[Noobposter]

DocHolliday, you seem pretty hung up on this "doctorate" level of education and how most CRNA degrees are classified as master's. The truth is that you just happen to live in one of the only countries in the world that would honor your first professional degree with such a title. If we were in the UK (or most any other country in the world for that matter), you would have a bachelor degree to brag about.

[wtbcrna]

What can I say, but I must be wrong and the largest profession in the US (nursing) must always be totally subserviant to MDs, because we all know that MDs know everything and us little "physician wannabes know nothing". We should call a physician for everything...I need that physician/MDA there everytime something goes wrong, because I am too stupid and uneducated to know how to work in a crisis situation.....hmm I wonder how military CRNAs have survived this long working independently in deployed/humantarian environments without the help of MDAs....But since there are no valid research studies out there besides the Silber study (NOT) what can I say. I bow to your great wisdom/your secret medical education that is conferred upon becoming an MD, your 4yrs of medical school, and your 6 WEEKS of Anesthesia training.....

Originally Posted by DocHolliday

Silber study showed nothing that could be used to compare CRNA outcomes vs. MDAs. I know you could probably care less what the AANA thinks, but their write clearly demonstrates why no other medical journal, but the ASA would publish this study.

Actually, it did. But like all research, it has its detractors, e.g. the AANA. Of course, the conclusions of the Silber study certainly fall in line with the common knowledge that more educated individuals are better suited to perform a job than less-educated individuals.

Yes, I flat out refuse to believe/have not seen it demonstrated/worked with an MDA that would change my mind to the contrary/or aware of any valid research that would suggest that MDAs are more qualified anesthesia providers.

An extra four years of medical education and training are of no significance in your opinion. Oh, but your measely one year of work experience as a nurse in an ICU means a lot!

I have no discrepancy saying that MDAs would be more qualified to do long term ICU care over a CRNA, but that is not what you are refering to. I don't think being an MD makes someone more qualified to take care of anesthesia emergencies. The anesthesia provider's experience counts first and foremost.

"I have no discrepancy"? Look up the meaning of the word "discrepancy".

Anyway, tell me why anesthesiologists are more qualified to provide long-term ICU care, and then tell me why this added qualification for long-term ICU care wouldn't translate into more qualification to provide anesthesia services? You make a clear distinction between anesthesia and medicine.

As a surgeon you absolutely have no idea about anesthesia or CRNAs.

Wrong! My ENT residency included an anesthesiology rotation. Although it was brief (6 weeks), I nonetheless worked at the resident level and performed the same tasks as anesthesiology residents. So I do no a thing or two about anesthesia and anesthesiology. And I can tell you with the utmost confidence that the practice of anesthesiology potentially draws on medical knowledge more than any other field of medicine, with perhaps the exception of internal medicine.


I am not trying to get rid of MDAs. The MDAs I work with have all so far have been great! We all work together in a cooperative envirnoment. The scope of practice where I am doing clinicals allows for complete autonomy of CRNAs (no MDA supervision/no signing off charts behind us etc). MDAs and CRNAs can both work independently in the same environment, give great care, and with equal outcomes.

That's because you your definition of "anesthesia" is sticking a tube in someone's throat and turning up the gas. Anesthesiologists are trained for far more things than you are. God forbid should I or anyone I care about find themselves in need of anesthesia services, I want the most highly-trained person performing it. And that is not you.

Maybe you can answer me this: Why is that some MDs (like yourself) think everyone in the medical field is inferior to them in education/experience and otherwise? Your posts clearly support that you think MDs are the only ones qualified to give quality care.

Define "inferior". I'm not saying CRNAs (or other mid-levels) are inferior, as I define the word. They have certain jobs to do. And no, I don't think physicians are the only ones qualified to provide quality care. But I do have a problem with mid-levels like you who seem to think that they are doctors, minus the doctoral degree. Moreover, I think that physicians should have oversight over everything that mid-levels do, in order to guarantee for the patients that there is someone who is as highly-trained as possible watching over their care.

A medical degree is awesome accomplishment and for the most part is great education, but it is hardly some secret knowledge that MDs learn.

How the hell would you know? From your nursing degree?

CRNAs are taught out of the same books as MDAs, a lot of us share the same instructors as the medical students, go to the same residency sites, have the same preceptors/staff training us etc., and you think there is really going to be a difference in outcomes...No there is not and is proven day in and day out all over the United States.

I have news for you, where I was in medical school, the dental students used the same texts, some of the same faculty, and even took some of their classes with us. Does that make their knowledge of medicine similar to ours? Nor does it make yours.

Nurse anesthesia is speciality education from day one and MDAs have to wait until they get to residency to really start training in anesthesia.

You've made some idiotic statements over the course of our debate here, but this one by far takes the cake. You are a real discredit to your profession, and my impression of the CRNA profession has diminished, knowing that someone so obtuse as you can be a member of it.

Whether you realize it or not, you are saying by this statement is that someone who intends to provide anesthesia is better off without the extensive background in medicine of an M.D. or D.O. (or D.D.S., for dental anesthesiologists).

What exactly do you think medical school is for, Wtbcrna? You think we are trained to treat HTN and perform DRE's, and little else? Do you not see the medicine involved in anesthesia? You obviously know some of it. Physicians obviously know a hell of a lot more of it than you. Someone before me cleverly pointed out that medical training is additive; the scope and depth of medical school better prepares physicians to handle any field of medicine than your 2-year nursing degree does.

Obvisously MDAs wouldn't be able to do what they do without medical school, but it is the residency that makes a true physician not the medical school.

Spoken like someone who's never been to medical school. They grant us the M.D. degree and the title of "physician" because we have shown that we have learned everything required to be awared the degree and the title. In order to practice medicine, we are required to spend merely one year after school in some sort of post-grad training program. Residency, on the other hand, is for the purpose of specialization. I am a physician who specialized in otolaryngology, not a medical school graduate who became a physician during his otolaryngology residency.

This discussion is getting old. I understand fully what you are saying and I totally disagree with you, and you have no valid research to back up your arguement.

No, you do not understand the points I am making. You think in a complete vacuum, with absolutely no regard for the realities around you.

And as far as research goes, neither do you. Don't think for an instant that I (and the entire anesthesiology profession) am unaware of the motivations behind the "research studies" conducted (under the auspices of the CRNA profession) to show that CRNAs don't need any help from their more educated counterparts.

[lsufan]

And not only that, I seriously doubt that the doctoral degree awarded in a DNAP is not going to be a clinical doctoral degree. It'll be more like a Ph.D. (i.e. like a Ph.D. in nursing, or a Ph.D. in pharmacology--degrees that do not grant any clinical privileges).

Actually, "Doc" there is a school that offers a DNAP clinical degree in TN. So it's not "more like" anything.....
To Everyone else, maybe if we just ignore him he will go away.

[DocHolliday]

Originally Posted by lsufan

And not only that, I seriously doubt that the doctoral degree awarded in a DNAP is not going to be a clinical doctoral degree. It'll be more like a Ph.D. (i.e. like a Ph.D. in nursing, or a Ph.D. in pharmacology--degrees that do not grant any clinical privileges).

Actually, "Doc" there is a school that offers a DNAP clinical degree in TN. So it's not "more like" anything.....
To Everyone else, maybe if we just ignore him he will go away.

You missed my point entirely.

Let me simplify it for you:

You know how dentists earn a D.D.S.? Or how podiatrists earn a D.P.M.?

Dentists and podiatrists are doctors, with the same level of authority and autonomy as physicians, except their doctoral degrees are in specialized fields where there are no equivalent specialists in medicine (i.e. there are no physicians who perform root canals or treat in-grown toe-nails). That's why these degrees exist.

I seriously doubt that the DNAP degree is a doctoral degree that is equivalent to a D.D.S. or D.P.M. Why should there be such a degree that awards a doctoral degree in anesthesia when there are already M.D. and D.O. physicians who perform anesthesia?

Catch my point? The DNAP degree seeks to create something that is entirely redundant to the existing anesthesiologists....except for the fact that DNAP's will still have less education than anesthesiologists.

And even if, by some chance, this degree sought to produce a "doctor" who had the same level of education and training as an anesthesiologist, a logical person (in charge) would say, "Well, why don't these hypothetical prospective DNAP students go to medical school and specialize in anesthesiology?"

Does that make sense to you?

[DocHolliday]

Originally Posted by wtbcrna

What can I say, but I must be wrong and the largest profession in the US (nursing) must always be totally subserviant to MDs, because we all know that MDs know everything and us little "physician wannabes know nothing". We should call a physician for everything...I need that physician/MDA there everytime something goes wrong, because I am too stupid and uneducated to know how to work in a crisis situation.....hmm I wonder how military CRNAs have survived this long working independently in deployed/humantarian environments without the help of MDAs....But since there are no valid research studies out there besides the Silber study (NOT) what can I say. I bow to your great wisdom/your secret medical education that is conferred upon becoming an MD, your 4yrs of medical school, and your 6 WEEKS of Anesthesia training.....

Wtbcrna, that's a very childish response.

You need to stop looking at it as being "subservient", and start recognizeing it for what it is: a more highly trained health care professional having oversight over a less highly trained health care professional.

Nobody is saying that you shouldn't be able to make clinical decisions. Nobody's even saying that you're not qualified to handle emergencies. What I'm saying is that there should be an anesthesiologist present to supervise, should problems occur that are beyond the scope of your training. That's why there are physicians who specialize in anesthesiology. Someone, a long time ago, determined that anesthesia and its associated sciences are diverse enough to warrant a physician to specialize in it.

And just FYI, anesthesia is not a nursing profession, as you think. And anesthesiologists aren't dipping into your field. Hell, the concept of anesthesia was invented by a dentist (Dr. William Morton) in the 1800's, so if anything, it is dentistry that "owns" anesthesia. But do you see dentists complaining about anesthesiologists (and CRNAs) stealing their turf.

Regarding my anesthesia experience: I never said that my training in anesthesia made me an authority on the subject. What I've said is that my degree and my training in anesthesia have made me well aware that it is a highly medicine-oriented specialty, and as such, there are certain aspects of it for which mid-levels with nursing degrees aren't sufficiently trained.

Finally, never use the military as an example. The military is the epitome of an organization that has historically been willing to cut corners where health care is concerned.

[DocHolliday]

Originally Posted by Noobposter

DocHolliday, you seem pretty hung up on this "doctorate" level of education and how most CRNA degrees are classified as master's. The truth is that you just happen to live in one of the only countries in the world that would honor your first professional degree with such a title. If we were in the UK (or most any other country in the world for that matter), you would have a bachelor degree to brag about.

We're not talking about the rest of the world, now are we.

That aside, whatever degree a physician holds elsewhere, he or she is still a physician--with all the rights and privileges of a physician. They are not considered to be the equivalent of mid-levels. So, your point makes no sense.

[jwk]

Originally Posted by DocHolliday

And not only that, I seriously doubt that the doctoral degree awarded in a DNAP is not going to be a clinical doctoral degree. It'll be more like a Ph.D. (i.e. like a Ph.D. in nursing, or a Ph.D. in pharmacology--degrees that do not grant any clinical privileges).

Why? Because there are already doctoral degree that cover the field of anesthesia: M.D., D.O., and even D.D.S.

Who in the hell is going to acknowledge a doctoral nursing degree in a specific discipline as an equivalent to one of the current doctoral degrees?

The P in DNP or DNAP is "practice", although it's a strange concept since most of the curricula I've seen have little to do with clinical practice and a lot to do with nursing theory and politics. They're certainly not equivalent to a PhD - they may do a little research worth a few credit hours, but their degree is not based on research and defending a thesis. Also, a PhD in pharmacology is not the same thing as PharmD. The DNP, PharmD and DPT are the equivalents for nursing, pharmacy and physical therapy.

Scope of practice is not determined by degree, but by legislatures and regulatory boards in each state. Of course therein lies the other problem, which as a surgeon, you may or may not be aware of. CRNA's are or are seeking to practice in the area of chronic pain management, including such things as epidural steroid injections, X-Ray guided blocks, and even implantation of nerve stimulators and pain pumps. Louisiana has already ruled that this crosses over into the practice of medicine, but other state boards of nursing feel they can dictate their own rules, regardless of legislation to the contrary. Most of these infringements upon the practice of medicine will end up in the courts or back in the legislature to clarify the definitions of medical and nursing practice.

[DocHolliday]

Originally Posted by jwk

The P in DNP or DNAP is "practice", although it's a strange concept since most of the curricula I've seen have little to do with clinical practice and a lot to do with nursing theory and politics. They're certainly not equivalent to a PhD - they may do a little research worth a few credit hours, but their degree is not based on research and defending a thesis. Also, a PhD in pharmacology is not the same thing as PharmD. The DNP, PharmD and DPT are the equivalents for nursing, pharmacy and physical therapy.

Indeed, a PhD in pharmacology is not a clinical degree. It is a research degree. What I think, though, is that a clinical doctorate in nursing is absolutely ridiculous. It's like bronzing a crushed aluminum can. A nursing degree is not a foundation on which to build a clinical doctoral degree. And there is no need for a specific doctoral degree in anesthesia (stacked on top of a BSN degree).

Think about it, and compare the two:

Student A goes to med school for four years and becomes a physician, and subsequently enters a four year anesthesiology residency to become an anesthesiologist.

Student B goes to nursing school for two years (then works in an ICU for some period of time), then goes to a DNAP program for what, two, three years to become what exactly? What exactly is a DNAP? Why does this "doctor" exist? What the hell is a "doctor of nursing?" Now, you compared DNAP's to PharmD's (which are comparable to DDS's and DPM's, which are 'physician-level' doctors of specific branches of the medical profession). DDS's, DPMs, and PharmD's are doctors that exist to serve a unique and specific need. What need does a "doctor of nursing in anesthesia" serve that is not already served by CRNAs and anesthesiologists? You see my point?

If you ask me, this idea of a DNAP degree is just another ploy to sugar-coat the nursing professions efforts to obtain the rights and privileges of doctors without going to medical school.

This is fight for expanded privileges is not unique. About half the oral surgery residency programs out there now are six years in duration rather than four--the extra two years so that they can earn M.D. degrees as part of the residency. For what? It doesn't make a damn bit of difference to the oral surgeon himself or herself; the single-degree residents get the same surgical training as the dual-degree residents. It's a ploy, so that oral surgeons could more easily expand their scope of practice to include procedures that were traditionally considered to be "medical" in nature, like facial cosmetic surgery, head/neck oncology (my turf!), and so on. At least, at very least, oral surgeons acknowledged the significance of a medical degree in their plight to solidify their expanded scope of practice.

Nursing, on the other hand, brazenly seeks to gain parity with physicians by bypassing the M.D. degree altogether, and instead creating some bogus "doctoral" degree in nurse-anesthesia.

Originally Posted by jwk

Scope of practice is not determined by degree, but by legislatures and regulatory boards in each state. Of course therein lies the other problem, which as a surgeon, you may or may not be aware of. CRNA's are or are seeking to practice in the area of chronic pain management, including such things as epidural steroid injections, X-Ray guided blocks, and even implantation of nerve stimulators and pain pumps. Louisiana has already ruled that this crosses over into the practice of medicine, but other state boards of nursing feel they can dictate their own rules, regardless of legislation to the contrary. Most of these infringements upon the practice of medicine will end up in the courts or back in the legislature to clarify the definitions of medical and nursing practice.

No, I'm aware of everything you said there, except for the topic of CRNAs implanting nerve-stimulators. Boy, they really are cocky, aren't they! That is a surgical procedure, and as a surgeon who busted his tail for four years in medical school and five years in an ENT residency working literally 80+ hours a week to get where he is, I am personally offended that some cockamamie nurse thinks he or she should have the same rights and privileges to surgically modify someone's body.

As a physician, I am also offended that these nurses, advanced practice or otherwise--doesn't matter--wish to practice medicine without a medical degree.

[Noobposter]

Why does this "doctor" exist? What the hell is a "doctor of nursing?" Now, you compared DNAP's to PharmD's (which are comparable to DDS's and DPM's, which are 'physician-level' doctors of specific branches of the medical profession).

What are "physician-level" doctors?? What does that even mean?

DDS's, DPMs, and PharmD's are doctors that exist to serve a unique and specific need. What need does a "doctor of nursing in anesthesia" serve that is not already served by CRNAs and anesthesiologists?

What purpose do MDs serve that aren't already served by DOs?

Nursing, on the other hand, brazenly seeks to gain parity with physicians by bypassing the M.D. degree altogether, and instead creating some bogus "doctoral" degree in nurse-anesthesia.

Again, here you are going on about this "doctoral" level education of yours. I thought we already went over this. You have a first professional degree, which isn't a real doctorate. If you want to brag about a doctoral degree, finish a PhD, like us real doctors.

[wtbcrna]

I was going to write a very lengthy response back, but arguing with you is getting old. This arguement has been ongoing with physicians since the early 1900's and nurse anesthetists have won the right to independent practice over and over again. It doesn't matter what your opinion is or for that matter what mine is. That is a pure and simple fact. There is also plenty of research that shows no differences in outcomes of patients whether they are cared for by MDAs or CRNAs.
Here is a timeline/link to court cases and research studies in favor of nurse anethetists (just FYI...not meant for you Doc H) http://www.aana.com/resources.aspx?u...nuID=6&id=1729

Physicians like you are why most CRNAs feel the need to be politically active. If there is anyone who is acting irrationally on here it is you. You deny research not in your favor, you flaunt "I am doctor and you are not so automatically I must know more" in every post. You think that only physicians can give quality care, and what I mean by that is that if a physician isn't holding another type of provider's hand supervising them then it must not be qualitiy care no matter what the research has shown.

By the way how much time have you spent in the military to make a judgement on military care???

Originally Posted by DocHolliday

Wtbcrna, that's a very childish response.

You need to stop looking at it as being "subservient", and start recognizeing it for what it is: a more highly trained health care professional having oversight over a less highly trained health care professional.

Nobody is saying that you shouldn't be able to make clinical decisions. Nobody's even saying that you're not qualified to handle emergencies. What I'm saying is that there should be an anesthesiologist present to supervise, should problems occur that are beyond the scope of your training. That's why there are physicians who specialize in anesthesiology. Someone, a long time ago, determined that anesthesia and its associated sciences are diverse enough to warrant a physician to specialize in it.

And just FYI, anesthesia is not a nursing profession, as you think. And anesthesiologists aren't dipping into your field. Hell, the concept of anesthesia was invented by a dentist (Dr. William Morton) in the 1800's, so if anything, it is dentistry that "owns" anesthesia. But do you see dentists complaining about anesthesiologists (and CRNAs) stealing their turf.

Regarding my anesthesia experience: I never said that my training in anesthesia made me an authority on the subject. What I've said is that my degree and my training in anesthesia have made me well aware that it is a highly medicine-oriented specialty, and as such, there are certain aspects of it for which mid-levels with nursing degrees aren't sufficiently trained.

Finally, never use the military as an example. The military is the epitome of an organization that has historically been willing to cut corners where health care is concerned.