Question from applicant
Dear Dr. Macario,While I was on my rotation at Stanford, I was able to obtain some feedback from the current residents regarding CRNAs at Stanford. I would be interested to have your perspective. As I understand it, there currently aren’t any CRNAs within the department. Do you think CRNAs will have a role within the department in the future? And if so, how do you think it might impact the residency program? Thank you.
Your question is a good one. Stanford anesthesia residents have rotations in 4 hospitals, and two of these hospitals, the Palo Alto VA Medical Center and the County Hospital in Santa Clara, do have a few CRNAs. The majority of the resident’s time however is spent at the main Stanford University Hospital and at Packard Children’s Hospital in which physicians provide all anesthesia care. Most academic anesthesia departments in the United States have CRNAs as part of the staffing for the growing number of cases in the operating rooms. We are currently evaluating whether to incorporate CRNAs in our department. In fact, a survey of our faculty this year showed that many are interested in working with CRNAs.
For those of you in the 2009 NRMP match, that means you’ll finish your residency in 2013 and some of you will practice till 2050. A fundamental question then is: “What will the day-to-day job of the anesthesiologist be in twenty to thirty years?” One model that looks increasingly likely is for the anesthesiologist’s advance medical training to be fully utilized and reserved for the most complex patients. This may require most graduates doing a clinical fellowship (last yr 12 of our 21 graduates signed on for a fellowship – a record high percentage!) to have the subspecialty expertise, in ICU, cardiac, or peds for example, to care for the sickest patients. Along with this, the physician anesthetist will likely supervise nurse anesthetists as part of an anesthesia care team for routine patients. Remember that there aren’t enough anesthesiologists in the country to do all the anesthetics required, so working with CRNAs is commonplace for our trainees after residency even now. Residency programs that do have CRNAs believe that the best learning cases are reserved for the resident. The model we’ve used at Stanford up till now is for the best learning cases to be done by the residents, and the more routine cases performed by attending anesthesiologists solo. The faculty is currently deliberating the role of CRNAs in the department’s future.