November 6, 2019 • 43 mins
Dr Matthew Mazurek talks about his article on CRNA history, his views on why friction between the CRNA and MD professions originated, a possible solution, why CRNAs should be working to the top of their license, why surgeon supervision is antiquated and how titles do not matter! An amazing discussion with a true advocate for the best patient care and our shared profession of Anesthesiology!
Article Found Here: https://www.linkedin.com/pulse/crnas-short-history-nurse-anesthesia-future-care-matthew-mazurek-md/
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Episode Transcript
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Mike MacKinnon (00:00):
I'm here with Dr Mazurek p hysician a
(00:31):
nesthesiologist to talk abouthis article that he wrote and
published on LinkedIn"A shorthistory of Nurse Anesthetists"
and the future of anesthesiacare.
Hello, Dr Mazurek.
Great to talk to you.
Tell us a little bit aboutyourself.
Dr Mazurek (00:43):
Yeah, good afternoon.
First, before I get started, Ijust would like to put in a
disclaimer that the content andopinions and any of the answers
that I reveal in this interviewhere are solely my own and not
related to any organization, myemployer or hospital or
healthcare network for which Iwork.
(01:04):
I kind of wandered intoanesthesia.
I was born and raised in Fresno,California and my passion
growing up was astronomy.
And I was set on the track for acareer in astrophysics and I
went to Fresno state, graduatedhigh school in 1989 there in
Fresno.
(01:26):
And after about a year and ahalf of physics study, I wasn't
growing bored, but I think whatwas happening to me was I was
trying to understand that someof my colleagues and some of
them, some of my classmates inschool, we're going to be my
professional peers as I've movedforward.
Um, there were, uh, dare I sayto many a star Trek nerdy type
(01:51):
conversations at 2:00 AM and the, uh, the study hall.
And I thought, you know, do Ireally want to turn something I
love, which is a great hobby.
I'd built telescopes and onevariable stars.
Do I want to turn it into aprofessional career and
completely dedicate myself tothat type of research.
So I had taken a course fromPhilip Levine in the English
(02:11):
department there at Fresnostate.
And of course he was a poetlaureate.
So here's a, here's where Iwandered, physics switched gears
to English literature, creativewriting.
Towards the end of that I hadhad a series of personal
experiences and that made medecide on a career in medicine.
What happened was first I hadkidney surgery when I was 21
(02:33):
years old and being in thehospital was uh, you know, an
eyeopening experience and I wasalways fascinated by the human
body.
My wife was a secretary in acritical care unit and
coincidentally I applied for andaccepted a job as a living
skills instructor with aseverely developmentally
(02:54):
disabled adults.
So the group home there inClovis, California, it was that
experience three years while Iwas getting my English degree,
that made me decide to become aphysician.
So I applied to medical schoolafter graduating with my English
degree.
I had to go back and do twoyears of, uh, post-baccalaureate
(03:16):
pre-medical sciences courses,like organic chem and bio, chem
and cell biology, et cetera, andapply to med school in 1996
applied to 35 schools and got mydream shot.
Of course out of those 35schools, what's interesting, I
had 29 rejection letters, so sixinterviews.
(03:40):
I got into the UC Davis Irvineand then UCSF late in the summer
of 97 and you know, kind of thekernels of anesthesia had kind
of been sown a little bit in mejust based on some of what my
wife had told me aboutcritically ill patients.
And this kind of seems like aninteresting career path.
(04:02):
Well not, not one to not takeadvantage of opportunities.
My first year of med school Imet one of my most important
mentors, dr C Spencer Yost whowas at UCSF, I believe he's one
of the vice chairs now.
He's a critical care trainedphysician as well.
I worked in his lab on volatileanesthetic mechanisms of action
(04:26):
with channel potassium channelsafter my first year of medical
school with the genome techresearch fellowship.
And I carried on that researchfor the next three years and we
published a couple of reallyinteresting articles.
One in anesthesiology, one inthe journal of biological
(04:49):
chemistry and then applied to,uh, you know, anesthesia
residencies, decided to stay atUCSF.
It was a great experience.
And here I am today.
Love my job.
Mike MacKinnon (05:03):
That is awesome.
That's quite the roundabout wayfrom astronomy to anesthesia!
Dr Mazurek (05:09):
Well, yeah, it is.
When, you know, when I wasinterviewing for some of my
residency program positions, Ivividly recall one of the
professors looking up and downmy resume.
Cause I also did agric chemicalresearch in one of those summers
in college were dally Lanco onpesticides and herbicides and
this kind of thing.
And he says, you know, when Ilooked at your resume, it
(05:31):
doesn't look like you reallyknow what you want to do with
your life.
I said, well, you can look at itthat way or you can look at it
as, you know, I'm just a, just akid who's taken advantage of
nearly every opportunity that'sbeen thrown out in the front
because I'm super curious and Ilike to learn and, you know,
good answer, I guess.
Mike MacKinnon (05:48):
Yeah, that works.
And so what ended up, uh, youknow, developing your interest
in anesthesia history and basedon this article, sure.
It's not the first time you'vewritten and read about it.
What ended up running you downthat road?
Dr Mazurek (06:02):
Well, you know what's interesting is when, when
I was an English major, uh, oneof my professors, my Shakespeare
professor, um, he was, uh, hehad a bachelor of science in
geology.
He had a Juris doctorate and hewas a practicing lawyer in
Michigan, hated it, went backand got a PhD in English.
(06:23):
So he was a Renaissance man.
So when I was taking some of myEnglish courses, it became
glaringly apparent to me that inorder to understand the context
for which a piece was written,you had to understand the
political, economic, and socialenvironment of the life and
times of that individual livingwith that time period, writing
(06:45):
that particular piece.
I mean, it's, uh, so withanesthesia of course there've
been, you know, numerousadvances throughout the last
century and I'm always curious,why are we doing it this way
today?
And where were we yesterday andwhere would we like to be
tomorrow?
So of course just being curious,I start digging around in the
(07:07):
dirt and you find out all kindsof interesting things.
And uh, you know, this articlewas, was one of them.
I've also done a couple of other, uh, history articles and
presentations on Chauncey leekand di vinyl oxide.
And I did another one on ofcourse Sir William MacEwen in
the history of intubation.
So there's a lot of reallyinteresting stuff out there.
Mike MacKinnon (07:27):
Anesthesia got a really interesting history,
particularly how we got toplaces like blocks and
intubation and all the foiblesthat happened in the way to
them.
That's for sure.
Dr Mazurek (07:37):
Absolutely.
Mike MacKinnon (07:39):
And so in the article there was one particular
place where you mentioned, um,talking about when nurses and
physicians recognize the need tocreate formal societies and that
they happen within a five yearperiod, which you mentioned was
not a coincidence and that thatdoes seem to ring true.
And what do you, what were youreferring to that was the
significance of that quickwithin the two of creating a
(07:59):
formal society?
Dr Mazurek (08:01):
Well, you know, that was of course, in the early
thirties.
And you know, Ralph Waters had,of course, you know, created the
first professional MD, you know,formal residency program there
and Madison in 1927 and he was,of I'm not mistaken, I believe
he was recruited from Kansas andhe was originally trained as an
(08:23):
obstetrician generalistphysician, but had an intense
interest in anesthesia and haddone some, some of his own
research on it.
Now, of course.
Dovetailing with this whole timeperiod, of course, you know, you
had the CRNAs forming their ownformal training programs and I
believe I mentioned in thearticle, Alice McGee on the West
coast in Portland forming one ofthe first schools in 1909.
(08:47):
Uh, during that time periodthough from 1910 to 1920, there
were numerous lawsuits, againstthe CRNAs having an independent
type of practice.
In other words, they had to besupervised and that sort of
thing where, you know, they werebasically told, you're
practicing medicine, you can'tdo it, so you have to stop.
Now, of course, this was also atthe same time period that the
(09:09):
American medical system wasrecognizing that during the 19th
century, I mean, you know, inthe 1860s to become a physician,
all you had to do is paysomebody in a private school,
throw a certificate on the walland you know, hand out the
mercury so to speak.
In other words, it really wasmore witchcraft than it was
medicine towards, towards thelate 19th century especially.
(09:32):
But getting back to thatquestion on, on the
organization, the, theorganization and the
organization of medicine ingeneral too was taking place.
It wasn't just an anesthesia,you had other medical societies
also forming professionalorganizations.
Um, you know, the AMA of coursewas becoming more powerful.
I just don't, I don't think it'sa coincidence because too in
(09:55):
1927 when you had that formalresidency program created by, by
Ralph Waters, there was then anurgency for, um, you know,
other, other programs to kind ofconsolidate.
In other words, it was just kindof a general movement, so to
speak, to create a politicalorganization and an academic,
(10:16):
you know, organization andsetting for both arms of, you
know, anesthetists andanesthesiologists to, uh, to
move forward.
Mike MacKinnon (10:26):
Right.
it was just before all this thatthe Flexner report(1909) came
out and that's what really kindof revolutionize medicine, I
think.
Right?
Dr Mazurek (10:33):
Oh yeah.
The Flexner report was immense,it really was.
I mean, we, you know, especiallyin the late 19th century, if you
think about it you hadhomeopaths, um, you had, uh, you
know, allopathic, you know, MDs,uh, practicing medicine and
there was a lot going on, butthe quality, the quality, I
mean, we talked about quality ofcare, you know, 2019 the quality
(10:57):
of care and the late 19thcentury, of course, first of
all, we didn't have that muchknowledge, but frankly, you
know, it was, some of it wasdangerous.
You know, the homeopaths, earlyin the 19th century, even around
the turn of the Americanrevolution, physicians were
bloodletting leeches, puttingmercury and arsenic salves on
people like that.
(11:18):
So, you know, we've obviouslycome a long, long way in the
last 200 years just in thepractice of Madison.
So.
Mike MacKinnon (11:25):
Absolutely.
And do you think, do you thinkwater's Dr.
Waters and McGee were aware ofeach other during that period of
time?
Or do you think that was sort ofhappening in isolation?
Dr Mazurek (11:35):
Well, Magee's program was in 1909 and Water's
really developed an interestthere in the late teens, early
twenties, if I'm not mistaken,one 27 from this program.
So he's about two decades afterher.
And you know, the, I think thatpoint in time, by the time Ralph
(11:55):
Waters had decided to focus oncreating a formal academic
department, um, I think AliceMcGee almost would have sort of
been lost in the noise.
There are a lot of schools, so,uh, unless they had perfect, you
know, run into each other, Idoubt seriously that they were
even aware of each other'sexistence.
Now, I don't think that's thecase.
(12:16):
Most of solely with Magaw whowas down here in Rochester at
the mayo with the mayo brothers.
Um, I'm, I'm pretty sure he wasaware of, of what she had
accomplished.
I mean, it's just, it'simpossible not to.
She had published in the Lancet,um, you know, she was, she was
kind of famous within the mayosystem and you can't ignore that
(12:39):
kind of a history or, or be, youjust can't be ignorant of it.
Mike MacKinnon (12:44):
Yeah.
It seems like it'd be hard notto be aware of her in particular
based upon, you know, the 10,000plus anesthetics performed
without a single death, whichseems almost near impossible
based upon what they were using.
But you know, with that kind ofa number of people be aware and
she published that.
Dr Mazurek (13:00):
Well, yeah, well number actually it was 14,000.
I mean, but still using that14,000 anesthetics without a
death back then with nomonitoring.
Uh, you know, I mean, you,you're talking, you're talking
about a pretty, a prettyremarkable skillset and, and uh,
you know, physiologically awareknowing what's going on.
(13:21):
I mean, t hat's an incredible,it's actually an incredible feat
if you think about it.
Mike MacKinnon (13:25):
Yeah.
Extraordinarily vigilant.
And I have one of the things youmentioned in your articles, you
had that super cool 1903certificate of anesthesia,
probably one of the first onesever given from Scotland to a
guy named dr Broughton head.
You still have it?
Dr Mazurek (13:46):
I still do.
I've got it kind of in acubbyhole where it doesn't get
much sunlight, but it's stillframed up on, you know, I moved
to that in Tucson of course, butI got that certificate.
Now there's this little historybehind that.
I was awarded that by MerlinLarson who was one of my mentors
when I was exploring some of thetopics and in anesthesia
(14:11):
history.
And he presented that to me.
Uh, golly, I forget when, Idon't think it was during
residency.
It may have been, I know when itwas.
Yes, it was in 2004 and it wasat the anesthesia and American
anesthesia history associationmeeting in Las Vegas.
He presented it to me.
So yeah, it's a, yeah, to hissir William MacEwen.
(14:37):
Again, you know, he was, youknow, a pioneer in his over
across the shores when he wasattempting to intubate patients.
And of course there were noventilators, but you know, he
had a couple of very badoutcomes that probably had
nothing to do what he was doingand more to do with how sick the
patient was that he juststopped, stopped doing it, but
(14:57):
he was the first to do it.
Mike MacKinnon (15:00):
And so now in your, in your career and your
history, what has been yourexperience generally with CRNAs?
Dr Mazurek (15:06):
Well, generally, I mean, I view the CRNAs as my
colleagues and my partners in anoperating room and, uh, you
know, I, I'm not one to get hungup on a whole lot of titles.
You know, I, I worked with CRNAswhen I was a resident there at
UCSF and we had more CRNAs thereat San Francisco general.
(15:28):
Um, I think we had about six orseven.
We had one or two of them, MountZion and there were only one or
two at UCSF at the time.
Of course, that number'scompletely off now.
I think they're 60 or 70, if notmore now in the program there at
UCSF.
But we were doing level onetrauma at San Francisco general.
And you know, one of thesethings, of course when you're
(15:50):
sitting there eating lunch andyou all have the pagers, it
really doesn't matter who's,who's going down as your wing
man during some of these traumaactivations.
And you know, especially as anR1 when you don't really know
that much when you're a CA1,pardon me.
Uh, you really, you're not veryfinessed and you just don't have
enough experience.
(16:10):
I mean, a few of the CRNAs Iworked with, you know, they'd
been doing it for 20-25 years.
And of course they have, theyhave tons to teach at first year
anesthesia resident, you know, Imean, you're basically fresh and
green.
And so yeah, I worked alongside,them we broke them they broke us
and you know, we k ind o f did alittle shift thing there at the
(16:32):
County a s we l ove toaffectionately call it.
You know, we never really, wenever really thought of anything
political s kill s et wise oranything else.
I t's j ust we're here a ndwe're taking care of patients.
We're here to do a good job and, and learn from each other.
Mike MacKinnon (16:50):
Do you think that at that time and more or
might be more specifically inthose facilities that things
were just less politicallycharged than they are today?
Or was that very unique to thatplace?
Dr Mazurek (17:02):
No, I, I don't know.
Um, uh, and I have to speakfrom, the only thing I can
remember from that time periodwas just making sure I could get
enough sleep and I can eat, youknow, that kind of thing and
learn.
Right.
Because you know how it is inmedicine, you're training
programs, medical school andCRNA school was like drinking
(17:26):
from a fire hydrant, so tospeak.
And then when you're in trainingor clinical training, your work
and you know, 70, 80 hours aweek and honestly you're just,
you're wanting to see yourpillow.
So I was really wasn't aware of,you know, I wasn't sensitive to,
it wasn't aware of it, nevereven really gave it much thought
to be honest with you at thattime period.
(17:48):
Well, what was, what was ofinteresting, you know, Dr.
Miller, you know, he was ourchairman and of course everyone
knows who he is.
Um, when he was assigned to the,or he would often have a CRNA
cover his room, which, you know,I was like, okay, it's Dr.
Miller and you know, have a CRNAcover his room.
I mean, you know, actions speaklouder than words in my opinion.
(18:11):
And he was excellent.
You know, where I learned, welearned a tun from him.
Um, and uh, you know, it'sbecause Miller was pretty busy.
He only was, I think he wasassigned to a room once every
couple of weeks, you know.
Mike MacKinnon (18:25):
And you mentioned in your article at one
point a, there's always beenconflict, basically between us.
I think more specificallybetween our organizations than
individuals.
And a, the quote was with regardto scope of practice,
independence, education andorganization.
And why, why do you generallythink that there's been that
kind of conflict or difficultybetween organizations or maybe
(18:46):
even individual providersthrough that time period?
Dr Mazurek (18:49):
Well, you know, in retrospect, and this is
something I hadn't reallythought of when I wrote the
article, but I had one of thoseaha moments.
Um, you know, when, when theMcGee formed the first school in
1909, this was, you know, rightat the height of the women's
suffrage movement.
(19:10):
And if you think about it, mostof the CRNAs at that time
period, I mean, there were, Ihave yet to find one, one male
nurse anesthetist from that era.
Uh, conversely, how many femaleswere also physicians.
So not, I don't want to, youknow, the thing is, what was
happening to was you've got thenurse anesthetist, women
(19:35):
organizing, politically learn,you know, to gain right to vote.
And we also now have thesenurses organizing politically
and academically to, you know,formally train each other on
performing anesthesia.
So, you know, of course went andsuffrage passed in 1920 so this
time period and this era therewas a lot of conflict, not just
(19:58):
between, you know, I'm not goingto, you know, anesthesiologist
or you know CRNAs but there wasconflict just in the political
arena over over women's rights.
So when Ralph Waters of courseformed his first Anesthesia
residency program, the waterbabies were all men.
I mean, no one, no one can denythat.
It's just a simple fact.
(20:20):
So I don't, in the modern erait's very difficult to talk
about these sensitive subjectswithout sounding sexist or you
know, that kind of thing, whichI certainly don't want to.
But again, I think that's whypeople need to appreciate that
where you have, where we were inthat era is just the way things
(20:41):
were at that time period.
Here we are, you know, a hundredyears later and things have
obviously changed dramatically.
But I think that some of the,some of the dynamic was fueled a
little bit around that.
So when Ross waters from thefirst program and it was very
academically minded, he wantedMDs and he wanted, he wanted to
basically, you know, bring backthe entire practice of
(21:05):
anesthesia and to and into aformal medical practice.
And of course up to that timeperiod even before the Nurse
Anesthetists medical studentswere doing anesthesia and you
know, the training wasn't reallyvery formal.
Mike MacKinnon (21:20):
That really is an interesting perspective.
And I think you're right.
I think there's definitely trueinsight there into what, I mean,
you know, colloquially wouldterm that as gender Wars at a
time when, you know, when womenwere were trying to reach for
equality and men, we're stillseeing them as less than equal.
If you were doing what would beconsidered a a man's job, quote
(21:42):
unquote, that would be a sourceof contention, you know, that'd
be a reason right there.
Yeah, that makes total sense.
Dr Mazurek (21:49):
No, absolutely.
And you know, the thing that youcant, it's absolutely, it's
foolishness to try to deny astatement like that too.
Because, and that's why I saidso the, you know, the thing is
the political organizations, ofcourse the AANA, which wasn't
named that then, and the ASA ofcourse formed around that time,
(22:10):
just after that time period, itcame after the heels.
I mean it would, there wereformed less than two decades
after the suffrage movement.
So you've got an organization ofpredominantly women and an
organization of predominantlymen
Mike MacKinnon (22:25):
and things are still hot
Dr Mazurek (22:26):
doing the same thing and things are still hot.
So when you have, you know, it's, it's one of the things, you
know, I've learned in a lot ofmanagement courses in my
master's program, you know,culture is an exceptionally
difficult thing to change.
It really, truly is.
And, and, and, and a companyculture, for example, when you
(22:49):
walk into a hospital, I'm sureyou've had this, you walked into
a hospital as a certain feel,the people in the C suite can
change, the guy in the lab canchange, but you still walked
through there and it has acertain feel that feel is the
culture of the place.
So I think that, you know, someof the, some of the discontents
or some of the, I should saydisharmony, if you will kind of
(23:11):
was probably laid down underthat fabric more than anything
else.
So I don't, cause it does, itdoesn't make any sense to me
otherwise.
Mike MacKinnon (23:20):
That really makes total sense.
I had never thought of it thatway before, but it's totally
true.
One of the things you mentionedis you had supported our efforts
and at that time I was uh,involved in the Arizona
association nurse anesthetist topush through a bill, um, in
related to removing liabilityfrom surgeons.
And uh, we had a larger bill atthat time that didn't pass and
(23:40):
you had supported us.
And on behalf of all the ArizonaCRNAs, I'd like to say thank you
for that!
Dr Mazurek (23:45):
Oh, you're welcome.
Mike MacKinnon (23:46):
We, luckily we passed what we really wanted to
the next year, which effectivelywe put in statute that a surgeon
couldn't be liable for theactions of actions, negligence
or malpractice of a CRNA thatthey worked with a, actually it
says a physician so reallyanybody.
And that that was, we wanted totake responsibility for our own
actions effectively.
You know, if you're doing it,you should take responsibility
(24:08):
for it.
That's how I was raised.
Right.
What spurred you to want tosupport us?
Dr Mazurek (24:12):
Uh, just my experience working with CRNAs,
uh, you know, to be honest,first of all, there's a critical
shortage of anesthesia care inrural areas in the country.
Um, you know, you, you'd be hardpressed to find an MD or three
or four MDs, you know, willingto practice in some of the
smaller communities.
The other thing too is, youknow, my experience so far
(24:35):
working with CRNAs, you know, asmy professional colleagues has
been, um, it's beencollaborative.
And again, I think I said thisat the start of the, uh, you
know, at the start of theinterview, we're doing the same
job.
We're doing it for the samereasons.
And we're, we're both, bothsides of the spectrum, very,
(24:57):
very highly trained.
And you know, we're, we'regiven, we're given a lot of
credentials and we're given alot of time to develop our
skillset, which is, you know,earned.
And I think that too, if wedeny, if we deny someone the
privileged to basically practicewithout that supervision from
(25:18):
the surgeon, then you're goingto be denying care to patients
especially and it just doesn'tmake sense.
I think I kind of pointed tothis in the article.
I really, I can't think of asurgeon.
I've never met a surgeon otherthan, you know, maybe a
cardiothoracic surgeon who wouldfeel comfortable doing it.
I just can't, I can't think of asurgeon today with the
(25:40):
specialties the way they are whoare still comfortable, you know,
breaking scrub, running acrossthe drape and looking at what we
do because it's incrediblycomplex.
You know, we're not doing opendrop either, you know?
Mike MacKinnon (25:54):
Yeah.
It's, it's not simple.
And you know, surgeons ingeneral and get between two
weeks and maybe four weeks of ananesthesia rotation, which may
or may not be involved.
Them actually doing a lot ofanesthesia.
And so their perspective is notthe same as ours.
We're looking at a biggerpicture.
They're looking at putting thetube between the cords.
Most of the time it's adifferent focus, you know,
(26:14):
that's a skill.
Everything else is thinking
Dr Mazurek (26:17):
there's, you know, let's be clear, there's a big
difference between, you know,doing the anesthesia and
intubating someone.
Right,
Mike MacKinnon (26:23):
exactly.
Dr Mazurek (26:24):
You know, I mean the pulmonologists do it.
The ER docs do it now and theyrun and they can, they actually,
you know, do a pre anestheticplan perform the anesthetic,
PACU discharge plan, wakesomebody up, know when to give
narcs, that kind of thing.
I mean that takes years todevelop and the, the history of
course of nurses beingsupervised again goes back to
(26:46):
the early 20th century and thelate 19th century where the
surgeon of course is consideredmore or less the captain of the
ship so to speak.
And of course if you have nursesin there, it's very easy to give
them orders on what to do.
But with open drop ether I mean,we're not talking about, you
know, we're not even startingIVs on these patients.
(27:07):
I mean it's a whole, if we wereto go back in time 120 years and
see how anesthesia wasadministered, I think all of us
would, would, you know, be kindof an interesting thing to see.
Almost scary if you asked me.
But today with the complexventilators, all the bells and
whistles, the variety of drugs,I mean, and now we are doing
(27:28):
opioid free anesthesia.
Uh, and you know, we're runningmultiple drips for some of these
ERAS cases.
When you walk across and youfind the blue drape that what
we're doing, there's a lot goingon.
And I just don't think, I justdon't think it's fair to a
surgeon to expect them tounderstand what we do.
And that's another reason why Iwas like, wait a second here.
(27:50):
You can't say that the surgeonknows as much as the CRNA they
don't, it just doesn't makesense.
Mike MacKinnon (27:58):
Yeah.
As a couple of my friends fromAlabama would say that dog just
don't hunt.
Dr Mazurek (28:03):
Yeah.
Right.
Mike MacKinnon (28:04):
And one of the things you mentioned in the
article that I thought wasreally a great idea was the idea
of having a joint sort ofconference or, or ASA AANA
meeting to actually sit down andhave an honest discussion about
the future of anesthesiaconcerns, getting them together.
And I know in the past the, theleadership of the ASA and the
AANA have sat together and Iknow they do currently, uh, have
(28:25):
meetings, but as far as a realmeeting with members to get
together and sit and talk andmix because, you know, I think,
I think that things get mucheasier when you sit in front of
someone and have a conversation,you know, you, you've
personalized them then, right?
Dr Mazurek (28:39):
Oh, absolutely.
Uh, you know, last fall Iattended the Minnesota Minnesota
association of nurse anesthetistconference there in the cities.
And you know, I was one of what,I may have only actually been
one of the only MDanesthesiologists there, but
there was a wonderful conferenceand event I sat in on some of
the lectures, you know, thetopics are the same.
(29:02):
I mean we're talking aboutpeople and physiology here that
is common between us.
I mean, and there really iscommon ground.
I mean there are issues,concerns and topics that are
very relevant to bothorganizations and both types of
practitioners.
And I think if we were tostrike, you know, some ground on
(29:24):
common ground so to speak andkind of meet halfway on some of
these topics, the shortage ofanesthesiologists and CRNAs is
one of them.
What's the long term solutionfor that?
Mike MacKinnon (29:36):
Or the low, the low pay, the low reimbursement
by um, you know, Medicare foranesthesiology.
Dr Mazurek (29:42):
Well, and that's that that affects both
organizations as well.
Uh, and uh, the recertificationthing is affecting the
practitioners in bothspecialties as well with the
ABA.
And I believe now the nurses arealso having to recertify as well
as that.
Is that correct?
Mike MacKinnon (30:00):
Yeah.
With an exam, the whole thing.
Yeah.
Yeah.
Dr Mazurek (30:03):
We have a MOCA minute now for the ABA, which is
different than this old 10 yearexam.
But you know, the principles ofit are the same.
So we're both, you know, bothorganizations and not saying
they're reinventing the wheel,but we have some common ground
to come together on.
And I think that would be kindof a bridge for us to forge
better partnerships in somesettings.
(30:25):
I mean, our practice setting isvery, very unique up here in
Northern Minnesota.
I still do my own cases.
I don't supervise, or medicallydirect, I do the pre ops, we all
do the blocks, we prepare them,the CRNAs can do pre-ops and
then do their own cases.
And you know, we all help eachother out.
And uh, you know, it's, uh, it'sa great environment and I have
(30:47):
the students from two of thenurse anesthesia programs here
in the upper Midwest who come inand we teach a lot of regional
anesthesia.
So, you know, that's a technicalskill.
And you know, in the words ofMark Rosen, who was our
residency program director, hesaid, do you want to teach
everyone around you as much asyou can?
(31:09):
It doesn't matter what theirtitle is.
If it's a technical skill, theycan learn it.
You don't need an MD, you don'tneed an RN like masking, you
know, a patient for instance.
You don't need an MD.
You need the practice, you know,doing the, doing the bag and the
mask so to speak.
Mike MacKinnon (31:26):
Absolutely.
Raise all the people up aroundyou too high as possible.
And that's all better forpatients at the end of the day.
Yes.
Dr Mazurek (31:32):
The end of the day.
And that's what Mark Rosen wouldeven say.
If you're going to teachsomebody how to save someone's
life and you've done your job,it's a good philosophy to have.
Mike MacKinnon (31:41):
And I think you're right.
I think we have much more incommon in our, so even our
association level then we, thenwe don't, it's a, it's
unfortunate that there's so muchpolitical angst because I think
that could be resolved withexactly the kind of idea that
you have of have a meeting wherepeople all come together that
are open, you know, open, have adiscussion about it.
(32:03):
Right.
Dr Mazurek (32:04):
I was just thinking, I mean, some, you know, what may
eventually happen too is, I meanrather than have a formal
conference from the societies, Imean CRNAs from state groups
might just band together withsome other societies from other
States and have smallerconferences as kind of an
organic start to the wholeprocess.
Mike MacKinnon (32:25):
And one of the things I, uh, that's going on
recently you probably know aboutis, um, CMS has proposed that
CRNAs should be able to do thepre anesthetic evaluation at
ambulatory surgery centers,which effectively is what
happens anyway.
Right.
Um, but, and that, that would bea change from currently, you
know, uh, a surgeon if it's justCRNAs with surgeons would have
(32:46):
to at least sign off in theirsurgeons record that they, that
they agree with the anesthesiaevaluation and the plan and you
know, organizations are, areagainst that in general.
And the organizations, ofcourse, you know, the ASA as
well as the American college ofsurgeons even came out against
that, which is interesting.
What is your idea?
What do you think about that?
I mean you, you're a prettyapolitical individual.
(33:08):
And so when I, when I look atthis, I, what I see is, you
know, there isn't a surgeon or apodiatrist or a dentist who
knows as much about theanesthetic assessment as I do.
That's my perspective and Idon't know any that I work with
of the 20 or so, you know,providers that would ever
suggest that they did.
You know, they don't question uswhen we decided to cancel a case
cause it's unsafe.
So why would that be?
(33:30):
Why would they want to beagainst that?
Dr Mazurek (33:31):
Yeah.
You know, I, I mean I'm familiarwith it, but I'm not familiar
with, with the resistance.
You know, why there would besome resistance.
I'll be blunt though.
I mean having a podiatrist or adentist, if you want to say that
they're more capable than a CRNAof, of making an anesthetic
evaluation, I'm kind of baffledhonestly that doesn't even make
(33:55):
any sense at all.
To me it just doesn't, not evenany in any way, shape or form.
That's not really a politicalstatement.
So much as their trainingabsolutely doesn't give you the
experience or the knowledge tomake that assessment.
You know, for example, let'sjust say you were going to do a
(34:16):
mini dose spinal on someone withcritical AS at a surgery center.
Of course, you know you wouldn'tdo it, but you know these, these
are the kinds of questions onall boards that we get asked.
You get asked as a, as an answer, you know, as a CRNA I get
asked on boards, you're going todo a spinal for a hip on someone
with critical AS.
(34:37):
No, I'm not going to do a spinaland I can guarantee you a
dentist and podiatrists wouldlook at me and say, why not when
they would that.
Why?
Well there's a massivesympathectomy there.
Do you know how afterloadpreload?
I mean, do you know there, doyou know the real physiological
impacts of, of what we're doingand you know, unless you're
actually doing that day in andday out the way we do it,
(34:57):
because we're not reallyanesthesiologists, we're not
anesthetists We're physiologistsis what we are.
We are, we are applied orapplied physiologist.
That's what we do.
We altered physiology during thedrugs we administer.
And unless you're doing that ona day in, day out basis and
we're familiar with all theeffects, you just can't say that
(35:18):
you're going to know what'sgoing to happen, you know?
Mike MacKinnon (35:21):
Exactly.
You know, I think, uh, thingslike pulmonary hypertension and
AS, those are prime examples.
You know, I understand what anRVSP is.
I understand how to calculatethe RVSP.
I know what PA pressures are.
I know when it's going to be toodangerous to do in a particular
place.
And where I live at 6,200 feetabove sea level, part of the
anesthetic assessment may be totransfer this case to a lower
(35:44):
sea level just to be safebecause they'll do better.
Right.
But even some of our surgeonswould look at that and go, well,
I don't get it.
Why?
Because the last time theylooked at pulmonary hypertension
was probably medical school.
You know, that's not their focusunless there may be a
cardiothoracic surgeon or youknow, a cardiovascular surgeon,
one of those two.
Dr Mazurek (36:03):
No, but I mean, I, you know, I don't want to pick
on specialties, but you know,some of our surgical
subspecialists, our ENTsurologists our are orthopedic
surgeons, plastic surgeons, thatkind of thing.
I mean, they're not, they're notnearly as in tune with that kind
of thing as we are.
And, uh, and, and I completelyagree, which is why I'm saying a
(36:23):
dentist.
I mean really, I just kindalost.
I'm lost.
I'm not saying that, you know,they're, they're good at doing,
you know, at dental history andphysical.
Mike MacKinnon (36:34):
So, yeah, I agree that it's an odd thing.
I mean, I think, you know, Ithink when you, when you sum it
up, ultimately the answer ismoney.
What was the question?
And that's kind of what it comesdown to.
And so you get into these kindof battles for silly, silly
reasons when, when ultimatelythe goal is to take care of
patients and you should have theperson who is most trained at
(36:54):
the job in the, in the positionthey're in, take care of that
portion that they're mosteducated in.
Really.
I mean, I think that's a nobrainer for just about anyone
looking at that from theoutside.
The other thing I wanted to askyou about is there's a, there's
a movement in the CRNA communityand the AANA has recognized this
as a descriptor, uh, utilizingthe term nurse anesthesiologist.
(37:15):
And I think the reason thatthat's been pushed has been
related to sort ofanesthesiologist assistants
utilizing the term anesthetists.
So, you know, in, in the U Sanesthetist has always been CRNA
anesthesiologists was developedand created to be a physician
anesthesiologist.
Whereas of course in, in the UKand Australia, this is exactly
(37:36):
the opposite, all physician areall anesthetists.
But this has been sort of amovement to separate CRNAs as
sort of an independent providerfrom an AA as a dependent
provider because there's been amovement to lump them all in
together.
Basically.
What, what is your take on thatkind of thing?
Dr Mazurek (37:52):
Well, you know, I mean that's, that's part of it.
But you know, now that most ofthe CRNA programs, are going to
a doctoral program.
Now we're going to have DNPs.
You know, in fact, I actuallyhave, you know, one of my
colleagues here, um, you know,she has her doctorate in nursing
practice and for all intents andpurposes, there's no rhyme or
reason why she can't, you know,introduce herself as dr XYZ
(38:14):
right now.
She doesn't do that because inher world, she doesn't want to
misrepresent herself as anallopathic physician because I
think that's what, you know,patients expect.
If you walk up and you say yourdoctor X, they're assuming
you've gone to medical school,you know, as far as far as I'm
concerned.
And I did the whole title thing.
It just, I, I don't get it.
(38:36):
And I get it in some levels.
I mean, it's just one of theseways where we have to kind of
distinguish ourselves on onefront to differentiate our
training.
Um, but, uh, you know, the, the,the whole AA thing, that's
another political, that'sanother political arena right
now.
I mean, if you think, if youthink about it, it's another
(38:57):
layer of complexity.
You know, that's kinda beenintroduced.
And, uh, right now it remains tobe seen where, how all of this
is going to unfold.
Mike MacKinnon (39:09):
Yeah, that's for sure.
It's complicated.
And you know, we're in a timewhen there's economic pressure
on healthcare so there's goingto be more and more, looking for
more and more alternative modelsin order to meet these needs
effectively.
Dr Mazurek (39:23):
Well it's similar to what's happening in a lot of
primary care practices and evenhospitalist practices.
They have NPs and they have PA's, you know, they basically have
the three layers system and thesame, same.
I mean in my opinion it's thesame kind of thing happening now
with anesthesia, AAs, CRNAs andMDs.
You know, the thing is though,what's going to happen, and
(39:43):
I've, I've written this on someother articles on LinkedIn, I
think that, you know, the role,the role of the anesthesiologist
and, and, and anesthesia care,it's extending way beyond the
operating room anymore.
You know, Loma Linda, I believenow has a anesthesiology
hospitalist program where theanesthesiologists basically are
(40:06):
responsible for the entireperioperative care period.
And the surgeon has been, youknow, I'm not going to say
relegated into a technology, youknow, a technician, but the
anesthesiologist's manages,their pain, et cetera, and the
surgeon nouns as a consultant,not as the primary caregiver and
their length of stay decrease.
You know, so that's a, you know,it's kind of, we're seeing a lot
(40:28):
of different, remarkable thingshappen in medicine right now.
I think that the most importantthing is for us not to get hung
up on, on who's got what titleon and that kind of thing and
more realize that we're allbringing different perspectives
to the table, a differenttraining experience that table,
but all for one common goal,which is to really, you know,
(40:50):
take great care of people and doit in a lot, you know, do it
with less money.
Uh, we have to be focused onthat as well.
You know, we have to be moreeconomically minded.
Mike MacKinnon (41:00):
Yup.
I agree.
Totally.
So this has been a greatinterview.
You've been great.
And, uh, what is the last thingI'd like to say is, uh, what
would you like to say to CRNAsphysician, anesthesiologist who
may be listening to the podcast?
What message would you like toleave with them?
Dr Mazurek (41:16):
Well, you know what, it sounds really cliche, but you
know, we're kind of all on the,we're all in this together and
we're all on the same team atthe end of the day.
Uh, you know, we've workedalongside each other for, for
decades, taking care of patientsand saving lives and that's what
we're going to continue to do.
And I'm passionate about my job.
I absolutely love anesthesia.
(41:37):
I love my practice and I loveworking with my MD colleagues,
CRNA, colleagues, my surgicalcolleagues, the nurses on the
floor, anyone who's in that, inthat common goal.
And I think, I think that thenumber one thing is, you know,
and I, I say this especially atthis time in medicine, don't
forget why we're doing whatwe're doing.
It's a calling, you know, it's aprofessional calling to do what
(42:00):
we do.
It's also a privilege to be ableto do what we do.
And not everyone has the, hasthe capability to take care of
people the way we do.
Mike MacKinnon (42:08):
Absolutely.
Matt, you have been a totalbreath of fresh air.
I intentionally when I set upthis podcast, I want to talk to
not just CRNA physicians and getperspectives that were, that
were, you know, kind ofapolitical and just interested
in exactly what you just said.
We're all in it together.
We're all trying to do our bestfor patients.
You know, you got into itbecause you wanted to take care
(42:30):
of patients ultimately.
And so that's the goal.
Right.
Thank you so much for agreeingto come on.
Amazing article that you wrote.
Uh, I think everyone inanesthesia, no matter what their
title, appreciates, people likeyou.
Dr Mazurek (42:44):
Alright, well thank you very much for your time.
I'm here with Dr Mazurek p hysician a
(00:31):
nesthesiologist to talk abouthis article that he wrote and
published on LinkedIn"A shorthistory of Nurse Anesthetists"
and the future of anesthesiacare.
Hello, Dr Mazurek.
Great to talk to you.
Tell us a little bit aboutyourself.
Dr Mazurek (00:43):
Yeah, good afternoon.
First, before I get started, Ijust would like to put in a
disclaimer that the content andopinions and any of the answers
that I reveal in this interviewhere are solely my own and not
related to any organization, myemployer or hospital or
healthcare network for which Iwork.
(01:04):
I kind of wandered intoanesthesia.
I was born and raised in Fresno,California and my passion
growing up was astronomy.
And I was set on the track for acareer in astrophysics and I
went to Fresno state, graduatedhigh school in 1989 there in
Fresno.
(01:26):
And after about a year and ahalf of physics study, I wasn't
growing bored, but I think whatwas happening to me was I was
trying to understand that someof my colleagues and some of
them, some of my classmates inschool, we're going to be my
professional peers as I've movedforward.
Um, there were, uh, dare I sayto many a star Trek nerdy type
(01:51):
conversations at 2:00 AM and the, uh, the study hall.
And I thought, you know, do Ireally want to turn something I
love, which is a great hobby.
I'd built telescopes and onevariable stars.
Do I want to turn it into aprofessional career and
completely dedicate myself tothat type of research.
So I had taken a course fromPhilip Levine in the English
(02:11):
department there at Fresnostate.
And of course he was a poetlaureate.
So here's a, here's where Iwandered, physics switched gears
to English literature, creativewriting.
Towards the end of that I hadhad a series of personal
experiences and that made medecide on a career in medicine.
What happened was first I hadkidney surgery when I was 21
(02:33):
years old and being in thehospital was uh, you know, an
eyeopening experience and I wasalways fascinated by the human
body.
My wife was a secretary in acritical care unit and
coincidentally I applied for andaccepted a job as a living
skills instructor with aseverely developmentally
(02:54):
disabled adults.
So the group home there inClovis, California, it was that
experience three years while Iwas getting my English degree,
that made me decide to become aphysician.
So I applied to medical schoolafter graduating with my English
degree.
I had to go back and do twoyears of, uh, post-baccalaureate
(03:16):
pre-medical sciences courses,like organic chem and bio, chem
and cell biology, et cetera, andapply to med school in 1996
applied to 35 schools and got mydream shot.
Of course out of those 35schools, what's interesting, I
had 29 rejection letters, so sixinterviews.
(03:40):
I got into the UC Davis Irvineand then UCSF late in the summer
of 97 and you know, kind of thekernels of anesthesia had kind
of been sown a little bit in mejust based on some of what my
wife had told me aboutcritically ill patients.
And this kind of seems like aninteresting career path.
(04:02):
Well not, not one to not takeadvantage of opportunities.
My first year of med school Imet one of my most important
mentors, dr C Spencer Yost whowas at UCSF, I believe he's one
of the vice chairs now.
He's a critical care trainedphysician as well.
I worked in his lab on volatileanesthetic mechanisms of action
(04:26):
with channel potassium channelsafter my first year of medical
school with the genome techresearch fellowship.
And I carried on that researchfor the next three years and we
published a couple of reallyinteresting articles.
One in anesthesiology, one inthe journal of biological
(04:49):
chemistry and then applied to,uh, you know, anesthesia
residencies, decided to stay atUCSF.
It was a great experience.
And here I am today.
Love my job.
Mike MacKinnon (05:03):
That is awesome.
That's quite the roundabout wayfrom astronomy to anesthesia!
Dr Mazurek (05:09):
Well, yeah, it is.
When, you know, when I wasinterviewing for some of my
residency program positions, Ivividly recall one of the
professors looking up and downmy resume.
Cause I also did agric chemicalresearch in one of those summers
in college were dally Lanco onpesticides and herbicides and
this kind of thing.
And he says, you know, when Ilooked at your resume, it
(05:31):
doesn't look like you reallyknow what you want to do with
your life.
I said, well, you can look at itthat way or you can look at it
as, you know, I'm just a, just akid who's taken advantage of
nearly every opportunity that'sbeen thrown out in the front
because I'm super curious and Ilike to learn and, you know,
good answer, I guess.
Mike MacKinnon (05:48):
Yeah, that works.
And so what ended up, uh, youknow, developing your interest
in anesthesia history and basedon this article, sure.
It's not the first time you'vewritten and read about it.
What ended up running you downthat road?
Dr Mazurek (06:02):
Well, you know what's interesting is when, when
I was an English major, uh, oneof my professors, my Shakespeare
professor, um, he was, uh, hehad a bachelor of science in
geology.
He had a Juris doctorate and hewas a practicing lawyer in
Michigan, hated it, went backand got a PhD in English.
(06:23):
So he was a Renaissance man.
So when I was taking some of myEnglish courses, it became
glaringly apparent to me that inorder to understand the context
for which a piece was written,you had to understand the
political, economic, and socialenvironment of the life and
times of that individual livingwith that time period, writing
(06:45):
that particular piece.
I mean, it's, uh, so withanesthesia of course there've
been, you know, numerousadvances throughout the last
century and I'm always curious,why are we doing it this way
today?
And where were we yesterday andwhere would we like to be
tomorrow?
So of course just being curious,I start digging around in the
(07:07):
dirt and you find out all kindsof interesting things.
And uh, you know, this articlewas, was one of them.
I've also done a couple of other, uh, history articles and
presentations on Chauncey leekand di vinyl oxide.
And I did another one on ofcourse Sir William MacEwen in
the history of intubation.
So there's a lot of reallyinteresting stuff out there.
Mike MacKinnon (07:27):
Anesthesia got a really interesting history,
particularly how we got toplaces like blocks and
intubation and all the foiblesthat happened in the way to
them.
That's for sure.
Dr Mazurek (07:37):
Absolutely.
Mike MacKinnon (07:39):
And so in the article there was one particular
place where you mentioned, um,talking about when nurses and
physicians recognize the need tocreate formal societies and that
they happen within a five yearperiod, which you mentioned was
not a coincidence and that thatdoes seem to ring true.
And what do you, what were youreferring to that was the
significance of that quickwithin the two of creating a
(07:59):
formal society?
Dr Mazurek (08:01):
Well, you know, that was of course, in the early
thirties.
And you know, Ralph Waters had,of course, you know, created the
first professional MD, you know,formal residency program there
and Madison in 1927 and he was,of I'm not mistaken, I believe
he was recruited from Kansas andhe was originally trained as an
(08:23):
obstetrician generalistphysician, but had an intense
interest in anesthesia and haddone some, some of his own
research on it.
Now, of course.
Dovetailing with this whole timeperiod, of course, you know, you
had the CRNAs forming their ownformal training programs and I
believe I mentioned in thearticle, Alice McGee on the West
coast in Portland forming one ofthe first schools in 1909.
(08:47):
Uh, during that time periodthough from 1910 to 1920, there
were numerous lawsuits, againstthe CRNAs having an independent
type of practice.
In other words, they had to besupervised and that sort of
thing where, you know, they werebasically told, you're
practicing medicine, you can'tdo it, so you have to stop.
Now, of course, this was also atthe same time period that the
(09:09):
American medical system wasrecognizing that during the 19th
century, I mean, you know, inthe 1860s to become a physician,
all you had to do is paysomebody in a private school,
throw a certificate on the walland you know, hand out the
mercury so to speak.
In other words, it really wasmore witchcraft than it was
medicine towards, towards thelate 19th century especially.
(09:32):
But getting back to thatquestion on, on the
organization, the, theorganization and the
organization of medicine ingeneral too was taking place.
It wasn't just an anesthesia,you had other medical societies
also forming professionalorganizations.
Um, you know, the AMA of coursewas becoming more powerful.
I just don't, I don't think it'sa coincidence because too in
(09:55):
1927 when you had that formalresidency program created by, by
Ralph Waters, there was then anurgency for, um, you know,
other, other programs to kind ofconsolidate.
In other words, it was just kindof a general movement, so to
speak, to create a politicalorganization and an academic,
(10:16):
you know, organization andsetting for both arms of, you
know, anesthetists andanesthesiologists to, uh, to
move forward.
Mike MacKinnon (10:26):
Right.
it was just before all this thatthe Flexner report(1909) came
out and that's what really kindof revolutionize medicine, I
think.
Right?
Dr Mazurek (10:33):
Oh yeah.
The Flexner report was immense,it really was.
I mean, we, you know, especiallyin the late 19th century, if you
think about it you hadhomeopaths, um, you had, uh, you
know, allopathic, you know, MDs,uh, practicing medicine and
there was a lot going on, butthe quality, the quality, I
mean, we talked about quality ofcare, you know, 2019 the quality
(10:57):
of care and the late 19thcentury, of course, first of
all, we didn't have that muchknowledge, but frankly, you
know, it was, some of it wasdangerous.
You know, the homeopaths, earlyin the 19th century, even around
the turn of the Americanrevolution, physicians were
bloodletting leeches, puttingmercury and arsenic salves on
people like that.
(11:18):
So, you know, we've obviouslycome a long, long way in the
last 200 years just in thepractice of Madison.
So.
Mike MacKinnon (11:25):
Absolutely.
And do you think, do you thinkwater's Dr.
Waters and McGee were aware ofeach other during that period of
time?
Or do you think that was sort ofhappening in isolation?
Dr Mazurek (11:35):
Well, Magee's program was in 1909 and Water's
really developed an interestthere in the late teens, early
twenties, if I'm not mistaken,one 27 from this program.
So he's about two decades afterher.
And you know, the, I think thatpoint in time, by the time Ralph
(11:55):
Waters had decided to focus oncreating a formal academic
department, um, I think AliceMcGee almost would have sort of
been lost in the noise.
There are a lot of schools, so,uh, unless they had perfect, you
know, run into each other, Idoubt seriously that they were
even aware of each other'sexistence.
Now, I don't think that's thecase.
(12:16):
Most of solely with Magaw whowas down here in Rochester at
the mayo with the mayo brothers.
Um, I'm, I'm pretty sure he wasaware of, of what she had
accomplished.
I mean, it's just, it'simpossible not to.
She had published in the Lancet,um, you know, she was, she was
kind of famous within the mayosystem and you can't ignore that
(12:39):
kind of a history or, or be, youjust can't be ignorant of it.
Mike MacKinnon (12:44):
Yeah.
It seems like it'd be hard notto be aware of her in particular
based upon, you know, the 10,000plus anesthetics performed
without a single death, whichseems almost near impossible
based upon what they were using.
But you know, with that kind ofa number of people be aware and
she published that.
Dr Mazurek (13:00):
Well, yeah, well number actually it was 14,000.
I mean, but still using that14,000 anesthetics without a
death back then with nomonitoring.
Uh, you know, I mean, you,you're talking, you're talking
about a pretty, a prettyremarkable skillset and, and uh,
you know, physiologically awareknowing what's going on.
(13:21):
I mean, t hat's an incredible,it's actually an incredible feat
if you think about it.
Mike MacKinnon (13:25):
Yeah.
Extraordinarily vigilant.
And I have one of the things youmentioned in your articles, you
had that super cool 1903certificate of anesthesia,
probably one of the first onesever given from Scotland to a
guy named dr Broughton head.
You still have it?
Dr Mazurek (13:46):
I still do.
I've got it kind of in acubbyhole where it doesn't get
much sunlight, but it's stillframed up on, you know, I moved
to that in Tucson of course, butI got that certificate.
Now there's this little historybehind that.
I was awarded that by MerlinLarson who was one of my mentors
when I was exploring some of thetopics and in anesthesia
(14:11):
history.
And he presented that to me.
Uh, golly, I forget when, Idon't think it was during
residency.
It may have been, I know when itwas.
Yes, it was in 2004 and it wasat the anesthesia and American
anesthesia history associationmeeting in Las Vegas.
He presented it to me.
So yeah, it's a, yeah, to hissir William MacEwen.
(14:37):
Again, you know, he was, youknow, a pioneer in his over
across the shores when he wasattempting to intubate patients.
And of course there were noventilators, but you know, he
had a couple of very badoutcomes that probably had
nothing to do what he was doingand more to do with how sick the
patient was that he juststopped, stopped doing it, but
(14:57):
he was the first to do it.
Mike MacKinnon (15:00):
And so now in your, in your career and your
history, what has been yourexperience generally with CRNAs?
Dr Mazurek (15:06):
Well, generally, I mean, I view the CRNAs as my
colleagues and my partners in anoperating room and, uh, you
know, I, I'm not one to get hungup on a whole lot of titles.
You know, I, I worked with CRNAswhen I was a resident there at
UCSF and we had more CRNAs thereat San Francisco general.
(15:28):
Um, I think we had about six orseven.
We had one or two of them, MountZion and there were only one or
two at UCSF at the time.
Of course, that number'scompletely off now.
I think they're 60 or 70, if notmore now in the program there at
UCSF.
But we were doing level onetrauma at San Francisco general.
And you know, one of thesethings, of course when you're
(15:50):
sitting there eating lunch andyou all have the pagers, it
really doesn't matter who's,who's going down as your wing
man during some of these traumaactivations.
And you know, especially as anR1 when you don't really know
that much when you're a CA1,pardon me.
Uh, you really, you're not veryfinessed and you just don't have
enough experience.
(16:10):
I mean, a few of the CRNAs Iworked with, you know, they'd
been doing it for 20-25 years.
And of course they have, theyhave tons to teach at first year
anesthesia resident, you know, Imean, you're basically fresh and
green.
And so yeah, I worked alongside,them we broke them they broke us
and you know, we k ind o f did alittle shift thing there at the
(16:32):
County a s we l ove toaffectionately call it.
You know, we never really, wenever really thought of anything
political s kill s et wise oranything else.
I t's j ust we're here a ndwe're taking care of patients.
We're here to do a good job and, and learn from each other.
Mike MacKinnon (16:50):
Do you think that at that time and more or
might be more specifically inthose facilities that things
were just less politicallycharged than they are today?
Or was that very unique to thatplace?
Dr Mazurek (17:02):
No, I, I don't know.
Um, uh, and I have to speakfrom, the only thing I can
remember from that time periodwas just making sure I could get
enough sleep and I can eat, youknow, that kind of thing and
learn.
Right.
Because you know how it is inmedicine, you're training
programs, medical school andCRNA school was like drinking
(17:26):
from a fire hydrant, so tospeak.
And then when you're in trainingor clinical training, your work
and you know, 70, 80 hours aweek and honestly you're just,
you're wanting to see yourpillow.
So I was really wasn't aware of,you know, I wasn't sensitive to,
it wasn't aware of it, nevereven really gave it much thought
to be honest with you at thattime period.
(17:48):
Well, what was, what was ofinteresting, you know, Dr.
Miller, you know, he was ourchairman and of course everyone
knows who he is.
Um, when he was assigned to the,or he would often have a CRNA
cover his room, which, you know,I was like, okay, it's Dr.
Miller and you know, have a CRNAcover his room.
I mean, you know, actions speaklouder than words in my opinion.
(18:11):
And he was excellent.
You know, where I learned, welearned a tun from him.
Um, and uh, you know, it'sbecause Miller was pretty busy.
He only was, I think he wasassigned to a room once every
couple of weeks, you know.
Mike MacKinnon (18:25):
And you mentioned in your article at one
point a, there's always beenconflict, basically between us.
I think more specificallybetween our organizations than
individuals.
And a, the quote was with regardto scope of practice,
independence, education andorganization.
And why, why do you generallythink that there's been that
kind of conflict or difficultybetween organizations or maybe
(18:46):
even individual providersthrough that time period?
Dr Mazurek (18:49):
Well, you know, in retrospect, and this is
something I hadn't reallythought of when I wrote the
article, but I had one of thoseaha moments.
Um, you know, when, when theMcGee formed the first school in
1909, this was, you know, rightat the height of the women's
suffrage movement.
(19:10):
And if you think about it, mostof the CRNAs at that time
period, I mean, there were, Ihave yet to find one, one male
nurse anesthetist from that era.
Uh, conversely, how many femaleswere also physicians.
So not, I don't want to, youknow, the thing is, what was
happening to was you've got thenurse anesthetist, women
(19:35):
organizing, politically learn,you know, to gain right to vote.
And we also now have thesenurses organizing politically
and academically to, you know,formally train each other on
performing anesthesia.
So, you know, of course went andsuffrage passed in 1920 so this
time period and this era therewas a lot of conflict, not just
(19:58):
between, you know, I'm not goingto, you know, anesthesiologist
or you know CRNAs but there wasconflict just in the political
arena over over women's rights.
So when Ralph Waters of courseformed his first Anesthesia
residency program, the waterbabies were all men.
I mean, no one, no one can denythat.
It's just a simple fact.
(20:20):
So I don't, in the modern erait's very difficult to talk
about these sensitive subjectswithout sounding sexist or you
know, that kind of thing, whichI certainly don't want to.
But again, I think that's whypeople need to appreciate that
where you have, where we were inthat era is just the way things
(20:41):
were at that time period.
Here we are, you know, a hundredyears later and things have
obviously changed dramatically.
But I think that some of the,some of the dynamic was fueled a
little bit around that.
So when Ross waters from thefirst program and it was very
academically minded, he wantedMDs and he wanted, he wanted to
basically, you know, bring backthe entire practice of
(21:05):
anesthesia and to and into aformal medical practice.
And of course up to that timeperiod even before the Nurse
Anesthetists medical studentswere doing anesthesia and you
know, the training wasn't reallyvery formal.
Mike MacKinnon (21:20):
That really is an interesting perspective.
And I think you're right.
I think there's definitely trueinsight there into what, I mean,
you know, colloquially wouldterm that as gender Wars at a
time when, you know, when womenwere were trying to reach for
equality and men, we're stillseeing them as less than equal.
If you were doing what would beconsidered a a man's job, quote
(21:42):
unquote, that would be a sourceof contention, you know, that'd
be a reason right there.
Yeah, that makes total sense.
Dr Mazurek (21:49):
No, absolutely.
And you know, the thing that youcant, it's absolutely, it's
foolishness to try to deny astatement like that too.
Because, and that's why I saidso the, you know, the thing is
the political organizations, ofcourse the AANA, which wasn't
named that then, and the ASA ofcourse formed around that time,
(22:10):
just after that time period, itcame after the heels.
I mean it would, there wereformed less than two decades
after the suffrage movement.
So you've got an organization ofpredominantly women and an
organization of predominantlymen
Mike MacKinnon (22:25):
and things are still hot
Dr Mazurek (22:26):
doing the same thing and things are still hot.
So when you have, you know, it's, it's one of the things, you
know, I've learned in a lot ofmanagement courses in my
master's program, you know,culture is an exceptionally
difficult thing to change.
It really, truly is.
And, and, and, and a companyculture, for example, when you
(22:49):
walk into a hospital, I'm sureyou've had this, you walked into
a hospital as a certain feel,the people in the C suite can
change, the guy in the lab canchange, but you still walked
through there and it has acertain feel that feel is the
culture of the place.
So I think that, you know, someof the, some of the discontents
or some of the, I should saydisharmony, if you will kind of
(23:11):
was probably laid down underthat fabric more than anything
else.
So I don't, cause it does, itdoesn't make any sense to me
otherwise.
Mike MacKinnon (23:20):
That really makes total sense.
I had never thought of it thatway before, but it's totally
true.
One of the things you mentionedis you had supported our efforts
and at that time I was uh,involved in the Arizona
association nurse anesthetist topush through a bill, um, in
related to removing liabilityfrom surgeons.
And uh, we had a larger bill atthat time that didn't pass and
(23:40):
you had supported us.
And on behalf of all the ArizonaCRNAs, I'd like to say thank you
for that!
Dr Mazurek (23:45):
Oh, you're welcome.
Mike MacKinnon (23:46):
We, luckily we passed what we really wanted to
the next year, which effectivelywe put in statute that a surgeon
couldn't be liable for theactions of actions, negligence
or malpractice of a CRNA thatthey worked with a, actually it
says a physician so reallyanybody.
And that that was, we wanted totake responsibility for our own
actions effectively.
You know, if you're doing it,you should take responsibility
(24:08):
for it.
That's how I was raised.
Right.
What spurred you to want tosupport us?
Dr Mazurek (24:12):
Uh, just my experience working with CRNAs,
uh, you know, to be honest,first of all, there's a critical
shortage of anesthesia care inrural areas in the country.
Um, you know, you, you'd be hardpressed to find an MD or three
or four MDs, you know, willingto practice in some of the
smaller communities.
The other thing too is, youknow, my experience so far
(24:35):
working with CRNAs, you know, asmy professional colleagues has
been, um, it's beencollaborative.
And again, I think I said thisat the start of the, uh, you
know, at the start of theinterview, we're doing the same
job.
We're doing it for the samereasons.
And we're, we're both, bothsides of the spectrum, very,
(24:57):
very highly trained.
And you know, we're, we'regiven, we're given a lot of
credentials and we're given alot of time to develop our
skillset, which is, you know,earned.
And I think that too, if wedeny, if we deny someone the
privileged to basically practicewithout that supervision from
(25:18):
the surgeon, then you're goingto be denying care to patients
especially and it just doesn'tmake sense.
I think I kind of pointed tothis in the article.
I really, I can't think of asurgeon.
I've never met a surgeon otherthan, you know, maybe a
cardiothoracic surgeon who wouldfeel comfortable doing it.
I just can't, I can't think of asurgeon today with the
(25:40):
specialties the way they are whoare still comfortable, you know,
breaking scrub, running acrossthe drape and looking at what we
do because it's incrediblycomplex.
You know, we're not doing opendrop either, you know?
Mike MacKinnon (25:54):
Yeah.
It's, it's not simple.
And you know, surgeons ingeneral and get between two
weeks and maybe four weeks of ananesthesia rotation, which may
or may not be involved.
Them actually doing a lot ofanesthesia.
And so their perspective is notthe same as ours.
We're looking at a biggerpicture.
They're looking at putting thetube between the cords.
Most of the time it's adifferent focus, you know,
(26:14):
that's a skill.
Everything else is thinking
Dr Mazurek (26:17):
there's, you know, let's be clear, there's a big
difference between, you know,doing the anesthesia and
intubating someone.
Right,
Mike MacKinnon (26:23):
exactly.
Dr Mazurek (26:24):
You know, I mean the pulmonologists do it.
The ER docs do it now and theyrun and they can, they actually,
you know, do a pre anestheticplan perform the anesthetic,
PACU discharge plan, wakesomebody up, know when to give
narcs, that kind of thing.
I mean that takes years todevelop and the, the history of
course of nurses beingsupervised again goes back to
(26:46):
the early 20th century and thelate 19th century where the
surgeon of course is consideredmore or less the captain of the
ship so to speak.
And of course if you have nursesin there, it's very easy to give
them orders on what to do.
But with open drop ether I mean,we're not talking about, you
know, we're not even startingIVs on these patients.
(27:07):
I mean it's a whole, if we wereto go back in time 120 years and
see how anesthesia wasadministered, I think all of us
would, would, you know, be kindof an interesting thing to see.
Almost scary if you asked me.
But today with the complexventilators, all the bells and
whistles, the variety of drugs,I mean, and now we are doing
(27:28):
opioid free anesthesia.
Uh, and you know, we're runningmultiple drips for some of these
ERAS cases.
When you walk across and youfind the blue drape that what
we're doing, there's a lot goingon.
And I just don't think, I justdon't think it's fair to a
surgeon to expect them tounderstand what we do.
And that's another reason why Iwas like, wait a second here.
(27:50):
You can't say that the surgeonknows as much as the CRNA they
don't, it just doesn't makesense.
Mike MacKinnon (27:58):
Yeah.
As a couple of my friends fromAlabama would say that dog just
don't hunt.
Dr Mazurek (28:03):
Yeah.
Right.
Mike MacKinnon (28:04):
And one of the things you mentioned in the
article that I thought wasreally a great idea was the idea
of having a joint sort ofconference or, or ASA AANA
meeting to actually sit down andhave an honest discussion about
the future of anesthesiaconcerns, getting them together.
And I know in the past the, theleadership of the ASA and the
AANA have sat together and Iknow they do currently, uh, have
(28:25):
meetings, but as far as a realmeeting with members to get
together and sit and talk andmix because, you know, I think,
I think that things get mucheasier when you sit in front of
someone and have a conversation,you know, you, you've
personalized them then, right?
Dr Mazurek (28:39):
Oh, absolutely.
Uh, you know, last fall Iattended the Minnesota Minnesota
association of nurse anesthetistconference there in the cities.
And you know, I was one of what,I may have only actually been
one of the only MDanesthesiologists there, but
there was a wonderful conferenceand event I sat in on some of
the lectures, you know, thetopics are the same.
(29:02):
I mean we're talking aboutpeople and physiology here that
is common between us.
I mean, and there really iscommon ground.
I mean there are issues,concerns and topics that are
very relevant to bothorganizations and both types of
practitioners.
And I think if we were tostrike, you know, some ground on
(29:24):
common ground so to speak andkind of meet halfway on some of
these topics, the shortage ofanesthesiologists and CRNAs is
one of them.
What's the long term solutionfor that?
Mike MacKinnon (29:36):
Or the low, the low pay, the low reimbursement
by um, you know, Medicare foranesthesiology.
Dr Mazurek (29:42):
Well, and that's that that affects both
organizations as well.
Uh, and uh, the recertificationthing is affecting the
practitioners in bothspecialties as well with the
ABA.
And I believe now the nurses arealso having to recertify as well
as that.
Is that correct?
Mike MacKinnon (30:00):
Yeah.
With an exam, the whole thing.
Yeah.
Yeah.
Dr Mazurek (30:03):
We have a MOCA minute now for the ABA, which is
different than this old 10 yearexam.
But you know, the principles ofit are the same.
So we're both, you know, bothorganizations and not saying
they're reinventing the wheel,but we have some common ground
to come together on.
And I think that would be kindof a bridge for us to forge
better partnerships in somesettings.
(30:25):
I mean, our practice setting isvery, very unique up here in
Northern Minnesota.
I still do my own cases.
I don't supervise, or medicallydirect, I do the pre ops, we all
do the blocks, we prepare them,the CRNAs can do pre-ops and
then do their own cases.
And you know, we all help eachother out.
And uh, you know, it's, uh, it'sa great environment and I have
(30:47):
the students from two of thenurse anesthesia programs here
in the upper Midwest who come inand we teach a lot of regional
anesthesia.
So, you know, that's a technicalskill.
And you know, in the words ofMark Rosen, who was our
residency program director, hesaid, do you want to teach
everyone around you as much asyou can?
(31:09):
It doesn't matter what theirtitle is.
If it's a technical skill, theycan learn it.
You don't need an MD, you don'tneed an RN like masking, you
know, a patient for instance.
You don't need an MD.
You need the practice, you know,doing the, doing the bag and the
mask so to speak.
Mike MacKinnon (31:26):
Absolutely.
Raise all the people up aroundyou too high as possible.
And that's all better forpatients at the end of the day.
Yes.
Dr Mazurek (31:32):
The end of the day.
And that's what Mark Rosen wouldeven say.
If you're going to teachsomebody how to save someone's
life and you've done your job,it's a good philosophy to have.
Mike MacKinnon (31:41):
And I think you're right.
I think we have much more incommon in our, so even our
association level then we, thenwe don't, it's a, it's
unfortunate that there's so muchpolitical angst because I think
that could be resolved withexactly the kind of idea that
you have of have a meeting wherepeople all come together that
are open, you know, open, have adiscussion about it.
(32:03):
Right.
Dr Mazurek (32:04):
I was just thinking, I mean, some, you know, what may
eventually happen too is, I meanrather than have a formal
conference from the societies, Imean CRNAs from state groups
might just band together withsome other societies from other
States and have smallerconferences as kind of an
organic start to the wholeprocess.
Mike MacKinnon (32:25):
And one of the things I, uh, that's going on
recently you probably know aboutis, um, CMS has proposed that
CRNAs should be able to do thepre anesthetic evaluation at
ambulatory surgery centers,which effectively is what
happens anyway.
Right.
Um, but, and that, that would bea change from currently, you
know, uh, a surgeon if it's justCRNAs with surgeons would have
(32:46):
to at least sign off in theirsurgeons record that they, that
they agree with the anesthesiaevaluation and the plan and you
know, organizations are, areagainst that in general.
And the organizations, ofcourse, you know, the ASA as
well as the American college ofsurgeons even came out against
that, which is interesting.
What is your idea?
What do you think about that?
I mean you, you're a prettyapolitical individual.
(33:08):
And so when I, when I look atthis, I, what I see is, you
know, there isn't a surgeon or apodiatrist or a dentist who
knows as much about theanesthetic assessment as I do.
That's my perspective and Idon't know any that I work with
of the 20 or so, you know,providers that would ever
suggest that they did.
You know, they don't question uswhen we decided to cancel a case
cause it's unsafe.
So why would that be?
(33:30):
Why would they want to beagainst that?
Dr Mazurek (33:31):
Yeah.
You know, I, I mean I'm familiarwith it, but I'm not familiar
with, with the resistance.
You know, why there would besome resistance.
I'll be blunt though.
I mean having a podiatrist or adentist, if you want to say that
they're more capable than a CRNAof, of making an anesthetic
evaluation, I'm kind of baffledhonestly that doesn't even make
(33:55):
any sense at all.
To me it just doesn't, not evenany in any way, shape or form.
That's not really a politicalstatement.
So much as their trainingabsolutely doesn't give you the
experience or the knowledge tomake that assessment.
You know, for example, let'sjust say you were going to do a
(34:16):
mini dose spinal on someone withcritical AS at a surgery center.
Of course, you know you wouldn'tdo it, but you know these, these
are the kinds of questions onall boards that we get asked.
You get asked as a, as an answer, you know, as a CRNA I get
asked on boards, you're going todo a spinal for a hip on someone
with critical AS.
(34:37):
No, I'm not going to do a spinaland I can guarantee you a
dentist and podiatrists wouldlook at me and say, why not when
they would that.
Why?
Well there's a massivesympathectomy there.
Do you know how afterloadpreload?
I mean, do you know there, doyou know the real physiological
impacts of, of what we're doingand you know, unless you're
actually doing that day in andday out the way we do it,
(34:57):
because we're not reallyanesthesiologists, we're not
anesthetists We're physiologistsis what we are.
We are, we are applied orapplied physiologist.
That's what we do.
We altered physiology during thedrugs we administer.
And unless you're doing that ona day in, day out basis and
we're familiar with all theeffects, you just can't say that
(35:18):
you're going to know what'sgoing to happen, you know?
Mike MacKinnon (35:21):
Exactly.
You know, I think, uh, thingslike pulmonary hypertension and
AS, those are prime examples.
You know, I understand what anRVSP is.
I understand how to calculatethe RVSP.
I know what PA pressures are.
I know when it's going to be toodangerous to do in a particular
place.
And where I live at 6,200 feetabove sea level, part of the
anesthetic assessment may be totransfer this case to a lower
(35:44):
sea level just to be safebecause they'll do better.
Right.
But even some of our surgeonswould look at that and go, well,
I don't get it.
Why?
Because the last time theylooked at pulmonary hypertension
was probably medical school.
You know, that's not their focusunless there may be a
cardiothoracic surgeon or youknow, a cardiovascular surgeon,
one of those two.
Dr Mazurek (36:03):
No, but I mean, I, you know, I don't want to pick
on specialties, but you know,some of our surgical
subspecialists, our ENTsurologists our are orthopedic
surgeons, plastic surgeons, thatkind of thing.
I mean, they're not, they're notnearly as in tune with that kind
of thing as we are.
And, uh, and, and I completelyagree, which is why I'm saying a
(36:23):
dentist.
I mean really, I just kindalost.
I'm lost.
I'm not saying that, you know,they're, they're good at doing,
you know, at dental history andphysical.
Mike MacKinnon (36:34):
So, yeah, I agree that it's an odd thing.
I mean, I think, you know, Ithink when you, when you sum it
up, ultimately the answer ismoney.
What was the question?
And that's kind of what it comesdown to.
And so you get into these kindof battles for silly, silly
reasons when, when ultimatelythe goal is to take care of
patients and you should have theperson who is most trained at
(36:54):
the job in the, in the positionthey're in, take care of that
portion that they're mosteducated in.
Really.
I mean, I think that's a nobrainer for just about anyone
looking at that from theoutside.
The other thing I wanted to askyou about is there's a, there's
a movement in the CRNA communityand the AANA has recognized this
as a descriptor, uh, utilizingthe term nurse anesthesiologist.
(37:15):
And I think the reason thatthat's been pushed has been
related to sort ofanesthesiologist assistants
utilizing the term anesthetists.
So, you know, in, in the U Sanesthetist has always been CRNA
anesthesiologists was developedand created to be a physician
anesthesiologist.
Whereas of course in, in the UKand Australia, this is exactly
(37:36):
the opposite, all physician areall anesthetists.
But this has been sort of amovement to separate CRNAs as
sort of an independent providerfrom an AA as a dependent
provider because there's been amovement to lump them all in
together.
Basically.
What, what is your take on thatkind of thing?
Dr Mazurek (37:52):
Well, you know, I mean that's, that's part of it.
But you know, now that most ofthe CRNA programs, are going to
a doctoral program.
Now we're going to have DNPs.
You know, in fact, I actuallyhave, you know, one of my
colleagues here, um, you know,she has her doctorate in nursing
practice and for all intents andpurposes, there's no rhyme or
reason why she can't, you know,introduce herself as dr XYZ
(38:14):
right now.
She doesn't do that because inher world, she doesn't want to
misrepresent herself as anallopathic physician because I
think that's what, you know,patients expect.
If you walk up and you say yourdoctor X, they're assuming
you've gone to medical school,you know, as far as far as I'm
concerned.
And I did the whole title thing.
It just, I, I don't get it.
(38:36):
And I get it in some levels.
I mean, it's just one of theseways where we have to kind of
distinguish ourselves on onefront to differentiate our
training.
Um, but, uh, you know, the, the,the whole AA thing, that's
another political, that'sanother political arena right
now.
I mean, if you think, if youthink about it, it's another
(38:57):
layer of complexity.
You know, that's kinda beenintroduced.
And, uh, right now it remains tobe seen where, how all of this
is going to unfold.
Mike MacKinnon (39:09):
Yeah, that's for sure.
It's complicated.
And you know, we're in a timewhen there's economic pressure
on healthcare so there's goingto be more and more, looking for
more and more alternative modelsin order to meet these needs
effectively.
Dr Mazurek (39:23):
Well it's similar to what's happening in a lot of
primary care practices and evenhospitalist practices.
They have NPs and they have PA's, you know, they basically have
the three layers system and thesame, same.
I mean in my opinion it's thesame kind of thing happening now
with anesthesia, AAs, CRNAs andMDs.
You know, the thing is though,what's going to happen, and
(39:43):
I've, I've written this on someother articles on LinkedIn, I
think that, you know, the role,the role of the anesthesiologist
and, and, and anesthesia care,it's extending way beyond the
operating room anymore.
You know, Loma Linda, I believenow has a anesthesiology
hospitalist program where theanesthesiologists basically are
(40:06):
responsible for the entireperioperative care period.
And the surgeon has been, youknow, I'm not going to say
relegated into a technology, youknow, a technician, but the
anesthesiologist's manages,their pain, et cetera, and the
surgeon nouns as a consultant,not as the primary caregiver and
their length of stay decrease.
You know, so that's a, you know,it's kind of, we're seeing a lot
(40:28):
of different, remarkable thingshappen in medicine right now.
I think that the most importantthing is for us not to get hung
up on, on who's got what titleon and that kind of thing and
more realize that we're allbringing different perspectives
to the table, a differenttraining experience that table,
but all for one common goal,which is to really, you know,
(40:50):
take great care of people and doit in a lot, you know, do it
with less money.
Uh, we have to be focused onthat as well.
You know, we have to be moreeconomically minded.
Mike MacKinnon (41:00):
Yup.
I agree.
Totally.
So this has been a greatinterview.
You've been great.
And, uh, what is the last thingI'd like to say is, uh, what
would you like to say to CRNAsphysician, anesthesiologist who
may be listening to the podcast?
What message would you like toleave with them?
Dr Mazurek (41:16):
Well, you know what, it sounds really cliche, but you
know, we're kind of all on the,we're all in this together and
we're all on the same team atthe end of the day.
Uh, you know, we've workedalongside each other for, for
decades, taking care of patientsand saving lives and that's what
we're going to continue to do.
And I'm passionate about my job.
I absolutely love anesthesia.
(41:37):
I love my practice and I loveworking with my MD colleagues,
CRNA, colleagues, my surgicalcolleagues, the nurses on the
floor, anyone who's in that, inthat common goal.
And I think, I think that thenumber one thing is, you know,
and I, I say this especially atthis time in medicine, don't
forget why we're doing whatwe're doing.
It's a calling, you know, it's aprofessional calling to do what
(42:00):
we do.
It's also a privilege to be ableto do what we do.
And not everyone has the, hasthe capability to take care of
people the way we do.
Mike MacKinnon (42:08):
Absolutely.
Matt, you have been a totalbreath of fresh air.
I intentionally when I set upthis podcast, I want to talk to
not just CRNA physicians and getperspectives that were, that
were, you know, kind ofapolitical and just interested
in exactly what you just said.
We're all in it together.
We're all trying to do our bestfor patients.
You know, you got into itbecause you wanted to take care
(42:30):
of patients ultimately.
And so that's the goal.
Right.
Thank you so much for agreeingto come on.
Amazing article that you wrote.
Uh, I think everyone inanesthesia, no matter what their
title, appreciates, people likeyou.
Dr Mazurek (42:44):
Alright, well thank you very much for your time.
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