For current Anesthesia MDs:conflicts in the OR

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BigRedPingpong

BigRedPingpong

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Who get's the final word in the OR about Pt managment? If something goes wrong, how do they determine fault (ie the surgeon or yours)? Do you ever find yourself fighting a surgeons superiority complex? Have you ever encountered an obnoxious surgeon who treated you like crap because s/he thought they were "better,smarter" than you because he is a surgeon? Who needs who more? How does one handle a antagonistic surgeon? How do you feel about nurse anesthesiologists taking over docs jobs in florida? I know that went kaput real fast because of poor outcomes. Sorry for the multiple questions. But if you can just cover the conflict with surgeons, that would be great.
 
BigRedPingpong said:
Who get's the final word in the OR about Pt managment? If something goes wrong, how do they determine fault (ie the surgeon or yours)? Do you ever find yourself fighting a surgeons superiority complex? Have you ever encountered an obnoxious surgeon who treated you like crap because s/he thought they were "better,smarter" than you because he is a surgeon? Who needs who more? How does one handle a antagonistic surgeon? How do you feel about nurse anesthesiologists taking over docs jobs in florida? I know that went kaput real fast because of poor outcomes. Sorry for the multiple questions. But if you can just cover the conflict with surgeons, that would be great.
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I have seen some pretty pompous surgeons in my time in anesthesiology. As far as management in the OR, the anesthesiologist is in charge. She or he is the one that monitors the patients vitals, pulse oximetry, capnography, rhythm, and etc..., runs the vent, and administers the anesthesia as well as bring the patient out. The anesthesiolgist manages the patient while the surgeon does his or her thing.

The surgeon and his team prep the sterile field and does the procedure. There have been times that I have seen where the anesthesiologist has cancelled a procedure even though the surgeon wanted to proceed due to potential complications from anesthesia. Essentially, the anesthesiologist has final say as to whether or not a patient is put under anesthesia.
 
Wahoowa said:
I have seen some pretty pompous surgeons in my time in anesthesiology. As far as management in the OR, the anesthesiologist is in charge. She or he is the one that monitors the patients vitals, pulse oximetry, capnography, rhythm, and etc..., runs the vent, and administers the anesthesia as well as bring the patient out. The anesthesiolgist manages the patient while the surgeon does his or her thing.

The surgeon and his team prep the sterile field and does the procedure. There have been times that I have seen where the anesthesiologist has cancelled a procedure even though the surgeon wanted to proceed due to potential complications from anesthesia. Essentially, the anesthesiologist has final say as to whether or not a patient is put under anesthesia.
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When you are in the OR, it is ESSENTIAL that you remember that you are a part of a team - truly. Everyone has a job that is important from the scrub tech to the rotator. It serves no one well to get into a pissing-contest with surgeons either. Many surgeons do this stuff all the time. I have watched well-adjusted surgery interns entering with me become lunatics within the first year, and I have learned to understand that somehow this seems to be the nature of the specialty (no offense to my surgery bretheren).

Personally, when I have a conflict with a surgeon concerning pt care, I turn to scientific logic in the face of the pts hx and clinical picture. I say to the surgeon: "Look, do you really want to put this pt in a potentially dangerous situation when we can simply try a more conservative route for only a short while?" This buys the pt time to get tuned-up... if possible.

Works every time! 👍
 
BigRedPingpong said:
How do you feel about nurse anesthesiologists taking over docs jobs in florida? I know that went kaput real fast because of poor outcomes.
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I probably shouldn't open up this can of worms :laugh: - do you even know what you're talking about? Obviously you don't. There is no such thing as a "nurse anesthesiologist".
 
jwk said:
I probably shouldn't open up this can of worms :laugh: - do you even know what you're talking about? Obviously you don't. There is no such thing as a "nurse anesthesiologist".
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Not trying to start a "im more knowledgeable that you contest because I have been an MD for 76 years." so leave the attitude at the door.
OK, I may not have worded everything correctly, but you know what I'm refering to right?
 
Poor outcomes with CRNAs in Florida?
 
ether_screen said:
Poor outcomes with CRNAs in Florida?
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For a while Florida tried to use nurses in place of docs. A study was conducted, data collected, and a paper was published (very recently about 2 weeks ago, so sorry I can't provide a link). Turns out nurses at the head of the table had poor outcomes, so Florida will have to reconsider their decision.
 
there will always be differences of opinion between MDs.... and this happens everywhere in the hospital... between IM and Nephrology, between Cardiology and Cardiac Surgery, between ER and surgery, etc.... what matters is how these differences in opinion are handled with 2 options:
1) the primary team decides to disagree with the consultant and then opts for another opinion
2) the consultant gets the finaly say because in a court of law they have more training/experience...

in the OR, differences in opinion usually stem from misunderstandings... I find that when i discuss the case before getting into the OR that helps smooth over most potential misunderstandings. However, once in the OR, Anesthesia has the final say on whether the surgery starts/stops, the final say on patient management intra-operatively and the final say on patient disposition after. There will always be a few surgeons who don't like that, and that is usually remedied with providing good logical reasoning based on current literature...

in the most extreme situations, i have told them that they can mismanage their patients on the floor but not in the OR 🙂
 
Tenesma said:
there will always be differences of opinion between MDs.... and this happens everywhere in the hospital... between IM and Nephrology, between Cardiology and Cardiac Surgery, between ER and surgery, etc.... what matters is how these differences in opinion are handled with 2 options:
1) the primary team decides to disagree with the consultant and then opts for another opinion
2) the consultant gets the finaly say because in a court of law they have more training/experience...

in the OR, differences in opinion usually stem from misunderstandings... I find that when i discuss the case before getting into the OR that helps smooth over most potential misunderstandings. However, once in the OR, Anesthesia has the final say on whether the surgery starts/stops, the final say on patient management intra-operatively and the final say on patient disposition after. There will always be a few surgeons who don't like that, and that is usually remedied with providing good logical reasoning based on current literature...

in the most extreme situations, i have told them that they can mismanage their patients on the floor but not in the OR 🙂
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Tenesma is right. The best situation is to discuss a plan prior to the case going to OR. When it's an add-on and a quick turn-over and you don't see the surgeon hanging around, this can be a problem. The surgeons tend to expect the anesthesiologist to have the pt deep before they make their grand entrance, so when the case gets held up becuase you don't want to go back to the room with the pt, is when the tantrums can start.

You'll learn med student, we have to be skilled physicians and the masters of mediation. Just a part of the job. 😉
 
BigRedPingpong said:
For a while Florida tried to use nurses in place of docs. A study was conducted, data collected, and a paper was published (very recently about 2 weeks ago, so sorry I can't provide a link). Turns out nurses at the head of the table had poor outcomes, so Florida will have to reconsider their decision.
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I assume you're talking about CRNA's (Certified Registered Nurse ANESTHETISTS). And no, I'm not a CRNA. But before you spout off about something which you have no knowledge about, learn some facts. And if you can't provide a source quotation or link to an article, your assertion for the moment is worthless.
 
If you are current with literature, you will have probably heard of the article I'm talking about. There is no link because, usually you have to pay to get scholarly, peer-reviewed journals. Go to pub med, med line, whatever...type in CNRA, nurse anesthetists, mortality, etc. and hit the search key. I'm not going to do it for you.

I never asserted that you were a CRNA, and I could care less what you are either way.
 
BigRedPingpong said:
Who get's the final word in the OR about Pt managment? If something goes wrong, how do they determine fault (ie the surgeon or yours)? Do you ever find yourself fighting a surgeons superiority complex? Have you ever encountered an obnoxious surgeon who treated you like crap because s/he thought they were "better,smarter" than you because he is a surgeon? Who needs who more? How does one handle a antagonistic surgeon?
Click to expand...

Now for the more important questions of your original post...

The "captain of the ship" doctrine has not applied for years in medicine or surgery. Each person is responsible for their own acts. There are plenty of obnoxious surgeons around. Ignoring their attitudes only works for a while. Sooner or later, someone has to put them in their place. That can be done face to face with a little "heart to heart" chat behind closed doors, or can be dealt with at an administrative level if need be. Most surgeons behave professionally, and most, if their behavior is pointed out to them as abusive, will change their ways. However, some don't.

In our facility, formal complaints regarding physicians are dealt with by the medical staff office and officers (chief of surgery, chief of staff, etc.) Verbally abusive physicians are not tolerated, and sanctions can and have resulted in requirements for anger management programs or other therapy, suspension or loss of privileges. Surgeons have been prosecuted for acts of physical violence (throwing a scalpel, slapping a staff member, etc.) Hospitals that tolerate verbally and physically abusive surgeons (whether that abuse is directed at professional staff or hospital employees) invite significant legal problems, particularly with repeated incidents that are ignored. The hospital may want to try and ignore these incidents because they fear the loss of that physician's referrals. They simply cannot afford to do that any more. Sexual harassment from physicians falls into this same boat. Hospitals that ignore the problem will suffer the consequences.
 
BigRedPingpong said:
If you are current with literature, you will have probably heard of the article I'm talking about. There is no link because, usually you have to pay to get scholarly, peer-reviewed journals. Go to pub med, med line, whatever...type in CNRA, nurse anesthetists, mortality, etc. and hit the search key. I'm not going to do it for you.

I never asserted that you were a CRNA, and I could care less what you are either way.
Click to expand...

Boy, they sure teach ATTITUDE early wherever you're in med school.
 
BigRedPingpong,

Not one of the following sources brought up anything about higher mortality rates with CRNAs in Florida:
Medline search
American Association of Nurse Anesthetists
ASA website
Florida ASA
Florida Association of Nurse Anesthetists

Since you are obviously quite knowledgeable about the subject, could you please provide a reference?
 
ether_screen said:
BigRedPingpong,

Not one of the following sources brought up anything about higher mortality rates with CRNAs in Florida:
Medline search
American Association of Nurse Anesthetists
ASA website
Florida ASA
Florida Association of Nurse Anesthetists

Since you are obviously quite knowledgeable about the subject, could you please provide a reference?
Click to expand...

The following is a study from Penn. Notice it's from CHOP, HUP, and Wharton. Interpret it as you will. Note, there are some studies that disagree with the following.

[B]Anesthesiologist Direction and Patient Outcomes[/B]
[CLINICAL INVESTIGATIONS]
Silber, Jeffrey H. M.D., Ph.D*; Kennedy, Sean K. M.D.?; Even-Shoshan, Orit M.S.?; Chen, Wei M.S.?; Koziol, Laurie F. M.S.[//]; Showan, Ann M. M.D.#; Longnecker, David E. M.D.**

Received from the Center for Outcomes Research, the Department of Anesthesiology and Critical Care Medicine, The Children?s Hospital of Philadelphia; the Departments of Anesthesia and Pediatrics, The University of Pennsylvania School of Medicine; the Department of Health Care Systems, The Wharton School and The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania.
Submitted for publication February 17, 2000.
Accepted for publication May 12, 2000.
Address reprint requests to Dr. J. H. Silber: The Children?s Hospital of Philadelphia, Center for Outcomes Research?, 3535 Market Street, Suite 1029, Philadelphia, Pennsylvania 19104. Address electronic mail to: [email protected].



Abstract
Background: Anesthesia services for surgical procedures may or may not be personally performed or medically directed by anesthesiologists. This study compares the outcomes of surgical patients whose anesthesia care was personally performed or medically directed by an anesthesiologist with the outcomes of patients whose anesthesia care was not personally performed or medically directed by an anesthesiologist.

Methods: Cases were defined as being either ?directed? or ?undirected,? depending on the type of involvement of the anesthesiologist, as determined by Health Care Financing Administration billing records. Outcome rates were adjusted to account for severity of disease and other provider characteristics using logistic regression models that included 64 patient and 42 procedure covariates, plus an additional 11 hospital characteristics often associated with quality of care. Medicare claims records were analyzed for all elderly patients in Pennsylvania who underwent general surgical or orthopedic procedures between 1991?1994. The study involved 194,430 directed and 23,010 undirected patients among 245 hospitals. Outcomes studied included death rate within 30 days of admission, in-hospital complication rate, and the failure-to-rescue rate (defined as the rate of death after complications).

Results: Adjusted odds ratios for death and failure-to-rescue were greater when care was not directed by anesthesiologists (odds ratio for death = 1.08, P < 0.04; odds ratio for failure-to-rescue = 1.10, P < 0.01), whereas complications were not increased (odds ratio for complication = 1.00, P < 0.79). This corresponds to 2.5 excess deaths/1,000 patients and 6.9 excess failures-to-rescue (deaths) per 1,000 patients with complications.

Conclusions: Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. These results suggest that surgical outcomes in Medicare patients are associated with anesthesiologist direction, and may provide insight regarding potential approaches for improving surgical outcomes.

Silber JH. Kennedy SK. Even-Shoshan O. Chen W. Koziol LF. Showan AM. Longnecker DE. Anesthesiologist direction and patient outcomes.[see comment]. Anesthesiology. 93(1):152-63, 2000 Jul.


my 2 cents - if you have to feel that you're better than anyone to feel good, you've got work to do. just do your job well, take that big f'n paycheck (CRNA and MDA) and enjoy life outside of the hospital.
 
Jeff05 said:
my 2 cents - if you have to feel that you're better than anyone to feel good, you've got work to do. just do your job well, take that big f'n paycheck (CRNA and MDA) and enjoy life outside of the hospital.
Click to expand...

:clap: :clap: :clap:
 
jwk said:
Boy, they sure teach ATTITUDE early wherever you're in med school.
Click to expand...

I return attitude for attitude.

By the way, thank you for answering the original question instead of trying to pick a fight with a lowly, rookie, green med student. 👍 🙂
 
ether_screen said:
BigRedPingpong,

Not one of the following sources brought up anything about higher mortality rates with CRNAs in Florida:
Medline search
American Association of Nurse Anesthetists
ASA website
Florida ASA
Florida Association of Nurse Anesthetists

Since you are obviously quite knowledgeable about the subject, could you please provide a reference?
Click to expand...

Not a guru here. I was at a Bellevue conference for AAs and Anesthesiologists and heard one of the speakers refer to a paper published 2 WEEKS AGO (New papers usually cant be found in databases) regarding care given by MD's vs care given by CRNAs soley in FL. I'm not crapping anyone or trying to pick a fight with CRNAs. Just curious if anyone has read it.
 
BigRedPingpong said:
Not a guru here. I was at a Bellevue conference for AAs and Anesthesiologists and heard one of the speakers refer to a paper published 2 WEEKS AGO (New papers usually cant be found in databases) regarding care given by MD's vs care given by CRNAs soley in FL. I'm not crapping anyone or trying to pick a fight with CRNAs. Just curious if anyone has read it.
Click to expand...
I'd love to see it too. Unfortunately, most of these studies, both pro and con, CRNA and MD, leave a lot to be desired as far as study methods. So many variables in a retrospective study, yada, yada, yada.
 
BigRedPingpong said:
Who get's the final word in the OR about Pt managment? If something goes wrong, how do they determine fault (ie the surgeon or yours)? Do you ever find yourself fighting a surgeons superiority complex? Have you ever encountered an obnoxious surgeon who treated you like crap because s/he thought they were "better,smarter" than you because he is a surgeon? Who needs who more? How does one handle a antagonistic surgeon? How do you feel about nurse anesthesiologists taking over docs jobs in florida? I know that went kaput real fast because of poor outcomes. Sorry for the multiple questions. But if you can just cover the conflict with surgeons, that would be great.
Click to expand...

Here is a study about office based practice...which the Florida Anesthesiologist group used as some evidence to push the Florida board of medicines decision on medically directed anesthesia in that setting....

Vila H Jr, Soto R, Cantor AB, Mackey D. Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers. Arch Surg. 2003; 138:991-995.

Interesting one of the authors is a little biased: http://www.asahq.org/Newsletters/2003/03_03/mackey.html

btw...that decision has been apealed, and is now void

http://www.fana.org/

I am sure that the florida association of anesthesiology will try to file a stay on the ruling...but they must come up with substantial evidence (besides the Silber study...which used HCFA data, and only showed significance with the anesthesia care team model)

Anyway, nice try. Show me a single study that concludes that MDA only is safer and I will shut up.

anti
 
Don't get an anesthetic in Florida!! :scared:
 
Ok. Now I would like to ask about the relationship between Anesthesiologists and CRNAs. It seems like there is a lot of animosity between them. Also, AAs vs CRNAs. How is the OR supposed to function if one person is thinking "I sure hate doctor X, he's paid too much anyway."
 
Bigredpingpong,

Thanks for at least attempting to backup your accusations. 🙄

Furthermore, the OR is full of individuals with superiority complexes regardless of their respective titles, however we share a common goal - excellent patient care.
 
ether_screen said:
Bigredpingpong,

Thanks for at least attempting to backup your accusations. 🙄

Furthermore, the OR is full of individuals with superiority complexes regardless of their respective titles, however we share a common goal - excellent patient care.
Click to expand...

Accusations? Guess someone slipped through the cracks of first grade reading 🙄 .

BigRedPingpong said:
Not a guru here. I was at a Bellevue conference for AAs and Anesthesiologists and heard one of the speakers refer to a paper published 2 WEEKS AGO (New papers usually cant be found in databases) regarding care given by MD's vs care given by CRNAs soley in FL. I'm not crapping anyone or trying to pick a fight with CRNAs. Just curious if anyone has read it.
Click to expand...
 
I think what this whole "unsupervised" thing has evolved into is not the intened profile of what a CRNA or AA was at its inception. To let it continue would only leave ourselves (as physicians) to blame..

?First they came for the Communists, but I was not a Communist so I did not speak out. Then they came for the Socialists and the Trade Unionists, but I was neither, so I did not speak out. Then they came for the Jews, but I was not a Jew so I did not speak out. And when they came for me, there was no one left to speak out for me.?

?Martin Niemoeller
 
How do you feel about nurse anesthesiologists taking over docs jobs in florida? I know that went kaput real fast because of poor outcomes.
Click to expand...

Bigredpingpong,

You have thus claimed that CRNAs demonstrate poorer outcomes, at least when examined in Florida. In reference to my previous post, you still have NOT come forth with anything to support your claim. In fact, the office based practice situation in Florida has just been ruled in favor of CRNAs. 😉
 
ether_screen said:
Bigredpingpong,

You have thus claimed that CRNAs demonstrate poorer outcomes, at least when examined in Florida. 😉
Click to expand...

I have not claimed anything. I have referenced an article, FOR THE 10 billionth time, that is still FRESH ON THE PRESS. For crying out loud, it's only been accepted 2 weeks ago. If you want to wait a while for it to be public, then wait. In the mean time quit bitching.

If the slower people out there need this to be explained again, please see the special ed teacher.
 
BigRedPingpong said:
Not a guru here. I was at a Bellevue conference for AAs and Anesthesiologists and heard one of the speakers refer to a paper published 2 WEEKS AGO (New papers usually cant be found in databases) regarding care given by MD's vs care given by CRNAs soley in FL. I'm not crapping anyone or trying to pick a fight with CRNAs. Just curious if anyone has read it.
Click to expand...

It doesn't look like the courts in Florida read it. Look at this link: http://www.aana.com/news/2004/news100104.asp

Cheers
 
BigRedPingpong said:
Ok. Now I would like to ask about the relationship between Anesthesiologists and CRNAs. It seems like there is a lot of animosity between them. Also, AAs vs CRNAs. How is the OR supposed to function if one person is thinking "I sure hate doctor X, he's paid too much anyway."
Click to expand...


The US is the only country that has CRNAs and Nurse Practitioners. Why cause they can pay them less to do the same job. While your stuck will all the on call work and all the legal responsibility. While they get a nice paycheck and a 9-4 job with no worries.

http://forums.studentdoctor.net/showthread.php?t=153483
 
For the grossly uninformed?

CRNAs are utilized in over 100 different countries throughout the world:
Austria
Denmark
Finland
Germany
Italy
Norway
Switzerland
Holland ? Netherlands
France
Sweden
Taiwan
Thailand
INFA - "The International Federation of Nurse Anesthetists is a Federation of National Associations of Nurse Anesthetists." Learn that there are nurse anesthestists in over 100 different countries!
 
OzDDS said:
The US is the only country that has CRNAs and Nurse Practitioners. Why cause they can pay them less to do the same job. While your stuck will all the on call work and all the legal responsibility. While they get a nice paycheck and a 9-4 job with no worries.

http://forums.studentdoctor.net/showthread.php?t=153483
Click to expand...

Yet another on this thread who has no clue what they're talking about.

All medical professionals (and 😱 maybe even dentists) are responsible for their own acts or omissions. Period. Responsibilities may be different - but to think that anesthetists have no legal responsibilities shows your complete lack of knowledge and understanding of the facts.
 
You know what they say about dentists as failed medical school applicants? I sense a bit of hostility.
 
I like the personal bashing.. shows lots of class. This was just the type of response I have heard from a lot of the MD anesth who complain about the crnas. Sorry, apperantly I was misinfomred. But I don't think Canada, the UK, or Australia has crnas though.
 
OzDDS said:
I like the personal bashing.. shows lots of class. This was just the type of response I have heard from a lot of the MD anesth who complain about the crnas. Sorry, apperantly I was misinfomred. But I don't think Canada, the UK, or Australia has crnas though.
Click to expand...

Oh it's nothing personal - but if you want to rag on a group of people, you gotta have facts - and you don't. You are totally clueless about this discussion - you obviously have no personal knowledge about anesthetists, only stuff that you've heard from someone else. What are you a first year dental or med student about two months out of college? Yeah, that gives you a broad knowledge base from which to discuss this topic. :laugh: Why do you even care? I thought you were more interested in chiropractic and alternative medicine judging from most of your other posts.
 
jwk said:
Oh it's nothing personal - but if you want to rag on a group of people, you gotta have facts - and you don't. You are totally clueless about this discussion - you obviously have no personal knowledge about anesthetists, only stuff that you've heard from someone else. What are you a first year dental or med student about two months out of college? Yeah, that gives you a broad knowledge base from which to discuss this topic. :laugh: Why do you even care? I thought you were more interested in chiropractic and alternative medicine judging from most of your other posts.
Click to expand...



"The federal regulation does not distinguish between a DDS anesthesiologist and a D.O. or M.D. anesthesiologist." This also says that a DDS anesthesiologist has the same ability to supervise CNRAs that an MD or DO anesthesiologist has.

http://www.kscourts.org/ksag/opinions/1998/1998-057.htm
 
so I guess it does pay to do the full residency 🙂
 
OzDDS said:
http://www.nbanesth.org/history.html
Click to expand...
You're bashing anesthetists, not anesthesiologists. Learn about them before you attempt to debate the topic.

Anyway, this is a tired repeat of a thread that's been done many times before. Do a search and read all the hold MD / CRNA threads. You'll find quickly that YOU have nothing new to add to the argument.
 
ether_screen said:
CRNAs can practice independently.
Click to expand...


We note that as a condition of obtaining federal financial assistance through Medicaid,(13) participating hospitals must require that a CRNA administer anesthesia only under the supervision of the "operating practitioner" or of "an anesthesiologist" who is immediately available if needed.(14) The federal regulation does not distinguish between a DDS anesthesiologist and a D.O. or M.D. anesthesiologist. The federal regulation imposing supervision is currently being considered for amendment to allow greater flexibility of hospitals and practitioners and to provide deference to State laws governing scope of practice by deleting the supervision requirement and allowing the CRNA to function without supervision where this is in accordance with State law.(15)


This was dated 1998.. I guess it's old news. Sorry for my ignorance. So CRNAs can create their own anesthesia groups and create contracts with hospitals and work independantly without any need whatsoever for any doctor to supervise or sign them off in anyway in all 50 states?
 
So why do we need doctors to train in anesthesiology anymore if nurses are doing the job without us?
 
OzDDS said:
So why do we need doctors to train in anesthesiology anymore if nurses are doing the job without us?
Click to expand...

:laugh:

"The person who knows 'how' will always have a job. The person who knows 'why' will always be his boss."
-Diane Ravitch, commencement address to Reed College, 1985
 
OzDDS said:
So why do we need doctors to train in anesthesiology anymore if nurses are doing the job without us?
Click to expand...


Thats it buddy, I'm outta here. Maybe I can squeeze into your dental school and we can have coffee and donuts together. I also could be your wingman at hooters.
 
OzDDS said:
We note that as a condition of obtaining federal financial assistance through Medicaid,(13) participating hospitals must require that a CRNA administer anesthesia only under the supervision of the "operating practitioner" or of "an anesthesiologist" who is immediately available if needed.(14) The federal regulation does not distinguish between a DDS anesthesiologist and a D.O. or M.D. anesthesiologist. The federal regulation imposing supervision is currently being considered for amendment to allow greater flexibility of hospitals and practitioners and to provide deference to State laws governing scope of practice by deleting the supervision requirement and allowing the CRNA to function without supervision where this is in accordance with State law.(15)


This was dated 1998.. I guess it's old news. Sorry for my ignorance.
Click to expand...

Gee, ya think? That's 6 years ago - a lot has changed. Stick to anatomy and physiology and teeth cleaning for a few more years.

And as far as a DDS anesthesiologist - they're very few and far between, and unless they've completed a full four-year anesthesiology residency, they'll have little luck finding a job.
 
OzDDS said:
So why do we need doctors to train in anesthesiology anymore if nurses are doing the job without us?
Click to expand...

I was being friggen sarcastic! I was trying to prove a point. :idea:
 
VentdependenT said:
Thats it buddy, I'm outta here. Maybe I can squeeze into your dental school and we can have coffee and donuts together. I also could be your wingman at hooters.
Click to expand...


Sweet!! I'll order you some wings.. :meanie:
 
Skip Intro said:
:laugh:

"The person who knows 'how' will always have a job. The person who knows 'why' will always be his boss."
-Diane Ravitch, commencement address to Reed College, 1985
Click to expand...


EXCELLENT QUOTE !! :clap: :clap:

SOOOOO TRUE!!!
 
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