- Joined
- Jun 8, 2003
- Messages
- 26
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When I was a premed student, I thought that CRNAs worked under the supervision of an anesthesiologist like any other nurse. When I got into medical school I vehemently stated that MDAs were better than CRNAs, but I really didn't know. When I got into residency, I began to be concerned because I noticed that the CRNAs were doing the same cases that I was. Now that I'm in private practice, I noticed that there is a BIG difference. Here are the minor differences:
CRNAs usually concentrate in specific areas of anesthesiology (Ob, outpatient, Gyn, ortho, cardiac) while many MDAs are diversified and may exclude one or two areas.
Many private practice groups employ CRNAs to handle OB, an area that MDAs don't typically make much money.
Most CRNAs are employees, and do not share in the profits of a group. Thus, they usually work shifts and may change jobs more than MDAs.
Many CRNAs are technically very skilled and sometimes even better than the MDAs.
However, the big difference is that MDAs are consultants and not just technicians. The two people I first heard this from were MDAs who were former CRNAs. They stated that as CRNAs, they had no idea what they didn't know but realized it when they became MDAs.
A MDA can make medical management changes and recommendations for patients beyond what would be needed for a case. You can make medical diagnoses and even outpatient medication regimen. MDAs can walk into an ER, clinic, and ICU and still function as a physician. My colleagues at several other groups expressed the same feelings.
In my group, the differences came to our attention by the surgeons. The gastric bypass patients did better (early extubation, decrease postop CHF, MI and infections) with MDA care. Our vascular and cardiac preops performed by MDAs had less cancellations for the cases. It didn't matter if the CRNAs were newly trained or not, we had the same problems. But when it came to OB and outpatient cases, there were no difference and even a higher satisfaction with the OB CRNA. I routinely educate patients who request MDAs when the CRNA is equally good. I also try my best to maintain CRNA coverage for OB because I believe he does a much better job than the MDAs. It's funny how our CRNAs who have been in practice for 20+ years are adhamant that they are not as good as physicians. These are are most skilled CRNAs.
MDA vs CRNA should not be the fight. There aren't enough providers in the rural areas right now. The fight is counterproductive. We, CRNAs and MDAs should be getting together and fighting for higher reimbursements, better OR efficiency, and better distribution of resources. CRNAs are not physicians. They are a key part of anesthesiology services that could not exist without them. So, your jobs are not secure as long as there is a fight. And the winner will be HMOs, hospital administrations, and medicare.
CRNAs usually concentrate in specific areas of anesthesiology (Ob, outpatient, Gyn, ortho, cardiac) while many MDAs are diversified and may exclude one or two areas.
Many private practice groups employ CRNAs to handle OB, an area that MDAs don't typically make much money.
Most CRNAs are employees, and do not share in the profits of a group. Thus, they usually work shifts and may change jobs more than MDAs.
Many CRNAs are technically very skilled and sometimes even better than the MDAs.
However, the big difference is that MDAs are consultants and not just technicians. The two people I first heard this from were MDAs who were former CRNAs. They stated that as CRNAs, they had no idea what they didn't know but realized it when they became MDAs.
A MDA can make medical management changes and recommendations for patients beyond what would be needed for a case. You can make medical diagnoses and even outpatient medication regimen. MDAs can walk into an ER, clinic, and ICU and still function as a physician. My colleagues at several other groups expressed the same feelings.
In my group, the differences came to our attention by the surgeons. The gastric bypass patients did better (early extubation, decrease postop CHF, MI and infections) with MDA care. Our vascular and cardiac preops performed by MDAs had less cancellations for the cases. It didn't matter if the CRNAs were newly trained or not, we had the same problems. But when it came to OB and outpatient cases, there were no difference and even a higher satisfaction with the OB CRNA. I routinely educate patients who request MDAs when the CRNA is equally good. I also try my best to maintain CRNA coverage for OB because I believe he does a much better job than the MDAs. It's funny how our CRNAs who have been in practice for 20+ years are adhamant that they are not as good as physicians. These are are most skilled CRNAs.
MDA vs CRNA should not be the fight. There aren't enough providers in the rural areas right now. The fight is counterproductive. We, CRNAs and MDAs should be getting together and fighting for higher reimbursements, better OR efficiency, and better distribution of resources. CRNAs are not physicians. They are a key part of anesthesiology services that could not exist without them. So, your jobs are not secure as long as there is a fight. And the winner will be HMOs, hospital administrations, and medicare.
hopefully....
