Where should I (would you) go?

[narcotics999]

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 ....

It does not. It only means no job for CRNAs, and higher value for our services.

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[dannyboy1]

It does not. It only means no job for CRNAs, and higher value for our services.

??
How is there higher value for our services? If you have CRNA independance in your hospital they will have work. It’s not like all of the surgeons who mostly view us as faceless and interchangeable are suddenly going to refuse to work with CRNA’s independently. Maybe a few will be annoyed but by and large they will just get on with their day. Once the CRNA’s establish themselves in the hospital as reasonably competent providers it will make no sense for the practice (or hospital/AMC) to hire a doc at twice the salary. Sure they may keep a few around for harder cases and cantankerous surgeons but for the most part the docs salary will be similar to CRNA ...

 

[Urzuz]

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.

Just a question since it has been a long time since I have done a pedi heart...but why don't you guys just do your pedi hearts solo instead of having a CRNA there? Is it helpful to have an extra pair of hands in the room?

 

[Mman]

Just a question since it has been a long time since I have done a pedi heart...but why don't you guys just do your pedi hearts solo instead of having a CRNA there? Is it helpful to have an extra pair of hands in the room?

It's always helpful to have an extra pair of hands. It's never not helpful. It's also a good excuse to leave the room while on pump.

 

[GravelRider]

??
How is there higher value for our services? If you have CRNA independance in your hospital they will have work. It’s not like all of the surgeons who mostly view us as faceless and interchangeable are suddenly going to refuse to work with CRNA’s independently. Maybe a few will be annoyed but by and large they will just get on with their day. Once the CRNA’s establish themselves in the hospital as reasonably competent providers it will make no sense for the practice (or hospital/AMC) to hire a doc at twice the salary. Sure they may keep a few around for harder cases and cantankerous surgeons but for the most part the docs salary will be similar to CRNA ...

I think if our only argument for preventing CRNA independence is we want to get paid more then we have a pretty weak argument.

 

[Mman]

??
How is there higher value for our services? If you have CRNA independance in your hospital they will have work. It’s not like all of the surgeons who mostly view us as faceless and interchangeable are suddenly going to refuse to work with CRNA’s independently. Maybe a few will be annoyed but by and large they will just get on with their day.

Those surgeons will potentially see massive increases in their malpractice insurance as they are now the "captain of the ship" for anything bad that happens in the OR even if it's a pure anesthetic complication and nothing to do with their operation.

 

[Echo33]

Hello. New to the forum. I have to agree with Blade. I think 1:3 is ideal.

I supervise anywhere from 1:2 (rare) to 1:4. For those who think there is no difference in 1:4 to 1:8, I completely disagree. Nothing in life is black and white. There is obviously a limit to what a human can do but I can honestly say I am in tune with what is going on in every room. I am present for key portions and perform all procedures including neuraxial and invasive monitors. 1:4 can be tough. 1:3 is perfect. 1:8 would be crazy. There’s is absolutely a difference. Yes, in an ideal world I would be solo in the room doing every aspect of the anesthetic. But I don’t think this is how we are best utilized. I enjoy multitasking, evaluating patients, doing procedures, caring for post-op patients, etc. And I still feel as though I know what’s going on at all times. The key is that it takes effort, getting off your butt and being present. The only rooms I try to stay out of after the start are total joints, to limit the in an out/sterility (our hospital policy)

 

[dannyboy1]

Those surgeons will potentially see massive increases in their malpractice insurance as they are now the "captain of the ship" for anything bad that happens in the OR even if it's a pure anesthetic complication and nothing to do with their operation.

Maybe. But this only means that you need an MDA’s (sorry to use the term) name in the chart, even if it is 1:8. What do you think Happens to the job market in this scenario. ?

 

[dannyboy1]

I think if our only argument for preventing CRNA independence is we want to get paid more then we have a pretty weak argument.

It is what it is. Yes we can agree among ourselves that MD care is “superior”. But this superiority is very hard to demonstrate. For now the culture at most places is to have CRNA’s covered by anesthesiologists. But do not kid yourself. your practice (especially if you are employed by an AMC) would kick you out in a minute and have the CRNA’s practice independently if they could get away with it....

 

[mmag]

Back to OP's question, the west is where there are more practices that are physician only so yes WA or OR would be reasonable if you don't want to supervise. Central California can also be a place to consider with higher income potential and lower real estate values. You can always drive a couple of hours to the coast.
By choosing a physician only practice, you are making it harder to recruit for supervision positions and perhaps driving up the pay for those positions. It's so much less stressful to do your own cases.

 

[deleted162650]

Back to OP's question, the west is where there are more practices that are physician only so yes WA or OR would be reasonable if you don't want to supervise. Central California can also be a place to consider with higher income potential and lower real estate values. You can always drive a couple of hours to the coast.
By choosing a physician only practice, you are making it harder to recruit for supervision positions and perhaps driving up the pay for those positions. It's so much less stressful to do your own cases.

Central CA is the worst of both worlds. Hot as hell, nothing to do, crap schools, oh and you get pay to CA taxes on that fat salary without any of the perks that might actually make living here worth it.

 

[Hoya11]

Hello. New to the forum. I have to agree with Blade. I think 1:3 is ideal.

I supervise anywhere from 1:2 (rare) to 1:4. For those who think there is no difference in 1:4 to 1:8, I completely disagree. Nothing in life is black and white. There is obviously a limit to what a human can do but I can honestly say I am in tune with what is going on in every room. I am present for key portions and perform all procedures including neuraxial and invasive monitors. 1:4 can be tough. 1:3 is perfect. 1:8 would be crazy. There’s is absolutely a difference. Yes, in an ideal world I would be solo in the room doing every aspect of the anesthetic. But I don’t think this is how we are best utilized. I enjoy multitasking, evaluating patients, doing procedures, caring for post-op patients, etc. And I still feel as though I know what’s going on at all times. The key is that it takes effort, getting off your butt and being present. The only rooms I try to stay out of after the start are total joints, to limit the in an out/sterility (our hospital policy)

you beat me to it, and well said

 

[Twiggidy]

Just a question since it has been a long time since I have done a pedi heart...but why don't you guys just do your pedi hearts solo instead of having a CRNA there? Is it helpful to have an extra pair of hands in the room?

Yes

 

[Twiggidy]

Central CA is the worst of both worlds. Hot as hell, nothing to do, crap schools, oh and you get pay CA taxes on that day salary without any of the perks that might actually make living here worth it.

Preach

 

[pgg]

Central CA is the worst of both worlds. Hot as hell, nothing to do, crap schools, oh and you get pay to CA taxes on that fat salary without any of the perks that might actually make living here worth it.

LOL, lot of truth here.

I lived in central CA for a few years not too long ago.

Hot as hell but the pool got used 9 months out of the year.
Nothing to do, true, so I worked like a maniac & made hay.
Excellent charter public school for the kids, lucked out there.
Didn't pay CA taxes on 1/2 my income due to military orders and not-CA state residency.

We still left.

I miss good Mexican food. It's hard to find a decent taco anyplace east of the Mississippi. There are none in Virginia. None. I found one great place in North Carolina, but even I won't drive 3 hours for a taco.

 

[deleted162650]

LOL, lot of truth here.

I lived in central CA for a few years not too long ago.

Hot as hell but the pool got used 9 months out of the year.
Nothing to do, true, so I worked like a maniac & made hay.
Excellent charter public school for the kids, lucked out there.
Didn't pay CA taxes on 1/2 my income due to military orders and not-CA state residency.

We still left.

I miss good Mexican food. It's hard to find a decent taco anyplace east of the Mississippi. There are none in Virginia. None. I found one great place in North Carolina, but even I won't drive 3 hours for a taco.

Ya, if the idea of living in CenCal appeals to you, you would be much better off just going to NV, OR, AZ, etc and keeping a lot more money in your own pockets instead of the Moonbeam Brown Fund.

The best burrito I could find in VA was Moe’s.

 

[Twiggidy]

Ya, if the idea of living in CenCal appeals to you, you would be much better off just going to NV, OR, AZ, etc and keeping a lot more money in your own pockets instead of the Moonbeam Brown Fund.

The best burrito I could find in VA was Moe’s.

I’m not ashamed to say I was a huge Qdoba fan when I lived back east. Excellent queso