Superior CRNA vs. MDA

  1. I'm reviving this topic because I am starting a doctorate CRNA program next month and am interested in how the field will be when I graduate in three years.

    Of course everyone knows that recently it's been mandated that by 2021 all CRNA programs admitting new students must be a doctorate program so that by the time they graduate in 2025 they will be graduating with their doctorate. Ultimately I think most all of us know that besides having some more published research papers and some more leadership and admin courses there won't be much difference between the previous CRNA programs and the new DNP/DNAP. Although I'm hearing feedback from MDA's and MDA wannabe's that suggest they are greatly disturbed by it.

    I expect that more research will be coming out with more studies indicating that CRNA's independent practice is safe and provides outcomes identical to MDA counterparts to supplement the demand that all new CRNA's have doctorates. This is obvious to everyone in the field that the AANA is vying for more independence and parity with MDA's.

    So while I fully support all this and am in fact going to be one of these new CRNA DNP's who will research and apply myself so that I can practice at full capacity and autonomously I'm anticipating the MDA backlash that will come. The more power and autonomy CRNA's get, the more animosity and backhanded "safety" policy MDA's and hospitals will attempt to implement.

    Where do you see this going and what current behaviors and policy have you seen in your clinical practice? I'm about to start school and am hearing comments about MDA's not wanting to teach or train CRNA's, showing deliberate favor to the superior anesthesia resident, attempting to implement policy that CRNA's only take easy cases like total knee's and attempting to keep them from getting blocks and cardiac cases. I want to learn EVERYTHING in anesthesia and practice to the full extent of my ability, aka do anything as good as an MDA does. What I'm hearing though is that only a few CRNA's if any get specially trained on the high risk cases and it's up to an MDA to (authorize?) it.

    Do you have any advice or tips to make this happen?
    •  
  2. 46 Comments

  3. by   RegularNurse
    CRNAs will never reach clinical parity with MDAs until they complete residencies and possibly fellowships. From a health care organization standpoint, pay will reach equilibrium when CRNAs have a broadened scope and equal billing capacities.

    However, CRNAs are the cheaper alternative and have a much smaller barrier of entry into the field. I think CRNA is the way to go if you want to get into the anesthesia game in the United States.


    Workforce Projections:

    The number of MDAs is expected to increase by 19% from 46k (2010) to 54.8k by 2025.

    The number of CRNAs is expected to increase by 87% from 44K (2010) to 82k by 2025.

    In 2025, there will be an expected 1.5 CRNAs for every MDA, obviously there is tremendous job growth for CRNAs.

    This isn't a big deal with the current model and utilization of CRNAs in less complicated higher volume cases such as GI suites and basic ortho surgery. But unless CRNA training becomes significantly more rigorous, MDAs will dominate the anesthesia game in clinical prowess because their training is simply superior.

    Even if you control for med school for MDAs and ICU experience for CRNAs, the length of internship, residency, and fellowship (in certain sub specialties) results in nursing schools' ability to simply outpace MDA programs at churning out doctors. This abbreviated training alone should answer your question. If anybody thinks you can condense that level of training into a three year grad school program, or soft doctorate (from what I've heard), they are not being objective.

    To be blunt, a doctorate degree is not the same as a residency/fellowship. I think the real solution here for CRNAs is to challenge the anesthesia boards after performing their own structured residency program. I think CRNAs could absolutely successfully challenge the boards if they had a regimented, structured residency like physicians. If they pass the boards, then they can at least objectively demonstrate equal clinical acumen by existing gold training standards.

    Best of luck in your program. Regardless of any legislation or cultural changes, you will have a very fulfilling career as a CRNA. I have never met a miserable CRNA, but I have met plenty of miserable anesthesiologists.

    Workforce Projection Source:

    http://bhpr.hrsa.gov/healthworkforce...pecialties.pdf
    Last edit by RegularNurse on Jun 29, '16 : Reason: error in post
  4. by   AAC.271
    Can I offer some candid advice brother? Based on your stated goals and concerns, I honestly feel like you would be a better fit as an MDA as opposed to a CRNA. Look, I'm very pro NP education and I'm an sNP. However, I do get the vibe from you that you are already concerned about the politics CRNA's have to deal with as well as your desire to be the top dog of your profession. I know you said you didn't want to go through the process of going thorugh medical school and residency, but you also don't seem too pleased about having to go through the process of defending your degree and you have stated your goal is trying to learn as much as possible in anesthesia (Which frankly the doors are much more open with anesthesiology fellowships and what not)

    I know it is incredibly difficult because you will be starting your program, but it's honestly never too late since you're a young guy.

    Or you could get your CRNA and then your MD degree afterwards. I know a few CRNA's who actually did that, but that just doubles the amount of time. If you really have that mindset you are expressing right now, then I would say 1. Take a step back and keep an open mind and forget about the CRNA/MDA war. 2. Ask yourself what type of provider do you want to be 20 years from now. 3. Sit down and think it through and remember that people enter CRNA school or medical school all at different ages. I think you said you were 24 right now? You have many years to still decide.
  5. by   RegularNurse
    Quote from AAC.271
    Can I offer some candid advice brother? Based on your stated goals and concerns, I honestly feel like you would be a better fit as an MDA as opposed to a CRNA. Look, I'm very pro NP education and I'm an sNP. However, I do get the vibe from you that you are already concerned about the politics CRNA's have to deal with as well as your desire to be the top dog of your profession. I know you said you didn't want to go through the process of going thorugh medical school and residency, but you also don't seem too pleased about having to go through the process of defending your degree and you have stated your goal is trying to learn as much as possible in anesthesia (Which frankly the doors are much more open with anesthesiology fellowships and what not)

    I know it is incredibly difficult because you will be starting your program, but it's honestly never too late since you're a young guy.

    Or you could get your CRNA and then your MD degree afterwards. I know a few CRNA's who actually did that, but that just doubles the amount of time. If you really have that mindset you are expressing right now, then I would say 1. Take a step back and keep an open mind and forget about the CRNA/MDA war. 2. Ask yourself what type of provider do you want to be 20 years from now. 3. Sit down and think it through and remember that people enter CRNA school or medical school all at different ages. I think you said you were 24 right now? You have many years to still decide.
    Fantastic and accurate advice.
  6. by   Bluebolt
    I appreciate both your viewpoints.

    I was selected for a med school internship 6 years ago in my undergrad and almost abandoned my nursing major to do premed and go straight to med school. After seeing the way the medical field was moving, insurance company reimbursement, lifestyle demands, etc I chose to not go that route. I wanted to work in anesthesia and saw CRNA as the best way to do that within an acceptable time and financial commitment. Ultimately it will still take me 7.5 years in school, 4 years ICU practice time and $150,000 in student loans but I find that preferable to 4 years undergrad, 4 years med school and then residency and anesthesia fellowship.

    I've spoken candidly to my friends who were my fellow interns now in residency about my career path and they heavily support my choice. Many of them have said they would have definitely did what I did if they thought they could have put up with being a bedside nurse for a few years, insert poop joke here.

    I don't think in order to practice at my full extent of licensure and training capacity I should have to give up being a CRNA and go be an MDA. They quite literally are taught to do the exact same thing and must have the same skills. The only real difference is that MDA's do a full anesthesia fellowship where they are hand picked to have the best and most high risk cases, practicing the more advanced skills. Of course if you're given the more advanced cases over and over and have more energy invested in your training then you will have a better grasp of that skill.

    My request is that both anesthesia providers who have evidenced based research showing they produce the same safe results should also have similar opportunities at practicing advanced anesthesia skills. Is there an environment other CRNA's have seen this happening? With the way the market is moving I see things shifting in that direction anyway but for those CRNA's practicing now I'd be interested in your opinion on it.
  7. by   wtbcrna
    There has always been politics in anesthesia. The politics has only increased as reimbursement for anesthesia has increased.

    https://www.aana.com/resources2/prof...2012102009.pdf

    It will never matter to some people the amount of studies that show independent CRNAs are just as safe and as effective as anesthesiologists. Some anesthesiologists see independent CRNAs as a direct threat to their bottom line and cushy jobs.

    1. CRNAs complete residencies already. They are structured differently than medical residencies, but are designed so that CRNAs are able to be independent CRNAs right out of school. There are some schools and training sites that sabotage SRNAs to try to make them dependent on MDAS by limiting exposure to CVLS, PNBs, and independent practice, but luckily those aren't the majority of schools.
    2. There are also a limited number of fellowships for CRNAs.

    Most nurses that work in large hospitals that utilize medical direction/supervision models have no clue what CRNAs can and do do. All they see is their microcosm that is not representative of the entire CRNA working community.

    Current policy is moving towards the removal of barriers to full indpendent practice for all APRNs/CRNAs. The DOD did away with the majority of these barriers decades ago. The VA is trying to to change their nursing handbook to allow indpendent APRNs in all facilities now. There are more opt out states and several other states moving towards opt out, full prescriptive authority for APRNS, and recognition of CRNAs in other states.
  8. by   AAC.271
    ,I'm not expert on the anesthesia field, but the same arguments MDA's use against CRNA's, the CRNA's use against AA's. To be a devil's advocate, are CRNA's in favor of expanding AA practice? they are basically the PA's of Anesthesia but receive far less training than CRNA's and can't practice in every state. They do cost less than CRNA's.

    Look. as an sNP, I know the CRNA folks are the creme of the crop of the nursing profession and I have tremendous respect for you folks. The profession attracts some of the best and brightest folks in our field. I also know that in the anesthesia field, the training CRNA's go through is far more extensive than the training the PA's go through (the anesthesiology assistants) and longer with the new DNP programs coming out. However, I'm also pretty sure the data will show results between AA and CRNA are similar because anesthesia is fairly safe nowadays.

    The point being is that we need to walk a very fine line in arguing for expanded practice rights or else we will get bit right in the back from other professions asking for equality among all providers.

    One thing that has really worried me is that my former hospital is picking up a bunch of medical assistants instead of LPN/RN's. The RN's still run the show, but the MA's are slowly creeping in because they are cheaper and less trained, but can do your vitals and the basic things.
  9. by   AAC.271
    As much as I want the future of healthcare to have NP/MD/DO in the same echelon, we have to be cognizant that there are other mid levels among us who will want to join us or will start competing with us. Because of how established the MD's are, they will generally always be the last to be laid off, but if AA's start gaining steam, then who do you think the greedy hospitals look to let loose? the CRNA's, especially if the AA organization starts conducting studies showing how safe they are compared to Anesthesiologists/CRNA.
  10. by   ICUman
    Quote from AAC.271
    if AA's start gaining steam, then who do you think the greedy hospitals look to let loose? the CRNA's, especially if the AA organization starts conducting studies showing how safe they are compared to Anesthesiologists/CRNA.

    AA's can never practice independently as CRNA's can, so that isn't going to be an issue.
  11. by   AndersRN
    Quote from AAC.271
    As much as I want the future of healthcare to have NP/MD/DO in the same echelon, we have to be cognizant that there are other mid levels among us who will want to join us or will start competing with us. Because of how established the MD's are, they will generally always be the last to be laid off, but if AA's start gaining steam, then who do you think the greedy hospitals look to let loose? the CRNA's, especially if the AA organization starts conducting studies showing how safe they are compared to Anesthesiologists/CRNA.
    That will happen when they have Chamberlain University School of Medicine...Anyone can get in... online classes... find your own preceptor(s)... on and on and on.
    Last edit by AndersRN on Jul 1, '16
  12. by   wtbcrna
    1. There are no studies comparing independent CRNAs and independent AAs, and there never will be. Independent AAs do not exist.
    2. APRNs/CRNAs are not mid level anything. CRNAs have have been around longer, as a group, than anesthesiologists and CRNAs never have needed anesthesiologists to practice anesthesia. Mid level is used as a term to try denote that APRNs are lower and less qualified than our physician counterparts.
    3. The salary of AAs might be lower than the average CRNA salary, but that does not mean they are the lower cost provider. CRNAs are the lowest cost provider since CRNAs cost less to train than MDAs and don't require supervision/direction to work. AAs always have to have an anesthesiologist to supervise/direct them actually making more costly to employ.
    4. The lowest cost anesthesia practices are in order of lowest to highest cost: CRNA only, mixed CRNA and MDA both working independently, ACT (supervision/direction by MDAs. This is where all AAs have to work), and MDA only practices.
    5. AAs maybe gaining ground in some states, but APRNs are gaining full autonomy much quicker. That more than levels the playing field.

    https://www.aana.com/resources2/rese...j_10_hogan.pdf
    Last edit by wtbcrna on Jul 1, '16
  13. by   BigPappaCRNA
    Quote from AAC.271
    As much as I want the future of healthcare to have NP/MD/DO in the same echelon, we have to be cognizant that there are other mid levels among us who will want to join us or will start competing with us. Because of how established the MD's are, they will generally always be the last to be laid off, but if AA's start gaining steam, then who do you think the greedy hospitals look to let loose? the CRNA's, especially if the AA organization starts conducting studies showing how safe they are compared to Anesthesiologists/CRNA.

    There never will will be a study about independent AAs. Because they cannot practice independently. Ever. They can only practice in the most expensive model of anesthesia care, which is the ACT. AAs are nothing more than a solution desperately searching for a problem.
  14. by   sirI
    Please note some posts have been removed as they do not really help the OP.

    If a member(s) wants to discuss other non-nursing aspects of anesthesia (education, training, etc.), please start a new thread.

    Thanks.

Must Read Topics


close