CRNA vs. MD/DO-A - should CRNAs be independent?

[DrPresident]

Uh oh, there it is again. The big question - CRNA vs MD-A?

I know it has been posted on more than one occasion here on SDN, and the "facts" are plastered on the internet from California to the New York island; from the Redwood Forest to the gulf stream waters. I'm curious to actually be engaged in the conversation though, without reigniting a dead thread. So I'm curious, from physicians/to-be-physicians/CRNAs/anyonereallyimeanhowhardisanasthesia.

Some of the points I've found to be the most commonly talked about:

1. MD/DO requires 4 years of undergrad, 4 years of medical school, and 3-4 years of residency. So 11-12 years of training. CRNA requires 4 years of BSN (or other B.S. followed by MSN to a PMC in Nursing Anesthesiology) followed by 1-2 years of ICU work experience, then 36 months (28-36 variable) CRNA school. This adds up to 7.5-9 years of training.

Does this gap really make that much of a difference? I have seen those fighting "on the MD side" say that the breadth of knowledge and skill is so much deeper for the MD, but the training time doesn't seem to reflect that too much. However, the clinical hours certainly favor the MD (I saw one figure with something like 1600 CRNA vs 12-16k for MD).

2. 17 states have opted out of the MD-A supervision of CRNAs. Thoughts? With some experience, from most of what I've read CRNAs are probably more than capable for most situations. It seems that the MD advocates seem to think they're incapable to handling an emergency situation effectively without the MD. Is this really true? I have a hard time believing that the CRNA is the cop that can't stop Dr. Evil but tries really hard and the MD swoops in with the red cape and muscle suit and saves the day. But then, I don't know how the CRNA is trained in these situations and am confident that the MD is definitely trained to handle the situation.

Thoughts?

3. Surgeons becoming the supervising physician...

Ruh Roh. That doesn't sound good. Surgeons cut, MD-As gas. Who would take over as the supervising physician, or could the CRNA become the responsible party for the gas & drugs? Who's to say that a physician absolutely has to be the supervising all-power here? I know, of course, there are laws that say just that. But if a CRNA is considered an APRN, why would they be required to have physician supervision - wouldn't they be the responsible party themselves for the anesthesia?

I myself am pursuing CRNA after I finish my current MSN, and honestly don't have an opinion one way or the other. I have no quarrels with working under an MD - they certainly will be a fantastic resource & supervising power, and I expect to still have a reasonable amount of autonomy either way. I'm just trying to understand both sides - I've seen some pretty strong opinions both ways. Please share!

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[WashMe]

Uh oh, there it is again. The big question - CRNA vs MD-A?

I know it has been posted on more than one occasion here on SDN, and the "facts" are plastered on the internet from California to the New York island; from the Redwood Forest to the gulf stream waters. I'm curious to actually be engaged in the conversation though, without reigniting a dead thread. So I'm curious, from physicians/to-be-physicians/CRNAs/anyonereallyimeanhowhardisanasthesia.

Some of the points I've found to be the most commonly talked about:

1. MD/DO requires 4 years of undergrad, 4 years of medical school, and 3-4 years of residency. So 11-12 years of training. CRNA requires 4 years of BSN (or other B.S. followed by MSN to a PMC in Nursing Anesthesiology) followed by 1-2 years of ICU work experience, then 36 months (28-36 variable) CRNA school. This adds up to 7.5-9 years of training.

Does this gap really make that much of a difference? I have seen those fighting "on the MD side" say that the breadth of knowledge and skill is so much deeper for the MD, but the training time doesn't seem to reflect that too much. However, the clinical hours certainly favor the MD (I saw one figure with something like 1600 CRNA vs 12-16k for MD).

2. 17 states have opted out of the MD-A supervision of CRNAs. Thoughts? With some experience, from most of what I've read CRNAs are probably more than capable for most situations. It seems that the MD advocates seem to think they're incapable to handling an emergency situation effectively without the MD. Is this really true? I have a hard time believing that the CRNA is the cop that can't stop Dr. Evil but tries really hard and the MD swoops in with the red cape and muscle suit and saves the day. But then, I don't know how the CRNA is trained in these situations and am confident that the MD is definitely trained to handle the situation.

Thoughts?

3. Surgeons becoming the supervising physician...

Ruh Roh. That doesn't sound good. Surgeons cut, MD-As gas. Who would take over as the supervising physician, or could the CRNA become the responsible party for the gas & drugs? Who's to say that a physician absolutely has to be the supervising all-power here? I know, of course, there are laws that say just that. But if a CRNA is considered an APRN, why would they be required to have physician supervision - wouldn't they be the responsible party themselves for the anesthesia?

I myself am pursuing CRNA after I finish my current MSN, and honestly don't have an opinion one way or the other. I have no quarrels with working under an MD - they certainly will be a fantastic resource & supervising power, and I expect to still have a reasonable amount of autonomy either way. I'm just trying to understand both sides - I've seen some pretty strong opinions both ways. Please share!

I'll bite.

yesus christe, how much more insulting, arrogant, and uninformed could you be? I sincerely hope you do NOT get into a CRNA program, for the benefit of the patients and the field.

1. You have a huge chip on your shoulder, calling yourself DrPresident when you are a nurse and don't even have a master's degree.
2. Stop calling it MD-A. I think you mean "anesthesiologist," as in "doctor."
3. "anyonereallyimeanhowhardisanesthesia" -- evidently hard enough that you can't even imagine the nuances.
4. To compare years of training, you have to ask "years of training doing WHAT?"
5. You've "read that CRNA's are more than capable for most situations," but who wrote that? And why?

When you ask "Does this gap really make that much of a difference?" you sound dangerous. That's like asking whether someone who trained to fly a single-prop plane could hop in a jet fighter and fly it like Maverick. You are a pilot of neither (i.e. not an anesthesia doctor or an anesthesia nurse), so you hardly understand the question at all, but I hope you get some perspective or get away from the field.

 

[Psai]

For someone who wants to practice anesthesia, you don't seem to have much respect for it.

 

[Man o War]

Uh oh, there it is again. The big question - CRNA vs MD-A?

I know it has been posted on more than one occasion here on SDN, and the "facts" are plastered on the internet from California to the New York island; from the Redwood Forest to the gulf stream waters. I'm curious to actually be engaged in the conversation though, without reigniting a dead thread. So I'm curious, from physicians/to-be-physicians/CRNAs/anyonereallyimeanhowhardisanasthesia.

Some of the points I've found to be the most commonly talked about:

1. MD/DO requires 4 years of undergrad, 4 years of medical school, and 3-4 years of residency. So 11-12 years of training. CRNA requires 4 years of BSN (or other B.S. followed by MSN to a PMC in Nursing Anesthesiology) followed by 1-2 years of ICU work experience, then 36 months (28-36 variable) CRNA school. This adds up to 7.5-9 years of training.

Does this gap really make that much of a difference? I have seen those fighting "on the MD side" say that the breadth of knowledge and skill is so much deeper for the MD, but the training time doesn't seem to reflect that too much. However, the clinical hours certainly favor the MD (I saw one figure with something like 1600 CRNA vs 12-16k for MD).

2. 17 states have opted out of the MD-A supervision of CRNAs. Thoughts? With some experience, from most of what I've read CRNAs are probably more than capable for most situations. It seems that the MD advocates seem to think they're incapable to handling an emergency situation effectively without the MD. Is this really true? I have a hard time believing that the CRNA is the cop that can't stop Dr. Evil but tries really hard and the MD swoops in with the red cape and muscle suit and saves the day. But then, I don't know how the CRNA is trained in these situations and am confident that the MD is definitely trained to handle the situation.

Thoughts?

3. Surgeons becoming the supervising physician...

Ruh Roh. That doesn't sound good. Surgeons cut, MD-As gas. Who would take over as the supervising physician, or could the CRNA become the responsible party for the gas & drugs? Who's to say that a physician absolutely has to be the supervising all-power here? I know, of course, there are laws that say just that. But if a CRNA is considered an APRN, why would they be required to have physician supervision - wouldn't they be the responsible party themselves for the anesthesia?

I myself am pursuing CRNA after I finish my current MSN, and honestly don't have an opinion one way or the other. I have no quarrels with working under an MD - they certainly will be a fantastic resource & supervising power, and I expect to still have a reasonable amount of autonomy either way. I'm just trying to understand both sides - I've seen some pretty strong opinions both ways. Please share!

You are going to be a fantastic CRNA, you've already consumed the kool aid so they won't have to spend the first few months of your CRNA schooling convincing you of your equality.

 

[Arch Guillotti]

Closing.

This thread has nowhere to go.