Anesthesiologists in a wide variety of practices have noticed the increased demand for anesthesiology expertise in non-O.R. anesthesia (NORA). Our proceduralist colleagues are developing more complex procedures and using them to treat patients with increasingly complicated co-morbidities. Many of us have been asked to care for NORA patients who would be considered too ill or unstable to bring to an O.R., especially patients who need palliative procedures. In addition, the more routine diagnostic procedures can be challenging. We are often working in spaces not designed with the anesthesiologist in mind which may not contain the equipment that we consider necessary and that may be located in places far away from colleagues who could help in a crisis. As an additional challenge, we are working with proceduralist colleagues who may not understand our protocols for safe patient care.