Will a surplus of CRNAs affect AA salary??

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2Fast2Des said:
Agree completely, there is no less of the 2 evils for the long run via mid-level route. I chose Anesthesiology to have the ability to provide 1-1 care and apply my training and skills as every patient deserves. I don't know where and why this supervising thing came about, it's made the Anesthesiologist irrelevant imo, I feel like a good practice can run without having the "extra" guy\gal. If I was a bean counter I could see the role in going to an independent mid-level, and eliminate another extra salary. Getting back in the rooms is the best way to show that we actually exist. Why keep fighting for care team model if the team doesn't want to you on it?
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How many more anesthesiologists would need to be trained to have enough that there is one in every room?
 
MEN2C said:
How many more anesthesiologists would need to be trained to have enough that there is one in every room?
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The goal of the corporate executives is to have 5 or more midlevels for every Anesthesiologist. Remember they are only concerned about finances and know nothing about Anesthesia. The only way this freight train will stop is if Anesthesiologist lobby successfully to prevent higher ratios. And if individual Anesthesiologists convince their hospitals that higher ratios are unsafe. As an individual you can also refuse to practice medicine in this manner. You may have to look a little further to find a job but it can be done by saying "no" when you are asked to supervise at insane ratios. And you have a good reason to say "no." Your liability and chance of getting sued has just multiplied by 5!
 
Money Moniker said:
I'm not a nurse, and I think all midlevels should be relegated back to nursing duties and purged from the practice of medicine. The fact some of you think I must be a nurse because I pointed out that increasing the supply of midlevel providers in anesthesiology will be bad for anesthesiologists regardless of whether these midlevels are AAs or CRNAs reflects poorly on your intellects. It's such a basic, inarguable fact of not just economics, but common sense, that I'm amused you think you can dismiss it by calling me nurse and burying your heads in the sand.

I'm not going into anesthesiology, so do what you wanna do. I do think it is hilarious that instead of using what feeble political power you have to fight against the midlevel takeover of anesthesiology, you want to use it instead to accelerate the process by lobbying in favor of the one group of midlevels which cannot yet lobby on its own. Good luck with that.
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You seem confused or uninformed or both.
 
MEN2C said:
How many more anesthesiologists would need to be trained to have enough that there is one in every room?
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At least triple the number that there are now, maybe more. Like it or not, it's simply not possible. How large would the residencies have to be, and how long would it take? We're way too far down the road to go back.
 
jwk said:
At least triple the number that there are now, maybe more. Like it or not, it's simply not possible. How large would the residencies have to be, and how long would it take? We're way too far down the road to go back.
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Why not? If there are enough cases for srna and crna to be doing, why can't a resident be doing those cases instead? There's volume
 
2Fast2Des said:
Why not? If there are enough cases for srna and crna to be doing, why can't a resident be doing those cases instead? There's volume
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Look - I've said plenty of times on SDN that physician-only anesthesia is fine for those that can swing it. CRNAs have been around for 100 years. AAs are coming up on 50. None of them are going away.

How many residents/fellows come into the market each year? Something like 1500? Where will the dollars come from to triple the size of current residencies, or add enough other programs to get to that number? The dollars simply aren't there. And even if there were - you're looking at increasing the overall number of actively practicing providers by a very small percentage each year. And all the while, the number of non-physician providers are also increasing. They aren't suddenly going away while all that is happening, waiting for a drastically increased number of anesthesiologists to come out and fill the gaps.

Assume that physician-administered anesthesia is the ideal. Great. For those that can swing it, more power to you. But the economics are working against you more and more. Not my fault, not your fault. The idea behind the ACT concept, as originally envisioned by Steinhaus, Gravenstein et al back in the 60's, is that it enables a physician anesthesiologist to be involved with the care of each and every patient that receives an anesthetic. Every one. AAs fully support that concept. CRNAs, as a profession, do not. AAs can't and don't work outside that framework. It is embedded in the laws and regulations that allow us to practice in the first place. None of us are trying to change that. For the rogue AA who thinks they're better than that, by all means - get rid of them. That is not how our profession is designed.

In the end, you have to deal with reality as it is.
 
jwk said:
Look - I've said plenty of times on SDN that physician-only anesthesia is fine for those that can swing it. CRNAs have been around for 100 years. AAs are coming up on 50. None of them are going away.

How many residents/fellows come into the market each year? Something like 1500? Where will the dollars come from to triple the size of current residencies, or add enough other programs to get to that number? The dollars simply aren't there. And even if there were - you're looking at increasing the overall number of actively practicing providers by a very small percentage each year. And all the while, the number of non-physician providers are also increasing. They aren't suddenly going away while all that is happening, waiting for a drastically increased number of anesthesiologists to come out and fill the gaps.

Assume that physician-administered anesthesia is the ideal. Great. For those that can swing it, more power to you. But the economics are working against you more and more. Not my fault, not your fault. The idea behind the ACT concept, as originally envisioned by Steinhaus, Gravenstein et al back in the 60's, is that it enables a physician anesthesiologist to be involved with the care of each and every patient that receives an anesthetic. Every one. AAs fully support that concept. CRNAs, as a profession, do not. AAs can't and don't work outside that framework. It is embedded in the laws and regulations that allow us to practice in the first place. None of us are trying to change that. For the rogue AA who thinks they're better than that, by all means - get rid of them. That is not how our profession is designed.

In the end, you have to deal with reality as it is.
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Very true. And there is a place for well trained CRNAs in most practices. When I look at a practice and see 12 Anesthesiologists and 6 CRNAs, it make sense. The cases appropriate for the CRNAs are being chosen, Anesthesiologists are maintaining their skills by personally providing Anesthesia. Recent MD grads are developing their skills by seeing cases from beginning to end, sitting on the stool, dealing with emergencies etc.

But when I see a practice with 5 Anesthesiologists and 15 CRNAs I wonder, are they just signing charts? Are their skills atrophied because they are not spending enough time in the OR? Are new MD graduates moving right into supervisory roles without spending time running their cases without an Attending standing by? Are the CRNAs becoming the masters of the OR while the MDs are becoming the masters of the Preop and post op Suite? Maybe it has not gotten this bad yet, but I feel like we have to demand and maintain our place in the OR or risk being marginalized as a profession.
 
skypilot said:
Very true. And there is a place for well trained CRNAs in most practices. When I look at a practice and see 12 Anesthesiologists and 6 CRNAs, it make sense. The cases appropriate for the CRNAs are being chosen, Anesthesiologists are maintaining their skills by personally providing Anesthesia. Recent MD grads are developing their skills by seeing cases from beginning to end, sitting on the stool, dealing with emergencies etc.

But when I see a practice with 5 Anesthesiologists and 15 CRNAs I wonder, are they just signing charts? Are their skills atrophied because they are not spending enough time in the OR? Are new MD graduates moving right into supervisory roles without spending time running their cases without an Attending standing by? Are the CRNAs becoming the masters of the OR while the MDs are becoming the masters of the Preop and post op Suite? Maybe it has not gotten this bad yet, but I feel like we have to demand and maintain our place in the OR or risk being marginalized as a profession.
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In the academic world 99% of staff couldn't do a machine check nor how to chart to save their life when rarely they do own case if short staffed when residents have academic time. I've heard residents who took over their rooms that they're usually complete messes and poorly documented.
 
2Fast2Des said:
In the academic world 99% of staff couldn't do a machine check nor how to chart to save their life when rarely they do own case if short staffed when residents have academic time. I've heard residents who took over their rooms that they're usually complete messes and poorly documented.
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99% of staff can't do a machine check? Not trying to argue with you, but seriously?
 
I'm a Fake Doctor said:
99% of staff can't do a machine check? Not trying to argue with you, but seriously?
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Ok maybe not 99% but an overwhelming majority. Had to teach one how to use a smart pump, and he was a well reputed guy as well. Situations where small routine things can't be done is where it makes me never want to supervise, as I'd hate to become a chart signer and lose skills
 
2Fast2Des said:
Ok maybe not 99% but an overwhelming majority. Had to teach one how to use a smart pump, and he was a well reputed guy as well. Situations where small routine things can't be done is where it makes me never want to supervise, as I'd hate to become a chart signer and lose skills
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What’s a smart pump?
 
2Fast2Des said:
Ok maybe not 99% but an overwhelming majority. Had to teach one how to use a smart pump, and he was a well reputed guy as well. Situations where small routine things can't be done is where it makes me never want to supervise, as I'd hate to become a chart signer and lose skills
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Makes sense. You're not alone in that aspect. I promise.
 
AdmiralChz said:
We have them in endoscopy. You set the propofol then pull up Netflix on it. I always make the nurse put in their login.

I’m almost done with The Office hopefully we will have a long ERCP tomorrow!
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Is The Office on Netflix? Do you know where/how I can get Brooklyn 99? 😉
 
I know we have mostly moved on from this, but psai is absolutely right. The cat is out of the bag with CRNAs and you aren’t going to put them back in it. What you can do is favor AAs. Now, will AAs become as bad as CRNAs? Maybe. But there’s a chance that they’re not, and at this point that’s better than nothing.

I’m also somewhat less concerned than some people here. Would it be nice to not have mid-levels at all? Sure....but realistically you don’t need an anesthesiologist for every simple simple case out there. And it’s not like Every other field in medicine isn’t dealing with mid-level creep to some degree.

Paradoxically the fact that nursing almost always overproduces people/allows “mill” programs degrades the overall quality of the degree, NP or CRNA.

It used to be that the path to NP degree was BSN (4 years) then 4-5 years clinical practice then 3 years on top. Now someone that majored in English can get an NP within 3 years. This kills the degree. So now you have an insane amount of variability, which makes for ****tier outcomes and overall lack of trust of people with that degree.

Same thing is true for CRNAs. As requirements get looser (ED being treated the same as ICU) we will see a similar lowering in quality, and an overall backlash against the degree on the whole. Now you might say well it’s the admins that make that decision! Which, sure. But when CRNAs start having higher rates of malpractice, their insurance goes up, overall population becomes more skeptical after a few high profile **** ups, the rest is history.

I also think there is a tendency to assume that there is 0 chance anyone would want to stay in their lane and know their limitations. This couldn’t be further from the truth. I know plenty of CRNAs that don’t want to be anesthesiologists, don’t want that responsibility, know their limitations, and enjoy making 150-200k. It’s okay to question intentions etc. but the idea that no one could be satisfied with 150,000 dollars doing what AAs do is a bit silly. I do think there is a malignant culture in CRNA schools, and a lot don’t know to stay in their lane or call for help when needed, but the idea that it’s INEVITABLE that AAs would become the same is a bit unfair (and as mentioned, CRNA schools at least already have issues with that so I don’t see a problem favoring AAs).
 
resiroth said:
I know we have mostly moved on from this, but psai is absolutely right. The cat is out of the bag with CRNAs and you aren’t going to put them back in it. What you can do is favor AAs. Now, will AAs become as bad as CRNAs? Maybe. But there’s a chance that they’re not, and at this point that’s better than nothing.

I’m also somewhat less concerned than some people here. Would it be nice to not have mid-levels at all? Sure....but realistically you don’t need an anesthesiologist for every simple simple case out there. And it’s not like Every other field in medicine isn’t dealing with mid-level creep to some degree.

Paradoxically the fact that nursing almost always overproduces people/allows “mill” programs degrades the overall quality of the degree, NP or CRNA.

It used to be that the path to NP degree was BSN (4 years) then 4-5 years clinical practice then 3 years on top. Now someone that majored in English can get an NP within 3 years. This kills the degree. So now you have an insane amount of variability, which makes for ****tier outcomes and overall lack of trust of people with that degree.

Same thing is true for CRNAs. As requirements get looser (ED being treated the same as ICU) we will see a similar lowering in quality, and an overall backlash against the degree on the whole. Now you might say well it’s the admins that make that decision! Which, sure. But when CRNAs start having higher rates of malpractice, their insurance goes up, overall population becomes more skeptical after a few high profile **** ups, the rest is history.

I also think there is a tendency to assume that there is 0 chance anyone would want to stay in their lane and know their limitations. This couldn’t be further from the truth. I know plenty of CRNAs that don’t want to be anesthesiologists, don’t want that responsibility, know their limitations, and enjoy making 150-200k. It’s okay to question intentions etc. but the idea that no one could be satisfied with 150,000 dollars doing what AAs do is a bit silly. I do think there is a malignant culture in CRNA schools, and a lot don’t know to stay in their lane or call for help when needed, but the idea that it’s INEVITABLE that AAs would become the same is a bit unfair (and as mentioned, CRNA schools at least already have issues with that so I don’t see a problem favoring AAs).
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This is a great post.
I’ve seen the CRNA quality degrade markedly on average over the last couple decades. No question.
 
btbam said:
Thanks for the support. My fiancee is applying for peds surgery fellowship broadly since it's such a competitive fellowship. Unfortunately, as an AA I am geographically limited and we keep hoping she matches in a state I can actually work in otherwise it'll be a real headache. The CRNA lobbying power is real and scary. They have been brutally efficient at limiting our entry into new states.

I agree with OP's general premise about pay, although I'm not sure that's actually happening. In our large mixed AA/CRNA practice pay is the same, and the big hospitals in town are hiring 10+ new AA grads.
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Are you an AA?
I'm interested to apply the AA Program. Do you honestly think it's a prestigious, respectable, and good career? Anything you regert that you wish you chose medical school or something else?

Do AA and CRNA make same money and benefits?
Thank you for your help.
 
alex2021 said:
Are you an AA?
I'm interested to apply the AA Program. Do you honestly think it's a prestigious, respectable, and good career? Anything you regert that you wish you chose medical school or something else?

Do AA and CRNA make same money and benefits?
Thank you for your help.
Click to expand...
PM me
 
2Fast2Des said:
Ok maybe not 99% but an overwhelming majority. Had to teach one how to use a smart pump, and he was a well reputed guy as well. Situations where small routine things can't be done is where it makes me never want to supervise, as I'd hate to become a chart signer and lose skills
Click to expand...

I saw some of those types as a resident. I swore I'd never be one, and I'm not. I'm glad I get to sit my own room about 10 or 15% of the time. But, even if you strictly supervise, you can still make it a point not to lose touch the way some do.....
 
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