’t doctors like I do, is anesthesia just gonna be miserable? I hear stories of great teamwork and I also hear tales of crnas going rogue and being annoying as crap. What worries me is that the ones saying "the crna problem isn’t that bad" are the more submissive docs with a different standard. Much like the neurosurgeon explaining his work life balance actually isn’t all that bad when soothing student concerns because he gets to see his wife and kids for about an hour a day (wow a whole 7 hours a week with the family, amazing!), I fear when I’m told that crnas (and surgeons for that matter) aren’t that bad it’s simply because the "MDA’s" personality is different from mine - that they’re someone who is just ok taking the bull****.

I’ve heard that in the real world, if you clap back, there are repercussions. So that when you hear of docs who do stand up for what they believe in, they suffer in small ways that you need to decide if you’re ok with should you decide to as well.

Furthermore, supervision. I mean how are you supposed to know if you will like that crap? West coast isn’t an end all be all answer. Some people that can’t move out there will get boned. Do you have to be a partner in a group to even have power? I cannot imagine a worse scenario than having an employee who thinks they’re as good as you not even be YOUR employee. It seems like this is what is common though. Most anesthesia jobs are employee jobs and the crnas are employed by the hospital or by the partners. They do some malignant bs and you can’t even discipline them. Is this the type of crap that you guys mean when you say stay the hell away?

I can’t lie when I wrestle back and forth between a)the great money and awesome procedural aspects and b)the lack of being the guy in control. I could be happy in family medicine. But for me it would be is half the money and loss of almost all procedures worth the increase in autonomy?

what do you guys think?

Members don't see this ad.
 
Ok so if you’re an absolute prick and have this idea that nurses aren’t doctors like I do, is anesthesia just gonna be miserable?
I know this is a troll post, but I'm still gonna respond. I've got some very bad news for you OP. If you're an absolute prick, you're gonna have a bad time...no matter what you do.
 
  • Like
  • Haha
Reactions: 13 users
Ok so if you’re an absolute prick and have this idea that nurses aren’t doctors like I do, is anesthesia just gonna be miserable? I hear stories of great teamwork and I also hear tales of crnas going rogue and being annoying as crap. What worries me is that the ones saying "the crna problem isn’t that bad" are the more submissive docs with a different standard. Much like the neurosurgeon explaining his work life balance actually isn’t all that bad when soothing student concerns because he gets to see his wife and kids for about an hour a day (wow a whole 7 hours a week with the family, amazing!), I fear when I’m told that crnas (and surgeons for that matter) aren’t that bad it’s simply because the "MDA’s" personality is different from mine - that they’re someone who is just ok taking the bull****.

I’ve heard that in the real world, if you clap back, there are repercussions. So that when you hear of docs who do stand up for what they believe in, they suffer in small ways that you need to decide if you’re ok with should you decide to as well.

Furthermore, supervision. I mean how are you supposed to know if you will like that crap? West coast isn’t an end all be all answer. Some people that can’t move out there will get boned. Do you have to be a partner in a group to even have power? I cannot imagine a worse scenario than having an employee who thinks they’re as good as you not even be YOUR employee. It seems like this is what is common though. Most anesthesia jobs are employee jobs and the crnas are employed by the hospital or by the partners. They do some malignant bs and you can’t even discipline them. Is this the type of crap that you guys mean when you say stay the hell away?

I can’t lie when I wrestle back and forth between a)the great money and awesome procedural aspects and b)the lack of being the guy in control. I could be happy in family medicine. But for me it would be is half the money and loss of almost all procedures worth the increase in autonomy?

what do you guys think?

This is happening in almost every aspect of medicine. Cheaper, quicker to train nurses who are displacing physicians. Bean counters did the math. Don't think for a second that the care is equivalent though
 
Members don't see this ad :)
I know this is a troll post, but I'm still gonna respond. I've got some very bad news for you OP. If you're an absolute prick, you're gonna have a bad time...no matter what you do.
It was sarcasm. Midlevels would have you believe your an elitist jerk just for believing a physician is better trained.
 
I’ve heard that in the real world, if you clap back,
Pop culture update.
Don’t clap back, or you’ll be put on blast.
that’s not on fleek. For realz.

Apparently instead of a BURP technique for airway management, some anesthesia providers like to BARK. Barking at the attending for trying to be involved. Woof.
 
This is happening in almost every aspect of medicine. Cheaper, quicker to train nurses who are displacing physicians. Bean counters did the math. Don't think for a second that the care is equivalent though
Yeah 100%. The difference though with anesthesia is that most jobs directly involve the supervision of these nurses. Its an act job or its a solo job. With other specialties, it's not a "midlevel job or solo job." You might work with midlevels but it isn't defining your job.
 
Yeah 100%. The difference though with anesthesia is that most jobs directly involve the supervision of these nurses. Its an act job or its a solo job. With other specialties, it's not a "midlevel job or solo job." You might work with midlevels but it isn't defining your job.

no one will force you to supervise CRNAs if you go into anesthesiology. You make that choice yourself.
 
It was sarcasm. Midlevels would have you believe your an elitist jerk just for believing a physician is better trained.

Advance practice nurses organizations are full of some of the most malignant narcissists alive, and their logic defying anti intellectual propaganda machine would put even thr soviet communists to shame.
 
Last edited:
  • Like
Reactions: 1 users
This is happening in almost every aspect of medicine. Cheaper, quicker to train nurses who are displacing physicians. Bean counters did the math. Don't think for a second that the care is equivalent though
As a now retired physician who had to make these arguments, the problem is that the "we have more training argument" simply does not fly in 21st Century America.

It is all about outcomes.

If you want to have any chance of success, you need to argue actual outcome based data. Good old morbidity and mortality. That is the only thing people will listen to, from patients, to administrators, to politicians.

Unfortunately, that is the one thing I rarely hear used. It is always, "we went to medical school", "we completed a residency." The bottom line is that no one cares.

Outcomes, outcomes, outcomes.

If you don't have numbers, no one is listening.

(Now to avoid any confusion; I know the data is there, but that is what you need to be waving around.)
 
Last edited:
  • Like
Reactions: 1 user
As a now retired physician who had to make these arguments, the problem is that the "we have more training argument" simply does not fly in 21st Century America.

It is all about outcomes.

If you want to have any chance of success, you need to argue actual outcome based data. Good old morbidity and mortality. That is the only thing people will listen to, from patients, to administrators, to politicians.

Unfortunately, that is the one thing I rarely hear used. It is always, "we went to medical school", "we completed a residency." The bottom line is that no one cares.

Outcomes, outcomes, outcomes.

If you don't have numbers, no one is listening.

(Now to avoid any confusion; I know the data is there, but that is what you need to be waving around.)

Outcomes in of itself does not matter to hospital admin. They care about the cost of negative outcomes and whether that exceeds the cost of hiring a physician instead of a midlevel.
 
  • Like
Reactions: 11 users
Money is the number one factor and all that matters for administrators. We and the CRNAs are simply vendors of the same service in administrators' view, and they will always pick the cheaper vendor, even if the service is inferior, since the law allows it. If the CRNA kills a patient that would not be the administrator's fault since that CRNA is legally licensed to practice in that state.
What is also damaging is the overwhelming number of anesthesiologists who forgot or actually never learned how to behave like doctors. They act and practice like glorified and expensive nurses.
 
  • Like
Reactions: 5 users
As a now retired physician who had to make these arguments, the problem is that the "we have more training argument" simply does not fly in 21st Century America.

It is all about outcomes.

If you want to have any chance of success, you need to argue actual outcome based data. Good old morbidity and mortality. That is the only thing people will listen to, from patients, to administrators, to politicians.

Unfortunately, that is the one thing I rarely hear used. It is always, "we went to medical school", "we completed a residency." The bottom line is that no one cares.

Outcomes, outcomes, outcomes.

If you don't have numbers, no one is listening.

(Now to avoid any confusion; I know the data is there, but that is what you need to be waving around.)
The problem is, the data ISN'T there. What data IS there is ****ty and paid for by people with a financial incentive in the results. It's the parachute problem; is it really ethical to do a good, large, randomized trial that encompasses the entire realm of anesthesia? Going to randomize some congenital cardiac kids' anesthetics to MD vs unsupervised CRNA?
 
  • Like
Reactions: 4 users
Advance practice nurses organizations are full of some of the most malignant narcissists alive, and their logic defying anti intellectual propaganda would put even thr soviet communists to shame.
I always laugh when I used to see(or still see) these individuals railing on Trump.
It’s mind blowing how little self awareness these folks have.
 
I personally suspect a reckoning is coming. It will go one of three ways.

1) Medicare for all (Universal healthcare, or whatever you want to call it) passes and physicians unionize. Then the power of the union is used to force concessions regarding hours, supervision ratios, solo practice, etc.

2) A 2 tier system emerges. In group A you have the city hospital fully staffed by APRNs, CRNAs, NPs, etc where the poor, uninsured, underinsured, illegal, and basically anybody can go to get care. In group B you have the private hospitals where its physician only care. Anybody who has any means will go exclusively to hospital B, which will require some sort of supplemental insurance or payment to be accepted. The outcomes in A vs B will never be studied in an official capacity but everybody who works in group A will exclusively take their families for care to group B, all the while arguing that the two systems are equal for any reporter who wishes to listen.

3) One last option is that wages for anesthesiologists go down and it becomes unappealing to hire CRNAs. $300K for a physician vs $250 for CRNA for example. The HR packages keep going up in price. For $50k more you get someone who works 10 more hours a week, participates in committees, is what patients really desire, has better knowledge, and actually cares and takes responsibility.

I hope reckoning #2 happens.
 
  • Like
Reactions: 3 users
Advance practice nurses organizations are full of some of the most malignant narcissists alive, and their logic defying anti intellectual propaganda machine would put even thr soviet communists to shame.
As opposed to America’s logical and intellectual non propaganda
 
  • Haha
Reactions: 1 user
Advance practice nurses organizations are full of some of the most malignant narcissists alive, and their logic defying anti intellectual propaganda machine would put even thr soviet communists to shame.
At least the Soviets didn’t let their nurses practice medicine.
 
  • Like
  • Haha
Reactions: 4 users
Top