Residencies To Avoid: Joint CRNA Training

[Consigliere]

As a non-Anesthesia doc, I do simple cases at the hospital and request MAC. I usually get a CRNA and on occasion the MD would come by to assist. I cannot tell the difference between the two in any way. I have not had any patient crump.

Algos is right- Our hospital just fired the current Anes team that was in place for 20 years and is replacing it with a few MD's and 30CRNA's that will rotate up from their home base. The Ortho/Uro/Gyn/ENT guys I eat lunch with are a little perturbed right now. They knew their Anes docs well, now they will get random CRNA to help them out.

In 2 weeks they'll have forgotten all about it.

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[Sdp]

avoid USC like the plague! residents have to share rooms with the SNRAs. residents play it off as "oh its an extra set of helping hands to have"

That certainly is disturbing.

I wouldn't avoid a program just because there is an SRNA program. I don't necessarily like it but I think that it is dogmatic to shun these programs. These "sharing" programs are a different matter though.

USC has an SRNA program. SRNAs do the majority of their training outside of USC. The only interaction residents have with SRNAs during their (residents') entire training is 1 month during their junior cardiac month. The CA-2 puts in all the lines and does TEE while the SRNA intubates and hangs fluids. It's like having a med student in your room. If you don't like that, don't come here. Do I agree with it? No. Do most of our residents agree with it? Probably not.

Is USC a stellar training program? Yes. Is it 10 times better than I thought it would be? Yes. Are residents happy here? Yes. Would any of our residents give up the case volume/variety, supportive atmosphere, benefits, living in LA, and future job prospects in exchange for a program without an SRNA school? I think the answer would be a resounding hell no.

There were approximately 50 med students who did audition rotations at USC this year. Some of them had >250 STEP scores. I went to the resident selection meeting. The average STEP score for applicants who interviewed at USC this year was in the high 230s. There were many with 260s and 270s. Ultimately, this is your training and your future. You have to decide what is best for you. Like others have said, you are doing yourself a disservice if you pick programs based on whether there is an SRNA school. If you don't take that spot, someone else will.

 

[kazuma]

Keep your eye on the prize and don't get bogged down in trivia. Neophytes never value the opinions of those with decades of experience.....that is expected. But the whole point is not whether Penn residents or any resident believes themselves tacitly superior to the lowly CRNA ......the surgeons across the country do not. And btw, once you are in practice, no one gives a flip if you graduated from any particular residency, no matter the reputation. You are from that point on just a cog in a wheel. Your profession is under threat- keep your focus on what counts: the preservation of anesthesiology.

Sadly, I agree with this. Many of the surgeons I have met in PP share this belief. From my limited experience some surgeons actually prefer a CRNA over an anesthesiologist because they feel like they have more say in the anesthetic descisions and in one surgeons own words "It reinforces who's in charge and who's the captain of the ship."

Excellent points. In rural areas, CRNAs have replaced anesthesiologists for years without supervision or direction. In many busy city hospitals, CRNAs are used as worker bees due to lack of manpower, but it all depends. In the city where I live, population a bit over a million, there is a very very large anesthesiology group with 100+ anesthesiologists covering several hospitals and surgery centers. Zero CRNAs. Zero. They all make a very nice living and are professionally very happy with their jobs. There are four other anesthesiology groups in large hospitals that are all MD, zero CRNAs. They also financially do very well. At the fringes of the city are the lower tier hospitals that have CRNAs. They are used interchangeably with physicians A bit further out it is CRNA only. We need CRNAs at this time only because there are not enough anesthesiologists, but CRNAs are far more aggressive than you might imagine. Hospital exclusive contracts are now going to CRNA only groups because unlike anesthesiologists, they accept whatever contracts the hospitals made with insurers. The future is murky, and the resident anesthesiologists of today have the choice of practicing half assed anesthesia in a CRNA group filled with malcontents that would love to take over your job or practice quality medicine in all physician groups. Those choices will determine whether the profession survives as an entity or whether "anesthesia providers" become the norm, a generic for anyone that can pass gas, regardless of the qualifications, training, or expertise.

Your description sounds similar to the UT market. From what I have heard the SLC market is primarily MD/DO with very little CRNA influence.

 

[LSUkitten]

Wow. I was googling for different nursing specialties to learn what my options would be after I get my BSN. I read this entire thread and I feel that most of you are a bunch of haters.

If you love being an Anesthesiologist so much, then you would do it even if the pay was lower right? Like, below $100k? I think the pay difference is the main reason why hospitals or clinics use CRNAs. Secondly, while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work - I didn't have that luxury. I worked three years in my undergrad in three different hospitals. Burn units, ICUs, Psych Wards, Telemetry, Recovery, Same Day, and ERs. Although I did EKGs and Holter Monitors, I learned to work with and help out doctors, nurses, and techs. I also recall the first day the new doctors would begin their residencies and not know a damn thing. My point here being that nurses learn, just like everybody else. They put in the same hours near patients and learn on the job training from others. Every job is iffy in the beginning and newbies aren't as well trained. But that's in every job, and in every field. My Dermatologist is incredibly incompetent, with a well paying job, own business, and taking more days off work than being at it. My point here is that you all think so highly of your schooling, which is okay to do so, but you're bashing everyone else. Not everyone is paid so much to where, when they get their medical bills they're happy to see how much the fees were for services by an Anesthesiologist. It all comes down to money.

There are problems getting sound, secure jobs everywhere. Optometrists compete with online websites, Chiropractors fight with insurance companies, and graduating Lawyers are now taking temp jobs. Nursing Masters are turning into Nursing Doctoral programs within the next few years. Then what will happen? Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience? That's not including clinicals.

For the person who said to let the associate nurses compete with nurses who hold bachelors degrees - there's not much of a pay difference between the two. Just so you know. And they work together. Both take care of your grandparents and sick family members when they visit clinics and hospitals, at the cost of maybe 1/5th of your salary. So why are you so upset? Even as a CRNA you'd make about 2-3x more than an RN.

Like I said, it all comes down to money.

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it. Not one of you mentioned the difference in pay between a CRNA and an Anesthesiologist. I, myself, would rather prefer to go into Epidemiology. But in this crazy economy, I may get my degree and not have a job out there, so I'm doing Nursing now as a backup. Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD. While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer. I just don't see where you all would think since everyone else is having problems adjusting to the modern day job market that this profession would be the only one untouched. If you don't like what you do, and you think it's all bull****, go back to school. That's what the rest of us my age are doing. Not that it will improve things. Even Florists need licenses now. There's not much hope for a secure job in this world anymore.

Thank you.

*Occupations were capitalized to show respect, in case you wondered.

 

[okayplayer]

Ok? Thanks for sharing.

 

[WholeLottaGame7]

Wow. I was googling for different nursing specialties to learn what my options would be after I get my BSN. I read this entire thread and I feel that most of you are a bunch of haters.

If you love being an Anesthesiologist so much, then you would do it even if the pay was lower right? Like, below $100k? I think the pay difference is the main reason why hospitals or clinics use CRNAs. Secondly, while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work - I didn't have that luxury. I worked three years in my undergrad in three different hospitals. Burn units, ICUs, Psych Wards, Telemetry, Recovery, Same Day, and ERs. Although I did EKGs and Holter Monitors, I learned to work with and help out doctors, nurses, and techs. I also recall the first day the new doctors would begin their residencies and not know a damn thing. My point here being that nurses learn, just like everybody else. They put in the same hours near patients and learn on the job training from others. Every job is iffy in the beginning and newbies aren't as well trained. But that's in every job, and in every field. My Dermatologist is incredibly incompetent, with a well paying job, own business, and taking more days off work than being at it. My point here is that you all think so highly of your schooling, which is okay to do so, but you're bashing everyone else. Not everyone is paid so much to where, when they get their medical bills they're happy to see how much the fees were for services by an Anesthesiologist. It all comes down to money.

There are problems getting sound, secure jobs everywhere. Optometrists compete with online websites, Chiropractors fight with insurance companies, and graduating Lawyers are now taking temp jobs. Nursing Masters are turning into Nursing Doctoral programs within the next few years. Then what will happen? Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience? That's not including clinicals.

For the person who said to let the associate nurses compete with nurses who hold bachelors degrees - there's not much of a pay difference between the two. Just so you know. And they work together. Both take care of your grandparents and sick family members when they visit clinics and hospitals, at the cost of maybe 1/5th of your salary. So why are you so upset? Even as a CRNA you'd make about 2-3x more than an RN.

Like I said, it all comes down to money.

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it. Not one of you mentioned the difference in pay between a CRNA and an Anesthesiologist. I, myself, would rather prefer to go into Epidemiology. But in this crazy economy, I may get my degree and not have a job out there, so I'm doing Nursing now as a backup. Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD. While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer. I just don't see where you all would think since everyone else is having problems adjusting to the modern day job market that this profession would be the only one untouched. If you don't like what you do, and you think it's all bull****, go back to school. That's what the rest of us my age are doing. Not that it will improve things. Even Florists need licenses now. There's not much hope for a secure job in this world anymore.

Thank you.

*Occupations were capitalized to show respect, in case you wondered.

Just to clear some stuff up, in the order in which it was presented:
1) Economics certainly comes into play, but good luck finding a CRNA that would work for less than $100K. They make more than the majority of primary care physicians.
2) I don't know what the percentage is, but the overwhelming majority of med students major in biology.
3) Interns have a lot of on the job training to learn, but to say they "don't know a damn thing" is a little bit of an exaggeration. Almost...hater-ish...
4) Nurses don't spend nearly as much time in the hospital as doctors.
5) Nurses only need 1 year of ICU experience before applying to CRNA school.

Doctors are proud of their education and training because it took a lot of time, effort, money, and sacrifice to achieve. Certainly some doctors may seem to "bash" other's education, but I doubt it's a much higher percentage than nurses that belittle a physician's education by trying to equate the two.

For all parties, it's best not to judge things you don't understand.

 

[pd4emergence]

Wow. I was googling for different nursing specialties to learn what my options would be after I get my BSN. I read this entire thread and I feel that most of you are a bunch of haters.

If you love being an Anesthesiologist so much, then you would do it even if the pay was lower right? Like, below $100k? I think the pay difference is the main reason why hospitals or clinics use CRNAs. Secondly, while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work - I didn't have that luxury. I worked three years in my undergrad in three different hospitals. Burn units, ICUs, Psych Wards, Telemetry, Recovery, Same Day, and ERs. Although I did EKGs and Holter Monitors, I learned to work with and help out doctors, nurses, and techs. I also recall the first day the new doctors would begin their residencies and not know a damn thing. My point here being that nurses learn, just like everybody else. They put in the same hours near patients and learn on the job training from others. Every job is iffy in the beginning and newbies aren't as well trained. But that's in every job, and in every field. My Dermatologist is incredibly incompetent, with a well paying job, own business, and taking more days off work than being at it. My point here is that you all think so highly of your schooling, which is okay to do so, but you're bashing everyone else. Not everyone is paid so much to where, when they get their medical bills they're happy to see how much the fees were for services by an Anesthesiologist. It all comes down to money.

There are problems getting sound, secure jobs everywhere. Optometrists compete with online websites, Chiropractors fight with insurance companies, and graduating Lawyers are now taking temp jobs. Nursing Masters are turning into Nursing Doctoral programs within the next few years. Then what will happen? Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience? That's not including clinicals.

For the person who said to let the associate nurses compete with nurses who hold bachelors degrees - there's not much of a pay difference between the two. Just so you know. And they work together. Both take care of your grandparents and sick family members when they visit clinics and hospitals, at the cost of maybe 1/5th of your salary. So why are you so upset? Even as a CRNA you'd make about 2-3x more than an RN.

Like I said, it all comes down to money.

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it. Not one of you mentioned the difference in pay between a CRNA and an Anesthesiologist. I, myself, would rather prefer to go into Epidemiology. But in this crazy economy, I may get my degree and not have a job out there, so I'm doing Nursing now as a backup. Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD. While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer. I just don't see where you all would think since everyone else is having problems adjusting to the modern day job market that this profession would be the only one untouched. If you don't like what you do, and you think it's all bull****, go back to school. That's what the rest of us my age are doing. Not that it will improve things. Even Florists need licenses now. There's not much hope for a secure job in this world anymore.

Thank you.

*Occupations were capitalized to show respect, in case you wondered.

I think you should check out www.nurse-anesthesia.org and check out the respectful discourse that goes on there. Hatin goes both ways. By the way if your dream job is being taken up by physicians then maybe, you should do that.

 

[Consigliere]

Wow. I was googling for different nursing specialties to learn what my options would be after I get my BSN. I read this entire thread and I feel that most of you are a bunch of haters.

If you love being an Anesthesiologist so much, then you would do it even if the pay was lower right? Like, below $100k? I think the pay difference is the main reason why hospitals or clinics use CRNAs. Secondly, while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work - I didn't have that luxury. I worked three years in my undergrad in three different hospitals. Burn units, ICUs, Psych Wards, Telemetry, Recovery, Same Day, and ERs. Although I did EKGs and Holter Monitors, I learned to work with and help out doctors, nurses, and techs. I also recall the first day the new doctors would begin their residencies and not know a damn thing. My point here being that nurses learn, just like everybody else. They put in the same hours near patients and learn on the job training from others. Every job is iffy in the beginning and newbies aren't as well trained. But that's in every job, and in every field. My Dermatologist is incredibly incompetent, with a well paying job, own business, and taking more days off work than being at it. My point here is that you all think so highly of your schooling, which is okay to do so, but you're bashing everyone else. Not everyone is paid so much to where, when they get their medical bills they're happy to see how much the fees were for services by an Anesthesiologist. It all comes down to money.

There are problems getting sound, secure jobs everywhere. Optometrists compete with online websites, Chiropractors fight with insurance companies, and graduating Lawyers are now taking temp jobs. Nursing Masters are turning into Nursing Doctoral programs within the next few years. Then what will happen? Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience? That's not including clinicals.

For the person who said to let the associate nurses compete with nurses who hold bachelors degrees - there's not much of a pay difference between the two. Just so you know. And they work together. Both take care of your grandparents and sick family members when they visit clinics and hospitals, at the cost of maybe 1/5th of your salary. So why are you so upset? Even as a CRNA you'd make about 2-3x more than an RN.

Like I said, it all comes down to money.

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it. Not one of you mentioned the difference in pay between a CRNA and an Anesthesiologist. I, myself, would rather prefer to go into Epidemiology. But in this crazy economy, I may get my degree and not have a job out there, so I'm doing Nursing now as a backup. Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD. While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer. I just don't see where you all would think since everyone else is having problems adjusting to the modern day job market that this profession would be the only one untouched. If you don't like what you do, and you think it's all bull****, go back to school. That's what the rest of us my age are doing. Not that it will improve things. Even Florists need licenses now. There's not much hope for a secure job in this world anymore.

Thank you.

*Occupations were capitalized to show respect, in case you wondered.

Most of this idiotic babble is complete fiction, but I actually laughed out loud at this part!

 

[Gern Blansten]

This thread was resurrected just to say all that? Thanks for the info?!

 

[pgg]

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it.

Ah, great idea. I'll just head on over to all-nurses.org or allnurses.net or whatever it is, bump an old thread, and let them know how how a doctor sees things.

Oh, wait, no I won't. Because that would be rude.

after I get my BSN.

So you're not a nurse, and you're just imagining how you think a nurse might see things?

while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work

Where do you get this wacky idea that pre-med undergrads don't take biology or chemistry? Or that none of us worked?

They put in the same hours near patients

No, they don't. Perhaps 1/2. And the quality of the hours aren't remotely comparable either, in the context of management, decision making, or learning judgement.

My Dermatologist is incredibly incompetent

I don't know your dermatologist, but I do know that you aren't the slightest bit qualified to comment on a doctor's competency.

Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience?

Oh, my.

Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD

No. Doctorates are not pre-requisites for masters degrees. Likewise, middle school is not a kindergarten prereq.

While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer.

I thought about asking exactly what you meant by this, but on second thought, I don't really care.



Look ... I'll be brief. One of the biggest reasons nurses (and pre-nurses like you) get unfriendly welcomes on SDN is because you typically arrive bubbling this kind of ridiculous stream-of-consciousness nonsense. It gets old. It makes us tired.

You're ignorant. You don't know what you don't know.

 

[partydoc]

Wow. I was googling for different nursing specialties to learn what my options would be after I get my BSN. I read this entire thread and I feel that most of you are a bunch of haters.

If you love being an Anesthesiologist so much, then you would do it even if the pay was lower right? Like, below $100k? I think the pay difference is the main reason why hospitals or clinics use CRNAs. Secondly, while most of you had better grades in your undergrad (that most likely wasn't biology/chemistry - lucky you) from not having to work - I didn't have that luxury. I worked three years in my undergrad in three different hospitals. Burn units, ICUs, Psych Wards, Telemetry, Recovery, Same Day, and ERs. Although I did EKGs and Holter Monitors, I learned to work with and help out doctors, nurses, and techs. I also recall the first day the new doctors would begin their residencies and not know a damn thing. My point here being that nurses learn, just like everybody else. They put in the same hours near patients and learn on the job training from others. Every job is iffy in the beginning and newbies aren't as well trained. But that's in every job, and in every field. My Dermatologist is incredibly incompetent, with a well paying job, own business, and taking more days off work than being at it. My point here is that you all think so highly of your schooling, which is okay to do so, but you're bashing everyone else. Not everyone is paid so much to where, when they get their medical bills they're happy to see how much the fees were for services by an Anesthesiologist. It all comes down to money.

There are problems getting sound, secure jobs everywhere. Optometrists compete with online websites, Chiropractors fight with insurance companies, and graduating Lawyers are now taking temp jobs. Nursing Masters are turning into Nursing Doctoral programs within the next few years. Then what will happen? Did you even know for a nurse to apply to a CRNA program, they had to of had 3-5 years of ICU experience? That's not including clinicals.

For the person who said to let the associate nurses compete with nurses who hold bachelors degrees - there's not much of a pay difference between the two. Just so you know. And they work together. Both take care of your grandparents and sick family members when they visit clinics and hospitals, at the cost of maybe 1/5th of your salary. So why are you so upset? Even as a CRNA you'd make about 2-3x more than an RN.

Like I said, it all comes down to money.

Why am I posting on this thread? Because I read it and just thought I'd let you all know how a nurse would see it. Not one of you mentioned the difference in pay between a CRNA and an Anesthesiologist. I, myself, would rather prefer to go into Epidemiology. But in this crazy economy, I may get my degree and not have a job out there, so I'm doing Nursing now as a backup. Apparently, getting a MPH requires you to have a JD, PhD, MD, DDS, or OD. While MY dream job is being taken up by physicians who don't want to do THEIR work, I have to suffer. I just don't see where you all would think since everyone else is having problems adjusting to the modern day job market that this profession would be the only one untouched. If you don't like what you do, and you think it's all bull****, go back to school. That's what the rest of us my age are doing. Not that it will improve things. Even Florists need licenses now. There's not much hope for a secure job in this world anymore.

Thank you.

*Occupations were capitalized to show respect, in case you wondered.

I worked 30 hrs/ week in undergrad. Majored in chemistry, with honors.

Please stop pretending like you know everyone's deal, or what you are even talking about, as a "pre health" student. Take your pity party somewhere else.

FYI- something like 80% of med students majored in bio in college.

 

[787dreams]

Interesting topic...why is there tension between crnas and mdas? I think they equally want what is best for the patient.

 

[BuzzPhreed]

Interesting topic...why is there tension between crnas and mdas? I think they equally want what is best for the patient.

Well, for one, because you continue to refer to us as "MDAs". Doctor will suffice.

 

[Psai]

.

 

[Baller MD]

The funny thing is that I thought CRNAs were bad people from reading threads like this one. Then when I rotated, many of the anesthesiologists pretty much ignored me while the best teaching and only opportunity to intubate happened when I was in a room with a very intelligent and experienced CRNA who was doing a neurosurgery case. I am interested in anesthesia, relatively intelligent, showed up early in the morning and did what I was told to do which was not much. What gives?

Sample size is too small.

 

[Choo]

OMG!!! The sky is falling!!!

Make sure to avoid Baylor, Columbia, and other great programs because they have CRNAs.

 

[deleted171991]

OMG!!! The sky is falling!!!

Make sure to avoid Baylor, Columbia, and other great programs because they have CRNAs.

The problem is not in having CRNAs. The problem is letting them do complicated cases. That should never happen in academia; those cases should be done by residents or fellows. That's exactly how we got in this **** in the first place.

 

[urge]

I think you should check out www.nurse-anesthesia.org and check out the respectful discourse that goes on there.

I never realized how empowering visiting that forum can be. Just reading about independent nurses groups doing major cases, tee, regional, peds.... Makes me think I have no limits and that there is no case above me. I'm ready for the anemic JW patient with ebola going for a lung transplant. Bring it on!

 

[Baller MD]

OMG!!! The sky is falling!!!

Make sure to avoid Baylor, Columbia, and other great programs because they have CRNAs.

...

 

[Consigliere]

I'll tell up you what residency program to avoid - anesthesiology.

 

[Triple AAA]

CRNAs/SRNAs are not a problem from a training perspective IF they are used appropriately. Where I trained, we were often sent to relieve THEM, many times hours before their shift were to end. I literally was told to relieve a CRNA once as she was about to wheel a patient to PACU because the case had ended at shift change and she had a nail appointment. As a result, I had to sign out a patient to the recovery room who I knew nothing about, for a case I knew nothing about and scrambled to figure out from the anesthesia record. For these indiscretions, I actually blame the attendings that facilitated it rather than the nurses themselves.

 

[BuzzPhreed]

CRNAs/SRNAs are not a problem from a training perspective IF they are used appropriately. Where I trained, we were often sent to relieve THEM, many times hours before their shift were to end. I literally was told to relieve a CRNA once as she was about to wheel a patient to PACU because the case had ended at shift change and she had a nail appointment. As a result, I had to sign out a patient to the recovery room who I knew nothing about, for a case I knew nothing about and scrambled to figure out from the anesthesia record. For these indiscretions, I actually blame the attendings that facilitated it rather than the nurses themselves.

That is complete bullsh*t. Talk about having your cake and eating it.

This is the biggest obstacle to independent practice, as a whole, for their profession. Many of them still want the "shift" job. That's why I say turn 'em loose if they get it. Forge ahead with physician-only practices. Plenty of people on here say that they make it work. I currently work in a practice that flipped from CRNA > MD to MD > CRNA over the past 7 years when the group that recruited me took over and began to establish how it was going to be. Business has never been better for the hospital. We simply provide a greater range or services, without complaining about missing nail appointments, than the clock-watchers.

 

[Random Anesthesiologist]

The problem is not in having CRNAs. The problem is letting them do complicated cases. That should never happen in academia; those cases should be done by residents or fellows. That's exactly how we got in this **** in the first place.

I have a concern about this along with relieving nurses. Our residency director listens to us and we see slow improvement, but it often depends on who makes the schedule that we see random residents unassigned, with nurses doing kidney transplants and CA3s doing eyeballs. The residents are pretty vocal about it, but I wonder how much good it will do. IDK.

 

[deleted171991]

One needs to learn to do eyeballs, too, occasionally. There are many more eye surgeries than kidney transplants.

I had no idea how to properly do eye (and most outpatient) cases until I became an attending. Sometimes a MAC case, especially a long one where one does not have access to the airway, with an anxious morbidly obese patient, can be more difficult than a kidney transplant.

The same way CA-1's would benefit tremendously from a weeklong endoscopy rotation (airway management and sharing).

 

[afteranesthesia]

Who makes your schedule? At my program, the chief resident chooses all of our cases first and then the leftovers go to the crnas. We are never unassigned due to this. Could you advocate that this becomes a chief responsibility?

 

[deleted171991]

Who makes your schedule? At my program, the chief resident chooses all of our cases first and then the leftovers go to the crnas. We are never unassigned due to this. Could you advocate that this becomes a chief responsibility?

 

[Mman]

Who makes your schedule? At my program, the chief resident chooses all of our cases first and then the leftovers go to the crnas. We are never unassigned due to this. Could you advocate that this becomes a chief responsibility?

That's how every program I'm familiar with operates. Not sure why it would ever be done any other way.

 

[deleted171991]

At my (big) program, the floor runner (attending) would decide who does what. And if I were that floor runner today, I would find it very funny to debate the subject every day with a CA-3, even if chief.

 

[Random Anesthesiologist]

Who makes your schedule? At my program, the chief resident chooses all of our cases first and then the leftovers go to the crnas. We are never unassigned due to this. Could you advocate that this becomes a chief responsibility?

One of the staff handles the schedule each day. It will never fall to resident responsibility. I have no problem doing eyeballs as a CA1. I have no problem doing any case within reason. But a CA3? While there are unassigned CA1s? It's annoying, especially on a call day or late day, to be doing a case that you've done lots of and has minimal further educational value vs a big case with an unstable patient. Even kidneys.

I feel like the residency education should be front-loaded, which is why I get irritated with unassigned days (I have another one today) while CRNAs do fairly big cases that I can learn from. Or relieving them for breaks or the day. CA3s could benefit from more study time, especially later this year. Idk, I just see things that make me wonder why.

 

[deleted171991]

There is a simple explanation for that: how much supervision does a CA-3 need, vs a CA-1?

 

[Infexious]

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[Sirach38]

I am surprised that there are programs that this could happen. Whoever is the CA-3 coordinator for the day sets the schedule for the following day by picking out the best cases for the residents and the CRNAs and their students get what is left.

We do not give breaks to CRNAs, they relieve us. And as a side note we do not have "unassigned" days either.

What program is this at?

 

[deleted171991]

What program is this at?

The Grimm brothers'.

 

[Sirach38]

The Grimm brothers'.

Is this too good to be true?

 

[deleted171991]

There is no perfect residency, and what matters the most are not the "idle" days, or the CRNA breaks, but the active teaching in the OR. The latter is rarely excellent, because the entire concept of post-graduate medical training in the US is mostly about cheap labor, not world-class education. The medical science and technology are world-class, but the teaching, on average (and especially in anesthesia programs), is not. Your role, as a candidate, is to find those few places which take extreme pride in their teaching. There is a big difference between mostly passive learning by doing tough cases and active teaching. (Have you ever seen a surgeon walk her trainee through every single step of a procedure, with explanations? That's it.)

The main question to ask when interviewing for any training program: What would be the impact if all trainees decided not to show up for work one day? In every American program I trained in and I have seen, the hospital would crumble. Being paid $13-15/hour and getting crappy teaching in exchange = not OK. Again a matter of supply and demand where the employer is in control, something you'll see a lot after graduating an anesthesia residency.

Not even the most famous American medical schools emphasize teaching as the no. 1 priority. Nope, it almost always comes after research (very few physicians, if any, become professors just on the basis of their clinical knowledge and quality of teaching, but any ***** can with the right amount of published crap). Why we still call them "schools" I have no idea.

 

[Random Anesthesiologist]

There is no perfect residency, and what matters the most are not the "idle" days...

I have some really great teachers in my staff. But when I have runs of "idle" days, how am I supposed to access them? It's not as easy as just waltzing into another resident's case either. I'm a little disappointed at bringing up what I thought was a legitimate residency issue to now be mocked.

 

[afteranesthesia]

Can you ask to have the crna cases when they post the day before and you are unassigned?

 

[deleted171991]

I have some really great teachers in my staff. But when I have runs of "idle" days, how am I supposed to access them? It's not as easy as just waltzing into another resident's case either. I'm a little disappointed at bringing up what I thought was a legitimate residency issue to now be mocked.

I honestly don't see where I was mocking your problem, but I assure you that was not my intent.

Doing occasional eye cases instead of kidney transplants (or whatever) does not sound like a legit CA-3 problem. It sounds like senioritis ("I am too good to be doing this"). But that's just me. I would have understood if a CRNA had been doing a neuro case, or something more involved. (In my program, kidney transplants were a CA-1 only pent-sux-tube job.)

 

[Random Anesthesiologist]

I honestly don't see where I was mocking your problem, but I assure you that was not my intent.

Doing occasional eye cases instead of kidney transplants (or whatever) does not sound like a legit CA-3 problem. It sounds like senioritis ("I am too good to be doing this"). But that's just me. I would have understood if a CRNA had been doing a neuro case, or something more involved. (In my program, kidney transplants were a CA-1 only pent-sux-tube job.)

I'm not a ca3. I'm a ca1. Our ca3s don't really care, but I do, trying to get more OR time with associated teaching and experience. CRNAs do get signed to neuro cases. Very strange, but whatever.

Sorry, I've had my coffee now and a little more relaxed.

Afteranesthesia, often the person making the schedule is gone by the time we get our assignments. Apparently it can be a logistical nightmare to reschedule people, or so I'm told. I'm starting to get that "I just don't care anymore" feeling.

 

[BuzzPhreed]

CRNAs do get signed to neuro cases. Very strange, but whatever.

Get used to it. There are plenty of practices out there who allow this as well. In the practice I left, CRNAs did neuro (cranis, etc.) and cardiac. This is what it's come to in some places. And when you're 4:1 there's really not a whole lot of "direction" that goes on. Cookie-cutter bullsh*t and only calling you after there was a problem and they were at a loss as to what to do next.

It's all about what the 'ologist overlords in a particular practice will allow. As well as what the surgeons will allow. (Some of the surgeons didn't like it but had no balls either.)

Forget it. Life is too short. I don't want to be part of such an arrangement. I saw a lot of questionable care. Don't want my name on those charts. I left. Vote with your feet. Or, if you're a resident looking for work, thoroughly vet a practice you're considering joining and avoid such places like the plague.

 

[deleted171991]

I'm not a ca3. I'm a ca1. Our ca3s don't really care, but I do, trying to get more OR time with associated teaching and experience. CRNAs do get signed to neuro cases. Very strange, but whatever.

Sorry, I've had my coffee now and a little more relaxed.

Afteranesthesia, often the person making the schedule is gone by the time we get our assignments. Apparently it can be a logistical nightmare to reschedule people, or so I'm told. I'm starting to get that "I just don't care anymore" feeling.

Don't worry, as long as it doesn't happen more than a few times a month. CA-1s need the most supervision so, sometimes, when choosing the resident to get a day off, the floor runners choose a CA-1. Also, many attendings prefer having a CRNA in at least one of the two rooms they cover (makes for an easier day). As I said above, the system is not tuned for teaching.

 

[Infexious]

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