DebbieSue

I totally agree. I read the article, and found the silence re: CRNAs to be absolutely deafening. Didn't say anything bad about them, mind you, just completely and totally ignored their existence. Very subtle, very potent.

My vote is for Anywears. I have been an ICU RN for almost 30 years and was developing plantar fasciaitis, or something causing real bad heel pain. I got a pair of Anywears, and have never looked back. I have something like 8 pair in different colors. For a couple years after getting that first pair, I didn't wear any shoes ever except Anywears. Now, I wear them when I work, garden, do housework. I wash them in the dishwasher, and wash the inserts in the washing machine. They are great with or without socks, and with or without the inserts. The website is anywears.com.

I am applying to 3. Have sent in application to 2. Third wanted me to send the recommendations with the app., so had to wait for the last of 3 recommendations. Second week in June the CT surg director mailed out the recommendations. So, 2 of the 3 have everything within the last month, and I am mailing the 3rd tomorrow. For August 2007.

Maybe they are trying to get twice as much reimbursement because it is twice as hard to teach anything to an anesthesiology resident ;) JUST KIDDING, people, REALLY.

Hey Mike, congrats on getting into school..... I've been off the boards awhile, sort of in seclusion during the few weeks before and after my 'sadiverary', but today seemed ready to resume life. I got those anesthesia sheets a month or so ago. They seem great and were highly recommended on what ever site I first read about them.... Good for you to get to spend time with that great doc. Today I made a list of the most commonly used texts and am deciding what one to start with. I figure if I start the 'booklearning' now, I might give myself a break when classes start. Any little thing to help. Maybe the crush won't be as bad.... Debbie in PA

I was pissed off by the Lidocaine thread, but most especially about the organ donation/anesthesia thread. My mouth dropped open when I read that one. How anyone with that degree of ignorance could get into anesthesia school in the first place made me seriously rethink applying..... I recently took PALS, and was interested in the IO route of med/fluid delivery. Is it ever used in anesthesia? I can't wait to have clinical questions to ask you, Yoga. Debbie

I don't know anything about this from an anesthesia standpoint, but as a long-time CTICU RN at a tertiary-quad care cardiovascular care center, I have cared for lots of these pts. I find it fascinating that the patient is, for all intents and purposes, DEAD. We treat is so blasely, talking nonchalantly about 'circ arrest time'..etc. This is the cutting edge of medicine, in my opinion. The history of the development of this is really fascinating. Potentially dead....potentially alive..... Whew. I would love to do a study about how many of these pts have Near Death Experiences.... Debbie

Holy crap! They really nailed you. Well, my CV has 28+ years as a CC nurse and my CV nursing MSN, so I better remember every arcane thing I ever knew and forgot about the heart! :chuckle Digging out the grad school notes....OMG, they may ask me about the statistical tests used on my thesis research.....sh*t.....this could be bad. I was going to say that forwarned is forearmed, but I'm reserving the right to change it to forewarned is ****PSYCHOTIC****( and this is only the interview, for gods sake....)

You would probably love CCM-L.org. It is the Critical Care Medicine List. Quite a fair number of anesthesiologist/intensivists and RNs, and RRTs, and surgeons, etc. etc., from all over the world. Extremely active group, intelligent, rambunctious. Its CCM-L.org. A lot of the members also belong to gas.net. Of all the mail-lists to which I have belonged, about 50 over the years, related to profession, hobbies, etc. etc., it is by far my favorite and the one to which I always return. Debbie p.s. how about that monsterously long thread on the AA thing? I read the whole thing and now see someone is trying to revive that decomposing horse again. p.s.s. love your new avatar. LOL

This damned horse has been kicked over and over and *someone* keeps resuscitating it..... Will someone PLEASE shoot it in the head and put it out of it's (my, our) misery. WHERE are the moderators of this forum????

Mke, you are not thinking in the advanced practice mode yet. The core courses in the MSN programs are not 'fluff'. If you only look at it all from a putting-people-to-sleep aspect, they might not help you do that any better. Masters level core courses help you 'grow up' as a nurse, help you see the big picture and your place in the big picture. All doctorate programs are not heavy into research. The Ph.D. is. But that is not the doctorate degree of the allied health practice doctorates. There are research doctorates and there are practice doctorates. They do not have the same focus. More important things call.....like going downstairs to watch 'Big Love' My brain is fried.

The point that Jen and Vicky are missing is that the DNP is being created specifically to replace the advanced practice MSN level of education. This is the whole point: advanced practice RNs practice at a very high level. Let's put them on an even playing field with, let's say, doctorate-level pharmacists, PTs, chiropractors, optomotrists, etc. since they practice at the same level as these others already. It's the BSN-to-MSN-to-doctorate progression that is going to change in nursing. The MSN is going to disappear--at least in the advanced practice specialties (i.e., NP, CRNA, CNM, CNS). It will not be a 'dumbed-down' doctorate--what we have now is a 'too-smart' practice-Masters in nursing.APNs (with a Masters degree) are as advanced in their practice as other allied-health doctorates. The powers-that-be in nursing want advanced practice nurses to get the credit they deserve, and the money, and are trying to convert the practice-Masters to a practice-Doctorate for this reason. It's essentially going to be a change in-name-only, since the nursing-practice-Masters is already equivalent to the practice-Doctorate in other fields. That's why I say there will be 'grandfathering'. You have to think of grandfathering in this specific situation--and forget about the 'grandfathering' that has happened at other times in nursing. CRNA practice is already doctorate-level practice, as is the practice of NPs and CNMs and CNSs. Nursing has unfortunately for decades and decades thought of the doctoral level as being only about research and the Ph.D. That is now known to be a fallacy: research is one but not the only way to be a doctorate-level nurse. The powers-that-be finally got their heads out of the ivory towers, looked at what APNs actually DO, were pretty darned impressed, and realized that the 'levels' as they have been set for all these years are wrong. Advanced practice is not somehow 'less' than doing research. Again, it is just different. What CRNAs do, for example, is certainly not 'less' than what a researcher does. It is simply a different body of knowledge. In fact one could say, since actual practice is what nursing is really all about, that advanced practice is just as good as, if not more illustrious than, research. That certainly is a new way of looking at things, isn't it??? The AACN has acknowledged this and is trying to make things right. I personally think things got off kilter because, for many, many years, the Ph.D. was the only doctorate degree that one could get in a nursing program. I mean, nursing schools in universities offered a BSN, an MSN, and a Ph.D with Education and Administration tracts. These well-educated nurses were as far removed from actual practice as they could possibly be. Meanwhile, some of the nurses in the trenches, so to speak, were moving into advanced practice roles totally outside the 'control' of the University crowd and outside of the 'usual' BSN-MSN-Ph.D. route. These were the nurses becoming nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists. They learned the job on the job and not in the university setting. That doesn't mean, however, that these advanced roles did not require alot of very high-level knowledge. Only fairly recently has the dissemination of that high-level knowledge happened in MS programs. Even so, the knowledge is not MSN-level; it really is doctorate-level knowledge and, thus, the DNP-related goals of the AACN are appropriate. The AACN is actually playing catch-up trying to get the advanced practice programs positioned correctly within the levels of the schools of nursing. It has taken a long time to do this because the bulk of doctorate-prepared nurses in this country are not advanced PRACTICE nurses, but instead are advanced RESEARCH nurses. All those Ph.D.s really did not know where to position these programs but had the bias that if it was nursing practice, it couldn't be as demanding as nursing research. That's the reason that 3 out of the 4 advanced practice roles at first required only a certificate, and only much later required a Masters degree. Finally, advanced practice nursing has grown up and gotten the full attention of the-powers-that-be in nursing. This is why I believe that the move toward the DNP is a VERY good thing for the profession as a whole and the advanced practice roles specifically. It certainly is about time. The logistical issues, such as finding doctorally-prepared teachers, will not derail this coming change because it is really a fundamental change in nursing as a whole: finally acknowledging the supremacy and importance of hands-on patient care for even the highest 'level' nurses. The focus has moved away from seeing only the 'ivory tower' Ph.D.s as the 'stars' of the profession. ...thus spake Debbie....

Well, if the DNP does not take off nationally, it will be because the current Masters-prepared APNs will put up a fight. In every article I have read about the DNP, the one question everyone asks is, "What about the current APNs?" I have a friend who is currently setting up one of those replace-the-MSN DNP programs, and there will be few, if any, additional courses. I very highly doubt if the AACN (the credentialling org) is going to make it hard to convert. The whole point that everyone acknowledges started this all is that APNs AT THEIR CURRENT PRACTICE LEVEL are comparable to other allied health practice doctorates. I wouldn't be surprised if the trend becomes BSN-to-Ph.D when the BSN-to-DNP becomes common. This whole thing is about getting rid of the Masters level. As long as other professions have ed programs that are Bachelors to Doctorate, then the push is going to be to do that in nursing, too. I don't think that a regulation mandating a switch to DNP will work in anesthesia because so many of the programs are not MSN and the instructors have non-nursing Masters degrees. There will be no official or unofficial 'grandfathering' of those Masters up to the DNP. I'm sure that the AANA will eventually get around this somehow. As far as faculty goes, I know that the program my friend is starting is going to be taught by 'grandfathered' DNPs. She will be one of them. And I am talking a very prestigious School of Nursing--one of the top 10 in the nation. An interesting point, however: the head of the anesthesia program is not talking about the DNP yet, probably because the AANA is not completely on board yet. The only anesthesia programs that could make the change quickly are MSN ones. My friend is working on the NP and CNS switch. This bandwagon is already rolling.....and programs are jumping on all over the place. And doing what they have to do to make it happen. As far as podiatry goes.....like nurse anesthesia, nurse midwifery, nurse practitioning, and the CNS, it is a deep but narrow knowledge-base. I don't think that doing foot surgery as it is done by them is any more advanced than what a CRNA or NP or CNM or CNS does....it is just different. All the allied health advanced practice (including nursing) is deep but narrow. MDs/DOs knowledge base is deep and broad. That's what MDs get out of all the additional years of school and residency. That's what they should get credit for. That's what they get paid for-- and why they are paid more. This is an interesting discussion.... Debbie, RN, MSN, CNS

I don't see any reason why any time should be added to the current educational programs in order to convert them from MSwhatever to DNP. I think that the DNP acknowledges that the level of practice is very high, certainly equivalent at least to chiropractors, optomitrists, podiatrists, etc., etc. And even if the DNP were not rewarded until after one year of practice--that wouldn't be adding any actual time to the process. You could still take the CRNA boards and start to practice. I think it should be: same educational requirements as now + one year of actual practice = DNS. You would be a CRNA after passing boards and before the year of practice, getting paid, etc. And the DNP would be awarded to you after a year of practice. It's like being a Ph.D. even before you have completed your dissertation--people do get to call themselves "Ph.D.s (pending)" before they are totally done. It could be the same with the DNP--you would call yourself a DNP, but to keep that credential, you would have to complete a year of practice. And there would be a deadline by which time one would have to complete the practice year. And if the Masters-prepared advanced practice nurses get grandfathered in when the DNP starts (at which time the Masters programs will disappear) why then all anesthesia faculty would become grandfathered-DNPs and would/could continue as faculty. It is my understanding that the DNP education is going to replace the Masters education. Not be in addition to it. And since one big sticking point is going to be NOT creating a system that totally screws all the Masters-prepared APNs currently in practice, I really think that there WILL be a stipulation to somehow grandfather the current MSN APNs to being DNPs. I think the TRUE stumbling block most likely to occur is not a longer program, or lack of faculty, but the bugaboo of how non-nursing Masters programs, like MS in Anesthesia, or MS in Health Science, or any of the other non-nursing Masters degrees that CRNAs come out with, how they are going to transition to DNP? I mean, will only MSNs be able to grandfather to DNP?? Anesthesia is the only advanced practice nursing specialty that allows non-nursing Masters. I'm pretty sure that midwifery Masters are all nursing Masters, and I'm sure that the nurse practitioner and nurse specialist Masters are all nursing Masters. Anesthesia has a number of non-nursing Masters degrees. I don't understand why this is, since it is a NURSING specialty. Anyway, this is all just pipe-dreaming. Unitl I start to actually see the BSN to DNP happening, this is moot. And also, regardless of what credentials one has, to others in the healthcare systems, a nurse is a nurse is a nurse, etc. I doubt if most docs even know what the term 'advanced practice nursing' means........And no way within the hospital will we ever be allowed to be called 'Doctor' anything. (Although I know of PhD psychologists who have priveleges and are called Dr. within the hospital and while in the company of psychiatrists.) Having CRNAs given the title Doctor would make the ASA and AMA go ballistic--but it would be great for APNs to actually get the recognition for what they have been doing all these years. God, I have forgotten what my reason for 'reply'ing actually was......

The move toward making the DNP the standard ed. level for all advanced practice RNs is the 'next big thing'. I, for one, agree with it. First of all, it's about time that there is a CLINICAL doctorate in nursing. In this case the 'NP' in DNP stands for Nursing Practice (not Nurse Practitioner). So there will be 2 tracks: one the research-focused Ph.D., and the clinical practice DNS. In this day and age of Doctor of Chiropractic and Doctor of Podiatry, advanced practice nursing really NEEDS to go in this direction. Please let's not diss the other advanced nursing practice specialties. When you do that, it just shows that you are seriously lacking a broad viewpoint and experience in the field and/or don't have the maturity that is required of advanced nursing practice. You can't compare apples and oranges. What gives anyone on this board the right to downplay the schooling and expertise that nurse midwives need everyday in their practice? Or acute care NPs? Or neonatal NPs who essentionally do everything that an MD can do as far as management of tiny vulnerable premies and procedures, etc.? CNSs develop and design system-wide programs that can and do change the entire practice of all the nurses in a system. I'm sorry about the people who want to zip from not-yet-a-nurse to CRNA, but I don't see any reason why there should necessarily be options to make that transition quick. I , for one, don't think that transition should be able to be quick. It just smacks so much of "I'm an auto mechanic, but want something that pays better and I heard that you can become a nurse anesthetist, whatever that is, in 7-ish years beginning-to-end, and really rake in the bucks...." Or a marine biologist, or an engineer, or a paramedic. I think that part of the reason that nurse anesthesia is considered the 'poor relation' of advanced practice nursing specialities is that so many people seem to ignor the N in CRNA. Wanting the 'glory', but not willing to do the up-front 'growing as a nurse'. And not doing anything to grow nursing as a profession after becoming CRNA. It's the same as saying, "Let's see, I have always dreamed of delivering babies...what is the absolute quickest way I can get to do that? Oh, and by the way, I'm just going to have to try to put up with those pesky requirements that I go through nursing school, become a nurse, and practice for a year." Holy god, keep that person away from me when I'm pregnant!!!! And there is no way that any anesthesia DNP program would be equal in time to becoming an anesthesiologist. Puhleeze! 4 years pre-med, 4 years med school, and then residency, which is always at least 3-4 years. And besides, there are huge fundamental differences between nursing and medicine. OK, off my soapbox. I wish the DNP thing was happening right now. I'm just hoping the current, Masters-prepared APNs get grandfathered in somehouw.

The urology doc was a guy who signed up of his own free will to help out the gals and guys putting themselves in harm's way everyday in Iraq. He felt it was his duty. He had a wife pregnant with their first child. He felt it was a duty he was called to do. The article is very moving. What an environment in which to practice medicine. Front-line trauma care. Lots of it. All the time. Whew......

I have two options in paying for anesthesia school. I am able to use IRA money with no penalty, and have more than enough to get me through anesthesia school with no debt. I would have to take out enough extra to also pay the income tax on it (IRA savings are tax deferred). OR I can take out loans. I have two kids to support besides myself, a monthly house mortgage, and one car payment. After I complete the program, I would be either paying off loans or paying back my IRA. Does anyone out there have enough of a financial background to know if there are hidden disadvantages to using IRA money for CRNA school/living expenses?

You guy's humor is pathetically twisted and I love it..... I'm kind of an adrenaline junkie, too, but it's one thing for me to say it and something different for someone who is clueless and not even done with the basic nursing program. Many if not most successful critical care nurses do well under pressure. Why in tarnation would one WANT to work in such an environment if not for that?? In fact, whenever I was in positions to interview prospective new hires to CT ICU, my most important question was this: do you like adrenaline rushes? If the answer was yes, I hired them. They would be motivated and quick to learn. If they had no clue what I was talking about, I figured the answer was prob. no and that it would be a long, hard, slow learning curve. Being an adrenaline junkie does not mean that you WANT to be involved in a crisis all the time; it means that, if the crisis does happen, you are able to deal with it. In critical care, the very environment and acuity of the patients involves hovering slightly on the edge and priding yourself in your ability to keep the patient from falling over the edge. High acuity critical care and, I think, anesthesia have the inherent characteristic that things can go to hell in a handbasket in a minute and you better be able to deal with it. That being said, unremitting chaos and carnage and death and destruction, like during wartime in a warzone, is a completely different animal. In that case, the handbasket's already landed, and you are pulling young lives from over the edge all the time. I think the motivator in that case is saving young lives and any adrenaline rush is absolutely meaningless except in that it helps you keep going yet another day, attack, ambush, or whatever. I was glad when that urology doc made the cover of Newsweek. I think it is kind of strange for a not-yet-nurse to be lusting after adrenaline rushes in anesthesia, but what about people like me? What kind of cases keep the CRNA REALLY on his/her toes? I know, I know, anesthesia always keeps you on your toes, that comes with the territory. But what cases are never routine? Liver transplant, dissecting and leaking TAA, big trauma, what??? I am almost 50, I am extremely calm, cool, and collected, I love having stable patients, I love keeping them stable, I love making them stable, but I HATE code browns. Please don't reprimand me....I am asking from the outside looking in. Is every case in anesthesia enough to give one that little zing? Are there some kinds of cases that give one a bit more of that little zing? (Come ON people, work with me on this....don't you know I'm trying to procure my drug of choice??!!??) I KNOW there are seasoned, mature practitioners of anesthesia out there who know what I mean.

There is no way that this guy's experience is not full blown critical care. Period. Trauma and CTICU experience, followed by flight nursing. Unless his ICU experience totalled less that about 1.5 years. Maybe that is the issue--did you go into flight nursing just after that requisite one year of ICU experience? In that case, they may think that it was not quite enough being that it was 4+ years ago. Otherwise, that director is whacked. I think 'they' in general want enough ICU experience to make one at least proficient in critical care nursing. I personally do not believe that less than 1.5 years results in proficient practice. Of course, one could have 10 years of CC nursing and not be much more than competent. A lot of experience does not = expertise, but you rarely find expertise without a good amount of experience. That being said, I can not imagine surviving as a flight nurse if one was not pretty damn sharp in critical care nursing. I would have been offended by the arms in the air motions. That was plain rude. Unless she has been a flight nurse, how in the hell would she know anyways? Maybe SHE has been out of ICU practice too long to know what kind of train-wrecks get flown into tertiary care centers these days. I work at a facility that has an absolutely top-notch Life Flight program, and I know the Life Flight RNs will always bring the patient to me better than they found them. And they have to be generalists, too, cardiac, pulmonary, neuro, trauma, ortho, you name it, they see it all. Hang in there, friend, you will find that program that fits. BTW, this is worrying me......I have decades of ICU, SICU, and CTV ICU experience, and an MSN, but have been very part time since my dear husband died in June...(being with the kids, etc.)--I think I would go ballistic if someone suggested that I don't have enough 'current' experience....... gasp.....adjusting attitude, adjusting attitude, adjusting attitude. adj.........................gasp.....

Stuff like that is nobody else's business, but it always generates lots of gossip and outrage. And gets everyone riled up. That's what causes the problems. Let's face it, we get pretty close to people we've worked with for years. You don't want your friends to get hurt or to do stupid things. People messing around, innocently or not, have to work to keep it private if they don't want to have to answer to friends. It's not as though its realistic to expect people who have been working along side you during years of dating, marriage, pregnancy, kids, deaths in families, etc., etc. to just suddenly butt out of your life because you want them to. I disagree totally, though, with the HR thing unless their performance at work is impaired. And a sense of generalized moral outrage and furious gossip in the unit is not the same as their work being impaired....it probably DOES impair the work of the morally outraged, however.....

Thanks for the interesting point re: looking into a doctorate. I knew that not having to take the core APN courses wouldn't shorten the 28 months....maybe if the program were frontloaded, but it's not. Clinical starts in the first term. I hope I like/get accepted into the Allegheny Valley program, because I am really looking for a 2 year program. Graduating in May vs. December seems like a pretty good deal to me as I am 49 and a single mom. On the other hand, I hear the clinicals at Pitt are awesome--doing Peds at Kiddies, OB at Magee, and all that transplant at Presby. On the other other hand, there is an active anesthesiology residency program at UPMC, and I wonder how much competition there is with residents vs. SRNAs getting 'good' cases.....

I think that, from now on on this forum, 'shiznit' is going to be an inside joke!! Priceless!! And as for not getting why ICU experience is necessary, that is purely a matter of not knowing what one does not know. Our engineer poster does not have a clue......there is a LONG way from where he/she is now to where she/he will have to get to. And as far as it being a 'heated' topic: please don't forget that CRNAs are NURSES. When one totally discredits getting nursing experience, it makes me think 'WTF??!!!'. Focusing so much on the CRNA part before one has a nanosecond of nursing experience is REALLY putting the cart before the horse. It riles me up when people assume they will be quickly capable of advanced nursing practice before they can even be called a novice. It seems very arrogant and chauvanistic to me. I see the same attitude lots of times in EMTs/paramedics. I've been doing advanced practice critical care nursing a long time, and I laugh at the idea that even 2 years makes one an expert. No way. Two years experience MAY result in competent practice. So all of these discussions about 'how much is enough, is 10 months enough? Is one year enough? I'm counting down the minutes left in my one year......' make me just shake my head in amazement. Believe me, those people who go into anesthesia with one year of ICU experience may come out with competency in performing anesthesia, but they are not critical care experts. And every experienced ICU nurse knows that. So, let's call a spade a spade: critical care nursing and doing anesthsia are two different animals. And the one is NOT simply an irritating stepping stone to the other. One is not better that the other, nor do you have to be 'smarter' to do one vs. doing another. I have lots of autonomy and accountability when doing critical care (depends on the unit) and just like not every assignment is life-saving heroics, not every anesthesia procedure is either. It is important to be respectful...... Debbie, CV CNS, MSN, etc.

In the bottom left of my post I notice something that says: Warn (0%) and then 5 joined little tan boxes. Can anyone tell me what these mean?

Thanks everyone for the great replies. I am a single mom because I am a widow--dear husband died of pancreatic cancer June 05. It's been really tough for the 3 of us, but I think the worst is behind and I am excited to be excited about the future. I ruled out becoming a CRNA 20+ years ago because I loved that intense family/patient contact, the ICU environment. Got my MSN as a CV CNS, loved all of it. But not anymore. My favorite pt is a propofolized one. I have done all the family/pt stuff, I have taught, mentored, precepted, committeed. I am so done with all of that. I was really clueless about what I wanted to do in the future (for the first time in 30 years as a nurse) until I had a dream one night about becoming an anesthesiologist. In my dream I was thinking how that would be impossible--too much time and money and I am too old to start that kind of thing. When I awoke, I was wondering where THAT dream come from. Then I had a true Eureka! moment--become a CRNA!!! It fits perfectly. I would start in Aug 2007 if accepted and that gives us as a family to really get ourselves together and for me to buy the textbooks to study. My oldest will graduate from HS the same month I would graduate. I would need some time to visit colleges with her, but there are vacation days, right? She will learn to drive before I start. My youngest will be done with 10th grade when I graduate. Teaching her to drive would be a group effort. That being said, I have always loved school, love a learning challenge. It doesn't stress me, but it really gets my adrenaline flowing. And I would love my girls to see me in school. I finished my MSN 4 years before the oldest was born. And the prospective salary range impresses even my kids. They understand living on a advanced practice nurses salary, all except CRNAs I mean, which is always just making it now that it is just me, vs. living and paying for college on the salary of a CRNA. This site is great--and has been a great help to me. Debbie in Pittsburgh

There was a good amt of response to the question re: the Excela Health program. What about the Allegheny Valley Hospital/La Roche program? In fact, could you compare the three programs and grads, including Pitt, Excela, Allegheny Valley please. I am going to apply to all three. I already have an MSN from Pitt (cardiovascular CNS). I hear that Pitt has awesome clinicals, and a great simulation lab. But it is also 28 months. I think I like the idea of a 24 month program better, since I don't need any of the non-anesthesa Advanced Practice Nursing courses. Been there/done that. Already did thesis, etc. And is it true that if you already have an MSN, that you don't need to retake the GRE, no matter how long ago one completed the MSN program (1986 for me)? I have a grad school GPA of 3.98. 20plus years of CT ICU experience. Have been a CV CNS, CT ICU unit educator, transplant coordinator. Thanks so much for the input. It's hard to get good info on the real differences of the programs and the abilities of the grads. Debbie in Pittsburgh