Experienced CRNA...ask me anything

Excellent. Here's why:

1. Anesthesia practices are rapidly moving from anesthesiologist-owned or hospital-employed groups to corporate model anesthesia management companies. Even on the West Coast, where anesthesiologist-only practices (I am talking outside the Kaiser or University settings) have been the norm, the model is changing to mixed-practice CRNA-anesthesiologist. It is just not economically feasible, nor is it necessary, to have an anesthesiologist do his/her own cases.

2. AAs numbers have increased, certainly, but they will never have the presence that CRNAs do. Never. They will remain a regional entity for the forseeable future, with a bit of push into areas where anesthesiologist AND program AND practice AND legislation support is strong. The AANA is a political powerhouse. CRNAs are sole providers in many rural facilities, and those facilities are subsidized with tax dollars to use a CRNA. CRNAs can practice independently. AAs cannot.

3 There is a large cohort of experienced CRNAs that are: ready to retire, disillusioned with the career, transitioning to part-time/prn, moving into pain practices, management, etc. Some of these got caught short by the recession in the mid-2000s and had to work longer than they anticipated. They are old and tired. Whatever the reason, they are moving away from the head of the bed, and the arrival of anesthesia management companies is expediting their exit.

4. Competition will remain for the choicest positions in desirable geographic locales with great working environments. But the days of making 200k+ clocking

5. Understand the economics of health care. Surgery is a multi-billion dollar industry in this country. It is typically a revenue-generating department (when well-managed) for a facility. Follow the money.

So go for it. The jobs will be there. Just do it for the RIGHT reasons.

I strongly advise SRNAs to join the broadest, least-restrictive practice upon graduation they possibly can - and work as a CRNA for at least a couple of before pigeonholing into a specialty, whether that is pediatrics, cardiac, OB, etc.

That said, I will answer honestly that I do not support independent CRNA practice in pain management. CRNAs can, and do, provide a valuable supportive role in this area. Those practice settings are limited. It is my opinion that pain management is a highly complex specialty that is the practice of medicine, and as such, is the purview of physicians who have completed a pain management fellowship.

Independent practice as a new graduate CRNA is doable if the CRNA had excellent, varied clinical experiences, a strong personality (you must present a calm, firm presence in the OR), good judgment (the ability to know when to say no, and what to do), and an experienced mentor CRNA at the facility. I absolutely cannot recommend solo independent CRNA practice as a new graduate.

The transition from student to clinician is more difficult than you can appreciate when you are an SRNA - even more so when you are on your own and everyone in the OR is looking at you when things get real. The pressure is intense and the decisions you make (or fail to make) can seriously harm or kill a patient. Can you handle that straight from the gate? Would you, and your patients, be better served if you gained some experience in a collaborative setting? Likely.

So, in anesthesia, as in life, the answer is yes - you can. But should you? Is it the smartest choice for you? Is it fair to your patients? There are no easy answers.

Independent CRNAs are everywhere. Pick a state and you will find them. I worked independently (often solo) in a number of different states, and speaking from my own experience, the best settings for that type of practice were rural. They were grateful for the help.

A couple-few years of ICU experience in an adult ICU that deals with complex patients is sufficient. CVICU experience can be of use during your cardiac rotations and with rhythm interpretation, obviously.

Emotional maturity, judgment, temperament, and common sense are important. Probably more so. Your program will teach you what you need to know.

CRNAs are usually employees, so to think of pay as an hourly rate is rare unless you are working locums or per diem. Usually you are presented a package - $xxx,xxx salary plus benefits.

Regardless, I think pay will continue to level. I know students look at Gaswork all the time and see a job posted for 250k for 30 hours a week. Those jobs are not real.

Salaries are in the low 90s to 120s for a "job" in metro areas in the Southeast and Florida and in desirable areas out West. Any area that has a significant presence of anesthesia management companies usually experiences downward trending of salaries. That's just economics.

So is supply and demand - and there are a lot of CRNA programs.

With enough CRNAs and good use of personnel resources, overtime can be limited or eliminated. There are also lots of scheduling tricks that groups use to ensure you do not get paid overtime.

Again, the takeaway is this: do not pursue this job just for the money. Not in this era of managed care. Nurses in CA are making $80+/hr with benefits. I just talked to a young CRNA who is working PRN for $65/hr in an area where the market is saturated with CRNAs. She cannot find a job as a CRNA with fixed shifts and no call.