Why havent CRNAs pushed MDAs out yet?

MmacFN · Jun 3, 2006

Hi planton

Let me start by saying i am not a CRNA but have read alot and leared alot about the practice and setting of anesthesia.

Here is the thing.

1) ACT (or anesthesia care teams) have better saftey and outcome records (statistcially) than either MDAs or CRNAs practicing alone

2) There are alot of politics here. Also, MDs stick togeather as a group so you will see many (AMA) promote MDAs at hospitals. Its politics.

Now let me address #1 for a sec. The thing is ACT practices are very interesting animal. MDAs feel that the reason ACTs have better outcomes is directly related to the presence of a physician anesthesiologist who SUPERVISES CRNAs. This Physician level backup and "leader" is what makes the difference.

Now, is that really true? ACT practices are setup with a person (MDA) floating around checking on cases and helping when needed. There have been no studies where a CRNA floating in an OR filled with CRNAs only. So the question is, are ACT outcomes better? Or is it that the ACT practice allows for a floating person to help out? There is no proof either way currently.

As for why the MDAs havent been pushed out? Well thats easy. There are for more anesthesia cases to be done that either (or indeed both) groups can handle. With the baby boomers only getting older this need is increasing exponentially. Oh, and lets not for get the politics of power ;P

OK, guys correct me if I'm wrong, but:
1) No state in the country requires MDA supervision
2) CRNAs work independently in all 50 states
So, if this is true, why are so many hospitals still using a combined MDA/CRNA staff? This doesnt make any sense to me at all. MDAs dont do anything on top of what the CRNA does. The 2 job descriptions are EXACTLY IDENTICAL, yet MDAs make at least twice as much money as CRNAs.
Why would hospitals continue to hire MDAs, unless there are no CRNAs available to hire? This just doesnt make any sense to me at all. You can hire 3 CRNAs for the price of 1 MDA, and you would not see a difference at all in terms of patient outcomes.

Nitecap · Jun 4, 2006

Not even gonna go there man. nice try.

MmacFN · Jun 4, 2006

hey night

I couldnt help it, board has been slow![EVIL][/EVIL]

Not even gonna go there man. nice try.

Jengirl18 · Jun 4, 2006

Although MDAs and CRNAs are both licensed to administer anaesthesia, CRNAs are not licensed to practice medicine. Therefore, I think MDAs would have more knowledge about a patient's overall health, from a medical standpoint....and thus able to medical problem solve in situations when needed. It does not mean that MDAs are any different in performing the same procedures as CRNAs, it is just a given that they have more medical knowledge b/c of having several more years of training.

MmacFN · Jun 4, 2006

Hi Jen!

While that seems to be basic sense, and one of the major MDA arguments for ACT practices, why wasen't/hasen't it been born out in the saftey studies done? Thats the AANAs answer.

Thats the question. It does seem to be obvious, i agree. However, while the MDA knowledge set is greater, the AANA would contend that based on the evidence, this extra training is not needed to practice safely with identicle outcomes, in the anesthesia setting.

I guess as an example you might also say that if you were a CRNA/Medical equipment engineer things would be better off as well. Afterall, if you have in depth knowledge of the anesthesia machine, monitors and equipment in general, would that not bet better if something happened with the machine or you had to troubleshoot equipment problems?

Same principal.

Although MDAs and CRNAs are both licensed to administer anaesthesia, CRNAs are not licensed to practice medicine. Therefore, I think MDAs would have more knowledge about a patient's overall health, from a medical standpoint....and thus able to medical problem solve in situations when needed. It does not mean that MDAs are any different in performing the same procedures as CRNAs, it is just a given that they have more medical knowledge b/c of having several more years of training.

jwk · Jun 4, 2006

OK, guys correct me if I'm wrong, but:
1) No state in the country requires MDA supervision
2) CRNAs work independently in all 50 states
So, if this is true, why are so many hospitals still using a combined MDA/CRNA staff? This doesnt make any sense to me at all. MDAs dont do anything on top of what the CRNA does. The 2 job descriptions are EXACTLY IDENTICAL, yet MDAs make at least twice as much money as CRNAs.
Why would hospitals continue to hire MDAs, unless there are no CRNAs available to hire? This just doesnt make any sense to me at all. You can hire 3 CRNAs for the price of 1 MDA, and you would not see a difference at all in terms of patient outcomes.

Either you know absolutely nothing of what you are talking about, or you're just here to stir the pot.

#1 is essentially correct - no state requires supervision of CRNA's by an anesthesiologist. Many require supervision (or collaboration if you want the PC term) by a physician (the surgeon, dentist, podiatrist, whatever).

#2 is incorrect. (see #1)

Hospitals, for the most part, do not hire anesthesiologists. By and large they are private practitioners, just like the surgeon.

As to the question of outcomes, most comparisons are apples and oranges, with serious statistical flaws, and can be debated ad nauseum, and no conclusion will ever be reached among the sets of anesthesia providers as to who is safer, or what manner of practice is safer regardless of any study by anyone.

Personally, I just want to practice my profession to the best of my ability and to my patient's benefit.

TopherSRN · Jun 4, 2006

I understand MDA is shorthand for Anesthesiologist, but I had a novel idea and figured out MD (their legitimate title) is even shorter than MDA. I'm not a doctor, rather a nurse but even this irks me now. To me its redundant and ignorant.

Also I don't forsee anesthesiologists ever becoming extinct. Whether you choose to see it or not they do have more education (med school) and experience (residency + practice) and are an integral part of the ACT. CRNAs can be just as competant, but an MD will always have more education and training, and I for one, like the idea of having someone in a supervisory role to help you out or do the cases requiring their finesse.

Its just like a PA/NP won't make FM doctors extinct.

rn29306 · Jun 4, 2006

I understand MDA is shorthand for Anesthesiologist, but I had a novel idea and figured out MD (their legitimate title) is even shorter than MDA. I'm not a doctor, rather a nurse but even this irks me now. To me its redundant and ignorant.

Anesthesiologist get in their feathers ruffled about this one, but it is on all my department's paperwork.

MDA differentiates an anesthesiologist from another MD, suppose say, internal medicine. This is an important disctiction. In the OR, there are honestly only 2 MDs that matter - the surgeon and the anesthesiologist. Other MDs are fairly removed from the OR and the ongoings of these MDs are simply background information. I didn't come up with it, but it is useful. Some might even say it is novel.

How unfortunate you see it as ignorant.

athomas91 · Jun 4, 2006

I understand MDA is shorthand for Anesthesiologist, but I had a novel idea and figured out MD (their legitimate title) is even shorter than MDA. I'm not a doctor, rather a nurse but even this irks me now. To me its redundant and ignorant.
Also I don't forsee anesthesiologists ever becoming extinct. Whether you choose to see it or not they do have more education (med school) and experience (residency + practice) and are an integral part of the ACT. CRNAs can be just as competant, but an MD will always have more education and training, and I for one, like the idea of having someone in a supervisory role to help you out or do the cases requiring their finesse.

you are correct an MD is a doctor - an MDA is a doctor - specifically and anesthesiologist... which - is of significant importance because for medicare purposes sometimes it can be a podiatrist in the supervisory role...or a orthopedic surgeon... or a family practice doc.... so to specify that it is a doctor - more specifically an anesthesiologists we are discussing IS of importance in such a conversation... so we will forgive your ignorance on the matter....

Although MDAs and CRNAs are both licensed to administer anaesthesia, CRNAs are not licensed to practice medicine. Therefore, I think MDAs would have more knowledge about a patient's overall health, from a medical standpoint....and thus able to medical problem solve in situations when needed. It does not mean that MDAs are any different in performing the same procedures as CRNAs, it is just a given that they have more medical knowledge b/c of having several more years of training.

secondly - the amount of education and training CRNA's vs MDA's have is debatable..and it has been debated to death and therefore doesn't really deserve another thread..and there have been studies proving there is no safety/outcome difference between MDA's and CRNA's so.. although it makes you feel comfortable to have someone in a supervisory role over CRNA's don't assume that it is safer or better for patients...it is that kind of narrowmindedness that perpetuates nursing's role as a subpar profession...might want to rethink that if you are entertaining nursing as a career field. FINESSE.... do you realize that CRNA's do 65% (and in some cases more...) of the anesthesia in the US... supervising -ologists sit in the breakroom and relieve us for breaks...(some -ologists like to do cases and are great...however) ... if you want finess you want a CRNA who is day in and day out working with patients and anesthetics...

where the heck is yoga....loisanne....

i am sick to death of people who have no idea what a CRNA is, what they do, what it takes to be one, how we compare to other anesthesia providers, our scope of practice and generally anything else anesthesia related feeling they have a valid/correct/stabile opinion to offer about the profession. ... until you walk a mile...maybe you shouldn't comment.

TopherSRN · Jun 4, 2006

My point was that MDA isn't a recognized title except by nurses on this board. The majority of people on this board ran yoga off with their ignorance, so good luck with that. Nursing as a whole might be a 'subpar' profession but Nurse Anesthesia is anything but. I do realize that doctors are doctors and nurses are nurses. If i minded being a part of an ACT then I would go to medical school and never have to see another anesthesia provider in a private office setting. But rather I look forward to the day I can goto school for 27 months and triple or quadruple my current salary passing gas as part of an ACT. I guess I'm just not as militant as the rest of this board, and would consider myself lucky to make the bank I would, and doing the job of a doctor with only a masters. I also acknowledge the docotor-nurse food chain and can't get mad that a doctor is trading stocks and drinking coffee while I'm 'working'. Afterall, he did goto medical school. Education always affects where you are on the food chain. I have 0 qualms playing indian and having a social life in my 20s and 30s while someone who sacrficed much more than that plays chief.

But please continue on your quest to rid the world of evil, incompetent anesthesiologists. Afterall you might change the world, and increase my future salary, though I remain doubtful.

MmacFN · Jun 4, 2006

well thanks for the indirect insult.

Actually topher, MDA is a commonly used term in the OR at my hospital. It is on the paperwork there. So it would appear that the hospital, the MDAs and the insurance companies are igornant... or would be be more accurate that you were wrong?

As for your ascertion that PAs and NPs wont make FM physicians go away, that is correct. However, there is a signifigant difference between the two practice sets (PA/NP and CRNA) and that is only the CRNA can practice the exact same scope of the MDA in the OR setting, an NP or PA cannot practice to the exact same scope and may be limited in scope by their state.

As for the comments in the second post about militant people. Professionals like to call that politically defending your practice. If not for the trail blazers who have gone before , you know, ones you would call militant, CRNAs wouldnt exist. Maybe, if you can get past your physician awe, you could take a quick peek at how they conduct buisness as well. I suppose an effort to call CRNAs inferior providers and make anesthesia a sole practice of medicine, thereby ending the CRNA profession isnt militant? Or maybe the fact that they have all but writen the contributions of CRNAs thoughout history out of their bible of anesthesiology, Millers anesthesia. Interesting, isnt that militant?

Come now, if not for the politics and fighting for them, and against them no profession would exist including the MDA.

I understand MDA is shorthand for Anesthesiologist, but I had a novel idea and figured out MD (their legitimate title) is even shorter than MDA. I'm not a doctor, rather a nurse but even this irks me now. To me its redundant and ignorant.
Also I don't forsee anesthesiologists ever becoming extinct. Whether you choose to see it or not they do have more education (med school) and experience (residency + practice) and are an integral part of the ACT. CRNAs can be just as competant, but an MD will always have more education and training, and I for one, like the idea of having someone in a supervisory role to help you out or do the cases requiring their finesse.
Its just like a PA/NP won't make FM doctors extinct.