GAS in Transition

[doctorr]

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these comments are not to offend the gas people but i just wonder this residency as being a transitional period where as before no one was interested in this field. i undrestand there was a talk of replacing gas docs with technicians years ago kind of like PAs and Nurse practioners who could mange cases and the field was at a sinking state and least competitive. that obviously took a turn for political reasons and now being a competitive field i refuse to beleive people who love to go into this field beside the Ca$h and hours. how many of us dreamed of intubating patients before going to med school or did anyone know that a gas needed to go to med school. having said that i myself would feel safer if an MD was anesthetizing me for a case than a NP but i think the hype of this field is excessive now. Some of the things that turned me off to go into this field was you' re never the boss, the surgeon tells you what and when, you're not mentally challenged to use medicine everyday rather than wait and hope nothing goes wrong, in which most cases it doesnt and you're monitering a machine for hours, and being stuck in the OR all day..that was a personal preference, i do not like being in the OR, its a claustophobic effect not to mention the breathing mask that makes it hard to talk or breath all day...but its funny what a raise in salary can make people love the field where before programs would pay for your meals and hotels just to interview with them. my advice is to people to do what fits your personality, are you a social person who enjoy people interaction and challenge of true medicine then think about it before applying because if you're good at what you do there are plenty of opportunities to make money...

 

[UTSouthwestern]

You have a lot of misconceptions, but rather than go into each one, I would refer you to previous posts covering this topic and just address one point: If the surgeons are the boss, then how did my attending manage to cancel a purely elective CABG on this beautiful Sunday in Dallas? Even at lowly resident level, I have cancelled cases that needed to be cancelled and I NEVER let a surgeon dictate how I manage an anesthetic.

 

[Wahoowa]

You have a lot of misconceptions, but rather than go into each one, I would refer you to previous posts covering this topic and just address one point: If the surgeons are the boss, then how did my attending manage to cancel a purely elective CABG on this beautiful Sunday in Dallas? Even at lowly resident level, I have cancelled cases that needed to be cancelled and I NEVER let a surgeon dictate how I manage an anesthetic.

Amen brother!

I just started my transitional year in anesthesia. I am perplexed as to where the impression that the surgeon is the boss of the OR comes from. As a medical student, I did several anesthesia rotations and saw firsthand where the anesthesiologist has cancelled cases before discussing it with the surgeon. In the OR, what the anesthesiologist says, goes. The surgeon (whoever it may be) comes into the OR, does his thing and leaves. Also, the anesthesiologist is responsible for that space in time where rapid diagnosis and treatment are required.

 

[Mr_Money]

You are so misinformed about the field of anesthesiology that your nonsensical diatribe does not even warrant a response. Suffice it to say, my colleagues LOVE the field of anesthesiology as do I. Good luck finding a specialty with as many happy people as there are in anesthesia.

Lovin' life........

 

[crna2004]

Good luck finding a specialty with as many happy people as there are in anesthesia?

Well, that may be true today, but I seriously doubt it will be like that in 10 years. A lot of the current appeal for anesthesia revolves around the great hours and $$$$. But, in reality you are OR techs. As anesthesia machines become more sophisticated, the need for MDAs will continue to decline. The change is already well underway. I seriously doubt that anesthesia in 10 years will look anything like it is today. CRNAs and AAs will perform all but the most complicated procedures. Newly minted MDA's will compete for the few remaining jobs, but many will be unemployed. If you are a current resident, you may have a few lucrative years before the change is fully implemented, but current medical students - you will be out of luck. Anethesia, when you finish med school/residency will be a field dominated by nurses. Good luck finding a job.

 

[Mr_Money]

Good luck finding a specialty with as many happy people as there are in anesthesia?

Well, that may be true today, but I seriously doubt it will be like that in 10 years. A lot of the current appeal for anesthesia revolves around the great hours and $$$$. But, in reality you are OR techs. As anesthesia machines become more sophisticated, the need for MDAs will continue to decline. The change is already well underway. I seriously doubt that anesthesia in 10 years will look anything like it is today. CRNAs and AAs will perform all but the most complicated procedures. Newly minted MDA's will compete for the few remaining jobs, but many will be unemployed. If you are a current resident, you may have a few lucrative years before the change is fully implemented, but current medical students - you will be out of luck. Anethesia, when you finish med school/residency will be a field dominated by nurses. Good luck finding a job.

Ummmmm........in reality, CRNAs are the OR techs with the MDs dictating what they do. In my practice, the anesthesia nurses run the cases by me and I decide what happens. As for your dire predictions.........we'll see. The same thing happened in the early 90's. I ain't scared..........I ain't scared at all. Believe me........and you may want to write this down ANESTHESIA WILL BE A FIELD THAT IS NEVER DOMINATED BY NURSES. This is reality, accept it nurse.

 

[DoctorG]

Crna 2004,
As someone applying to gas this year, I do thank you for your unsolicited "advice". I just wanted you to know that no scare tactics is going to prevent me from applying to gas or becoming an anesthesiologist. Good luck with your profession.

 

[sandman1]

First, I would like to tell doctorr that I don't let the surgeon call the shots, even though they are very talented at throwing tantrums.

For crna2004, all I have to say is that going to medical school gives us physicians an appreciation to pathological and emergent conditions from our experience and training that is devoid in yours. That is just a fact of the training. Therefore, if the specialty is ever "dominated" by AAs and nurses in an unsupervised fashion - God help us all!!

 

[undecided05]

Must.... restrain.... from.... responding.....

Oh I give up; people it's obvious that crna2004 is a recent grad or still a current student at nursing school; yes nursing school. It brings him/her great delight to come on to a medical forum and sound off like he/she is someone of intelligence and importance. I liken him/her to the miserable nurses that I had while taking call on OB/GYN at the beginning of 3rd year; inflating their self-importance to the third year students while if anything truly bad were to happen, they'd s%it a brick. I doubt that crna2004 has the cajones to bust up to a doctor and go on his/her little diatribe about the future of medicine.

Go on I dare you... I double dog dare you.


Oh well, I'm bored.

 

[crna2004]

"Must.... restrain.... from.... responding.....

Oh I give up; people it's obvious that crna2004 is a recent grad or still a current student at nursing school; yes nursing school. It brings him/her great delight to come on to a medical forum and sound off like he/she is someone of intelligence and importance. I liken him/her to the miserable nurses that I had while taking call on OB/GYN at the beginning of 3rd year; inflating their self-importance to the third year students while if anything truly bad were to happen, they'd s%it a brick. I doubt that crna2004 has the cajones to bust up to a doctor and go on his/her little diatribe about the future of medicine."

I think you misunderstood me. I have nothing against MDAs. In fact, I work closely with them, and totally respect them. They are CLEARLY well trained (better trained than I am). There are good/bad MDAs, just as there are good/bad CRNAs. All I am saying is that there appears to be an ever increasing emphasis of current medical student for lifestyle specialities ("ROAD"). I think that this is a large reason why more people than ever are interested in anesthesia. I applaud current medical students who are going into anesthesia because they love it. In 10 years, even if they make less money than current anesthesiologists, they will still be happy - as they entered the field for legitimate reasons, and enjoy the job. It is, however, those that are considering the field exclusively for the $$$/lifestyle that I pity. For, in 10 years time those perks will likely be gone, and I feel that they will regret their decision.

 

[2ndyear]

You know, I was thinking about this the other day. I hate rounding. I hate general medicine, floors in any field just puts me to sleep. So I was thinking to myself, yeah, I'd be pretty darn happy making what crna's do being an anesthesiologist. It's still exciting, still fun, still better than writing for poopers and sleepers on old farts, better than wiping noses and butt all day in peds, better than worrying about whether to start a b-blocker or an ACEi. CRNA's make more than peds docs, about the same as a lot of general internists and FP's. So yeah, I'd still do it 'cuz I like it.

On another note, is the real world like this? I really don't know yet as I'm a PGY-1, but I never saw crna's and MD's fighting in real life. Is this doom and gloom stuff made up? I mean come on. How many NP's graduate each year? Can't they do 99% of general internal medicine and FP. Aren't they worried about their jobs? Don't they have independent practice rights in some states? So far all that I can tell that's happened this year so far is CRNA's got independence in some more states, and all of a sudden there will be no more MD's in anesthesia ever again. But what really has changed? None of us can tell the future. The ASA and the AANA have been meeting, peacefully, recently.

And to crna2004 who is predicting that in 10 years anesthesia will look completely different, isn't that what they said 10 years ago? So now we are here today, and what is different now? Who knows, maybe you're right, maybe it will look different. Also, how much more sophisticated will the anesthesia machine become? It's not the machine, it's the operator. Maybe someday they will come up with different machine controlled algorithims for hypotension and arrythmias and the like.

 

[jwk]

On another note, is the real world like this? I really don't know yet as I'm a PGY-1, but I never saw crna's and MD's fighting in real life. Is this doom and gloom stuff made up? I mean come on. How many NP's graduate each year? Can't they do 99% of general internal medicine and FP. Aren't they worried about their jobs? Don't they have independent practice rights in some states? So far all that I can tell that's happened this year so far is CRNA's got independence in some more states, and all of a sudden there will be no more MD's in anesthesia ever again. But what really has changed? None of us can tell the future. The ASA and the AANA have been meeting, peacefully, recently.

And to crna2004 who is predicting that in 10 years anesthesia will look completely different, isn't that what they said 10 years ago? So now we are here today, and what is different now? Who knows, maybe you're right, maybe it will look different. Also, how much more sophisticated will the anesthesia machine become? It's not the machine, it's the operator. Maybe someday they will come up with different machine controlled algorithims for hypotension and arrythmias and the like.

Most of the real anti-MD rhetoric comes from the relative view far left-wing CRNA's and their state and national associations. MOST CRNA's do a great job, whether in a small rural practice or a busy urban practice.

And you're so right about it being the operator, not the machine. There is no such thing as an automated anesthesia machine that does everything for you. There have been numerous attempts to build such a thing with all the monitors integrated into computer algorithms to manage drugs and gases, and they all fail miserably.

There is plenty of work for everyone - MD, CRNA, and AA.

 

[crna2004]

"There is plenty of work for everyone - MD, CRNA, and AA."

There IS plenty of work for everyone today. That is why MDA reimbursement is so high. It is also why so many current medical students are considering anesthesia residency training, and also why so many current RNs are entering CRNA training programs. Look for yourself, the numbers of both have steadily increased over the past 5 years. However, people tend to chase after things too late. Whether it's jumping on a stock that has already soared 200% or jumping into a profession because the current job market it good, the analogy is the same. You may have missed the boat. Will the market continue to support what is literally 2-3 times more anesthesia provides (when you take into account the increase in both anesthesia residency fill rates and increased enrollment in CRNA training programs)? Maybe. But, compensation will fall due to the laws of supply/demand. Jobs will be less plentiful, due to the simple fact that more and more people are entering anesthesia residency and CRNA positions. So, to argue that "there is plenty of work for everyone" is short-sighted. While that may be true today, it will likely not be true a short time down the road.

 

[gaslady]

Doctorr's view of anesthesiology is pretty off. Medical students are looking at lifestyle and money more and more, but it's not that simple. When anesthesia had it's low years, medical schools didn't just not encourage, they actively discouraged students from pursuing the field. One of my attendings as a medical student told me that his Dean sat him down and told him he was stupid and making a huge mistake by going into anesthesia.
"Being trapped in the OR all day" is made such a bigger deal by people who aren't familar with it, than it actually is. The OR is actually a very social place. You see a bunch of people in preop and PACU everyday. You have many interactions in the lounge when you have your break and lunch. The real difference is that you can't just walk out of the room, you need to get someone to relieve you. I think it's a really fun place because in general, the people there really like to be there. It's not like hours of medicine rounds that drag on and on without escape and half the people there are in agony.

Not mentally challenging.... having people's lives in your hands everyday on a minute to minute basis and actually having to make quick decisions is mentally challenging. We don't agonize over differential diagnosis for hours and days. It's just a different type of challenge -> get the patient to not be awake, not move, not feel pain with many different drugs that have very significant physiologic effects all the while trying to keep their physiology unchanged.

NP's don't practice anesthesia.

 

[jwk]

"There is plenty of work for everyone - MD, CRNA, and AA."

There IS plenty of work for everyone today. That is why MDA reimbursement is so high. It is also why so many current medical students are considering anesthesia residency training, and also why so many current RNs are entering CRNA training programs. Look for yourself, the numbers of both have steadily increased over the past 5 years. However, people tend to chase after things too late. Whether it's jumping on a stock that has already soared 200% or jumping into a profession because the current job market it good, the analogy is the same. You may have missed the boat. Will the market continue to support what is literally 2-3 times more anesthesia provides (when you take into account the increase in both anesthesia residency fill rates and increased enrollment in CRNA training programs)? Maybe. But, compensation will fall due to the laws of supply/demand. Jobs will be less plentiful, due to the simple fact that more and more people are entering anesthesia residency and CRNA positions. So, to argue that "there is plenty of work for everyone" is short-sighted. While that may be true today, it will likely not be true a short time down the road.

And you're speaking as a new grad or CRNA student and know it all. And you'd like to believe that CRNA's are THE answer, as your national organization would like everyone to believe. It ain't necessarily true.

I've heard the same predictions for 25 years. The fact remains that the number of procedures requiring anesthesia continues to increase faster than we are able to produce new MD's, CRNA', and AA's. Although reimbursement may change, the demand is there for the forseeable future, for all three of these professions.

 

[cak]

No matter what happens in the immediate future, the mass production of CRNAs is analogous to the development of the assembly line. In induustry it is used to speed production and reduce costs, and, inevitalby, the quality of a product made so quickly and cheaply is inferior. (We are all familiar with this concept). It won't be long before enough deadly mistakes are made by CRNAs from lack of knowledge and training (especially in states where they practice alone) that PATIENTS themselves will request that only a DOCTOR administer their anesthestic. I don't know about other people, but I know that I have a choice and will always request that an MD/DO be at the head of my bed should I need to undergo a procedure. And as the number of mistakes made increases and the general public becomes educated, they too will request an anesthesiologist to be present during their procedure. You can see what's happening here...
I don't think there is anything to worry about in the near or long-term future, especially as the field of anesthesiology becomes more complex. If anything, CRNAs are the short-term answer to the shortage of anesthesiologists created by the freak-out of the 90's.
It takes a lot more time and hard work to become a doctor than it does to become a nurse, and no matter how bad healthcare gets, patients will always realize and respect this.
The bottom line is, the assembly line will only churn out CRNAs for a short time before it self-destructs.
I understand that there are many excellent CRNAs, but a physician who has gone to med school and completed a residency is far better trained and qualified to handle any situation that may arise in the OR. Period.

For everyone considering anesthesiology as a profession, have no fear, you have a bright future.

Just my $0.02.

 

[uroguy20000]

My take on anesthesia, as a chief urology resident. I have changed my user ID to protect my annonymity, but feel free to flame away!

For years I have watched anesthesiology residents in the OR... Every chance I get, I mock them. I enjoy yelling at the anesthesiology residents - as they are perhaps the biggest set of gomes I have ever seen in my entire life. And I am not alone. Everyone in the urology program, and other surgical subspecialities, resident and attending alike, taunt the anesthesiologists at every chance we get. I had one the other day who spent 30 minutes trying to put in an IV into a vein that any 3rd year medical student could easily handle.

What I can't figure out is why anyone would want to do anesthesiology? You accomplish nothing. At the end of the day, I have removed a cancerous kidney, but what have you done besides play second fiddle to the surgeon, and get me extra gloves when I need them? Not a single patient ever requests an anesthesiologist. They get whoever is assigned to their room. No patient wants you to care for them, or even knows your name. How do you deal with that?

But, now that I think about it...perhaps that is how you like it. People shop around for the best surgeon in the country. That means, to be a good surgeon you must have a good reputation, and be very skilled. Hence, only the good surgeons get patients, book cases, and make a living. However, even the most incompetant anesthesiologist can get patients. They don't need to worry about how skilled they are. The patients are stuck with you, having never met you before.

What does that lead to? Anesthesiology attracts some of the most incompetant medical students/residents that I have ever seen. You people don't have the skills to have your own practice, and get your own patients. Rather, you simply take what we give you. We bring in the patients, because we are the best. They are stuck with you.

For years, us surgeons have mocked you. You and I both know it. Sure, you might casually put aside our taunts (and say that we are jealous of your lifestyle). But, I find it incredibly funny how currently even the nurses (CRNAs) and politicians (Kerry) have now joined us, and put down your skills/qualifications, and question your necessity. How does it feel going to work every day in a job where nobody respects you? How will it feel when CRNAs replace you?

 

[tkim]

Couple people here posting from the same institutional IP address. Any more trolls coming from that IP, and that entire IP will be blocked.

That's gonna make a lot of people unhappy.

 

[dbiddy808]

I could see how urologists might act this way. Look at these peoples lives, they suck. When I was a medical student the surgeons were the most bitter people I've ever met. Surgeons have to worry about paying office costs, going to clinic, rounding on patients, sucking up to refering doctors. Every time they go on vacation they have to get people to cover for them and they lose money. It never stops. It would suck. As a result they would become bitter and look to belittle others. Their title and the ego boost it gives them to be a powerful surgeon is all they've got.

 

[jwk]

No matter what happens in the immediate future, the mass production of CRNAs is analogous to the development of the assembly line. In induustry it is used to speed production and reduce costs, and, inevitalby, the quality of a product made so quickly and cheaply is inferior. (We are all familiar with this concept). It won't be long before enough deadly mistakes are made by CRNAs from lack of knowledge and training (especially in states where they practice alone) that PATIENTS themselves will request that only a DOCTOR administer their anesthestic. I don't know about other people, but I know that I have a choice and will always request that an MD/DO be at the head of my bed should I need to undergo a procedure. And as the number of mistakes made increases and the general public becomes educated, they too will request an anesthesiologist to be present during their procedure. You can see what's happening here...
I don't think there is anything to worry about in the near or long-term future, especially as the field of anesthesiology becomes more complex. If anything, CRNAs are the short-term answer to the shortage of anesthesiologists created by the freak-out of the 90's.
It takes a lot more time and hard work to become a doctor than it does to become a nurse, and no matter how bad healthcare gets, patients will always realize and respect this.
The bottom line is, the assembly line will only churn out CRNAs for a short time before it self-destructs.
I understand that there are many excellent CRNAs, but a physician who has gone to med school and completed a residency is far better trained and qualified to handle any situation that may arise in the OR. Period.

For everyone considering anesthesiology as a profession, have no fear, you have a bright future.

Just my $0.02.

You act like CRNA's are some new development. They've been around for over 100 years. Even AA's have been around for over 30 years. Where have you been?

 

[jwk]

My take on anesthesia, as a chief urology resident. I have changed my user ID to protect my annonymity, but feel free to flame away!

For years I have watched anesthesiology residents in the OR... Every chance I get, I mock them. I enjoy yelling at the anesthesiology residents - as they are perhaps the biggest set of gomes I have ever seen in my entire life. And I am not alone. Everyone in the urology program, and other surgical subspecialities, resident and attending alike, taunt the anesthesiologists at every chance we get. I had one the other day who spent 30 minutes trying to put in an IV into a vein that any 3rd year medical student could easily handle.

What I can't figure out is why anyone would want to do anesthesiology? You accomplish nothing. At the end of the day, I have removed a cancerous kidney, but what have you done besides play second fiddle to the surgeon, and get me extra gloves when I need them? Not a single patient ever requests an anesthesiologist. They get whoever is assigned to their room. No patient wants you to care for them, or even knows your name. How do you deal with that?

But, now that I think about it...perhaps that is how you like it. People shop around for the best surgeon in the country. That means, to be a good surgeon you must have a good reputation, and be very skilled. Hence, only the good surgeons get patients, book cases, and make a living. However, even the most incompetant anesthesiologist can get patients. They don't need to worry about how skilled they are. The patients are stuck with you, having never met you before.

What does that lead to? Anesthesiology attracts some of the most incompetant medical students/residents that I have ever seen. You people don't have the skills to have your own practice, and get your own patients. Rather, you simply take what we give you. We bring in the patients, because we are the best. They are stuck with you.

For years, us surgeons have mocked you. You and I both know it. Sure, you might casually put aside our taunts (and say that we are jealous of your lifestyle). But, I find it incredibly funny how currently even the nurses (CRNAs) and politicians (Kerry) have now joined us, and put down your skills/qualifications, and question your necessity. How does it feel going to work every day in a job where nobody respects you? How will it feel when CRNAs replace you?

I've said it before, and I'll say it again:

1) Anesthesia makes surgery possible, not easy.

2) Anesthesia keeps the patient alive in spite of the surgeon's best efforts to do otherwise.

 

[GeddyLee]

My take on anesthesia, as a chief urology resident. I have changed my user ID to protect my annonymity, but feel free to flame away!

For years I have watched anesthesiology residents in the OR... Every chance I get, I mock them. I enjoy yelling at the anesthesiology residents - as they are perhaps the biggest set of gomes I have ever seen in my entire life. And I am not alone. Everyone in the urology program, and other surgical subspecialities, resident and attending alike, taunt the anesthesiologists at every chance we get. I had one the other day who spent 30 minutes trying to put in an IV into a vein that any 3rd year medical student could easily handle.

What I can't figure out is why anyone would want to do anesthesiology? You accomplish nothing. At the end of the day, I have removed a cancerous kidney, but what have you done besides play second fiddle to the surgeon, and get me extra gloves when I need them? Not a single patient ever requests an anesthesiologist. They get whoever is assigned to their room. No patient wants you to care for them, or even knows your name. How do you deal with that?

But, now that I think about it...perhaps that is how you like it. People shop around for the best surgeon in the country. That means, to be a good surgeon you must have a good reputation, and be very skilled. Hence, only the good surgeons get patients, book cases, and make a living. However, even the most incompetant anesthesiologist can get patients. They don't need to worry about how skilled they are. The patients are stuck with you, having never met you before.

What does that lead to? Anesthesiology attracts some of the most incompetant medical students/residents that I have ever seen. You people don't have the skills to have your own practice, and get your own patients. Rather, you simply take what we give you. We bring in the patients, because we are the best. They are stuck with you.

For years, us surgeons have mocked you. You and I both know it. Sure, you might casually put aside our taunts (and say that we are jealous of your lifestyle). But, I find it incredibly funny how currently even the nurses (CRNAs) and politicians (Kerry) have now joined us, and put down your skills/qualifications, and question your necessity. How does it feel going to work every day in a job where nobody respects you? How will it feel when CRNAs replace you?

Heh. You know, the funny thing is, everyone hates surgeons. As medical students, we all talked smack about every attending, resident, fellow in any surgical discipline....because they are all empty people. The childishness of your post and bragging about mocking another profession only proves my point. Surgeons are all low-life a$$holes.

Oh...don't be so sure your schedule will be booked because of your great reputation. More likely, it will be booked because all the other surgeons in town are even more booked.

It's good that you look to John Kerry, who has no training, to decide what specialties are necessary.

By the way...I've never seen any surgery resident yell at an anesthesiology resident, or any surgery attending for that matter. In fact, most surgeons understand that they could not complete their work without anesthesia.

A word of advice for you.....grow up! I doubt you are what you say you are, since there are so many inaccuracies in your statements. If you are, you are a pathetic person....maybe you should get laid once in a while, instead of spending all you time jerking off in the call room...maybe then you can tolerate other professionals.

 

[2ndyear]

In defense of the profession of anesthesiology, a few points in rebuttal to the urology resident. First, not all anesthesia residents are bottom of the barrel med school flunkies as you make it seem. Plenty of AOA people in my class matched anesthesia and this is true all over the country. Look at SUNY Downstate, they had 40 something students match last year. Now your point about some incompetent residents is well taken, but needs a frame of reference. Plain and simple there are lots of anesthesia spots, especially compared to urology. Some of the less desireable programs are bound to get less desireable applicants and residents. Just like IM, FP, peds, psych, etc. This is improved in the last several years and should result in better people entering the field. But is incompetent equal to slow or not running into trouble once in a while? No. I'm sure that your own first lap nephrectomy wasn't exactly perfect, and I mean that with utmost respect to your profession. There is a learning curve to everything.

In regards to the patients not picking an anesthesiologist, this is more true than not in general. The profession just didn't establish itself in the same way that surgery did, ie: go to x surgeon because he is the best. But the surgeons do pick! Cardiothoracic surgeons want only the best qualified person for the job, same goes millions of times over for peds. Possibly urology procedures just don't have the morbidity that others do, hence your view of the field.

With the thoughts that MD's aren't needed in anesthesia any longer, I think that we all forget about the patient. CRNA's have a conscious too. Are they going to be doing Norwoods and Fontans even if they think they can? No, they are going to call in the best person for the patient. They're not stupid money hungry people who are going to work above their training. The whole practice of medicine is based in the consultant mode and this will not change.

 

[Gator05]

Speechless.

Maybe I'm just lucky to be around at good times, but I've heard several surgeons respond to anesthesia residents that they're impressed with how smoothly their cases go. Also, our Anesthesia-CCM guys (and girls) command uber-respect from the surgeons.

CT surgery? The triumvirate of surgeons, perfusionist and anesthesiologist. And the surgeons are increasingly adamant about having someone there who can read TEE.

Why anesthesiology? I enjoy taking care of really sick people. Once you've seen it go wrong once, you'll realize just how important the specialty is.

Also, did you ever stop to think of the patient-centered perception of being in the OR? I'm thinking about concerns for patient comfort, for a swift recovery back to their original state of activity. Yes, their is a surgical component to this, but there is also a large anesthesia component as well.

We don't even know how the general anesthetics work. We give lethal medications (sometimes to patients already on the verge of dying), and successfully rescuscitate them at the same time. We're not content with patient's surviving surgery; we're pushing the envelope to how they feel immediately after, how quickly they can return to work, with what happens 5 years down the line. This happens thousands of times each day, mostly without a hitch.

It's like the first pump case I saw. It seemed miraculous, susceptible to dramatic and lethal failure with every turn of the rotor. And yet somehow, it had become routine.

Like I said; miraculous.

 

[Tenesma]

uroguy... while you are right about patients choosing surgeons based on reputation, that is actually not as often the case as you may suspect... In fact, it is frequently the PCP or the insurance carrier who chooses the surgeon... and that is why CT surgeons kiss the ass of every cardiologist around because that is the only way they get patients....

Anesthesiologists are consultants.... Patients don't come into a hospital for an anesthesia consult, just like they don't come into a hospital for a renal consult when they go into ATN from a drug prescribed by a urologist.... And for most consults, any board-eligible/certified consultant will do the trick. For the more precarious patient, the surgeon will consult specifically somebody they trust....somebody who has established a reputation.

As far as John Kerry is concerned... he recently had surgery at MGH (this is not a HIPPA violation as it was all over the news recently), and he specifically requested an anesthesiologist...hmmm....

now the whole deal about mocking other people... other than being childish and immature, it is also kinda silly.... tell me how you would propose to remove a "cancerous" kidney without anesthesia?

by the way, as far as mocking goes.... i have yet to find a urology resident who properly understands the critical care implications of bleomycin, despite the fact that it is a relatively common drug used for testicular ca.... and if you are going to say something stupid about an IV taking 30 minutes, how about the GU resident who takes 3 hours to do an inguinal hernia and still manages to screw up the vas deferens.....

 

[jwk]

uroguy... while you are right about patients choosing surgeons based on reputation, that is actually not as often the case as you may suspect... In fact, it is frequently the PCP or the insurance carrier who chooses the surgeon... and that is why CT surgeons kiss the ass of every cardiologist around because that is the only way they get patients....

Anesthesiologists are consultants.... Patients don't come into a hospital for an anesthesia consult, just like they don't come into a hospital for a renal consult when they go into ATN from a drug prescribed by a urologist.... And for most consults, any board-eligible/certified consultant will do the trick. For the more precarious patient, the surgeon will consult specifically somebody they trust....somebody who has established a reputation.

As far as John Kerry is concerned... he recently had surgery at MGH (this is not a HIPPA violation as it was all over the news recently), and he specifically requested an anesthesiologist...hmmm....

now the whole deal about mocking other people... other than being childish and immature, it is also kinda silly.... tell me how you would propose to remove a "cancerous" kidney without anesthesia?

by the way, as far as mocking goes.... i have yet to find a urology resident who properly understands the critical care implications of bleomycin, despite the fact that it is a relatively common drug used for testicular ca.... and if you are going to say something stupid about an IV taking 30 minutes, how about the GU resident who takes 3 hours to do an inguinal hernia and still manages to screw up the vas deferens.....

 

[Zeffer]

Couple people here posting from the same institutional IP address. Any more trolls coming from that IP, and that entire IP will be blocked.

That's gonna make a lot of people unhappy.

posted regarding the banning of uroguy20000

Before everyone continues to beat down a very interesting specialty, please note that several trolls are posting from the same IP address. I can only speculate as to who the potential poster with multiple personalities is, but please don't feed trolls.

 

[sones]

And you're speaking as a new grad or CRNA student and know it all. And you'd like to believe that CRNA's are THE answer, as your national organization would like everyone to believe. It ain't necessarily true.

I've heard the same predictions for 25 years. The fact remains that the number of procedures requiring anesthesia continues to increase faster than we are able to produce new MD's, CRNA', and AA's. Although reimbursement may change, the demand is there for the forseeable future, for all three of these professions.

Very well put JWK 👍

 

[crna2004]

And you're speaking as a new grad or CRNA student and know it all.

Spoken like you know me - which you do not. I have been a CRNA for many, many years.

And you'd like to believe that CRNA's are THE answer, as your national organization would like everyone to believe.

THE answer? What does that mean? The answer to what? In the ideal world, the most qualified people would be providing patient care. I fully admit that means a MDA with 20+ years of experience. He/she would do every case, and CRNAs, AAs and residents would have no direct patient care. But, this is not the ideal world. That is impossible and far too expensive. Medicine is pragmatic, not idealistic.

 

[painmanager]

You know, this board has gotten really stupid. It used to actually be a helpful forum that had useful information on it, but it's basically degenerated into a worthless site. I hardly check here anymore, and lo and behold what do I see when I check, the same stupid things that were being argued a month ago. No jobs for anesthsiologists, CRNAs are taking over, anesthesia sucks, blah blah blah. I have a few friends that are also going into gas, and they've all said the same thing about it. I think the moderator should really stop these trolls from ruining this forum. Freedom of speech yeah, great, if we want to hear about how bad our jobs suck, we can just do a search that'll return 5000 hits. I don't think we need it rehashed every 2 days.

 

[jwk]

You know, this board has gotten really stupid. It used to actually be a helpful forum that had useful information on it, but it's basically degenerated into a worthless site. I hardly check here anymore, and lo and behold what do I see when I check, the same stupid things that were being argued a month ago. No jobs for anesthsiologists, CRNAs are taking over, anesthesia sucks, blah blah blah. I have a few friends that are also going into gas, and they've all said the same thing about it. I think the moderator should really stop these trolls from ruining this forum. Freedom of speech yeah, great, if we want to hear about how bad our jobs suck, we can just do a search that'll return 5000 hits. I don't think we need it rehashed every 2 days.

Then why do you read the thread and contribute? If you don't like what you see, don't read it!!!

And according to your profile, you just joined last month.

 

[gaslady]

One thing about some of these ridiculous posts that show up sometimes, such as uroguys, is that they let us address some of the absurd misconceptions that some people who don't know any different may have.

Thanks uroguy for giving up proof what jerks surgeons can be. Here's some other stories:

I heard about a surgeon who was such a jerk that none of the anesthesiologists in the group that covered the hospital where he operated would work with him anymore. He couldn't get anyone to cover his cases, so he had to leave that hospital and move.

There was a surgeon who was an arrogant SOB and treated other people like crap all the time. One day he hit one of the nurses. They had him arrested. I'm sure his God complex didn't help him out of that one.

BTW, how do you know what IP address someone is posting from?

 

[painmanager]

Actually JWK, I was part of this board for a long time under a different screen name that stopped working for some reason. I still check it because it was actually a useful tool for me when I was applying to anesthesia programs last year, and I was hoping to do the same for others who are now going through the same thing. Usually around now the questions about the match come up, people want to know about strengths/weaknesses of various programs etc. But none of that anymore, let's instead continue the stupid CRNA vs MD debate, I don't think I've heard enough about that already. I guess it's really no surprise, when you consider the kind of type A obnoxious bags of **** that enter medicine, your reply is no surprise to me, in fact I was expecting it.

 

[jwk]

Actually JWK, I was part of this board for a long time under a different screen name that stopped working for some reason. I still check it because it was actually a useful tool for me when I was applying to anesthesia programs last year, and I was hoping to do the same for others who are now going through the same thing. Usually around now the questions about the match come up, people want to know about strengths/weaknesses of various programs etc. But none of that anymore, let's instead continue the stupid CRNA vs MD debate, I don't think I've heard enough about that already. I guess it's really no surprise, when you consider the kind of type A obnoxious bags of **** that enter medicine, your reply is no surprise to me, in fact I was expecting it.

Get a grip - if you don't like a thread, you don't have to read or contribute to it. There are plenty of threads to look at - not all of them deal with the endless CRNA vs. MD debate. There were quite a few on matches and residency programs (my favorites are the ones looking for a "cush" residency - yeah, those are REALLY the ones I want doing my anesthesia in a few years).

 

[painmanager]

Hey amnesic, I tried to reply to your PM, but apparently your account is set up so you can't recieve PMs

 

[tkim]

Inflammatory CRNA vs. MDA threads are now going to be closed.