CRNA, Anesthesiologist Relationships

[cristianomiguel]

To any SRNAs and CRNAs,

I am an RN starting CRNA school later this year. Anesthesia intrigues me, and I have highly enjoyed every shadowing experience I've had with CRNAs. I have spent years of my life committed to joining this field. While preparing for school, I've perused the internet regarding the state of the field of anesthesia, and it is worrying. I've seen so much animosity between physicians and nurse anesthetists.

I hate drama. I don't like politics distracting from the quality of patient care. I know people can be entirely different behind the computer screen (e.g. keyboard warriors), but I am still worried. Are these online wars of malicious opinions a true reflection of the field? Is there animosity in the clinical setting? Maybe it is all over-exaggerated, but I've seen so many negative opinions of the field of anesthesia and the direction it's heading from both sides (nurses and physicians). I just don't want to join a field that is in the middle of a huge war.

I respect physicians and the years of their lives they've spent dedicated to the practice of medicine. I equally respect nurses and APRNs who've done the same. Any reflections and experiences would be appreciated.

[wtbcrna, MSN, DNP, CRNA]

44 minutes ago, DO_question said:

Anesthesiology is the study and practice of medicine as it pertains to anesthesia, analgesia, sedation, etc. In order to be any sort of anesthesiologist you'd need a medical degree of some sort, since medicine and nursing are distinct, a nursing degree would not suffice.

It should be fraudulent whether you throw nurse in front of it or not.

Anesthesiology is literally the study of anesthesia. Modern anesthesia was invented by a dentist and was a nursing speciality decades prior to it being a medical speciality so if you want to quote historical precedent then physicians are practice a nursing speciality. The term nurse anesthesiologist has been around since at least the 1950s.
That is without even quoting the early court battles that determined when a nurse practices anesthesia it’s a nursing speciality.

[DO_question]

From Websters definition of Anesthesiologist:

"specifically: a physician specializing in anesthesiology"

When anesthesia was dripping ether nurses lead the field. As developments in airway management, improved inhaled and intravenous anesthetics, paralytics, and monitoring were revised or invented by physicians it is clear that "historical precedent" very clearly identifies this as a medical specialty.

Don't confuse legality with something being as it should be. In Oregon "naturopathic" doctors can be your primary care doc... We all know that's nonsense, but it's legal. A CRNA calling themselves an anesthesiologist is no different.

[wtbcrna, MSN, DNP, CRNA]

22 minutes ago, DO_question said:

From Websters definition of Anesthesiologist:

"specifically: a physician specializing in anesthesiology"

When anesthesia was dripping ether nurses lead the field. As developments in airway management, improved inhaled and intravenous anesthetics, paralytics, and monitoring were revised or invented by physicians it is clear that "historical precedent" very clearly identifies this as a medical specialty.

Don't confuse legality with something being as it should be. In Oregon "naturopathic" doctors can be your primary care doc... We all know that's nonsense, but it's legal. A CRNA calling themselves an anesthesiologist is no different.

Just because it bothers your ego does not change the facts that anesthesia has always been a nursing speciality long before it was medical speciality. The exact definition of anesthesiology is the study of anesthesia. Where were you when AAs were/are calling themselves Anesthetists? Are you going to say that AAs had a historical precedence from 70+ years ago calling themselves anesthetists?.
CRNAs calling themselves a nurse anesthesiologist is neither deceiving or harmful in any way and accurately describes their job. The descriptor also sets them apart from assistants calling themselves anesthetists. The only thing getting harmed here is some physicians’ egos.

[wtbcrna, MSN, DNP, CRNA]

https://nurseanesthesiologist.squarespace.com/thefacts

[DO_question]

CRNAs and AAs are actually far closer in education than a CRNA and MD/DO so really, nurse anesthetist is perfectly adequate and accurate description. You realize AAs were created in an era of concern specifically about CRNA educational quality right? The whole profession is meant to be a less egocentric alternative to CRNAs. I can see that you don't care for that.

[wtbcrna, MSN, DNP, CRNA]

2 minutes ago, DO_question said:

CRNAs and AAs are actually far closer in education than a CRNA and MD/DO so really, nurse anesthetist is perfectly adequate and accurate description. You realize AAs were created in an era of concern specifically about CRNA educational quality right? The whole profession is meant to be a less egocentric alternative to CRNAs. I can see that you don't care for that.

AAs are not similar at all and neither is their education. The only way that their education is seen as similar is in the way the ASA takes abridged and often fabricated view of CRNA training. The only place CRNAs and AAs are similar is in restrictive ACT practices. AAs were created supposably d/t not having enough overall anesthesia providers at that time.

“2. What is the origin of the Anesthesiologist Assistant profession?

In the 1960s, three anesthesiologists, Joachim S. Gravenstein, John E. Steinhaus, and Perry P. Volpitto, were concerned with the shortage of anesthesiologists in the country. These academic department chairs analyzed the spectrum of tasks required during anesthesia care. The tasks were individually evaluated based on the level of professional responsibility, required education and necessary technical skill. The result of this anesthesia workforce analysis was to introduce the concept of team care and to define a new mid-level anesthesia practitioner linked to a supervising anesthesiologist. This new professional - the Anesthesiologist Assistant or AA - had the potential to at least partially alleviate the shortage of anesthesiologists.”

https://aaaa.memberclicks.net/faqs#originofAAs

The true purpose of AAs, at least in recent history, is to have an anesthesia provider that is completely controlled by physician anesthesiologists allowing physicians to completely control the anesthesia market. It’s not about patient safety or increases access to care it’s about money and physician egos.

[subee, MSN, CRNA]

12 hours ago, DO_question said:

CRNAs and AAs are actually far closer in education than a CRNA and MD/DO so really, nurse anesthetist is perfectly adequate and accurate description. You realize AAs were created in an era of concern specifically about CRNA educational quality right? The whole profession is meant to be a less egocentric alternative to CRNAs. I can see that you don't care for that.

What was the anesthesiologists' concerns about CRNA education? What is the value of being an experienced ICU nurse before even being considered for application to CRNA school? You guys have been at this for decades but have never been able to squash us. I suspect that you have no idea what our education is like. We used Guyton for our physiology classes....the same one the medical students were using. You are so ridiculous.

[BigPappaCRNA]

On 4/23/2020 at 4:11 PM, DO_question said:

Anesthesiology is the study and practice of medicine as it pertains to anesthesia, analgesia, sedation, etc. In order to be any sort of anesthesiologist you'd need a medical degree of some sort, since medicine and nursing are distinct, a nursing degree would not suffice.

It should be fraudulent whether you throw nurse in front of it or not.

Well, it is not fraudulent. That is one of the reasons the ASA felt it important and necessary to further define their job as "physician anesthesiologist" because they knew that "anesthesiologist" in and of itself was not accurate and could not be regulated.

[DO_question]

On 4/24/2020 at 8:46 AM, subee said:

What was the anesthesiologists' concerns about CRNA education? What is the value of being an experienced ICU nurse before even being considered for application to CRNA school? You guys have been at this for decades but have never been able to squash us. I suspect that you have no idea what our education is like. We used Guyton for our physiology classes....the same one the medical students were using. You are so ridiculous.

The concerns were chiefly that before 1976 CRNAs were getting a bachelor's degree... I have 5 years of clinical experience prior to my medical education and I can tell you it's worth something. It's made me a better student and a better provider than I would be otherwise, but it's no replacement for formal medical education.

Nobody wants to squash you. CRNAs are rather obviously here to stay and I don't think sane persons want that to change. We take issue with claims of equivalency or that CRNAs should be practicing without supervising physicians. I presume you guys just think we twiddle thumbs for years more than you? Call it what you want, but you're practicing medicine without the support of a full medical education or a full residency training.

Cool story. My undergrad used the same text for anatomy as one of my professors in medical school... Does that mean anything? No. What a ridiculous conclusion to think that reading the same textbook means you know a subject to the same depth... You guys start taking our board exams (both medical school and board certification exams) and we can talk equivalency.

Little boy,
The reason the ASA pushed "physician Anesthesiologist" is related to this discussion, CRNAs (or more accurately their lobbies) seem to be so insecure that they push to make themselves as indistinguishable from Anesthesiologists as possible in every way but the education and residency rigor.

[wtbcrna, MSN, DNP, CRNA]

On 4/26/2020 at 7:04 AM, DO_question said:

The concerns were chiefly that before 1976 CRNAs were getting a bachelor's degree... I have 5 years of clinical experience prior to my medical education and I can tell you it's worth something. It's made me a better student and a better provider than I would be otherwise, but it's no replacement for formal medical education.

Nobody wants to squash you. CRNAs are rather obviously here to stay and I don't think sane persons want that to change. We take issue with claims of equivalency or that CRNAs should be practicing without supervising physicians. I presume you guys just think we twiddle thumbs for years more than you? Call it what you want, but you're practicing medicine without the support of a full medical education or a full residency training.

Cool story. My undergrad used the same text for anatomy as one of my professors in medical school... Does that mean anything? No. What a ridiculous conclusion to think that reading the same textbook means you know a subject to the same depth... You guys start taking our board exams (both medical school and board certification exams) and we can talk equivalency.

Little boy,
The reason the ASA pushed "physician Anesthesiologist" is related to this discussion, CRNAs (or more accurately their lobbies) seem to be so insecure that they push to make themselves as indistinguishable from Anesthesiologists as possible in every way but the education and residency rigor.

1. I highly doubt you have any personal knowledge of any of these topics especially from the 1970s, and as previously stated the “official” reason AAs came into being was the lack of overall anesthesia providers.

2. The term is nurse anesthesiologist goes back to at least the 1950s. I feel sorry for you if you think introducing yourself as Nurse anesthesiologist is confusing. Were you complaining when AAs introduce themselves as anesthetists? The only thing getting hurt using the title nurse anesthesiologist is physician egos.

3. By your definition dentists, psychologists, podiatrists, optometrists are all practicing medicine. It’s a stupid argument and has been determined to be untrue for over 100 years. Physicians don’t own a certain subset of knowledge and the type practice solely depends on the type of provider doing it I.e. it’s a practice of medicine when performed by a physician and a practice of nursing when performed by a nurse.

4. The gambit that physician education inherently makes them better/safer providers is a lie. There are zero benefits from physician supervision or improved patient safety. Physician PACs have been trying to fund studies for decades to prove that and haven’t been able to. Although, there are a multitude of studies showing APRNs can and do provide equal care in similar specialities including anesthesia.

5. CRNAs aren’t pushing to obtain independence. CRNAs are pushing to maintain the independence they have always had. It’s the medical PACs that have taken that independence away in some states for no reason other than to line their constituents pockets and protect their egos while lying saying its to protect patient safety.

You are more than welcome to try and prove me wrong with actual studies.

[subee, MSN, CRNA]

It has nothing to do with insecurity. It's about how we are all forced to participate in fradulent billing procedures and need to bill without that signature to keep it all above board. I've worked both independently and mostly ACT but when after many years of experience, I was denied to ability to do my own spinals, I went on the warpath to expose excessive anesthesia costs by using providers in an ineffecient way. Joan Rivers might not have died at the hands of a CRNA because we HAVE to be better and don't feel so obligated to kiss the surgeon's tush. We need both MDA's and CRNA's. But 1 to 10 seems like a good ratio to me. Now, I started school in the early 80's in a master's program so don't dish out that old hash about bachelor's only. I go back to the days when obstetricians or ANY MD were allowed to pick up extra money in the ER. So glad those days are gone. I remember when family docs were permitted to do OR procedures. So, I think I've experienced the best and the worst times in medicine. You're whining isn't going to change any facts. Most of you just do a CRNA's job. I said MOST, not ALL.

This is for the DO, WTB. We were typing replies at the same time and you slid in under me.

[erwindt, MSN, RN]

Very interesting thread. While others make very good points, other just seem to have a lot of anger. Some physicians are troubled and don’t like the idea about nurses becoming APRNs and having independence as clinicians. They simply see them as “wanna be” doctors. I admire and respect every health care providers. For one, I don’t have respect for any physicians or nurses that are nasty. I have seen physicians that aren’t as bright, as well as nurses, and just makes me wonder how they manage to through the system. The patient is always our priority.