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  • Anesthesiologist vs CRNA Training hours: The Truth



    ASA Claims of 12000-16000 hours of training and that CRNAs get an average of 1651 hours.

    Lets start with the ASA Claims of 12000-16000 hours


    So if they meant their residency in anesthesia that is only 3 years which is a total of 26,280 hours counting every hour in that 3 years.


    • With their claim of 12000 hours that would mean they would have had to work 11 hours every single day for 3 years straight. (365 x 3 = 1095, 12000/1095 = 11/day)
    • With their larger claim of 16000 hours they would have had to work 14.6 hours every day for 3 years straight. (365 x 3 = 1095, 16000/1095 = 14.6/day)


    Now if they consider the hours of their intern year (PGY 1) which has nothing to do with anesthesia it might be a little more possible but still outrageous.

    • With their claim of 12000 hours that would mean they would have had to work 11 hours every single day for 3 years straight. (365 x 4 = 1460, 12000/1460 = 8.2/day)
    • With their larger claim of 16000 hours they would have had to work 14.6 hours every day for 3 years straight. (365 x 4 = 1460, 16000/1460= 11/day)


    So when we review their clinical gross hours it is still quite unreasonable that they could possibly do 12000-16000 hours in either 3 OR 4 years (if we include the irrelevant intern scut monkey year). This would mean:

    · They never took vacation
    · They never took a day off for other educational opportunities (conferences, lectures etc)
    · They never had a SINGLE DAY OFF during residency and intern year.

    What we know is that the RULES say a resident cannot work more than 80 hours in a week. That is the rule. Therefore:

    • 3 years of residency straight through maxing the 80 hours a week would be a total of 12480 hours. (52 wks/year x 80 = 12480).
    • This assumes no days off, no vacations, working an average of 11.4 hours PER DAY 7 days a week.


    Again this does not appear reasonable or possible.

    Per the UNC chapel hill residency program (https://www.med.unc.edu/anesthesiolo...y/copy_of_FAQ) here is what they say residents ACTUALLY do:

    · Average 55 hours/week
    · 2-3 weekends off a month
    · When not on call, residents are typically relieved from the OR by 4:30pm
    · 3 weeks off each year (15 working days) (weekend off before and after for 9 days off in a row)

    • 5 sick days/year
    • 5 days each year for attending national meetings and conferences

    · Each resident will far surpass the minimum number of cases required by the ACGME and can expect to do more than 1,200 cases during their three years of Anesthesiology training. THERE IS NO CASE MINIMUM.


    So now lets do the math with that information.


    · 365 days a year – 5 sick days = 360
    · 360 – 5 meeting days = 355
    · 355 – 15 weekdays of vacation = 340
    · 340 – 48 days (2 weekends a month off) = 292 or 340 – 72 (3 weekends off) = 268

    So what we see here is that a resident could only possibly work between 268-292 days in a year and that depends on how many weekends off they get per month (2 or 3). So to be fair we will average the 2 and call it 280 days worked a year. Now lets do that math.

    · 280 days per year worked / 7 days a week = 40 weeks worked a year
    · 40 x 55 hrs/week = 2200 hours worked per year.
    · 3 years x 2200 hours = 6600 hours worked during residency.

    What we see here is the REAL amount of clinical time gained during an anesthesia residency. This 6600 hours does not include all the time spent at M&M meetings, resident meetings etc. However, we will forgive that and pretend that a resident spends 6600 hours in anesthesia clinical time over 3 years. We are also not removing the hours which could be spent during residency doing an ICU rotation.

    What we now have to consider is how many cases residents do. The UNC program said more than 1200 cases in general for their ENTIRE residency. It is difficult to get exact numbers but the Stanford program does give averages which one can assume since most do not are higher than the average program. (http://med.stanford.edu/anesthesia/e...residency.html)


    · Stanford: 600 anesthetics in the first year, 400 cases in each of the next two years
    · That is a total of 1400 cases

    A resident has an average of 6600 clinical hours in their entire 3 years so then one must do the calculation to figure per case hours.

    • If they counted hours like CRNAs do (time in the OR only) then the average case time would be 4.71 hours. (6600/1400 cases).
    • Clearly this is not the case, so one must conclude the 6600 hours are simply hours IN the hospital as a resident not actually doing cases.


    So now lets look at CRNA education and do the same calculation.

    · CRNAs are required to have a min of 600 cases in their training period
    · Many Student CRNAs average 900 cases (like Stanford this is the higher end)
    · CRNA programs are 2.5-3 years in length

    Out of the 2.5-3 years of a CRNA program 1.5-2 years are spent in the OR doing cases, lets use the same numbers as UNC therefore:

    · 280 days per year worked / 7 days a week = 40 weeks worked a year
    · 40 x 55 hrs/week = 2200 hours worked per year
    · 1.5 - 2 years x 3300 – 4400 hours during a CRNA training program

    What are some caveats?

    • CRNA programs do not rotate 1-2 months in ICU but residency programs count these hours.
    • CRNAs come in with a minimum of 2080 hours of work experience (1 year full time) which would bring the “clinical hours” total up to 6080. The average CRNA has 2.5 years experience prior to anesthesia school which would push it to 5200 + 4400 = 9600 hours of ‘clinical hours’.
    • CRNA programs currently ONLY count hours doing an anesthetic not the time you are waiting between cases or just being in the facility (the MDA programs count it all)
    • It is clear that the ASA has chosen to count all the education from beginning of med school (and possibly pre med) to the end of residency (to reach 12000-16000 hours) and yet they do not count the same for CRNAs to minimize numbers
    • These calculations do not include holidays where less providers are needed in the OR and therefore many residents and Student Nurse Anesthetists could be off.


    Conclusions:

    • The ASA claims of 12000-16000 hours of anesthesia training are considerably exaggerated
    • The ASA claim that CRNAs only get 1651 hours is impossible
    Comments 10 Comments
    1. Nilefried's Avatar
      Nilefried -
      Is there any way to make the ASA accountable for these huge discrepancies in hours? It seems like they intentionally fudged the numbers in order to make the claim "Physician anesthesiologists complete 10 times the clinical training of nurse anesthetists," as seen on their when seconds count media campaign.
    1. ADMIN's Avatar
      ADMIN -
      No there isn't, except to confront their lies with the actual facts. Which is what we did
    1. mpkowal's Avatar
      mpkowal -
      Excellent calculations. Very well done! I remember spending 12-14 hours per day in class followed by doing cases, and seeing patients for the next day. All this while MD anesthesia residents would be long gone.
    1. niceshotman's Avatar
      niceshotman -
      not to start another dick measuring contest but i need to clarify the training hours that anesthesiologists undergo (I graduated anesthesia residency in 2014-we had duty hour rules to abide by). At my program we had 4 weeks vacation per year and including intern year this was 4 years. The average week was about 65 hours per week. 48 weeks/year x 65 hours/week=12,480 hours. We had some weeks of 90-100 hours but mostly it was a lot of 60-65 hour weeks. ICU call and intern call was always 27 hours (24 treating new patients/3 hours rounding). Anesthesia call always 24 hours in house. Call could be anywhere from q3-q5. 1-2 weekends/month. typical day was 7 am until 6pm (we weren't allowed to log hours for setting up OR early morning-you start the clock when you see your patient-that was the rule to avoid violating ACGME duty hour laws). We had SRNA program at the same hospitals with us. SRNA hours may vary from program to program but they only worked M-F, no call and usually out at 3:30. From my experience there was a huge difference in training hours.
    1. niceshotman's Avatar
      niceshotman -
      Def a lot of "scut work" as intern but a lot of solid training too. I will never look back at that year as wasted time or just scut work. Learning medicine, pathology and co-existing disease-I still use this knowledge perioperatively. I learned a ton of medicine from the senior medicine residents and attendings. A lot of the time was admitting medical patients from ER. At night just senior resident and Intern in house-very little downtime. Most of the night doing admissions, running codes, treating problems in the ICU-every night was an adventure. For the first time making decisions on my own when senior resident unable to help me. We learn how to take care of multiple critical patients at once in the unit so when running the unit as senior anesthesia resident we are ready. Also, making tough medical decisions not only in ICU but running the medical floor too. Remember that intern year is 1/3 of an internal medicine residency. I walked away from that year much more comfortable with critical patients, learned a ton of medicine, and pretty solid at lines and intubations too.
    1. cook26's Avatar
      cook26 -
      The school I'm in (SRNA), we work 50-55 hours a week. Some days are done at 3, others go until 7 or beyond. We work plenty of call; there is a resident and an SRNA on call and we alternate cases. There are also a great deal of 12 hour shifts on Saturday and Sunday.
    1. subee's Avatar
      subee -
      Niceshotman: Feel free to continue with dick measuring. It was low blow to identify the intern's year as scut work...just as silly as comparing ICU experience as anesthesia training.
    1. niceshotman's Avatar
      niceshotman -
      Something that I had forgot to add was that more and more physicians are doing a fellowship after completing residency (I did cardiothoracic). 65 hours/week for 5 years (48 weeks/year)=15,600 hours. Like I said before, a 60-65 hour week is the routine average week, sometimes the hours could go much higher than this depending on the call schedule. The cardiothoracic department was treated almost as its own residency program with its own rules-you round everyday in the unit, you don't skip cases to go to lecture, you finish every case you start, and you stay in hospital until the hearts are done. Hours could add up to 90+ and frequently did. I never felt like this was "scut work" as I ended up staying an extra year to compete the fellowship after graduation. I trained many SRNA as a fellow and as an attending before leaving academia for private practice. I will tell all of the SRNA reading this what I told all of my students-don't just do the minimum number of hearts needed to graduate (I think it was 5 hearts required for the SRNA) I'm pretty sure some of my SRNA students only did the minimum to graduate while many of the residents usually had 40-60 by graduation (they were required to spend 2 months on cardiac service in addition to getting emergency hearts at night throughout residency). Spend as much time getting the experience as you can even if it means staying much later than required by your program. It is easy for me to tell the difference between the students who have put in the hours to get the experience vs the ones who haven't.
    1. yankeern's Avatar
      yankeern -
      Quote Originally Posted by niceshotman View Post
      Something that I had forgot to add was that more and more physicians are doing a fellowship after completing residency (I did cardiothoracic). 65 hours/week for 5 years (48 weeks/year)=15,600 hours. Like I said before, a 60-65 hour week is the routine average week, sometimes the hours could go much higher than this depending on the call schedule. The cardiothoracic department was treated almost as its own residency program with its own rules-you round everyday in the unit, you don't skip cases to go to lecture, you finish every case you start, and you stay in hospital until the hearts are done. Hours could add up to 90+ and frequently did. I never felt like this was "scut work" as I ended up staying an extra year to compete the fellowship after graduation. I trained many SRNA as a fellow and as an attending before leaving academia for private practice. I will tell all of the SRNA reading this what I told all of my students-don't just do the minimum number of hearts needed to graduate (I think it was 5 hearts required for the SRNA) I'm pretty sure some of my SRNA students only did the minimum to graduate while many of the residents usually had 40-60 by graduation (they were required to spend 2 months on cardiac service in addition to getting emergency hearts at night throughout residency). Spend as much time getting the experience as you can even if it means staying much later than required by your program. It is easy for me to tell the difference between the students who have put in the hours to get the experience vs the ones who haven't.
      It seems like you went to a good program. Not all are like that. The one at my hospital the residents leave by 3 and when they do call they are in our not very busy OBN, the CRNAs do the trauma. As far as counting hours for clinical SRNAs can only count the actual hours in the OR, not the total hrs. In the hospital, that is were your numbers are misleading. If a SRNA was at the hospital first 12 hrs but was only in the actual OR for 6 hours let's say they can only count the 6 hours not the whole 12.

      Sent from my SM-G935V using Tapatalk
    1. makawka's Avatar
      makawka -
      I finished anesthesia training in 1983. I had done 10 baby hearts in my program and that did not include the adult hearts that I was able to do. Upon graduation, I worked at a major medical center in the golden ages of heart surgery where we easily did 3 cases a day in 4 heart rooms (sometimes 5 rooms!) with 2-3 rooms staffed with CRNAs, 1-2 with residents, and an attending ratio of 2 heart rooms, one with a CRNA and one with a resident. Most often, the attending was involved in teaching our residents while the CRNAs were left to our own devices coming off bypass. The collegiality was so much more intense between all of us because we were so busy! The first heart was outside the door at 0600 and we would race to see who could get the lines in first. Everyone worked hard and there was a minimum of the afore mentioned measurements (niceshotman).

      All of this argument from the new and whinier old physicians over who has how many hours in training is actually a moot point in that in this business if you are not a lifelong learner you will be a terrible practitioner. Your training never ends if you are a quality anesthesia provider so who thought that you stopped learning when you left your training program? Like many of my colleagues, I work two jobs now with well over 60 hours per week in the hospital - not including call. Over the last 38 years that's a lot of clinical hours!

      Thanks to the GME limitation on residency hours, CRNAs are looking better all the time! The residents are out doing non anesthesia stuff, posting it on Facebook, and the SRNAs are staying late and picking up the great cases! I work with students from 3 University SRNA programs and I will say that as it has always been, the student who puts in the most hours gets the most out of their program and is the most likely to continue to excel when they go out into practice. I do not feel that we need to compete with any other providers. Our safety record speaks for itself.