DNP vs MD/DO

Bluebolt · Apr 29, 2017

I see you are in crna school, I will give them credit for nearly always doing a good job though. Do not see much difference between mda/crna in on the cases I do, but then again I am not really doing many high risk procedures besides the occasional banding on some cirrhotic patient that's hemoing from EV. If I remember from past rotations they usually had an MDA in on most super-high-risk cases, but I never really paid much attention to what they did diff than CRNAs. I work with more crna/mda residents than people who have completed mda residencies since everybody wants a day off from the life of difficult to sit there and pump benzos and read books for scopes.

Yes, I'm in a doctorate CRNA program. Legally and as far as scope of practice and training goes CRNAs are capable of doing anything in anesthesia, just like an anesthesiologist can. Where we differ is the general physician traning that MDAs have before their residency that qualifies them to manage patients outside of anesthesia, not that they often do that.

Another difference is that some CRNA programs spend a lot of their years of clinical training at sites that have anesthesia residencies. This means the CRNA either has to share an interesting complex case with the resident or give up the complex case and take the more run of the mill cases. In order to take boards you're required to have had some complicated cases with a certain number of PA cath insertions, CVLs, blocks etc but if all you got was the bare minimum you won't be an expert. So it's very important for a student applying to a CRNA program to know how often they'll be sharing case loads with a facility that has a residency program.

I've not done GI rotations yet but many CRNAs I know say it can be frustrating and boring. You're often using tons of propofol and the patient is continually moving. It's much more comfortable from an anesthesia standpoint to intubate, heavily sedate and paralyze with NMBs so you can properly take care of the patient. I hear GI is a great retirement job though, bread and butter cases they seem to call it.

offlabel · Apr 29, 2017

Outcome studies...what does that mean? I really don't have the interest in wading through stacks of papers because I really don't care that much, but for those that do...do the "outcomes" vary with who does the study? Are they specific, head to head comparisons, like, "in the care of hepato-renal failure patients, no differences between care from NP's and physicians can be identified", or comorbid diabetes or comorbid vascular disease?

What outcomes are measured? Lack of death? Death after a certain number of years after diagnosis? Quality of life? Average blood sugar?

Unless it is a true apples to apples comparison, references to "outcome" studies aren't really that helpful. The reality is that the truth lies somewhere in the middle. If what we're talking about is primary care, rashes, sore throats and high blood pressure, then, sure, no difference.

Smokers with lung dz, vascular, renal and HTN comorbidities may not match up as well.

Anyone?

offlabel · Apr 29, 2017

I've not done GI rotations yet but many CRNAs I know say it can be frustrating and boring. You're often using tons of propofol and the patient is continually moving. It's much more comfortable from an anesthesia standpoint to intubate, heavily sedate and paralyze with NMBs so you can properly take care of the patient. .

If this is the training where you are, there's a problem with the training. Whether it is the endoscopists that are too heavy handed or the anesthesia department is. With a skilled endoscopist, there is no need for anything more than moderate sedation for the vast majority of colonoscopies and certainly not adult EGD's

Bluebolt · Apr 29, 2017

If this is the training where you are, there's a problem with the training. Whether it is the endoscopists that are too heavy handed or the anesthesia department is. With a skilled endoscopist, there is no need for anything more than moderate sedation for the vast majority of colonoscopies and certainly not adult EGD's

I haven't done the GI rotations yet so I'm not 100% but I think they did mention using a lot of Propofol throughout the day in GI and that many of the patients are difficult to maintain in that sweet spot of awake enough but not too awake. I'll let you know how it goes.

hogger · Apr 29, 2017

1. in response to offlabel- we do get more weak consults from np/pas by a moderate margin, that I take loose note of during outpatient referrals for stuff like persistent heartburn, achalasia- like- symptoms and what not. Many times its just Hpylori that nobody thought of testing for and what not. And a few other things I can think of. Only keep track of this stuff since I did quite a bit of homework on advanced practice providers taking up much of the primary care track which turned my interest into a specialty to sort of wall off any competition I guess for patients. But GI is more interesting than IM anyway to myself. If it wasnt for APPs (what they call them at the teaching hospital im at) I probably would have stuck with IM since who wants to be in training for another 2-3 years making table scraps lol.

Not really sure how to do a head to head study though,, ,that seems difficult.

In other news they frown heavily on pumping propofol in academic medicine here, even though most community hospitals do it pretty often. Especially frowned for upper endos... we usually use versed and fent so we dont go from 0-60 on the knockout scale. Colos sometimes prop but even then anesthesia is to keep it as light as possible. Not an anesthesia expert but we still, as in any procedural specialty, have to have a decent idea of what the drugs do, and even if we completely wanted to be oblivious we had to have learned them in med school, rotations, ICU rotations, ER rotations, and all I have to do is look over my shoulder to see bottles of the good stuff laying on the table.

They also at least at this facility dont let CRNAs work in certain specialties such such as CTS, neuro surg, and transplant, so at least here they are not completely in the same regard as the MDAs. They do have a CRNA school here though somewhere in the area that does rotations here. no idea what its called or anything about it, just know they are with their preceptor people in on some scopes and what not. I think even MDA have to do a 1 year fellowship to get in on the bigger chest procedures, at least here.

Jules A, MSN · May 2, 2017

What outcomes are measured? Lack of death? Death after a certain number of years after diagnosis? Quality of life? Average blood sugar?

Exactly. The outcomes of basic conditions such as otitis media likely lend themselves to excellent results even if a 5yo diagnosed and prescribed.

1. Did they actually have an ear infection? Either way its been cured!

2. Was the antibiotic effective or did it resolve on its own?

3. Did they survive? Would be fairly hard to kill someone with the conditions monitored in these studies

4. Was the customer satisfied with their inefficient, brow mopping, hand holding NP regardless of their skillset? Yeah Buddy.

offlabel · May 2, 2017

Exactly. The outcomes of basic conditions such as otitis media likely lend themselves to excellent results even if a 5yo diagnosed and prescribed.
1. Did they actually have an ear infection? Either way its been cured!
2. Was the antibiotic effective or did it resolve on its own?
3. Did they survive? Would be fairly hard to kill someone with the conditions monitored in these studies
4. Was the customer satisfied with their inefficient, brow mopping, hand holding NP regardless of their skillset? Yeah Buddy.

I don't draw a distinction between PA's and NP's after a couple of years of practice. But PA's sure better back away from the independent practice apple. It's one thing for APRN's to do that with so much precedent and no ties to state BOM, it's altogether another for PA's to kick that hornet's nest ultimately biting the hand that created them. That might not end so well.

Jules A, MSN · May 2, 2017

I don't draw a distinction between PA's and NP's after a couple of years of practice. But PA's sure better back away from the independent practice apple. It's one thing for APRN's to do that with so much precedent and no ties to state BOM, it's altogether another for PA's to kick that hornet's nest ultimately biting the hand that created them. That might not end so well.

Its unfortunate that the MD organizations didn't fight for tougher NP education requirements and instead have largely, imo, sat back and just complained about us. Now the cow is out of the barn with all the direct entry and online NP programs with minimal if any entry requirements. Its unfortunate and I'm doubtful even the soft outcomes previously published will hold up 10 years out if this trend continues.

offlabel · May 2, 2017

Its unfortunate that the MD organizations didn't fight for tougher NP education requirements and instead have largely, imo, sat back and just complained about us. Now the cow is out of the barn with all the direct entry and online NP programs with minimal if any entry requirements. Its unfortunate and I'm doubtful even the soft outcomes previously published will hold up 10 years out if this trend continues.

They did advocate for more meaningful training...for PA's. As if that would turn out OK.

I still believe that APRN's hold the edge in the midlevel arena because of the ability to recruit from "battle hardened" ranks, but I'd have rather seen RN organizations fight for tougher NP education requirements instead of largely handing the reigns over to the Nurse Self Actualization and Empowerment clubs that run nursing programs.

Jules A, MSN · May 2, 2017

They did advocate for more meaningful training...for PA's. As if that would turn out OK.
I still believe that APRN's hold the edge in the midlevel arena because of the ability to recruit from "battle hardened" ranks, but I'd have rather seen RN organizations fight for tougher NP education requirements instead of largely handing the reigns over to the Nurse Self Actualization and Empowerment clubs that run nursing programs.

Yeah but the MDs have done nothing to assist them or us with NP requirements other than complain.

In my opinion the reason nurses haven't put a stop to this farce of admitting anyone who can fog up a mirror if held under their nose and pay tuition is because the power players are all sitting on their fat, old orifices working as educators, many with little if any experience of their own so this is a freaking boon for retention/tuition/job security.

SummitRN, BSN, RN · May 2, 2017

Website in the OP is down

And OP needs to learn how to use the quote button