crna making 120000 to 180000

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pleas, stop this thread.
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Actually the increased safety in anesthesia is largely atributable to one thing.....the pulse oximeter. Followed closely by all the other advances in technology and pharmaceuticals.

Hey! since the engineers and pharmacologists have advanced the profession so far, maybe they should be the ones to provide anesthesia!

At any rate, another point to ponder is that there has been no large scale study to evaluate overall morbidity and mortality. The study quoted in to Err is Human (1:200,000) was based on an extremely small population sample at one hospital. While I am sure that anesthesia is safer today then it was 20 years ago, who knows how much safer, relatively speaking.
 
Wow I have been gone a week and this silly and *****ic topic is still up!!

Mr. Sandman, PT=ROM is the same as RN=CB (change bedpan)
Both are incorrect, but each is a job of the noted profession.

As for clavicula...what are you talking about??? Once again, is this nursing anatomy? Do you mean the uvula?
 
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All I can say, is thank GOD for RNs, PTs, CRNAs, NPs, and PAs, because if every new doc on this board is a reflection of our future, watch out!! I've never seen such arrogance and greed in all my life!!!!!!!!!!!!!!!!!!! I admit, not everyone here is like that, however, most of the replies to this post have been overwhelmingly crued and greedy. Thank GOD there are other health care professionals in the world to take care of patients, because from what I see here, our future is dark!!!!!
 
Speaking of arrogant statements.....
 
Vocab Lesson:

Arrogance----

1) Having or displaying a sense of overbearing self-worth or self-importance.
2) Marked by or arising from a feeling or assumption of one's superiority toward others

Where do I speak of self importance or surperiority of others!!!!!!!! NEVER!!!!!!!!!!
 
The clavicula is just another name for the clavicle (according to Stedman's)
 
KYSUNS, what are you talking about?? Drink some tea have a nice rest, use your inhaler. The most arrogant people I have ever met were allied health professionals!! I know, because I used to be one...medical school added humility.

I would challenge anyone to call the clavicle a "clavicula" to any orthopod, physiatrist, rheumatologist or anatomy professor...and expect to NOT be laughed out of the room.
I believe Mr. Sandman made a mistake.
 
I'm not speaking to anyone specifically, just the way this whole thread has gone in general. Arrogance in that you think your GOD b/c you went to med school. Studies have shown that LENGTH of education does not measure intelligence. Yes, you may have studied medicine for 4 years + 4 years + whatever straight, does that mean I'm dumb b/c I'm not a doctor? No... For example, my friends decided to have a sleep over and take each others IQ's. All my friends are 4th yr MD students and I'm the only one that isn't. Some of them are looking into psych, so, they brought home some "official" IQ tests. well, guess who scored the highest at 183???? Not them I assure you!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! So...Please don't label people as stupid b/c they didn't spend countless time and dollars in school focused on medicine. That's all I'm saying to each of you.
 
LOL, somebody has an inferiority complex...
 
I just have to add a little story to this immortal thread.

I'm from Denmark. I was doing a surgical clerkship in a hospital that was being evaluated (for some odd reason) by an American accreditation service. It was a stressful day when the three female evaluators floated around the wards. They looked in trash cans, asked the cleaning ladies what they would do to the patient in Room 8 if world war three broke out. Questions like that.

Well, we were on our way to high marks when, in the ICU, they see a nurse giving a patient morphine. Ha, I never saw this myself but they went on and on about how a nurse wasn't trained to administer potent analgesics. This is something nurses do everyday here so the nurses got very bitchy and almost went on strike. The hospital administrator was sweating beads and pleaded with the Yanks that that was how we did things here. They finally backed down. OVER MORPHINE!?! The nurses kept bitching about all them crazy laws in the US and how everyone sues each other. It was hilarious.

But having read this thread (okay, some of it), I'm a little confused about what these evaluators talked about. All you nurses seem well-equipped to administer morphine.

One thing though.... I'm reading through this McHugh persons posts and I'm picturing this hot nurse (prolly going commando under her gown) and she's all opinionated (when she's not busy tanning at the topless beaches). Umm, talk trash to me, baby.

Then it's signed Kevin!! Whatsupwiththat?
 
•••quote:•••Originally posted by Ryo-Ohki:
•What would happen if new cnra schools are started because of increased demand for cheaper labor? Hmmmm....

You seem angry, my friend. Why is that?•••••Actually, there is a push to create (a few) more schools that produce CRNA's. The problem, among others, is the accreditation is very difficult. Therefore, there has been only one new school started in the US in the last five years or so that I am aware of.

I'm not angry. I don't think I even appear angry. I think my arguments have been well thought out, complete, and well stated, as others on the board have noted. On the other hand, you seem quite angry about CRNA's, and keep making that known. So, a couple of very direct questions. I'm asking for very direct answers, that are supported by logical reasoning. Feel up to the challenge?

1. Should CRNA's even exist? If not, who does anesthesia in the near term in rural areas? Bear in mind, flooding the market with anesthesiologists isn't really feasible, considering the number of residencies available annually. Also, if such a flood were possible, it would likely drive down the salaries of all MDA's.

2. You've made it quite clear that you believe CRNA's make too much. Why do you believe that? Is it simply because they didn't go to school as long as you have? How much is a reasonable salary for a CRNA? What reasonable support can you offer for lowering the salary of CRNA's?

Now, that's a pretty direct way to ask Ryo-Ohki those questions, with no beating around the bush. The only question left is can you answer them?

Kevin McHugh, CRNA
 
•••quote:•••Originally posted by Ryo-Ohki:
•LOL, somebody has an inferiority complex...•••••Or perhaps someone has a superiority complex, deserved or not.

Kevin McHugh, CRNA
 
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•••quote:•••Originally posted by BellKicker:
•One thing though.... I'm reading through this McHugh persons posts and I'm picturing this hot nurse (prolly going commando under her gown) and she's all opinionated (when she's not busy tanning at the topless beaches). Umm, talk trash to me, baby.

Then it's signed Kevin!! Whatsupwiththat?•••••Sorry, Bellkicker. I'm 6'4" tall, weigh about 275, and sport a mustache. I do go topless when I can get to the beach, but I'd hope that would not bring you any excitement. I did spend a number of years in the US Army, and did "go commando" to one degree or another, though.

Kevin McHugh, CRNA
 
No, KYSUNS definitely has a inferiority complex. Poor kid.
 
•••quote:•••Originally posted by KMcHugh:
I'm 6'4" tall, weigh about 275, and sport a mustache. I do go topless when I can get to the beach, but I'd hope that would not bring you any excitement. I did spend a number of years in the US Army, and did "go commando" to one degree or another, though.

Kevin McHugh, CRNA[/QB]••••Fantasy and excitement is officially off :) I'm thinking about sporting a mustache myself; they are really coming back in style!
 
Well, Ryo-Ohki? The questions are still on the table. You feel up to answering? Or has all that extra education left you ill prepared to enter reasonable debate?

Kevin McHugh, CRNA
 
•••quote:•••Originally posted by BellKicker:
•

Well, we were on our way to high marks when, in the ICU, they see a nurse giving a patient morphine. Ha, I never saw this myself but they went on and on about how a nurse wasn't trained to administer potent analgesics. This is something nurses do everyday here so the nurses got very bitchy and almost went on strike. The hospital administrator was sweating beads and pleaded with the Yanks that that was how we did things here. They finally backed down. OVER MORPHINE!?! The nurses kept bitching about all them crazy laws in the US and how everyone sues each other. It was hilarious.•••••I don't know what they were talking about with morphine. Nurses on every flooer, ICU or not give morphine on a daily basis here in the US. Maybe the person giving it was not an RN but a less trained professional (we call them Certified Nurses Assistants - CNAs in the US. Not to be confused with CRNA.)
 
Inferiority complex? Why? Because I'm not a MD or a MD student? I live in a world where no one is better or worse than anyone else, so to say I'm inferior or superior to anyone is an understatement. I am EQUAL!!!!!!!!!!!!! It's the majority of the MD students that think they are superior......
 
•••quote:•••Originally posted by Whisker Barrel Cortex:
•
I don't know what they were talking about with morphine. Nurses on every flooer, ICU or not give morphine on a daily basis here in the US. Maybe the person giving it was not an RN but a less trained professional (we call them Certified Nurses Assistants - CNAs in the US. Not to be confused with CRNA.)•••••Hi Whisker Barrel Cortex.

I'm sure I didn't get the full story. I do know it somehow involved morphine. But the anger was directed at how the accreditors were asking "you let NURSES do THIS?"

I'm pretty sure they were fully fledged nurses. I still haven't got my US heatlh care acronym badge but I do know CNA and CRNA.

Later.
Click to expand...
 
I live in a world where no one is better or worse than anyone else,
KYSUNS,
Where is this...Fantasy Island? Give me a break, just by saying "I took an IQ test and mine was the best at 183" was trying to prove that you WERE better (but yet no one knew...wiping tears from your eyes).

So what, people show some pride in their acheivements...if you don't like what they have to say, get OFF THE BOARD! This is called the STUDENT DOCTOR NETWORK! There are ALWAYS people who think their training is greater or better than others...just ask PT's about PTA's, or RN's about LPN's, or OT's about COTA's, Lawyers from Harvard vs paralegals from U of Illinois, or Union Electricians about non-union, or CPA's about non-CPA's...each group has pride in their accomplishments and usually fights to maintain their designated rights!
This can be found in every nook and crany in American Culture and throughout the world.
So give me a break with your "fantasy island" view of reality.
 
Your reply greatly proves my point. What an egotistic, superior, rude, hateful, and unprofessional response!!! I don't live in a fantasy world. I know that there will always be someone who thinks they are better, smarter, richer, prettier, etc than me. My point is that YOUR putting peoples lives in your hands, so shouldn't you set an example for the rest of the world? Do CPAs and Paralegals hold lives in their hands? NO… That is the problem with this world today, professionals like you that have a "better than GOD" attitude. I'm not saying have pride in your achievements and work, BE PROUD!!! I'm very proud of everyone here that has the guts and stamina to spend countless years of their lives dedicated to medicine, but why have such a shi@@y attitude about yourself? Why feel you are better than the rest of the hospital staff b/c your badge says MD and not "RN, CRNA, PT, etc"???? I guess almost dying of a brain tumor at 16 and again at 26 puts a whole new perspective on the world. Hopefully, your choosing a speciality that doesn't require much bedside manner.
 
KYSUNS, Typically I do not engage in banter in this forum.. but I cant resist. The problem is your thinking is encompassed within the thinking of those replying to your posts. What I mean is no one is actually arguing who is BETTER than who, the underlying argument is really who is BETTER PREPARED. A typical nurse could probably get through medical school, obviously this does happen. So it is not a matter of ABILITY it is a matter of ACHIEVEMENT. This is not 19th century Russia. So no one is telling you what you have to do for an occupation. Dont rely on the comments of others justify your placement or acceptance in society. Since we live in a market society POTENTIAL means nothing. You need to see a Nike commercial or two. You need to be satisfied with your station in life or change it. Just to get to the nursing level is something to be commended, so you are currently disgracing the profession of nursing because most of them have achieved what they wanted to achieve. Dont think that just because you have the ability to work as a physician and could engage all the rights and responsibilities means you should be granted those rights without having to travel the path we take. So, while your "equality" issue holds up well among PEERS and in society, it does not hold up in occupation.

PS-I would want an arrogant snotty physician over a passive-aggressive "I can do it too!" mid-level provider any day.
 
Point Taken. I guess my whole point was this:

1) Do what you like
2) Do it well
3) Be proud of it
4) DON'T act superior or inferior to others and their professions
5) Have respect for others and their opinions
 
By the way, I dont remember saying I was a RN or RN student, for all anyone knows I could be the Medical School Dean of Harvard :)
 
KYSUNS, you are so far off base... Your responses are so filled with anger and spite, I wonder what your occupation actually is? Why are you even on this board?
When did I say I was better than anyone else? I know that when I went from being PT to medical school graduate, I have learned more than I EVER could have when I was merely a therapist. Going through that training and then graduating offers particular rights...those that do not (nor should they) belong to a therapist. I can say this because I have graduated from both PT and Medical School.
And for you to assume anything of me based upon my response to your naive, ill tempered, and ridiculous posts...proves only that I should have my head examined just for RESPONDING to you.
 
"naive, ill tempered, and ridiculous posts"

Whatever...

Maybe you should have your head examined b/c you obviously have some anger management issues!
 
•••quote:•••Originally posted by KYSUNS:
•By the way, I dont remember saying I was a RN or RN student, for all anyone knows I could be the Medical School Dean of Harvard :) •••••You can not be the 'Medical School Dean of Harvard' since no such title exists. However, I suppose it is remotely possible that you could be the Dean of Harvard Medical School.

-SW
PS: Veritas!
 
the fact that Anesthesiology is getting all this attention is a testable that it is fast becoming not only popular again, but that it will lead to increasing competition.

i am also confident that anesthesiology will always be around as it has proven through the years. it is also subject to my lulls than other specialties, but history shows that anestheiologists have always enjoyed some of the highest pay of any medical specialists and will continue that way. But, I also agree students should not go into it for money...b/c you should do it only if you love the field...the money is a secondary benefit. There are other specialties you may like and still have the lifestyle and money.
 
Dear gasdoc,

I just sent you a Private Message.
 
•••quote:•••Originally posted by KMcHugh:
• •••quote:•••Originally posted by Ryo-Ohki:
•What would happen if new cnra schools are started because of increased demand for cheaper labor? Hmmmm....

You seem angry, my friend. Why is that?•••••Actually, there is a push to create (a few) more schools that produce CRNA's. The problem, among others, is the accreditation is very difficult. Therefore, there has been only one new school started in the US in the last five years or so that I am aware of.

I'm not angry. I don't think I even appear angry. I think my arguments have been well thought out, complete, and well stated, as others on the board have noted. On the other hand, you seem quite angry about CRNA's, and keep making that known. So, a couple of very direct questions. I'm asking for very direct answers, that are supported by logical reasoning. Feel up to the challenge?

1. Should CRNA's even exist? If not, who does anesthesia in the near term in rural areas? Bear in mind, flooding the market with anesthesiologists isn't really feasible, considering the number of residencies available annually. Also, if such a flood were possible, it would likely drive down the salaries of all MDA's.

2. You've made it quite clear that you believe CRNA's make too much. Why do you believe that? Is it simply because they didn't go to school as long as you have? How much is a reasonable salary for a CRNA? What reasonable support can you offer for lowering the salary of CRNA's?

Now, that's a pretty direct way to ask Ryo-Ohki those questions, with no beating around the bush. The only question left is can you answer them?

Kevin McHugh, CRNA•••••Ryo-Ohki: We are anticipating a reply to the above question. It's only common courtesy that you at least respond in a manner that is expected of the profession.
 
Kevin, apparently he has no logical, clear, meaningful answer to those questions, b/c if I remember correctly, he didnt bother to answer them the last time you asked!! Ughh..
 
Well, I have waited two or three days, and it is rapidly becoming apparent that Ryo-Ohki isn't going to respond to my questions. I can only conclude that s/he made the original arguments out of emotion, rather than reason. But, we all do that from time to time. For each of us there is an issue that hits us in the gut, and for which we have strong emotional feelings. We cannot always support those feeling logically, but we know we have the response, anyway. The trick is knowing the difference.

Kevin McHugh, CRNA
 
Thought I'd get around to a couple of older thoughts.

MacGyver posted a while back:

"Do you think there are circumstances when only an MDA should be allowed to run the anesthesia (i.e. very complex, serious cases) or do you think CRNAs can handle (on their own) absolutely anything that the hospital can dish out to them?"

I asked the question once, though maybe I was not as clear as I thought. What kinds of cases are you referring to? What kind of case is so complex or serious that it requires the attention of an MDA over a CRNA? There are cases that cannot be handled by one CRNA, but those same cases cannot be handled by one MDA. If you have done anesthesia, you know that there are times where two sets of hands, or even more, are required at the head of the table just to keep the patient alive. And when you find yourself in that situation, you won't care if the extra set of hands belong to a CRNA or an MDA. It's kind of like a saying we had in the military: In a firefight, there are no racists. You WILL just be happy to have the help, where ever it comes from. So, again, what cases are you referring to?

Gasdoc posted:

"And, furthermore, CRNA salaries will never match anesthesiology salaries. That's just the way it is."

And in a later post:

But, you must see it from my point of view as a doctor when there is a minority of CRNAs who openly espouse independence, separation, and total equality between the anesthesiologist and nurse anesthestist. True I don't have the knowledge or experience that you or other CRNAs who have been practicing a long time have, but it still seems unfair, tragic, and even professionally stupid for some CRNAs to openly say that they are as good as any anesthesiologists out there. And, I am not the only MD who feels insulted. If you look at the ASA site, there are numerous comments made by established anesthesiologists at how dismayed and insulted they are by the arrogance of some CRNA's.

First, there are CRNA's out there making $250K a year and more, or about what an anesthesiologist makes. Why? Because they work in areas where there are no MDA's. They are practicing anesthesia independently, separately, and equally. And, just to be sure you understand this point, CRNA's practicing independently can bill for their services AT EXACTLY THE SAME RATE as MDA's. When doing the billing, the insurance company (and medicare, in states that have opted out of the supervision clause) does not discriminate between who provided anesthesia services, MDA vs CRNA. They simply pay at the rate predetermined for that anesthetic procedure.

I think the argument about who is better, who is safer, etc, is silly. It ignores the simple fact that CRNA's and MDA's arrived at where they are at by entirely different paths. Therefore, it's very difficult to compare them. Yes, the schooling an MDA has received was longer, and IN SOME SUBJECTS, more in depth. But, the training a CRNA receives in school is anesthesia specific. How many classes in med school are specifically about the administration of anesthesia? Another difference: When I, as a student CRNA, administered my first anesthetic, I already had three years of caring for intensive care patients under my belt. The average MDA resident, doing his/her first anesthetic, does not have that experience. Does that make the nurse better? No, no more so than the extra schooling makes the MDA resident better. Just different experiences. As I have said, those of you who are saying a CRNA can't clinically do all the same things an MDA does are blind to current events.

Kevin McHugh, CRNA
 
After reading some of the posts...not all...too numerous between doctors/medical students/CRNA students/CRNAs, etc, I have come to one CERTAIN conclusion:

THERE WILL ALWAYS BE "FRICTION" AND "HOSTILITY" BETWEEN ANESTHESIOLOGISTS AND CRNA'S. I doubt that there will be friction when they are working side-by-side in the OR, but I am certain that the fight will go on in congress and in public statements, including those between the two warring associations of the anesthesiologists and CRNA. Its unfortunate, but when it comes to scope and practice and money, that's just how it will always be. Just like communism and capitalism, water and oil, night and day, the two professions will never be harmonious and mixed.
 
Kevin,

To answer your questions (in Rho's placec I suppose):

1. Should CRNA's even exist?

Absolutely, because frankly there aren't enough physicians to cover the cases, and physicians refuse to practice rural anesthesia. So therefore there needs to be another provider.

If not, who does anesthesia in the near term in rural areas?

Same point as above. Though by using the track that you and others have posted, I could get an anesthesiology assistant to also cover those cases. They are trained specifically in anesthetics and can be trained well enough to deliver anesthesia. Disregarding number of AA programs, or class size etc, you would have to concede using your own argument that AA's can deliver anesthesia in rural areas. Medicare has just not allowed independant reimbursement of these professionals yet. They might have to at the current rate of nursing shortage.

Bear in mind, flooding the market with anesthesiologists isn't really feasible, considering the number of residencies available annually. Also, if such a flood were possible, it would likely drive down the salaries of all MDA's.

Well, it would both drive down the salaries of MDA's and limit the number of CRNA positions that are available, correct? If a physician is willing to take a lower salary, then is there an economic argument to having a CRNA? And it may no actually drive down the salary; only the salary in respect to hours of service performed. It would almost certainly reduce the need for additional anesthesia providers. So, in response, true but not completely.

2. You've made it quite clear that you believe CRNA's make too much. Why do you believe that?

I think in deference to my physician collegues, that their dander is raised because there are physicians that don't make as much as CRNA's. They have to take it in perspective to that market. That is their problem with actualization. But salary discrepency in medicine is a rampant problem, that would really only be solved by unionization...but because some of us naively assume that we will be looked out for by the powers that be solely because we are healers and/or that the government will someday miraculously remove anti-trust exemption for physicians, we take it. That's our fault not the CRNA's. You guys are just getting what the market demands.

Is it simply because they didn't go to school as long as you have?

Well, their path of entrance and movement and achievement is easier wouldn't you agree. I believe your achievements and accomplishments are the exception not the rule. So, I think it's understandable (maybe not logical but understandable) that people who are physicians would feel that getting to be a CRNA did not require as much effort as becoming a physician, and therefore should not be remediated as such. Is that logical? Probably not, but it's understandable I believe. Needless to say, if you saw an AA making more than a triage nurse...you might be mildly chagrined. I believe the analogy applies here as well.

How much is a reasonable salary for a CRNA?

That's a hard question to answer. Almost as hard as what can't a CRNA do. Well, what can't a nurse do. I have friends who are paralegals for 20 years and honestly, know the law better than most anyone I've ever known. In life experience is the best teacher. But, the free market works by credential. Therefore all I can say is a CRNA can make whatever salary they want; it just shouldn't be higher than an MDA in the same market working the same hours. Reasonable, don't you think?

What reasonable support can you offer for lowering the salary of CRNA's?

Their credentials are not as well paid for as an MDA's. Therefore they should make less than an MDA delivering the same service. Let me explain that statement. If I had a PA read a pathology slide, and I had a physician read a pathology slide there may not be a difference 90 percent of the time. But the reality is, that there is a difference 10% of the time (or maybe even less who knows). Now, this is where professional liability comes into play. Do you believe that people get malpractice to prevent a 100 mistakes or just one mistake. My belief is that it is to prevent AT LEAST one mistake. In the same sense, I believe a physician delivering a similar service to a CRNA should be able to bill more. Is that arrogant? I assume that's based on perception. But then it begs you to ask the question, why do you pay a lawyer from a top firm more per hour than the district attorney. Because there is that one time when you're really up S creek, and the trial lawyer is the only one with the paddle (or at least a paddle that can get you out of the mess). Like I said Kevin, I believe you are the exception not the rule. Not because other CRNA's can't be as good, but because they may not have the passion you do. All things being equal, you should pay more for the credential than that which does not have the credential, and that should be the system. And in relation to anesthesia, as all other fields of medicine it will be.

Overall, I still believe that it is not the quantity of care, or what happens 95% of the time; it is the one time something goes wrong, and the quality of care that matters in the end. Do I believe that CRNA's aren't as good as MD's? Well do I believe PA's don't have the capacity to do procedures that family docs do? No, I believe procedural is procedural. I believe you can teach a radiation therapist to deliver radiation, a surgery tech to remove a gallbladder, etc, etc. BUT, I BELIEVE A PHYSICIAN IS AROUND FOR THE EXTRAORDINARY NOT THE ORDINARY. Not because he's smarter, but because he is more well trained in the application. Like I said Kevin, I believe you are the exception. The reason is because, there is no premium placed on nurses having more theoretical knowledge of anesthetics and outcomes. They get paid to do procedures by and large. The nurses who have a passion for it, learn and study more and dedicate time to that knowledge. WHETHER A PHYSICIAN LIKES IT OR NOT, HE IS COMPELLED TO LEARN THEORY AS WELL AS PRACTICE, and that is what separates the two. I hope you see why that is, and I believe you do. I can't comment to the fairness of it; I can just tell you that it is my personal belief that regardless of whether the PA and a pathologist had the same amount of experience, I would want a pathologist reading my slides if I had the option or the choice. Not because of the 99 times that things go right, but for the one time something goes wrong, and only his theoretical knowledge can tell me why. Is that fair, or do you believe that argument is flawed? Because if you do, then you need to contact the AMA and tell them to shorten our residencies and let us get to the billable labor of private practice earlier. Because our additional knowledge serves us no benefit, and I believe you and I both agree that this is not the case.

Thanks for your insightful comments, and I await your reply.

Sincerely,

Brownman
 
Brownman

I'll respond to your post, but first, a point or two. I believe you and I are in agreement on two fundamental points. First, that CRNA's should exist, and do perform a vital service in health care. Second, CRNA's are not overpaid. Your points about the market determining the value of services were exactly correct. If tomorrow somehow, the market were flooded with CRNA's, then CRNA salaries would decrease. I would not like it, but there would be little I could do about it. As you said, simple economics. I do appreciate your well thought out, intelligent posts.

On to your post. I've done a little editing for the sake of brevity, though I fear I have only succeeded in giving brevity a passing nod.

"Though by using the track that you and others have posted, I could get an anesthesiology assistant to also cover those cases. They are trained specifically in anesthetics and can be trained well enough to deliver anesthesia. Disregarding number of AA programs, or class size etc, you would have to concede using your own argument that AA's can deliver anesthesia in rural areas. Medicare has just not allowed independant reimbursement of these professionals yet. They might have to at the current rate of nursing shortage."

The AANA has come out strongly against AA's. I have not fully made up my mind, though the AANA makes some good points. The CRNA, before ever beginning school, has experience dealing with critically ill patients, since a minimum of one year's ICU experience is a prerequisite to all CRNA programs. The MDA, before ever beginning residency, must complete medical school. The AA is required to do neither. There is some justification, therefore, to saying that AA's have neither the experience nor education of CRNA's or MDA's.

But, you miss one other critical point. The license of the AA is dependent. In other words, the AA must practice under the supervision of an MDA. CRNA's, on the other hand, are independently licensed. In fact, all RN nursing licenses are independent. Any nurse can practice nursing, without the supervision of a physician. At the level of the bachelor's prepared RN, this has little consequence. Once the nurse is an advanced practitioner, however, the consequences of this independence are manifest. The AA, like all other PA's, has a dependent license. S/he must practice under the auspices of a physician. So, on that legal point, your argument fails.

"Well, it would both drive down the salaries of MDA's and limit the number of CRNA positions that are available, correct? If a physician is willing to take a lower salary, then is there an economic argument to having a CRNA? And it may no actually drive down the salary; only the salary in respect to hours of service performed. It would almost certainly reduce the need for additional anesthesia providers. So, in response, true but not completely."

Point taken. However, as I, you, and others have pointed out, the economic argument is spurious. CRNA's practicing independently bill at the same rate for their services as MDA's.

"Well, their path of entrance and movement and achievement is easier wouldn't you agree. I believe your achievements and accomplishments are the exception not the rule. So, I think it's understandable (maybe not logical but understandable) that people who are physicians would feel that getting to be a CRNA did not require as much effort as becoming a physician, and therefore should not be remediated as such. Is that logical? Probably not, but it's understandable I believe. Needless to say, if you saw an AA making more than a triage nurse...you might be mildly chagrined. I believe the analogy applies here as well."

Actually, I'm not the exception. All CRNA's attend master's level programs to become what they are, and most are very skilled and knowledgeble. Note, I did not say all, but then not all MDA's are highly skilled and knowledgeble, either, are they? It is also true that all of us, regardless of education, knowledge, or experience, is subject to the "brain fart." We are human, and can all make mistakes. I am a relatively new CRNA. For an MD to say s/he deserves more, from my viewpoint, IS understandable, but as you say, probably not logical. Each of us secretly believes we have done different things, have some innate ability or skill that makes us more than those around us. Most of us don't proclaim our secret belief, but at some level, it is there anyway. I won't say the path of entrance and achievement for a CRNA is easier than for an MD, but it is fundamentally different. I've highlighted some of those differences in earlier posts. Does that make the MDA better prepared to deliver an anesthetic than the CRNA? Each of us has our own opinions on that topic. Actually, AA's do make more than triage nurses (if I understand what you are referring to). The ER triage nurse is paid at the level of all other staff nurses, depending on experience. Where I live, that's between 30K and 50K a year. The last time I looked, a new graduate AA could expect to make about 70K right out of school. Of course, I last looked about three years ago. That may have gone up since then.

"I have friends who are paralegals for 20 years and honestly, know the law better than most anyone I've ever known. In life experience is the best teacher. But, the free market works by credential. Therefore all I can say is a CRNA can make whatever salary they want; it just shouldn't be higher than an MDA in the same market working the same hours. Reasonable, don't you think?"

You are correct, ours is a credential based society. Every profession, from auto mechanics, to physicians, has varying levels of professional certification. Each encourages the public to seek out the professional with the certification, and those with the certification earn higher salaries than those without. This is a simple fact of economics. To ask whether it is reasonable or not is like asking whether it is reasonable that the sky is blue. Reasonable or not, it is what it is. Whether the CRNA makes less, more, or the same as an MDA in the same market is equally a function of economics. As I pointed out earlier, an MDA fresh out of residency will often have difficulty breaking into a market that has been the domain of an all CRNA group. Surgeons, like all of us, are largely creatures of habit. The CRNA group is known to them, and they to the group. Preferences on both sides are well known. The new MDA has a very difficult time competing. Additionally, the new MDA generally does not have the experience of the CRNA group. Again, it is what it is. All that said, I agree with your fundamental premise, that a CRNA working in a market should not make more than an MDA in the same market, "all other things being equal."

"In the same sense, I believe a physician delivering a similar service to a CRNA should be able to bill more. Is that arrogant? I assume that's based on perception. But then it begs you to ask the question, why do you pay a lawyer from a top firm more per hour than the district attorney. Because there is that one time when you're really up S creek, and the trial lawyer is the only one with the paddle (or at least a paddle that can get you out of the mess). Like I said Kevin, I believe you are the exception not the rule. Not because other CRNA's can't be as good, but because they may not have the passion you do. All things being equal, you should pay more for the credential than that which does not have the credential, and that should be the system. And in relation to anesthesia, as all other fields of medicine it will be."

Again, arguing this point is like arguing the reason for the sky being blue. It is what it is. I have no qualm with MDA's being paid more than CRNA's when both are working in the same group. However, I differ on billing. Let's say that I and an MDA both perform an anesthetic for a patient undergoing a lumbar laminectomy. The outcome in both cases is the same, and both patients are well cared for (which I believe is true for the vast majority of anesthetics, whether delivered by an MDA or a CRNA). Why should I not be able to bill at the same rate? Your argument of paying lawyers is not applicable. Both lawyers have the same credential. You pay more to the top law firm because of a proven track record of winning cases, not for greater credential. Using this analogy, the anesthesia provider with the best track record, not the highest credential, should be highest paid. That's a true free market economy. However, payment for any medical service is capped by what medicare or the insurance company will pay. As I have said, I work for an anesthesia group owned and operated by anesthesiologists. In return for the anesthesia services I provide, I am paid a salary. That salary is lower than the income I generate through billing for the group, and less than the anesthesiologists that work in the same group. That's more simple economics. If I wanted, I could earn two to three times my current salary by leaving the urban area to work in a more rural community. I don't currently want to do that. In addition to my salary, my working for an anesthesia group relieves me of a large number of headaches. I don't have to worry about my malpractice insurance, my own health care coverage, or deal with the headaches of billing, among other things. And, as I have said, I am backed up by anesthesiologists with a ton of experience. But, the bottom line, where I work and how much I earn is, within limits, my choice. I want it to stay my choice.

"BUT, I BELIEVE A PHYSICIAN IS AROUND FOR THE EXTRAORDINARY NOT THE ORDINARY. Not because he's smarter, but because he is more well trained in the application." … "The reason is because, there is no premium placed on nurses having more theoretical knowledge of anesthetics and outcomes. They get paid to do procedures by and large. The nurses who have a passion for it, learn and study more and dedicate time to that knowledge. WHETHER A PHYSICIAN LIKES IT OR NOT, HE IS COMPELLED TO LEARN THEORY AS WELL AS PRACTICE, and that is what separates the two. I hope you see why that is, and I believe you do. I can't comment to the fairness of it; I can just tell you that it is my personal belief that regardless of whether the PA and a pathologist had the same amount of experience, I would want a pathologist reading my slides if I had the option or the choice. Not because of the 99 times that things go right, but for the one time something goes wrong, and only his theoretical knowledge can tell me why. Is that fair, or do you believe that argument is flawed? Because if you do, then you need to contact the AMA and tell them to shorten our residencies and let us get to the billable labor of private practice earlier. Because our additional knowledge serves us no benefit, and I believe you and I both agree that this is not the case."

If it is true that the physician is around for the extraordinary, not the ordinary, and that the training of the physician makes them more well versed in the application, why have residencies at all? Because med school gives the theoretical foundation for the practice of medicine. Unfortunately, the theoretical foundation is useless without experience. See my earlier example about the residents at the code. The AMA has discovered the best way to get that experience in a manner as safe as possible for both the physician and the patient is in the controlled environment of the residency. Knowledge must be tempered by experience. The CRNA, before ever beginning school, gets theoretical knowledge in nursing school, and experience working in the ICU. Once school is started, the CRNA student can expect a much more in depth, more difficult course of study in both theory and practice of anesthesia. Whatever your beliefs about me, the fact is I learned nearly all my theoretical knowledge in school. I firmly believe no one should perform an anesthetic without a foundation in the science that makes anesthesia work. So does the AANA, and that's why the requirements for what must be taught are so stringent.

Let me provide a simple example. In nearly every general anesthetic I do, I use a heat and moisture exchanger in the circuit. I know that it takes about 20 minutes for the HME to heat up and really provide for some conservation of heat, but it only takes about three breaths before it begins to conserve patient fluids. I am also fully aware that use of an HME involves a trade off. In exchange for the conservation of heat and humidity, I am increasing resistance in the breathing circuit, causing the patient to work harder to breathe. Resistance is one of the fundamental principles of physics that underlies breathing and mechanical ventilation. Knowing this, as we near the end of the case and I am trying to get the patient to breathe independently again, I often remove the HME from the circuit. I am particularly careful to do this with elderly patients or patients with COPD. They have a tough enough time as it is. I learned these theoretical principles in my CRNA master's program, not through self study. I have seen these theoretical principles at work in my practice. The point is that CRNA's are equally compelled to learn theory in school.

Your example of the PA versus the pathologist is not a good example. The PA does not have either the education or experience that a pathologist has. Let's make it a bit closer to home. Suppose you needed an aortic valve replacement. Who would you rather have perform the anesthetic, an MDA fresh out of residency, or a CRNA with 10 years of experience in open heart surgery? Personally, I'd take the CRNA. His/her experience is what has prepared him/her for the "zebra." While in school, I performed anesthetics for nearly 100 open heart procedures. I have had a large number of both residents and MDA's tell me that I gained far more experience with open heart patients than they did in their residency. Experience, even in the most complicated cases, is the real teacher. The AMA knows this, and this is why a residency is required.

Kevin McHugh, CRNA
 
•••quote:•••Originally posted by KYSUNS:
•No... For example, my friends decided to have a sleep over and take each others IQ's. All my friends are 4th yr MD students and I'm the only one that isn't. Some of them are looking into psych, so, they brought home some "official" IQ tests. well, guess who scored the highest at 183???? Not them I assure you!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! So...Please don't label people as stupid b/c they didn't spend countless time and dollars in school focused on medicine. That's all I'm saying to each of you.•••••I've been reading through this thread for amusement with no intention to post anything, but I wanted to say one thing. I was previously in a Ph.D. program in clinical psychology, but left after finishing a MA to attend medical school. I was, however, trained in IQ testing before leaving. I'm not sure what "official" IQ test is being cited in the above post. In the Wechsler Adult Intelligence Scale (WAIS), the most widely used IQ measure, 183 is not a valid IQ score. Researchers found that scores above 140 are unreliable and, therefore, they do not make measures that produce scores this high. So in answer to the question above, my guess is nobody scored 183.

Please note, I'm not trying to make any statement about anybody's intelligence.
 
I have no idea what type of test it was, my friend brought and said it was 'official'. So, I'm not saying I'm a genius, heck, that test could have been from Cosmo for all I know. The point of that statement was that I am not stupid as someone had pointed out!
 
Ah, unfortunately, Ryo-Ohki has weeks where he has a life outside of SDN. Since you're so interested, I'll answer your question when I get back.
 
1) How much do you think CNRAs should be paid:
They should be paid according to free market principles. For our purposes, this discussion should be limited to service based compensation. Capital based compensation is another discussion altogether.
Assuming demand for CNRAs is constant, the main factor we should look at is supply. What dictates supply of a particular job class? Education years, education difficulty, and expected compensation are among the major factors. CNRAs have one or two years of post-bacc education. Expected compensation is in the mid 100K range. Education difficulty is obviously less then medical school. Given these factors, I believe supply will grow rapidly, barring governmental, business or union/trade union interference. Even with these interferences, the market will eventually hit an equilibrium (see the UWA and the trend to outsource to Mexico).

2) Do you think CNRAs should exist?
Strange question. Obviously, if quality of service is not sacrificed, then a cheaper solution is always welcome. Your long posts on this subject indicate some sort of dissonance. Are you seeking validation? In the end, all that matters is if you feel like you are worth what you are paid. Do you feel like the services you offer are so unique that you are worth more then a primary care physician, an administrative law judge, or a O-10 with 20+years of service?
 
Well, I was unsure what Ryo-Ohki's position on CRNA's was, then s/he came along with this answer, really muddying the waters:

"They should be paid according to free market principles. For our purposes, this discussion should be limited to service based compensation. Capital based compensation is another discussion altogether."

Cool statement. Essentially meaningless to the present argument, but it sounds really cool.

"Assuming demand for CNRAs is constant, the main factor we should look at is supply. What dictates supply of a particular job class? Education years, education difficulty, and expected compensation are among the major factors. CNRAs have one or two years of post-bacc education. Expected compensation is in the mid 100K range. Education difficulty is obviously less then medical school. Given these factors, I believe supply will grow rapidly, barring governmental, business or union/trade union interference. Even with these interferences, the market will eventually hit an equilibrium (see the UWA and the trend to outsource to Mexico)."

You think anesthesia is going to start to outsource? Exactly what does automobile building in North America have to do with anesthesia. Look, you have repeatedly said WHY you think there will be a glut of CRNA's in the near future. I (and others) have provided ample proof of exactly where the flaw in your thinking is. Perhaps you have only this argument, and are holding onto it as the last shred of hope that the evil CRNA's will do themselves in. If you were correct, such a catastrophe would have occurred long ago (in that CRNA's have been around as a specialty for over 100 years).

"Strange question. Obviously, if quality of service is not sacrificed, then a cheaper solution is always welcome. Your long posts on this subject indicate some sort of dissonance. Are you seeking validation?"

No dissonance on my part. I have only tried to respond to allegations and invective from those on this board who object to CRNA's in one way or another. And certainly, I seek no validation from the likes of you. As for cheaper, if you read my posts a little more closely, you would discover that CRNA provided anesthesia is no cheaper to the consumer than MDA provided anesthesia. Not very good at this debate thing, are you?

"In the end, all that matters is if you feel like you are worth what you are paid. Do you feel like the services you offer are so unique that you are worth more then a primary care physician, an administrative law judge, or a O-10 with 20+years of service?"

This seems to be the real crux of your own dissonance. First, you tell us that you are in favor of free market principles ruling what any one makes, then you ask a question like this. This question assumes that there is some way to compare the value of what I do to what these professions do. Read Brownman's posts carefully. The only fair comparison is to compare what I make to what an MDA makes. The other professions, and their salaries, are spurious. Unless, of course, you advocate someone, perhaps the federal government, assigning a fixed salary value to each profession based on what they do, how they contribute. But if you advocate that, then you must be advocating a vast reduction in MDA salaries. You see, I have pretty well established that there are CRNA's doing exactly what MDA's are doing every day. Therefore, since what we do for a living is similar, how can you say that an MDA should make more than "primary care physician, an administrative law judge, or a O-10 with 20+years of service."

You cannot have it both ways. If you believe in the free market determining salaries, then you cannot compare the salary of a profession to the salary of an unrelated profession, asking whether the discrepancy is fair. Such a question is nonsense.

Kevin McHugh, CRNA
 
Kevin and the other nurses no matter how much they scream and kick will always be nurses and will have the judgement of nurses. They dont have the intuition that a physician has nor do they have the education.. For one to dumb down medicine is a shame..

True, Physicians salaries have decreased dramatically because they let that happen. If they decided not to accept this the insurance companies would have no choice than to pay them what they deserved period or there would be no one treating patients. But due to greed some physicians will accept this fee because they feel something is better than nothing, and this is true but it sets a precedence and all the other physicians have to accept this or lose a patient.. this is the problem, It will all be solved when medicine becomes such a mess and the number of applicants to medical school falls to such an abysmal low, which will happen,that someone will do something about it.
 
What is really quite comical about this whole pathetic exchange is that everyone is trumping this theoretical "free market" ideology that supports that individuals are paid what they're worth.

But...I have said this before and I will (gladly) say it again: EVERY patient that I have ever spoken to before his/her surgery has requested an MDA to administer the anesthesia - not a cRNA. When they are going 'under,' they want a DOCTOR watching over them. Period. Because cRNAs are compensated similarly for their services is really quite a shame--and rather unfair to the American public. Why should they have to pay such an obscene amount of their hard earned dollars for the services that they want but are administered by the providers they don't?

Hopefully, anesthesiology PDs will increase the amount of positions which will place more MDAs on the market. This will probably drive down ALL salaries but at least patients will receive the care they deserve.

I will await a passive-aggressive assault by Kevin McHugh.
 
•••quote:••• I will await a passive-aggressive assault by Kevin McHugh. ••••heh heh.
 
•••quote:•••Originally posted by bigfrank:
•What is really quite comical about this whole pathetic exchange is that everyone is trumping this theoretical "free market" ideology that supports that individuals are paid what they're worth.

But...I have said this before and I will (gladly) say it again: EVERY patient that I have ever spoken to before his/her surgery has requested an MDA to administer the anesthesia - not a cRNA. When they are going 'under,' they want a DOCTOR watching over them. Period. Because cRNAs are compensated similarly for their services is really quite a shame--and rather unfair to the American public. Why should they have to pay such an obscene amount of their hard earned dollars for the services that they want but are administered by the providers they don't?

Hopefully, anesthesiology PDs will increase the amount of positions which will place more MDAs on the market. This will probably drive down ALL salaries but at least patients will receive the care they deserve.

I will await a passive-aggressive assault by Kevin McHugh.•••••I agree completely w/ BigFrank. For all of CRNAs' rhetorrics, they have an inferiority complex...no insult...but that's my feeling as a MD going into anesthesia. For instance, whenever I am doing an anesthesia rotation or surgery rotation and observe them in the PACU or preop holding, I notice that 95% of them never I identify themselves FULLY. That is, doctors would usually say "hi" to the patient and introduce themselves as "Dr. So-and-so". CRNAs and SRNAs, for the most part, just say something like, "Hi Sally (patient), I am w/ anesthesia" or something nebulous to that regard. I even seen a few instances where the CRNA/SRNA are so blatant to say "Hi Sally, I am your anesthesiologist..." Very very times do I see them identify themselves are CRNA or nurse anesthetist... I wholeheartedly believe this is INTENTIONAL. They want the public to be so to speak...in the dark. If they don't know who is providing the anesthesia, they can't complain. Compound that w/ the fact that most patients are not at all familiar w/ medical titles, job descriptions, and are nervous as heck about surgery, and Anesthesia is the perfect breeding ground for many CRNAs to keep on "pretending" and even "impersonating" the role of the anesthesiologists. Now, I know that I am going to get rimmed for these inflammatory remarks by angry CRNAs, but I am certain I am not the only MD resident who thinks like that.

Also, I am sure that CRNAs can see why medical students and doctors are some infuriated at the high salaries and power of CRNAs. I and probably many others, thought that we were going to get delayed gratification (as in the old days for doctors...meaning respect, money, lifestyle, exclusive status, etc) for our hard work, from getting into good colleges, studying our butts off for the MCAT, and doing the same for medical school and residency. Then, we realize that the "world has turned upside down". In the medicine of today, CRNAs make more than primary care doctors. PA's can pull in 80% as much as the MD who has to supervise him/her. Furthermore, doctors in the old days were truly "king". Nurses gave up the seat when the doctor arrives. Hospital CEOs in the old days kiss the doctors' feet. The reason was doctors chose what hospital a patient gets admitted to. Doctors bring in the money for hospitals and all its employees. Now, HMOs and third party providers dictate where patients are sent. Hospital CEOs make millions while doctors make measily thousands. So, naturally we would be infuriated.

So, given this scenerio, perhaps the CRNAs can see it from our point of view. We feel betrayed that mid-level providers are making almost as much as us b/c of the NEW MEDICAL ENVIRONMENT. Its not the nurses' fault, but nevertheless, we are upset. Add to this the fact that some midlevel providers, especially CRNA's, openly contest and challenge their abilities to that of MDA's, and you got a wild fire going.

Oh yeah, I do believe that CRNA's won't be so high paid, and neither would anesthesiologists, as more new anesthesiologists like myself come off of the pipeline. As the CRNAs point out in previous posts, they charge the same fee as the MDAs, so why would a hospital or anesthesia group hire them over the MDAs, if the salary is about the same???? Bottomline, as the number of MDAs increase, the demand for CRNAs will decrease.

All this being said, I also believe that CRNAs provide an invaluable service to society and anesthesiologists. That is, the CRNAs who believe in the anesthesia team approach and want to work w/ us, not against us. As a team the CRNAs and MDAs can provide better and safer anesthesia. Just because CRNAs can provide anesthesia independently (like in rural areas where ther eare no MDA's) doesn't mean that the patients are receiving the same level of service. Family practitioners in rural areas, where there are no surgeons and ob/gyns, perform appys and choles and deliver babies, does that make the argument that FPs can replace surgeons and OB/Gyns in general? That appears to be the CRNAs' argument, that if they can provide independent anesthesia, mostly in rural places, that they are just as good as anesthesiologists.
 
Posted by bigfrank:

"I will await a passive-aggressive assault by Kevin McHugh."

Snort, chuckle, guffaw.

I tried, I really did, to come up with a reasoned response to this post, but was having great difficulty. I couldn't figure out why, until I realized that the post was essentially more personal opinion, unsubstantiated by any line of reasoning beyond the seven year old, stamping his feet, pouting, crying "it just isn't fair!" Get over it, Sparky, life ain't fair, especially within the narrow confines of what you define as fair.

This thread started out as an outraged cry over how much CRNA's commanded in salary. Before I came along, it deteriorated into a diatribe over CRNA's, nurses in general, and who can ever forget the immortal Ryo-Ohki's snotty, elitist "Yes, it matters if someone who doesn't deserve $180K/year gets to control that much capital. Above providing for your family, salary goes into the economy as capital. You can literally shape the world with this money (fund political campaigns, give to the needy, etc)." (Which, by the way, is a comment Ryo has yet to defend.) I could have entered with an outraged assault on you all, what children you are, how you have never seen much outside of the comfy world of academia. I realized, however, that such generalizations would not be correct, and pointless to boot. I chose instead to present the other side of the argument in a reasonable, calm manner. In making assertions, or answering questions, I have supported my points with numerical, historical, or current event based facts. Rather than invective, I have chosen to give reasoned responses, with my reasoning spelled out. "Passive aggressive assault" is the best you can muster in response? I would have thought someone who touts their education so highly could have done better. How disappointing.

I have never introduced myself to a patient as anything other than a nurse anesthetist. In fact, in introducing myself, I tell all patients "Hi. I'm Kevin, and I'm a nurse anesthetist. I'll be handling your anesthesia today." If a patient does not understand, or calls me the anesthesiologist, I am quick to explain who and what I am. The patient has the absolute right to know. With one exception, I have never had a patient object, from the very wealthy, to the very poor, from the highly educated, to the high school dropout, from the anonymous to the locally famous. The one exception occurred while I was still a student. This particular patient's objection was not to nurse anesthetists, but to students. He wanted no SRNA's, no student nurses, no residents of any type, involved in his care. He had no objection to a CRNA, he just didn't want any students involved in his care. The behavior described by gasdoc on the part of some CRNA's is unethical, and does more to damage our own profession than to help the CRNA in question. I know one Ph.D. prepared CRNA who is entitled to the honorific "Doctor" yet refuses to use it in any but the academic setting. He feels (correctly) to do so would be unethical and misleading. He is proud of what he is and what he accomplished to get where he is. From my own experience, I'd guess that gasdoc's experiences are atypical.

One other point. I had to stop and laugh at gasdoc's last post, specifically at this point: "I and probably many others, thought that we were going to get delayed gratification (as in the old days for doctors...meaning respect, money, lifestyle, exclusive status, etc) for our hard work, from getting into good colleges, studying our butts off for the MCAT, and doing the same for medical school and residency." &#8230; "Nurses gave up the seat when the doctor arrives. Hospital CEOs in the old days kiss the doctors' feet." <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" /> How sad is it that you can be disappointed over the lost ability to debase others to make you feel good about yourself? &#8216;Nuff said.

Kevin McHugh, CRNA
 
Just interested/curious/wondering. Why have I "wasted" or "am wasting" the next 12 years becoming an anaesthesiologist, when I could have done the CRNA route in much less time, been as well prepared (?), and, certainly, been very well compensated for my effort and expense?
 
•••quote:•••Originally posted by mick2003:
•Just interested/curious/wondering. Why have I "wasted" or "am wasting" the next 12 years becoming an anaesthesiologist, when I could have done the CRNA route in much less time, been as well prepared (?), and, certainly, been very well compensated for my effort and expense?•••••Well, Mick, that's a question that only you can answer.

Kevin McHugh, CRNA
 
Well, one more bottom line. I guess CRNA's, as other MD students have pointed out, are smarter than us to have chose the CORRECT/SHORTENED (yet equal in quality in providing anesthesia) path for the same end point...i.e. providing anesthesia. Bottomline, CRNA's and KEVIN WIN!!! We MDAs LOSE. There is no way in challenging you so I will do the only thing that other anesthesiologists have done. Join my ASA and become active in the ASA. That's the only way for MDA's to get their point across. I am going to try my best to stop arguing b/c its hopeless and useless.
 
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