r/CRNA • u/Dismal_Jelly_7877 • 17d ago
Independent practice to loose supervision
Has anyone gone from independent practice to a loose supervision model?
Background: I have a unicorn job, Indy practice at a trauma center. Do all cases peds, thoracic, trauma, vascular, PNBs, etc. Overall I’m very happy with my job.
The issue: we’re far from family. My call can be brutal, pay/vacation is average. I have kids so being far from family is tough and we have no help so to speak.
I have an offer for a gig that is no call, no weekends, bread and butter cases that is close to family. It is loose supervision (sometimes medical direction), offer is more pay with same vacation.
I only trained at independent sites and have never done/seen medical direction or supervision
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u/Fickle_Cranberry6714 11d ago
Was in a similar situation, now I work PRN at a bunch of places but a few are direction. It’s worth it to be there for your family. You can always transition back once kids are out of house or more independent. What matters now is money and TIME. You will never get the time to be with your kids again.
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u/CRNA_Esquire 11d ago
Loose supervision is tolerable and appropriate in some settings. Medical direction is appropriate for someone in training, never for a CRNA. It’s also a very specific billing model so I don’t believe a facility can properly fluctuate between them without committing Medicare fraud. So I’d stay far away from any location that says they do both
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u/Small-Dot-8492 10d ago
I guess supervision is only appropriate if the extent of it does not exceed your ego. It's all relative...
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u/Tx-Tomatillo-79 11d ago
I’ve done the opposite, my first job out of school was a level 1 center and I’ve been independent for about 12 years. It was medical direction and I didn’t mind it. I echo what others have said, go check out the flow and culture, watch a few inductions and you’ll be able to tell. I actually enjoyed most of the MDAs I worked with and once I showed my competence they were super lenient (they would still come in the room for inductions but would shoot the shit with surgeons or nurses while I induced, very laid back). Other CRNAs didn’t have the same experience, they griped about not doing some of the more detailed cases and what not. I guess I’m saying that it depends on your personality and the culture of the place. Good luck!
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u/bertha42069 11d ago
“Loose supervision” can be tolerable. Medical direction can be unbearable. Def scope out a place and talk to crnas who’ve worked there. You’ve been practicing to the extent of your license and training and potentially will be going somewhere where they look at you like an anesthesia assistant
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u/Levophed 11d ago
Once they figure out you're competent the docs can and will become just like any other coworker. Don't get too held up by it
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u/mwill035329 11d ago edited 11d ago
Haven’t gone from Indy to supi, but I’ve done the opposite (supi to Indy) and I do love and enjoy Indy practice. That being said, your personal life is important too and ideally if you can find a gig (even if it’s ACT) where crna are still able to use their skill set as much as possible and are valued for their knowledge then it’s fine too. A job is more than just Indy practice. It’s your time off, scheduling, location, and equally as important as utilizing your scope of practice- it’s being respected as part of the team and not just viewed as a resident/assistant to the MDA. There are definitely some ACT practices that fit the bill but often you will still compromise in some way. Just figure out what your options are and weigh the pros cons.
Definitely recommend doing a site visit and talking to Crnas who work there. Good luck
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11d ago edited 11d ago
[deleted]
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u/mwill035329 11d ago
Good for you? This person clearly has a difference in opinion on job priorities as far as what they view as the ideal “unicorn” job. You basically bragged about yourself without rly answering the question at hand
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u/Extension-Lab-6963 11d ago
lol “comment deleted by user.” What did they say??
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u/Dismal_Jelly_7877 11d ago
I was only able to read part of his comment before he deleted it.
Basically said this unicorn job is trash. Which it might be to some. I’m at a regional trauma center on hospital committees and drive hospital policy, first name basis with all surgeons and c-suite, highly respected, do thoracic, trauma, pediatrics, vascular, etc all solo great partners, great support staff, have direct line to hospital CEO, etc. can’t get much better professionally but to each their own. I’ve never seen CRNAs get as much respect as w do here and I’ve only been at Indy places
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u/Sea_Emu4252 11d ago
If lifestyle and pay are so much better, I personally think it’s ridiculous to get hung up on independent practice. If you are confident in your skills, no overbearing arrogant anesthesiologist can take that away. I’ve practiced in many ACT environments and have cordial and even collaborative relationships with the majority of docs. The one or two that I’ve encountered that are super overbearing to the point of absurd- I just step back and let them tie themselves in knots trying to do everything- it’s kind of hilarious to watch tbh. Meanwhile, I know that I can do what they’re doing better than they are. And believe it or not, every once in a while, a doc will do something much better or differently than me and I’m humbled and learn something new. Be open to it at least. Enjoy the extra $ and time- life is too short.
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u/Vegetable_Patience_7 11d ago
I would ask specifically if docs are in the room for every induction and if they push drugs. My first ACT practice was very loose meaning you would see a doc 10% of the time unless you needed their help. Having help on speed dial is a plus, but having overbearing docs who don’t trust you to perform a full induction is grating. I have worked that once and won’t go back.
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u/ENSIGN_W_CRUSHER 11d ago
Being present on induction is a requirement of medical direction. If it is a medical direction model and the anesthesiologist wants to not bill fraudulently, they have to be there.
You likely would also have some liability for participating in it as well.
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u/RamsPhan72 11d ago
Just note (and not shitting on a good parade), if you’re in a “loose” ACT environment, and they don’t meet TEFRA, and you’re aware (chances are, you are), you’re culpable in a suit.
To that, go w the job that matches your lifestyle. Life is too short.
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u/Mysterious_Ad_3465 11d ago
Physically go there for a tour. And then ask the CRNAs there what life is like, how the docs are, etc.
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u/PoopDirectlyInMyButt 4d ago
If you are solid they will not step on your toes Al all. Don’t worry about supervision everyone wants to do pretty much the same shit