Does it bother CRNA's that MDA's get so much more...?

Specialties CRNA

Published

Hey guys,

I'm not a CRNA yet. I want to be. I just got hired in a MICU/SICU. I was just wondering if it bothered any CRNA's the fact that MDs who practice anesthesia get paid wayy more for doing the same thing? I know some hospitals/facilities require the MDA oversee the CRNA, but does that equate to a couple hundred K more?

I don't know...I just feel CRNA's are not compensated enough for the ENORMOUS amount of responsibility and knowledge they hold.

Study after study has shown equal care when given by independent CRNAs, MDAs, or CRNA/MDA teams.

One thing to note is that generally the nursing world funds these studies, so OF COURSE it's beneficial for them to show that they're all equal. Like all research...it should be taken with a grain of salt. As much as we would all love if bias did not exist...it does, and companies tend to not be against twisting their data slightly if it allows them to look much, much better.

Up Vote Up Vote ×
Specializes in CRNA.
I have no idea if there really ever was such a position as "assistant anesthesia RN," but you can't assume that there wasn't just because you never heard of it. You own post states that CRNAs have been around for more than 100 years, and you are still young at 31, so they could have existed before "your time."

A fairly large part of nurse anesthetist education focuses on the history of anesthesia and that of nurse anesthetists. CRNAs have NEVER been called assistant anesthesia RNs. Aside from anesthesiologists and CRNAS, the only other provider in the United States that is legally licensed to provide anesthesia is an anesthesiologist assistant. JWK would know this better, but I believe they first opened their doors to education in 1969 at Case Western Reserve. Again, how about taking a look at that book I recommended.

Up Vote Up Vote ×
Specializes in Anesthesia.
i applaud your passion .....as a crna you are not an independent practioner in some states, so i stand corrected. somewhere you have a medical director signing off and providing "coverage" especially when medicare patients are involved. but you cannpt practice independently in all state as that is mandated by stae law.

the degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law. so in my state there is the requirment for an md present for induction and emergence. some states use the term collaboration to define a relationship where the supervising physician is responsible for the patient and provides medical direction for the nurse anesthetist. other states require the consent or order of a physician or other qualified licensed provider to administer the anesthetic.

nurses have been administering anesthesia for 150 years.. dating to the civil war.....the official first nurse was sister mary benard in 1877. the first school of nurse anesthesia was formed in 1909 at st. vincent hospital, portland, oregon. established by agnes mcgee, the course was six months long, and included courses on anatomy and physiology, pharmacology, and administration of common anesthetic agents. the council of accredation were developed in the 1970's around 1976. around 1978 an official masters collegiate cirriculum at cal state with kaiser perm. in the united states, nurse anesthetists practice under the state's nursing practice act (not medical practice acts), which outlines the scope of practice for anesthesia nursing.

so, i'm not as uneducated as you think...... want to be crna.:heartbeat

the largest group in independent practicing crnas are the military and you mentioned civilian pay.....are you military? i didn't say crna's weren't good at what they do....they're nurses so i have every faith they are educated and caring and are perfectly capable and conciencious....in some instances mor3e than md's because we all know how they can be.

i didn't say it wasn't cost effective to have crna's i said to the op....if you want the same pay as an md then be an md. we as nurses....we all deserve more pay. the amount of responsibility we are burdened with far supasses our reimbursement in our pockets.

op you can request for crna's to answer, but you cannot dictate who does....it's the nature of the site.

good luck in school!!!!!! peace....:smokin:

there is no state law that states the physician must be present for induction/emergence, if there is post it. there is a lot of confusion about supervision and crnas, but again there are independent crnas in every state. what i imagine is that you work for a hospital(s) that employ the act practice model, and you are confusing (or being confused by the local anesthesia providers/mdas) the local policy vs. state policy.

i am military trained/active-duty military crna. my pay versus civilian crna pay sucks at least during payback......:lol2:

https://allnurses.com/certified-registered-nurse/supervision-required-no-97727.html

here is an old thread. yoga crna on there is a past aana president, lawyer, solo/independent crna, and nurse anesthesia educator. her posts do a much better job than i could ever do explaining the unique phenomenon that is nurse anesthesia practice.

Up Vote Up Vote ×
Specializes in Anesthesia.
One thing to note is that generally the nursing world funds these studies, so OF COURSE it's beneficial for them to show that they're all equal. Like all research...it should be taken with a grain of salt. As much as we would all love if bias did not exist...it does, and companies tend to not be against twisting their data slightly if it allows them to look much, much better.

Yeah, I have heard that argument before. It is about on par with "we never landed on the moon" or "the Masons actually run the whole country" etc. There have been studies that have been funded fully or partially by the AANA. There are also studies that the AANA had nothing to do with at all, and the results were exactly the same. CRNAs are safe and effective providers with no difference in patient outcomes when compared with MDAs.

You believe what you want, but if there was a study that the ASA could fund and show that CRNAs were inferior to MDAs they would have done it and published one hundred times over.

Up Vote Up Vote ×

The degree of independence or supervision by a licensed provider (physician, dentist, or podiatrist) varies with state law. So in my state there is the requirment for an MD present for induction and emergence.

So, why don't you show us since you claim it is true. I'm pretty sure the anesthesia folks know their politics and scope of practice better than you claim to know it.

Up Vote Up Vote ×
Specializes in Anesthesia.
I have no idea if there really ever was such a position as "assistant anesthesia RN," but you can't assume that there wasn't just because you never heard of it. You own post states that CRNAs have been around for more than 100 years, and you are still young at 31, so they could have existed before "your time."

I have never heard that term either. It doesn't show up on a google search or on a search of the AANA website. Do you have AAs in your state? I imagine that was local term or a term used to describe AAs. You aren't from Georgia are you?

Up Vote Up Vote ×
Specializes in Pedi ICU.

Esme12: Prior to making declarative statements regarding a field you do not understand well, do some research. I won't talk about flight nursing or how deep sea welders should do their job. You do the entire nursing field a disservice with your incorrect, misguided statements.

To the OP: wtbcrna is a great anesthesia resource for this site.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So, why don't you show us since you claim it is true. I'm pretty sure the anesthesia folks know their politics and scope of practice better than you claim to know it.

Commonwealth of MA.....244 CMR 4.05

http://www.mass.gov/Eeohhs2/docs/dph/quality/boards/nursing_244cmr4.00_task_force.pdf

Current regulation:

Supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of Massachusetts who

1) has completed approved ACGME training in the United States or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from MA department of health and the DEA

3) develops a mutually agreeed upon guidelines for the APN practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

The Board of Registration in Medicine's regulation 243 CMR 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the ACGME or RCPSC in a specialty area appropriately related to the nurse's area of practice, is Board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. This regulation includes advanced practice nurses who practice pursuant to MGL 112 sec. 80 H. A physician who is not an anesthesiologist may be a supervising physician for a CRNA as long as he/she complies with the requirements of 243 CMR 2:10.

.............:rolleyes: There.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Esme12: Prior to making declarative statements regarding a field you do not understand well, do some research. I won't talk about flight nursing or how deep sea welders should do their job. You do the entire nursing field a disservice with your incorrect, misguided statements.

To the OP: wtbcrna is a great anesthesia resource for this site.

You do the entire nursing field a disservice with your incorrect, misguided statements. (see above :rolleyes:) Your inexperience shows in your rush to judgement and harsh statements......and I say that in the nicest way possible...

I agree....wtbcrna is very knowledgable and a great resource....no one questioned her integrity. The OP was talking about money and I said if you want to make that kind of money be a doctor...I knew I'd get flamed and that's ok. It it just what I experienced at a prominent hospital where I worked and have seen at other hospitals in my area. All areas of nursing are regulated differently in every state and some are more restrictive than others.

I type in peace.......*wine;) Flame on!!!!!!!!!!:flmngmd:

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
the level of ignorance regarding the nurse anesthetist profession on this website is absolutely astounding. that is why you do not find too many crnas posting. crnas have actually been around for more than 100 years and "otjt" ended in sister mary bernard's day (1880's). i have never heard of an "assistant anesthesia rn". i have heard of anesthesiologist assistants. they are not necessarily nurses but they have been practicing for over 32 years. there are also no programs that run 15-18 months and you cannot get your degree online. we do not practice under a physician's license. we practice under our own license. we are allowed to administer anesthesia independently. in fact there are many crna only groups throughout the united states. do you think crnas in the armed services practice under the license of an anesthesiologist? may i suggest reading a book called watchful care by marianne bankert. it will give you a pretty solid history lesson concerning nurse anesthetists. also, if you really want to know what we can or cannot do, check out a more reliable site, aana.com. that way, the next time a poster would like to comment on the practice rights of a crna they will be accurate.

if one is angry with their salary or resentful of someone else because they make more...welcome to life. it is not always fair. there is no rule that says it has to be. crnas are paid what they are worth because of market demand and location. want to make more, go work in independent practice, moonlight or move to a rural location. no one is stopping you.

http://www.amazon.com/watchful-care-history-americas-anesthetists/dp/082640510x

commonwealth of ma.....244 cmr 4.05

http://www.mass.gov/eeohhs2/docs/dph...task_force.pdf

current regulation:

supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of massachusetts who

1) has completed approved acgme training in the united states or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from ma department of health and the dea

3) develops a mutually agreeed upon guidelines for the apn practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

the board of registration in medicine's regulation 243 cmr 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the acgme or rcpsc in a specialty area appropriately related to the nurse's area of practice, is board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. this regulation includes advanced practice nurses who practice pursuant to mgl 112 sec. 80 h. a physician who is not an anesthesiologist may be a supervising physician for a crna as long as he/she complies with the requirements of 243 cmr 2:10.

good book by the way......:)

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
------------------------

and what state exactly do you live in? there is a difference between national/federal/state legal policy and independent groups coming up with position papers and standard of care policies. as far as i know, and i encourage you to correct me, there is no state that has a state law that requires a mda to be present during induction or extubation. the only state laws (that i know of) that is tied into this policy has to do with billing issues. if the mda follows the independent group's standard of care policy then they are able to bill medicare 100% value of their services. if they do not follow the independent group's standards then they are only allowed to bill 50% (or some appreciatively lower percentage) for their services. no one is being arrestested, no licenses are being retracted in the latter case. it is merely a billing issue that some like to contort in order to inflate their egos. there is no state that bans independent practice of a crna. and again, if i'm wrong,.. please update me with the state statute. ( and i say this without sarcasm..seriously.)

as for the pay issue. there are drawbacks for every path that one may take. like others said, if you want something, take the path thats going to lead you there. crna is not the path if you're looking for 200k base salary. as for md's getting paid more because they take on a greater responsibility....you are both responsible for the patients life, responsible for assessing the patient and anticipating crisis. you are both equally in danger of being sued.

like almost all careers, the more school, the more suffering, the more money.

commonwealth of ma.....244 cmr 4.05

http://www.mass.gov/eeohhs2/docs/dph...task_force.pdf

current regulation:

supervising physician (summary)

means a physcian holding an unrestricted full license in the commonwealth of massachusetts who

1) has completed approved acgme training in the united states or is board certified in the nurses area of specialty or has hospital admitting privileges in that area of specialty

2) has valid registration to prescribe medication orders to rpescribe narcotics and anesthestic agents from ma department of health and the dea

3) develops a mutually agreeed upon guidelines for the apn practice and prescribing practices

4) reviews and provides direction for the nurse's prescriptive practices at least every three months

the board of registration in medicine's regulation 243 cmr 2:10 provides that a physician may be a supervising physician for any advanced practice nurse engaged in prescriptive practice if he/she has completed training approved by the acgme or rcpsc in a specialty area appropriately related to the nurse's area of practice, is board-certified in a specialty area appropriately related to the nurses area of practice, or has hospital admitting privileges in a specialty area appropriately related to the nurse's area of practice. this regulation includes advanced practice nurses who practice pursuant to mgl 112 sec. 80 h. a physician who is not an anesthesiologist may be a supervising physician for a crna as long as he/she complies with the requirements of 243 cmr 2:10.

Up Vote Up Vote ×
So in my state there is the requirment for an MD present for induction and emergence.

You've still not pointed this out to us. Inquiring minds would like to know.

Up Vote Up Vote ×
+ Add a Comment