CRNA vs. anesthesiologist

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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

a little condascending, don't ya think?

Referring to you folks as "you mid-levels" is condescending?

Why do you consider the title of "mid-level" to be something unfavorable?

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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.

No, my comments are a simple mentioning of the facts. CRNAs do not possess the extent, the breadth, nor the depth of training possessed by anesthesiologists. That is not an opinion. That is a fact.

As far as my personal experiences go, you may be surprised to know that I have never had a bad experience with a CRNA (and I perform many surgeries). They have always met, and at times, surpassed my expectations. Because I perform a lot of surgery in OR settings, because my procedures always require some form of general anesthesia, and because I frequently deal with very ill patients, I am just fully cognizant of the educational and training differences between CRNA and anesthesiologists.

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.

Calling CRNAs less educated than anesthesiologists is not a globalized statement. It's a fact.

If you consider this fact to be a "discredit" to your profession, then you're the one with the problem.

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".

That's an incredibly weak argument. First off, there's no such thing as "barely out of medical school". When we complete our four years of educational hell, we are doctors. The average age of completion is around 28 years of age. By the age of 33, we are either finished with our residencies or approaching the end. I finished medical school at 26, and completed my residency at 31, and my fellowship at 32. I am 33 years old now. Do I have all the experience of my older colleagues? Of course not. But the state in which I reside and the hospitals where I have privileges certainly think I have enough "real world" experience.

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.

Your comment here reeks of an inferiority complex.

Make no mistake about it: I think mid-levels are invaluable. I cannot imagine performing my work without them.

You, however, seem to think that for physicians to view you as "invaluable", we have to view you as peers, i.e. as equal parties in the team of professionals charged with patient care. You expect us to think that you can serve in many ways as our surrogates. We don't think this.

Rest assured, I treat the PAs and NPs (and yes, the CRNAs) with whom I work with the utmost respect. I am always welcoming of their input, and when they're wrong about something, I still treat them respectfully.

But I never mistake them for my physician colleagues. That just seems to drive you up the wall. It is almost as if you wish that you could somehow be physicians without having to deal with those pesky little hassles called medical school and residency. You know, it just dawned on me; your use of the terms "CRNA" vs. "MDA". I wonder why you don't just refer to MDAs as "anesthesiologists" or "Anesth" or "Ans". I wonder if perhaps you use the letters "MD" in front of the "A" in order to make a distinction between "physician anesthesiologists" and what you apparently perceive to be "nurse anesthesiologists".

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Specializes in Anesthesia.
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.

You must be absolutely right.....research means nothing, but since having an MD means everything plus the duration of education means even more at least when it is combined with an MD (if I understand what you are saying) then all MDs should be under the direct supervision of MD-PhDs because obviously those two degrees together must make better clinicians.

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

Good Luck in your profession DocHoliday and try not cough on any of your patients...:bowingpur

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DocHolliday,

Last time I checked the name of this website is allnurses.com......:nurse:

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Referring to you folks as "you mid-levels" is condescending?

Why do you consider the title of "mid-level" to be something unfavorable?

i meant what i said - "you mid-levels" is condascending. it is a general consensus whenever "you" is placed in front of the people you are addressing, it can be assumed that the person speaking views him or herself as on a different level.

no, mid-level is anything but unfavorable. it's just the way anyone with the word "nurse" in his or her title is addressed by superiors that is often condascending.

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You must be absolutely right.....research means nothing, but since having an MD means everything plus the duration of education means even more at least when it is combined with an MD (if I understand what you are saying) then all MDs should be under the direct supervision of MD-PhDs because obviously those two degrees together must make better clinicians.

I swear, it's like I'm talking to my two year-old.

First off, the PhD is a research degree. It is not a degree like an M.D., D.D.S., D.O., D.P.M., etc. that provides training in clinical medicine (or one of its branches). Students in MD-PhD programs want both degrees because they want to conduct research, but have the ability to combine research with patient care.

Anyways, did you not read what I said about the research to which you referred? Do you not comprehend the possibility that just because someone does research on a topic does not mean that his/her results do not necessarily produce accurate information? The very research to which you refer fails to take into account many things pertaining to the use of CRNAs in the delivery of anesthesia care, and because of it, neither I nor any of the anesthesiologists with whom I work regularly consider the research to be accurate in its conclusions--i.e. that CRNAs can do the jobs of anesthesiologists. Like I said, data can be cherry-picked to make any conclusion that you want.

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

You know, I've heard lots of sayings. Such as "that's the way the ball bounces" or "it ain't over 'til the fat lady sings". I've even heard a saying that goes "If God didn't intend for us to eat animals, he wouldn't have made them out of meat."

But I've never heard the saying that "anesthesiologists are the only MDs that work in a nursing profession." That must be one that's used only by nurses playing make-believe, pretending to be anesthesiologists.

Good Luck in your profession DocHoliday and try not cough on any of your patients...:bowingpur

Thanks! That's wonderful advice, doctor. (You don't mind if I call you "doctor", do you?)

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referring to you folks as "you mid-levels" is condescending?

why do you consider the title of "mid-level" to be something unfavorable?

is this a troll?

dr. h

i do not think anyone here feels the title of mid-level is something unfavorable. i believe it is you that have drawn this conclusion. i can only imagine perhaps you like controversy or enjoy showing off your intellectual capacity for debate. you are very talented.

what you are sensing here is slight tension and perhaps animosity toward what i feel to be an insensitive attitude. it is the method in which you present that people are finding offensive. considering your mental acuity i would go as far as to say you are doing this intentionally to illicit the very responses we see here.

i am certain you are a very intelligent person and a competent physician, however i think you are going about this the wrong way. i would recommend refraining from posting legal briefs and try to be a little more compassionate.

a young physician is impressive. a young physician with wisdom and compassion is amazing.

my 2 cents :twocents:

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Specializes in Pain Management.

As the saying goes "anesthesiologists are the only MDs that work in a nursing profession".

That statement is entirely wrong. Since the use of anesthesia actually dates back to the father of Chinese surgery, Hua Tuo, then CRNA's/AA's and MDA's are all actually practicing Traditional Chinese Medicine.

http://en.epochtimes.com/news/4-2-6/19495.html

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I was going to quote you but I just don't have the time. Boy you're a tough one. Inferiority complex? Not nice...and where do you get this from?

And I am curious...when you deal with your colleagues or staff members and you do not agree with them do you ask them if they have an inferiority complex?

OK Dr. Holiday...

Less education... Perhaps...lets compare the pathways just for fun...

By your rule:

You stated undergrad does not count. I think you stated it was a requirement. OK, Let's see...

The CRNA program is a doctorate level program which requires 36 months of education, lots of didactic AND...

Here are last years residency case statistics for the graduating CRNA class:

Total cases - 640

ASA III and IV - 318

Class V - 6

Pediatric-50

Emergencies 68

Intracranial 8

Intrathoracic 27

Heart 10

Obstetrical 41

Invasive line insertions 10

Regional administration 52

You being the expert, how do the above stats compare to those of an Anesthesiologist program?

Now an RN can't get into CRNA school without 1-2 years of critical care experience...but according to your rule this experience counts for ZERO...it is a requirement. Curious...I can't count ICU time and I am wondering why you place no value on critical service. Isn't this the place where you send all your post-op patients? Aren't we the ones that keep them alive? But no credit...OK. Mental note...ICU unimportant to surgeons...OK.

To continue...

The CRNA program -- 3 years PLUS residency PLUS didactic for CRNA = 4 years for a total of 7.5 years of nursing education with 4 of those years FOCUSED on anesthesiology. Oh but wait...As per your rule we can only count the 4 years.

Anesthesiologist...

Undergrad in whatever you want.

3 years med school + residency for total of 4 years. Wow...8 Years!

How long is the program to become an Anesthesiologist? Is it 4 years?

Fours years of anesthesia training for the doctor. Total of 12! WOW!

I believe the definition of Anesthesiologist is: A medical doctor trained to administer anesthesia.

And the definition of a CRNA or Certified Registered Nurse Anesthetist is: a registered nurse trained to administer anesthesia.

So both disciplines trained in the same...Anesthesia.

Now if we were comparing an MD to an RN I'd say the MD has the RN hands down when it comes to education in general. Meaning the MD spent way more time in school then the RN.

But today Dr. Holiday we are talking about CRNA vs MDA...

Thats a registered nurse trained to administer anesthesia vs. a medical doctor trained to administer anesthesia.

And by your rule...

The RN undergrad does not count and neither does experience.

So by your rule...

Medical school DOES NOT COUNT for the MD...it is a requirement to be trained as an Anesthesiologist.

Simply stated:

The MDs training is 4 years and allows him/her to administer anesthesia.

The RNs training is 4 years and allows him/her to administer anesthesia.

One must be a doctor or a nurse in order to be TRAINED to administer anesthesia. Now its not the nurse's fault the MD chose to go to school for 12 years to do the same job and in all honesty I'd be upset too if that good looking CRNA standing next to me was getting paid the same $$.

CRNA's are trained and paid to do the same job as an Anesthesiologist. You're not practicing gereral medicine, diagnosing illness or giving orders to the floor nurse...tube and gas - 4 years PERIOD Dr. Holiday...

The inferiority complex exists with the MDs that are afraid to recognize educational pathways beyond their own. I mean really...if we start calling nurses DOCTOR...heaven forbid...who would want to go to medical school?

But don't worry...I won't command that you call me doctor when I have DNP added to my name. You can go on calling me the nurse with the inferiority complex...:bowingpur

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Specializes in Pain Management.

Do you honestly believe that a BSN program is comparable to medical school? How about 1 year ICU experience + 36 month CRNA school being comparable to a four year anesthesiology residency?

Seriously?

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i was going to quote you but i just don't have the time. boy you're a tough one. inferiority complex? not nice...and where do you get this from?

it seems to me that making mention of the fact that your training in the medicine of anesthesia is less than that of an anesthesiologist elicits a negative response from you. it's the truth, yet, it's a truth you don't want to be reminded of.

and i am curious...when you deal with your colleagues or staff members and you do not agree with them do you ask them if they have an inferiority complex?

my goodness, you're not even understanding what i'm saying, let alone agreeing with what i'm saying. the most obvious aspect of my whole argument here is that i am not belittling your profession. did i come to this forum and say, "crnas are incompetent pukes who should be cleaning bed-pans?" no. i came here saying essentially, "anesthesiologists have superior training in the area of medicine called anesthesiology."

ok dr. holiday...

less education... perhaps...lets compare the pathways just for fun...

by your rule:

you stated undergrad does not count. i think you stated it was a requirement. ok, let's see...

undergrad is required for every graduate-level educational program. crnas are not in any way unique by having completed undergraduate degrees. you know this. so stop bringing your 4 years in college into the picture, because we all had to do it.

the crna program is a doctorate level program which requires 36 months of education, lots of didactic and...

like hell it's a "doctorate level" program. if it were a doctorate level program, you would be awarded the title of doctor. obviously, you are not. not only is not not a doctorate level program, it doesn't even meet the duration of a doctorate level program. with the exception of law school, there is no doctorate level program that is less than 4 years in duration. there is one exception to this: there is one dental school out of 50+ dental schools, to my knowledge, that has managed to squeeze 4 years-worth of dds training into a 3 year curriculum (by cutting out vacations and severely intensifying the program)....at least, that's what an omfs friend of mine who went there told me. every other dental school if 4 years (and miserably hard, from what my friends who are dentists tell me), optometry school is 4 years, podiatry school is 4 years, veterinary medicine school is 4 years, hell.....even chiropractic school is 4 years! but according to you, crna programs, which for some bizarre reason award a masters degree, are just 2.5 years in length.

yet, you submit that crna programs are doctorate-level.

here are last years residency case statistics for the graduating crna class:

"residency"? that's rich!

total cases - 640

asa iii and iv - 318

class v - 6

pediatric-50

emergencies 68

intracranial 8

intrathoracic 27

heart 10

obstetrical 41

invasive line insertions 10

regional administration 52

you being the expert, how do the above stats compare to those of an anesthesiologist program?

i'm a head/neck surgeon, not an anesthesiologist. so obviously, i don't know the number of cases. i wish i did, however, it would have helped me make my argument.

i would be absolutely shocked (and humbled) if those numbers surpassed the numbers and variety of cases handled by anesthesiology residents.

now an rn can't get into crna school without 1-2 years of critical care experience...but according to your rule this experience counts for zero...it is a requirement. curious...i can't count icu time and i am wondering why you place no value on critical service. isn't this the place where you send all your post-op patients? aren't we the ones that keep them alive? but no credit...ok. mental note...icu unimportant to surgeons...ok.

we covered this ground before, did we not?

work experience is not the same as formal training. i'm not saying it counts for zero. what i am saying is that it is not something that should be considered as an equivalent to formal training.

look, i know you like to add whatever experiences you have to your collection to make yourself appear closer to anesthesiologists in extent of training. but don't do it. it just makes your argument sound desparate.

to continue...

the crna program -- 3 years plus residency plus didactic for crna = 4 years for a total of 7.5 years of nursing education with 4 of those years focused on anesthesiology. oh but wait...as per your rule we can only count the 4 years.

first, most crna programs are 2.5 years, are they not? where's all this other "didactic" and "residency" crap coming from? i looked up a few crna programs using google, and saw that they were 28 months in duration.

anesthesiologist...

undergrad in whatever you want.

but since we're not counting undergrad, neither for crnas nor anesthesiologists, it doesn't matter what we study, now does it.

3 years med school + residency for total of 4 years. wow...8 years!

three years in med school? funny, i spent four years in medical school. i must have been held back a year without being notified of it....just like my 120+ classmates. perhaps i should sue.

how long is the program to become an anesthesiologist? is it 4 years?

fours years of anesthesia training for the doctor. total of 12! wow!

yes. twelve years. "wow" is a very good description of it.

i believe the definition of anesthesiologist is: a medical doctor trained to administer anesthesia.

and the definition of a crna or certified registered nurse anesthetist is: a registered nurse trained to administer anesthesia.

don't you think you've oversimplified the job of an anesthesiologist just a tad? anesthesiologists are physician experts in critical care medicine and pain management. something crnas are not.

so both disciplines trained in the same...anesthesia.

see my comment above.

now if we were comparing an md to an rn i'd say the md has the rn hands down when it comes to education in general. meaning the md spent way more time in school then the rn.

but today dr. holiday we are talking about crna vs mda...

thats a registered nurse trained to administer anesthesia vs. a medical doctor trained to administer anesthesia.

you see, you are making the claim that the "anesthesia training" completed by a crna is the same as that completed by an anesthesiologist, and therefore, the only difference between crnas and anesthesiologists is the pre-requisite degree for their respective programs. you are wrong. like i said, crna programs are geared toward training nurses to provide anesthesia services. anesthesiology residencies are responsible for training doctors to become specialists in the science of anesthesia and critical care medicine.

and by your rule...

the rn undergrad does not count and neither does experience.

nurses coming out of nursing school have very limited knowledge in medicine and i think you know this to be the case. your rn degree and pre-requisite "critical care" experience is certainly helpful, i'm sure, but it is not to be considered as formal training. it's just work experience that the crna programs want you to have so that they don't have to teach you how to "tie your shoes" during your 28-month program, so to speak.

so by your rule...

medical school does not count for the md...it is a requirement to be trained as an anesthesiologist.

simply stated:

the mds training is 4 years and allows him/her to administer anesthesia.

the rns training is 4 years and allows him/her to administer anesthesia.

i'm about ready to have a heart-attack here....

your problem is that you are viewing the roles of anesthesiologists and nurse-anesthetists as being identical. once again, they are not.

anesthesiology is a specialty of medicine. it is not a trade like plumbing or auto mechanics. the anesthesiologist is a specialized physician....just like me. let me say it again: the anesthesiologist is a specialized physician. there is no such thing as being an anesthesiologist without having an m.d., d.o., or d.d.s. degree (yes, there are dentist anesthesiologists who work only with dentists).

one must be a doctor or a nurse in order to be trained to administer anesthesia. now its not the nurse's fault the md chose to go to school for 12 years to do the same job and in all honesty i'd be upset too if that good looking crna standing next to me was getting paid the same $$.

do you know that oral/maxillofacial surgeons (omfs) are trained to put patients under general anesthesia (i.e. intubate, administer ga agents like fentanyl, propofol, and halogenated ethers, as well as provide peri-operative management)? do you know how much anesthesia training omfss get during their 4 to 6 year residency? four to six months! they learn to do much of what crnas do in four to six months. what does this tell you? that administering anesthesia safely isn't that difficult. what else does this tell you? that the training of an anesthesiologist, whose residency is 48 months (including 12 months of internal medicine, which you crnas barely even touch) covers the science of anesthesia and critical care medicine in a level of detail that no crna program can touch.

as far as the money goes, there's no comparison. crnas may get paid very well for compared to other nurses, but they don't come close to anesthesiologists.

crna's are trained and paid to do the same job as an anesthesiologist. you're not practicing gereral medicine, diagnosing illness or giving orders to the floor nurse...tube and gas - 4 years period dr. holiday...

obviously, you are ignorant of the training and skill of an anesthesiologist--to the point where you consider them to be essentially crnas with md degrees (which is probably why you refer to them as mdas). i don't know what else to tell you. it's your intent to continue your career in ignorance.

the inferiority complex exists with the mds that are afraid to recognize educational pathways beyond their own. i mean really...if we start calling nurses doctor...heaven forbid...who would want to go to medical school?

what are you talking about? we m.d.'s recognize d.o.'s as our peers, do we not? what you are expecting of us is that we recognize as equals health care providers who have had less training than we have had.

but don't worry...i won't command that you call me doctor when i have dnp added to my name. you can go on calling me the nurse with the inferiority complex

well, look at it this way: if you want to call yourself the "chief of surgery", i couldn't care less. but should you ever find yourself administering anesthesia for a patient of mine, don't forget whose license you are working under, and from who you will be taking orders.....should i be inclined to give them.

i cannot believe i have wasted so much time arguing this topic with you. you obviously have made up your mind on the subject, and will continue to disregard every fact presented to you.

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If anyone has an inferiority complex here, it is the young DocHolliday. What kind of doctor would register an account on a nursing forum just to belittle the posters? :down:

And after reading his post, I'm convinced he hasn't even read the study he is trying to critique. :nono:

It shouldn't be surprising that CRNA's and anesthesiologists have similar patient outcomes. With the improved anesthetics and monitoring equipment, anesthesia is much safer these days. Accidents are most commonly from lack of attention, not lack of education.

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