Med school drop out, now a CRNA. Ask me anything...

Specialties CRNA

Published

The title says it all. Did not do well in med school, dropped out, did a ABSN program, worked in the ICU for 2 years before going on to CRNA school. Now I am a CRNA.

I understand this is coming from your perspective which is shaped by your personal programs education didactically and clinically. I don't want people to get confused and think that your statements are broad ones that cover the entire nations CRNA training programs and degrees.

I have a different viewpoint coming from a different training program and degree. With a three year doctorate, my program was able to spend 3 years teaching the hard sciences and anesthesia concepts. We spent a majority of the first year doing genetics, advanced A&P, general pharmacology, gross dissection, advanced pathophysiology, advanced organic chem, research statistics.. etc. We were required to learn many difficult concepts that had nothing to do with anesthesia. We all groaned about it at the time having to memorize the genetic mutation linked to Brugada syndrome but hearing how some masters programs seem to be lacking I suppose I should be grateful for the thorough education.

We also were not taught anesthesia procedurally but in a way that encompasses the entire perioperative period. We spend time in pre-op and post-op reviewing labs, X-rays, EKGs, assessments deciding if a case should be canceled or delayed. In the classroom, we were taught with the idea that we were the only anesthesia provider present and it was necessary for us to have the answers and be an independent provider.

Some people disparage the new doctorate requirement but realizing that I would have already graduated at this point instead of having another year to learn and grow into the professional role of a CRNA I have to say I've found great value in it.

To be clear, I am not saying that everything in its entirety taught in medical school is covered in CRNA school. I would point out that anesthesia is not a topic taught in medical school.

As for which is "harder", that is a subjective opinion.

Sounds like a terrific program! I hope to have such a positive experience in anesthesia school.

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I'm very informed, thanks.

I haven't been through med school or CRNA school, but OP has and yet he agrees. So maybe it's not so much speculation on my part. Google "CRNA Horror Stories" on Student Doctor Network and you will hear the MDA side of the story. Maybe you will get a different perspective on this.

Well, be careful here, Sport. For every CRNA "horror story" you find, I can see and raise you one anesthesiologist "horror story". As to SDN, I'd take the word of runny nosed 20 somethings training as anesthesia doctors with a grain of salt. They're all in academic centers with a culture light years removed from real, day to day conduct of the business of anesthesia. They're just trying to ingratiate themselves to their attendings anyway. I have to giggle at the absurd statements these children who were still in diapers when I was doing cardiac anesthesia make. Reminds me of when my kids were toddlers and they'd dress up in my shoes, jackets and ties to play "grownup".

People with axes to grind are not always the most reliable sources for the truth. Same goes for CRNA's, btw.

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Well, be careful here, Sport. For every CRNA "horror story" you find, I can see and raise you one anesthesiologist "horror story". As to SDN, I'd take the word of runny nosed 20 somethings training as anesthesia doctors with a grain of salt. They're all in academic centers with a culture light years removed from real, day to day conduct of the business of anesthesia. They're just trying to ingratiate themselves to their attendings anyway. I have to giggle at the absurd statements these children who were still in diapers when I was doing cardiac anesthesia make. Reminds me of when my kids were toddlers and they'd dress up in my shoes, jackets and ties to play "grownup".

People with axes to grind are not always the most reliable sources for the truth. Same goes for CRNA's, btw.

Duly noted, although there are seasoned MDs on SDN as well. You make a valid point.

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Specializes in Anesthesia.
I think everyone here is being too hard on the op. First, he/she gets accused of being a fraud, now he has to defend the screen name, which is really irrelevant to thread. This is his story and experience, so opinions aside, he can narrate as he sees fit.

Let's be clear about another thing: The claims of a CRNA being equal/similar in training is not even comparable. While they essentially do the same job, the MDA has a vastly greater body of knowledge than the CRNA, and if the case is very complex, the MDA is the authority anesthesia care provider for these types of patients.

As I tell every person that makes these uneducated claims about CRNAs: Show me the evidence and come deploy with me. CRNAs have a proven track record that shows we give equal or better care than our anesthesiologist colleagues.

Why is it that the US military has CRNAs only on spec ops medical teams working with surgeons or why CRNAs are the ones that forward deploy instead of anesthesiologists. It is because CRNAs have proven for over a century that we are equal to providing any anesthetic anywhere in the world independently. Our education is somewhat different than anesthesiologists, but our outcomes are the same.

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As I tell every person that makes these uneducated claims about CRNAs: Show me the evidence and come deploy with me. CRNAs have a proven track record that shows we give equal or better care than our anesthesiologist colleagues.

Why is it that the US military has CRNAs only on spec ops medical teams working with surgeons or why CRNAs are the ones that forward deploy instead of anesthesiologists. It is because CRNAs have proven for over a century that we are equal to providing any anesthetic anywhere in the world independently. Our education is somewhat different than anesthesiologists, but our outcomes are the same.

I think you probably know a lot about this topic than I do, and I respect your expertise (of which I have none on the topic) but what you are claiming is highly debatable:

"EVIDENCE-BASED REVIEW DID NOT FIND NURSE ANESTHETISTS' CARE EQUAL TO THAT OF PHYSICIAN ANESTHESIOLOGISTS

EXECUTIVE SUMMARY

In July 2014, The Cochrane Collaboration published a literature review, "Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients." Of more than 8,000 titles/abstracts screened by the authors, only six articles were included in their qualitative review.1

In this review, the researchers attempt to assess the safety and effectiveness of different models of anesthesia care delivery. The authors properly conclude that, when considered as a group, currently available scientific evidence is unable to answer this question. Although the authors "hoped that this [the review] may lead to an increase in confidence in the skills of NPAs [nurse anesthetists] within the anaesthetic community..." (p. 4), their review provided no such support.

• No new data were presented.

• There were no studies that focused on outcomes for high-risk patients.

The American Society of Anesthesiologists® (ASA®) believes it is time for a new research agenda. Among the questions to be addressed are patient experience measures and outcomes beyond death and complications resulting from anesthesia. We believe no other specialty is positioned better to help answer these questions."

DEVELOPED AND ISSUED BY THE ASA COMMITTEE ON HEALTH POLICY RESEARCH.

"Dr. Jane Fitch, recently elected First Vice President of the American Society of Anesthesiologists, began her career as a nurse anesthetist with a master's degree. Troubled by her limited knowledge compared to the physicians she worked with, she soon went back for eight more years of education-completing medical school, residency, and then a fellowship in cardiac anesthesiology. While she was a nurse anesthetist, "I didn't know how much I didn't know," Dr. Fitch says."

https://www.kevinmd.com/blog/2011/11/unsupervised-anesthesia-care-nurse-anesthetist-threat-patient-safety.html

"Outcome Statistics

Death within 30 days of admission was determined from the HCFA Vital Status file. Complications (table 3) were identified using a set of 41 events defined by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and CPT (Physician's Current Procedural Terminology, 4th edition) codes available from HCFA databases for the hospital stay of interest, previous hospital stays, and outpatient visits within 3 months before the index hospital stay. CPT codes billed before the hospital stay were used to determine long-standing conditions that would aid in distinguishing complications from comorbidities. Failure-to-rescue rate (FR) was defined as the 30-day death rate in those in whom either a complication developed or who died without a recorded complication. "

AND

"After adjustments for severity of illness and other confounding variables, we found higher mortality and failure-to-rescue rates for patients who underwent operations without medical direction by an anesthesiologist."

Anesthesiologist Direction and Patient Outcomes | Anesthesiology | ASA Publications

I realize the bias involved in Anesthesiologist reports, but my point is that this issue is, and has been, debatable for a long, long time, as you probably are aware. I still side with the CRNA after all is said and done, but I'm not simply going to ignore and write off the research presented from the MDAs. I present this information only because I care so much about the future of CRNAs and anesthesia, and I only want the best outcomes for patients; with all due respect.

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Google "CRNA Horror Stories" on Student Doctor Network and you will hear the MDA side of the story. Maybe you will get a different perspective on this.

Oh, student doctor network is the gold standard for truth now? My bad.

If you only knew how many incompetent and lazy MDA's there are out there, your perception of MDA's might be changed.

Yes, there are individuals like that in every profession.

if the case is very complex, the MDA is the authority anesthesia care provider for these types of patients.

To suggest that an MDA is more competent or able than a CRNA, is a false statement.

The MDA is not the "authority provider" on complex patients. Have you ever even shadowed a CRNA to know?

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Specializes in Anesthesia.
I think you probably know a lot about this topic than I do, and I respect your expertise (of which I have none on the topic) but what you are claiming is highly debatable:

"EVIDENCE-BASED REVIEW DID NOT FIND NURSE ANESTHETISTS' CARE EQUAL TO THAT OF PHYSICIAN ANESTHESIOLOGISTS

EXECUTIVE SUMMARY

In July 2014, The Cochrane Collaboration published a literature review, "Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients." Of more than 8,000 titles/abstracts screened by the authors, only six articles were included in their qualitative review.1

In this review, the researchers attempt to assess the safety and effectiveness of different models of anesthesia care delivery. The authors properly conclude that, when considered as a group, currently available scientific evidence is unable to answer this question. Although the authors "hoped that this [the review] may lead to an increase in confidence in the skills of NPAs [nurse anesthetists] within the anaesthetic community..." (p. 4), their review provided no such support.

• No new data were presented.

• There were no studies that focused on outcomes for high-risk patients.

The American Society of Anesthesiologists® (ASA®) believes it is time for a new research agenda. Among the questions to be addressed are patient experience measures and outcomes beyond death and complications resulting from anesthesia. We believe no other specialty is positioned better to help answer these questions."

DEVELOPED AND ISSUED BY THE ASA COMMITTEE ON HEALTH POLICY RESEARCH.

"Dr. Jane Fitch, recently elected First Vice President of the American Society of Anesthesiologists, began her career as a nurse anesthetist with a master's degree. Troubled by her limited knowledge compared to the physicians she worked with, she soon went back for eight more years of education-completing medical school, residency, and then a fellowship in cardiac anesthesiology. While she was a nurse anesthetist, "I didn't know how much I didn't know," Dr. Fitch says."

Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

"Outcome Statistics

Death within 30 days of admission was determined from the HCFA Vital Status file. Complications (table 3) were identified using a set of 41 events defined by International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and CPT (Physician's Current Procedural Terminology, 4th edition) codes available from HCFA databases for the hospital stay of interest, previous hospital stays, and outpatient visits within 3 months before the index hospital stay. CPT codes billed before the hospital stay were used to determine long-standing conditions that would aid in distinguishing complications from comorbidities. Failure-to-rescue rate (FR) was defined as the 30-day death rate in those in whom either a complication developed or who died without a recorded complication. "

AND

"After adjustments for severity of illness and other confounding variables, we found higher mortality and failure-to-rescue rates for patients who underwent operations without medical direction by an anesthesiologist."

Anesthesiologist Direction and Patient Outcomes | Anesthesiology | ASA Publications

I realize the bias involved in Anesthesiologist reports, but my point is that this issue is, and has been, debatable for a long, long time, as you probably are aware. I still side with the CRNA after all is said and done, but I'm not simply going to ignore and write off the research presented from the MDAs. I present this information only because I care so much about the future of CRNAs and anesthesia, and I only want the best outcomes for patients; with all due respect.

Cochrane is notorious for dismissing any conclusions that aren't RCTs. That being said not all studies are indicated or feasible to be RCTs.

WANA: Cochrane Review

https://www.aana.com/docs/default-source/fga-aana-com-web-documents-(all)/mya2017-crna-fast-facts1.pdf?sfvrsn=245c49b1_6

https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/quality-of-care-in-anesthesia.pdf

The Sibler study did not look at differences in CRNA and anesthesiologist outcomes. The study could not be replicated from the records, and the only journal that would publish the article was the ASA.

"E. Conclusions

The following conclusions can be drawn from a careful examination of the study "Anesthesiologist Direction and Patient Outcomes":

• The study described has nothing to do with the quality of care provided by nurse anesthetists.

• The study examines postoperative physician care, not anesthe- sia care.

• The researchers so much as admit that the study does not prove anything with regard to the effect of anesthesiologist involvement in patient care.

• The timing of the publication in the ASA's own journal was politi- cally motivated.

• HCFA/CMS finds no credence in ASA and Dr. Silber's assertions regarding the results of the Pennsylvania study."

With all due respect this isn't a topic you are familiar with and you should not be posting statements about nurses staying in their lane when you are ignorant of the research.

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No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians

https://www.healthaffairs.org/doi/10.1377/hlthaff.2008.0966

Just some information for those not in the anesthesia field but trying to comment on it as an authority.

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If you want to know what's it's like to be an anesthesiologist then talk to an anesthesiologist. Better yet, talk to several and shadow them for a day. Same goes for CRNA's. If you want a polarized view of one field commenting on another then come to the internet! As to the Cochrane review (conclusion below), the results were misinterpreted by both sides. "No definitive statement can be made" is not the same as saying there is no difference (for or against CRNA's or anesthesiologists). Or as the last line reads it is "impossible to provide a definitive answer to the review question" due to the low rate of complications and poor quality of available studies. This has been and will likely remain an emotional argument.

No definitive statement can be made about the possible superior- ity of one type of anaesthesia care over another. The complexity of perioperative care, the low intrinsic rate of complications relat- ing directly to anaesthesia, and the potential confounding effects within the studies reviewed, all of which were non-randomized, make it impossible to provide a definitive answer to the review question.

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Specializes in Nephrology, Cardiology, ER, ICU.

Staff note: per our terms of service, to which all members agree too, staff can and do remove posts that violate the terms of service.

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Did you find it hard to get a job in the ICU as an RN with no nursing experience?

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Specializes in Emergency Room.

Congratulations. Very positive,refreshing thread. The 100s of negative nurse postings will make anyone question if they should pursue this career.

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