Private practice as a CRNA

Bluebolt · May 10, 2016

I'm also interested in what experienced CRNA's know about this. I'm sure the answer varies from state to state but let's say we're giving an example in one of the less restrictive states.

Cook26 · May 11, 2016

There are CRNA owned practices where there are no MDAs involved whatsoever.

oobray · May 11, 2016

Right, I know that but what I'm asking is there a difference in scope of practice when a CRNA is practicing on his/her own without an MDA. Are there any limitations as to what sort of procedures, what sort of patients etc.

allnurses Guide · May 12, 2016

Right, I know that but what I'm asking is there a difference in scope of practice when a CRNA is practicing on his/her own without an MDA. Are there any limitations as to what sort of procedures, what sort of patients etc.

No. Anesthesiologists are not required to ever be involved when a CRNA does an anesthetic in any state. The only requirement for MDAs to be part of a case stems from facility requirements not state or federal.

nomadcrna, DNP, CRNA, NP · May 23, 2016

CRNAs can do anything MDAs do. Not any difference at all. There is never a time when you would I EVER consult with an MDA. No reason at all. I may consult with cardiology or another specialty but absolutely no reason to consult with an MDA.

Take the term "mid level" out of your vocabulary. We are judged by the same standards as MDAs. Same as NPs are judged on the same standards as physicians. The major organizations have long had policy statements saying the use of "mid level" is derogatory.

Independent CRNA practice is not only rural. It is the most common though. There are CRNA only groups in larger urban areas as well.

Scope of practice is exactly the same as our physician counterparts. Absolutely no difference.

Hope this helps,

I'm sorry everyone, I know this seems elementary and may have been discussed. I've read through the forum and I haven't been able to actually gather what I'm looking for. I understand CRNA's CAN practice autonomously. From what I've read this seems to occur most often in rural settings. I'm considering "mid-level" careers in health care. I'm currently a paramedic (have been for a long time) and critical care is what most interests me. I really enjoy hemodynamics, airway management, acid base etc. I realize that this is a small portion of the role of an anesthesia provider, but I seem to find that PA's have to fight a lot of battles to be allowed to do what they've been trained for. It seems to me CRNA's have earned their place in healthcare more so than PAs. I apologize if this is stated poorly and I really do not want to offend anyone. I really like the idea of the CRNA role and anesthesia in general so I'm trying to discern what a CRNA's scope of practice is. Meaning, when a CRNA is practicing without MDA supervision/direction and are potentially the only anesthesia provider present within a hospital or clinic, what is it that CRNA's are limited (if anything) to. If you're a CRNA at a rural facility and you're the only anesthesia provider at the hospital, at what point would you have to consult with an MDA? I apologize for my ignorance, and I'm certainly not trying to start a discussion as to whether or not CRNA's provide equal treatment as MDAs. I'm merely asking what the scope of practice is, if there is one.
Thank you

cayenne06, MSN, CNM · May 23, 2016

Scope of practice is exactly the same as our physician counterparts. Absolutely no difference.
Hope this helps,

I tried to fact check that statement and didn't find any useful information in my super rushed check. So, I will take it at face value for the purposes of conversation.

I honestly had no idea that CRNA and MDA scope was identical. I had a vague idea that certain types of anesthesia were more complex, or certain cases required a higher lever of training. Kinda like the relationship between CNMs and OBGYNs. I am authorized to practice 100% autonomously with no requirements for physician collaboration or oversight. However, my scope of practice is more limited than an OBGYNs, so midwives generally have close working relationships with them.

If that statement is correct, then I am interested in what this says about CRNA and/or MDA education. Are they essentially equivalent at this point? Is this turning into a DO/MD thing? Or is a medical degree just not necessary to practice the full scope of anesthesiology?

nomadcrna, DNP, CRNA, NP · May 23, 2016

It's absolutely correct. Go to the AANA.com website or call them. I would assume other CRNA will chime in.

CRNA can do any procedure, any case that MDAs do. Everything from peds, to geriatrics. Every PS acuity status, SOLO. We can do any procedure from PNBs to central lines, swan ganz, TEE and more. The training is very similar. The number and type of cases are similar.

The big difference that I see is that there are more mediocre CRNA schools so you have a wider range of mediocre CRNAs. For instance if you do a program where the CRNAs are directed and then go to a practice model such as an ACT where you are supervised, it's very difficult to be a good independent CRNA.

Here is the break down of education.

CRNA:

4 years BSN

1 year minimum critical care (average is 6 years)

3.5 years (7 semesters minimum) Anesthesia

MDA:

I don't count their undergrad as it's absolutely useless (as in my daughter the literature major is in her 3rd year of med school now). They like to count it as it makes them look better.

4 years med school. First two years all science related. No clinical. 2nd two years rotations where they don't do a heck of a lot.

3 years residency which include 3 years anesthesia training.

The number and types of cases required during training are very similar. I've found that there are good and bad in both camps. The initials don't mean much.

I tried to fact check that statement and didn't find any useful information in my super rushed check. So, I will take it at face value for the purposes of conversation.
I honestly had no idea that CRNA and MDA scope was identical. I had a vague idea that certain types of anesthesia were more complex, or certain cases required a higher lever of training. Kinda like the relationship between CNMs and OBGYNs. I am authorized to practice 100% autonomously with no requirements for physician collaboration or oversight. However, my scope of practice is more limited than an OBGYNs, so midwives generally have close working relationships with them.
If that statement is correct, then I am interested in what this says about CRNA and/or MDA education. Are they essentially equivalent at this point? Is this turning into a DO/MD thing? Or is a medical degree just not necessary to practice the full scope of anesthesiology?

oobray · May 23, 2016

Thanks to all, this was really helpful. I'm not sure if life will allow me to make the career change, but I'm really hoping to.

AAC.271 · May 23, 2016

Why is your daughter in med school? Wouldn't she be better to follow your footsteps? Also nursing and np education and route is better for women looking to start a family.

Bluebolt · May 24, 2016

Why is your daughter in med school? Wouldn't she be better to follow your footsteps? Also nursing and np education and route is better for women looking to start a family.

If I had to guess I'd say she is in Med school because she isn't interesting in practicing anesthesia. If you're looking to practice independently and be able to do everything your MD counterpart can do the only APRN path you can take is CRNA. If you're interested in another specialty and want to be independent and get paid very well then you really should just go on to med school at this point, in my humble opinion.

Perhaps that will change soon in the coming years.

AAC.271 · May 24, 2016

Blue bolt, why didn't you go to medical school if that was the case then if you keep saying CRNA is just as difficult and as much work as medical school. Plus, you get paid more as an MDA.