anesthetist vs anesthesiologist

forane2001 · Apr 26, 2004

Hi, i was reading an earlier post about possible interview questions and one of them was:
"Do you know the difference between a nurse anesthetist and an anesthesiologist ?"
It kind of hit me that im not really sure of the answer, i know this sounds kind of dumb but i was hoping someone could clarify what the actual difference is, thanks for your help.

Anesthetist is a registered nurse. anesthesiologist is a medical doctor. We do the same job. The nurse anesthetist has the same responsibility and liability as the MDA(anesthesiologist.) Keep in mind that the courts have ruled time and again that anesthesia is the practice of nursing. In the mind of the MDA it is medicine. Medical knowledge will only take you so far when giving anesthesia. Anesthesia never cured anybody. It does not diagose any disease. It is an essential service for the surgical treatment of disease. There are great opportunities out there for both anesthesia providers. You may or may not have heard of a third (yes a third) anesthesia provider called an anethesiologists assistant or AA. They must be supervised by an MDA where as A nurse anesthetist may practice indepenent of an anesthesiologist in every state. That is why they dislike us so much. A very politically charged career. Anyway the anesthesia training is pretty much the same. If you have the knowledge and skill you can pretty do everything the MDA can do. I would place my skills up against any MDA I work with. just my 02 cents:p

Tenesma · Apr 27, 2004

forane...i thought the original poster had a very good legitimate question, but your post just rubbed me the wrong way...

1) we don't do the same job

a) MDs can supervise CRNAs and AAs and run 4 rooms at the same time

b) we provide ICU care, we run the PACU

c) we run all the research departments throughout the country

d) we can officially read an EKG

e) we do TEEs and interpret them

2) we don't have the same liability - which is reflected by our different malpractice insurance rates - and in the court of law we are held to the standard of care of our peers (other MDs, not CRNAs)

3) "medical knowledge will only take you so far in anesthesia" - hmmm, that is a load of BS

4) anesthesia has cured people and it has treated diseases:

a) anesthesia for refractory asthma with isoflurane

b) phenobarb coma induction for refractory seizures

c) without anesthesia 99% of inpatient surgeries would be impossible

d) epidural steroid injections, spinal pump implantation, celiac plexus blocks, etc...

d) a large component of anesthesia is critical care and therefore involves the diagnosis and management of intra-operative:

1 - pulmonary/air/fat/cement/amniotic emboli

2 - myocardial infarctions

3 - and other intra-operative catastrophes

5) anesthesia training is not the same

a) CRNA gets 1500-1600 clinical OR hours during the course of study

b) MD gets 9500-10000 clinical OR hours during the course of study, which doesn't include 4-6 months of ICU time - and that doesn't include patient contact/medical knowledge acquired during medical school and internship. At the end of residency, I had done over: 15 pedi hearts, 90 adult hearts, 4 heart transplants, 6 BIVAD placements, 3 double lung transplants, 7 liver transplants, 35 neonatal cases (between the age of birth and 72 hours of life), 450 pedi cases, 80 thoracic cases (including 14 tracheal resections and reconstructions, and 8 carinal resections), 70 cranis (3 of which were done on cardio-pulmonary bypass), 4 ruptured thoraco-abdominal aneurysms, 29 AAA (of which 20 were supra-celiac) and over 2300 other cases.... 500 a-lines, 400 central lines, 250 PA lines (of course those numbers are a bit higher due to the high volume in the ICU).

6) you can't do everything I can do... How do i know this? because i assume that you are similar to the CRNAs I work with. They know that they can't do everything i can, and will come to me with pre-operative issues/questions, they will refuse to do certain cases due to complexity of care, and they will often ask me to come assist when they are having difficulty intra-operatively.

7) when you say that you can put your skills up against any MDA... what do you mean with that? can you put your knowledge up against any MDA too? (oh i forgot... according to you, medical knowledge will only take you so far...)

jrvb · Apr 27, 2004

Wow-

That was pretty passionate. I have to agree with Tenesma. Even as an SRNA I understand that the level of training and understanding regarding physiology and differential diagnosis is not equal. Nor should it be when someone has spent that much time, energy and money on their education.

Kiwi, BSN, RN · Apr 27, 2004

Thanks Tenesma. I knew there had to be differences, but until your post, I thought CRNAs could practice everything that an MDA does. While this is true, it's only half of the story. Thanks for sharing your time and talents with us.

PS- caffine, I love your avatar - that's a dog's dog!

MaleAPRN · Apr 27, 2004

Hi all,

I'm not an SRNA yet...but, there is definitely a clear distinction between an MDA and CRNA. They may appear to do the "same" things...but, the total years of training invested and knowledge base clearly differs. Going into this profession is truely humbling for me. I can't compare myself (even if I become a seasoned CRNA someday) side-by-side to an MDA. There's just no saying that both professions are EQUAL. :)

gaspassah · Apr 27, 2004

hmmm... first time i ever saw tenesma go off.

if i may ask a few questions out of curiosity..

tenesma would you say that your training was standard or above average compared to other mda's?

what cases do you think CRNA's should not do?

with regard to AA's, if you supervise 4 AA's and there is an intra-operative catastrophe in 2 rooms, what is the protocol?

please do not take this as a knock, i often read your posts and you appear to give respect to CRNA's when it's due, and i often appreciate your insight into the delivery of safe anesthesia.

i believe in collaborative practice, but also believe in the ability to practice to the fullest extent of my scope (when it gets here and i pass boards). to me that means i should be allowed to do axillary, interscalene, epidural, spinals etc. i was wondering how you felt about that, as long as the provider has sufficient training in said practice.

thanks for any reply in advance

david

Tenesma · Apr 27, 2004

gaspassah...

it is difficult for me to compare myself to other MDAs --- i know that everybody at my residency program had similar experiences.

i think CRNAs are very well trained - and that they should do any case they feel they can handle (of course this statement is directed towards those who know their limits). The advantage is that most complicated cases that are done at CRNA-only hospitals are done in the setting of plentiful resources (cardiologists/intensivists, etc.), so there is a safety net in place. I don't think that there is a case that a CRNA shouldn't do (purely based on the case), but I think that there are certain patient populations that shouldn't be done without an MDA available. if you feel perfectly comfortable doing a newborn for gastroschesis, then so be it.

sure you can do epidurals/spinals/regional (just as long as you are cognicent of indications/complications) - and i think mastering those skills will add a lot of value to your anesthesia practice.

gaspassah · Apr 27, 2004

Tenesma, thanks for your reply. i appreciate your honesty and professionalism. i realize that this is a "heated" topic for all people in anesthesia and i appreciate the candor.

david

Impartial_pressure · Apr 27, 2004

Tensema:

I am caught off guard by your feelings. especially at a time when our professional associations are trying to "mend the fence".

I truely believe that if the A$A or any other medical association for that matter could push a button today that would rid the world of nurses THEY WOULD. We really have no other reason to believe otherwise. Statements are constantly made like yours infering that we are less competent.

I am literally sick inside. speechless that you feel like this.

I have 4 medical student friends right now that are in med school. we talk about this often as some are now leaning toward anesthesia. one thing we agree on is that you can't call Residency "school". In other words you can't include it in your numbers when you talk about the hell youv'e been through. Why? because your getting paid. The fine line between "working" and "schooling". If so why couldn't we coun't our years as CNA's LPN's, all those years on Med/surg and ICU. Those years had to happen to meet our end goal just as you will argue Residency has to happen to meet your end goal.

In additon these medical students don't even go to class. It is admitedly so easy and with the practice exam questions don't have to.

I wish you could hear the tone in my head, I am not mad or defensive I am really sad for this occasion. It will go on and on and on and on.

Nurses that go into Anesthsia have it as a long time goal. this means they knew what they wanted to do from the begining (not all)

many, many, many medial students go into "medicine" not even knowing what they want to specialize in. do you know what that means? It means they don't care, they just want' to be called "doctor" and make money. And that is whose hands our societies health care is in??? these 5 friends of mine all are very competitive in nature, I get the feeling they have something to prove. two fatal charcater flaws. It also means, and especially when you talk about running 4 rooms that you don't want to do the work. phycians don't start from the ground and work up like as is the case in most industries. Rather, they hope to jump in and be in charge without a true knowledge of whats involved, (not clinically, I mean the human side, culture, value, traditon ect.)

I wish that med school would require Nursing degrees to apply. That would instanteously fix the nursing shortage and also make better prepared physicians.

As far as Anesthesia goes I think CRNA's do have the knowledge to do the skills and cases you elude to. and they are held to the same standard in court. settlements do not respect what type of provider you are.

CURE: This word cure, I do not think it means what you think it means. (princess bride) Cure means a return to health, the destruction of disease. The last Cure Medicine had was Penicillin (and that was an accident). improve quality of life; maybe. but cure? hacking off limbs or destroying tissue is not curative.

post edit...........

you seem reasonable and level headed. I only mean this to show that nurses can never, ever let their guard down. If you are a nurse that thinks I am to harsh, that physcians are on our side. you need to read some of the associations platforms. (and not just ASA) when was the last time a Nurse spoke at any phycian sponsored convetion. ... . none. they speak at ours all the time. but would consider it a professional failing to consider the converse

jrvb · Apr 27, 2004

Incompetent Pressure:

What a poorly articulated, ridiculous and baseless statement. Please do not be an ambassador for the profession because you do not represent it well.

snakebitten · Apr 27, 2004

I have found working with many physicians (not MDA's--where in the hell did they come up with that abbreviation any way) and many CRNA's-(which I am )--that usually everyone gets along great. My experience is that like life-usually 99% of all the noise and complaints come from 1 percent of the providers. I have worked with multiple butthead, downright dumb physicians AND CRNA's. I find it very interesting though that where I now work ,very rural New Mexico town with numerous ASA 4-5 patients, we cannot even get an anesthesiologist to bite on an interview. Rural hospital CRNA's are expected to function independently in all aspects of perioperative care including pain management. I would love to work WITH an anesthesiologist, but they just won't come out to the boonies...