Interesting job outlook perspective

[militarymd]

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nice to see a REAL anesthesiologist back.

The other thread closed, so I was not able to respond, but I think everyone would be interested in Dr Dew's secret identity.

http://forums.studentdoctor.net/showthread.php?p=1814812#post1814812

i'm an MS3. Just wondering...for our shelf exam do we have to know DSM4tr criteria for each d/o ??? Or is just having a general understanding and knowing pharmacotherapy, etc good enough?

Thanks

That quote is from september of 2004.

 

[davvid2700]

So your colleagues will leave an anesthetized patient alone in another room to come help you when you have a problem? Doesn't that go against the whole vigilance thing we pride ourselves on?

cmon dude. obviously you dont do anesthesia

 

[davvid2700]

You are such a tool. How about someone sends a link to your insurance carrier (attention mr insurance rep) just for posting something as stupid as what you describe above. Its a public board, don't make it personal.

Shut up nurse and go back to allnurses.. and i never made it personal he did.. He is the one who told us where he worked and proceeded to dumb down all the physicians' education on here.. He was banned for a week too.. LEts see if he comes back on here. Send a letter to my insurance rep.. I am board certified with NO CLAIMS thus far. I am anal in everything I do..Tell him that.. He will love it biotch..

 

[rn29306]

Not to start a subjective debate, but to offer a true "what would you have done?"

I was on a CABG and they were still harvesting saphenous, still 15-30 minutes before sternotomy. It's 1800, there's no floater, I'm the only CRNA there, and the only anesthesiologist is upstairs putting in a labor epidural. The senior SRNA across the hall is sitting on a trach/PEG placement on an ICU patient who came already intubated. (At this point I had had no involvement with this case - I had started my CABG prior to the trach's arrival).

The circulator from the trach/PEG burst into my OR, begging me to help as the SRNA's pt had suddenly dropped their SaO2 (and their HR), the surgeon was screaming for anesthesia help, and the SRNA neck deep in alligators.

I had two seconds to think, and decided to run across the hall based on these criteria:

-- my patient had been stable as a rock since intubation
-- the pt had a gallon of vec on board
-- the perfusionist was already in the OR (reading a book, but there)
-- there was an extra RN in my room (circulator in training) who I instructed to take my stool, and to immediately fetch me if any vital sign varied by more than 5%.

I ran across the hall, took 10 seconds to diagnose and treat the airway problem (mainstem ETT), and ran back to my OR.

Did I abandon my pt? I don't think so .... I didn't just nonchanantly walk away from my responsibilities, and I didn't leave my OR prior to employing a contingency plan. To me, technically, I was still immediately available (albeit now across the hall), with constant communication possible. It's not like I went to the cafeteria without first arranging another pair of eyes for my pt, with a means to contact me.

We could debate this splitting of hairs for the next decade I agree. If my pt had been unstable, about to be cannulated, go on/off pump, etc, I wouldn't have left him. But I made an educated professional judgement (based on all the unique circumstances of that particular moment) and it was a win/win situation.

Hey Trin. Crap happens and we all know it. You sounded like you handled your situation in an appropriate manner, esp being in close proximity. The situation that was described that I was responding to was one in which there is no float MD due to scheduling on a regular basis. If that case were to go to court, I can see the attorney arguing that in a regular day, with multiple rooms running, due to not wanting to have to pay an extra MD to be available out of a simple economic basis, that a MD has to leave a patient to bail another MD out of trouble.
True, emergencies happen and the courts can handle the specifics. You do what you gotta do. But if you are in a situation solo because the head MD of the group believed another MD was not needed simply on a monetary basis, and had to pull another anesthesia provider from an anesthetized patient and a bad outcome did happen, then I would bet that the financial payout would be considerable. Staffing in this way is not very smart IMHO and leaves you very open in a court of law.

 

[davvid2700]

.

When I get sick or don't feel well at my current job, I schedule myself in a room because it allows me to have an easy day on my butt.

yeah right? who are you trying to kid? Thw worst lies are the lies you tell yourself..

 

[davvid2700]

David, so you're workin' with an orthopod and you're in the OR doing a case. The next case is a shoulder and he wants an interscalene with general and pt needs a central line due to poor IV access. The OR techs are settin' up another room to do this case. When ya going to put the central line in and do the interscalene? How long between cases? With team approach, I got the central line in and interscalene. Pt is asleep, prepped and positioned in other room ready to rock and roll while the CRNA is waking up the pt you're working on now. It's impossible to beat my times unless you have that MD "floater". That MD floater will make the same as you as each individual rotates in the floater spot. Your reimbursements probably will not be high enough to pay for the floater spot. Regards, ---Zip

I put the interscalene in and the central line in.. whats the big deal? Why does it have to be done before hand? i dont understand! it doesnt take that long.

 

[rn29306]

Shut up nurse and go back to allnurses.. and i never made it personal he did.. He is the one who told us where he worked and proceeded to dumb down all the physicians' education on here.. He was banned for a week too.. LEts see if he comes back on here. Send a letter to my insurance rep.. I am board certified with NO CLAIMS thus far. I am anal in everything I do..Tell him that.. He will love it biotch..

Its like antagonizing a 5 y/o with Tourette's and then sitting back and watching the fireworks..... So easy to get you riled up....

No I don't and wouldn't do anything like sending a letter. Honestly how childish can you get? Grow up. Just trying to make a point that you obviously don't get.

That whole anal confession, while I'm sure its true and certainly each to his own, that is TMI bro.

 

[davvid2700]

PS And your attacks are unwarranted.

ANd the bigotry and racism on this board are warranted and acceptable? cmon dude.. get a ****ing life..

Im here to tell you that they are not. And I will continue to tell you that they are not.

Im here fighting for the medical specialty of anesthsia and yall are hating on me but when some people on this board make "blatantly" racist comments and I call them out on it and point out that they are dead wrong and mock them Im the a s s h o l e. Un believable.

 

[Noyac]

"WE may have lost..." no, the OB/GYN dude may have lost a baby. You stay put in your room doin' your case. Oh, the OB dude can't wait for the 2nd call guy. Throw em that that bottle of 1% lidocaine and tell em to start gettin' cowboy-- C/S with local. Make sure the dumb phuck OB nurse who wheeled the pt down has a tight grip on the OB dude's balls so they don't smack the ground. My viewpoint is brutal but legally, it does not pay to be a hero in any hospital facility. Regards, ---Zip

Look Zip, I respect you and have probably never disagreed with you or any of your posts (at least not that I can remember) to this date. And I know that there are differences of opinion but I don't let legal crap get in the way when I am trying to do what "I" feel is right. I think there is always an exception to every rule out there.
This was not a case for 2% Lido and some versed. It was truely a slash and deliver kind of case. I would never leave a pt in jeopardy if I didn't think that the pt would be fine. I have been doing this long enough to know when a pt will be stable for some time or not. I told the surgeons that were doing the ex lap to hold on and do nothing until things were under control which they were happy to do and they began to help the PACU RN manage the pt while I was out (turn the sevo up, turn the dopa down, etc). My fear was that they would get into something and cause some sort of septic situation with the mediators being released in the process. Everyone in the first case was fine with my absence at the time and comfortable with the pt while I was gone. So theoretically the pt was not abandoned b/c there were 2 surgeons present and willing to help.

 

[Noyac]

ANd the bigotry and racism on this board are warranted and acceptable? cmon dude.. get a ****ing life..

YOu have just about pissed off every person on this forum that is a regular as far as I can tell. Does that tell you anything? Your comment above to me is just as rude as anything thrown at you from others and all I did was call you out without insulting you. You need some social skills and fast.

I don't know what your idea of a life is (but I got a good idea) but I'll take mine over yours, I'm sure of that.

 

[zippy2u]

Fair enough Noyac on your midnight case, and glad it turned out well for you. ---Zip

 

[zippy2u]

On the topic of supervising CRNAs vs. MD doing the cases. When I was single and full of piss and vinegar and giggin' those locum jobs, many o' times I had the opportunity to do my own cases along with the CRNAs or supervise the CRNAs or be the MD floater for MDs. Without question, I would always choose to do my own cases. Less headaches for me because as a locums, your primary goal is to minimize your headaches. Less malpractice risk. My concern and risk were limited to the cases I did that day-- not the cases in the other 3 rooms for example. It is more difficult and more stressful to be the MD consulting floater for the CRNAs or MDs for that matter-- Militaryman is spot on. David has not supervised CRNAs out in the real world. Tell you what David, for your next one or two week vacation rather than going to Disney World, hook up with a locum tenens agency and try a gig supervisin' some CRNAs. Then post back on the forum and let us know how it went, enquiring minds want to know. Regards, ---Zippy

 

[militarymd]

yeah right? who are you trying to kid? Thw worst lies are the lies you tell yourself..

I guess you must be right, and EVERYONE else here, who, by the way, has more experience than you in the anesthesia community, must be wrong.

Wait, not EVERYONE, student DR. MountainDew, MSIV, not even in residency yet, but slept at Holiday Inn Express during his price fixing business venture as a 19 year old, and who surfed the in-room internet, reading posts on SDN from d2700, so therefore must know all there is to anesthesia practice........ is right too.

 

[davvid2700]

ANd the bigotry and racism on this board are warranted and acceptable? cmon dude.. get a ****ing life..

YOu have just about pissed off every person on this forum that is a regular as far as I can tell. Does that tell you anything? Your comment above to me is just as rude as anything thrown at you from others and all I did was call you out without insulting you. You need some social skills and fast.

I don't know what your idea of a life is (but I got a good idea) but I'll take mine over yours, I'm sure of that.

DUDE, I dont care what you do!. You wanna run a mill of crnas.. thats fine with me. Im not saying that it is wrong. all im saying is that it is dumbing down our specialty. But i will tell you that the bigotry on this board is amazing coming from people who claim to be "educated". MilitaryMD et al...

 

[militarymd]

Slick...i gotta go to bed...gotta wake up at 5 (sure you do too)....belive me, i wouldnt work for ya anyways. Militant? nope. Assertive and protective of ANESTHESIOLOGY...absolutely.

This is hilarious.....sort of like Michael Douglas' character in "falling down"....doesn't really have a job, but gets up every morning and drives out somewhere for a while, so that his mother who he lives will think he actually has a job.

 

[Cyndee MSN NP]

DUDE, I dont care what you do!. You wanna run a mill of crnas.. thats fine with me. Im not saying that it is wrong. all im saying is that it is dumbing down our specialty. But i will tell you that the bigotry on this board is amazing coming from people who claim to be "educated". MilitaryMD et al...

Even though I'm not a CRNA, I take offense to your remark about CRNA's "dumbing down the specialty". CRNA's were providing anesthesia before anesthesiologist were EVER INVENTED! I absolutely LOVE the fact that you egotistical idiots with your God complex are being replaced by NURSES 😀 . THERE ARE POWER IN NUMBERS BUDDY, so don't think for a minute that the autonomy of CRNA's is going to change anytime soon, if anything IT'S GOING TO INCREASE. There are more CRNA's coming out of school than there will EVER be anesthesiologists! GO WITH IT, or move to another country where people will kiss your a-- b/c you're a fricking DOCTOR! Oh yeah...I hear that Nurse Anesthetist programs are going to start requiring a doctorate soon. So, those CRNA's will be called DOCTORS!! HA HA! It must REALLY suck to put in all those years in college and then COMPETE WITH NURSES FOR THE SAME JOBS HA HA HA HA! SUCKER!

 

[Cyndee MSN NP]

This is hilarious.....sort of like Michael Douglas' character in "falling down"....doesn't really have a job, but gets up every morning and drives out somewhere for a while, so that his mother who he lives will think he actually has a job.

DITTO!

 

[Trisomy13]

..I hear that Nurse Anesthetist programs are going to start requiring a doctorate soon. So, those CRNA's will be called DOCTORS!! HA HA! It must REALLY suck to put in all those years in college and then COMPETE WITH NURSES FOR THE SAME JOBS HA HA HA HA! SUCKER!

well... if they require a doctorate then they should be called doctors.... right?

 

[Cyndee MSN NP]

Shut up nurse and go back to allnurses.. and i never made it personal he did.. He is the one who told us where he worked and proceeded to dumb down all the physicians' education on here.. He was banned for a week too.. LEts see if he comes back on here. Send a letter to my insurance rep.. I am board certified with NO CLAIMS thus far. I am anal in everything I do..Tell him that.. He will love it biotch..

You may not have any malpractice claims YET, but DAVVID (didn't your mother know how to spell or does "stupid" just run in your family?) you're gonna get slapped with a lawsuit if you start telling nurses to "shut up" or even better, you'll get your a-- FIRED! The last word you wrote was "biotch", were you trying to spell biotech or b----? I'd give anything for you to speak to me like that, a lawsuit would be the least of your problems !

 

[Cyndee MSN NP]

🙂

well... if they require a doctorate then they should be called doctors.... right?

which school was the one offering a pain fellowship for crnas ?

Anyone with a Ph.D should absolutely be called DOCTOR! I know a NP who has a Ph.D and the docs around here are hating it that she's referred to as such. As far as the school that's offering a pain fellowship...I have no idea. That must have been someone elses post.

 

[jetproppilot]

I put the interscalene in and the central line in.. whats the big deal? Why does it have to be done before hand? i dont understand! it doesnt take that long.

Sorry, theres no way you can compete with a model that preps the patient while the surgeon is still doing his previous case.

While the scalpel dude is snapping in his last skin staple, you're hurrying him to the adjacent operating room, where his next patient is ready and waiting.

If you're a stud, you can do a central line and an interscalene in 15 minutes, plus-or-minus 5 minutes.

15 minutes in between 7 or 8 cases means you and your surgeon colleague finish 2 hours earlier....operate a machine like that over the course of a year and the time saved, not to mention the money saved, is very, very significant.

 

[Trisomy13]

🙂

Anyone with a Ph.D should absolutely be called DOCTOR! I know a NP who has a Ph.D and the docs around here are hating it that she's referred to as such. As far as the school that's offering a pain fellowship...I have no idea. That must have been someone elses post.

a bunch of my friends are PhD's (and have been for a while now) and are kidding me about going to med school just so i could be a doctor also. a doctorate is a doctorate. i feel no more important than my buddy who models the movement of molecules in the cell membrane lipid bilayer. or more important than any nurse who is doing their job better than i should be doing mine. it all boils down to labels, and at the end of the day, if you're not pulling your weight, you're a putz.. doc, nurse, admin, whatever.

oh and the pain remark... i was being snarky. i actually removed it from my post.

 

[Cyndee MSN NP]

🙂


a bunch of my friends are PhD's (and have been for a while now) and are kidding me about going to med school just so i could be a doctor also. a doctorate is a doctorate. i feel no more important than my buddy who models the movement of molecules in the cell membrane lipid bilayer. or more important than any nurse who is doing their job better than i should be doing mine. it all boils down to labels, and at the end of the day, if you're not pulling your weight, you're a putz.. doc, nurse, admin, whatever.

oh and the pain remark... i was being snarky. i actually removed it from my post.

It's nice to hear from someone who appreciates another person for working hard, no matter what they do. 🙂

 

[jetproppilot]

DUDE, I dont care what you do!. You wanna run a mill of crnas.. thats fine with me. Im not saying that it is wrong. all im saying is that it is dumbing down our specialty. But i will tell you that the bigotry on this board is amazing coming from people who claim to be "educated". MilitaryMD et al...

Saying we run a "mill of crnas" is a completely derogatory comment.

I'm sorry, there is no way an all MD model can compete with the efficiency of a team model.

Even if you're a stud, and you can throw in a central line and an interscalene in 15 minutes plus-or-minus 5 minutes, you cant compete with a model that completely preps the patient while the surgeon is still working on his previous case, which enables you to monitor the surgeon's room, and time when to take the patient into the adjacent OR before the surgeon is done, gettim' on the bed, monitors on, start the prep&drape, so when the surgeon is shooting his gloves into the trashcan, you're biting at his heels to get to the adjacent OR where his next patient is ready. Oh, and Mr Ortho dude, stop at the scrub sink in between your two rooms and scrub your hands before coming in here!

Total turnover time, 3 minutes.

As I have said before, I respect the all MD model, and was headed for one right outta residency (Las Vegas). Fate intervened, I stayed in the southeast, and was exposed to the team approach.

Unless you have spent time working in the team approach model, it is impoossible for you to refute it.

Additionally, regardless of the antagonistic posters here, there simply arent enough MDs to occupy every anesthesia site, and there never will be. But more importantly,

If you are able to take your ego out of the equation (not you personally, you generally, me included), and you are able to ignore the militant posters who insist they are equal to us and can do every thing we can, like the new terrorist Cyndee MSN NP (why is it nurses list EVERY degree/certificate they've ever earned behind their name?),

you would realize the team model is an excellent approach to anesthetic care .

 

[jetproppilot]

🙂

Anyone with a Ph.D should absolutely be called DOCTOR! I know a NP who has a Ph.D and the docs around here are hating it that she's referred to as such. As far as the school that's offering a pain fellowship...I have no idea. That must have been someone elses post.

Your useless, terrorist propeganda on this doctor's forum is resented.

I am not posting anti nurse propeganda on allnurses.com, and I'd appreciate it if you'd take your message to an audience that would appreciate it, like allnurses.com.

 

[jetproppilot]

It's nice to hear from someone who appreciates another person for working hard, no matter what they do. 🙂

Lets make no mistake here. Yes, I am a TEAM anesthesia model advocate, but that does not mean that I do not recognize the simple fact that paraprofessionals are attempting to not only impede, but OVERTAKE many professions, not just anesthesia.

Why is that?

Its fact that getting into med school is a feat in itself, and surviving the medschool/residency onslaught is one of the most physically/emotionally straining career paths one can endure. We did it. BUT WAIT...you can to. This is America...you have the opportunity to obtain a bachelor's degree, and apply to med school like anyone else.

Choose not to do that? I respect that. And I'm sure you can contribute to the health field in a plethora of career options.

But your attempt to come to an MD forum and scream/yell that a CRNA that gets a PhD should be called "Doctor", in the clinical sense,

IS PURE IMPERSONATION. .

Please take your unwanted propeganda elsewhere.

We too have propeganda, but how many of us are posting antagonistic threads on allnurses.com?

 

[Cyndee MSN NP]

Saying we run a "mill of crnas" is a completely derogatory comment.

I'm sorry, there is no way an all MD model can compete with the efficiency of a team model.

Even if you're a stud, and you can throw in a central line and an interscalene in 15 minutes plus-or-minus 5 minutes, you cant compete with a model that completely preps the patient while the surgeon is still working on his previous case, which enables you to monitor the surgeon's room, and time when to take the patient into the adjacent OR before the surgeon is done, gettim' on the bed, monitors on, start the prep&drape, so when the surgeon is shooting his gloves into the trashcan, you're biting at his heels to get to the adjacent OR where his next patient is ready. Oh, and Mr Ortho dude, stop at the scrub sink in between your two rooms and scrub your hands before coming in here!

Total turnover time, 3 minutes.

As I have said before, I respect the all MD model, and was headed for one right outta residency (Las Vegas). Fate intervened, I stayed in the southeast, and was exposed to the team approach.

Unless you have spent time working in the team approach model, it is impoossible for you to refute it.

Additionally, regardless of the antagonistic posters here, there simply arent enough MDs to occupy every anesthesia site, and there never will be. But more importantly,

If you are able to take your ego out of the equation (not you personally, you generally, me included), and you are able to ignore the militant posters who insist they are equal to us and can do every thing we can, like the new terrorist Cyndee MSN NP (why is it nurses list EVERY degree/certificate they've ever earned behind their name?),

you would realize the team model is an excellent approach to anesthetic care .

If I listed every credential after my name, it would be LONGER! I'm not a terrorist...I'm just tired of NURSES being put down!

 

[jetproppilot]

If I listed every credential after my name, it would be LONGER! I'm not a terrorist...I'm just tired of NURSES being put down!

And we're tired of nurses trying to equal us.

 

[jetproppilot]

If I listed every credential after my name, it would be LONGER!

Pure sign of an insecurity issue.

You've come to the wrong forum to get into a how-many-degrees-do-I-have pissing contest.

 

[Cyndee MSN NP]

Lets make no mistake here. Yes, I am a TEAM anesthesia model advocate, but that does not mean that I do not recognize the simple fact that paraprofessionals are attempting to not only impede, but OVERTAKE many professions, not just anesthesia.

Why is that?

Its fact that getting into med school is a feat in itself, and surviving the medschool/residency onslaught is one of the most physically/emotionally straining career paths one can endure. We did it. BUT WAIT...you can to. This is America...you have the opportunity to obtain a bachelor's degree, and apply to med school like anyone else.

Choose not to do that? I respect that. And I'm sure you can contribute to the health field in a plethora of career options.

But your attempt to come to an MD forum and scream/yell that a CRNA that gets a PhD should be called "Doctor", in the clinical sense,

IS PURE IMPERSONATION. .

Please take your unwanted propeganda elsewhere.

We too have propeganda, but how many of us are posting antagonistic threads on allnurses.com?

First off, I've completed two 4yr degrees and have a MS degree in nursing, so I'm not INTERESTED IN GOING TO MED SCHOOL! I'm a NURSE PRACTITIONER AND PROUD OF IT. For you to imply that a "doctorate" is the domain of the physician is laughable! In case you haven't noticed, we live in a FREE country, so I'll post my views where ever I want. Do you actually think that what you do is more important than the person who's doing research in cancer? Do you actually think you are SMARTER? You ARE NOT GOD! So GET OVER IT DOCTOR!

 

[Noyac]

If I listed every credential after my name, it would be LONGER! I'm not a terrorist...I'm just tired of NURSES being put down!

If you are tired of nurses bring put down then act like a human being and not like someone with an inferiority complex. It is nurses like yourself that causes people to put you down.

And I am a Doctor, but I don't insist on being called Doctor. I am called by my first name at my hosp. just as most of the other doctors here. So your comment on nurses receiving a Phd and then being called doctor is amusing at best. Only a nurse like yourself would insist on being called doctor in order to decieve the lay public all while strocking your own inflamed ego. Take a pill or something. And I invite you to return to your own forum.

 

[Cyndee MSN NP]

Pure sign of an insecurity issue.

You've come to the wrong forum to get into a how-many-degrees-do-I-have pissing contest.

Excuse me? I'm insecure? I'm not the one who is flipping out because I have to compete with CRNA's! I can assure you, the general public has HAD IT with doctors and their GOD COMPLEX! That's why YOU GUYS are getting sued more than the Advanced Nurse Practitioners - HA HA!

 

[jetproppilot]

First off, I've completed two 4yr degrees and have a MS degree in nursing, so I'm not INTERESTED IN GOING TO MED SCHOOL! I'm a NURSE PRACTITIONER AND PROUD OF IT. For you to imply that a "doctorate" is the domain of the physician is laughable! In case you haven't noticed, we live in a FREE country, so I'll post my views where ever I want. Do you actually think that what you do is more important than the person who's doing research in cancer? Do you actually think you are SMARTER? You ARE NOT GOD! So GET OVER IT DOCTOR!

You are putting words in my mouth that never emerged.

I have taken alot of flack from posters here because I realize how effective the team model is to anesthetic care, so your assumptions to my "doctor complex" are quite erroneous.

What you won't admit to yourself is that doctors are the only ones issued medical licenses to practice medicine.

I am not implying I am smarter than anyone.

What I AM saying, quite strongly, is I am a doctor, licensed to practice medicine. And you are not, nor is a CRNA with a PhD.

Throwing around one's weight egotistically is one thing.

Defending one's profession against infiltrating terrorists on a doctor's forum, I'm sure most would agree, is an entirely different thing.

 

[camkiss]

We get sued more because that is where the money is, honey. Get a life.

 

[militarymd]

That's why YOU GUYS are getting sued more than the Advanced Nurse Practitioners - HA HA!

Actually, the real reason physicians get sued is because we carry higher malpractice coverage, so the pay out is higher.

 

[militarymd]

We get sued more because that is where the money is, honey. Get a life.

You beat me to it.

 

[Soon2BENT]

I don't care what field it is, the line tends to always end at an MD (oversight, signing a note, signing a script meds/narcs, etc).

My opinion, if you're doing research and running a lab and want to be called doctor, cool. If you're a nurse, nursing student, PA, medical student, and have a PH D. and want to be called doctor while in the hospital on wards or in clinic, I think its inappropriate because it confuses patients. Doctors of Philosophy and Doctors of Medicine are two different things.

A residency that has CNRAs is probably the best thing resident can ask for (unless you want to work until 8pm and do all the flaps everyday).

Everyone needs to get off their high horses. The field of anesthesia benefits from both CNRA and MDs. Remember, there are things that an MD can/should do that a CNRA can't/shouldn't do (run an ICU, etc). But, anesthesia wouldn't be this great "lifestyle" profession without CNRAs either. So lets all get over it. Neither will be going away anytime sooon and practices will continue to hire both MDs and CNRAs and both will continue to be paid well.

 

[Cyndee MSN NP]

If you are tired of nurses bring put down then act like a human being and not like someone with an inferiority complex. It is nurses like yourself that causes people to put you down.

And I am a Doctor, but I don't insist on being called Doctor. I am called by my first name at my hosp. just as most of the other doctors here. So your comment on nurses receiving a Phd and then being called doctor is amusing at best. Only a nurse like yourself would insist on being called doctor in order to decieve the lay public all while strocking your own inflamed ego. Take a pill or something. And I invite you to return to your own forum.

I'm laughing Please lowly nurse...return to your own forum...you're not educated enough to post on this forum! Doctor, maybe you should post on GOD.COM

 

[Soon2BENT]

We get sued more because that is where the money is, honey. Get a life.

ditto this...i havent heard of a nurse being sued. they may get fired, but they dont get sued.

 

[MDEntropy]

I am really not trying to jump into the middle of this debate here and take a side and argue it.

That said, I want you to be realistic with me JPP. Do you think things often and regularly run as effeciently as you are describing? It seems that it is possible that things could sometimes work out as well as your example, but to do this consistently, essentially you need more than just a few CRNA's to make things work the way you describe. You need more or nurses, more or scrub techs, even more operating rooms, all so the surgeon can save, lets say 30 minutes between what are probably relatively long cases if they need an IS block and a CVP. Even if the surgeon has a couple of PA's and is bouncing back and forth between two rooms what is the likelihood that he or she will have perfect timing so as to move from room to room just as s/he is needed. I mean, I like your example, but I don't see things really working out quite as you describe and actually being efficient (given the ineffecieny of 2 rooms, and two sets of everything for one typical ortho surgeon.) except possibly given some very unique circumstances. Maybe I am missing something? Even if you had one "float" team for say 8 OR's, and you only ran 7 rooms and always had one "open" you would still regularly have the problem of two rooms finishing simultaneously.

I think macario and dexter pretty much say that the focus on turnover time is way overblown. But maybe those guys work in environments too diverse to reap the benefits of efficieny that come with repitition and simplification. On the other hand, your practice sounds pretty varied. It's not like you are running a knee scope shop. So do your surgeons really run from room to room all day? If you guys are really running things this tight all day everyday, with no slack, please tell me how it is done.

As an aside, I think this may have been the thread where zippy asked questions/made comments in reference to 'the bell curve', although he failed to cite his source. I am not going to go back and read all the old posts to find out exactly what was said, but my recollection is that both Mil and Zippy had their feet in their mouths. For one of them this is not unusual, for the other it was surprising. Even now, the comments and much of the ensuing discussion truly embarasses me. I like to think that as physicians we are well informed - broadly. Of course, we will still disagree regarding medicine, business politics, religion etc but I like to think that we are, generally, intellectuals. So I will simply say this - Zippy, if your question wasn't in fact rhetorical, the answer/s is/are easy to find. The bell curve was quickly dismissed by academics, so I suggest you look into why that's the case - that is, if you really want to know the answer. To everyone reading, I'll point at that, as many of you know, there are in fact some major metropolitan areas in this country where things are so far from "black and white" I think some of you would be really be shocked if you tried to practice there while applying some of the biases you so firmly believe in.

Saying we run a "mill of crnas" is a completely derogatory comment.

I'm sorry, there is no way an all MD model can compete with the efficiency of a team model.

Even if you're a stud, and you can throw in a central line and an interscalene in 15 minutes plus-or-minus 5 minutes, you cant compete with a model that completely preps the patient while the surgeon is still working on his previous case, which enables you to monitor the surgeon's room, and time when to take the patient into the adjacent OR before the surgeon is done, gettim' on the bed, monitors on, start the prep&drape, so when the surgeon is shooting his gloves into the trashcan, you're biting at his heels to get to the adjacent OR where his next patient is ready. Oh, and Mr Ortho dude, stop at the scrub sink in between your two rooms and scrub your hands before coming in here!

Total turnover time, 3 minutes.

As I have said before, I respect the all MD model, and was headed for one right outta residency (Las Vegas). Fate intervened, I stayed in the southeast, and was exposed to the team approach.

Unless you have spent time working in the team approach model, it is impoossible for you to refute it.

Additionally, regardless of the antagonistic posters here, there simply arent enough MDs to occupy every anesthesia site, and there never will be. But more importantly,

If you are able to take your ego out of the equation (not you personally, you generally, me included), and you are able to ignore the militant posters who insist they are equal to us and can do every thing we can, like the new terrorist Cyndee MSN NP (why is it nurses list EVERY degree/certificate they've ever earned behind their name?),

you would realize the team model is an excellent approach to anesthetic care .

 

[mountaindew2006]

........ but that does not mean that I do not recognize the simple fact that paraprofessionals are attempting to not only impede, but OVERTAKE many professions, not just anesthesia.

Why is that?

Its fact that getting into med school is a feat in itself, and surviving the medschool/residency onslaught is one of the most physically/emotionally straining career paths one can endure. We did it. BUT WAIT...you can to. This is America...you have the opportunity to obtain a bachelor's degree, and apply to med school like anyone else.

I agree w/ the above whole heartedly. if anyone goes and checks my posts I've been stating this from the GETGO. This was the basis for many of my arguments. WE ARE DOCTORS and DOCTOR TO BEs. Then there was the wise a$$ who stated that he went to medical school to become a 'physician' and not a doctor. (I know that it wasnt u Jet but had to bring it up ).

 

[mountaindew2006]

First off, I've completed two 4yr degrees and have a MS degree in nursing, so I'm not INTERESTED IN GOING TO MED SCHOOL! I'm a NURSE PRACTITIONER AND PROUD OF IT. For you to imply that a "doctorate" is the domain of the physician is laughable! In case you haven't noticed, we live in a FREE country, so I'll post my views where ever I want. Do you actually think that what you do is more important than the person who's doing research in cancer? Do you actually think you are SMARTER? You ARE NOT GOD! So GET OVER IT DOCTOR!

yes, I have had problems w/ JET and MILMD...well I dont cnsider them problems, rather healthy discussions. NEVERTHELESS, I am not going to let some NURSE talk $hit to any one of my colleagues.

As was pointed out earlier in my threads...ppl like CYNDEE are the reason why I think that we ANESTHESIOLOGISTS need to band/stick together. You have je$k offs like her who think as a nurse they are equal to doctors/physicians.

Do you guys understand WHY i resent ppl like her (who are becoming a majority now in the world of nursing). I have MANY MANY friends/family members that are nurses but NONE of them are like CYNDEE. Most nurses I know are hardworking,etc. There are these new generation of jer$ offs that want to take over. WE MUST COLLABORATE and thwart it.

Yes, both DAVVID and I may be ULTRA conservatives and JET and MIL are probably a little less conservative, but nevertheless Anesthesiologists must band together.

 

[mountaindew2006]

First off, I've completed two 4yr degrees and have a MS degree in nursing, so I'm not INTERESTED IN GOING TO MED SCHOOL! I'm a NURSE PRACTITIONER AND PROUD OF IT. For you to imply that a "doctorate" is the domain of the physician is laughable! In case you haven't noticed, we live in a FREE country, so I'll post my views where ever I want. Do you actually think that what you do is more important than the person who's doing research in cancer? Do you actually think you are SMARTER? You ARE NOT GOD! So GET OVER IT DOCTOR!

this is friggin laughable. I dont care if you have 5 bachelor degrees. YOU ARE A NURSE.

go back to NURSES.com

let me give you an example as to why nurses will NEVER be called doctors. Pharmacists are now given PharmDs. They too are trying to take over a lot (moreso from what internists do)... Nevertheless, places like walgreens will NEVER allow them to be called DOCTOR X. in fact the managers at walgreens who MAY have gotten a bachelors is called Mr. Smith and likewise calls the pharmacist Mr. White. WHY?

it's MISLEADING TO THE PATIENT. Most ppl/ organizations realize that the term 'doctor' atleast in a clinically setting means physician. As such it would be MISLEADING for NURSES to be called doctors honey.

Secondly, i agree w/ jet in the sense that all you nurses that get MSN, NPs (BS BS BS) friggin post all those things on your white coats. I personally dont think you deserve a white coat (my conservatism again)...but I find it laughable that you all put all these degrees on your coat somehow thinking if you do, you will somehow be equal to a doctor.

Wrong forum baby girl. YOU ARE and will always be a NURSE. Unless you take advantage of the 'free country' you speak of and decide to attend a MEDICAL SCHOOL.

 

[cloud9]

My opinion, if you're doing research and running a lab and want to be called doctor, cool. If you're a nurse, nursing student, PA, medical student, and have a PH D. and want to be called doctor while in the hospital on wards or in clinic, I think its inappropriate because it confuses patients. Doctors of Philosophy and Doctors of Medicine are two different things.

Kinda like the (urban legend?) story of the "Dr. J T Whatever" on an airliner. A woman goes into labor during the flight and the flight attendent pages "Dr Whatever" only to find out he has a PhD in Literature. Not much help to the laborer.

On the wards, in the OR, anywhere in the hospital, anyone other than an MD really should clarify to the patients who they are.

 

[mountaindew2006]

...
On the wards, in the OR, anywhere in the hospital, anyone other than an MD really should clarify to the patients who they are.

F you took the words out of my boca

 

[mountaindew2006]

hey CYNDEE

it seems tht you want to be a doctor or atleast want to be called one so bad.

Here's an idea....to all those intials after your name, try adding another one....MD

then we'll talk

 

[cloud9]

First off, I've completed two 4yr degrees and have a MS degree in nursing, so I'm not INTERESTED IN GOING TO MED SCHOOL! I'm a NURSE PRACTITIONER AND PROUD OF IT. For you to imply that a "doctorate" is the domain of the physician is laughable! In case you haven't noticed, we live in a FREE country, so I'll post my views where ever I want. Do you actually think that what you do is more important than the person who's doing research in cancer? Do you actually think you are SMARTER? You ARE NOT GOD! So GET OVER IT DOCTOR!

1) Why "2" 4 yr degrees?

2) I think you are really putting words in their mouths. It is not about stroking ones ego, it is about the safety (and sanity) of the patient. Some of these folks are already a bit delirious and then when they think they've seen 4 docs that day you inform them that you are the first doctor to see them. Confusion, confusion, confusion.

 

[Cyndee MSN NP]

yes, I have had problems w/ JET and MILMD...well I dont cnsider them problems, rather healthy discussions. NEVERTHELESS, I am not going to let some NURSE talk $hit to any one of my colleagues.

As was pointed out earlier in my threads...ppl like CYNDEE are the reason why I think that we ANESTHESIOLOGISTS need to band/stick together. You have je$k offs like her who think as a nurse they are equal to doctors/physicians.

Do you guys understand WHY i resent ppl like her (who are becoming a majority now in the world of nursing). I have MANY MANY friends/family members that are nurses but NONE of them are like CYNDEE. Most nurses I know are hardworking,etc. There are these new generation of jer$ offs that want to take over. WE MUST COLLABORATE and thwart it.

Yes, both DAVVID and I may be ULTRA conservatives and JET and MIL are probably a little less conservative, but nevertheless Anesthesiologists must band together.

The terrorist is posting again on God.com. I almost fell out of my chair when I read that your "friends/family members are nurses" but NONE of them are like CYNDEE! In other words, they are subservient little wimps who can't stand up to GOD! The PUBLIC respects us more and we ARE replacing you in anesthesiology, pediatrics, primary care, obstetrics, etc. It's not MY fault that the healthcare system is running out of money and the lowly nurses are taking your jobs. Didn't you guys take a course in economics (like us lowly nurses)? WE ARE REPLACING YOU AND DOING JUST AS GOOD A JOB! I'm going to order Haldol 10mg, Ativan 2mg and Benadryl 50 mg IM...maybe THAT will calm your nerves!

 

[jetproppilot]

I am really not trying to jump into the middle of this debate here and take a side and argue it.

That said, I want you to be realistic with me JPP. Do you think things often and regularly run as effeciently as you are describing? It seems that it is possible that things could sometimes work out as well as your example, but to do this consistently, essentially you need more than just a few CRNA's to make things work the way you describe. You need more or nurses, more or scrub techs, even more operating rooms, all so the surgeon can save, lets say 30 minutes between what are probably relatively long cases if they need an IS block and a CVP. Even if the surgeon has a couple of PA's and is bouncing back and forth between two rooms what is the likelihood that he or she will have perfect timing so as to move from room to room just as s/he is needed. I mean, I like your example, but I don't see things really working out quite as you describe and actually being efficient (given the ineffecieny of 2 rooms, and two sets of everything for one typical ortho surgeon.) except possibly given some very unique circumstances. Maybe I am missing something? Even if you had one "float" team for say 8 OR's, and you only ran 7 rooms and always had one "open" you would still regularly have the problem of two rooms finishing simultaneously.

I think macario and dexter pretty much say that the focus on turnover time is way overblown. But maybe those guys work in environments too diverse to reap the benefits of efficieny that come with repitition and simplification. On the other hand, your practice sounds pretty varied. It's not like you are running a knee scope shop. So do your surgeons really run from room to room all day? If you guys are really running things this tight all day everyday, with no slack, please tell me how it is done.

As an aside, I think this may have been the thread where zippy asked questions/made comments in reference to 'the bell curve', although he failed to cite his source. I am not going to go back and read all the old posts to find out exactly what was said, but my recollection is that both Mil and Zippy had their feet in their mouths. For one of them this is not unusual, for the other it was surprising. Even now, the comments and much of the ensuing discussion truly embarasses me. I like to think that as physicians we are well informed - broadly. Of course, we will still disagree regarding medicine, business politics, religion etc but I like to think that we are, generally, intellectuals. So I will simply say this - Zippy, if your question wasn't in fact rhetorical, the answer/s is/are easy to find. The bell curve was quickly dismissed by academics, so I suggest you look into why that's the case - that is, if you really want to know the answer. To everyone reading, I'll point at that, as many of you know, there are in fact some major metropolitan areas in this country where things are so far from "black and white" I think some of you would be really be shocked if you tried to practice there while applying some of the biases you so firmly believe in.

A very good post, MD.

You are very correct. Efficiency depends on more than anesthesia efficiency. But the simple fact is that a team approach has "free hands" (the circulating MDs) available. I'm sure that most all MD models, at least the one's I've been exposed to, do not.

We do not give two rooms to every surgeon. But in fact, the very busy, big players at our hospital very frequently (advocated by me) do. For example, we have a very busy orthopod who typically does five or six cases per day, twice a week at our facility. I'll work to get him 2 rooms, and can have him out much earlier if that is accomplished.

As you inferred, running an efficient OR is complex...it is a balancing act...an orchestra...and requires insight, foresight, manpower, and cooperation.

If I have a CRNA "float", which I do (well, I did pre-Katrina, and I will again, once everyone gets back), this enables me to line the second heart in holding and go back to the second heart room while the surgeon is putting in wires..so by the time he is done the second case is asleep, and prep is initiated. Same concept with the ortho dude.

And you are right...saving thirty minutes for one surgeon is not that big of a feat...but for an anesthesia group, for the operating room and their overhead, and for the surgeons who have added on cases and are awaiting the first possible hole in the schedule so they can do their add on case....every 15 minutes...20 minutes...30 minutes you can shave off of turnover, starting at 7am, all adds up by the time 3pm comes around....it adds up to literally hours of saved time.

And no, it doesnt always work out...people call in sick, the OR call team from the previous night who has to work today was up until 2am so their arrival is delayed, surgeons show up late, etc. But the focus stays the same. Find holes in the schedule during the day...(Oh...Dr X finished early...we can plop Dr. Y's second case in room 4...), have the anesthesia "prep work" done on a patient before you go in the room, try and flip-flop whenever you can, minimize turnover time.

It works. And once you lose sight of that, or stop caring about that, everyone's days are longer, add-ons go later.

 

[Noyac]

I'm going to order Haldol 10mg, Ativan 2mg and Benadryl 50 mg IM...maybe THAT will calm your nerves!

Just like a nurse. Orders a standard dose across the board treating everyone the same way.