06crna

Carterjcr - Apologies, but I am not the right resource for your question re: DNP/DNAP. I obtained an MSN in early 2000, well before the transition to doctoral preparation for allied health providers. I had no interest in obtaining a doctoral degree in nursing or education.

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.

Not over the public domain. You are welcome to private message me.

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.

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.

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.[

Thank you, Offlabel, for clarifying. Carry on.

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!

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.

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?

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.

Relatively rare.

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" Otherwise. Agreed. I concede. As you say. Carry on.

To be clear: the halfwit ACT practice was CRNA/anesthesiologist medical-direction model employed by a large corporate anesthesia management company. Your two statements are unrelated. What is the salient point? Medical direction is not equivalent to competency. I am unapologetically supportive of the AA role. We all have our place. I urge you to be one of the open-minded, thoughtful practitioners who recognizes that we will go much farther if we respect one another's choices and work collaboratively. If you wish to practice independently, then by all means do so! Just don't diminish another's role in the process. It's unnecessary and unkind - and ultimately a reflection of you. Not them. I work with AAs. Every day. Do you?

Decades and decades. I know many anesthetists who are still practicing well into their 60s, though very few of those are working full-time, and none of them are taking call. I cannot think of any who are beyond 70. Anesthesia is a physical job in many ways. Patients are large. Pushing beds is physically taxing. Moving sedated/anesthetized patients is taxing. It is hard work. I am a petite, fit woman and I am physically tired more days than not. I know several anesthetists who began training in their 40s. I don't know how many of those are still working and/or felt that it was worth the trade-offs at that late stage in their careers.

Kind of you to post. Thank you. Keep that skepticism of the corporate model of healthcare, but also keep in mind that the vast majority of our patients haven't the slightest idea how our billion-dollar industry works. They often choose their surgeon....but they almost never choose their anesthetist. I wish you all the best in your endeavor!

Offlabel! Have a care, please. Not all locums providers are carrion-picking money-grubbers. I am well-liked, well-regarded, and well-compensated for good reason.

One step at a time! Good luck!

Congratulations on your acceptance! Re: change. Well. Frankly? I despised being treated like a halfwit on a daily basis when I was a staff CRNA in an ACT. So, leaving that behind was nice. I have had my own sole-proprietorship for years, so I simply returned to independent contractor work. As an experienced CRNA with a varied, high-acuity background and management experience, I am valuable. I am firm but fair - and completely unemotional when it comes to business negotiations because the product I am selling is myself. I command a very high hourly rate and a fully-paid housing/living/travel package. How clients choose to implement some/all of the services I can provide is their choice - provided they are willing to pay. I am making phenomenal money, but the freedom to make my own career choices has been the better payoff. Sorry. You will have to clarify the question re: look for/avoid. As it pertains to....??

I must respectfully disagree. I am currently working alongside AAs and students from two AA programs in a large teaching facility. CRNAs and AAs function interchangeably in this facility. There are some CRNAs here that terrify me, and there are AAs here whose knowledge base and skillset make me look like a neophyte. Generalities are....generally...useless.

There is a teachable moment here for aspiring and newly-practicing CRNAs. When you work for a physician-owned practice, which is a business model rapidly being replaced by anesthesia management companies and hospital-employed anesthesia provider models, anesthetists are the commodities that generate billable hours - yet they are viewed as economic liabilities. Do you understand what that means? That means every dollar your physician owner pays you is a DOLLAR OUT OF HIS POCKET (certainly if the group participates in profit-sharing). Now imagine the tension that creates in the group. Think about it.

BRILLIANT. Period. The End.

I'm no help when it comes to verbal whatever-it-is you alluded to, but I am in graduate school currently. The academic ivory-tower non-applicable research I am forced to read is a daily eyeroll. This is a personal request, but could someone PLEASE do a substantive capstone project about the noise levels in the OR? Especially on emergence? Just write it all out...because I am deaf from this racket.

Kate, I cannot honestly answer that question. There are far too many individual variables. I will take a moment, though, to relay once again that CRNA programs are incredibly time-intensive...and your children are only young once. Consider carefully how you will deal with being an absentee mother. Also consider your job options if you plan to remain in your rural area. While many rural locations are desperate for anesthesia, there are many with established providers who are lifers at their facility. Best luck!

Everyone's priorities are different. I could never begin to answer a question about whether pursuing a CRNA career is "worth the sacrifice" because that is a question only your family can answer. What I can tell you is that getting through a CRNA program will require much more than "childcare for your little ones". Your husband will be consumed with school - studying, attending classes, and then working in clinicals. He will be an absentee father and husband. He has to be, to at least some degree, in order to stay in school. Read what I say and understand my words. I am going to bold them since it is a statement I keep repeating. Getting into a CRNA program is not that hard. Making it through a program is very, very hard. Insofar as whether it would be financially advantageous, that is a question with too many variables to be able to answer honestly without more information.