anesthetist vs anesthesiologist

Tenesma · Apr 27, 2004

impartial pressure - your posting must have been written after a long shift...

1) why would anybody want to rid the world of nurses? that is just plain silly... and patients would suffer...

2) i never called residency "school" - but since you are trying to make a point here, i will have to reply anyway. Residency is funded by medicare in the form of a student stipend. Because we fall under the federal guidelines of what constitutes student/apprentice, we can't use the Fair Labor Act to our benefit. Which means that minimum wage doesn't apply to us, that there is no mandatory vacation/overtime/maternity leave, etc... so you are right, residency is considered by the federal government to be "school".

.... as far as the rest of your post: are you on crack?

Kiwi, BSN, RN · Apr 27, 2004

.... as far as the rest of your post: are you on crack?

:roll ROFL

nurseunderwater · Apr 27, 2004

speaking as a nurse....ahem....

I think it would be a prudent idea for MD's to work for a while as nurses. A creative solution to a myriad of problems.

Apologies for my :chuckle: re: the crack comment....I stand corrected.

deepz · Apr 27, 2004

impartial pressure - your posting must have been written after a long shift... are you on crack?

Where is that 'moderation' when a BB needs it?

Kindly take your insults, your Major Diety attitude and your braggadocio elsewhere.

deepz

duckboy20 · Apr 27, 2004

I can see both sides of the fence. I would agree that MDAs have more extensive training than CRNA's. Don't quite think the physician profession would like to get rid of staff nurses because they might have to get their hands dirty. No knocks, just don't think that nurses get half the respect they deserve. Not too many physicians will go to the ICU and go digging in someone's butt for crap, nope, the nurses must do it. They don't clean up anything, just make messes. Anyhow, back to the original topic, I think both professions are needed to make anesthesia the best it can be. I would just predict that many MDA's place themselves on a higher level than CRNA's.

gaspassah · Apr 27, 2004

This is where i think the problem with the aana and asa initiates. why cant there be a level headed discussion between professionals. yes i agree that we disagree on many issues. taking all manner of issues as personal attacks will get us nowhere.

i do agree that as nurses time spent at the bedside is a learning environment if you so choose to make it one. i personally have 8 years of nursing experience. 1.5 as an acute care dialysis nurse. this i believe helped me tremendously as an icu nurse and as a srna. fluid shifts, hemodynamic lability, drug elimination etc.

then my experience as an icu nurse. 6.5 years at a teaching hospital for most of it. it was not uncommon for us (nurses) to run codes because we could only get a third year resident to respond quickly to a page.

sitting at the bedside for 12 hours a night titrating gtts, adjusting vents and documenting the pt responses are in my opinion is "residency" for lack of a better term.

i will agree that i have had enough of florence nightengale after semester 1 of nursing school that should be it. i would much rather take organic chem, physics or some other science than study dorothy orem. i think this hurts us as advanced practice nurses. here is where we lack...hard science.

however, interpersonal communication, dealing with patients one on one remains important.

i respect physicians for their knowledge, it comes hard with long hours and dedication.

i respect nurses for their long hours, dedication, and the willingness to wade around in other peoples excrement, while dealing with distraut families, sometimes less than attentive physicians, (this goes both ways, i've seen plenty of unattentive nurses).

but to get where we are crna, srna, mda, it takes an above average person. doubt any of us here were below average nurses, and tenesma does not strike me as a physician that would not return a page at 3 am, nor talk down to a nurse at the bedside.

petty catfighting will get the profession of anesthesia nowhere.

yes the asa has an agenda, they are trying to protect turf.

yes the aana has an agenda, trying to protect turf and gain respect.

there has to be middle ground. do i know what that is...not yet..but the longer i work in this profession the closer to an answer i hope to get.

i dont want to sound like a sellout, that's not it. i want what all other crna's/srna's want, but i realize butting my head against the wall wont get me there.

i would hope that mda's would realize that crna's perform quality safe anesthesia. that we dont have to be "supervised" to do it. it is proven every day that we don't need to be in places many mda's dont want to go.

i would hope that crna's / mda's could see the value in a partnership of sorts where each person performs his or her anesthesia to the best of their ability while not intruding into each others practice.

i think many mda's, not all, concider crna's to be techs...this is definetly not the case. i would like to see mda's respect crna's for their knowledge and competence, not a flunky who needs supervision on induction and emergence.

i'm sure to get flamed here for some of this but that's just how i feel.

there is alot of anesthesia in the world, there has got to some way to share.

hell i teach my kids to share everyday.

CougRN · Apr 27, 2004

gaspassah i agree with a lot of what you had to say. and all of this "dr.s should be nurses first" is a bunch of junk. only because we as people should try not to judge anyone's job until we have done it or know more about it. it goes back and forth. can you as a nurse really know what a dr. has to put up with and do if you haven't been one? NO! same for PT's RT's SLP's or Tech's. we can all do each position or completely know what each other does. so we need to treat each other with respect and try to give each other support instead of tearing each other down to make ourselves feel better. everyone has a job to do and everyone got trained to do that job. i think if we can all be happy with what we do and take stock in the fact that we worked hard to get where we are no matter what the job then things might get a little better. respect each other for the work it took to earn your degree and do your job well. i think it starts here. just my opinion.

J.L.Seagal · Apr 27, 2004

All bickering aside, let's look at the practical side. Can MDA's supervise 4 ORs efficiently without trusting the CRNAs in them are doing their best? MDA's must be able to trust the CRNA's ability for critical thinking and that they will call for assistance when needed.

CRNAs must be able to realize his/her limits in both knowledge and clinical expertise. Gaspassah, I tend to agree with you that in the field of nurse anesthesia, a solid foundation in the sciences/pharmacology over nursing theory would be extremely helpful in closing the gap of misunderstanding between CRNAs and MDAs--we can at least all begin to speak the same language during consultations over difficult cases.

Let us discuss instead who is the most important person in OR--THE PATIENT. CRNAs and MDAs must be able to leave their egos at the OR door, share each other's knowledg and concentrate on doing their best, as a team, for that patient. In the end, everyone will win!

Passin' Gas · Apr 27, 2004

I have copied Tenesma's original post and interjected my comments after his/her comments. Please refer to the original post if clarification of who said what is needed.

I'm going to preface this reply with I enjoy Temesma's participation on this forum. However, I feel some of these points require a response from a practicing CRNA to offer some perspective on current practices. Again, I respect Tenesma's viewpoints and expertise.

forane...i thought the original poster had a very good legitimate question, but your post just rubbed me the wrong way...

As stated above, I respect the information and knowledge you provide to this forum. Please do not take the following comments as a personal affront. However, I'm having the same reaction to your post...it just rubbed me the wrong way....

1) we don't do the same job

No, I do not supervise other CRNAs nor AAs, I do my own anesthesia. I can supervise the administration of anesthesia by a SRNA. You, by the tone of your posts, spend (and have spent) many hours personally administering anesthesia. That's not something all MDA/DOAs can say.

a) MDs can supervise CRNAs and AAs and run 4 rooms at the same time

CRNAs do not require supervision, AAs MUST be supervised by an MDA/DOA to practice anesthesia

b) we provide ICU care, we run the PACU

So can intensivists; PACUs can be directed by a physician with the CRNA anesthesia department's collaboration

c) we run all the research departments throughout the country

CRNAs are also actively participating in anesthesia research. I do not know of a CRNA who is department chair of a research department. Got me on that one.

d) we can officially read an EKG

No, I do not believe I can collect the $1.37 from medicare for interpreting an ECG (have not tried), however, I can interpret ECGs and develop an anesthetic plan based on that interpretation

e) we do TEEs and interpret them

There are clinically based training courses available should a CRNA desire to 'officially' learn interpretation. No, I'm not a cardiologist, I can recognize

'obvious' defects. No, I'm not going to prescribe a long-term medical regimen for a patient postoperatively, I can tell if there's a change in wall-motion, utilize that information, incorporate other data that is available during a procedure and figure out what is happening. Finer nuances? No, can't do that. After a few hundered TEEs, with the instruction of an attending/instructor and additional formal education, you betcha, I can do a TEE. Today, at my level, no. But I can learn.

2) we don't have the same liability - which is reflected by our different malpractice insurance rates - and in the court of law we are held to the standard of care of our peers (other MDs, not CRNAs)

CRNA income on average is 1/3 of an MDA. That is a BROAD generalization. Malpractice insurance is a.....I'm at loss for an adequate descriptor that encompasses the pain and agony of attempting to attain DECENT coverage for independent practice (and it's not just CRNAs having this problem, it's a difficulty for both providers).

Funny thing, MDA/DOAs often testify in cases involving CRNAs.

3) "medical knowledge will only take you so far in anesthesia" - hmmm, that is a load of BS

I agree with your response. No, I don't know the algorithm for treatment of HTN. I DO understand the different antihypertensive agents and the impact they have on the administration of anesthesia.

4) anesthesia has cured people and it has treated diseases:

a) anesthesia for refractory asthma with isoflurane

Yes, I, too understand the disease of asthma and when all other avenues have been exhausted that isoflurane can provide bronchodilation that other modalities may not have been able to produce.

b) phenobarb coma induction for refractory seizures

Refractory seizures and barbiturate coma. Hmmm. Was a neurologist consulted? That would be my first choice. (oops, that was a less than professional slip, no more)

c) without anesthesia 99% of inpatient surgeries would be impossible

Yes, and CRNAs can provide anesthesia. Supervision is NOT required.

d) epidural steroid injections, spinal pump implantation, celiac plexus blocks, etc...

Can be done by CRNAs with additional education that covers these techniques and modalities.

d) a large component of anesthesia is critical care and therefore involves the diagnosis and management of intra-operative:

1 - pulmonary/air/fat/cement/amniotic emboli

2 - myocardial infarctions

3 - and other intra-operative catastrophes

And there's also intensivists. Plus, don't sell us all so short on management of these complications. Again, no, I'm NOT a PHYSICIAN. Yes, I have had patients with pulmonary/air/fat/cement/and (unfortunately) amniotic emboli. Was I able to identify the cause and handle the crisis as an anesthesia provider. Yes. Was I capable of the ICU management for an 84 year old female who had a PE during a hip replacement? No. Out of my realm of expertise. Was there a pulmonologist to take over? Yes. Was there an MDA involved in the case. No.

5) anesthesia training is not the same

a) CRNA gets 1500-1600 clinical OR hours during the course of study

Negative. I had over 3,000h actual, sitting in the OR DOING anesthesia in my anesthesia program. I graduated with >800 cases in the program. And no, that didn't include call time, classes, studying for cases, setting up the OR was not included in this tabulation. Is that equivalent to 9500-10000h? No. But what about the five years of 40h a week in the ICU? 10,400h. That's NOT including an average of 4-8h of overtime a week. No, I wasn't doing anesthesia but providing direct patient care. Administering drugs, titrating infusions, dealing with families, dealing with doctors, dealing with peers, administrators, housekeeping, radiology, oncology, ER, the kitchen, lithotripsy........oh, yeah, AND take care of the patient!

b) MD gets 9500-10000 clinical OR hours during the course of study, which doesn't include 4-6 months of ICU time - and that doesn't include patient contact/medical knowledge acquired during medical school and internship. At the end of residency, I had done over: 15 pedi hearts, 90 adult hearts, 4 heart transplants, 6 BIVAD placements, 3 double lung transplants, 7 liver transplants, 35 neonatal cases (between the age of birth and 72 hours of life), 450 pedi cases, 80 thoracic cases (including 14 tracheal resections and reconstructions, and 8 carinal resections), 70 cranis (3 of which were done on cardio-pulmonary bypass), 4 ruptured thoraco-abdominal aneurysms, 29 AAA (of which 20 were supra-celiac) and over 2300 other cases.... 500 a-lines, 400 central lines, 250 PA lines (of course those numbers are a bit higher due to the high volume in the ICU).

I am certainly not going to discount your knowledge and expertise. Again, that is evident in your responses to threads on this forum. And no, I have not been exposed double lung transplants. I did not have clinical training at a facility that does those types of cases and do not currently work at a facility that does those types of cases.

ICU nurses do bring in a level of expertise that, I believe, is not as appreciated as the years of 'formal' training you describe. One on one with a patient for 12 hours watching vital signs, interpreting trends, drawing labs, assessing results, titrating vasoactive infusions as needed to hemodynamic parameters, interacting with families and feeling all of the emotions that go with taking care of people whose lives are forever changed....some tragically impacted.....the 28 year old mother of three who takes two weeks to succumb to injuries sustained in an MVA when a drunk hit her car when she was taking the kids home from soccer practice. Well, you kind of get attached to the kids, oh, no kids in ICU...well, I was never one for rules. My point is that there's a different perspective that nurses gain from ICU experience. No, I didn't rack up 9500 hours in anesthesia school. I did do ICU nursing for 5 years. Yes, there's doctor's orders. Those orders don't cover 99% of the decisions I made in those years of caring for those patients in the ICU.

6) you can't do everything I can do... How do i know this? because i assume that you are similar to the CRNAs I work with. They know that they can't do everything i can, and will come to me with pre-operative issues/questions, they will refuse to do certain cases due to complexity of care, and they will often ask me to come assist when they are having difficulty intra-operatively.

I pray that your peers (MDAs) show the same recognition of their lack of expertise. No, not every MDA/DOA can do pediatric hearts, the same MDA/DOA may not be the best provider for the adult heart transplants. I know my limitations and will not jeopardize my license and career to do a pediatric heart 'because I think I can.' Could I learn with education and further training? Absolutely. Do I want to? Absolutely not. Anesthesia is a broad field with many areas people can choose to be specialized in one area or be a general practitioner who can handle most types of cases.

7) when you say that you can put your skills up against any MDA... what do you mean with that? can you put your knowledge up against any MDA too? (oh i forgot... according to you, medical knowledge will only take you so far...)

Four years undergrad, four years medical school and at least three years anesthesia residency. Yes, that is extensive education. Nurse anesthesia: four years undergrad, at least one year ICU, (most average 2-4 years before entry into a program) 2-3 years nurse anesthesia program. Yes, that too is an extensive education. Are they the same? No. Is the focus different? Yes. I'm am not educated in how to treat hypertension, as stated before, I do understand how the disease and the drugs the patient is taking will impact the anesthetic plan.

Am I a doctor? NO. Am I a nurse who is educated in administering anesthesia competently to a wide variety of patients? Yes. Can I do everything? No. Can YOU do EVERYTHING? ....?

Again, I made every effort to maintain a tone of professional discussion. I hope none of the comments offended anyone. I also hope this will (and probably will) spur further discussion.

TraumaNurse · Apr 27, 2004

I realize that this is a heated topic but there is no reason we can not have an intelligent discussion without demeaning statements and name-calling. I think differing points of view make for an interesting discussion, but as moderator, I have to ask you to keep it civil and professional without insulting each other. Thank you.

As for the OP's question. There are differences in CRNAs and MDAs, just as there are a lot of similarities. They both complete pre-anesthesia assessments, place lines, induce patients, manage a patient under general anesthesia, do regional anesthesia, and follow up with the patient until they are released from anesthesia care. The difference is that an MDA does have more years of training, has more management and supervisory roles and can be intensivists and run ICUs and PACUs. What CRNAs are trained and capable of doing is also different from what they are allowed to do, and this is usually regulated by the individual hospital/ group that they are employed with. This is a question I had in my interview and was asked on separate occassions by the director of the CRNA program as well as the chief anesthesiologist. I did not get feedback to my answer, but did get into the program.

Both providers are essential parts of the anesthesia team and usually work together to provide outstanding patient care. This should not be an argument over who is better, because there will aways be good CRNAs/MDAs and very bad CRNAs/MDAs. I think the majority of CRNAs and MDAs have (and should) a mutual respect for each other and that there are a few on both sides who fuel these ridiculous arguments about who is better or safer. Just my 2 cents.

Sheri257 · Apr 27, 2004

Four years undergrad four years medical school and at least three years anesthesia residency. Yes, that is extensive education. Nurse anesthesia: four years undergrad, at least one year ICU, (most average 2-4 years before entry into a program) 2-3 years nurse anesthesia program. Yes, that too is an extensive education. Are they the same? No. [/quote']
On a side note, this comparison always makes me wonder if one should go ahead and pursue medical school. As this post demonstrates, the time invested can, for all practical purposes, be about the same, give or take a year or two. It's unfortunate that CRNA's are somewhat under attack by the MDA lobby with the whole AA situation, among other things, after investing so much time in training, education, etc. and, in the end, wind up making a third or half of the salary. Not to mention the AANA having to constantly defend the merits of the profession.
It really makes you wonder if becoming a CRNA is worth it ...
:uhoh21:

loisane · Apr 27, 2004

"Do you know the difference between a nurse anesthetist and an anesthesiologist ?"

Caffine, You asked a simple question. But it triggered an age old debate, and some of the "mine's better than yours" attitutude that goes along with it.

Please don't get too lost in this debate. Yes, it is part of the territory. And I think this dialogue has been good, and maybe even productive. But it is way beyond the scope of the original, simple question.

My answer to your question is this. Nurse anesthetists are nurses who give anesthesia, anesthesiologists are physicians who give anesthesia. It is as simple as that. The anesthesia is the same, it is only the provider that differs.

All other questions are really focusing on bigger issues. How should our anesthesia care be delivered? What is the best practice model for the delivery of that care? What is the responsible allocation of resources for education of those professionals who will provide anesthesia?

I think one of the reason that programs ask this question is to see how much you are aware of the involved professional issues. Thanks to this debate, you should have a real feel for that now!

loisane crna