CRNA vs. anesthesiologist

armynse · Jan 7, 2008

Thanks EBEAR for clearing that up. It helps, because I have worked in the or before but I live a very RURAL area, and there are NO anesthesiologist ONLY CRNA's. So I have never had the pleasure of having to "KISS UP" or witness their superiority. I must say though, that in our little local hospital the CRNA's have quite the attitude to . I guess it is a supply and demand thing, we get them their supplies because that is what they DEMAND. hahaha.
THanks again

About the CRNAs with 'tudes...I've worked in big city hospitals where you couldn't tell the CRNA from the MDA based upon attitude alone. Seems that some, not all, have selective memories...they forget where they came from. I start anesthesia school in a matter of months and I vow not to look down on other nurses or treat them like personal slaves...supply and demand!!!

GASping · May 13, 2008

Hi,

I'm one of those non-all mighty MDs. A lot of people here seem to think that CRNAs and MDs are equal. Agree in the matter of technical aspects. I however could even teach a high school kid how to intubate. So this point has no need to be addressed for claims of superiority.

But there is more to that in gas. When to do what requires good old critical thinking. Critical thinking about someone's disease is something that is not emphasized as much in nursing school based on my sis; however, I agree the whole patient comfort thing is emphasized. As much as people disregard the extra training, it does help in the way you approach things. I could never imagine being a resident without ever being a 3rd year medical student who could never imagine not knowing basic physiology and anatomy in the first 2 years. Everything does build.

Other few myths to fix up here that shouldn't be spread.

First, dentists were the first ones to give anesthesia. Not doctors, not nurses.

Second, anesthesia specialty amongst physicians was formed more or less in the 1950s. Anesthesia made a lot of gains in patient safety by doing the research clinically and non-clinically. Who spearheaded that mostly in 70-80s? MDs, which is why anesthesia has become safer today. CRNAs cannot take whole credit in shaping anesthesia. And MD contribution cannot be ignored b/c I had an attending who had to watch out for things blowing up in the OR 35 years ago; that's not the case now.

Third, everyone works with jerks. I work with jerk surgeons and also nice ones. I don't label them all as bad. I don't label all CRNAs as lazy and stupid because the ones that I know do 7-3 shifts and need to go home after that (shift mentality vs. pickup extra slack) or are in a heart case and just don't get it why we have to watch out for certain things ahead of time. It's personality. Please join a group that cares about that. Even junior docs have to deal with the "stiffing" from the senior ones.

I personally don't mind CRNAs. I however do mind the conflict that is arising in this field as well as others because it doesn't help any of us. I only envision the following for gas: in-fighting MD vs CRNA will only lead to lesser gains down the road. I also see why hospitals are getting involved in this too. It gives them leverage to order around nurses versus docs so right now they will let this keep going until they can essentially enslave their gas departments. It actually hurts long-term. An odd truth: higher MD salaries/reimbursement do translate into better CRNA salaries from a strictly political purpose. If they think MD gas is not important, they won't find CRNA gas to be important as well. We both go down together. The strive for a so-called independence will not make a CRNA necessarily independent from the system. HMOs, PPOs, WashDC still run the show. Then, the RVU for gas will decrease and reimbursement goes down.

If you are a good CRNA who is willing to do the work and be part of the team, I'm coool with that. Nurses who constantly think that should be granted the power of doctor needing to fulfill their ego or doctors who think nurses can't be part of the team just don't work. It doesn't work in internal medicine, gastro, cardio, etc. No one in a good setting likes these attitudes.

By the way, I work with CRNAs just fine. They do the bread and butter that I don't care to do. And I actually show up to see what's going on. I'm not playing Tetris on my computer. I'm managing the ORs. If I'm not in one room, doesn't mean I get to sit around because I have to make sure the rooms keep going. Or Dr. Ortho will throw a fit. Somehow, there is a common misperception that I don't earn my living. :banghead:

ebear, BSN, RN · May 13, 2008

Wow, Dr. GASping. Sounds like you may need a nerve block. :lol2:

INFIDEL, CRNA · May 13, 2008

Besides the "Initials MD, vs CRNA" what are the practicing differerences between a CRNA and and anesthesiologist. For the CRNA's out there, what was it that led you to make the choice to become CRNA's vs. anesthesiologist. Also I am finishing my B.S. in nursing, and would love to persue a CRNA degree but I am cautious because of all of the physics involved. I would love any input on pro's and con's of this position. THANKS

Ohhhh about $100 to $200 K a year and driving a Carerra Turbo vs a Cayman S.

SuperSleeper · May 13, 2008

Thank you, GASping, for an intelligent reply.

I think most agree with the fact that not all MDAs can be lumped into the bad apple category. We all appreciate the schooling that MDs endure/aquire. As for your alluding to the lack of critical thinking about disease in nurses, though, one cannot forget that while we get a more holistic training in nursing school, CRNAs have spent time in hands on training in the ICU. This is where we develop that process. Sure we didn't go over it as much in school, but we were thrown to the wolves and learned it do-or-die. I, personally, believe that with the acuity found in hospitals today, the sporifice amount of in-depth, detailed disease process study is a sorely lacking point of undergraduate nursing programs. But that is another thread.

It can't be discounted that in one way or another, CRNAs have spent a minimum of 7-8 years of training through school and hands-on experience to get where they are. This is the minimum, most spend a lot longer than that. Many MDs do not realize what the nurses really do. They, understandably, get a snapshot look at it -- when rounding and when the nurse calls. I myself have, over the years, saved many people through dx the immediate problem w/o the help of the MD. I can look at a pt and, if available, the numbers, and pin things down to individual organ or disease process pretty darn well...and I am usually right.

Nurses get placed in situations where there is little to no help. I have delivered babies on my own, I have had my hands inside someone's chest removing clots during a tamponade code, I have had to figure out what the heck was going on and save someone who suddenly crashed while on CVVHD because the machine malfunctioned...but still said everything was fine. I am not going on a high and mighty run here, I'm just giving examples to point out that critical thinking about disease process was my daily gig for years while working in the CVICU...as it is for many nurses. On top of that, we have to be holistic to remain within the definition of our career.

There are CRNAs out there that clock-in, do their time, and go. Most I have known, though, will stick it out as long as necessary. I would be careful about statements like, "They do the bread and butter that I don't care to do." That subtly smells of Bush's comments that we need the illegal immigrants to do the jobs the rest of us don't want to do. I know you didn't mean it that way and I took no offense, but some could -- very easily.

I wholeheartedly agree with you about the clashing only bringing us down. A united front is always stronger. And, yes, if you make more, we will make more. I do have one question, though. In the rural areas where MDAs don't want to practice and CRNAs perform the vast majority of anesthesia care solo, why shouldn't they get the same money? They would be doing the exact same work as MDAs and are held to the same practice standards. Not setting up for argument just legitimately curious.

Like I said, thank you for an intelligent response. We need more non-inflammatory dialogue in order to progress education about our profession.

SS - RN, CCRN, SRNA

djc1981 · May 28, 2008

Like a previous poster said, the biggest difference is getting paid half the amount of MD doing the same work! Makes you just wanna go to med school!

Trauma1RN · May 31, 2008

It honestly surprises me how many people are losing respect for M.D's these days. Nurses especially, if you are going to act like you know everything a M.D does then go to medical school and stop complaining about you pay.

GASping · May 31, 2008

Actually, I don't understand all the details to the Medicare mess that exists right now. BUT, if we all the did the same cases, meaning just Medicare, we would all actually earn pretty much the same. The difference would be negligible. Surprised.

Why do anesthesiologists make more? Hospital subsidy. Why do CRNAs make more than regular nurses? Hospital subsidy. Gas overall makes nothing compared to cardiology from public funding. Surprised again. We are paid well FOR NOW because we keep ORs running, and ORs are a great revenue for hospitals in terms of facility billing. We are in demand FOR NOW. It will change within 10 years. Gas will be worth nothing and all the MDs and RNs will not go through the training. The problem overall is Medicare/Aid. They have systematically F'ed all healthcare providers. We are at their mercy.

Message of the day: If you are thinking of investing in healthcare training (med school, nursing school, whatever), the debt and training time may not be worth it later on. Start paying that debt NOW.

And eBear, you sound like one of the "over-confidents." I hope you don't carry that attitude around work where probably behind your back, they are talking about how charming your personality is. Or do you bow to surgeons and then vent here? You must be that nurse who flogs interns because somehow that makes you feel better about yourself. :up: and :bow:

Dr.Nurse2b · Jun 2, 2008

It's been my experience that the majority (not all) anesthesiologists cannot lift a finger to help themselves. The clinical aspect of providing anesthesia care is the same for both. Because they were RNs first, the CRNA seems to be more in tune with pt. care details and comfort measures. The MDAs I've worked with seem to be quite cocky and think they poop ice cream. Give me an excellent CRNA any day!!!! :cheers: I once worked with an MDA who put the pt. on "auto pilot" and walked up and down the hall reading the Wallstreet Journal ! Got to check those stocks ya know!!!!

Ice Cream! :yeah: Too funny...I have a buddy who worked in the OR for years...I think he said they poop sorbet...anyway...he told me stories about MDAs taking naps and leaving the nurses to care for the patients...

I think this is why doctors do not want nurses being called "Doctor". God forbid patients see "Doctors" performing menial tasks...like patient care :wink2:...then doctors would be expected to care for patients...AND poop ice cream.

8mpg · Jun 2, 2008

Thank you, GASping, for an intelligent reply.
I think most agree with the fact that not all MDAs can be lumped into the bad apple category. We all appreciate the schooling that MDs endure/aquire. As for your alluding to the lack of critical thinking about disease in nurses, though, one cannot forget that while we get a more holistic training in nursing school, CRNAs have spent time in hands on training in the ICU. This is where we develop that process. Sure we didn't go over it as much in school, but we were thrown to the wolves and learned it do-or-die. I, personally, believe that with the acuity found in hospitals today, the sporifice amount of in-depth, detailed disease process study is a sorely lacking point of undergraduate nursing programs. But that is another thread.
It can't be discounted that in one way or another, CRNAs have spent a minimum of 7-8 years of training through school and hands-on experience to get where they are. This is the minimum, most spend a lot longer than that. Many MDs do not realize what the nurses really do. They, understandably, get a snapshot look at it -- when rounding and when the nurse calls. I myself have, over the years, saved many people through dx the immediate problem w/o the help of the MD. I can look at a pt and, if available, the numbers, and pin things down to individual organ or disease process pretty darn well...and I am usually right.
Nurses get placed in situations where there is little to no help. I have delivered babies on my own, I have had my hands inside someone's chest removing clots during a tamponade code, I have had to figure out what the heck was going on and save someone who suddenly crashed while on CVVHD because the machine malfunctioned...but still said everything was fine. I am not going on a high and mighty run here, I'm just giving examples to point out that critical thinking about disease process was my daily gig for years while working in the CVICU...as it is for many nurses. On top of that, we have to be holistic to remain within the definition of our career.
There are CRNAs out there that clock-in, do their time, and go. Most I have known, though, will stick it out as long as necessary. I would be careful about statements like, "They do the bread and butter that I don't care to do." That subtly smells of Bush's comments that we need the illegal immigrants to do the jobs the rest of us don't want to do. I know you didn't mean it that way and I took no offense, but some could -- very easily.
I wholeheartedly agree with you about the clashing only bringing us down. A united front is always stronger. And, yes, if you make more, we will make more. I do have one question, though. In the rural areas where MDAs don't want to practice and CRNAs perform the vast majority of anesthesia care solo, why shouldn't they get the same money? They would be doing the exact same work as MDAs and are held to the same practice standards. Not setting up for argument just legitimately curious.
Like I said, thank you for an intelligent response. We need more non-inflammatory dialogue in order to progress education about our profession.
SS - RN, CCRN, SRNA

Simple..they went to medical school. Just like many other jobs out there, the certificate on the wall means more than anything else. That is just how the world works. BSN's make more than an ADN because the extra schooling but they do the same work. I know the difference isnt much ($.50-2.00) but that is just how it is.

djc1981 · Jun 2, 2008

simple..they went to medical school. just like many other jobs out there, the certificate on the wall means more than anything else. that is just how the world works. bsn's make more than an adn because the extra schooling but they do the same work. i know the difference isnt much ($.50-2.00) but that is just how it is.

i've never seen a place that pays bsns any extra actually. there are some (so i've heard) but they are few and far between. it's one reason why most see no real need to get the bsn.

DocHolliday · Jul 6, 2008

Thank you, GASping, for an intelligent reply.
I think most agree with the fact that not all MDAs can be lumped into the bad apple category. We all appreciate the schooling that MDs endure/aquire. As for your alluding to the lack of critical thinking about disease in nurses, though, one cannot forget that while we get a more holistic training in nursing school, CRNAs have spent time in hands on training in the ICU. This is where we develop that process. Sure we didn't go over it as much in school, but we were thrown to the wolves and learned it do-or-die. I, personally, believe that with the acuity found in hospitals today, the sporifice amount of in-depth, detailed disease process study is a sorely lacking point of undergraduate nursing programs. But that is another thread.
It can't be discounted that in one way or another, CRNAs have spent a minimum of 7-8 years of training through school and hands-on experience to get where they are. This is the minimum, most spend a lot longer than that. Many MDs do not realize what the nurses really do. They, understandably, get a snapshot look at it -- when rounding and when the nurse calls. I myself have, over the years, saved many people through dx the immediate problem w/o the help of the MD. I can look at a pt and, if available, the numbers, and pin things down to individual organ or disease process pretty darn well...and I am usually right.
Nurses get placed in situations where there is little to no help. I have delivered babies on my own, I have had my hands inside someone's chest removing clots during a tamponade code, I have had to figure out what the heck was going on and save someone who suddenly crashed while on CVVHD because the machine malfunctioned...but still said everything was fine. I am not going on a high and mighty run here, I'm just giving examples to point out that critical thinking about disease process was my daily gig for years while working in the CVICU...as it is for many nurses. On top of that, we have to be holistic to remain within the definition of our career.
.
SS - RN, CCRN, SRNA

Please see the areas of your post I put in boldface:

What you described sounds just fine and dandy, but the reality is that everything you point out in your argument exemplifies the problem with CRNAs and other mid-level providers; an almost complete failure to recognize the importance of the didactic training acquired in medical school, and the ultra-intensive training (which includes didactic) acquired in residency.

I have no doubt that you've learned some valuable things hands-on, but your knowledge of the finer points of anesthesia will never match that of an anesthesiologist. As a surgeon, I deal with both CRNAs and anesthesiologists, and when dealing with critically-ill patients, the difference between CRNAs and anesthesiologists is very apparent.

I appreciate CRNAs for what they do--they have an important job. But what I find extremely disturbing about them is that there is a common sentiment above them that they are basically anesthesiologists, minus the MD degree and the four-year residency.

If there's one all-important thing I've learned since becoming a doctor, it's that there is absolutely nothing more dangerous than a practitioner who doesn't know what he/she doesn't know.

Finally, your comments about CRNAs having "7 to 8 years of training" is a blatant distortion of the facts. CRNAs are required to have a nursing degree, which may be acquired in two years as part of a four-year four-year undergraduate degree. Your undergraduate degree is not considered to be "training". I sure as hell never considered my four years as an undergrad at UVA to be "medical training"! After your two years of nursing training (which is of minimal pertinence to the science of anesthesia), you are required to have work experience in some sort of ICU setting. Again, this is not considered to be "training" either, rather, it is simply work experience.

Your actual training is merely two to three years in duration.

Compare that with an anesthesiologist, who has spent (after spending four years in college, just like you), four years in medical school (which is bar-none the most grueling educational program of all), and four years in residency training (approximately 80+ hours a week). Some anesthesiologists even go on to do fellowships.

There is absolutely no comparison between an anesthesiologist and a CRNA with regard to training. Anesthesia is more than sticking a tube down a patient's throat, administering halogenated ethers, and pushing benzos and narcs. It is a specialty of medicine, and the anesthesiologist is the doctor who must be not only be able to examine a patient, but must have an intimate knowledge of a patient's condition and formulate an anesthesia plan accordingly. If CRNAs could do that with the same competence that anesthesiologists could, they'd have been awarded MD degrees somewhere along the way! The anesthesiologist is a physician. The CRNA is a skilled worker. There is an enormous difference between the two.