What is up with CRNA/AA/MDA politics.

Specialties CRNA

Published

I am way not in it but long term, i am aspiring to be a CRNA so i hang out on various boards and i am amazed at what i see. I see MDAs to be talking about having nurses do the mundane work becasue they deserve it after all the hard work they put in. I see AAs saying that they get a better education, though how they come up with that i don't know.

Why are people, who are supposedly well educated and claim to be adults, so monstrously disrespectful of the work others have done or are doing.

What's the deal here? and if i successfully complete a program, am i gonna have to hear that kind of nonsense from people in my professional life?

Obviously it wouldn't make sense if everyone passed. That would mean the exam is far too easy.

I wonder what the cumulative pass rate is after the 2nd or 3rd attempt? I know a fair number of docs that didn't pass the first time, especially on the orals, but made on the second try.

the story behind this is an interesting one.... in 1995 there were 2 news reports regarding a bad job situation for anesthesiologists... therefore anesthesia residency applications fell into the toilet and very few of the 1200 spots were filled by american graduates. The hospitals didn't have much of a choice, and were unfortunately forced to fill their anesthesia programs with residents from foreign countries who had 1) severe communication/language barriers 2) serious learning issues and 3) serious reliability issues. This was unfortunate on a whole, because those hundreds upon hundreds of residents were filling holes in residency programs to keep ORs running - but not necessarily in the interest of the patient :( A HUGE block of those weak/crappy/useless residents are responsible for the high board failure rate in the ensuing years. In fact, you don't see good quality medical students going back into anesthesia residency until about 1998/99 (those who would be taking boards in 2002/03) - and thus the changes in the board scores. The board exam itself hasn't been changed over that time period/nor has the grading system.... The good news financially is that for all the people who did pass the boards and who could communicate in the english language there was a huge SUPPLY of jobs because they had no competition from their colleagues when they graduated (part of the reason why there continues to be a shortage of MDs).

NGACRNA - you are right that the board certification process is voluntary - in the sense, that if a graduating resident doesn't feel like going through the process then he/she doesn't have to pass the boards or take the oral component. However it is a requirement of all anesthesia residencies that certify their residents as having completed the required years of residency, that they are signed up for the written boards that are administered in July. All groups that I know of require either Board certification OR Board eligibility with completion of board certification within one year in order to keep their job. The same thing applies for all university centers that I know of. Can somebody without board certification practice anesthesia - sure, but very few people would hire them!!!

ONE c-section during residency - give me a break... the ACGME requirement for graduation is 20 c-sections and the national average is 35-40. (here is a link to give you an idea of the averages: http://etherdome.org/Education/ResiInfo/Caseload.html

a simple machine check can't be done??? gimme the reference to that ASA newsletter - i would love to read it (because i searched their newsletters and couldn't find a reference)

ONE c-section during residency - give me a break...

i think the statement was one c section under general

As for the average anesthesiologist only doing one general C/S during residency?

at least that's how i interpreted it.

one c section for any anesthesia provider would be sad.

d

sorry - i misread about the GA part. you are right, those aren't very common... Most centers that do >3,000 deliveries per year would average 2-4 GAs per month (based on my readings). I don't know what the average c-sections under GA, but it wouldn't surprise me if some anesthesia residents never get to do a c-section under GA. which is sad...

sorry - i misread about the GA part. you are right, those aren't very common... Most centers that do >3,000 deliveries per year would average 2-4 GAs per month (based on my readings). I don't know what the average c-sections under GA, but it wouldn't surprise me if some anesthesia residents never get to do a c-section under GA. which is sad...

I'd still like to see where that stat comes from. And if an anesthesia resident only does one, how many does a CRNA do? And where does that stat come from?

The number of general C-Sections done is going to be a function of how busy the OB service is. If you're doing a very low percentage of general C-Sections, there simply won't be that many numbers to do, and it will have nothing to do with whether you're a CRNA or AA or MD. At my training hospital, it was kind of funny, but it was whoever got to the head of the bed first when they paged overhead for a STAT section was the one that actually stayed and did the case.

I don't know our exact numbers, but I would guess it's less than 5% general C-Sections, and most of those will be for walk-ins in active labor with bad heart tones, prolapsed cords, moms who have HELLP syndrome or some other coagulopathy or contraindication to a regional, and EXIT procedures which require a general C-Section.

I would be interested in learning more about anesthesiology residency education. Specifically, hours spent in didactic per week and level of supervision during cases.

Also, do physician anesthetists typically count all their OR time and time on call as hours, or only their actual "bag-time" as we are told to do? Using Tenesma's post of over 10000 hours in a physician residency, this amounts to a little over 10 hours a day, five days a week for four years. Definetly possible, but resulting in pretty long days if you aren't counting turnover time, pre-oping patients, A-lines and central lines out of the OR, sitting around in OB, sitting around waiting on call or in the OR etc. In a big teaching hospital with longggg cases of course, this might be easier to achieve.

Also, what is the culture in physcian residency programs concerning reading during cases? In my....(I hesitate to use the term).....residency (internship, studentship, slave labour camp....please insert whatever you feel most comfortable with), reading non-anesthesia material during a case results in immediate expulsion. It seems the anesthesiologists I work with do not have this same cultural norm.

brenna's dad - i can't answer for all anesthesia residencies but i can tell you about my experiences

1) didactics (meaning lecture/class-room setting - includes grand rounds) is about 3-4 hours/week.... the first month or two of anesthesia residency you might get about 6-10 hour/week.

2) OR time of 10,000 hours is about an average of 75 hours of OR time/week for 11 months for a total of 3 years (instead of 12 months, since one month is usually non-OR related stuff the residents do: pain clinic, ICU, vacation, etc.)... the 75 hours is an average since OR time is usually 7am to 6pm and then the residents take 1 to 2 24 hour shifts during the week. So this isn't "bag-time" by definition, but includes all pre-op activity/lines/regionals etc...

3) reading-material: you can ONLY have patient related reading material in the room - if there is an article on intra-aortic balloon pumps while you are doing a breast case that is big TROUBLE. However, i am sure quite a few people cheat with those crazy palm pilot thingies everybody has... but if you were caught being non-vigilant (ie: surfing the web, reclining in the corner) you went straight to the chairman's office.... i don't think anybody has ever been expelled, but they have been banished to some ****** ORs instead :)....

plus i think it is very disrespectful/unprofessional to everybody in the room, ESPECIALLY the patient to be reading --- if i am not sure, I always ask myself: "what would the patient think if he/she knew what i was doing right now?".

Specializes in Anesthesia.
.......OR time of 10,000 hours is about an average of 75 hours of OR time/week for 11 months for a total of 3 years ..... and then the residents take 1 to 2 24 hour shifts during the week. ......

Anyone else see anything wrong with this math? Counting days on call, then counting the hours more than once? Duh.

Remember the past President of the A$A who told a congressional committee IN SWORN TESTIMONY that he had *personally* performed over 300,000 anesthetics?

deepz

first of all nobody can perform 300,000 anesthetics...

but my math is correct:

monday: 7am - 6pm 11 hours

tuesday: 7am - 6pm 11 hours

wednesday: 7am - 6pm 11 hours

thursday: 7am-6pm 11 hours

friday: 7am - 7am 24 hours

saturday: 7am-7am OFF

sunday: 7am to 7am (but i will only count the first 17 hours until sunday night)

total: 85 hours - now that is a crappy week but we averaged that week once a month

the easiest week:

monday: 7am - 6pm 11 hours

tuesday: 7am- 6pm 11 hours

wednesday: 7am-7am 24 hours

thursday: 7am-7am off

friday: 7am 6pm 11 hours

saturday: 7am 7am 24 hours

total: 81 hours - is a bit more average...

the average of 75 hours comes from non-clinical time in the OR/meetings/average sickdays, etc.... at least for my former institution...

so where is my math wrong?

I was with a very cool senior resident today. he is likeable and gets along with most of the RRNA's he got a new book to study for boards. we went through some of the questions together.

he told me that the book he had was a great one becuase the service that made the book recruited people who had just taken the written boards to "regurgitate" questions from the writen. immeaditly my mind flashed back to a letter I had received from the AANA about how apauling they felt that was.

he told me that it goes on with alot of medical board exams

hmmmmm.....

i do know for a fact that durring medical school they are given "sample" questions for tests..

furthermore. we have let see..... about 6 MDA attendings mabye 8 and I think 3 or 4 are board certified. I take that back there maybe 5

furthermore. we have let see..... about 6 MDA attendings mabye 8 and I think 3 or 4 are board certified. I take that back there maybe 5

So "maybe" 5 out of 6?

And let's get real - the memorizing of test questions goes on with CRNA's, MD's, biology students, nursing students, psychology students, yada yada yada. Don't pretend it only happens with anesthesiologists.

And of course every professional organization professes their abhorrence and disgust with the idea. What do you expect them to do?

+ Add a Comment