anesthetist vs anesthesiologist - page 3

Hi, i was reading an earlier post about possible interview questions and one of them was: "Do you know the difference between a nurse anesthetist and an anesthesiologist ?" It kind of... Read More

  1. by   melrey11
    Caffine,
    I dont even want to get in to this thread.....yikes. But it gives you an idea of the types of issues you might deal with. As a SRNA, I just hope to work with a a great collaborative team, and enjoy my job as part of the TEAM!! Of the teams I have spent shadowing time with, its always been the case.

    By the way.....CUTE dog!!!!!!!
  2. by   alansmith52
    theres not much else to say.
    this fight is very predictable.
    its interesting to me to see nurses pick their side.
    its so william wallaceesque. some will some won't
  3. by   Businessman
    Reading between the lines on this topic: many of us will leave here with the same opinions, simply because both physicians and CRNA's are a competitive bunch, when it comes to profession.
    However, many CRNA's responded here with an open mind and levelheaded.
    I am sad to say that in similar threads on SDN, most medical students and physicians were enraged, very mean and obtuse.
    This difference in attitude surely translates in the profession quite often, unfortunately (maybe even hurting the patients).
  4. by   jdpete
    couldn't help but notice that some srna's failed to compare yourself to MDA's----When you get out and you see how little they do throughout the day, yet have the surgeons, and sadly, the public in their corner, it will make you sick---they have without a doubt, the easiest job I have ever seen for a physician---however, I come from a group who does very little---we do almost all the epidurals, spinals, central lines, arterial lines, in the hospital---this I like, but at the same time, it drives you crazy to see the laziness these guys have---When I was in school I had high regard for many MDA's because they got to step back and teach you, quiz you, etc---(while the CRNA worked!) It really sickens me at times, and it is very hard to put up with--CRNA's must always claw for respect---Is the art of Anesthesia nursing, or medical? Most of the time, it is clearly nursing. The initial poster said he would put his "skills" up against any MDA. That is a very fair statement. I was shocked Tenesma took this so personal and flared up anyway. I too, could read TEE's as well, if I learned it in school, or had it taught to me. I don't believe it is rocket science. I just never had the training to do so. Like the first poster said, "If you have the knowledge and skill." CRNA's are not offered extensive teaching in TEE's. Most MDA's dont fuss like nurses do, they don't have to. Nurses, in general, must always band together and stick up for each other, whether it be, LPN's, RN's, or advance practice nurses. As for the 13 years training compared to 6.5 years...... I would trade my four years of SICU experience against many MDA's four year Bachelor of Arts and Music degree anytime. I am not saying I am smarter, but work in my enviornment and you will understand. Plus, I could "run" the PACU as well if I sat on my *** in the office beside it all day-----

    P.S. JRVB, you will see the light in time, my friend---believe me...
    Last edit by jdpete on May 2, '04
  5. by   alansmith52
    What a refreshing post.
    It makes me glad to see we have some who get it. jdpete: thankyou and drive on.
  6. by   NCgirl
    Ditto on jdpete....I've already seen way too many anesthesia departments function that way.
  7. by   user69
    I just wanted to make a quick interjection about a recent comment.

    Quote from jdpete
    I would trade my four years of SICU experience against many MDA's four year Bachelor of Arts and Music degree anytime.
    Do you really think that any doctors got into med school with just a BA in Art or Music? The required Chem, O-Chem, Calc based Physics, and other classes needed to even get an interview for med school takes them far past just a BA. While I was working on my masters in Molecular Chemistry I taught physics classes that were geared for the pre-med students and people going into the hard sciences and also to the BA students including students heading into nursing. There is almost no comparison between the undergrad classes that the two groups have to take.

    I am working on my BSN now, and have great respect for our profession! And I believe that many nurses are more that smart enough to make it through med-school. And I know that many of the MDs that I have dealt with over the years do not appear to be the brightest bulbs, but I know that they made it through a lot harder classes than what nursing requires.

    In this thread I have seen the comment "Yes a CRNA can do that with additional training", and this is true. But with enough additional training you are a MDA. I guess if they come out with a new certification that was a step above CRNA but had all of the training that a MDA has this argument would go away.
  8. by   Tenesma
    jdpete

    - the easiest job you have ever seen for a physician... it is so "easy" that it would explain that the burn-out rate is 2nd to ER docs - that the training is longer than for internal medicine, pediatrics, emergency medicine, nuclear medicine - I would back off on those kind of generalizations until you walk in the shoes of an anesthesiologist - or at least until you have spent a bit more time in the field.

    - they "run" the PACU sitting on their *** - you have clearly not spent much time in a PACU at a major operating center... so therefore i can't hold this myopic view against you

    - you too could learn to do TEEs... it isn't rocket science... you are absolutely right, what we do isn't rocket science. It is actually far more dangerous because we make minute-to-minute decisions that can affect somebody's life without the luxury of being on a team of physicists who go over and over the same calculations/measurements a million times. the argument that you can do anything once you are taught how to do it is only 50% correct: while you can be taught technical skills, you also need to be taught the justification and reasoning behind those skills, and that takes time, more education, and experience. This brings me back to my original point: most CRNA graduates can't do everything an MDA graduate can do - they need more training in central line placement/management, regional, cardiac, OB, etc....

    - 4 years of SICU experience vs. a Bachelors degree [that must be a tough comparison - how about an easier one: your 10 years of SICU experience and my 1 year of Internship]
  9. by   WntrMute2
    You know this whole comparison thing really is getting tiresome. There is a role for both providers especially if we can exist peacfully. CRNAs CAN do most of the things docs are routinly trained to do but many schools do not provide the training and even the best schools seem to lack sufficent numbers in line placement to really become proficent. For instance I went to a school that provided lots of opportuntity to place lines and I made a special arrangement to do 8 extra weeks of cardiac to get more experience. Guess how many lines I placed? 40, that is not enough to feel comfortable doing them in the middle of the night without backup in emergant situations. Would I do it if I had to? Yup, would I want another experienced provider there if possible? You betcha. To make blanket statements that we can do everything that MDs or DOs can do is silly, Only some can. I know of a number of schools that do not do any lines at all and only offer the minimal regional experiences needed to graduate. To say they are equal to MDAs is really quite insulting and inflamatory and I'm a CRNA who fully believes we should have a full scope of practice. In conclusion, I think there are SOME CRNAs that can do whata well trained MDA can do but they are probably fewer than we like to think. Just one opinion.
  10. by   Athlein1
    Here's a thought. There is no such thing as a recipe for an anesthesia provider. It's not about education and clinical experience alone. [font=Book Antiqua]x years of a certain type of education with y years of specific clinical experience. So what? To think that additional education and experience automatically confer a superior practice is naive.

    I should preface that by saying that I am in the middle of my didactic portion of my anesthesia program. It's not about intellect. I chose another career route while my SO started med school. But I saw what those early med school years were like, as well as the USMLE Steps, and it simply cannot be disputed that nurse anesthesia programs cannot do in 24-36 months what med schools and residency do in 7+ years in terms of depth or focus. So what?

    Anesthesia is a highly individualized clinical practice. Whether you consider it a practice of medicine or nursing often depends on the initials after your name. The proof is in the pudding, folks. When you are in clinicals, take the time to look around that PACU. Anesthesia has the glorious benefit of instant feedback. Whose patients are barfing, overnarcotized, showing signs of myocardial ischemia, in pain? What are those anesthesia providers doing that might be causing those states for their patients? What can you learn from their practice? Clinical is as much about learning what NOT to do, after all.
    Do those follow-up visits and calls, too. This is McAmerica. If patients have a poor experience, many of them will happily tell you all about it (and all their friends and family, too!). Learn from this. You will realize that there are MDAs/CRNAs that you wouldn't let anesthetize you for a million bucks, just as there are MDAs/CRNAs that practice safe, high-quality, compassionate anesthesia care.

    The beauty of being a CRNA is that you can choose where you work and who to work for. If you want to work in a high-level teaching hospital doing trauma or working on the cardiac team, fine. You'll likely do that knowing that you will be supervised, directed, and, in some cases, the "worker bee" to the "thinking" MDA. If you deliver safe anesthesia care, take good care of your patients, and you are happy, then go for it.

    The "anesthesia care team" model has an ugly downside in that some team practices, certainly not all, use the CRNA as the bedside technical worker (worker is a descriptive term here, because you get worked near-to-death when you are a CRNA in that situation) while the MDAs are in PACU, pre-op, present for takeoffs and landings only, or consulting for lines or pain. Or, sadly, in the breakroom or their offices. It's stupid, it's infuriating, but it exists nonetheless, and the best way to avoid it is to make the choice to practice somewhere else.

    If you want a higher degree of autonomy, go to some rural locale where you function independently. No, you won't be doing super-technical teaching stuff and fancy heads/hearts. But there are plenty of sick people out there, and crises like intra-op MI and MH happen out in the boondocks, too.

    Often, too much is made of motor skills, i.e. line placement. Their importance in the difference and scope of practice between the two providers is overemphasized. As in, MDAs can do lines, CRNAs cannot, therefore, the difference in their practice is a motor skill. It is far more complex than that.

    The only question that really matters is this one: which kind of anesthesia provider do I want to be, and how do I get there from here?
    Last edit by Athlein1 on May 2, '04
  11. by   jdpete
    I probably deserved some of the grief I got, and I accept. There is one good doc where I work, that is real hands on and helps out some, but the majority are definitely on the lazy side, that is my point. The one good young doc we have is slowly getting sucked into the practice of his colleagues though, and is getting less "hands on" than he was. It does however surprise me that a doc would scout a "nursing board" and actually get mad enough to go off like that. I forgot to mention radiologist as probably being easier too, if that makes a difference. Burn out? I can give you that if you do hearts all day, or even run a room of your own. But burnout at my rural hospital? These guys have been around forever, there is no burnout around here, I can tell you that. They have it made, anybody in this OR will agree with that. I am not saying I am smarter, work harder, or deserve more money. (OK, I do work harder) But it would just be nice to see these guys drop their newspapers, eat breakfast at home instead of the anesthesia office at 8:45, check their stocks after the market closes instead of keeping tabs ALL DAY LONG, actually give a break or a lunch now and then, maybe help you turn a room over, move a patient, etc etc etc, instead of "pushing and pushing for room turnover to go home for the day. We take 24 hour in house call and sometimes stay over the next day for up to 6 hrs. So I am a little biased. I respect "most" of their intelligence, and like all of them for the most part personally. I have never seen one start a case and get it going so you can take 20 minutes. They act as if the place could implode if they go in the room for more than 5 minutes with you out of it.

    I feel as if the patient benefits from the team of both providers, no question. I think you guys are really intelligent, and I go to them when I have to without a doubt. But as you told me, walk in our shoes just for a while. It gets pretty damn aggravating as well.


    As for user 69,,,I know about all your chemistry, thanks for the input. But I stand behind my statement. I personally know of an anesthesiologist who has a bachelor of some kind of foreign art. Yes, I know they take chemistry, physics, etc etc etc to get in med school, I am not a complete idiot. Only point being, the years of school is always thrown in our face---as if to say that they had 13 yrs of anesthesia and we had 6. I also know that 4 years of SICU is not BETTER than Med school. If you read between the lines, I am just saying that it is not always as big of difference as they would like to make it.
  12. by   TraumaNurse
    I have to agree with Dave that this whole argument of who is better is very tiresome and silly really. I also agree there is a place for both providers and that just as there are good CRNAs and MDs, there are also many CRNAs and MDAs alike that are useless. I have worked with brilliant MDAs in the ICU who have great knowledge and technical skills. I have had great respect for these people. However, I have also worked with MDAs and residents that I can't figure out how they made it out of medical school at all and the only thing I can think of, is that they are 'book-smart' but clinically pathetic. Same will be true of CRNAs.
    I think it is appropriate for CRNAs to lobby and educate the public about their significant and important roles and that they do provide high quality, safe anesthesia, but to get into "I'm better than you", "I am more educated than you", statements get so ridiculous that it takes away from the ligitamacy of the argument.
    Keep in mind, I have not started school yet, but I have enough experience with both providers to know that many times it is about the individual, not the initials after their name that make for a great provider. CRNAs are well educated and do provide excellent and safe care, but I don't see why some people need to make comparisons between the education of a CRNA and an MDA. MDAs DO have much more education and experience in their schooling/residency, no argument from me. Does this mean that ALL anesthesiologists are excellent at taking care of people and providing high quality anesthesia, I don't think so.
    Each type of provider should be given the respect they deserve. I may be dreaming, but that is my opinion.
  13. by   athomas91
    i really, truly , honestly wasn't going to comment...but i feel driven to say a few small things.
    1. i respect ALL medically trained individuals esp. CRNA's and MDA's because it is surely not an easy road to traverse - and not only takes intelligence but also time and a huge amount of determination....

    however....i think that when placing new CRNA's against new MDA's it is very much individual dependent. Some CNRA's have had extensive training in Central line placement and regional techniques...and i work w/ some CRNA's who are heads above some of the MDA's - BUT AGAIN - it is individual dependent....some of the posters have stated that medical school is hard...etc...etc... well yes it is....and yet they still have to learn how to do an IV - which some nurses can do in the dark, with their eyes closed and one hand tied behind their back.... so how about instead of having this petty who is better than who...and who had a harder o-chem class - we just agree that the pt is our priority and when we work together as a team we are surely unbeatable!
    for the origional poster....the difference is a CRNA is a nurse an MDA is a doctor - however CRNA's can work independently and do not require supervision - this is of course state and facility dependent...

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