snakebitten

There are some decent jobs to found in ABQ, but they are far and few between. I live in ABQ, but work on the Navajo reservation 1 week on 1 week off for full time pay. Of course there are no anesthesiologists that want to work there. It is a great environment, plenty of autonomy. There are great jobs to be found around the state in an all CRNA practice for lots of $$$ if thats what you are lookinf for. Mike CRNA

How about this perk. AUTONOMY. I was trained in the military, will finish my 20 years at the age of 43. I will RETIRE with half my pay. Yes the pay on paper is less, but with the benefits and all of the current incentive bonuses, it get close if not exceeds the pay of many institutions. You cannot beat the armed forces training. Over the years, I have worked with many CRNA's who are poorly trained in the civilian sector. Many CANNOT work without supervision, collaboration or whatever the term is for the day. The military teaches you from day 1 how to work on your own. As for the hazardous duty assignments..yes they can occur, but your going to have them in the OR working under supervision. Try making your own decisions with an MD who thinks differently. Guess what--you just became a tube monkey/technician. We deserve better. Our profession is continuosly under assault (hazardous duty in my opinion). So before you who bad mouth the military think twice. I would rather have a CRNA from the ARMY,NAVY or Air Force put me to sleep than a tube monkey. Mike

sissies

I agree, Desflurane or as our my other colleagues call it "Deathflurane" is like inhaled barbed wire IF you use insufficient narcotics. It works like a charm with higher doses of narcotics. I might try switching over to Sevo now that they lost their patent and its cost per bottle will plummet. I can't wait to talk to the Desflurane rep who has been badmouthing Sevo (cost, potential low flow Comp A etc...) now that Baxter (the same company who peddles Des) now will be selling Sevo. Man, she is going to owe us some serious food bribes :chuckle . As for remifentanil and alfenta--It is not cost effective. Compare Fentanyl (dirt cheap) to the others. I don't like the idea of giving these rapidly metabilized/distributed drugs and then only having to rescue them soon on emergence. Again, just my preference. What ever works for you-more power to you. Mike CRNA

Yes, I know alot of you think that 15cc of Fentanyl is excessive. It has worked for me for 10 years here. I run very little gas 2-3% Desflurane with Nitrous. Gas (and Narcan by the way) are intruments of the devil. High narcotics dosages as you all know have many beneficial attributes. For those of you who are worried about recall...I used the BIS monitor for a couple of years and the numbers were in the 20's with the low inhalational agents. I stopped using the BIS for many reasons--no problems. I do not think that the Decadron is an excessive dose when used alone. I agree that 4mg would suffice if you are using Zofran or droperidol with it. Just my preference. The last time I had some hurl in the PACU was 5 years ago when I used Morphine. I have a couple of colleagues who were trained by Dr. Stanley? He was some dude in the south who despises gas opting for narcotics. Anyways, they use 100mics of Sufenta on induction all up front and rarely have a problem with emergence. Now they do hurl more frequently but you get the point. Later Mike

Here is my recipe for lap choles. By the way, I work on an Indian reservation where we do 20 per week. 1. 750 mics of Fentanyl all up front 2. 100 mg propofol 3. Vec. 5 mg 4. Des/Nitrous 5. Toradol 60 IM 6. Decadron 10 mg for antiemetic Surgeons take anywhere from 30-40 minutes 7. Neostigmine/Robinol Eyes open, suction no bucking extubate... Of course, there are deviations on the narcotic requirements for the elderly, very young (yes we 10-12 year old choles) and more for the drunks.

I have used the LMA Proseal for a Lap Chole. I inserted an NG tube through the lumen and held it to suction. Will I do it again, probable not. I just tried it on a thin women. No problems. But I did suck about 200cc's of bile out of her belly, which spooked me a little. Mike

I work independently for the Indian Health Service in Northern New Mexico. It depends on how remote you want to get...There are a quite a few jobs available. I know they have been looking for a CRNA in Raton, Farmington, Shiprock (Indian Health Service). There are a few more places down south that pay more but I really enjoy the mountains instead of the Southern desert. There are a few jobs in Albuquerque but thats like any other big city..besides most places in Albuquerque have supervision whereas the in the rural areas you are alone, which I prefer. My advice..take a look at Farmington, NM...Durango is 1 hour away. The san Juan River (best fly fishing in the country) is 30 minutes away. There are plenty of hiking, mountain biking trails. he city is near the San Juan Mountain range at elevation of about 7000 feet. Winters are great..Snow but plenty of sunshine all year long. Population about 50-60 thousand..Check out Gas Work website and check out there benefits salary etc....I would be there if my kids/wife weren't so happy here. Mike

Wrong--1% to 100% supervised means just that. The MD can come in and change your plan if he or she feels necessary. They will be there on induction, sometimes push your drugs (that they decide), start your lines etc.. and leave, then come back for emergence and extubation. (Try to do a locum job in Pennsylvania and you will see what I mean) To them you are a technician, uncapable of making a sound decision on your own. Why do CRNA's need to "collaborate"? Define collaborate. True autonomy is making your own SOLO decisions, depending only on yourself. Anyway, Gotta go do my next case--(All by myself on call 24 hours as it should be) Mike CRNA

Come to New Mexico-we are an "opt out state". No supervision necessary. In my opinion--"collaboration" is supervision on a smaller scale. If someone can come in to my room and push my drugs, start any part of the anesthetic or change my plan without my approval --its supervision. Call it what you want--but until you can work truly alone, by yourself 24 hours without "collaborating" your supervised. Mike CRNA

I find it a sad state of affairs that there are CRNA's out there that graduate without being proficient at ALL regional blocks. I work in a rural city (Opted out state) ALONE. It gives the profession a black eye when I hire a locum to help me out and the surgeons/staff are upset that our schools are sending people out who cannot do an epidural,SAB,axillary,interscalene etc...They end up supervised by me, which defeats the purpose of me hiring them in the first place. Alot of people on this forum are crying about MD's trying to take away their autonomy and supervision etc..well in my opinion, if you cannot do deliver ALL aspects of anesthesia you deserve to be supervised. As a independent provider, when I hire a locum, I give them the keys to the carts and expect them to be able to do everything all week all by themselves. Now I understand that some programs have their hands tied for various reasons and they cannot teach their students regional skills. Don't go to those schools! Your just giving other providers more of a reason to control your work. I consider regional anesthesia on all patients for postop pain relief and intraoperative care. What are you going to do if your asked to help out in pain management? Oh well enough--:angryfire

Why don't you all spend your money, letters, calls and energy petitioning your governor to "opt out"--that would solve alot of your problems. Mike (from New Mexico--an opted out state)

Tenesma is right on the money..also if your department can afford it--a site right ultrasound is a great tool to have... Mike

Typical Day--Today To work at 715, set up room draw up drugs machine check. I work in rural New Mexico town, where we are independent practitioners (We are one of the opt-out states). On todays schedule. C-section, AV graft, Ex-Lap, colonoscopy-EGD, AV fistla. Declot of grafts. A coupleofhe patients are ASA 4's one with a Potassuim of 7.1. Oh well, gave him an Albuteral TX, Insulin, Kaexalate and went with it. Things were done by 5.00. On call till Monday-alone. The best part of my job is I do what I want by myself. There are 2 other providers, we get along well and help if needed but you are expected to work alone. Went home to start the hard work--4 kids under 10 Mike

I'm with JWk..Well said