CRNA VS anesthesiologist MD

BCRNA · Jan 22, 2011

I checked Emory's website and the state medical boards. In Georgia and Kentucky it is possible to be both an AA and a PA, but they do differentiate betweeen the two. In all other states I looked at an AA is not allowed to use the title of PA, particulary Texas who actually has a law against it. It just depends on what state they work in. They are fairly new and not widespread yet, so things may change as they progress. Though many sites did refer to AA's as a specialty physician assistants, that is not their credential though in most states.

allnurses Guide · Jan 23, 2011

Here is everything you ever wanted to know about the differences in CRNAs and AAs. http://everhadgas.com/CRNA-AA_Comparison_Table_update_208.pdf

remifentanil · Jan 23, 2011

And let us not forget there are no AAs in the military.

ssrhythm · Jan 25, 2011

OK....Line by line it is............
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Same here. I admit I come across somewhat abrasive around here sometimes, although justifiable most times. I honestly have a lot of respect for nurses, specifically CRNA's. I just find the nursing agenda, specifically the AANA, full of hogwash propaganda. A good friend from RT school has been an RN for a few years now and was accepted at SUNY Downstate's nurse anesthesia program...ironically he says during his interview they were very interested in his RT experience. Grrr.....

Page, I am an RRT who is 16 months from becoming a CRNA. I completely understand where you are coming from regarding the "regression" aspect of becoming a nurse. Folks, he has a point here. I have a BS in Biology from Clemson University, and AD in Respiratory Therapy from Shelton State Community College, and a BSN from The University of South Carolina, so I am ultra-experienced in higher education! :rolleyes: Any RRT going back to nursing school is going to sit in those classes and want to stab himself in the temple with his pencil as the classes, while different in many ways, are a step below what a RRT has already completed...especially if that RRT has been out practicing for any length of time with any level of autonomy. That is a fact. That said, (take note PageRT) the critical care nursing experience gained as an RN is HUGE! There needs to be some type of RRT to BSN program, but they don't exist. Unfortunately, to go from an RRT to CRNA, you have to take that step backwards (nursing school) to take a very critical step forward (ICU NURSING experience). Sorry if that steps on toes, but there were absolutely no classes in my BSN program that advanced my understanding of patient care. The additional pharmacology was great, and there were aspects of Med-Surg that were helpful, but not until I graduated and started working as a CVICU nurse did I start adding skills and knowledge that have actually been helpful in my CRNA program. When I graduated from my RT program, I understood pathophysiology, IABP, hemodynamics, vasoactive pharmacology etc. at a level that my BSN never touched on; heck, we had IABP, central line, and PAP catherter insertion labs. While RN programs cover a much broader base of material, they do not touch in nearly the detail the aspects of pathophysiology and critical care that my RT program did. So I get where pageRT is coming from. PageRT, there are definite skillsets that RNs have that are critical to being a great anesthesia provider. While there are areas that I've had a huge advantage as an RRT, there are experienced RNs in my program that have a huge advantage over me due to their 10+ years of CC nursing experience. In the anesthesia masters programs, students will be taught everything we learned in RT school to a greater degree except for mechanical ventilation. In those same programs, however, students will not necessarily be taught what you learn when you are a practicing critical care nurse; those skills are expected to be there and be strong. It would be very, very difficult to seamlessly provide great anesthesia care without that nursing experience. Could it be done? Sure it could, but as an experienced RRT, RN and now SRNA, I fully understand why the program is the way it is. I can honestly say that when I need anesthesia services, I want a CRNA taking care of me over any AA with the same experience. Now, If I could have an experienced CRNA that is both an RN and RRT, well that would be ideal. Regardless, the nursing component will be in there if you are going to administer anesthesia to this cat! Anyhoo, I feel you; I was in the same frustrating position five years ago. Most of the BSN process was brutal to deal with, but in the end it was worth it. I thoroughly enjoyed the critical care nursing (did not think I would) and it has helped tremendously in CRNA school. Do what you need to do, but when you look at the +s and -s of both programs, I'd bite the bullet and go CRNA over AA if I were you; I'd do it again without hesitation.

SuperSixEightMD · Feb 3, 2011

CRNA need 1-2 years critical care experience post BSN. and 2-3 years for the CRNA. the MD route will require 1-2 years additional science courses to get into med school for 4 more years followed by 3 years residency and 1-2 more years for fellowship. so post BSN 11 years for MD vs 3-5 for CRNA. Both perform the same procedures in the OR and many hospitals are hiring more CRNAs since they are cheaper. you can still plan on making 160-200k a year as a CRNA though so not shabby.

Actually, your description of an anesthesiologist's training is close, but not completely accurate.

We spend four years in undergrad. Four years in medical school. Then four years in residency. The first year of residency is typically devoted to medicine or surgery (although when you're a PGY-1 resident in surgery, you spend a lot more time dealing with medical issues than performing surgery in the OR).

Following the four-year residency, there are one-year fellowships in various areas of anesthesiology such as obstetrics, cardiac, pediatric, pain management, and critical care medicine (although any anesthesiologist is pretty darn well trained in this). Fellowship is optional, and as I understand it, about half of the anesthesiologists nowadays are doing fellowships.

SuperSixEightMD · Feb 3, 2011

A CRNA does not work "under" anybody. CRNAs and Anesthesiologists collaborate within an anesthesia care team environment. CRNAs can also work independently of anesthesiologists.

I'm going to get flamed or banned from the forum for saying this, but it must be said.

Anesthesiologists don't "collaborate" with CRNAs. It never happens. In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role. Now, do I breathe down the backs of the CRNAs I'm supervising and tell them how much Propofol to push? Of course not. But hospital policy is that CRNAs are supervised by anesthesiologists.

There is, of course, no federal law requiring this. It's just something that most hospitals want.

SuperSixEightMD · Feb 3, 2011

I have made my decision on this whole deal, I have talked to a few MD anesthesiologist and 2 CRNAs. I am a people person, and from what the MDs have told me nurses and MDs look at a patient. Accord to the MDs they focus more on the illness while nurses focus more on the patient in a whole. Which has led me to decide to go for CRNA. Money isn't an issue, I know people hear that and say I am full of it, But I really am not.
So CRNA it is!

You know, that argument is getting awfully old. It's completely false, but you guys keep repeating it over and over and over....as though saying it more and more will somehow make it true.

It is impossible - I repeat, impossible - to practice medicine in any specialty by focusing on the disease. If you're a dermatologist treating some woman's acne, you darn-well better know how her ovaries are working. Treating the woman's zits without considering PCOS as the cause would be malpractice.

As an anesthesiologist, I don't look at the patient with rheumatoid arthritis and worry about their knees and cervical vertebrae. It is my responsibility to know that rheumatoid arthritis can also be associated with cardiac problems, pulmonary problems, and vascular problems as well.

In fact, all physicians...be they general practitioners or specialists.... deal with diseases that are in some way related to "the whole patient". So as you can imagine, we have to pay attention to "the whole patient"....more than anyone else in a health care setting does. We have to because, ultimately, the buck stops with us.

SuperSixEightMD · Feb 3, 2011

You are incorrect on a few points: CRNAs do not have to work under an MD/anesthesiologist. I work as a solo CRNA. As a credentialed member of the medical staff of several hospitals, I have been granted privileges by the medical staff members (physicians) to do the following: Administer a general anesthetic, insert central or arterial lines, even PA catheters, perform regional anesthesia including spinals, epidurals, femoral nerve blocks, interscalene blocks, axillary blocks, ankle blocks, Bier blocks, etc as well as write any necessary preop orders for any medication/diagnostics/consults with another specialty and I write post op orders for the recovery room. That list doesn't really differ from the privileges of the 2 anesthesiologists I work with....the same ones I cover when they go on vacation! I love what I do and the patient's appreciate what I do for them. Anesthesia school is no walk in the park. Medical school gives you a lot more very detailed anatomy, histology, biochemistry, neuroanatomy, etc., most of which have no bearing on your ability to be an excellent anesthesia provider...much of which is forgotten by the time a resident enters anesthesia training!

Oh? I'm wondering how you'd know what part of a medical education isn't relevant, since you've never been to medical school?

I can tell you, as an anesthesiologist, that this stuff does have a bearing on one's ability to be an excellent anesthesia provider. And while I forgot a lot of material I learned in medical school, I also remembered a hell of a lot of it. I still do.

And the things I forgot, they're still in the back of my head, collecting dust, waiting for that rare patient who sparks my memory and compels me to read about those distant facts and medical considerations lying dormant in my head......i.e. the facts that a CRNA never learned to begin with.

So, yeah, it makes a difference.

That attitude of "If I don't know it, it isn't relevant" is really inappropriate.

SuperSixEightMD · Feb 3, 2011

I just have to laugh at this post. If you will be "more qualified" why can you not practice independently as a CRNA can? Why can you not practice in all states, as a CRNA can?
Why can you not get prescriptive authority, as a CRNA can? I can go on and on but I'll stop there.
Very amusing post, keep telling yourself that. :)
Ron

I've worked with both AAs and CRNAs. Functionally, they are identical entities with similar training and similar capabilities. As AA's become more prominent, they'll eventually push for more autonomy......just as CRNAs have.

So, the answer to your question is this: time.

allnurses Guide · Feb 3, 2011

I'm going to get flamed or banned from the forum for saying this, but it must be said.
Anesthesiologists don't "collaborate" with CRNAs. It never happens. In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role. Now, do I breathe down the backs of the CRNAs I'm supervising and tell them how much Propofol to push? Of course not. But hospital policy is that CRNAs are supervised by anesthesiologists.
There is, of course, no federal law requiring this. It's just something that most hospitals want.

That would be wrong again. You give a very narrow view of anesthesia practices around the country.

The Army and AF both have it written in their scope of practices that CRNAs and Anesthesiologists will collaborate for ASA 3&4 patient and children under 2 going under GA.

The Navy has a totally independent scope of practice model.

Not all practices all are ACT models their are hybrid models where MDAs and CRNAs both work together independently, consultant model (Army and AF), all anesthesiologist only practices, and all CRNA only practice models.

allnurses Guide · Feb 3, 2011

Oh? I'm wondering how you'd know what part of a medical education isn't relevant, since you've never been to medical school?
I can tell you, as an anesthesiologist, that this stuff does have a bearing on one's ability to be an excellent anesthesia provider. And while I forgot a lot of material I learned in medical school, I also remembered a hell of a lot of it. I still do.
And the things I forgot, they're still in the back of my head, collecting dust, waiting for that rare patient who sparks my memory and compels me to read about those distant facts and medical considerations lying dormant in my head......i.e. the facts that a CRNA never learned to begin with.
So, yeah, it makes a difference.
That attitude of "If I don't know it, it isn't relevant" is really inappropriate.

Hmm...seems to bothers you when other people refer to your education which they have never personally experienced, but you seem to have no problem endlessly debating CRNA and DNP education which you never have experienced.

loveanesthesia · Feb 3, 2011

In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role.

No one supervises me on my cases, I am a Licensed Independent Practitioner with all the responsibilities of a LIP.