WHY? Why are you guys still training CRNA's?

[badasshairday]

I just don't understand why. When I was a medical student I shyed away from anesthesia, which in part had to do with CRNAs. I was hoping you guys would have dealt with this issue by now, ie. Anesthesiology assistants. I don't understand why any MD would teach a CRNA despite all the bold claims they make. Let them train themselves since they say they can do it all solo.

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[GaseousClay]

easy answer - it comes down to the money and cowardly administration

 

[Doctor4Life1769]

$$$$$$$$

 

[Psai]

"pcuser911MD - Anesthesiology 39 points 11 days ago

As a physician anesthesiologist with an NP for a wife I want to give my two cents worth. NPs have no business practicing without a collaborating physician. Period. She would agree and she has been doing it for almost 10 years. NP school is a joke, mostly online, very little foundational sciences, and the board exam is similar to the nclex that focuses on communication rather than diagnosis.

However I would be hung by my colleagues for saying this, but CRNAs are not the same. For 99% of cases a good CRNA does not need supervision. With the exception of our fellowship training in CV and critical care, their training is adequate and compares to that of many residencies. With that said, there are ****ty anesthesiologists and ****ty crnas. When I have needed surgery, I chose a CRNA. Even though our practice is supervision model, I would be completely comfortable if most all our crnas put me to sleep in a solo crna practice. I make sure they all practice blocks, central lines, alines and our 9 CV crnas even do TEEs. We don't let them do chronic pain yet, but we are sending some off to training and will be allowing that within the year. This is the future. Our group had accepted it and are providing a smooth transition."

"pcuser911MD - Anesthesiology 5 points 4 days ago

So no experience whatsoever. You are gonna go to a 2 year program (1 year didactic, 1 year clinical) and have the delusion that you are "providing" anesthesia? I have 4 years undergrad, 4 years medical school, and 4 years residency total. CRNAs have 4 years nursing school, 4+ years ICU experience, and 3 years anesthesia training. You really think you will be able to provide anesthesia? Of course you will always be strictly supervised with no decision making ability, but I would never hire a warm body to sit on a stool and write down vitals. AAs are dangerous and I will have no part in it."

From reddit. Although I'm not convinced that he's really an anesthesiologist

 

[GravelRider]

Anesthesiologists like to give lip service to the notion that we are better trained and we need to fend off the CRNAs' drive for independent practice. Then they go back to supervising 1:4. I'm sorry, but supervising 1:4 is doing nothing but reinforcing the notion that crnas can practice independently.

It's going to take the new generation of anesthesiologists, who want to actually practice and not just sign charts, to revive a dead field. The old guys sold it out long ago to make a few bucks.

I actually agree with the above posting about preferring a crna over the old guys who have been supervising 1:4 the majority of their career...give me a crna any day. The old partners in my crummy PP who don't work couldn't deliver a safe anesthetic on their own on a bet.

 

[ryanjmy]

"pcuser911MD - Anesthesiology 39 points 11 days ago

As a physician anesthesiologist with an NP for a wife I want to give my two cents worth. NPs have no business practicing without a collaborating physician. Period. She would agree and she has been doing it for almost 10 years. NP school is a joke, mostly online, very little foundational sciences, and the board exam is similar to the nclex that focuses on communication rather than diagnosis.

However I would be hung by my colleagues for saying this, but CRNAs are not the same. For 99% of cases a good CRNA does not need supervision. With the exception of our fellowship training in CV and critical care, their training is adequate and compares to that of many residencies. With that said, there are ****ty anesthesiologists and ****ty crnas. When I have needed surgery, I chose a CRNA. Even though our practice is supervision model, I would be completely comfortable if most all our crnas put me to sleep in a solo crna practice. I make sure they all practice blocks, central lines, alines and our 9 CV crnas even do TEEs. We don't let them do chronic pain yet, but we are sending some off to training and will be allowing that within the year. This is the future. Our group had accepted it and are providing a smooth transition."

"pcuser911MD - Anesthesiology 5 points 4 days ago

So no experience whatsoever. You are gonna go to a 2 year program (1 year didactic, 1 year clinical) and have the delusion that you are "providing" anesthesia? I have 4 years undergrad, 4 years medical school, and 4 years residency total. CRNAs have 4 years nursing school, 4+ years ICU experience, and 3 years anesthesia training. You really think you will be able to provide anesthesia? Of course you will always be strictly supervised with no decision making ability, but I would never hire a warm body to sit on a stool and write down vitals. AAs are dangerous and I will have no part in it."

From reddit. Although I'm not convinced that he's really an anesthesiologist

I read a few more of his posts. That's clearly a crna posing as an anesthesiologist. Most likely a doctor of nursing. Pathetic...

 

[Stank811]

It is starting to change. Especially in places that have not been associated with a CRNA training program. They are transitioning to primarily AAs and are starting AA schools. Takes time.

 

[partydoc]

It is starting to change. Especially in places that have not been associated with a CRNA training program. They are transitioning to primarily AAs and are starting AA schools. Takes time.

Ah stank. You always seem to have such a positive outlook on things, which I wonder is bc your practice is rural and you have a good group dynamic. But for most of us that will not be the case. I believe your practice is MD only?

 

[GravelRider]

It is starting to change. Especially in places that have not been associated with a CRNA training program. They are transitioning to primarily AAs and are starting AA schools. Takes time.

There are no AAs on the east coast that I am aware of. Again, this is by far the most populated region of the country with by far the largest concentration of jobs and practicing anesthesiologists. Thinking that AAs are going to be the solution to CRNAs is heavy optimism. I just don't see the CRNAs just giving up their fight because AAs are practicing at a few rural hospitals.

 

[Laryngophed]

It is starting to change. Especially in places that have not been associated with a CRNA training program. They are transitioning to primarily AAs and are starting AA schools. Takes time.

I've seen the opposite.

 

[aneftp]

There are no AAs on the east coast that I am aware of. Again, this is by far the most populated region of the country with by far the largest concentration of jobs and practicing anesthesiologists. Thinking that AAs are going to be the solution to CRNAs is heavy optimism. I just don't see the CRNAs just giving up their fight because AAs are practicing at a few rural hospitals.

AAs in DC. AAs are in Georgia. Also in Florida. I believe that's East coast. Unless one's definition of East Coast is Philly to NYC to Boston

 

[GravelRider]

AAs in DC. AAs are in Georgia. Also in Florida. I believe that's East coast. Unless one's definition of East Coast is Philly to NYC to Boston

A world exists outside of NYC?! I don't believe it...

 

[deleted171991]

A world exists outside of NYC?! I don't believe it...

I would venture that the further one gets from it the happier one will be.

 

[sleepallday]

"pcuser911MD - Anesthesiology 39 points 11 days ago

As a physician anesthesiologist with an NP for a wife I want to give my two cents worth. NPs have no business practicing without a collaborating physician. Period. She would agree and she has been doing it for almost 10 years. NP school is a joke, mostly online, very little foundational sciences, and the board exam is similar to the nclex that focuses on communication rather than diagnosis.

However I would be hung by my colleagues for saying this, but CRNAs are not the same. For 99% of cases a good CRNA does not need supervision. With the exception of our fellowship training in CV and critical care, their training is adequate and compares to that of many residencies. With that said, there are ****ty anesthesiologists and ****ty crnas. When I have needed surgery, I chose a CRNA. Even though our practice is supervision model, I would be completely comfortable if most all our crnas put me to sleep in a solo crna practice. I make sure they all practice blocks, central lines, alines and our 9 CV crnas even do TEEs. We don't let them do chronic pain yet, but we are sending some off to training and will be allowing that within the year. This is the future. Our group had accepted it and are providing a smooth transition."

"pcuser911MD - Anesthesiology 5 points 4 days ago

So no experience whatsoever. You are gonna go to a 2 year program (1 year didactic, 1 year clinical) and have the delusion that you are "providing" anesthesia? I have 4 years undergrad, 4 years medical school, and 4 years residency total. CRNAs have 4 years nursing school, 4+ years ICU experience, and 3 years anesthesia training. You really think you will be able to provide anesthesia? Of course you will always be strictly supervised with no decision making ability, but I would never hire a warm body to sit on a stool and write down vitals. AAs are dangerous and I will have no part in it."

From reddit. Although I'm not convinced that he's really an anesthesiologist

The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried.

 

[Psai]

The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried.

My school has a crna that does peds but heavily supervised. However, attendings seem very comfortable teaching their crnas how to do lines. When I was on surgery, the presence of the anesthesiology attendings was not felt very strongly at all except in peds. Did not rank them.

 

[btbam]

AAs in DC. AAs are in Georgia. Also in Florida. I believe that's East coast. Unless one's definition of East Coast is Philly to NYC to Boston

Also SC and NC...

 

[Jimmy Chitwood]

On one hand, you don't want them to squeeze us out or drive our salaries down. On the other hand, you are supervising them, and your license is on the line, so you'd like them to be functional and not assassinate patients with your name on the chart.

 

[anes121508]

"sleepallday, post: 17791594, member: 331273"]The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried

This isn't the case everywhere...

I'm at a big academic institution with crnas and srnas. The crnas complain and demand high acuity cases. Cardiac, peds, neuro, trauma, thoracic, transplant ect....

Wanna hear something sad?....we have tons of great cardiac cases: lvads, transplants, triple valves, Circ arrest ....super sick people getting sent here ....great opportunity to learn and train....attendings cover 1:1....unfortunately the cardiac group of attendings doesn't like to teach all that much and the surgeons are malignant (kinda, depending on which whiney resident you talk to).

So resident Evals and feedback said that the cardiac rotation was poor and that here wasn't much teaching going on. the response and solution was to train a group of crnas so that the attendings didn't have to be in the room as often or teach much. Sad, on all accounts. So now you have a crna in a bentall in one room and a crna in another room doing lvad exchange....and the resident on cardiac rotation out in EP land for an ablation[/QUOTE]

 

[anes121508]

This is just an example of how we have gotten where we are today

 

[codeb1ue]

That is unacceptable for a teaching institution to prioritize crnas above resident education. You need to take this up to a higher level and if they don't make any changes, reveal this institution publicly and make the med students aware to never go there.


Sent from my iPhone using SDN mobile app

 

[anes121508]

That is unacceptable for a teaching institution to prioritize crnas above resident education. You need to take this up to a higher level and if they don't make any changes, reveal this institution publicly and make the med students aware to never go there.


Sent from my iPhone using SDN mobile app

Agree 100%. And I will just tell you that it all stems from people that take academic jobs that have zero interest in teaching.

This move was made purely out of self interest. Train a crna over a couple of months then you don't have to watch the newbie as close and teach him or her the ropes...sad

Used to be that residents has tons and tons of heart numbers (more quantity over quality)....now they will struggle to hit their numbers

 

[k12balla]

In other news.... There's a big push by, guess who, to push AAs out of the Houston market. And by all accounts, they are winning on that battle front as well.

Sent from my SM-G920T using SDN mobile

 

[GravelRider]

"sleepallday, post: 17791594, member: 331273"]The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried

This isn't the case everywhere...

I'm at a big academic institution with crnas and srnas. The crnas complain and demand high acuity cases. Cardiac, peds, neuro, trauma, thoracic, transplant ect....

Wanna hear something sad?....we have tons of great cardiac cases: lvads, transplants, triple valves, Circ arrest ....super sick people getting sent here ....great opportunity to learn and train....attendings cover 1:1....unfortunately the cardiac group of attendings doesn't like to teach all that much and the surgeons are malignant (kinda, depending on which whiney resident you talk to).

So resident Evals and feedback said that the cardiac rotation was poor and that here wasn't much teaching going on. the response and solution was to train a group of crnas so that the attendings didn't have to be in the room as often or teach much. Sad, on all accounts. So now you have a crna in a bentall in one room and a crna in another room doing lvad exchange....and the resident on cardiac rotation out in EP land for an ablation

That's terrible. If I were a resident there, I would refuse to work until that situation was corrected. The problem is, I bet there are a handful of residents perfectly happy not doing those cases. Where I trained, if there was a complicated heart or transplant or something, you can be sure there was a resident in there. The CRNAs weren't even allowed to give pump breaks in the heart rooms.

 

[badasshairday]

"sleepallday, post: 17791594, member: 331273"]The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried

This isn't the case everywhere...

I'm at a big academic institution with crnas and srnas. The crnas complain and demand high acuity cases. Cardiac, peds, neuro, trauma, thoracic, transplant ect....

Wanna hear something sad?....we have tons of great cardiac cases: lvads, transplants, triple valves, Circ arrest ....super sick people getting sent here ....great opportunity to learn and train....attendings cover 1:1....unfortunately the cardiac group of attendings doesn't like to teach all that much and the surgeons are malignant (kinda, depending on which whiney resident you talk to).

So resident Evals and feedback said that the cardiac rotation was poor and that here wasn't much teaching going on. the response and solution was to train a group of crnas so that the attendings didn't have to be in the room as often or teach much. Sad, on all accounts. So now you have a crna in a bentall in one room and a crna in another room doing lvad exchange....and the resident on cardiac rotation out in EP land for an ablation

[/QUOTE]

Are you kidding me? If so, is anesthesiology a dying field? I mean you have people literally training their replacements.... I'm not trying to troll. I was just shocked when I found out that VA plan of going solo CRNA and wanted to find out more.

 

[Man o War]

"sleepallday, post: 17791594, member: 331273"]The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried

This isn't the case everywhere...

I'm at a big academic institution with crnas and srnas. The crnas complain and demand high acuity cases. Cardiac, peds, neuro, trauma, thoracic, transplant ect....

Wanna hear something sad?....we have tons of great cardiac cases: lvads, transplants, triple valves, Circ arrest ....super sick people getting sent here ....great opportunity to learn and train....attendings cover 1:1....unfortunately the cardiac group of attendings doesn't like to teach all that much and the surgeons are malignant (kinda, depending on which whiney resident you talk to).

So resident Evals and feedback said that the cardiac rotation was poor and that here wasn't much teaching going on. the response and solution was to train a group of crnas so that the attendings didn't have to be in the room as often or teach much. Sad, on all accounts. So now you have a crna in a bentall in one room and a crna in another room doing lvad exchange....and the resident on cardiac rotation out in EP land for an ablation

[/QUOTE]


Man. This makes me grateful to my residency and fellowship program. There was very little CRNA presence in the cardiac room at either place, and it was well known that residents/fellows (cardiac or non cardiac) could bump a CRNA out of any room if they wanted the case. How it should be. I do think the younger generation of anesthesiologists are on to the CRNAs now, and are hesitant to teach some of the procedures. Can't blame them based on the rhetoric we are blasted with from them constantly.
Would be interested to hear from other members here how their programs were set up.

 

[anes121508]

That's terrible. If I were a resident there, I would refuse to work until that situation was corrected. The problem is, I bet there are a handful of residents perfectly happy not doing those cases. Where I trained, if there was a complicated heart or transplant or something, you can be sure there was a resident in there. The CRNAs weren't even allowed to give pump breaks in the heart rooms.

You are correct, a handful would rather have a nice easy day of total knees than an lvad or transplant

 

[Psai]

"sleepallday, post: 17791594, member: 331273"]The CRNA's that Ive worked with so far in my career have no desire to practice independently. To date not a single CRNA I've worked with does CV, peds, blocks, or even central lines. Most don't even bother with spinals. The ones that want to attempt spinals their fail rate >50%. I'm not worried

This isn't the case everywhere...

I'm at a big academic institution with crnas and srnas. The crnas complain and demand high acuity cases. Cardiac, peds, neuro, trauma, thoracic, transplant ect....

Wanna hear something sad?....we have tons of great cardiac cases: lvads, transplants, triple valves, Circ arrest ....super sick people getting sent here ....great opportunity to learn and train....attendings cover 1:1....unfortunately the cardiac group of attendings doesn't like to teach all that much and the surgeons are malignant (kinda, depending on which whiney resident you talk to).

So resident Evals and feedback said that the cardiac rotation was poor and that here wasn't much teaching going on. the response and solution was to train a group of crnas so that the attendings didn't have to be in the room as often or teach much. Sad, on all accounts. So now you have a crna in a bentall in one room and a crna in another room doing lvad exchange....and the resident on cardiac rotation out in EP land for an ablation

That is a complete embarrassment. CRNAs at an academic institution are hired to support resident education, not steal the best cases from them. That program needs to be outed and embarrassed, the crnas replaced and the anesthesiologists fired.

 

[Mman]

I just don't understand why. When I was a medical student I shyed away from anesthesia, which in part had to do with CRNAs. I was hoping you guys would have dealt with this issue by now, ie. Anesthesiology assistants. I don't understand why any MD would teach a CRNA despite all the bold claims they make. Let them train themselves since they say they can do it all solo.

what do you think MDs are teaching SRNA students? 99% of their training is from CRNAs. When I supervise a room with a CRNA and a student, the most the student will learn how to do is intubate and perhaps start a peripheral IV or arterial line aside from learning how to monitor effects of drugs we give. They in no way learn how to provide independent care for the patient.

 

[jwk]

"pcuser911MD - Anesthesiology 39 points 11 days ago

As a physician anesthesiologist with an NP for a wife I want to give my two cents worth. NPs have no business practicing without a collaborating physician. Period. She would agree and she has been doing it for almost 10 years. NP school is a joke, mostly online, very little foundational sciences, and the board exam is similar to the nclex that focuses on communication rather than diagnosis.

However I would be hung by my colleagues for saying this, but CRNAs are not the same. For 99% of cases a good CRNA does not need supervision. With the exception of our fellowship training in CV and critical care, their training is adequate and compares to that of many residencies. With that said, there are ****ty anesthesiologists and ****ty crnas. When I have needed surgery, I chose a CRNA. Even though our practice is supervision model, I would be completely comfortable if most all our crnas put me to sleep in a solo crna practice. I make sure they all practice blocks, central lines, alines and our 9 CV crnas even do TEEs. We don't let them do chronic pain yet, but we are sending some off to training and will be allowing that within the year. This is the future. Our group had accepted it and are providing a smooth transition."

"pcuser911MD - Anesthesiology 5 points 4 days ago

So no experience whatsoever. You are gonna go to a 2 year program (1 year didactic, 1 year clinical) and have the delusion that you are "providing" anesthesia? I have 4 years undergrad, 4 years medical school, and 4 years residency total. CRNAs have 4 years nursing school, 4+ years ICU experience, and 3 years anesthesia training. You really think you will be able to provide anesthesia? Of course you will always be strictly supervised with no decision making ability, but I would never hire a warm body to sit on a stool and write down vitals. AAs are dangerous and I will have no part in it."

From reddit. Although I'm not convinced that he's really an anesthesiologist

Wow - if this guy is an anesthesiologist, he's been drinking the CRNA koolaid way too heavy. He is the classic "sit on his ass" anesthesiologist that is more than happy to let the CRNAs do all the work while he sits in the office.

Then he trashes AAs, that he has no experience with and knows even less about, and extols the virtues of CRNAs and practically equating their training to that of an anesthesiolgist. THIS type of doc is the reason that CRNAs think anesthesiologists are irrelevant.

 

[anes121508]

That is a complete embarrassment. CRNAs at an academic institution are hired to support resident education, not steal the best cases from them. That program needs to be outed and embarrassed, the crnas replaced and the anesthesiologists fired.

In talking to friends, it happens all over the place. Sad.

Like somebody else said though, it's also on the residents....if you aren't proactive, hungry to get better, and willing to work hard then there are plenty of people looking to replace you. Me personally, I'd rather take over the CABG/valve who failed coming off pump and is now getting an RVAD on nitric oxide and other jet fuel than a boring ortho fracture case where I am building random things out of the supplies in the cart. I don't care how poor the teaching is in a room like that....hell, by osmosis you will still learn. Of course it was a pain transporting to the ICU with a balloon pump, nitric, and the centrimag, but it was either me or the CRNA.

Around here CRNA's threaten to jump ship if they don't get X amount of cases <1 yo, or X amount of "big" general cases, or X amount of good cardiac cases.

Higher up people want to keep the "good" CRNA's so they get away with it.

Let's face it, a CRNA practicing >10 years is a whole lot better and easier to supervise than a CA-1 on his first month of thoracic or pedi. Yes it's 1:1, mayyyyybbbeeee 1:2, but it still makes the attending's job easier.


My point isn't about exposing my program for what goes on or to complain and share frustrations about where I've been (hopefully it changes), but just to point out that it's not just the 4:1 supervising docs in PP that are allowing this to go on. It happens all over the place.

 

[anes121508]

what do you think MDs are teaching SRNA students? 99% of their training is from CRNAs. When I supervise a room with a CRNA and a student, the most the student will learn how to do is intubate and perhaps start a peripheral IV or arterial line aside from learning how to monitor effects of drugs we give. They in no way learn how to provide independent care for the patient.

Assignment the other day....mini AVR 1:1 with attending. SRNA also assigned to the room. Attending wanted me to teach the SRNA to do the neck line and PA vent....."Because when she stays on with us, we can plug her right into the room and she will hit the ground running"

how do you reply to this?

Our SRNA's cover cases on their own covered by attending 2:1 or 1:1......they do spinals, thoracic epidurals, alines, fiberoptic intubations, pa catheters, neck lines ect.....they wanted to do APS with us and learn to do blocks. At least the residents put a hard stop on that one.

I understand the care team approach and I am friends with our SRNA's, but I fundamentally disagree with this type of stuff. Not that they can't, but for my own purely selfish reasons....If I am a honda engineer/venture capitalist and spend 100 mil and years of research to come up with a car that gets 9999999 mpg, why would I turn around and start showing the guys at Ford how to make the car?????!?!?!?!

 

[Planktonmd]

What these academic anesthesiologists are doing is a direct reflection of the ASA's policy and vision of the future.
They have given up on intra-op patient care and they want to hand it over to the CRNAs, because now they want you to become the surgical home doctor!

 

[Chloroform4Life]

I really hope it takes them 20 to 30 years to fully inplement this surgical home doctor crap so I can be near retirement by then.

 

[GravelRider]

It's also because they plan on hiring these SRNAs once they are finished. They have no intention on hiring the new grad residents. You need to bring this up to your PD and threaten a resident work stoppage if it continues. This is your training.

None of this surprises me though. Anesthesia is a dead field.

 

[anes121508]

What these academic anesthesiologists are doing is a direct reflection of the ASA's policy and vision of the future.
They have given up on intra-op patient care and they want to hand it over to the CRNAs, because now they want you to become the surgical home doctor!

Beleive me, there are plenty of graduating residents that has had this experience and feel strongly that it is wrong, not just at my place but all over the country. I may be optimistic but I have a feeling that my generation won't be politically and vocally passive once we have a platform and have built some credibility as attendings. It's just like my little brother, grew up getting picked on now he is the last guy you dare cross (hahaha probably not a good thing but u get the point)....Hopefully it's just not too late...

Now how crazy would it be for attendings to tell their crna group (pp or academic)...write in on behalf of the docs to the VA or take a hike? Hahaha That'd be something

Teachers strike and do stuff like this over 3 holidays they no longer have....isn't this our livelyhood and way of putting food on the table?

I mean debt is higher than ever, Current residents have interest rates 6.8-7.2%, and there are choppy waters ahead? Everybody has a breaking point and soon it won't be play so nice.

 

[sethco]

Assignment the other day....mini AVR 1:1 with attending. SRNA also assigned to the room. Attending wanted me to teach the SRNA to do the neck line and PA vent....."Because when she stays on with us, we can plug her right into the room and she will hit the ground running"

how do you reply to this?

Our SRNA's cover cases on their own covered by attending 2:1 or 1:1......they do spinals, thoracic epidurals, alines, fiberoptic intubations, pa catheters, neck lines ect.....they wanted to do APS with us and learn to do blocks. At least the residents put a hard stop on that one.

I understand the care team approach and I am friends with our SRNA's, but I fundamentally disagree with this type of stuff. Not that they can't, but for my own purely selfish reasons....If I am a honda engineer/venture capitalist and spend 100 mil and years of research to come up with a car that gets 9999999 mpg, why would I turn around and start showing the guys at Ford how to make the car?????!?!?!?!

First of all, SRNAs are not your friends. As nice as they are to your face, I can almost guarantee that they talk **** behind your back.

I did my training at a place where the CRNAs (and by extension the SRNAs) had great autonomy and influence. I actually wouldn't be surprised if you are at my alma mater. It seemed like as the years went by the SRNAs wanted to do more and more procedures, but I never had them in my room for the case. Teaching them to do Heartport lines, thoracic epidural, PACs, blocks is insane.

It is hard as a resident to refuse your attending instructions, but something needs to be done. It is much easier if you do it as a United front among all the residents. A good start would also be letting future applicants to said training program know about the environment.

Good luck

 

[Psai]

Assignment the other day....mini AVR 1:1 with attending. SRNA also assigned to the room. Attending wanted me to teach the SRNA to do the neck line and PA vent....."Because when she stays on with us, we can plug her right into the room and she will hit the ground running"

how do you reply to this?

Our SRNA's cover cases on their own covered by attending 2:1 or 1:1......they do spinals, thoracic epidurals, alines, fiberoptic intubations, pa catheters, neck lines ect.....they wanted to do APS with us and learn to do blocks. At least the residents put a hard stop on that one.

I understand the care team approach and I am friends with our SRNA's, but I fundamentally disagree with this type of stuff. Not that they can't, but for my own purely selfish reasons....If I am a honda engineer/venture capitalist and spend 100 mil and years of research to come up with a car that gets 9999999 mpg, why would I turn around and start showing the guys at Ford how to make the car?????!?!?!?!

So not only are the attendings too lazy to do these procedures themselves, they are even too lazy to train your replacement? That's like those articles where companies bring in those indians and have the american workers train them to do their jobs. CRNAs should not do any of those things. So many things can go wrong, can you imagine supervising 4 rooms where all the crnas are doing those at the same time? Insanity.

 

[btbam]

I'm an AA at a big pedi center. Totally agree with what is being said here. I am sometimes put in a difficult spot, because as referenced above some attendings want to work with an experienced anesthetist on a "bigger" case vs. a CA-1/2 on their first pedi rotation. I am put between a rock and a hard place and while I personally think the resident should be getting the experience, I'm overstepping my boundaries to say "no stick the resident in there."

 

[Consigliere]

I really hope it takes them 20 to 30 years to fully inplement this surgical home doctor crap so I can be near retirement by then.

I've said it before but it bears repeating: IF the surgical home crap comes to fruition, I will quit doing anesthesia.

 

[neutro]

I did a chronic pain fellowship not *just* because I have an interest in it. It is because like any other specialty besides anesthesia, I wanted to have independence and freedom (as much as one can get being a doctor these days). I felt anesthesia as a specialty was crippled with poor decisions made by others, and lack of power given to us for the amount of responsibility expected of us - that made me very uneasy. I felt that the role of anesthesiologist was always being questioned and it was impossible to rectify it and bring respect back to the profession. I could not tolerate that personally. Maybe its my ego or maybe its my anger - I dont know. I just felt it wasnt right.

After I had matched into pain fellowship - I didnt take crap from anyone, CRNAs, sRNAs, nurses...I used to be very blunt. To me, the pecking order went God (if you choose to believe in one), Program directors and Attendings and my fellow anesthesiologists. Nurses, CRNA, administrators do not fit into my paradigm.
I remember shouting at a nurse in my last month of residency because the incoming CA-1 that I was supervising was "walking through the sterile field" - (obviously when he did not). They were just messing with him. I made sure that the nurse knew her place, and also my fellow CA-1 with shiny bright eyes knew what his role was as a doctor. I was just angered at the amount of respect given to us.

Practicing pain management is difficult. Quality of patients and chronicity is terrible - and I am not any different from most pain docs. But what I will never give up is the ability to practice how I want, when I want and which patients, surgeons and doctors I wish to work with. To me that was VVIP.

Sure I may lose 30-50K per year being selective and independent once I finish my current employment contract and start my own practice, but that is the price I pay for independence and freedom. I felt I could never have that in anesthesia unfortunately and the worst was, I did not know if there was a solution to fix it - infact I just saw the profession getting worse for anesthesiologists. We just do not have enough numbers and those before us have made it very difficult for the newer breed to take meaningful leadership roles and fight for our cause.

 

[Planktonmd]

I did a chronic pain fellowship not *just* because I have an interest in it. It is because like any other specialty besides anesthesia, I wanted to have independence and freedom (as much as one can get being a doctor these days). I felt anesthesia as a specialty was crippled with poor decisions made by others, and lack of power given to us for the amount of responsibility expected of us - that made me very uneasy. I felt that the role of anesthesiologist was always being questioned and it was impossible to rectify it and bring respect back to the profession. I could not tolerate that personally. Maybe its my ego or maybe its my anger - I dont know. I just felt it wasnt right.

After I had matched into pain fellowship - I didnt take crap from anyone, CRNAs, sRNAs, nurses...I used to be very blunt. To me, the pecking order went God (if you choose to believe in one), Program directors and Attendings and my fellow anesthesiologists. Nurses, CRNA, administrators do not fit into my paradigm.
I remember shouting at a nurse in my last month of residency because the incoming CA-1 that I was supervising was "walking through the sterile field" - (obviously when he did not). They were just messing with him. I made sure that the nurse knew her place, and also my fellow CA-1 with shiny bright eyes knew what his role was as a doctor. I was just angered at the amount of respect given to us.

Practicing pain management is difficult. Quality of patients and chronicity is terrible - and I am not any different from most pain docs. But what I will never give up is the ability to practice how I want, when I want and which patients, surgeons and doctors I wish to work with. To me that was VVIP.

Sure I may lose 30-50K per year being selective and independent once I finish my current employment contract and start my own practice, but that is the price I pay for independence and freedom. I felt I could never have that in anesthesia unfortunately and the worst was, I did not know if there was a solution to fix it - infact I just saw the profession getting worse for anesthesiologists. We just do not have enough numbers and those before us have made it very difficult for the newer breed to take meaningful leadership roles and fight for our cause.

Excellent post!
The question is : Why did you need to do an anesthesia residency to reach these accurate conclusions about the future of the specialty?
You obviously did not want to be a pain specialist but you did the fellowship because you wanted a way out anesthesia, you did not want your 4 years investment to be completely wasted.
Why no one told you the truth when you interviewed for your residency position?
Residency program directors and faculty all know the truth, and all see where we are heading, but they knowingly and intentionally lie to the young applicants.
They took 4 years of your life that you will never get back.

 

[neutro]

^I am doing anesthesia one day a week for NAPA in addition to working full time pain 45 hrs a week. I consider myself an anesthsiologist more than a "pain physician". It is how I practice in clinic also - not like a neurologist, not like a PMR - but an anesthesiologist. There are philosophical differences and differences in approach to pain management. I also like periooperative pain medicine, which PMR and Neurologists tend to be really weak in.

Anyways, to answer your questions, I did not know why I chose anesthesia. I suppose it was because I liked it more than other specialties, and the compensation was good. Perhaps it was my foolish optimism as a medical student. I am not sure to be honest with you.
But doing pain medicine gives me at least the freedom I need to practice independently.

 

[GravelRider]

Don't you think it's only a matter of time before the gigantic hospitals and megacorps employ the majority of pain docs? I mean I see it happening to proceduralists who traditionally did very well, like surgeons, cardiologists, GI, etc. If there is money to be made, you can guarantee that some businessman is licking his chops and looking for a way to exploit your medical license for profit.

Going into a specialty just because it gives you independence for now is short sighted advice.

 

[Consigliere]

Don't you think it's only a matter of time before the gigantic hospitals and megacorps employ the majority of pain docs? I mean I see it happening to proceduralists who traditionally did very well, like surgeons, cardiologists, GI, etc. If there is money to be made, you can guarantee that some businessman is licking his chops and looking for a way to exploit your medical license for profit.

Going into a specialty just because it gives you independence for now is short sighted advice.

Definitely trending in that direction.

 

[MarioKart]

Just wondering, when exactly do anesthesiologists "hand over" these tasks to CRNAs? I was in an OR a few days ago and the resident anesthesiologist pretty much took over and I didn't really see a CRNA. This is at a huge hospital in NY though so I'm not sure if it's representative.

BTW anesethesiology seems like a great speciality that I really enjoy but I have once concern: do people worry about encroachment from other degrees? Like how NPs basically run family practices now (atleast whenever I go for a visit) would the same thing EVER happen in anesthesiology?!?!?! I hope not

 

[neutro]

Don't you think it's only a matter of time before the gigantic hospitals and megacorps employ the majority of pain docs? I mean I see it happening to proceduralists who traditionally did very well, like surgeons, cardiologists, GI, etc. If there is money to be made, you can guarantee that some businessman is licking his chops and looking for a way to exploit your medical license for profit.

Going into a specialty just because it gives you independence for now is short sighted advice.

I do not think that pain doctors will really depend on a hospital system - there is TOO much demand and we are very few. The demand has increased even more now the restrictions on opiates, and need for quality pain docs well versed in interventional pain procedures.
In fact, I think private practice model is far more efficient than the hospital model. Currently, the salaries provided by the hospital are really good because the facility fees we bring in. The insurance companies hate giving this facility fees because you can have a lumbar epidural steroid injection in a clinic for 25% of the cost.
Eventually, this facility fee non-sense will go away and salaries will drop. It has to - its not ethical IMO; even when I do the injections which cost 500 in clinic, but 1800 in hospital, i say to myself - really?. Its just a way for the hospital to take advantage of the doctor (by not including it in their RVUs) and the insurance company.
There are a lot of practice models out there for pain physicians. Obviously, having hospital affiliation is important. But for some it is not. Its important for me since I like in-patient pain medicine, and get consulted by oncologists and surgeons.
As to how I practice, I do not even see the patient until and unless I do a thorough review, background check, speak to the referring physicians, look at the documents and study them and the patient fills out an 8 page word document. It takes a lot of work, but then my patient population also is very good and reliable. I dont accept unreliable patients. I want to practice that way. I don't want to carry more than 750 patients in my census and have a couple of PAs and NPs to help me, who I directly supervise. I keep my own opiate tracking charts and see opiate use for patients with the eventual goal to wean all of them off to lowest acceptable level. I am in process of starting Chronic Behavioral Therapy for all opioid patients and will not rx meds unless strict criteria is met. I require them to lose weight if they are obese and have back pain, etc. I am strict with patients - firm, but nice.
It is hard work, but I do not care. I enjoy it pesonally. It is needed in my community as I am the first true pain physician ever hired by the hospital. I want to practice this way as an independent physician - and not as an employee. I am too poor to buy my own fluoro and pay rent and buy equipment and pay salaries at this time.
I want to have my own brand of pain medicine, which is evidence based, and actually is geared towards improving the patient's life and not just injecting them or feeding them oxys, essentially a multidisciplinary model. The only model which has shown to work.
Will I survive PP? I dont know. Many docs are thriving. So I hope so also. I hope to survive by having a good reputation and doing the right thing. Money, albeit is secondary. Being able to work independently the way I want to practice, and provide a much needed service is good enough for me. At least I get to sleep well at night and not worry about which mid-level I will have to fight tomorrow.

 

[Planktonmd]

Just wondering, when exactly do anesthesiologists "hand over" these tasks to CRNAs? I was in an OR a few days ago and the resident anesthesiologist pretty much took over and I didn't really see a CRNA. This is at a huge hospital in NY though so I'm not sure if it's representative.

BTW anesethesiology seems like a great speciality that I really enjoy but I have once concern: do people worry about encroachment from other degrees? Like how NPs basically run family practices now (atleast whenever I go for a visit) would the same thing EVER happen in anesthesiology?!?!?! I hope not

Oh boy...

 

[MarioKart]

Oh boy...

My apologies if the question somehow sounded naive? I really am curious though!

 

[deleted162650]

My apologies if the question somehow sounded naive? I really am curious though!

Do you not read any of the other posts on this thread or any other thread on this forum??????

 

[MarioKart]

Do you not read any of the other posts on this thread or any other thread on this forum??????

SaltyDog, Maybe I should have rephrased my initial question. Would you (or whomever this concerns) encourage a medical student to enter the profession of anesthesia knowing what you know? Yes, I have read previous threads and this one too, , but I just wanted a solid, short answer on whether you (as an attending) or anyone on this thread would recommend going into this?!? Thank you!!! Apologies if I still sound naive, but I just do not have the knowledge nor experience to know this (hence me coming on SDN)