anesthetist vs anesthesiologist

loisane · Apr 27, 2004

gaspassah...
The advantage is that most complicated cases that are done at CRNA-only hospitals are done in the setting of plentiful resources (cardiologists/intensivists, etc.), so there is a safety net in place.

I disagree with the characterization of specialist availability as a "safety net". I hold an alternative view.

The anesthesia provider is an anesthesia specialist. That person is held accountable for anesthesia. CRNAs consult specialists when events require skills outside of their expertise. This is not a "safety net". It is appropriate care.

"Safety net" implies to me, that these specialists' availability is neccessary because of the absence of anesthesiolgists. Not true. If a case is complicated by nature or co-morbidity, that there is a predictable chance of adverse events, these factors dictate the type of facility and specialist availability required for the case. Not the type of anesthesia provider.

Anesthesiologist also consult specialists, as they should when patient needs dictate it.

loisane crna

caffine · Apr 27, 2004

I'd like to thank everyone for the feed back, it has helped put things into perspective...some what :)

melrey11 · Apr 27, 2004

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!!!!!!!

alansmith52 · Apr 27, 2004

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

Businessman · Apr 28, 2004

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).

jdpete · May 2, 2004

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...

alansmith52 · May 2, 2004

What a refreshing post.

It makes me glad to see we have some who get it. jdpete: thankyou and drive on.

NCgirl · May 2, 2004

Ditto on jdpete....I've already seen way too many anesthesia departments function that way.

user69 · May 2, 2004

I just wanted to make a quick interjection about a recent comment.

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.

Tenesma · May 2, 2004

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]

WntrMute2 · May 2, 2004

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.

Athlein1 · May 2, 2004

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. 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?