CRNA vs. anesthesiologist

[jermaughan0814]

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

[SuperSleeper]

GASping

Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

Stereotyping and insults. I was obviously incorrect in my judgment about your communication style.

SS

[8mpg]

GASping

Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

Stereotyping and insults. I was obviously incorrect in my judgment about your communication style.

SS

LOL...you were wrong and you know it. DocHoliday is correct. Medical doctors do went to medical school and did way more specialty training than any CRNA did. It is unfair to say that a doctor does the job of a nurse. Would you say a paramedic is the same as a flight nurse, and that a flight nurse does the job of a paramedic? No, they do more, did different schooling, etc...

[wtbcrna, MSN, DNP, CRNA]

LOL...you were wrong and you know it. DocHoliday is correct. Medical doctors do went to medical school and did way more specialty training than any CRNA did. It is unfair to say that a doctor does the job of a nurse. Would you say a paramedic is the same as a flight nurse, and that a flight nurse does the job of a paramedic? No, they do more, did different schooling, etc...

I see from your profile that you are speaking from a vast amount of experience and knowledge on this matter. Would you like to pull up some research to show that MDAs have better outcome than CRNAs?..

CRNA school builds on your undergraduate nursing education (2yrs),requires a minimum of one year acute care nursing experience, & 2-3yrs of actual nurse anesthesia school. So, for us it is 5-6yrs of schooling if you don't count the 1st two years of undergraduate education, and it is 7-8yrs for physicians (depending on if you count there internship year). CRNA school is different from medical school, but there still is not one valid study that shows a difference in patient outcomes when you compare CRNAs and MDAs.

Just for the record most of the instructors at my school that teach both med students and nurse anesthesia students think our program is more intense, because we have to cover so much material in such a short period of time.

Not all schools require the same time committment, but I have to pull call just like the MDA residents. I have to go to the same classes during my clinical phase, and my hours suck just as bad as theirs. The big difference is I will graduate a lot sooner, and we are way ahead on clinical skills/general anesthesia knowledge from day one. Our school is applied graduate education from day one. Where medical students are generalists until they get to usually their 2nd year after graduation (depending on how they do their 1st year/internship).

Everyone has a opinion on if the education of one anesthesia provider over another is better, but the simple truth is that the research just doesn't pan out showing a difference. So, if one surgeon wants to have an MDA do all his "critically ill" patients more power to him or her. The rest of us will just hope him or her won't base the rest of their practice on anecdotal evidence.

[DocHolliday]

Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

SuperSleeper, your comments are in boldfaced text above.

Your problem, Supersleeper, is that you fail to recognize the significance of the word "doctor". To you, my M.D. indicates that I possess "just a little more education" than what an advanced practice nurse possesses. As long as you harbor that perception of the difference between doctors and advanced practice nurses, you will forever pose a danger to your patients. Why? Because, whether you're willing to admit it or not, and whether you're even cognizant of it or not, you will always be performing your duties as a CRNA having something to prove. This attitude will make you a little more likely to take risks tackling problems you are incompletely trained to tackle....unlike an anesthesiologist who has nothing to prove, and who feels no shame in asking a more experienced colleague for advice.

The reality is that many mid-level providers have an inferiority complex. It is not only apparent on this board, it is apparent in practice--both in private practice settings and hospital settings. They are, as you are, a little....how shall I put it...."sensitive" about the fact that they are healthcare providers, but not doctors. So, in order to compensate, they try and argue that they have some element of parity with doctors--both in terms of education and scope of work--by tweaking, distorting, and even misrepresenting their educational and work experiences.

What you mid-levels need to understand is doctors are not smarter than you by virtue of being doctors. We simply chose a career path that covers medical sciences in much greater detail than you did.

Finally, as for your argument that "most CRNAs have had more training than the minimum required": I don't give a hoot what "extra credit" you guys performed. The bottom line is that you can become a CRNA with about 2.5 years of anesthesia training---training that is not only shorter in duration and geared toward producing a mid-level provider, but training that is also of less thoroughness than that endured by an anesthesiologist.

They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities.

This is an utterly meaningless statement. Not only is there absolutely nothing to substantiate it, it serves no purpose in this argument. We are comparing the training required to become an anesthesiologist vs. the training to become a CRNA. Moreover, the "paths of training and experience" of anesthesiologists is a lot longer and more thorough than that of a CRNA. You know this. So please don't try and white-wash me with preposterous statements like the one above.

Finally, my previous post was not meant to be inflammatory. It was meant to be direct. If the truth is inflammatory, I suggest you go to medical school and work harder than you ever have and become an anesthesiologist. It sounds to me like you wish you had.

[DocHolliday]

I see from your profile that you are speaking from a vast amount of experience and knowledge on this matter. Would you like to pull up some research to show that MDAs have better outcome than CRNAs?..

CRNA school builds on your undergraduate nursing education (2yrs),requires a minimum of one year acute care nursing experience, & 2-3yrs of actual nurse anesthesia school. So, for us it is 5-6yrs of schooling if you don't count the 1st two years of undergraduate education, and it is 7-8yrs for physicians (depending on if you count there internship year). CRNA school is different from medical school, but there still is not one valid study that shows a difference in patient outcomes when you compare CRNAs and MDAs.

Just for the record most of the instructors at my school that teach both med students and nurse anesthesia students think our program is more intense, because we have to cover so much material in such a short period of time.

Not all schools require the same time committment, but I have to pull call just like the MDA residents. I have to go to the same classes during my clinical phase, and my hours suck just as bad as theirs. The big difference is I will graduate a lot sooner, and we are way ahead on clinical skills/general anesthesia knowledge from day one. Our school is applied graduate education from day one. Where medical students are generalists until they get to usually their 2nd year after graduation (depending on how they do their 1st year/internship).

Everyone has a opinion on if the education of one anesthesia provider over another is better, but the simple truth is that the research just doesn't pan out showing a difference. So, if one surgeon wants to have an MDA do all his "critically ill" patients more power to him or her. The rest of us will just hope him or her won't base the rest of their practice on anecdotal evidence.

I have read a number of those articles comparing "outcomes" of CRNAs vs. anesthesiologists. They are similar to the articles comparing outcomes between ARNPs and MDs.

Such articles are utterly nonsensical. Let me give you a little story, just to illustrate a point:

Just recently, I was having some aching in my maxillary teeth extending up the side of my face, and I was certain that I had cracked a tooth. I went to my dentist, who checked the teeth, and found nothing dental in origin. He then asked me some questions, palpated my mid-face (which hurt like hell), and diagnosed me with a sinus infection. He put me on a 10-day course of amoxicillin, and by the 5th day, my pain was gone.

How many of us would consider a dentist as someone from whom you'd seek treatment for a sinus infection? I sure as hell didn't! After all, they aren't trained to deal with pathologies of the sinuses--at least, general dentists aren't. Apparently, they do know a thing or two about the subject matter. As much as a physician would? Probably not.

But you know what? The outcome of my dentists treatment of my sinus infection was every bit as good as an ENTs. Would I dare conclude from this that a dentist is as qualified to treat sinus infections as an ENT?

Absolutely not. And why not? Because, my case was a simple case.

Most diabetics can be controlled with dietary changes or medications. Most hypertensive patients can be controlled with lifestyle changes, ACE inhibitors, beta-blockers, or some other anti-hypertensive med.

The statistics surrounding "outcomes" are flawed for two reasons:

1. Because the vast majority of problems crossing the path of mid-levels or primary care physicians are relatively simple and straightforward.

2. Because mid-levels often send to physicians the more complex cases, i.e. the cases where the mid-level is unable to address it. These are not reported as "bad outcomes"

Is a CRNA going to be as skilled intubating and anesthetizing a healthy 30 year-old male? Sure. But is a CRNA going to be as qualified to put a severely medically-compromised patient under as an anesthesiologist would? Is a CRNA going to be as qualified to formulate an anesthesia plan for this patient as the anesthesiologist? Of course not.

A CRNA, like any mid-level, is not a doctor who has had extensive training not only in human health and disease, but in diagnosis as well.

[wtbcrna, MSN, DNP, CRNA]

DocHoliday,

The proof is in the research, and you just spent your time posting your opinion and nothing else. Simply put the research has long been established that CRNA/MDA outcomes are the same.

If you want to state opinions all day long then my opinion is MDAs really only get 3yrs of anesthesia training. The 1st year of residency training is traditionally an internship year followed by 3yrs of actual anesthesia training, and most of a residents 1st year anesthesia training is just learning how to do direct patient care.

If 4yrs of medical school/3yrs of residency training make MDAs better than CRNAs then provide one valid research study to prove your point.

FYI:

I am not anti-MDA, but I do believe that a CRNA does not need supervision of an MDA/physician, but should work cooperatively with all healthcare providers.

[SuperSleeper]

DocHolliday-

You greatly underestimate a profession that is working in conjunction with you to provide optimal patient care. It's not about the doctor or the CRNA. It's about the patient. And, no matter what you throw back at CRNA's as a profession, we ARE better trained to deal with the patient while MDs are better trained to deal with the disease. CRNAs, as well as nursing as a profession, know this and accept it. Neither aspect is better, both are needed for excellent patient care. That's why the team works.

That said, CRNAs are trained to perform anesthesia. No amount of posturing will change that. Evidence shows they are quite capable and quite good at it. Every CRNA I know has no problem asking for help from the more experienced (CRNA or MD) if necessary. Those who don't have no business being in the medical field. That goes for MDs and RNs, as well! In my years I have found only 2 CRNAs with inferiority complexes, they're very rare. I agree with you, they present a danger in that mindset. I have witnessed far more issues with MD superiority complexes. I have never understood it. Yes, they know more about what they do, but they still get naked for showers and go to the bathroom like the rest of us...they are no better humans than the rest of us because they are doctors.

I have no sense of having to prove anything. Pride is never an issue when it comes to my patients. It shouldn't be for anyone. I do whatever is necessary to provide optimal care. Sometimes that is alone, sometimes that is with assistance. I don't see an MD as someone with "a little more education" than me. My best friends are MDs. I am fully cognizant of your journey. I respect MDs for what they are trained to do. However, that does not always make them better. I do not wish I went to med school. I could have. I was offered a full ride. I turned it down. I wanted to be the person who took care of the patient and not the disease. Yes, yes, there is more to it than that, but at the decision point, that was my reasoning. Also, I wanted a life. I do not regret a moment of it.

It is unfortunate you do not know who I am because your picture of me is completely off the mark. It could not be further from the truth. I reiterate that it is important to know a person's background before you judge. You might be quite surprised to know to whom you are actually speaking right now.

SS

[Dr.Nurse2b]

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

i believe the above quote is accurate - 2 to 3 years...

and i also think we may as well stand side by side, unzip and compare appendages.

i always try to offer a story...so here is my 2 cents for anyone who cares to read...

the scenario is a routine inter-facility transport of a stable patient headed to the cath lab. the patient was being transferred from the icu and came complete with his own physician. we normally transported with a nurse - medic team but on this day we were heavy the one doc who was a quiet guy and apparently had an interest in the patient other then routine transport.

i'll spare you all the details...the patient's condition deteriorated enroute. the doctor looked at me and stated "i think in this environment you are better suited to treat the patient". the doc was apparently unfamiliar with the ambulance and admitted he did not know how to operate the life pak. the patient presented with an arrhythmia and i quickly communicated what i was seeing and asked for feedback. the doctor asked that the ambulance be stopped so he could analyze a strip. the doctor agreed, however he provided additional information in regard to very specific physiologic processes and recommended treatment. the patient's outcome was quite positive as a result of collaborative efforts.

the doc was very young but in my opinion very wise. he shared with me his thoughts... "in order to be therapeutic one must know his limitations".

regardless of age, experience, education or title...when it comes to patient care and another person's life i will take a knee and listen to anyone who has something to offer.

i believe our father of medicine dates back to some 400 years bc. i also believe that professional or organized nursing did not exist until the 1800s.

with that said i feel as nurses we must realize our profession is in its infancy and what we are experiencing now is evolution. as professionals we must realize our knowledge is based on medicine and as nursing science improves so will the nursing profession continue to evolve.

if i have learned anything from a doc it is they are a respectful, tight-knit group with an infinite amount of respect for their chosen profession and each other. i would expect allnurses to be the same.

respect is earned, never given and so i suggest to my fellow nurses that we refrain from comparison and contrast of nursing and medicine in order to determine which is better; and focus on unifying our profession so that we can provide a level of care never witnessed before.

in closing, i do not believe leaders simply announce themselves; they sit quietly and are chosen by those who will follow. let as all sit quietly now, together.

my 2 cents

[hbgwan, LPN, LVN]

What you mid-levels need to understand is...

a little condascending, don't ya think?

[hbgwan, LPN, LVN]

I am not anti-MDA, but I do believe that a CRNA does not need supervision of an MDA/physician, but should work cooperatively with all healthcare providers.

thank you.

[DocHolliday]

DocHoliday,

The proof is in the research, and you just spent your time posting your opinion and nothing else. Simply put the research has long been established that CRNA/MDA outcomes are the same.

Assuming that you're an educated person, you should know perfectly well that "research" doesn't necessarily produce fact. Research can exist to support any conclusion the researcher chooses.

That being said, it is almost as if you've completely ignored my comments regarding the comparison of "outcomes" of anesthesia administered by MDs and CRNAs. The devil is always in the details, and these "outcome" studies are grossly devoid of details. I suggest you re-read my previous post regarding the topic of "outcomes", and address the comments I made about it.

If you want to state opinions all day long then my opinion is MDAs really only get 3yrs of anesthesia training. The 1st year of residency training is traditionally an internship year followed by 3yrs of actual anesthesia training, and most of a residents 1st year anesthesia training is just learning how to do direct patient care.

Once again.....you are completely and utterly disregarding the importance of the didactic training a physician has had that you do not have. You seem to view anesthesia as purely a vocation--i.e. something that any bumb off the streat can be trained to perform--i.e. a skill that does not benefit from extensive background knowledge of human medicine.

First off, the four years an anesthesiologist spent in medical school makes him/her a physician. The two years you spent in nursing school makes you a nurse. While you may choose to ignore this difference, it is nonetheless an enormous difference.

The "internship" year to which you refer is a year working as a resident in medicine. Again, that extends the training discrepancy between MDAs and CRNAs much further.

Finally, don't compare your 2.5 years of CRNA training to the 3 years of training an anesthesiologist gets. They may be similar in duration, but they are not the same in difficulty, thoroughness, or demand placed on the practitioner. I have no doubt that you think your CRNA program was hard as can be, but it was nevertheless geared toward producing a mid-level provider, not a specialized physician. Again, humungous difference between the two.

If 4yrs of medical school/3yrs of residency training make MDAs better than CRNAs then provide one valid research study to prove your point.

What the hell for?? You mid-levels are the ones trying to buck the system and show that it's not necessary to be a physician to be an "anesthesiologist".

FYI:

I am not anti-MDA, but I do believe that a CRNA does not need supervision of an MDA/physician, but should work cooperatively with all healthcare providers.

You say this because you are ignorant. I have no doubt that you are supremely confident that you think you know everything that an anesthesiologist does about the science and practice of anesthesia.

Don't get me wrong; I work with CRNAs with some regularity. But when the you-know-what hits the fan, I (and ALL of my physician colleagues) feel much better with an anesthesiologist in charge of our patients' lives. It's as simple as that.

[Dr.Nurse2b]

a little condascending, don't ya think?

Yes I agree...

It is reasonable to think that perhaps Dr. Holiday's comments are based on a previous experience with an individual and not directed toward all CRNAs. Being very young and new to the profession perhaps he is frustrated or overwhelmed with his new position.

I can't imagine that an MD with years of education and experience behind them would issue such a globalized statement and discredit an entire profession.

This would be almost bad as someone posting "a 33 year old doctor is barely out of medical school and certainly does not have the maturity or enough real world experience to pass judgement on the world".

My recommendation here is to pick and choose our battles. I have a long list of MDs that believe mid-level praticioneers are invaluable. I am not concerned with those who think otherwise. In time their confidence will be won over. Until that time of awakening we should do our best to support them regardless of condescending remarks.