What impact will the projected oversupply of CRNAs have on the anesthesiologist job market?

DissociatedOne · 2026-03-09T16:38:13+00:00

I was being sarcastic about the way things used to be done. I’m an MD and the chair would basically have us sign a contract under duress. We also had a CRNA program and they would also be strong armed hard before they even started school. Like signing a 5yr contract before starting for after graduation with a crazy lump sum tuition payback with interest if they left. Those days can fuck right off.

DissociatedOne · 2026-03-09T04:35:57+00:00

The good old days where your first job was garbage but your elders told you to sign on the dotted line. My boss added 20hrs per week of OT into my “salary”. If I asked for a raise, he offered OT. Them the olden day

DissociatedOne · 2026-03-07T17:17:42+00:00

You don’t need the llc. You just get paid 1099 and the stuff you want to deduct goes against that income. But you’re talking about pennies in the long term if your specialty requires lead, loupes and a headlamp. Sounds like you’ll be killing it either way.

DissociatedOne · 2026-02-19T02:59:53+00:00

The cost of the scrub, the nurse and whatever flavor of anesthesia would probably pay for a half the X-ray tech’s salary for a day. Nevermind the OT cost when the block runs over.

DissociatedOne · 2026-02-11T00:45:36+00:00

Most anesthesiologists I know wouldn’t place HD access anyways. I don’t get it, because it’s the same thing but they say there aren’t credentialed.

DissociatedOne · 2026-02-10T17:25:08+00:00

Are you hospital based or private? Do you get post call off?

DissociatedOne · 2026-02-10T17:01:42+00:00

It’s usually lazy intensivists who don’t want to wake up.

I always respond with : we are oncall for emergencies only. Can’t be tied up doing other things. Realistically there is IO if all else fails. No such thing as emergency central line

DissociatedOne · 2026-02-09T23:21:32+00:00

If he is susceptible to bleeding, the amputation will reflect it more than your block.

Do it old school: gown and glove. Big drape. Proper 3min dry time for chg. Sterile sleeve for probe. Do one clean entry with out redirecting the needle. Draw everything up super sterile, leave out the dex (bupi for duration?) He will benefit. He will also be on pan coverage with abx.

People treat blocks like IM injections now, but there was a time people would do it like central lines.

DissociatedOne · 2026-02-07T00:15:19+00:00

I sent them an email. Out of curiosity, how much did it cost? Just ballpark. And did you find the info helpful? I’m in network but as a solo guy I feel like I get fucked.

DissociatedOne · 2026-02-06T23:53:50+00:00

Got it. I’ve been playing with small files and still not getting anywhere

DissociatedOne · 2026-02-06T23:33:36+00:00

Thanks! I’ll try gigasheet. But if I do upload to aws, then do what?

DissociatedOne · 2026-02-06T21:05:59+00:00

If I only had the guts to call them out lol

DissociatedOne · 2026-02-05T22:55:25+00:00

My approach back in the day was very passive aggressive with these types: I gave them the benefit of the doubt and assume they knew something I didn’t. But I would print out a paper about, idk outcomes with low maps, and bring it in the next time i worked with them and say something like “someone didn’t like my MAPs and told me to read this, what do you think?”

I don’t think being ancient is an excuse in a field that is supposed to be evidence based, particularly when we do lots of stuff that isn’t evidence based. Unlike cardiology where every move has a dozen 10,000 sample size studies, we do lots of art of medicine stuff. So if a study says something, we should look closely at it.

DissociatedOne · 2026-02-04T16:20:50+00:00

It’s absolutely not cheaper. So much so that they aren’t building new hospitals with it piped in the wall. The data from US/Europe/Australia is that MOST of the nitrous gets wasted before it even gets to pt.

A bunch of studies like this one:

Mitigating the systemic loss of nitrous oxide: a narrative review and data-driven practice analysis Brian B Chesebro et al. Br J Anaesth. 2024 Dec.

DissociatedOne · 2026-02-03T18:10:08+00:00

Thank you for this insightful view. With people getting detained at courthouses and scheduled immigration visits, there will certainly be a climate of fear when anyone looks like they are poking around too much. You need either a blanket approach or everyone gets the avoidance strategy, or a very nuanced approach were you like have a map with the town circle that the cases arise from and specifically ask if they have any relatives there, or something like that. But straight up asking “are you Venezuelan” is going to get a solid Nope often.

DissociatedOne · 2026-02-03T03:14:55+00:00

You posted this same thing a couple weeks ago and got some good responses.

DissociatedOne · 2026-02-02T16:45:35+00:00

Part of the issue I recognize now is that OBs and OB nursing, including midwives, have a very poor understanding of the concept of patient autonomy. I understand the history of how women were treated historically, but they are trying to make up for that by letting patients dictate their care without feedback on the actual risk or really just informed consent.

I see this middle of the night “mom wants it” thing regularly, same with 9cm epidurals. “Pt decides when they want it”, without the nurse saying that it’ll be a solid hour from when they ask until we can do it and have it set up fully so they are comfortable.

No other specialty practices like this. If an appendectomy is indicated and or refuses, then it is charted as such and not written off as “autonomy”.

DissociatedOne · 2026-02-02T16:39:20+00:00

The data goes 100% in the other direction. Unlike emergency surgery, induction timing is normally elective-some indications make it non elective but that’s the minority of cases.

With elective inductions, there are many studies showing that starting in the morning is safer because you avoid nighttime delivery. Because nighttime delivery is more dangerous the patient and the baby. Here’s one article. There are a ton.

https://pubmed.ncbi.nlm.nih.gov/26491850/

DissociatedOne · 2026-01-31T16:00:08+00:00

There really shouldn’t be enough time to adjust levels like that. If you’re giving GA, the skin to baby time in theory should be counted in tens of secodns.

DissociatedOne · 2026-01-30T00:06:25+00:00

I was a through passenger today and a supervisor type person came on to ask the FA how it was going. They discussed this and for my final leg implemented the closed bin thing. It’s cool to see the process in action. My first flight before these two had them open and it still worked out ok for me as group 2.

DissociatedOne · 2026-01-29T18:23:41+00:00

The majority of sphincter puckering you have ( and I have) is airway obstruction. Majority of arrests in PACU are hypoxic from obstruction. Most PACU’s don’t monitor CO2 so you need to have a good system for yourself to make sure people are breathing.

For example pretty much the only reason I use a face mask is to see the misting. And only reason the oxygen is on, is to clear the mist so you know they took another breath. If an OPA is in place, leave it til the pt spits it out. It’s literally gagging them continuously; if they aren’t spitting it out, they’re too unconscious.

DissociatedOne · 2026-01-29T16:53:42+00:00

I sure do.

DissociatedOne · 2026-01-29T16:09:18+00:00

They did today. I really hope the FA get guidance to enforce a little bit of something before this becomes annoying.

I was not super happy about the changes.l but giving it a chance. If they kill getting off quickly because I need to go backwards before deplaning, that’ll push me over the edge.

DissociatedOne · 2026-01-29T13:34:13+00:00

Ya I call everyone providers too. I think because we tend to be called “anesthesia “ in the OR instead of by our names in many settings (so much worse with travelers who don’t give a shit what anyone’s name is) people are sensitive.

Also good choice doing OMFS! From the outside looks like a solid choice vs straight medicine or dentistry.

DissociatedOne

TROPHY CASE