SuziQ1978

What about the state income taxes? That keeps me away from California. No Thank you.

When you are on call, even though you are technically free you are tethered which causes it to be a lower quality of life for some people. Versus working 7-10 hours a day and being on call once a week. I don't know. I guess if you know that you aren't gonna get called in, your anxiety disappears. I personally prefer just working straight shifts that I am used to. I am not sold on the whole CRNA thing myself yet if I gotta be on call but I know in the cities there are plenty of practices that are all shift work. She's geographically limited to two states/areas where her family is. She has looked.

I know for a fact that there are rural CRNAs who have independent practices that are "CRNA only" that are making 350-450k. So you guys can stop saying that all you are making is 220K and being on call 24/7. Maybe those CRNAs weren't at rural access hospitals but they were rural enough to block MDs from joining and have 'CRNA only practices". Let's be honest on that one. I am sure there are plenty of those practices. Some of those hospitals do not hire the CRNAs as we all know. While there may be a lot of "hearsay" from my friend, I also have CRNA friends who keep me informed.

Sounds exciting. What is a typical day like? How many hours are you actually working versus being "available" on pager? I mean if one is making 220-250 and not working too much but constantly on pager that may suck more, than just working a regular 7-10 hour day regularly. I don't know how much you all are working. At her 100 bed hospital it was fairly busy but not bad but now she works a lot in the West Coast and is sick of the big city and would like something like what she had at the 100 bed hospital, maybe slightly slower. She hates the city life.

I am talking about the multiple less than 100 bed hospitals that she has called that have told her that they don't use physicians. Only CRNAs. So how is this not blocking if the hospitals won't even consider her because they have a contract with CRNAs? I don't think they are smaller than 25 beds but they have been less than 100. And when she looks at practices they say "Independent CRNA only practices". Those dots connect just fine.

No, you said I have worked in only one type of practice. I said no, I have worked in two types of practice. ACT and Doc only.

Forget the money. A 25 bed hospital sounds boring as heck. I mean how complicated a case are they doing there? How many cases is someone doing there? It sounds completely and utterly boring. Twiddling my thumbs kind of money. I know she wants to slow down some, but she doesn't want to be bored out of her mind. So she has been blocked by CRNAs who simply got there first before she did. WOW!.

Nope. I have worked in a couple of hospitals in my town and one of them has CRNAs whereas most of the others only have docs. I have dealt with both but mostly docs.

Thanks. Will do. Good night.

Interesting. So if you are saying that they are hired by the hospital, then you are right. I know she has contacted hospitals that are less than 100 beds, but not as small as 25 and has been told that "we don't work with anesthesiologists just CRNAs" I could work for 220. She was looking for more like 300K.

Maybe it is complicated, I give you that. But we may be talking of different scenarios. I am saying in a situation where the CRNA didn't call for help until it was too late. Not the CRNA going rogue and doing their own thing. I would assume the doc would put down the anesthetic plan to cover themselves and then hopefully get dropped. In that scenario, the doc and the CRNA's would both be held liable no?

So what are these CRNAs in independent practices making? I mean is 300K reasonable? My friend is not looking to make a mil. Just looking to get closer to her family members spread amongst a couple of states. Living in the country is cheap. If CRNAs are making 200-250K in the city as salaried employees I don't see why they can't make even double that when no one is skimming off the top and giving them a salary. I suppose that if docs in the cities are getting subsidies from the hospitals then the CRNAs could very well be asking for and getting subsidies too. Are they not? Does rural passthrough make it mandatory for the CRNAs to be hired by the hospital? The docs and CRNAs are all billing the insurance companies, and getting reimbursed the same, but yet talk about how cost effective and cheaper they are. Would you call that honest or disingenous? CRNAs are only cheaper if they are on a salary not billing the insurance themselves, but are keeping many MDs from the rural areas while saying that MDs don't want to be in the rural areas so CRNAs are left to fill the void. Well I have seen second hand how they are kept away. Look, I am thinking of CRNA school because I am in my forties and my friend tells me that the MD route will not give me a good ROI compared to the CRNA route. I am all for it, but I also see her frustrations. My CRNA friends in the ACT model only complain about certain jerk docs. For the most part, they are happy and are treated well.

I would venture to say that most anesthesiologists and CRNAs get along just fine. But apparently some people on here just want to focus on the negatives that docs just want to keep CRNAs down and Docs want to turn every practice into an ACT practice, etc BS. I am an ICU/OR nurse (full time ICU) and am thinking of CRNA school. My best friend I grew up with went on to medical school and I got my RN degree. We have a group of friends who are RN/CRNA/MDs. We all get along great. Don't be disheartened. The real world is probably not as bad as this board. I don't understand why nurses would let the MDs take over the practice if that's the case. How did this happen? Was the AANA around then?

Oh Gosh. The CVICU, my worst nightmare. Not because of the patients as much as because of the surgeons. Talk about Egos. Good luck. I work in the Neuro ICU and love it. Would consider the MICU to learn more pathology. Never the CVICU.

Didn't know this. Not what I have heard from my friend. She has had friends who work in the couple of ACT hospitals in town been involved in lawsuits involving CRNAs who didn't call for help when they should have and ended up in a bad outcome. Whatever the case, at minimum both the doc and the CRNA are liable in a bad outcome in an ACT model correct? Not only just the CRNA who is in the room the entire time.

I hear you on the last part. My friend hated supervising or doing ACT whenever she had to cover more than two rooms as well as pre op and post op. Felt like she was running around like a chicken with her head cut off and only does her own cases now. And yes, It's sometimes impossible to be in that many places at once when supervising. Even though you may have a point about the majority of anesthesiologists, the AANA and some CRNAs are preventing people like my bestie from going rural because of pass through. People who don't care about CRNA independence. I don't claim to know what most docs or CRNAs think unlike you, but the politics gets in the way. You aren't addressing the fact that independent CRNAs out in the rural areas are not making average CRNA salary. They are making much more with subsidies from rural passthrough and billing the insurance companies directly. She's a partner in her practice and she's dealt with insurance company negotiations and in her dealings with insurance she's been told that they reimburse the same as the reimburse the CRNAs. There are more and more CRNAs are moving to our town (large group sold out). Didn't know that you have to fight to be reimbursed equally and she may eventually end up supervising again which she hates. From my understanding, about twenty states don't require any physician involvement with CRNAs at all. Why then can't the hospitals just get rid of all the docs and keep the CRNAs?

Some of those stethoscopes in the OR are the cheap isolation ones that hardly work. Buy your own, but you don't need to buy an expensive one. Get one that costs 50 bucks or so. And not all ORs have stethoscopes.

You seem to be making a lot of assumptions and generalizations. How do you know about what physicians want? Many don't care about CRNA independence. Leads to less bickering. Let them do their cases and vice versa. Are you telling me that independent CRNAs in rural areas aren't billing the exact same way anesthesiologists are billing? And therefore making what an anesthesiologist would be making where he/she not blocked from going to many rural hospitals? Thanks for admitting that the AANA is working to keep physicians out of rural practices. She's worked rural before, but again not too small of a hospital and left because it was too cold. Then she went out West and SouthWest and has met many roadblocks. There was a practice in the South that told her the "CRNA's are independent, but you have to sign their charts at the end of the day", that she turned down. Two states, multiple rural hospitals no headway. CRNAs never work under anyone else's license? Totally didn't know that. Then why is the doc in the room multiple times and checking and signing the CRNA chart? And whether or not what you are saying is true, (gotta research that, thanks for the tidbit of knowledge) we all know who the lawyers are going to go after when a bad outcome happens. The ones who are perceived to have the deeper pockets. The docs. I am a nurse, and I always document when I notify the doctor about a concern regarding a patient. My CRNA friends tell me they do the same as well and also when they communicate with the surgeon about something. "Surgeon notified". It is to cover our butts.

Addressing your last line. The difference is, in an ACT practice, the CRNA is working under the license of the MD/DO and not just his/her license. So if something bad happens to the patient, then the MD/DO is ultimately responsible. Their name is on the chart as directing the anesthestic. The buck stops with them. So yeah, I am going to call the doc. We aren't talking of an independent CRNA practice here. Clearly if that were the case, and the CRNA told me that they didn't need help, I would leave it alone and not call anyone unless it started turning into a code situation. Who is there to call unless they asked me to call for help from other CRNAs in an independent practice. Again, I am out West. Not used to many CRNAs. Certainly not independent ones in my practice in the city. What I don't understand is people who choose to work in an ACT practice and then complain that they can't be independent. I know there are many people stuck in geographic locations, but hell, most people have bosses in the real world. Deal with it, or go out where you can practice independently. I personally can't wait to possibly one day practice independently.

You really aren't answering the question and are not acknowledging the AANA agenda of keeping docs outside of rural hospitals. She doesn't care about CRNA independence. She says have at it and is encouraging me to be one. She cares about finding a job in the country because she likes it there, hates big city traffic and people but has met roadblock after roadblock and then finds out about the rural passthrough and the AANA blocking her efforts. I never said anywhere in my post that 'CRNAs are figthing for independence". Where did I say that? You clearly have a chip on your shoulder. I say that most docs and CRNAs get along just fine, you bring up the docs putting down CRNAs on SDN; I say that my friend wants to go rural but keeps getting blocked and CRNAs are gaining more and more autonomy you bring up "fighting for independence". Are you OK? Is it a tit for tat with the AANA because they feel that anesthesiologists are being too restrictive for them?

So if my friend was interested in joining an independent CRNA group and make the same as they make because she will bill on her own, or are you saying she would be welcome with open arms by the independent rural CRNA groups? Because if the hospital has straight up told her that they don't use MDs, and the AANA is trying to prevent physician expansion into rural areas, how exactly is she supposed to get a rural job?

So you are saying that SDN contributors are "most doctors"? I highly doubt that. SDN just like this website is just a small fraction of physicians in the entire US. Most of them I doubt participate on online forums. Come on. There are arrogant people on both sides. But if a CRNA is working in an ACT practice, you better believe I am gonna call for help when the patient needs it. I am there for the patient. Not for anyone's ego. There have been times that I have called for help for the docs too. The docs aren't afraid to call for help. What's wrong with calling for help. And what is it with this whole MDA thing? Out here, we just call them docs.

I live out West where it's mostly physicians providing the anesthesia. So I don't know what you mean about keeping themselves out of the OR as that was not my experience when I was in the OR. Only in the past few years have I started seeing more and more CRNAs in the hospital. I have to say that I have seen some bad docs out here though. Can't speak too much about the CRNAs working independently since they don't in my town, but I have seen some bad Wild Wild West medicine. I have seen bad CRNAs but again, we hardly use them. And I was the kind of circulator who always called for help when I thought the CRNA was in trouble whether or not they wanted me to call.

Well, some of these hospitals don't employ the CRNAs. The CRNAs form their own groups and bill independently. I have friends who are CRNAs who work rural and make just as much money as my doc friend. My friend has called around small towns and asked if they were looking for anesthesiologists and has been told straight up that "we don't use Anesthesiologists, we only use CRNAs. And that's why she's encouraging me at my age to go the CRNA route instead of the MD route. More bang for my buck(less time training and less loans) and I can go rural again if I want. And since CRNAs and NP's are gaining so much autonomy in this country, it makes perfect sense.

Most anesthesiologists and CRNAs get along just fine from what I have seen at my hospital. My friend the doc tells me that as well. It's just a few who are always espousing "we are even better than MDAs" and putting down doctors education. We have CRNA friends in our RN/CRNA/MD circle.