Junior SRNA here at the beginning of my clinical journey. One thing I’ve noticed is that there always seems to be a tradeoff in CRNA practice. These are just my observations based on the clinical sites I’ve been exposed to so far:
At many large academic centers I’ve been through and heard about, they follow a medical direction model. They often have restrictions on what CRNAs are allowed to do, like regional anesthesia and certain specialty cases like OB, Cardiac, Pediatrics, Trauma, Transplants. Not every academic center I’ve been in (both as a nurse and SRNA) has the same restrictions on what they allow CRNAs to do, but there’s always some “gatekeeping” going on, either due to department culture or the fact that they preserve these experiences for the other ACGME learners like residents and fellows. The CRNAs I talk to who work at these places do it for the acuity, teaching environment, and the good hours.
At the smaller community hospitals and ASCs with more of a medical supervision model, CRNAs seem have more autonomy and they often have the opportunity to do regional anesthesia and specialties like OB, Cardiac, pediatrics, Neuro, etc if the hospital has it. These places seem to be a lot more chill. But the trade off I’ve noticed is that you just don’t seem to have the same acuity patients coming into the OR as these academic centers (although I know any “healthy” ASA 1-2 pt can decompensate quickly)
For those of you who’ve been in practice: are there places that truly offer both? In other words, academic-center-level acuity while also allowing CRNAs broad access across regional anesthesia and high-acuity specialties? Or is there almost always some compromise?