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

Ditto. I can only WISH I had the free time DocHolliday apparently has!

What makes you think I have so much free time? Because I can spend five minutes here and there throughout the day to respond to posts on a message board?

I'm not in the OR every minute of every day, just for your information.

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If you wanted independence, you should have gone to medical school.

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Specializes in Anesthesia.

Silber study showed nothing that could be used to compare CRNA outcomes vs. MDAs. I know you could probably care less what the AANA thinks, but their write clearly demonstrates why no other medical journal, but the ASA would publish this study.

Yes, I flat out refuse to believe/have not seen it demonstrated/worked with an MDA that would change my mind to the contrary/or aware of any valid research that would suggest that MDAs are more qualified anesthesia providers.

I have no discrepancy saying that MDAs would be more qualified to do long term ICU care over a CRNA, but that is not what you are refering to. I don't think being an MD makes someone more qualified to take care of anesthesia emergencies. The anesthesia provider's experience counts first and foremost.

As a surgeon you absolutely have no idea about anesthesia or CRNAs.

I am not trying to get rid of MDAs. The MDAs I work with have all so far have been great! We all work together in a cooperative envirnoment. The scope of practice where I am doing clinicals allows for complete autonomy of CRNAs (no MDA supervision/no signing off charts behind us etc). MDAs and CRNAs can both work independently in the same environment, give great care, and with equal outcomes.

Maybe you can answer me this: Why is that some MDs (like yourself) think everyone in the medical field is inferior to them in education/experience and otherwise? Your posts clearly support that you think MDs are the only ones qualified to give quality care.

A medical degree is awesome accomplishment and for the most part is great education, but it is hardly some secret knowledge that MDs learn. CRNAs are taught out of the same books as MDAs, a lot of us share the same instructors as the medical students, go to the same residency sites, have the same preceptors/staff training us etc., and you think there is really going to be a difference in outcomes...No there is not and is proven day in and day out all over the United States. Nurse anesthesia is speciality education from day one and MDAs have to wait until they get to residency to really start training in anesthesia. Obvisously MDAs wouldn't be able to do what they do without medical school, but it is the residency that makes a true physician not the medical school.

This discussion is getting old. I understand fully what you are saying and I totally disagree with you, and you have no valid research to back up your arguement. So at this point we will just have to agree to disagree, and I hope I don't have to work with you if you act this condscending in the OR.

At most, the study's conclusions support the proposition that certain facilities would benefit from having a board-certified anesthesiologist in the Intensive Care Unit. This might result in the "rescue" of some patients who have undergone elective cholecystectomies and transurethral prostatectomies and developed life-threatening postoperative complications. The Silber study's conclusions have nothing to do with nurse anesthetists or the nature of who may supervise, direct, or collaborate with nurse anesthetists. At most, the study concluded that anesthesiologists may play a clinically valuable role in caring for postoperative complications. The study, however, did not involve examination of the outcomes of anesthesia in the operating room.

WTBCRNA....

First off, as a physician, I am not particularly interested in what the AANA thinks about a study. Nurse anesthetists and their governing bodies are not an authority on the practice of anesthesia. Anesthesiologists and the ASA are.

Moreover, even if what you said above were the only thing the Silber study rightfully demonstrated, that in itself is proof that CRNAs cannot be left alone without some sort of drop in quality of care under certain circumstances.

Nobody's saying that CRNAs aren't able to handle routine anesthesia (and yes, "routine" complications). What I am saying, and what anesthesiologists are saying is that it's the complicated things they are not as qualified to handle as anesthesiologists are.

I mean, do you just flat-out refuse to accept that a physician with four more years of training than you knows a thing or two more about the practice of anesthesia and its associated sciences? You think that you, a nurse who spent 28 months in an anesthesia masters program, is going to have the same scope and depth of knowledge as a physician who spent 48 months in a residency program?

The conclusion to be drawn from this study is that, although the presence of board-certified anesthesiologists may not make a difference in the operating room, it may make a difference in the failure to rescue patients from death or adverse occurrences after postoperative complications have arisen. This conclusion is in keeping with the expanded role that anesthesiologists have identified for themselves in post-operative care....

My point exactly. Anesthesiologists, because they are physicians who have, unlike CRNAs, intimate knowledge of human health and disease, are better able to manage complicated situations.

This Dr. Pine character certainly is splitting hairs, isn't he. Like you (and other CRNAs), he seems to view "anesthesia" as pumping some poor sap full of Diprivan, sticking a tube down their trachea, cranking up the gasses, then turning everything off and extubating when the procedure is done, and making sure the patient is waking normally inthe PACU. After that, according to Dr. Pine, the provider administering the anesthesia can dust off his or her hands, because he or she is done and no longer responsible.

Well, anesthesia is a little broader in scope than that which CRNAs are trained for....as the Silber study seems to demonstrate.

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Specializes in Anesthesia.
If you wanted independence, you should have gone to medical school.

CRNAs are allowed to practice independently in every state, local hospital policy and billing of Medicare/Medicaid are the only things that prohibit independent practice.

COOPERATION between healthcare providers is what is needed not SUPERVISION, especially by some egotistical physician.

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Specializes in ICU.
What makes you think I have so much free time? Because I can spend five minutes here and there throughout the day to respond to posts on a message board?

I'm not in the OR every minute of every day, just for your information.

Well, how you choose to use your "5 minutes" is of course up to you, but for someone so seemingly frustrated and hell bent on measuring education levels ad nauseum, I would think some down time would be healthier. Maybe go outside and breathe some fresh air or listen to some calming music via an iPOD. Have you always been so caustic, or is this an outgrowth of unhappiness elsewhere? CRNA's have been here and will continue to be here long after your gone.

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Silber study showed nothing that could be used to compare CRNA outcomes vs. MDAs. I know you could probably care less what the AANA thinks, but their write clearly demonstrates why no other medical journal, but the ASA would publish this study.

Actually, it did. But like all research, it has its detractors, e.g. the AANA. Of course, the conclusions of the Silber study certainly fall in line with the common knowledge that more educated individuals are better suited to perform a job than less-educated individuals.

Yes, I flat out refuse to believe/have not seen it demonstrated/worked with an MDA that would change my mind to the contrary/or aware of any valid research that would suggest that MDAs are more qualified anesthesia providers.

An extra four years of medical education and training are of no significance in your opinion. Oh, but your measely one year of work experience as a nurse in an ICU means a lot!

I have no discrepancy saying that MDAs would be more qualified to do long term ICU care over a CRNA, but that is not what you are refering to. I don't think being an MD makes someone more qualified to take care of anesthesia emergencies. The anesthesia provider's experience counts first and foremost.

"I have no discrepancy"? Look up the meaning of the word "discrepancy".

Anyway, tell me why anesthesiologists are more qualified to provide long-term ICU care, and then tell me why this added qualification for long-term ICU care wouldn't translate into more qualification to provide anesthesia services? You make a clear distinction between anesthesia and medicine.

As a surgeon you absolutely have no idea about anesthesia or CRNAs.

Wrong! My ENT residency included an anesthesiology rotation. Although it was brief (6 weeks), I nonetheless worked at the resident level and performed the same tasks as anesthesiology residents. So I do no a thing or two about anesthesia and anesthesiology. And I can tell you with the utmost confidence that the practice of anesthesiology potentially draws on medical knowledge more than any other field of medicine, with perhaps the exception of internal medicine.

I am not trying to get rid of MDAs. The MDAs I work with have all so far have been great! We all work together in a cooperative envirnoment. The scope of practice where I am doing clinicals allows for complete autonomy of CRNAs (no MDA supervision/no signing off charts behind us etc). MDAs and CRNAs can both work independently in the same environment, give great care, and with equal outcomes.

That's because you your definition of "anesthesia" is sticking a tube in someone's throat and turning up the gas. Anesthesiologists are trained for far more things than you are. God forbid should I or anyone I care about find themselves in need of anesthesia services, I want the most highly-trained person performing it. And that is not you.

Maybe you can answer me this: Why is that some MDs (like yourself) think everyone in the medical field is inferior to them in education/experience and otherwise? Your posts clearly support that you think MDs are the only ones qualified to give quality care.

Define "inferior". I'm not saying CRNAs (or other mid-levels) are inferior, as I define the word. They have certain jobs to do. And no, I don't think physicians are the only ones qualified to provide quality care. But I do have a problem with mid-levels like you who seem to think that they are doctors, minus the doctoral degree. Moreover, I think that physicians should have oversight over everything that mid-levels do, in order to guarantee for the patients that there is someone who is as highly-trained as possible watching over their care.

A medical degree is awesome accomplishment and for the most part is great education, but it is hardly some secret knowledge that MDs learn.

How the hell would you know? From your nursing degree?

CRNAs are taught out of the same books as MDAs, a lot of us share the same instructors as the medical students, go to the same residency sites, have the same preceptors/staff training us etc., and you think there is really going to be a difference in outcomes...No there is not and is proven day in and day out all over the United States.

I have news for you, where I was in medical school, the dental students used the same texts, some of the same faculty, and even took some of their classes with us. Does that make their knowledge of medicine similar to ours? Nor does it make yours.

Nurse anesthesia is speciality education from day one and MDAs have to wait until they get to residency to really start training in anesthesia.

You've made some idiotic statements over the course of our debate here, but this one by far takes the cake. You are a real discredit to your profession, and my impression of the CRNA profession has diminished, knowing that someone so obtuse as you can be a member of it.

Whether you realize it or not, you are saying by this statement is that someone who intends to provide anesthesia is better off without the extensive background in medicine of an M.D. or D.O. (or D.D.S., for dental anesthesiologists).

What exactly do you think medical school is for, Wtbcrna? You think we are trained to treat HTN and perform DRE's, and little else? Do you not see the medicine involved in anesthesia? You obviously know some of it. Physicians obviously know a hell of a lot more of it than you. Someone before me cleverly pointed out that medical training is additive; the scope and depth of medical school better prepares physicians to handle any field of medicine than your 2-year nursing degree does.

Obvisously MDAs wouldn't be able to do what they do without medical school, but it is the residency that makes a true physician not the medical school.

Spoken like someone who's never been to medical school. They grant us the M.D. degree and the title of "physician" because we have shown that we have learned everything required to be awared the degree and the title. In order to practice medicine, we are required to spend merely one year after school in some sort of post-grad training program. Residency, on the other hand, is for the purpose of specialization. I am a physician who specialized in otolaryngology, not a medical school graduate who became a physician during his otolaryngology residency.

This discussion is getting old. I understand fully what you are saying and I totally disagree with you, and you have no valid research to back up your arguement.

No, you do not understand the points I am making. You think in a complete vacuum, with absolutely no regard for the realities around you.

And as far as research goes, neither do you. Don't think for an instant that I (and the entire anesthesiology profession) am unaware of the motivations behind the "research studies" conducted (under the auspices of the CRNA profession) to show that CRNAs don't need any help from their more educated counterparts.

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Well, how you choose to use your "5 minutes" is of course up to you, but for someone so seemingly frustrated and hell bent on measuring education levels ad nauseum, I would think some down time would be healthier. Maybe go outside and breathe some fresh air or listen to some calming music via an iPOD. Have you always been so caustic, or is this an outgrowth of unhappiness elsewhere? CRNA's have been here and will continue to be here long after your gone.

I don't think I'm caustic. Just very, very direct . I'm actually a very nice guy at the office, on the surgical ward, and in the OR.

Speaking of which, my beeper just went off! Probably some drunk bumb who got his face broken in a fight. See? You probably won't see another post from me tonight. I'll be in the OR.....fixing this guy's face.....for free!

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The CRNA program is a doctorate level program which requires 36 months of education

OK, let's at least give real facts here. Almost all CRNA programs are at the Master's Degree level. Perhaps a couple of made a jump to the DNAP concept, and it won't even be a requirement for several more years, if it happens at all. Also, at the master's level, almost no CRNA programs are 36 months long. Most are 24-27 months.

What makes you think I have so much free time? Because I can spend five minutes here and there throughout the day to respond to posts on a message board?

I'm not in the OR every minute of every day, just for your information.

Doc - you're in enemy territory - as much as I agree with almost every word you say, it ain't gonna matter here.

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i think it's time docholliday ends this ******* contest and goes back to his posse.

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OK, let's at least give real facts here. Almost all CRNA programs are at the Master's Degree level. Perhaps a couple of made a jump to the DNAP concept, and it won't even be a requirement for several more years, if it happens at all. Also, at the master's level, almost no CRNA programs are 36 months long. Most are 24-27 months.

Doc - you're in enemy territory - as much as I agree with almost every word you say, it ain't gonna matter here.

And not only that, I seriously doubt that the doctoral degree awarded in a DNAP is not going to be a clinical doctoral degree. It'll be more like a Ph.D. (i.e. like a Ph.D. in nursing, or a Ph.D. in pharmacology--degrees that do not grant any clinical privileges).

Why? Because there are already doctoral degree that cover the field of anesthesia: M.D., D.O., and even D.D.S.

Who in the hell is going to acknowledge a doctoral nursing degree in a specific discipline as an equivalent to one of the current doctoral degrees?

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DocHolliday, you seem pretty hung up on this "doctorate" level of education and how most CRNA degrees are classified as master's. The truth is that you just happen to live in one of the only countries in the world that would honor your first professional degree with such a title. If we were in the UK (or most any other country in the world for that matter), you would have a bachelor degree to brag about.

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Specializes in Anesthesia.

What can I say, but I must be wrong and the largest profession in the US (nursing) must always be totally subserviant to MDs, because we all know that MDs know everything and us little "physician wannabes know nothing". We should call a physician for everything...I need that physician/MDA there everytime something goes wrong, because I am too stupid and uneducated to know how to work in a crisis situation.....hmm I wonder how military CRNAs have survived this long working independently in deployed/humantarian environments without the help of MDAs....But since there are no valid research studies out there besides the Silber study (NOT) what can I say. I bow to your great wisdom/your secret medical education that is conferred upon becoming an MD, your 4yrs of medical school, and your 6 WEEKS of Anesthesia training.....:bowingpur

Silber study showed nothing that could be used to compare CRNA outcomes vs. MDAs. I know you could probably care less what the AANA thinks, but their write clearly demonstrates why no other medical journal, but the ASA would publish this study.

Actually, it did. But like all research, it has its detractors, e.g. the AANA. Of course, the conclusions of the Silber study certainly fall in line with the common knowledge that more educated individuals are better suited to perform a job than less-educated individuals.

Yes, I flat out refuse to believe/have not seen it demonstrated/worked with an MDA that would change my mind to the contrary/or aware of any valid research that would suggest that MDAs are more qualified anesthesia providers.

An extra four years of medical education and training are of no significance in your opinion. Oh, but your measely one year of work experience as a nurse in an ICU means a lot!

I have no discrepancy saying that MDAs would be more qualified to do long term ICU care over a CRNA, but that is not what you are refering to. I don't think being an MD makes someone more qualified to take care of anesthesia emergencies. The anesthesia provider's experience counts first and foremost.

"I have no discrepancy"? Look up the meaning of the word "discrepancy".

Anyway, tell me why anesthesiologists are more qualified to provide long-term ICU care, and then tell me why this added qualification for long-term ICU care wouldn't translate into more qualification to provide anesthesia services? You make a clear distinction between anesthesia and medicine.

As a surgeon you absolutely have no idea about anesthesia or CRNAs.

Wrong! My ENT residency included an anesthesiology rotation. Although it was brief (6 weeks), I nonetheless worked at the resident level and performed the same tasks as anesthesiology residents. So I do no a thing or two about anesthesia and anesthesiology. And I can tell you with the utmost confidence that the practice of anesthesiology potentially draws on medical knowledge more than any other field of medicine, with perhaps the exception of internal medicine.

I am not trying to get rid of MDAs. The MDAs I work with have all so far have been great! We all work together in a cooperative envirnoment. The scope of practice where I am doing clinicals allows for complete autonomy of CRNAs (no MDA supervision/no signing off charts behind us etc). MDAs and CRNAs can both work independently in the same environment, give great care, and with equal outcomes.

That's because you your definition of "anesthesia" is sticking a tube in someone's throat and turning up the gas. Anesthesiologists are trained for far more things than you are. God forbid should I or anyone I care about find themselves in need of anesthesia services, I want the most highly-trained person performing it. And that is not you.

Maybe you can answer me this: Why is that some MDs (like yourself) think everyone in the medical field is inferior to them in education/experience and otherwise? Your posts clearly support that you think MDs are the only ones qualified to give quality care.

Define "inferior". I'm not saying CRNAs (or other mid-levels) are inferior, as I define the word. They have certain jobs to do. And no, I don't think physicians are the only ones qualified to provide quality care. But I do have a problem with mid-levels like you who seem to think that they are doctors, minus the doctoral degree. Moreover, I think that physicians should have oversight over everything that mid-levels do, in order to guarantee for the patients that there is someone who is as highly-trained as possible watching over their care.

A medical degree is awesome accomplishment and for the most part is great education, but it is hardly some secret knowledge that MDs learn.

How the hell would you know? From your nursing degree?

CRNAs are taught out of the same books as MDAs, a lot of us share the same instructors as the medical students, go to the same residency sites, have the same preceptors/staff training us etc., and you think there is really going to be a difference in outcomes...No there is not and is proven day in and day out all over the United States.

I have news for you, where I was in medical school, the dental students used the same texts, some of the same faculty, and even took some of their classes with us. Does that make their knowledge of medicine similar to ours? Nor does it make yours.

Nurse anesthesia is speciality education from day one and MDAs have to wait until they get to residency to really start training in anesthesia.

You've made some idiotic statements over the course of our debate here, but this one by far takes the cake. You are a real discredit to your profession, and my impression of the CRNA profession has diminished, knowing that someone so obtuse as you can be a member of it.

Whether you realize it or not, you are saying by this statement is that someone who intends to provide anesthesia is better off without the extensive background in medicine of an M.D. or D.O. (or D.D.S., for dental anesthesiologists).

What exactly do you think medical school is for, Wtbcrna? You think we are trained to treat HTN and perform DRE's, and little else? Do you not see the medicine involved in anesthesia? You obviously know some of it. Physicians obviously know a hell of a lot more of it than you. Someone before me cleverly pointed out that medical training is additive; the scope and depth of medical school better prepares physicians to handle any field of medicine than your 2-year nursing degree does.

Obvisously MDAs wouldn't be able to do what they do without medical school, but it is the residency that makes a true physician not the medical school.

Spoken like someone who's never been to medical school. They grant us the M.D. degree and the title of "physician" because we have shown that we have learned everything required to be awared the degree and the title. In order to practice medicine, we are required to spend merely one year after school in some sort of post-grad training program. Residency, on the other hand, is for the purpose of specialization. I am a physician who specialized in otolaryngology, not a medical school graduate who became a physician during his otolaryngology residency.

This discussion is getting old. I understand fully what you are saying and I totally disagree with you, and you have no valid research to back up your arguement.

No, you do not understand the points I am making. You think in a complete vacuum, with absolutely no regard for the realities around you.

And as far as research goes, neither do you. Don't think for an instant that I (and the entire anesthesiology profession) am unaware of the motivations behind the "research studies" conducted (under the auspices of the CRNA profession) to show that CRNAs don't need any help from their more educated counterparts.

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