I am neither pro MDA or pro CRNA, if there is competition involved. I am pro-anesthesia, because I have discovered people in anesthesia tend to be very competent, very patient oriented. Sure, there are MDA's and CRNA's out there that are bone heads, but my experience is that there are generally fewer bone heads in anesthesia than other medical specialties. I can't say specifically why this is true, though I believe the broad range of knowledge that must be mastered to perform anesthetics, whether by a nurse or an MDA, tends to attract people that are self starters, competent, and trustworthy. So, if you finish your CRNA program, and work for a time as a CRNA, then find you want the challenge of going back to med school and becoming an MDA, more power to you. I would never consider you a traitor, or somehow disloyal to the ranks of CRNA's.
I'm happy with what I do, and happy to work with the competent physicians in our anesthesia group. We all work together to do a good job. There is one doc with whom I occasionally disagree on the anesthetic plan, but I consider that minor. He's been an anesthesiologist for over 30 years, and damned if he hasn't taught me as much in a year as I could possibly pack in. So, if he wants me to do a case differently than I had planned, then I guess flexibility is part of working in anesthesia. Following the bosses plan is also part of being an adult in the working world. But, on the whole, changing my plan is a pretty rare event. Even if I plan on doing an anesthetic in a manner he would not have chosen, as long as its safe, he knows I am a safe, competent provider, and allows me to proceed as I had planned. I think on the whole, this is the attitude you will find among most docs out there.
One other thing. I've been out of school for a little over a year now. I graduated with just enough knowledge to provide safe anesthetics in MOST cases. (I think most MDA's coming fresh from residency are in pretty much the same position, though med school gives a somewhat broader, less focused, education.) I started with the attitude, and still have it, if an MDA or experienced CRNA tells me they would do a case differently than I had planned, I don't take that as an insult or a personal challenge. Its a great opportunity to learn a new way to skin the cat. I never used remifentanil in school. Those on the board who have read my posts will tell you I sing the praises of that drug from the rooftops now, because an MDA who was supervising me suggested I try that rather than fentanyl to do a carotid. Everything is an opportunity to become a better practitioner. Look at it that way.
Kevin McHugh, CRNA