While most days I do my own rooms and cases, when I am the charge doctor I might supervise up to 7 CRNAs at a time. Supervision is very different than direction. There is a learning curve on how to do it, such as how to prioritize and how to delegate. You learn how to relay pertinent information that you want done a certain way, and how to decide if there are many ways that something can be done and allow the CRNA to choose the way they are most comfortable with. You must have a group of CRNAs that you trust.
Prior to the case I have foreseen and warned the CRNA about what they will likely have trouble with and how they should address it. Thus the most common emergencies I am called for are help with intubations, help with placing the spinal, help with an arterial line. But I am still called for hypotension, tachycardia, and a few other thinking problems. I have a good, but small group of CRNAs, so I know each of them well, their strong and weak suits. We try and teach them to call for help quickly, because we know things that they don't know. We only have 1 that is a bit militant (read prideful), but even she knows to come to us for help, which happens a lot more than she might believe it does.
I find it a little funny that even though they are doing 100% cases and I am supervising every 5th day (5 MDs), that I am still so much better than them at the procedures (intubations, spinals, epidurals, etc).
After practicing in this model with some pretty experienced CRNAs whom I highly trust, I would not want to give any of them independent practice. They would too often miss far too many of the big pictures and small details. There is absolutely a difference in the way we think about problems.
