The Story of the Pastry Chefs

[sweetdreame, BSN, RN]

The Price of Pastries

Christina and Milton both love pastries. They both have dreams of one day becoming pastry chefs and making excellent pastries. Let's follow their respective journeys after high school graduation.

Christina

Christina decides to start taking cooking classes after high school graduation. She takes three years of cooking classes before becoming an apprentice cook for one year.

After her apprenticeship, Christina passes a state board exam to become a Registered Cook. Christina gets a job working at a café where she cooks daily and becomes very familiar with different ingredients and how they interact. She spends four years working as a Registered Cook where she learns about and becomes comfortable working with the ingredients. Unfortunately, at the café, Christina works on a team and does not get to cook or bake independently. Christina loves baking, especially with really difficult recipes, so she decides to go back to school to become a baked-goods and pastry chef.

Christina applies to the Pastry Chef Bakery Academy, where doughnuts were first created. The Academy is very selective, and only takes cooks with excellent experience in the kitchen. Each candidate must be very familiar with the ingredients and be comfortable in the kitchen. Christina is accepted at the Pastry Chef Academy where she will spend 3 years becoming an expert in preparing any type of pastry or baked treat.

For 1.5 years, The Pastry Chef Bakery Academy teaches Christina everything she could possibly need to know about baking and pastries. She is tested on this specific knowledge many times before she is allowed to become a pastry sous chef.

Christina spends the remaining 1.5 years as a baker and pastry sous chef where she learns to function as an independent pastry chef and baker. She graduates from the Pastry Chef Bakery Academy, passes the National Baker's & Pastry Chef Board Exam, and applies for a job at The Doughnut Shop & Bakery.

Milton

Milton decides to get a general education in the science of cooking. He spends two years learning about basic topics, and two years learning about cooking sciences. Milton decides to apply to Cordon Bleu to become a chef.

Cordon Bleu is one of the most selective programs for chefs. It is very difficult to gain acceptance. Milton has made good grades in cooking sciences. But Milton is relieved that he doesn't need any cooking experience to get into Cordon Bleu because he has never stepped foot in the kitchen.

At Cordon Bleu, Milton learns about many cuisines from all over the world. He gains understanding about many topics: Chinese food, steaks, salad, hot dogs, cookies, and more. When Milton graduates he is very familiar with many different styles of cooking, and even some ingredients. But, alas he has still never been allowed to cook.

Milton is relieved when he is accepted to be a baker and pastry sous chef. However, the first year he is a sous chef, he is made to follow around many different chefs, not just the baker. He learns about various types of cuisine. Some of the chefs even let him cook as they watch.

In the final 3 years of his training, Milton finally gets to start baking. He works exclusively as a Pastry sous chef and learns everything he could possibly need to know about baking and pastries. He is tested many times on this specific knowledge before he graduates. Unlike Christina, Milton does not have to pass board certification to bake or make pastries. He is allowed to work independently just because he graduated from Cordon Bleu. Milton also applies for a job at The Doughnut Shop & Bakery.

After Graduation...

Milton and Christina both get a job working at The Doughnut Shop & Bakery. Because Milton went to Cordon Bleu, he gets a job as a supervisor. He watches over Christina and three other Pastry Chef Academy graduates while they make doughnuts and other pastries. Christina is dissatisfied with this situation because she knows how to make doughnuts very well (without supervision). In fact, many of Christina's fellow graduates are the only pastry chef at their bakeries and work without supervision. Despite her qualms, Christina embraces her new position and enjoys making doughnuts, cupcakes, and other pastries all day every day. She can make different varieties and flavors and becomes an expert at her job.

Christina and the three other Pastry Chef and Bakery Academy graduates make $2.00 for each doughnut. Since Milton is supervising them, he also is paid $2.00 for each doughnut. They make 1 doughnut each hour, so Milton makes $8.00 per hour. Milton will occasionally make doughnuts, but he mostly runs the cash register and talks to customers.

One day a loyal customer comes in. She is recently engaged. She loves doughnuts and wants The Doughnut Shop & Bakery to make her wedding cake.

Milton immediately assumes that he is more qualified to make the wedding cake because of his advanced knowledge of international cuisine and Cordon Bleu education. Christina feels more qualified because she bakes and makes pastries every day. Both Christina and Milton are pastry chefs and they use the exact same cookbook. Ask yourself:

1. Who do you think is more qualified to make the wedding cake?

2. Do you think the doughnuts would be less tasty without Milton's supervision?

3. Who do you think makes better doughnuts?

4. Do you think doughnuts would be cheaper if Christina and her fellow Pastry Chef Academy graduates were not being supervised? Would you be willing to pay Milton's price for his services?

5. Does this system make sense?

Here is the Bottom Line:

What if you were told that this scenario exists every day in the American healthcare system? Certified Registered Nurse Anesthetists (represented by Christina) provide safe and effective anesthesia that has been proven to be of the same safety and quality of their anesthesiologist colleagues (represented by Milton). Did you know that an anesthesiologist can "supervise" four CRNAs at one time and bill for 50% of each case (doughnut) that the CRNA performs? This means that the supervising anesthesiologist can make 2 times more money if he or she supervises a CRNA rather than providing anesthesia--even if he or she never steps into the room. The anesthesiologist does not even have to see or talk to the patient to bill for services. To continue with the analogy, the anesthesiologist's role in this setting (Anesthesia Care Team) is to be "available" in case someone wants to order a wedding cake (anesthesia emergency). If any party is more qualified (which may not be the case), wouldn't it stand to reason that the pastry chefs who bake every day would be better able to make a wedding cake? That is for you to decide. There is no state in the United States that requires anesthesiologist supervision over CRNAs. The interest of many anesthesiologists is not the patient's outcome but their own income$$.

Inform Yourself.

I wrote this analogy to help friends and family understand the role of CRNAs and other advanced practice nurses. I hope it helps you to understand as well. As you do your own research, I encourage you to stay away from opinion and focus on facts. There are many campaigns and opinion-pieces that are designed to elicit an emotional response and scare the public without producing facts based on patient outcomes and cost-effectiveness. Focus on the EVIDENCE.