Experienced CRNA...ask me anything

06crna · Sep 22, 2018

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. Well done on your part. You are asking the right questions.

The pay and benefits package can be negotiable, a practice culture and politics can not. I agree to some extent, but what I understand as a practicing CRNA is that the culture and politics can change in a blink. Complication after a PNB and no more regionals. Group loses contract and you have a new employer in 90 days. No stability. The one thing you can count on is change. 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. I hope so! My interviewing experience is currently limited to students who are carrying a staggering amount of debt and wish to live in an urban area. So there's that.

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. I know several AAs and CRNAs who work in metro Atlanta. To the person, they report a difficult restrictive work environment. Unfortunate. Great town!

06crna · Sep 22, 2018

offlabel said:
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.

Thank you, Offlabel, for clarifying. Carry on.

06crna · Sep 22, 2018

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' Above statements are all accurate. But I've worked with AAs for over ten years, and they have always called themselves anesthetists. Far better than the "I'm Whoever from Anesthesia" that is used by AAs and CRNAs. 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. That is surprising. I don't know any anesthesiologists that refuse to work with them. I know many who prefer them, though.[

charleychocolate · Oct 1, 2018

So I wanna go to CRNA school.... Only problem is that the closest school that offers a CRNA program is 2 hours away and moving closer is not realistic... So that now brings me to the idea of online CRNA schools.. Only problem is I don't know if they exist and if they do... are they any you can recommend in the state of texas?

allnurses Guide · Oct 1, 2018

charleychocolate said:
So I wanna go to CRNA school.... Only problem is that the closest school that offers a CRNA program is 2 hours away and moving closer is not realistic... So that now brings me to the idea of online CRNA schools.. Only problem is I don't know if they exist and if they do... are they any you can recommend in the state of texas?

There not currently any online CRNA schools. CRNA school is probably going to be problematic for you no matter where you go, if commuting is an issue as a lot of schools have distance clinical sites over 2 hours away. There are exceptions, but most schools have some distant clinical sites.

06crna · Oct 3, 2018

After overhearing a frank conversation between anesthesiologists and administration, I can no longer support the AA role. I was naive.

I feel empathy for AAs as people who want to make a good living for their families and have a nice career, but they are absolutely pawns in an ugly political game.

Carry on.

06crna · Oct 4, 2018

FROM THE AMERICAN ACADEMY OF ANESTHESIOLOGIST ASSISTANTS WEBSITE

FAQs

4. What are the differences between Nurse Anesthetists (CRNAs) and CAAs?

Although both are considered to be equivalent clinical non-physician anesthesia providers and may serve as physician extenders in the delivery of anesthesia, CAAs and CRNAs are very different with regard to their educational background, training pathway and certification process.

That statement is a blatant lie.

Not equivalent. CRNAs are capable of, and trained to provide, independent anesthesia practice.

AAs are not.

Period. The End.

loveanesthesia · Oct 4, 2018

Can you share the main points of the conversation?

06crna · Oct 4, 2018

Not over the public domain.

You are welcome to private message me.

allnurses Guide · Oct 4, 2018

06crna said:
FROM THE AMERICAN ACADEMY OF ANESTHESIOLOGIST ASSISTANTS WEBSITE
FAQs
4. What are the differences between Nurse Anesthetists (CRNAs) and CAAs?
Although both are considered to be equivalent clinical non-physician anesthesia providers and may serve as physician extenders in the delivery of anesthesia, CAAs and CRNAs are very different with regard to their educational background, training pathway and certification process.
That statement is a blatant lie.
Not equivalent. CRNAs are capable of, and trained to provide, independent anesthesia practice.
AAs are not.
Period. The End.

Anytime AAs feel their training is equivalent to CRNAs they are more than welcome to take one of the solo CRNA forward operating base deployments.

06crna · Oct 4, 2018

Followup re: overheard conversation.

It provides such insight into the politics and economics of mixed practices that I am going to post a few general takeaways:

1. The anesthesiologists are not making the money they once did. At the same time, anesthetist salaries are increasing. Unacceptable.

2. The hiring strategy will shift toward new-graduate AAs because they have lower expectations for salaries and PTO. They are also easier to train to the medical direction model and less likely to make independent decisions (comparing AAs to CRNAs).

3. A new schedule and salary matrix will be introduced that eliminates part-time and no-call positions. Anesthetists will either convert to full-time benefitted positions with rotating shifts and call or PRN hourly with no guarantees.

4. Anesthetists will be assigned tasks in the event they are not in the OR during their shifts - stocking rooms, organizing anesthesia carts, assisting anesthesiologist, patient followup, preop data entry, etc. - in an effort to maximize efficiency.

5. Overtime will be eliminated. An 80 hour/2 week period will be used to determine overtime. Anesthetists may be asked to clock out and return to duty later in a scheduled shift if they are in danger of accruing overtime.

offlabel · Oct 4, 2018

06crna said:
Followup re: overheard conversation.
It provides such insight into the politics and economics of mixed practices that I am going to post a few general takeaways:
1. The anesthesiologists are not making the money they once did. At the same time, anesthetist salaries are increasing. Unacceptable.
2. The hiring strategy will shift toward new-graduate AAs because they have lower expectations for salaries and PTO. They are also easier to train to the medical direction model and less likely to make independent decisions (comparing AAs to CRNAs).
3. A new schedule and salary matrix will be introduced that eliminates part-time and no-call positions. Anesthetists will either convert to full-time benefitted positions with rotating shifts and call or PRN hourly with no guarantees.
4. Anesthetists will be assigned tasks in the event they are not in the OR during their shifts - stocking rooms, organizing anesthesia carts, assisting anesthesiologist, patient followup, preop data entry, etc. - in an effort to maximize efficiency.
5. Overtime will be eliminated. An 80 hour/2 week period will be used to determine overtime. Anesthetists may be asked to clock out and return to duty later in a scheduled shift if they are in danger of accruing overtime.

This an AMC? If not, won't be long before it becomes one. Sounds like they're going to guarantee a group implosion.