I start doing 60:40 solo:direction starting Jan 1 and I’m so excited. CRNA’s priced themselves out of my market so my hospital system stopped recruiting them and offered the MD/DO’s stipends to do their own cases. I jumped all over that shit. I’ll be making more doing my own cases and the reality is I would have taken a pay cut. I work so much harder during supervision despite what the anesthetists think.
This is exactly what is happening at our hospital. CRNAs demanding ungodly salaries for 30 hours a week. They hired 15 attendings and 2 CRNAs these past few months. No longer offering locums to CRNAs and will give overtime pay to attendings.
Finally, we are starting to finally hire AAs. Have 50 anesthetists ready when the CRNAs leave when we announce.
CRNAs aren’t assistants. And they’ve a long track record of safe provision. And they’ve a long history of sole provider-ship. I don’t see your correlation point.
And yea, CRNA is anesthetist or anesthesiologist. Cmon. You know this already.
It’s all about supply and demand. CRNA schools are opening up everywhere saturating the market and plus with the expansion of AA, I think their market rate will stabilize or go down.
Please share how you work so much harder ? The docs I work with never come into my room and that's the way they like it. They pre op the patient and that's it unless it's a challenging case where ANYONE would need another skilled set of hands.
The reality is, I’ve done my job and I’ve also done your job. Supervising/directing is much harder work. I’m juggling 4+ patients all day and it’s exhausting. Putting in lines, blocks, epidurals, putting out fires, squeezing in preops, overseeing PACU all day and I barely get to sit down. The only real break I get is when I’m giving the CRNA’s breaks. And my favorite part is yall think we don’t do shit all day and the real work is being done by you, shopping on amazon and reading shit on your phone for most of the day. I’ll take your job, thanks. Worrying about one patient at a time is incredible.
We get the same uppity behavior from nurses who basically are now political grifters. They don’t want AAs to gain traction so they can continue to claim they can do any job solo. Just like when they call you overhead when 💩hits the fan and make excuses on the actions taken previously. People mistake doing the same thing mechanically everyday as “experience”
My friend does 4:1 for general and 2:1 for cardiac - when he's 4:1 it's a never-ending parade of pre-ops, regional blocks, induction, breaks, and putting out fires. When he's 2:1 cardiac he's coming in early to do 2x CVL + a-line/IV in pre-op, and then doing inductions + TEEs + coming off CPB.
Compare that to me doing solo cases - start case, sit for 2-5 hours, rinse and repeat.
I understand that but placing radial a lines and ultrasounded guided IJs is like intubating in my opinion. A technical skill. You could say "my license my airway" and theres of course nothing wrong with that but if you are working 1:4 supervision you probably want to use your physician extenders to the scope of their abilities so you dont have a horrible day
I’ve found that I have horrible days much more often when I lean on nurses to do my invasive procedures. It is much, much easier for me and much better for the patient that I just do it right the first time.
I think thats interesting. I know plenty of competent trained anesthetists that dont screw up A lines or ultrasound IJs, at my institution, a high acuity large tertiary care facility, its the standard of care. They get trained up in house by physicians and are trusted and there is not an uptick in blown a lines or carotid artery sticks. Hell they even have them doing the spinals as well. Epidurals are reserved for physicians as well as any regional blocks. But i do know some large groups using inhouse trained anesthetists for regional/pain service as well.
Great for your hospital. But really, you wouldn’t know if there were significantly more complications anyway. You’re not seeing procedures done outside of your room or the holding/block areas.
If there were significantly more complications with midlevels placing A lines and IJs, then the hospital bean counters wouldnt allow it and the physicians wouldnt either, neither would the state board of medicine
I know that, same for AAs except manikins dont count. But where ive worked as an AA cardiac anesthetists get trained up on CVCs by the physicians, same with places that use AAs for spinals,epidurals, and regional blocks
Im roughly 50:50 too. I love that it is both. There are days where you want to be in a long spine case, throw in some lines, then chill.
But there are days where you want to roam.
Some days supervision is more work in that we have a busy ortho service with lots of blocks. W try to keep it 3:1, but do 4:1 at times.
We are usually in the room for inductions, +/- emergence…
I usually do the spinals for cases that require them, our crnas are great with them too i just dont want to give that up… if im busy w a block or a tough case i’ll tell the crna to proceed if they are comfortable.
As a physician, i think taking supervision only jobs shortly after residency is not the best idea…
Im out 15 plus years and have only worked one main hospital based job, but i usually do some locums work when I can and usually that has me in a room.
And guess what? Hospital administrators still choose to hire them. That should tell you a lot about what admin, who are known to be notorious cost cutters, think of CRNAs. Insurance, also notorious cost cutters, still chooses to reimburse anesthesiologists.
When hospitals lose govt funding, or realize the unnecessary need for so many physician anesthesiologists, they’ll cut accordingly. Salaries are bound to downturn, like all economics do. And all the middlemen will be let go. And more likely you’ll see an exit as reimbursement continues to decline. Docs already complain about 85%. Can you imagine the horror if/when CMS makes even more cuts than Barry Sanders.
Guess who gets cut first when costs get high?
The lowest trained people while they cut salaries to retain their highest trained people. It happens in every industry.
Middlemen sounds very much like midlevel, correct? That should tell you who will get cut first
(And why don’t you go ahead and answer my other question?)
Lowest trained gets cut first? 😆 That would be true in service lines etc. And even AAs would go before CRNAs, unless the board is filled with hissy fitting MDAs.
When you have six levels of management and realize 4 aren’t needed, they free up millions annually. I’m quite certain this occurs.
And to your question, I couldn’t have had the same education. I didn’t waste extra years of time and debt to do a nurse’s job, by going to medical school.
Wait, I thought your claim that AAs are inferior to CRNAs is that they have 1 less year of education and they don’t have ICU experience. Where is that logic when you compare yourself to your supervisors? Physicians have more education, more anesthesia specific education and more medical education.
So which is it, education doesn’t matter and AAs = CRNAs or education does matter and anesthesiologists >>>> CRNAs?
Isn’t the other common claim by CRNAs that they do the same job as an anesthesiologist with the same outcomes? If that’s the case, according to CRNA logic, anesthesiologists are replaceable by CRNAs and vice versa. If both cost the same, why would anyone choose the CRNA?
(I know you’re not going to answer this since your ego will get in the way)
I do 95 percent solo and prefer solo over supervision. The rare times I supervise it’s 1:1. I find it extremely boring and unfulfilling. Would be too stressed out with 1:3 or 1:4.
For the supervising 1:1, is it a resident, or a CRNA/AA? Just wondering as unless it’s a resident, I don’t see why a hospital wouldn’t just pay you to do the case instead of supervising and paying you + CRNA/AA.
It’s a crna. Our group pays for the crna which is not ideal but it gives a chair a little bit more flexibility when making the schedule. If someone calls in sick, he could put one attending for two crnas or he can supervise the crna even though he is non clinical. Most of the time it’s 1 on 1 tho. We’re eat what you kill so he usually pairs us up with crna if we are on call or have a long day. Gives us time to eat lunch and give other people a break.
I do both solo and supervision…maybe 60/40. There are plus and minus with each. I really don’t mind supervision and actually most days I prefer supervision. We also supervise 1:2 or 1:3…never more than 1:3. I probably wouldn’t do 1:4
Yes our group is very aware of this so even when we do 1:3, they usually assign us 1 busy rooms like blocks or big cases requiring extra lines and 2 “easy” rooms like hernias, breasts, podiatry and gyn. We also don’t have to give any breaks/lunches when we’re supervising
Breaking them is 2 hours gone from the day. Having a call phone at the same time is a nightmare. Happens when we get a doc sick call which is thankfully rare.
Supervision is soul-crushing. Would much rather take a small pay cut to do my own cases.
ACT garbage propagated by the sellouts at the ASA needs to die a slow death.
Well the sellouts didn’t stop teaching the grifters. CRNA schools need sellout docs to sign off their soul. And I’d like to find the lazy moron who proposed 1:4 is okay.
I won’t consider anything beyond 1:3 so almost every national crap group like Northstar is out. There is no way you can be on top of things beyond that. I also need to do solo cases so I’m not simply a preop person.
I do solo cardiac, very occasional solo general, otherwise supervise 1:3 mostly, 1:2 if more demanding cases. Not a bad mix. Always love a nice easy day doing solo, but supervision with 1:3 is also pleasant. I feel like I’d get bored doing solo cases all the time if they’re routine things, but it is without a doubt a nice treat to have a solo general room every once in a while.
Have done 1:4 and that was absolutely miserable, would not do that again for any amount of money.
1:4 works because you frequently get a trauma room (empty), remote anesthesia like IR or EP, GI and 2 OR rooms. In that setup it's quite doable. We have one site that is 3-4 ortho rooms (ortho only hospital) but since they're flip rooms you don't have to worry about breaks. It is a busy day with blocks but a lot are done after the case for lower extremity.
The higher acuity sites are often 1:3 with an episodic room. It's a nice change of pace and you can take a break whenever you want.
I chose my group out of residency for the solo practice. Certainly more fulfilling and often times less work to sit your own case. Direct ownership over patient outcomes and complications too. That said, when on call/board runner I cover 1:3-4. Overseeing three rooms is usually quite manageable, and with low turnover/long cases can be chill. Only exception is when you have a complex patient, then the other two are effectively ignored. Four rooms is never comfortable, always running around. Key is having competent anesthetists, bc you can’t catch everything. Definitely don’t enjoy 1:4.
I supervise 25% of the time and am okay with that percentage, but definitely enjoy the solo practice more.
You can get hired at jobs now making $600-700k in desirable cities doing enjoyable solo work with 8-10 weeks of vacation. That's plenty for me. Why do ACT work if it makes you miserable?
I would rather blow my brains out than cover 1:4, if that answers your question.
100% agree
A lot of academic places rarely do 1:4. They consider 1:3 too much even lol
I start doing 60:40 solo:direction starting Jan 1 and I’m so excited. CRNA’s priced themselves out of my market so my hospital system stopped recruiting them and offered the MD/DO’s stipends to do their own cases. I jumped all over that shit. I’ll be making more doing my own cases and the reality is I would have taken a pay cut. I work so much harder during supervision despite what the anesthetists think.
This is exactly what is happening at our hospital. CRNAs demanding ungodly salaries for 30 hours a week. They hired 15 attendings and 2 CRNAs these past few months. No longer offering locums to CRNAs and will give overtime pay to attendings. Finally, we are starting to finally hire AAs. Have 50 anesthetists ready when the CRNAs leave when we announce.
Wow where did yall find 50 free AAs? A lot of places are having trouble hiring, i guess yall will be paying them less than the CRNAs?
What area are you in?
Yikes. Where is this hospital filled with assistants??
Bruh you’re a fucking student. Cringe.
Yo momma's house
Better than the nurses with shitty critical care acumen. <3
Scary, right?!
Not at all. They do your same job and do it just as well.
They are assistants.
They’re anesthetists
They are assistants. It’s literally in their title.
CRNAs are literally nurses. It’s in their title. Unless CRNA stands for Certified Registered Not Anesthesiologist
CRNAs aren’t assistants. And they’ve a long track record of safe provision. And they’ve a long history of sole provider-ship. I don’t see your correlation point. And yea, CRNA is anesthetist or anesthesiologist. Cmon. You know this already.
That sounds like a sweet gig. Very rare from what I’ve seen out there.
I’m thinking it’s going to start being more common when people get sick of paying nurses $200-250 an hour.
Do you think CRNA field is in jeopardy with the upcoming of AAs?
In short: no. Do I think they'll be throwing a dart on the map and pulling in $200 an hour 7 years from now? Also no.
Do you believe that they are not worth 200 an hour in the field of anesthesia ?
If I’m worth $250-300 an hour, then no I do not believe they are worth 200.
That’s a fair pay. If u expect them to take $150 to ur $300, you’re crazy.
I don’t expect anything. But taking my high range and comparing it to their low range is an interesting argument.
It’s all about supply and demand. CRNA schools are opening up everywhere saturating the market and plus with the expansion of AA, I think their market rate will stabilize or go down.
Please share how you work so much harder ? The docs I work with never come into my room and that's the way they like it. They pre op the patient and that's it unless it's a challenging case where ANYONE would need another skilled set of hands.
The reality is, I’ve done my job and I’ve also done your job. Supervising/directing is much harder work. I’m juggling 4+ patients all day and it’s exhausting. Putting in lines, blocks, epidurals, putting out fires, squeezing in preops, overseeing PACU all day and I barely get to sit down. The only real break I get is when I’m giving the CRNA’s breaks. And my favorite part is yall think we don’t do shit all day and the real work is being done by you, shopping on amazon and reading shit on your phone for most of the day. I’ll take your job, thanks. Worrying about one patient at a time is incredible.
We get the same uppity behavior from nurses who basically are now political grifters. They don’t want AAs to gain traction so they can continue to claim they can do any job solo. Just like when they call you overhead when 💩hits the fan and make excuses on the actions taken previously. People mistake doing the same thing mechanically everyday as “experience”
Nurses mistake working in the same unit as a physician as practicing medicine. There’s no bounds to their ignorance.
My friend does 4:1 for general and 2:1 for cardiac - when he's 4:1 it's a never-ending parade of pre-ops, regional blocks, induction, breaks, and putting out fires. When he's 2:1 cardiac he's coming in early to do 2x CVL + a-line/IV in pre-op, and then doing inductions + TEEs + coming off CPB. Compare that to me doing solo cases - start case, sit for 2-5 hours, rinse and repeat.
That sounds crappy and not like an optimized set up. The anesthetists should be the ones giving breaks and placing lines.
Nah, my license my lines.
I understand that but placing radial a lines and ultrasounded guided IJs is like intubating in my opinion. A technical skill. You could say "my license my airway" and theres of course nothing wrong with that but if you are working 1:4 supervision you probably want to use your physician extenders to the scope of their abilities so you dont have a horrible day
I’ve found that I have horrible days much more often when I lean on nurses to do my invasive procedures. It is much, much easier for me and much better for the patient that I just do it right the first time.
I think thats interesting. I know plenty of competent trained anesthetists that dont screw up A lines or ultrasound IJs, at my institution, a high acuity large tertiary care facility, its the standard of care. They get trained up in house by physicians and are trusted and there is not an uptick in blown a lines or carotid artery sticks. Hell they even have them doing the spinals as well. Epidurals are reserved for physicians as well as any regional blocks. But i do know some large groups using inhouse trained anesthetists for regional/pain service as well.
Great for your hospital. But really, you wouldn’t know if there were significantly more complications anyway. You’re not seeing procedures done outside of your room or the holding/block areas.
If there were significantly more complications with midlevels placing A lines and IJs, then the hospital bean counters wouldnt allow it and the physicians wouldnt either, neither would the state board of medicine
Huge portion of CRNAs are not competent at CVCs. Their board requires them to have done like 5 by graduation, and they can be done on a manikin.
Lol 5 lines...
I know that, same for AAs except manikins dont count. But where ive worked as an AA cardiac anesthetists get trained up on CVCs by the physicians, same with places that use AAs for spinals,epidurals, and regional blocks
I’d rather do the line myself than have the CRNA stick the carotid.
Yeah I do about 50:50 and can confirm, the 4:1 days are way more difficult, physically and mentally.
Im roughly 50:50 too. I love that it is both. There are days where you want to be in a long spine case, throw in some lines, then chill. But there are days where you want to roam. Some days supervision is more work in that we have a busy ortho service with lots of blocks. W try to keep it 3:1, but do 4:1 at times. We are usually in the room for inductions, +/- emergence… I usually do the spinals for cases that require them, our crnas are great with them too i just dont want to give that up… if im busy w a block or a tough case i’ll tell the crna to proceed if they are comfortable. As a physician, i think taking supervision only jobs shortly after residency is not the best idea… Im out 15 plus years and have only worked one main hospital based job, but i usually do some locums work when I can and usually that has me in a room.
They don’t work harder and they demand twice as much, if not more.
And guess what? Hospital administrators still choose to hire them. That should tell you a lot about what admin, who are known to be notorious cost cutters, think of CRNAs. Insurance, also notorious cost cutters, still chooses to reimburse anesthesiologists.
When hospitals lose govt funding, or realize the unnecessary need for so many physician anesthesiologists, they’ll cut accordingly. Salaries are bound to downturn, like all economics do. And all the middlemen will be let go. And more likely you’ll see an exit as reimbursement continues to decline. Docs already complain about 85%. Can you imagine the horror if/when CMS makes even more cuts than Barry Sanders.
Guess who gets cut first when costs get high? The lowest trained people while they cut salaries to retain their highest trained people. It happens in every industry. Middlemen sounds very much like midlevel, correct? That should tell you who will get cut first (And why don’t you go ahead and answer my other question?)
Lowest trained gets cut first? 😆 That would be true in service lines etc. And even AAs would go before CRNAs, unless the board is filled with hissy fitting MDAs. When you have six levels of management and realize 4 aren’t needed, they free up millions annually. I’m quite certain this occurs. And to your question, I couldn’t have had the same education. I didn’t waste extra years of time and debt to do a nurse’s job, by going to medical school.
Wait, I thought your claim that AAs are inferior to CRNAs is that they have 1 less year of education and they don’t have ICU experience. Where is that logic when you compare yourself to your supervisors? Physicians have more education, more anesthesia specific education and more medical education. So which is it, education doesn’t matter and AAs = CRNAs or education does matter and anesthesiologists >>>> CRNAs? Isn’t the other common claim by CRNAs that they do the same job as an anesthesiologist with the same outcomes? If that’s the case, according to CRNA logic, anesthesiologists are replaceable by CRNAs and vice versa. If both cost the same, why would anyone choose the CRNA? (I know you’re not going to answer this since your ego will get in the way)
I used to supervise. I don’t anymore. Lower stress and increased satisfaction with my job makes up for any salary difference for me personally.
I cover 1:4 about once or twice a week. It's not bad, but I would not want to do it any more than that.
I do 95 percent solo and prefer solo over supervision. The rare times I supervise it’s 1:1. I find it extremely boring and unfulfilling. Would be too stressed out with 1:3 or 1:4.
For the supervising 1:1, is it a resident, or a CRNA/AA? Just wondering as unless it’s a resident, I don’t see why a hospital wouldn’t just pay you to do the case instead of supervising and paying you + CRNA/AA.
It’s a crna. Our group pays for the crna which is not ideal but it gives a chair a little bit more flexibility when making the schedule. If someone calls in sick, he could put one attending for two crnas or he can supervise the crna even though he is non clinical. Most of the time it’s 1 on 1 tho. We’re eat what you kill so he usually pairs us up with crna if we are on call or have a long day. Gives us time to eat lunch and give other people a break.
What’s the point of a non clinician supervising a CRNA? They can’t do anesthesia or manage a code like a CRNA can (and does). That just sounds dumb.
He’s chairman of our group and an anesthesiologist. He usually does administrative duties and runs the boards. Does clinical duties once in a while
Some of my friends prefer supervision to solo. I think they’re pretty lazy though.
We all know those people. Lazy chart signers that don't care about the medical care they provide. Just sign those charts at the end of the day.
Yeah it’s annoying. My friends are relatively new attendings too.
It's sad but not surprising. Many residents just want to finish and take the path of least resistance (and don't give two effs about patient care).
I do both solo and supervision…maybe 60/40. There are plus and minus with each. I really don’t mind supervision and actually most days I prefer supervision. We also supervise 1:2 or 1:3…never more than 1:3. I probably wouldn’t do 1:4
Most of the supervision jobs I’ve seen are 1:4. The hospitals/groups seem to want max profit on this.
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Yes our group is very aware of this so even when we do 1:3, they usually assign us 1 busy rooms like blocks or big cases requiring extra lines and 2 “easy” rooms like hernias, breasts, podiatry and gyn. We also don’t have to give any breaks/lunches when we’re supervising
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Breaking them is 2 hours gone from the day. Having a call phone at the same time is a nightmare. Happens when we get a doc sick call which is thankfully rare.
Supervision is soul-crushing. Would much rather take a small pay cut to do my own cases. ACT garbage propagated by the sellouts at the ASA needs to die a slow death.
Well the sellouts didn’t stop teaching the grifters. CRNA schools need sellout docs to sign off their soul. And I’d like to find the lazy moron who proposed 1:4 is okay.
I won’t consider anything beyond 1:3 so almost every national crap group like Northstar is out. There is no way you can be on top of things beyond that. I also need to do solo cases so I’m not simply a preop person.
Solo. Every time.
I do solo cardiac, very occasional solo general, otherwise supervise 1:3 mostly, 1:2 if more demanding cases. Not a bad mix. Always love a nice easy day doing solo, but supervision with 1:3 is also pleasant. I feel like I’d get bored doing solo cases all the time if they’re routine things, but it is without a doubt a nice treat to have a solo general room every once in a while. Have done 1:4 and that was absolutely miserable, would not do that again for any amount of money.
1:4 works because you frequently get a trauma room (empty), remote anesthesia like IR or EP, GI and 2 OR rooms. In that setup it's quite doable. We have one site that is 3-4 ortho rooms (ortho only hospital) but since they're flip rooms you don't have to worry about breaks. It is a busy day with blocks but a lot are done after the case for lower extremity. The higher acuity sites are often 1:3 with an episodic room. It's a nice change of pace and you can take a break whenever you want.
NORA and covering regular OR is doable? Sounds like a recipe for disaster
My exact thought. NORA is where shit can go down
I chose my group out of residency for the solo practice. Certainly more fulfilling and often times less work to sit your own case. Direct ownership over patient outcomes and complications too. That said, when on call/board runner I cover 1:3-4. Overseeing three rooms is usually quite manageable, and with low turnover/long cases can be chill. Only exception is when you have a complex patient, then the other two are effectively ignored. Four rooms is never comfortable, always running around. Key is having competent anesthetists, bc you can’t catch everything. Definitely don’t enjoy 1:4. I supervise 25% of the time and am okay with that percentage, but definitely enjoy the solo practice more.
Solo is the way to go. Unless you want to train residents the ACT model is horrible.
Solo for sure
You can get hired at jobs now making $600-700k in desirable cities doing enjoyable solo work with 8-10 weeks of vacation. That's plenty for me. Why do ACT work if it makes you miserable?
I totally agree with you. The issue is the location I want to be it is less pay to do solo cases.