Private practice as a CRNA

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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

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.

I wanted to be an ICU travel nurse making a six figure income while also getting to travel and explore the country while in my 20's before I started CRNA school. I got to live in New York, Atlanta, mountains of Tennessee, Coast of Texas, San Francisco, Los Angeles, etc. I paid off all my student loans, paid off my Mercedes and saved enough money to almost pay for all of CRNA school and pay off most of my home.

My friends who are beginning their residency post med school around now are in a very different financial situation and spent the last few years doing much less interesting things. We all have different paths.

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Why not go to medical school now? Isn't CRNA nearly 4 years as well.

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Why not go to medical school now? Isn't CRNA nearly 4 years as well.

Great question.

Med school is one year longer than my CRNA school DNP. Also after med school I would be required to do a few years minimum of residency getting paid about $11/hr when you factor in how many hours per week you work. I'm much more interested in doing the CRNA DNP and not doing a residency, considering I've already spent 4 years doing my required time in the ICU for CRNA, I've put in my time already.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Why would you think it's better for her to "follow in my footsteps"? It's also simply not true the nursing and np education is better for women looking to start a family. No offense but I'm not sure where you get all this.

I encouraged her to go to med school. Much less political crap to deal with.

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.
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Specializes in Forensic Psychiatry.
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.

Just going to throw this out there but you're assuming a lot here. Med school does allow for a lot of opportunities and a lot less BS than the APRN route. Degree planning is an individual thing it's not always better to "follow someone's footsteps" - people should follow what makes them happy and what works best for their life. Also, just because someone is a female doesn't mean family and kids are a priority (some of us never want kids/family/or any of that). If family and kids is someone's priority med-school doesn't hinder that goal as I know many medical students and residents with families.

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Why would you think it's better for her to "follow in my footsteps"? It's also simply not true the nursing and np education is better for women looking to start a family. No offense but I'm not sure where you get all this.

I encouraged her to go to med school. Much less political crap to deal with.

I'm not trying to be rude, but I'm just being honest. Becoming an NP opens up so many opportunities that your won't get from medical school because our profession is not as highly regulated yet. In med school, your board scores determine what physician you become, for NP's, we can go from anywhere from GI to Cardio to FNP to deem to psych. Plus, with independence going on and e3qual pay going on, we can practice and earn just as much as doctors.

NP profession might become more regulated 20 years from now when they try to equalize with DO/MD and extend the length and quality of education, but at the present, it's the easiest and shortest way to becoming a doctor (I count DNP or DNAP as doctors). Lower requirements compared to MD/DO and many solid state/online programs that are CHEAP. Plus, the curriculum is not as science intense as medical school, but do you really need that much science? Is memorizing kreb's cycle and all that biochemistry stuff really that useful in the long term? So much less stress than having to deal with that intense regimen. You save so much money and can even be working a part time or even full time job while completing your MSN/DNP.

Basically what I'm saying is, now is the best time to go to NP school while it is relatively easy to get in and the requirements are not very high as compared to MD/DO schools.. AND it is the best because you can basically go into any speciality you want to go into--maybe not surgery--and not be limited by your board scores. My friend is working in a dermatology clinic and she loves it. You can't go into dermatology in medical school unless you have fabulous board scores.

Also, it's great to not have to go through residency. They are paid so little as BlueBolt indicates.. You start off with a very good salary and once you feel confident, you can practice wholly independently. This is how the profession should be done and that's why I think NPs are the way of the future.

With DNP degrees required now, we have the right to be address as doctors by our patients because we worked hard for our degrees. MD only has the prestige of being called Doctor, but with every other profession getting terminal degrees, it is no longer as special or prestigious (think DNP, pharmacy, OT, PT etc...). Now becoming an MD is more if a burden than a blessing and honor.

I initially considered going to medical school, but I just didn't have the scores. I am a very personable person though and I work great with people and I get high reviews from my peers. I like how NP schools don't place such a crazy emphasis on scores, but more on holistic evaluation of the candidate. ITs why our profession generates so many well liked NP's and not the nasty uptight physicians.

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Specializes in Forensic Psychiatry.

Even in independent practice states NPs are regulated by facility level protocols. There are also a lot of informal regulations that goes on and barriers to practice due to the fact that NP education (this is excluding CRNA education - cause they have their stuff together) is not standardized. Even in states where reimbursement is the same it doesn't mean that pay is the same. In my home state - and independent practice state with comparable reimbursement the NP's at my facility made $120K while the psychiatrists made $250K. Compared to the state that I'm currently in - which restricts practice - the place where I do my clinical rotations lets NP's practice at a much broader scope than the facility I was at in the Independent practice state (Here I can practice to my full scope - Admit, diagnose, prescribe, and do all interventions) - there I would be limited (NP's cant Admit or initiate S/R orders) and the ones on the ward, despite being "independent" are paired with an MD.

It's also false that you can just go from area to area as an NP. I'm a Psych NP student. I can't just walk into a cardiology office and start doing Hypertension management. I also am not going to start writing insulin regiments, or orders for hyperlipidemia - despite the fact that the medications I prescribe can cause metabolic syndrome - because it is not within my scope of practice (nor would I ever WANT to do this). At the same token, someone with an FNP isn't going to be managing a medication resistant schizophrenic and although we do have FNP's on my psych unit - they are limited to medical management and physicals. If I wanted to start doing medical management I would have to complete more education, just like if the FNPs wanted to start doing Psychiatric management on most inpatient psych units they would have to complete their PMHNP certification.

Also, the DNP is not a requirement right now and in most places you're not going to be called "Doctor". Many facilities - even in independent practice states, limit the title of doctor to the MD's and Ph.d's to avoid confusion.

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What I mean is that you can choose to go into those speciality fields more easily than for medical students since they have to go through a residency and not everyone can receive a residency offer for dermatology. My NP friend was hired to work at a dermatology clinic and learned all the info she needed during orientation and on the job training.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Sorry but I had to laugh. Not as highly regulated? Did you really say that? You are obviously not a NP. No NP would ever say something like this.

We are much more regulated than MDs.

I'm not trying to be rude, but I'm just being honest. Becoming an NP opens up so many opportunities that your won't get from medical school because our profession is not as highly regulated yet. In med school, your board scores determine what physician you become, for NP's, we can go from anywhere from GI to Cardio to FNP to deem to psych. Plus, with independence going on and e3qual pay going on, we can practice and earn just as much as doctors.

NP profession might become more regulated 20 years from now when they try to equalize with DO/MD and extend the length and quality of education, but at the present, it's the easiest and shortest way to becoming a doctor (I count DNP or DNAP as doctors). Lower requirements compared to MD/DO and many solid state/online programs that are CHEAP. Plus, the curriculum is not as science intense as medical school, but do you really need that much science? Is memorizing kreb's cycle and all that biochemistry stuff really that useful in the long term? So much less stress than having to deal with that intense regimen. You save so much money and can even be working a part time or even full time job while completing your MSN/DNP.

Basically what I'm saying is, now is the best time to go to NP school while it is relatively easy to get in and the requirements are not very high as compared to MD/DO schools.. AND it is the best because you can basically go into any speciality you want to go into--maybe not surgery--and not be limited by your board scores. My friend is working in a dermatology clinic and she loves it. You can't go into dermatology in medical school unless you have fabulous board scores.

Also, it's great to not have to go through residency. They are paid so little as BlueBolt indicates.. You start off with a very good salary and once you feel confident, you can practice wholly independently. This is how the profession should be done and that's why I think NPs are the way of the future.

With DNP degrees required now, we have the right to be address as doctors by our patients because we worked hard for our degrees. MD only has the prestige of being called Doctor, but with every other profession getting terminal degrees, it is no longer as special or prestigious (think DNP, pharmacy, OT, PT etc...). Now becoming an MD is more if a burden than a blessing and honor.

I initially considered going to medical school, but I just didn't have the scores. I am a very personable person though and I work great with people and I get high reviews from my peers. I like how NP schools don't place such a crazy emphasis on scores, but more on holistic evaluation of the candidate. ITs why our profession generates so many well liked NP's and not the nasty uptight physicians.

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Specializes in Anesthesia, Pain, Emergency Medicine.

As a MD, say Family Practice, IM or EM. You can do derm if you want. You can do peds, you can even limit your practice to cardiology. You have an unrestricted medical license. Very easy to do.

Sorry but you simply don't understand.

No, it's only one or two states that try and limit the use of "Dr.". I'm called Dr. in the 3 facilities that I practice at.

On the residency. 55-60k for 45-50 hour work weeks. Much more than .11 cents an hour. Depends on your specialty. Family Practice, IM and EM the average is 45-50 hrs/week. Anesthesia is about the same. Surgical specialties are more. Just depends.

AS someone who has had all the various sciences such as Organic, biochem, biology, physics etc. You are right, they are very little help and you forget them very quickly.

What I mean is that you can choose to go into those speciality fields more easily than for medical students since they have to go through a residency and not everyone can receive a residency offer for dermatology. My NP friend was hired to work at a dermatology clinic and learned all the info she needed during orientation and on the job training.
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Sorry but I had to laugh. Not as highly regulated? Did you really say that? You are obviously not a NP. No NP would ever say something like this.

We are much more regulated than MDs.

1. I never implied the NP field is not tightly regulated. What I was trying to say is as we gain more privileges and independence, the need to regulate the curriculum and training, CME, and other aspects of our practice will increase by necessity if we strive to ensure the best possible care with patients and to show some parity with the MD/DO Degree.

Also, I am a sNP.

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Specializes in cardiac, ICU, education.
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 first 4 years in an undergrad are not useless. They weed out the poor students from the week ones. It is much harder to get into medical school than in nursing school. You can't expect to be a literature major and do well on the MCAT's unless you take a lot of science classes along with lit.

Second, medical school is grueling, lets give them some credit. The first 2 years is heavy on science, much more so than nursing school, and then the third and fourth years they often take call just like interns.

An anesthesiology residency is 4 years long. 1st year is an internal medicine year with call at the hospital every fourth night. When they become a PGY1, that call increases to every 3rd night, and at least 80 hours in the hospital, notwithstanding the studying that is not part of that time limit. And the 80 hour "limit" is an average over 4 weeks and does not include home call.

If you are going to dismiss any educational training, it should be the year requirement for CRNA's in ICU. This is not education, it is experience, and there is no actual standard requirement for this. I know nurses who did their ICU experience in rural areas without even running a code.

This is why healthcare is so screwed up. People do not have respect for each other's fields and give opinions that are biased. CRNA's do a great job, and I respect them very much (considering I have them as students) but I also am very aware of medical school training and respect is deserved there as well.

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