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Every time I administer an anesthetic, patient safety is my sole focus; thank you for your reminder to 'focus on patient safety', though, your reminder is quite unnecessary! Good patient outcomes, happy surgeons...awesome! The fact that our surgeons don't care if it's because of a CRNA or an MDA, priceless!

"A few misguided CRNAs seem to think that they can 'work solo'"...Let me be the bearer of bad news: thousands of CRNAs DO work solo, and no, it's not dangerous, as studies show that we 'get away with it' in equal numbers that our physician colleagues 'get away with it'. We work solo because there is a need for our anesthesia services. We go through the credentialing process and any peer review process just as an MDA would. As far as thinking 'in any way shape or form' that CRNAs are 'equal to an anesthesiologist', first of all, I don't consider being an anesthesiologist the gold standard of the anesthesia profession. I never insinuate that I am a physician, why would I? The gold standard for me is vigilance, thoroughness, continuing education, personal ethics, and good patient outcome. If I can achieve that with every anesthetic that I render, who cares what my title/'label' is??!! How arrogant of you to think that a CRNA would even want to be equated with an MDA. We are anesthesia providers and yes, MDAs are anesthesia providers, too...so, we have that in common but I am 100% satisfied that I am a CRNA and 100% satisfied that I am not an anesthesiologist!

Semantics and presentation are all the MDAs (some hate being called MDAs, by the way! hehehe:lol2:, they are an M.D. just like a CT surgeon is, no need to differentiate with the 'A', so they grumble) have to instill fear in the unknowing public. That being said, they are pathetically grasping at straws to elevate their own interests. Hospitals wouldn't hire us, credential us as a member of their medical staff and grant us all the same privileges as an MDA if evidence showed that we are dangerous. Surgeons would not go for that and we all know that surgeons are the $$ makers and have a strong voice and influence. I do believe, however, that there are individuals (both MDAs and CRNAs) who are dangerous but you can't label an entire profession based on certain individuals. CRNAs are providers and members of the medical staff whereas the regular RNs are employees who do not have the skill set we have, do not have provider numbers for billing, etc...but MDAs want to blur the picture and make it appear as if Nancy Nurse, who just gave a bed bath, is now going to give someone's anesthesia a whirl. That tactic is very transparent but it's all they have. Funny story: While at a locums assignment, I was asked to go give one of the locums MDAs a lunch break. When I went in his room and offered lunch, he was so rude, nasty and indignant...I am a doctor, doctors don't take breaks...I said, "Well, it makes no difference to me, do you want lunch or not?" And the little jerk eventually decided to take lunch! His ego was bruised...fact of the matter, no one really cared if he was a doc or a CRNA, whether he took lunch or not...it only mattered to him. At another locums assignment, my attending (a locums) offered me lunch and when I returned, mayhem had broken out...another attending was in my room helping my attending dig out of a big hole. When the dust settled, the surgeons later told me that I could not leave again if that meant the locums MDA would be covering for me! The ETT had migrated and the anesthesia doctor didn't diagnose it and the patient started to really decompensate. So there you go! Those 'MD' initials didn't help my attending one bit! We have one of the best professions in the world!

The facilities (and there are MANY!) that credential and grant CRNAs privileges don't agree with you! You look like a complete goof when you say 'we all know that'...By the way, who is 'we all'? If you can provide concrete sound evidence, I might be inclined to think you had a point...just because you couldn't hack it in solo practice and felt insecure enough to go back to med school doesn't mean the rest of us in solo practice fall short of being competent providers. Obviously you are feeling the need to justify having to totally repeat an anesthesia career from the very beginning. Look at the time and expense, only to end up in the same place but with a different set of initials after your name! Please disclose who 'we all' is and demystify for all of us your concrete evidence that states MDA involvement in anesthesia delivery is safer...you CAN'T do it and we all know that you know you can't! It has been put to rest, by the way! It continues to be put to rest every year that the data banks are reviewed!

LOL...please define 'properly supervised'....is it proper supervision when the ologist is in the office on the computer, or even outside going for a jog??? Also, it has already been proven that all models of anesthesia delivery are equally safe. And no, it wasn't a waste of time(your words), as several studies have been done and all point to the same conclusion. That has already been put to rest. Closed claims cases and data banks have been studied ad nauseum...can't argue with the numbers and anyone who does argue with the numbers looks foolish and uninformed. Leaving certain medical decisions 'up to the patient' makes no sense, as most lay people are clueless about the intricacies of all the people involved in their perioperative care. As I stated in another post, that's like asking the patient if they want a total knee by Johnson and Johnson or Zimmer and the patient choses JNJ because that's what they have 'heard of'. Do you tell a pt that an RNFA will be suturing/closing the wound and that it's not safe because the RNFA isn't a doctor? Just because the general public has 'heard of' an anesthesiologist or has 'heard of' Johnson and Johnson doesn't mean they are informed to make certain decisions about their care. I have never worked at a facility where the patient is even presented with the option about who administers their anesthesia. Each facility decides what anesthesia model they will have on staff and that's the end of it. The surgeons usually have a big say in that policy-making process. I worked at a place where the surgeons preferred CRNAs, so, no MDAs were on staff; I have also worked at a facility where a few orthopods wanted only docs, so, those surgeons only worked with MDAs. It goes both ways and both ways are safe!

This 'real nurse's' privileges (according to the medical staff credentialing committee)are as follows: Administer general anesthetic; administer regional anesthetic including spinal, epidural, ankle block, axillary block, interscalene block, popliteal block, femoral nerve block; Securing airway with ETT, LMA, FOI, etc.; Insertion of arterial line, central line, PA catheter; Too many more to list, but it's the same set of privileges granted to the MDAs. A certain degree bestowed upon someone doesn't inherently include safety...where are you coming up with the 'safer if done by a doc' philosophy? Sounds like wishful thinking but the studies and data banks strongly contradict that line of thinking. I did 2 emergency cases over the past 36 hours...patients are fine, one guy has even gone home! The surgeon is always grateful and pleased! Hospitals want happy surgeons. Whether it's a CRNA or an MDA who provides good service, administration doesn't really care. If I were 'insecure' as you suggest, I would then go back to medical school but I am secure that my education and experience continues to serve me well and make me a safe and vigilant anesthesia provider. It was your insecurity that made you go to medical school. I have worked with a lot of docs who are outstanding and I always take advantage of any learning opportunities from them, simply because they have been doing anesthesia longer than I have. I also gleen any learning opportunities from a very seasoned CRNA, too. There is nothing like years of experience, regardless of your degree. I still think you probably have some regrets of doing the MD route, cramming your brain full of minutia, regurgitating it back on an exam, and forgetting most of it by the time you actually pick up a laryngoscope for the first time as an anesthesia resident. Many docs actually tell me they wouldn't go to med school if they had it to do all over again.

Patients are clueless...that's like letting them make the decision that they want a Johnson and Johnson total knee rather than a Zimmer knee because they have 'heard of Johnson and Johnson'.

Obviously you are incorrect. Tell that to the multitude of medical staff credentialing committees that grant privileges to CRNAs to work solo. If you did your homework, you would see rather that your assertions are 'uncommon'.

I did a locums assignment in CA where a world renowned surgeon is on staff. He said that he prefers CRNAs over anesthesiologists. Guess what? There are NO anesthesiologists at that hospital because that's what the surgeons want! I did the anesthesia for one of the hospitalists at my former hospital. He was fine with that and he could have had an anesthesiologist if he wanted! In PACU, he told me how wonderful he felt! So, you are just blowing hot air based on zilch. You seem to have a problem that you chose a field that highly overlaps with an advanced practice nurse. You should have chosen surgery or another field to feel more like a 'real doctor'.

What is something that a CRNA 'couldn't handle'? If you say airway, I have seen MDAs who couldn't intubate; if you say complex hemodynamic management, that's 2nd nature to a CRNA because of our ICU experience; diagnosing a pneumo? We can do that AND treat it! Please, do tell what you think a CRNA couldn't handle. I am ACLS trained, just like any doc. I can do a cricothyrotomy or even a trach if I had to...most anesthesia providers (docs included) don't even do that in their career. Get back to me on that would ya?

My comment concerns the improved safety of anesthesia over the last 100 years: Improved drugs and monitoring! Can you imagine dropping ether and not having pulse oximetry or the other 'standard' monitors we employ today? It's not the arrival of the latecomers, anesthesiologists, to the practice of anesthesia that can take credit for the improved safety. The accumulation of knowledge is huge, leading to evidence-based practice. Did you know that the first anesthetic-related death is from aspiration? Now, patients are NPO based on such data, just as surgical procedures have improved over the years due to better equipment and a huge compilation of data and 'learning from the past'.

You are incorrect on a few points: CRNAs do not have to work under an MD/anesthesiologist. I work as a solo CRNA. As a credentialed member of the medical staff of several hospitals, I have been granted privileges by the medical staff members (physicians) to do the following: Administer a general anesthetic, insert central or arterial lines, even PA catheters, perform regional anesthesia including spinals, epidurals, femoral nerve blocks, interscalene blocks, axillary blocks, ankle blocks, Bier blocks, etc as well as write any necessary preop orders for any medication/diagnostics/consults with another specialty and I write post op orders for the recovery room. That list doesn't really differ from the privileges of the 2 anesthesiologists I work with....the same ones I cover when they go on vacation! I love what I do and the patient's appreciate what I do for them. Anesthesia school is no walk in the park. Medical school gives you a lot more very detailed anatomy, histology, biochemistry, neuroanatomy, etc., most of which have no bearing on your ability to be an excellent anesthesia provider...much of which is forgotten by the time a resident enters anesthesia training!

BRAVO GregRN! You elucidated the foolishness of the previous argument of what does and doesn't constitute 'education' based on if one is drawing a salary or not. I am a CRNA and shared my cardiac rotation with an anesthesia resident (a 'doctor'); he had no clue how to handle the hemodynamics/drugs and even an episode of VT immediately post-op. My ICU experience made my cardiac rotation seem like cake; the resident, on the other hand, was a deer in headlights much of the time! Attending grand rounds as residents presented their cases (the binds they got themselves into), was amusing...giving Dilantin IV slam and then you have no BP which is refractory to any pharmacological intervention...and the list goes on! Of all the years of education that an MDA has, really only 3 or 4 of that is anesthesia training. I used the same text books as residents, worked side by side with them...no magical powers came from their M.D. status that made them a better anesthesia provider. Vigilance, ethics, continuing education, skill and ability do not depend on the degree one possesses; it stems from the motivation of the individual.

Your comments stem from pure ignorance. Get out and see how CRNAs function solo...and check their outcomes...facts and data are something you haven't seemed to have checked. As a physician, shouldn't you have an 'evidence-based' way of approaching things? We are all credentialed members of the medical staff with the same priviledges as an MDA with regard to providing anesthesia and medical emergency services. Check the databanks of the thousands of CRNAs who work solo and compare with MDAs...why would the physicians on a medical staff committee sign off for CRNAs to work solo if we were so 'dangerous'? Go do another residency in another field so you can feel like a legitimate 'doctor' whose practice doesn't strongly parallel an advance practice nurse.

I don't feel the need to be or not be equal with anyone! An anesthesiologist is not the gold standard for an excellent anesthesia provider. I am a vigilant anesthesia provider and I can give just as good and safe of an anesthetic as the next anesthesia provider, be it a CRNA or a MDA. My outcomes are great and my data bank is squeaky clean! Afterall, isn't good patient outcome what is ultimately important and not the anesthesia provider's degree? Both MDs and CRNAs have bad outcomes...that's just the nature of what we do for a living. You seem to really be fighting for your 'doctor status'! You should have been a surgeon, a real doctor whose practice doesn't highly overlap with an advanced practice nurse, otherwise, you will forever be a physician practicing nurse anesthesia! I work per diem at a facility and I cover for the MDAs when they go on vacation! How bout that??!! I am credentialed medical staff, so says the credentialing committee of physicians!