View Full Version : Anesthesia Care Team is a Joke
I visited with a CRNA friend today and had a very interesting conversation. She works in an Anesthesia Care Team in about a 200 bed hospital. All of the CRNAs are hospital employed and there are 2 MDAs who are not employees of the hospital. The MDAs bill for supervision and get to keep all of the money. The even bill at night when they are not there, but supervising from home. So they are making big bucks, doing little work and the hospital has to pay the CRNAs. My friend just heard that the MDAs are also getting subsidized from the hospital for managing the anesthesia department, also get free lunches and parking. CRNAs have to pay.
MDAs are always drinking coffee, reading newspapers, talking to their stock brokers or on the internet in the anesthesia office. Hardly ever in the OR and when they are, they sign the chart and are useless.
What a fraud.
Had to vent.
08-24-2006, 07:49 PM
You do like controversy don't you?..;)
You are citing one incidence of one practice. Yes, their practice is very lame. The MDAs are obviously not following the TEFRA requirements for reinbursement of services and can be indicted for Medicare Fraud if turned in by anyone who has witnessed this behavior.
My ACT is different. I'm employed by the hospital too. 50% of the anesthetic fee goes to the hospital and 50% goes to the anesthesiologists. They are always in house when cases are going on. There definately isn't any "at home" medical direction. Yes, they do spend an inordinate amount of time doing extra-curricular activities during cases done by CRNAs but that's the name of the game for them. They are always available should you need a second hand, second opinion or there is an emergency situation.
There are many practice options opened to CRNAs. That's why it's such a great job. Choose what makes you happy.
08-25-2006, 09:15 AM
I completely agree with skipaway. You are in a bad practice and unfortunately these situations do exist.
Our ATC environment is very nice to work in. All TEFRA requirements are met and the MDs are always around intra-op if needed. They will stick their heads in during the case and ask if we need anything, medically or personally. They themselves will offer to give a break to the senior SRNAs or CRNAs if the boardrunner is running behind having available people for AM or PM breaks. Obviously this is quite hard to do during the busy times and meeting TEFRA regs, but they do it. Say a request comes up for a drug or the MD wants to give something that isn't normally stocked, these guys will go and get it for us.
The market is yours. You certainly don't have to stay where you aren't happy with the job situation.
08-25-2006, 03:46 PM
there are pro's and con's to every and any practice - and unfortunately just like the previous posters - it sounds like your friend is in one w/ all the cons -
i practice in a medically directed practice - and i would say that 97% of the time it is as autonomous as it gets - you will always find "those" people who just like to exert control regardless of if it is appropriate or not... but if you are in a solo practice you have the downfall of NO back up - which is a significant risk you must 1. have the confidence to do and 2. have the skill to back up the confidence and 3. be willing to assume any and all responsibility when it doesn't go right.
there are good team practices out there - just make sure to find them BEFORE you sign on!
08-25-2006, 07:29 PM
Now for a message from the uninitiated ;)
Let me play devils advocate here for a minute.
Isnt there something wrong when a supervising physician typically does less actual work and makes more than the 4 CRNAs he/she "supervises" combined?
It seems that there is little (if any?) true oversight how these "teams" are run. That being the case, you essentially seem to have ONE guy who does little but makes a fortune. Secondly, the fact that they arent running cases suggests (like with anything else) their skills are fading without use. Is that the backup you really want?
While there isnt an "I" in Team... there is definitly a "ME" and that seems to be the MDA based on work expectation and pay.
08-27-2006, 07:55 AM
Emme, I understand your fustration. It sounds like abuse of the system. There are better practices out there. If those CRNAs know what is going on and are happy then it's hard to argue. If they are not happy and choose to stay, then they have themselves to blame for encouraging the practice.
Even in solo practices, there is often help nearby if you need it unless it's a 2 CRNA contract where one is at the hospital and the other at home. Many times you can delay or stall a case and help out a colleague on an expect difficult airway. If you have a good working rapport with your surgeons, then they usually won't fuss.
Also with the help of a good circulator, you can tackle most problems you run into.
Also I've always tried to be as self sufficient as I can. Not saying I don't need help or don't want it. I will never hesitate to call for help, but I don't want to be dependent on another anesthesia provider. I don't always call them in when there are problems. I will typically try to solve it myself and tell them about any issues later if need be.
Now if the problem may be too big for 1 person, then I make sure I have backup equipment and help nearby or in the room prior to initiating anesthesia.
I agree with people here. Be a part of the practice model that makes you happy. There are definitly pluses and minuses to both and there are both practice extremes that are not healthy work situations. Depending on your MDAs, ACT can be very rewarding, especially when you just get out of school and still green. Even if your Docs don't work much, they have many years of experience that you can learn and benefit from.
When you graduate, you have a lot of head knowledge but less clinical experience. You know how to provide basic anesthesia and fix some problems. It takes years of practice and lots of cases and problems, in order to develop and improve your problem solving skills.
Despite how much you don't like the ACT model or your MDAs, when they help or bail you out of a problem, you'll be thankful they were down the hall having coffee.
08-27-2006, 01:40 PM
Nicely said tran
I guess what im wondering is, why does it have to be an MDA and not a Senior CRNA?
The essence of ACT practice seems to be the MD at the center of the decision tree. Does it really need to be an MDA? Why cant it still be an ACT practice with a CRNA at the center as a resource?
Thats where the politics come in.
The practice I described was not mine, but that of a friend. I posted it in response to her frustration and sense of futility.
From what I remember, there may be some billing fraud issues involved. Yoga, any thoughts?
It seems like most of you have adapted to that particular model and are comfortable with it. It is not my way of practicing and I agree with Mike about having another CRNA assist you.
I guess I just have a problem with dishonesty and don't want to be associated with it. The old adage of "guilt by association".
08-27-2006, 07:56 PM
Hey all, I just edited my post to say GRNAs with a lot of head knowledge and less clinical experience instead of "little clinical skills". Poor choice of words on my part and it really upset at least one member. If anyone knows me, they know I'm not arrogant or puffed up. I'm always 1st to admit fault and mistakes. We are all here to learn from one another, CRNAs, SRNAs and anyone else who wants in.
Mike, if you are working in an ACT model, then you are welcome to call in any bystanding anesthesia provider whether it be a CRNA or MDA. In an emergency, all who are available should respond anyhow. However do let your MDA know as well. He/she will be pissed if they find out later there was a problem and you didn't bother to notify them. It will hurt their ego and he/she may see it as extremely disrepectful. Also many CRNAs/MDAs also hesitate to get involved in cases not assigned to them, unless it's an emergency. Try asking people questions about cases they are not directly involved and many just seem to shy away.
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