CRNA VS anesthesiologist MD - page 7

I am trying to decide weather I should become a CRNA or anesthesiologist. Can anyone help with the pro's and con's of each What do CRNA do that is different than a anesthesiologist? What can... Read More

  1. by   wtbcrna
    Quote from SuperSixEightMD

    So basically what I'm trying to say is that CRNAs and DNPs, being in possession of a narrow knowledge-base, are not in a position to make an accurate assessment of what knowledge is useful and what isn't. I think this is a very reasonable argument.
    Might sound logical if you had any research at all to back up your assumption. I think we are in a perfect position to know that our knowledge base works quite well, and we even have the research to back it up. More and more states are agreeing with up too (16 states so far.....2 in the last year).

    A DNP is nothing more than a degree. You don't have to be an APN to get your DNP. You could get your DNP with focus in management, education, and/or advanced practice nursing.

    It is nothing more than ego when physicians think that advanced practice nurses can't work independently especially when all the research shows that we are just and safe as physicians.
  2. by   wtbcrna
    Quote from SuperSixEightMD
    You're making reference to the military, and simultaneously accuse me of having a "very narrow view of anesthesia practices around the country"??

    The military is a bizarre entity that is notorious for taking cost-cutting measures where health care is concerned. Come to think of it, the only time the military seeks out the best available is where weaponry is concerned.

    Out in the real world, there's a hierarchy.

    Moreover, I think you may be misunderstanding the term "collaborate" as the military intends it to be interpreted. Sounds to me like "collaborate" means "get some help from someone who knows more" rather than "discuss the case as equals".
    Yeah.....yeah.....you know absolutely nothing about military medicine. Our budget far outstrips anything I have seen at any private hospital. How many military facilities have you worked in? There are approximately 1.4 million military members currently. The military has one of the largest medical facilities and capabilities in the world. The military is one of the largest trainers of physicians in the US. So, who is deluded themselves with their narrow views?

    Do you really think the only place I have ever worked is the military? I have worked as an anesthesia provider at civilian facilities in Ohio, Delaware, Maryland, and Alaska.
  3. by   SuperSixEightMD
    Quote from stanman1968
    I have never practiced "under" an anesthesiologist. He did his cases I did mine, no "supervision". You really do not have a clue do you super whatever.
    Dream on, stanman.


    Why don't you go and ask the chair of your hospital's anesthesia department who plays a supervisory role when CRNAs and anesthesiologists are working "together".

    And when I say "supervisory", I don't mean directing you, per se. But when the you-know-what hits the fan, you'll see what the hospital's policy is as to who has authority when anesthesiologists are present in the OR suite.
    Last edit by NRSKarenRN on Feb 5, '11
  4. by   nomadcrna
    LOL, neither of us is employed by the hospital. Even if we were, he would not be responsible as the state allows me to practice with total independence and the hospital as credentialed me as an independent provider.
    So how on earth can you even begin to know what the hospital dictates? I'm giving you some leeway but you are really stretching here.

    I hate to break your bubble but I've seen good and bad in both camps. I've seen many more MDAs who try to use the excuse of "supervision" because they want to make money off of us. You and I both know this is true.
    I practice evidenced based medicine. So far the studies show that CRNA independent practice is just as safe as MDA alone or the team approach. So you can BELIEVE whatever you want but that does not make it true.

    Ron

    Quote from SuperSixEightMD
    You didn't describe your practice setting.

    Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.
  5. by   loveanesthesia
    Quote from SuperSixEightMD
    You didn't describe your practice setting.

    Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.
    I'm employeed by the anesthesia group, and the hospital does not dictate that the anesthesiologists are responsible for me. I am credentialed as a LIP and I am legally responsible for what I do. The LIP status is the key concept in the relationship.
  6. by   SuperSixEightMD
    Quote from stanman1968
    No an anesthesiologist is not "responsible" for me, he does his case I do mine period. You have got to be a med student or some new resident, it is quite clear that you are not at all familiar with any practice arrangment outside of an acedemic center.

    I strongly advise you aquaint yourelf with the nurse practice acts and the application of them, you would not be nearly as ignorant if you woulod educate yourself before you speak.
    Stanman, I think you're paying a bit too much attention to the "nurse practice acts" and not enough attention to the place where the rubber hits the road -- the hospital or surgery center.

    Granted, I work in a large, teaching hospital with a department of anesthesiology that utilizes CRNAs as extenders. Nonetheless, I'm aware of how "practice arrangements" work, and that a CRNA can be in business for himself/herself and make a contract with a hospital or surgery center to put patients to sleep for surgery.

    But at any hospital, if both entities are present, and under certain circumstances, it will be hospital policy that the anesthesiologist has authority that the CRNA does not.
  7. by   stanman1968
    I am sorry did you say that I pay too much attention to the LAWS and REGULATIONS governing my practice? That hospital policy somehow trumps them? Nice try that defense in court buddy it will be short at least.

    It is refreshing to see however that you admit that your experience is limited to your one whole academic practice, gosh such a deep well of experience, you will have to forgive me but as you say "where the rubber meets the road" AKA the real world what you do there does not mean squat.

    I hope that you are not so caviler in understanding your obligations and responsibilities legally speaking, I suggest you arm yourself with FACTS nor ASA propaganda or opinion, one will save you the other sink you guess which is which.
  8. by   sewnew
    Quote from SuperSixEightMD
    You didn't describe your practice setting.

    Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.
    If I were an MDA (hypothetically speaking, of course), why would I want to take "responsibility" for a CRNA who is not even in the same room as me???
  9. by   nomadcrna
    I don't think super is actually an MDA. He seems to be obsessed that if we happen to be in the OR suite when an MDA is present, they will magically be in "charge" if something happens.
    You really don't understand credentialing and bylaws. You blew it, bud.
  10. by   SuperSixEightMD
    Quote from nomadcrna
    I don't think super is actually an MDA. He seems to be obsessed that if we happen to be in the OR suite when an MDA is present, they will magically be in "charge" if something happens.
    You really don't understand credentialing and bylaws. You blew it, bud.
    Clue me in, what did I blow here?

    Check your hospital policies, Nomad. If there are anesthesiologists available, then there's a heirarchy. Saying this casts into doubt that I'm an anesthesiologist? Unbelievable.
  11. by   wtbcrna
    I think it is time to stop feeding the troll and let them crawl back to some other corner of the internet.
  12. by   stanman1968
    your point is that if an anesthesiologist is there then they are supervising and are in charge, that is not the case as pointed out in many practice environments. The multiple misunderstandings and misstatements defiantly call your "expertise" into question.

    Perhaps if you were limit your statements to fact instead of opinion it would improve your credibility.
  13. by   NRSKarenRN
    asa response to ny times a-bomb editorial on crna supervision: paradigm shift
    the law med blog
    posted by lawmed on september 9th, 2010



    ...indeed 'supervision' and 'medical direction' are terms born of the insurance industry, not of the health care community. actual state practice laws vary in their requirements from total independent practice in iowa where crnas are considered equal colleagues with physicians under the law, to "collaboration" in maryland where crnas work independent of any physician but collaborate with a designated physician as needed, to states which require supervision but fail to define it in a meaningful way. such 'supervision' states fall short of the insurance definitions of supervision which generally spell out the activities of a supervising or medically directing physician. however only medicare requires physician supervision in order for a crna to get paid for their services (which the physician gets a percentage of), and only in states which have not opted out of the requirement. other insurance supervision requirements are used to determine whether a physician will be paid part of the anesthesia reimbursement or it will all go to the crna.

    no state requires that a crna be supervised by an anesthesiologist.

    ...no study has been produced which supports the asa position convincingly, despite multiple attempts. the safety record of anesthesia is indisputable and no one has been able to show that anesthesiologist involvement is responsible for that safety. meanwhile crnas are the sole anesthesia providers in various surgical settings across the country absent any cries of alarm or indications of increased morbidity or mortality in patients....and this has been the practice for over 130 years. surely we would have seen some indication of a problem by now? or is the health care community part of a vast conspiracy supporting nurse anesthetists while ignoring patient safety?

    aana - fact sheet: concerning state opt outs
    Last edit by NRSKarenRN on Feb 6, '11

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