Travel CRNA opportunities for new grads-Realistic?

Lalaith · Jul 8, 2004

You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology.
Sorry, the comparison is weak.
TD,
I have read this board for a few months now strictly in the mode of intermittent catch-up, when I have the time, much as I feel you may do. That often explains how sometimes we may miss the point, or at least skirt around it rather obtusely. When deepz posted the excerpt from an emergency resident's thoughts and insights on his experiences, he stated nowhere he was making a comparison. Rather he stated that he felt this was an educational perspective for us all to take into consideration. Perhaps he felt we could from this excerpt better gain a portion of his viewpoint on the importance of humility, and the impact of a few moments in time potentially upon a career, and more importantly, on a human beings life. That perspective easily spans a second year resident's frame of reference, as well as a CRNA's or even a person who has COMPLETED a 3 year residency in anesthesiology. If you go to argue that a person's syllogism or comparison is weak, one should be sure it is actually being made.

TejasDoc · Jul 8, 2004

Ahh, to be young and ignorant and so full of oneself again.

Oh come on deepz, you don't have to long for the past, you're plenty ignorant and full of yourself now ... I imagine it would make up for an entire life of humility.

TD,
I have read this board for a few months now strictly in the mode of intermittent catch-up, when I have the time, much as I feel you may do. That often explains how sometimes we may miss the point, or at least skirt around it rather obtusely. When deepz posted the excerpt from an emergency resident's thoughts and insights on his experiences, he stated nowhere he was making a comparison. Rather he stated that he felt this was an educational perspective for us all to take into consideration. Perhaps he felt we could from this excerpt better gain a portion of his viewpoint on the importance of humility, and the impact of a few moments in time potentially upon a career, and more importantly, on a human beings life. That perspective easily spans a second year resident's frame of reference, as well as a CRNA's or even a person who has COMPLETED a 3 year residency in anesthesiology. If you go to argue that a person's syllogism or comparison is weak, one should be sure it is actually being made.

You're right Lalaith, I may have misread Deepz. This I will freely admit. But, in a previous post he wrote.

Wow. 'Locums is not a big deal for MDs fresh out of residency.' There you have it: the bone-headed arrogance that gets so many docs in big trouble.

Then he posts his little anecdote about physician arrogance, using the example from a junior resident. So sure, I'll buy that maybe he's talking about the impact of a few moments on a human life. It's a distinct possibility. I've read it again and I can see how it would be read that way.

I just want you to acknowledge that maybe he was taking a jab at gotosleepy after calling him arrogant, and then presenting that little anecdote as a chance to show how arrogant doctors like gotosleepy can kill people. I just don't think inside the bitterness and anger is a nice guy trying to teach me something about humility.

Though Deepz, and everyone else who read his post, I want you to think about something. If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?

BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.

TD

Lalaith · Jul 9, 2004

TD,

First of all, I appreciate your willingness to concede you may have misread the intention of deepz's post; obviously the only one who can directly speak to that is deepz, but I believe that was done by him in the post prior to mine.

Then he posts his little anecdote about physician arrogance

Interesting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason,

an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance.

If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?
Gee, TD, here you go having me thinking you are discussing this with an admirable amount of equanimity, and then you go off with a quote like this. I see your analogy, but your argument gets lost in the emotive "saving your butt". And by your logic, the next inference that can be gained is that I should have been making a *@ of a lot more money over my career up to this point; that is, when a nurse comes in and saves residents' and doctors' butts many more times than once or twice a year, why should they not get a cut of the doc's money for that day? And how is the remuneration decided? Are there some butts saved that should get a better recompense than others , or should there be a general butt-salvage stipend for each incidence? :) :)
The truth is, sometimes we all need a helping hand sometimes, we can all get too close to the trees to see the forest, or vice-versa. We also all possess the potential to "save someone's butt''! The insight needed does not necessarily come forth in every situation from a doctor or a nurse, nor even the most experienced provider. But the true insight is found in the provider who is able to admit that he/she is over his/her head and needs advice, and is able to sift through and discern the proper course, most especially in novel situations.
BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.
"Touche!", TD, or should I say, "en garde"? However, I believe I actually called us both obtuse, and thanks for the welcome. After the length of this missive, you probably wish to retract it!

Lalaith

TejasDoc · Jul 12, 2004

TD,
First of all, I appreciate your willingness to concede you may have misread the intention of deepz's post; obviously the only one who can directly speak to that is deepz, but I believe that was done by him in the post prior to mine.

Then he posts his little anecdote about physician arrogance

Interesting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason,

an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance.

If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?
Gee, TD, here you go having me thinking you are discussing this with an admirable amount of equanimity, and then you go off with a quote like this. I see your analogy, but your argument gets lost in the emotive "saving your butt". And by your logic, the next inference that can be gained is that I should have been making a *@ of a lot more money over my career up to this point; that is, when a nurse comes in and saves residents' and doctors' butts many more times than once or twice a year, why should they not get a cut of the doc's money for that day? And how is the remuneration decided? Are there some butts saved that should get a better recompense than others , or should there be a general butt-salvage stipend for each incidence? :) :)
The truth is, sometimes we all need a helping hand sometimes, we can all get too close to the trees to see the forest, or vice-versa. We also all possess the potential to "save someone's butt''! The insight needed does not necessarily come forth in every situation from a doctor or a nurse, nor even the most experienced provider. But the true insight is found in the provider who is able to admit that he/she is over his/her head and needs advice, and is able to sift through and discern the proper course, most especially in novel situations.
BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion.
"Touche!", TD, or should I say, "en garde"? However, I believe I actually called us both obtuse, and thanks for the welcome. After the length of this missive, you probably wish to retract it!

Lalaith

No retraction. I enjoyed reading your post. I knew as soon as I wrote the "save your butt" thing, I shouldn't have. But I let it go. Oh well, ya make some mistakes and you move on.
I apologize. But I think you recognized the point I was trying to make, even if I wasn't making it in the best possible manner. Compensation is a tricky thing, and I don't really know that much about how it's done.
Anyway, gotta catch some sleep, and there's still one more post I need to make.
TD

Gotosleepy · Jul 12, 2004

hmmm... arrogance...??? anecdotal stuff about new MD grads not ready for locum...???

all i can tell you is that I did locum straight after residency (right before my fellowship)... It was a piece of cake, AND i provided CRNA supervision... Now you will all cry that CRNAs don't need supervision. Well for one, in the state I was in they can't bill without my name on the chart, and for two, the CRNAs (including the older/more experienced ones) always deferred to my medical decisions/plans, and many a time I had to guide them through tricky clinical decision making. Let's see: three years of about 75 hours/ week with a total of 9 weeks of vacation... That is 11025 hours of experience - and that doesn't even include the 100/wk (now it is limited to 80hrs/week) during internship... which adds up to 5000 hours of patient care (managine MIs, managing PEs, managing arrythmias, providing central venous access, etc...) prior to anesthesia residency.

SOO back to the original question: is it realistic for a new grad to do Locum Tenens? Not really, unless you want to dig a big hole for yourself. I would recommend at least 2-3 years (w/ as broad an exposure as you can get) prior to doing locum....

Now, based on my review of the postings on this board, I have to say I think working w/ Yoga or Loisane or McHugh would be a pleasure (even though I have a feeling based on my postings on this board, they may not feel the same way)- they sound like they have their head on their shoulders, and also have a good clinical sense.

Deepz- however... You have never brought anything of value to any of the clinical scenarios that were discussed in previous postings... Your messages revolve around ways of including "A$A" in your sentences... kinda sad...

loisane · Jul 12, 2004

Well for one, in the state I was in they can't bill without my name on the chart, and for two...

None of the 50 states require an 'ologist involvement in an anesthetic in order to bill. Federal regulations that require physician involvement do not specify it be an 'ologist.

So, if 'ologist involvement was required at this institution, I believe it was because of an internal, institution policy.

loisane crna

Gotosleepy · Jul 12, 2004

loisane - you are absolutely right.