Fight For The Profession: Tres, By Jet

[militarymd]

Plus, it's not just about the insertion of a A-line or an epidural. It's also about what are the indications, contraindications. should it really be done? what should I do next if somethign goes wrong.

That's what I've been saying all along. Don't confuse procedural skills with medical decision making.

And dude, I really dont think we should degrade each other here on this forum. The SRNAs etc feed of of that!

Look back on the threads, when someone starts "degrading" me, I can't help but defend myself.

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[nedflanders]

That's what I've been saying all along. Don't confuse procedural skills with medical decision making.



Look back on the threads, when someone starts "degrading" me, I can't help but defend myself.

Just like the saphenous vein extraction can be done by a tech, the insertion of a line can be done by a CRNA...The key distinction though is the tech is directly supervised by the surgeon and you can bet all the $ in the world that if something is going wrong, the surgeon is taking over....Military, you're right in that anyone can learn the skills to place lines, etc - but we are the ones - as physicians that must oversee the tasks, and when things go wrong - takeover because of our experience, medical background, etc....That along with our entire perioperative medical decision-making is why CRNA's must only be allowed to practice with supervision. It's simply a safer environment for all.

 

[Noyac]

Just like the saphenous vein extraction can be done by a tech, the insertion of a line can be done by a CRNA...The key distinction though is the tech is directly supervised by the surgeon and you can bet all the $ in the world that if something is going wrong, the surgeon is taking over....Military, you're right in that anyone can learn the skills to place lines, etc - but we are the ones - as physicians that must oversee the tasks, and when things go wrong - takeover because of our experience, medical background, etc....That along with our entire perioperative medical decision-making is why CRNA's must only be allowed to practice with supervision. It's simply a safer environment for all.

We used a lot of crna's in my last gig but some skills were left up to the physician. Those were all lines incl a-lines, all blocks even spinals and epi's, and the hearts, crani's and most major vascular cases were done by MD only. There were some exceptions as to vascular cases but thats it. There are some times when its just less work to do it yourself.

 

[beezar]

One question/complaint about CRNA's (at least at my residency):
when they take "sick days" (ie: not really sick but have to go run errands, or are tired of working that month and just want a day off), we residents have to work our asses off to pick up the slack. sucks big time.

now does that happen in private practice? I'm assuming the CRNAs get a set number of sick days there as well... at my residency, they use them all up while we pick up the slack, whereas for the residents and attendings, they have to be literally puking there guts out q2mins before they take a sick day.

 

[mountaindew2006]

Guys...

I think we all need to focus on the issue at hand. I realize we can all banter about our CRNA issues (just like I have)...but what can we do. We must put our words into action! This AANA beast is a big one.

Let's bounce some constructive ideas about how we can get the ASA to limit the CRNA practice. Especially all you young MD's out there.

WE ARE THE ONES THAT WILL SUFFER the most if we let this issue get out of hand. We need to take charge, become more active, and have changes made before the CRNA lobby group takes us by the balls.

Let's brainstorm.

 

[jwk]

One question/complaint about CRNA's (at least at my residency):
when they take "sick days" (ie: not really sick but have to go run errands, or are tired of working that month and just want a day off), we residents have to work our asses off to pick up the slack. sucks big time.

now does that happen in private practice? I'm assuming the CRNAs get a set number of sick days there as well... at my residency, they use them all up while we pick up the slack, whereas for the residents and attendings, they have to be literally puking there guts out q2mins before they take a sick day.

You're working towards the cheap shot department...you're taking the situation at one place (yours) and assuming every other place is the same. It's not.

Personally, I'd rather not have my anesthesia provider puking in the OR.

 

[jwk]

Guys...

I think we all need to focus on the issue at hand. I realize we can all banter about our CRNA issues (just like I have)...but what can we do. We must put our words into action! This AANA beast is a big one.

Let's bounce some constructive ideas about how we can get the ASA to limit the CRNA practice. Especially all you young MD's out there.

WE ARE THE ONES THAT WILL SUFFER the most if we let this issue get out of hand. We need to take charge, become more active, and have changes made before the CRNA lobby group takes us by the balls.

Let's brainstorm.

The ASA per se really has no way to limit CRNA practice. Laws in 50 states authorize nurse anesthesia practice, just as separate laws enable physician practice. There have been a few successes in lobbying efforts about physician/anesthesiologist supervision of CRNA's (NC, NJ) but then again there's still those 15 states that have opted out of supervision requirements for Medicare patients despite heavy lobbying by the ASA and others.

Like it or not, not all hospitals or outpatient surgery center or private offices use anesthesiologists - they use only CRNA's - most probably from an economic standpoint, some from an availability standpoint, and some because they just like them better (I know you hate that ). But it's also important to realize that even though the AANA likes to toss out figures about 65-70% of anesthetics are administered by CRNA's, 65-70% of anesthetics are also administered as part of a medically-directed/supervised/anesthesia care team environment as well. Many rural areas can't attract anesthesiologists for a variety of reasons. Neither can many smaller hospitals. But very very few large major hospitals will be without anesthesiologists. Those larger hospitals comprise a much larger percentage of overall caseload than the combined cases of all the Podunk Community Hospitals and 20-bed rural county hospitals. There might be 87.3 rural counties in Texas without an anesthesiologist, but the number of anesthetics in those counties is a fraction of the number of cases done at the big centers, all of which involve an anesthesiologist at some level.

But like it or not, admit it or not, as several have pointed out, there simply aren't enough anesthesiologists to do EVERY anesthetic in this country. You could increase the residency slots several times over (which won't happen) and you still can't make up the shortage. Although it varies by locale, there is no shortage of available anesthesia positions (MD, CRNA, or AA) on a nationwide basis. That won't change any time in the forseeable future. Many places are begging for providers of any type.

In the end, sooner or later, it's always going to be a money issue. $$$ to hire someone. $$$ for medical school. $$$ for residency programs. And remember that always-declining $$$ in reimbursement.

Don't get me wrong - as an AA, I have HUGE problems with nurse anesthesia organizations. The battles on many fronts are definitely worth fighting, but in the end, $$$ is often the controlling or limiting factor.

 

[MAC10]

But it's also important to realize that even though the AANA likes to toss out figures about 65-70% of anesthetics are administered by CRNA's, 65-70% of anesthetics are also administered as part of a medically-directed/supervised/anesthesia care team environment as well.

This is interesting. I saw these numbers displayed on the AANA website a while back. So if 70% of anesthetics are administered by CRNAs, then nearly 30% ( im assuming AAs dont make up a large %) are given by MD/DOs. Of the 70% given by CRNAs i would guess that 90% are supervised by MD/DO. That would mean that well over 90% of the anesthestics given in the country involves a physician. These are the numbers the public/legislature need to consider. Fuzzy math people, fuzzy math.

 

[mountaindew2006]

This is interesting. I saw these numbers displayed on the AANA website a while back. So if 70% of anesthetics are administered by CRNAs, then nearly 30% ( im assuming AAs dont make up a large %) are given by MD/DOs. Of the 70% given by CRNAs i would guess that 90% are supervised by MD/DO. That would mean that well over 90% of the anesthestics given in the country involves a physician. These are the numbers the public/legislature need to consider. Fuzzy math people, fuzzy math.

This is good. I agree the public needs to know this type of MATH so does the legislative branch of our govt.

JWK, thanks for your input. But I'm not going to just throw my hands up because I think it's all an economic issue. Nor do i think the ASA will not act...especially if we force them too. The members of the ASA are there to serve the needs of anesthesiologists as the AANA is there to serve the CRNAs. If they cant get thinks done, that are in the best interest of the majority...well then its time for them to get the boot.

I sincerely, believe we can fight this AANA organization. We need to campaign and let the public know about Anesthesia administration. Today I was able to get another convert at the gym i work out it. Dude didnt have a clue about anesthesia and didnt even know that CRNAs were administring this stuff. He basically told me that if he had a choice he would want someone like me (physician) to be taking care of him when he was down under.

Here's the bottom line. If the public demands anesthesiologists, hospitals will be forced to hire them. That creates more jobs for MDs and job security. But at the end of the day, the patient is taken care by a DOCTOR. Doctors w/o a doubt provide the best patient care. I dont think anyone can argue w/ that.

p.s. the aside about insufficient Anesthesiologists. I'm not too sure that will be a concern in the near future. There are a heck more of us going into anesthesiology now. Let's just mk sure htat the CRNA scare of the 90's does repeat.

 

[schutzhund]

I'm really glad I read this post. It's refreshing to see that people realize that there are some serious issues with mid-levels.

As a mid-level to physician convert, I can tell you two things for certain. 1) Yes, the CRNAs, NPs and midwives (etc.) really do think that they are completely capable of practicing "medicine" and they have been actively (and successfully) pursuing this. 2) Their education is nothing like yours. It's tempting (especially for students or junior residents) to give too much credit for the education of the mid-levels. I can assure you that the difference is truly like day and night.

I have serious concerns about the effect of the mid-levels on the future of medicine and anesthesia seems to be a major battle ground. After years of reading nursing propaganda, I had almost completely written off anesthesia as a specialty because of issues with the CRNAs.

I'm encouraged to see some of you guys telling it like it is. SDN seems like its becoming a repository for midlevel propaganda. The truly sad thing is that I see a lot of medical students and residents buying in to it. It's like a classical political maneuver, continuously expose people to the idea until there is desensitization, change some terminology, act like your agenda is the norm, chastise the objectors as being closed-minded, and recruit some "converts."

Keep fighting the good fight.

 

[mountaindew2006]

I'm really glad I read this post. It's refreshing to see that people realize that there are some serious issues with mid-levels.

As a mid-level to physician convert, I can tell you two things for certain. 1) Yes, the CRNAs, NPs and midwives (etc.) really do think that they are completely capable of practicing "medicine" and they have been actively (and successfully) pursuing this. 2) Their education is nothing like yours. It's tempting (especially for students or junior residents) to give too much credit for the education of the mid-levels. I can assure you that the difference is truly like day and night.

I have serious concerns about the effect of the mid-levels on the future of medicine and anesthesia seems to be a major battle ground. After years of reading nursing propaganda, I had almost completely written off anesthesia as a specialty because of issues with the CRNAs.

I'm encouraged to see some of you guys telling it like it is. SDN seems like its becoming a repository for midlevel propaganda. The truly sad thing is that I see a lot of medical students and residents buying in to it. It's like a classical political maneuver, continuously expose people to the idea until there is desensitization, change some terminology, act like your agenda is the norm, chastise the objectors as being closed-minded, and recruit some "converts."

Keep fighting the good fight.

thanks dude.

It's guys like you who I wish would step up and help us confront the issue. I think you are right...if you fling enough mud ...it'll stick. let's stop letting the CRNAs toss the mud

 

[davvid2700]

This is interesting. I saw these numbers displayed on the AANA website a while back. So if 70% of anesthetics are administered by CRNAs, then nearly 30% ( im assuming AAs dont make up a large %) are given by MD/DOs. Of the 70% given by CRNAs i would guess that 90% are supervised by MD/DO. That would mean that well over 90% of the anesthestics given in the country involves a physician. These are the numbers the public/legislature need to consider. Fuzzy math people, fuzzy math.

I think someone posted the actual ruling in favor of the anesthesiologist a few days ago.. The 65-70 percent number was actual 9.7 percent of all medciare reimbursements was for crna services, the others were medically directed crnas. I have to use the search function to find out where that was. I applaud the state of New Jersey for this ruling. GO GOVERNOR CORZINE. Thats my home state by the way.

 

[davvid2700]

We used a lot of crna's in my last gig but some skills were left up to the physician. Those were all lines incl a-lines, all blocks even spinals and epi's, and the hearts, crani's and most major vascular cases were done by MD only. There were some exceptions as to vascular cases but thats it. There are some times when its just less work to do it yourself.

I think you are right. It IS much easier to do the case yourself. Especially if the anesthetist is pushing too much narcotic, too much muscle relaxant, extubationg too early or just plain doing dumb s h i t. Then you come in for a surprise.. By the way, " I HATE SURPRISES" thats why im doing the cases on my own.

 

[militarymd]

I think you are right. It IS much easier to do the case yourself.

Wait....I thought you said that supervising means "playing with yourself", "drinking coffee", "surfing the internet", "reading the newspaper"....so doing those things are harder?????

If it's harder, then why would I be getting "fat, eating donuts in the cafeteria"?

I don't understand.....so which is it????

Is it harder or easier to supervise?

 

[davvid2700]

Wait....I thought you said that supervising means "playing with yourself", "drinking coffee", "surfing the internet", "reading the newspaper"....so doing those things are harder?????

If it's harder, then why would I be getting "fat, eating donuts in the cafeteria"?

I don't understand.....so which is it????

Is it harder or easier to supervise?

Relax there big guy. are you texting this message from the cafeteria or the OR Lounge?

It is easier in the sense that I dont have any ******* i n g surprises you probably have and you can kind of control whats going on better, vs the other way around you are always out of the loop (because you are always eating and "jacking off" ) until something goes down.. I like to know before something goes down and watch it happen then intervene then being called in and something is going down and you dont have heads up before you do something. and you have to do make an intervention with insufficient information . does that make sense?? SO i find it harder in that sense.

dont you remember when you used to pull the endotracheal tube out of prone patients militarymd when you were a resident and then you used to call your attending "stat" to the room to ask for his/ her help. I think that attending would think his job not the easiest

and your fat because you eat too many donuts, drink too much coffee and you dont work out. Thats why you are fat.

 

[militarymd]

and your fat because you eat too many donuts, drink too much coffee and you dont work out. Thats why you are fat.

I'm sure you're more fit than me....spending all that time on your knees dumping urine, and getting up from your stool to move the bed.

I'll work on cutting back on the donuts and coffee.

As for supervising, I guess your idea of supervising and mine are different. I guess the way you supervise, it would be an easy job.

Unfortunately, Medicare rules do not describe supervising the way you do, and it is harder because I'm managing 4 patients at one time, not dumping the urine of one.

 

[davvid2700]

I'm sure you're more fit than me....spending all that time on your knees dumping urine, and getting up from your stool to move the bed.

I'll work on cutting back on the donuts and coffee.

As for supervising, I guess your idea of supervising and mine are different. I guess the way you supervise, it would be an easy job.

Unfortunately, Medicare rules do not describe supervising the way you do, and it is harder because I'm managing 4 patients at one time, not dumping the urine of one.

supervising four rooms.. How did they sucker you into that job? I bet we make the same amount..
I didnt even consider any jobs that required me supervising.


me: Im calling about the anesthesia job

guy on the phone: yeah, what would you like to know?

me: HOw much does it pay?

guy on the phone; it pays (insert low ball figure here),

me; How much vacation do i get?

guy on the phone: 4 weeks

me: how many people are in your group?

guy on the phone: we have 6 docs and 40 crnas

me: mmmmm.. can you hold for a second?

guy: sure

me: (after feining a call waiting) listen thats my grandmother, she cant find her dentures. can i call you back?

guy: Ok we really need somebody so call me back ok

me: sure thing

i never called back

 

[militarymd]

supervising four rooms.. How did they sucker you into that job? I bet we make the same amount..
I didnt even consider any jobs that required me supervising.

So it IS about the MONEY!!!

You don't want to work hard for your money like I do then?????

You just want to dump pee and move the table, and make the same amount I do????

So which is it???? Being a doctor, or making money????

I'll take less pay....as long as I'm doing a doctor's job.

Is this why you want to get rid of CRNAs???? So that you can do a nurse's job , and get paid like a doctor????

Come on now....keep your story straight.

 

[VA Hopeful Dr]

supervising four rooms.. How did they sucker you into that job? I bet we make the same amount..
I didnt even consider any jobs that required me supervising.


me: Im calling about the anesthesia job

guy on the phone: yeah, what would you like to know?

me: HOw much does it pay?

guy on the phone; it pays (insert low ball figure here),

me; How much vacation do i get?

guy on the phone: 4 weeks

me: how many people are in your group?

guy on the phone: we have 6 docs and 40 crnas

me: mmmmm.. can you hold for a second?

guy: sure

me: (after feining a call waiting) listen thats my grandmother, she cant find her dentures. can i call you back?

guy: Ok we really need somebody so call me back ok

me: sure thing

i never called back

Long time lurker in this section (don't usually understand most of what y'all say, but some of it makes for good stories). One thing I did want to comment on though: this part makes you look like something of a jerk. If you aren't going to take the job, its common curtesy to just say up front "I'm not interested" so that employer can start looking for someone else. Says something, I think.

As a side note, who typically does anesthesia for the really quick and easy outpatient stuff (cataracts, for example). I've seen that, in my state, an MD is supervising, so who is actually in the OR? I don't know enough to be either pro or anti non-physician provider, but this kinda made me think. Do all of you folks who want to completely do away with all non MD providers.... do you really want to spend your entire day on those 10 minute procedures? From what I"ve seen, being the provider for cases like that would get just mind-numbing.

 

[supahfresh]

I'm sure you're more fit than me....spending all that time on your knees dumping urine, and getting up from your stool to move the bed.

I'll work on cutting back on the donuts and coffee.

As for supervising, I guess your idea of supervising and mine are different. I guess the way you supervise, it would be an easy job.

Unfortunately, Medicare rules do not describe supervising the way you do, and it is harder because I'm managing 4 patients at one time, not dumping the urine of one.

X-MD, you appear to have some lines zigzagging on your abdomen. Perhaps you should get that checked out.

 

[militarymd]

X-MD, you appear to have some lines zigzagging on your abdomen. Perhaps you should get that checked out.

I'll see my weight management specialist tomorrow

 

[Noyac]

X-MD, you appear to have some lines zigzagging on your abdomen. Perhaps you should get that checked out.

Thats not lines!

Those are rolls from all those donuts!

 

[jwk]

I think you are right. It IS much easier to do the case yourself. Especially if the anesthetist is pushing too much narcotic, too much muscle relaxant, extubationg too early or just plain doing dumb s h i t. Then you come in for a surprise.. By the way, " I HATE SURPRISES" thats why im doing the cases on my own.

And you never get surprised or make mistakes on your cases? Wow, that's impressive.

 

[Noyac]

And you never get surprised or make mistakes on your cases? Wow, that's impressive.

I wouldn't say "I never" because that is a long time, but I can't remember the last surprise I had in the OR that wasn't caused by the surgeon. And while supervising it was every day all day. I will tell you this, the stress is less when doing your own cases by far. There is no comparison.

 

[davvid2700]

So it IS about the MONEY!!!

You don't want to work hard for your money like I do then?????

You just want to dump pee and move the table, and make the same amount I do????

So which is it???? Being a doctor, or making money????

I'll take less pay....as long as I'm doing a doctor's job.

Is this why you want to get rid of CRNAs???? So that you can do a nurse's job , and get paid like a doctor????

Come on now....keep your story straight.

I never said actually doing the case was a nurses job... you said that.. the way you practice is not "hard". Its being a sucker! (sorry) why would i supervise four rooms and not make four times as much. according to your logic. I will take the less pay to do a "doctors" job. thank you very much. and i do more than dump pee and move the table. Thats is just a miniscule task that i do. You add up all the miniscule tasks equals very important ****. rather than being a chart signer

 

[davvid2700]

One thing I did want to comment on though: this part makes you look like something of a jerk. If you aren't going to take the job, its common curtesy to just say up front "I'm not interested" so that employer can start looking for someone else. Says something, I think.

.

dude

you havent met some of the shady ass folks i met on the interview trail.

I doubt highly that guy was waiting for my phone call.

I know a friend of mine who applied for a job out in southern california.. Really desirable group to go to. SHe is a great anesthesiologist, fellowship trained. SO she interviewed with them. SHe is not the greatest interviewer because she says what she thinks too much/ "Like me". thats why we're friends. Anyway they called around for references. But they are sneaky. They dont call the people you put down as references. They call ORs randomly where you worked and ask random people about you. surgeons etc. So they get a hold of a random attending in our residency who didnt like her. Had nothing to do with clinical stuff at all. Just thought she was too outspoken. He says something like," She is too aggressive" or something like that. Guess what, they email her( dont even call her and talk to her personally) and say you know we have been interviewing other people and stuff so those people decided to take the job.. talk about beating around the bush. I would have confronted her saying Look, this guy said this about you is this true etc etc etc.. " we want to hire you but this is concerning". that would earn my respect. SO dont tell me how to handle these guys who are hiring because they are just people looking to hire people who they think they will like not someone who is actually the most competent. I didnt have a problem not being competely forthcoming at all.. In this business, its always, " what can i do for me?" because if you dont think like that you are going to get screwed big time.

 

[davvid2700]

I wouldn't say "I never" because that is a long time, but I can't remember the last surprise I had in the OR that wasn't caused by the surgeon. And while supervising it was every day all day. I will tell you this, the stress is less when doing your own cases by far. There is no comparison.

you answered it the way i would.. I make mistakes but i dont get surprised.. I HATE SURPRISES.

 

[militarymd]

I never said actually doing the case was a nurses job... you said that.. the way you practice is not "hard". Its being a sucker! (sorry) why would i supervise four rooms and not make four times as much. according to your logic. I will take the less pay to do a "doctors" job. thank you very much. and i do more than dump pee and move the table. Thats is just a miniscule task that i do. You add up all the miniscule tasks equals very important ****. rather than being a chart signer

Wait a minute....you keep confusing me.

First you say, doing my job is easy (so easy that it leads to obesity and hand warts...because of masturbation and chart siging), then it is hard (so hard that it's easier to do it yourself), and now it is being a sucker (because I don't make 4 x your salary) .....which is it??? Please make up your mind.

Lurking readers....go back to his posts....that is what d2700 has stated in his previous posts.



Or perhaps d, you just don't read carefully.

I never said supervising is to make more money....I said supervising is a more cost effective and efficient way of providing peri-operative care. Meaning, is costs insurance companies, medicare, and society in general, less money......it doesn't mean....for me to make more money.

You must learn how to read....or at least pay a attention to what you are reading.

I hope you review medical records more carefully than how you read threads.....oh wait...reviewing medical records is a doctor's job, and I did say that YOU do a nurse's job.

So continue with your confabulations.

This is entertaining.

 

[militarymd]

you answered it the way i would.. I make mistakes but i dont get surprised.. I HATE SURPRISES.

So you aren't surprised when YOU make a mistake....only when other people make them......

How interesting.....

Hey guys, d2700 can predict when he screws up....he can predict when people have laryngospasm before it happens.....but he lets it happen anyways...so it doesn't surprise him....it's just a mistake then...

Hey guys, d2700 can predict the unexpected difficult airway....so he's never surprised when he can't intubate.....it 's just a mistake that he made....even though he predicted it...

Keep it coming fella.....I'm having a blast reading your ideas and thoughts.

 

[davvid2700]

Wait a minute....you keep confusing me.

First you say, doing my job is easy (so easy that it leads to obesity and hand warts...because of masturbation and chart siging), then it is hard (so hard that it's easier to do it yourself), and now it is being a sucker (because I don't make 4 x your salary) .....which is it??? Please make up your mind.

Lurking readers....go back to his posts....that is what d2700 has stated in his previous posts.



Or perhaps d, you just don't read carefully.

I never said supervising is to make more money....I said supervising is a more cost effective and efficient way of providing peri-operative care. Meaning, is costs insurance companies, medicare, and society in general, less money......it doesn't mean....for me to make more money.

You must learn how to read....or at least pay a attention to what you are reading.

I hope you review medical records more carefully than how you read threads.....oh wait...reviewing medical records is a doctor's job, and I did say that YOU do a nurse's job.

So continue with your confabulations.

This is entertaining.

military md,

you are just pissed at me because i think you are drink cofee, sit in the office and surf the internet for porn. which you do.


The job you do would be much harder for me because I am a "control freak". I need to have control of everything that is going on with the patient down to the last drop of fluid. I dont like surprises.. Its easier for you because you are a lazy sloth who likes sitting on his ass all day. But my job is physically more demanding.. stop trying to turn the tables around. you know what i mean.

Its hard for me to review medical records because i cant ******* i n g decipher what the **** people are writing. I can make out every third word.

yeah it is entertaining how you are trying to turn the table on me are you a lawyer or something.

 

[militarymd]

Really desirable group to go to. .......They dont call the people you put down as references. ........ So they get a hold of a random attending in our residency who didnt like her. Had nothing to do with clinical stuff at all. ................that would earn my respect. SO dont tell me how to handle these guys who are hiring because they are just people looking to hire people who they think they will like not someone who is actually the most competent. I didnt have a problem not being competely forthcoming at all.. In this business, its always, " what can i do for me?" because if you dont think like that you are going to get screwed big time.

So, why is this group so "desirable" if they behave in a manner that you find so despicable?????

What's wrong with hiring someone you like????? You're telling me just because some one is competent, they have to have what ever job they want????

Why bother having an interview???? Why not just read the letter from your residency and look at your board scores????

So we are supposed to hire jerks that we DON't like?????

d2700, give me a break....what country are your from? where do you get your ideas?

Selective groups will call around beyond your handpicked reference list....that is called being a smart employer....

Selective job seekers look at the group beyond just what the interviewer tells you also. I tell interviewer's to speak with the hospital administration, the CRNAs, the surgeons, AND the competing anesthesia group in town when they come to interview.....I tell them to call and speak with all of these people after they leave.

Looking and calling around is called being smart....

but I guess you expect everyone to fall all over themselves over people like yourself because you dump pee so well????? and move tables in a fraction of a second from when the surgoen beckons?

 

[militarymd]

military md,

you are just pissed at me because i think you are drink cofee, sit in the office and surf the internet for porn. which you do.


The job you do would be much harder for me because I am a "control freak". I need to have control of everything that is going on with the patient down to the last drop of fluid. I dont like surprises.. Its easier for you because you are a lazy sloth who likes sitting on his ass all day. But my job is physically more demanding.. stop trying to turn the tables around. you know what i mean.

Its hard for me to review medical records because i cant ******* i n g decipher what the **** people are writing. I can make out every third word.

yeah it is entertaining how you are trying to turn the table on me are you a lawyer or something.

No I'm not a lawyer, but it doesn't take one to mock someone like you.

Your string of thoughts are inconsistent, you say one thing than another without thinking about what you have said before.

You degenerate rapidly to name calling and insults....and insults are inaccurate. (fat, lazy, slow) ....and I know what doing cases is like....I watch nurses doing it all day....they SIT there...while I move about...

You ARE very entertaining for me AND for a lot of readers.

 

[militarymd]

military md,

you are just pissed at me because i think you are drink cofee, sit in the office and surf the internet for porn. which you do.

.

d2700,

I'm not pissed at you....I'm glad you're here to provide entertainment for me...Normally, I'm in bed by now, but I can't wait for your next post.

 

[davvid2700]

So, why is this group so "desirable" if they behave in a manner that you find so despicable?????

What's wrong with hiring someone you like????? You're telling me just because some one is competent, they have to have what ever job they want????

Why bother having an interview???? Why not just read the letter from your residency and look at your board scores????

So we are supposed to hire jerks that we DON't like?????

d2700, give me a break....what country are your from? where do you get your ideas?

Selective groups will call around beyond your handpicked reference list....that is called being a smart employer....

Selective job seekers look at the group beyond just what the interviewer tells you also. I tell interviewer's to speak with the hospital administration, the CRNAs, the surgeons, AND the competing anesthesia group in town when they come to interview.....I tell them to call and speak with all of these people after they leave.

Looking and calling around is called being smart....

but I guess you expect everyone to fall all over themselves over people like yourself because you dump pee so well????? and move tables in a fraction of a second from when the surgoen beckons?

MILITARY MAN,

If you call enough people there will always someone who gives you a lukewarm or even a downright negative reference for whatever reason. They dont like your religion, they dont like your friends, you like cherry coke they dont etc.. You screwed them on the last vacation pick. You always get better cases. And if you base your hiring decision simply on hear say then you "may" be passing up a candidate that may work out. Caliing the previous OR and asking random people about the candidate in my opinion is irresponsible because if they are leaving there is probably no love lost. Im not saying checking around is not prudent. Check the references on the resume, check the national practicioner database, interview the candidate and make your judgement. and if you choose not to hire them tell them "up front", we didnt like what the references said about you.. The hospital credentialing commitee will do the rest.

I would rather have someone who has no problems with any case and makes sound decisions that i dont care for than having someone I love who constantly is a pain in the ass about doing cases. period.But obvioulsy military differs.

A desirable group is based on Location, payor mix, salary, surgical quality, reputable hospital, quality of consultants.. and most of the desirable groups really scutinize your "personality" moreso than the skill you possess. (yeah i know weird ) I lost out on a couple of "great jobs" because the group didnt feel like I would mesh. They felt I was too confident too soon. I told them what i wanted, not the other way around. So one of the partners told me. I was grateful to him for sharing that with me and i actually still talk to him . But you know what, thats not how i "roll" so i would not have liked them. I interview someone, if he has credentials and I think he can do the job, and is pretty clean record welcome aboard, check a reference or 2 and thats it. I locummed for 2 months before i found this place. No interview or nothing. I just walked into this OR and started doing cases right out of residency. took call q 3. huge cases. never even met the chief for like a week Those guys were trying to hire me, but i had a job already. I was waiting for credentialing. I think military wants to like fall in love with everyone who he interviews. You dont own the friggin hospital, those guys have a right to practice. Regardless of whether they are a little histrionic,,, narcisistic... etc..

 

[davvid2700]

No I'm not a lawyer, but it doesn't take one to mock someone like you.

Your string of thoughts are inconsistent, you say one thing than another without thinking about what you have said before.

You degenerate rapidly to name calling and insults....and insults are inaccurate. (fat, lazy, slow) ....and I know what doing cases is like....I watch nurses doing it all day....they SIT there...while I move about...

You ARE very entertaining for me AND for a lot of readers.

You are the one who is trying to give the profession away with your DO bashing, CRNA glorifying RHetoric.

My post degenerate rapidly when im responding to you because halfway through the post Im so pissed that im responding to someone like you i have to call you names and get it over with.. I cant believe that I am trying to get you to see things my way when I know you are a lost cause.. And what infuriates me further is that probably a lot of the people who are heading up the ASA are your exact clones . And thats why 15 states have opted out of physician supervision, thats why we are losing autonomy and our salaries are diminishing. ( and this is not "the sky is falling banter") THem are the facts and they cannot be disputed.

 

[davvid2700]

So you aren't surprised when YOU make a mistake....only when other people make them......

How interesting.....

Hey guys, d2700 can predict when he screws up....he can predict when people have laryngospasm before it happens.....but he lets it happen anyways...so it doesn't surprise him....it's just a mistake then...

Hey guys, d2700 can predict the unexpected difficult airway....so he's never surprised when he can't intubate.....it 's just a mistake that he made....even though he predicted it...

Keep it coming fella.....I'm having a blast reading your ideas and thoughts.

DUDE,

Laryngospasm is not a mistake. DOing things that lead to aryngospasm is a mistake. I can damn sure predict someone who is going to have laryngospasm if i see the train of events..

Unexpected difficult airway is not a mistake.. putting someone to sleep that you were not entirely sure of is.. putting someone to sleep with out proper airway evaluation is those are mistakes..

 

[ReefTiger]

Ok, so I finally decided to register after being a lurker for the past 6 years. I will tell all that I am in my 1st year of anesthesia residency and have seen this thread or some other form of it many times before.

It is borderline devolving so I want to try and give it some new light.

I respect all views except for nurses or student nurses who for some reason get a little training and think they are all of a sudden equal to doctors.

The bottom line is money and prestige. People are mad because they feel that CRNAs could take jobs/money from MDs because they have a foothold in some states albeit mainly rural in nature. This could be the crack in the door all the militants need to try and convince the government and public (who by the way is generally clueless about the issue) that CRNAs are equal to MDs. This aggravates MDs (prestige) because it is true that they are not equal. However since the demand is so high for providers we cannot eliminate mid-levels, and they know that. In the meantime CRNAs are trying to get programs passed (and maybe they have already) to allow them to get doctorates of nursing or doctorates of nursing anesthesia. Is this going to take away jobs- no, but it will lead to more confusion for the public, and add to their already inflated egos as they could potentially mislead with the Dr. title.

I have worked with a private practice doc who had CRNAs with him and he said he loved them--implying that he could make more money, and I will say that none of them were of the militant type. Also, this is the expected model of practice in the Southeast region. I have read that this team model is the most productive/safest opposed to MD or CRNA only. I mention this as the safest model because some MDs may say they aren't concerned about money/prestige but rather patient safety.

So, I will admit that until I became an anesthesia resident I never realized exactly what anesthesia entailed. I also love my job and have great satisfaction. The public really has no idea either and the question really becomes does it matter?

My questions are these to the now attendings and ongoing residents:

Mil MD- I understand that monkey skills can be taught and being a resident is about learning these skills. It sounds as if you are a preop machine and called upon for mistakes/trouble/disasterous situations. I am sure you are likely present for induction/emergence-but maybe not. I am sure you take care of issues in the PACU also. My question is-how will I learn to make these decisions/manage others when I see CRNAs at my institution coming up with their own plans, I spend all my time in a room (granted I know I must do this), and I never see residents (3rd years) manage CRNAs? At least when I was a medicine intern I could delegate jobs to PAs and nurses. Why are we made to feel almost equal to CRNAs by what we do throughout residency when we know we are not, and then are expected to supervise a population who we have no experience supervising? Furthermore, if you say charting in a room is nurses work why do we physicians spend so much of our training doing what you call "nurse work"? If this is true, how can I say there is more that I can do as an anesthesia doctor than a CRNA can when I never do more than the CRNA does (except of course work twice as many hours and take call, and relieve them)? Is it just that I can order preop/postop labs and give orders in the PACU?

Also, if you or any doctor from any other field were having surgery would you want a CRNA doing the case? I can tell you that any physician from any other field would request the MD. California and the northeast have very limited CRNA model types as most are performed by MD only--are they better than the rest of the country? You know they think they're better than the poor and dumb South (I can say that as I'm from the South).

I know that when I finish I will likely work in a group with CRNA supervision as I will likely work in the South. I also know that I will have a job waiting. It is true that there will always be a need for MD anesthesia, the question is how hard do we try to educate everyone else about what it means to be an anesthesiologist? Do we care? I know I do, but given my experiences I have a hard time defining it. Maybe someone else can define it better than the same old college + med school + residency. Some may say perioperative medicine, but my question is what about in the states that opted out? Who preops and makes decisions about anesthetics and post op/PACU care there?

 

[toughlife]

Well, our 4th AA school is now accepting applications, and more are in the planning stages. We would welcome your support wherever new programs are established.

Hadn't heard about Detroit, but I'm very familiar with a residency program in the southeast that also has a CRNA program. The director of the CRNA program was told by the chair of the anesthesiology department that their students would need to get their regional and invasive monitoring training at other clinical sites because they were taking too many procedures away from the residents.

I would be more than happy to support expansion of AA programs.

 

[toughlife]

Why are doctors so insecure about their specialty that you feel you have to "fight" for it.

1) There will ALWAYS be a need for physicians who specialize in the care of the anesthetized patient, No matter what "militant" physicians extenders say or do.

2) There will ALWAYS be a need for physician extenders who anesthetize patients, either independently or under the direction of a physician.

The above statements represent the reality of perioperative care in the 21st century and beyond in the United States.

Young, inexperienced anesthesiologists (d2700, et al.) and militant CRNAs who fight each other in the OR, over a practice, and on anonymous forums only serve to make us ALL look like fools to our surgical colleagues and patients.

Easy for you to say because you are already there. Let us indulge in our beliefs and learn the hard way.

 

[toughlife]

DUDE,

who the f are you? what are you a nurse anesthetist in disguise. You think you can confidently learn all the above in one year including peripheral nerve blocks. thoracic epidurals and do it well. youve been sniffing too many exhaust fumes or something if you think that. YOu better re think what you just said and get back to me? If you really really believe that an epidural is a monkey skill and that you only need one year of training to learn all the skills in anesthesia maybe you should go to the nursing forum.. Join the aana and become their spokes person.

.

 

[militarymd]

DUDE,

Laryngospasm is not a mistake. DOing things that lead to aryngospasm is a mistake. I can damn sure predict someone who is going to have laryngospasm if i see the train of events..

Unexpected difficult airway is not a mistake.. putting someone to sleep that you were not entirely sure of is.. putting someone to sleep with out proper airway evaluation is those are mistakes..

So I guess you NEVER have laryngospasm....just like NO ONE ever bites a tube when you do a case.....oh yeah, I remember ALL your posts.

Jet is right, about you, when posted that one about NO ONE ever biting a tube when you do a case, beccause "the reflex is to gag".

So I guess you NEVER had an expected difficult airway....I guess you don't need the ASA's difficult airway algorithm....at least the part about unanticipated difficult airway....because you know it all..

Let me tell you something, there is a reason why that group you liked didn't hire you.....over confidence kills patients.... I have seen many junior nurses who administer anesthesia in the OR say things that you are spouting right now.

It's funny , hearing it from a nurse basher.

 

[militarymd]

Reef tiger

The anesthesia residency is very short. You may be confident with many things when you finish training, but you've still got a lot to learn after residency.

Take a look at the training duration in the UK and Europe. Their training is much more rigorous.

When I passed my critical care boards, I felt that I was just starting to learn to be a good physician.

If you think you've learned it all at the completion of your training like some of the folks here, then you're probably lost.

Things that you need to learn in residency that is not taught:
1) humility
2) interpersonal skills
3) humility
4) manangement skills
5) supervising skills
6) humility

You can choose to or NOT, to complete your training after your residency.

 

[militarymd]

My post degenerate rapidly when im responding to you because halfway through the post Im so pissed that im responding to someone like you i have to call you names and get it over with.. I cant believe that I am trying to get you to see things my way when I know you are a lost cause.. And what infuriates me further is that probably a lot of the people who are heading up the ASA are your exact clones . And thats why 15 states have opted out of physician supervision, thats why we are losing autonomy and our salaries are diminishing. ( and this is not "the sky is falling banter") THem are the facts and they cannot be disputed.

Anger management courses, my little friend....I'm happy and confident about the future of anesthesiology.....There will always be a place for me.

There is no CRNA who can take my job.

But I guess for you........I don't know...there must be some reason you're afraid and insecure....maybe you AREN't as good as you say you are????

 

[davvid2700]

So I guess you NEVER have laryngospasm....just like NO ONE ever bites a tube when you do a case.....oh yeah, I remember ALL your posts.

Jet is right, about you, when posted that one about NO ONE ever biting a tube when you do a case, beccause "the reflex is to gag".

So I guess you NEVER had an expected difficult airway....I guess you don't need the ASA's difficult airway algorithm....at least the part about unanticipated difficult airway....because you know it all..

Let me tell you something, there is a reason why that group you liked didn't hire you.....over confidence kills patients.... I have seen many junior nurses who administer anesthesia in the OR say things that you are spouting right now.

It's funny , hearing it from a nurse basher.

DID I say i never had laryngospasm. no i never said that. Did i say i never face difficult airways? no i never said that.
I said i try to minimize those occurences. ANd the group didnt hire me because I was asking too many questions about the group and the finances of said group and they more than likely felt "hey who is this guy out of residency asking all of the right questions?" he should be lucky we are even interviewing him. So they didnt hire me. It had nothing to do with what anybody said about me, it was a feeling they had. And i guess they were in a good position to turn down an " ideal" candidate;( young eager right out of training) maybe they had people busting their door down looking to work for them. who knows? I interviewed with the group i am now. night and day. These guys answered my questions, practice was fair and balanced, every month the accountant sits with us and I know what i make and what everyone else in the group makes. there were no hidden agendas. Our chief is fair. There is no dead weight here.

 

[davvid2700]

Anger management courses, my little friend....I'm happy and confident about the future of anesthesiology.....There will always be a place for me.

There is no CRNA who can take my job.

But I guess for you........I don't know...there must be some reason you're afraid and insecure....maybe you AREN't as good as you say you are????

of course there is no crna that can take your job because no crna wants your job. a poster said earlier. you are a pre op machine. thats all you do. Personally, i did not go to residency to pre op patients that i wasnt doing the case. you also prolly sign patients out of the pacu Im not insecure at all. I am just not a preop machine.

 

[davvid2700]

Reef tiger

The anesthesia residency is very short.
.

didnt feel short to me.. 4 years/

 

[davvid2700]

Reef tiger

Take a look at the training duration in the UK and Europe. Their training is much more rigorous.

in what respect? they take more call? it is much longer? They teach different things there? the "attendings" are more draconian? explain. towards what end?

 

[davvid2700]

Reef tiger

.

When I passed my critical care boards, I felt that I was just starting to learn to be a good physician.
.

Then you were way behind. Most people "start" to learn to be a good physician when they first leave medical school..

 

[davvid2700]

Reef tiger

Things that you need to learn in residency that is not taught:
1) humility
2) interpersonal skills
3) humility
4) manangement skills
5) supervising skills
6) humility

/QUOTE]

What are you going to say next? we need to make anesthesia residency 5 years an extra year to learn how to "supervise" and "pre op" like you do.and to learn "humility" you know if there was a motion to extend anesthesia residency there would actually people in favor of doing so and it would probably pass at the ASA level and everyone would have to spend 5 years of residency and the quality of residents woul dbe the same. and its people like you who make these assinine notions..

Back in the eighties, anesthesia residency was 3 years.. 1 year of internship and 2 years of actual "residency". Then in 89 they said we "Have to make it three years". FOr what? we are doing the same things we did back in the 80s.

 

[davvid2700]

Reef tiger


Things that you need to learn in residency that is not taught:
1) humility
2) interpersonal skills
3) humility
4) manangement skills
5) supervising skills
6) humility

You can choose to or NOT, to complete your training after your residency.

What are you going to say next? we need to make anesthesia residency 5 years an extra year to learn how to "supervise" and "pre op" like you do.and to learn "humility" you know if there was a motion to extend anesthesia residency there would actually people in favor of doing so and it would probably pass at the ASA level and everyone would have to spend 5 years of residency and the quality of residents woul dbe the same. and its people like you who make these assinine notions..

Back in the eighties, anesthesia residency was 3 years.. 1 year of internship and 2 years of actual "residency". Then in 89 they said we "Have to make it three years". FOr what? we are doing the same things we did back in the 80s.