Where should I (would you) go?

[leaverus]

Just lost my job to a AMC takeover. Right now don't have any ties, single no kids and don't particularly want to stay in the midwest. Where can I go to earn the most as a non-fellowship anesthesiologist and a willingness to put in insomniac-type hours for the next 10yrs or so to attain financial independence in that time frame? i'm not someone who flits around from place to place either, so ideally somewhere I wouldn't mind living the rest of my life too; certainly somewhere on the coast would be nice. WA? OR?

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[deleted162650]

I’d take a long hard look at AK. I wasn’t super impressed with compensation in coastal WA back when I looked (5ish years ago). If you can stand not being coastal, MT and WY would be high on my list.

 

[midazzoler]

Just be a mercenary. See if you can stick it to the AMC at your current place. When you find a better deal or the AMC tries to change the terms, roll out.

 

[Arch Guillotti]

Just lost my job to a AMC takeover. Right now don't have any ties, single no kids and don't particularly want to stay in the midwest. Where can I go to earn the most as a non-fellowship anesthesiologist and a willingness to put in insomniac-type hours for the next 10yrs or so to attain financial independence in that time frame? i'm not someone who flits around from place to place either, so ideally somewhere I wouldn't mind living the rest of my life too; certainly somewhere on the coast would be nice. WA? OR?

Why did you lose your job if you don't mind sharing?

Non compete issues?
Downsizing, higher supervision ratios?
Hospital unhappy with group?

 

[leaverus]

Why did you lose your job if you don't mind sharing?

Non compete issues?
Downsizing, higher supervision ratios?
Hospital unhappy with group?

I think hospital wanted to go with cheaper subsidy option in terms of AMC; I heard their bid was very lowball. existing partners of group had option of staying and becoming employees of AMC or leave. so technically didn't "lose" the job but I don't like being a pawn in those types of games either. meanwhile doing locums til I find something permanent.

 

[IMGASMD]

I think hospital wanted to go with cheaper subsidy option in terms of AMC; I heard their bid was very lowball. existing partners of group had option of staying and becoming employees of AMC or leave. so technically didn't "lose" the job but I don't like being a pawn in those types of games either. meanwhile doing locums til I find something permanent.

So they didn’t even get a chance to sell? Just lost the contract to AMC? Can you negotiate with AMC?

One of my senior resident went to Mississippi. Crazy supervision, (1:8+). Made somewhere in 8s. Not something I can do.

 

[anbuitachi]

So they didn’t even get a chance to sell? Just lost the contract to AMC? Can you negotiate with AMC?

One of my senior resident went to Mississippi. Crazy supervision, (1:8+). Made somewhere in 8s. Not something I can do.

8s?! Thats insane! one of my senior resident went to 1:8 for 500, not in missispsi though

 

[IMGASMD]

8s?! Thats insane! one of my senior resident went to 1:8 for 500, not in missispsi though

Essentially singing charts and put out fires. Just saying there are jobs like that out there. If you’re welling to play the game. Also Deep South cost of living is much lower than NE.

 

[Urzuz]

One of my senior resident went to Mississippi. Crazy supervision, (1:8+). Made somewhere in 8s. Not something I can do.

If that structure looks/sounds remotely appealing to you, you should seriously consider finding a different career since you are not practicing anesthesiology at that point.

 

[IMGASMD]

If that structure looks/sounds remotely appealing to you, you should seriously consider finding a different career since you are not practicing anesthesiology at that point.

I’ve heard a third hand story of people who don’t even show at the hospital/surgical site, but once a week to sign charts. No you’re not practicing anything, just gambling with your license. Strike rich, before bust.

 

[anbuitachi]

If that structure looks/sounds remotely appealing to you, you should seriously consider finding a different career since you are not practicing anesthesiology at that point.

Isn't that the idea of that job? Make enough money to gain independence and retire.

 

[GravelRider]

If that structure looks/sounds remotely appealing to you, you should seriously consider finding a different career since you are not practicing anesthesiology at that point.

Why is 1:4 some arbitrary cutoff for acceptable supervision levels? I would argue that you’re not really practicing anesthesia at 1:4 ratios.

If 1:8+ gives you 800+ salary somewhere, I say do it. Roll the dice for a few years and then get out and find some cushy non-call job in your coastal town of choice.

 

[Urzuz]

Isn't that the idea of that job? Make enough money to gain independence and retire.

Yes, but you are opening yourself up to a world of liability and risk. If all you want is money and to retire, find a different career path where you will make much more money with less hours. Or, if you've already doomed yourself to medicine, pick a different specialty

 

[aneftp]

I’d take a long hard look at AK. I wasn’t super impressed with compensation in coastal WA back when I looked (5ish years ago). If you can stand not being coastal, MT and WY would be high on my list.

Agree. My buddy and I both left when amc took over our practice. He went to Arkansas (his wife hometown) and even as hospital employee makes in the mid 400s with 9 weeks off and pretty good hours limited call back (beeper). So he’s usually done 5-6pm even on call and than beeper

 

[Urzuz]

Why is 1:4 some arbitrary cutoff for acceptable supervision levels? I would argue that you’re not really practicing anesthesia at 1:4 ratios.

I agree, hence why I'm in an MD only group. 1:2 or 1:4 may fall into a gray area, but 1:8 I think is safe to assume you aren't practicing squat at that point.

If 1:8+ gives you 800+ salary somewhere, I say do it. Roll the dice for a few years and then get out and find some cushy non-call job in your coastal town of choice.

Dangerous (and quite frankly sad) advice.

 

[anbuitachi]

Yes, but you are opening yourself up to a world of liability and risk. If all you want is money and to retire, find a different career path where you will make much more money with less hours. Or, if you've already doomed yourself to medicine, pick a different specialty

Definitely know what you mean but i dont think its as easy as you make it sound to be. How many fields can you go into from anesthesiology and quickly make 8 figures with less hours..?

 

[Arch Guillotti]

I think hospital wanted to go with cheaper subsidy option in terms of AMC; I heard their bid was very lowball. existing partners of group had option of staying and becoming employees of AMC or leave. so technically didn't "lose" the job but I don't like being a pawn in those types of games either. meanwhile doing locums til I find something permanent.

Why did your group need a subsidy? Paying for the nurses, or something else?

 

[GravelRider]

I agree, hence why I'm in an MD only group. 1:2 or 1:4 may fall into a gray area, but 1:8 I think is safe to assume you aren't practicing squat at that point.



Dangerous (and quite frankly sad) advice.

We all know the risks. OP says he/she wants to make a bunch of money and achieve financial independence within 10 years. He/she didn’t say anything about protecting the integrity of the specialty.

 

[Urzuz]

We all know the risks. OP says he/she wants to make a bunch of money and achieve financial independence within 10 years. He/she didn’t say anything about protecting the integrity of the specialty.

But why actively promote the bastardization of our specialty by encouraging young anesthesiologists to seek out these opportunities?

 

[skypilot]

Just lost my job to a AMC takeover. Right now don't have any ties, single no kids and don't particularly want to stay in the midwest. Where can I go to earn the most as a non-fellowship anesthesiologist and a willingness to put in insomniac-type hours for the next 10yrs or so to attain financial independence in that time frame? i'm not someone who flits around from place to place either, so ideally somewhere I wouldn't mind living the rest of my life too; certainly somewhere on the coast would be nice. WA? OR?

Just remembering the saying: "Location, lifestyle, and Income" You can pick two. If I was young and single I would pick location and lifestyle. You are going to make a good upper middle class income no matter where you go that will allow you to achieve financial independence in 10 years if you put your mind to it. You can always pick up extra shifts no matter where you are. In general if you want to make more money you should go to the less desirable areas. (ie stay in the Midwest , deep south, rural west, Northern Maine, Alaska, and less desirable cities in any state. But if it were me and I had to do it over again I would go for my dream location based on lifestyle. I would also consider what the practice setup is and what kind of cases they are doing (lifestyle). Supervision ratios would be a consideration too.

I have heard of good incomes in Texas. And there is no state income tax. It might be someplace you could build a career.

 

[GravelRider]

But why actively promote the bastardization of our specialty by encouraging young anesthesiologists to seek out these opportunities?

Because I don’t see a difference between 1:4 and 1:8 models. If you’re going to make that much more money going from 1:4 to 1:8 then why not? I’m not sure why 1:4 is the accepted cutoff. Is that based on anything?

Our specialty has already been bastardized. I’m actually a proponent of CRNA independence. I don’t want to sign their charts or be responsible for their decisions.

 

[IMGASMD]

.

I have heard of good incomes in Texas. And there is no state income tax. It might be someplace you could build a career.

The last I heard with Texas, the biggest hurdle is getting a license. Can take 6months to a year before you even see that thing.

 

[leaverus]

So they didn’t even get a chance to sell? Just lost the contract to AMC? Can you negotiate with AMC? One of my senior resident went to Mississippi. Crazy supervision, (1:8+). Made somewhere in 8s. Not something I can do.

that is correct - no chance to sell or negotiate.

Agree. My buddy and I both left when amc took over our practice. He went to Arkansas (his wife hometown) and even as hospital employee makes in the mid 400s with 9 weeks off and pretty good hours limited call back (beeper). So he’s usually done 5-6pm even on call and than beeper

Pretty sure AK is Alaska. I totally forgot Alaska is even part of the US - while I've never been there and pictures make it look like a beautiful place to live, it's so far that i'd feel like I was in a different country. No, i'd like to stay on continental US.

We all know the risks. OP says he/she wants to make a bunch of money and achieve financial independence within 10 years. He/she didn’t say anything about protecting the integrity of the specialty.

True I didn't but i'm definitely all for protecting the integrity of the field. ideally would prefer an all-MD group and do my own cases but
that's not realistic. yes I said make the most but I guess I meant "make the most while preserving the future of anesthesiologists" . I would never do 1:8 and I would never take a job in which there wasn't some percentage of solo and complex cases.

 

[skypilot]

that is correct - no chance to sell or negotiate.

True I didn't but i'm definitely all for protecting the integrity of the field. ideally would prefer an all-MD group and do my own cases but
that's not realistic. yes I said make the most but I guess I meant "make the most while preserving the future of anesthesiologists" . I would never do 1:8 and I would never take a job in which there wasn't some percentage of solo and complex cases.

If you would prefer an all MD group then go for it. There are plenty of them out there and it IS realistic. Look at California, Texas, Arizona, Virginia. Go for what you want and don't compromise unless you are forced to.

 

[chocomorsel]

But why actively promote the bastardization of our specialty by encouraging young anesthesiologists to seek out these opportunities?

It’s been bastardized since the 80s when all
These greedy ass anesthesiklogists started supervising high nurse ratios.

 

[gasdoc77]

Because I don’t see a difference between 1:4 and 1:8 models. If you’re going to make that much more money going from 1:4 to 1:8 then why not? I’m not sure why 1:4 is the accepted cutoff. Is that based on anything?

Our specialty has already been bastardized. I’m actually a proponent of CRNA independence. I don’t want to sign their charts or be responsible for their decisions.

So how long after independence will you be arguing "equal pay for equal work?" Which AMC did you say you work for (with)?

 

[GravelRider]

So how long after independence will you be arguing "equal pay for equal work?" Which AMC did you say you work for (with)?

I don’t work for an AMC, but I do know that my days spent supervising (~30%) are way less enjoyable than my days doing my own cases. If the wave of the future is a choice between supervising 1:4 or greater versus CRNA independence, I will choose CRNA independence every single time. I don’t like supervising, sorry.

I’m not here to save the integrity of the specialty. It was sold out long ago.

 

[skypilot]

So how long after independence will you be arguing "equal pay for equal work?" Which AMC did you say you work for (with)?

Once you get to 1:5 you might as well fire the Anesthesiologist cause they are just signing charts and doing pre-ops. You can get a Nurse Practitioner to do the pre-ops. Everyone who participates in the ACT model, including me, is helping the corporate bosses to gradually reduce the number of Anesthesiologists. Make no mistake, the goal is for you to train your non-physician replacements, and absorb the liability for their errors until you can be replaced entirely.

Eventually there will be some superhuman Anesthesiologist who has memorized Miller, has a photographic memory , is a triathlete with running shoes, and has the manual dexterity of a Japanese chef who will volunteer to supervise 15 rooms for a million dollars a year. And everyone in this forum will comment about how great Anesthesiology salaries have become. Sure great salaries. But at the cost of the entire profession.

 

[IMGASMD]

Once you get to 1:5 you might as well fire the Anesthesiologist cause they are just signing charts and doing pre-ops. You can get a Nurse Practitioner to do the pre-ops. Everyone who participates in the ACT model, including me, is helping the corporate bosses to gradually reduce the number of Anesthesiologists. Make no mistake, the goal is for you to train your non-physician replacements, and absorb the liability for their errors until you can be replaced entirely.

Eventually there will be some superhuman Anesthesiologist who has memorized Miller, has a photographic memory , is a triathlete with running shoes, and has the manual dexterity of a Japanese chef who will volunteer to supervise 15 rooms for a million dollars a year. And everyone in this forum will comment about how great Anesthesiology salaries have become. Sure great salaries. But at the cost of the entire profession.

Better be starting at 1.5 mil for 15 rooms. At some point the math wouldn’t really work out anymore. Or things like what happened in NC, or OP’s practice is going to happen more and more.

What’s the difference between working for AMC or hospital? Can anyone comment?

 

[anes121508]

Just be a mercenary. See if you can stick it to the AMC at your current place. When you find a better deal or the AMC tries to change the terms, roll out.

 

[anes121508]

If that structure looks/sounds remotely appealing to you, you should seriously consider finding a different career since you are not practicing anesthesiology at that point.

Agree. I think folks who take those types of jobs are responsible for giving our specialty a bad name amongst surgeons and perpetuating the amc problem and crna independence. The aba shouldn’t renew license for folks that cover 8:1. Because honestly you are not practicing anesthesiology

 

[anes121508]

Why is 1:4 some arbitrary cutoff for acceptable supervision levels? I would argue that you’re not really practicing anesthesia at 1:4 ratios.

If 1:8+ gives you 800+ salary somewhere, I say do it. Roll the dice for a few years and then get out and find some cushy non-call job in your coastal town of choice.

Yeah agree that 4:1 is not far from a chart signer, depending how busy the rooms are. 4 rooms with 24-30 cases in 8 hours....tough to do anything other than set a plan and put out fires

 

[anes121508]

I don’t work for an AMC, but I do know that my days spent supervising (~30%) are way less enjoyable than my days doing my own cases. If the wave of the future is a choice between supervising 1:4 or greater versus CRNA independence, I will choose CRNA independence every single time. I don’t like supervising, sorry.

I’m not here to save the integrity of the specialty. It was sold out long ago.

Been a while since I been on Sdn, but glad to see you have the same outlook . I share your sentiment

 

[anes121508]

Why did your group need a subsidy? Paying for the nurses, or something else?

Folks in here warned me that joining a group dependent on subsidy was prime for the picking. I’m sorry it happened to you. How big was the subsidy?

 

[anes121508]

Once you get to 1:5 you might as well fire the Anesthesiologist cause they are just signing charts and doing pre-ops. You can get a Nurse Practitioner to do the pre-ops. Everyone who participates in the ACT model, including me, is helping the corporate bosses to gradually reduce the number of Anesthesiologists. Make no mistake, the goal is for you to train your non-physician replacements, and absorb the liability for their errors until you can be replaced entirely.

Eventually there will be some superhuman Anesthesiologist who has memorized Miller, has a photographic memory , is a triathlete with running shoes, and has the manual dexterity of a Japanese chef who will volunteer to supervise 15 rooms for a million dollars a year. And everyone in this forum will comment about how great Anesthesiology salaries have become. Sure great salaries. But at the cost of the entire profession.

Woah man...even at 1:5 I’d put more thought into a preop than an NP...you ever seen those things? I should start photographing and making a book of the nonsense I come across.

 

[anes121508]

Better be starting at 1.5 mil for 15 rooms. At some point the math wouldn’t really work out anymore. Or things like what happened in NC, or OP’s practice is going to happen more and more.

What’s the difference between working for AMC or hospital? Can anyone comment?

I believe it depends on the hospital admin and the amc. Not all amcs are equal and not all hospital admins are equal. Buddies of mine work for a hospital and do very well. They work well with the admin and continually progress. Hospital where I work....I have it better working for amc than my buddies who are hospitalists working for the hospital.

 

[IMGASMD]

I believe it depends on the hospital admin and the amc. Not all amcs are equal and not all hospital admins are equal. Buddies of mine work for a hospital and do very well. They work well with the admin and continually progress. Hospital where I work....I have it better working for amc than my buddies who are hospitalists working for the hospital.

I have met people who swear they won’t work for hospitals. But I’ve also learned AMC aren’t created equal. And even within the same AMC, you can have very different practice styles. When it’s profitable, everyone turn a blind eye; when the company is losing money, that’s when the fun really starts.

I think I am more interested, does one entity (amc vs hospital) have more leverage on the physician than the other? If that’s still too vague, why would YOU (anyone) work for one but not the other?

Just food for thought.

 

[nimbus]

I think I am more interested, does one entity (amc vs hospital) have more leverage on the physician than the other? If that’s still too vague, why would YOU (anyone) work for one but not the other?

Just food for thought.

If you look at what happened in Charlotte, and before that in Asheville and also with the EM docs in Akron, it’s clear that hospital systems are the most powerful entity at this time.

 

[IMGASMD]

If you look at what happened in Charlotte, and before that in Asheville and also with the EM docs in Akron, it’s clear that hospital systems are the most powerful entity at this time.

Thanks. I did a quick search regarding Asheville, only found some sort of announcement. I will keep digging. Also if the news was correct, that was more than 6 years ago. 35 physicians 140 CRNA? Must be fun working there.....

 

[BLADEMDA]

Thanks. I did a quick search regarding Asheville, only found some sort of announcement. I will keep digging. Also if the news was correct, that was more than 6 years ago. 35 physicians 140 CRNA? Must be fun working there.....

Rumors are flying around that Envision/Sheridan may take the contract in Asheville. The hospital is unable to bill insurance companies at anything close to what Envision can. This isn't a level playing field and the big AMCs do have a huge advantage over hospitals when it comes to collections.

 

[Ronin786]

I think the responses to gravelrider's suggestion are very enlightening. Many anesthesiologists like to pretend 1:4 supervision is some magically safe number. It's probably only marginally better than higher ratios.

The folks doing 1:4 and running around signing charts all day are just as bad as the theoretical 1:8. They just have cognitive dissonance about their reality.

 

[BLADEMDA]

I think the responses to gravelrider's suggestion are very enlightening. Many anesthesiologists like to pretend 1:4 supervision is some magically safe number. It's probably only marginally better than higher ratios.

The folks doing 1:4 and running around signing charts all day are just as bad as the theoretical 1:8. They just have cognitive dissonance about their reality.

That's not true. I've supervised 1:2 all the way to 1:6 and there is a limit to supervision. One can cover up to 4 rooms and still be marginally involved with the cases. Once the ratio exceeds 1:4 you become a fireman. So, what is the correct ratio? 1:3. With 3 rooms I can remain fully involved with the preops as well as the cases. I'd argue that hearts, lungs, carotids should be 1:2 but that's a different post.

 

[chocomorsel]

That's not true. I've supervised 1:2 all the way to 1:6 and there is a limit to supervision. One can cover up to 4 rooms and still be marginally involved with the cases. Once the ratio exceeds 1:4 you become a fireman. So, what is the correct ratio? 1:3. With 3 rooms I can remain fully involved with the preops as well as the cases. I'd argue that hearts, lungs, carotids should be 1:2 but that's a different post.

Key word Blade is "marginally". Hit the nail right on the head there. Is marginally what we should strive for?
Or should we turn a blind eye, pray that some bad s hit doesn't happen and smile all the way to the bank?

 

[BLADEMDA]

Key word Blade is "marginally". Hit the nail right on the head there. Is marginally what we should strive for?
Or should we turn a blind eye, pray that some bad s hit doesn't happen and smile all the way to the bank?

Uh..no. The answer is 1:3 ratios where one can be fully involved in the cases. Sure, you are busy most of the day but 1:3 still means good supervision/direction.

 

[Mman]

I’m not sure why 1:4 is the accepted cutoff. Is that based on anything?

Well I mean the obvious answer is it's based on CMS guidelines for reimbursement for medical direction. What that is based on is probably as much as any of their other guidelines.

But when it comes to medical direction/supervision and ratios, the answer is always that it depends. is 4:1 more unsafe than 3:1 or 2:1? Just depends on the cases. When we do pediatric hearts, it's often just 1:1 for the case. Cardiac cases are usually 2:1 but with a room that's easy alongside the heart. If I'm just doing things like lap choles and hernias all day I might be at 1:3 at the start and then up to 1:4 once things are rolling.

It just depends....

 

[Man o War]

Well I mean the obvious answer is it's based on CMS guidelines for reimbursement for medical direction. What that is based on is probably as much as any of their other guidelines.

But when it comes to medical direction/supervision and ratios, the answer is always that it depends. is 4:1 more unsafe than 3:1 or 2:1? Just depends on the cases. When we do pediatric hearts, it's often just 1:1 for the case. Cardiac cases are usually 2:1 but with a room that's easy alongside the heart. If I'm just doing things like lap choles and hernias all day I might be at 1:3 at the start and then up to 1:4 once things are rolling.

It just depends....

This.
Arbitrary ratios make absolutely no sense. The person in charge of scheduling/running the board needs to customize each day’s schedule to an extent.
We even had to filter through and strategically schedule certain CRNAs for the higher acuity cases, because we had plenty who just couldn’t hack it in those rooms.

 

[GravelRider]

That's not true. I've supervised 1:2 all the way to 1:6 and there is a limit to supervision. One can cover up to 4 rooms and still be marginally involved with the cases. Once the ratio exceeds 1:4 you become a fireman. So, what is the correct ratio? 1:3. With 3 rooms I can remain fully involved with the preops as well as the cases. I'd argue that hearts, lungs, carotids should be 1:2 but that's a different post.

So, I just want to clarify a few points. If I had the choice between supervising 1:4 or higher ratios all the time or letting the crnas run free, I would choose CRNA independence every single time. Not only do I get zero satisfaction at doing pre-ops and figuring out how to time my breaks on my supervision days, but I don’t like spreading my liability too thin.

However, for someone who is comfortable in consistent 1:4 supervision, I don’t see anything wrong with getting a job with 1:8 supervision if the compensation is directly proportional to the number of cases you do. You know the risks going into a situation like that. I understand that not all 1:4 supervision days are created equal, but I do think it is somewhat arbitrary to pick 1:4 as some acceptable supervision ratio. As someone who does a mix of solo and supervision, I am much more thorough and thoughtful for my solo patients than I am for the patients I supervise. My attention (and time) is divided 3 or 4 ways at a time when I am supervising.

The comparison to internal medicine (I think in the other thread), is not an equivalent comparison. As an internist I am still diagnosing and treating one patient at a time. That plan is then carried out by nurses a lot more slowly. Those internal medicine patients also don’t have surgeons actively hacking into vital organs while those plans are carried out.

 

[BLADEMDA]

So, I just want to clarify a few points. If I had the choice between supervising 1:4 or higher ratios all the time or letting the crnas run free, I would choose CRNA independence every single time. Not only do I get zero satisfaction at doing pre-ops and figuring out how to time my breaks on my supervision days, but I don’t like spreading my liability too thin.

However, for someone who is comfortable in consistent 1:4 supervision, I don’t see anything wrong with getting a job with 1:8 supervision if the compensation is directly proportional to the number of cases you do. You know the risks going into a situation like that. I understand that not all 1:4 supervision days are created equal, but I do think it is somewhat arbitrary to pick 1:4 as some acceptable supervision ratio. As someone who does a mix of solo and supervision, I am much more thorough and thoughtful for my solo patients than I am for the patients I supervise. My attention (and time) is divided 3 or 4 ways at a time when I am supervising.

The comparison to internal medicine (I think in the other thread), is not an equivalent comparison. As an internist I am still diagnosing and treating one patient at a time. That plan is then carried out by nurses a lot more slowly. Those internal medicine patients also don’t have surgeons actively hacking into vital organs while those plans are carried out.

Fortunately, you don't get to decide about CRNA independence in my state. By law, they must be supervised by a physician at my hospital and the surgeons want no part of the liability in covering anesthesia nurses.

 

[dannyboy1]

Because I don’t see a difference between 1:4 and 1:8 models. If you’re going to make that much more money going from 1:4 to 1:8 then why not? I’m not sure why 1:4 is the accepted cutoff. Is that based on anything?

Our specialty has already been bastardized. I’m actually a proponent of CRNA independence. I don’t want to sign their charts or be responsible for their decisions.

Agreed. Even in 1:4 there is at least one CRNA who is being ignored (sometimes more if some of your cases are complicated).
Still, would not want CRNA independence unless you are willing to accept salary parity. I’m not ....

 

[narcotics999]

Fortunately, you don't get to decide about CRNA independence in my state. By law, they must be supervised by a physician at my hospital and the surgeons want no part of the liability in covering anesthesia nurses.

What's wrong with CRNA independence? If we refuse to do supervision and surgeons do not want unsupervised CRNA, doesn't it improve the prospect of our profession, and pt safety?