gassyjon

I had a feeling it would end up like this. I won't be part of a forum that has such an overwhelmingly militaristic attitude. Good luck to all.

sigh. i posted the same thread over at the med student forum, and noone has yet questioned my credentials, but for those that must, I graduated high school a year early. I had a 7 year plan, which I fulfilled. I did my ICU time at the University of Rochester/Strong Memorial. Beyond that, I guess I can't prove who I am, so I guess you'll have to decide what to believe yourself. I'm not going to protest any further. I don't have a negative or anti CRNA attitude. I am against our attitude. If you take a look at our website as opposed to the ASA website, there is a huge, huge difference in how we go about trying to adavnce our issues. i agree with the points made on the AANA website, but the way it is presented is all wrong. This is not an attack. This is my opinion. I stand by it no matter how much I may be flamed by overzealous, power hungry CRNAS on this forum. The same goes for gaspasser.com. It reads like something a jealous child would write! I want to maintain our right to practice as much as anyone else, but I refuse to do it at the cost of superior patient care. I have no intention of ever supporting the notion that MDs should not be included in our practice. Everyone is supervised by someone, including the MDs. Furthermore, the vast majority of MDs out there work TOGETHER with CRNAs, deveoping an anesthesia plan rather than rejecting CRNA input out of hand. If that IS the case where you work, you need to find another job someplace else. I enjoy working with the MDs at my institution, and we work together to acheive the best possible patient outcome. The vast majority of CRNAs out there have a similar experience. Again, if your work experience is different, and you have been an adult about trying to change it, and have been unsuccessful...then you have noone to blame but yourself for staying. OF COURSE THERE ARE BAD APPLES AMONG MDs. REMEMBER though, there are bad apples among CRNAs as well. That's all I have to say. I refuse to allow this to disintegrate into another CRNA vs. MD debate. It's been said, it's old, it' s tired. It's about our attitudes and patient care. Nothing else. I WILL NOT respond to any further inflammatory, attacking, or malicious responses. Seeing this is a public forum, You have the right to speak your mind, but know if it is not in the form of constructive discussion, I will not respond, and will request that the thread be locked. Thanks for the support to those who have given it, and even to those who disagree. I just won't be pulled into a childish pissing match.

glad to see that the first few replies to my post are constructive and positive....i was afraid it would be a witch hunt! LOL JON

Hello all... I am a long time reader, and have never been motivated to post before now. I have to admit, I'm exteremely disheartened by all these political threads both here and on SDN about scope of practice of anesthesiology! Make no mistake, I'm the first one to advocate preserving the right to practice for CRNAs, but there is an important factor we are leaving out of these discussions...the patient! It seems as though these discussions are no longer about what's important. They read very much like a pissing match over "territory" of CRNAs vs. MDs. We need to worry less about our "rights" and our paychecks, and more about the most important person in the OR, the PATIENT! When it comes right down to it, we all know that when a patient crumps, its GREAT to have a second mind and set of hands there. So I have to ask, what's the big deal about supervision? I for one love the idea of having an MD there to help me out if a patient cant be ventilated, or if they are in sever bronchospasm. I know that the docs feel the same way about me. Again....having that kind of team approach only benefits the patient. I also think we have to acknowledge one thing. I know some people aren't going to like this, but MDs do have more extensive training and education than us. I for one know that the MD I work with in the heart room knows alot more about managing acute MI than I do, and if a patient starts going ischemic I am GLAD to have him there. If I was having a CABG, I would certainly want MD backup, and I think other CRNAs would be hard pressed to disagree! They supervise us because they should! I work quite frequently on the labor deck at my institution. I know I would be quite put off if RNs suddenly started putting in and managing epidurals. Why? Because they don't have equivalent education! Nonetheless, I believe it would be of benefit to the PATIENT to have the RN there to assist should a probelm arise. And if you're concerned about your paycheck, I have to ask why. It's unfair to refer to MDs as "making $700K off of CRNAs" and the like. First off, I don't know an MD making that much in anesthesia. Regardless, they go through a minimum of 12 years of training...more if they pursue a fellowship. It makes sense that they make more money. They also have a considerable burden of debt...the MD I work with has $250k in loans from undergraduate and med school combined. My debt, and the debt of most CRNAs, does not approach that. bottom line is, we make a nice living doing what we do, and most of us get a huge amount of satisfaction from it without regard to whether or not we are being supervised by an MD. Getting back to the patient, the most important person(I want to reiterate that): I read all over this forum that there is no evidence that supervised anesthesia is superior outcome-wise to non-superivsed anesthesia. I wish this were true, because it would simplify a complex issue, but it's not. If you check out this article: http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-200007000-00026.htm;jsessionid=C2Yi8r1TJNa1YQPms0ChEn9pxFt9A19yChuQu6dWGq3PoFadx2Zq!250931426!-949856145!9001!-1 There's a pretty clear advantage to having supervision in the OR in terms of mortality. Don't trust the MDs journal you say? Well, I'm not sure I do either, but there are studies in our own journal that, depending on how you interpret them, you could conclude that there is either no difference OR an advantage to being supervised. Of course, there are problems with these studies, as with all studies, but the BOTTOM LINE is the same....there is a paucity of good evidence, and neither the CRNAs nor the MDs can make any claims either way about outcomes. It's inappropriate, and just not good science at this point in time. And even if there were good science to support unsupervised anesthesia, it would not change the central issue. Why do I bring up the research? Just to drive home my point again. why does it matter? We should be worried about our patients, not who gets a bigger paycheck or whether or not we are supervised. The same goes for the MDs...however I would caution CRNAs....the MDs appear, to the public at least, to be more interested in patient safety than we are. Has anyone read the recent article in the Wall Street Journal about anesthesiology as a field of medicine? If you haven't you should.... http://webreprints.djreprints.com/1254400029287.html This article was brought to my attention BY A PATIENT, along with a question about what CRNAs do to improve patient safety. It scared me when I could not answer. In the past, the WSJ has continually criticized anesthesiologists for poor outcomes, publicizing unfortunate and rare cases as routine, and thus making anesthesia practitioners as a whole look bad. With that in mind, I think that this article is a real breakthrough for anesthesiologists. In contrast, our website (AANA) reads like a childish attack on MDs (IMHO). In my opinion, publicizing this type of attitude is not the way to move our initiatives forward. I'm done. If you took the time to read this long-winded rant, I thank you. I want to emphasize that ALL of the above goes for the "other" side of the conflict as well. I hope they have a similar voice of reason on their forums. The patient is the important person. Ask yourself this: if you were on the table for a CABG, or if your wife of child was going under the knife, do you want your anesthesia provider thinking solely about the case, or do you want them thinking about how to thwart the MDs? Let's make a good name for ourselves and keep the patient at the center of our attention. Jon