NY Shut 'Em Down!

[Consigliere]

They shut 'em, shut 'em down! Way to go NY!!

Message From NYSANA's President, Cheryl Spulecki - New York State Association of Nurse Anesthetists

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[Psai]

Makes me feel like the money I donated to the pac was really worth it. Will continue to do so in the future.

 

[AdmiralChz]

My colleagues and co-fellows from NY have been very worried about this - it was a sneaky and nasty way to promote CRNA independence.

Good for NY state. Onward!

 

[anbuitachi]

Yea A lot of people donated money because of this. This is good news. However we can never win the war if all we do is defend.

 

[izzygoer]

If CRNA s want to practice independently why do mds train them? If their training is equivalent to medschool and residency there should be no need for an md to teach or train a CRNA student anything.

 

[deleted59964]

If CRNA s want to practice independently why do mds train them? If their training is equivalent to medschool and residency there should be no need for an md to teach or train a CRNA student anything.

exactly and why do you bail them out, if you don't have liability ... let them fail - it's for the greater good

 

[Mman]

exactly and why do you bail them out, if you don't have liability ... let them fail - it's for the greater good

who amongst us is bailing people out that they have no liability for? And even if there are I have a hard time arguing that letting patients die is for the greater good.

 

[Southpaw]

exactly and why do you bail them out, if you don't have liability ... let them fail - it's for the greater good

Should a general surgeon ‘bail out’ the GI doc when they perforate the colon? What about the cardiologist who puts stents absolutely anywhere and everywhere throughout the entire body? Should the CT or vascular guys help out when they screw it up?

There is certainly a business to healthcare. And doctors are often put in awkward positions because at the end of the day the patient needs cared for, and if something goes wrong it’s quickly shot to the top of the totem pole to the person most skilled who can help when others can’t.

The nonsense of the AANA is exactly that, nonsense. And isn’t it amazing that you can claim nursing independence all you want, but in actual patient care, when something goes wrong there’s typically a well trained anesthesiologist there to help fix the situation and care for the patient.

 

[UnoMas]

Should a general surgeon ‘bail out’ the GI doc when they perforate the colon? What about the cardiologist who puts stents absolutely anywhere and everywhere throughout the entire body? Should the CT or vascular guys help out when they screw it up?

There is certainly a business to healthcare. And doctors are often put in awkward positions because at the end of the day the patient needs cared for, and if something goes wrong it’s quickly shot to the top of the totem pole to the person most skilled who can help when others can’t.

The nonsense of the AANA is exactly that, nonsense. And isn’t it amazing that you can claim nursing independence all you want, but in actual patient care, when something goes wrong there’s typically a well trained anesthesiologist there to help fix the situation and care for the patient.

"collaboration" between "colleagues"

 

[deleted171991]

exactly and why do you bail them out, if you don't have liability ... let them fail - it's for the greater good

The patient comes first. That's why incompetents can survive in medicine, because other docs will step in and save the day. One cannot just walk away when one is the most competent to help and save a life.

 

[DocVapor]

They prey on the whole reason we went into medicine to begin with: to help people.

 

[deleted126335]

They shut 'em, shut 'em down! Way to go NY!!

Message From NYSANA's President, Cheryl Spulecki - New York State Association of Nurse Anesthetists

 

[deleted59964]

Should a general surgeon ‘bail out’ the GI doc when they perforate the colon? What about the cardiologist who puts stents absolutely anywhere and everywhere throughout the entire body? Should the CT or vascular guys help out when they screw it up?
.

Of course - but then they’re all doctors.
Nurses have no business delivering anaesthesia.

 

[Mman]

Of course - but then they’re all doctors.
Nurses have no business delivering anaesthesia.

independently or as part of an ACT model?

 

[deleted59964]

independently or as part of an ACT model?

look - i understand a lot of you support nurses giving anaesthesia under supervision but I do not support that.
we do not have nurses giving anaesthesia AT ALL.

we do all our own cases, that no doubt has pros and cons.

we train GPs (what you would call family medicine doctors) to give anaesthetics to mainly ASA 1's and 2's, they work almost exclusively in regional and remote centres - they act like the doctors they are, they know their limits have sound knowledge bases in broader medicine and get focused training do give simple anaesthetics well. they practice independantly - and seek help / advice when necessary.

we do need to train a LOT of anaesthetists as a result ... but that gives us a LOT of political clout because we are the biggest group of doctors in every hospital.

i know you will never go to that sort of model in the USA, but it is possible and it does work - even in a geographically enormous and sparsely populated country.


I just noticed that with the changes to the appearance of this board since April 1 - the location of the poster doesn't appear under the avatar ... I'm an aussie

 

[Mman]

look - i understand a lot of you support nurses giving anaesthesia under supervision but I do not support that.
we do not have nurses giving anaesthesia AT ALL.

we do all our own cases, that no doubt has pros and cons.

Nobody has to do anything, but the surgical world would basically end in the US without ACT model. We'd need way more anesthesiologists than we currently have and way way way more than we have the ability to train currently.

Also, ACT model is as safe as physician only care and has been demonstrated over and over and over again. Every single residency program is functioning that way, unless you want to argue a day 1 resident is as safe as a board certified anesthesiologist to be left alone in the room.

 

[skypilot]

Nobody has to do anything, but the surgical world would basically end in the US without ACT model. We'd need way more anesthesiologists than we currently have and way way way more than we have the ability to train currently.

Also, ACT model is as safe as physician only care and has been demonstrated over and over and over again. Every single residency program is functioning that way, unless you want to argue a day 1 resident is as safe as a board certified anesthesiologist to be left alone in the room.

Not really arguing with you, but the residents are not left alone on day one. In addition they are already physicians who have gone through extensive screening and rigorous training including an internship. And the cases are carefully selected for them when they do go solo. Usually start with the easy stuff and work your way up. As long as the cases are carefully selected by an Attending Anesthesiologist to match the abilities of the CRNA and there is backup readily available in the hallway, no problem. Some CRNAs are better than others. Some would fail miserably at independent practice.

 

[Mman]

Not really arguing with you, but the residents are not left alone on day one. In addition they are already physicians who have gone through extensive screening and rigorous training including an internship. And the cases are carefully selected for them when they do go solo. Usually start with the easy stuff and work your way up. As long as the cases are carefully selected by an Attending Anesthesiologist to match the abilities of the CRNA and there is backup readily available in the hallway, no problem. Some CRNAs are better than others. Some would fail miserably at independent practice.

At some point the CA1 is left alone. Obviously it isn't July 1st. For most programs it's by August 1st. And that's what I'm referring to as day 1. To argue that we need a board certified anesthesiologist doing every case themselves is not what any residency program does. And yes some CRNAs are better than others. I don't think anyone here is arguing in favor of independent practice for any of them. What I am a proponent of is the ACT model that is tried and true and allows a physician to supervise every single anesthetic.

Docs can do their own cases. I have no problems with anyone that wants to. I wouldn't do it because I find it boring and underutilizing my training and abilities, but I see no fault in anyone who does wish to do it.

 

[chocomorsel]

Nobody has to do anything, but the surgical world would basically end in the US without ACT model. We'd need way more anesthesiologists than we currently have and way way way more than we have the ability to train currently.

Also, ACT model is as safe as physician only care and has been demonstrated over and over and over again. Every single residency program is functioning that way, unless you want to argue a day 1 resident is as safe as a board certified anesthesiologist to be left alone in the room.

So you think supervising 2 residents is as equally safe or dangerous as supervising 4 CRNAs?

In the real world, are you only supervising 2 rooms?

Maybe your argument would hold more weight if this was the case. Most docs are supervising 3 to 4 rooms. Or even more if it’s steictly supervision and not medical direction. Often times on different floors and different parts of the hospital.

And how do we know the surgical world wound end without CRNAs? How has it not ended out west where it’s mostly physician only? Probably a lot of unnecessary surgeries would be delayed or cancelled sure, but the OR world wound not end.

Why do we fight so hard for this model when most docs are stretched thin with a high ratio of supervision?

 

[deleted162650]

 

[Mman]

So you think supervising 2 residents is as equally safe or dangerous as supervising 4 CRNAs?

In the real world, are you only supervising 2 rooms?

Maybe your argument would hold more weight if this was the case. Most docs are supervising 3 to 4 rooms. Or even more if it’s steictly supervision and not medical direction. Often times on different floors and different parts of the hospital.

And how do we know the surgical world wound end without CRNAs? How has it not ended out west where it’s mostly physician only? Probably a lot of unnecessary surgeries would be delayed or cancelled sure, but the OR world wound not end.

Why do we fight so hard for this model when most docs are stretched thin with a high ratio of supervision?

LOL. I can only assume you've never been at a well run ACT practice. We supervise between 1:1 and 4:1 depending on the cases. The answer is always that it depends. And I talk quite frequently with colleagues at residency programs and they share horror stories of what they end up covering and with who (and these are at "top 5" and "top 10" programs by any measure).

As for the surgical world ending in the US, it's simple math. My entire state would shut down and so would many others. Surgical volumes would plummet. Does it work in the west? Sure, because the staffing is already in place. You can't just transition the majority of the country from ACT model to MD/DO only care. There aren't enough anesthesiologists. How many get board certified per year? 1200 or so? 1400? You'd have to probably double the number of grads per year and it'd take about 20 years to catch up to the demand that would create. So all those surgeries people can't have aren't exactly "unnecessary". You'd have to ration care drastically.

And nevermind the simple fact that ACT model is proven safe and effective so why bother with trying to get rid of it? The best study ever done with mortality data comparing physician only to ACT model to CRNA only found ACT model had the lowest overall mortality rate (I believe it was from the 70s and 80s from North Carolina data but I'm too lazy to find it right now).

 

[chocomorsel]

This is Amerrrca!!! Money always talks.

 

[chocomorsel]

LOL. I can only assume you've never been at a well run ACT practice. We supervise between 1:1 and 4:1 depending on the cases. The answer is always that it depends. And I talk quite frequently with colleagues at residency programs and they share horror stories of what they end up covering and with who (and these are at "top 5" and "top 10" programs by any measure).

As for the surgical world ending in the US, it's simple math. My entire state would shut down and so would many others. Surgical volumes would plummet. Does it work in the west? Sure, because the staffing is already in place. You can't just transition the majority of the country from ACT model to MD/DO only care. There aren't enough anesthesiologists. How many get board certified per year? 1200 or so? 1400? You'd have to probably double the number of grads per year and it'd take about 20 years to catch up to the demand that would create. So all those surgeries people can't have aren't exactly "unnecessary". You'd have to ration care drastically.

And nevermind the simple fact that ACT model is proven safe and effective so why bother with trying to get rid of it? The best study ever done with mortality data comparing physician only to ACT model to CRNA only found ACT model had the lowest overall mortality rate (I believe it was from the 70s and 80s from North Carolina data but I'm too lazy to find it right now).

Honestly, right now I can't even think of what ACT stands for. And I can't find studies comparing the three models. But maybe you can find them for me, because honestly I can't.

It works for you. Great. You get bored doing your own cases. I get it. Sometimes I do too. I have only been in one ACT model where I supervised mostly 2 sometimes three rooms, and when I had 3 sick ones or 4 healthy ones, I still felt like I was running around like a chicken with my head off not knowing what was going on in each room and walking into a few disasters with CRNAs who thought knew it all. But hey, at least I had time to eat. I did make a friend who was a CRNA at this practice. However, she truly believed in having the physician there during the key moments and was very respectful and polite from the get go. We are still friends to this day. Plenty of CRNAs are not this way.

It's not a matter of trying to get rid of the ACT model. Its continuing this whole mantra of "it's proven safest and best" that really bothers me. Supervising 4 rooms of nurses, all with different level of skill and experience, with 4 sometimes sick patients like many of these large nationwide companies do, is not safe and beneficial to the patients. Oh, and then the patient gets two bills that they have no clue about. Even better.

We are fed that BS constantly and some, who benefit financially and/or enjoy the ACT model really continue to pass that along like it's golden. Is it really? Or is it it the money? Who did the study? No other first world seems to have this CRNA problem, does that mean they have higher mortality and morbidity since their docs are the ones doing the anesthetics?

I am sure your practice is one of the safest and efficient ones out there where if you do supervise 4 rooms they are all healthy appys, and choleys.

Like I said, maybe if we supervised no more than 2 patients at a time, then we could call it "the best practice". But anymore, seems a stretch that I am sure anyone benefiting financially from this model could come up with a study showing how this is the best level of care.

I found the ACT definition after adding anesthesia to the end of my search subject. But seems like all the studies I see are comparing cost effectiveness and not quality.

 

[Twiggidy]

Nobody has to do anything, but the surgical world would basically end in the US without ACT model. We'd need way more anesthesiologists than we currently have and way way way more than we have the ability to train currently.

Also, ACT model is as safe as physician only care and has been demonstrated over and over and over again. Every single residency program is functioning that way, unless you want to argue a day 1 resident is as safe as a board certified anesthesiologist to be left alone in the room.

Respectfully.....I disagree. That main problem in the US (and probably a similar problem happening in the NHS) is that no one wants to WAIT. Everything here is treated as emergent or semi-urgent so everything must go now or soon. Also, medicine is such a business that "if we have the ORs we have to fill them an run them.

We don't NEED CRNAs, but in a world without them people would have to be okay with ORs running longer and just about everyone involved working in some sort of shift work.

Which makes me wonder, do other countries have "CRNAs" or something similar? How do things work in a country like say, France, where there is a mandatory maximum amount of hours one can work a week?

Again, we don't NEED our system but we have it because the system is trying to take care of as many people as possible as fast as it can to make the most MONEY

 

[Twiggidy]

This is Amerrrca!!! Money always talks.

THIS

 

[dhb]

Which makes me wonder, do other countries have "CRNAs" or something similar? How do things work in a country like say, France, where there is a mandatory maximum amount of hours one can work a week?

France has a very clearly divided system of public ans private hospitals. Most public hospitals are very slow with very light OR schedules but they also handle the most complex pathologies (for the big university center). CRNAs will often be working 1/1 or 2/1 with an MD.
In private hospitals pace is the essence since their reimbursment is lower than the public centers. Here CRNAs will do solo GI scopes or work one room with the MD in an other room supervising loosely.

 

[Twiggidy]

France has a very clearly divided system of public ans private hospitals. Most public hospitals are very slow with very light OR schedules but they also handle the most complex pathologies (for the big university center). CRNAs will often be working 1/1 or 2/1 with an MD.
In private hospitals pace is the essence since their reimbursment is lower than the public centers. Here CRNAs will do solo GI scopes or work one room with the MD in an other room supervising loosely.

that part is interesting

basically you have to work faster and efficiently to make more money in the private system (correct?) whereas here, we work more in the private system to make EVEN more

as choco said, "money talks"

 

[skypilot]

Respectfully.....I disagree. That main problem in the US (and probably a similar problem happening in the NHS) is that no one wants to WAIT. Everything here is treated as emergent or semi-urgent so everything must go now or soon. Also, medicine is such a business that "if we have the ORs we have to fill them an run them.

We don't NEED CRNAs, but in a world without them people would have to be okay with ORs running longer and just about everyone involved working in some sort of shift work.

Which makes me wonder, do other countries have "CRNAs" or something similar? How do things work in a country like say, France, where there is a mandatory maximum amount of hours one can work a week?

Again, we don't NEED our system but we have it because the system is trying to take care of as many people as possible as fast as it can to make the most MONEY

Eventually an AMC is going to offer you boatloads of money to supervise 6 rooms. . . Just say "no!" The sucker who says "yes" is going to get paid really really well. That is why we are doomed.

 

[chocomorsel]

Eventually an AMC is going to offer you boatloads of money to supervise 6 rooms. . . Just say "no!" The sucker who says "yes" is going to get paid really really well. That is why we are doomed.

There are plenty of those "suckas". And maybe they aren't suckas as much as they like to live a high risk high reward system. Maybe we who don't get with the program are the suckas?

And of course when this happens, I am sure there will be some study touting how safe this 1:6 or 1:8 model is the "bestest and safest" of them all because it saves the hospitals money.

 

[Twiggidy]

Eventually an AMC is going to offer you boatloads of money to supervise 6 rooms. . . Just say "no!" The sucker who says "yes" is going to get paid really really well. That is why we are doomed.

It's easy to say this but when you have mortgages to pay, kids to feed, private schools/college to pay for, and a lovely wife/husband to keep happy, it becomes not so easy to "just say no"

think about all the AMCs that we call "the devil" on this board but they're are still up and functioning. it's because when you have necessities to take care of you can't just say no

granted, i'm on your side and am all about the fight, but in this world there will always be someone who will do what you wont because they need the money

 

[deleted171991]

We don't need more anesthesiologists. We need fewer useless surgeries, or anesthesia for trivial procedures, such as endoscopies or cataracts. That's what's different in countries like France. They simply won't do joint replacements in 90 year-olds, or useless back surgery after useless back surgery, or anesthesia for MRI (doesn't that sound ridiculous?). While we operate on everything that's billable and breathes, even the fly on the wall if it were possible. The United States of Greed. The average American citizen has a God-given right to get useless treatments that simply wouldn't fly in socialized medicine.

Also, in those foreign countries, many of the anesthesiologists practice intensive care, too, and still the ORs don't screech to a halt.

The ACT model is ridiculous, both with CRNAs and residents. We don't let residents operate unsupervised; why do we allow them to perform anesthesia without an attending in the room? Greed. The average Millennial anesthesiology resident is not much different than the average CRNA; both of them don't know what they don't know, are cocky and impossible to micromanage (as attendings should, but don't/can't). Just because we have found a way to rationalize the ACT on a daily basis, to be able to live with ourselves as doctors, doesn't make it less disgusting.

If I could go back and give one advice to my 25 year-old self, it would be: don't go to America, just because of how low American doctors will sink. I did not go into medicine to become a blue-collar worker, or to who*e myself out for money.

 

[flightnurse2MD]

Not really arguing with you, but the residents are not left alone on day one. In addition they are already physicians who have gone through extensive screening and rigorous training including an internship. And the cases are carefully selected for them when they do go solo. Usually start with the easy stuff and work your way up. As long as the cases are carefully selected by an Attending Anesthesiologist to match the abilities of the CRNA and there is backup readily available in the hallway, no problem. Some CRNAs are better than others. Some would fail miserably at independent practice.

At my program, after 6-months, CA-1s relieve the nurse anesthetists at 4pm and 5pm. Clearly tells me the level of an anesthesiologist's training in residency and much more beyond.

 

[deleted171991]

At my program, after 6-months, CA-1s relieve the nurse anesthetists at 4pm and 5pm. Clearly tells me the level of an anesthesiologist's training in residency and much more beyond.

Bull****. I would rather have an experienced CRNA in a room than a cocky spoiled millennial anesthesiology resident (which is the par for the current generation).

Some of the residents are so disrespectful they should have been thrown out of residency ages ago, if not for all this PC BS that surrounds us. Since I started working with them, I have gained tremendous respect for some of my former teachers.

 

[flightnurse2MD]

Bull****. I will rather have an experienced CRNA in a room than an anesthesiology resident.

For bread and butter cases though?

 

[Twiggidy]

For bread and butter cases though?

Probably more so for a bread and butter case.

 

[chocomorsel]

@FFP, you is on fire! Love it. Preach!
In America we will find a way to justify squeezing money out of anyone and anything. After all, how the hell does the rest of the world survive without boatloads of money!!!

 

[flightnurse2MD]

Bull****. I would rather have an experienced CRNA in a room than a cocky spoiled millennial anesthesiology resident (which is the par for the current generation).

Some of the residents are so disrespectful they should have been thrown out of residency ages ago, if not for all this PC BS that surrounds us. Since I started working with them, I have gained tremendous respect for some of my former teachers.

Glad I didnt start medical school until age 39 then. Age has humbled me.

 

[chocomorsel]

@FFP, as someone who isn’t officially a millennial but trained with them, are we not allowed to question anything coming from attendings?

Not ever attending is a rockstar you know. And plenty of them are teaching antiquated medicine.

I believe we can question respectfully. Although I did get in trouble in residency quite a bit because I didn’t know how to respectfully take abuse from evil nurses and surgeons. And even secretaries. Yes, I talked back. But I was supposed to sit back and take their s hit and say “Thank you, may I please have some more?” Hard to do when older and have experienced the real world some.

 

[chocomorsel]

Glad I didnt start medical school until age 39 then. Age has humbled me.

Yes, but since you are training with millennials do you get “grouped” with the millennials?
Just wondering.

 

[dhb]

We need fewer useless surgeries, or anesthesia for trivial procedures, such as endoscopies or cataracts

True we need fewer and better selected procedures and more preventive medicine.

They simply won't do joint replacements in 90 year-olds, or useless back surgery after useless back surgery, or anesthesia for MRI

Not true
You idealise European medicine. We unfortunately do as much unnessesary surgeries as you do. Maybe we shorten ICU care a little bit but futile care is still very present.

 

[Psai]

For anything. It's the attitude that drives me nuts, same as for militant CRNAs.

I have to control myself not to throw them out of the room, when they say "that's OK with me" about my plan, or when they start contradicting me. Maybe I should start doing that, like some of the best cardiac attendings in my own residency used to do (they could afford it because they were 1:1). Spoiled brats. Shut the F up, listen and watch, and maybe you'll learn something today!

It's ridiculous to have CRNAs in their fifties who are more willing to learn something new than a snotty CA-3. There is a reason we have the oral boards, to teach all the cocky fresh grads a lesson.

I'm glad to see your opinion. As a cocky, inexperienced resident, I have been thinking about this topic a lot lately. I feel like as I get further in, my respect for my attendings has been going way up. I don't think it's something done maliciously, just a lack of perspective.

Then again, there are lots of times when attendings push meds then leave until extubation. While the autonomy is nice, I feel like the education can be lacking. It's also tough to have a discussion without trying to seem like you are challenging the beliefs of someone who has been doing it for longer than you've been alive. I get what the nurses are saying when they say they need to bring up suggestions gently in a question format so as not to step on toes.

 

[deleted171991]

@FFP, as someone who isn’t officially a millennial but trained with them, are we not allowed to question anything coming from attendings?

Not ever attending is a rockstar you know. And plenty of them are teaching antiquated medicine.

I believe we can question respectfully. Although I did get in trouble in residency quite a bit because I didn’t know how to respectfully take abuse from evil nurses and surgeons. And even secretaries. Yes, I talked back. But I was supposed to sit back and take their s hit and say “Thank you, may I please have some more?” Hard to do when older and have experienced the real world some.

There is a way to question things. And I don't abuse my residents (or CRNAs). But nothing is more annoying than a resident who thinks s/he's your equal and always needs to have the last word. Let's not forget: the resident works on the attending's license, so whatever the attending says should fly, regardless how antiquated it is. In my experience, the cockier a resident is the less s/he actually knows and the more unsafe s/he is.

This generation has been brainwashed into nurse-type thinking. They have been spoiled by their parents during childhood, so they had no respect for adults even as children. One day, one of them suggested that we are a team of quasi-equals. No, my young padawan, you are my apprentice, so watch and learn. Do what you're told and save the impertinent questions for the end of the day (if you insist on asking them at all). Again, it's not the questions, it's their tone that irks me. They forget that they are neither my peer nor my supervisor.

I am NOT a rockstar, but neither are they.

 

[Consigliere]

Since I started working with them, I have gained tremendous respect for some of my former teachers.

Agree but keep in mind our generation was MUCH more respectful towards our attendings.

 

[Twiggidy]

There is a way to question things. And I don't abuse my residents (or CRNAs). But nothing is more annoying than a resident who thinks s/he's your equal and always needs to have the last word. Let's not forget: the resident works on the attending's license, so whatever the attending says should fly, regardless how antiquated it is. In my experience, the cockier a resident is the less s/he actually knows and the more unsafe s/he is.

This generation has been brainwashed into nurse-type thinking. They have been spoiled by their parents during childhood, so they had no respect for adults even as children. One day, one of them suggested that we are a team of quasi-equals. No, my young padawan, you are my apprentice, so watch and learn. Do what you're told and save the impertinent questions for the end of the day (if you insist on asking them at all). Again, it's not the questions, it's their tone that irks me. They forget that they are neither my peer nor my supervisor.

I am NOT a rockstar, but neither are they.

I definitely had cocky colleagues as a resident, though I felt the cockier ones were the one's who did better on their ITEs and were praised by the program leadership as the best, by simply being the best on paper. My program held the ITEs really high in regard to how you were as a resident and not how you performed in the OR, which was ridiculous. Some of the best residents in my eye may not have always been the strongest on ITE.

Our field is tough because we worked with 10 different attendings who do it 10 different ways so it's very natural when someone says, "My way is the right way" to respond "Well this guy down the hall did it like this and it worked to and it's more comfortable for me." Now granted, I had to learn to bite my lip, which I guess is what alot of "millennial" residents should learn to do. In contrast surgery tends to be more of an "apprenticeship" type field and that mindset is established early. When you're a 3rd year and finally are in the OR as a surgery resident you're grabbing on to everything the Chief or Attending tells you because you finally get to do surgery and you keep your mouth shut because you actually may get kicked out and never operate again if you say the wrong thing.

I do remember once when an abuse attending tried the "well just leave" card on my......so I did. He never did that again.

 

[deleted171991]

Our field is tough because we worked with 10 different attendings who do it 10 different ways so it's very natural when someone says, "My way is the right way" to respond "Well this guy down the hall did it like this and it worked to and it's more comfortable for me."

And who the heck cares what's "more comfortable" for the resident? I do what's best for my patient, in my judgment.

I do remember once when an abuse attending tried the "well just leave" card on my......so I did. He never did that again.

That's one of the things that's wrong with our current system. Granted, I had a serial abuser in my residency that I specifically asked not to be ever paired with again (and I was not the only one), but still s/he taught me a lot. I just didn't know how to listen. To the date, I extubate using his/her method, and to the date I avoid the person at conferences.

Some of the CA-3s are just glorified better CRNAs (a lot of knowledge coupled with a lot of bad judgment). Pampering the residents without strong supervision is one of the reasons why. God bless the oral boards, they just don't fail enough people.

 

[chocomorsel]

Agree but keep in mind our generation was MUCH more respectful towards our attendings.

@FFP, I do remember on my CV rotation an attending telling me to give the patient a push of Esmolol at least 30 minutes before the case even started. I asked the attending why, because it didn't make sense. I got in trouble because I should not have done it in front of the patient and made him look bad. I was doing a bit of thinking out loud and questioning what the hell benefit esmolol in pre-op before a CV case is going to accomplish in a stable, non tachycardic, non symptomatic patient who either forgot their B Blocker that morning or we were doing the whole B blocker before surgery thing.

Whatever the case, my lack of situational awareness and making the attending look bad got me in the principals office and in trouble. Surprise surprise. I learned my lesson. It was at an abusive away rotation in Houston where the attending anesthesiologists were some of the biggest dinguses I had ever seen. Very unusual for anesthesiologists.

But in my program it was my directness that would get me in trouble. I am direct person who doesn't beat around the bush which from a black woman, is a little intimidating to a lot of people. Some found it disrespectful and my problem in residency was the whole "professionalism" BS. I needed to learn to keep my mouth shut. But besides that whole away rotation BS, and me talking back to this vascular surgeon who screamed at me repeatedly while I was waiting on my attending it was always the damn nurses and techs and secretaries who I would get into it with. I was a nurse in my past life and didn't experience that level of abuse and didn't see the need for it, so therefore was not gonna have it. But academics is a different beast. Some nurses thrive on being jerks to residents.

Anyway, I hate academics as the two academic places I have worked have both left a horrible taste in my mouth. I am sure they aren't all like that. At least I hope.

 

[Twiggidy]

And who the heck cares what's "more comfortable" for the resident? I do what's best for my patient, in my judgment.

That's one of the things that's wrong with our current system. Granted, I had a serial abuser in my residency that I specifically asked not to be ever paired with again (and I was not the only one), but still s/he taught me a lot. I just didn't know how to listen. To the date, I extubate using his/her method, and to the date I avoid the person at conferences.

Some of the CA-3s are just glorified better CRNAs (a lot of knowledge coupled with a lot of bad judgment). Pampering the residents without strong supervision is one of the reasons why. God bless the oral boards, they just don't fail enough people.

well in defense on residents, I'd say that's a problem right there. if you have resident, you're at a teaching program, so you have to actually teach. you may say who cares what's more comfortable, but that resident has to eventually go out into the world and actually practice anesthesia and if they never get comfortable doing things in a way the provides them success then they'll be sh*tty "real world attending". trust me, i see this everyday when some of our "weaker colleagues" dump patients on our service and I ended doing the case and saying "what the hell? this was easy". the "my way or the highway" attending does nothing for the resident who's there to learn and also hone their skills.

An example, I'm left handed, and when I first started learning cardiac to put in a RIJ with my right hand was super awkward, so I had do it from the side of the patient using my left hand. for some attendings this was an issue because i'm "supposed to be standing behind the head of the patient" and doing it like they do it. Or what about attendings who never use ultrasound because "that's how they learned". Well in the real world (and with many colleagues in their programs) residents are taught to use ultrasound. "Who cares if you're more comfortable with ultrasound? Do it my way."? You see how that can be problematic?

 

[chocomorsel]

And who the heck cares what's "more comfortable" for the resident? I do what's best for my patient, in my judgment.

That's one of the things that's wrong with our current system. Granted, I had a serial abuser in my residency that I specifically asked not to be ever paired with again (and I was not the only one), but still s/he taught me a lot. I just didn't know how to listen. To the date, I extubate using his/her method, and to the date I avoid the person at conferences.

Some of the CA-3s are just glorified better CRNAs (a lot of knowledge coupled with a lot of bad judgment). Pampering the residents without strong supervision is one of the reasons why. God bless the oral boards, they just don't fail enough people.

Did your residency support your request to not pair you with the serial abuser? If so, that's great.

And do you think that as residents we are supposed to be abused and smile and ask for another? I know you said you don't abuse, and quite frankly even in PP, a lot of the abuse doesn't come from our side of the curtain. It's so prevalent and I feel that it's unnecessary and not right. But of course as a resident if your program doesn't have your back, you are screwed. However, this leads to poor mental health in plenty of people and for me has also assisted in leading me out of the OR, hopefully permanently. Even though I always had a passion for the ICU, being in PP for the past few years and seeing how toxic so many OR environments are in has given me that final push. My mental health is not worth it.

 

[Twiggidy]

@FFP, I do remember on my CV rotation an attending telling me to give the patient a push of Esmolol at least 30 minutes before the case even started. I asked the attending why, because it didn't make sense. I got in trouble because I should not have done it in front of the patient and made him look bad. I was doing a bit of thinking out loud and questioning what the hell benefit esmolol in pre-op before a CV case is going to accomplish in a stable, non tachycardic, non symptomatic patient who either forgot their B Blocker that morning or we were doing the whole B blocker before surgery thing.

yeah, that was an instance of learning situational awareness. now matter how strange something sounds you really shouldn't question authority in front of patients (I learned that from the show "ER" lol)

@FFPBut in my program it was my directness that would get me in trouble. I am direct person who doesn't beat around the bush which from a black woman, is a little intimidating to a lot of people. Some found it disrespectful and my problem in residency was the whole "professionalism" BS. I needed to learn to keep my mouth shut. But besides that whole away rotation BS, and me talking back to this vascular surgeon who screamed at me repeatedly while I was waiting on my attending it was always the damn nurses and techs and secretaries who I would get into it with.

I think this is a combination of A) being a woman and B) being a black woman. It's an experience that very few others can relate to. Your female colleagues with empathize with you. I watched a few female residents have it out with people in the OR (as you said, mainly nurses and techs) for not respecting their decisions. With the later, we know how people view outspoken black women so from me, I see everything you're saying and I had a couple black female colleagues who go the same treatment.

 

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