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Mr. Knowlton- I appreciate your commentary and view it as only that. You probably should have mentioned that your name appears on the Board of Trustees of the New Jersey State Nurses Association. Not exactly an unbiased source are you? Also, I found it interesting that the New Jersey Health Care Quality Institute supports the Leapfrog Group's initiative to have ICU's staffed by critical care physicians. Are you aware that it is an anesthesiologist who heads up this Leapfrog committee? So patients in ICU's deserve a physician /anesthesiologist but not in the OR?? Seems a bit of a double standard. Anesthesia in America was introduced by Crawford Long and popularized by Morton (neither were nurses). Physicians became involved in anesthesia to improve its safety. Anesthesia has an amazing safety profile thanks to the hard work of anesthesiologists. Physicians are the ones writing the textbooks, conducting research and development, staffing committees, formulating guidelines and advancing the field. Where would we be without these anesthesiologists? Probably still dropping ether. You also alluded to a "study" in the journal of Health Affairs. This "research" is politically-charged and poorly designed. It was privately funded by the American Association of Nurse Anesthetists and involved a retrospective chart review of billing codes. This is hardly good evidence based medicine. Every other "study" has the same flaws, and is no more than political propaganda. You then went on a strange tangent about independent midwives. You are absolutely correct that they can practice independently and there is no "data" to suggest that women in New Jersey are better served by an OB/GYN. This is of course true until a patient needs an emergent operative delivery (i.e. C-section) when it's sure nice to have a MD nearby. I currently work with CRNA's and have the opportunity to train student nurses anesthetists (in addition to physician residents). I appreciate the skill set and knowledge of my CRNA colleagues. I do not totally disagree with your argument (i.e. independent CRNA practice), but I believe it is much more complex than a few simple paragraphs. If you want a real study then randomize new CRNA grads and physician anesthesiologist to all areas of anesthesia including high risk OB, emergency heart surgery, complex pediatrics and pain medicine and let's see how it goes. However, no physician (myself included), patient or CRNA in their right mind would allow this to happen. Like all things in life, the answer probably lies somewhere between the two extremes. Thank you for presenting one of those extremes.