CRNA Debate from www.studentdoctor.net - page 8

hey guys, it's me again! this is a debate that is going on in the resident forum of www.studentdoctor.net . brett the poster is listed above his\her comment ... Read More

  1. by   Montague
    I couldn't agree more. Die thread die!!!!!!!!!!!!
  2. by   Sheri257
    What's the big deal? I didn't know about this thread, but found it to be a fascinating read.

    Kevin is always worth reading, and I also thought David's recent post made some excellent points that I didn't see from anyone else, and I read entire thread.

    So shoot me for bumping up this thread, but there's a lot of valuable information here.

    And BTW, this thread may be 18 months old, but they're STILL talking about this over at studentdoctors.net. The last post was just five days ago.

    I say this not to fan the flames, but I personally would like to see continued CRNA input on this issue, since this seems to be an ongoing concern for some future doctors.

    So what if it gets personal at times. It's still quite informative for those of us who are interested in learning about these issues.
    Last edit by Sheri257 on Dec 31, '03
  3. by   Passin' Gas
    On reconsideration of my earlier post, yes, there is valuable information in this thread.

    The plea to let this thread lie in peace was a knee-jerk reaction to spending time reading the entire thread and tiring of the less mature comments that are in great abundance. The thought-provoking, insightful comments from Kevin and a few others do enlighten many aspects of this complex, and often emotionally charged, issue.

    Overall, this forum does a great job of maintaining a professional demeanor in the discussions.

    The second reason for my plea: dneill01 addressed his comments to 'halothane'. This individual is a participant on studentdoctor.net, not this forum (hopefully). Just hit me wrong. Guess my caffeine titers were low....

    PG
  4. by   hbscott
    I just thought his post was a follow up of an albeit dated thread but still relevant topic. I can see how it can be hard for some not to respond in anger but the issues noted above still exists in anesthesia practice today. My hospital just got out of a very nasty "political" fight between the CRNA's and MDA's which resulted in several resignations and one firing.

    Student Doctors (who may be immature, lack experience, etc.) are not the root cause of this "turf fight" in Anesthesia.

    -HBS
  5. by   Sheri257
    Originally posted by hbscott

    My hospital just got out of a very nasty "political" fight between the CRNA's and MDA's which resulted in several resignations and one firing.

    Student Doctors (who may be immature, lack experience, etc.) are not the root cause of this "turf fight" in Anesthesia.

    -HBS
    You mentioned this on the other thread. What happened? Are you at liberty to say?

    I'm fascinated not just with the politics of this thing, but what's happening in the marketplace, so to speak, since that seems to be the bottom line here.
    Last edit by Sheri257 on Dec 31, '03
  6. by   hbscott
    Originally posted by lizz
    You mentioned this on the other thread. What happened? Are you at liberty to say?
    Without getting into particulars, the Chief of Anesthesia Service (MDA) directed that CRNA's could not work unless under the direct supervision of an MDA. The senior CRNA objected stating that CRNA's could work independently with limited supervision. This set into motion a chain of events that resulted in the firing and resignation of several anesthesia personnel secondary to a "hostile work environment" lawsuit brought against the anesthesia department by a CRNA.

    It was very ugly and there are some very raw emotions and deep wounds still being felt in the department.

    -HBS
  7. by   Sheri257
    Isn't the supervision required by law, unless the state opts out?And has D.C. opted out or, are they treated differently?

    (I used to live in D.C. and vaguely remember the home charter thing.)
    Last edit by Sheri257 on Dec 31, '03
  8. by   hbscott
    Originally posted by lizz
    Isn't the supervision required by law, unless the state opts out? And has D.C. opted out or, are they treated differently?
    (I used to live in D.C. and vaguely remember the home charter thing.)
    This is where I have to be careful about revealing certain facts in order to protect the innocent so to speak. But where I practice the law is different in regards to defining "direct supervision" Versus "under supervision" and this language is what started the battle between the CNRA's and MDA's at my institution.

    It was all so very sad.

    -HBS
  9. by   Alnamvet
    If the comments made about nurses in general are being made by MD students, than I have only three words for them: PISS ON THEM!!!
  10. by   odrnusa
    originally posted by meandragonbrett
    hey guys,
    it's me again! this is a debate that is going on in the resident forum of www.studentdoctor.net .

    brett

    the poster is listed above his\her comment
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    debakey
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    anesthetists are seeing their salaries soar according to usa today, any comment
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    trg2002
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    here's the article...

    http://careers.usatoday.com/service/...e-anesthetists

    it's a shame that it has gotten this far.

    interesting quote by the crna in maine.

    -trg
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    debakey
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    thanks for posting that article, does anybody else feel that anesthesiologists are going to see their salary fall even lower?
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    moz
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    in the recent us news and world report issue for best graduate schools, they state that anesthesiology is one of the three hottest specialties to go into. the reason being that people made lots of money in the stock market during the 90s and are electing to have more cosmetic procedures done thus increasing the need for anesthesiologists. i think as the number of surgeries increase in the us the demand for anesthesiologists will increase and so too their salaries. crna's provide a valuable service but i don't think they can make anesthesiologists obsolete. as a physician you always will have more training than a nurse and a better understanding of the inner workings of body which will help in providing better care for your patients.
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    analu
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    wow, sure hate to have emergency surgery in some rural area in iowa, nebraska, idaho, or minnesota!
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    bigfrank
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    i have a close friend who just graduated from crna school. he is, literally, competing with mdas for jobs and - surprise! he just landed a job in kansas city making $140k/year with $25k/year being put away in retirement for him.

    i'm not saying that mdas are going to be losing jobs in the near future, but finding good jobs in urban areas is going to get tougher and tougher. period.
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    the pill counter
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    i guess i'm just an idiot for spending nine years of my life and a small fortune on my education.
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    halothane
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    its simply ridiculous, crnas in a little town where my uncle is an internist make over 200k....more than the fps, peds, psychs and internists. and all they have is a couple of years of graduate education. and go look around on the websites of crna schools, they spend most of the time in theory.....learn pharm physio etc. during the crna courses!!! compare that to a mdas 4 years of clinical work and his sound background in the basic scienses and intermal medicine. crnas donno anything and they are avoided when it involves complicated procedure. u penn has established that mortality is higher if crnas work unsupervise...not suprised, nurses doono enough pham, micro and internal med.

    besides crnas were supposed to drive down the cost of healthcare...not become competition to physician salaries. these guys are so rotten they do not want the training of anesthesia assistants so that they can keep making their money......and have no concern for quality of patient care. most are in it for money and now becoming a crna is nice shortcut to make a physicians salary without medical school.

    funny...even canada does not have crna....god save america from the attack of the para medicals. soon we will have people taking 2 years masters to become primary care physicians( like the greedy nps want to ).
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    esu_md
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    i would put myself up against any anesthesiologist in the country," says nurse anesthetist roman dashawetz

    comments like this are exactly the type that cause alot of dissent among physicians. crna certainly has a big role, but there are simply not as trained as a physician.

    i am personally offended to hear a nurse talking like that and am sure that a ca-2 can better manage any anesthesia problem better than any type of nurse "practicioner"

    sounds like this guy has med school envy
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    johnm
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    quote:

    i would put myself up against any anesthesiologist in the country," says nurse anesthetist roman dashawetz"

    end quote

    i think that this guy is probably an exception, and there is no need to have a fit over it. mda's still make a lot of money, and always will. there will always be enough jobs - too many in fact, which is why small towns need crna's to fill the gap.
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    drfeelgood
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    i've run into a fair share of cocky crnas. yeah some of them are good, b/c they've done a procedure 300 times. it's situations that are 1 in 5,000 that i'm worried about. situations where unexpected things happen....

    i've even had one tell me that i was wasting my time going to med school.

    a lot of anesthesiologists are sell-outs too. i had one tell me that he never plans on doing a case all by himself b/c he'll just have his crna (man-*****) do it for him. what's up with that??

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    trg2002
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    quote:

    originally posted by drfeelgood:

    "i had one tell me that he never plans on doing a case all by himself b/c he'll just have his crna (man-*****) do it for him. what's up with that?? "

    end quote.

    it is exactly that same attitude that got us where we currently are.

    just wondering, but how much do aa's make? (anesthessia assistants)....they serve the exact same purpose as a crna in the majority of situations. my guess is not as much as crna's make....why is that? they're doing the exact same thing...

    -trg
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    painman
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    i for one think it would be great to monitor 2-3 crna's doing healthy cases while picking up 1 complex case a day. they can earn me as much as they want!
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    kimya
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    why do people get so offended that a nurse specialty is making more than some doctor specialties? some lawyers make much more than doctors with a similar amount of schooling time to crna's. bill gates is raking in the dough without even doing college.

    i think all specialties should be paid more, including doctors. however, many of the other health care professions really have gotten the short end of the stick salary-wise for a long time. they deserve just compensation too. i don't begrudge someone making good money "just because they didn't go to school as long as a doctor". fact is some specialties get paid a lot more. i thought people weren't going into this for the money, but because of their love of the profession?
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    ryo-ohki
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    yeah, i just get mad when they can provide more to their children and spouses.

    it seems like the #1 graduate from hms in his fourth year of residency will make less then a common crna. that is wrong.

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    dr. cuts
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    drfeelgood
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    kimya.... (hope you got your asbestos suit on cuz here it comes!!!!)

    it's not all about money. it's about the way americans have settled for the cheaper alternative. we're being invaded by middle-men. i heard kaiser is now starting nurse endoscopy school...so watch out all you budding gi docs. what next??? residency training for the primary-care pa??? there are plenty of jobs that pay more than medicine, i'm not arguing that. i get pissed of when wannabes try to play doctor.

    why not fly on a plane flown by an certified pilots assistant????? hell...anyone can land an aircraft. wouldn't that be cheaper??? i'm glad the asa is finally fighting back against the crna lobby.
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    dr. cuts
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    quote:

    originally posted by painman:
    i for one think it would be great to monitor 2-3 crna's doing healthy cases while picking up 1 complex case a day. they can earn me as much as they want!

    end quote

    i am suprised at these two very uninformed and illogical comments. the advent and rise of the crna is inarguably a bad thing for anesthesiologists. it's basic economics people... if demand for crnas goes up (and it will/is b/c they are still "cheaper" than mds) while their supply stays the same, their salaries (i.e. their "price" in economic terms) will go up. period. it's an economic certainty.
    now let's analyze painman's comment... while he covers that one complex case and simultaneously monitors 3 crnas doing 3 other cases, 3 mds are out of a job! back to economics 101... this results in demand for anesthesiologists going down... so if their supply were to the stay the same...??? see where i'm heading with this people? either anesthesiologists #s will stay the same and their salaries will go down, or, they will have to cut back on available positions to keep the salaries at their present level. if this trend continues, it's just a matter of time...
    this article is very disturbing to me. enough so that although i have until now been giving serious consideration to anesthesia for next year for myself, i'm going to have to follow this trend closely and may ulimately be disuaded from it. damn rns.

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    drfeelgood
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    it's people like painman who are selling our profession out!!!!

    my stupid family doc just hired 3 pas to man his three clinics. (freakin sellout)



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    dr. cuts
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    quote:

    originally posted by drfeelgood:
    it's people like painman who are selling our profession out!!!!

    my stupid family doc just hired 3 pas to man his three clinics. (freakin sellout)

    end quote

    it's really not about "selling out." it is, as many things are, basically a matter of money. if crnas can indeed perform just as well as mds in most situations and their salaries are less, it's only logical that the powers that be would prefer their services in those situations... and i doubt that that money being saved is going to the make-a-wish foundation either.
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    the pill counter
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    i think part of the resentment is that nothing about the profession of medicine seems sacred anymore. crna's are not part of the medical profession, yet in essence, are practicing medicine. same goes for pa's and nurse practioners. ultimately, the public is going to get used to this para-medical care, which is sub-standard no matter what the circumstances. a crna argues, 'i would put myself up against any anesthesiologist in the country', but that simple statement is ignorant, in that a vocational course could ever equal the rigours and training of 7+ years of university and many more years of residency! while you're at it, you might as well say goodbye to fp's and peds as your primary care provider. you'll be taking your kids to see their np (who'll prescribe anything he/she pleases) with little understanding about the pharmacology or pathophysiological processes involved. unbelievable...
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    ryo-ohki
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    look for nurse surgeons in the future. heh heh

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    halothane
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    nurses are dumb period. they probably have lesser gpa and stuff than people going into pure scineces, computers, humanities etc. let alone be in comparision with doctors , dentists and lawyers. and they go about saying crap like they can match anyone....then why dont those smartasses come up with ground breaking research. the reason anesthesia became safer in the last 20 years is not because of some stupid crnas but because more mds entered anesth from 60 onwards. the groundbreaking work has been done mda. crnas are the or scutmonkeys who now wanna ape their creators. theyinfact have the guts go about doing proganada that nurses were the first to do anesthesia when medical historians clearly give that credit to dentists and docs. well i guarentee you their infinitely inferior iqs will not survive against mda......the docs will emerge successful. the us has a tendency to be reactive instead of proactive. when they become the butt of ridicule of the rest of the world for letting para professionals take over they will do something about it. the ass of a crna who said he could be as good as say some pioneers of anesthesia, soem of the guys who have done amazing research in say cardiac an, pain etc. is a fool to the core. he talks crap. the guys at hopkins, wash u etc. in the research dept. of anesth are sterling. they are geniuses ( many of them are md, phds) and a lowly nurse with 2 years of grad education( and i bet they only know the pharm of anesthesia, these guys dont have an idea of many commmon microorganisms, let alone complex physio and path)says he is as good. well thats free speech ( sounds like saddam saying he can finish the us). well the asa wants to make a slight oversupply of mda...cos shortage means a firmer footing for crnas. all medical professionals must join to rid the medical profession of wannabes.
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    ryo-ohki
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    i don't know. they may be stupid, but at least they have enough common sense to unionize.

    it kind of stupid that a 30 year old crna can be making more then a fellowship doctor of the same age. but the fault like with those who believe they should be brutalized. those meds who suffer from some sort of battered wives syndrome.

    so, no, nurses aren't stupid. they seem to have more common sense then some young doctors.
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    halothane
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    so, no, nurses aren't stupid. they seem to have more common sense then some young doctors.

    as said by ryo ohki

    well doctors are sensible enough to spend a decent amount of time to learn their stuff. to be competent. docs do not believe in taking the back door to practice med( thats why we became docs.). docs do not go into medicine cos they were rejected in nursing school( as it is soemtimes the other way). if all the physicians no matter what their field get together and work at keeping these half doctors from takin over we can keep quality of care better here. or soon we are gonna have midwives instead of obg, nps for primary( imagine our insurance carriers saying we have to get clearance from a pnp instead of pcp for a referral!!) and god forbid nurse cardiologists and or nurse surgeons.
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    pacmatthew
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    coming from a paramedical professional, you guys are absolutely right!!!!! that is why i have left the pa profession and 6 figure salary to head back to school to become a physician. pa's were really the first paramedical profession to compete with or shall i say do the job that only physicians previously did. the pa concept was superb. it was meant to train a person to go work like a physician in a place where physicians would not work. and the crna thing was created to do the same thing. however, legislation got out of control, and now you see the vast majority of crna's and pa's, np's working right where physicians would normally work, but for lesser money. the physicians that use pa's love them because they are competent and make them tons of money. i made about 100k per year and brought in about 400k a year. what phycisian would want to pay a physician to do this when he can make this kind of money off a pa? the creation of the professions like pa's and crna's was justifiable, but as always, while physicians slept, these people came in and put their lobbying power together to relax their practice rights. what is important to know is that these groups of paramedicals do provide a valuable service in areas where they are needed(like in the military and in rural areas). the reality of it though is that most of them don't work where they are needed. the lesson to be learned here physicians is that when you give one solitary inch to non-physicians, they will take a mile. physicians can't take back what they have already given away, but they can keep other groups from canabalizing their entire practice rights. stop the pharmacists now before they decide to be practicing medicine at k-mart, and stop psychologists from prescribing. don't give another inch.
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    the pill counter
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    i wholeheartedly agree, and coming from an allied-health profession, i know the desire is strong to expand one's professional role and profile. when practicing pharmacy, the greatest passtime was saying 'this doctor was crap or that guy doesn't what he's doing.' fact of the matter was, we didn't know what the hell we were talking about. i learned to be a pharmacist in pharmacy school, not a doctor. i'm learning to be a doctor now, and only medical school can do that.
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    ryo-ohki

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    yes, nurses are smarter then these residents/med students who enjoy or say they will enjoy getting brutalized with 80 hour work weeks and slave wages. how else can you explain the fact that a md(!) 4th year resident earns about as much as an rn. whose services are worth more? pure naivety on the part of some young docs.

    i think we're arguing differents points.

    nurse brain surgeons. i would personally like to see that.

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    a little elf
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    the reason that we got into this situation in the first place is because the old slow docs believed that they were invinsible and that no one would ever dream of stepping up and doing the job that they did without a medical license. now, the younger generation of docs is paying for their laziness...and they think that we've got it easy...maybe they should share their savings account
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    mmaher
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    i am not really sure how it works, but i bet that these nurses and pa's would be less inclined to practice if they they had to shell out for malpractice insurance to cover themselves. as of right now, most of these allied health professionals are the responsibility of the supervising physician. we need to all be smart when we get out of med school and protect ourselves. for some reason or another, medicine has been targeted, and we must react appropriately. how? i am not sure, but i am all ears.
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    jargon124
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    i just want to say that i agree with all that is being said - particularly with you halothane. as in incoming medical student i am already wary of these issues and won't forget s i continue on through my career. we all need to see to it that this sort of crap doesn't go too far, if it hasn't already.
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    dr. mc smile
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    i've been following this topic and find it very interesting. now that we are on the issue of malpractice insurance (hot-topic lately) i was wondering why these paramed folks don't have to pay even heftier premiums?

    read: less knowledge/experience = higher risk ... no?

    just curious
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    emedpa
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    drfeelgood-
    there are already residency programs for p.a.'s and have been for over 20 years. residencies are in surgery,ortho, emergency medicine, psych, peds/neonatology, derm, im, etc. most are 2 years with a few 1 yr programs out there. most programs are at major medical centers(hopkins, yale etc.) and have the pa doing the same curriculum as the pgy1 and pgy2 residents.
    see this site for the american academy of postgrad p.a. programs for a list:
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    neurogirl
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    ryo-ohki,

    unionizing has absolutely nothing to do with "common sense". but then, if you knew anything about the practice of medicine, you'd know that! the purpose of unions is to gain bargaining power by using the ultimate threat of strike. physicians haven't unionized because we won't strike. how would you feel if you or a loved one needed urgent care but the doc said, "sorry, i'm on strike"! our oath (committment to humanity) prevents us from withholding care for the sake of money. nurses, on the other hand can strike since there are always physicians available to handle care if necessary.
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    meandragonbrett
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    first off, halothane, since nurses are stupid, why do we have them??j\w answer that one for me. because i'm pretty sure you "residents" aren't going to go to the floor and perform nursing duties are you? no, i didn't think so. another thing, why do you guys keep brining this debate up anyway?

    if you come around my area and look for a md to do your anesthesia you are going to have trouble b\c there aren't many. many aren't practicing anesthesia anymore because their salaries were dropping, aww poor thing, can't afford their bmws anymore crnas have the market around here. starting salaries are around 160+ benefits and malpractice is paid by the anesthesia group. sounds pretty good for somebody "who doesnt know anything" eh?

    and it also seems that the residents on this board and in other places are the ones that keep firing up the discussion on this issue. it's like you guys have nothing else better to do. i've never seen the confrontation you guys have with each other in the real world. you make it out to be like mdas hate crnas guts because "they are taking over" i've never seen a conflict between a crna and a mda. it seems that it's mostly the students and people who don't do anesthesia. although, i'm not saying i know everything, this is what it looks like to me.

    aa's do not get paid as much b\c there's not a demand for them. they can only work in 13 states, and must be under direct supervision of the anesthesia doc. aa's aren't required to have previous medical work either. pre-med reqs and the mcat is all that's required. they have no experience in the monitoring required for this type of work.

    if you want something to debate, how about you guys debate the mda and aa issue? oh no, md's will never have a problem with aas because aas can do the md's work and the md still gets paid for doing it also. i also believe that the asa is a very large advocate for the aa profession. correct me if i'm wrong.

    i don't have any more time to go on, but i'd love to debate some other time.

    brett
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    this is as far as the debate has gone at the moment. i have a question for the srnas and crnas on the board. have you guys ever seen or had a conflict with mdas? was i right when i said that it seems to be people who aren't involved with anesthesia, predominately students and residents are the ones that have problems with crnas? now i know the asa and the aana don't like each other but on the "real-world" level? please let me know if i'm wrong. i just thought this was something to post that might spark a discussion here on the board.

    brett

    :roll
  11. by   bluemoose21
    I think that some of you should be excited that a NURSE is even considered for such a position and such a salary. I dont know about yall but i think that the pursuit of happiness includes finance. lots of it at that. if you are a nurse and you dog out nurses that extend their knowledge base than take a look around. i am excited that nurses even have that option. think about it...we are the most uneducated people in the hospital. all the other professionals enter their careers at least at the graduate level.
  12. by   odrnusa
    hey halothane,

    your inputs are pretty inflamatory towards nurses. let me ask you and all of the docs out there: are there any problems that doctors have (professionally or financially) that weren't created by your predecessors)? please enlighten this poor uneducated dumb nurse. to read your post(s), one has to think all md's are just brilliant and are research "geniuses". you must be kidding..lol. medicine is NOT rocket science. I don't know a single nurse who does not respect the effort and dilligence it takes to complete all the steps to becoming an MD. That earned respect is acutely diminished when I read your oral gas...as for the money crna's make-they didn't set the market, too few MDA's probably did. I am strongly considering a CRNA program, and perhaps one day I will work under your supervision. A word of advice if that day comes: keep your identity and opinions on the web. Your dentist has enough work.
  13. by   meandragonbrett
    Just a little note for the previous two posters......Those users that you were replying to are not members here at All Nurses. They are at StudentDoctor.net.

    Welcome to the board!
    Brett

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