[hbgwan]

Originally Posted by DocHolliday

Referring to you folks as "you mid-levels" is condescending?

Why do you consider the title of "mid-level" to be something unfavorable?

i meant what i said - "you mid-levels" is condascending. it is a general consensus whenever "you" is placed in front of the people you are addressing, it can be assumed that the person speaking views him or herself as on a different level.

no, mid-level is anything but unfavorable. it's just the way anyone with the word "nurse" in his or her title is addressed by superiors that is often condascending.

[DocHolliday]

You must be absolutely right.....research means nothing, but since having an MD means everything plus the duration of education means even more at least when it is combined with an MD (if I understand what you are saying) then all MDs should be under the direct supervision of MD-PhDs because obviously those two degrees together must make better clinicians.


I swear, it's like I'm talking to my two year-old.

First off, the PhD is a research degree. It is not a degree like an M.D., D.D.S., D.O., D.P.M., etc. that provides training in clinical medicine (or one of its branches). Students in MD-PhD programs want both degrees because they want to conduct research, but have the ability to combine research with patient care.

Anyways, did you not read what I said about the research to which you referred? Do you not comprehend the possibility that just because someone does research on a topic does not mean that his/her results do not necessarily produce accurate information? The very research to which you refer fails to take into account many things pertaining to the use of CRNAs in the delivery of anesthesia care, and because of it, neither I nor any of the anesthesiologists with whom I work regularly consider the research to be accurate in its conclusions--i.e. that CRNAs can do the jobs of anesthesiologists. Like I said, data can be cherry-picked to make any conclusion that you want.

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

You know, I've heard lots of sayings. Such as "that's the way the ball bounces" or "it ain't over 'til the fat lady sings". I've even heard a saying that goes "If God didn't intend for us to eat animals, he wouldn't have made them out of meat."

But I've never heard the saying that "anesthesiologists are the only MDs that work in a nursing profession." That must be one that's used only by nurses playing make-believe, pretending to be anesthesiologists.

Good Luck in your profession DocHoliday and try not cough on any of your patients...

Thanks! That's wonderful advice, doctor. (You don't mind if I call you "doctor", do you?)

[Dr.Nurse2b]

Originally Posted by DocHolliday

Referring to you folks as "you mid-levels" is condescending?

Why do you consider the title of "mid-level" to be something unfavorable?

Is this a Troll?

Dr. H

I do not think anyone here feels the title of mid-level is something unfavorable. I believe it is you that have drawn this conclusion. I can only imagine perhaps you like controversy or enjoy showing off your intellectual capacity for debate. You are very talented.

What you are sensing here is slight tension and perhaps animosity toward what I feel to be an insensitive attitude. It is the method in which you present that people are finding offensive. Considering your mental acuity I would go as far as to say you are doing this intentionally to illicit the very responses we see here.

I am certain you are a very intelligent person and a competent physician, however I think you are going about this the wrong way. I would recommend refraining from posting legal briefs and try to be a little more compassionate.

A young physician is impressive. A young physician with wisdom and compassion is amazing.


My 2 cents

[Josh L.Ac.]

Originally Posted by wtbcrna

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

That statement is entirely wrong. Since the use of anesthesia actually dates back to the father of Chinese surgery, Hua Tuo, then CRNA's/AA's and MDA's are all actually practicing Traditional Chinese Medicine.


http://en.epochtimes.com/news/4-2-6/19495.html

[Dr.Nurse2b]

I was going to quote you but I just don't have the time. Boy you're a tough one. Inferiority complex? Not nice...and where do you get this from?

And I am curious...when you deal with your colleagues or staff members and you do not agree with them do you ask them if they have an inferiority complex?

OK Dr. Holiday...

Less education... Perhaps...lets compare the pathways just for fun...

By your rule:

You stated undergrad does not count. I think you stated it was a requirement. OK, Let's see...

The CRNA program is a doctorate level program which requires 36 months of education, lots of didactic AND...

Here are last years residency case statistics for the graduating CRNA class:

Total cases - 640
ASA III and IV - 318
Class V – 6
Pediatric-50
Emergencies 68
Intracranial 8
Intrathoracic 27
Heart 10
Obstetrical 41
Invasive line insertions 10
Regional administration 52

You being the expert, how do the above stats compare to those of an Anesthesiologist program?

Now an RN can't get into CRNA school without 1-2 years of critical care experience...but according to your rule this experience counts for ZERO...it is a requirement. Curious...I can't count ICU time and I am wondering why you place no value on critical service. Isn't this the place where you send all your post-op patients? Aren't we the ones that keep them alive? But no credit...OK. Mental note...ICU unimportant to surgeons...OK.

To continue...

The CRNA program -- 3 years PLUS residency PLUS didactic for CRNA = 4 years for a total of 7.5 years of nursing education with 4 of those years FOCUSED on anesthesiology. Oh but wait...As per your rule we can only count the 4 years.

Anesthesiologist...

Undergrad in whatever you want.

3 years med school + residency for total of 4 years. Wow...8 Years!

How long is the program to become an Anesthesiologist? Is it 4 years?

Fours years of anesthesia training for the doctor. Total of 12! WOW!

I believe the definition of Anesthesiologist is: A medical doctor trained to administer anesthesia.

And the definition of a CRNA or Certified Registered Nurse Anesthetist is: a registered nurse trained to administer anesthesia.

So both disciplines trained in the same...Anesthesia.

Now if we were comparing an MD to an RN I'd say the MD has the RN hands down when it comes to education in general. Meaning the MD spent way more time in school then the RN.

But today Dr. Holiday we are talking about CRNA vs MDA...
Thats a registered nurse trained to administer anesthesia vs. a medical doctor trained to administer anesthesia.

And by your rule...

The RN undergrad does not count and neither does experience.

So by your rule...

Medical school DOES NOT COUNT for the MD...it is a requirement to be trained as an Anesthesiologist.

Simply stated:

The MDs training is 4 years and allows him/her to administer anesthesia.

The RNs training is 4 years and allows him/her to administer anesthesia.

One must be a doctor or a nurse in order to be TRAINED to administer anesthesia. Now its not the nurse's fault the MD chose to go to school for 12 years to do the same job and in all honesty I'd be upset too if that good looking CRNA standing next to me was getting paid the same $$.

CRNA's are trained and paid to do the same job as an Anesthesiologist. You're not practicing gereral medicine, diagnosing illness or giving orders to the floor nurse...tube and gas - 4 years PERIOD Dr. Holiday...

The inferiority complex exists with the MDs that are afraid to recognize educational pathways beyond their own. I mean really...if we start calling nurses DOCTOR...heaven forbid...who would want to go to medical school?

But don't worry...I won't command that you call me doctor when I have DNP added to my name. You can go on calling me the nurse with the inferiority complex...

[Josh L.Ac.]

Do you honestly believe that a BSN program is comparable to medical school? How about 1 year ICU experience + 36 month CRNA school being comparable to a four year anesthesiology residency?



Seriously?

[DocHolliday]

I was going to quote you but I just don't have the time. Boy you're a tough one. Inferiority complex? Not nice...and where do you get this from?

It seems to me that making mention of the fact that your training in the medicine of anesthesia is less than that of an anesthesiologist elicits a negative response from you. It's the truth, yet, it's a truth you don't want to be reminded of.

And I am curious...when you deal with your colleagues or staff members and you do not agree with them do you ask them if they have an inferiority complex?

My goodness, you're not even understanding what I'm saying, let alone agreeing with what I'm saying. The most obvious aspect of my whole argument here is that I am not belittling your profession. Did I come to this forum and say, "CRNAs are incompetent pukes who should be cleaning bed-pans?" No. I came here saying essentially, "Anesthesiologists have superior training in the area of medicine called anesthesiology."

OK Dr. Holiday...

Less education... Perhaps...lets compare the pathways just for fun...

By your rule:

You stated undergrad does not count. I think you stated it was a requirement. OK, Let's see...

Undergrad is required for every graduate-level educational program. CRNAs are not in any way unique by having completed undergraduate degrees. You know this. So stop bringing your 4 years in college into the picture, because we ALL had to do it.


The CRNA program is a doctorate level program which requires 36 months of education, lots of didactic AND...

Like hell it's a "doctorate level" program. If it were a doctorate level program, you would be awarded the title of doctor. Obviously, you are not. Not only is not not a doctorate level program, it doesn't even meet the duration of a doctorate level program. With the exception of law school, there is no doctorate level program that is less than 4 years in duration. There is ONE exception to this: there is one dental school out of 50+ dental schools, to my knowledge, that has managed to squeeze 4 years-worth of DDS training into a 3 year curriculum (by cutting out vacations and severely intensifying the program)....at least, that's what an OMFS friend of mine who went there told me. Every other dental school if 4 years (and miserably hard, from what my friends who are dentists tell me), optometry school is 4 years, podiatry school is 4 years, veterinary medicine school is 4 years, hell.....even chiropractic school is 4 years! But according to you, CRNA programs, which for some bizarre reason award a masters degree, are just 2.5 years in length.

Yet, you submit that CRNA programs are doctorate-level.


Here are last years residency case statistics for the graduating CRNA class:

"Residency"? That's rich!


Total cases - 640
ASA III and IV - 318
Class V – 6
Pediatric-50
Emergencies 68
Intracranial 8
Intrathoracic 27
Heart 10
Obstetrical 41
Invasive line insertions 10
Regional administration 52

You being the expert, how do the above stats compare to those of an Anesthesiologist program?

I'm a head/neck surgeon, not an anesthesiologist. So obviously, I don't know the number of cases. I wish I did, however, it would have helped me make my argument.

I would be absolutely shocked (and humbled) if those numbers surpassed the numbers and variety of cases handled by anesthesiology residents.


Now an RN can't get into CRNA school without 1-2 years of critical care experience...but according to your rule this experience counts for ZERO...it is a requirement. Curious...I can't count ICU time and I am wondering why you place no value on critical service. Isn't this the place where you send all your post-op patients? Aren't we the ones that keep them alive? But no credit...OK. Mental note...ICU unimportant to surgeons...OK.

We covered this ground before, did we not?

Work experience is not the same as formal training. I'm not saying it counts for zero. What I am saying is that it is not something that should be considered as an equivalent to formal training.

Look, I know you like to add whatever experiences you have to your collection to make yourself appear closer to anesthesiologists in extent of training. But don't do it. It just makes your argument sound desparate.

To continue...

The CRNA program -- 3 years PLUS residency PLUS didactic for CRNA = 4 years for a total of 7.5 years of nursing education with 4 of those years FOCUSED on anesthesiology. Oh but wait...As per your rule we can only count the 4 years.

First, most CRNA programs are 2.5 years, are they not? Where's all this other "didactic" and "residency" crap coming from? I looked up a few CRNA programs using Google, and saw that they were 28 months in duration.


Anesthesiologist...

Undergrad in whatever you want.


But since we're not counting undergrad, neither for CRNAs nor anesthesiologists, it doesn't matter what we study, now does it.


3 years med school + residency for total of 4 years. Wow...8 Years!

Three years in med school? Funny, I spent four years in medical school. I must have been held back a year without being notified of it....just like my 120+ classmates. Perhaps I should sue.


How long is the program to become an Anesthesiologist? Is it 4 years?

Fours years of anesthesia training for the doctor. Total of 12! WOW!

Yes. Twelve years. "Wow" is a very good description of it.


I believe the definition of Anesthesiologist is: A medical doctor trained to administer anesthesia.

And the definition of a CRNA or Certified Registered Nurse Anesthetist is: a registered nurse trained to administer anesthesia.

Don't you think you've oversimplified the job of an anesthesiologist just a tad? Anesthesiologists are physician experts in critical care medicine and pain management. Something CRNAs are not.

So both disciplines trained in the same...Anesthesia.

See my comment above.

Now if we were comparing an MD to an RN I'd say the MD has the RN hands down when it comes to education in general. Meaning the MD spent way more time in school then the RN.

But today Dr. Holiday we are talking about CRNA vs MDA...
Thats a registered nurse trained to administer anesthesia vs. a medical doctor trained to administer anesthesia.

You see, you are making the claim that the "anesthesia training" completed by a CRNA is the same as that completed by an anesthesiologist, and therefore, the only difference between CRNAs and anesthesiologists is the pre-requisite degree for their respective programs. You are wrong. Like I said, CRNA programs are geared toward training nurses to provide anesthesia services. Anesthesiology residencies are responsible for training doctors to become specialists in the science of anesthesia and critical care medicine.

And by your rule...

The RN undergrad does not count and neither does experience.

Nurses coming out of nursing school have very limited knowledge in medicine and I think you know this to be the case. Your RN degree and pre-requisite "critical care" experience is certainly helpful, I'm sure, but it is not to be considered as formal training. It's just work experience that the CRNA programs want you to have so that they don't have to teach you how to "tie your shoes" during your 28-month program, so to speak.

So by your rule...

Medical school DOES NOT COUNT for the MD...it is a requirement to be trained as an Anesthesiologist.


Simply stated:

The MDs training is 4 years and allows him/her to administer anesthesia.

The RNs training is 4 years and allows him/her to administer anesthesia.

I'm about ready to have a heart-attack here....

Your problem is that you are viewing the roles of anesthesiologists and nurse-anesthetists as being identical. Once again, they are not.

Anesthesiology is a specialty of medicine. It is not a trade like plumbing or auto mechanics. The anesthesiologist is a specialized physician....just like me. Let me say it again: the anesthesiologist is a specialized physician. There is no such thing as being an anesthesiologist without having an M.D., D.O., or D.D.S. degree (yes, there are dentist anesthesiologists who work only with dentists).


One must be a doctor or a nurse in order to be TRAINED to administer anesthesia. Now its not the nurse's fault the MD chose to go to school for 12 years to do the same job and in all honesty I'd be upset too if that good looking CRNA standing next to me was getting paid the same $$.

Do you know that oral/maxillofacial surgeons (OMFS) are trained to put patients under general anesthesia (i.e. intubate, administer GA agents like fentanyl, propofol, and halogenated ethers, as well as provide peri-operative management)? Do you know how much anesthesia training OMFSs get during their 4 to 6 year residency? Four to six months! They learn to do much of what CRNAs do in four to six months. What does this tell you? That administering anesthesia safely isn't that difficult. What else does this tell you? That the training of an anesthesiologist, whose residency is 48 months (including 12 months of internal medicine, which you CRNAs barely even touch) covers the science of anesthesia and critical care medicine in a level of detail that no CRNA program can touch.

As far as the money goes, there's no comparison. CRNAs may get paid very well for compared to other nurses, but they don't come close to anesthesiologists.


CRNA's are trained and paid to do the same job as an Anesthesiologist. You're not practicing gereral medicine, diagnosing illness or giving orders to the floor nurse...tube and gas - 4 years PERIOD Dr. Holiday...

Obviously, you are ignorant of the training and skill of an anesthesiologist--to the point where you consider them to be essentially CRNAs with MD degrees (which is probably why you refer to them as MDAs). I don't know what else to tell you. It's your intent to continue your career in ignorance.

The inferiority complex exists with the MDs that are afraid to recognize educational pathways beyond their own. I mean really...if we start calling nurses DOCTOR...heaven forbid...who would want to go to medical school?

What are you talking about? We M.D.'s recognize D.O.'s as our peers, do we not? What you are expecting of us is that we recognize as equals health care providers who have had less training than we have had.

But don't worry...I won't command that you call me doctor when I have DNP added to my name. You can go on calling me the nurse with the inferiority complex

Well, look at it this way: if you want to call yourself the "chief of surgery", I couldn't care less. But should you ever find yourself administering anesthesia for a patient of mine, don't forget whose license you are working under, and from who you will be taking orders.....should I be inclined to give them.

I cannot believe I have wasted so much time arguing this topic with you. You obviously have made up your mind on the subject, and will continue to disregard every fact presented to you.

[Noobposter]

If anyone has an inferiority complex here, it is the young DocHolliday. What kind of doctor would register an account on a nursing forum just to belittle the posters?

And after reading his post, I'm convinced he hasn't even read the study he is trying to critique.

It shouldn't be surprising that CRNA's and anesthesiologists have similar patient outcomes. With the improved anesthetics and monitoring equipment, anesthesia is much safer these days. Accidents are most commonly from lack of attention, not lack of education.

[firecoins]

Originally Posted by wtbcrna

If 4yrs of medical school/3yrs of residency training make MDAs better than CRNAs then provide one valid research study to prove your point.

So 2 years of RN school and 28 month CRNA training program makes CRNA equivalent to 4 years of med school and 36 month residency program? I guess AAs should also become independant.

[QuestForWa]

People, for the love of God, why is it so hard to face facts? Don't you think there are reasons for the requirements for each, CRNA and MDA?
CRNA's and MDA's are competent and capable clinicians, but there is no denying that the Med school component and it's inherent instillation of a certain method of thinking is to be so easily dismissed.


Disclaimer: I am a 24 yr old ICU RN w/ 2yrs exp. with the hope of entering CRNA school soon. I enjoy working with RNs and Dr's and other specialties(RT,PT, etc), providing they aren't arrogant or insensible, and I've seen a fair share that were from each class.

In this time I have kept my eyes, ears, and mind open to absorb EVERYTHING I could about nursing, medicine, critical care, patient interaction, and of course anesthesia. In turn I have learned much due to my own studying, but also due to my interaction with nurses AND DOCTORS of all levels. The ones that are patient and interested enough have gone into depth on issues (clotting cascade pathologies, TRUE 12 lead interpretation, sepsis markers and outcomes) have a thorough understanding and quite honestly get a little over my head by the end.

My friend since 1st grade is now done with his 2nd yr of med school. He has shown me what he is tasked with learning and knowing. It is insanely in depth! True, some of the residents will forget this stuff by the time the ICU comes around, but how many nurses can accurately recall pharmacodynamics after school? For the most part they have their knowledge bank correct and I learn something from them every day. I also just completed an advanced physiology class (using medical student text) for CRNA school and it was damn hard. The demand placed on the BSN student to learn their physio and pharm however, pales in comparison the their doctor counterparts. Point being, yes we will learn the same theories and principles, but I believe the doctors will have more depth and reinforcement on all aspects REGARDING THE PERIOPERATIVE ANESTHESIA PROCESS.

ICU work/training is invaluable. It gets an RN comfortable with necessary topics prior to CRNA school, drugs, hemodynamics, vigilance, technical interpretation. But beyond that, it's what the RN puts into it that determines what they come out with TRULY KNOWING. Seriously, my boss is concerned with the stupidest stuff ever; careplan completeness, error-free lab specimen labeling, etc. vs knowledge and "critical thinking" (i hate that phrase...) Unless I push myself I won't advance. I once caught an MI in progress on a pt. due to a subtle EKG change and behavioral change, pt went to cath lab that night and was scheduled for open heart the next day. Even the jerk Cardiologist (he really is) was impressed. However, my NURSE boss/manager the next day commented on how my tubings weren't properly dated, with no mention of what I did last night (granted, I was only doing my job). Point here is that just saying you have have "2 yrs ICU exp" means nothing if you didn't bust your butt EVERYDAY to earn it, because not many others will take you to task and make you into the quality CRNA applicant you should be.

Beyond that, I can't comment. I haven't been through CRNA school and don't know enough about MDA residency to spout off about either. But if both are rendering anesthesia in the OR when the dust settles, there has to be a good deal of consistency between the two.

The main reason for this fight to opt out and do away with the MDA is crazy. I have a feeling some of it is due to the ACT model and CRNA 's getting frustrated with that type of smothering. But for the most part, it would be good to have an MDA around. Sure, there are scenarios where the CRNA can and does do everything. But what about the ones where the pt. is deteriorating and the surgeon can't offer help, and your elder CRNA cohort(if there is one there) can't work it out either, and there is no MDA in house or on call. Then who suffers? Most of the CRNA's i've talked with and shadowed are happy with thier collaboration with the MDA's and are given a good amount of latitude, and consistently comment on how much they enjoy their job. The exception is the CRNA essentially feeling like a tech and strictly following orders. If there are any CRNA's still posting here, feel free to correct me on the above if I'm way off.

Doc Holliday: I don't believe that a CRNA is practicing under your license. Your liability from anesthesia is dependent on the extent that you choose to direct the anesthetics' delivery, whether by CRNA or MDA. On that note, it wouldn't be in your favor to order the anesthetist just to reaffirm your order on the totem pole, as that is what the tone of your comment suggested. https://www.aanafoundation.com/uploa...iefsp89-93.pdf

That comment aside, Doc has been completely reasonable in his recounts and narration of his thoughts, yet people here are blatantly missing the point and looking silly, or poking their heads in to throw a jab at a doctor that "dared to come here" and give his 2 cents on the subject. His replies may be direct and unabashed, but it is the other posts that are laden with barbs.

And Dr.Nurse2b, if you are going to make a case for us, take the time to get the facts right.

CRNA: 4 yrs BSN, 1 yr ICU, 27-36 months CRNA school = 7.5-8yrs.
MDA : 4 yrs undergrad, 4 yrs med school 4 yrs Anes. residency= 12yrs.

And considering everything builds on the past, that summation factor ultimately favors the MDA.

I think only 1 CRNA school offers the DOCTORATE DNAP at this time, the others award a MASTER'S.

A CRNA is still the most fascinating and exciting role I could imagine working as. But I will know, or at least seek to know, my limitations. I don't mind having someone else around smarter than me, who may tell me I'm wrong because of something that I simply didn't have knowledge of. Think of it this way, the pt doesn't get hurt or die, and you learn something new that you will likely remember, move on... Perhaps my views will change after 10 yrs of being a CRNA, but hopefully this crap won't still be going back and forth and we can all just clam it and realize WE ALL have the opportunity to do some of the best, and most important work on the planet.