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Is anyone else tired of this topic??
CRNA=MDA??
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since this thread is so popular I'll ask here:
can anybody (MDA, CRNA, medical student, resident ... anybody) describe their typical MDA-CRNA interactions? Who does what? Who's responsible for what tasks/aspects of anesthesia?
Thanks,
Adcadet
can anybody (MDA, CRNA, medical student, resident ... anybody) describe their typical MDA-CRNA interactions? Who does what? Who's responsible for what tasks/aspects of anesthesia?
Thanks,
Adcadet
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Currently, I don't work with MDA's, but at my last job, I worked in an anesthesia group with both MDA's and CRNA's. Generally, the CRNA's in the group were rather, um, well....less than pleasant. The MDA's on the other hand, were great. Generally, we worked very well together. MDA's supervised the rooms, and were present for induction. After the patient was induced, the MDA left the room, but was available to be called back if we ran into a problem. They did not return for emergence.
I worked with a group of very good MD's. All of them were willing, even eager to teach, so I took advantage of that whenever possible.
Truth be told, the CRNA vs MDA issue isn't much of an issue at work in most places. Generally its an issue at the ASA - AANA level, and sometimes that debate spills over to places like this.
Kevin McHugh, CRNA
I worked with a group of very good MD's. All of them were willing, even eager to teach, so I took advantage of that whenever possible.
Truth be told, the CRNA vs MDA issue isn't much of an issue at work in most places. Generally its an issue at the ASA - AANA level, and sometimes that debate spills over to places like this.
Kevin McHugh, CRNA
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Thank you Kevin. I'm afraid the large CRNA vs. MDA debates here may be giving anesthesiology a bad name, and I am hoping that "real life" working conditions are cordial, or even pleasant. Can you comment further about when the MDA would get involved vs. stuff the CRNA would do procedure-wise? Any other comments about how the different groups got along? Or was it like most advanced practice nurse-MD relations that I've seen (pleasant and cordial) and thus not really worth commenting on.
Any MDA's want to comment on their experiences and show this eager young MS1 that working life as an MDA is not full of constant bickering?
Thanks,
Adcadet
Any MDA's want to comment on their experiences and show this eager young MS1 that working life as an MDA is not full of constant bickering?
Thanks,
Adcadet
Another noob question from me- in places where the MDAs leave after induction and never come back, what do they do for the rest of the day? Go from room to room to check in/give breaks? Sit back and read? Go check out the SICU?
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To answer a few questions:
First, to The Gas Man: Well, believe it or not, it did happen. In most cases, I wasn?t there so much to supervise as to sign the chart for billing purposes. (I was an employee of the anesthesia group, not a hospital employee.) By the time they came to our group for open heart rotations, most residents were either in their late second year or in their third year of residency, and of course did not need much supervision. I actually enjoyed doing this, because in most cases, I could leave the room. I?d check back from time to time so the resident could take a break, or to make sure there wasn?t anything for which they needed a second set of hands.
There was a time or two though, when we were dealing with a resident who was known to be weak, that I would be directed by the attending to stay in the room. His words to me were ?the resident is doing the case, but s/he is a student, you are not. You have the final say on matters of patient care.? At the same time, the attending was in the hospital, supervising other rooms, and was available for problems. Essentially, I supervised the resident under the supervision of the attending.
Next, to Adcadet: I wouldn?t worry too much about ?constant bickering.? It doesn?t really happen much. There are, of course, CRNA?s who chafe at being ?supervised,? but again, that?s generally not a problem.
One case stands out in my mind. I don?t remember the kind of case that was being done, but essentially, the patient was hypotensive at any anesthetic level. The CRNA wanted to start one pressor, but the attending (who was fairly recently out of residency) wanted her to use a different pressor. After the attending left the room, the CRNA used the pressor she preferred. The attending felt (rightly) that the CRNA was insubordinate and had violated the practice act for nurses. My feelings at the time (and still) was that the CRNA had let her attitude (?I?ve been doing this for 20 years. I?m not letting some wet behind the ears MD tell me how to do an anesthetic!?) overtake her common sense. In the end, she had done a disservice to the patient, IMO (not to mention that the CRNA was probably guilty of practicing medicine without a license). The bottom line is that when it comes to anesthesia, there are as many ways to ?skin the cat? as there are anesthesia providers. The CRNA had become hidebound in her anesthetic administration, and had let her stubborn pride override her responsibilities to the attending. I always welcomed MDA?s suggesting a different way to do things. It?s a great way to learn new methods that could be better for the patient than the way you are doing things.
Overall, I had a great relationship with the MDA?s I worked with. We not only worked together, but occasionally got together after work. At the level of the folks doing the anesthesia, there are generally pretty good relations.
Finally, to Veritas: Generally, when the MDA is supervising, s/he is supervising more than one CRNA. In our group, that meant the supervising physician started the day going to 3 to 5 different rooms for induction. Then, after the cases were started, the attending often checked to see how things were going in various rooms, handled other issues (scheduling of cases, etc) and remained readily available should someone need some help. S/he might also check in on our patients in the recovery room or SICU, or pre-op patients in the holding area. They were also responsible for our next assigned cases, making sure all our cases got covered in a timely fashion. They might get a chance to go to the lounge for a bit to do whatever. Who did what at induction depended on the CRNA and the attending. With one of our physicians, unless the CRNA wanted him to do something, he stayed in the background during induction as we pushed the drugs, intubated the patient, inserted lines as necessary, etc. Then, when he was satisfied things were under control, he?d leave. Another took a more proactive approach, pushing the drugs and staying at the table until the patient was asleep. Some CRNA?s resent one approach or the other, but I think most of us feel that if the attending wants us to do everything, that?s fine, but if they want to be active in induction, that?s ok too. I never object to a second set of hands. Some of it depends on the attitudes of both the CRNA and the MDA. If the CRNA resents the MDA?s efforts as interference, then that will cause friction. By the same token, if the MDA thinks CRNA?s are only capable of babysitting stable patients, that?s bound to cause some chafing too.
I think overall, the relationship between most CRNA?s and most MDA?s is cordial. We respect one another, and usually have a pretty good time working together. Getting cases done safely and in a timely fashion is a team effort. When it is approached that way, the day goes smoothly. And bottom line, what ALL of us want is a safe, smooth day.
Kevin McHugh, CRNA
First, to The Gas Man: Well, believe it or not, it did happen. In most cases, I wasn?t there so much to supervise as to sign the chart for billing purposes. (I was an employee of the anesthesia group, not a hospital employee.) By the time they came to our group for open heart rotations, most residents were either in their late second year or in their third year of residency, and of course did not need much supervision. I actually enjoyed doing this, because in most cases, I could leave the room. I?d check back from time to time so the resident could take a break, or to make sure there wasn?t anything for which they needed a second set of hands.
There was a time or two though, when we were dealing with a resident who was known to be weak, that I would be directed by the attending to stay in the room. His words to me were ?the resident is doing the case, but s/he is a student, you are not. You have the final say on matters of patient care.? At the same time, the attending was in the hospital, supervising other rooms, and was available for problems. Essentially, I supervised the resident under the supervision of the attending.
Next, to Adcadet: I wouldn?t worry too much about ?constant bickering.? It doesn?t really happen much. There are, of course, CRNA?s who chafe at being ?supervised,? but again, that?s generally not a problem.
One case stands out in my mind. I don?t remember the kind of case that was being done, but essentially, the patient was hypotensive at any anesthetic level. The CRNA wanted to start one pressor, but the attending (who was fairly recently out of residency) wanted her to use a different pressor. After the attending left the room, the CRNA used the pressor she preferred. The attending felt (rightly) that the CRNA was insubordinate and had violated the practice act for nurses. My feelings at the time (and still) was that the CRNA had let her attitude (?I?ve been doing this for 20 years. I?m not letting some wet behind the ears MD tell me how to do an anesthetic!?) overtake her common sense. In the end, she had done a disservice to the patient, IMO (not to mention that the CRNA was probably guilty of practicing medicine without a license). The bottom line is that when it comes to anesthesia, there are as many ways to ?skin the cat? as there are anesthesia providers. The CRNA had become hidebound in her anesthetic administration, and had let her stubborn pride override her responsibilities to the attending. I always welcomed MDA?s suggesting a different way to do things. It?s a great way to learn new methods that could be better for the patient than the way you are doing things.
Overall, I had a great relationship with the MDA?s I worked with. We not only worked together, but occasionally got together after work. At the level of the folks doing the anesthesia, there are generally pretty good relations.
Finally, to Veritas: Generally, when the MDA is supervising, s/he is supervising more than one CRNA. In our group, that meant the supervising physician started the day going to 3 to 5 different rooms for induction. Then, after the cases were started, the attending often checked to see how things were going in various rooms, handled other issues (scheduling of cases, etc) and remained readily available should someone need some help. S/he might also check in on our patients in the recovery room or SICU, or pre-op patients in the holding area. They were also responsible for our next assigned cases, making sure all our cases got covered in a timely fashion. They might get a chance to go to the lounge for a bit to do whatever. Who did what at induction depended on the CRNA and the attending. With one of our physicians, unless the CRNA wanted him to do something, he stayed in the background during induction as we pushed the drugs, intubated the patient, inserted lines as necessary, etc. Then, when he was satisfied things were under control, he?d leave. Another took a more proactive approach, pushing the drugs and staying at the table until the patient was asleep. Some CRNA?s resent one approach or the other, but I think most of us feel that if the attending wants us to do everything, that?s fine, but if they want to be active in induction, that?s ok too. I never object to a second set of hands. Some of it depends on the attitudes of both the CRNA and the MDA. If the CRNA resents the MDA?s efforts as interference, then that will cause friction. By the same token, if the MDA thinks CRNA?s are only capable of babysitting stable patients, that?s bound to cause some chafing too.
I think overall, the relationship between most CRNA?s and most MDA?s is cordial. We respect one another, and usually have a pretty good time working together. Getting cases done safely and in a timely fashion is a team effort. When it is approached that way, the day goes smoothly. And bottom line, what ALL of us want is a safe, smooth day.
Kevin McHugh, CRNA
People like you make me sick. I've read some of your other posts, and you sound like a complete mook. Get real. Your attitude does nothing to help the profession of healthcare as a whole. I'm about to tell you something that all your fancy GPA and all your fancy schooling won't ever tell you. I'm about to tell you some next level ish, punk:
If there is anything that needs to be fought it's the fact that all professions are in jeopardy. Engineers are facing it, and we as health professionals will face it eventually. The USA is seeing a huge amt of professional work being done in foreign countries. Engineers are a glut in the USA because many companies are hiring engineers in countries such as India and China. Why pay a USA engineer 90k when you can pay a foreign engineer 20k who can provide the same quality of work? You think healthcare is immune? Like the rest of your life, you're wrong. With the new digital era, digitalized radiographs can be sent to doctors in foreign countries, read, and then interpretations sent via e-mail back to the hospital in whichever country. All within a rapid turnover and cheaper costs, and most likely the Chinese counterpart will work much harder than the "fat, lazy American." No patient contact is not such a good thing now, is it? Those doctors that have actual hands-on with patients are somewhat immune, but are still vulnerable. Insurance, hospitals, legislatures, and various ancillary companies are now making plans to fly in doctors, including surgeons, from other countries to the USA. Other alternatives including flying pts who are seeking elective surgery to foreign countries. Why pay an American doctor several thousand when you can pay a foreign doctor several hundred? You get the idea? Doctors aren't in trouble. We all are, and if we don't start lobbying and working together to prove to big government that we can deliver the best healthcare at an affordable price, we'll all see our jobs going overseas or across the border. It's already happening with engineers and pharmaceuticals. Do you think we're immune? What do you really think these multiple twin separations that's happening in various countries around the globe is really about? Let me give you a hint: It's not about being captain of the team because, trust me, you aren't captain. You're a pawn just like the rest of us.
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For the person who posted the CRNA course list:
I don't see any Pathology or Pathophysiology in there...the basis for practicing medicine. All I see is a watered down anatomy course, physio, pharm, some BS touchy-feely courses, and Chem and Physics stuffed into one class...two subjects which physicians spend a year EACH on...in undergrad!
I don't see any Pathology or Pathophysiology in there...the basis for practicing medicine. All I see is a watered down anatomy course, physio, pharm, some BS touchy-feely courses, and Chem and Physics stuffed into one class...two subjects which physicians spend a year EACH on...in undergrad!
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I am just a medical student but I have not seen any bickering between the MDA'sand CRNA's. Sometimes the CRNA's may be a little snotty to a student, but so are the MD residents (sometimes). Heck the circulators and scrub techs anre snotty to us sometimes, and some med students are the snottiest of all, in my limited experience.
For the most part, all have been pleasant to work with and eager to teach. A very good CRNA (all of them I have seen have been very good) helped me intubate my first time and walked me through an induction my first time in the OR. The CRNA's and MD's treat each other with respect, just like they do the surgeon, PA's, scrub nurses, scrub techs, circulators, etc. We are all professionals, guys, and everybody deserves respect as a part of a team, and I don't see any of the bickering we see here in the OR. I think this has been blown a bit out of proportion from some of the way off-base remarks about worker bees and monkeys.
Again, just my 2 cents.
For the most part, all have been pleasant to work with and eager to teach. A very good CRNA (all of them I have seen have been very good) helped me intubate my first time and walked me through an induction my first time in the OR. The CRNA's and MD's treat each other with respect, just like they do the surgeon, PA's, scrub nurses, scrub techs, circulators, etc. We are all professionals, guys, and everybody deserves respect as a part of a team, and I don't see any of the bickering we see here in the OR. I think this has been blown a bit out of proportion from some of the way off-base remarks about worker bees and monkeys.
Again, just my 2 cents.
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I don't really like to get involved in this type of discussion because it is all based on the limited experiences people have had. One bad apple doesn't ruin the bunch.
Anyway, I just finished a month rotation with a private Anesthesia group. The group is very large covering several private hospitals in town. They utilized CRNA's a lot. From what I could tell, the CRNA's were equivalent to "residents" in the private world. The MDA's would start the cases/be in the room when the case started and the CRNA's would fly the plane. The MDA's would supervise 2-3 rooms at a time. They would give the CRNA's breaks, be there if anything went wrong, etc.
Now how is that different than Academic MDA's? I don't see a difference except in academics, MDAs have residents while in private practice, they don't.
By the way, during my month I spent extensive time with the CRNA's and they were wonderful. They had been doing the job for a long time and they taught me a lot.
***One note - They all seemed worried that CRNA's salaries keep increasing while MDAs were not which might kill their jobs. They were worried that there would be no incentive to use them instead of MDAs. But in the end, I think a supply and demand issue remains.
My two cents as well.
Anyway, I just finished a month rotation with a private Anesthesia group. The group is very large covering several private hospitals in town. They utilized CRNA's a lot. From what I could tell, the CRNA's were equivalent to "residents" in the private world. The MDA's would start the cases/be in the room when the case started and the CRNA's would fly the plane. The MDA's would supervise 2-3 rooms at a time. They would give the CRNA's breaks, be there if anything went wrong, etc.
Now how is that different than Academic MDA's? I don't see a difference except in academics, MDAs have residents while in private practice, they don't.
By the way, during my month I spent extensive time with the CRNA's and they were wonderful. They had been doing the job for a long time and they taught me a lot.
***One note - They all seemed worried that CRNA's salaries keep increasing while MDAs were not which might kill their jobs. They were worried that there would be no incentive to use them instead of MDAs. But in the end, I think a supply and demand issue remains.
My two cents as well.
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It depends on the contract agreement. Sometimes CRNAs work for the practice, sometimes for the hospital. But overall CRNA salaries are on the rise. You can check out gaswork.com. Depending on location, the difference between salaries is not huge. I've looked at it the other day and some places they are paying CRNAs 200K+.
Don't get me wrong, MDAs make great money. A lot better than their primary care counterparts. I can't wait to make good money someday......
Don't get me wrong, MDAs make great money. A lot better than their primary care counterparts. I can't wait to make good money someday......
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HOLY ****!!!
Did you see some of those salaries being offered CRNA's on gaswork.com. My lord, about a third of them for between 140k and 160k and some at 200k+. This is my first post regarding money and the physician, but those numbers boggle the imagination. I'm pretty sure that most primary care physicians (peds, IM, phsych, etc.) don't make that sort of money. Am I wrong about that?
The typical MDA salary was about 250k-270k, which is a huge number, but still not that much higher than CRNA. I think I have read here many times that MDA's get starting offers around 160k to 190k. Is this about right? I take it, then, that these numbers will go up after a few years of practice?
In any event, the ironic part of all of this is that an M4 who fails to place into a Gas residency is better off chucking the whole thing and becoming a CRNA (I guess there is no shortcut for this, though) rather than settle for a residency he doesn't want (in peds or IM, for instance). He's get to push gas, which is what he wanted, AND he'll make more money than wiping noses. huh!!
Judd
Did you see some of those salaries being offered CRNA's on gaswork.com. My lord, about a third of them for between 140k and 160k and some at 200k+. This is my first post regarding money and the physician, but those numbers boggle the imagination. I'm pretty sure that most primary care physicians (peds, IM, phsych, etc.) don't make that sort of money. Am I wrong about that?
The typical MDA salary was about 250k-270k, which is a huge number, but still not that much higher than CRNA. I think I have read here many times that MDA's get starting offers around 160k to 190k. Is this about right? I take it, then, that these numbers will go up after a few years of practice?
In any event, the ironic part of all of this is that an M4 who fails to place into a Gas residency is better off chucking the whole thing and becoming a CRNA (I guess there is no shortcut for this, though) rather than settle for a residency he doesn't want (in peds or IM, for instance). He's get to push gas, which is what he wanted, AND he'll make more money than wiping noses. huh!!
Judd
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Die thread! Die!!! 
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I'm married to a second year nurse anesthesia student at Georgetown U. and there was a time when he was was considering nurse anesthesia vs med school, and we decided that the nurse anesthesia route would be better mostly since we're both in our mid thirties and the MD route seemed like a long haul (we didn't really want to be in our mid-forties to start reaping the benefits so to speak That was just a personal decision and I think for the most part it was the right one for us. I also want to say that from what I've seen, my husband's program is one of the most rigourous I have ever seen (nothing touchy feely about it). I just spent 6 years in academia (I have a Ph.D. in Biology) so I've had the pleasure with working with many med students, pharmacy students etc, and I've got to say that the CRNA curriculum (at least at Georgetown) is very challenging to say the least. In his program anything below and 83% is a failing grade (and the administration is not afraid to toss out people who get an 82% in a class). Now I'm sure that not all CRNA programs are equal, nor are med schools. Some are better than others, but in my eyes my husband and his classmates have are very much challenged by their classes and clinicals. The clinicals are 5 days a week, about twelve hrs a day, with three nights of call per month, and a weekly classs to boot (I'm certainly glad I didn't go into medicine Better him than me.
Also it seems that in clinical sites there is basically no bickering or competition between CRNAs and MDA...everyone plays nice together. And the CRNAs get access to the doctor's lounge!! Ha ha (sorry I couldn't resist).
The bottom line is that I believe there is a room for CRNAs and MDAs both (I've even been anesthetized by both), this is the way it has been and the way it will be. Of course MDAs have more experience and will always make great money, and no-one begrudges them that.
PS We did see a CRNA position which paid $300,000 on gaswork.com in rural NM!! I really don't think that's the norm though....but it sounds darn tempting
cheers
k
That was just a personal decision and I think for the most part it was the right one for us. I also want to say that from what I've seen, my husband's program is one of the most rigourous I have ever seen (nothing touchy feely about it). I just spent 6 years in academia (I have a Ph.D. in Biology) so I've had the pleasure with working with many med students, pharmacy students etc, and I've got to say that the CRNA curriculum (at least at Georgetown) is very challenging to say the least. In his program anything below and 83% is a failing grade (and the administration is not afraid to toss out people who get an 82% in a class). Now I'm sure that not all CRNA programs are equal, nor are med schools. Some are better than others, but in my eyes my husband and his classmates have are very much challenged by their classes and clinicals. The clinicals are 5 days a week, about twelve hrs a day, with three nights of call per month, and a weekly classs to boot (I'm certainly glad I didn't go into medicine Better him than me.Also it seems that in clinical sites there is basically no bickering or competition between CRNAs and MDA...everyone plays nice together. And the CRNAs get access to the doctor's lounge!! Ha ha (sorry I couldn't resist).
The bottom line is that I believe there is a room for CRNAs and MDAs both (I've even been anesthetized by both), this is the way it has been and the way it will be. Of course MDAs have more experience and will always make great money, and no-one begrudges them that.
PS We did see a CRNA position which paid $300,000 on gaswork.com in rural NM!! I really don't think that's the norm though....but it sounds darn tempting
cheers
k
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I wanna hear more from linear! Specifically, I want to hear more about the overseas surgery. Where are people going? And is it 0.1% or 0.01% of US surgieries. Radiology going overseas is a theoretical possibility (assuming the radiologists don't leverage their interventional skills against hospitals/ins co., etc) but the idea of hands on medicine being farmed out sounds nutty.
Applying an issue going on in engineering/computers/customer service, etc to medicine is a leap to say the least.
Applying an issue going on in engineering/computers/customer service, etc to medicine is a leap to say the least.
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I wanna hear more from linear! Specifically, I want to hear more about the overseas surgery. Where are people going? And is it 0.1% or 0.01% of US surgieries. Radiology going overseas is a theoretical possibility (assuming the radiologists don't leverage their interventional skills against hospitals/ins co., etc) but the idea of hands on medicine being farmed out sounds nutty.
Applying an issue going on in engineering/computers/customer service, etc to medicine is a leap to say the least.
Applying an issue going on in engineering/computers/customer service, etc to medicine is a leap to say the least.
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Adcadet, my icon wants to eat your icon.
Nothing much to add to the previous reports about the MDA CRNA relationship. We have a strong relationship with our CRNA's at Southwestern and we have a couple of RRNA's rotate through the general and OB units. Some individual personality conflicts aside, the relationship is very collegial especially with the older CRNA's. The younger ones still seem to be trying feel around for their role.
I read the last review of our program by one of the medical students on the scutwork main page. If he/she thinks the CRNA's get the "good hours" each day and get to coast through their shifts, I would encourage that person to revisit the OR. Our CRNA's take a lot of 7a to 7p shifts and that helps defray the case load significantly. They also know that their training is complete and that the residents need the good cases to complete theirs so they know that they may frequently get stuck in the eye room or the billions of lap choles our surgeons love to schedule. For our afternoon PBLD's or mock orals, they are the ones that will take over as well so that no resident is forced to miss an educational event.
While that may seem to be prejudicial against our CRNA's, if you know what call is like at Parkland and the caseload that gets processed daily, both you and they will know that they will get more than their fair share of difficult cases to stay sharp in those situations.
Otherwise, I can't recall any major conflicts between MDA and CRNA in our program with the exception of one MDA who manages to get on EVERYONE's nerves. They know that they are here to help with the volume and they also know that they will get well trained so their doesn't seem to be much issue here.
Nothing much to add to the previous reports about the MDA CRNA relationship. We have a strong relationship with our CRNA's at Southwestern and we have a couple of RRNA's rotate through the general and OB units. Some individual personality conflicts aside, the relationship is very collegial especially with the older CRNA's. The younger ones still seem to be trying feel around for their role.
I read the last review of our program by one of the medical students on the scutwork main page. If he/she thinks the CRNA's get the "good hours" each day and get to coast through their shifts, I would encourage that person to revisit the OR. Our CRNA's take a lot of 7a to 7p shifts and that helps defray the case load significantly. They also know that their training is complete and that the residents need the good cases to complete theirs so they know that they may frequently get stuck in the eye room or the billions of lap choles our surgeons love to schedule. For our afternoon PBLD's or mock orals, they are the ones that will take over as well so that no resident is forced to miss an educational event.
While that may seem to be prejudicial against our CRNA's, if you know what call is like at Parkland and the caseload that gets processed daily, both you and they will know that they will get more than their fair share of difficult cases to stay sharp in those situations.
Otherwise, I can't recall any major conflicts between MDA and CRNA in our program with the exception of one MDA who manages to get on EVERYONE's nerves. They know that they are here to help with the volume and they also know that they will get well trained so their doesn't seem to be much issue here.
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Lets change the subject
Well to begin with you don't see pathology because we aren't practicing medicine as CRNA's. FYI. Patho we take as undergrads ourselves, plus chemistry and physics. The one "stuffed" class as you call it is chem/physics as it relates only to anesthesia. As undergrads we also take Anat/Phys/Pharm and then in grad school the classes are only related to anesthesia, period. Some of those touchy feely classes you referred to are the classes that go along with our clinical education. They may have a lame name but they aren't what you seem to think they are. Everything we take is based on anesthesia and giving anesthesia. But again, we don't practice medicine which is probably the largest difference between us and MDA's.
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I have no stake in this debate whatsoever, but I was shocked to learn that nurses take pathology in their undergrad (?)
I talked to a few BSNs about this, and none of them even knew what Robbins was!? I know that nursing programs usually have a course entitled "Pathophysiology," but I asure you, it is nothing like medical school pathology.
In fact, my undergrad physiology teacher also taught the nursing "Pathophysiology" course, and he said it was easier than the Bio major's physio course.
Again, nothing against nurses, CRNAs, etc...but lets be accurate when we compare our educations.
Actually, this thread is kinda depressing. If I would have known about the CRNA route years ago, I would have probably went for it. My wife and I are 33 and 32, respectively, and we're really tired of being poor. Unfortunately, I'm still and MS-III and have years more of hardship and poverty ahead of me before we can start enjoying any kind of quality of life.
Had I taken the BSN --> CRNA path, I could already be making 140-160k/yr! Amazing...that's more than most primary care docs.
Not only that, but I think I'd really enjoy anesthesiology, but I probably don't have the scores for it (51st percentile COMLEX)....I would have had a better shot at becoming a CRNA!
Oh well...live and learn.
I guess it's probably too late in the game to quit and go to nursing school, huh? Sad thing, I could probably do that and still start making money sooner!
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B]5) the reason there is a delay of patients getting into theaters (or ORs) has very little to do with the anesthesia provider deficiency, but rather with the miserably failing system of socialized medicine that exists in the UK.... the same system (or similar at least) is set up in CANADA, where for the most part there are more than enough Anesthesia providers, and they still have 6 month delays for elective surgeries...[/B]
Well... what do i know, i only live and workfor the National Health Service, my mother is only a Surgical Nurse Practitioner (yes she does surgery!!!!!!!!!! actual operations, under local anaesthetic) and my father is only a Consultant (equiv' of Attending) Anaesthetist (UK term and spelling) and Clinical Director of Anaesthetics and Pain Services at my hospital. i plucked some of my research from the AANA website. i guess i should have put the references in now. Ho hum.
Anywho, the reason we have waiting lists is a combination of a lack of anaesthetic staff and a bed shortage, but it owes more to a shortage of anaesthetic providers than one owuld think.
Secondarily, we have waiting lists because we treat everyone really. I suppose in the UK, it's because healthcare is a right, not a privilege. Oooh deep.
But yeah that's the truth,and i would hardly call the NHS a failing system, considering it serves everyone. i would say that the US health system is failing because your country leaves so many people behind.
Also, did you know that the French, who are ranked as having the #1 healthcare service in the world are abandoning some aspects because they can't afford it anymore.
An do you know which countrys' healthcare system they're going to adapt?
The UK's Naional Health Service.
I love irony, it gets all the creases out of my stomach
Well... what do i know, i only live and workfor the National Health Service, my mother is only a Surgical Nurse Practitioner (yes she does surgery!!!!!!!!!! actual operations, under local anaesthetic) and my father is only a Consultant (equiv' of Attending) Anaesthetist (UK term and spelling) and Clinical Director of Anaesthetics and Pain Services at my hospital. i plucked some of my research from the AANA website. i guess i should have put the references in now. Ho hum.
Anywho, the reason we have waiting lists is a combination of a lack of anaesthetic staff and a bed shortage, but it owes more to a shortage of anaesthetic providers than one owuld think.
Secondarily, we have waiting lists because we treat everyone really. I suppose in the UK, it's because healthcare is a right, not a privilege. Oooh deep.
But yeah that's the truth,and i would hardly call the NHS a failing system, considering it serves everyone. i would say that the US health system is failing because your country leaves so many people behind.
Also, did you know that the French, who are ranked as having the #1 healthcare service in the world are abandoning some aspects because they can't afford it anymore.
An do you know which countrys' healthcare system they're going to adapt?
The UK's Naional Health Service.
I love irony, it gets all the creases out of my stomach
well not to bring this discussion to the top of the list again but when i said patho i meant pathophysiology. not pathology. and my pathophys class was in the bio majors group and not watered down like some nursing courses.
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quote:
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Originally posted by Tenesma
yawn... can somebody kill this thread please
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agreed.........
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I second that!
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Originally posted by Tenesma
yawn... can somebody kill this thread please
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agreed.........
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I second that!
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Yes. Die already!
Die thread, die!
Die thread, die!
I'm sorry, but I can't resist. If you guys are so smart, maybe you could figure out that posting to a thread does not make it die. 
Anyway, regarding this post:
Is this really feasible? Flying patients to foreign countries for elective surgery? I'm suddenly having visions of some middle aged woman going in for cosmetic surgery, and being told she needs to fly to India or China for the procedure. Hmmmm ...
Maybe you have a point with things like the radiographs. But some of this seems to be a bit farfetched. Of course, I could be wrong.
Anyway, regarding this post:
Is this really feasible? Flying patients to foreign countries for elective surgery? I'm suddenly having visions of some middle aged woman going in for cosmetic surgery, and being told she needs to fly to India or China for the procedure. Hmmmm ...
Maybe you have a point with things like the radiographs. But some of this seems to be a bit farfetched. Of course, I could be wrong.
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Have no fear, most medical specialties are completely shielded from this sort of thing. I recently read a magazine article about the job losses in manufacturing, etc. There were a lot of interviews with "woe is me" folks who lost their jobs. Anyway, one excellent piece of advice was offered in the article:
Go into a field where your physical presence is absolutely required.
Luckily for us, this is true for most medical fields. People are not going to be flying from the US to europe for their Gyn appt, or for their annual physical. People are not going to fly abroad for lap choles and appy's. You're not going to see dialysis patients at the airport 3 days a week flying to China for their treatment. No long line of cancer patients waiting at the airport to fly to South America for chemo.
Anyway...you get my point. Don't believe all these doom & gloom "the sky is falling" crowd. Medicine is one of the wisest career choices you can make. Still rated #1 in the Jobs Rated Almanac. Every source, including the Bureau of Labor Statistics, forecasts an abundance of opportunities, i.e. medicine will see enormous job growth in the next decade.
Go into a field where your physical presence is absolutely required.
Luckily for us, this is true for most medical fields. People are not going to be flying from the US to europe for their Gyn appt, or for their annual physical. People are not going to fly abroad for lap choles and appy's. You're not going to see dialysis patients at the airport 3 days a week flying to China for their treatment. No long line of cancer patients waiting at the airport to fly to South America for chemo.
Anyway...you get my point. Don't believe all these doom & gloom "the sky is falling" crowd. Medicine is one of the wisest career choices you can make. Still rated #1 in the Jobs Rated Almanac. Every source, including the Bureau of Labor Statistics, forecasts an abundance of opportunities, i.e. medicine will see enormous job growth in the next decade.
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Tenesma said:it is interesting how this question comes up on a regular basis, either because of 1) applicants who have heard a lot of discussion regarding CRNA vs MD 2) non-anesthesia people stirring up the pot....
2 big points:
1) skill sets: while you can train any monkey to do a procedure - there is a HUGE difference in skills between graduating CRNAs and MDs..... the required CVP lines are 5 for CRNA graduation (go to AANA.com and look up certification guidelines) - and if they are performed on manequins that counts too.... your average anesthesia MD at end of residency (and this number DOESN'T include the lines placed during a medical or surgical internship) has placed 200-300 central lines.... CRNAs have to have placed 25 a-lines, anesthesia resident has placed 400-500.... the list goes on....
2) clinical exposure: the required clinical hours for CRNA graduation is on average 1600 hours.... Clinical hours for your average MD at end of residency is between 9,500 and 11,000 hours.... and that DOESN'T include the 4000 hours of patient management from internship....
and relying on a surgeon's opinion on what makes good anesthesia is a waste of time, as their's is entirely bogus and biased.... their criteria for judgement are based on their exposure.... just as anesthesiologists we prefer surgeons who are fast and don't lose any blood, but I know for sure that surgeons would argue that there is a lot more to being a competent surgeon than that
so for those who are worried about CRNAs... don't be... they have their role, MDs have theirs.... and for future anesthesia residents: it is a great field (one that i enjoy every day)
Sorry, I am honestly not trying to start a flame war here..
I have been reading this forum over the last couple days, and have seen the "can teach monkeys to do the procedures" in references to nurses..(I know this is an old post, but the ones that I wanted to reply to were closed, and this monkey thing just REALLY burns me up, I don't know why)
do any of you actually say this to the nurses you work with? I would love to hear their reactions..but I'm guessing you don't.
I'm not a doctor, nor a nurse. I'm someone who hopes to go into medicine. But judging by some of the people in this forum, such as the above poster, and the navy guy, I can see why nurses loathe MDs.
note: I know that I won't know what you guys go through until I walk in your shoes, but I don't understand how some of you can act so superior and as if your feces does not stink. scary stuff.
sorry for those who I might have offended, and thank you to those who treat "the little people" like people, and not primates.
edit: Just wanted to add I am in NO way trying to fuel the CRNA vs MD debates. I know there is a difference. I am just concerned with some med students and MD's perceptions and opinions of nurses and other health care workers in general. thanks for allowing me to state my opinion.
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If you want to ask a question, you should just ask it on a new thread instead of digging up one that is best kept buried. You say you don't intend to start a flame war between MD's and CRNA's, yet you pick a thread with the title "MD vs. CRNA". Wonderful choice Peachy, just pure genius.
I'd ask the mods to lock this thread or separate your post to a new thread.
I'd ask the mods to lock this thread or separate your post to a new thread.
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UTSouthwestern said:
I will do that.
However, I would like to say something to you. Awhile back, someone nominated you for mod, before they made Vent one. I SERIOUSLY hope they were joking. You are as judgemental and high and mighty as anyone.
And I will swear on my grandmother's grave that I was not trying to start a flame war. I am not a nurse, and some of the things said in this forum just stuns me. "monkeys," "worker ants," "etc." Do any of the people, including you, realize how offensive that is?
If you need to put people down on a message board, UT, go right ahead. If you treat strangers and your colleagues, or "peons," like this, I can only imagine how you treat your family.
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Thanks for remaining totally non judgemental with your comments ranging from rosy smelling feces to my high and mighty attitude to my now implied abuse of my family. I will be sure to relay your concerns to my wife and kids.
I never treat anyone like a peon, but why prove it with facts when I can just see a newbie come to the board and dig up an old thread with:
You entered this post with a proclamation of curiosity, yet you immediately label us as high and mighty and now abusive.
So I ask you: WHAT KIND OF RESPONSE DID YOU EXPECT WITH YOUR INFLAMMATORY COMMENTS AND EXCEEDINGLY POOR CHOICE OF THREADS? Ask a question without an insult, and I was VERY insulted by your comments, and you will get a thoughtful response.
Since you have obviously lurked on this board long enough to know the types of arguments and quibbles that exist here, what possessed you to pull up such an acrimonious thread and do so with the comments you placed in your post?
I never treat anyone like a peon, but why prove it with facts when I can just see a newbie come to the board and dig up an old thread with:
You entered this post with a proclamation of curiosity, yet you immediately label us as high and mighty and now abusive.
So I ask you: WHAT KIND OF RESPONSE DID YOU EXPECT WITH YOUR INFLAMMATORY COMMENTS AND EXCEEDINGLY POOR CHOICE OF THREADS? Ask a question without an insult, and I was VERY insulted by your comments, and you will get a thoughtful response.
Since you have obviously lurked on this board long enough to know the types of arguments and quibbles that exist here, what possessed you to pull up such an acrimonious thread and do so with the comments you placed in your post?
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First off, I apologize. I jumped off the handle when you insulted me with the genius. In my time on message boards, I figured that starting a thread about this would just be locked.. (usually people would say "go do a search and post it on one of the 100,000 threads!!") However, you came back with a rude response when the post was NOT EVEN DIRECTED AT YOU!! (edit: nevermind, I see you made the "monkey" comment on the first page as well). I have since pm'ed Vent and asked him to start a new topic out of it.
I realize it's a touchy topic. And while I guess it is an impossible feat, I hoped to find out what Doctors really thought of nurses and why they treat them like they do.
And like I said in my edit for my first post, I did not PURPOSELY pick the CRNA vs MDA thread. This was the 7th or 8th thread that I found with the "monkey" reference..The first couple (that are still opened and more recent) I just passed, thinking "what do I care? it doesn't affect me." Then, the next couple I came to were closed. And the more I read it, the more it bothered me. I don't know why. When I get to be a doctor someday, maybe I'll hear a comment from the hospital admins about doctors being their monkeys, and I'll fly off on one of them. Sorry, maybe I'm just sheltered and hope too much for the best.
So I am sorry for getting defensive, but please take a look and realize that although Doctors are some of the most intelligent and prestigious people out there, it won't mean a thing if you don't have the respect of the people you work with, and those that had wanted to be like you one day.
I realize it's a touchy topic. And while I guess it is an impossible feat, I hoped to find out what Doctors really thought of nurses and why they treat them like they do.
And like I said in my edit for my first post, I did not PURPOSELY pick the CRNA vs MDA thread. This was the 7th or 8th thread that I found with the "monkey" reference..The first couple (that are still opened and more recent) I just passed, thinking "what do I care? it doesn't affect me." Then, the next couple I came to were closed. And the more I read it, the more it bothered me. I don't know why. When I get to be a doctor someday, maybe I'll hear a comment from the hospital admins about doctors being their monkeys, and I'll fly off on one of them. Sorry, maybe I'm just sheltered and hope too much for the best.
So I am sorry for getting defensive, but please take a look and realize that although Doctors are some of the most intelligent and prestigious people out there, it won't mean a thing if you don't have the respect of the people you work with, and those that had wanted to be like you one day.
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Understand that I admire your efforts to inquire about the profession you are about to join, but you seem to already have some preconceptions about what the medical field entails with regards to interdisciplinary attitudes. The "monkey" comments refer to manual dexterity and skill through repetition, NOT evolutionary stage, position in food chain, or bias.
In any event, there are many people who I would describe as "territorial" to put it mildly, but there are at least an equal amount of people in the medical profession who go beyond all necessity to ensure that their colleagues (ALL of them, be it MD, DO, RN, CRNA, OD, DDS, etc.) are treated equally. I walk around Southwestern and make sure that I do everything I can to make it the best environment for myself and my colleagues to work in, whether it is something as simple as saying hello or thank you to covering overnight calls for fellow residents who have an emergency.
It is something that I have a passion for because I came to anesthesiology from a program that did not provide that environment and left me determined to ensure that I gave the most positive influence on my new surroundings and new friends.
Will there always be conflicts among the many practitioners of medicine? Unfortunately, it is probable more than just possible so if you feel that the perception of one discipline of the medical spectrum (physicians) is contributing to that problem, just enter the field with the daily goal to facilitate the best relationship that can be had between yourself and your colleagues as well as between your colleagues themselves. DON'T judge them even though you may have an uncontrollable urge to, and if you do, don't show it and treat someone based on your personal opinion. Everyone is a member of the hospital team and cutting an arm or leg off doesn't help you and especially the patient.
In any event, there are many people who I would describe as "territorial" to put it mildly, but there are at least an equal amount of people in the medical profession who go beyond all necessity to ensure that their colleagues (ALL of them, be it MD, DO, RN, CRNA, OD, DDS, etc.) are treated equally. I walk around Southwestern and make sure that I do everything I can to make it the best environment for myself and my colleagues to work in, whether it is something as simple as saying hello or thank you to covering overnight calls for fellow residents who have an emergency.
It is something that I have a passion for because I came to anesthesiology from a program that did not provide that environment and left me determined to ensure that I gave the most positive influence on my new surroundings and new friends.
Will there always be conflicts among the many practitioners of medicine? Unfortunately, it is probable more than just possible so if you feel that the perception of one discipline of the medical spectrum (physicians) is contributing to that problem, just enter the field with the daily goal to facilitate the best relationship that can be had between yourself and your colleagues as well as between your colleagues themselves. DON'T judge them even though you may have an uncontrollable urge to, and if you do, don't show it and treat someone based on your personal opinion. Everyone is a member of the hospital team and cutting an arm or leg off doesn't help you and especially the patient.
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UTSouthwestern said:
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hi peach
i am glad that you dug up my post...
1) no, i don't tell nurses to their faces that they are monkeys.... but I do consider most health care practitioners who are short of an MD or a DO to be protocol/algorithm/policy driven - which implies that with repitition they get good at a specific thing.... as they are not taugh the same reasoning.
2) nurses love me... and that is because i treat them with respect, and I value their insight into patients (especially in the ICU) and family interactions.
3) i hope by the time you make it into medical school you will be able to appreciate similes and metaphors for what they are, instead of misunderstanding them.
i am glad that you dug up my post...
1) no, i don't tell nurses to their faces that they are monkeys.... but I do consider most health care practitioners who are short of an MD or a DO to be protocol/algorithm/policy driven - which implies that with repitition they get good at a specific thing.... as they are not taugh the same reasoning.
2) nurses love me... and that is because i treat them with respect, and I value their insight into patients (especially in the ICU) and family interactions.
3) i hope by the time you make it into medical school you will be able to appreciate similes and metaphors for what they are, instead of misunderstanding them.
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Guys, CRNAs and MDAs have coexisted for years...... Its incredulous to think that every hospital in America has an MDA available. I agree that certain patient population are best served with the collaboration that occurs between MDAs and CRNAs. I am in the military and when deployed there is rarely more than one or two MDAs with 10-12 CRNA in a Combat Support Hospital and with a Forward Surgical Team there are no MDAs (with some of the worst trauma you have ever seen). We have the best resuscitative treatment and evacuation in the world and the major provider of anesthesia is the CRNA. I totally respect our physician anesthetists and consult with them as appropriate..... I have placed many Central lines, A-lines, etc am proficient in several regional techniques, and have been the direct anesthesia provider in numerous battlefield traumas. The experience of some of your CRNA colleagues should not be diminished.
I work with a great MDA (who was formerly a CRNA), we have defined our roles very well. He is the expert of anesthesia. When there is an issue a haven't dealt with in some time I consult him to verify that my plan is appropriate. He is not in the room when we do our anesthetic (unless we ask for his assistance). When appropriate (typically ASA III and ASA IV pts) he gets the courtesy of a consult. Our roles are defined in Army Regulation 40-68 if anyone is interested. I respect him and he respects me (and the CRNA staff). Again, I feel the debate rages because of a few MDAs and a few CRNAs. Overall, I love this profession and the people (MDAs and CRNAs) that I work with.
I guess what I am trying to say is that it is impossible to serve the needs of America (as we currently do) with the number of MDAs and CRNAs. In the rural and underserved areas there are typically no MDAs but the surgical pt population still exists in those areas. We as CRNAs are very competent anesthesia providers.
There is a rift between a certain subsection of the AANA and ASA and the bottom line is money. I agree that an MDA should be paid more than a CRNA, they deserve it. My only advice is that you respect that many of us have been performing anesthetics in all arenas for years and are very polished. I have seen and worked with excellent MDAs and CRNAs in both the military and civilian setting (but the reverse is also true). My bottom line is patient safety.
"can't we all just get along............"
Take Care,
Mike
I work with a great MDA (who was formerly a CRNA), we have defined our roles very well. He is the expert of anesthesia. When there is an issue a haven't dealt with in some time I consult him to verify that my plan is appropriate. He is not in the room when we do our anesthetic (unless we ask for his assistance). When appropriate (typically ASA III and ASA IV pts) he gets the courtesy of a consult. Our roles are defined in Army Regulation 40-68 if anyone is interested. I respect him and he respects me (and the CRNA staff). Again, I feel the debate rages because of a few MDAs and a few CRNAs. Overall, I love this profession and the people (MDAs and CRNAs) that I work with.
I guess what I am trying to say is that it is impossible to serve the needs of America (as we currently do) with the number of MDAs and CRNAs. In the rural and underserved areas there are typically no MDAs but the surgical pt population still exists in those areas. We as CRNAs are very competent anesthesia providers.
There is a rift between a certain subsection of the AANA and ASA and the bottom line is money. I agree that an MDA should be paid more than a CRNA, they deserve it. My only advice is that you respect that many of us have been performing anesthetics in all arenas for years and are very polished. I have seen and worked with excellent MDAs and CRNAs in both the military and civilian setting (but the reverse is also true). My bottom line is patient safety.
"can't we all just get along............"
Take Care,
Mike
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As UT stated if someone wants to post a subject on the matter of CRNA's and their role in anesthesia working along side MDA's then start a new thread. Preferably not one that begins with "CRNA's VS MD's" or "what the hell makes MDA's treat CRNA's like poo."
That being said this is going to be closed. To the rehashing op please take the advice given by UT.
Vent
That being said this is going to be closed. To the rehashing op please take the advice given by UT.
Vent
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