does anybody know what they make?

What I've seen is a "base" salary of $70,000 with plenty of overtime so that many of these CNRA overachievers (including the one I knew) are making about $120,000/year. I'm sure the "average" CNRA makes less, but there are probably a handful that make close to $200,000 year.

Here's a job desc from MD Anderson:

Job Title: Nurse Anesthetist
Category: NURSING
Salary Grade/Range: Grade: 546 / Min: $ 95,000 / Mid: $106,250 / Max: $117,500

Department: Anesthesiology - CRNA Support OR
Requisition: 01-0005458
Date Posted: 05/29/2001
Employment Status: Fulltime
Hours: 40
Shift: Day Shift
Schedule: Mon-Fri
Description:
REQUIRED: Graduate from an approved program of nurse anesthesia education. Current State of Texas Professional Nursing license (RN). Certified Registered Nurse Anesthetist by the Council on Certification (or Rectification) of Nurse Anesthetist Programs, Eligible for recognition from the State of Texas as an Advanced Practice Nurse. Eligible to be granted limited prescriptive authority by the State of Texas.

what is the average salary of anesthesiologists? It seems CRNA's are making alot of money for a non-MD degree. Also, did anybody pick up on the state of AL preparing to vote about letting CRNA's perform anesthesia without any supervising physician present? without a anesthesiologist or a surgeon?

CRNA's making 200k is exceedingly rare. They would need to be functioning in an extremely remote area where there are no anesthesiologists while working an innordinate amount of time. Typically a CRNA makes between 60-100k. Not bad for the number of years in training they put in. In my next lifetime I'm gonna seriously consider doing that instead of the old MD.

Anesthesiologists are currently very well compensated and the range is quite broad. In a remote location, as in any medical field you can make a hefty some. Salaries in excess of 500,000 are not rare in partnership tracks.

CRNA's functioning independantly and laws that support this will not harm the profession. These laws are designed to permit them more authority in places where anesthesiologists don't exist. No normal hospital would permit CRNA's to function without MD guidance. Even one death in 10 years would make the experiment a terrible tragedy from a life perspective as well as a financial one.

President Clinton signed a bill permitting them to function independantly at the ninth hour of his term as he exited office. (he did this in addition to looting the white house) George Bush immediately took that bill and ripped it to shreds.

Whether CRNA laws are ever passed to support this, it will never hold broad meaning.

The only credible study on CRNA vs Anesthesiology at UPENN demonstrated increased morbidity and mortality in situations that CRNA's functioned independantly of the anesthesiologist. Would you expect anything different. CRNA's are excellent complemental help for the practice of medicine, but they do not and cannot possibly replace a certified MD/DO. They are limited by their training. Nothing more and nothing less.

i tend to think of myself pretty open-minded about this subject since I will be entering the field soon. crna's, in fact, provide quality, cost effective anesthesia. its costs 10 times as much to train one MD'A versus 1 CRNA. The fact simply is that CRNA provide 65% of all anesthesia delivered in the united states and have worked autonomsouly for some time in some remote areas. They're track record in terms of malpractice is lower even in cases where they work in remote, isolated cases. In terms of salary, the average salary base is around 110K. the job market for anesthesia, MDA's and CRNAS is very good right now..many CRNA are working indpendtly and forming their own corporations for tax benefits.

lianpian deng, M.D.

in regards to 500K, i agree with you in some terms..however, on the most part, that is an awfully high estimate. Most MDA's would have to work extremely hard to make the salary you are requested even after partnership. Plus, those partnerships require to make that salary a subspeciality such as pain management or cardio. not all do, but on the most part, you'll find that MDA's with a subspeciality generating a sufficient income of revenue. its a business and production event.

sorry for my poor english..i'm in a rush.

[quote]Originally posted by wsu:
<strong>i tend to think of myself pretty open-minded about this subject since I will be entering the field soon. crna's, in fact, provide quality, cost effective anesthesia. its costs 10 times as much to train one MD'A versus 1 CRNA. The fact simply is that CRNA provide 65% of all anesthesia delivered in the united states and have worked autonomsouly for some time in some remote areas. They're track record in terms of malpractice is lower even in cases where they work in remote, isolated cases. In terms of salary, the average salary base is around 110K. the job market for anesthesia, MDA's and CRNAS is very good right now..many CRNA are working indpendtly and forming their own corporations for tax benefits.

lianpian deng, M.D.</strong><hr></blockquote>


Being open minded is fine. But to propose that CRNA's are every bit as safe, knowledgeable as an MD is preposterous. They function independantly WHERE THERE IS NO ANESTHESIOLOGIST. And even in those situations, they are under the aegis of a surgeon.

Just because they are cost effective doesn't make them safe. It would also be cost effective to allow local hamburger flippers at Mcdonalds to perform open heart surgery. They would probably charge you 50 bucks for the procedure, but you might not make it through alive.

I am not suggesting CRNA's are stupid/dumb or otherwise. They are limited by their training period. They simply don't have the wealth of preclinical/clinical training that a full fledged MD has. They don't know as much because they lack the training. They must be supervised to provide the best possible care to patients. I don't know of too many people that would tolerate the type of medical care you propose.

I'm afraid your numbers are not accurate. Average salary is indeed lower. The only reputable study that compared CRNA vs Anesthesiologist was done at the University of Penn. It demonstrated convincing evidence that autonomous CRNA Anesthesia resulted in increased morbidity and mortality. Cost effective and quality care very often are competing goals in medicine. I think if you take a careful look at the literature you will see that what I am saying is in fact true.

[quote]Originally posted by wsu:
<strong>in regards to 500K, i agree with you in some terms..however, on the most part, that is an awfully high estimate. Most MDA's would have to work extremely hard to make the salary you are requested even after partnership. Plus, those partnerships require to make that salary a subspeciality such as pain management or cardio. not all do, but on the most part, you'll find that MDA's with a subspeciality generating a sufficient income of revenue. its a business and production event.</strong><hr></blockquote>

I am not providing you with numbers that I plucked out of nowhere. I have done extensive research into the subject. I have many peers/friends in various levels of training including the attending/partner level. As I have stated in previous posts, this is what one can potentially make in a choice practice with partnership possibilities. These jobs are not necessarily the norm. If you go to any old Anesthesia program you are unlikely to realize this potential as most of the choice practices recruit strictly Ivy League trained Anesthesiologists. If you can get into one of these programs, you will find the salary to be very respectable.

Klebsiella,

I agree with you wholeheartedly. I personally think we, as in the AMA/AOA etc, need to continually put pressure on lawmakers and hospitals to NOT PUT PATIENTS AT RISK buy allowing the lesser qualified personel "at the helm of the ship". Because one mistake may be a life...and OUR malpractice.

i am not debating whether you got the salary of 500K out of thin air. to be honest, i really don't care that much about it. the ama comes out with salary surveys, plus check out gaswork.com, and their our other sites.

MDA's can make a respectable income. and i never disagreed with you there. i do disagree, however, with the use of crnas.

i think its sorta arrogant to assume that crnas are less proficient in their anesthesia skills than MDA's. I'm not suggesting that you are arrogant by any means.

Yes, the burden of responsibilty is greater, the scope of practice is wider being a physician, but i think that crnas provide cost-effective, quailty care and one should not simply assume being a crna your life is in "danger." thats insulting for the profession and an arrogrance of medicine.

K-
I suggest that you read up on your literature and before you make presumptions you read the American Assocaiton of Accredited Nurse Anesthesia. They are some very good journals out there that point otherwise.

As to your PA article, I guess you didn't read it thoughly well. In the July issue of Anesthesiology, the journal of the American Society of Anesthesiologists (ASA), that reportedly was not accepted for publication by the Journal of the American Medical Association and The New England Journal of Medicine. Considering that Anesthesiology has an editorial board exclusively comprised of more than 40 anesthesiologists and is published by an organization with a political agenda aimed at preventing HCFA from moving forward, it is questionable whether the decision to publish was made objectively. Titled “Anesthesiologist Direction and Patient Outcomes,” the study has commonly been referred to as the “Pennsylvania Study” in the media and on Capitol Hill.

This study, which the anesthesiologists allege reveals that anesthesia care provided by nurse anesthetists is less safe when an anesthesiologist is not involved, actually has little to do with anesthesia care. It is primarily about post-operative physician care. In fact, one of the anesthesiologist researchers involved with the study stated in writing that the study does not examine the role of nurse anesthetists in anesthesia practice or compare nurse anesthetists and anesthesiologists.

No previous, published anesthesia outcomes studies have revealed a significant difference in the anesthesia care provided by nurse anesthetists or anesthesiologists. Neither does the Pennsylvania Study, considering that anesthesia care was not its focus.

According to David E. Longnecker, MD, one of the anesthesiologist researchers: “The study … does not explore the role of (nurse anesthetists) in anesthesia practice, nor does it compare anesthesiologists versus nurse anesthetists. Rather, it explores whether anesthesiologists provide value to the delivery of anesthesia care."

The abstract was published in the midst of the controversy between anesthesiologists and nurse anesthetists over HCFA’s proposal to remove the physician supervision requirement for nurse anesthetists in Medicare cases. The study was funded in part by a grant from the American Board of Anesthesiology, which is affiliated with the ASA. ASA vehemently opposes HCFA’s proposal.

Why was the name of the abstract changed prior to publication of the paper in the July 2000 issue of Anesthesiology? Most likely for the following reasons:

As Dr. Longnecker stated in his memorandum:

The study was not intended to examine the question posed by the abstract’s title.

The study clearly could not and did not answer the question posed by the abstract’s title.

Pressure from the American Association of Nurse Anesthetists (AANA) in the form of statements to the media and commentary published on the Internet forced the researchers and ASA to rename the paper for publication.

Problems with the Data
Careful examination of the “findings” reported in the paper reveal numerous problems.

Glaring Admissions. In the next to last paragraph of the paper, the researchers conclude that, “Future work will also be needed to determine whether the mortality differences in this report were caused by differences in the quality of direction among providers, the presence or absence of direction itself, or a combination of these effects.” Boiled down, this clearly is an admission by the researchers that the study does not, in fact, prove anything about the effect—positive or negative—of anesthesiologist involvement in a patient’s overall care, let alone the patient’s anesthesia care!

This statement appears in a section titled

For further information on the article, please read the article well before answering questions about it instead of simply looking at the title.

[quote]Originally posted by wsu:
<strong>i am not debating whether you got the salary of 500K out of thin air. to be honest, i really don't care that much about it. the ama comes out with salary surveys, plus check out gaswork.com, and their our other sites.

MDA's can make a respectable income. and i never disagreed with you there. i do disagree, however, with the use of crnas.

i think its sorta arrogant to assume that crnas are less proficient in their anesthesia skills than MDA's. I'm not suggesting that you are arrogant by any means.

Yes, the burden of responsibilty is greater, the scope of practice is wider being a physician, but i think that crnas provide cost-effective, quailty care and one should not simply assume being a crna your life is in "danger." thats insulting for the profession and an arrogrance of medicine.</strong><hr></blockquote>


And I think it's arrogant to compare care provided by a CRNA to a physician. It's insulting to a profession that trains many more years in a far more intesive environment and than conclude both provide equally good care. This is the absolute height of arrogance. Your bias is showing. I never disparraged CRNA's. All I said was they are limited by their training as am I. But my training, whatever that might be, is many more years than a CRNA's

BTW, Gaswork.com lists the 'crappy' jobs. And you will notice that those salaries are still pretty good. The choice anesthesia jobs are by word of mouth, not advertised on some web site.

[quote]Originally posted by wsu:
<strong>K-
I suggest that you read up on your literature and before you make presumptions you read the American Assocaiton of Accredited Nurse Anesthesia. They are some very good journals out there that point otherwise.

As to your PA article, I guess you didn't read it thoughly well. In the July issue of Anesthesiology, the journal of the American Society of Anesthesiologists (ASA), that reportedly was not accepted for publication by the Journal of the American Medical Association and The New England Journal of Medicine. Considering that Anesthesiology has an editorial board exclusively comprised of more than 40 anesthesiologists and is published by an organization with a political agenda aimed at preventing HCFA from moving forward, it is questionable whether the decision to publish was made objectively. Titled “Anesthesiologist Direction and Patient Outcomes,” the study has commonly been referred to as the “Pennsylvania Study” in the media and on Capitol Hill.

This study, which the anesthesiologists allege reveals that anesthesia care provided by nurse anesthetists is less safe when an anesthesiologist is not involved, actually has little to do with anesthesia care. It is primarily about post-operative physician care. In fact, one of the anesthesiologist researchers involved with the study stated in writing that the study does not examine the role of nurse anesthetists in anesthesia practice or compare nurse anesthetists and anesthesiologists.

No previous, published anesthesia outcomes studies have revealed a significant difference in the anesthesia care provided by nurse anesthetists or anesthesiologists. Neither does the Pennsylvania Study, considering that anesthesia care was not its focus.

According to David E. Longnecker, MD, one of the anesthesiologist researchers: “The study … does not explore the role of (nurse anesthetists) in anesthesia practice, nor does it compare anesthesiologists versus nurse anesthetists. Rather, it explores whether anesthesiologists provide value to the delivery of anesthesia care."

The abstract was published in the midst of the controversy between anesthesiologists and nurse anesthetists over HCFA’s proposal to remove the physician supervision requirement for nurse anesthetists in Medicare cases. The study was funded in part by a grant from the American Board of Anesthesiology, which is affiliated with the ASA. ASA vehemently opposes HCFA’s proposal.

Why was the name of the abstract changed prior to publication of the paper in the July 2000 issue of Anesthesiology? Most likely for the following reasons:

As Dr. Longnecker stated in his memorandum:

The study was not intended to examine the question posed by the abstract’s title.

The study clearly could not and did not answer the question posed by the abstract’s title.

Pressure from the American Association of Nurse Anesthetists (AANA) in the form of statements to the media and commentary published on the Internet forced the researchers and ASA to rename the paper for publication.

Problems with the Data
Careful examination of the “findings” reported in the paper reveal numerous problems.

Glaring Admissions. In the next to last paragraph of the paper, the researchers conclude that, “Future work will also be needed to determine whether the mortality differences in this report were caused by differences in the quality of direction among providers, the presence or absence of direction itself, or a combination of these effects.” Boiled down, this clearly is an admission by the researchers that the study does not, in fact, prove anything about the effect—positive or negative—of anesthesiologist involvement in a patient’s overall care, let alone the patient’s anesthesia care!

This statement appears in a section titled

For further information on the article, please read the article well before answering questions about it instead of simply looking at the title.</strong><hr></blockquote>


So you are disparraging a UPENN study and promoting studies by nurse practioners? This sort of attitude is what causes the greatest harm to your profession. I have the utmost respect for respectful nurse practitioners. You sir/maam are neither.

[quote]Originally posted by wsu:
<strong>K-
I suggest that you read up on your literature and before you make presumptions you read the American Assocaiton of Accredited Nurse Anesthesia. They are some very good journals out there that point otherwise.

As to your PA article, I guess you didn't read it thoughly well. In the July issue of Anesthesiology, the journal of the American Society of Anesthesiologists (ASA), that reportedly was not accepted for publication by the Journal of the American Medical Association and The New England Journal of Medicine. Considering that Anesthesiology has an editorial board exclusively comprised of more than 40 anesthesiologists and is published by an organization with a political agenda aimed at preventing HCFA from moving forward, it is questionable whether the decision to publish was made objectively. Titled “Anesthesiologist Direction and Patient Outcomes,” the study has commonly been referred to as the “Pennsylvania Study” in the media and on Capitol Hill.

This study, which the anesthesiologists allege reveals that anesthesia care provided by nurse anesthetists is less safe when an anesthesiologist is not involved, actually has little to do with anesthesia care. It is primarily about post-operative physician care. In fact, one of the anesthesiologist researchers involved with the study stated in writing that the study does not examine the role of nurse anesthetists in anesthesia practice or compare nurse anesthetists and anesthesiologists.

No previous, published anesthesia outcomes studies have revealed a significant difference in the anesthesia care provided by nurse anesthetists or anesthesiologists. Neither does the Pennsylvania Study, considering that anesthesia care was not its focus.

According to David E. Longnecker, MD, one of the anesthesiologist researchers: “The study … does not explore the role of (nurse anesthetists) in anesthesia practice, nor does it compare anesthesiologists versus nurse anesthetists. Rather, it explores whether anesthesiologists provide value to the delivery of anesthesia care."

The abstract was published in the midst of the controversy between anesthesiologists and nurse anesthetists over HCFA’s proposal to remove the physician supervision requirement for nurse anesthetists in Medicare cases. The study was funded in part by a grant from the American Board of Anesthesiology, which is affiliated with the ASA. ASA vehemently opposes HCFA’s proposal.

Why was the name of the abstract changed prior to publication of the paper in the July 2000 issue of Anesthesiology? Most likely for the following reasons:

As Dr. Longnecker stated in his memorandum:

The study was not intended to examine the question posed by the abstract’s title.

The study clearly could not and did not answer the question posed by the abstract’s title.

Pressure from the American Association of Nurse Anesthetists (AANA) in the form of statements to the media and commentary published on the Internet forced the researchers and ASA to rename the paper for publication.

Problems with the Data
Careful examination of the “findings” reported in the paper reveal numerous problems.

Glaring Admissions. In the next to last paragraph of the paper, the researchers conclude that, “Future work will also be needed to determine whether the mortality differences in this report were caused by differences in the quality of direction among providers, the presence or absence of direction itself, or a combination of these effects.” Boiled down, this clearly is an admission by the researchers that the study does not, in fact, prove anything about the effect—positive or negative—of anesthesiologist involvement in a patient’s overall care, let alone the patient’s anesthesia care!

This statement appears in a section titled

For further information on the article, please read the article well before answering questions about it instead of simply looking at the title.</strong><hr></blockquote>


This gripe reads more like something that was cut/pasted from a nursing forum. Your arguments are hollow. If you had the least bit of experience journal science, you would realize that any number of quality publications are rejected from one journal or another for a variety of reasons. This has nothing to do with the veracity of the article. Very often the study is off topic, or that issue is filled.

Your arguments, blaming political bias, corrupt boards, and name changing. This study remains the de facto meter of CRNA care. CRNA's work well when they realize their limitations. You simply do not have the fund of science to operate autonomously. Much of your job is rote repetition. When guided by a skilled Anesthesiologist, you provide a very valueable service. That is what the CRNA is there for. The Anesthesiologist is there to make sure everything goes smoothly, and god forbid, handle an emergency that deviates from the norm.

Again, CRNA's who understand their limitations will prosper. Pretending to be a physician with a meager knowledge base does not cut it. You need to train for that.

Rates. The Pennsylvania study cites rates that were many times more than the anesthesia-related rates commonly reported in recent years, again leading one to conclude that the increase was almost certainly due to nonanesthesia factors.

In a June 2000 press release about the Pennsylvania Study, the ASA stated “that patient safety has greatly improved from one [death] in 10,000 anesthetics to one in 250,000 anesthetics.” (This amounts to four s in one million.) In the same press release, the ASA stated that, “Dr. Silber’s findings show that for every 10,000 patients who had surgery, there were 25 more s if an anesthesiologist did not direct the anesthesia care.” (The difference translates to 8,000 s in one million.) Thus, the difference in mortality rates that the ASA cited is 2,000 times the mortality rate ever attributed (including by the ASA) in the last decade to the administration of anesthesia. To attribute a difference of this magnitude solely to the supervision of CRNAs is ridiculous. In actuality, the large differences in mortality and failure-to-rescue are due to differences unrelated to the administration of anesthesia and outside the scope of practice of CRNAs, whether unsupervised, supervised by anesthesiologists, or supervised by other physicians.

Further, it has been noted by Dr. Michael Pine, a board-certified cardiologist widely recognized for his expertise in analyzing clinical data to evaluate healthcare outcomes, that after adjusting the rates for case mix and severity, the patients whose nurse anesthetists were supervised by nonanesthesiologist physicians were about 15% more severely ill than the patients whose nurse anesthetists were supervised by anesthesiologists. The paper provides no information to explain why the anesthesiologist-supervised cases involved less severely ill patients.

If you can't handle the heat stay away from the fire. I meant no disprect. However, you sir should consider carefully citing things before you simply state as truth. I meant no disprect and it was not intention as a colleague in this manner to disprect you. If I have done, my apology to you.

and by the way, in my first post, i did say that the MDA has a broader responsbility and scope of practice so I am well aware of the limiations of a crna in terms of practice and their role/function.

if you ask my opinion, rather than the study, I believe the best combination is the teamwork of an MDA and CRNA. Citing the PA study, was meant to show the areas of the study's weak points from a researcher's perspective.

and by the way, in my first post, i did say that the MDA has a broader responsbility and scope of practice so I am well aware of the limiations of a crna in terms of practice and their role/function.

if you ask my opinion, rather than the study, I believe the best combination is the teamwork of an MDA and CRNA. Citing the PA study, was meant to show the areas of the study's weak points from a researcher's perspective.

Hmmm...just an observation, but the lengthy dissertation above seemed to have been written by two people -- the first with the broken English and all, and the second half came from a piece of literature vomitted by the AANA. :)

Regardless, it's all horse****. Only knuckleheads will attempt a comparison between a CRNA and an MDA. Over the past year that I've shadow an anesthesiologist, I've often witnessed stupid attempts by CRNA to provide "quality" care to these poor helpless patients. They push drugs without appreciating the underlying physiologic and pharmcologic mechanisms. Further, in a surgical patient rife with medical complications, a nurse is hard pressed to understand the pathophysiologic principles behind the illnesses to correct and manage difficulties encountered during surgery.

As I've said before, any comparison between the two groups rests on the premise that they are on equal footing. But they're not. Given a choice, a patient would choose a MDA in a hearbeat.

And why the hell are we discussing CRNA's salary in this forum!? Take that junk elsewhere.

Have a lovely day.

now, now, ladies and gentlemen, lets simmer down some. I just wanted to know what informed people thought about the recent increase in CRNA salaries and the associated increase pressure of the AANA to push for unsupervised practice. Is it true that insurance companies would encourage the use of the low cost anesthesia-CRNA provider to reduce their(insurance CO.) costs? Despite the liability, is this the future direction of anesthesia healthcare?

c

[quote]Originally posted by Sandpaper:
<strong>Hmmm...just an observation, but the lengthy dissertation above seemed to have been written by two people -- the first with the broken English and all, and the second half came from a piece of literature vomitted by the AANA. :)

Regardless, it's all horse****. Only knuckleheads will attempt a comparison between a CRNA and an MDA. Over the past year that I've shadow an anesthesiologist, I've often witnessed stupid attempts by CRNA to provide "quality" care to these poor helpless patients. They push drugs without appreciating the underlying physiologic and pharmcologic mechanisms. Further, in a surgical patient rife with medical complications, a nurse is hard pressed to understand the pathophysiologic principles behind the illnesses to correct and manage difficulties encountered during surgery.

As I've said before, any comparison between the two groups rests on the premise that they are on equal footing. But they're not. Given a choice, a patient would choose a MDA in a hearbeat.

And why the hell are we discussing CRNA's salary in this forum!? Take that junk elsewhere.

Have a lovely day.</strong><hr></blockquote>


Sandpaper, I'm hoping I simply misunderstood your comments. You seem to wage sweeping and highly deragotory remarks about my point of view. I believe my opinion was respectful and knowledge based. The literature I quoted was from University of Pennsylvania study. MR WSU seemed to be sharing clippings from a nurse aneshtetist site. The study I quoted was not garbage. I am hoping that these comments were not directed at me.

[quote]Originally posted by smokinjoe:
<strong>now, now, ladies and gentlemen, lets simmer down some. I just wanted to know what informed people thought about the recent increase in CRNA salaries and the associated increase pressure of the AANA to push for unsupervised practice. Is it true that insurance companies would encourage the use of the low cost anesthesia-CRNA provider to reduce their(insurance CO.) costs? Despite the liability, is this the future direction of anesthesia healthcare?

c</strong><hr></blockquote>


Without a doubt, insurance companies will do whatever they can to lower costs, patients be damned. The problem is that the hospital will not permit this. This is why the anesthesiologists role is so important. They keep the patient alive in often very harrowing instances. No reputable hospital will permit nurses to administer life preserving medication without any meaningful kind of physiologic/pharmacologic knowledge. These hospitals would close very quickly.

Substituting nurses for md's in this fashion is tantamount to permitting janitors to perform neurosurgery. Neither one has the skill or knowledge to function autonomously. Both might temporarily save you money on the operation, but morbidity and mortality would skyrocket along with malpractice and litigation.

Disclaimer: I am not an anesthesiologist, and don't play one on TV.

Klebsiella, you are preaching to the choir!!! Amen brother!! And I think sandpapers point is also very valid.

I THINK PEOPLE (patients) should be WELL AWARE of who is providing their anesthesiology! I will wear a tag (in a few short months) of Dr. ____...each of my patients in the ED will know whom to thank or to blame. When a patient enters surgery, they have EVERY RIGHT TO INSIST UPON PHYSICIAN CONTROLLED ANESTHESIA.

I know at the hospital where I work we have 40 CRNA's and 4 MDA's the CRNAs are the only ones in the OR the entire time. The CRNAs push the meds they want to push. The only thing the MDAs do at our hosptial is sit on their rears and do paper work all day. They are also there if an anesthesia consult is needed.

For those of you who are still med students or residents. You will have to change your attitude about CRNAs or you will not make it in your practice. CRNAs and the MDAs must learn to work together. I'm a Scrub nurse and it's been my obseration that the CRNA is NOT the one causing the problems. It's the MDA who is upset because the CRNA's are stepping on "Their side" In fact, for those of you who don't know, Nurses where the first group to give anesthesia.

And to the poster who said that patients would opt for a MDA in a heart beat. That's not be my observation either. Most of the patients and the hospital where I work are fine with having a CRNA give their anesthesia. It's explained to them who don't know what they are. They are nurses with graduate training in anesthesia. They are fully capable of running cases by themselves UNDER THE SUPERVISION OF THE OPERATING SURGEON.

On a final note, can we please act like 1/2 mature adults and QUIT discussing this topic? J\W

And for those of you wondering, i'm on my son's screen name. He's planing on being a CRNA. Please don't flame me because of my post; i'm just stating my point.

Thanks,
Pat

[quote]Originally posted by meandragonbrett:
<strong>I know at the hospital where I work we have 40 CRNA's and 4 MDA's the CRNAs are the only ones in the OR the entire time. The CRNAs push the meds they want to push. The only thing the MDAs do at our hosptial is sit on their rears and do paper work all day. They are also there if an anesthesia consult is needed.

For those of you who are still med students or residents. You will have to change your attitude about CRNAs or you will not make it in your practice. CRNAs and the MDAs must learn to work together. I'm a Scrub nurse and it's been my obseration that the CRNA is NOT the one causing the problems. It's the MDA who is upset because the CRNA's are stepping on "Their side" In fact, for those of you who don't know, Nurses where the first group to give anesthesia.

And to the poster who said that patients would opt for a MDA in a heart beat. That's not be my observation either. Most of the patients and the hospital where I work are fine with having a CRNA give their anesthesia. It's explained to them who don't know what they are. They are nurses with graduate training in anesthesia. They are fully capable of running cases by themselves UNDER THE SUPERVISION OF THE OPERATING SURGEON.

On a final note, can we please act like 1/2 mature adults and QUIT discussing this topic? J\W

And for those of you wondering, i'm on my son's screen name. He's planing on being a CRNA. Please don't flame me because of my post; i'm just stating my point.

You are correct to say nurses and physician should get along. Your comments about the physicians who 'sit on their rears and do paper work all day' is highly derogatory and downright insulting. CRNA's function as professional babysitters who can perform quite a bit of procedural medicine including medical dispensation under the aegis of the physician. They can do this because they have done it a million times before and are well acquainted with the algorithms. They have this ability because the physician knows what they can and cant handle.

You should be very proud of your son. A nurse is a very important part of the team. But they must realize their limitations. A CRNA is a nurse nonetheless. Arrogance breeds trouble for the team and the patient.

Thanks,
Pat</strong><hr></blockquote>

The only thing I will flame you for is demanding we end this topic for discussion despite the fact you yourself perpetuate it. A bit hypocritical wouldn't you say. In any case, I appreciate your very personal attachement to the CRNA profession.

I am certainly not saying that they are not valueable members of the TEAM. The problem is that CRNA's are team members, subordinate ones at that. Whatever you call their training 'graduate nursing', it aint an MD. Not even by a long long long shot. They are nurses with more training, period. They operate under the aegis of the physician, largely having minimal understanding of what they are doing. It's not that they are dumb, it's that their training isn't nearly long enough or comprehensive enough to impart this kind of knowledge.

[quote]Originally posted by meandragonbrett:
<strong>I know at the hospital where I work we have 40 CRNA's and 4 MDA's the CRNAs are the only ones in the OR the entire time. The CRNAs push the meds they want to push. The only thing the MDAs do at our hosptial is sit on their rears and do paper work all day. They are also there if an anesthesia consult is needed.

For those of you who are still med students or residents. You will have to change your attitude about CRNAs or you will not make it in your practice. CRNAs and the MDAs must learn to work together. I'm a Scrub nurse and it's been my obseration that the CRNA is NOT the one causing the problems. It's the MDA who is upset because the CRNA's are stepping on "Their side" In fact, for those of you who don't know, Nurses where the first group to give anesthesia.

And to the poster who said that patients would opt for a MDA in a heart beat. That's not be my observation either. Most of the patients and the hospital where I work are fine with having a CRNA give their anesthesia. It's explained to them who don't know what they are. They are nurses with graduate training in anesthesia. They are fully capable of running cases by themselves UNDER THE SUPERVISION OF THE OPERATING SURGEON.

On a final note, can we please act like 1/2 mature adults and QUIT discussing this topic? J\W

And for those of you wondering, i'm on my son's screen name. He's planing on being a CRNA. Please don't flame me because of my post; i'm just stating my point.

Thanks,
Pat</strong><hr></blockquote>

One other point you may or may not be aware of. Nurse anesthetists work for the physicians typically. There is a growing number of practices that have moved to exclude them altogether because of the strife between the two professions. If anesthesiologist opt for this arrangement, the good life CRNA's are currently enjoying may suddenly become a pipe dream. Realize that anesthesiology is one of the hotter fields this year, and pumping out 1000+ a year will limit the need for CRNA's.

is medical care trending toward a decrease in quality-that is, cheaper healthcare in the larger spectrum of HMO's. Will CRNA's end up working directly for hospitals as their escalation in salary outpaces the salary increase of anethesiologists? What will the future hold?

First of all most "lay" people do not have a clue about exact level of expertise of CRNAs vs Anesthesiologists. In fact most people do not ask who will be their anesthesiologist. This is shame because the anesthesiologist is just as important as the doctor doing the surgery. Also I would rather the CRNAs be supervised by an attending anesthesiologist rather than any surgeon who does not do critical care (SICU) day in and day out. Lastly, if it was my family or me under the knife, no way would I let a CRNA lay a hand on us, even if this costs us a little bit more $. In my opinion, it is well worth the extra $ to have a good anesthesiologist there and I will pay if necessary to have them be there. When/if the crap hits the fan, I want the anesthesiologist to have been monitoring my case every step of the way.

One of the previous posters stated that they had 40 CRNA's and only 4 MD's in their hospital and all the MD's did was sit on their butts.

They also stated that MD's are only used for anesthesiology consults........I assume difficult airways, crashing patients, tough cases etc....

Doesn't this mean that MD's are absolutely necessary for CRNA's to practice? If the 4 MD's weren't there who would do the anesthesiology consults when the CRNA couldn't do something?

later

I don't think it follows that more training equals less mortality. The argument put forth seems to be just that, that more training, by necessity, will lead to fewer deaths. Zero supporting evidence is supplied. I can't really say anything about the literature, but if one of the study's authors states that the paper does not compare effectiveness between CRNAs and MDAs, then we shouldn't use the paper in that way. I'd wager, also, that the notion of cost-effectiveness it absolutely important, even to "real" hospitals. I would be very surprised if hospital/HMO bean counters across the nation weren't calculating the number of additional deaths due to whatever differences there may be between CRNA and MDA care that would be financial accptable, balancing salary savings versus lawsuits and PR. In this healthcare market, it's naive to think hospitals and HMOs are going to do the "safer" thing regardless of cost. That said, I'd sure as heck want an MD in charge of that aspect of my care. Weird.

Let's get some things straight. Anesthesiologist have much more training than CRNAs. Anesthesiologist on average are (much) smarter than CRNAs hands down on any test you give related to intelligence and anesthesiology. Anesthesiologists have to worry about malpractice. I have NO doubts that the average anesthesiologist would provide (much) better care than the average CRNA especially when things go bad.

Anesthesiologists are well worth their price. If it ever got into the papers that a particular hospital crunched the numbers to save a few bucks on personell costs vs dollar value from morbidity and mortality law suits, that hospital would be sucked dry by the lawyers (and they will use all means necessary to prove this... just look at the Ford Pinto case). The hospital would learn and re-"think" its position in the future on CRNAs.

Lastly, I believe in the use of CRNAs if there are a shortage of anesthesiologist in your area to handle routine and uncomplicated cases, but that's it. And if you asked 99 out of a 100 surgeons, ICU doctors, and/or ER docs (non-anthesiologist as they do not have a vested interest), they would agree with the previous statement.

cchoukal,
No paper shows that PAs who assist surgeons create any additional morbidity or mortality for patients. Does that mean a medical training is unnecessary for outcomes dealing with surgical services? You don’t pay an anesthesiologist to just deliver a nice bundled up service. You pay him or her to have the knowledge and skill to handle life-threatening situations. If you think medical school and an anesthesiology residency are unnecessary to protect against and solve these problems (and thus lower mortality) then I question your understanding of medical training altogether.

although there is not any literature that directly compares patient outcomes in comparision with a crna vs. mda.

i would think that the best approach is a team effort. although i have a deep respect for our counterparts (CRNAs) since they provide a great deal of aid to our patients, I believe that only through working as a team can the patient obtain the best, quality of care..

No, i'm not bashing MDAs or crnas. The previous post that I submitted may have appeared as such. I was displeased with the PA study since as a scientist I feel that its conclusions were weak and needed further analysis.

crnas and mdas should in most cases work as colleagues and as such have a mutual understanding, appreciation, and respect for both professions. they both bring to the patient qualities that are unique from each profession. without crnas, our work as mdas would be much more difficult to accomplish. so i don't think we should really say which is better than the other.

but, mdas bring an extra piece of knowledge, responsiblity, and greater scope of practice that crnas currently do not have. crnas provide us with the help that mdas need in accomplishing some of our day-day to tasks. i am very apprecitave of our crnas and respect both professions very highly.

although there is not any literature that directly compares patient outcomes in comparision with a crna vs. mda.

i would think that the best approach is a team effort. although i have a deep respect for our counterparts (CRNAs) since they provide a great deal of aid to our patients, I believe that only through working as a team can the patient obtain the best, quality of care..

No, i'm not bashing MDAs or crnas. The previous post that I submitted may have appeared as such. I was displeased with the PA study since as a scientist I feel that its conclusions were weak and needed further analysis.

crnas and mdas should in most cases work as colleagues and as such have a mutual understanding, appreciation, and respect for both professions. they both bring to the patient qualities that are unique from each profession. without crnas, our work as mdas would be much more difficult to accomplish. so i don't think we should really say which is better than the other.

but, mdas bring an extra piece of knowledge, responsiblity, and greater scope of practice that crnas currently do not have. crnas provide us with the help that mdas need in accomplishing some of our day-day to tasks. i am very apprecitave of our crnas and respect both professions very highly.

wsu,

I agree the team approach to anesthesia care is the best way to go. I think having nurses in the university setting is especially attractive to me. They can provide their service during simple procedures in low risk patients so that residents can get the best training in the medically relevant cases.

I interviewed at Penn and talked to Dr. Longnecker (Chairman of the Department of Anesthesiology) about his Pennsylvania study. He does believe the study shows some benefit of having an MD controlling the cases. We also discussed that the ultimate study would be an adverse outcome one comparing anesthesiologists to CRNAs. The problem with it would be that the mortality and morbidity would be so much higher in the CRNA group that the study would have to be stopped. In any case, if you are ?displeased? with the Pennsylvania study I?m sure Dr. Longnecker would discuss it with you. If you need a study to prove that your education provides you with better tools to take care of patients than CRNAs, you should ask yourself why you went to med school and why you are going into the field.

?so i don't think we should really say which is better than the other.? -wsu
What?s your definition of better? If better means the highest level of patient care possible, we really should say who is better. If we analyze better from a politically correct perspective then who knows what anyone is taking about.

?mdas bring an extra piece of knowledge, responsibility, and greater scope of practice that crnas currently do not have? - wsu

Medical school and a residency in anesthesiology aren?t gaining just an extra piece of knowledge. It?s a volume of knowledge. By your statement it sounds as if the training of the CRNA is somehow in the future possibly going to morph into some sort of medical education. Not going to happen.

Wow...I leave for interviews and a riot breaks out..you guys are killing me,

Ok...this argument seems to be as eternal as the chicken and the egg. Aneshesia33 I met with Dr. Longnecker as well (interviewed at Penn this weekend), and he stated basically the same things. My personal belief is that to justify allowing nurse anestesists to run their own cases would require greater training on their part (ICU/Critical Care, etc.), more school (a few extra years at least), and access to truly sick patients (you know the ones I mean...inner city...multi-organ pathology...absolute medical nightmares). I don't disagree that CRNA's serve a role...and that the care team in the end is the best concept (both financially and in terms of reality). I used to date a CRNA (gorgeous girl, really smart...ended up marrying some stock broker dufus...totally pissed me off), and one of the points she always made was (and in my mind this is what the majority of CRNA's believe), "THE AUTONOMY WOULD MEAN I WOULD HAVE TO HANDLE EVERY CASE...INCLUDING THE SICK ASS PATIENTS THAT ARE TRULY DIFFICULT TO MANAGE...I WOULD NEVER LEAVE THE HOSPITAL". Monetary compensation has it's price...that's the whole point of life. Nothing is for free, and in the end I would warn the vocal minority of CRNA's to be careful what they wish for...they just might get it. And ladies and gentleman, I don't know if it's apparent to anyone else...BUT THERE IS A FRIGGIN NURSING SHORTAGE THE LIKES OF WHICH HAS NEVER BEEN SEEN. I mean across the board guys...even CRNA's..it's ugly. Nobody wants to go into the field anymore...and it'll be an even tougher recruit when they have to increase their schooling and standards to qualify. The point that it costs ten times the cost to train an MD is true...but if the CRNA's have it their way...that won't be the case. Their cost to benefit ratio will drastically change. It's a tough argument no matter who you slice it...other than to realize the silent majority of MD's and CRNA's have just been working together. They don't care about autonomy, and rights etc. They all want to get compensated, and they want to get the work done. The best commentary ever on this subject I recieved this weekend from an MDA who used to be a CRNA and has literally been on every board of both fields. And his comment said it best...'THIS USED TO BE A FINANCIAL ISSUE WHEN I WAS A CRNA...BECAUSE ANESTHESIOLOGISTS WOULD BOOK 300,000 FROM A COLLECTION OF CASES AND GIVE THE CRNA'S 13,000 DOLLARS FROM IT. NOW, THEY BOOK 300,000 AND A 100,000 GOES TO THE SAME CRNA'S. This is the best they've ever had it financially, as we MDA's are out there humping it and getting cases for our team so that every one can make money and be profitable. Even if CRNA's get autonomy, the financial changes will be minimal. They make that same money now, because we are all now being paid by the same provider. The need for autonomy is a retarded argument, and the only thing about it that's tough is that CRNA's want autonomy in cases where their level of training just isn't high enough to handle negative outcomes. If they get what they want...they'll regret. Coming from a former CRNA's mouth...I know what it'll be like. Very...very...ugly. Add another three to four years training in critical care and basic sciences. Is it still worth it too study as long as a physician for a nursing degree?". Couldn't be more succint...that is basically the argument. Part of a care team...great. I hope everybody in the end gets what they want. A direct fight against MD's maybe a tough battle to win, and sorry CRNA's...but the amount of money that was there in the 80's we don't see anymore...what you're making now...is what you'll make in the future. It's a damn great...salary, and I would be pretty content with it. But then again, what the hell do I know...I'm just an MD. Good luck everybody...I through talking about this shizzz. JUST WANTED TO GO OUT IN STYLE.

Late

can anyone explain why CRNA salaries have risen 60% over the past 15 years and why? Where will their salaries be ten years from now?

While all these things being said are true (bad things happen and you want someone who knows what's up to handle it, etc.), if those extra years of MD training were all that important, you'd think there'd be some improvement in morbidity and mortality relative to the CRNAs. Of course S*%T goes down in the OR, but if it wasn't being handled with CRNAs at the helm, there should necessarily be a higher mortality for those folks. I agree that, intuitively, you'd think MDs would be "better" at it, but the research seems to show that they aren't killing any fewer patients than the CRNAs. Funny; they just paged Anesthesia, STAT, overhead...

cchoukal,

?That said, I'd sure as heck want an MD in charge of that aspect of my care. Weird.? Couldn?t say it better myself Friend. And thank God the general public believes that the more training you have at something the better you are at that something. How dare they use logic!

As a current transitional intern going into anesthesiology, I like Klebsiella, have a problem w/ WSU's statements concerning CRNA's.

WSU says that an MD'A (i.e anesthesiologist) is 10 x more expensive to train than a CRNA. Yet, he/she believes that the CRNA is equally as qualified to provide the same quality and safe care. Now, how can it be? Why would medical schools and SOCIETY AND THE GOVERNMENT in general bother to train some schmuck like myself, 8 years of medical school and residency and 4 years of college, vs. the CRNA's nursing school and TWO years of CRNA school so that I can provide the SAME care that a CRNA, WHO is 10x cheaper to train and 3-4x less expensive!!! If you ask me, SOCIETY (not the insurance and HMOs, might you), must think that the PHYSICIAN can do a better and safer job of providing to anesthesia.

My second point is, who made all the advances that made anesthesia as SAFE as it is now? CRNAs will all reply how it was nurses that started to practice the majority of anesthesia initially. But, can they refute the fact that its PHYSICIANS who did the research and provided the hard work leading to advances into safer and more effective anesthesia. Also, it was physicians who discovered anesthesia and pain control. It really burns me that the CRNA's directly benefit from the work of our past anesthsiologists. YET, now they are say they are just as good as us and some want to get rid of us doctors altogether! I have nothing against working in harmony w/ CRNAs, but when they are saying they are just as good as me and so forth, I begin to roll my eyes.

For those who do not know, Mr. Clinton's mother was a CRNA. Senator Spector of PA who introduced the CRNA independence bill that Clinton passed was HEAVILY funded by the CRNA association.

Also, I have talked w/ CRNAs. There appears to be 2 major groups. There's one group who believe they are just as good as anesthesiologists and believe they should practice independently. They are the VOCAL group. Then, there is another group who believes that they work best WITH an anesthesiologist and they are CONTENT w/ our current HARMONIOUS setup of the anesthesia-team, which I am clearly a proponent of.

:laugh: :laugh: Sorry fellas (& gals, if applies) but your averages for CRNA salaries is WAY off base. I don't know where you all are, but in Texas the average starting salary for a new grad CRNA is between $120,000 & $150,000 for the metroplex area (Dallas/Ft. Worth/Austin/Houston/San Antonio). As you go more rural, such as areas like Temple, Tyler, and South Padre the amount increases by $10,000-25,000. Even in these areas there are still MD's on staff and call is rare. For the really remote areas where the CRNA is most independent salaries range from $160,000 to $220,000 +. It isn't rare for a CRNA to make above $150,000 and becoming less rare for one to make $200,000+. Some states, such as Georgia, are offering between $200,000 & $300,000 (I just spoke to a recruiter about one of these positions yesterday). Obviously MD's make a ton more money, and yes, have a much greater education base. But, I disagree with the gentleman who wrote that CRNA's treat by the "vital signs" rather than the pathophysiological basis of anesthesia administration. Our programs (which are all master level programs) have INTENSE training in pathophysiology, chemistry, etc. In fact, the professors who taught my program also taught for the local medical school and all swore that our curriculum was almost as intense. So, CRNA's are much removed from just the standard RN. Our level of expertise is extremely high and we are very adapt at line placement (central and arterial) and epidurals, as well as the administration of anesthetics. :) By the way, I know tht medical school is VERY expensive, but don't underestimate the cost of a CRNA program my friends (try loans exceeding $145,000). Also, the program is almost 3 years long, not 2. AND, in order to even qualify for the program you must have critical care experience AND pass an oral interview where you are seated in front of a panel and bombarded with critical care questions ("here's a blood gas, here are the hemodynamics, now diagnosis and treat the patient....gee, looks like metabolic acidosis to me stemming from lactic acidosis from poor tissue perfusion from the hypotensive state....blah, blah, blah....that was one of my actual interview questions and answer). Gee, maybe all CRNA's aren't dummies after all, huh? UNLIKE medical students who become residents and have basically NO critical care experience, and face it fellas, how many of you HONESTLY will admit that a critical care nruse saved you from complete ruin a time or two during your residency? Now, be honest..... Ok, so my point is valid. NO WAY do I have the training or expertise that you guys do, hands down. But I am MUCH more qualified than just dealing with low-key easy cases. In fact, I routinely work neuro cases, which was my specialty prior to becoming a CRNA. We, MD's, DO's, and CRNA's, each have our own place in this game and each of us has earned our right to be here. I know that every surgeon I've ever worked with has told me (save for one) that they are just as comfortable with a CRNA on the case as the MD/DO. Not that I am better, just different. I realize my own limitations, I know when I need help, and yes, I do call into the doctors lounge on occassion and request back up.:

OK buddy - did you realize this post was from 2001????

I can tell you that the days of a CRNA making above 100K are limited. As health care spending is cut across the board, payers (ie insurance/Medicare) are going to realize that CRNAs are still nurses. CRNAs making above 200K is likely going to end much sooner. As the job market becomes saturated (CRNA schools are churning them out) the number of jobs will decrease and CRNAs will be willing to work for less. Add into that the fact that many MDAs are going to be taking pay hits, WE will all be taking those 200K jobs.

I have utmost respect for CRNAs but, I really don't understand why you guys are always trying to prove yourselves equal. The bottom line is no matter how hard you try you are not. We are all there to take care of the patient but, we all have a role and the MDAs are to supervise the CRNA. That is because MDAs are more educated and have more experience.

Great - your debt is almost as much as ours. Why wouldn't you just go to medical school then?

Great - you have almost the same education as us MDs. Try again. 2 years for AA, 2 years nursing school, 1 year ICU, 2 years CRNAs is no where near the 12 - 13 years of school MDAs have (4 years undergrad, 4 years med school and then 4 - 5 residency/fellowship). There are so many extra training hours the MDAs has to endure that the CRNA doesn't. Still, it really doesn't matter b/c the people who are paying the bills are going to dictate who does what cases and how the MDA plays a role.

You are right, a nurse has saved my butt in the ICU once (even though I was a med student she saved me from looking like a dummy in front of my fellow) but, this was at 3 in the morning. She had all day to sleep while I was at the hospital from 6am the previous morning. ICU nurses are some of the best but, they have a different knowledge base.

I'll tell you what - both my mother and my aunt are nurses. I have a lot of friends who are nurses but, I would NEVER let a nurse be in charge of my anesthesia. If I were to code (unlikely) or something bad were to happen (with my ASA 1 self) I would MUCH, MUCH, MUCH rather have a MDA making the vital decisions! Eventually we (both me and my MDA colleagues) will finally figure out how best to educate the public about this whole issue so they can decide who should be in charge.

I don't want to be the attending that sits around and reads the newspaper; I actually detest those who do. I will work hard and I will make sure that every single one of my patients understands the difference between a CRNA and MDA so they can make their own decision about who should be in charge of their anesthetic.

This is an old thread, but I'll post anyways.

You MDAs/docs are really myopic. Open your eyes. Take a look around. A rural hospital that used to have 5 MDAs on staff and 10 CRNAs now has 2 MDAs and 15 CRNAs. Make of that what you will.

OK buddy - did you realize this post was from 2001????

I can tell you that the days of a CRNA making above 100K are limited. As health care spending is cut across the board, payers (ie insurance/Medicare) are going to realize that CRNAs are still nurses. CRNAs making above 200K is likely going to end much sooner. As the job market becomes saturated (CRNA schools are churning them out) the number of jobs will decrease and CRNAs will be willing to work for less. Add into that the fact that many MDAs are going to be taking pay hits, WE will all be taking those 200K jobs.

I have utmost respect for CRNAs but, I really don't understand why you guys are always trying to prove yourselves equal. The bottom line is no matter how hard you try you are not. We are all there to take care of the patient but, we all have a role and the MDAs are to supervise the CRNA. That is because MDAs are more educated and have more experience.

Great - your debt is almost as much as ours. Why wouldn't you just go to medical school then?

Great - you have almost the same education as us MDs. Try again. 2 years for AA, 2 years nursing school, 1 year ICU, 2 years CRNAs is no where near the 12 - 13 years of school MDAs have (4 years undergrad, 4 years med school and then 4 - 5 residency/fellowship). There are so many extra training hours the MDAs has to endure that the CRNA doesn't. Still, it really doesn't matter b/c the people who are paying the bills are going to dictate who does what cases and how the MDA plays a role.

You are right, a nurse has saved my butt in the ICU once (even though I was a med student she saved me from looking like a dummy in front of my fellow) but, this was at 3 in the morning. She had all day to sleep while I was at the hospital from 6am the previous morning. ICU nurses are some of the best but, they have a different knowledge base.

I'll tell you what - both my mother and my aunt are nurses. I have a lot of friends who are nurses but, I would NEVER let a nurse be in charge of my anesthesia. If I were to code (unlikely) or something bad were to happen (with my ASA 1 self) I would MUCH, MUCH, MUCH rather have a MDA making the vital decisions! Eventually we (both me and my MDA colleagues) will finally figure out how best to educate the public about this whole issue so they can decide who should be in charge.

I don't want to be the attending that sits around and reads the newspaper; I actually detest those who do. I will work hard and I will make sure that every single one of my patients understands the difference between a CRNA and MDA so they can make their own decision about who should be in charge of their anesthetic.

I'm not expert of anything whatnot - but maybe you need to be perfectly SECURELY rich and securely sane 'till the day you die. Because I've seen many professionals in their 70's - 90's (former doctors, lawyers, former succesfull businessmen) who are in nursing homes and they don't look happy at all. Do you think you'll always be in control of everything?

I won't mind a CRNA. As long as they are trained on what they do.
I also understand that CRNA's are not allowed to do complicated cardiac cases (?). Then they utilize MD's (?).

What if you were in an accident in a small town somewhere...... - and the Emergency hospital only has a CRNA?

Now what - you're going to educate this small town ER regarding the difference between an MD and CRNA???

goodluck......I don't mean to be harsh.....But what can you do if a CRNA has to take care of your anesthesia??????

I have a couple observations to throw in here...

1) It seems like several threads in this forum start with an innocent (or in this case a trolling-undertone-laden) question, and it rapidly digresses into a CRNA vs Anesthesiologist battle. Why do we keep letting our conversations turn from productive to completely unproductive and downright hurtful??

2) What's up with WSU? In his/her first response on this forum, he signed it with a name followed by "MD." Later on, he/she started indicating that he/she deeply respected Anesthetists, and then finally just started citing CRNA rhetoric/propaganda.

3) Someone made the observation that there are 2 camps of CRNA's - those who want independent practice, and those who want to work harmoniously with Anesthesiologists. It's a solid observation - once you're in residency/practice, you will hear the former referred to as "militant." These are the people who, somehow through training and their experiences, have become progressively more jaded and twisted to the point where their professional purpose shifts from patient care to lobbying lawmakers. And along with that thread, their training was in effect completely cost-ineffective because they no longer contribute to patient care. So they pretty much short-circuit their own argument that CRNA's are more cost-effective. Oh yeah, what do I call the latter CRNA (who works well with Anesthesiologists)? "Successful." They understand that we're all just here to do our jobs. Don't make waves and piss people off. Everyone goes home with a very nice paycheck. If you don't like the practice, find one better suited to you rather than making the work environment unpleasant (and unsafe) because you're too busy writing emails to your congressman while your patient's BP is 60/20. But this is a double-edged sword, folks. You're going to come across plenty of Anesthesiologists who do the same thing. So it's just not the CRNA's who are busy screwing the other side. That being said, CRNA's seem to be actively lobbying to decrease the current practice of Anesthesiologists, while Anesthesiologists are just lobbying to keep things teh way that they are. Case in point, CRNA's lobbying to limit the number of residents an Anesthesiologist can supervise (2) despite surgeons' ability to supervise 4. Anesthesiologists were lobbying to give parity to Anesthesiologists. However, the AANA decided to spend money to lobby against anesthesiologists, stating that this would hurt SRNA's. That's just plain-old dirty, and quite frankly, unprofessional. The Anesthesiologists weren't even doing anything to CRNA's - they were just trying to keep an even playing field with surgeons. I'm sure there are probably examples of Anesthesiologists somewhere trying to limit a CRNA's practice, so don't jump down my throat - I'm just telling you what I know, and this particular fact is the truth.

4) Don't get your panties in a bunch when a militant CRNA tells you that the starting salary is $x in [name your location here]. Next, they'll be telling you that they got a 10 billion dollar signing bonus, a private jet, and an unlimited supply of Twinkies. They're just trying to piss you off, make you jealous, and deter undecided medical students from going into the field. The fact of the matter is that Anesthesiology is becoming far more competitive because med students are realizing what an attractive field it is. Gone is mid-90's scare. Gone is the huge influx of FMG's into the field (no offense, there are very good FMG's - but the fact remains that you are a lot less likely to lobby in congress and fight for your rights when you are worried about your visa status and whether you'll get deported for making waves). The simple truth is that is a very large supply of bright, motivated med students entering and now graduating from Anesthesiology residency programs, and that will just serve to strengthen the field for future generations and undo the damage that was created about 10 years ago.

5) There was someone who posted saying that he was a TY resident just getting ready to start residency in Anesthesiology. Good for you - it's a great field. Keep your head up, work hard, play harder, and there will be bountiful payoffs. If your program does have CRNA's, your hours will be better, and you will learn some tips from old pros on how to do things. Just because there are a few bad eggs in the bunch who like to try and scare you away (like on this forum), there are a ton of very good CRNA's who are very willing to teach you the ropes and show you shortcuts that you can take. Just because CRNA's may not have the same clinical and pre-clinical knowledge as you does not mean that they do not understand the art of anesthetic care. As a resident, it's your job to learn how to put someone to sleep and wake them up safely. But waking them up smooth and looking good while you do it is an art - something that a lot of CRNA's I know do a hell of a lot better than a lot of Anesthesiologists (who supervise) that I know. But these statements are all generalizations - independent results will vary.

6) Salaries ---- do your job. You'll be paid well, CRNA or Anesthesiologist. You'll make a ton more than the national average income. That's all there is to it. If you work harder, you'll make more.

7) Don't fall into the habit of referring to an Anesthesiologist as an "MDA." I'm glad to see on this forum that this term is starting to fall out of favor. That's an old term used by seasoned militant CRNA's that caught on. All it serves to do is to liken your field to a CRNA's.

Hope this helps anyone who cared to read all this crap. Time to eat some twinkies. I have a lifetime supply.

Time to eat some twinkies. I have a lifetime supply.
Gee thanks, I spewed my half-chewed Twinkie all over the monitor after reading this because I was laughing so hard! :laugh:

Great post by the way. :thumbup:

Voodoo,

your statement that its just a handful of CRNAs pushing this agenda is flat out wrong. Yes, its a small vocal group that gets the most attention but bottom line is that the VAST MAJORITY of CRNAs want what the AANA lobby is pushing, or they wouldnt be supporting their PACs with all that money.

You hook up all CRNAs nationwide to a lie detector test and ask them if they favor the AANA's lobbying for independence and 99% of them will say yes. They might not say it to your face and they might not make waves about it, but money talks and bull**** walks and you can rest assured they are supporting thier local PAC in fighting against MDAs.

... and I certainly appreciate your standpoint. Just be careful not to become equally twisted and hateful as the militant CRNA's, or you'll find yourself losing revenue one day because you, too, will be furiously emailing your congressman. That's all I'm saying.

I'm just saying that in my experience, the attitude I've portrayed a couple posts ago will keep you friends with CRNA's and Anesthesiologists alike.

I honestly don't know what response 99.9% of S/CRNA's would give posed the question of independent practice. I guess I don't really care. If you asked 99.9% of custodians whether they're rather be the CEO of the company that they're mopping the floor of, they'd probably say yes. Please don't get me wrong, it's not that I'm not concerned. It's just that I know what the end result is, I give support in my own little way, and then I just sit back and watch the show.

p.s. I loved the time when you built the flamethrower and killed all those poisonous ants.

ABGs, hemodynamics, lactic acidosis? im not trying to be argumentative here, but those, child, are concepts that second year medical students are well versed in. some pH down, bicarb down, blah blah blah- when i went through interviews for residency, we weren't asked questions such as those because it was a GIVEN that we would be able to analyze those. when i went through fellowship interviews, it was a GIVEN that i knew, after 8 years of medicine, how to interpret such BASIC values.

Working as an ICU nurse for a year- yes, you had better know how to interpret basic ABGs because you will know the minute to minute changes on your patient the best....but then what? You call the intensivist, because it takes some medical school, residency, and fellowship experience to MANAGE patients- not based on what orders were carried out on the past 10 similar patients, but what must be done with THIS patient.

I think mid level providers and CRNAs are great. Most that I've worked with would never consider themselves to be at the expertise of an anesthesiologist, just as most NPs and ICU nurses would never consider taking over the MANAGEMENT of ICU patients from physicians. There are a few CRNAs that certainly believe themselves to be more qualified than they are during routine cases, but the rigorous training difference between getting into medical school vs nursing school, surviving medical school vs. nursing school, working as a resident vs. a nurse, and this whole time building skills to manage a patient versus provide good nursing care cannot be underestimated. We provide such valuable roles as a healthcare team, with our roles clearly defined- not for the purposes of egos and pride, but for the safety of patients.... so when you are on your own, feel free to wear long coats and introduce yourself as the person who will be in charge of anesthesia- whatever you need to do, please do it. But do not think when a patient's BP starts tanking and an arrhythmia comes up that you spent those rotations on cardiology managing patients as your anesthesiologist did. Please just swallow your pride and give a call out for the deeper level of expertise and management. Bottom line- R.N. + CRNA + even put a Ph.D in there too, but it does not equal an M.D. or D.O. And I hate to sound so mean, but its true.

By the way, this is only in response to eutopiaCRNA. Real world people- anesthesiologists/ intensivists, CRNAs, NPs- for the most part we have a blast in and out of the OR and ICU..

I always love it when people say "I knew xyz before you did so I'm better qualified". Its such a falicious arguement. Who cares what I do or do not know about anesthesia before residency. Its what I learn during the reisidency that matters. No one cares whether you were CRNA for 12 years before medical school or went strait from college w/out setting a foot in a hospital. On day 1 of your residency, everyone is on the same footing and we're all expected to perform @ the same level when we're done. No amount of previous experience can make up for the years of residency. Period, end of story, move on.