TejasDoc

Then he posts his little anecdote about physician arroganceInteresting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason, an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance. No retraction. I enjoyed reading your post. I knew as soon as I wrote the "save your butt" thing, I shouldn't have. But I let it go. Oh well, ya make some mistakes and you move on. I apologize. But I think you recognized the point I was trying to make, even if I wasn't making it in the best possible manner. Compensation is a tricky thing, and I don't really know that much about how it's done. Anyway, gotta catch some sleep, and there's still one more post I need to make. TD

Hellllllo Nurse, I would hate to disappoint you, so here I am. I've been incredibly busy with my own training to get back here as often as I'd like. There are a lot of things in your message that I'd like to respond to. Here goes. Sorry that happened to you. I'm not really sure what you said or what you asked, but I can tell you I understand about being jumped on by the majority at a bulletin board. You just have to get up and post again another day. I'm embarassed to say that I imagine at many medical schools, there is not. Mine may have been the exception, because I did have a formal class about the training and education of nurses and different advanced practice nurses. But it was elective, it wasn't part of the required curriculum, and it was literally just ONE class, not a course, but a class. I've honestly not thought that much about it, and maybe I should, I've been a little obsessed with my own situation recently. I'm a new resident, you can imagine, it's somewhat overwhelming. I can tell you what I do, and I try to make a conscious effort of it. The nurses I work with are great. They're smart, qualified and they work really hard. I try really hard to be nice, to thank them every time I get a chance, and defer to their opinions when I know they know more than I do. Not a day has gone by since I started that I haven't learned something from a nurse I work with, and I make sure they know that. I try to make my relationship with them as pleasant as possible. If the nurses I work with aren't happy with their work environment, I didn't cause it. That's my contribution. I'm really sorry that you've been treated badly and called nasty things ... all I can do is try not to be that way myself. Ether, Hmmmmm, I don't know where you are, but I wish I had interviewed at a program that put residents at the front of the bus. Last I checked they just shortened my work week to 80 hours ... wow, what luxury. And now, I can only work 30 hours in a row. Yep, I'm pampered. Lucky for me I make less money as a resident than I did when I graduated from college. Maybe if you all run up to the front of the bus, we can tip the thing over and I can get a couple extra hours of sleep. TD

Oh come on deepz, you don't have to long for the past, you're plenty ignorant and full of yourself now ... I imagine it would make up for an entire life of humility. You're right Lalaith, I may have misread Deepz. This I will freely admit. But, in a previous post he wrote. Then he posts his little anecdote about physician arrogance, using the example from a junior resident. So sure, I'll buy that maybe he's talking about the impact of a few moments on a human life. It's a distinct possibility. I've read it again and I can see how it would be read that way.I just want you to acknowledge that maybe he was taking a jab at gotosleepy after calling him arrogant, and then presenting that little anecdote as a chance to show how arrogant doctors like gotosleepy can kill people. I just don't think inside the bitterness and anger is a nice guy trying to teach me something about humility. Though Deepz, and everyone else who read his post, I want you to think about something. If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year? BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion. TD

'Stalker' deepz? No not quite. But I have a keen sense of smell, and I'm able to follow the scent of BS from one website and to another. It's not rocket science. Hellllllo Nurse, I agree, there is a huge difference in the sub-standard nursing lounge and the opulent physicians lounge. I think it's awful that the nursing staff is given such a horrible facility. I just don't think it's the same as the civil rights movement and "drinking from a different water fountain", in the civil rights sense of it. The difference isn't obviously clear, and you may or may not agree with me, but here's what I think. In the civil rights sense of it, you were black, you were treated unfairly, and there was really no escaping it. You, if you don't like the nursing lounge, and feel SO strongly about it, can just quit. No oppression, no being forced into submission, nothing. Just quit ... find another job that treats nurses better. OR, and I can only imagine the **** storm I am opening up by even suggesting this, go to medical school, finish a residency, and then go ahead and enjoy the opulent physicians lounge. That option, while being a lot of work to enjoy a lounge, is also available to you. Blacks couldn't just quit being black, and they definitely couldn't just go to school and become white through education. So do I think the nurses lounge you describe is awful? Yes I do. Do I think the physicians should get a beautiful lounge the the nurses a hell hole? No, awful idea. I just don't think it's comparable to the civil rights movement. No, no way, no how. You're not an oppressed people, you described a crummy lounge, that's all. You can only imagine how I feel about the Nazi holocaust thing that Alan Smith mentioned. Soon I'm going to have to read a comparison of the treatment of CRNAs to the genocide of Native Americans. TD

Deepz, While I think that anecdote from the resident is educational in sheading light on the experience of training physicians, it does not really apply here. You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology. Sorry, the comparison is weak. TD

It's a ridiculous comparison, and if you would ever use such a comparison in a setting that wasn't anonymous like this message board, people would think you were ridiculous. It's ridiculous that you would defend it, though at 60, you'd know better than I the oppression that African Americans lived under in this country ... I don't think there's a hospital anywhere that makes CRNAs drink from a different water fountain. Though who knows what's going on in Durango ... Unfortunately, there's no way for me to filter out nonsense messages and comments. I read some interesting things from time to time on this board, if I have to read some garbage now and again, well, that's just the cross I have to bear. BTW, you're welcome to wear clean badges. TD

Yet another really offensive comparison of CRNA's to slaves by sleepy. You're on a role man. Nobody is oppressing you Sleeepy. Nobody lied to you about what being a CRNA would entail, and nobody twisted your arm not to become an anesthesiologist. You still have the opportunity. Don't make it seem as though you're under a blanket of oppression and simply cannot escape. Not only is the assertion ridiculous, it's just wrong, but also really ridiculous ... and did I mention wrong? In the very end, this is all academic. As I've been told many times, CRNA's are not restricted by law from practicing anywhere, yet in major metropolitan areas and medical centers throughout this country, CRNAs are not the sole providers of anesthesia care or pain management medicine. So Sleepy, while you may go to bed at night thinking that I'm having nightmares about CRNAs taking my job and livelihood, you're wrong. As far as money goes, tt's really a non-issue for me as I imagine it is for most anesthesiologists. Now that you know, you too can 'wake up!'. TD

Yet another really offensive comparison of CRNA's to slaves by sleepy. You're on a role man. Nobody is oppressing you Sleeepy. Nobody lied to you about what being a CRNA would entail, and nobody twisted your arm not to become an anesthesiologist. You still have the opportunity. Don't make it seem as though you're under a blanket of oppression and simply cannot escape. Not only is the assertion ridiculous, it's just wrong, but also really ridiculous ... and did I mention wrong? In the very end, this is all academic. As I've been told many times, CRNA's are not restricted by law from practicing anywhere, yet in major metropolitan areas and medical centers throughout this country, CRNAs are not the sole providers of anesthesia care or pain management medicine. So Sleepy, while you may go to bed at night thinking that I'm having nightmares about CRNAs taking my job and livelihood, you're wrong. As far as money goes, tt's really a non-issue for me as I imagine it is for most anesthesiologists. Now that you know, you too can 'wake up!'. TD

So yeah, that's pretty offensive, comparing the "plight" of nurse anesthetists making more than 100k a year PLUS overtime to the actual plight of a race of people who had to come out from under the foot of hundreds of years of slavery and legalized oppresion. Like I said before, the comparison is just offensive. And as I've been told numerous times, you by law can practice as an independent anesthesia provider, so what are you complaining about? I hear there are plenty of jobs just a few hours outside the major metropolitan areas in South Dakota and Montana just waitin' to be picked up by an eager CRNA like yourself. Not an anesthesiologist in sight, so have fun. TD

So yeah, that's pretty offensive, comparing the "plight" of nurse anesthetists making more than 100k a year PLUS overtime to the actual plight of a race of people who had to come out from under the foot of hundreds of years of slavery and legalized oppresion. Like I said before, the comparison is just offensive. And as I've been told numerous times, you by law can practice as an independent anesthesia provider, so what are you complaining about? I hear there are plenty of jobs just a few hours outside the major metropolitan areas in South Dakota and Montana just waitin' to be picked up by an eager CRNA like yourself. Not an anesthesiologist in sight, so have fun. TD

I am. TD

thanks, though i knew what you were getting at the first time, it was a rhetorical question. but that's my fault, i gave you an excuse for a diatribe, i can't really complain when you do. though maybe it'll make you feel better if you look at the situation you described in a different manner. just think of all the autonomy you get at night in those situations! wow, how exciting. see, the glass is half full, not half empty. it must be quite a sight at 3pm, all those mds leaving, wearing their flight suits with a donut in one hand and a driver in the other talking to their brokers on a cell phone and counting the money they make off your back breaking labor. td

Lemme guess Deepz, you turn into a pumpkin? TD

I'm sure you've heard the surgery saying ... "Sometimes in error ... never in doubt." I do my fair share of moaning and groaning about the attitude of surgeons, but I think it takes a certain healthy amount of bravado to think that you can affect healing by cutting into the human body. TD

Gaspassah, I haven't had a chance to say, but I REALLY appreciate the court cases you posted. I wish I could say that I've had time to look them up, I haven't. I've just been too busy with work stuff recently. I will take a look at some point, just don't know when yet. But thank you for posting those. Loisane ... you're right, this discussion has gotten pretty far away from the anesthesia care team topic that it started on. In the very end, I don't know what's going to happen with this model of care. If nothing else, I hope it ends up that CNRAs and anesthesiologists have an amicable relationship. From what I hear, in the private world, this is true. I think anesthesiology, from a physician point of view, is going to stress this perioperative role more and more. Right now, the ABA is considering tacking on more time in the ICU during an anesthesiologist's residency. Abroad, many anesthesiologists have to spend a year in ICU training as a part of their residency. A lot of physicians are changing their practices, cardiothoracic surgeons have to contend with interventional cardiologists, general surgeons with GI docs, neurosurgeons with interventional neuroradiologists ... everyone's practice will change eventually. I don't really know what's going to happen in our case. I disagree with Deepz, this is not an issue of economics. I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist. As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half. So perhaps in that case, many of you are thinking that the reimbursement will simply drop to half, therefore the health care consumer is only paying half what they were before, to get anesthesia care (in this case, imagine there is no supervision, CRNAs are treated as exact equals to an anesthesiologist). So in this case, if an anesthesiologist does a case, he gets X amount, if a CRNA does a case, they get X amount. While I think this sounds like it would be agreeable to CRNAs, you know it would not be. Can you imagine the **** storm that the AANA would create if before, you got paid X to do an anesthetic, but now that nurses and physicians are equal in this matter, you got paid half of X? I just don't see that happening, so I don't think it's an issue of the economics of it all. You said you thought there might be cases when the expertise of an anesthesiologist would be needed, but not every case. But which cases? I imagine you wouldn't necessarily know, so that would mean that every hospital in America that performs surgeries should at least have a consultant anesthesiologist on staff, just in case one of those emergencies arises. But every hospital does not have an anesthesiologist, and they'll never get one if the anesthesiologist receives his/her only compensation from consultation. As for the leadership of the ASA. I don't really know. I know very little about the attitude of the leadership. From a financial point of view, I'll lead a very good life if supervision of CRNAs in an anesthesia care team stays the predominant model. And I know I'll lead a good life if anesthesiologists are the sole providers of anesthesia care in this country. But if CRNAs are doing all their own cases under a full scope of practice, well, how will this help me? You really just then become my direct competition for employment. The ASA is protecting the practice of anesthesiology for me ... so I wouldn't be reclaiming anesthesiology, I'd just be giving a bigger chunk to you if I tried to vote in a more pro-CRNA leadership. Why would I want to do that? Deepz, I'm not sure you've ever had anything positive or constructive to say in this discussion, if I'm mistaken, I'd hope someone would point it out to me. It's always something negative, it's always a jab at anesthesiologists, the ASA, or AAs, and rarely is it backed up by any kind of real facts or substantial proof. This last message is a great example, you could have made a simple comment about the anesthesia provider shortage and supervision not really being "proscriptive of any standard of care", but you ruined a perfectly reasonable argument with comments about CNBC, golf, and stock brokers. Again though, I'm going to agree with you, Loisane makes good posts, people could learn a lot from her approach, including me. TD

I agree that I think this test shows whether or not medical students can talk to people, but in the form of a history and physical exam. I think you're making this into more of a personality test, like I said before, and I don't think that's the point. Plenty of people in medical school have poor people skills, I'm not going to disagree with you there. But there are a few specialties in medicine that these people might excel in, and therefore, I don't know if you can make this a requisite of entering school. And if you did make it a requirement, how would you test this? As for the chart throwing ... that's childish too, nobody is going to disagree with that. Some people don't have any control of their temper. And the computer thing, I don't know about that, maybe the doc forgot how to use the computer. Anyway, these all seem like communication skills between a doctor and a nurse, and as far as I know, this isn't a tested skill on this particular exam. The golf thing ... blah blah blah. The people on this board are obsessed with talking about doctors, their golfing and their donuts. TD

What kind of test do you think this is? It's not a personality test, it's not to test if you're a sociopath or a bad people person. Here's a blurb from the USMLE webpage. "Purpose Statement. Step 2 CS assesses whether an examinee can demonstrate the fundamental clinical skills essential to safe and effective patient care under supervision. These clinical skills include taking a relevant medical history, performing an appropriate physical examination, communicating effectively with the patient, clearly and accurately documenting the findings and diagnostic hypotheses from the clinical encounter, and ordering appropriate initial diagnostic studies." These are all things that you would learn in medical school, and should not necessarily be expected to know as a function of getting in. I would be surprised if med students aren't sweating this exam in a big way. We're talking about an exam which determines whether or not they can get a license to practice medicine, and nobody they know has ever taken it. Furthermore, residency programs might see these results if the test is taken before the application process. Finally, certain schools require a passing score on USMLE Step 1 and Step 2 before they will allow you to graduate. So I think you're wrong, I think people are probably concerned about it. How does this test mean that doctors are getting to be more like nurses? Anyway, I'm not sure how prevalent it is, but this kind of test was required of me in medical school already. Now they're just making it a requirement of licensing. I agree, this is just going to cost medical students a bunch more money, and I'm not sure if you're going to get a better doctor. TD

So I'm not really sure, what was wrong with that statement that made? I said absolutely nothing about anesthesiologists or supervision, not a thing. All the things you wrote about have to do with increased knowledge, which is exactly what I was talking about. BUT, since you brought it up. While I can't prove that anesthesiologists are not the reason why anesthesia is so much safer now than 100 years ago, I would be surprised if you can prove that is was NOT anesthesiologists. Like I said, I can't prove it, but I could put forth some arguments that would support the possibility. Anyway, I just had to chime in and say that you're putting words in my mouth or you're not reading my posts carefully enough. Either way, if you're going to call me out about something I've said, I should have said it. Why is the word 'order' here in quotes? Does someone actually have to put an order in the chart for anesthesia services to be provided in the states that require physician supervision? Is that the only involvement that they have? If they have to put an actual order in the chart, then I don't understand why 'order' would be in quotes. AND, if they have to put an order in the chart, then I don't understand how they're not liable if something goes wrong and it is determined that anesthesia was at fault. If I'm in the ICU, and I write an order for a dopamine drip, and it is later determined that the dopamine drip killed the patient, I'm screwed. And I wouldn't have administered the drip, the ICU nurse would have administered the drip, but I wrote the order ... sooooooo. But maybe it's a different kind of order, I don't know. I don't think we can throw around the word 'order' unless we're talking about a medical order from a physician, as we all know it. From our point of view as health care professionals, physician orders have a very specific meaning, if this isn't the right word, we need to find out what is the right word. Countless lawsuits ... but not just lawsuits, countless lawsuits ... so, I need a lawsuit to use as a reference. Just one, something I look up, something that is a matter of record in a court of law here in the United States. What would be even better is the precedent setting case in this matter. But since there are countless numbers of them, any really juicy one will do, but I need a real point of reference. I'm glad you also find it hard to believe that all states do not require the services of an anesthesiologist for the provision of anesthesia care. Whew, I didn't think we'd agree on anything. :> Actually, I'm getting the distinct feeling you're not reading my posts. To be totally honest, I don't care. Read my posts, don't read my posts, save 'em, burn 'em, whatever. But if you're going to argue with me about issues that I've already commented on, at least make sure that you're quoting me properly. I didn't say that the states required anesthesiologist supervision, I said some states require PHYSICIAN supervision, and then asked if a physician is in a position to supervise anesthesia care, shouldn't that physician be an anesthesiologist. Now I've said it twice. Ok, it's decided, you're not reading a thing I'm writing. I actually wrote out a list of things and said "Let's just call these 'practice priviledges' to make it easy." So why did you ask what I was talking about? I spelled out specifically what I was talking about and called the group of things I was talking about 'practice priviledges'. So your post was really just jumping down my case about a bunch of things I didn't actually say. Please let me know if you find those cases, I think they'd make interesting reading. Nope, he didn't, he actually did a very bad job. Loisane, you do such a good job posting, your comments are well thought out and well articulated. I'm going to agree with gaspassah on this one and say you've got him beat. TD

Loisane, you had so much to say, I can't really comment on it all, so I've kind of bitten of chunks and pieces. As always, your comments were great. I'm not sure if this is totally true, and I don't think it's necessarily propaganda. I think you're right that it's something the ASA likes to say, but we'll get to that. You're right, as a group, nurses were the first to specialize in anesthesia. No arguments there. Anesthesiologists and supervisors of anesthesia care did come around later, leaving a gap where nurse anesthetists were not supervised. Having conceded this, will you concede that surgical / anesthesia care in the 21st century bares little resemblence to the surgical / anesthesia care provided during this period where there were very few anesthesiologists? That surgeries and anesthesia have become increasingly complex and that while yes, anesthesia is safer now than it has ever been, it is not because the anesthesia itself has gotten easier, but because we know so much more now than we ever have. These communities, these were not major metropolitan areas were they? My experience here is somewhat limited, having lived in many cities over the course of my life, but having spent the vast majority in cities with a population over 1 million. So here is my question regarding this statement, do communities that are served only by CRNAs choose this? Or are they unable to attract an anesthesiologist, but if they could they would? Are there hospitals that only have CRNAs practicing as a matter of hospital policy? Do they turn away physicians because they choose not to utilize anesthesiologists for anesthesia services? From what I've read, this is right, no state laws or nursing boards require a CRNA to be supervised by an anesthesiologist. But I am also under the impression that many states require a CRNA to work under the direction/supervision of a physican/podiatrist/dentist ... is this correct? And as far as I've been able to find, these requirement are not about reinbursement, not at all. There's a fortune to be made in anesthesia if you follow all the rules too. I just cannot imagine that the ability to bill for things you may not actually have done, and make a fortune doing so, factored that much into what medical students chose to be their medical specialty. I consider myself about run of the mill when it comes to my knowledge of how physicians get paid to do what they do, at least at my level of training. And I know just a little more than NOTHING. I know anesthesiologists make a good living, and they have a comfortable lifestyle (so do dermatologists, radiologists, ophthamologists, plastic surgeons). Anymore than that, and I'd just be guessing. The unscrupulous ability to make money never once factored into my decision. This may change I guess if being the 'physician of record' has only something to do with reimbursement, and nothing to do with state regulations regarding physicians supervising CRNA care. Assuming this is true, in those states, where the surgeon is the supervising physician, how does his/her liability not increase? Not anesthesiologists, but physicians ... I think. And at the VERY LEAST, is it not a stretch to say that in those states where supervision by a physician is require, should that physician not be an anesthesiologist? I never said you were a cracker jack nurse or anything like it. I do believe this though, too much emphasis is placed on the history. It's used too much like a professional qualification, which it is not. It is very true that if you go back 100 years, you will be hard pressed to find yourself a physician specializing in anesthesiology and you would find an abundance of nurse anesthetists. But, I think you will also admit that there are many things that were done a 100 years ago in medicine that we would never do in a million years today ... we just know better now. Don't apologize ... if nothing else, I learned something about medicare billing. Really great post overall. I guess this is what I meant by 'legislate', and maybe I just used the wrong term. I think anesthesiologists do not see themselves as having issues with supervision, scope of practice, what some states will let them do and what other states won't, what some hospitals say they can do, and what others say they cannot, how they can bill medicare, etc. Let's just call these 'practice priviledges' to make it easy. I also don't think anesthesiologists have issues with how much they're paid compared to CRNAs, they as a general rule, make more. So this is how I think anesthesiologists might see it, and I'm really only guess here (honestly) ... they see it as though CRNAs want the 'practice priviledges' and pay of a anesthesiologist, but instead of going back to medical school and doing a residency, they lobby to have Medicare rules changed, and lobby changes in policy, such as those regarding office based anesthesia, like in Florida (I think). Anyway, I'm getting so tired, it's hard to keep my head from hitting the keyboard. Trying to make a cohesive argument is getting to be more effort that I'm really interested in trying to expend. If my post was off in some way, I'm going to blame it on sleep. Ask me tomorrow, I can try to clarify. Thanks for engaging me on the issues, I'm enjoying the discussion. TD

Like I said before, not a comment about things you said that weren't actually true, or only partially true, just attacks on me. You're right, I called you childish, and I even gave reasons why. Everyone else can decide if they agree or disagree. And I did come here to learn, and it's been a pretty informative lesson so far. If nothing else, I've learned to always check whether or not the stuff you say is actually true, and that really makes it all worth it in the end. The things I've learned just fact checking you has been impressive - thanks for the education. Chest beating? Come on. Are you talking about my comments about supervision and superior training? I was asked those questions specifically, if people didn't want my opinion about those things, they shouldn't ask. I didn't bring those things up, and I didn't come to this discussion to have those conversations. But I think people ask because they knew what I would say, and that's what they wanted me to say. Everyone needs a villain. And the "... this ..., doctor", "... that ..., doctor" is getting old already, but if you say it a million times, I could see if the ASA would send you a set of steak knives. TD Instead of looking up catchy proverbs on the web, one should check their facts. ---TejasDoc Internet Proverb

TennRN2004, I agree with you, it is a struggle and a sacrafice for the families of physicians in training ... my spouse would be more than happy to tell you all about it. :) As for anesthesiologists being superior to nurse anesthetists ... I have to be very careful with this, 'cause if I breathe the wrong way, somebody is going to be offended. I think an anesthesiologist receives superior training when applied to the practice of anesthesia. It sounds like the physicians you work with don't try very hard to have meaningful relationships with their patients. I don't really know what to say about that, except that we're not training to be that way. As for physicians not examining their patients on rounds and using your assessment. It's one thing to use your assessment of vitals, it's another to just copy "III/VI holosystolic murmur best heard in the axillary line". BUT, nurses get lazy too, how many times have I read that a patient's respiratory rate is 20? Do you know what kind of **** storm I would hear if I pulled a nurse aside to explain that 20 wasn't normal?! I appreciate you explaining your training to me, and how you approach patients. I can tell there are even differences in the terminology we use, I don't say 'assess', I use the word 'examine'. You and I have to approach patients differently, my paradigm is one of diagnosis and treatment, and this is where I think my training is superior when applied to the practice of anesthesia. All of my training is suposed to be able to prepare me to recognize the signs of pathophysiology, whether that be through examination or interpretation of tests and labs, and make a differential diagnosis or a definitive diagnosis. If I have a differential, I must decide what options are available for me to attain a specific diagnosis, weigh the pros and cons, and decide what tests/exams/studies I should order. I have to be able to interpret these and then come up with a treatment plan. This is what happens in the OR, but it's a critical care setting and very acute. If for example, I see that a patient is hypoxemic. I have to decide why --> e.g. make a diagnosis. If I can't, it becomes my job to narrow down the differential through interventions, tests, or examination. Once I have a diagnosis, I need to treat, otherwise, what was the point of figuring out why? This is why I see anesthesia as a medical profession, one of diagnosis and treatment. In addition, my clinical anesthesia training is longer and encompasses a wider range of care, including the ICU. If I choose, I may receive advanced subspecialty training in many fields as well, further expanding my body of knowledge and experience. As far as I know, the option to fellowship train in anesthesia subspecialties does not exist for CRNAs. Anyway, I hope this kind of answers your question. I think I was long winded, and may or may not have made the point I was trying to. I just didn't think I could say that I thought my training was superior, and then not say why. TD

Deepz, You're just a tough guy to have a discussion with - partially because of childish things like 'A$A', but mostly because you say things that either aren't really true, or only partially true, don't ever give references, and then when somone calls you on it (see post about the # of board certified anesthesiologists) you ignore it. Because you believe the things you write does not so much bother me. You're only one person, lots of people have beliefs that aren't true. But you're a senior experienced nurse anesthetist. The people on this board probably look to you for your opinion and knowledge. So you're right, the American Society of Anesthesiologists was not formed in 1905. Their website it pretty clear on that. http://www.asahq.org/aboutAsa/history.htm Here's another pretty good page, it gives you more details, if you're interested. http://www.nyssa-pga.org/society_hist.html And it wasn't the AANA in 1931. http://www.aana.com/archives/imagine/1997/04imagine97.asp The group that would become the AANA was founded in 1931, but called something else. But you did have 'national' or 'american' in your name from the get go, congratulations. 'M-Deity' --> Wow, are these all original, or is there a website that posts these for people to use? I just don't think what we do is the second most important thing happening in the OR. General anesthesia may not be the reason why people come to the OR, but modern surgical practice as it exists today owes itself to our ability to keep patients alive and make them unconscious and insensible to pain. TD

Check out some of these links, interesting stuff out there. http://www.asahq.org/Newsletters/2002/12_02/greene.html http://www.aana.com/press/2002/111302.asp http://www.aegis.com/news/ads/2003/AD032201.html http://www.news-star.com/stories/120802/hea_14.shtml I think there's more out there, but this is a good start for anyone who'd be interested. Science, human interest, we've got it all. Enjoy. TD

Someone is a little touchy, don't you think? You yourself have not been doing anything for a 100 years, so stop saying it as though you have. Really though, isn't that what's happening deepz? You think you do what an anesthesiologist does, just as well. Yet the anesthesiologist makes more money, gets more respect, and isn't in a position to be supervised, etc. (I know someone out there is going to say that they are a CRNA and are the only person within a 100 miles that does anesthesia, so they get plenty of respect, are never supervised, do pediatric hearts and make a gazillion dollars a year. Don't. I know you exist, I'm generalizing.) So you have 2 options, you can go to school and train to be an anesthesiologist, which will gain you all the before mentioned things, or you can try to legislate changes to get what an anesthesiologist has. I'm just trying to state facts. I didn't call you a 'wannabe'. I never said anesthesia cured asthma, though I think I made a reference to the post that did. I think you might just be angry I call you out on your D.O.A. fantasy. Sorry. TD

TennRN2004, I want to congratulate you on finishing nursing school. And I agree with you totally, we have a lot to learn from each other, and I have no problem admitting that I can learn a lot from the experience of the CRNAs here and at work and I can learn a lot about anesthesia care from ya'll too. As far as I'm concerned, the issue of 'anesthesia nurse' vs. 'nurse anesthetist' is answered for me. I understand ya'll's viewpoint on the issue, it is a reasonable request, and I have no problem making sure to address you and refer to you as nurse anesthetists. I don't understand exactly what your professor meant ... junior doctor vs senior nurse. Did he/she mean junior doctor as in resident, or junior doctor as in someone who doesn't know very much? I don't know, you know the conversation, in its context. Anyway, please elaborate. Now, I do want to address something, only if to make you think about something a little, if you haven't already, and maybe you have. You said you chose to be a nurse, you are a nurse, and you want to be a CRNA. I applaud you for your accomplishments and your dreams. You have conquered difficult training and you have plans for even more rigorous training in the future. I guess I'm interested, since you're so young (I'm young too, we're probably very close in age, I imagine), why chose being a CRNA over being an anesthesiologist? (I promise, I'm trying to ask this question in the least loaded way possible) Is it because you really want to be a CRNA, with everything that it means to be a CRNA now, or is it because you want to be in the anesthesia field, but don't want to spend 4 years in medical school and 4 years as a resident? I guess what I'm saying is this. If you want to practice anesthesia with the rights, priviledges, respect and recognition of an anesthesiologist, go to medical school and finish a residency in anesthesiology. And if you want to be a CRNA, with all the rights, priviledges, respect and recognition of a CRNA, by all means, good luck, it's a worthly and impressive goal also. But to me, it seems wrong, if you train to be a CRNA and then try to legislate your way to being treated like an anesthesiologist. Good luck, I look forward to hearing what you think about all this. And no worries, I knew coming into this that being 'jumped on' what part of the gig. TD P.S. Deepz ... D.O.A. huh? Doctor of anesthesia. Dream on buddy. I know what kind of fun you have with the whole 'A$A' thing, I can only imagine what you would do with DOA. Alas, your dream will never be a reality.