Question for the Post Grads

Hey all.

After much discussion with anesthesiologist friends of mine I wanted to seek the opinion of the experienced CRNAs on the list here.

First, let me say that these guys were quite positive about CRNAs and are personal friends not just "random docs". All good people and im sure, great anesthesiologists. Since at the time, i had MDA friends but had little interaction with CRNAs, I went to them about the decision to goto CRNA school. Not only were they supportive, but they were excited about it I have since been in the OR with them on numerous occasions learning about the equipment and job as well as tubing.

Now. Here is my question. Do the CRNAs on the list feel that a good first job is in the ACT model in order to get the best experience with excellent resources and back up?

Now I know that this is certainly dependant upon how restrictive the environment you work in is as we have discussed in various other threads. I may well be in a position to take a job with a group a few of my friends are in. They have told me that 90% of the "tentativeness" that MDAs have toward CRNAs is directly related to not knowing them or their capability etc. As time goes on and someone proves themselves, this tends to dissappear and a professional trusting relationship ensues. Essentially, I would already start with the personal relationship and knowledge about my character etc. Has this been the experience of those of you in the trenches?

thanks!

Haha, as I am sure you have seen over the past hour or two from my posts, I (surprise) have an opinion:rotfl:

I have not graduated yet (December 8th is fast approaching) but have accepted a job. While practicing in a CRNA group or solo practice does appeal to me, I am choosing to work in the ACT environment for a while. In all honesty, I don't think that a couple of years of school/clinical would give me the experience to work with little backup should a situation arise. I want to get more exposure to the sicker cases, etc. I am lucky in that my chosen place of employment, while one of the larges anesthesia residencies in the country (actually the largest department according to our chairman) also allows CRNAs a pretty broad scope of practice. I can do my own lines, blocks, etc, if I am interested. So there is my opinion, for what it's worth as a lowly student:-) Yes, I think the ACT is a great thing for a new grad. Do I think it's the only thing I will ever do? No, definitely not. But it's a great place to start if its a supportive environment with opportunities to practice what you have spent years learning.

Hey again!

Im glad you replied and that im not the only lazy procrastinator today

You echoed exactly what i was thinking. Since im not in the program or near done as you are, i have no point of reference for how "ready" i would feel. My expectation is that i would not be comfortable practicing on my own right out of school. Im glad to see you think the same way, i didnt want to say it since how would i really know.

Thanks, thats exactly what i was looking for!

Haha, as I am sure you have seen over the past hour or two from my posts, I (surprise) have an opinion:rotfl:

I have not graduated yet (December 8th is fast approaching) but have accepted a job. While practicing in a CRNA group or solo practice does appeal to me, I am choosing to work in the ACT environment for a while. In all honesty, I don't think that a couple of years of school/clinical would give me the experience to work with little backup should a situation arise. I want to get more exposure to the sicker cases, etc. I am lucky in that my chosen place of employment, while one of the larges anesthesia residencies in the country (actually the largest department according to our chairman) also allows CRNAs a pretty broad scope of practice. I can do my own lines, blocks, etc, if I am interested. So there is my opinion, for what it's worth as a lowly student:-) Yes, I think the ACT is a great thing for a new grad. Do I think it's the only thing I will ever do? No, definitely not. But it's a great place to start if its a supportive environment with opportunities to practice what you have spent years learning.

i will take a stab at this one, again be assured different ppl have different opinions.

when you graduate you will think that you are the smartest you have ever been. be advised, as much as you think you know, there is at least that much more that you dont. i dont advocate being in an ACT specifically, but you need to work in an environment where there is anesthesia support, whether it be other crna as in a crna only practice or with docs. the learning curve for crna's has been purported to be 2 years. meaning, the first 2 years you are out, you will probably learn as much then as you did in school. your basic and i mean basic clinical skills should be there, but there is alot that goes along with the decision making that experience will account alot for.

so i suggest a group job first few years, then venture to private, clinic, office stuff later.

just my 2 cents.

d

hey gas

that makes alot of sense. I had not ruled out a CRNA group but based on the majority of practices out there ACT seems to be the one existing in large institutions with a huge variety of case experiences avaliable. Which im sure ill need.

Hey great posts all. I am ashamed to say that I haven't been keeping up with the political front and have not read up on the ACT. I've been busy honing my skillz, making a living, and posting on this forum.

I do agree that your 1st job should be in a supervised model. Most CRNA groups are independent practices. While you do have support from your coworkers, you work mostly by yourself in these groups. And most CRNA groups are in the small towns doing mostly bread and butter stuff. Go to the big hospitals and find a good group that is CRNA friendly. Do as much as you can and learn as much as you can. Don't stay there forever. Independent practice has it's pluses and minuses. Mostly pluses though.

MmacFN, I'm sure the docs you know are a bunch of good guys. Just be aware that anesthesia is a business of money. many MDA groups make a ton of money off of CRNA's by billing for your cases. A "high" CRNA salary of $100K+ with Benefits, PTO, 401K may sound tempting, but is actually worth $300K+ in anesthesia billing. Also many anesthesia groups get supplimented by the hospital. I don't know the exact numbers but know this gestimate is not far off. Guess who's pocketing the difference, yup you're MDA buddies drinking coffee with their feet kick up while you're doing cases. Some people don't even have the decency to get you breaks and lunches in a timely fashion. Again, not saying all MDA's are like this or bad. This is just how the system is set up. You see, MDA's are not against CRNAs, just against CRNA's practicing independently. Why ? cuz if all CRNA's worked and billed independently, MDA's salaries would drop and they'd have to do the cases themselves. Only billing for the 1 case he's sitting in and not the 3 cases he's supervising. Has nothing to do with patient safety. If that arguement was remotely true, then why would an MDA allow a CRNA (who's obviously dangerous and under educated) to do the anesthesia. Doesn't make sense does it? Many of these supervise practices, you'll only see the MDA for induction and he/she pops their head in every 2-3 hrs and signs on your record that he was there q 30min. This is so they can keep getting their big fat checks. They do very little real supervising. CRNA's come out of school self sufficient for the most part. But whose is doing the cases literally unsupervised? YOU! MDA's can be very supportive of CRNA's, they love it when CRNA's remain clueless doing cases and taking all the call and make 1/2 of what they should be. Anyways enough venting. Get what you can out of this posts. If you don't believe me, work with MDAs for a couple of years, you'll see the truth..

And when you quit, they'll be 4 GRNAs waiting in line for your job. Beautiful isn't it?

Ah the economics of medicine! Wonderful isnt it!