DO vs CRNA
 

Hey all,

Just wanted some advice on which made more sense for me. I did an undergrad degree at an ivy league school but didn't take any of the prerequisites aside from organic chemistry, where I made a C-. I decided to do an accelerated nursing program in nursing, where I made a 4.0. I want to be more than just an RN, but I think there isn't enough standardization in NP programs and they don't go into enough depth for me. CRNA programs, on the other hand, are very specialized, and they have more classroom based anesthesia training than anesthesiologists. I like anesthesia, and would likely even pursue it if I'm a doctor. I'd rather be a doctor, admittedly, because I would be trained in things other than anesthesia - a whole body approach...but im just not sure it makes sense for me and I was hoping for some advice.

To finish pre-reqs and necessary experience I would likely apply to start Fall 2014 for either path. For CRNA I'd be finished in around 2016 or 2017. I could then work right away and begin paying back loans, with a starting salary around $130,000. If I choose DO I would finish in 2018 and still have to do residency. That would take me into 2021 and beyond at a low salary and long hours...and if I end up doing general medicine (I am keeping my options and mind open) I would likely make right at the same salary....but still I would be a doctor and maybe all of that is worth it for that level of education.

Advice? Others choose DO over CRNA?

Thanks in advance!

If you already have all the RN experience required to pursuit a CRNA program and you're dead set on anesthesiology then go for it. Going to a DO school will not only be more than twice the amount of education...it won't guarantee you'll match into an anesthesiology program. That being said, if you did go to med school and did well enough to match into anesthesiology, you would make more than twice what a CRNA makes.

So it comes down to a safe bet (get to do anesthesia, make a good salary) versus a more risky but possibly higher paying bet (may not get into anesthesia, could end up spending way more time to make less money and do something I don't enjoy as much....but could possibly end up doing the SAME job with more money). Of course theres also the fact that I'd rather be a doctor....and I'm not dead set on anesthesia. I like derm and ob/gyn too...hmm

Derm is even harder than Anesthesia. OB is easier but still not that easy. I think it comes down to how much do you want to sacrifice. When you do medicine, you have to give up a lot early on. CRNA isnt a bad gig and you'll have far less loans.

Be grateful you know now that you'd rather be a doctor than in 2017. Go DO, enjoy medicine, and see where life takes you. There are hundreds of specialties to choose from; one (or five) could be just what you've always wanted out of life. Just don't do it for the money.

Do everyone a favor and don't be a physician. Go get your CRNA and save people the trouble of seeing a grumpy doctor who only cares about income. You don't sound like you have the fortitude to become a physician if you're complaining about the schooling before you've even taken pre-reqs.

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Speak for yourself, please. The OP has a legitimate question.

Depends whether you wanna be the captain of the ship.....or an officer.

"Mrs. Jones, this is your anesthetist Dr...er....Mr. Myownpath."

No thank you!

Ah I expected a response like that - someone pretending they are high and mighty and only went into medicine for medicines sake. The truth is, if medicine was considered a service job and the salary was around 70K the vast majority of people on this board wouldn't even be applying. It's not "all about the money" as you say...but money is an important consideration with any career choice, otherwise you're just plain dumb. For me, healthcare is what I love doing, and I can't figure out if I should do it as a CRNA or a DO because of a variety of confounding variables, yes, including money. I'm asking for advice, not some completely out of line and off base judgement, so please don't post if you want this thread to devolve into that. How you decided I was 'grumpy' based on my question is quite the mystery though.

Haha that's actually one of my main issues. I want my patients to feel comfortable and know I know what I'm doing. Nurse anesthesists are well trained and studies have shown their anesthesia care to be equivalent...but the vast majority of the population doesn't know that and will hear 'this nurse is in charge of putting you under' :scared:

At the same time, as much as I think I'd rather be a doctor, it is a significant undertaking in every way - financially, emotionally, physically. We're talking 2 years of courses, applications, MCAT prep, etc, then 4 years of $50K+ loans, followed by deferring those while I work 80 hours a week at 10$/hr avg. By the time I have my loans paid off and can start enjoying my life and have nice things, I will be in my upper 30s or even 40s.

On paper the medical route seems horrible, and still I cannot get it out of my head. Deep down I know it would put me on a long, horrible, debt filled path...and yet still it's something I've always wanted. I have no idea what to do :/

This is SDN and asshattery runs rampant here....just let it roll off your back and keep it moving. Premeds tend to be douchebags and make douchebag comments. You are 100% correct, I sure as hell wouldnt have gone to med school if the salary was 70k....hell, i was making more than that working before med school. Nobody is going to spend 10 years post college in training for a shit salary.

How old are you? If you are like 21/22 I would vote that you take the prereqs and go the DO route. I started med school at 27...so its not really a big deal. Being older/experienced you have a much easier time in med school and its just way less stressful (in my experience). You are a nurse and that will help you significantly as well. Just being able to talk the talk is huge.

Like I alluded to in my last post....what type of person are you? I could never be a midlevel. And that is something I decided when I was applying to med school....if I didnt get in I was planning on leaving healthcare. I NEED to be the commander. I worked in healthcare long enough and was sick of taking orders. How would you feel about being "oh so close" yet still not a doctor? I know that would kill me.

Dont worry about salary, because even if you were a GP you would still be making more than 130k in most cases. ( I personally know 5 GPs who played the game properly and are all millionaires before age 40...multimillionaires at that). Medicine is a long road, but if its what you see yourself doing, dont take shortcuts like a midlevel program of some sort. You wont be happy in the long run.

Med school is a pain in the ass - it is a path fraught with sacrifice and uncertainty - but I have not met a doctor who would rather be a nurse or PA. If you want to be a CRNA, go for it. Do what you want, not what people tell you. Find your own risk/reward ratio.

The route is horrible bro...and I am in the thick of it right now. But its worth it. I have grown more as an individual and as a professional in the last 2 years than I had 5 years I was working before I started med school. Its a sucky, but very fulfilling journey. Like any tough experience in life it makes you realize how much of a beating you can take and keep coming back for more. Most people NEVER get to experience something like med school...and it truly is an honor.

And as far as CRNAs go.....I dont think I would allow a CRNA to run my anesthesia. Sure, they are great for routine things, but if SHTF I would want an actual physician there handling business. Lets not even get into the AANA and their shady tactics. As a practitioner its a great route for certain people.....but not for me. You are clearly scared of the commitment of being a physician(and with good reason, if you werent id be concerned you didnt think through things enough) and dont really want to be a CRNA but are just looking for the next best thing. Focus on the end....not the journey. Its obvious what you want to do.....so do it!

Thanks for your comments so far guys, it really is helpful to hear from other people. Like I said, it's not about which one makes more money, I just want to know I can be comfortable with either route. I've never heard a doctor say they would rather be a PA or NP but I HAVE heard them say they'd rather be a CRNA. One of my college friends had a father who was an anesthesiologist. The guy told me his dad was always recommending they do CRNA if they are interested in healthcare, because from his POV they had it way better - better hours, high salary, less debt...heck, many hospitals will pay for you to go to CRNA school if you committ to work with them for two years or so after graduation...

As for the medical route, I honestly don't think I could get into an MD school. My grades just aren't there, and without the grade replacement thing I don't think I could get there. In addition, I've heard DO schools are much more open to nurses and respect their experience, where MD schools seem to be more elitist in that regard. Yet...so many people I've talked to have no idea what a DO is. I tried explaining to my on and she thought it was a 3 year medical degree and told me she has always requested a switch to an MD when in the hospital. I told my best friend and he thought it was someone who practiced homeopathic medicine and that it was a joke degree....so in a way, I feel like I'd be defending my career my whole life ('no really, I'm just like an MD, I promise!'). Again though, I really just want that knowledge, and in my opinion DO school would fulfill that need completely. If i do choose DO though, I wonder if I could even get in...I saw a practice MCAT online once and didn't even understand the questions lol

You wont have to defend your degree. Granted I am a med student, but there are plenty of attendings on here who have testified to the fact that theyve been asked very infrequently about their degree. Sorry about your "on" (aunt??) thats a little bit ridiculous. Either way, you introduce yourself as Dr Willen and if they dont want you to treat them because they view you as inferior than so be it...keep it movin...99% of patients just want to get better and dont care where you got your degree. There are going to be patients who find issues with you for various reasons: they dont like the way you talk, they dont like the way you look, they dont like that you are black or asian or hispanic. Its just part of the game. You can do everything right for a patient, and in your mind you delivered excellent healthcare....but they were pissed because you called them Ms. or Mrs Jones instead of Mary....and you are "impersonal and the physician didnt treat me like a person" on your press ganey survey. It just comes with the territory.

Tell your "on" not to get in an accident requiring a trip to the ER - there might be DOs working there! And if you don't understand the MCAT questions, you have a helluva long way to go to obtain the joke degree. :D

Anyway, public ignorance abounds regarding anything medical. There are people who think patella is an Italian bread, or anything "cervical" is a female problem. Every professional who works in American healthcare knows what a DO is. The public ignorance is probably due to geography and paucity, i.e. people are much more likely to be seen or treated by a DO in the Midwest/Oklahoma/Texas vs other regions.

Save yourself a lot of heartache...go to med school...people will never doubt your ability to do your job...what part of the country are you? As far as the south (FL), I dont see people even question their physician about degree..Once you say "I am doctor John Doe", everybody assumes that you are a MD even if that person is DO or an optometrist etc..

I think from a very specific point of view this statement may be correct... but functionally and applicably no. I would not use "superior training" as a reason to pursue this even if all other aspects of healthcare aside from anesthesia are completely unappealing to you. A restricted or narrowed curriculum may mean more "specialized" but it does not mean deeper/more profound.

I am creating an SDN rule:
Pre-meds are never allowed to tell people they don't have what it takes to be a doctor or they going to be a bad doctor

Instatewaiter has spoken

Agree.

just wanted to throw this in here since it irritates the hell out of me when people skew data to further their own agendas
http://www.aana.com/newsandjournal/D...ts/109-116.pdf This is the popularly touted paper that says that CRNAs do not have worse outcomes as compared to anesthesiologists. The last page (7 of 8) has the actual mortality rate breakdown.

Here are some problems...
Look at the "type" column.. There are a bunch of letters there with a key down below. A1 = anesthesiologist only. A2 = CRNA only. There are some letters for mixing and matching, and then 3 more for "xxx working alone + team care". I am not entirely sure how to interpret that... if this was other post op or operative care or what...

The "anesthesiologist only" category includes types B and D, which are defined as co-care but each practitioner working independently. The CRNA breakdown has a similar problem. There are patient outcomes in each of these which should be attributed to the other group or given a separate analysis....
So the only valid comparisons are direct.
A1 to A2 MD>CRNA
B and D - irrelevant... Both groups contain this dataset
C1 to C2 MD>>CRNA.

They do not give 95%CI (which honestly is a mortal sin of publishing) so we have no idea if these numbers are significant or not... Sure 0.45-0.41 is small, but that is not the statistical definition of "significant". The "significance" relies on whether or not the statistical "true" values have a 1/20 chance of overlapping.

also, I have no idea where they got these "predicted rate" numbers. According to this they have generated some expected outcome, and then compared the actual to the expected and presented that ratio as some sort of meaningful number. The O/P for the A2 (CRNA only) type is 0.897 vs the A1 (MD only) which is 1.049.... so according to this analysis the CRNAs had a lower mortality rate than expected and MDs had higher. But the expected for CRNAs was 0.50 and the expected for MDs was 0.39. How does this make sense? The bar for success was lowered for CRNAs in the analysis...

With an attitude like that you clearly don't have what it takes to be a doctor :thumbup:

99% of the time this is the main problem with studies comparing MD/DO to mid-levels.

UGH! I know.

This was was very bad... I mean, I am not sure what thought processes other than intent to produce a result could lead someone to think that "anesthesiologist" alone included all situations where an anesthesiologist did work alone, even if there was also a CRNA providing care.

The other big problem in all of the studies is that they use a completely inappropriate study design looking for rare outcomes. It really isnt appropriate to look at #deaths out of #total and then claim mid level = or > MD/DO. The first design flaw is that if the outcome (death) is already rare, it is already nearly impossible to extract significance when compared to the whole. Think cohort vs case control. You wouldnt use a case control to link living under telephone wires to cancer. Nearly everyone in the genpop has the "exposure" so it is of no surprise that it becomes significant when compared to the outcome (cancer). You go the other way. You look at people with the exposure and check for the disease (cohort). each study design has a specific use and a specific meaning. The BEST thing the AANA study can claim is "we arent out there killing enough extra people compared to physicians to get upset about". But that does not at all say that they are of equal probability to cause harm.

Also this paper excludes data from "high risk" cases.... wtf?
so.... "In conclusion: If the patient wasnt likely to die anyways we did not see an increase in mortality". Bravo AANA

So I just read that study in its entirety, which I had never actually seen before, and I don't see what the confusion is about. It seems when a CRNA provided care, death was about .45% after adjusting for innate risk of the surgery itself, and for anesthesiologists it was .41%. Obviously it was indeed lower for anesthesiologists, but it's not really what I would consider statistically significant, some think based on this study the 'they have similar outcomes' argument still stands. The predicted versus observed death rate is odd, but it's not used in the final claim that death rates are almost equal, so it's irrelevant.

But you're right...without the confidence intervals we can't figure out significance...but the fact is the numbers are definitely comparable, and this was in the 90s. I'm sure rates have become even closer since then.

OK im being grumpy right now because finals are coming and my caffeine/sleep ratio while still being functional is probably a novelty to medical science...

Please, never utter those words again. You do not get to consider what is "statiscially significant". You can choose if a statistically significant figure is clinically significant, but this has no bearing on its statistical significance. The statistical significance is just a measure of how likely the "true value" lies within a 95%CI of the mean, and therefore a "Stat-Sig" (because im sick of typing it out) difference is a measure of how likely the "true value" for each measurement within each respective 95%CI is actually the same value i.e. the values overlap. Without providing the 95%CI we cannot comment on statistical significance.

The major issue is that they found their proclaimed lack of Stat-Sig by combining CRNA and MD outcomes together. Their conclusion is not a reflection on A1 vs A2 but on the combined groups constituting their definition of "Physician only" and "CRNA only".

To do some math, there are 40k some odd CRNAs in the US I believe who have a .04% chance of killing someone relative to an MD (without giving 95%CI) or .0004. that is 4 people killed for every 10,000 patients treated. So assuming 1 patient per day per CRNA that is 16 people/day or 5840 people/year. (this is conservative... I bet they handle more than 1 a day)

and the study excludes emergent and complicated cases which would obviously arise if CRNAs expand their practice.

That is why the conclusion of "CRNAs are as competent as anesthesiologists" is not appropriate. The only appropriate conclusion from the data is "CRNAs are not overwhelmingly more likely to kill a patient in a bread and butter case"

you posted this while I was typing the stuff below so now I am less grumpy :)

but you cannot assume that rates are closer. On what basis do you make this assumption? We could just as easily assume that rates have spread as mid-level programs expand to meet needs compared to medical programs.

Ok, I was going to avoid this thread like the plague because I do not agree with CRNAs having the power that they do now. For me, it is a sore subject that CRNAs now require no physician oversight in my state and many others. However, I considered the CRNA route for a brief period of time and as the OP and I are the same age roughly (estimating from your earlier thread about age) I'll weigh in to try and help.

First, I have tens of thousands of hours in healthcare and am a Paramedic at the current time. Naturally, CRNA and Anesthesiology appeal to me as I have knowledge of airway maintenance, control, etc (including RSI). Second, CRNA is on its way to quickly becoming a doctorate program (estimated to be 2014 per one CRNA that I talked to in Iraq). Third, CRNA requires 2-3 years of experience in ICU/ER settings (and as a nursing new grad it is quite hard to get into those departments even for someone like me with previous critical care experience, as well as other recent changes here lately. Plus, although schools state one thing they're looking for more experience per some friends that went onto NP/CRNA programs). Fourth, CRNA is currently 2 years but if the jump is made to doctorate you can probably expect 3 years for completion of the program. Fifth, CRNA is not recognized in a lot of other countries (whereas a DO/MD is, yes DO is not as many yet but this is changing).

For me, is my educational debt higher (honestly if CRNA programs become doctorate pgms this might change quite a bit)? Yes. Will I have a possible higher salary even as an anesthesiologist? Yes. Can I practice international medicine? YES, a huge factor for me. Am I responsible to anyone else in any state in the Union? No. Do I have to undergo nursing training, hope for a Critical Care position, and then apply to CRNA programs hoping to get in? No. Which is a faster path for me (crucial at my current age, long term speaking)? DO/MD. Case closed for me. A word on bashing salaries, physicians undergo a lot of years of education to get there and imho are undervalued for that. However, I would still go through the training to become a physician if salary ranges were lower.

Ok, so there you have the trail of thinking that I went through when deciding to go DO/MD period (or gtfo out of healthcare except for being a volunteer Paramedic). OP, I seriously recommend that you think through all of these factors. Good luck with your decision and I hope that I helped some.

The AANA deadline is 2025. There is plenty of time to earn a Doctorate of Nurse Anesthesia Practice in the comfort of your own home:
https://www.txwes.edu/academics/gpna/doctorate.aspx
http://keck.usc.edu/en/Education/Aca...P_Program.aspx
http://www.bcm.edu/gpna/curriculum_ms_dnp.cfm

these people (and they are not alone) have bastardized the meaning of the word "doctorate"..... It is still jut a masters level program that they have rechristened something else...

Do it right and become an actual anesthesiologist.

:thumbup:

For some reason I get hungup on this type of crap too. I have a few friends who brag about their "masters" degrees in teaching. I have a masters, it took me 2 years. All those teaching masters degrees are 1 year....thats not a masters. I dont know why this bothers me but it does haha.

IMO, a "master" is someone who has mastered the material that is out there. A "doctor" can contribute to it. And no, I am not including these half-assed attempts at papers published in the AANA. A golfer writing an article for Golfers Digest does not make him a golfer. There are more and more of these 3 year doctorate degrees popping up.... Back in the day, (ok, I'm not that old, but still) a doctorate took 4-6 years (PhD) to complete and is tested at the end by a committee of soon-to-be peers. The MD/DO degree was the only routine 4 year doctorate (5 years for a good many of us) and arguably medical education is taught at a pace that would take these midlevel "doctors" nearly a decade to complete. Our class was told by a chiropractor that they get more training in the nervous system than we got. Longer time spent does not equal more training. You have to establish rate, and given that it takes them 4 semesters at palmer to cover human anatomy I can safely say they do not get to take their training wheels off until after they graduate.

Very true. Sound familiar to the credit comparison of ND programs?

Lol yes. It is a common theme and misconception. Having spent more time on a subject doesn't preclude the possibility that you required more time to gain proficiency. But now I'm just beating a dead horse lol. I just get a little bent at the lunacy that suggests people with half the qualifications by standardized tests and grade point think they are doing "the same if not more" as those who have routinely outperformed them and are still struggling to stay afloat. 95% of my stubbornness and obtuseness on these boards boils down to that point alone. The other 5 is just bored trolling :)

Edit: did you see my post about that in the ND thread or was this coincidence?

Saw your post ; ) I get a real kick out of that thread.

Sorry, I had to weigh in on this one. I usually stay out of these discussions, as I am an attending anesthesiologist, but I got something to say:

First off, DO degree is highly respected in the medical community. There is essentially no difference between MD and DO these days.

Next, CRNA's are a necessary (because they are unfortunately here to stay) part of the anesthesia care team. They won't go away! They are also a lower form of life, so to speak. I work with them, and teach thier students. Trust me, they are not doctors!!!

If you go to med school, and get into an anesthesiology residency; then decide you hate it, you can switch to something else without wasting your time. Everything you learn will help you be a better physician of any ilk. If you go the CRNA route, and don't like it, you are screwed. There's no where else to go.

The studies touted by the AANA, are so ridiculously skewed towards relatively healthy anesthesia patients, that it is almost impossible to show any difference between care with regards to outcomes. Anesthetists just don't singlehandedly take care of high risk patients like anesthesiologists do. I mean really, I can teach my son (14) to give a safe anesthetic to a healthy patient. The difference between doctors and nurses in anesthesia come out when there are problems or confounding comorbidities that increase the risk of bad outcomes if sound medical decision making is not used. Nurses are not taught to diagnose, devise anesthesia plans for, or handle those sorts of issues. Trust me, in the years to come, with many states "opting out" of supervision, there will be a huge increase in morbidity for those patient's who are cared for solely by nurse anesthetists. We can't wait to hear what will happen then.

Bottom line is, if you want to be a doctor, go to medical school. If you want to make good money, but not feel in charge, then go ahead and become a nurse. Yes, the path is easier and cheaper, but the rewards are also less.

That is a massive understatement. There are very few DO derm spots and you have to be an incredibly stunning DO applicant to match ACGME derm. I b elieve 3 or 4 DOs total have matched ACGME derm since 2007, and you're talking thousands of DO graduates. Plenty of DO people match ACGME gas every year and they have their own residencies as well (though I hear that the quality varies from decent to shoddy). Plenty of DOs match ACGME Ob/Gyn every year as well.

If the OP is deadset on doing anesthesia, then I agree that going the CRNA route makes sense. It is cheaper, he/she gets done faster, and the pathway is just easier. But I would say the same thing to the OP if he were debating MD vs CRNA. It's the fact that he/she pretty much knows that she wants to do gas that makes this an easy answer in my opinion, so DO vs MD doesn't even come into play.

Won't it take decades for studies using this data to come out, considering that most risky cases are still done by an anesthesiologist? Many CRNAs only work on the ASA 1 and 2 cases when they're supervised by an anesthesiologist, right? I know that many of the CRNAs practicing independently in the opt-out states are in the rural areas. I imagine that they refer at least some of the riskier patients to the nearby suburbs/cities where they can have anesthesia either provided by or supervised by an MD/DO? As you mentioned, that's why the studies that the AANA funds look quite rosy. It is not surprising that mortality/complication rates are comparable when the CRNAs are operating on the subset of patients with lower risk factors. That's the issue -- getting a good amount of data, which will take a significant amount of time. When you're talking about 5 deaths per million anesthetics administered and CRNAs cherry-picking patients, it could take 30 years to accumulate that data from the time the study is opened.

Take a look at this link:

http://www.settlementboard.com/wrong...practice-case/

The press release doesn't make it clear who was responsible for the death in that case (the CRNA or the anesthesiologist), but it sounds like the CRNA was being supervised and perhaps both providers screwed up. If more states opt out, I think we can count on the lawyers to hold the CRNAs in check. It will take time for the studies to come out because lots of data will be required (independent studies not funded by the AANA or ASA that use appropriate comparisons i.e. similar % of ASA1/2 patients in each cohort), but once they do, I think it will be difficult for CRNAs to get affordable malpractice coverage if they want to practice independently. If they can't get coverage and have to fly naked, then I think they will stay away from the sicker patients.

That case was discussed quite a bit on Sermo (forum for physicians). It was a CRNA **** up. The doc was supervising, but clearly not actively enough to save the patient.

Right, until mid levels get full autonomy we can never really show the differences in outcomes we know to exist. Every mid level screw up is legally classified as a physician screw up.

I think this qualifies for catch22