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

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).

Actually, "Doc" there is a school that offers a DNAP clinical degree in TN. So it's not "more like" anything.....

To Everyone else, maybe if we just ignore him he will go away.

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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).

Actually, "Doc" there is a school that offers a DNAP clinical degree in TN. So it's not "more like" anything.....

To Everyone else, maybe if we just ignore him he will go away.

You missed my point entirely.

Let me simplify it for you:

You know how dentists earn a D.D.S.? Or how podiatrists earn a D.P.M.?

Dentists and podiatrists are doctors, with the same level of authority and autonomy as physicians, except their doctoral degrees are in specialized fields where there are no equivalent specialists in medicine (i.e. there are no physicians who perform root canals or treat in-grown toe-nails). That's why these degrees exist.

I seriously doubt that the DNAP degree is a doctoral degree that is equivalent to a D.D.S. or D.P.M. Why should there be such a degree that awards a doctoral degree in anesthesia when there are already M.D. and D.O. physicians who perform anesthesia?

Catch my point? The DNAP degree seeks to create something that is entirely redundant to the existing anesthesiologists....except for the fact that DNAP's will still have less education than anesthesiologists.

And even if, by some chance, this degree sought to produce a "doctor" who had the same level of education and training as an anesthesiologist, a logical person (in charge) would say, "Well, why don't these hypothetical prospective DNAP students go to medical school and specialize in anesthesiology?"

Does that make sense to you?

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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

Wtbcrna, that's a very childish response.

You need to stop looking at it as being "subservient", and start recognizeing it for what it is: a more highly trained health care professional having oversight over a less highly trained health care professional.

Nobody is saying that you shouldn't be able to make clinical decisions. Nobody's even saying that you're not qualified to handle emergencies. What I'm saying is that there should be an anesthesiologist present to supervise, should problems occur that are beyond the scope of your training. That's why there are physicians who specialize in anesthesiology. Someone, a long time ago, determined that anesthesia and its associated sciences are diverse enough to warrant a physician to specialize in it.

And just FYI, anesthesia is not a nursing profession, as you think. And anesthesiologists aren't dipping into your field. Hell, the concept of anesthesia was invented by a dentist (Dr. William Morton) in the 1800's, so if anything, it is dentistry that "owns" anesthesia. But do you see dentists complaining about anesthesiologists (and CRNAs) stealing their turf.

Regarding my anesthesia experience: I never said that my training in anesthesia made me an authority on the subject. What I've said is that my degree and my training in anesthesia have made me well aware that it is a highly medicine-oriented specialty, and as such, there are certain aspects of it for which mid-levels with nursing degrees aren't sufficiently trained.

Finally, never use the military as an example. The military is the epitome of an organization that has historically been willing to cut corners where health care is concerned.

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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.

We're not talking about the rest of the world, now are we.

That aside, whatever degree a physician holds elsewhere, he or she is still a physician--with all the rights and privileges of a physician. They are not considered to be the equivalent of mid-levels. So, your point makes no sense.

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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?

The P in DNP or DNAP is "practice", although it's a strange concept since most of the curricula I've seen have little to do with clinical practice and a lot to do with nursing theory and politics. They're certainly not equivalent to a PhD - they may do a little research worth a few credit hours, but their degree is not based on research and defending a thesis. Also, a PhD in pharmacology is not the same thing as PharmD. The DNP, PharmD and DPT are the equivalents for nursing, pharmacy and physical therapy.

Scope of practice is not determined by degree, but by legislatures and regulatory boards in each state. Of course therein lies the other problem, which as a surgeon, you may or may not be aware of. CRNA's are or are seeking to practice in the area of chronic pain management, including such things as epidural steroid injections, X-Ray guided blocks, and even implantation of nerve stimulators and pain pumps. Louisiana has already ruled that this crosses over into the practice of medicine, but other state boards of nursing feel they can dictate their own rules, regardless of legislation to the contrary. Most of these infringements upon the practice of medicine will end up in the courts or back in the legislature to clarify the definitions of medical and nursing practice.

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The P in DNP or DNAP is "practice", although it's a strange concept since most of the curricula I've seen have little to do with clinical practice and a lot to do with nursing theory and politics. They're certainly not equivalent to a PhD - they may do a little research worth a few credit hours, but their degree is not based on research and defending a thesis. Also, a PhD in pharmacology is not the same thing as PharmD. The DNP, PharmD and DPT are the equivalents for nursing, pharmacy and physical therapy.

Indeed, a PhD in pharmacology is not a clinical degree. It is a research degree. What I think, though, is that a clinical doctorate in nursing is absolutely ridiculous. It's like bronzing a crushed aluminum can. A nursing degree is not a foundation on which to build a clinical doctoral degree. And there is no need for a specific doctoral degree in anesthesia (stacked on top of a BSN degree).

Think about it, and compare the two:

Student A goes to med school for four years and becomes a physician, and subsequently enters a four year anesthesiology residency to become an anesthesiologist.

Student B goes to nursing school for two years (then works in an ICU for some period of time), then goes to a DNAP program for what, two, three years to become what exactly? What exactly is a DNAP? Why does this "doctor" exist? What the hell is a "doctor of nursing?" Now, you compared DNAP's to PharmD's (which are comparable to DDS's and DPM's, which are 'physician-level' doctors of specific branches of the medical profession). DDS's, DPMs, and PharmD's are doctors that exist to serve a unique and specific need. What need does a "doctor of nursing in anesthesia" serve that is not already served by CRNAs and anesthesiologists? You see my point?

If you ask me, this idea of a DNAP degree is just another ploy to sugar-coat the nursing professions efforts to obtain the rights and privileges of doctors without going to medical school.

This is fight for expanded privileges is not unique. About half the oral surgery residency programs out there now are six years in duration rather than four--the extra two years so that they can earn M.D. degrees as part of the residency. For what? It doesn't make a damn bit of difference to the oral surgeon himself or herself; the single-degree residents get the same surgical training as the dual-degree residents. It's a ploy, so that oral surgeons could more easily expand their scope of practice to include procedures that were traditionally considered to be "medical" in nature, like facial cosmetic surgery, head/neck oncology (my turf!), and so on. At least, at very least, oral surgeons acknowledged the significance of a medical degree in their plight to solidify their expanded scope of practice.

Nursing, on the other hand, brazenly seeks to gain parity with physicians by bypassing the M.D. degree altogether, and instead creating some bogus "doctoral" degree in nurse-anesthesia.

Scope of practice is not determined by degree, but by legislatures and regulatory boards in each state. Of course therein lies the other problem, which as a surgeon, you may or may not be aware of. CRNA's are or are seeking to practice in the area of chronic pain management, including such things as epidural steroid injections, X-Ray guided blocks, and even implantation of nerve stimulators and pain pumps. Louisiana has already ruled that this crosses over into the practice of medicine, but other state boards of nursing feel they can dictate their own rules, regardless of legislation to the contrary. Most of these infringements upon the practice of medicine will end up in the courts or back in the legislature to clarify the definitions of medical and nursing practice.

No, I'm aware of everything you said there, except for the topic of CRNAs implanting nerve-stimulators. Boy, they really are cocky, aren't they! That is a surgical procedure, and as a surgeon who busted his tail for four years in medical school and five years in an ENT residency working literally 80+ hours a week to get where he is, I am personally offended that some cockamamie nurse thinks he or she should have the same rights and privileges to surgically modify someone's body.

As a physician, I am also offended that these nurses, advanced practice or otherwise--doesn't matter--wish to practice medicine without a medical degree.

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Why does this "doctor" exist? What the hell is a "doctor of nursing?" Now, you compared DNAP's to PharmD's (which are comparable to DDS's and DPM's, which are 'physician-level' doctors of specific branches of the medical profession).

What are "physician-level" doctors?? What does that even mean?

DDS's, DPMs, and PharmD's are doctors that exist to serve a unique and specific need. What need does a "doctor of nursing in anesthesia" serve that is not already served by CRNAs and anesthesiologists?

What purpose do MDs serve that aren't already served by DOs?

Nursing, on the other hand, brazenly seeks to gain parity with physicians by bypassing the M.D. degree altogether, and instead creating some bogus "doctoral" degree in nurse-anesthesia.

Again, here you are going on about this "doctoral" level education of yours. I thought we already went over this. You have a first professional degree, which isn't a real doctorate. If you want to brag about a doctoral degree, finish a PhD, like us real doctors.

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Specializes in Anesthesia.

I was going to write a very lengthy response back, but arguing with you is getting old. This arguement has been ongoing with physicians since the early 1900's and nurse anesthetists have won the right to independent practice over and over again. It doesn't matter what your opinion is or for that matter what mine is. That is a pure and simple fact. There is also plenty of research that shows no differences in outcomes of patients whether they are cared for by MDAs or CRNAs.

Here is a timeline/link to court cases and research studies in favor of nurse anethetists (just FYI...not meant for you Doc H) http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=164&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1729

Physicians like you are why most CRNAs feel the need to be politically active. If there is anyone who is acting irrationally on here it is you. You deny research not in your favor, you flaunt "I am doctor and you are not so automatically I must know more" in every post. You think that only physicians can give quality care, and what I mean by that is that if a physician isn't holding another type of provider's hand supervising them then it must not be qualitiy care no matter what the research has shown.

By the way how much time have you spent in the military to make a judgement on military care???

Wtbcrna, that's a very childish response.

You need to stop looking at it as being "subservient", and start recognizeing it for what it is: a more highly trained health care professional having oversight over a less highly trained health care professional.

Nobody is saying that you shouldn't be able to make clinical decisions. Nobody's even saying that you're not qualified to handle emergencies. What I'm saying is that there should be an anesthesiologist present to supervise, should problems occur that are beyond the scope of your training. That's why there are physicians who specialize in anesthesiology. Someone, a long time ago, determined that anesthesia and its associated sciences are diverse enough to warrant a physician to specialize in it.

And just FYI, anesthesia is not a nursing profession, as you think. And anesthesiologists aren't dipping into your field. Hell, the concept of anesthesia was invented by a dentist (Dr. William Morton) in the 1800's, so if anything, it is dentistry that "owns" anesthesia. But do you see dentists complaining about anesthesiologists (and CRNAs) stealing their turf.

Regarding my anesthesia experience: I never said that my training in anesthesia made me an authority on the subject. What I've said is that my degree and my training in anesthesia have made me well aware that it is a highly medicine-oriented specialty, and as such, there are certain aspects of it for which mid-levels with nursing degrees aren't sufficiently trained.

Finally, never use the military as an example. The military is the epitome of an organization that has historically been willing to cut corners where health care is concerned.

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DocH,

I think it's nonsense to try to make the general case that a MDA is more qualified, more highly trained, or somehow "better" than a CRNA. It really depends on whom you're comparing, doesn't it? Take, for example, my wife. Two years of school to get her ADN, 3 years of clinical experience in hospital obstetrics, 5 years critical care, 2 more years of school to get her BSN. Now she's in her second year of CRNA school and recently started 20 months of clinicals. 3.9 GPA, CCRN certification.

*In my opinion* her 8 years of clinical experience, 5 of which were in critcial care, and her 4 years of college with a heavy emphasis on healthcare and life sciences trumps an undergraduate degree and 4 years of med school.

According to her, and as one would expect, the first year anesthesiology residents she has worked with so far have been fairly clueless, so I would say a resident spends the first year just getting their clinical "sea legs." So that leaves 3 years compared to the 1.5 years for the typical CRNA: a 1.5 year difference.

That would not be insignificant if it weren't for the fact that during that 1.5 years the SRNA (now CRNA) is of course continuing to get clinical experience just as the resident is.

Now you might argue that my wife is not the typical SRNA. But I contend she's much more typical than the person you continue to use in your arguments who enters nurse anesthesia school with the minimum credentials and requirements. Given the competitiveness of nurse anesthesia schools today, the typical SRNA has a BSN, 5 or more years of clinical experience mostly in critical care, CCRN certification (plus ACLS, BLS, PALS, etc.), and was at the top of their class throughout school.

So it's really not so cut and dried, is it?

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What are "physician-level" doctors?? What does that even mean?

There is a word to describe the idea I'm trying to get across, but it eludes me at the moment. What I mean by 'physician-level' is a doctor who is not subject to the oversight of anyone but the boards.

DDS's, DPMs, and PharmD's are doctors that exist to serve a unique and specific need. What need does a "doctor of nursing in anesthesia" serve that is not already served by CRNAs and anesthesiologists?

What purpose do MDs serve that aren't already served by DOs?

You cannot be serious with this question! DO's and MD's are both physicians. DO's, however, offer--or at very least, claim to offer--a different approach to medicine than M.D.'s. And just FYI, osteopathic medicine was created by an M.D. So your question is a bad one, on it's face.

Again, here you are going on about this "doctoral" level education of yours. I thought we already went over this. You have a first professional degree, which isn't a real doctorate. If you want to brag about a doctoral degree, finish a PhD, like us real doctors.

Are you just saying this just for the sake of being argumentative, or do you really mean what you say here?

A Ph.D. is a doctor of philosophy. An M.D. is a doctor of medicine, a D.D.S. is a doctor of dental surgery, a D.P.M. is a doctor of podiatric medicine. Do you notice any similarities between these degrees? I.e. the word "doctor"?

The degree being a "professional degree" does not in any way prevent a degree from being a doctoral degree. Yes, it is possible to have a doctoral degree in a profession.

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Specializes in MICU.

I cannot believe this argument has been going on this long. I do feel holiday is in the wrong place for his arguments, even though I agree with him. And I do find it somwhat offensive when he refers to those who do not have the education he has as mid levels.

anyways, FYI I am starting CRNA school in jan, and these are my opinions. There is abosoluetly no way you can compare med school to any type of school nurses go through. nursing school is a joke, the hard sciences are not drilled into your head like they are in med school. yes, in nursing school you will get some, but it just doesnt compare. now in CRNA school I feel that is a comparison, (and I currently know a CRNA who is going back for their MD and this is what I have been told) however, the 27 months doesnt compare to the total of what MDA's have been through. and to compare working as an ICU nurse for years does not to compare to residency.

I believe CRNA's can do anything an MDA does, and they are trained to do everything an MDA does. however I do see holiday's point in stating the more intimate knowledge of the body and sciencies that they built up over the years is greater than a CRNA.

now on the comment about the situation with the crna who he thought had a brian fart or something. I have seen some pretty stupid things done by MDA's also, even so that the icu nurse caught somethign he didnt, so it happens.

tony.

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You cannot be serious with this question! DO's and MD's are both physicians.

You asked why should there be another doctorate degree for performing anesthesia. I'm asking why there needs to be this additional doctorate degree in medicine.

A Ph.D. is a doctor of philosophy. An M.D. is a doctor of medicine, a D.D.S. is a doctor of dental surgery, a D.P.M. is a doctor of podiatric medicine. Do you notice any similarities between these degrees? I.e. the word "doctor"?

The degree being a "professional degree" does not in any way prevent a degree from being a doctoral degree. Yes, it is possible to have a doctoral degree in a profession.

A doctorate has historically been a license to teach and perform research. It has been a distinction granted to those that have reached the highest academic level. On average, it takes eight years beyond a bachelor's degree and culminates in writing and defending a original, book-length contribution to one's academic discipline.

Your "doctoral" degree is essentially honorary in the US. It's not a real doctorate degree by any definition of the word anywhere else in the world. Yet you try to pass off your 2 years of classroom study and 2 years of OTJ clinical training as a doctoral level education. :rolleyes:

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