Med school for experienced CRNA?

allnurses Guide · Jan 18, 2010

Paindoc, I thought you were a jackorifice when I read your first post. BUT now I see your point. And it is a good one. I have a BSN and graduated with a 4.0, was in the honors college at my university, was an anatomy TA, and took ALL of the required usual pre-medicine courses (including physics, organic chemistry, etc.) and obtaining A's or A+'s in all of them BEFORE I applied to CRNA this past year (and got in). I also currently work in ICU and I have to agree with you, EDUCATION is key, ESPECIALLY for nursing. I cannot stand the ADN nurses who work with me who got into their programs based on a non-competitive LOTTERY. I don't understand why these programs are not mandated by the ANA to up their standards. In summary, their critical thinking is NOT there. I have had many students who are in ADN and BSN programs and there is a HUGE disparity between the two... the BSN students are significantly more 'bright'. And by bright I mean this: no one cares if you can start an IV faster your first day on the job as an ADN than a BSN but can't think your way through why you should use fentanyl instead of morphine in an obese trauma patient. BSN and today's education teaches critical thinking, research, and application of knowledge and less focus on "tasks" without rationale. Tasks will come with practice, but critical thinking is a learned behavior that requires a strong knowledge base topped with reasoning, evaluation, and rationale.
I agree with paindoc. All advanced practice nursing ESPECIALLY something as critical as anesthesia should be at the BARE minimum a DNAP/PHD/DNP/etc. degree. This advanced education teaches one to think, to apply advanced concepts in physiology and pharmacology into practice instead of being task oriented as paindoc mentioned when saying old CRNA's MAY (not all of course) simply get into a routine of blindly following a sequence of events of intubation --> recovery. These degrees also emphasize research which is essential to any field of practice. The DNAP/DNP degrees teach a whole other type of student in general. It would be better for the public and profession if grandfathered NP's/CRNA's were REQUIRED to go back to school and earn today's degrees. We should be thirsty for more education. More knowledge, more ways to tackle the same situation in the OR, etc. It seems that old nurses are sometimes (not always, again) indeed stuck in their ways, from bedside to CRNA. The ADN programs need to go. Additionally, all online programs need to go with them. If you don't have the time to attend class face-to-face with your peers and instructors, then maybe you shouldn't be going to school (but but, I have a family! Again, maybe you should reconsider your priorites). Any online program for any healthcare profession is a joke to us and to the public and should be disbanded.
But paindoc, don't complain about our salary to that of 'other' MD's. Compare our duties to that of a plug-and-chug family practice physician managing the same old chronic diseases day in and day out. Who should get paid more? In reality, it would do hospitals, insurance companies, and today's healthcare system a huge favor to pay MDA's same as CRNA's. If the same safe and effective anesthesia is provided by both, then why is there a huge disparity in salary?

So what your telling us from being a nurse for 2-3yrs working at one to two hospitals that you are prepared to make blanket statements about all BSN and ADN students? That is a giant cognitive leap since I have heard just the opposite thing about BSN students for years, and before you ask I was never an ADN. The region of Texas where I went to BSN school it was the ADN programs that were competitive, and it was actually easier to get into the local BSN program.

Also, you haven't even started CRNA school and you are passing judgement on CRNAs that have been practicing for 20-30+ yrs? Have you even worked with CRNAs that have been prepared at all the different education levels? I think I can safely say I have, and I can't tell the difference in the OR except for the years of experience/time spent in the OR. What I can tell you is the vast amount of clinical experience that comes from a CRNA or MDA with 20-30yrs is that it has no bearing whether they were a diploma grad, have their doctorate, or only did two years of anesthesia residency versus 3yrs. In general most doctorate prepared CRNAs aren't that good at delivering anesthesia. The majority of doctorate prepared CRNAs spend the biggest part of their time away from the bedside, and tend to lose the day to day "smoothness" and critical thinking that most experienced CRNAs have.

Do you realize that medical students don't have to goto the majority of their classes? The majority of medical students where I went to school and quite a few MDs that I know used the recorded lectures/scribe services etc. and didn't go to most of their classes. Everyone learns in different ways and not everyone needs to sit in class to learn. Most of your learning in NA school will be outside the classroom. You sound like an intelligent person, but remember didatic is only one part of the equation you still have to make it through clinicals. After you start clinicals you should come back and post who you learned more from the doctoral prepared CRNA or the 20+yr BSN/Diploma CRNA. Two of my favorite preceptors whine in NA school were a CRNA that had been practicing for 30+ yrs, and a MDA that had doing anesthesia for almost 40+yrs.

I would challenge you to find a study that states how a doctoral prepared CRNA is better clinically/has improved outcomes over a non-doctoral prepared CRNA.

stanman1968 · Jan 18, 2010

While I to agree that education is key I must disagree with the idea of eliminating on line programs. How many classes have you been in with hundreds of students? Ever get any particular value of just being in the classroom? It is how much you read and study that determines how much you learn and the results, not where.

The didactics on line are not a joke, clinical component is just that clinical it requires hands on, ever take chemistry, of course you have remember lab? did sitting in class teach you HOW to perform the experiment?

On line does not replace content just the location.

As for ADN vs BSN being a former ADN to BSN to CRNA (MSNA), I found no disparity in "critical thinking" between myself and my BSN compatriots.

As for that plug and chug FP Doc what about his "critical thinking"?

The services hospitals pay for from anesthesiologists and CRNA's are for the most part technical not critical thinking it is supply and demand that drives salaries, rest assured if NP's in family practice or FP docs made the same coin you would here all about "critical thinking" "deep knowledge of pathophysiology", "Understanding the whole patient" blah, blah, blah.

Supply and demand supply and demand.

CRNAzzle · Jan 19, 2010

So what your telling us from being a nurse for 2-3yrs working at one to two hospitals that you are prepared to make blanket statements about all BSN and ADN students? That is a giant cognitive leap since I have heard just the opposite thing about BSN students for years, and before you ask I was never an ADN. The region of Texas where I went to BSN school it was the ADN programs that were competitive, and it was actually easier to get into the local BSN program.
Also, you haven't even started CRNA school and you are passing judgement on CRNAs that have been practicing for 20-30+ yrs? Have you even worked with CRNAs that have been prepared at all the different education levels? I think I can safely say I have, and I can't tell the difference in the OR except for the years of experience/time spent in the OR. What I can tell you is the vast amount of clinical experience that comes from a CRNA or MDA with 20-30yrs is that it has no bearing whether they were a diploma grad, have their doctorate, or only did two years of anesthesia residency versus 3yrs. In general most doctorate prepared CRNAs aren't that good at delivering anesthesia. The majority of doctorate prepared CRNAs spend the biggest part of their time away from the bedside, and tend to lose the day to day "smoothness" and critical thinking that most experienced CRNAs have.
Do you realize that medical students don't have to goto the majority of their classes? The majority of medical students where I went to school and quite a few MDs that I know used the recorded lectures/scribe services etc. and didn't go to most of their classes. Everyone learns in different ways and not everyone needs to sit in class to learn. Most of your learning in NA school will be outside the classroom. You sound like an intelligent person, but remember didatic is only one part of the equation you still have to make it through clinicals. After you start clinicals you should come back and post who you learned more from the doctoral prepared CRNA or the 20+yr BSN/Diploma CRNA. Two of my favorite preceptors whine in NA school were a CRNA that had been practicing for 30+ yrs, and a MDA that had doing anesthesia for almost 40+yrs.
I would challenge you to find a study that states how a doctoral prepared CRNA is better clinically/has improved outcomes over a non-doctoral prepared CRNA.

I appreciate the response. It adds to great discussion.

It isn't about individual cases and anecdotal instances regarding this one particular BSN student you worked with or this other ADN student or heresay on the floors. It has to do with the philosophy of the programs, BSN vs ADN. We have all met the bright and the not so bright from all disciplines whether it be cardiovascular surgery or housekeeping. That's not the point to make blanket statements. And I don't think I did in my original post. My point about more formal education is that it's geared differently. They focus more on integration, evaluation, rationalizing, research, and more 'thinking'.

For the public's sake, all of our programs need to be competitive, if they aren't already.

I am not necessarily passing judgement out of my behind. My point is not to compare a NEW grad doctorate prepared CRNA vs a diploma CRNA with 20-30 years experience, that would be foolish. Now, take that doctorate prepared CRNA and give them the same 20-30 years experience and on average (not 100%, of course) there would be a disparity in overall ability when compared to the non-doctorate prepared CRNA with the SAME amount of experience. The key here would be the new-aged, if you will, approach to education now-a-days compared to the more task-oriented one from the past. The DNAP CRNA with the same 20-30 years of experience as the non-DNAP CRNA with the same experience would ON AVERAGE show a difference in ability.

Lots of experience can compensate for lack of more formal education, yes. But I would place my money on the fact that more education adequate experience would produce the better practitioner. The smoothness you are talking about may very well be routine and expertise in a given field which is a given no matter what area we examine. But how many old-school CRNA's/RN's/etc. would be fond of doing research today if they were never TAUGHT the importance of it in their formal education? That's only an example, as research isn't everything.

Also, don't be so quick to pass judgment yourself :) when you say: "In general most doctorate prepared CRNAs aren't that good at delivering anesthesia." Because how long have these doctorate degrees/programs for CRNA's been around? I believe there are only a handful of them even as I write this right now. But give these CRNA's 20-30 years and I am sure you will see a difference (positively).

Regarding online programs... it just sounds silly. If for example, to the public you were to say, "I was an online prepared surgeon," what kind of reaction would you anticipate for the layperson? Even if they 'don't know any better' we shouldn't place ourself in a position to tarnish our image. Whether or not some courses in school happen to be online doesn't mean they are 'online programs' which only require you to show up once a month while you spend the other half working full-time. CRNA's perform the same service as MDA's. We ought to demonstrate similar educational preparation and WANT to learn as much as possible, whether through more formal education or not. Nursing's public image could do away with more kicks and punches as has already been done by lack of terminal degree preparation and online programs.

stanman1968 · Jan 20, 2010

It sounds silly, well that is really an answer based on critical thinking. :cool:

allnurses Guide · Jan 20, 2010

I appreciate the response. It adds to great discussion.
It isn't about individual cases and anecdotal instances regarding this one particular BSN student you worked with or this other ADN student or heresay on the floors. It has to do with the philosophy of the programs, BSN vs ADN. We have all met the bright and the not so bright from all disciplines whether it be cardiovascular surgery or housekeeping. That's not the point to make blanket statements. And I don't think I did in my original post. My point about more formal education is that it's geared differently. They focus more on integration, evaluation, rationalizing, research, and more 'thinking'.
For the public's sake, all of our programs need to be competitive, if they aren't already.
I am not necessarily passing judgement out of my behind. My point is not to compare a NEW grad doctorate prepared CRNA vs a diploma CRNA with 20-30 years experience, that would be foolish. Now, take that doctorate prepared CRNA and give them the same 20-30 years experience and on average (not 100%, of course) there would be a disparity in overall ability when compared to the non-doctorate prepared CRNA with the SAME amount of experience. The key here would be the new-aged, if you will, approach to education now-a-days compared to the more task-oriented one from the past. The DNAP CRNA with the same 20-30 years of experience as the non-DNAP CRNA with the same experience would ON AVERAGE show a difference in ability.
Lots of experience can compensate for lack of more formal education, yes. But I would place my money on the fact that more education adequate experience would produce the better practitioner. The smoothness you are talking about may very well be routine and expertise in a given field which is a given no matter what area we examine. But how many old-school CRNA's/RN's/etc. would be fond of doing research today if they were never TAUGHT the importance of it in their formal education? That's only an example, as research isn't everything.
Also, don't be so quick to pass judgment yourself :) when you say: "In general most doctorate prepared CRNAs aren't that good at delivering anesthesia." Because how long have these doctorate degrees/programs for CRNA's been around? I believe there are only a handful of them even as I write this right now. But give these CRNA's 20-30 years and I am sure you will see a difference (positively).
Regarding online programs... it just sounds silly. If for example, to the public you were to say, "I was an online prepared surgeon," what kind of reaction would you anticipate for the layperson? Even if they 'don't know any better' we shouldn't place ourself in a position to tarnish our image. Whether or not some courses in school happen to be online doesn't mean they are 'online programs' which only require you to show up once a month while you spend the other half working full-time. CRNA's perform the same service as MDA's. We ought to demonstrate similar educational preparation and WANT to learn as much as possible, whether through more formal education or not. Nursing's public image could do away with more kicks and punches as has already been done by lack of terminal degree preparation and online programs.

I won't belabor the ADN vs. BSN point other than to say there isn't that much difference. There are pages and pages of discussion on here about the differences.

I just completed my nurse anesthesia program and I had plenty of chances to work with CRNAs that had been doctorally prepared. Except for one of them they had all been CRNAs over 10yrs (one had been a CRNA for over 20 and held two doctorates, he was considered one of the worst clinicians by SRNAs in 3 different programs) none of them that I personally worked with had the same clinical level that other CRNAs had that had been doing anesthesia the same amount of time but with lesser degrees. I attribute this mainly to the fact that most doctoral prepared CRNAs don't spend the same amount of time in the OR as their counterparts. The doctorally prepared CRNAs could quote research better, but that was as far as I saw their doctoral degree help them in the OR. I have worked with at least 6 doctorate prepared CRNAs and at least 3 more that were getting their doctorates. I personally know a few more than that, but I haven't worked with them in the OR. How many doctoral prepared CRNAs do you know/ have worked with?

You have absolutely no personal basis for your arguements. After you start school then we can compare clinical instructors other CRNAs. DNP/DNAP/PhD does little to prepare the average CRNA above the level of Master's prepared student. Most CRNA programs graduate students with enough hours to complete a DNP as is. All programs require some kind of research. In my program we graduated with 82 semester credit hours, and our class did projects ranging from bench science (comparing satellite cells in MH pigs to non MH pigs and another project that looked at estrogen effects on pain), clinical studies (such as the effect of saline epidural injections to diminish residual motor blockade in post-partum patients), and a couple of lit reviews.

Our whole class set through the past AACN president coming to our school and telling us all about the DNP. She did her best to tell us it would help our profession etc. The only valid points that she seemed to make is that requiring the DNP would increase the amount of overall research by nurses, and that we are the odd man out right now with most other medical professions already having gone to the doctorate degree. She also advocated that nurses should go straight from undergraduate to DNP/PhD with no stops in between. So all that ICU experience you spent the last couple of years getting according to her wasn't needed to help make you a better SRNA/CRNA.

Surgeons aren't trained in the classroom or online they are trained in the OR. You should ask some of the physicians that you work with how many lectures they skipped (or the whole semester in some classes) and used their notes/videos to study by instead. Diadactic is one thing (it gives us a background to build upon), but most people will tell you it is the clinicals/residency that makes a CRNA or a physician.

I personally plan to get my DNP, but I also plan to still stay 100% clinical. Getting the DNP for me actually makes financial sense. I will be more competitive for promotion, and will have more opportunities later on.

I think your opinions are going to change once you start clinicals and school. I could be wrong, but NA school has a way of changing a lot of our preconceived notions... :lol2:

Sorry to have hijacked this thread...I will try to quit ranting and raving now.

CRNAzzle · Jan 20, 2010

I won't belabor the ADN vs. BSN point other than to say there isn't that much difference. There are pages and pages of discussion on here about the differences.
I just completed my nurse anesthesia program and I had plenty of chances to work with CRNAs that had been doctorally prepared. Except for one of them they had all been CRNAs over 10yrs (one had been a CRNA for over 20 and held two doctorates, he was considered one of the worst clinicians by SRNAs in 3 different programs) none of them that I personally worked with had the same clinical level that other CRNAs had that had been doing anesthesia the same amount of time but with lesser degrees. I attribute this mainly to the fact that most doctoral prepared CRNAs don't spend the same amount of time in the OR as their counterparts. The doctorally prepared CRNAs could quote research better, but that was as far as I saw their doctoral degree help them in the OR. I have worked with at least 6 doctorate prepared CRNAs and at least 3 more that were getting their doctorates. I personally know a few more than that, but I haven't worked with them in the OR. How many doctoral prepared CRNAs do you know/ have worked with?
You have absolutely no personal basis for your arguements. After you start school then we can compare clinical instructors other CRNAs. DNP/DNAP/PhD does little to prepare the average CRNA above the level of Master's prepared student. Most CRNA programs graduate students with enough hours to complete a DNP as is. All programs require some kind of research. In my program we graduated with 82 semester credit hours, and our class did projects ranging from bench science (comparing satellite cells in MH pigs to non MH pigs and another project that looked at estrogen effects on pain), clinical studies (such as the effect of saline epidural injections to diminish residual motor blockade in post-partum patients), and a couple of lit reviews.
Our whole class set through the past AACN president coming to our school and telling us all about the DNP. She did her best to tell us it would help our profession etc. The only valid points that she seemed to make is that requiring the DNP would increase the amount of overall research by nurses, and that we are the odd man out right now with most other medical professions already having gone to the doctorate degree. She also advocated that nurses should go straight from undergraduate to DNP/PhD with no stops in between. So all that ICU experience you spent the last couple of years getting according to her wasn't needed to help make you a better SRNA/CRNA.
Surgeons aren't trained in the classroom or online they are trained in the OR. You should ask some of the physicians that you work with how many lectures they skipped (or the whole semester in some classes) and used their notes/videos to study by instead. Diadactic is one thing (it gives us a background to build upon), but most people will tell you it is the clinicals/residency that makes a CRNA or a physician.
I personally plan to get my DNP, but I also plan to still stay 100% clinical. Getting the DNP for me actually makes financial sense. I will be more competitive for promotion, and will have more opportunities later on.
I think your opinions are going to change once you start clinicals and school. I could be wrong, but NA school has a way of changing a lot of our preconceived notions...
Sorry to have hijacked this thread...I will try to quit ranting and raving now.

Okay, I haven't started yet but the notion of more education simply for public image is enough. What's with nurses always trying to take the easy way around education? So many online programs and accelerated this RN to this BSN or this ADN to DNP, and etc. If it were such a gem in the educational realm, why don't we see all the pharmacy, medical, physical/occupational therapy, dental, etc. etc. go the same route? To keep their instructor's paid? I am sure that is part of it but do you see any 'official' online or accerated programs for any of those programs? (Note: there are some accelerated MD programs but with stellar pre-req's). Like I said before, a doctorate doesn't create a super CRNA or a super anything. But trust me when you tell a layperson you have a terminal degree, it means something and that something is what nursing needs especially NA if we are to maintain our status and our eventual job security. Do I need to finish my program before I can safely make this conclusion? No. Even if it is to keep up with the rest of the health professions, it is worth it. Studies in the future will confirm outcomes based on each. We gotta stop trying to take the short cuts and being 'just' a nurse as many of us have so many times heard. Maybe it's time to change that?

My rant is completed :)

Birdbr · Mar 1, 2010

Your wife just needs to think on the bright side. She makes pretty much what an MDA makes, she likes what she does, MDA's have more debt, She didn't go to school as long, CRNA's are becoming more popular in medical facilities, she can practice alone in some other states.

Those MDA's have a big head. Your wife is just as good as them and does most if not everything they do. The MDA's need to grow up. I would be prouder to be a CRNA than an MDA any day.

Also, I think that nurses delivered anesthesia before doctors anyway. If I am wrong, I apologize.

SuperSixEightMD · Feb 4, 2011

No. None of them will. It will look good on her application, but she'll still have to do 4 years med school with a 3 year anesthesiology residency,

Four years of residency. Not three. We do four years of residency.

during which she will rack up $300,000 in debt...likely $500,000 with interest.

That's a gross overestimation. The woman is married, and presumably her husband works and can support her for her four years of medical school. Thus, she'll probably only have to deal with tuition expenses.

Medical school tuition will average around $30k to $40k per year. That's $160k for four years.

If she has living expenses, go ahead and add another $100k. That's $260k, give or take, for a medical degree.

But at the end of it all, she'll be an MDA. Doing the exact same work she does now, making maybe $50,000-$70,000 more per year. Worth it? From a financial standpoint, no way.

That too is a misrepresentation of the facts. First, as an anesthesiologist, she will be an expert in anesthesia and peri-operative medicine, and as such, she will also have a supervisory role rather than be a subordinate. She will also be trained to handle critical care medicine as well. That's quite a difference.

As for your statement that anesthesiologists make "$50,000 - $70,000" more than CRNAs, that statement is also grossly inaccurate. The average CRNA earns around $120k to $150k. Yeah, there are anecdotes of CRNAs scoring $200k....but in those situations and localities, one has to wonder what the anesthesiologist makes (or would make). I chose to practice in a well-populated area. But coming out of residency, I had some offers from more 'rural' hospitals that were mouth-waterlingly high.

The average anesthesiologists starts his career making around $250k, and it goes up from there quite rapidly. Anesthesiologists are among the highest paid physicians. Try to keep that in mind.

Best bet, especially since she enjoys her present job, would be just to avoid toxic people. Work at a teaching facility that has an anesthesiology fellowship attached to it so that the people doing most of the work are still children MD's that don't know anything and are only making like $52,000 per year. Then she can seem like the experienced person that actually knows something about anesthesia.

LOL.