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As many anesthesiologists have commented on their immense worth, my comments will be brief. In my time delivering anesthesia, I've seen many CRNAs and MDAs, some excellent, some horrible. Indeed, anesthetic knowledge and it's practice is within the scope of both - but how this knowledge is used is on a continuum. In isolation, yes - CRNAs and MDAs both possess the knowledge needed to practice independently. In reality, both providers can be used efficiently and collaboratively. Thus, the best model would be a collaborative one, not a supervisory model. Unfortunately, for reasons not at all related to patient saftey, and closely related to preservation and greed, physicians have said they are needed in every anesthetic. This is an outright lie, and should be treated as such. Physician consultation is at times helpful, especially since their experience can be broader in comparison. But all providers have their limits - even physicians - and this is exemplified in how often they consult one another. In the same way, CRNAs know when they need to consult a physician - be it an anesthesiologist, cardiologist, or surgeon. They are full professionals in their own right - and the practice model for anesthesia MUST be a collaborative one if it is to be mindful of the professionals involved, and financially stable. But this model will never be endorsed by the ASA, because it admits that 1) Registered Nurses can be educated to act independently at the highest practice standards, and can even advance the science of anesthesia and 2) it puts CRNAs and MDAs on too close of a playing field. Simply, this removes too many potential dollars out of the pockets of those leading the ASA. While some physicians are truly worth every dollar they are paid - others make their living 'supervising' from outside of the operating room. These physicians are often the loudest when it comes to how much they are needed. Keep in mind anesthesia is the only medical specialty that is not dedicated to the curing of disease. Rather, it is the removal of pain, along with the optimization of each patient's unique disease status. Many CRNAs are fully capable of doing this, and doing it independently. Others benefit greatly from physician consultation. In addition, not all anesthesiologists are equal. Some barely meet requirements, and enter their practice with minimal training in certain aspects of anesthesia. Many are never certified in anestheisa. Yet, we trust them because of their "MD," which may very well be from a sub-standard, non-American school. For example - I've spoken to many new attendings that were deficient in regional anesthesia, while many CRNAs, especially military trained CRNAs, are not only excellent at regional anesthesia, but are leading the field in new techniques. Physicians who comment here and disparage CRNAs are ruining their credibility. CRNAs have and will continue to provide excellent services to Americans, as they have been doing, with the same saftey rate of their physician counterparts, for over 100 years. Unfortunantly for the ASA, the time of society swallowing the ASAs propaganda coming to a close. Many new MDAs are fighting more fiercely than ever, but some new attendings are embracing the collaborative model. Clinicians in collaborative practices know that greater productivity is found when all clinicians have autonomy and respect. They know that their national organizations would be better off spending their time focused on patients, rather than the need to defend themselves or the need to demonize others. They know that anesthesia is a unique field in American medicine, one that has been shared by many professionals, including dentists. And of course - they know that patients - because patients ARE the focus of our careers - patients will be better off when collaborative models become the standard in American anesthesia.