ASN -> CRNA? NP? MD?

  1. Hi, all. I'm thrilled to find this site! I'm getting my ASN around June (hopefully) and starting to think about advancement. I'm a 31 yr old LVN/LPN currently working home health part time. I have a supportive husband that would allow me to go to school full time (provided that we could get loans for tuition except for books and nick nacks). I do want to continue working at least part time if at all possible as an RN while I go to school if I can. I have a three yr old daughter that could be placed in pre-school. I'm considering CRNA, NP, & MD. I know what I don't want for sure. I don't want to be wearing pagers outside of work meaning I want to have private life. I do not want to be forced to work overtime. I do want family life. I know that making this decision will require countless sleepless nights of soul searching but I do want input from ya'll that have more experience than I. Here are the factors important to me (not in any order):

    Autonomy

    Prestige/pride

    $$$$

    Impact on patients

    Scope of practice

    Average hours/wk

    Years of training

    Cost of programs

    Employment outlook

    Any input will be greatly appreciated!

    Ammie
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  2. 20 Comments

  3. by   Kason
    First of all, congrats on achieving you ADN! Asking a CRNA discussion board about what field is better, don't be surprised if we a little biased. CRNA schools cost anywhere from 25,000 to 75,000 give er take a few bucks. School is very demanding and most school discourage the student from working at all. Programs are anywhere from 24-36 months. Geographically there are more progarms in the eastern states. If your in an area that doesn't have a program, I see moving van in your future. The future for CRNAs is very bright. In many instances you can write your on ticket. 30,000 dollar sign ons are not uncommon. Salary from 90,000 to 300,000/year depending on location, speciality, and time commitments. Right now you can pick and choose your schedule. Some hospitals offer straight m-f 7-3, no on-call, no weekens (usually for less money), others offer a 24 hour shift and a 16 hour shift and that's it. I've found that the majority of jobs require a certain amount of oncall and weekends, but you can in most instances, negotiate. Autonomy depends on location and hospital policies, there is a definite sense of pride, and their is an impact on pts. I'm personally in my 2nd semester of crna school, I'm married and have one 2 month old baby. I don't work, I'm living on love and a lot of caffeine, but it's fun and well worth the 2700+ mile trip from home. Hope this helps, and good luck!
  4. by   bookworm
    I would go CRNA-I'm also a newbie, welcome.
  5. by   Roland
    Let's look at time commitment which is about all that I'm qualified to evaluate: With CRNA you are looking at about two years from the time you are an RN to gain the requisite experience and BSN to apply (some schools will take a BS/BA in a different subject instead of BSN). Then you are looking at from 24 to 35 months in CRNA school. Thus you are talking about five years from the time you are an RN to be a CRNA. You will probably start out between 100 to 140K in most locations. Depending upon how aggressive you are in pursueing higher paying jobs, and how willing you are to work call and move to various area's of the country you will probably "max out" at around 200K per year (potentially double that if you are willing to go into private practice in a group).

    Now lets look at the MD route. You would probably STILL want to get your RN (that way you've got something to fall back on if medical school doesn't play out). However, you may or may not choose to get a BSN (you would be more likely to go ahead and get the BSN IF you wanted to keep your options open with regard to becoming an NP or CRNA). However, you would definitely have to take some extra classes to be serious medical school material which would include things like General Chem I & II, Physics I (maybe II), Organic Chem I& II, standard comparitive zoology, Biology I&II, Microbiology (generally a different section from the one you might have taken as an ASN prerequistie) genetics, and many medical students are now taking Biochemistry (after the two semesters of Organic). Thus, you would be looking at about 18 months of classes after your BSN (actually you would want to take these classes BEFORE getting a four year degree so that your financial aid didn't go "poof"). Then you would take your MCAT (at some point about a year ahead of when you applied for medical school). Once in medical school your looking at a standard four year program (including your internship). Most anesthesia residencies are three years, but to really be competitive your looking at more like a five year residency or a three year residency plus a two year post residency fellowship. Thus, your time investment would be about eight and half to ten and half years from the time you got your ASN degree. You would probably start out at around 120K to 150K. However, you would probably top out at around 500,000 thousand, more if you went into independent practice.

    Thus, the YOUNGER you are the more sense the MD route makes. Also, getting a degree other than a BSN wouldn't cut much off of these estimates because of the EXTRA biology or chemistry classes needed to get degrees in those subjects. I think you would be well respected in either profession, but obviously nothing tops being an MD. Also, you could conceivably specialize in difficult anesthesia situations as an MD. However, you malpractice insurance could be much higher. I cannot evaluate this aspect of the decision.
  6. by   rhp123
    First of all, I think for me, the best way to make a decision is to work as an RN first, get exposed to these advanced careers, then decide which one I like most and want to proceed.

    But monetary wise, I would think although MDAs make more money, residency is pretty competitive. And before that, one need to work very hard to get into medical school first. That is a very tough process itself. From my perspective it requires much more time and committment than preparing for BSN school, or even CRNA school.

    To get into CRNA school, you work in acute care field. But you are doing your job and making not bad money compared to other professionals. If you do not plan to go to CRNA school, you still do the same job and make the same money. You are not losing anything preparing to go to CRNA school. But to get into medical school, most schools require voluntary experience, and to be competitive, one might need more time, basically you work for free. This need to be included into MDAs cost. (giving our topic, I am not including the benefits of helping other people, different exposure, life experience etc, from voluntary experience, which, are of course, very important and cherishable)

    Also, from RN-BSN, most likely I guess one can get some financial assistance from the hospital. But with pre-med, who is going to pay tuition for you? and to maximize your chance, you need to go to a good school, and face a tough competition: everybody in pre-med program wants to maximize their GPAs. But in RN-BSN program, how many of them have decided they want to go for CRNA? On equal-credit basis, you need more time on pre-med program than on a BSN program, which means, you are making less money during pre-med than during nursing school becuase you are spending more time studying.

    What if one cannot get into a US medical school? OK, he goes to a carribean school, now probably will end up with a internal medicine/family practice physician, basically earning the same money as CRNAs, this also applies to a common US medical school graduate. Same with DO schools.
  7. by   Businessman
    Ammie,
    Everybody here gave you a lot of good info. The ultimate decision is up to you, and it's not based only on quantifiable facts.
    Here is a comparison between CRNA and MDA as you wanted:
    Autonomy - both career the same

    Prestige/pride - more prestige as a MD

    $$$$ - CRNA = avg. $140,000/yr., MDA = $400,000/yr.

    Impact on patients - same, or more as a CRNA

    Scope of practice - same

    Average hours/wk - same (both CRNA's and MDA's can work either short or long hours, depending on location).

    Years of training - CRNA = 5 yrs. min., MDA = 10 yrs. min. (from your point of view)

    Cost of programs - CRNA = approx. $60,000, MDA = approx. $160,000 (tuition only for both)
    Employment outlook - same for both = great.

    One thing you should consider is how much is worth to you the "family time".
    The MDA route will require a longer time commitment (80 hrs./wk).

    I'm in a somewhat similar situation, and I chose the CRNA route - family is more important to me.

    Good luck :hatparty:
  8. by   rhp123
    I doubt MDA can really make $400,000/year. I heard an MDA in a university hospital in New Jersey only makes 220,000/year. But maybe because that guy does not work for private practice.
  9. by   Tenesma
    academic/university centers usually pay 1/2 of what private practice partners make
  10. by   rhp123
    But then what's the reason for people to stay at university/academic?

    I heard all the malpractice insurance are taken care of by the university hospital.
  11. by   Tenesma
    a few reasons:

    - research
    - teaching
    - no malpractice insurance
    - no lawsuits
    - no pressure to be productive
    - tolerates eccentric personalities
    - cheap tuition for children at that institution
    - a LOT less call
    - a LOT less work
  12. by   Roland
    Business Man, don't you think that the scope of practice would be greater for an MDA? Don't certain patient types such as those in the ICU who need CT surgery and other "difficult cases" usually goe to an MDA by default? Also, I think that the spread in salary between an MDA and CRNA might be somewhat misleading. You shouldn't compare an MDA who works on average eighty hours a week to a CRNA who might only work say fifty-five. I think if we "normalized" the average workweek to an even eighty hours that the CRNA would probably be closer to $200K plus. Also, I think that the 400K figure probably reflects either the very high range of working for an institution (for an MDA) or the low range for working in private practice (although when you consider the cost of malpractice insurance these days perhaps it's really not so much in the low range).

    Personally, I think if you are truly fascinated by physiology, and medicine that alone (cetaris paribus) justifies the MDA route. However, if you are older and maybe changing careers, have a family (or want one in the near future) that the CRNA route makes more sense. As a rule of thumb, if you are under twenty five and not already an RN or in nursing school you should PROBABLY lean more to the MDA path. Over twenty-five, already an RN or working on a BSN and you should probably think more CRNA. In my case I would be somewhat happy with just my WIFE being a CRNA, living on Oahu in a decent one bedroom apartment (with my 290K mile 94 Toyota Camry), with a useable surfboard, and a kicking telescope! After about ten years I could probably afford a forty five foot sail boat (with an outboard motor of course for backup) and head out for my around the world voyage! From there on out I would support myself providing low cost medical service (using my ACNP training, and Navy Corpman experience) to natives in Fiji, Polynesia, and elsewhere. Maybe find a nice semi abandoned island with a few wild boar still running around....
  13. by   meandragonbrett
    Quote from Roland
    As a rule of thumb, if you are under twenty five and not already an RN or in nursing school you should PROBABLY lean more to the MDA path. Over twenty-five, already an RN or working on a BSN and you should probably think more CRNA.
    Not necessarily. There are some of us that are under 25 and not a RN/just starting nursing school that have no desire whatsoever to be a physician.

    Brett
  14. by   MJB
    Roland says: "you will probably "max out" at around 200K per year (potentially double that if you are willing to go into private practice in a group)."


    ---Is this true? A CRNA can make $400K a year if they go to private practice? If it is, can anyone attest to it?

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