8 depressing rules to being a good anesthesiologist

[GoodmanBrown]

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8 Simple Rules To Being A "Good" Anesthesiologist

1. It helps to be female.
2. Play good music.
3. Avoid temper tantrums.
4. Be a comedian.
5. Show no initiative.
6. Watch ESPN.
7. No eccentricities.
8. Buy food for the OR staff.

Kinda depressing, though the poster says it's tongue in cheek in the comments section. Clearly there's an element of truth to it though. Any thoughts from those in the same position as the poster?

 

[Intensivist]

rubbish, most likely written by arogant surgeon... 😀
besides playing good music, and be loose and all, l'll be the opposite!

 

[WholeLottaGame7]

8 Simple Rules To Being A "Good" Anesthesiologist

1. It helps to be female.
2. Play good music.
3. Avoid temper tantrums.
4. Be a comedian.
5. Show no initiative.
6. Watch ESPN.
7. No eccentricities.
8. Buy food for the OR staff.

Kinda depressing, though the poster says it's tongue in cheek in the comments section. Clearly there's an element of truth to it though. Any thoughts from those in the same position as the poster?

I would say that that it's about 50% accurate (2,3,4,7). #1 was definitely written by a surgeon.

 

[Planktonmd]

8 Simple Rules To Being A "Good" Anesthesiologist

1. It helps to be female.

It's actually the opposite

2. Play good music.

Yes, sometimes

3. Avoid temper tantrums.

YES!!!

4. Be a comedian.

If you can

5. Show no initiative.

No, show initiative but understand the political dynamics of where you work.

6. Watch ESPN.

YES

7. No eccentricities.

YES

8. Buy food for the OR staff.

It helps, but not necessary.

Kinda depressing, though the poster says it's tongue in cheek in the comments section. Clearly there's an element of truth to it though. Any thoughts from those in the same position as the poster?

 

[hoyden]

8 Simple Rules To Being A Good "Surgeon":

1. STFU
2. Be on time.
3. STFU
4. Hurry up with the surgery.
5. STFU
6. Don't add on cases.
7. STFU
8. Go home.

👍

 

[citi]

These rules just point the the sad state of our profession, the absolute lack of respect we get from the surgeons, the nurses and the administrators. You have to recognize that you are just another piece of equipment in OR that can and will be tossed at the whim of any surgeon or administrator should you accidentally offend either by any imperceptible transgression. Thus these 8 basic rules on how to not offend those who really matter.


Hospitals where we work exist for one reason, to enrich and entertain the administrators. We are just an easily replaced annoyance to the administrators, should we offend the sensibility of the the suits we can expect to be promptly canned. Surgeons conversely have value to the suits, since patients come to the hospital to be under the care of the surgeon, who can just as easily send them to the hospital on the other side of town, thus depriving the suits of their precious money.

 

[aredoubleyou]

These rules just point the the sad state of our profession, the absolute lack of respect we get from the surgeons, the nurses and the administrators. You have to recolonize that you are just another piece of furniture in OR that can and will be tossed at the whim of any surgeon or administrator should you accidentally offend either by any imperceptible transgression. Thus these 8 basic rule on how to not offend those who really matter.


Hospital where we work exist for one reason, to enrich and entertain the administrators. We are just an easily replaced annoyance to the administrators, should we offend the sensibility of the the suits we can expect to be promptly canned. Surgeons conversely have value to the suits, since patients come to the hospital to be under the care of the surgeon, who can just as easily send them to the hospital on the other side of town, thus depriving the suits of their precious money.

Our interreplacability (i think I invented a word) is part of the lure of the specialty, since it is the reason that we can work in shifts, cover each others call, and not sit by a pager all night because a certain PCP wants you and not the guy whose on call (happens to surgeons, cardiologists, etc). The consequence of this is that I can walk in and steal your job on a whim, and vise versa.

 

[gaspasser2004]

In residency I met a moonlighting attending who had previously done a gig in Reno, NV where the surgeons decided who did their anesthesia. He was telling me that the highest income anesthesiologists weren't the best clinicians, but rather the best BS'ers. He described to me this hypothetical scenario:

There is a surgeon in town who has a very lucrative practice (quick, easy cases on well insured patients). Another anesthesiologist (perhaps even one of your partners) is currently covering his Monday cases.

Anesthesiologist: "Hey Bob (surgeon), my family and I are going to Aspen for the weekend to ski. We've got this fabulous lodge overlooking the mountain. How would you and your family like to join us? Don't worry about the airfare, I got tons of frequent flier miles I can give you to buy the tickets."

On the ski lift in Aspen after a day of skiing...

Anesthesiologist: "You really smoked that last run Bob. Where did you learn to ski like that? Hey, I was thinking, how are your Monday cases going? You know, I just cleared my Mondays with Dr. X (other surgeon) retiring/leaving/not having well insured patients and I'd really like a crack at your Monday line up. Dr. Y (other anesthesiologist) is a great guy, but I think I could provide you with much better service."

Surgeon: "Let me think about that..."


Basically, the anesthesiologists are reduced to being Stryker reps. The previous posters are right - as long as you don't seriously F' up, we are viewed as being completely interchangeable. One of the unintended consequences of large groups who cover hospitals efficiently (on demand anesthesia and smooth hand off's) is that the anesthesia consumers see anesthesia not as a service provided personally by "Dr. Smith", but rather as a utility, like electricity where you just have to turn a switch.

 

[aredoubleyou]

One of the unintended consequences of large groups who cover hospitals efficiently (on demand anesthesia and smooth hand off's) is that the anesthesia consumers see anesthesia not as a service provided personally by "Dr. Smith", but rather as a utility, like electricity where you just have to turn a switch.

Hit the nail on the head.

And that, sadly, is the least of our problems. When consumers equate MD = CRNA, our bargaining power is further reduced.

 

[Tuohy]

Any environment where you have to have the surgeons pick you (and there are many states/practices like that) sounds like it really sucks!!! Not for me...

 

[citi]

Any environment where you have to have the surgeons pick you (and there are many states/practices like that) sounds like it really sucks!!! Not for me...

I have never been anywhere the surgeons didn't try to exert some say over who did their anesthesia. The more money the surgeon make for the hospital the more power and thus the more control over who does their cases. This is much better when the surgeons have some say in who does the cases than what is happening in to many places where the Administrators have sold the right to provide anesthesia services to a management company, The management company who invariable looks for the cheapest providers and the administrators will gladly force the surgeons to accept whoever the management company provides for anesthesia. The management company makes the Administrators job easier and compensates the Administrators for offering the anesthesia contract.

 

[igottaquestion]

but are these the battles that have been fought for decades, or does it portend something about the future of the profession?

 

[cfdavid]

but are these the battles that have been fought for decades, or does it portend something about the future of the profession?

I can't speak as if I'm a PP dude. I just began residency.

But, in general, our world has become much less "personable". So, if a product or service can be commoditized, it will be. IMHO, the reason this is possible where at one time it wasn't so much, is because of the free flow of technology and information as well as human capital. This often equals efficiencies and "flexibility" never before dreamed of, and in a world ruled by the bottom line, personal relationships can get trumped in a hurry.

I'm speaking in general terms, but again, if something can (or allows itself) be commoditized then it will.

The key for professionals is to make sure you are never viewed as a commodity. Others have eluded that the structure of many modern day private practices is such that consumers of anesthesiology services view the providers as often interchangeable (probably more so in large practices).

The solution is for such practices to never allow THE PRACTICE or the GROUP to be viewed as one big commodity. So, offering exptertise such as fellowshiped trained docs handling the peds cases, CT guys doing the hearts etc. will be important in the future, it seems to me. SERVICE SERVICE SERVICE is going to be ever more the key to success. This is true across any profession and within medicine is not exclusive to anesthesiology.

Just my 2 cents.

cf

 

[rmbsstock]

out..

 

[Curious Biff]

1. It helps to be female.
2. Play good music.
3. Avoid temper tantrums.
4. Be a comedian.
5. Show no initiative.
6. Watch ESPN.
7. No eccentricities.
8. Buy food for the OR staff.

Number 3-7 apply to all physicians. Numbers 1 and 6 are only critical in dealing with orthopedic surgeons and sports medicine types.

Point is, no one wants to work with a pain in the ass. This is true inside and outside of the OR. Specific to number 5, most doctors are horribly conservative (and generally spineless) and want you to simply go with the flow and do what's expected. This goes for all consultants. We want you to do what we're used to. If you fly too far outside the box too often, you're going to get labeled as an unpredictable or, worse, "dangerous" provider. That's a death knell (and goes true for any and every consultant).

The best anesthesiologists I work with bring patients to the ICU stable, adequately resuscitated, and not screaming in pain. They also unfailingly exhibit a calm, "in control" demeanor. The worst ones regularly and almost unavoidably fail at all of those things.

Biff

 

[Bertelman]

The best anesthesiologists I work with bring patients to the ICU stable, adequately resuscitated, and not screaming in pain. They also unfailingly exhibit a calm, "in control" demeanor. The worst ones regularly and almost unavoidably fail at all of those things.

Biff

Those traits aren't necessarily the things that bring you favor with certain surgeons. If your personality is similar to a doorknob, the boy's club at the surgicenter could care less about your ability to cruise into the ICU.

 

[glade]

I find it interesting that people were in agreement with the whole "surgeons need to speed up and also not add on cases" thing and then you're all up in arms that surgeons treat you interchangeably. When I was starting residency, I had Anesthesiologists who would literally wake the patient up while I was closing, so long as the attending had left. They considered that "good motivation" for me to hurry. In fact, that's stupid for a number of reasons:

- That slows me down.
- Even if I was inclined to hurry up at that point, I'm not going to; I'll just stop working and stare at the wall -- what are you going to do once the patient is awake with an open abdomen? Start extubating them? Go ahead.
- Now all you've done is left a patient in pain. Congrats.

And yet that constantly happened. So I just stared at the wall a lot and our Anesthesiologists would go nuts like "WHAT ARE YOU DOING?? HURRY UP!! CLOSE!!! NOW!!!!! THE PATIENT IS AWAKE!!!" These are guys who were thirty, maybe forty years older than me and yet that's how they were acting.

Or you'd add on a case and people would act like it was the end of the world, even though they were on shifts and you weren't. That's pathetic, to be quite honest. If we got an Anesthesiologist who worked hard and did his job, nobody ever gave him any crap or lip. The times you guys get derided is when you drag your feet and complain all day about having to do a "late" case at 5 PM and in retaliation you just sit around.

No wonder some of you are terrified of working in areas where there are competing groups. That would mean you'd have to provide quality service, like other physicians who compete with each other. I mean, sure, there are lots of surgeons who are a-holes and guess what? They lose out. Now, if they were like some of you guys, their response would be "man, we need it so that there's no competition so that we can continue to be a-holes." Fine and dandy. If that's going to be your response, then I'm glad there are CRNAs who are undermining you and cutting you out.

 

[Mman]

My rules (in order)

1) Be safe (everything takes a back seat to this)

2) Be fast

3) Be friendly

4) Be the calming influence in the room when stuff hits the fan




I don't really worry about anything else

 

[Mman]

I find it interesting that people were in agreement with the whole "surgeons need to speed up and also not add on cases" thing and then you're all up in arms that surgeons treat you interchangeably.

I never complain about doing more cases. That's what pays the bills. I do complain about people being slow, though. The reason is that because a fast surgeon makes my job easier. However sick the patient or however complicated the procedure, the anesthetic will be easier to manage if it is shorter in duration and the patients will have better outcomes provided the procedure is done appropriately.

Slow surgeons can screw up a great anesthetic plan and lead to a worse experience for a patient.

Don't get me wrong, I'm not complaining about every little time add on. But when I'm sitting back and watching an attending do an AV fistula under MAC and it takes > 4 hours, all I'm doing is remember when I was a med student scrubbed in on those cases and they were done in 1-2 hours tops.

And this..."If that's going to be your response, then I'm glad there are CRNAs who are undermining you and cutting you out. "

All the surgeons I know are terrified of their malpractice insurance skyrocketing in this scenario.

 

[WholeLottaGame7]

No wonder some of you are terrified of working in areas where there are competing groups. That would mean you'd have to provide quality service, like other physicians who compete with each other. I mean, sure, there are lots of surgeons who are a-holes and guess what? They lose out.

Lose out meaning...? I'm just curious if there's a large group of unemployed a-hole surgeons somewhere?

My experience is that there are a-holes all throughout medicine, and unless they do something egregious, it doesn't keep them from having a job.

Also, I too hated it when the anesthesia provider would wake a patient up while I was trying to suture. As if it weren't hard enough for a med student already. Although, CRNAs were more often the not the culprits in those cases.

 

[hoyden]

Lose out meaning...? I'm just curious if there's a large group of unemployed a-hole surgeons somewhere?

My experience is that there are a-holes all throughout medicine, and unless they do something egregious, it doesn't keep them from having a job.

Also, I too hated it when the anesthesia provider would wake a patient up while I was trying to suture. As if it weren't hard enough for a med student already. Although, CRNAs were more often the not the culprits in those cases.

In a year you will learn to hate it even more - from the other side of the "blood-brain barrier" - when finally a long, bloody surgery, with a patient on 2 vasopressor infusions and the one which is scheduled to go to ICU ( because of the surgery complications - blood loss mainly), at 4.30 am here comes a medstudent to practice stitches the first time in his/her life and keeps embroidering the abdomen for 35 minutes more

Or you going to love it, right?

 

[glade]

Oh. right, RIGHT, I forgot ...it was all a joke! My bad, nobody has ever had Anesthesia complain about adding on cases or ask "how much longer are you going to be ...why am I asking? Oh, uh, no reason." 🙄

Well played, sir! Well played!

 

[fastosprintini]

well glade, yes, try and learn to take a joke with a smile, yes , realize that there is some truth in this, we need surgeons to be fast, show up on time and do the case in the time they requested , it's simple to keep the or flow running, no pride or personal offense involved, if surgeons think they can book a case at 2 pm for 90 min, and then waltz in around 330pm after their clinic is finished and do this case in 180 min, yes, that IS a problem that throws a spanner in the gears or EVERYBODY who works in the or, not only anes....
so, put the personal pride aside and realize that we all want to make money but prefer to do so in an efficient fashion...
just my 0.02 $
fasto

 

[glade]

Your assumption is that when surgeons aren't on time, it's because they're trying to "waltz" in to prove they're king or something (which, to be fair, does occur). That's because you guys don't have any other duties. Which is fine, nobody's knocking that, but it's rather short-sighted of you to assume everyone is like you. I mean, I understand the OR nurse, who practically only has a high school education, to think that way, but I thought you guys would realize otherwise. You realize we have office hours, floor patients, sometimes go between hospitals? Sure, you do, theoretically, but you act like you don't.

 

[hoyden]

Your assumption is that when surgeons aren't on time, it's because they're trying to "waltz" in to prove they're king or something (which, to be fair, does occur). That's because you guys don't have any other duties. Which is fine, nobody's knocking that, but it's rather short-sighted of you to assume everyone is like you. I mean, I understand the OR nurse, who practically only has a high school education, to think that way, but I thought you guys would realize otherwise. You realize we have office hours, floor patients, sometimes go between hospitals? Sure, you do, theoretically, but you act like you don't.

And you do not know that the surgery you booked for 90 minutes you are not going to manage less than in 180?
Well played, sir, well played )))))

 

[Mman]

Oh. right, RIGHT, I forgot ...it was all a joke! My bad, nobody has ever had Anesthesia complain about adding on cases or ask "how much longer are you going to be ...why am I asking? Oh, uh, no reason." 🙄

Well played, sir! Well played!

Don't forget that a surgeon's favorite thing to blame for is "anesthesia". Whether it's cancelling a case or slow room turnover or equipment malfunctions, we tend to get the blame for everything. It's a running joke in most insititutions between the surgeons and anesthesiologists, because the surgeons know they are always complaining about anesthesia.


I try not to make any broad assumptions about diverse groups of individuals.

 

[WholeLottaGame7]

In a year you will learn to hate it even more - from the other side of the "blood-brain barrier" - when finally a long, bloody surgery, with a patient on 2 vasopressor infusions and the one which is scheduled to go to ICU ( because of the surgery complications - blood loss mainly), at 4.30 am here comes a medstudent to practice stitches the first time in his/her life and keeps embroidering the abdomen for 35 minutes more

Or you going to love it, right?

Haha I don't know what you're talking about, next year I'll probably be terrified I'm going to wake someone up too soon and will be dying for a med student 30-minute suture.

Also, FYI, I have yet to see glade's involvement in a thread in which he doesn't get into a fight with someone.

 

[glade]

Also, FYI, I have yet to see glade's involvement in a thread in which he doesn't get into a fight with someone.

Sure, but also FYI you have yet to see my involvement in a thread where I don't have people agree with me.

Your defense of the inanity on this thread is basically to try to redirect things to me. That's fine, but it doesn't change much. I'm not here to demand that you act a certain way. All I ever said, and that hasn't changed, is that if you're going to act the way you do as a professional group of people, then don't be all shocked or sit around and yell when things happen to you. Your response to all this may be "fine, then I'll only practice whenever I don't have anyone competing against me so that I can do whatever I want," and that may work for you. It doesn't, however, make your point of view right.

 

[WholeLottaGame7]

Sure, but also FYI you have yet to see my involvement in a thread where I don't have people agree with me.

Your defense of the inanity on this thread is basically to try to redirect things to me. That's fine, but it doesn't change much. I'm not here to demand that you act a certain way. All I ever said, and that hasn't changed, is that if you're going to act the way you do as a professional group of people, then don't be all shocked or sit around and yell when things happen to you. Your response to all this may be "fine, then I'll only practice whenever I don't have anyone competing against me so that I can do whatever I want," and that may work for you. It doesn't, however, make your point of view right.

I'm just curious as to how you can say "act the way you do as a professional group of people"? You can't stereotype anesthesiologists anymore than you can surgeons or pediatricians, etc. I mean, you can, and it's fun, but it's also grossly inaccurate.

And I think it's fair to get up in arms about competition when that competition is trained on an entirely different level and claiming equivalency. That's like saying surgeons couldn't complain about competition if surgery NPs rose up and started offering to do surgery for cheaper.

 

[glade]

Actually, this thread had little to nothing to do with CRNAs, so to suddenly act as if that was the goal of this thread is rather silly. I mean, I'm with you on the CRNA issue and all nursing encroachment, no matter what specialty. That happens to be irrelevant. My point is that certainly anesthesia is a necessary component of surgery, of course. But you can see that this feeling from a percentage of your profession that surgeons are these lunks who are incompetent and slow and are merely there to waste your time with long cases or add-ons is the real problem. Well, that plus the fact that the pendulum swung too far in the opposite direction. It used to be that Anesthesia was fairly uncompetitive and now it's semi-competitive with high reimbursements that were manufactured by the ability to oversee large pools of CRNAs and therefore run more cases. So it's your own profession's fault, really, and to act like Surgery did it to you is specious.

 

[hoyden]

Haha I don't know what you're talking about, next year I'll probably be terrified I'm going to wake someone up too soon and will be dying for a med student 30-minute suture.

Also, FYI, I have yet to see glade's involvement in a thread in which he doesn't get into a fight with someone.

You will get there, bro - to the point when you are not terrified of that anymore 🙂

I am just teasing you a little bit and just reminding that there is always a different point of view except yours 😀
Which changes with the mere change of place were you stand in that room.

 

[WholeLottaGame7]

You will get there, bro - to the point when you are not terrified of that anymore 🙂

I am just teasing you a little bit and just reminding that there is always a different point of view except yours 😀
Which changes with the mere change of place were you stand in that room.

Haha, or with how long you've been in the operating room. Very excited to be there, just have to get through intern year...

 

[Coastie]

Oh. right, RIGHT, I forgot ...it was all a joke! My bad, nobody has ever had Anesthesia complain about adding on cases or ask "how much longer are you going to be ...why am I asking? Oh, uh, no reason." 🙄

Well played, sir! Well played!

I wanna know how long its gonna be so I can wake the patient up just as the drapes come down...

or maybe I'm subtly telling you to move your meat wagon..

either way, what's the problem?

 

[hoyden]

Haha, or with how long you've been in the operating room. Very excited to be there, just have to get through intern year...

Dude, you are an intern - your admiration is understandable 😉

 

[rmbsstock]

out..

 

[hoyden]

incoherent blah-blah-blah

 

[rmbsstock]

:cry::cry:

 

[hoyden]

Get lost, goose.

I am a woman.

 

[Bertelman]

I am a woman.

Shocking.

 

[rmbsstock]

:cry::cry:

 

[Coastie]

nag nag nag psychology nag narcisistic nag.

Didn't you say you were never coming back to our forum?

You'd make a great nurse supervisor.

 

[TenaciousGirl]

I am glad that you are a woman, (things are adding up better and clearer in my mind regarding your attitude). 👍 By the way, I am a lady.
I see now that you maybe harassing these guys due to:
a) Freudian complex
b) Need to fit among men
c) Being hurt by men, and trying to lash out
d) low self esteem

and I can keep on, and on. The idea is, the way to discuss any concern you might have is to discuss it in a respectful and professional manner, but not in a demeaning and a put down manner. All what you are doing is building high walls around you that is going to keep you very lonely because everyone is going to hate to be with you.
For example, you do not tell me "Get lost, goose."
1) That shows that you need to go back to school to learn the difference between humans and birds. (maybe you were absent that day when the class took that lesson!!)
2) I like to be visualized as a Peacock (since I am very pretty). Also, when they analysed my personality traits, I was the 'Lion', can you believe that!!
I can. I cannot bare seeing someone so insecure attacking others...
I have so much respect to the anesthesiologists, and I cannot sit down and watch ANYONE talking to them as if they are better than them.

First of all, when glade said "well played, sir" he was being sarcastic ... look that up in the dictionary.

Second, this is not therapy hour 101 ... why are you lecturing a physician in such a manner?

Third, if you're going to read the anes forum respect the territory. I come on here to read about anesthesia, not psychobabble ... there's enough of that, say, in the psych forums.

 

[hoyden]

Shocking.

Why?

 

[Bertelman]

Why?

No particular reason, I just didn't see it.

 

[Laryngophed]

🙁

Get lost, goose.

I am a woman.

Shocking.

Maybe not shocking but definitely not the image that I had in mind. Oh well, I like the new image better.

ETA - Dang. It helps to read the entire thread before posting.

 

[Gastrulation]

8 Simple Rules To Being A "Good" Anesthesiologist

1. It helps to be female.
2. Play good music.
3. Avoid temper tantrums.
4. Be a comedian.
5. Show no initiative.
6. Watch ESPN.
7. No eccentricities.
8. Buy food for the OR staff.

Kinda depressing, though the poster says it's tongue in cheek in the comments section. Clearly there's an element of truth to it though. Any thoughts from those in the same position as the poster?

1. I am female
2. Surgeons choose the music where I work, but I like to change it and laugh when "Wind beneath my wings" starts playing during a hernia repair
3. Watching a grown man (i.e. surgeon) stomp around and throwing his hands up in the air after losing a raytec - nothing could be better. Hungry? Grab a Snickers.
4. True - comedic relief is great in these situations. Anesthesiologists: Masters of Sarcasm
5. False - nobody knows when we show initiative, because that's when everything is going well (patient remains paralyzed, asleep, no pain, normotensive because we're giving the meds to keep them that way...and compensating for surgical blood loss). Think about it - if we showed no initiative, the patient would be in pre-op until everyone's thumbs were out of eachother's anuses.
6. F*** no, but I'll have a beer.
7. Too bad - you'll have to live with me. ...or get a CRNA... but I'm more amusing - especially after Taco Salad for lunch.
8. Done.

 

[Gastrulation]

I find it interesting that people were in agreement with the whole "surgeons need to speed up and also not add on cases" thing and then you're all up in arms that surgeons treat you interchangeably. When I was starting residency, I had Anesthesiologists who would literally wake the patient up while I was closing, so long as the attending had left. They considered that "good motivation" for me to hurry. In fact, that's stupid for a number of reasons:

- That slows me down.
- Even if I was inclined to hurry up at that point, I'm not going to; I'll just stop working and stare at the wall -- what are you going to do once the patient is awake with an open abdomen? Start extubating them? Go ahead.
- Now all you've done is left a patient in pain. Congrats.

And yet that constantly happened. So I just stared at the wall a lot and our Anesthesiologists would go nuts like "WHAT ARE YOU DOING?? HURRY UP!! CLOSE!!! NOW!!!!! THE PATIENT IS AWAKE!!!" These are guys who were thirty, maybe forty years older than me and yet that's how they were acting.

Or you'd add on a case and people would act like it was the end of the world, even though they were on shifts and you weren't. That's pathetic, to be quite honest. If we got an Anesthesiologist who worked hard and did his job, nobody ever gave him any crap or lip. The times you guys get derided is when you drag your feet and complain all day about having to do a "late" case at 5 PM and in retaliation you just sit around.

No wonder some of you are terrified of working in areas where there are competing groups. That would mean you'd have to provide quality service, like other physicians who compete with each other. I mean, sure, there are lots of surgeons who are a-holes and guess what? They lose out. Now, if they were like some of you guys, their response would be "man, we need it so that there's no competition so that we can continue to be a-holes." Fine and dandy. If that's going to be your response, then I'm glad there are CRNAs who are undermining you and cutting you out.

That's pretty hilarious - the whole staring at the wall deal. Passive agression. Awesome. And I'm being sincere here, for once. But I want you to understand that our anesthesia attendings tell us that we need to be ready to extubate the patient as soon as you guys are done closing - to decrease turnover time - that helps everybody, since faster room turnover = more cases, increased business and = everyone is done earlier.

Also, just because a patient's extubated doesn't mean they are awake (maybe I am letting slip an anesthesia secret here) but I can mask ventilate a patient for hours and just pump gas into the circuit. Patient will still be asleep- just extubated. Ever seen a MAC case? The unfortunate side effect is O.R. toxicity, so everyone gets a little bit of kidney/liver...possibly brain damage. Surgeons just seem to be under the false impression that extubated and moving = "AWAKE" like that bad movie Luke Skywalker just made.

And, like you say... I don't mind the competition. I see it as a team effort - if there are CRNA's, that probably means that they are needed. I'd prefer to sleep rather than be on call 3 days a week, and the CRNA's/PA's/AA's help me do that. My only compalint is when CRNA's post videos like this: http://www.youtube.com/watch?v=zjjv7q0C79g <--- can anybody say "Communist Propaganada"?