CRNA vs MDA. Who wins?

akulahawkRN, ADN, RN, EMT-P · Dec 28, 2014

In short, the MDA wins. Basically the big difference is the 4 years of Medical School and the 4 years residency. The newly-minted CRNA (in your example) has 2.5 years of education after the BSN and that's nowhere near the knowledge-base of a newly-minted attending MDA. Yes, the CRNA should ideally have ICU time but that isn't quite the same as doing an MDA program and residency...

I'm well trained as an athletic trainer and I can do much of the same evaluation as an orthopedic surgeon and at my best, I was about as accurate... but that doesn't mean that I have all the expertise that the Orthopod has when it comes to evaluation of ortho injuries.

Of course the MDA has a lot more debt to deal with than the CRNA if all else is equal.

mh0712, MSN, RN · Dec 28, 2014

My personal opinion is that the CRNA wins because granted the argument will always be- med school and residency make you better and you do so much more; however, the numbers do not add up and some MDA residency programs do the same number of cases as CRNA programs. In the end CRNAs end up doing more general cases since they do the whole case, and many docs who "supervise" only show up when there is an issue. That is one reason CRNA only groups are flourishing, and so much CRNA hate goes on. MDAs have had it so good for so long occupying the break room and getting paid triple what their CRNAs get paid who do all the work. The healthcare system cannot and will not support this. That is why there is so much hate. CRNAs and MDAs learn in such similar fashions, use the same textbooks, and often have the same preceptors. No difference in outcomes proves that both are effective, yet one is half the cost. Do the math, it is CRNA all the way.

elkpark · Dec 28, 2014

Who "wins"? I didn't realize it was a contest ...

allnurses Guide · Dec 28, 2014

Comprehensive comparison of lengths of education and training
CRNA: 4 years for a BSN followed by 1-2+ years as a tele/medsurg followed by 2+ years in the ICU followed by 2.5+ years in the crna program. In Total: 12 years +
Anesthesiologist: 4 years for BS degree, 4 years med school, 4 years residency. Total 12 years
In-conclusion, it takes the same length of time if not longer for nurse anesthetists and yet "most" anesthesiologists earn twice as much (comparing avg salaries 150K vs 300K), are higher on the totem pole when making authoritative decisions (they supervise crnas and have more say in the hospital cases), and IRONICALLY the crna's are the workhorses while the MDAs are slacking.
What gives?

It is more like 4yrs BSN +2-3yrs ICU experience (there are still a few new grad ICU residency programs scattered throughout the country) +3yrs of NA school (all CRNA schools are moving to a minimum of 3yrs). It will take you approximately 7 years of formal training to become a CRNA or 12 years of formal training to become an MDA. You will spend about 10 years working to become a CRNA or 12 years to become an MDA.

MDA residencies are also very competitive. Someone could literally go through undergraduate and medical school and never get MDA residency slot when their initial goal was to be an MDA. Then he or she would most likely be stuck doing FP or general surgery residency.

MDAs are usually able to make more d/t the way the charges for billing are done thus making an MDA working in an ACT environment a more profitable entity versus a CRNA even though it still often costs the hospitals more to have an ACT practice versus a mixed independent or CRNA only practice.

Become a CRNA

TheNextCRNA · Dec 28, 2014

Elkpark, not a contest but rather competition. Both put in the same amount of discipline and hard work (and I would argue the 3 years of ICU experience combined with 3 years of CRNA school is a lot tougher than just 4 years training for the MDA) You probably don't realize the tension between the two providers but I've witnessed it first hand.

I saw a fresh new MDA telling an experienced CRNA what to do. "You better watch his blood pressure, MDA said. After she left, the crna told me it was her first year on the job and she was already bossing him around. The crna told me if she knew anything about his urine output, there would be no concern over his bp (or something to that effect).

The point i'm making is would you like someone who works half as hard as you, to make twice as much as you? Who cares about the debt either one has (that's old news), what matters is their contribution in the NOW, the work output they do to help others NOW.

allnurses Guide · Dec 28, 2014

The education (costs of education and time to educate) and the pay of anesthesiologists is what makes MDAs less financially viable and CRNAs more financially viable, if MDAs and CRNAs both made the same what would be the incentive to hire CRNAs. MDA salaries are their greatest detriment in a system where it is just as safe to have a CRNA do your anesthesia as an MDA.

Medscape: Medscape Access

TheNextCRNA · Dec 28, 2014

"If MDAs and CRNAs both made the same, what would be the incentive to hire CRNAs?"

The MDA did two years of general book work, 2 years of really general and vague hospital rotations (1-2 months each) to see where he or she would fit (4 years wasted). At this point the ICU nurse has worked their butt off, providing care to the sickest patients, and getting real world experience. Why wouldn't there be an incentive to hire more crnas? They should be equally compensated for their equal contributions.

The adage goes "use it or lose it". I rather have a crna put me to sleep than an MDA who hasn't touched a case in years.

What's that in your avatar picture, a big shark chasing a boat? Yes, I've read studies that CRNAs provide the same quality of care as MDAs and I think most people agree on that. But the real question is how long will it be for something to be implemented; for action to be taken?

How long will it be before the MDA party is put to a halt (your best prediction-5 years,10 years, 50 years from now)?

allnurses Guide · Dec 28, 2014

"If MDAs and CRNAs both made the same, what would be the incentive to hire CRNAs?"
The MDA did two years of general book work, 2 years of really general and vague hospital rotations (1-2 months each) to see where he or she would fit (4 years wasted). At this point the ICU nurse has worked their butt off, providing care to the sickest patients, and getting real world experience. Why wouldn't there be an incentive to hire more crnas? They should be equally compensated for their equal contributions.
The adage goes "use it or lose it". I rather have a crna put me to sleep than an MDA who hasn't touched a case in years.
What's that in your avatar picture, a big shark chasing a boat? Yes, I've read studies that CRNAs provide the same quality of care as MDAs and I think most people agree on that. But the real question is how long will it be for something to be implemented; for action to be taken?
How long will it be before the MDA party is put to a halt (your best prediction-5 years,10 years, 50 years from now)?

Medical school goes into a lot more detail about pathophysiology than nursing or NA school does. It gives MDAs more theoretical background, in general, than CRNAs. I would say MDAs internship year is a hit or a miss. It can either be helpful or a complete waste, and that is from MDAs I have worked with who told me that. The majority of MDAs work in an ACT environment, but that doesn't mean that some MDAs don't regularly do their own cases. This is especially true for fellowship trained MDAs. There are good and bad MDAs and CRNAs.

ICU training is fine, but it from a nursing point of view not a provider's view. ICU gives CRNAs a skill base that hopefully won't have to be repeated in CRNA school. Working in the ICU won't teach you how to be a provider, which is a lot of CRNA school is about if you want to learn how to be independent.

When dealing with healthcare executives you are either someone who brings in money (i.e. a provider that can bill) or a cost (nursing/housekeeping/maintenance/lab etc). Healthcare executives will always want to have the lowest overhead with the most income possible, but there is a lot politics involved with healthcare some of that is even at accreditation level (i.e. level 1 trauma centers).

Some surgeons still believe in the "Captain of the Ship" doctrine thinking that they can be found liable for independent CRNA actions, but not for an MDAs. This is one myth among many the ASA likes to tell other physicians.

Surgeon Liability

My Avatar is a great white shark following a kayaker. I always said I felt like the kayaker when I was in NA school, and the shark was the NA instructors.

The ASA PAC is the most well funded medical PAC there is. I don't see any dramatic changes with anesthesia practices unless TEFRA billing requirements change or the vast majority of states opt-out of medicare supervision for billing requirement for CRNAs.

akulahawkRN, ADN, RN, EMT-P · Dec 29, 2014

"If MDAs and CRNAs both made the same, what would be the incentive to hire CRNAs?"

There would be less of a desire to hire CRNAs because the MDA can still practice medicine. The CRNA cannot.

The MDA did two years of general book work, 2 years of really general and vague hospital rotations (1-2 months each) to see where he or she would fit (4 years wasted). At this point the ICU nurse has worked their butt off, providing care to the sickest patients, and getting real world experience. Why wouldn't there be an incentive to hire more crnas? They should be equally compensated for their equal contributions.

That's 2 years of very in-depth A&P, pathophys, etc. along with 2 years of rotations to start cementing that all together, and is not 4 wasted years. If you think it's wasted time, why not see if you can keep up with a 1st year resident/intern during rounds and be able to present a case and medical plan to others equally well without going to Medical School.

The adage goes "use it or lose it". I rather have a crna put me to sleep than an MDA who hasn't touched a case in years.
What's that in your avatar picture, a big shark chasing a boat? Yes, I've read studies that CRNAs provide the same quality of care as MDAs and I think most people agree on that. But the real question is how long will it be for something to be implemented; for action to be taken?
How long will it be before the MDA party is put to a halt (your best prediction-5 years,10 years, 50 years from now)?

Likely never because the MDA has an unrestricted license to practice Medicine. A CRNA does not. If the MDA is also board certified in Internal Medicine or General Surgery or some other field, the employer gets to use them for duties that the CRNA cannot perform.

I'm not saying that the CRNA is unsafe or anything like that... just that the CRNA doesn't have the full depth and breadth of the MDA's education and if the CRNA did have an equivalent depth/breadth of education, the CRNA would be able to be licensed as a Physician. Personally, I think that CRNA's are fantastic!

TheNextCRNA · Dec 29, 2014

Every one is entitled to their own opinion, but I wouldn't be surprised if you had some good friends or close affiliations with MDAs. Since you argue CRNAs are safe, why are they even supervised?

The health care system can't afford to have more MDAs, they are too much of a strain on the system.

akulahawkRN, ADN, RN, EMT-P · Dec 29, 2014

Every one is entitled to their own opinion, but I wouldn't be surprised if you had some good friends or close affiliations with MDAs. Since you argue CRNAs are safe, why are they even supervised?
The health care system can't afford to have more MDAs, they are too much of a strain on the system.

Prepare to be surprised then... I don't have any known friends or close affiliations with any MDAs. CRNAs do need to be supervised in some manner (to be determined by individual practice IMHO) as the CRNA cannot practice medicine. Basically the CRNA has to be able to "punt to" the MDA if the case is too complex or out of the depth of the CRNA. Frankly, my closest physician association is with a specific orthopedic surgeon and I haven't worked with him in over a decade.

If there were more MDAs, there would be downward pressure on salaries for them and they'd be more affordable. That would, in turn, put downward pressure on the CRNA salary...

If I'm employing physicians and there were lots of MDAs to choose from, I'd choose one that's also certified in another field, like IM or General Surgery, then I can pay them a little more and put them on the rotation to cover other services than just anesthesiology. Why not have an IM/MDA doc work as a hospitalist and cover non-operative anesthesiology services when not in the OR? The CRNA can't do that...