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

Started by badasshairday
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MarioKart said:
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 still have not come to a conclusion of whether the speciality will remain the way it is currently for years to come. I realize that MANY specialites have concerns like this, and yeah it's not possible to know the future, 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!!! 🙂
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Based on what we know today, the answer is a resounding No (except maybe for the people who are crazy about it).

Come back in a few years and ask again. The answer will probably be Noooooooooooooooooooooooooooooooooooooooooooooooo! 🙂
 
FFP said:
Based on what we know today, the answer is a resounding No (except maybe for the people who are crazy about it).

Come back in a few years and ask again. The answer will probably be Noooooooooooooooooooooooooooooooooooooooooooooooo! 🙂
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That's what I thought. 🙁 Oh well, thanks for an honest answer FFP 🙂
 
I agree with the above statements. I try not to teach a crna and def not a srna anything. Part of the problem is when the anesthesiologist is not in the room most of the time it implies certain things aka: lazy, uninterested, incompetent etc. I am not saying that these are all true but it is the perception. Where I am presently at crna's work under anesthesiologists because it is an academic institution/hosp policy. However, the state laws here allow for them to practice independently. The majority of them are nice and pleasant and understand their role. It is the new ones/younger ones who usually are trouble. I cannot reiterate the importance of doing your own cases just for the sake of getting to know the surgeons/staff. If you are around them/in the trenches it is easier for them to support you. The dichotomy between academics and pp makes it even harder. I know there are still multiple physician only groups. Much more so on the west coast and even still some back in the east/NE. I would seek these out 🙂 I would even potentially go out on a limb and say look at the states where crnas can practice independently. There will be a large percentage of physician only groups located there.
 
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I would not discourage med students from considering anesthesiology. There will ALWAYS be a need and a place for MD/DOs in Anesthesia but it will evolve and change. The question for med students will be if they see themselves happy within those changes or not. If you want to sit the stool and micromanage mid levels anesthesia will not be for you in the future.
 
KurtBrie said:
I would not discourage med students from considering anesthesiology. There will ALWAYS be a need and a place for MD/DOs in Anesthesia but it will evolve and change. The question for med students will be if they see themselves happy within those changes or not. If you want to sit the stool and micromanage mid levels anesthesia will not be for you in the future.
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Says a midlevel, I would guess.

Most midlevels have to be micromanaged for some patients. That's the only way to avoid "surprises". I would also argue that sick patients deserve a physician "stool sitter", not just a remotely-uncontrolled CRNA.

They (would) love a system in which we give them the safety net, but don't "micromanage", i.e they can do whatever the heck they want, while we put out the fires and take the liability. As far as this doc is concerned, they should just practice independently, as in a CRNA-only group.
 
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MarioKart said:
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)
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Yes. Your big decision is whether or not to go into medical school, not which specialty to choose. Every specialty faces encroachment from midlevels and decreasing reimbursement (some more than others, but in your career it will hit all of them).

So the specialty you choose to go into should be the one you actually enjoy doing. Don't pick for the money or the hours or whatever because those can and will change, pick the job you enjoy doing the most and would do for $100K per year. Then you won't mind if things get worse because it'll still be good enough for you.
 
Mman said:
Yes. Your big decision is whether or not to go into medical school, not which specialty to choose. Every specialty faces encroachment from midlevels and decreasing reimbursement (some more than others, but in your career it will hit all of them).

So the specialty you choose to go into should be the one you actually enjoy doing. Don't pick for the money or the hours or whatever because those can and will change, pick the job you enjoy doing the most and would do for $100K per year. Then you won't mind if things get worse because it'll still be good enough for you.
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Love this. Thank you!
 
anes121508 said:
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?????!?!?!?!
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What. The. F***.

I'm not a particularly outspoken individual, but even as a resident, I would have flatly refused, then reported that person to the program director. Also would be salivating waiting to fill out my ACGME program evaluation. And telling applicants for interviews.

The only way to change behavior is for there to be consequences. Your program leadership will either be supportive of resident education and put a stop to the shenanigans, or they won't. And then you can burn s***t down (on the way out, of course).

Just for the medical students out there, not all programs are this way. We had no CRNAs in cardiac or thoracic rooms (they did do EP lab). No PNBs. No thoracic epidurals. Lumbar epidurals and spinals OK. A-lines OK. 1 or 2 attendings out of 80 or so would let CRNAs place CVLs on the sly, but it was rare to the point that it was newsworthy when it happened. Never had an SRNA in the room with me. The only time I even saw them was as a CA3 supervising a CRNA room on call.

It's on you as a medical student to figure out which programs are which, and if you have the option, to choose wisely. Obviously not everyone is able to be so selective, but think long and hard about ranking these programs.
 
100% agree. I would've straight up refused and talk to the program director about this. And I agree with WholeLottaGame7. My program also had a heavy crna presence but never had to compete with them for the complicated cases. I can count with one hand the number of times I saw them in out cardiac, Thoracic, or neuro rooms. They typically covered the GI suite and EP room. I also never saw the srnas ever. Didn't even know our institution trained them until way later in my residency.

I definitely did have particular qualms about our crnas though, particularly with the fact that we as residents were the ones to relieve all of them at 5pm sharp. I couldn't believe how many of them paged me when they were still stuck in the room at 5:05 asking me where their relief was. I got a good glimpse into their shift work mentality.


Sent from my iPhone using SDN mobile app
 
Mman said:
Yes. Your big decision is whether or not to go into medical school, not which specialty to choose. Every specialty faces encroachment from midlevels and decreasing reimbursement (some more than others, but in your career it will hit all of them).

So the specialty you choose to go into should be the one you actually enjoy doing. Don't pick for the money or the hours or whatever because those can and will change, pick the job you enjoy doing the most and would do for $100K per year. Then you won't mind if things get worse because it'll still be good enough for you.
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I very much agree. These issues we face are not unique to anesthesiology... although we are on the front end of (overconfident) midlevel encroachment.

EM, derm, FP, IM, psych, peds, NICU, cardiology, et al... they are all crumbling too. Perhaps the only ones left will be surgery and rad onc. But rest assured, at some point the surgery and rad onc "providers" will arrive. Ask your non-physician hospital CEO for more information.

The sky is actually falling.
 
Really, I think a lot of the issues on this thread boil down to flat out laziness. Sometimes I wonder if lazy type personalities are drawn to anesthesia because of the dynamic between CRNAs and the docs....maybe not. It's a chicken/egg thing I go back and forth in my mind about when I think about the CRNA problem. I just really hope the younger/middle generation in this specialty steps up their game. I can't really see a reason we should be teaching these people anything beyond case management type stuff.
 
FFP said:
Says a midlevel, I would guess.

Most midlevels have to be micromanaged for some patients. That's the only way to avoid "surprises". I would also argue that sick patients deserve a physician "stool sitter", not just a remotely-uncontrolled CRNA.

You (would) love a system in which we give you the safety net, but don't "micromanage", i.e you can do whatever the heck you want, while we put out the fires and take the liability. As far as this doc is concerned, please go practice independently, as in a CRNA-only group.
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Says a realist Physician. The writing is on the wall that this is where it is headed, like it or not and if someone entering med school today (or in yr 1/2) plans on Anesthesiology that is how it will be. Just read all the post on this forum, they all suggest the same thing. Not sure why what I said was somehow an attack.
 
KurtBrie said:
Says a realist Physician. The writing is on the wall that this is where it is headed, like it or not and if someone entering med school today (or in yr 1/2) plans on Anesthesiology that is how it will be. Just read all the post on this forum, they all suggest the same thing. Not sure why what I said was somehow an attack.
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A realist physician who knows exactly who posts as ADMIN on nurse-anesthesia.org? Interesting.
KurtBrie said:
Just some added clarification

- All front page articles on that website are published through the "ADMIN" account. There are over 20 users who write articles but any CRNA user can write one and it gets reviewed by one of 8 "administrators" then published through the generic "ADMIN" account.

- The original creator of the website took the MCATs, was accepted to a D.O. school and decided to forgo medical school to attend CRNA school (at one point he posted an acceptance letter to medical school and his MCAT scores). He is no longer active on the website.
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And only midlevels tend to complain that doctors micromanage (them). Hence my confusion.
 
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Man o War said:
Really, I think a lot of the issues on this thread boil down to flat out laziness. Sometimes I wonder if lazy type personalities are drawn to anesthesia because of the dynamic between CRNAs and the docs....maybe not. It's a chicken/egg thing I go back and forth in my mind about when I think about the CRNA problem. I just really hope the younger/middle generation in this specialty steps up their game. I can't really see a reason we should be teaching these people anything beyond case management type stuff.
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Many have and many will continue to step up and bring their "A" game. The comments on SDN have and always will be negative. It is a forum where people go to vent. No one will come to this forum and say "hey ladies and gents I made seven figures last year in a all MD group at this hospital working 40 hrs a week with 8 wks of vacation for obvious reasons." Same reason why most people don't report to MGMA bc they are fearful that it will put a target on their back which unfortunately decreases the perceived median income of anesthesiologist. Most people on this forum are anonymous so always question their intention.

Most hospitals, AMC, or any group that is going to employ you wants you to think that the market price is 250-350k for a new grad employed anesthesiologist. I am the one on here telling you that is BS. You can believe you are worth no more than 250k and go work for pennies while some suit collects the additional 500k+ off your work and the risk you are taking. Or you can look for the job you want and continue searching until you find it....most likely you will have to move to a city you never heard of. But how much is it worth to move 1-2hrs away from a major city to make double with most likely more vacation and time off....and guess what you might even like going into work.
 
Stank811 said:
Many have and many will continue to step up and bring their "A" game. The comments on SDN have and always will be negative. It is a forum where people go to vent. No one will come to this forum and say "hey ladies and gents I made seven figures last year in a all MD group at this hospital working 40 hrs a week with 8 wks of vacation for obvious reasons." Same reason why most people don't report to MGMA bc they are fearful that it will put a target on their back which unfortunately decreases the perceived median income of anesthesiologist. Most people on this forum are anonymous so always question their intention.

Most hospitals, AMC, or any group that is going to employ you wants you to think that the market price is 250-350k for a new grad employed anesthesiologist. I am the one on here telling you that is BS. You can believe you are worth no more than 250k and go work for pennies while some suit collects the additional 500k+ off your work and the risk you are taking. Or you can look for the job you want and continue searching until you find it....most likely you will have to move to a city you never heard of. But how much is it worth to move 1-2hrs away from a major city to make double with most likely more vacation and time off....and guess what you might even like going into work.
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didnt mean to imply even the majority are lazy, but there are a lot....and they are doing a lot of damage to perception of us. I'm actually very happy with my job/pay, and even happier to be done dealing with CRNAs...for now anyway
 
Yes.

My wife is a CRNA who has been on that website for years.

You make the suggestion that I am a liar because I am saying EXACTLY the same things many other posters here have been 'doom and glooming' about for 5+ years. You do not have to like it but the fact is our future is headed to looser supervision, higher ratios and the eventual end of the 1:4 (or less) care team model. This will result in an inability to micromanage and an increase in the 'fireman' role. It is what it is and it is already happening.

FFP said:
A realist physician who knows exactly who posts as ADMIN on nurse-anesthesia.org? Interesting.

And only midlevels tend to complain that doctors micromanage (them). Hence my confusion.
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Consigliere said:
Well, now we know who hates med students on SDN...
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Don't forget that residents wear pink eyeglasses, not having been exposed to the realities of attending life. It's not their fault.
 
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KurtBrie said:
Yes.

My wife is a CRNA who has been on that website for years.

You make the suggestion that I am a liar because I am saying EXACTLY the same things many other posters here have been 'doom and glooming' about for 5+ years. You do not have to like it but the fact is our future is headed to looser supervision, higher ratios and the eventual end of the 1:4 (or less) care team model. This will result in an inability to micromanage and an increase in the 'fireman' role. It is what it is and it is already happening.
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I don't recall ever seeing a regular physician poster on this board refer to supervision as micromanaging. Most of you all need to be micromanaged since you're putting the physician's license on the line.
 
GravelRider said:
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.
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He's talking about opening his own practice- they can't force him to sell something he owns. The whole reason so many prior are going the employed route is that they don't want the headaches of being a practice owner, but there's still plenty of opportunity for the business-inclined.
 
KurtBrie said:
Yes.

My wife is a CRNA who has been on that website for years.

You make the suggestion that I am a liar because I am saying EXACTLY the same things many other posters here have been 'doom and glooming' about for 5+ years. You do not have to like it but the fact is our future is headed to looser supervision, higher ratios and the eventual end of the 1:4 (or less) care team model. This will result in an inability to micromanage and an increase in the 'fireman' role. It is what it is and it is already happening.
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You listen to your wife too much. We call that "drinking the CRNA koolaid".
 
Mad Jack said:
He's talking about opening his own practice- they can't force him to sell something he owns. The whole reason so many prior are going the employed route is that they don't want the headaches of being a practice owner, but there's still plenty of opportunity for the business-inclined.
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Yes they can force him to sell! If he works at an area where some mega conglomerate owns all the medical practices in town they might control referrals and if you want to be independent you will have no patients!
This is a very common situation today where everyone including the primary physicians end up being employed by the big company and outsiders can not compete.
 
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Mad Jack said:
He's talking about opening his own practice- they can't force him to sell something he owns. The whole reason so many prior are going the employed route is that they don't want the headaches of being a practice owner, but there's still plenty of opportunity for the business-inclined.
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Oh sure, he can open up his own practice. So can I...I was an internist before. The system is rigged such that the obstacles to owning your own practice nowadays are pretty insurmountable. The government is in bed with big business to make sure it stays that way. Sure, the proceduralists can last a little longer than the primary care docs, but their day is coming too. Once a big hospital system moves to an area, they lay waste to all independent practices in sight.
 
AAs get sweet gigs right out. How about no weekends, no holidays, 8 weeks vaca and 7-3 @ 160k? This is a newly minted AA student job who starts this summer. Not bad.

I ALMOST went to AA school @ Emory back
in the late 90's. Accepted but decided to go the MD route instead.

Would have been good to me I think. Going forward, it's going to get better. We put a lot of effort at the legislative level to get more AA states approved. It's only a matter of time.
 
Consigliere said:
Well, now we know who hates med students on SDN...
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I made the right choice by choosing Anesthesiology. I enjoy it a lot, and I am not in the minority based on recent surveys. I am not one of those that discourage entry into the field.

As for mid-level encroachment and the question posed by OP, it is probably a consequence of greed, laziness, and lack of passion for the field. So NO, we should not be training or using crnas.
 
sevoflurane said:
AAs get sweet gigs right out. How about no weekends, no holidays, 8 weeks vaca and 7-3 @ 160k? This is a newly minted AA student job who starts this summer. Not bad.

Would have been good to me I think. Going forward, it's going to get better. We put a lot of effort at the legislative level to get more AA states approved. It's only a matter of time.
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Thanks for your efforts with AA legislation.

I've got a bunch of new AAs starting this summer, but they're not getting the deal you describe. 🙂
 
Machinery said:
I made the right choice by choosing Anesthesiology. I enjoy it a lot, and I am not in the minority based on recent surveys. I am not one of those that discourage entry into the field.

As for mid-level encroachment and the question posed by OP, it is probably a consequence of greed, laziness, and lack of passion for the field. So NO, we should not be training or using crnas.
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That's the right answer. Greed and laziness is what brought on the death of anesthesia quicker than other fields of medicine. The lack of passion exists in all areas of medicine now. Once the suits came in and protocolized everything and it all became about profits for CEOs rather than caring for the people in your community, the passion in medicine disappeared.
 
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sevoflurane said:
AAs get sweet gigs right out. How about no weekends, no holidays, 8 weeks vaca and 7-3 @ 160k? This is a newly minted AA student job who starts this summer. Not bad.

I ALMOST went to AA school @ Emory back
in the late 90's. Accepted but decided to go the MD route instead.

Would have been good to me I think. Going forward, it's going to get better. We put a lot of effort at the legislative level to get more AA states approved. It's only a matter of time.
Click to expand...
What state are you in? I wish that gig existed in Atlanta..
 
Mad Jack said:
He's talking about opening his own practice- they can't force him to sell something he owns. The whole reason so many prior are going the employed route is that they don't want the headaches of being a practice owner, but there's still plenty of opportunity for the business-inclined.
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False.
 
btbam said:
What state are you in? I wish that gig existed in Atlanta..
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You can't practice here yet...

The job I'm referring to is in Missouri. Rural.
Rumor has it, it used to be 10 weeks and recently dropped to 8 weeks. I must say,I was amazed at what this student AA landed as her first gig. The rule of 3s applies everywhere.
 
sevoflurane said:
You can't practice here yet...

The job I'm referring to is in Missouri. Rural.
Rumor has it, it used to be 10 weeks and recently dropped to 8 weeks. I must say,I was amazed at what this student AA landed as her first gig. The rule of 3s applies everywhere.
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Missouri see also: Misery

She deserves every penny and every second of vacation.
 
Carbocation1 said:
For those advising students to purse other fields, check out this new thread: http://forums.studentdoctor.net/threads/rheumatology-job-offers.1160991/#post-17796572

Rheum salary < CRNA
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Someone in that thread was working 8:30-5 with a 1 hour lunch break and making 245k. That is not a bad life at all.

That is not much less than I am making and my lunch break is shoving a protein bar in between cases. Getting home at 5 is an early day for me. I take 24 hour call a few times a month, and work many weekends and holidays. I can't think of any rheumatologic emergency off the top of my head that would require a wake up call in the middle of the night. Maybe a rheumatologist has to round on a few consult patients in the hospitals on a holiday, but that's about it.

Anesthesia is not a lifestyle field. Your HOURLY pay will be less than many other specialties. Don't go into a specialty for money.
 
jwk said:
Thanks for your efforts with AA legislation.

I've got a bunch of new AAs starting this summer, but they're not getting the deal you describe. 🙂
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AA salaries are depressed by the CRNA diploma mills that crank out more new grads than are needed each year.
 
sevoflurane said:
You can't practice here yet...

The job I'm referring to is in Missouri. Rural.
Rumor has it, it used to be 10 weeks and recently dropped to 8 weeks. I must say,I was amazed at what this student AA landed as her first gig. The rule of 3s applies everywhere.
Click to expand...
Supply and demand ALWAYS rules.
 
jwk said:
Thanks for your efforts with AA legislation.

I've got a bunch of new AAs starting this summer, but they're not getting the deal you describe. 🙂
Click to expand...

We have one guy in our group who is hitting home runs for you guys- he spends much of his time in DC and at our local governance meetings clearing up smoke.
 
GravelRider said:
Someone in that thread was working 8:30-5 with a 1 hour lunch break and making 245k. That is not a bad life at all.

That is not much less than I am making and my lunch break is shoving a protein bar in between cases. Getting home at 5 is an early day for me. I take 24 hour call a few times a month, and work many weekends and holidays.
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If indeed this is true, then you are a motherfuc_king chump for working like this. Do you have some "issues" that cause you to work in such a draconian environment?
 
Consigliere said:
If indeed this is true, then you are a motherfuc_king chump for working like this. Do you have some "issues" that cause you to work in such a draconian environment?
Click to expand...

Bad market is part of it. Lies in the contract is the majority of it. I am on my way out and deciding whether to use this opportunity to just suck it up for a year and do a fellowship.
 
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