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Thread: Want to Join The Profession? Think Long and Hard

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  1. #1
    Join Date
    Sep 2006

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    Default Want to Join The Profession? Think Long and Hard

    This is probably going to be the most negative post I have ever written to potential applicants to CRNA schools. While I will admit that there may be some subliminal, selfish, personal reasons for writing this, that isn’t my real goal. I’m trying to do what I have always done. Be up front and honest about the profession and your chances for becoming not just a CRNA, but a happily employed CRNA. Things have changed in the profession, and you need to be fully aware of what you are pursuing.

    Let me start by telling you that I have been a CRNA for 10, almost 11 years, and I love what I do. I love the interaction I have with patients, and to a more limited extent, with their families. I love the daily challenge of anesthesia, and I love learning new techniques, I love the variety in my day to day employment. That said, I’ve seen some troubling developments in the last several years. Let’s start with the realities of schools. I’m not going to talk about any specific schools, and when I talk about things I’ve seen, I won’t reveal what schools I’m talking about, so don’t ask.

    There has, in the last few years, been an explosion in the number of schools that offer CRNA programs. There are a couple of reasons for this. When I started school in 1999, there were far fewer schools, and our profession was facing a critical shortage of CRNA’s. Competition for the few school seats was tight, and schools were able to select only the best candidates. That situation has completely reversed. Now, the schools are competing for candidates to fill the seats. As a result, many folks who would not have even made it to the interview stage 12 years ago are being accepted into schools. This isn’t meant to be nearly as elitist as it sounds. The fact is, both the students and the profession are being done a great disservice in the overall process. Let me explain:

    First, there are “CRNA mills” that accept as many as 120 students per class. If they could graduate that many (which they can’t), they would long ago have completely killed the job market in a wide radius around their location. So, how do they avoid doing that? Well of course, they accept students from other areas, knowing these students are likely to go “home” after graduation. But there is another built in safeguard. I’ve heard of more than one of these mills that accept more students to start the class than they have clinical sites to support. In other words, while they may initially accept 120, they have only 80-100 available spots with the didactic phase ends and the clinical phase begins. That means in the intervening time between acceptance and clinicals, they must lose (i.e. flunk out) 20-40 students. Think about that for a minute. This means that the school has no incentive to help the struggling student, the student who is just not getting it. In fact, these schools have a strong incentive to not help these students in any meaningful way. Get into one of these programs, and you are competing with 120 other students for a professor’s “office hours.” And the closer a class gets to the clinical phase, the less incentive the school has to help the struggling.

    This leaves a number of RN’s, forced to return to jobs paying RN salaries, with anywhere from one to three semesters of CRNA school debt. So, why would they accept more students than they can train? Well, no one has ever come out and said it to me, but I have my own opinion. CRNA education is expensive. Very expensive. The more students the school takes in, the more money they can make, which is the school’s ultimate aim. So, if they can get 120 students, knowing they will have to drop 20-40 students, that’s OK. They will at least get up to half the program’s tuition out of those students they are “forced” to flunk out.

    But the smaller schools have their problems, too. The explosion of schools has greatly increased the COA, the body that certifies CRNA graduate programs. While members of that board my say differently, I contend that the increased workload has created a situation whereby weak schools are able to get by with little or no notice. Right off the top of my head, I can think of two programs that have opened since I started practicing whose students I have trained have just been weak across the board. Every student, in every situation. I know of more than one case where these students have graduated, passed boards, then had difficulty keeping a job because they simply could not keep up, could not practice independently enough, even in an ACT environment. And while I have no evidence, I think there is a great potential for these folks to get sued.

    The job situation isn’t great, either. A changing economic climate, coupled with the increased number of seats available has vastly changed the employment landscape. When I started, it was projected that as many as 50% of active CRNA’s were going to retire in the next 10 – 15 years. That, coupled with the low number of graduates that were coming out yearly, meant a CRNA could “write their own ticket.” Jobs were plentiful, anywhere one wanted to work. Salaries were climbing fast, and sign on bonuses of $20,000 or more were common.

    But, owing to huge losses of retirement savings in the economic crash, most who were projected to retire have stayed in the work force. Couple that the increasing number of people coming out of school, and the employment picture has turned 180 degrees around. Salaries have stagnated, and are falling in some places. Look around this board. There are very few to no jobs to be had in California, Colorado, and other states. Look at just one example (you might not expect).

    In Tennessee and Arkansas, when I first moved to the area in 2004, jobs were literally everywhere. Now, there are no fewer than 8 schools in the area producing CRNA’s. Jobs in both states have almost completely dried up. I’ve even heard a rumor that CRNA’s have been laid off in Chattanooga. I just now checked Gaswork, and there are three jobs available in Tennessee, one for a Chief CRNA. There was only 1 in Arkansas, at an endoscopy center in Little Rock. I work with a CRNA in Texas now who is a new graduate from Little Rock. She did not want to leave the area, but there just weren’t any jobs available.

    Salaries, as I’ve said, have stagnated. In many urban areas, salaries have even gone down, particularly for new graduates. Raises are non-existent. I make exactly the same base pay now as I made in 2004, but other forms of compensation (i.e. overtime, call pay, etc) have decreased pretty dramatically. If you want to be a CRNA, don’t plan too much on finding a job where you go to school or do your clinicals.

    The upshot is this: if you want to be a CRNA for the challenge, for the increased knowledge, then I encourage you to go for it. But if, upon graduation, you will be tied to a particular spot, especially if that spot is where you are going to school, or where you are going to do your clinical rotations, do your due diligence. Make sure there will be a job for you. Get a commitment, if you can (unlikely). Think long and hard. I know more than one CRNA who feels stuck in a suck job because they can’t (or won’t) move. I know others (some on this board) who simply cannot find a job in a place they want to live.
    Last edited by kmchugh; 03-17-2012 at 08:07 AM.
    I gotta go where there ain't any snow; Where there ain't any blow; Cause my fin sinks so low; I gotta go where it's warm
    How's that hopey, changey stuff working out?

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