I am a practcing CRNA since 1982. Prior to that I worked as a nurse in intensive care for seven years. My experience in the ICU was invaluable while I was in anesthesia school. The last 13 years of my career has been in a Level 1 trauma center. I've lost track of how many ASA 3&4&5 cases I've done. Yes there are anesthesiologists there- the practice strongly advocates the anesthesia team. The MD is not present for most of the case. the minute to minute fine tuning of these critical patients is done by the experienced CRNA. Interpretation of ABG's and changes in ventilation as well as any NaHco3 or calcium needed. Interpretation of swan or svo2 data. do they need a pressor, beta blocker or blood?. Of course we monitor the blood sugar now- should we start an insulin drip? So my question is do AA's do this type of care also? I think the REAL difference is the Nurse part of the equation. We are required to have a minimum of two years of critical care after finishing our BSN. Most anesthesia programs are two and a half years now and there is strong talk within the higher ranks of the AANA to move beyond the masters degree to a PHD . Historically the first health care professionals to give anesthesia were nurses.(civil war) It wasn't until it looked lucrative did that start to change.Nurse anesthetists were the first "nurse practitioner".I respect everyone desire to get ahead and make a good living. I'm just very curious. How much schooling is required and is everything you do under the direct supervision of a MDA? thank you, sue.