Opinions on Anesthesia Assistants?

[anyusernamenottaken]

Hello All,
Let me start off by thanking you for taking the time to review my post.
I am currently a senior and at a crossroads. One path is MD and the other is going the Anesthesia Assistant route.(I know anesthesia is right for me through significant shadowing.) However as a Louisiana resident, I don't have the ability to shadow an Anesthesia Assistant.)
My question is, as an anesthesiologist(or any physician for that matter) how do you view working with an Anesthesia Assistant?
As a surgeon, do you loath the fact an AA is administering the anesthetics vs an MD? Do you respect an AA or view it as a short cut method?

As an anesthesiologist, what kind of working relationship do you have? Do you feel they are qualified and well trained enough to handle theirself in situations pertaining to their scope of practice , or is it view as "oh great, I get to babysit this guy/girl today?"ect ect.

I am just looking to get a feel of the working relationship in general between an MD and AA. Clearly, I know this will vary based on the group of people you work with.

Once again, thank you for your time; I really appreciate your help/thoughts.

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[Mman]

Hello All,
Let me start off by thanking you for taking the time to review my post.
I am currently a senior and at a crossroads. One path is MD and the other is going the Anesthesia Assistant route.(I know anesthesia is right for me through significant shadowing.) However as a Louisiana resident, I don't have the ability to shadow an Anesthesia Assistant.)
My question is, as an anesthesiologist(or any physician for that matter) how do you view working with an Anesthesia Assistant?
As a surgeon, do you loath the fact an AA is administering the anesthetics vs an MD? Do you respect an AA or view it as a short cut method?

As an anesthesiologist, what kind of working relationship do you have? Do you feel they are qualified and well trained enough to handle theirself in situations pertaining to their scope of practice , or is it view as "oh great, I get to babysit this guy/girl today?"ect ect.

I am just looking to get a feel of the working relationship in general between an MD and AA. Clearly, I know this will vary based on the group of people you work with.

Once again, thank you for your time; I really appreciate your help/thoughts.

I feel that AAs are virtually identical to CRNAs, although the relationship on the whole tends to be more cordial since AAs have no desire to replace MDs or argue they are equivalent to MDs.

 

[Chloroform4Life]

Hello All,
Let me start off by thanking you for taking the time to review my post.
I am currently a senior and at a crossroads. One path is MD and the other is going the Anesthesia Assistant route.(I know anesthesia is right for me through significant shadowing.) However as a Louisiana resident, I don't have the ability to shadow an Anesthesia Assistant.)
My question is, as an anesthesiologist(or any physician for that matter) how do you view working with an Anesthesia Assistant?
As a surgeon, do you loath the fact an AA is administering the anesthetics vs an MD? Do you respect an AA or view it as a short cut method?

As an anesthesiologist, what kind of working relationship do you have? Do you feel they are qualified and well trained enough to handle theirself in situations pertaining to their scope of practice , or is it view as "oh great, I get to babysit this guy/girl today?"ect ect.

I am just looking to get a feel of the working relationship in general between an MD and AA. Clearly, I know this will vary based on the group of people you work with.

Once again, thank you for your time; I really appreciate your help/thoughts.

I work with both AAs and CRNAs and feel that their skill levels are equivalent. There are those will poor skills and great skills in both categories. So my relationship with each individual is more based on that than their actual title.

I don't know what the job market for AAs are currently, but I think you may be limited geographically if you go the AA route. AA school is a lot shorter than Med School and residency though. I also think the stress level as an AA will be a lot less than that of an anesthesiologist. You may not make as much money in the long run as an AA, but the amount you make for the hours you work would be pretty good. I think my group pays AAs and CRNAs about the same.

 

[GABAergic]

Food for thought: somewhere around 80%+ of med school graduates end up in a different field than the one they said were most interested in as they started med school. Also, you will have 5 years of stuff between you the delivery of anesthesia to your first patient. That's a long time, opportunity cost, debt, delayed gratification, etc.

Do you really want to be a physician, or not?


Sent from my iPhone using SDN mobile app

 

[anyusernamenottaken]

Thank you for your responses! And yes, I would be limited geographically regardless of the job market due to licence regulations. And I would agree 100% that AA is less stressful. It is nice to have someone you can fall back on someone with more knowledge than yourself, so I feel like that is a plus for AA.

Assuming you are anesthesiologist and knowing 1st hand the finances/time commitment of medical school & residency, would you consider AA if you had to do it again? Also, do the AA you work with regret becoming an AA over MD.

Just trying to make an informed decision as possible, because unfortunately by the time you actually experience 1st hand if you chose right or wrong it is too late.

 

[Mman]

Thank you for your responses! And yes, I would be limited geographically regardless of the job market due to licence regulations. And I would agree 100% that AA is less stressful. It is nice to have someone you can fall back on someone with more knowledge than yourself, so I feel like that is a plus for AA.

Assuming you are anesthesiologist and knowing 1st hand the finances/time commitment of medical school & residency, would you consider AA if you had to do it again? Also, do the AA you work with regret becoming an AA over MD.

Just trying to make an informed decision as possible, because unfortunately by the time you actually experience 1st hand if you chose right or wrong it is too late.

I don't think anybody decides between AA vs MD. The question is whether or not you want to go to medical school and become an MD. People that debate becoming an AA are generally also considering becoming a PA or some other profession.

 

[anyusernamenottaken]

Thank you all for sharing your opinions!

 

[Cytarabine]

Thank you all for sharing your opinions!

Stick around, there's an AA who browses this forum regularly, cant remember name offhand, but they'll probably show up

 

[deleted171991]

Stick around, there's an AA who browses this forum regularly, cant remember name offhand, but they'll probably show up

@jwk

 

[anyusernamenottaken]

oh ok that would be great! I will be checking this board for the next few days anyway

 

[pjl]

In my mind it comes down to the question of whether you mind not being the expert, or having to listen to your boss tell you to do a plan which may not be the one you would like to do. As an AA you will be an employee, guaranteed. Only you can answer if you are ok with that. The far more predictable lifestyle, shorter training, and overall decent compensation may make that worth it.

With regards to AA vs MD financially, at current time, you would be better off being an MD, however this comes with more hours and responsibility. As the future progresses, nobody knows, but I would assume the difference will narrow further. Particularly if you factor in all the opportunity costs etc.


Sent from my iPad using SDN mobile app

 

[Man o War]

AAs are absolutely equivalent clinically to CRNAs with less attitude. I preferred working with them when I supervised.

 

[jwk]

Hello All,
Let me start off by thanking you for taking the time to review my post.
I am currently a senior and at a crossroads. One path is MD and the other is going the Anesthesia Assistant route.(I know anesthesia is right for me through significant shadowing.) However as a Louisiana resident, I don't have the ability to shadow an Anesthesia Assistant.)
My question is, as an anesthesiologist(or any physician for that matter) how do you view working with an Anesthesia Assistant?
As a surgeon, do you loath the fact an AA is administering the anesthetics vs an MD? Do you respect an AA or view it as a short cut method?

As an anesthesiologist, what kind of working relationship do you have? Do you feel they are qualified and well trained enough to handle theirself in situations pertaining to their scope of practice , or is it view as "oh great, I get to babysit this guy/girl today?"ect ect.

I am just looking to get a feel of the working relationship in general between an MD and AA. Clearly, I know this will vary based on the group of people you work with.

Once again, thank you for your time; I really appreciate your help/thoughts.

Anesthesiologist Assistants (AAs) are slowly but surely gaining footholds in a number of areas as CRNA's continue to shoot themselves in the foot with their drive for independent practice and assertion that they are just as good (if not better) than a board certified anesthesiologist.

AA vs MD is really up to you based on what your priorities are. Length of program (2+ vs 8+ years), costs involved, desired geographic location - all are points you need to consider.

AA's have great working relationships with anesthesiologists. We are recognized and supported by the ASA, and you will find AA's on a growing number of ASA committees. Practices that are committed to the Anesthesia Care Team concept will find AA's to be the ideal practitioner to work WITH anesthesiologists rather than against them. The bigger the practice/hospital and more complex the procedures offered the more likely you are to find ACT practices. Many think AA's are a new profession because they haven't heard of them or worked with them, but we've actually been around for 45 years. If we're not where you are, there is one primary reason for that and you can probably guess what it is.

I don't know any anesthesiologists who "loathe" the idea that AA's are in the OR - that being said, there are certainly proponents of (and still are many) all-MD anesthesia. Those docs are pro-MD, not anti-AA. Nothing wrong with that.

Feel free to PM me with any questions.

 

[Daniel M. Pitta]

AA's make bank here in the DC area...2 years of school and immediately making six-figures, I say if your grades are competitive than it's a great option.

Contrastly, I have considered PT school, which is a 3-year doctorate where you typically come out making $60-80k with six-figures in debt. However these are 2 very different careers and job settings.

 

[Doctor4Life1769]

AAs will eventually turn into PAs attempting to claim equivalency. Just a matter of time.

 

[sevoflurane]

This may be true, however:

CRNA: governed by the Board of Nursing

AA: governed by ABMS

Big difference.

 

[deleted171991]

This may be true, however:

CRNA: governed by the Board of Nursing

AA: governed by ABMS

Big difference.

Agree.

I don't get why the AMA is not trying to get the independent APRNs under the boards of medicine. It's clear that they are not practicing "advanced nursing", but medicine.

 

[criticalelement]

Agree.

I don't get why the AMA is not trying to get the independent APRNs under the boards of medicine. It's clear that they are not practicing "advanced nursing", but medicine.

How can they practice medicine when they are nurses?

It is Nursing they are practicing..

 

[deleted171991]

How can they practice medicine when they are nurses?

It is Nursing they are practicing..

So when a chiropractor tells a patient to take an aspirin for his gastric ulcer it's not practice of medicine, it's advanced "chiropractice"?

Nursing has nothing to do with prescribing treatments. That's bull****. Nurses don't get to treat patients, period.

 

[jwk]

AAs will eventually turn into PAs attempting to claim equivalency. Just a matter of time.

How much time? We've been around since 1971.

It's not happening.

 

[Doctor4Life1769]

How much time? We've been around since 1971.

It's not happening.

I'm sure PAs said that too at one point. AAs just aren't popular enough yet nor utilized as much at this time.

 

[Doctor4Life1769]

So when a chiropractor tells a patient to take an aspirin for his gastric ulcer it's not practice of medicine, it's advanced "chiropractice"?

Nursing has nothing to do with prescribing treatments. That's bull****. Nurses don't get to treat patients, period.

Oh, but they do. NPs are treating patients all the time. Even some regular RNs (especially ICU or ER ones) claim to diagnose and treat and save lives.

 

[jwk]

I'm sure PAs said that too at one point. AAs just aren't popular enough yet nor utilized as much at this time.

Glad you think you know so much about my profession. Independent practice is not something that is even discussed. The ACT mode of practice was developed with AA's in mind back in the late 60's. Both through legislation and regulation, federal and state, AA's are required to work under the direction of anesthesiologists. It's not optional, it's not open to interpretation.

 

[Doctor4Life1769]

Glad you think you know so much about my profession. Independent practice is not something that is even discussed. The ACT mode of practice was developed with AA's in mind back in the late 60's. Both through legislation and regulation, federal and state, AA's are required to work under the direction of anesthesiologists. It's not optional, it's not open to interpretation.

Cool. We'll see circa 2050.

 

[jwk]

Cool. We'll see circa 2050.

As I've stated numerous times over the years - if all-physician anesthesiology is the way you want to practice, by all means do so. But if you're going to practice with non-physician providers, far better to do it with a more competent AA that WANTS to work with anesthesiologists than CRNAs who think they are better than anesthesiologists.

 

[Man o War]

As I've stated numerous times over the years - if all-physician anesthesiology is the way you want to practice, by all means do so. But if you're going to practice with non-physician providers, far better to do it with a more competent AA that WANTS to work with anesthesiologists than CRNAs who think they are better than anesthesiologists.

Hire your first AA and sit back and watch the CRNA tantrums. Extremely entertaining.

 

[Doctor4Life1769]

As I've stated numerous times over the years - if all-physician anesthesiology is the way you want to practice, by all means do so. But if you're going to practice with non-physician providers, far better to do it with a more competent AA that WANTS to work with anesthesiologists than CRNAs who think they are better than anesthesiologists.

I can't disagree with that but I'm just saying anesthesiologists should not be overly comfortable with AAs like other specialists have with PAs

 

[WholeLottaGame7]

I can't disagree with that but I'm just saying anesthesiologists should not be overly comfortable with AAs like other specialists have with PAs

Probably depends on how you use them. If you just sit in the break room and let them run cases start to finish entirely independently, they'll start to question why they aren't actually independent. S'what happened with CRNAs.

As a profession, we should be seeing the patient first, developing a plan, checking in as needed and making sure the plan is going according to plan, etc. If we are to expect other people to follow, then we need to actually lead.

 

[jwk]

Probably depends on how you use them. If you just sit in the break room and let them run cases start to finish entirely independently, they'll start to question why they aren't actually independent. S'what happened with CRNAs.

As a profession, we should be seeing the patient first, developing a plan, checking in as needed and making sure the plan is going according to plan, etc. If we are to expect other people to follow, then we need to actually lead.

Either you believe in physician-led anesthesia, or you don't. If you're signing onto www.safevacare.org and you and your partners vacate the premises at 3pm every weekday, or cede entire areas of a practice, such as OB, to your CRNAs because you don't want to mess with it, or decide that one doc "supervising" or "collaborating" with a dozen CRNAs is acceptable, then you're talking out of both sides of your mouth. This is what's happening in many practices, from a very large and very well known practice in South Texas, to a smaller hospital northeast of metro Atlanta. I hate the hypocrisy - and the CRNAs are lapping it up.

 

[Doctor4Life1769]

Probably depends on how you use them. If you just sit in the break room and let them run cases start to finish entirely independently, they'll start to question why they aren't actually independent. S'what happened with CRNAs.

As a profession, we should be seeing the patient first, developing a plan, checking in as needed and making sure the plan is going according to plan, etc. If we are to expect other people to follow, then we need to actually lead.

Of course.
My point is that anesthesiologists shouldn't be complacent and falsely believe that just because they are under the medical board they can get away with managing them and the cases like they did with CRNAs.

 

[CaliforniaDreamingAA]

Hello All,
Let me start off by thanking you for taking the time to review my post.
I am currently a senior and at a crossroads. One path is MD and the other is going the Anesthesia Assistant route.(I know anesthesia is right for me through significant shadowing.) However as a Louisiana resident, I don't have the ability to shadow an Anesthesia Assistant.)
My question is, as an anesthesiologist(or any physician for that matter) how do you view working with an Anesthesia Assistant?
As a surgeon, do you loath the fact an AA is administering the anesthetics vs an MD? Do you respect an AA or view it as a short cut method?

As an anesthesiologist, what kind of working relationship do you have? Do you feel they are qualified and well trained enough to handle theirself in situations pertaining to their scope of practice , or is it view as "oh great, I get to babysit this guy/girl today?"ect ect.

I am just looking to get a feel of the working relationship in general between an MD and AA. Clearly, I know this will vary based on the group of people you work with.

Once again, thank you for your time; I really appreciate your help/thoughts.

Have you considered pharmacy as another option? Or a general PA? Or even dental? If you are considering MD vs AA, then you should consider all the medical options out there. I'm a former AA who is unable to work where I currently live (CA) and if I had to do it all over again, I would choose a PharmD. Why? PharmD have incredibly flexible career options from working in retail pharmacy, medication therapy management where you are counseling patients how to take their drugs, working in drug research, clinical pharmacy in hospitals, public health policy, to pharma or medical device product development, clinical trials....the list goes on and many PharmDs who work in pharma industry are regarded as being doctors. (whether or not that is kosher is another thread).

Choosing between MD and AA/PA/CRNA is like choosing between apples and oranges.

It's a completely different dynamic if you are a allied health extender.If you think you would be comfortable making tough decisions, dealing with difficult cases and other difficult physicians, and enjoy having the respect of other doctors, then be a physician. Salary wise, you are looking at 3:1 minimum difference. Yes, I made a bit more than my pediatrician sister, but I also made 1/3 to 1/4 of an anesthesia MD. Just know that your salary will top out fairly quickly. You should not be basing your career choice on the political flavor of the moment. Most of my physician friends enjoy working with AAs and PAs, on the other hand, some also prefer working with CRNAs and NPs. For sure, you will always be the target of CRNA lobbying efforts.

Being an AA is a very specialized field AND even if you could work in all 50 states, you will only be employed in your niche. So that means there is no career advancement and you will be doing the same duties from day one til you retire. And as others have pointed out, you are very limited in where you can work - it has been an uphill battle in CA and I don't see it changing anytime soon. Even if a state is "open" to AAs that doesn't mean you can apply to any hospital to work in that state. The hospital has to specifically allow AAs to work and there are really only a handful of hospitals in those states that employ AAs. Yes, you can make good money right after graduation, but in the long run, a few more thousand bucks isn't that big a deal if you can't work where you want or do what you want. My advice to young people - do what will give you the most flexibility in terms of job options bc you just never know where you will end up in life and your interests will probably change.

 

[jwk]

Have you considered pharmacy as another option? Or a general PA? Or even dental? If you are considering MD vs AA, then you should consider all the medical options out there. I'm a former AA who is unable to work where I currently live (CA) and if I had to do it all over again, I would choose a PharmD. Why? PharmD have incredibly flexible career options from working in retail pharmacy, medication therapy management where you are counseling patients how to take their drugs, working in drug research, clinical pharmacy in hospitals, public health policy, to pharma or medical device product development, clinical trials....the list goes on and many PharmDs who work in pharma industry are regarded as being doctors. (whether or not that is kosher is another thread).

Choosing between MD and AA/PA/CRNA is like choosing between apples and oranges.

It's a completely different dynamic if you are a allied health extender.If you think you would be comfortable making tough decisions, dealing with difficult cases and other difficult physicians, and enjoy having the respect of other doctors, then be a physician. Salary wise, you are looking at 3:1 minimum difference. Yes, I made a bit more than my pediatrician sister, but I also made 1/3 to 1/4 of an anesthesia MD. Just know that your salary will top out fairly quickly. You should not be basing your career choice on the political flavor of the moment. Most of my physician friends enjoy working with AAs and PAs, on the other hand, some also prefer working with CRNAs and NPs. For sure, you will always be the target of CRNA lobbying efforts.

Being an AA is a very specialized field AND even if you could work in all 50 states, you will only be employed in your niche. So that means there is no career advancement and you will be doing the same duties from day one til you retire. And as others have pointed out, you are very limited in where you can work - it has been an uphill battle in CA and I don't see it changing anytime soon. Even if a state is "open" to AAs that doesn't mean you can apply to any hospital to work in that state. The hospital has to specifically allow AAs to work and there are really only a handful of hospitals in those states that employ AAs. Yes, you can make good money right after graduation, but in the long run, a few more thousand bucks isn't that big a deal if you can't work where you want or do what you want. My advice to young people - do what will give you the most flexibility in terms of job options bc you just never know where you will end up in life and your interests will probably change.

PharmD's have career options IF IF IF IF they can find a job. That's a big IF. Look on the pharmacy forums - there's a glut of pharmacists.

Surely you entered the AA profession knowing California was not open to AAs at present. Don't trash the whole profession because your personal track didn't go as planned, you didn't research the profession well, or made poor choices. AAs that want to work are all working. Job placement is virtually 100% as more practices look to AAs as the preferred provider instead of militant CRNAs. Most AAs are perfectly happy with their career choice. They may change job locations, but very few leave the profession.

And since you appear to have worked in the profession very little - AAs do indeed make decent money right after graduation - their incomes rise as they gain seniority, and there is certainly more than "a few more thousand bucks" difference between starting and experienced AAs.

 

[timgasman]

AAs will eventually turn into PAs attempting to claim equivalency. Just a matter of time.

AA will take the role of CRNA and the CRNA will take the role of the MD/DO. What will the MD/DO do?

 

[Doctor4Life1769]

AA will take the role of CRNA and the CRNA will take the role of the MD/DO. What will the MD/DO do?

Sleep and drink coffee.

 

[CaliforniaDreamingAA]

JWK...I'm not bashing AAs at all.... And I worked for over 12 years in the field so that is hardly "very little time" or "very little experience". And I would still be working IF I could. I can remember to this day Dr. Wesley T. Frazier (the director of the program) telling me that California and a bunch of other states were "opening up" whatever that really means. So please don't bash me for telling my story and giving my honest opinion. I think you are doing a disservice to young people by not giving the full story on the whole situation. The reality is that ALL professions go through ups and downs. I remember many of the anesthesia MDS could not find jobs when I graduated. Yes, traditional pharmacy jobs can be hard to find, but the good old days of medicine for a lot of medical professions is not what it used to be either. My point about pharmacy, is that has a LOT more options than just working at Walmart or Walgreens. Pharm can be a great career choice and they can work in ALL 50 states, heck they can work all over the world. And no, I'm not married to a pharmacist!

 

[IlDestriero]

AA will take the role of CRNA and the CRNA will take the role of the MD/DO. What will the MD/DO do?

Retire and never look back. And hope we don't get sick and need high acuity anesthesia care.


--
Il Destriero

 

[deleted171991]

Retire and never look back. And hope we don't get sick and need high acuity anesthesia care.


--
Il Destriero

Retire and move abroad to a cheaper country where doctor still means only physician.

 

[IlDestriero]

Retire and move abroad to a cheaper country where doctor still means only physician.

Even better.



--
Il Destriero

 

[chocomorsel]

JWK...I'm not bashing AAs at all.... And I worked for over 12 years in the field so that is hardly "very little time" or "very little experience". And I would still be working IF I could. I can remember to this day Dr. Wesley T. Frazier (the director of the program) telling me that California and a bunch of other states were "opening up" whatever that really means. So please don't bash me for telling my story and giving my honest opinion. I think you are doing a disservice to young people by not giving the full story on the whole situation. The reality is that ALL professions go through ups and downs. I remember many of the anesthesia MDS could not find jobs when I graduated. Yes, traditional pharmacy jobs can be hard to find, but the good old days of medicine for a lot of medical professions is not what it used to be either. My point about pharmacy, is that has a LOT more options than just working at Walmart or Walgreens. Pharm can be a great career choice and they can work in ALL 50 states, heck they can work all over the world. And no, I'm not married to a pharmacist!

Why don't you do some locums or something? Are you really so stuck in California that you can't make income as an AA at all? That seems to me to limiting yourself quite a bit. There are still something like 17 states to choose from. You must be doing well in CA doing something else outside of medicine.

You COULD be working as an AA somewhere else. You choose not to because you CHOOSE to live in CA. And that is your prerogative.

 

[chocomorsel]

Why don't you do some locums or something? Are you really so stuck in California that you can't make income as an AA at all? That seems to me to limiting yourself quite a bit. There are still something like 17 states to choose from. You must be doing well in CA doing something else outside of medicine.

You COULD be working as an AA somewhere else. You choose not to because you CHOOSE to live in CA. And that is your prerogative.

And if you ever want to go back to work as an AA in the future in CA or wherever, you are going to find it exceedingly difficult if you haven't worked in the profession in a while. You may not be given an opportunity to rejoin the workforce. Something to think about. Unless you are done with it completely.

 

[frosted_flake]

Oh, but they do. NPs are treating patients all the time. Even some regular RNs (especially ICU or ER ones) claim to diagnose and treat and save lives.

I have seen ER nurses do their "nursing diagnosis" on a regular basis. Not really sure how or why nurses would be diagnosing anything when the ER doctor is coming into the room right after they are.

 

[deleted171991]

Nurses are playing doctor more and more in the US. Just take a look at their books, or read some of their notes. It's like kids playing doctor with dolls.

Also, this makes them look important to the patient. Personally, it would piss the heck of me to be "examined" or "auscultated" by a nurse.

 

[chocomorsel]

FFP, In this country, nurses do examine and auscultate patients. I am sure it is so in other countries as well. Maybe not yours. I find that odd quite frankly. They learn this stuff in nursing school. Obviously they aren't supposed to diagnose, just describe what is heard and alert the docs if patient isn't doing well.

Come on, how many times has a nurse called you with a patient who is doing poorly and you ask them about the physical exam i.e lung sounds, HR, abdomen. Are they supposed to just sit there and not touch their patient except just butt wiping?

And quite frankly, why is it in some of this threads people are referring to nurses as just butt wipers? That is totally unnecessary. A good, astute nurse can save your ass sometimes.

Now I am glad I don't have to work with CRNAs, and most of them are brainwashed to think they are equal to us and don't need us, but don't see the need to go bashing on nurses. We are going too far.

 

[deleted171991]

FFP, In this country, nurses do examine and auscultate patients. I am sure it is so in other countries as well. Maybe not yours. I find that odd quite frankly. They learn this stuff in nursing school. Obviously they aren't supposed to diagnose, just describe what is heard and alert the docs if patient isn't doing well.

I don't find it odd at all. Yes, it's fine to examine the skin and whatever is their line of work (yes, the butt wiping), but don't play physical exam on me. First of all, I don't trust their physical exam skills. Second, I don't see why they need that information, since there is nothing they can/should do with it, except telling to the physician, who's supposed to examine me anyway. It also pisses the heck out of patients when they are asked the same question again and again, or are examined again and again.

Come on, how many times has a nurse called you with a patient who is doing poorly and you ask them about the physical exam i.e lung sounds, HR, abdomen.

If I say never, will you believe me? As I said, I don't trust their physical exam skills, especially when about negative predictive value. I want the general appearance, mental status and vitals, and I'll move my butt for the rest, as I am supposed to. Unless the patient is worsening, I don't see the need for a nurse to do physical exams on a patient (even then, just call me). Nursing should be what mothers do to their children; medicine is what doctors do to them.

Are they supposed to just sit there and not touch their patient except just butt wiping?

If you mean nursing, in the real meaning of the word, then bingo! Actually, many of them are not really trained for much more, if we consider the level of understanding disease processes.

I have been interrupted by nurses, while treating a stuporous patient with a MAP of 50 on 3 pressors, because they needed to clean the crap from his butt for 20 minutes, so that he won't develop a skin lesion by morning (when he was going to be dead anyway, absent a miracle). Not only that, but they gave him Fentanyl on top of it, so that he won't be bothered when turned (he didn't need it). Which brought the MAP to 40, for those 20 minutes. And these were ICU nurses, la crème de la crème.

And quite frankly, why is it in some of this threads people are referring to nurses as just butt wipers? That is totally unnecessary. A good, astute nurse can save your ass sometimes.

Abso-friggin-lutely! I have the utmost respect for nurses who excel at their job; I trust them, cherish them and take every opportunity to point out the good job they are doing.

 

[chocomorsel]

Wow FFP, in one sentence you say you don't trust them, in another you say you do. The reality is, they spend a lot more time with the patients than we do, so if they do their job right, without overstepping, then we can get along great and take care of patients in our respective roles.

I usually agree with you but let's just agree to disagree on this one.

 

[Mad Jack]

I can't disagree with that but I'm just saying anesthesiologists should not be overly comfortable with AAs like other specialists have with PAs

The number of independently practicing PAs is miniscule. You make it sounds like they're stealing fields from doctors lol. The vast majority of PAs both want to work in collaboration with a physician and currently do so.

 

[deleted171991]

Wow FFP, in one sentence you say you don't trust them, in another you say you do. The reality is, they spend a lot more time with the patients than we do, so if they do their job right, without overstepping, then we can get along great and take care of patients in our respective roles.

I usually agree with you but let's just agree to disagree on this one.

You misunderstand me. I generally trust most of them when about nursing level stuff (you know, the kind that's not medicine). And I love working with smart passionate people, and I show my appreciation, regardless what's written on their badge. But see the example above to understand their limits, and how the PC hospital bureaucracy is endangering patients by giving nurses too much power. There is a difference between speaking up and talking back.

There is this cult of personality for nurses in this country, and I don't know where it's coming from. I wish people cared so much about our veterans. That doesn't mean that there aren't some fantastic people out there. But I've also seen my share of ignorance, laziness, incompetence, bureaucracy etc. Most of the useless, stupid, non-evidence-based rules we have to follow were invented by nurses in power positions, for example.

You should see nurses chatting loudly in the ICU in the middle of the night, all doors open, all lights on. I couldn't sleep a second there, as a patient. Let's not mention breaks, lack of continuity (they just can't work more than three days in a row), lack of sedation breaks (an awake patient is just too much work), charting before doing, inability to do anything around shift change, taking 30 minutes to "admit" a patient before the intensivist can even examine him/her etc., all the situations where the patient does not come first. And these are critical patients, so every minute is organ. The lack of judgment is just breathtaking, on occasion, because they have been brainwashed into believing that they are the patient advocates against the big bad doctors.

I absolutely agree with the emphasized part of the quote. Except that you and I disagree on their role. We probably also disagree on the model; I think that the reason nurses are so prominent in patient care is because doctors are so overwhelmed with work and bureaucracy that they can't devote much time to patients. The solution to this is not giving more responsibility to nurses, it's fewer patients per physician. Yes, it costs more; it's also better care.

 

[Psai]

FFP, In this country, nurses do examine and auscultate patients. I am sure it is so in other countries as well. Maybe not yours. I find that odd quite frankly. They learn this stuff in nursing school. Obviously they aren't supposed to diagnose, just describe what is heard and alert the docs if patient isn't doing well.

Come on, how many times has a nurse called you with a patient who is doing poorly and you ask them about the physical exam i.e lung sounds, HR, abdomen. Are they supposed to just sit there and not touch their patient except just butt wiping?

And quite frankly, why is it in some of this threads people are referring to nurses as just butt wipers? That is totally unnecessary. A good, astute nurse can save your ass sometimes.

Now I am glad I don't have to work with CRNAs, and most of them are brainwashed to think they are equal to us and don't need us, but don't see the need to go bashing on nurses. We are going too far.

Or you could do your own physical exam like a doctor should? Why would you ever trust what a nurse says

 

[Doctor4Life1769]

The number of independently practicing PAs is miniscule. You make it sounds like they're stealing fields from doctors lol. The vast majority of PAs both want to work in collaboration with a physician and currently do so.

Only the start.

 

[Doctor4Life1769]

Or you could do your own physical exam like a doctor should? Why would you ever trust what a nurse says

Of course a physician wouldn't, but at the same time nurses often do initial assessments and triage and will give the physician a heads up.