Michigan CRNA's set up Go Fund Me page to raise money for lawyers!

[Baller MD]

@Aralc Why don't you use some of your free time and go on the CRNA forums to tell them to stop talking sh@t about anesthesiologists? I mean your husband IS an anesthesiologist right?

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[pgg]

sorry to upset you by deleting my posts. Look, if you want to use an open anonymous internet forum as an excuse to say things you would never say in public because you know they are shameful and embarassing to your profession, go ahead. From what I remember, I don't think you have so far, but some of your colleagues have. Tube monkey, baby sitter, incompetent, dangerous, etc. You all are just as bad as the nurse mob.

If you haven't figured it out yet, I am referring to the lives of seidnarb, his partners, their families, as well as members of the MI68 who unfortunately received bad advice from some toxic colleagues and are now unemployed.

Like I said, feel free to continue to abuse the CRNAs, but don't think people aren't reading and judging.

I'm not anonymous here. I don't go out of my way to post my name and location, but many people here know it. Countless people that I've worked with over the last 10 years know who exactly who I am here. I think I was about a week into residency in 2006 the first time someone in the hospital asked if I was that pgg guy. I even use the same moniker on other forums, one of which even appends my name and location in each .sig on each post. I don't write anything here I wouldn't be willing to say to anyone I work with.

I work with many CRNAs in the military, and the overwhelming majority of them are good CRNAs and great people. We have a good practice model that involves, among other things, schedule triage to give complex patients and cases to anesthesiologists and robust availability of anesthesiologists for help and consults. I think together we provide great care. There have been a few over the years that I haven't gotten along with or thought were bad clinicians, but not that many. My sample is biased because I mostly work in the military, and our CRNAs are a couple cuts above their civilian-trained counterparts.

All that said - the AANA is a toxic organization that is hazardous to the safe care of patients. It's long past time that CRNAs - especially the good ones, of which there are many - fully owned that organization they pay dues to, and recognized that their association's aggressive, militant, deceitful lobbying can have consequences beyond increasing their paychecks and bolstering their egos with "equivalent provider" rhetoric. Consequences like those that have befallen the Michigan 68.


I quit giving money to the American Medical Association a long time ago because I recognized what a terrible organization it was, and how it actively worked against my best interests as a physician. It is time that CRNAs recognized that the AANA is even worse. They should quit supporting it, for the good of patients, and for the good of their future employment prospects.

 

[Aralc]

@Aralc Why don't you use some of your free time and go on the CRNA forums to tell them to stop talking sh@t about anesthesiologists? I mean your husband IS an anesthesiologist right?

Don't you know that I did?

 

[Aralc]

PGG, I went back and edited my post because I realize I was being unfair to you. The "you" in my original post was more a universal "you", but clearly it ended up being directed to "you" specifically.
I did originally say, "From what I remember, I don't think you have so far," but I tried to make it clearer.

 

[Aralc]

I'm not anonymous here. I don't go out of my way to post my name and location, but many people here know it. Countless people that I've worked with over the last 10 years know who exactly who I am here. I think I was about a week into residency in 2006 the first time someone in the hospital asked if I was that pgg guy. I even use the same moniker on other forums, one of which even appends my name and location in each .sig on each post. I don't write anything here I wouldn't be willing to say to anyone I work with.

I work with many CRNAs in the military, and the overwhelming majority of them are good CRNAs and great people. We have a good practice model that involves, among other things, schedule triage to give complex patients and cases to anesthesiologists and robust availability of anesthesiologists for help and consults. I think together we provide great care. There have been a few over the years that I haven't gotten along with or thought were bad clinicians, but not that many. My sample is biased because I mostly work in the military, and our CRNAs are a couple cuts above their civilian-trained counterparts.

All that said - the AANA is a toxic organization that is hazardous to the safe care of patients. It's long past time that CRNAs - especially the good ones, of which there are many - fully owned that organization they pay dues to, and recognized that their association's aggressive, militant, deceitful lobbying can have consequences beyond increasing their paychecks and bolstering their egos with "equivalent provider" rhetoric. Consequences like those that have befallen the Michigan 68.


I quit giving money to the American Medical Association a long time ago because I recognized what a terrible organization it was, and how it actively worked against my best interests as a physician. It is time that CRNAs recognized that the AANA is even worse. They should quit supporting it, for the good of patients, and for the good of their future employment prospects.

I really like this post. I know I already "liked" it, but I wanted to quote it.

 

[Consigliere]

...disparaging CRNAs as an entire profession, that is OK, but seriously, saying there are only 2 competent team-player CRNAs that exist? And then why would a physician ever work with a CRNA? The only reason would be to make money off of them. Again, it doesn't put your profession in a good light.

You're right. There's only 1. He's a good dude.

 

[Consigliere]

Look Clara, I know you're mortified by the seemingly egregious behavior I am displaying on this anonymous internet forum. Please realize this is a place to vent our frustations; what is said here, at least by me, is somewhat of a hyperbole of how I actually feel. Also recognize that many here have been dealing with the duplicitous, lazy, "I'm superior to you and don't need you", overconfident, undertrained, militant attitudes of some CRNAs and their especially toxic organization - the AANA for a long time. You come on this forum having no idea what anesthesiologists have been dealing with for decades. It's easy for you to get on your judgemental high horse and criticize us.

 

[deleted171991]

Look Clara, I know you're mortified by the seemingly egregious behavior I am displaying on this anonymous internet forum. Please realize this is a place to vent our frustations; what is said here, at least by me, is somewhat of a hyperbole of how I actually feel. Also recognize that many here have been dealing with the duplicitous, lazy, "I'm superior to you and don't need you", overconfident, undertrained, militant attitudes of some CRNAs and their especially toxic organization - the AANA for a long time. You come on this forum having no idea what anesthesiologists have been dealing with for decades. It's easy for you to get on your judgemental high horse and criticize us.

And I can't like this post enough.

I too am tired of people who have not walked in our shoes telling us what to do, what to think and what to say. @Aralc, please come back and preach when one of your young healthy patients almost codes from being mismanaged by your midlevels. Or, much easier, next time when one of your midlevels openly ignores your instructions. Or, even easier, next time when they don't have a respectful demeanor towards you.

If any of those ever happens to you, that's when you'll begin getting a taste of what many anesthesiologists experience on a regular, even daily, basis.

 

[Aralc]

And I can't like this post enough.

I too am tired of people who have not walked in our shoes telling us what to do, what to think and what to say. @Aralc, please come back and preach when one of your healthy patients in her 20's almost codes from being mismanaged by your midlevels. Or, much easier, next time when one of your midlevels openly ignores your instructions. Or, even easier, next time when they don't have a respectful demeanor towards you.

If any of those ever happens to you, that's when you'll begin getting a taste of what many anesthesiologists experience on a regular, even daily, basis.

Look i have already apologized several times for what must seem like disrespect to you and your profession.

And I also said I did not really understand what you were going through. And I'm sorry about that as well.

But maybe sometimes it's good for an outsider to share their observations as to how you as a group appear to the rest of the world outside the safe bubble of SDN.

If, as Pgg suggested, you would like to enlist the help of the non-toxic CRNAs in your fight, perhaps it would be better to acknowledge that they exist.

Salerme came away with the same impression as me - don't you want her on your side?

Consigliere- I am sorry I singled you out, the post just happened to be there for the taking.

 

[deleted171991]

Yes, Aralc, I don't have a lot of respect for that profession. That might change in the future but, for now, I believe that people should not play doctor without a medical degree, even under supervision. I believe that these people practice not at the top of their license, but even beyond it.

Please feel free to refer your family and friends to (un)supervised APRNs, since you seem so fond of them. I for one will stick to physicians who see me personally and alone.

And again, please stop judging us. We are not the ones making a much higher income on account of working with APRNs.

 

[Aralc]

Yes, Aralc, I don't have a lot of respect for that profession. That might change in the future but, for now, I believe that people should not play doctor without a medical degree, even under supervision. I believe that these people practice not at the top of their license, but even beyond it.

Please feel free to refer your family and friends to (un)supervised APRNs, since you seem so fond of them. I for one will stick to physicians who see me personally and alone.

And again, please stop judging us. I am not one of the doctors having a much higher income on account of working with APRNs.

You know in oncology, all the top institutions in the area have APPs. I would bet that is the case at all the academic institutions. So you might be out of luck.

 

[deleted171991]

You know in oncology, all the top institutions in the area have APPs. I would bet that is the case at all the academic institutions. So you might be out of luck.

Speaking of greed...

 

[chocomorsel]

The problem is that some folks dont.

Consigliere says he works with CRNAs. Do you think he would ever say something like this to their face?

You clearly don't know Consigliere. I bet u 500bucks he would. Have you read his posts? The man speaks what comes to mind. No filter, no qualms. Would be quick to cuss you out and keep walking. He is quite entertaining actually.

 

[Arch Guillotti]

You clearly don't know Consigliere. I bet u 500bucks he would. Have you read his posts? The man speaks what comes to mind. No filter, no qualms. Would be quick to cuss you out and keep walking. He is quite entertaining actually.

I bet you he wouldn't. Despite employing the anesthetist he has to work with them every day no matter what. Anybody can be a stud on the internet.

 

[chocomorsel]

In my last practice we had 7 CRNAs.
2 of those,competent, bright and super easy to get along with. Had mutual respect for each other.

One very nice and easily guided down the right path and plan with a super easy demeanor. He was Ex military. He liked simple easy cases and didn't want to think too hard or stress about difficult patients.

Of the other four, 2 more competent ones, but with horrible attitudes to the OR nurses who apparently were beneath them and sometimes to me if they didn't like my plan.

Another was an ex independent CRNA with attitude. Why she joined a ACT model and gave attitude to her bosses baffles me.

The last one, my bosses favorite was "the best CRNA" according to the boss I worked for who was a sexist, condenscending jerk. He wasn't, a good or quite frankly competent, but he was a male who worked fast, but did some stupid, **** sometimes that endangered patients. Like the time I walked in on him bagging some 90 year old he had just given Versed to.

In my old residency, there are only 2 CRNAs left with a bunch of AAs. May be like 15 AAs. The CRNAs complained constantly about the department preference for AAs and tried to make the work environment toxic for them, so some were let go or quit. Very unnecessary really.

So as you can see I know personally of four competent CRNAs but only two I care to work with. And those two I still keep in touch with.

I know, this is anectodal, but I bet there are many practices like my old one out there. Of course I don't know for sure.

Why don't you check out Nurse Anesthesia .org and see how much so many of them despise us and get off on pissing us off.

 

[deltamed]

You know in oncology, all the top institutions in the area have APPs. I would bet that is the case at all the academic institutions. So you might be out of luck.

And in most specialties the midlevels accept physicians as team lead, are respectful, know their scope, work well collaboratively and do not claim equivalence (much less belong to organizations that claim equivalence and pay dues to make this political reality).

Aralc, I think you are comparing apples to oranges. Most doctors think midlevels are very valuable team members. Somehow CRNAs as a profession have "gone off the rails" and it's like watching a train wreck in slow motion. I just hope other specialties aren't heading the same direction. I'm actually surprised when I speak to my friends who are anesthesiologists that they arent *more* disgusted with the crna profession.

 

[Consigliere]

You clearly don't know Consigliere. I bet u 500bucks he would. Have you read his posts? The man speaks what comes to mind. No filter, no qualms. Would be quick to cuss you out and keep walking. He is quite entertaining actually.

And you, my friend, would be $500 richer.

 

[Consigliere]

I bet you he wouldn't. Despite employing the anesthetist he has to work with them every day no matter what. Anybody can be a stud on the internet.

Thing is, I'm a stud in real life too, brah. And that knowledge is comin' straight outta Compton.

 

[Consigliere]

You know in oncology, all the top institutions in the area have APPs. I would bet that is the case at all the academic institutions. So you might be out of luck.

Great! Then when you or a loved one is diagnosed with cancer, you'll have no qualms about sending them to an APP, right?

 

[Arch Guillotti]

takin' a life or two, that's what the hell I do. you don't like the way I'm livin'?

 

[Consigliere]

And in most specialties the midlevels accept physicians as team lead, are respectful, know their scope, work well collaboratively and do not claim equivalence (much less belong to organizations that claim equivalence and pay dues to make this political reality).

Aralc, I think you are comparing apples to oranges. Most doctors think midlevels are very valuable team members. Somehow CRNAs as a profession have "gone off the rails" and it's like watching a train wreck in slow motion. I just hope other specialties aren't heading the same direction. I'm actually surprised when I speak to my friends who are anesthesiologists that they arent *more* disgusted with the crna profession.

Very true. Someone on here said something I thought was very insightful in regards to the supervision of CRNAs...it went something like this: "I was trained to administer anesthesia, not sanction it." Unfortunately, if you want to be employed in......ohhh 75% of the USA, you'll be forced to supervise the administration of anesthesia.

 

[Consigliere]

takin' a life or two, that's what the hell I do. you don't like the way I'm livin'?

THEN EFF YOU!

 

[Aralc]

Speaking of greed...

I can't tell if you are being serious here or not, but ok, you get cancer, seek out the top academic oncologist in that area, and because they work with an APP to do their chemo toxicity checks and generally function in the role of a very well trained fellow you will call them greedy to their face (or behind their back)?

You must know that academic oncologists aren't in it for the money.

As for whoever asked about where I would go, in my area I would go to UM where all the top faculty work with APP. And they get paid way less than the community doc typically.

As for apples to oranges probably yes.

I think that the toxic ones need to go. But don't throw out the baby with the bath water.

The reason I liked Pgg's post is because he acknowledges the existence of some proportion, which may be larger in the military, of CRNAs who know their role in the ACT model and work well in it. (Maybe the importance of rank in the military also plays a part as to why they play nice there)

He condemns the toxic subset who are promoting lies and propaganda, ultimately at the expense of their colleagues.

He asks any APP who realizes the insanity and danger of hubris to help him - without denigrating their role.

Anyways - please continue.

 

[deleted171991]

I meant employer, not employee, greed.

I have no problems if a nurse does something protocol-based. (If it's protocol-based, maybe we don't need an APRN in the first place, just an RN.)

My problem is when I go in for something that cannot be looked up in a cookbook, which is 80% of medicine. For example, I don't think these people should diagnose without supervision in most age groups. I don't think they should even prescribe/adjust many treatments, unless if it can be reduced to the same algorithm the physician would follow.

Please don't compare APRNs with fellows. Fellows are board-certified attendings in a base specialty (in your case, internal medicine). They might be at the level of an APRN when about oncology, but I doubt they can compare when about everything else.

I want somebody who understands how the body works, both healthy and diseased, not just regurgitates facts or protocols. Because mistakes usually happen with one of the latter people; and they usually don't even realize they're wrong. I and my family have been misdiagnosed even by doctors, which is a great reason to place even less trust in less educated people.

 

[Aralc]

In my last practice we had 7 CRNAs.
2 of those,competent, bright and super easy to get along with. Had mutual respect for each other.

Why don't you check out Nurse Anesthesia .org and see how much so many of them despise us and get off on pissing us off.

I have checked it out and agree that there is some despicable behavior there as well. In fact I saw you call them out on it, good for you. It worked, to some degree, though admin never admitted they were wrong.

What I like about your post is you judge people as individuals, not as a group.

Clearly toxic behavior does not belong in the workplace. And I think that Pgg's point that CRNAs tolerate (or encourage) this behavior at the risk of their profession is a good one.

 

[Aralc]

I meant employer, not employee, greed.

Cmon now, you think academic hospitals are raking in the dough?

As an employee, you may not realize it, but there are finite amounts of monies coming in and salaries/expenses need to be paid. Academic institutions not only have to pay for physicians, they have to finance large teaching and research infrastructures.

As far as I know, they do not use extenders to gouge the public, but in order to make the best use of their limited and precious resources, including their human resources (time of some of the most brilliant and dedicated minds in the country).

 

[deleted171991]

Cmon now, you think academic hospitals are raking in the dough?

Have you seen the compensation level of their executives? All the semi-useless middle managers, the hospital bureaucracies? There is a ton of waste there, just where the bosses like it. They need to make money to pay for all those non-productive people.

Of course they cut corners, if it's not that obvious and means more money for the organization. They are just a touch better than physician management companies or private hospital systems. Nothing really non-profit or saintly about them.

 

[Aralc]

If you want to get the big bucks, get a degree in hospital administration and earn it. You want someone to trust you with a multimillion (billion) dollar enterprise? Why should they? What have you done to earn it?

I am not going to be soft on entitlement mentality here, any more than I was with the nurses.

 

[deleted171991]

If you want to get the big bucks, get a degree in hospital administration and earn it.

I am not going to be soft on entitlement mentality here, any more than I was with the nurses.

Again, why do you feel entitled to judge us? I bet you make more than many of us here.

And I don't see where I was complaining about my income. That's something I usually don't care that much about, except on a relative scale.

 

[Aralc]

Again, why do you feel entitled to judge us? I bet you make more than many of us here.

I bet you I don't. I probably make less than the CRNAs.

 

[deleted171991]

I bet you I don't. I probably make less than the CRNAs.

To follow your logic, it must be only your fault.

Going back to the subject of entitlement: I feel entitled to get the care I pay for. If I pay many tens of thousands of dollars for cancer therapy, I want the most competent people, not their "extensions".

 

[Aralc]

Look, I clearly don't have a lot of tolerance for BS and also like arguing way too much.

I don't have any "right" to judge anyone, but I call it like I see it.

To follow your logic, it must be only your fault.

Correct, it was my choice. I don't go around being bitter at people making more than I do, or getting more recognition. I made my choices and I am happy with them.

 

[deleted171991]

I don't go around being bitter at people making more than I do, or getting more recognition.

I don't either, as long as they don't exploit me and my work.

 

[Aralc]

I meant employer, not employee, greed.

I have no problems if a nurse does something protocol-based. (If it's protocol-based, maybe we don't need an APRN in the first place, just an RN.)

My problem is when I go in for something that cannot be looked up in a cookbook, which is 80% of medicine. For example, I don't think these people should diagnose without supervision. I don't think they should even prescribe/adjust treatments, unless if it can be reduced to the same algorithm the physician would follow.

Please don't compare APRNs with fellows. Fellows are board-certified attendings in a base specialty (in your case, internal medicine). They might be at the level of an APRN when about oncology, but I doubt they can compare when about everything else.

I want somebody who understands how the body works, both healthy and diseased, not just regurgitates facts or protocols. Because mistakes usually happen with one of the latter people; and they usually don't even realize they're wrong. I and my family have been misdiagnosed even by doctors, which is a great reason to place even less trust in less educated people.

An experienced oncology APP is probably better at routine oncology care than the fellow.

(Not to mention, a whole lot better at bone marrow biopsies than either the fellow or maybe even the academic oncologist. If you ever need one at an academic institution, I suggest asking for the best mid level.)

Part of diagnosis is seeing something again and again, and the APP has likely seen a lot more than the fellow, even if the fellow has extensive reading and understanding of pathophys etc.

Most fellows aren't clamoring to do a chemo check at some point in their fellowship, either.

 

[Aralc]

I don't either, as long as they don't exploit me and my work.

That is a valid point. Maybe the CRNAs feel that way as well, as your first post in this thread suggests.

Look, if you feel exploited, there are still better strategies than devolving into bitterness.

Find alternative employment, work your way up to being the owner. Realize that exploitation is abusive and vow never to endorse or be part of such a system again.

 

[Aralc]

To follow your logic, it must be only your fault.

Going back to the subject of entitlement: I feel entitled to get the care I pay for. If I pay many tens of thousands of dollars for cancer therapy, I want the most competent people, not their "extensions".

If you want the best care in the world, there will be residents and fellows, and most likely APPs in that practice. Now, as professional courtesy to a fellow physician, the oncologist may try to see you personally at every visit without an extender, but there WILL most likely be an extender of some sort involved in your care. Usually the most senior faculty have the dedicated APP leaving the junior faculty on their own.

The oncologist will personally evaluate you at the initial visit, and with every treatment decision. Even for the chemo checks, they will staff the case, and probably see you for a few minutes.

For a routine chemo check, and more so, a surveillance visit, trust me, you don't need the attending. (these visits are the equivalent of school forms and immunization updates. It is possible that early signs of something rare and unusual could be missed, but probably could be missed by doc as well. I saw world expert on CML miss a GI malignancy manifesting as iron deficiency - attributed the anemia to disease/treatment. We're all human.)


Oh, and in terms of cost, it is hundreds of thousands of dollars, as someone else pointed out. For many patients, millions over the entire course of treatment. (And to whoever commented on the cost of cancer care up thread, you must have missed the posts where I was talking about rationing).

 

[deleted171991]

That is a valid point. Maybe the CRNAs feel that way as well, as your first point suggests.

Look, if you feel exploited, there are still better strategies than devolving into bitterness.

Find alternative employment, work your way up to being the owner. Realize that exploitation is abusive and vow never to endorse or be part of such a system again.

Yes, mother.

If you want the best care in the world, there will be residents and fellows, and most likely APPs in that practice. Now, as professional courtesy to a fellow physician, the oncologist may try to see you personally at every visit without an extender, but there WILL most likely be an extender of some sort involved in your care.

The oncologist will personally evaluate you at the initial visit, and with every treatment decision. Even for the chemo checks, they will staff the case, and probably see you for a few minutes.

For a routine chemo check, trust me, you don't need the attending.

I trust you.

I promise I won't ask for the attending to check my blood pressure either.

 

[Aralc]

Yes, mother.

I trust you.

I promise I won't ask for the attending to check my blood pressure either.

Ok you made me laugh.

Thank you.

 

[deleted171991]

This thread is beginning to feel like medicine rounds: let's ignore the obvious and debate some more about minor stuff.

 

[Aralc]

This thread is beginning to feel like medicine rounds: let's ignore the obvious and debate some more about minor stuff.

Guess that's what happens when the IM doc pays a visit.

 

[deleted171991]

The elephant in the room is: first they came for the anesthesiologists...

 

[Aralc]

Ok ok ok.

You all have my allegiance to fight against the forces of evil that are responsible for this brutal mess.

I do think enlisting the help of the 'good' APPs would benefit the cause.

The resistance, you might say.

(Ps, calling them tube monkeys is unlikely to help in your recruitment efforts. But a situation like this might help wake them up).

 

[Psai]

What's an app? You mean like tinder and Google maps?

 

[Aralc]

But in case anyone really doesn't know:

Advanced practice providers. Just learned that is the preferred terminology over MLP - midlevel provider.

Whatever, in my opinion, not a big deal, but if you all get upset by MDA, I suppose they can get all huffy over MLP.

 

[deltamed]

Ok ok ok.

You all have my allegiance to fight against the forces of evil that are responsible for this brutal mess.

I do think enlisting the help of the 'good' APPs would benefit the cause.

The resistance, you might say.

(Ps, calling them tube monkeys is unlikely to help in your recruitment efforts. But a situation like this might help wake them up).

Glad you have come to reason. Given how far afield the crna movement seems to be, I can only imagine how humorous the conversation will be as the anesthesiologists recruit the "good" crnas.

Ie "um, your main society is sort of toxic. Can you please stop paying your dues there?"

"Um, I know you don't really believe in CRNA equivalence to doctors. Would you mind helping me repeal 20 years of lobbying efforts at independent practice laws?"

 

[Aralc]

Look, the reality of this MI68 situation is there are now some CRNAs who see only too clearly the toxicity and its consequences. I made some comments upthread about reality being a harsh teacher.

I honestly hope the entire truth can come out and spread in social media, just the way the lies did.

If the CRNA community comes to realize how they were snookered into supporting the toxic elements within the MI68, and how it might affect their employment opportunities, you might stand a chance.

Just to spell this out- the likely end result of pushing for independent practice while at the same time succeeding in alienating MDs will be independent CRNAs taking the crappy jobs that the MDs don't want in hospitals that can't afford MDs.

So there, that is at least part of my argument for why you docs don't need to worry about the independent CRNA, as long as you truly are better....

When I have told the whole truth of this story IRL, even to nurses, they are appalled. And when I get to the part of the Gofundme, they usually laugh.

 

[NightNight]

But in case anyone really doesn't know:

Advanced practice providers. Just learned that is the preferred terminology over MLP - midlevel provider.

Whatever, in my opinion, not a big deal, but if you all get upset by MDA, I suppose they can get all huffy over MLP.

Lol APP....I just call them what they are - nurse.

 

[Aralc]

Yeah I have too, as did many of the reporters. They took offense to that as well. Whatever. That's what they are, they should own it. Make nurse something to be proud of because it is.

 

[deltamed]

Lol APP....I just call them what they are - nurse.

APP sounds silly. Advanced compared to what? At least midlevel describes the level of training in general accurately ... But if they thinks that's derogatory somehow I have no problem with nurse, NP or PA.

But whatever. We should start calling ourselves "elite force practitioners" or "jedi knight doctors".

 

[Mjolner]

APP sounds silly. Advanced compared to what? At least midlevel describes the level of training in general accurately ... But if they thinks that's derogatory somehow I have no problem with nurse, NP or PA.

But whatever. We should start calling ourselves "elite force practitioners" or "jedi knight doctors".

I'm getting my name changed to Jedi Knight Doctor.