this is in response to 'bioncokie's' post under 'Doctor's Frustrations' ,
Let me first say that I think being a crna is a great job. I've been doing it for 5 years now, working in the anesthesia care team model. I work with MDAs daily and I'm glad that they are there. Although some of your comments may be seen as offensive by some of my fellow crnas, you DO have some valid comments. That's what this forum is about. Talking about issues, educating everyone on the experience of crna's and mda's.
It's true that we are NOT as smart as MDs. It's true that we DON'T know the 'medical knowledge' that you do. You're right about our board exams. We aren't nearly tested on our knowledge to the extent physicians are. My crna board exam was only like 80 questions and I had around 3 hours to complete it. I understand your board exams (USMLEs) and Anesthesia boards are way more difficult and time-pressured. You're tested not only on paper, but also in clinical scenarios (like you said in Step 2) and during anesthesia oral boards. It must be very difficult.
I did not feel pressured during either of my board exams (nursing school and anes). We had plenty of time to answer questions. But YOU have to make decisions quickly and those exams prepare you for that. Maybe we should have to take more tests, have more questions, and be 'pressured' by having less time. If 'we' wan't to sit here and try to say we 'do the same things, know the same things' as MDAs do, then we should have to prove it. I calculated all my board exams together. My NCLEX was around 75 questions.. and my CRNA National Cert. Exam (boards) was like 70-100 questions (dont recall exact number). So, I was essentially asked to answer 175 questions to prove myself, not only as a nurse, but also as a CRNA. 175 questions for my entire career. Once I stepped back from this and looked at it.. I was really shocked. MDAs are tested on a completely different level. On behalf of all crnas, i feel we should be tested harder. Maybe we should take the board exam for MDAs and they should take our Nat.Cert.Exam. I think that would answer alot of questions brought up in this forum. But, unfortunately I don't think that would be the best idea.
I have two close friends who went to medical school. I had the unpleasant priviledge to see some of their study materials for their board exams. It really does blow my mind.. how much they had to learn. The shear amount of information that they learn.. it's in a different league. Then they have to show proficiency on numerous USMLEs and Anes boards. There is no way I could learn all that information and answer those board style questions, especially in the short amount of time they have for each question. I graduated number 2 in my CRNA class of 36 students, and I can sure tell you that my classmates would have little or no chance at passing those exams. But that's why I didn't go to medical school. I know my limitations. That's not to say nurses aren't intelligent. But doctors are in a different league, whether you like it or not. They're essentially the top tier students that our nation's universities pump out. That's why society rightfully holds them to a different standard. The're the brightest minds our nation produces. My friend in medschool got his BS degree in chemistry. He graduated summa cum laude. I don't know one nurse who could sit through a physical chemistry/ quantum physics course and pull an 'A'. let alone pull an 'A' in all chemistry courses.
I also found out that 4 of the ICU docs here at my hospital were (are) Anesthesiologist. I asked them how they got where they were. They basically do an extra year in residency in the ICU. They then are qualified to treat patients in the ICU, and in the case here.. our ICU director is an Anesthesiologist. They said there are many MDAs that don't even do the extra year of training but can moonlight in ICUs on the side...
I think I speak for all crnas when I say.. there is no way I could step foot in the ICU, take complete control of treating the sickest and most critical patients in the hospital, and feel like I was doing something right. (even with 12 months of ICU experience after crna residency) I spent 4 years as an ICU nurse. When things went bad, I didn't look to my left and right.. I looked to the phone. I paged the doctor !!
I don't know why crnas get so upset with this issue. Maybe they don't know exactly what MDAs go through, how much they know, the ICU stuff, etc. Maybe crnas don't know how much they really don't know. Well I do. But I'm proud of what I do. We ARE NOT the same as them. We should be proud of who we are. What makes us different makes us unique!! We are UNIQUE. We are SPECIAL !! Rejoice in the fact that we're special !! I love being a crna.
I too am offended that you assume that my CHOICE not to attend medical school means I was not capable of doing so!
I am a woman and chose CRNA as a career b/c it was one that I could make a good salary WITHOUT becoming a slave to my job. It was a medical career I knew I would love (and I do) & I knew I could pay back while working PART-TIME if I wanted to at some point.
If I had gone to med school I could have NEVER chosen to work part-time. I would have been forced to work full-time FOREVER just to pay it back. I did not want that. I wanted children and a family----which I'm 32 and still haven't gotten around to yet but I can when I'm ready. And I wanted to have time to spend with my kids. I wanted to drop them off at school at attend soccer games. Otherwise, why have them?
My parents were not able to pay for my undergrad education much less my graduate MSN program, so obviously there's no way they could have paid for med school either. There's really no such thing as working "part-time" as a physician, and, so I very happily chose the route of becoming a CRNA so that I could become a mom and enjoy time with family and friends & my children working part-time. Working as a CRNA even part-time in the future will still allow me to make enough money to easily pay off my student loan debts without causing me financial stress.
I'll also have you know (the original poster) that I graduated summa cum laude with a double degree in Biochemistry and a BSN from a top-ranked state school---I could've gone to an Ivy League but my baby sister was born when I was 16 and I didn't want her to grow up with me on the wrong coast. And OH YEAH, I managed my first two degrees in 4 years---nearly 200 credit hours total. And I was a National Merit Scholar in high school which helped me get most of my undergraduate education paid for. I later graduated first in my class from a top-ranked CRNA school (a top five program).
Don't tell me I'm not capable of running with the big boys.
you go girl. you are a girl, right? i mean, valentine baby, well, never mind. you go !!!!! :)
I neither feel threatened nor upset by your post - but would like to take the time to thank you for it.
It has provided a degree of insight that many have found uncomfortable. Many have questioned your intent & truthfulness. I do not. For there is a clear difference. I am not too sure about the intelligence bend on your post - In my mind it is in terms of preparation rather than intelligence.
We are not schooled well (or in some cases ....not at all) in the art of differential diagnosis or actual medical management of pathologic states - from diagnostic, treatment, to resolution .....of which helps peri-operatively in management and recognition. Nor is our training in regional blocks (of which I have the training post grad - axill, scalene variations, fem, fa. iliacs, peribulbar, pop, etc..) up to par or even existing....Nor in chronic pain management, - the list goes on....Are many CRNAs really the "same"? No....
New grads, nor many in practice, actually get to do any of this - so when I hear someone in training or in practice say they are "as well trained as MDA" - upon questioning - they are far from it. Doing GA and central axis blocks is such a small component of practice.....Pushing drugs and flipping switches - I dare say...- my 10 year old can do that.
But being able to elaborate and extrapolate on a multiplicity of areas and levels - that shows thinking, training, and education.
This is not to say that the education is not available - it is - but only if one actively seeks it post graduation.
Preparation not intelligence - but thanks for your time and our post...
I agree with your post. There is a much higher level of academic rigor within a medical school curriculum that far exceeds what most people could tolerate. And, as you stated, this is the reason why only the brightest students are accepted. On the other hand, I certainly understand the sentiments of those people who were led to believe by your comment that only "less educated" people choose nursing.
Personally, I would have no problems getting into medical school, let alone completing it: 4.0 GPA in grad school, 3.95 undergrad in anthropology with organic, biochem, cell bio, physics, and microbiology, etc.--as just an example of some of my courses that I took; I am Phi Kappa Phi (top 10% of my graduating class) and Gama Beta Phi (top 15% of juniors); Dean's list every semester in college. And, I have alot of experience in the laboratory, research center, ER, ICU, and telemetry as a hospital corpsman. So, as you can see, I am certainly "educated". However, I chose nursing as a career since I enjoy overseeing the well being of my patients. Doctors do an outstanding job of diagnosing and treating the disease; however, nurses provide the physical, emotional, and spiritual well-being that plays a critical role in the recovery and overall health of the patient. The same can be said of the CRNA who plays a peri-operative role with the patient as it relates to the administering and monitoring of anesthesia.
I've chosen nursing since it is far less stressful than being a physician; and I have more flexibility to decide where I would like to work and how many hours I would like to work. In other words, there is a quality of life issue involved with my decision. To each his own, I guess. But, I never criticize another person for their career path. After all, we are part of the health care "team".
Look I do not see anyone jumping on FNP's if they say they can do a GP"S job. The truth is that a CRNA is just as capable of providing an anesthetic just as well as an anesthesiologist. We are not doctors, this is true. We did not take many of the courses that they did or spend as long in school. We are focused on one thing anesthesia. During a doctors education they will spend time rotating through many different areas then deciding the specialty they want, family medicine, surgery, anesthesia etc. Then they will spend x number of years learning that specialty. An anesthesia residency is 4 years, 1.5 years more the anesthesia school. So yeah in anesthesia we are equal in outcomes and abilities.
Although your post was interesting to a point that each person should be valued for their education, it takes away from the effort your put into your career. Based on what you wrote, I feel like you have a lack of confidence. That being said, I am not sure I would want you putting me to sleep! It takes prudent confidence in order to be good at anything. I am a firm believer that I can do anything I want. When it comes to patient care, we have to all work as a team to MANAGE the situation, even in ICU. I will be attending anesthesia school soon and will be starting at the bottom again. I have no fear of regaining confidence because I know the kind of person I am now, and that is someone who can do anything. If you had that much confidence in yourself maybe you wouldn't make it sound like you didn't work that hard for your degree.
On a side note, I value the MD's and Anesthesiologists that care for the ICU patients, but they are not gods of knowledge, just people with special training... LIKE YOU! You were not trained to care for that ICU patient in ICU. I don't even think there is room to compare the two as they are two different jobs and functions. I value them separately, but please, don't make the value intelligence.
P.S. I took chem, ochem, physics and biochem classes and got A's while working full time - so now you know another person that is capable of it!
I perform regional and general anesthesia every day to patient from 6 months old to 98 years old. "It aint bragging if you do it" And I do it every day safley.
I don't think WanaB implied that you couldn't deliver anesthesia safely. The point was anesthesiologists providing ICU expertise which is somthing that they do best. Sit CRNA down side by side with MDA in OR, and for the large majority of the cases, a surgeon or OR nurses couldn't tell the difference. But ICU care is another animal. W're NOT interchangeable. Each discipline has a place but agree that we could do with many less MDA's in the OR. Its all about the call schedule. No doc wants to take call every 3rd or 4th day unless you're in a small hospital.
it seems as though you were planning on attending medical school.....did you take the MCAT and apply?........
No, I have never taken the MCAT or applied to med school because I have never had the desire to be a physician. I have always planned to become a CRNA when I reached all my critical care goals. I took the courses I did because I write medical publications. That is correct, medical not nursing publications. Currently I am co-authoring a medical ER book for Mosby that will be used by ED physicians. I am writing with an ED doc from California. I took all those extra science & math courses post-degree so that I could have a better knowledge base for my writing.
dfk, RN, CRNA
501 Posts
you go girl. you are a girl, right? i mean, valentine baby, well, never mind. you go !!!!! :)