CRNA supervision by anesthia MD

wake9909 · Aug 6, 2009

CRNAs are board-certified to practice independently. The degree of MD supervision is facility-specific only; in other words, although CRNAs can and do practice 100% independently in many settings, specific facilities may require Anesthesiologist supervision based on their own policies or level of compensation.

stanman1968 · Aug 6, 2009

The CRNA NEVER has to be supervised byan anesthesiologist, by law. Hospital bylaws may require it but ratios and conditions vary. The customary levels are the CMS regulations they however are ONLY for billing CMS and have no force of law in themselves, it is custom that usually drives these staffing and superviory ratios.

subee, MSN, CRNA · Aug 6, 2009

In basic term, can anyone tell me how closely a CNRA has to be supervised by the anesthesia MD in charge; or put another way, is it usual practice to have one anesthesia MD supervising more than one CRNA doing a case at the same time? thanks

For us: outpatient 1:3. Inpatient 1:3 or 1:2 depending on patient complexity. Tertiary care center.

reded · Aug 6, 2009

CRNAs can practice independently etc,etc,etc. The bottom line is my experience over the last 23 years is supervision by an MD everywhere I worked except for Haiti and Guyana. Sometimes it's one on one sometimes it's three on one. Sometimes they're there for induction often they're not. It depends on how busy things are and they're confidence in you abilities to work alone. It would be nice if they would see the next patient if you are in a busy room. Often you see the patient, tell the attending about them and do the case with the attending available if needed. My experience has been in NYC and suburbs. I've gamed the system schedule-wise my entire career and that would be less likely were I some sort of independent practitioner. It's also nice to walk out of work at the end of the day and not have to worry about the bussiness end. Hard work and lifestyle is my credo. ED

loveanesthesia · Aug 6, 2009

Supervision is a billing arrangement, and in this arrangement it is common for a MDA to supervise 2-4 CRNAs. It is also common that a CRNA is not supervised.

darne20 · Aug 8, 2009

Thanks for the replies. If the surgeon agrees that the anesthesia will be performed by an anesthesia MD (because of patient request), is this a problem if agreed to in advance?

stanman1968 · Aug 8, 2009

No other then dragging a "supervising" anesthesiologist out of the lounge

TXCRNA · Aug 8, 2009

Its not a problem if the pt wants a MD. As long as the facility has anesthesiologists and if staffing permits. If its at a facility w/ anesthesia care team ( an MD supervising 2-4 CRNAs) staffing may be too limited to permit an MD being in one room. That would leave several rooms/cases now w/o a MD to supervise & the facility may not have another MD to staff the now unstaffed rooms. When this occurs @ my facilty the case is usually delayed until staff is available (Which could be hours. Work @ a busy private practice) or case may be cancelled til another day. Or staffing could permit--then case goes forward w/ no delays.

darne20 · Aug 9, 2009

Thanks, that's what I needed to know. I recently had surgery and there was an anesthesia problem; the surgeon suggested that I should make sure that I have a anesthesiologist when we reschedule not a CRNA like we had the first time. I'm guessing that an anesthesiologist could have made the same error that the CRNA made.

TXCRNA · Aug 10, 2009

What was the "mistake"? Surgeons tend to blame everything on the anesthesia provider. There are very good/competent CRNAs & MDs. Then there are some not so good CRNAs & MDs. In multiple studies it has been shown that anesthesia mishaps are related to vigilance of the anesthesia provider & not if the provider is CRNA vs. MD. CRNAs would not be allowed to practice independently otherwise. I would not hesitate to have a CRNA or MD anesthesiologist do my anesthesia. I would speak to whomever does your anesthesia in the future & explain what the anesthsia "mistake" consisted of. I am interested in what problem you had.

darne20 · Aug 11, 2009

I have documented med allergies to 2 meds and the CRNA gave me both.....30 years as a hospital pharmacist tells me that this happens; there would have been a difference if I had a MD provider: the CRNA admited that she made the error; I wonder if a physician would have been so forthcoming...still I'm scared of ever having anesthesia again......the MD's that I know have a high opinion of CRNA's; but want a MD doing the anesthesia when THEY have surgery................not sure of what to think of this.