Experienced CRNA...ask me anything

guest769224 · Sep 21, 2018

06crna said:
I am unapologetically supportive of the AA role. We all have our place.

Do you think AA's create job competition or threaten CRNA's job prospects at all?

06crna · Sep 21, 2018

ICUman said:
How common is it for CRNA's in the hospital setting to be directly employed as a hospital employee, vs. working for a separate anesthesia company that contracts to provide services in the hospital?

Relatively rare.

06crna · Sep 21, 2018

ICUman said:
Do you think AA's create job competition or threaten CRNA's job prospects at all?

Honestly? Both No and Yes. I will give one example of each. There are many more.

1. Because CRNAs who are discussing the fact that CRNAs can practice independently and AAs cannot are missing this stunningly obvious fact: AAs practice in urban/suburban areas...concentrated in areas with AA programs. If AAs were eliminated, would CRNAs be practicing in those locations independently? With no anesthesiologist on staff? NO. Would their salaries skyrocket? NO.

2. One thing that threatens job prospects? CRNAs with militant, contentious attitudes who interview at mixed AA/CRNA practices. Of course the anesthesiologists preferentially hire AAs in that circumstance. Why would any hiring manager choose a problem personality?

We, as CRNAs, should be far more concerned about the quality, quantity, and expense of nurse anesthesia training programs than what the twelve AA programs who graduate a few hundred AAs/year are doing. Our profession has caused many of our job problems. AAs are not a problem.

Here is the honest truth from what I see as a current preceptor of both AA and CRNA students in their 20s and 30s and a current interim manager. It matters not whether the provider is an AA or a CRNA. The interviewees want to know three things: 1. How much will I make? 2. What are my hours? 3. How much vacation?

That is the new reality of the millenial workforce that I have met. No one I have interviewed has any intention of moving to BFE for any amount of money. They want a home close to conveniences, mid-6 figure salary + 6 weeks vacation, and work/life balance.

allnurses Guide · Sep 21, 2018

On AAs:

1. Like the majority of CRNAs I don't see the need nor do I support AA practice. IMHO AAs are there as a tool for the ASA to try to control anesthesia practices and keep CRNAs salaries low in order to increase anesthesiologist salaries.

2. I have worked with AAs as part of my military trauma training. I was unimpressed as were many of the CRNAs that worked at that particular facility.

3. AAs do not increase services and increase costs overall.

4. I tend to be open minded, but when a product is put out that is designed to be dependent and less functional than the original product that is already in place with no shortages in supply I feel no reason for anyone to support said product. What you then have to wonder is why a replacement product/AAs is being pushed by the manufacture/ASA so readily, and the sole reason that is is money and control.

Five reasons that anesthesiologist assistants limit anesthesia flexibility and profitability

06crna · Sep 21, 2018

wtbcrna said:
On AAs:
1. Like the majority of CRNAs I don't see the need nor do I support AA practice. IMHO AAs are there as a tool for the ASA to try to control anesthesia practices and keep CRNAs salaries low in order to increase anesthesiologist salaries.
2. I have worked with AAs as part of my military trauma training. I was unimpressed as were many of the CRNAs that worked at that particular facility.
3. AAs do not increase services and increase costs overall.
4. I tend to be open minded, but when a product is put out that is designed to be dependent and less functional than the original product that is already in place with no shortages in supply I feel no reason for anyone to support said product. What you then have to wonder is why a replacement product/AAs is being pushed by the manufacture/ASA so readily, and the sole reason that is is money and control.

1. Are you citing data that surveyed the majority opinion?

2. Your experience differs from mine.

3. Impossible to apply that statement to all situations/settings in which AAs work.

4. Our own profession is producing new graduates with major gaps in their knowledge base, limited/no regional anesthesia/pediatric/neonatal/trauma experience, and no ability to think critically or practice independently. At the same time, the price of that education can exceed $150,000 - $200,000 for TUITION alone.

PS. The article appeared in an industry magazine that is light on factual data and heavy on advertising.

If nurse anesthetists can stand on their own, then why resort to adopting the same title as their physician counterparts by calling themselves "nurse anesthesiologists", as the author does?

allnurses Guide · Sep 21, 2018

06crna said:
1. Are you citing data that surveyed the majority opinion?
2. Your experience differs from mine.
3. Impossible to apply that statement to all situations/settings in which AAs work.
4. Our own profession is producing new graduates with major gaps in their knowledge base, limited/no regional anesthesia/pediatric/neonatal/trauma experience, and no ability to think critically or practice independently. At the same time, the price of that education can exceed $150,000 - $200,000 for TUITION alone.
PS. The article appeared in an industry magazine that is light on factual data and heavy on advertising.
If nurse anesthetists can stand on their own, then why resort to adopting the same title as their physician counterparts by calling themselves "nurse anesthesiologists", as the author does?

1. Informal sampling of many CRNAs. Also, the fact the AANA is representative of CRNAs and the AANA does not support AAs.

2. I imagine my experience differs from most non-military CRNAs, but I always make a point to work in the civilian sector no matter where I am stationed.

3. That statement is a fact for all ACT/directed practices, which is where AAs work. The only anesthesia model that is more expensive is anesthesiologist only model.

4. That is your opinion that doesn't hold up well to facts. The new graduates have higher standards than previous years graduates.

P.S. There are many reasons why that came about, but if anesthesiologists can stand on their own why did they adopt the "physician anesthesiologist" title?. That argument works both ways.

offlabel · Sep 21, 2018

06crna said:
Offlabel -
Correct. My interpretation. Not your words.
That said...
This statement of yours is a bit harsh, don't you think? "If you simply value procedures and paychecks"

I don't think there is anything wrong with that as long as the patient is expertly cared for. Those things are perfectly legitimate motivations. Doesn't mean the person that values those things is a tool. Not mutually exclusive of professional, ethical provision of anesthesia. In fact, those things are mandatory if sustainable hi dollar compensation is what is ultimately desired.

Bluebolt · Sep 22, 2018

06crna said:
Here is the honest truth from what I see as a current preceptor of both AA and CRNA students in their 20s and 30s and a current interim manager. It matters not whether the provider is an AA or a CRNA. The interviewees want to know three things: 1. How much will I make? 2. What are my hours? 3. How much vacation?
That is the new reality of the millennial workforce that I have met. No one I have interviewed has any intention of moving to BFE for any amount of money. They want a home close to conveniences, mid-6 figure salary + 6 weeks vacation, and work/life balance.

I'm a third-year SRNA currently looking at jobs. I fall into the millennial generation. I have a very different perspective than the one you describe, as do many of my classmates. We had a recruiter today who brought us lunch and gave the pitch. My first question was not about vacation or call schedule but what type of peripheral nerve blocks do the CRNAs perform in their practice. Other students wanted to know what practice model it was and did they us QZ billing. Is it collaborative or "supervised/directed". Will we be expected to float between multiple facilities. Are the CRNAs employed by the hospital or group members. Are CVLs and epidurals done by the CRNAs or MDAs.

The pay and benefits package can be negotiable, a practice culture and politics can not. I think you'll find this new generation of DNP graduates are more involved in future practice and autonomy and not just lifestyle. You will always have some who are interested in working somewhere with a light schedule and weekends free but that can be said for any career field.

You mention working somewhere with AAs and CRNAs and I really can't speak to that type of practice environment or culture because AAs are not allowed in my state or anywhere in states close to me. I did meet an SRNA at Mid Year Assembly who said during her rotations in Atlanta (huge concentration of AAs) she felt the environment was toxic with disgruntled aggressive interactions between all anesthesia providers. It got to the point where an AA would try to relieve her CRNA from a case and she would have to excuse herself as well because her clinical hours aren't allowed to be counted if an AA is on the case. Apparently, there were unpleasant things said by the AAs to the SRNAs about this.

Perhaps your perspective is from an environment that I'm just very unfamiliar with, along with SRNA training programs different than my own.

loveanesthesia · Sep 22, 2018

ICUman said:
Do you think AA's create job competition or threaten CRNA's job prospects at all?

I am not concerned about competition with AAs, I'm concerned that they are a tool of the ASA to diminish the CRNA role. CRNAs are limited to an AA role typically in practices with both CRNAs and AAs. Recently AAs started to call themselves CAA and 'Anesthetist'. MD support of AA programs over CRNA programs reduce the clinical experience available to STNAs. I will unabashedly do everything I can to prevent the spread of AAs to my state. Momentum is falling as the track record of AAs has become known and hospitals and surgeons as well as some anesthesiologists refuse to work with them.

rawz2014, APRN, CRNA · Sep 22, 2018

Random- I really love the " nurse anesthesiologist " descriptor term- I will be using it.

guest769224 · Sep 22, 2018

loveanesthesia said:
Momentum is falling as the track record of AAs has become known and hospitals and surgeons as well as some anesthesiologists refuse to work with them.

Is it really? That's fascinating to realize as CRNA momentum does the opposite. What an exciting time to be in the nurse anesthesia field.

I wonder how things will look 10 years from now in the MD/CRNA/AA practice environment.

06crna · Sep 22, 2018

We agree we have different perspectives.

"physician anesthesiologist" is a ridiculous title advanced by the ASA.

The politics in this specialty and rhetoric from the ASA are tiresome.