Why pick anesthesia? (Beating a dead horse)

[shortcoat]

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I just started my anesthesia rotation this week and I'm really dismayed to see just how much the CRNAs actually do. I was gung-ho anesthesia before starting, but now I can't stop asking myself "why pick a career that a nurse can (seeminlgy) do as well as a doctor"? I know the MDA v. CRNA debate has been covered countless times within in this forum. I'm not looking for a bunch of CRNAs to tell me why they're just as good as doctors or for a bunch of docs to tell me that CRNAs are idiots. As far as I can tell, the CRNAs that I've worked with are extremely competent and the MD operates only in an supervisory role. I understand that a physician is much more equipped to deal with intra-operative emergencies, but with a 1/250,000 mortality rate, how often is an MD really needed for a bread and butter case? I really enjoy the field, but I can't help but ask myself if I could use my skills better somewhere else. ANY advice or motivational speeches would be appreciated.

Thanks

 

[Arch Guillotti]

Dear thread,

Please die.

 

[lvspro]

Hi
I like your attitude. If you apply, please bring this up during the interview.

One more spot for me!!!

Please look in the FAQ section, the answers are there.

 

[2ndyear]

I don't think that this is an uncommon reaction the first week of an anesthesia rotation. Competent providers make it look easy, and yes CRNA's can do much of what MD's do in the OR. Look beyond the easy cases though. Spend some time in a heart room, watch the TEE. Do some high risk peds. Pick a vascular or neuro room for a few days. Spend some quality L&D floor time. Don't forget that anesthesiologists practice out of the OR doing pain and critical care too. While CRNA's do practice in most of these environments (and some quite well), you'll be more likely to see MD's using all of their medical knowledge. Maybe that can motivate your interest a bit.

Why pick a career that a nurse can do as good as a doctor? If you're worried about entering a field where non-docs can do 90% of what you do, then you'll have to look farther than just anesthesia. Medicine, FP, Peds, Psych, OB, even Ophtho have non-physicians able to practice at a high level.

Also be aware that anesthesia groups vary a lot in their makeup and how they run. In some, MDs do mainly supervision. In others they do all of their own cases. Some groups are MD only. CRNA's practice without anesthesiologists as well. There's something out there for everyone.

If you enjoy the field, then that is enough. It certainly isn't a field where you can expect loads of praise from patients and others, you really do need a sense of intrinsic satisfaction

 

[shortcoat]

Thanks a lot, 2nd year. That's excellent advice. I'm hoping for the best.

 

[powermd]

It certainly isn't a field where you can expect loads of praise from patients and others, you really do need a sense of intrinsic satisfaction

I agree that it's helpful to be able to find satisfaction in simply doing your job well, but my experience is that the level of praise you receive from your patients is highly dependant on your bedside manner and personality. I've had no problem eliciting plenty of praise from patients before and after surgery. Very often they know my name well, but ask questions like "what's the surgeon's name again?" when I go see them postoperatively. Patients having surgery are a very vulnerable group, and as the anesthesiologist you have an enormous opportunity to alleviate their anxiety and make them feel cared for. I do this starting with the pre-op visit by respectfully introducing myself to the patient, and all family members or friends present. I sit down before engaging in discussion, make good eye contact, and speak slowly, using a gentle, but firm tone. I assure the patient that my role is to keep them comfortable and safe throughout the procedure. I emphasize 'comfortable' and 'safe'. I explain exactly what is going to happen from the time they leave the pre-op area so there are no surprises. If someone is particularly anxious, I don't hesitate to offer a fentanyl lollypop, which always seems to be appreciated. I always received a lot of praise from patients during my IM internship, and I worried that I would lose that when switching to anesthesiology, but that really hasn't been the case. Relationships are definitely not as deep, especially on a busy day with rapid-fire turnover of cases, but the positive reactions are still there. Don't think you have to give up a satisfying doctor-patient relationship when you come to anesthesiology.

 

[VolatileAgent]

I'm not looking for a bunch of CRNAs to tell me why they're just as good as doctors or for a bunch of docs to tell me that CRNAs are idiots.

if that's all you've gotten from from the exchanges, no wonder you're confused. being an mda means your job (and responsibility to the pt) doesn't begin and end in the OR suite or the Pacu. you'll see.

 

[Frank Rizzo]

Dear thread,

Please die.

I second that.

 

[powermd]

Can we lose this stupid term "MDA" already? The "MDA" term does a lot to help people forget that as a group we have skills, training, talents, and responsibilities well beyond that of a CRNA. Let's not help further the cause of the militant AANA by applying a label to ourselves that helps their cause.

 

[VolatileAgent]

Can we lose this stupid term "MDA" already? The "MDA" term does a lot to help people forget that as a group we have skills, training, talents, and responsibilities well beyond that of a CRNA. Let's not help further the cause of the militant AANA by applying a label to ourselves that helps their cause.

fair enough. seems to be coined by recruiters...

http://www.smsanesthesia.com/provider/

http://www.americanhcare.com/index....ategory&sectionid=1&id=18&Itemid=41&menuid=41

http://www.rka100.com/jobs.asp?t=a

http://www.healthyjobs.com/statejobsearch.cgi?location=Midwest&pro=

http://healthcare.jobs.executiveregistry.com/healthcare/?C=qIl9uLe8kaPQH73

and nurses

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11061156&dopt=Abstract

http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=4836

of course, i like that this means an osteopath with training in anesthesiology would be a "DOA" 😀 but, you're right. we are doctors first and foremost who also happen to provide the technical aspects of anesthesia in addition to our other skills.

and, maybe this is the definitive word on the subject...

"Around the world, “anesthetist” is a designation reserved for physicians. Only in America is the public required to understand that “anesthesiologist” and “anesthetist,” terms used interchangeably elsewhere, have vastly different meanings. Our colleagues and patients are accustomed to hearing “The L&D nurse called me for an epidural” or “The operating room nurse introduced himself/herself to me before the procedure.” For the distinction they earned by virtue of their training beyond nursing school, we physicians should end the confusion and begin to use the proper terminology — anesthesia nurses. With medical jargon infiltrated deeply into everyday culture, it is understandable that patients, members of Congress and others would be confused. Even ANs will occasionally incorrectly use “M.D. anesthesiologist” (M.D.A. is a personal pet peeve) or “nurse anesthesiologist.”"

http://www.asahq.org/Newsletters/2001/10_01/letters1001.htm

 

[nitecap]

Few if any nurse anesthetists call themselves nurse anesthesiologists. The proper term is nurse anesthestist. I never intro myself to a patient without including the word nurse, never. Do not at all want them to think i am a MD. i provide a clear picture of my exact role in their anesthetic, as well as intro them to the attending MD if needed. I think the whole thing of MDA is just a quick abbreviation especially used online, I know it is not a formal title.

And CRNA's are used in many more different countries besides the U.S. Google the International Federation of Nurse Anesthetists and you will see 31 other countries that have nurses in someway delivering anesthetics. To list some : France, Denmark, Austria, germany, South Korea, Taiwan, Spain, italy, Jamaica, sweden. The list continues.

Most of these Nurse Anesthetists serve rural areas with poor MD access, similar to that of the U.S. There is even an Internation Federation of CRNA conference held every few years. Held in Chicago in 2000 I believe.

Many european countries operate in anesthesia care teams like the U.S. They have set international standards of care and guildlines for all NA. Goals of IFNA - global pt saftey issues, global standards of care, global quality and Globalization of the nurse anesthesia profession as a whole. We are world wide with advisors from the WHO and UNICEF assisting educational programs in developing countries to provide anesthesia services there. SO one doesnt have to travel hunderds of miles to have a routine surgery. Of course U.S. CRNA's are the strongest group and asssist the IFNA. Global recognition of NA qualitity care leading to global recognition and respect from the global public wil only lead to a stronger global CRNA presence. Sorry to burst your bubble.

Do your research before you speak up.

fair enough. seems to be coined by recruiters...

http://www.smsanesthesia.com/provider/

http://www.americanhcare.com/index....ategory&sectionid=1&id=18&Itemid=41&menuid=41

http://www.rka100.com/jobs.asp?t=a

http://www.healthyjobs.com/statejobsearch.cgi?location=Midwest&pro=

http://healthcare.jobs.executiveregistry.com/healthcare/?C=qIl9uLe8kaPQH73

and nurses

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11061156&dopt=Abstract

http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=4836

of course, i like that this means an osteopath with training in anesthesiology would be a "DOA" 😀 but, you're right. we are doctors first and foremost who also happen to provide the technical aspects of anesthesia in addition to our other skills.

and, maybe this is the definitive word on the subject...

"Around the world, “anesthetist” is a designation reserved for physicians. Only in America is the public required to understand that “anesthesiologist” and “anesthetist,” terms used interchangeably elsewhere, have vastly different meanings. Our colleagues and patients are accustomed to hearing “The L&D nurse called me for an epidural” or “The operating room nurse introduced himself/herself to me before the procedure.” For the distinction they earned by virtue of their training beyond nursing school, we physicians should end the confusion and begin to use the proper terminology — anesthesia nurses. With medical jargon infiltrated deeply into everyday culture, it is understandable that patients, members of Congress and others would be confused. Even ANs will occasionally incorrectly use “M.D. anesthesiologist” (M.D.A. is a personal pet peeve) or “nurse anesthesiologist.”"

http://www.asahq.org/Newsletters/2001/10_01/letters1001.htm

 

[militarymd]

Few if any nurse anesthetists call themselves nurse anesthesiologists. The proper term is nurse anesthestist. I never intro myself to a patient without including the word nurse, never. Do not at all want them to think i am a MD. i provide a clear picture of my exact role in their anesthetic, as well as intro them to the attending MD if needed. I think the whole thing of MDA is just a quick abbreviation especially used online, I know it is not a formal title.

And CRNA's are used in many more different countries besides the U.S. Google the International Federation of Nurse Anesthetists and you will see 31 other countries that have nurses in someway delivering anesthetics. To list some : France, Denmark, Austria, germany, South Korea, Taiwan, Spain, italy, Jamaica, sweden. The list continues.

Most of these Nurse Anesthetists serve rural areas with poor MD access, similar to that of the U.S. There is even an Internation Federation of CRNA conference held every few years. Held in Chicago in 2000 I believe.

Many european countries operate in anesthesia care teams like the U.S. They have set international standards of care and guildlines for all NA. Goals of IFNA - global pt saftey issues, global standards of care, global quality and Globalization of the nurse anesthesia profession as a whole. We are world wide with advisors from the WHO and UNICEF assisting educational programs in developing countries to provide anesthesia services there. SO one doesnt have to travel hunderds of miles to have a routine surgery. Of course U.S. CRNA's are the strongest group and asssist the IFNA. Global recognition of NA qualitity care leading to global recognition and respect from the global public wil only lead to a stronger global CRNA presence. Sorry to burst your bubble.

Do your research before you speak up.

very interesting.

 

[deleted50478]

Few if any nurse anesthetists call themselves nurse anesthesiologists. The proper term is nurse anesthestist. I never intro myself to a patient without including the word nurse, never. etc.

In my limited experience I have yet to here a CRNA use the word nurse. Mostly they just say anesthetist. I've heard nurses introduce themselves by saying, "Hi. I'm so&so with the Anesthesiology department." maybe not technically a lie but misleading.

 

[nitecap]

The title anesthetist is not limited to a MD.

www.dictionary.com

A person specially trained to administer anesthetics
A person trained to administer anesthetics.
a specialist who administers an anesthetic to a patient before he is treated

No where does it say MD, doctor of medical training. MDA's, CRNA's and AA's are all anesthetists.

If you are a CRNA that works in a hospitals Anesthesiology Dept than I guess you can say you are with that Dept, though I do agree that it may cause confusion, especially with male CRNA's. I see anesthesia Techs, even unit secretaries have dept of anesthesiology of their name badges.

Even as a RN patients especially old men always called me doc, even though they knew I was a RN. They as well called many female residents nurses or even nurse aides if you can believe that. They just think in the context of the old days when MD's were pretty much only men, and nurses were only women.

 

[VolatileAgent]

Do your research before you speak up.

ummm... was this snippy comment addressed to me? the entire response had to do with the term "MDA", not where nurse anesthetists practice. no search on the ASA website specifically endorses the term "MDA" as a legitimate acronym for an anesthesiologist, nor as stated is there any official national or international consensus on using the term "MDA" (e.g. in medicare/medicaid or any other governing body) that makes a specific distinction between any other MD and an MD who practices anesthesiology, hence necessitating the distinction "MDA". MDs are MDs. again, the "MDA" term seems to have been coined by nurses (i.e. the AANA, whose website is rife with the acronym) and recruiters. additionally, the "anesthetist" comments reflected are, if you'd read more carefully, the historical observations of one practicing anesthesiologist in the U.S., which you would have realized if you had actually clicked the hyperlink and read in toto what had been quoted.

stay focused and recognize what's actually being discussed before you get pissy. and lighten up while you're at it.

 

[nitecap]

Extremely focused here, don't worry about that. I have seen many many posts from residents as well as MD's refering to the term MDA. Like I said I understand MDA is not a formal title and I do not at all use the term to get under anyone's skin. I simply use it as a shortcut when typing on forums, in chat rooms ect. Do you have any other suggestions of maybe a more formal abbreviation of some sort that can be used instead of MDA. Im all ears, or eyes.

NOt getting pissy either, not pissy at all. Just like to correct fallacies and misinformation on this board. I dont even post until I see misinformation to rebute. And again anesthetist is not a title soley for MD anesthesia providers. Even looking in anesthesia history books back before the WWI era anesthesia providers were differentiated as Physician anesthetists and nurse anesthetists. I have even read posts where JWK refers to himself as an anesthetist and he is an AA. You can have the title anesthesiologist, but anesthetist is for us all to share. Anyway I rarely here an Anesthesiologist intro his/her self as an anesthetist. They most of the time say Im your anesthesiologist today so whats the big deal.

 

[jetproppilot]

Extremely focused here, don't worry about that. I have seen many many posts from residents as well as MD's refering to the term MDA. Like I said I understand MDA is not a formal title and I do not at all use the term to get under anyone's skin. I simply use it as a shortcut when typing on forums, in chat rooms ect. Do you have any other suggestions of maybe a more formal abbreviation of some sort that can be used instead of MDA. Im all ears, or eyes.

NOt getting pissy either, not pissy at all. Just like to correct fallacies and misinformation on this board. I dont even post until I see misinformation to rebute. And again anesthetist is not a title soley for MD anesthesia providers. Even looking in anesthesia history books back before the WWI era anesthesia providers were differentiated as Physician anesthetists and nurse anesthetists. I have even read posts where JWK refers to himself as an anesthetist and he is an AA. You can have the title anesthesiologist, but anesthetist is for us all to share. Anyway I rarely here an Anesthesiologist intro his/her self as an anesthetist. They most of the time say Im your anesthesiologist today so whats the big deal.

Know what? I've always tried to be political here. And I just lost a post you guys wouldnt've believed. BUT I'M SICK OF THIS MD vs CRNA BULL$HIT.

This is a doctor/pre-doctor forum, all you nurses out there. Thank you for coming, but F&CK YOU for stirring sh&t here. I really dont know why CRNAs/SRNAs are here unless they want to positively contribute. TAKE YOUR MILITANT SH&T ELSEWHERE. YOU ARE NOT A DOCTOR. THIS IS A DOCTOR FORUM. FU&K YOU. GO BACK TO YOUR NURSE FORUM. I DO NOT GO TO YOUR FORUM AND POST A BUNCHA CONTROVERSIAL BS.

F^CK YOU.

sorry, military/ut/venty.

 

[jetproppilot]

Know what? I've always tried to be political here. And I just lost a post you guys wouldnt've believed. BUT I'M SICK OF THIS MD vs CRNA BULL$HIT.

This is a doctor/pre-doctor forum, all you nurses out there. Thank you for coming, but F&CK YOU for stirring sh&t here. I really dont know why CRNAs/SRNAs are here unless they want to positively contribute. TAKE YOUR MILITANT SH&T ELSEWHERE. YOU ARE NOT A DOCTOR. THIS IS A DOCTOR FORUM. FU&K YOU. GO BACK TO YOUR NURSE FORUM. I DO NOT GO TO YOUR FORUM AND POST A BUNCHA CONTROVERSIAL BS.

F^CK YOU.

sorry, military/ut/venty.

This post was not aimed at the poster, cuz to tell you the truth, i dont remember whether they were pro or anti md. All I know is

THIS IS A DOCTOR FORUM. SO ALL YOU MILITANT CRNA/SRNAs, GO BACK TO

I'M AN RN THAT WISHED I COULDVE GOTTEN INTO MED SCHOOL DOT COM.

Even Jesus got pissed once and threw merchants out of his place of worship.

 

[jetproppilot]

This post was not aimed at the poster, cuz to tell you the truth, i dont remember whether they were pro or anti md. All I know is

THIS IS A DOCTOR FORUM. SO ALL YOU MILITANT CRNA/SRNAs, GO BACK TO

I'M AN RN THAT WISHED I COULDVE GOTTEN INTO MED SCHOOL DOT COM.

Even Jesus got pissed once and threw merchants out of his place of worship.

YEP, THATS RIGHT. ITS JET POSTING THIS.

I'm sorry, I dont have the INNER PEACE that UT and MILITARY HAVE. I'm a FLORIDA CRACKA THAT SACRIFICED MY TWENTIES, AND EVERY EMOTIONAL/MONETARY POSSESION I HAD TO GET WHERE I'M AT.

I'll be damned if I'm gonna be reserved while militant para-professionals come to a doctor website and post controversial BS. I'd rather be a Taco Bell manager than do that.

SO MILITANT CRNAs SRNAs, BRING IT ON. YOURE ON MY TURF. I'M DEFENDING IT. FU&K YOU.

 

[jetproppilot]

YEP, THATS RIGHT. ITS JET POSTING THIS.

I'm sorry, I dont have the INNER PEACE that UT and MILITARY HAVE. I'm a FLORIDA CRACKA THAT SACRIFICED MY TWENTIES, AND EVERY EMOTIONAL/MONETARY POSSESION I HAD TO GET WHERE I'M AT.

I'll be damned if I'm gonna be reserved while militant para-professionals come to a doctor website and post controversial BS. I'd rather be a Taco Bell manager than do that.

SO MILITANT CRNAs SRNAs, BRING IT ON. YOURE ON MY TURF. I'M DEFENDING IT. FU&K YOU.

AND ANESTHESIA DREW, AND ALL YOU ANESTHESIA DREW ANALOGUES, (CRNAs and SRNAs that post stuff on an MD forum way beyond their experience/education),

I'M AT THE TOP OF MY GAME. I'VE ACCOMPLISHED MORE IN THE LAST YEAR THAN YOU WILL EVER ACCOMPLISH. I'VE FORGOTTEN MORE ANESTHESIA THAN YOU'LL EVER MEMORIZE.

Bring it, militants. Bring it.

 

[jetproppilot]

Extremely focused here, don't worry about that. I have seen many many posts from residents as well as MD's refering to the term MDA. Like I said I understand MDA is not a formal title and I do not at all use the term to get under anyone's skin. I simply use it as a shortcut when typing on forums, in chat rooms ect. Do you have any other suggestions of maybe a more formal abbreviation of some sort that can be used instead of MDA. Im all ears, or eyes.

NOt getting pissy either, not pissy at all. Just like to correct fallacies and misinformation on this board. I dont even post until I see misinformation to rebute. And again anesthetist is not a title soley for MD anesthesia providers. Even looking in anesthesia history books back before the WWI era anesthesia providers were differentiated as Physician anesthetists and nurse anesthetists. I have even read posts where JWK refers to himself as an anesthetist and he is an AA. You can have the title anesthesiologist, but anesthetist is for us all to share. Anyway I rarely here an Anesthesiologist intro his/her self as an anesthetist. They most of the time say Im your anesthesiologist today so whats the big deal.

Nitecap,

I'll start with you.

JWK is a professional. He is valued here. You are not. Go back to your forum. And on the way, go f%ck yourself.

 

[blocks]

Amen, brotha, amen! 👍

YEP, THATS RIGHT. ITS JET POSTING THIS.

I'm sorry, I dont have the INNER PEACE that UT and MILITARY HAVE. I'm a FLORIDA CRACKA THAT SACRIFICED MY TWENTIES, AND EVERY EMOTIONAL/MONETARY POSSESION I HAD TO GET WHERE I'M AT.

I'll be damned if I'm gonna be reserved while militant para-professionals come to a doctor website and post controversial BS. I'd rather be a Taco Bell manager than do that.

SO MILITANT CRNAs SRNAs, BRING IT ON. YOURE ON MY TURF. I'M DEFENDING IT. FU&K YOU.