Travel CRNA opportunities for new grads-Realistic? - page 2

Is it realistic for a new crna to consider travel assignments/contracts? If so, what extra skills or experience should this person possess? Who are the best travel agencys to work for? ALL:)... Read More

  1. by   Gotosleepy
    you are right deepz... we aren't peers, we are colleagues. and i don't know what is wrong with calling an AA an anesthetist. They get about as much Anesthesia experience in AA school as a SRNA gets in CRNA school.

    you can call my statement boneheaded arrogance.... Or you can call locum tenens companies and ask them what percentage of their hires for MDAs are straight out of residency. In fact, most of their hires are straight out of residency (because that is when MDs are most mobile - way before they settle down into a financial partnership). Then ask them what percentage of their CRNA hires are straight out of CRNA school... you'd be surprised. So am i being arrogant? or are all of these locum tenens companies putting patients lives at risk (as you suggest).
  2. by   georgia_aa
    Quote from Gotosleepy
    you are right deepz... we aren't peers, we are colleagues. and i don't know what is wrong with calling an AA an anesthetist. They get about as much Anesthesia experience in AA school as a SRNA gets in CRNA school.
    Actually, the minimum number of clinical hours for AA's is 2615 which is more than the majority of CRNA programs.
  3. by   deepz
    Quote from Gotosleepy
    you are right deepz...
    Of course I am.

    Try this from MedScape for a perspective on arrogance. Note particularly the next to last sentence of the next to last paragraph of Dr Egan's column.

    "Learning Experiences

    Daniel Egan, MD

    As I think about what topics I will cover in my column each month, it strikes me that frequently what comes to mind are not incredibly positive experiences. I suppose that one could argue all of the experiences I am having in residency are, on the whole, positive in that they are helping to shape me as a physician. However, more often than not, I recall times when patients did not do well or, in my opinion, when I did not do well as a resident. My recent trip back to the intensive care unit provided me with a ready story that served to confirm these judgments.

    The past month has been slightly complicated for me. I wrote about my father's MI several months ago. The end result of that incident was an anticipated CABG that occurred 3 weeks ago. Since my father's heart attack, my brother has been deployed to Iraq as a member of the Army. I felt that my presence at home during this time was even more important because of his absence.

    My father sailed through the operation itself, but my mother and I received the phone call in the surgical waiting room less than 3 hours after the procedure began informing us that the doctor was coming up to talk to us. The doctor, we were told, was on his way. I commented to my mom on how weird that phrase sounded to me since I suppose many people probably tell their family members what "the doctor" -- meaning me - told them about their loved one.

    A very brief interaction with the cardiac surgeon followed, and we were taken shortly thereafter into the ICU to visit my father. That is, to visit my intubated father, who was hooked up to a Swan Ganz catheter, low doses of pressors, and multiple intravenous lines. My instincts were to check out the contents of what was hanging in each bag, look at the tracings on the monitor, and check his urine output. Suddenly, it hit me that at that point I was "son," not "doctor."

    I was struck again by that reality when, after spending the day at the hospital, my mother and I went home only to receive the dreaded phone call. The surgeon called to say they were taking my dad back to the OR because of bleeding from his chest tube, and suggested that we "come back to the hospital." How often had I told families that they should come to the hospital without knowing that those same words soon would haunt me? Thankfully, the source of his bleeding was nothing serious and he pulled through the second procedure just fine.

    Two days after my dad was out of the surgical ICU (SICU), I returned back to Boston to begin my delayed start in the SICU. Technically, it is the trauma/burn ICU, although historically it has been called the SICU even though there is one with a separate resident team next door. I began my call on a Sunday, a weekend day with minimal staff around. Arriving at 7AM, my stomach sank as I realized that a full 29 hours lay ahead of me.

    Apart from my father's stay in the SICU, I had not been in an intensive care unit for quite some time. We take care of critically ill patients all the time in the ED, but their long-term management is different, requiring frequent ventilator adjustments and medications that I do not work with very often. The beauty of this rotation (interpret this both literally and sarcastically) is that we are alone in the 10-bed unit. No other physicians to bounce ideas off of, although the fellow is easily reachable by phone. To our benefit -- and likely the patients' -- the nurses are right on and for the most part ask or tell us what needs to happen.

    One such example was Mr. E, a middle-aged man with advanced metastatic cancer. A palliative surgical procedure caused an acute lung injury in the setting of horrendous underlying parenchyma. As my call night went on, his oxygenation grew worse and worse. To say that I was nervous at 10 AM after rounds doesn't begin to capture the anxiety I felt when his condition began to deteriorate. I can still hear the nurse saying to me, "Talk to me. What do you want me to do?" In my mind I was thinking, "I have no idea what to do. Doesn't anyone else have any ideas?" Despite increasing amounts of oxygen and PEEP (positive end-expiratory pressure to keep his alveoli open) on the ventilator, his arterial oxygen level failed to budge. My calls for advice to the fellow turned into a plea for help -- which he responded to by heading to the hospital. Only with measures that frankly I did not even understand did the patient's status begin to improve. It definitely had nothing to do with what I could offer.

    There is nothing quite like that feeling of increasing fright as you stand in someone's room observing them spiraling downward and being unable to do anything about it. More often than not, I have found myself in that situation knowing that we have done everything and understanding the options. This was different. I did not know what to do next.

    I kept wondering if this only occurred to me or whether other people felt the same way in their SICU rotations. The rotation is billed among my fellow residents as a "great" month, but I kept waiting for the great part to begin. Perhaps it's great because I could not walk across the room and ask someone else for input, but it certainly was not great for inspiring confidence. Even as I write that, though, I wonder if that is really true. Someone in a lecture last week said that if you do not have a complete sensation of panic once a week, then something is wrong. To hear that from a seasoned attending physician was reassuring, to say the least.

    I am on call tomorrow -- my panic quota for the week has already been met, so I am hoping for a quiet night.

    ---- Daniel Egan, MD, 2002 graduate of Mount Sinai School of Medicine, New York, NY; second-year emergency medicine resident, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts"
    Last edit by deepz on Jul 6, '04
  4. by   athomas91
    Go2sleepy- the AA thing has been hashed - let's leave it alone...alrighty...

    i think it only makes logical (if you are of that mindset......) sense that ANYONE starting out should probably get some sound individual "non-student" experience before venturing out of their own...that stands for Doc, Nurse, or AA....if you follow such a thought - that same individual would also know when to ask for help rather than allowing harm to a pt...


    another question for you....
    as a new grad - would you stay where you are comfortable to get your wings - or would you venture to a new setting/new people/new learning experiences for the start of your career??
  5. by   TejasDoc
    Deepz,

    While I think that anecdote from the resident is educational in sheading light on the experience of training physicians, it does not really apply here. You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology.

    Sorry, the comparison is weak.

    TD
  6. by   deepz
    Quote from TejasDoc
    ......You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology. Sorry, the comparison is weak......

    Ahh, to be young and ignorant and so full of oneself again.

    I compare nothing in that citation. You may read into Dr Egan's column whatever you wish. Again, kiddos, take to heart the next to last sentence of the next to last paragraph. Sometimes we earn the worth of our entire year's salary in only a few critical seconds in the OR.

    deepz
  7. by   Lalaith
    [QUOTE]You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology.
    Sorry, the comparison is weak.

    TD,
    I have read this board for a few months now strictly in the mode of intermittent catch-up, when I have the time, much as I feel you may do. That often explains how sometimes we may miss the point, or at least skirt around it rather obtusely. When deepz posted the excerpt from an emergency resident's thoughts and insights on his experiences, he stated nowhere he was making a comparison. Rather he stated that he felt this was an educational perspective for us all to take into consideration. Perhaps he felt we could from this excerpt better gain a portion of his viewpoint on the importance of humility, and the impact of a few moments in time potentially upon a career, and more importantly, on a human beings life. That perspective easily spans a second year resident's frame of reference, as well as a CRNA's or even a person who has COMPLETED a 3 year residency in anesthesiology. If you go to argue that a person's syllogism or comparison is weak, one should be sure it is actually being made.
  8. by   TejasDoc
    Quote from Deepz
    Ahh, to be young and ignorant and so full of oneself again.
    Oh come on deepz, you don't have to long for the past, you're plenty ignorant and full of yourself now ... I imagine it would make up for an entire life of humility.

    Quote from Lalaith
    TD,
    I have read this board for a few months now strictly in the mode of intermittent catch-up, when I have the time, much as I feel you may do. That often explains how sometimes we may miss the point, or at least skirt around it rather obtusely. When deepz posted the excerpt from an emergency resident's thoughts and insights on his experiences, he stated nowhere he was making a comparison. Rather he stated that he felt this was an educational perspective for us all to take into consideration. Perhaps he felt we could from this excerpt better gain a portion of his viewpoint on the importance of humility, and the impact of a few moments in time potentially upon a career, and more importantly, on a human beings life. That perspective easily spans a second year resident's frame of reference, as well as a CRNA's or even a person who has COMPLETED a 3 year residency in anesthesiology. If you go to argue that a person's syllogism or comparison is weak, one should be sure it is actually being made.
    You're right Lalaith, I may have misread Deepz. This I will freely admit. But, in a previous post he wrote.
    Quote from Deepz
    Wow. 'Locums is not a big deal for MDs fresh out of residency.' There you have it: the bone-headed arrogance that gets so many docs in big trouble.
    Then he posts his little anecdote about physician arrogance, using the example from a junior resident. So sure, I'll buy that maybe he's talking about the impact of a few moments on a human life. It's a distinct possibility. I've read it again and I can see how it would be read that way.

    I just want you to acknowledge that maybe he was taking a jab at gotosleepy after calling him arrogant, and then presenting that little anecdote as a chance to show how arrogant doctors like gotosleepy can kill people. I just don't think inside the bitterness and anger is a nice guy trying to teach me something about humility.

    Though Deepz, and everyone else who read his post, I want you to think about something. If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?

    BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.

    TD
  9. by   Lalaith
    TD,
    First of all, I appreciate your willingness to concede you may have misread the intention of deepz's post; obviously the only one who can directly speak to that is deepz, but I believe that was done by him in the post prior to mine.

    [/QUOTE]Then he posts his little anecdote about physician arrogance

    Interesting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason,
    an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance.

    [QUOTE]If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?

    Gee, TD, here you go having me thinking you are discussing this with an admirable amount of equanimity, and then you go off with a quote like this. I see your analogy, but your argument gets lost in the emotive "saving your butt". And by your logic, the next inference that can be gained is that I should have been making a *&#@ of a lot more money over my career up to this point; that is, when a nurse comes in and saves residents' and doctors' butts many more times than once or twice a year, why should they not get a cut of the doc's money for that day? And how is the remuneration decided? Are there some butts saved that should get a better recompense than others , or should there be a general butt-salvage stipend for each incidence?

    The truth is, sometimes we all need a helping hand sometimes, we can all get too close to the trees to see the forest, or vice-versa. We also all possess the potential to "save someone's butt''! The insight needed does not necessarily come forth in every situation from a doctor or a nurse, nor even the most experienced provider. But the true insight is found in the provider who is able to admit that he/she is over his/her head and needs advice, and is able to sift through and discern the proper course, most especially in novel situations.

    [QUOTE]BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.

    "Touche!", TD, or should I say, "en garde"? However, I believe I actually called us both obtuse, and thanks for the welcome. After the length of this missive, you probably wish to retract it!


    Lalaith
  10. by   TejasDoc
    Quote from Lalaith
    TD,
    First of all, I appreciate your willingness to concede you may have misread the intention of deepz's post; obviously the only one who can directly speak to that is deepz, but I believe that was done by him in the post prior to mine.
    Then he posts his little anecdote about physician arrogance

    Interesting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason,
    an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance.

    [QUOTE]If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?

    Gee, TD, here you go having me thinking you are discussing this with an admirable amount of equanimity, and then you go off with a quote like this. I see your analogy, but your argument gets lost in the emotive "saving your butt". And by your logic, the next inference that can be gained is that I should have been making a *&#@ of a lot more money over my career up to this point; that is, when a nurse comes in and saves residents' and doctors' butts many more times than once or twice a year, why should they not get a cut of the doc's money for that day? And how is the remuneration decided? Are there some butts saved that should get a better recompense than others , or should there be a general butt-salvage stipend for each incidence?

    The truth is, sometimes we all need a helping hand sometimes, we can all get too close to the trees to see the forest, or vice-versa. We also all possess the potential to "save someone's butt''! The insight needed does not necessarily come forth in every situation from a doctor or a nurse, nor even the most experienced provider. But the true insight is found in the provider who is able to admit that he/she is over his/her head and needs advice, and is able to sift through and discern the proper course, most especially in novel situations.

    BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.

    "Touche!", TD, or should I say, "en garde"? However, I believe I actually called us both obtuse, and thanks for the welcome. After the length of this missive, you probably wish to retract it!


    Lalaith
    No retraction. I enjoyed reading your post. I knew as soon as I wrote the "save your butt" thing, I shouldn't have. But I let it go. Oh well, ya make some mistakes and you move on.

    I apologize. But I think you recognized the point I was trying to make, even if I wasn't making it in the best possible manner. Compensation is a tricky thing, and I don't really know that much about how it's done.

    Anyway, gotta catch some sleep, and there's still one more post I need to make.

    TD
  11. by   Gotosleepy
    hmmm... arrogance...??? anecdotal stuff about new MD grads not ready for locum...???

    all i can tell you is that I did locum straight after residency (right before my fellowship)... It was a piece of cake, AND i provided CRNA supervision... Now you will all cry that CRNAs don't need supervision. Well for one, in the state I was in they can't bill without my name on the chart, and for two, the CRNAs (including the older/more experienced ones) always deferred to my medical decisions/plans, and many a time I had to guide them through tricky clinical decision making. Let's see: three years of about 75 hours/ week with a total of 9 weeks of vacation... That is 11025 hours of experience - and that doesn't even include the 100/wk (now it is limited to 80hrs/week) during internship... which adds up to 5000 hours of patient care (managine MIs, managing PEs, managing arrythmias, providing central venous access, etc...) prior to anesthesia residency.

    SOO back to the original question: is it realistic for a new grad to do Locum Tenens? Not really, unless you want to dig a big hole for yourself. I would recommend at least 2-3 years (w/ as broad an exposure as you can get) prior to doing locum....

    Now, based on my review of the postings on this board, I have to say I think working w/ Yoga or Loisane or McHugh would be a pleasure (even though I have a feeling based on my postings on this board, they may not feel the same way)- they sound like they have their head on their shoulders, and also have a good clinical sense.

    Deepz- however... You have never brought anything of value to any of the clinical scenarios that were discussed in previous postings... Your messages revolve around ways of including "A$A" in your sentences... kinda sad...
  12. by   loisane
    Quote from Gotosleepy
    Well for one, in the state I was in they can't bill without my name on the chart, and for two...
    None of the 50 states require an 'ologist involvement in an anesthetic in order to bill. Federal regulations that require physician involvement do not specify it be an 'ologist.

    So, if 'ologist involvement was required at this institution, I believe it was because of an internal, institution policy.

    loisane crna
  13. by   Gotosleepy
    loisane - you are absolutely right.

close