Would you do it over again?

[GumBougie]

For those already in anesthesiology residency and beyond, would anyone choose to go into another field if they were able to do it over again? Im not sure if this question has already been posted but I could not find anything similar to this. Any input is appreciated.

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[UTSouthwestern]

For those already in anesthesiology residency and beyond, would anyone choose to go into another field if they were able to do it over again? Im not sure if this question has already been posted but I could not find anything similar to this. Any input is appreciated.

No

 

[BLADEMDA]

For those already in anesthesiology residency and beyond, would anyone choose to go into another field if they were able to do it over again? Im not sure if this question has already been posted but I could not find anything similar to this. Any input is appreciated.

You are making a mistake by going into Anesthesiology without examining the AANA/CRNA issue in great detail. Others will tell you all of Medicine is under assault by the Midlevels. I am telling you Anesthesiology is under the GREATEST assault compared to the rest of Medicine and will be the FIRST one to fall. The Board of Nursing is using the AANA like its "Marines" against the field of Medicine. The AANA/CRNA will be the first group of Nurses to achieve 100% Independence. Anesthesiology as a true Medical Specialty may cease to exist by 2020.

Blade

 

[CremeSickle]

Blade/ethermd

Respect the rules of the forum stop with the sermons.

 

[BLADEMDA]

Blade/ethermd

Respect the rules of the forum stop with the sermons.

Why not tell it to Zwerling and the AANA. The poster asked for my opinion and I gave it with an explanation.

Blade

 

[CremeSickle]

you should be banned.

 

[BLADEMDA]

you should be banned.

The truth can NEVER be banned for long. The Video of Zwerling PROVES my statements about the AANA.

Blade

 

[badgas]

I would attend CRNA school

 

[huron]

would anyone choose to go into another field if they were able to do it over again? Im not sure if this question has already been posted but I could not find anything similar to this. Any input is appreciated.

I am bored with Anesthesia it is the same crap every day.

Most places you are a nurse replacement so you are treated with no respect, the surgeons want instantaneous room turn over so the lifestyle sucks, you are always being pushed to work faster. The place I am at has warm lunch in the OR doctors lounge but 2/3 of the days I never get time to eat. Heaven forbid a surgeon might have to wait five minutes between cases so you can grab a bite to eat. Plus every where you go they want you to take call. Working all night and not getting the next day off sucks but many places that’s the way they run the call schedule.

 

[huron]

I would attend CRNA school

You would be wasting a lot of time in school and not get much benefit.

4 years to get your B.S. R.N.
ONE year of mandatory ICU nursing experience.
2.5 to 3 years of CRNA school.

7.5 to 8 years to get retrained as a CRNA, going into just about any other medical specialty would be a shorter route.

 

[badgas]

You would be wasting a lot of time in school and not get much benefit.

4 years to get your B.S. R.N.
ONE year of mandatory ICU nursing experience.
2.5 to 3 years of CRNA school.

7.5 to 8 years to get retrained as a CRNA, going into just about any other medical specialty would be a shorter route.

uhhh... it was a joke. cheer up

 

[fakin' the funk]

The truth can NEVER be banned for long. The Video of Zwerling PROVES my statements about the AANA.

Blade

You are extremely annoying.

 

[VentdependenT]

I am bored with Anesthesia it is the same crap every day.

Most places you are a nurse replacement so you are treated with no respect, the surgeons want instantaneous room turn over so the lifestyle sucks, you are always being pushed to work faster. The place I am at has warm lunch in the OR doctors lounge but 2/3 of the days I never get time to eat. Heaven forbid a surgeon might have to wait five minutes between cases so you can grab a bite to eat. Plus every where you go they want you to take call. Working all night and not getting the next day off sucks but many places that’s the way they run the call schedule.

Not too late for you to go into neurosurg. Only 7 more years.

 

[bowelprep]

You would be wasting a lot of time in school and not get much benefit.

4 years to get your B.S. R.N.
ONE year of mandatory ICU nursing experience.
2.5 to 3 years of CRNA school.

7.5 to 8 years to get retrained as a CRNA, going into just about any other medical specialty would be a shorter route.

From what I see you did your math wrong. If you count the BS degree than you should count 4 years BS + 4 years med school + 4 years residency = 12 which is about 4-4.5 years more than your 4+2.5/3+1=7.5-8

 

[Monty Python]

You would be wasting a lot of time in school and not get much benefit.

4 years to get your B.S. R.N.
ONE year of mandatory ICU nursing experience.
2.5 to 3 years of CRNA school.

7.5 to 8 years to get retrained as a CRNA, going into just about any other medical specialty would be a shorter route.

No, wait, that will be 3 to 4 years of CRNA school if you attend one of the several programs already mandating the doctoral-level degree, which becomes mandatory at ALL schools by 2015.

Despite my continuous asking, I have yet to be presented with a scientific study which demonstrates statistically-significant improvement in patient care resulting from care by doctorally-prepared RNs or CRNAs. This, in the bottom line, is nothing more than a ploy for nursing schools to extract another year's tuition from SRNAs.

 

[BLADEMDA]

You are extremely annoying.

As a third year Medical Student you have much to learn about my specialty.
The whole point of my posts is to help clear up ignorance about Anesthesiology. My opinions reflect MANY private practice attendings in my State.

Blade

 

[cfdavid]

As a third year Medical Student you have much to learn about my specialty.
The whole point of my posts is to help clear up ignorance about Anesthesiology. My opinions reflect MANY private practice attendings in my State.

Blade

Blade, I wouldn't even waste my breath on this person.

 

[VentdependenT]

For those already in anesthesiology residency and beyond, would anyone choose to go into another field if they were able to do it over again? Im not sure if this question has already been posted but I could not find anything similar to this. Any input is appreciated.

I dig what I do and wouldn't change my mind.

 

[foreverLaur]

You would be wasting a lot of time in school and not get much benefit.

4 years to get your B.S. R.N.
ONE year of mandatory ICU nursing experience.
2.5 to 3 years of CRNA school.

7.5 to 8 years to get retrained as a CRNA, going into just about any other medical specialty would be a shorter route.

if you have another BS, you can get your BSN/RN in just 20 months or less. At Drexel University you can get your BSN in 11 months.

 

[cfdavid]

No, wait, that will be 3 to 4 years of CRNA school if you attend one of the several programs already mandating the doctoral-level degree, which becomes mandatory at ALL schools by 2015.

Despite my continuous asking, I have yet to be presented with a scientific study which demonstrates statistically-significant improvement in patient care resulting from care by doctorally-prepared RNs or CRNAs. This, in the bottom line, is nothing more than a ploy for nursing schools to extract another year's tuition from SRNAs.

What impact do you think these requirements will have on future SRNA recruitment?? Currently, the big "advantage" is the significantly shorter training time of CRNAs. It's viewed as a great job, well paying, yet just a masters level program.

But, I'd suspect a much different group of people willing to dedicate an additional 2 years to a degree with no promise of pay increases. In fact, if the AANA succeeds in their no-longer-so-covert aim of turning anesthesiology into a nursing profession, non-physician providers are likely to make LESS money, for more schooling....

I'm not trying to contribute to an arguement, but what are your thoughts on this? It seems that the AANA is indeed going to shoot themselves in the foot.

 

[cfdavid]

No

Really? UT, I'm suprised. What else might you consider (in MEDICINE! lol) ?

 

[bulletproof]

Really? UT, I'm suprised. What else might you consider (in MEDICINE! lol) ?

UT replied "no" in response to "If you had to do it all over again would you go into a different field?" (paraphrasing). So his response was an affirmation of his decision to choose Anesthesiology. It threw me the first time I read it also.

 

[rmh149]

What impact do you think these requirements will have on future SRNA recruitment?? Currently, the big "advantage" is the significantly shorter training time of CRNAs. It's viewed as a great job, well paying, yet just a masters level program.

But, I'd suspect a much different group of people willing to dedicate an additional 2 years to a degree with no promise of pay increases. In fact, if the AANA succeeds in their no-longer-so-covert aim of turning anesthesiology into a nursing profession, non-physician providers are likely to make LESS money, for more schooling....

I'm not trying to contribute to an arguement, but what are your thoughts on this? It seems that the AANA is indeed going to shoot themselves in the foot.

Thats a good question. I believe in the past that was one of the arguments against moving toward the doctoral level.....decreasing numbers of CRNA candidates. However, I still believe there will be plenty of the top notch, creme of the crop RN's that will still want to pursue the prestige of nurse anesthesia. Adding a year isnt going to stop these over acheivers. There will still be a 1/25 acceptance ratio for qualified candidates.

 

[cfdavid]

UT replied "no" in response to "If you had to do it all over again would you go into a different field?" (paraphrasing). So his response was an affirmation of his decision to choose Anesthesiology. It threw me the first time I read it also.

Ah, yeah, I reread it. That's good to hear from some of the younger guys.

 

[cfdavid]

Thats a good question. I believe in the past that was one of the arguments against moving toward the doctoral level.....decreasing numbers of CRNA candidates. However, I still believe there will be plenty of the top notch, creme of the crop RN's that will still want to pursue the prestige of nurse anesthesia. Adding a year isnt going to stop these over acheivers. There will still be a 1/25 acceptance ratio for qualified candidates.

You mean 2 years?? What's up?

 

[rmh149]

You mean 2 years?? What's up?

Three semesters...only a year if you attend full-time year round. Many schools are 28 months without breaks (other than christmas). Adding three semesters would make it somewhere around 36-40 months depending how they structured the coursework.

 

[pd4emergence]

If I understand correctly you are a third year med student. If that is right then it is probably too late for you to pick another profession (you may never get your loans paid off otherwise). If I had it to do over again I would think up of a great disability scheme and retire to the islands. I would probably try to get hit by a beer truck.

Seriously, I enjoy what I do. I am in a busy private practice and it can get challenging. The lifestyle is pretty good compared to the surgical specialties and subspecialties. We are busy but if we weren't we would not be making any money.

 

[Monty Python]

What impact do you think these requirements will have on future SRNA recruitment?? Currently, the big "advantage" is the significantly shorter training time of CRNAs. It's viewed as a great job, well paying, yet just a masters level program.

But, I'd suspect a much different group of people willing to dedicate an additional 2 years to a degree with no promise of pay increases. In fact, if the AANA succeeds in their no-longer-so-covert aim of turning anesthesiology into a nursing profession, non-physician providers are likely to make LESS money, for more schooling....

I'm not trying to contribute to an arguement, but what are your thoughts on this? It seems that the AANA is indeed going to shoot themselves in the foot.

I'm not sure what effect the extra semester(s) of a doctoral program will have on the applicant pool. Could go either way.

Today I reviewed the curriculum of an on-line Doctor of Nursing Practice CRNA program. The additional courses (above and beyond what's currently contained in the Master's degree program) are such things as:

-- Nursing and Healthcare Policy
-- Economics of Healthcare
-- Legal and Ethical Issues of Advanced Nursing
-- Capstone Project (in lieu of research-based dissertation)

I still don't quite see how these courses translate into better skill at difficult laryngoscopy, tighter control of vital signs, precisely-timed extubation, higher core body temperature in PACU, decreased PONV, etc.

 

[lane]

it is what it says it is - a doctorate of nursing practice. it gives them as much extra skill in practicing anesthesiolgy as earning PhD in philosophy would. it seems like nothing more than a ploy to get "Dr." pasted on the front of their name and a few dollars on their paycheck.

 

[cfdavid]

it is what it says it is - a doctorate of nursing practice. it gives them as much extra skill in practicing anesthesiolgy as earning PhD in philosophy would. it seems like nothing more than a ploy to get "Dr." pasted on the front of their name and a few dollars on their paycheck.

Though I honestly wasn't trying to lure anyone into this one, that's exactly what I thought. Trinity, it's not any offense to you, personally, but this DNP sh..t is just that. Give me a friggin break people..... WTF.

 

[foreverLaur]

i think everything is going towards doctorates. aren't PT programs going to all be DPT?

 

[cfdavid]

I'm not sure what effect the extra semester(s) of a doctoral program will have on the applicant pool. Could go either way.

Today I reviewed the curriculum of an on-line Doctor of Nursing Practice CRNA program. The additional courses (above and beyond what's currently contained in the Master's degree program) are such things as:

-- Nursing and Healthcare Policy
-- Economics of Healthcare
-- Legal and Ethical Issues of Advanced Nursing
-- Capstone Project (in lieu of research-based dissertation)

I still don't quite see how these courses translate into better skill at difficult laryngoscopy, tighter control of vital signs, precisely-timed extubation, higher core body temperature in PACU, decreased PONV, etc.

I appreciate your candor Trin. Seriously. I just don't frickin get it. (actually I do). But, I can't agree with it. It's just f..ing cheesy.

 

[cfdavid]

i think everything is going towards doctorates. aren't PT programs going to all be DPT?

Yeah, but I, again, don't really know what it entails. Nevertheless, it's more benign in that PT's don't practice in the traditional medical setting. No patient of a PT is going to mistake that PT as being the internest or orthopod. That's pretty much gauranteed.

But, the DNP is such a friggin farce. I can NOT believe we may be headed towards a "doctor nurse" paradigm.... Unreal, and it needs to be exposed for what it is.

 

[rmh149]

Though I honestly wasn't trying to lure anyone into this one, that's exactly what I thought. Trinity, it's not any offense to you, personally, but this DNP sh..t is just that. Give me a friggin break people..... WTF.

You guys are not looking at the right degree. The DNP can be acquired by any nurse practitioner. As far as anesthesia is concerned the DNP is worthless unless they just want the credentials to run a program/teach.

The DNAP is a completely different degree specific to the practice of anesthesia. This will be the new standard in the near future.

 

[cfdavid]

You guys are not looking at the right degree. The DNP can be acquired by any nurse practitioner. As far as anesthesia is concerned the DNP is worthless unless they just want the credentials to run a program/teach.

The DNAP is a completely different degree specific to the practice of anesthesia. This will be the new standard in the near future.

rmh, no doubt. But, the fact that it doesn't apply singulary to anesthesia doesn't really change things. It still sounds pretty hollow, no? You tell me.
What additional skills will be gained by such a thing? I respect you, as you know. But, what's this really all about? It's going to be very difficult for others to accept, and more importantly, to respect.

 

[pd4emergence]

We used to have a guy (CRNA) in residency that had a doctorate. He would introduce himself as Dr. so and so. It was very confusing for the patients who could not figure out why they had two doctors taking care of them. Because of this it was very frustrating for my attendings. This guy was very militant and extremely difficult to work with. This and other issues were discussed with him and he simply would not change his behavior. Somehow he ended up being in the burn room whenever he was in the OR. He eventually left. We can't forget we are still in charge. Be direct, if a nurse (and he was still a nurse) does something that is not the way you want it, tell them. If they don't like we can make it miserable for them.

One other comment, give to the ASAPAC, AMAPAC, be active in your state society and national society. The AANA has a head start re: scope of practice fights. Most of their members donate to their PAC. The number of Anesthesiologists who donate to our PAC is pitiful but we are still making strides. If every ASA member and anesthesiologist gave to the PAC we would have a huge advantage. Unfortunately to politicians money talks, I don't like it but that is the way it is.

 

[rmh149]

rmh, no doubt. But, the fact that it doesn't apply singulary to anesthesia doesn't really change things. It still sounds pretty hollow, no? You tell me.
What additional skills will be gained by such a thing? I respect you, as you know. But, what's this really all about? It's going to be very difficult for others to accept, and more importantly, to respect.

The curriculum for the DNAP is much more than what Trinity listed.

Additional skills? For a non-seasoned CRNA, absolutely. More depth of knowledge for all...I hope so. I have spoken to several schools who plan to offer the DNP and DNAP degree. The DNP isnt really that beneficial for anesthesia practice. I have narrowed my scope down to one DNAP because of their increased curiculum in pharmacology, patho-physiology, and practice research. Other options are to focus on education, practice management and entrepreneurism.

The difference is that we learn how to do anesthesia before we get our doctorate (at least till 2015)....MD/DO's get their doctorate before they learn anesthesia. What makes one better than the other....who knows. The one thing I know is there are some MD/DO's that are better than some CRNA's...and some CRNA's better than some MD/DO's. Increasing the standards for CRNA's can only be good. The more the older non-degreed CRNA's retire the better CRNA's will be overall INHO.

Keep in mind...you will never meet someone that doesnt think their doctorate is better than the other. Regardless of which one is better, anesthesia as a whole would be better if all providers were doctorate prepared.

 

[pd4emergence]

"The difference is that we learn how to do anesthesia before we get our doctorate (at least till 2015)....MD/DO's get their doctorate before they learn anesthesia. What makes one better than the other....who knows."



RMH, I will tell you what makes one better than the other. A PHD and an MD don't compare. Its like trying to compare apples and oranges. The degrees are meant for two different things. MD/DO=the practice of medicine. A PHD is not meant for the practice of medicine. They are not equal and CRNA's are not equal to Doctors (I guess I should say MD's/DO's) since the lines are getting pretty blurry. I will tell you what, go to medical school. Go through the selection process, take the MCAT, make the grades to get in. Then go through 4 years of rigorous training, 2 years of basic sciences in which even very smart people have trouble. Then 2 years of clinical medicine. Then go through the residency interview process and try to get into a residency. Then go through a general internship where you and I mean you have to make the decisions. Not just a year in the ICU where you were told what to do. Then go through 3 whole years of anesthesia training. Not just being in the OR's because that is really the easy part, but do rotation in the ICU's, deal with other physicians on a daily basis, get your patients ready for surgery and not just leave it up to the surgeon. After you finish your residency pass your written and oral boards. If after all of this you want to come back and post that the PHD where you went and took some classes, some of which may have even furthered your already short clincal experience in the OR is equalivent to an MD or DO residency trained anesthesiologist then that is fine.

 

[badgas]

"The difference is that we learn how to do anesthesia before we get our doctorate (at least till 2015)....MD/DO's get their doctorate before they learn anesthesia. What makes one better than the other....who knows."



RMH, I will tell you what makes one better than the other. A PHD and an MD don't compare. Its like trying to compare apples and oranges. The degrees are meant for two different things. MD/DO=the practice of medicine. A PHD is not meant for the practice of medicine. They are not equal and CRNA's are not equal to Doctors (I guess I should say MD's/DO's) since the lines are getting pretty blurry. I will tell you what, go to medical school. Go through the selection process, take the MCAT, make the grades to get in. Then go through 4 years of rigorous training, 2 years of basic sciences in which even very smart people have trouble. Then 2 years of clinical medicine. Then go through the residency interview process and try to get into a residency. Then go through a general internship where you and I mean you have to make the decisions. Not just a year in the ICU where you were told what to do. Then go through 3 whole years of anesthesia training. Not just being in the OR's because that is really the easy part, but do rotation in the ICU's, deal with other physicians on a daily basis, get your patients ready for surgery and not just leave it up to the surgeon. After you finish your residency pass your written and oral boards. If after all of this you want to come back and post that the PHD where you went and took some classes, some of which may have even furthered your already short clincal experience in the OR is equalivent to an MD or DO residency trained anesthesiologist then that is fine.

 

[OB1🤙]

emergence-

Well played, sir. Well played indeed.

 

[rmh149]

pdemergence.

I'm sorry...I never said it was equivalent. I appologize if you got that impression. Please read my post again...sorry I didnt make myself completely clear.

I never said anyting about a PhD. I agree with you. The PhD and DNP for that matter, IMHO wont help CRNA's become clinically more capable.

The main point I was trying to get across is that anesthesia in the US as a whole will be better when the standard to practice is a doctorate degree. Not a DNP or PhD....but specifically in anesthesia (DNAP) or medicine (MD/DO).

I dont disagree with you. I respect you for your talent and hard work you have put in to get where you are. I dont compare the two paths because they are so different. But the fact is....CRNA's are practicing anesthesia. That is not going to change anytime soon. There is nothing wrong with increasing the standards....it can only make us better at what we do.....in the end it is better for the patient.

I understand the issue of a CRNA introducing themself as a "doctor". If I were an MD/DO it would irritate the hell out of me too. In my opinion a smart CRNA would keep that in mind if he wants to get along with those he is practicing with. The ego isnt important enough to piss off everyone around you. With me.....the patient will only know if I have a doctorate degree if they ask about my credentials.

 

[BLADEMDA]

pdemergence.

I'm sorry...I never said it was equivalent. I appologize if you got that impression. Please read my post again...sorry I didnt make myself completely clear.

I never said anyting about a PhD. I agree with you. The PhD and DNP for that matter, IMHO wont help CRNA's become clinically more capable.

The main point I was trying to get across is that anesthesia in the US as a whole will be better when the standard to practice is a doctorate degree. Not a DNP or PhD....but specifically in anesthesia (DNAP) or medicine (MD/DO).

I dont disagree with you. I respect you for your talent and hard work you have put in to get where you are. I dont compare the two paths because they are so different. But the fact is....CRNA's are practicing anesthesia. That is not going to change anytime soon. There is nothing wrong with increasing the standards....it can only make us better at what we do.....in the end it is better for the patient.

I understand the issue of a CRNA introducing themself as a "doctor". If I were an MD/DO it would irritate the hell out of me too. In my opinion a smart CRNA would keep that in mind if he wants to get along with those he is practicing with. The ego isnt important enough to piss off everyone around you. With me.....the patient will only know if I have a doctorate degree if they ask about my credentials.

Okay,

Here is where the rubber meeets the road. DO YOU AGREE WITH ZWERLING?
(see the video of him in action on the sticky). YES OR NO?

Blade

 

[rmh149]

Okay,

Here is where the rubber meeets the road. DO YOU AGREE WITH ZWERLING?
(see the video of him in action on the sticky). YES OR NO?

Blade

He was incorrect with the number of years anesthesiologists are trained before practicing. Maybe in the past the residency was 3 years, but I believe they are all 4 years now....one of those years as an intern. Am I correct?

Rep. Nicholas Micozzie's wasnt really interested (or clueless) when Zwerling was spouting off the education of both doctors and CRNA's. It was funny to hear him say "yeah OK, whatever...."

The one thing that I do agree with was Zwerlings statement of not needing an anesthesiologist in the room. I have to agree with it...otherwise I would be a hypocrite since I don't work under anesthesiologists at all. Of course that pisses you off as a doctor….I understand.

I know that most (or all) of you don't agree with the idea that CRNA's are practicing without an anesthesiologist. But that's how my gig is working right now. I'm not against the ACT model. It's just not what I am doing right now.

Let me put it to you this way.....I feel comfortable with my cases that I am doing. I have yet to feel overwhelmed. But, if I had a difficult medical question and I had to choose to ask MD/DO or a CRNA (not personally knowing either one), I would probably ask the MD/DO. Because you guys are freaken smart and I realize that. But when it comes to providing anesthesia where I practice (with the exception of cardiac since I have not touched a crd case in 3 years)...both seem pretty safe to me.

OK....start the bashing! I am bracing myself.

However, please dont consider this trolling.....I only responded to those who asked.

 

[The_Sensei]

The one thing that I do agree with was Zwerlings statement of not needing an anesthesiologist in the room. I have to agree with it...otherwise I would be a hypocrite since I don't work under anesthesiologists at all. Of course that pisses you off as a doctor….I understand.

Yeah, until something goes wrong or drops off your algorithmic approach to a problem

Listen, nurse.........cuz' that IS what you are is a nurse.....don't come into this forum and disparage anesthesiologists because I'm getting tired of it.

You do your own cases?!? Big f-ing deal........you are in some sh it-water burg in Texas most likely 65 feet from the Mexican
border. Yea! You are awesome!

Dude, no one cares if you can handle some simple ASA I-III cases by yourself. Look to see who did Bill Clinton and Michael DeBakey's anesthesia........that's right - physicians. No CRNAs present - unless they were peeking in the OR window!

 

[CremeSickle]

What is a DNAP? arent he DNP and DNAP the same thing?

Anyway, i see why APNs are going doctorate prepared, everyone else is PT,OT Pharm is etc. None of these need a doctorate but all of them have it. Nursing is just slower adopting it than the other 3. Funny how noone here disparages the other 3 for doing it yet attacks APNs? If you dont agree with the APN getting a DNP (or DNAP?) then you should agree with pharms, OT, PT etc.

Many ppl are jumping to the conclusion that getting a "doctorate" be it PhD or a clinical one like PharmD, OT-D, PT-D and DNP means these people will call themselves 'Doctor' in a clinical setting. That opinion just fits with propoganda. I have met many CRNAs now who have PhDs and not one of them had it even listed on their badge let alone said they were "Dr" to me or patients, i found out by talking to them. So really, its ignorance to suggest everyone will do it b/c youve seen one do it. Lets try to avoid blanket stereotyping of an entire profession shall we?

Sensi, you say nurse as if they feel like its a bad thing. Here is a clue, they dont. Neither did i when i was one. I knew i wanted to do more than just OR work so i became an anesthesiologist in order to do critical care medicine. I never (and dont) think nursing is, in anyway, inferior to Physicians just different with a different focus and expertise.

I also like how you somehow assume that all CRNAs who practice indy. work in backwater no-where USA. Thats just not true. Where i am there are many working for plastics and GI and i live in a big city. Also, i love how you suggest that Americans who live anywhere you wouldnt want to are somehow inferior and not worth "your time", how insulting and revealing. You are clearly one who chose anesthesiology as a "lifestyle" specialty for "the money", sad in my opinion.

You have mentioned clinton and debakley on a couple of occasions. Thtas interesting since you obviously dont have a clue that neither one of them requested anyone but ppl fought over who was going to do the anesthesia to get the 'limelight'. Ie: its meaningless. If it makes it clearer, a CRNA took care of Gov. Corzine in NJ and tubed him in the trauma bay on arrival. Does that mean anything? Of course not.

I have not seen trinity or rmh 'disparage' anesthesiologists at all, in fact the only one who disparages anyone during this thread is you.

I think CRNAs can work fine without anesthesiologists. I dont feel they should be doing cases such as transplants, neuro or hearts outside the Care Team but i have no problem with them in a room doing them, essentially, at their digression with an anesthesiologist available for consult (ie: care team). The CRNAs i have worked with have been nothing but helpful and respectful to me. I have become friends with many of them. Be as political as you like but insulting an entire group of people is not only disrespectful to them, but you make all anesthesiologists look bad by your words/actions.

 

[pd4emergence]

RMH, I know there are some places where CRNA solo practice is the way it is. I don't envy you. I would not want to be in solo practice anywhere because when it hits the fan you are the only one around. Its nice to have some extra hands when it goes bad. I also wonder how it is for you when surgeon's want to do the case and you don't think the patient is ready. You may be in a good situation where all the surgeon's listen to you everytime you think a case should not be done. My guess is it's probably half and half. To me, It's really the preparation that matters, what labs to get? Does he need any consultants to see him?, Does he need a stress test?, Does he need a cath or echo?, What are we going to do with the info that we get? These are the questions I try to get answered everyday before I do a case. If they aren't I can go to the surgeon (who at least has to act like I am his collegue) and say this patient is not ready. I am not being supervised by the surgeon. There will be a note on the chart from another physician (me) that says the case will not go. I feel that there are many other reasons that supervision by a residency trained anesthesiologist is beneficial for the patient. But it all comes down to training and the fact that there are many other facets to anesthesiology than just being in the OR.

 

[rmh149]

What is a DNAP? arent he DNP and DNAP the same thing?

As I understand it, the DNP is doctorate in nursing practice (nothing to do with anesthesia) open to all advance practice nurses, NP's CRNA's, WHNP's etc. The DNAP is a doctorate in nurse anesthesia practice, more pathophysiology, pharmacology, etc. It is a clinical doctorate specific to CRNA's and only for CRNA's.

In my opinion, the DNP for a CRNA would only be advantageous to be able to run a CRNA program and teach. It doesnt help in the clinical setting at all. The DNAP will deepen our knowledge of the practice of anesthesia.

I doubt that the DNAP and CRNA's being doctors will end the anesthesia care team. There are plenty (most) of CRNA's that will still enjoy the benefits of being an employee to a group of anesthesiologists...for the reasons pd4emergence explained above.

 

[rmh149]

RMH, I know there are some places where CRNA solo practice is the way it is. I don't envy you. I would not want to be in solo practice anywhere because when it hits the fan you are the only one around. Its nice to have some extra hands when it goes bad. I also wonder how it is for you when surgeon's want to do the case and you don't think the patient is ready. You may be in a good situation where all the surgeon's listen to you everytime you think a case should not be done. My guess is it's probably half and half. To me, It's really the preparation that matters, what labs to get? Does he need any consultants to see him?, Does he need a stress test?, Does he need a cath or echo?, What are we going to do with the info that we get? These are the questions I try to get answered everyday before I do a case. If they aren't I can go to the surgeon (who at least has to act like I am his collegue) and say this patient is not ready. I am not being supervised by the surgeon. There will be a note on the chart from another physician (me) that says the case will not go. I feel that there are many other reasons that supervision by a residency trained anesthesiologist is beneficial for the patient. But it all comes down to training and the fact that there are many other facets to anesthesiology than just being in the OR.

I understand what you are saying. Yes, there are huge advantages to having more than one person around when it hits the fan. Of course there have been situations when two people are needed. During the day it is fine because there is usually another CRNA and the anesthesia techs to come assist. In a crunch, an anesthesiologist from the other group will assist (try to avoid that due to billing complications). They have helped me out once when I just put in a spinal for a CS…..before the surgeon cut, another parturient was being rushed back for a crash section. An anesthesiologist that was free at the moment came back to take over the CS while I dealt with the crash. It worked out. We help them as well…usually in the middle of the night so they don't have to drive in from home for intubations and central line placements. It's a good relationship. I enjoy working along side the anesthesiologists and wouldnt at all mind working together (ACT). But our two groups are not set up that way....I dont see it changing any time soon. As we all know, its all about the money.

As far as having to cancel the case, the surgeons we work with probably give us as much grief as anyone else. The bottom line is they want to do the case. We present to them why we cant go forward ….they understand (may not agree). I guess our relationship with the surgeons is that good. They know we are there to serve them and do anything we can to move their cases. When we have to cancel, there is a clear reason to do so.

How much is the surgeon supervising us? As far as I know, in the admission orders of the patient there is an order with the option to delegate anesthesia to anesthesiologist or CRNA. Checking that box is as far as they go…..except when they say "no torodol".

 

[CremeSickle]

Well said.


I love working with CRNAs and Anesthesiologists. The more the merrier. When the **** hits the fan u need more hands. Also, i imagine that no other anesthesia ppl to talk to would be difficult as well.

RMH, I know there are some places where CRNA solo practice is the way it is. I don't envy you. I would not want to be in solo practice anywhere because when it hits the fan you are the only one around. Its nice to have some extra hands when it goes bad. I also wonder how it is for you when surgeon's want to do the case and you don't think the patient is ready. You may be in a good situation where all the surgeon's listen to you everytime you think a case should not be done. My guess is it's probably half and half. To me, It's really the preparation that matters, what labs to get? Does he need any consultants to see him?, Does he need a stress test?, Does he need a cath or echo?, What are we going to do with the info that we get? These are the questions I try to get answered everyday before I do a case. If they aren't I can go to the surgeon (who at least has to act like I am his collegue) and say this patient is not ready. I am not being supervised by the surgeon. There will be a note on the chart from another physician (me) that says the case will not go. I feel that there are many other reasons that supervision by a residency trained anesthesiologist is beneficial for the patient. But it all comes down to training and the fact that there are many other facets to anesthesiology than just being in the OR.

 

[cfdavid]

rmh, will the extra 2 years of course work and/or didactics etc. to complete the DNAP be done consecutively and full-time?? In other words, will there be an additional 2 years of true opportunity cost?

Or will this thing be something you guys do at night and weekends, while maintaining your jobs, full or part time?