Closing threads

[Pooh & Annie]

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I COMPLETELY understand why long-time members of the SDN forums would be sick of hearing certain issues beaten into the ground, in particular the anesthetist v -ologist issue. I also know that we can search the forum to find out what people have had to say about it in the past. But this is an evolving issue, and sometimes we're happy with new developments and sometimes we aren't. Regardless, this is OUR forum, and we should be able to discuss this stuff. If a few scumbags try highjacking threads, we should ignore them. I'm a soon-to-be ologist who has had his heart set on anesthesiology for quite some time, and I know this stuff profoundly affects me. I want to hear what other ANESTHESIOLOGISTS have to say about new developments.
I had never even heard of the "opting out" story, and it obviously touches some nerves. But there are turf battles in pretty much EVERY area of medicine. I wish we could discuss some of these issues so that people like me, who are not "up" on all the issues can learn more about them. I really appreciate the opinions of you guys that have been here for awhile like vent, UT, military, and jpp. I don't expect you to give your opinion about every new development, but sometimes it's be cool to get some input on how we might be affected from you knowledgable guys instead of instantly shutting threads down.

 

[militarymd]

I'll be the first to admit this:

CRNAs can do most of the things that anesthesiologists do just as well. I believe that there is truly no difference in outcome in the majority of cases.

As I have stated before, there are anesthesiologists who I would not let do my anesthesia while at the same time, there are CRNAs who I'll let take care of me and my family without "supervision".

So, the young and aspiring medical student will ask, "What's the difference?"

Some days, I have a hard time sorting it out, especially if you are surrounded by other "anesthesiologists" who do not function as a physician.

So, here is a list of things that I feel differentiate an anesthesiolgist from a CRNA:

1) ability to perform all aspects of anesthesia with perhaps the exception of neonatal anesthesia

2) ability to diagnose and treat medical conditions and decide which are "acceptably" treated...not necessarily "optimized" for the planned surgery...and consult when necessary

3) ability to function beyond the OR....specifically ICU.....

4) know surgical diseases...meaning being able to talk to surgeons intelligently ...beyond "when did the patient last have something to eat?"

What it boils down to is knowledge base....and that means a lot of reading.

That is my 2 cents.

 

[VentdependenT]

I COMPLETELY understand why long-time members of the SDN forums would be sick of hearing certain issues beaten into the ground, in particular the anesthetist v -ologist issue. I also know that we can search the forum to find out what people have had to say about it in the past. But this is an evolving issue, and sometimes we're happy with new developments and sometimes we aren't. Regardless, this is OUR forum, and we should be able to discuss this stuff. If a few scumbags try highjacking threads, we should ignore them. I'm a soon-to-be ologist who has had his heart set on anesthesiology for quite some time, and I know this stuff profoundly affects me. I want to hear what other ANESTHESIOLOGISTS have to say about new developments.
I had never even heard of the "opting out" story, and it obviously touches some nerves. But there are turf battles in pretty much EVERY area of medicine. I wish we could discuss some of these issues so that people like me, who are not "up" on all the issues can learn more about them. I really appreciate the opinions of you guys that have been here for awhile like vent, UT, military, and jpp. I don't expect you to give your opinion about every new development, but sometimes it's be cool to get some input on how we might be affected from you knowledgable guys instead of instantly shutting threads down.

I'll reopen that thread if you'd like but I've seen these things deconstruct into such an awful mess so often that its routine. It pisses folks off and brings an unwanted vibe to the forum.

Like I said I'll open it again and we'll see.

 

[Pooh & Annie]

Thanks, dude. It's not that this particular thread is all that important to me, it's just that I want to hear from you guys about some of this stuff.

 

[awdc]

2) ability to diagnose and treat medical conditions and decide which are "acceptably" treated...not necessarily "optimized" for the planned surgery...and consult when necessary

Can someone expand on this? I'm entirely too sure how this plays out in anesthesia practice?

3) ability to function beyond the OR....specifically ICU.....

How often does an anesthesiologist get to function outside of the OR? I guess what I really want to know is what an anesthesiologist's day/week would be like?

 

[bigdan]

awdc-

I'll let militarymd handle your first question, but please do check the FAQs that this forum has as "sticky" at the top of the thread list for the answer to your second question. There are excellent posts by both resident and attending anesthesiologists that will likely answer your questions.

dc

 

[militarymd]

I of my pet peeves is when I hear people ask "Is this patient OPTIMIZED?" during a perioperative consultation with a specialist.

Patients are almost never OPTIMIZED, but we still take them to the OR. As the anesthesiologist, it is our responsibility to make the MEDICAL judegement to decide whether a patient is ADEQUATELY treated or not for the planned procedure.

It is our job to decide whether additional treatment is needed prior to surgery, or treatment can be withheld until after surgery, or if treatment is needed at the same time as surgery.

Example:

DM patient with HA1C at 13%..Cr 2.2...with significant proteinuria and hypertension 160/99....with known inducible ischemia during exercise...whose only medication is insulin ....planned procedure is RIHR.

Patient is clearly not medically optimized....are you going to cancel the case? I would not, but the patient can clearly benefit from additional medical therapy.

Any monkey can put it a spinal or LMA for this case.

The anesthesiologist's job is:
1) Start Altace....per HOPE trial (look it up if you don't what it is..NEJM)
2) Start beta-blocker....per JNC VII (I hope you don't have to look this up)
3) Endocrine/Medical Consultation for long term care of this patient

 

[etherRN]

3) ability to function beyond the OR....specifically ICU.....

4) know surgical diseases...meaning being able to talk to surgeons intelligently ...beyond "when did the patient last have something to eat?"

What it boils down to is knowledge base....and that means a lot of reading.

That is my 2 cents.

Hi, I'm a moderator on allnurses.com CRNA board. This is my first post at SDN. Similarly to this board, topics that entreat candid discussion quickly turn into... well, you know the deal. I want to post on this forum because I'm a critical care RN now, and will be an SRNA in the future. I have a couple of immediate family members who are MDs. I know what docs go through.

I agree generally with militarymd on most of the statements above. I don't think that you are giving critical care nurses credit where credit is due. The training does vary from hospital to hospital, but some training programs are exceptional. For instance, I received internships in lines, hemodynamics, IABP's, open heart surgery, pathophysiology, ACLS, PALS, ICP drains/monitors, intubation and vents, conscious sedation, epidurals etc. Therefore, I believe that crit-care RNs are more equipt than other nurses at communicating the needs of the pt to a doctor. "when did the patient last have something to eat?" I mean, come on! Guess who gets called by the rest of the hospital to place PICCs when fluroscopy is closed, or when a med-surg pt is going downhill and needs a real assessment before the MD is paged, or when the new heart valve decides to go into A-flutter and the pacemaker needs some tweaking?

The knowledge that you have as an MD cannot be duplicated, for sure. But individuals who go into nurse anesthesia are from many different backgrounds. I am satisfied with my knowledge base with courses in o-chem, physics, and currently taking graduate pathophys. In fact, many people with degrees in the hard sciences (biochemistry etc.) become CRNA's. So, to prove my point, there are a few nurses who may talk about the G protein and C-terminal in the same sentence. 🙂

 

[militarymd]

Allow me to rephrase.

I see that nurses and physicians have different jobs. Frequently, they do overlap a lot, but the jobs and responsbilities are different....although, once again, they overlap frequently.

The primary responsbility of the physician is to DIRECT "medical management"...which requires experience and the knowledge base.

Although nurses frequently have the same experience and a lot of the knowledge, "medical management" is not a nurses' job.

 

[etherRN]

Thanks militarymd 👍

 

[VentdependenT]

Great post mmd. I hope I'll be half as good as you are.

Half the time I see someone like that they usually have 6 consultants on board and its the night before surgery. The other half I find out the night before on the phone and by then its too late to have gotten some things on board ahead of time. I have already done my share of double takes when the attending unlocks the bed and just starts rollen the pt back. We manage their poorly controlled HTN DM and ship em back to the internest with a sign that says "I need more medical management."

 

[toughlife]

I COMPLETELY understand why long-time members of the SDN forums would be sick of hearing certain issues beaten into the ground, in particular the anesthetist v -ologist issue. I also know that we can search the forum to find out what people have had to say about it in the past. But this is an evolving issue, and sometimes we're happy with new developments and sometimes we aren't. Regardless, this is OUR forum, and we should be able to discuss this stuff. If a few scumbags try highjacking threads, we should ignore them. I'm a soon-to-be ologist who has had his heart set on anesthesiology for quite some time, and I know this stuff profoundly affects me. I want to hear what other ANESTHESIOLOGISTS have to say about new developments.
I had never even heard of the "opting out" story, and it obviously touches some nerves. But there are turf battles in pretty much EVERY area of medicine. I wish we could discuss some of these issues so that people like me, who are not "up" on all the issues can learn more about them. I really appreciate the opinions of you guys that have been here for awhile like vent, UT, military, and jpp. I don't expect you to give your opinion about every new development, but sometimes it's be cool to get some input on how we might be affected from you knowledgable guys instead of instantly shutting threads down.

If attendings' salaries dropped to 150-200K (comparable to a CRNAs), who would the hospital hire assuming equal salary for both? an MD or a CRNA?

 

[nitecap]

If attendings' salaries dropped to 150-200K (comparable to a CRNAs), who would the hospital hire assuming equal salary for both? an MD or a CRNA?

Dont even try man. If MD's salary would drop to 150-200k then the CRNA's salaries would have dropped to 75-90k. Please dont start a fight here. Its been pretty calm here lately. This situation can and would not exist so no use even talking about it.

 

[toughlife]

Dont even try man. If MD's salary would drop to 150-200k then the CRNA's salaries would have dropped to 75-90k. Please dont start a fight here. Its been pretty calm here lately. This situation can and would not exist so no use even talking about it.

Not looking for a fight but rather to remind the OP that no matter how bad things may look in the future, there will always be room for anesthesiologists.

 

[toughlife]

Dont even try man. If MD's salary would drop to 150-200k then the CRNA's salaries would have dropped to 75-90k. Please dont start a fight here. Its been pretty calm here lately. This situation can and would not exist so no use even talking about it.

Not looking for a fight but rather to remind the OP that no matter how bad things may look in the future, there will always be room for anesthesiologists.
I was not directing the comment to CRNAs so no need to fret over it.