CRNA PHD Anyone?

  1. A Colleague and long friend of mine is on the task force researching the feasibility of all CRNA's programs to require a doctorate degree for entrance to CRNA practice.

    Though I am all for being well educated, I must pause to think on the rationale of this route.

    First of all, I know that there are limitations placed on CRNA's. From the public view of who provides care (oh so your an anesthesiologist?) to the incredible skill variability of the clinicians I know (most can provide a decent general anesthetic and some degrees of regional (central axis) - but are severely limited on peripheral nerve blocks and chronic pain management, to myopic understanding of some of the basic tasks of the ability to process varying differential diagnosis of cardiopulmonary issues (ie. be able to identify / substantiate rational for cancellation and verbalize the importance/interpretation and clinical relevance of required test(s) for risk stratification)...well I can go on - but most experienced CRNAs know what I am talking about....You dont leave school with these very critical and important skills - only maybe the ability to quote Morgan, Miller, or Barash......

    Almost the majority of these experiences have come post graduation for myself .... at the expense of learning on the job & at the potential detriment of my patients ( the old adage "I dont know what I dont know - so damn the torpedoes and full speed ahead" - please pass me some clean scrub bottoms also).

    Only a constant recognition that learning never stops has kept me in the loop.

    So yes...by all means.... Doctorate all the way - if this helps to bring all clinicians to a standard & elevated level of practice in these aforementioned areas ( list not all inclusive) ....but - that brings me to the core question......

    If this does become policy..CRNA PHD.( I am not sure about the time-line to implementation) ..would most people decide to go the MDA route? I know that I would have thought long and hard at that crossroad...

    AND....is this an attempt to assuage and lessen the gap that separates CRNAs from MDs?

    (Insert picture of sharks at a feeding frenzy here) Let the mud fly....

    Oldsalt
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  2. 10 Comments

  3. by   meandragonbrett
    I would venture to guess that the doctoral requirement would not be a PhD, but rather a DNP as many NP programs are changing to.
  4. by   paindoc
    The questions that must be asked are
    1. Would it enhance patient care?
    2. At what cost would such a program be to the participants?
    3. What value would such a degree confer?

    For 99.5% of anesthetics administered, having a nurse doctoral degree or PhD wouldn't make a hill of beans worth of difference. Providing an anesthetic is largely a technical skill. Given that anesthesia has become so safe, therefore there are no giant hurdles to be conquored by the profession. For comparison, look at pharmacists that now have PharmD degrees that are required. Do you really think in 99.5% of the cases it makes any difference? I certainly don't. Pharmacy, retail and most hospital pharmacy, is also a technical training skill in which the doctoral degree really made little difference except for the elite that are involved in drug development, specialized compounding, etc.
    The cost would be huge, but it would further fragment a profession that has significant disparity in training since most CRNAs are certificate CRNAs without a master's degree. Now adding another layer of education may eventually make the certificate CRNA equivalent to a LPN. Or would it....probably not. Probably no difference at all between the non-MS degree CRNAs, MS degree CRNAs, and PhD CRNAs functionally. But with multiple degree levels comes the potential for insurers to begin to pick off those without their designated requirements to be in their network.
    Adding 2 years of training to a profession with a 99.99% success rate in delivering anesthesia is absurd, unless it is for vanity so one could be called "doctor".
  5. by   piper_for_hire
    I seriously doubt this would result in anything but less people in the field. A PhD or a DNP wouldn't really change much in terms of "the gap" between MDAs and CRNAs. If this change were made I would have certainly gone the MDA route instead, despite the fact that I much rather be a CRNA.

    -S
  6. by   Oldsalt
    Quote from paindoc
    The questions that must be asked are
    1. Would it enhance patient care?
    2. At what cost would such a program be to the participants?
    3. What value would such a degree confer?

    For 99.5% of anesthetics administered, having a nurse doctoral degree or PhD wouldn't make a hill of beans worth of difference. Providing an anesthetic is largely a technical skill. Given that anesthesia has become so safe, therefore there are no giant hurdles to be conquored by the profession. For comparison, look at pharmacists that now have PharmD degrees that are required. Do you really think in 99.5% of the cases it makes any difference? I certainly don't. Pharmacy, retail and most hospital pharmacy, is also a technical training skill in which the doctoral degree really made little difference except for the elite that are involved in drug development, specialized compounding, etc.
    The cost would be huge, but it would further fragment a profession that has significant disparity in training since most CRNAs are certificate CRNAs without a master's degree. Now adding another layer of education may eventually make the certificate CRNA equivalent to a LPN. Or would it....probably not. Probably no difference at all between the non-MS degree CRNAs, MS degree CRNAs, and PhD CRNAs functionally. But with multiple degree levels comes the potential for insurers to begin to pick off those without their designated requirements to be in their network.
    Adding 2 years of training to a profession with a 99.99% success rate in delivering anesthesia is absurd, unless it is for vanity so one could be called "doctor".
    Thanks for the response.

    Let me be the devils advocate....

    I agree on some levels - but the argument was similar when anaesthetists were practicing at diploma levels when the transition to Masters was proposed..do you remember that?

    ...the other thing is this.... whereas I have found a sage and undeniable truth in practice ..... "once bitten...twice shy" ..... in which one or a few cases determine future action - usually due to poor outcomes and being completely at wits end - where one is reactive rather than proactive.

    I have found that merely functioning at a technical level is not enough when practicing privately. And that is a farce to imply otherwise.

    An old partner of mine said this most directly, in an all CRNA practice, ...... "It's not the anesthesia that is difficult, but the medicine"

    Administering the anesthesia is highly technical but - in order to get to that point of deciding "it is safe to proceed or should I not" can be daunting esp if these preoperative issues directly lead to intra-operative events. For example, new graduates I have met can do an enormous number of varying cases - but are severely lacking in areas that I have mentioned in my above post.

    It is not the large number of mind numbing and unchallenging cases that define us (they will establish routine/complacency- if anything -for sure) - but rather those cases that completely taken us by surprise, are challenging, have painted us in a corner, where tunnel vision has set in and we are at wits end - for some ...your .5% is more common than not ...and is also the base of morbidity and mortality numbers the ASA love to quote when speaking about anaesthetist (yes another mud fling)

    Take away point: Don't misread this - I am enormously proud of my peers - I just think d/t generalized and accepted constraints we are limited in the quality and amount of training. The ASA wants this difference - for that is what separates them from the rest of us "technicians"

    ....Do I support a PHd??? Heavens - no - But what do I support is a more and enriching education with less constraints on us...(Note to self - add this to Christmas list for next year)
  7. by   dfk
    to me, the clinical uncertainties cannot not be mastered by education (alone). yes, we can have all the physiology and pathophys. we can stand, but as previously stated, when in a corner and tunnel vision sets in, it's these conditions that any and all are usually unprepared for. i guess experience and time would heal these wounds, but surely a doctorate is not the cure, or bandaid, just the "sleep" lingering in some high-horse's eyes.. i want a doctorate on my terms, not someone elses.
  8. by   Oldsalt
    .... The possession of knowledge does not kill the sense of wonder and mystery. There is always more mystery.....Anais Nin

    Oh most certain - that there are no absolutes (other than the proverbial two) but my emphasis is on broad foundational knowledge tempered with clinical application. Yes - one cant avoid the uncertainties when Murphy raises his head - but one can certainly mitigate the shinnanagins that take place.

    I can read all the sports illustrated swim suit model editions ever written but it wont ever get me a date with one - just maybe be able to pick one out of a crowd
  9. by   cowpaper
    I think there is an aspect of this discussion that has been over looked, the "big picture" factor. If we, as a profession, do not contribute to our knowledge base through research then we are allowing physicians to dictate our practice. Doctoral education is a prerequisite to be taken seriously at the national level, to get funding and grant money. Most program directors do not even have a PhD. Is this acceptable in other professions? Not generally. More professors in nurse practitioner programs have PhDs and other doctorates that anesthesia programs.

    A CRNA DNP will not add that much time to the program length, and will lend parity with other professionals, such as PTs and ParmDs. Also, to say that one may have chosen to go to med school instead of CRNA school implies that they are seen as being equal in time and training, but this is not true. After a bachelor degree, a DNP will take 3-31/2 years, while med school + residency is 7+ years.
    From a strictly monetary standpoint, CRNA offers enormous "bang for your buck". Many physicians graduate with >150k in debt and if you are not a specialist will start out around 90k a year.
    CRNA have much less debt and start out making more money, in general.

    Doctoral education enhances the standing of the profession in a time when the struggle to legitimize ourselves has intensified.
  10. by   dfk
    i agree cowpaper,
    but remember that post-grad education is either PhD, DNP, or the newly evolving DNAP (per this discussion). with that, we as graduates or grad students shouldn't be "coerced" into post-grad education if it is not our choice. most educational programs are researched based (and driven), as you have stated, and if i don't want to pursue research, even though it is quite needed and warranted in the nurse anesthesia realm, then i shouldn't have to. now, with that, say the DNAP comes about, and a "leadership" track is chosen, one may not have to do the type or amount of research as say a PhD track. all i'm saying is that it would be nice to have the choice and not make it mandatory to even become a CRNA.
    just my thoughts~
  11. by   platon20
    You guys are confusing several issues here.

    First off, a PHD is an academic degree, not a professional one. That means you gotta do original research to get it and get published. Thats required for all PhD programs.

    What you really are talking about is a DNP, or a professional degree, like the MDs have. Thats a totally different animal than a PHD. Getting a DNP or MD or JD has nothing to do with original research or getting published, which is why they are professional (and not academic) degrees.

    Now, as for the matter at hand. CRNAs do absolutely everything and anything that an MDA does, period. There is absolutely zero difference between those jobs.

    So why would you want to add extra time? It would be a waste of time and money.
  12. by   SigmaSRNA
    I'm all for education and I think that the DNP is a good idea as long as its not made the entry into practice (an option) or at least not until the shortage of anesthesia providers is curtailed a bit. Can you imagine the recruiting pitch AAs schools will have in recruiting a fresh crop of ICU RNS!!!! ( Why go to school for 3 1/2 years when you can go for 2 1/2 and make the same money!!!) In hospitals that use both CRNAs and AAs the pay is exactly the same relative to experience (atlanta, ohio, south carolina, florida for examples). There are going to be alot of ICU nurses (at least in these states) who will be thinking twice about an extra year of school (which could cost them more than 120K not including the extra debt they would have)to pretty much do the same job. Hence the # of CRNAs could potential drop (especially with alot of older CRNAs retiring). The timing of this is just bad.

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