Episode 68: CRNAs with Andy Benson

In this episode, episode 68, I welcome our chief CRNA, Andy Benson, to the show to discuss his career path and how we can all work together to provide the best patient care possible.

11 Replies to “Episode 68: CRNAs with Andy Benson”

  1. I was pleasantly surprised to hear a show discussing the educational path and role of CRNAs. Sounds like JH is doing its part to ensure a collegial work environment in the Anesthesia department. Good job guys!

    1. Thanks Reggie. We certainly do our best. I think Andy and I both agree that when we all work together and respect each other we provide better patient care and have a better, more enjoyable environment for everyone.

      Best,
      Jed

  2. Hey Dr. Wolpaw, I know you aren’t getting in to the “politics” of this, but I have a question about the future of anesthesia. When you asked Andy about the future of anesthesia practice, he basically gives a vague answer of “there are going to be more and more advanced practitioners”. I have been told by some staff anesthesiologists that there are places on the east coast, where all of the OR’s are run by CRNA’s, with ONE physician overseeing the OR’s, a physician in the PACU, and a physician in a pre-op type of clinic. Other than that, it is all mid-level driven. I don’t know how true this is, because I have only heard this from word of mouth and have never seen it myself, nor been able to find data if this is the case. I know expecting 1:1 physician to patient is a thing of the past, but is 1:10 OR supervision what the future is going to hold? As a physician in a training program, I hate the idea of becoming staff and never being able to do my own intubations, lines, etc. and instead just watching someone else do them, and giving my stamp of approval. One of the reasons I went in to anesthesia is because I like the procedural aspect of this field, but it seems like this is not going to be something that is done on a day to day basis. I hear all the time that a physician will be asked to do the more “challenging procedures”, etc., but how can you really expect to keep your skills sharp when you aren’t practicing them on a daily basis? These are the thoughts keeping me up at night, and even make me question if I want to switch into a different specialty. I look forward to your insight in to this!

    1. Hi Stan,

      Good question and one that I’m sure lots of folks are thinking. I have to say up front, of course, that what I will share with you is just my opinion. No one knows for sure what the future holds. That said, I absolutely do NOT think that anesthesiologists will be out of work in the future. I have not heard about a 1:10 care model (which isn’t to say there may not be some settings where it may be happening or may make sense). I do believe that the model of a solo anesthesiologist alone in an OR taking care of one patient at a time is probably going away. And maybe in some settings (rural areas for example) the best model might be one anesthesiologist supervising a variety of CRNAs or AAs. But in busy private practices in urban areas and certainly in academic centers, I don’t see this happening. And medicare recognizes this, reimbursing much less for higher ratios than for 1:4 or lower.

      In terms of procedures, I can tell you that if you are at an academic center you will rarely do your own intubations, lines, etc. Your residents or CRNAs/AAs will do them. Not always. There may be some days you work alone, and there may be some days where you step in because it’s difficult and your resident or CRNA is struggling. I know it probably feels to you right now in the midst of your training like you will need to do procedures every day to keep up your skills. I don’t find this to be true. By teaching trainees and doing the most difficult procedures (often after someone else has tried and failed and so now made it even more difficult) I think you will find that your skills actually improve.

      I will say that I think doing a fellowship is a good idea if you have any particular area of interest. It will give you a dedicated year after residency to really work on your procedures and management of cases, which will help solidify your mastery of these things. It will also give you a niche that you can use to specialize.

      If you went into anesthesia because you want to do anesthesia by yourself for healthy people having low risk surgery, then you may find yourself disappointed in the future. But if you like taking care of sick patients having complex surgeries, if you like teaching, if you like working collaboratively and creatively, I think you’ll be very happy with your career. And you’ll still get to do enough procedures to satisfy you and to keep your skills up.

      I hope that’s helpful. Best of luck with your ongoing training!

      Best,
      Jed

        1. Hi Stan,

          I’m currently an AA student and and have rotated in many different hospitals and have seen how different places use anesthesiologists differently. There are still places out there that hire anesthesiologists only and don’t use any mid-level like AAs so don’t lose hope! There are also places where some days the physician will have their own room and some days they will monitor 2-3 different rooms, which allows them to keep their skills up. I have never seen a 1:10 ratio, but maybe it’s more common in places like endoscopy suites.

          And honestly, the presence of an AA isn’t for you to just sign your name on a chart, but it’s to provide an extra set of eyes when caring for the patient during induction and extubation, when the patient needs all the help that they can get. This is especially true when better medicine means sicker patients that are living longer. The best example I can think of was a this hysteroscopy where the patient had an LVAD, it was definitely not a one man type of a case. In private practice, having two sets of hands also speeds things along for greater efficiency so there are frequently times where the AA intubates while the attending throws in a large-bore IV and/or an A-line (and vice versa).

          In the end, if you want to work alone, a fellowship if your best bet. Many hospitals have anesthesiologists only for cardiac cases (non cath lab). Regional is also pretty anesthesiologist specific. Or if you want to be the captain of the OR ship: chronic pain.

          Hope this helps!

      1. Dr. Wolpaw,
        I am very impressed with your podcast and most certainly with your well-rounded perspective. You present current topics in a relatable and practical way… you consult other anesthesia providers and invite their thoughts, knowledge and opinions in an unbiased way.

        Your answer to the physician’s question was also impressive. I find you honest, positive, professional, and collaborative. You embrace the models utilized in healthcare today which ultimately benefits each and every patient we care for. You respect the idea of working together and for this, I respect you.

  3. Glad you did an episode on CRNAs. A couple things I wanted to clarify as an SRNA. There are several prerequisite classes and exams you must take in order to get into a program. You must take organic chemistry, microbiology, anatomy and physiology and you must take the CCRN exam and for some programs the GRE. GPA is extremely important, as well as a goal statement, interviews, and leadership as your guest mentioned. Thanks for your podcasts! They are so helpful, I listen to them on my drive into clinical every day.

  4. I am CRNA who has been a long time listener of your show. Thank you for discussion about CRNA’s and how we practice and interact with anesthesiologist. You brought up some great points that I hope everyone will take to heart. I’ve been doing anesthesia now for 33 years and during this time the conflict between our two professional organizations continues to grow. Which is too bad because I think both groups have something positive to provide to the field of anesthesia and our patients. Keep up the good work.

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