Independent CRNA Practice vs. Team Care Model Vs. Anesthesia Supervision

Your graduation is coming up in a few months and you are looking for your first job. A lot of questions are popping in your mind mainly to do with salary, schedule and location of your new job. All seems to be in place yet there is something you didn't think would be as important in making you happy in your new career. Working supervised or as an independent CRNA.

Now I am not here to put down one anesthesia work model for another so lets put egos aside and really think through this. People have different priorities be it family, money, social life or schedule. However, if we were to think of our profession alone, how should new graduates read that fine print in that job offer that is offering ridiculous amount of money but something just isn't right.

Working in a supervised CRNA practice can mean a lot of things. It can start anywhere from "we have anesthesiologist here as a consult or emergency supervision purposes" or "No, you as CRNAs are not allowed to push your own induction drugs". Motive behind why certain places enforce supervision to a certain degree are usually to do with how CRNAs are presented to the hospital board members by the leading anesthesia group members. These kinds of jobs are more prevalent in bigger cities ruled by anesthesia groups. So, what should you look for before accepting a job?

Working under Anesthesiologist Supervision (and Team Care Model)

1. Experience matters. This is not only true working with an anesthesiologist but also a senior CRNA. There are so many different ways of doing anesthesia but in dire situations, it is always good to have someone with more experience than you. So, as a new graduate CRNA (or an anesthesiologist) Knowledge sharing is a plus and it can be a good thing to work with someone. However, there is a very fine line where this can halt learning and turn you into a charting monkey. You cannot learn by not doing. Practical experience can only be gained by actually performing. Looking at someone else doing a regional block or putting in a central line won't mean anything until you get hands-on experience with it. Here is what you should pay attention to. It is a positive sign if you hear that anesthesiologist and CRNAs work together without restrictions and practical, hands-on teaching is promoted for all anesthesia providers. And you might want to rethink about places where you as CRNA don't do push induction drugs, call anesthesiologist for extubation and you cannot do peripheral or neuraxial blocks.
2. 2) Interpersonal Relationship- I have been through rotation where CRNAs are looked as second class citizens and treated with disrespect and constant abuse. It is important to know your limitations but equally important to know your value. If you are being trained to perform as an independent provider then you should protect that right and not disrespect yourself by working in such place. Ask the CRNAs or RNs about how anesthesiologists and CRNAs get along. Do you get lunch breaks when you have floats and how are people relieved at the end of the day. This is especially important as some places CRNAs will be the last ones to leave at the end of their day. Extremely important! Also, clarify on the things that you are and aren't allowed to do before starting.

CRNA-Only Practice

1. Now unless you are the sole provider for a facility, the pluses and minuses mentioned above still apply. Some CRNA-only practices run really efficiently with a comfortable working environment. Yet you can experience mistreatment if your group is being run by a poor leader. So be cognicent of that.
2. Are you a leader: Now we all think making it thru a CRNA school is difficult and you have to be assertive in order to make it. However, when you are really on your own its a different game. You have to be a good leader who can organize a group of people to safely provide care to patients. Surgeons can be tough to deal with but at times you will have to stand your ground and not get run over. This is especially true if you are in a private practice where every case that you cancel makes you look bad. And to make matters even worse, you work for the surgeon's patient so they can be very pushy to make you do something you don't feel like is the right thing to do. There is a fine line between keeping good relationships between your team members and being a safe anesthesia provider.

These are a few of the many pros and cons to working in team care model and CRNA-only practice. It is up to you to decide what you are comfortable with. Your schooling was supposed to make you be comfortable enough to practice independently as you are not Anesthesia Assistants (Aas). So, don't underestimate your skill level and be brave and open to learn everyday to improve yourself. Your career's future depends on you! I highly suggest against working in places where you are not valued and limited from fully practicing your scope.

P.S. Sorry about the looong delay in posts. Personal life has been challenging over the past four months and I just started the doctorate program!! Most on that later.

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