CRNA VS anesthesiologist MD

[chrisciwi]

I am trying to decide weather I should become a CRNA or anesthesiologist.

Can anyone help with the pro's and con's of each

What do CRNA do that is different than a anesthesiologist?

What can a anesthesiologist do that a CRNA can't?

Any other information would be great (I have a huge interest in anesthesiology, and I am in a BSN program now, but I have been told to look into becoming a MD instead of a CRNA.)

Any help would be great. And thanks!

[nomadcrna, DNP, CRNA, NP]

No flame from me. :)

I have had an MDA as a partner twice in my career. He was not my supervisor and I was credentialed as a Licensed Independent Provider. We each did our own cases and believe it or not he would ask for my help and opinions and I did the same with him. We each had our strong points and it was a good relationship both times.

I do understand that many places use the "team" approach. Mainly from a financial motivation.

Ron

I'm going to get flamed or banned from the forum for saying this, but it must be said.

Anesthesiologists don't "collaborate" with CRNAs. It never happens. In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role. Now, do I breathe down the backs of the CRNAs I'm supervising and tell them how much Propofol to push? Of course not. But hospital policy is that CRNAs are supervised by anesthesiologists.

There is, of course, no federal law requiring this. It's just something that most hospitals want.

[stanman1968]

I have never practiced "under" an anesthesiologist. He did his cases I did mine, no "supervision". You really do not have a clue do you super whatever.

[SuperSixEightMD]

Hmm...seems to bothers you when other people refer to your education which they have never personally experienced, but you seem to have no problem endlessly debating CRNA and DNP education which you never have experienced.

I think there are some assumptions that can be safely made here.

1. An anesthesiologists training is broader than a CRNA's. And an internists training is broader than a DNP's.

2. There is no such thing as 'knowing too much' where skilled labor is concerned. The person delivering a baby who understands the pathophysiology of childhood brain tumors is just as good as the person who does not possess such knowledge. Their ability to practice, at very least, is every bit as good (....if not better).

As mid-level providers, CRNAs -- who have less education and training than anesthesiologists -- are taking the position that the information that they don't have is useless anyway. It's simply impossible to know the significance, or lack thereof, of knowledge you don't possess.

So basically what I'm trying to say is that CRNAs and DNPs, being in possession of a narrow knowledge-base, are not in a position to make an accurate assessment of what knowledge is useful and what isn't. I think this is a very reasonable argument.

[SuperSixEightMD]

No one supervises me on my cases, I am a Licensed Independent Practitioner with all the responsibilities of a LIP.

You didn't describe your practice setting.

Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.

[SuperSixEightMD]

That would be wrong again. You give a very narrow view of anesthesia practices around the country.

The Army and AF both have it written in their scope of practices that CRNAs and Anesthesiologists will collaborate for ASA 3&4 patient and children under 2 going under GA.

The Navy has a totally independent scope of practice model.

Not all practices all are ACT models their are hybrid models where MDAs and CRNAs both work together independently, consultant model (Army and AF), all anesthesiologist only practices, and all CRNA only practice models.

You're making reference to the military, and simultaneously accuse me of having a "very narrow view of anesthesia practices around the country"??

The military is a bizarre entity that is notorious for taking cost-cutting measures where health care is concerned. Come to think of it, the only time the military seeks out the best available is where weaponry is concerned.

Out in the real world, there's a hierarchy.

Moreover, I think you may be misunderstanding the term "collaborate" as the military intends it to be interpreted. Sounds to me like "collaborate" means "get some help from someone who knows more" rather than "discuss the case as equals".

[stanman1968]

No an anesthesiologist is not "responsible" for me, he does his case I do mine period. You have got to be a med student or some new resident, it is quite clear that you are not at all familiar with any practice arrangment outside of an acedemic center.

I strongly advise you aquaint yourelf with the nurse practice acts and the application of them, you would not be nearly as ignorant if you woulod educate yourself before you speak.

[wtbcrna, MSN, DNP, CRNA]

So basically what I'm trying to say is that CRNAs and DNPs, being in possession of a narrow knowledge-base, are not in a position to make an accurate assessment of what knowledge is useful and what isn't. I think this is a very reasonable argument.

Might sound logical if you had any research at all to back up your assumption. I think we are in a perfect position to know that our knowledge base works quite well, and we even have the research to back it up. More and more states are agreeing with up too (16 states so far.....2 in the last year).

A DNP is nothing more than a degree. You don't have to be an APN to get your DNP. You could get your DNP with focus in management, education, and/or advanced practice nursing.

It is nothing more than ego when physicians think that advanced practice nurses can't work independently especially when all the research shows that we are just and safe as physicians.

[wtbcrna, MSN, DNP, CRNA]

You're making reference to the military, and simultaneously accuse me of having a "very narrow view of anesthesia practices around the country"??

The military is a bizarre entity that is notorious for taking cost-cutting measures where health care is concerned. Come to think of it, the only time the military seeks out the best available is where weaponry is concerned.

Out in the real world, there's a hierarchy.

Moreover, I think you may be misunderstanding the term "collaborate" as the military intends it to be interpreted. Sounds to me like "collaborate" means "get some help from someone who knows more" rather than "discuss the case as equals".

Yeah.....yeah.....you know absolutely nothing about military medicine. Our budget far outstrips anything I have seen at any private hospital. How many military facilities have you worked in? There are approximately 1.4 million military members currently. The military has one of the largest medical facilities and capabilities in the world. The military is one of the largest trainers of physicians in the US. So, who is deluded themselves with their narrow views?

Do you really think the only place I have ever worked is the military? I have worked as an anesthesia provider at civilian facilities in Ohio, Delaware, Maryland, and Alaska.

[SuperSixEightMD]

I have never practiced "under" an anesthesiologist. He did his cases I did mine, no "supervision". You really do not have a clue do you super whatever.

Dream on, stanman.

Why don't you go and ask the chair of your hospital's anesthesia department who plays a supervisory role when CRNAs and anesthesiologists are working "together".

And when I say "supervisory", I don't mean directing you, per se. But when the you-know-what hits the fan, you'll see what the hospital's policy is as to who has authority when anesthesiologists are present in the OR suite.

[nomadcrna, DNP, CRNA, NP]

LOL, neither of us is employed by the hospital. Even if we were, he would not be responsible as the state allows me to practice with total independence and the hospital as credentialed me as an independent provider.

So how on earth can you even begin to know what the hospital dictates? I'm giving you some leeway but you are really stretching here.

I hate to break your bubble but I've seen good and bad in both camps. I've seen many more MDAs who try to use the excuse of "supervision" because they want to make money off of us. You and I both know this is true.

I practice evidenced based medicine. So far the studies show that CRNA independent practice is just as safe as MDA alone or the team approach. So you can BELIEVE whatever you want but that does not make it true.

Ron

You didn't describe your practice setting.

Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.

[loveanesthesia]

You didn't describe your practice setting.

Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.

I'm employeed by the anesthesia group, and the hospital does not dictate that the anesthesiologists are responsible for me. I am credentialed as a LIP and I am legally responsible for what I do. The LIP status is the key concept in the relationship.

[SuperSixEightMD]

No an anesthesiologist is not "responsible" for me, he does his case I do mine period. You have got to be a med student or some new resident, it is quite clear that you are not at all familiar with any practice arrangment outside of an acedemic center.

I strongly advise you aquaint yourelf with the nurse practice acts and the application of them, you would not be nearly as ignorant if you woulod educate yourself before you speak.

Stanman, I think you're paying a bit too much attention to the "nurse practice acts" and not enough attention to the place where the rubber hits the road -- the hospital or surgery center.

Granted, I work in a large, teaching hospital with a department of anesthesiology that utilizes CRNAs as extenders. Nonetheless, I'm aware of how "practice arrangements" work, and that a CRNA can be in business for himself/herself and make a contract with a hospital or surgery center to put patients to sleep for surgery.

But at any hospital, if both entities are present, and under certain circumstances, it will be hospital policy that the anesthesiologist has authority that the CRNA does not.