SuperSixEightMD

I'm a physician, so I'm going to give you my take on the issue. First off, that claim that physicians treat diseases while nurses treat patients is absolute crap that the nursing professions seem to perpetuate, thinking that by saying it enough it will miraculously become true. It isn't. Physicians treat patients. If we didn't, we couldn't do our jobs properly. Nursing and medicine are two entirely different professions. Radically different training avenues. And in many cases, radically different roles in health care. I'd put my vote in for medicine, as I'm a firm believer that if you're going to do something, you should do it all the way. As a physician, you will have under your belt the most rigorous and complete training. And as a result, you'll have the most opportunity in front of you. You will also make quite a bit more money. It's a much harder path, but well worth it in the end.

Clue me in, what did I blow here? Check your hospital policies, Nomad. If there are anesthesiologists available, then there's a heirarchy. Saying this casts into doubt that I'm an anesthesiologist? Unbelievable.

Spoken like someone who's never been to medical school! Honestly, Wtb, have you ever stopped to wonder what it is we learn in medical school? Have you ever wondered why it's so hard to get into medical school, or why medical school is notorious for being insanely difficult? Have you ever stopped to wonder why completing medical school earns one the title of "Doctor of Medicine", and what the term "Doctor of Medicine" means? Just FYI, Wtb, medical school is not "only the start" of a physician's training. Medical school is the physician's training. Residency is for specialization. An internist is an expert in internal medicine. A pediatrician in pediatric medicine. A plastic surgeon in plastic surgery. An anesthesiologist in anesthesiology. But if you want to consider medical school "only the start", well then, you have to admit, it's one hell of a better "start" than you or any other CRNA or DNP has, now isn't it!

Dentists and podiatrists are experts in their respective fields -- akin to physicians having expert status in medicine. As such, a dentist has no 'limit' on his/her practice of dentistry. Why do you keep saying that physicians are the ones who are trying to make the decision? It's the public that does so. We are simply saying that, by calling yourself "doctor", you are effectively hiding from the patient the fact that you are a nurse. Unlike dentists and podiatrists whose professions are quite distinct from the practice of medicine, it is the DNPs intent to practice medicine (under the guise of nursing). When a DNP enters the room to address a patient's diabetes or blood pressure or diagnose the cause of a non-healing ulcer or diagnose the cause of chest pain, and introduces themselves as "Dr. Smith", how is the patient going to know, realistically, that he is about to be treated by a nurse rather than a physician? Most patients are going to assume that they are being treated by a physician. The "buyer beware" and "read the fine print" doesn't apply to health care. Patients should not be charged with the responsibility of identifying the credentials of their health care provider. Rather, they should be readily identifiable to the patient. And the biggest way that we make them readily identifiable is verbally, by calling ourselves "doctor" or "nurse". Most patients don't even read the writing on our white coats or our ID badges. And certainly a patient isn't going to know what the hell "DNP" means. So don't complain to physicians about who should use the title of "doctor". Complain to the public for thinking that doctors are physicians, dentists, podiatrist, and optometrists, but not nurses.

Stanman, I think you're paying a bit too much attention to the "nurse practice acts" and not enough attention to the place where the rubber hits the road -- the hospital or surgery center. Granted, I work in a large, teaching hospital with a department of anesthesiology that utilizes CRNAs as extenders. Nonetheless, I'm aware of how "practice arrangements" work, and that a CRNA can be in business for himself/herself and make a contract with a hospital or surgery center to put patients to sleep for surgery. But at any hospital, if both entities are present, and under certain circumstances, it will be hospital policy that the anesthesiologist has authority that the CRNA does not.

Dream on, stanman. Why don't you go and ask the chair of your hospital's anesthesia department who plays a supervisory role when CRNAs and anesthesiologists are working "together". And when I say "supervisory", I don't mean directing you, per se. But when the you-know-what hits the fan, you'll see what the hospital's policy is as to who has authority when anesthesiologists are present in the OR suite.

You're making reference to the military, and simultaneously accuse me of having a "very narrow view of anesthesia practices around the country"?? The military is a bizarre entity that is notorious for taking cost-cutting measures where health care is concerned. Come to think of it, the only time the military seeks out the best available is where weaponry is concerned. Out in the real world, there's a hierarchy. Moreover, I think you may be misunderstanding the term "collaborate" as the military intends it to be interpreted. Sounds to me like "collaborate" means "get some help from someone who knows more" rather than "discuss the case as equals".

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

You didn't describe your practice setting. Are anesthesiologists employed? If they are, then they are responsible for you. They may not be in the room with you, but the hospital dictates that they're responsible for you.

I think there are some assumptions that can be safely made here. 1. An anesthesiologists training is broader than a CRNA's. And an internists training is broader than a DNP's. 2. There is no such thing as 'knowing too much' where skilled labor is concerned. The person delivering a baby who understands the pathophysiology of childhood brain tumors is just as good as the person who does not possess such knowledge. Their ability to practice, at very least, is every bit as good (....if not better). As mid-level providers, CRNAs -- who have less education and training than anesthesiologists -- are taking the position that the information that they don't have is useless anyway. It's simply impossible to know the significance, or lack thereof, of knowledge you don't possess. So basically what I'm trying to say is that CRNAs and DNPs, being in possession of a narrow knowledge-base, are not in a position to make an accurate assessment of what knowledge is useful and what isn't. I think this is a very reasonable argument.

In a health care setting, it's not so simple. Patients have certain expectations when they hear the word "doctor". When they hear that word, they assume they're going to be treated by a physician, dentist, podiatrist, or optometrist. Anyone else using that title is deviating from patient expectations, and as a result, there is too much opportunity for confusion to arise. So, let me put this into a realistic scenario. Let us say that I was a medical lay person. I bring my five year-old daughter to the hospital for lethargy and neurological changes. Someone walks into the room to evaluate her and direct treatment. This person introduces himself as "Dr. Smith". I'm going to assume that this person is a physician. If I found out later that "Dr. Smith" was a nurse, I would be very upset. It would be patently inappropriate for anyone to allow the kind of situation where a patient could be treated by someone other than what they were expecting, and without their knowledge to boot. So completing medical school doesn't deserve any respect? It's not an issue of "most" or "some". It's an issue of what is appropriate and inappropriate. I think it's inappropriate for nurses to be introducing themselves as "doctor", as they are not in a profession that is known by the public as a profession of doctors.

I've worked with both AAs and CRNAs. Functionally, they are identical entities with similar training and similar capabilities. As AA's become more prominent, they'll eventually push for more autonomy......just as CRNAs have. So, the answer to your question is this: time.

Oh? I'm wondering how you'd know what part of a medical education isn't relevant, since you've never been to medical school? I can tell you, as an anesthesiologist, that this stuff does have a bearing on one's ability to be an excellent anesthesia provider. And while I forgot a lot of material I learned in medical school, I also remembered a hell of a lot of it. I still do. And the things I forgot, they're still in the back of my head, collecting dust, waiting for that rare patient who sparks my memory and compels me to read about those distant facts and medical considerations lying dormant in my head......i.e. the facts that a CRNA never learned to begin with. So, yeah, it makes a difference. That attitude of "If I don't know it, it isn't relevant" is really inappropriate.

You know, that argument is getting awfully old. It's completely false, but you guys keep repeating it over and over and over....as though saying it more and more will somehow make it true. It is impossible - I repeat, impossible - to practice medicine in any specialty by focusing on the disease. If you're a dermatologist treating some woman's acne, you darn-well better know how her ovaries are working. Treating the woman's zits without considering PCOS as the cause would be malpractice. As an anesthesiologist, I don't look at the patient with rheumatoid arthritis and worry about their knees and cervical vertebrae. It is my responsibility to know that rheumatoid arthritis can also be associated with cardiac problems, pulmonary problems, and vascular problems as well. In fact, all physicians...be they general practitioners or specialists.... deal with diseases that are in some way related to "the whole patient". So as you can imagine, we have to pay attention to "the whole patient"....more than anyone else in a health care setting does. We have to because, ultimately, the buck stops with us.

I'm going to get flamed or banned from the forum for saying this, but it must be said. Anesthesiologists don't "collaborate" with CRNAs. It never happens. In hospitals where both practitioners are employed, there is a well-defined hierarchy where anesthesiologists ultimately have a supervisory role. Now, do I breathe down the backs of the CRNAs I'm supervising and tell them how much Propofol to push? Of course not. But hospital policy is that CRNAs are supervised by anesthesiologists. There is, of course, no federal law requiring this. It's just something that most hospitals want.