1) RNs are responsible for their actions when they screw up - but trust me, in a lawsuit everybody gets named (especially the doctors and the hospital) because of the amount of money involved - just look at RNs insurance premiums vs MDs premiums...
2) your logic that since Nurses provided anesthesia before there were Anesthesiologists - and thus anesthesiologists are encroaching on their field, is erroneous.... Dentists were the first to use anesthesia, followed by medical students - way before nurses were allowed to stand at the bedside and drip ether. So based on your logic CRNAs are encroaching on dentists and medical students???
3) Your next point is flawed as well... a higher proportion of ASA III and IV get done by anesthesiologists than CRNAs for two reasons 1) CRNAs are primarily distributed in rural/suburban environments where as MDAs are primarily in urban/academic environments - and most tertiary referral centers (where "harder" cases get done) are urban/academic. 2) level of training
4) your statement that CRNAs must have racked up enough experience before CRNA school was probably a typographical error - because CRNAs have absolutely NO anesthesia experience before CRNA school.... sure, after CRNA school and a few years of experience will make most CRNAs relatively competent at providing safe anesthesia for most patients. But i'll go back to my original point of CRNA=1600 clinical hours of anesthesia/patient care vs MD=10,000 hours of anesthesia care (plus another 4,000 hours of further patient care as interns, plus another (in my case) 3,200 of ICU patient management)... there is a discrpeancy in breadth and depth of training.
5) the reason there is a delay of patients getting into theaters (or ORs) has very little to do with the anesthesia provider deficiency, but rather with the miserably failing system of socialized medicine that exists in the UK.... the same system (or similar at least) is set up in CANADA, where for the most part there are more than enough Anesthesia providers, and they still have 6 month delays for elective surgeries...
6) as far as the cash that anesthesiologists make - it is well earned - and obviously insurance companies feel it is money well spent or else they would have contracts with CRNAs alone and would refuse to pay us way above CRNA salaries for the services we provide
This is a post from our friend Tenesma.
So what does everyone think? Are we second best and handmaidens to MDA's? I know that initially we can't be expected to do everything but are we still MDA's Bith*'s?
Maybe this is all true. I am just looking from CRNA experience to step in. I'm not trying to start a war or anything. Just interested in responses from experienced CRNA's
Ok I just want to say that I'm sorry that I started this thread. It was mostly out of insecurity and snap judgement on my part. I appreciate those of you, including Tenesma, who have posted insightful responses. I will take this as a learning experience about how to let things roll off my back that I can't control. I like our BB to be positive so thanks again for those of you who help make it that way.
I am also glad for technical and educational input that Tenesma gives. However, as many have stated, it is just frustrating to read so many negative comments about crna's whenever the crna/ mda topic comes up on the student doctor network. I have many good friends who are physicians and I have worked well with 99% of doctors I have worked with over the last five years. I am just hoping that I can continue to work well with them when I graduate anesthesa school.
This is a problem you see across the board, not just in medicine. There was a television special about corporate outsourcing that I saw several days ago. Basically, corporate profit is the bottom line. Why pay an engineer in the USA 90k when you could pay someone in India 23k for equally skilled work? Obviously, healthcare by definition complicates the problem because of logistics and such, but even so, with the advancement of the internet, webcameras, and the invention of mechanics that enables you to control robotic arms a thousand miles away, the problem to logistics may be a non-issue.
Having said this, I think healthcare limited itself to possible outsourcing by keeping the numbers of professionals lower than what is needed. Healthcare is not only a highly skilled field, but also a highly intellectual field. You can't just walk into it, get a certificate in a few months, and start tackling whatever is out there. After all, these are people's lives we're talking about. An inadequate increase in slope of the learning curve means more people die. Thus, IMO CRNA's are not meant to replace MDA's, but rather complement the field of anesthesia in general. MDA's require a long time to "gestate," and as we all know, sickness and disease do not take breaks. CRNA's help to fill that gap.
But that's not to say that CRNA's are merely technicians. In order to become a CRNA, a lot of skill is required. Granted, the formal training doesn't quite compare to to an MDA, but if you look at the informal training of a CRNA, the CV might begin to be a bit more level. 4 years of college, at least 1 yr of ICU experience, with many obtaining up to 5 years of ICU experience and even more. Various certificates, including ACLS, PALS, CCRN, etc, and while there isn't much experience for nurses to give epidurals, ICU nurses deal very frequently with sedation, including Fentanyl, Versed, Diprivan, etc, which I think may cover many surgical procedures. ICU nurses also deal a lot with pressors, various arrhythmias and their management, beta- and calcium-channel blockers, and ACE-inhibitors but because nurses don't really get any formal training in school, it doesn't count? Come on, give credit where credit is due. Most of the time while residents are waiting for the EKG tech to come, the nurses is already preparing for what the doctor is going to order. Again, this isn't saying that nursing is the same as what MDA's have to go through, but it does say that nurses have something to give that mere technicians can never give.
With healthcare being the way it is, no one person will ever dominate the field. In fact, in my experience, the best doctors were the ones who knew when to ask for input--from anyone, including nurses. Granted, doctors know a lot, but often times, it's the nurses who modify the orders to the individual patient. I'll give a short example: Pt dx with vasculitis, temp of 40. The field of medicine falls somewhat short in this arena, so they treated it symptomatically with tylenol and a cooling blanket. It didn't work, so they dc'd the blanket. Another nurse came in, placed the cooling blanket appropriately, slammed in some tylenol, and within a few hours, the patient's temp fell to wnl. Is that mere tech work? I promise you, a tech would not continue an order that had been dc'd. Nor would a tech go through the lengths required to give that pt the comfort she required. Upon arrival, her eyes were wide open and she was visibly shaking, HR in the 130's, BP 150's/60's. Comfort measures were given and temp regulation was enacted. When treatment was complete, she was sleeping and BP began to fall wnl. You're going to tell me a tech can do all that?
Again, I'm not trying to compare nurses with doctors, but let's give credit where credit is due. Nurses provide something doctors can't provide, and doctors provide something that nurses can't. Together, nurses and doctors provide what we call healthcare, and I think it's this egalitarian teamwork approach that makes the USA's healthcare the best in the world. It's why the Iranian twins died in Singapore, and why the Philipinno twins survived intact in Dallas. Can't we just all get along?
To start with i am a jr in high school and i am going to a tec program 3 hours out of my school day to get my nersing assestent state cert. i already know long term i want to be a anesthesiologist. but from after high school im not sure how to get there. i was researching and came up with the idea of after becoming a RN and from there take a CRNA program and from there do my residency to become an anesthesiologist but i dont know if i missing steps .. or if there is a better way... and how i should do it ... im still young but i want a plan to go by and get a head start on it. i love the medical feild and i love science. i have already taken chem. this year i am taking anatomy and next year ap chem and physics.
I have read alot of your posts and you guys seem really smart and are doing what i want to and i am very open to suggestions and could really use the help thank you!
to start with i am a jr in high school and i am going to a tec program 3 hours out of my school day to get my nersing assestent state cert. i already know long term i want to be a anesthesiologist. but from after high school im not sure how to get there. i was researching and came up with the idea of after becoming a rn and from there take a crna program and from there do my residency to become an anesthesiologist but i dont know if i missing steps .. or if there is a better way... and how i should do it ...
i am not a crna yet, but i thought i would share some info with you that i have learned from reading. a nurse and a physician are two different, although complementary, practitioners in the healthcare field. therefore, they follow different educational paths after completing the bachelor's degree in college.
generally speaking nurses who want to become crnas get experience in the icu then go to crna school. after becoming licensed crnas are independent practioners.
students go on to medical school after college to become a doctor then complete a residency in anesthesiology. most physicians do not become nurses first. i mention this because it seems from reading your post that you have the impression that becoming a doctor is the next step from being a crna. it would be very redundant not to mention extremely expensive to pay twice for education to lead you to doing almost the same job. hope this helps.:wink2:
To start with i am a jr in high school and i am going to a tec program 3 hours out of my school day to get my nersing assestent state cert. i already know long term i want to be a anesthesiologist. but from after high school im not sure how to get there. i was researching and came up with the idea of after becoming a RN and from there take a CRNA program and from there do my residency to become an anesthesiologist but i dont know if i missing steps .. or if there is a better way... and how i should do it ... im still young but i want a plan to go by and get a head start on it. i love the medical feild and i love science. i have already taken chem. this year i am taking anatomy and next year ap chem and physics.
I have read alot of your posts and you guys seem really smart and are doing what i want to and i am very open to suggestions and could really use the help thank you!
Well the first thing to decide is do you want to become a doctor or a nurse? Even though CRNA and MDA perform in a very similar capacity in terms of employment, the path to becoming a CRNA is very different than the path to MDA. CRNA requires a BSN =4 years + at least 1 yr of ICU experience and you may not be able to go directly to ICU as a new grad nurse (really just depends and you may need more than one year of ICU experience to actually get into a program). Then the Anesthesia schooling is 2- 2.5 years. So minimum time frame is 7 years assuming you have no lag time between acceptance into your undergrad nursing program or your Anesthesia program. (that is a key thing to remember as well, you have to be accepted into the nursing program for a BSN and then later to an Anesthesia program. So you need top notch grades in all of your classes.)
You also will have licensing exams to pass to actually practice as a nurse.
To become an anesthesiologist, you need to have all of the medical school prerequisites completed with top grades as well as a bachelors degree in any field. (there may still be a school or two out there that doesn't "require" a bachelors degree, but everybody else applying to medical school will have one so you don't want to be at a disadvantage.) so 4 yrs for a BS/BA assuming you picked a major like Biology or Chem or Micro. If not, you probably don't have the required prereqs for med school done and will probably need an extra year or year and a half to finish. so that is 5/5.5 years. You also have to take a rigorous exam called the MCAT, receive a good score and then apply to Medical schools. The MCAT process can take a year because of money and testing dates and application cycles for Medical school. (or so I am told). Assuming you get in, you have 4 years of actual medical school. Towards the end you must apply for residencies in the specialty that you want and hope to get one. (Also along the way to continue as a med student, you must pass USMLE step tests). If all of this is completed and done and you get a residency in anesthesia, then you will start to train as an anesthesiologist. I think the residency is 4 years, but I am not sure it could be less. So to sum up CRNA aywhere from 7-10, MDA 10-12 due to residency). Also the two paths are not interchangeable. If you drop out of med school and decide to become a CRNA you have to go through an R.N program and the CRNA schooling and vice versa. This is a great board to learn things and I hope this post helps to clarify a few things. Talking to a guidance counselor or admissions officer at some colleges that you are interested in is always a good idea as well.
well the first thing to decide is do you want to become a doctor or a nurse? even though crna and mda perform in a very similar capacity in terms of employment, the path to becoming a crna is very different than the path to mda. crna requires a bsn =4 years + at least 1 yr of icu experience and you may not be able to go directly to icu as a new grad nurse (really just depends and you may need more than one year of icu experience to actually get into a program). then the anesthesia schooling is 2- 2.5 years. so minimum time frame is 7 years assuming you have no lag time between acceptance into your undergrad nursing program or your anesthesia program. (that is a key thing to remember as well, you have to be accepted into the nursing program for a bsn and then later to an anesthesia program. so you need top notch grades in all of your classes.)
you also will have licensing exams to pass to actually practice as a nurse.
to become an anesthesiologist, you need to have all of the medical school prerequisites completed with top grades as well as a bachelors degree in any field. (there may still be a school or two out there that doesn't "require" a bachelors degree, but everybody else applying to medical school will have one so you don't want to be at a disadvantage.) so 4 yrs for a bs/ba assuming you picked a major like biology or chem or micro. if not, you probably don't have the required prereqs for med school done and will probably need an extra year or year and a half to finish. so that is 5/5.5 years. you also have to take a rigorous exam called the mcat, receive a good score and then apply to medical schools. the mcat process can take a year because of money and testing dates and application cycles for medical school. (or so i am told). assuming you get in, you have 4 years of actual medical school. towards the end you must apply for residencies in the specialty that you want and hope to get one. (also along the way to continue as a med student, you must pass usmle step tests). if all of this is completed and done and you get a residency in anesthesia, then you will start to train as an anesthesiologist. i think the residency is 4 years, but i am not sure it could be less. so to sum up crna aywhere from 7-10, mda 10-12 due to residency). also the two paths are not interchangeable. if you drop out of med school and decide to become a crna you have to go through an r.n program and the crna schooling and vice versa. this is a great board to learn things and i hope this post helps to clarify a few things. talking to a guidance counselor or admissions officer at some colleges that you are interested in is always a good idea as well.
ok so i gota admit that was alot of info to take in lol...im just a little confused on how i shoud presue becomeing an anesthesiologist now i want the best way....would it be better or even possible to do it going through being a crna or mda. what i got out of it and the last post is being a crna would not be smart just gona prolong it and pay more because i want to be a physician not a nurse. this is all still really new to me and i want to get a plan going asp and i am exstreamly gratfull for all the help (thank you any one who has sent me a messege).
If you want to be a physician, then plan ahead to do what you need to to get into med school. Find out from a career counselor what courses you will need to take to get you going in the right direction.
At the same time. Do more research on becoming a nurse and then eventually a nurse anesthetist. That may actually be a more fitting career choice depending on what you want out of life.
DO NOT plan on becoming a nurse as a stepping stone to becoming a doctor. They are two different vocations in the healthcare field.
I hate going on studentdoctor.net...sometimes it can really drag morale down, the way they talk about nurses.
You know, I was just having this conversation w/ one of my colleagues the other day. The problem with student docs is that they are too new to realize that without nurses they can't do their jobs. They are too new to realize that nurses are some of their best resources. But don't worry, I'm sure that they all get their rude awakenings.
I think the bickering is minor and only between a few people. All of the anesthesiologists I've worked with have been wonderful people, and it has been a pleasure working with them as part of a team.
WntrMute2
410 Posts
Nice response Tenesma, you seem to be a doc one would be happy working with.