Looking for some perspective on all the hate?

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RapidResponseNurse

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Hello Everyone,

I am new to this site but have read many articles here and elsewhere about pervasive beliefs in the CRNA and MDA world. First off let me state for the record that I am an ICU nurse who is applying to CRNA school. That being said, my biggest supporter and mentor is an MDA, my step father was a nuclear cardiologist, my mother was a critical care flight nurse, and my sister is in medical school. This has given me much respect for both disciplines and I would like to engage in some respectful dialogue with others from different professions.

I have seen on many nursing sites where SNRAs/CRNAs have a hate for MDAs and think there is no need for them. Inversely, many medical oriented sites think CRNAs are not capable of critically thinking or providing excellent anesthesia.

Why is this? Anesthesia started as a nursing profession originally, when the medical community made anesthesia a specialty they made huge improvements to the field and are almost exclusively responsible for the current level of safety and precision that the specialty enjoys.

Why can't both sides praise the other for their respective strengths?

I have shadowed CRNAs and MDAs as requirements for my applications and both are phenomenal. I have sat in on ASA 4 open hearts where a CRNA did the preop plan, chose his meds, intubated, managed that patient during surgery, and followed them post op. The patient did fine and I later took care of that patient the next day in ICU. In my opinion this CRNA was an expert in his craft and deserve respect. It should also be pointed out that during the surgery there was an MDA available to serve as and EXPERT OPINION in the event that the CRNA needed help. Although the CRNA did not have to call on the services of the MDA I'm sure he felt confident knowing that there was a second pair of hands to help in the case of an emergency.

I have also seen a patient in the ICU develop sudden angioedema and need to be intubated. He was a very difficult airway and the attempts to intubate from the Critical Care fellow where unsuccessful. When the anesthesia team arrived the MDA attending allowed the CRNA to intubate first which was again unsuccessful. Then the attending attempted once more to intubate which was also unsuccessful. Without missing a beat the MDA called for an emergent airway box and trached the person on the spot. The patient survived and the MDA was a rockstar and very humble about the whole procedure.

I recently saw an MDA attending allow a veteran CRNA instruct the new anesthesia interns on small "pearls of practice" he had picked up when he was deployed in Iraq. Did that MDA know that he himself possessed more academic knowledge then the CRNA? Absolutely! Did that MDA also respect the technical skills that the CRNA had acquired by dealing with massive facial and thoracic trauma on a regular basis? ABSOLUTELY!

I know this has been long winded and I really hope it does not turn into a mud throwing contest but I really would like to hear from some MDAs (who are not militant toward CRNAs) regarding their views on the skill sets of CRNAs. For the record I posted a similar thread to a CRNA forum asking about MDAs.
 
RapidResponseNurse said:
I am new to this site but have read many articles here and elsewhere about pervasive beliefs in the CRNA and MDA world. First off let me state for the record that I am an ICU nurse who is applying to CRNA school. That being said, my biggest supporter and mentor is an MDA, my step father was a nuclear cardiologist, my mother was a critical care flight nurse, and my sister is in medical school. This has given me much respect for both disciplines and I would like to engage in some respectful dialogue with others from different professions.
Click to expand...

Use of the inflammatory term MDA = fail.

Also, today I learned that there is a sub-subspecialty of cardiology called nuclear cardiology. I though the nuc med guys did that.
 
fakin' the funk said:
Also, today I learned that there is a sub-subspecialty of cardiology called nuclear cardiology. I though the nuc med guys did that.
Click to expand...
Nuclear cardiology is a subspecialty of atomic cardiology. Like electronic cardiology.

Sorry, the repeated MDA brought out my trolling. It correlates with mediocrity in my book.
 
FFP said:
Nuclear cardiology is a subspecialty of atomic cardiology. Like electronic cardiology.

Sorry, the repeated MDA brought out my trolling. It correlates with mediocrity in my book.
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Is MDA somehow offensive? I did not mean it as such and I apologize if it was taken as such. MDA is just easier to type then Anesthesiologist and CRNA easier then Anesthetist. When someone refers to me as an "RN" I don't take it to be offensive even though I have my BSN and am certified as a Critical Care nurse (CCRN) and certified in Cardiac Medicine (CMC). I am a rapid response nurse in addition to working in critical care. I can intubate, initiate vasoactive drips, run codes, and place central venous lines. My correct title would be John Doe BSN, RN, CCRN-CMC, RRT but simple saying RN is far easier then all that, even though it took hundreds of hours to gain all those stupid letters.
 
You can say MD, or doctor, and everybody here will understand.
RapidResponseNurse said:
I can intubate, initiate vasoactive drips, run codes, and place central venous lines.
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I will give you the benefit of the doubt and just say that your current knowledge is a drop in the ocean of anesthesia knowledge. Seriously, saying "I can intubate" on an anesthesia forum will prompt a ROTFL.

But that's OK, as long as you realize how much you don't know, and appreciate those who do. I try to do this on a daily basis with people smarter than I, regardless of their letter salad.
 
fakin' the funk said:
Use of the inflammatory term MDA = fail.

Also, today I learned that there is a sub-subspecialty of cardiology called nuclear cardiology. I though the nuc med guys did that.
Click to expand...

Sorry for the confusion, he died when I was 14 but he ran a practice where he used nuclear medicine. I was just assumed that would be a nuclear cardiologist. Thanks for correcting me I will be more aware of the importance of small details when setting up a back story that was used to say that I respect the hell out of physicians.
 
FFP said:
You can say MD, or doctor, and everybody here will understand.

I will give you the benefit of the doubt and just say that your current knowledge is a drop in the ocean of anesthesia knowledge.
Click to expand...

Absolutely your knowledge far exceeds mine. All that matters when I show up to a hemorrhaging patient on the floor that I be able to fluid resuscitate and use what ever pressor is needed for the patient. Same if a patient is having an active MI, they need morphine, nitro, and oxygen unless of course it is a right sided MI then I would not want to vasodilate them with nitro/morphine. Im sure all the MDs out there could give me an awesome and welcomed education on the intricate details of hemodynamics. Right now, my job is to stabilize and resuscitate until expert intervention is available. I love what I do but want to expand my knowledge base to the fullest extent possible. Ideally I would go to medical school but I have a 2 year old daughter and 4 years of medschool and 4 years of residency is not an option in light of CRNA school that is 3.5 years in addition to the 4 years of school and 2 years of ICU experience I already have.

One question though, why does MDA = failure?? I think the title of MDA is one of great respect. Regardless if it not seen that way I will refer to y'all as physicians, MDs, anesthesiologists.
 
I'll try to get back on topic here. The OP probably is sincere (and naive), so I'll just give him/her the benefit of the doubt.

Let me list some of the reasons I personally don't like working with CRNAs for. I want to point out that all the CRNAs I work with are under my medical direction, as in they basically work on my license and my malpractice insurance (the buck literally stops with me), and they are legally obligated to follow my instructions. The following applies more or less to a good number of them.

- They behave like they are my equal professionally, even as if I am the one working for them, and not the other way round. Since we don't have equal liability, we are not equals; far from it.
- For somebody working under supervision, they do have an attitude. A resident would be fired in a month for what they get away with on a daily basis.
- They are much lazier than me. I am a much harder worker than most of them. They think that if we work the same number of hours we work the same.
- They refuse to do things that just require too much work. I had to cancel cases because the anesthesia plan did not fit their known "recipes".
- They care more about their breaks and the time on the clock than their patients. God forbid they have to stay overtime unpaid to finish a case.
- They are on their smartphone a lot during cases. That's understandable, since most of their anesthesia knowledge comes from Dr. Google. But they are not on Google, they are on Facebook and SMS.
- They don't know when to call for help. They put their egos ahead of patient safety. They will call you only when they are in ****, than they will deny that it was their fault, or that it was life-threatening **** in the first place.
- They consciously don't follow (all) my instructions. Just the ones they feel like. Because, you know, they don't need to be told what to do. But they don't have the guts to just move to an independent practice state and work solo.
- They don't check on their former patients in the PACU, between cases. I do, even when working solo.
- When not hostile to my face, they are duplicitous and passive-aggressive.
- They look down on PACU RNs. Yes, you read it right. Actually they look down on most non-OR nurses.
- Most of all, they don't know how little they know. They think just because our exams, experience or studies have similar names, they mean the same thing.
 
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FFP said:
I'll try to get back on topic here. The OP probably is sincere (and naive), so I'll just give him/her the benefit of the doubt.

Let me list some of the reasons I personally don't like working with CRNAs for. I want to point out that all the CRNAs I work with are under my medical direction, as in they basically work on my license and my malpractice insurance (the buck literally stops with me), and they are legally obligated to follow my instructions. The following applies more or less to a good number of them.

- They behave like they are my equal professionally, even as if I am the one working for them, and not the other way round.
- For somebody working under supervision, they do have an attitude. A resident would be fired in a month for what they get away with on a daily basis.
- They are much lazier than me. I am a much harder worker than most of them. They think that if we work the same number of hours we work the same.
- They refuse to do things that just require too much work. I had to cancel cases because the anesthesia plan did not fit their known "recipes".
- They care more about their breaks and the time on the clock than their patients. God forbid they have to stay overtime unpaid to finish a case.
- They are on their smartphone a lot during cases. That's understandable, since most of their anesthesia knowledge comes from Dr. Google.
- They don't know when to call for help. They put their egos ahead of patient safety. They will call you only when they are in ****, than they will deny that it was their fault, or that it was life-threatening **** in the first place.
- They consciously don't follow (all) my instructions. Just the ones they feel like. Because, you know, they don't need to be told what to do. But they don't have the guts to just move to an independent practice state.
- They don't check on their former patients in the PACU, between cases. I do, even when working solo.
- When not hostile to my face, they are duplicitous and passive-aggressive.
- They look down on PACU RNs. Yes, you read it right. Actually they look down on most non-OR nurses and healthcare staff.
- Most of all, they don't know how little they know. They think just because our exams, experience or studies have similar names, they mean the same thing.
Click to expand...

QED.

Well articulated. I work with 90% AA's and 10% CRNAs and their attitudes toward physicians differ drastically. Having the years in medicine in nursing prior to starting anesthesia very visibly skews the attitudes toward my attendings, versus someone that is new to medicine and knows they dont know what they dont know.

Some of the AAs that I work with have been practicing literally longer than I've been alive and never once have I had an uncomfortable conversation or heard them bitch or whine about how they disagree with an attending's plan, or "I'm not doing that, I'm just going to do [blank] when they leave the room."

Ultimately, I hate making generalizations about a particular group of people as a blanket statement because there are obviously aberrations even where I work, but it comes down to respect versus a lack of respect. You can google and see all the disrespect you want.
 
FFP said:
MDA is a term invented by the AANA, so that it sounds like CRNA to the general public. It's about as offensive as the n word.
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For the record I am a guy (ha that damn perception as nurses being female strikes again lol). Personally as a future CRNA I would appreciate the knowledge offered from an experienced MD. Here is my opinion for what it is worth. If I was going to have surgery I would take a new grad MD over a new grad CRNA any day of the week. I would take a seasoned MD over a seasoned CRNA any day of the week. But would I take a new MD over a seasoned CRNA probably not... That is not to be offensive that is just logical thinking. I don't know much in the world of anesthesia yet but it the world of critical care, MICU being my specialty, I get a lot of respect from the interns and residents. When a patient is crashing and going into shock most of the time I tell the physician, "Im starting XYZ does that sound good?" "I think the patient is suffering from XYZ should we order diagnostics ABC?" 90% of the time they say yes, 10% of the time they say know and educate me about why that is not a good option. In a code situation when the doctors arrive I always ask if they want to lead, most of them do but some that I work with on a daily basis will tell me to remain the code leader until ROSC or when my scope of ACLS has been exhausted.

Here is the thing you have to understand about nursing... We have severely harmed our profession by allowing so many entry points to get licensed. You can be considered a "nurse" by simply getting a diploma degree. Where as I carry a bachelors plus many national certifications to be called a "nurse." This is what bothers me. Currently my science/math classes include Calculus I/II, Statistics, A&P I/II, Pathophysiology I/II, Pathophysiology for advanced practitioners, Microbiology, Genetics, Pharmacology I/II, Pharmacology for advanced practitioners, Health assessment I/II, Health assessment for advanced practitioners, Physics, Chemistry I/II, Organic Chemistry, and Bio Chemistry. My GPA is ~3.8. There are many other "science classes" that I took in nursing school but that cant really be considered "true science" because nursing school waters down a lot of content. That is why in my opinion you have a much higher ratio of crappy nurses verses awesome nurses, then you do between crappy MDs and awesome MDs.

I am not trying to make myself seem like I am better than other nurses but it frustrating that they are a "Nurse" and I am a "Nurse" I guess in writing this I can see how you MDs feel when CRNA try to introduce themselves as Doctor just because they have a DNAP. While I am pursuing a DNAP degree and will want to be called doctor in the academia world, I am in no way a physician and would introduce myself, "Hello I will be your nurse anesthetist for the procedure."

This is the debate though, Should a CRNA, how ever rare they might be, who can safely practice on their own and is willing to ask for help have their scope limited even though in some states they have the legal right to practice independently. Does a new anesthesiologist not practice independently and ask for help when needed? I would not expect to be able to practice independently for many years after school but with 5-10 years of experience doesn't that make up a lot of ground for not having the additional 3 years of anesthesia training the new grad MD had over me?
 
For the record, I am totally against these CRNA mills that accept >70 students a year. I feel this does the profession of anesthesia a huge disservice and will only serve to water down the academic/professional practice of CRNAs. Further more it will only hurt reimbursement for both the CRNA and MD community. This is what happened to the other midlevel nursing professions. Look at your typical Nurse Practitioner, two years for a degree with no rigorous admission process and in many schools much of the didactic education is done online. This to me is unacceptable and is why a NP only makes ~90k/yr. I made 85k last year, granted I work some overtime but not that much...

I think all CRNA schools should strive for small classes that stress science and critical thinking. Personally I am only applying to the schools that meet these requirements. I am applying to Duke, Rush University, Mayo Clinic, Baylor, and the Army School of Anesthesia. All of these programs are doctorate level, have small classes (minus Army) and are respected institutions that hold their students to very high standards.

I wish the nursing world would wake up and require nurses to take more pharmacology and pathophysiology. I hate the perception that all bedside nurses do is pass meds and carry out orders. While I do follow doctors orders my order sets are start patient on and EV1000 hemodynamic monitoring with PA line, initiate CRRT, place patient on therapeutic hypothermia, and titrate norepinephrine, epinephrine, vasopressin, and dobutamine to keep MAP >65. Further more I keep the patient paralyzed with vecuronium and titrate sedation (usually propofol) to adequate SED line values based on my own judgment. There is no one directing me as to how much/how little pressors to use. Nephro orders the dialysate Rx but I manage the blood flow and ultrafiltration. I also do all the electrolyte replacement based on standing parameters. I am not saying I practice medicine but this is far out of the scope of your average nurse.

I guess at the end of the day I acknowledge the wealth of knowledge most MDs have and seek their education and guidance but I can't help but think that there are many ICU nurses in level one facilities that do the same thing I do on a daily basis. This isn't med school by any means but it also isn't a walk in the park like some people like to think. I sincerely hope that one day (after much additional training) I will be able to show the MD community that there are some nurses out there who truly know their stuff and can practice SAFELY to the fullest extent of their license while still appreciating/respecting the value of collaborating with MDs when needed and asking for guidance when necessary.
 
RapidResponseNurse said:
For the record I am a guy (ha that damn perception as nurses being female strikes again lol). Personally as a future CRNA I would appreciate the knowledge offered from an experienced MD. Here is my opinion for what it is worth. If I was going to have surgery I would take a new grad MD over a new grad CRNA any day of the week. I would take a seasoned MD over a seasoned CRNA any day of the week. But would I take a new MD over a seasoned CRNA probably not... That is not to be offensive that is just logical thinking. I don't know much in the world of anesthesia yet but it the world of critical care, MICU being my specialty, I get a lot of respect from the interns and residents. When a patient is crashing and going into shock most of the time I tell the physician, "Im starting XYZ does that sound good?" "I think the patient is suffering from XYZ should we order diagnostics ABC?" 90% of the time they say yes, 10% of the time they say know and educate me about why that is not a good option. In a code situation when the doctors arrive I always ask if they want to lead, most of them do but some that I work with on a daily basis will tell me to remain the code leader until ROSC or when my scope of ACLS has been exhausted.

Here is the thing you have to understand about nursing... We have severely harmed our profession by allowing so many entry points to get licensed. You can be considered a "nurse" by simply getting a diploma degree. Where as I carry a bachelors plus many national certifications to be called a "nurse." This is what bothers me. Currently my science/math classes include Calculus I/II, Statistics, A&P I/II, Pathophysiology I/II, Pathophysiology for advanced practitioners, Microbiology, Genetics, Pharmacology I/II, Pharmacology for advanced practitioners, Health assessment I/II, Health assessment for advanced practitioners, Physics, Chemistry I/II, Organic Chemistry, and Bio Chemistry. My GPA is ~3.8. There are many other "science classes" that I took in nursing school but that cant really be considered "true science" because nursing school waters down a lot of content. That is why in my opinion you have a much higher ratio of crappy nurses verses awesome nurses, then you do between crappy MDs and awesome MDs.

I am not trying to make myself seem like I am better than other nurses but it frustrating that they are a "Nurse" and I am a "Nurse" I guess in writing this I can see how you MDs feel when CRNA try to introduce themselves as Doctor just because they have a DNAP. While I am pursuing a DNAP degree and will want to be called doctor in the academia world, I am in no way a physician and would introduce myself, "Hello I will be your nurse anesthetist for the procedure."

This is the debate though, Should a CRNA, how ever rare they might be, who can safely practice on their own and is willing to ask for help have their scope limited even though in some states they have the legal right to practice independently. Does a new anesthesiologist not practice independently and ask for help when needed? I would not expect to be able to practice independently for many years after school but with 5-10 years of experience doesn't that make up a lot of ground for not having the additional 3 years of anesthesia training the new grad MD had over me?
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Practice Independently? Do you really think that most Physicians on the other side of the curtain will ever see you as more than an Advanced practice Nurse?
Sure, they will value working with you as long as you do what they say and they don't assume any legal responsibility for your actions. If they assume any legal responsibility for supervising you (like they can really supervise a CRNA with no knowledge of the specialty) they expect a big cut of the anesthesia fee.

The concept of CRNAs practicing independently is a smoke screen about giving 1/2 the anesthesia fee or more to the surgeon/Gi doctor or allowing a cheap-ass CEO in rural USA from having to pay for Physician anesthesia.
 
If you want to practice independently good luck to you.
If you want to work collaboratively with me in an anesthesia care team, great, but we do have to agree on a plan, etc.
If you want to practice "to the fullest extent of your license" but still have me to call if and when the stool hits the fan, and 5 minutes too late because you can handle it yourself, until you can't, fuçk that. Go fly solo. I don't need the liability, the coronary spasm, or the money. Though I'm sure there will be suckers that do.
 
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CRNAs in the USA should have went the way Barbers did who practiced Surgery; instead, we legitimized the Barbers and improved their education by training them the basics.


The History of the Royal College of Physicians and Surgeons of Glasgow: The Shaping of the Medical Profession, 1858-1999

British Medical Journal, Sept 2, 2000 by Jeremy Hugh Baron

The History of the Royal College of Physicians and Surgeons of Glasgow: The Shaping of the Medical Profession, 1858-1999 Andrew Hull, Johanna Geyer-Kordesch Hambledon Press, 30 [pounds sterling], pp 288 ISBN 1 85285187 2
Rating: ***
Most of the major royal colleges have commissioned solid scholarly histories. Here is the latest, representing five years' work by three historians of medicine funded by the Wellcome Trust. But the titles are misleading because, rather than merely being an account of the Glasgow Faculty and of the physicians and surgeons of Glasgow, the pair of books are admirably more comprehensive and interesting. They cover the whole history of medicine, in the broadest sense, of Glasgow and western Scotland from the 16th century, and even the medical novels of Smollett and John Moore.
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When it was founded in 1599, the Glasgow Faculty included not only physicians and surgeons but also apothecaries and barbers, who were dropped in 1722 as surgeons rose up the social scale. The faculty became royal in 1909 and a college in 1962.
As with most faculties, colleges, and guilds in Europe, the motive was to regulate training, registration, and practice--ostensibly protecting the public from incompetent irregulars and women but also protecting the doctors from competition. In 1714 Glasgow encouraged anatomy courses taught at the university and examined by the faculty, soon followed by clinical teaching. The necessary corpses were robbed from graves by students or shipped from Ireland. The faculty controlled midwives and taught obstetrics from 1802.
By the 1830s, Scotland produced more doctors than could be absorbed into civil society or into the army and navy. This might explain why NHS expenditure per person and the ratio of doctors and nurses per person are both higher in Scotland than in England. Throughout this period, when Glasgow was "the best place to study medicine," the faculty was at odds with the university and its medical school over control of the teaching of fee paying students at the hospitals.
British universities struggled to make medical degrees the sole registrable qualification, but the colleges kept their conjoint diplomas registrable for another century and a half. As in England, Scottish medical schools were forced in the 20th century to create full time clinical chairs in the teaching hospitals on the model of Johns Hopkins University. The many new English medical schools encouraged students to qualify by their degrees rather than by conjoint diplomas so that the latter eventually disappeared.
Colleges then saw their role as providing postgraduate education. They specified curriculums, set examinations, and approved hospital training posts. There were and are interminable arguments about whether college exams should be entry or exit diplomas for consultant posts in NHS, and now European, hospitals. At least cooperation has now produced a common MRCP(UK), with its exams sometimes held overseas.
In 1791 the Glasgow Faculty moved from its 1697 Trongate Building to St Enoch Square and then, in 1862, moved to neoclassical St Vincent Street, with alterations, expansion, women's toilets in the 1950s, and modernisation up to 1999. I noted that Scottish reticence seems to have so faded in the 21st century as to allow an author in the Introduction to thank his wife for her love and to wish his mother better.
I was mystified that the second book made no mention of Scotland's opposition in the 1930s to English barriers to medical refugees seeking asylum. The Medical Practitioners Union and the BMA did not want German and Austrian doctors to be admitted to practise in the United Kingdom, and the English royal colleges lengthened the time for refugee doctors to re-qualify to three years. The Scottish colleges allowed re-qualification within a year and saved the honour of British medicine by repeatedly rejecting English pressure to be equally restrictive and by reminding the English colleges that "the purpose of the medical licensing bodies was to protect the public and not the medical profession."
 
"CRNAs are now, more than at any time in our history, set to be the primary anesthesia services providers as the health care paradigm shifts. My beef is that our training isn't up to snuff yet to fill that role. "


CRNA from MilitantCRNA.org
 
BLADEMDA said:
Practice Independently? Do you really think that most Physicians on the other side of the curtain will ever see you as more than an Advanced practice Nurse?
Sure, they will value working with you as long as you do what they say and they don't assume any legal responsibility for your actions. If they assume any legal responsibility for supervising you (like they can really supervise a CRNA with no knowledge of the specialty) they expect a big cut of the anesthesia fee.

The concept of CRNAs practicing independently is a smoke screen about giving 1/2 the anesthesia fee or more to the surgeon/Gi doctor or allowing a cheap-ass CEO in rural USA from having to pay for Physician anesthesia.
Click to expand...


I am not asking to be seen as more than an advanced practice nurse, that is exactly what I will be. The thing is, I feel that with much education and experience I could be a damn good APRN who surgeons and other MDs trust to carry out anesthesia. BLADEMDA I have read many of your posts and you seem to be a very knowledgable and experienced MD. In one of your posts you stated that 95% of CRNAs could not manage an ASA 4 patient independently. I totally agree with you I think the vast majority of CRNAs should stick to lower acuity (ASA 1 and 2) patients if they want to practice independently. Additionally, if that CRNA is truly practicing independently they should absolutely be responsible for any errors they make and carry their own insurance.

The thing is I want to be that top 5% and am willing to do everything in my power to reach that level. If that means working under an MD for 5 or 10 years then so be it. I am not trying to say that a CRNA is as ready as an MD to practice by themselves right out of the gate by any means. Further more I believe many CRNAs should practice under a physician. But I do think there a small amount of driven, intelligent, and HUMBLE CRNAs out there who are masters in their craft. I aspire to be that CRNA even if it takes many years.
 
BLADEMDA said:
"CRNAs are now, more than at any time in our history, set to be the primary anesthesia services providers as the health care paradigm shifts. My beef is that our training isn't up to snuff yet to fill that role. "


CRNA from MilitantCRNA.org
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Even the most Militant CRNAs on the internet acknowledge the fact that the vast majority of CRNAs are NOT adequately trained for Independent Practice.
This alone should be enough to understand why we oppose Independent CRNA practice.
 
RapidResponseNurse said:
I am not asking to be seen as more than an advanced practice nurse, that is exactly what I will be. The thing is, I feel that with much education and experience I could be a damn good APRN who surgeons and other MDs trust to carry out anesthesia. BLADEMDA I have read many of your posts and you seem to be a very knowledgable and experienced MD. In one of your posts you stated that 95% of CRNAs could not manage an ASA 4 patient independently. I totally agree with you I think the vast majority of CRNAs should stick to lower acuity (ASA 1 and 2) patients if they want to practice independently. Additionally, if that CRNA is truly practicing independently they should absolutely be responsible for any errors they make and carry their own insurance.

The thing is I want to be that top 5% and am willing to do everything in my power to reach that level. If that means working under an MD for 5 or 10 years then so be it. I am not trying to say that a CRNA is as ready as an MD to practice by themselves right out of the gate by any means. Further more I believe many CRNAs should practice under a physician. But I do think there a small amount of driven, intelligent, and HUMBLE CRNAs out there who are masters in their craft. I aspire to be that CRNA even if it takes many years.
Click to expand...

A humble, Master CRNA knows when he/she should ask for help and is in over their head. I wouldn't concern yourself about the opinions of others on this board but rather go out and be the best CRNA possible; this means being the patient's advocate and not allowing the surgeon to dictate the anesthetic to you.
How many CRNAs will really stand up to the surgeon and NOT do what they are told? How many will argue with their "employer" over the care of the patient when it is appropriate?
 
IlDestriero said:
If you want to practice independently good luck to you.
If you want to work collaboratively with me in an anesthesia care team, great, but we do have to agree on a plan, etc.
If you want to practice "to the fullest extent of your license" but still have me to call if and when the stool hits the fan, and 5 minutes too late because you can handle it yourself, until you can't, fuçk that. Go fly solo. I don't need the liability, the coronary spasm, or the money. Though I'm sure there will be suckers that do.
Click to expand...

I feel a sign of a good practitioner is knowing when things are starting to go south while there is still time to make the appropriate interventions. Granted sometimes there is no warning but usually there are clinical indications that things are about to go awry. What happens when an MD with limited experience gets in over their head or when that 1 in a million complication arises? Do they not have the ability to ask their colleagues for help? I see our critical care docs ask for help from other critical care attendings and other specialties when ever things get very complicated. I don't feel like one person can know 100% of everything 100% of the time. It is the wise and truly gifted person who can recognize their limitations and ask for help when needed.

Correct me if I am wrong but doesn't a CRNA in an opt out state not carry their own malpractice insurance and are they not completely liable for any interventions that they make. I am honestly asking no sarcasm involved.
 
You're missing out on at the key element of our training here. An MD does not begin training in his/her intern year. They are focussed to think and train like a physician while in medical school. There training includes several facets to their understanding of various specialties with rigorous rotations , exams and clinical experience.
So a CRNA who has practiced 4 months of obstetric anesthesia is not comparable to a resident who probably has the same experience out of residency.They are taught to think about every aspect of how the disease process can affect the conduct of the anesthetic /perioperative care.
This knowledge gap is difficult to bridge without having the adequate exposure and training of medical school /residency irrespective of the experience one gains in doing procedures etc.You may technically become skilled at procedures/master one aspect of anesthesia(ex. cardiac/ general OR) but the way you think /analyse a complicated clinical situation differs a lot between these providers.

I am not against CRNA practice, but in my humble opinion should really understand that being an MD in very different to being an excellent CCRN/nurse anesthetist.
 
BLADEMDA said:
A humble, Master CRNA knows when he/she should ask for help and is in over their head. I wouldn't concern yourself about the opinions of others on this board but rather go out and be the best CRNA possible; this means being the patient's advocate and not allowing the surgeon to dictate the anesthetic to you.
How many CRNAs will really stand up to the surgeon and NOT do what they are told? How many will argue with their "employer" over the care of the patient when it is appropriate?
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I have on occasions not followed an order blindly because I am standing up for my patient. When that kind of situation arrises I do not give attitude or act like am smarter than the physician, clearly they have more knowledge and experience but sometimes even the docs that I have the utmost respect for place orders that can have terrible implications. I simply tell them that, "all my training (limited as it is) and gut instincts tell me that this is wrong." If they are able to explain it medically which usually they are, I acknowledge their expertise and carry out their orders. That being said, there have been a few times that I have said, "Dr. X, there is no way that I am going to push medication X because of issue Z." Although those times are very rare, that same physician has thanked me for not carrying out that order. I never make a public display of disagreements with the medical plan, I professionally talk to them privately, if at all possible, and give them the professional courtesy they have earned as deserve.
 
Many CRNA practices that are "collaborative" practices with anesthesiologists want "independent practice" yet have an anesthesiologist or two on staff as a fireman and H&P signers or whatever else they do to keep busy.
There is a huge difference between getting in trouble and calling for help and having the help assume some liability for your actions as they are the "responsible anesthesiologist" of the day. That's a real practice model out there now. If I call for help for a tanking trauma, etc. my colleagues don't have any liability risk (excepting some kind of gross malpractice or criminal action), the buck stops with me. That is not the case with some CRNA practices. They want to fly solo, but the buck stops with the anesthesiologist that is "covering" the ORs and wasn't really involved in the patients care at all.
If you want to fly solo, go for it. And if I was your "partner" in that truly solo practice, I would come and help if I was free, but I'd probably be in the or doing my own case. So good luck.
Fortunately I won't be that guy and I won't have that problem.
 
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If you really want to be an expert in anesthesia and 2 standard deviations better than average, you should go to medical school. Many people have children, previous debt, other baggage from previous careers, etc. and they make it work.
There are no short cuts if you really want to be the best of the best.
 
I'm about to graduate from residency in a couple months. I have four boys two of who are twins and were born the summer between 1st and 2nd years of med school. It's definitely doable to have kids in med school and residency. You will have to give up some things but it's not that bad. I feel like it forced me to be an expert in time management. Very little of each day is wasted and you sleep great. Go to med school if you truly want to fully realize your intellectual potential.
 
If a CRNA is so good that s/he could practice independently, in a CRNA-only group, more power to him/her. But then why do they try to hire an anesthesiologist fireman to get them out of crap, instead of relying just on the help of their oh so competent partners?

That's what a good number of so-called independent CRNAs are trying to do, having it both ways. And that applies also to those who are employed in anesthesia care teams. That's why many militant ones get no respect from us; the big mouth and attitude are there until they get in trouble, then suddenly they love having a physician anesthesiologist around.
 
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FFP said:
Too late for that. I have posted about the financial aspects of that kind of decision some time during February. CRNA school is a better deal.
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I can't disagree with the financial strain when comparing med school and residency to the CRNA pathway. Thus far in the discussion the OP has mentioned most often his desire for knowledge. If a better career is the only endpoint then the really is no question about what to do.
 
sevodex1 said:
You're missing out on at the key element of our training here. An MD does not begin training in his/her intern year. They are focussed to think and train like a physician while in medical school. There training includes several facets to their understanding of various specialties with rigorous rotations , exams and clinical experience.
So a CRNA who has practiced 4 months of obstetric anesthesia is not comparable to a resident who probably has the same experience out of residency.They are taught to think about every aspect of how the disease process can affect the conduct of the anesthetic /perioperative care.
This knowledge gap is difficult to bridge without having the adequate exposure and training of medical school /residency irrespective of the experience one gains in doing procedures etc.You may technically become skilled at procedures/master one aspect of anesthesia(ex. cardiac/ general OR) but the way you think /analyse a complicated clinical situation differs a lot between these providers.

I am not against CRNA practice, but in my humble opinion should really understand that being an MD in very different to being an excellent CCRN/nurse anesthetist.
Click to expand...


You are 100% correct that the value of medical school is something that CRNAs will never have. I think to be a great CRNA you would have to understand that fundamental fact. Does 3 years of high acuity level one ICU at a regional trauma center equate to 4 years of medical school? Not by a long shot. Does it give me a small base to build on with many years of study outside of CRNA school? I think it can. I will never be a physician even though I would love the opportunity to go to medical school. I have the grades, I have the extracurricular aspects, hell me and another nurse on my unit carried out an evidence based research project on the clinical implications of synthetic marijuana use, illustrating the physical and mental side effects it causes. That project caught the attention of our state senator and he proposed a senate bill to outlaw all analogues of synthetic marijuana.

While all my nursing buddies are out living it up going to bars and vacationing, I work overtime to expose myself to as much as I can. I look at my job as an extension of the classroom. I take every opportunity to pick our MDs brains and ask why they do what they do. Why does patient A who has disease X get a certain medication but is contraindicated in patient B who has disease X + Z? As I said this does not remotely replace formal medical school but is what I have to work with.

My step dad was a doctor and my sister is in medical school and I love the fact that she will have exponentially more knowledge then me. The reality of my situation is I am a single father and I need to be done with school before my daughter starts grade school. So the only thing I can do is strive to provide the best care by applying to the most respected CRNA schools and busting my ass to attempt to overcome (however insurmountable it may be) the deficit of not attending medical school.

My question is, at what point does the gap between didactic education and high acuity clinical practice begin to close? The CRNA that I am shadowing at my hospital routinely takes open hearts and unstable heads while collaborating with a senior MD. Granted he is a highly experienced CRNA with many years of experience in Iraq where level one trauma was a daily occurrence. He makes his anesthesia plan and runs it by the MD before surgery. The vast majority of the time he and the MD agree and he proceeds at his own discretion and only rarely does the MD recommend a different approach. when the MD does offer recommendation they are just that as he legally can carry out his own anesthesia plan because of the state we live in. The thing is he has the knowledge and wisdom to collaborate with the MD anytime they have a highly complicated case. Although this CRNA is a rock star in my opinion, I have heard that on rare occasions he has relinquished cases to a senior MD when he feels uncomfortable or will at least ask them to be in the room. I want to be that CRNA who was the medical knowledge and physical skills to carry out complicated cases while always being humble in the fact that there will always be someone with more experience who may be able to shed light on alternative avenues to a solution.
 
IlDestriero said:
Many CRNA practices that are "collaborative" practices with anesthesiologists want "independent practice" yet have an anesthesiologist or two on staff as a fireman and H&P signers or whatever else they do to keep busy.
There is a huge difference between getting in trouble and calling for help and having the help assume some liability for your actions as they are the "responsible anesthesiologist" of the day. That's a real practice model out there now. If I call for help for a tanking trauma, etc. my colleagues don't have any liability risk (excepting some kind of gross malpractice or criminal action), the buck stops with me. That is not the case with some CRNA practices. They want to fly solo, but the buck stops with the anesthesiologist that is "covering" the ORs and wasn't really involved in the patients care at all.
If you want to fly solo, go for it. And if I was your "partner" in that truly solo practice, I would come and help if I was free, but I'd probably be in the or doing my own case. So good luck.
Fortunately I won't be that guy and I won't have that problem.
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So even though in my state where the CRNA is completely independent he is not allowed to collaborate with an MD without that MD becoming responsible for the patient. I would understand if they where in a physician directed model but I would assume (please educate me if I am wrong) that if one independent practitioner where to ask for the opinion of an MD it would be no different from a Nurse Prac asking an Internal Med doc what he thinks about the situation. The IM doc can make recommendations but it is the NPs job to decide if they should follow those recommendations or not. At least thats the way it works in my opt out state in the ICU. Ultimately, correct me if I am wrong, wouldn't that independent CRNA be totally responsible for his actions even if they asked for the opinion of an MD? Now if the CRNA where to formally consult the MD then I could see it being a whole different story.

This may be comparing apples to oranges but as a rapid response nurse I can do many things such as intubate or start pressors under standing physician order sets but if I F#$* up royally it is on me and my license not the attending physician who developed the standing orders for our team. When I am placing a central line on a patient it is my license at risk if I am responsible for causing harm even though a physician placed the order. That order reads "consult rapid response team for CVL placement" maybe it is the word "consult" but who knows. All I know is it was hammered into my head that if I mess up its not the doctors fault it is mine. I guess that old adage of, "with great responsibility comes blah blah blah..." rings true in this case. Or then again I could just be comparing apples to oranges lol.

I think if CRNAs want to practice independently they should shoulder all the responsibility for their practice. I think it would be very hypocritical for a CRNA to consider themselves independent but have the liability fall on another practitioner when things go south, MD or otherwise.
 
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RapidResponse, you can't compare RN level practice with APRN level. You basically just execute physician orders; the physician is responsible for formulating the order, not for your inability to follow it. An APRN is supposed to direct medical care, independently or under physician supervision/direction.

With CRNAs, an anesthesiologist is supposed to be there for key events and regularly check on them. So if anything happens it can be easily be construed that s/he left the CRNA unsupervised, hence it's (also) his/her fault. In the real world, very few anesthesiologists have the luxury of checking on the CRNAs as frequently as they should; they rely on CRNA judgment to be called when needed, which I consider a big mistake (except with selected CRNAs).
 
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IlDestriero said:
It would depend how your practice is set up. And if your icu attending physician delegates you to place lines, etc. and you cause harm, the buck stops with them.
Click to expand...

If that is actually true, and I am sure you know what you are talking about, then that attending Critical Care doc has placed a lot of faith and confidence in our team. Maybe I should right him a thank you note or take him out for some drinks 🙂 Honestly though, if that is the case I will absolutely do everything in my power to hold myself to a high standard.

But surely there has to be some law that protects physicians like him. I mean having a dedicated rapid response team is required for a hospital to acquire magnet status. It is well known that flight nurses can intubate, place chest tubes, and do emergent cricothyrotomies. If the nurse is negligent it is their ass not a doctors. I would assume that a practitioner with much more education and autonomy such as the CRNA would have even more responsibility then the flight nurse or rapid response nurse.

Again I could be totally wrong on this subject.
 
RapidResponseNurse said:
If that is actually true, and I am sure you know what you are talking about, then that attending Critical Care doc has placed a lot of faith and confidence in our team. Maybe I should right him a thank you note or take him out for some drinks 🙂 Honestly though, if that is the case I will absolutely do everything in my power to hold myself to a high standard.

But surely there has to be some law that protects physicians like him. I mean having a dedicated rapid response team is required for a hospital to acquire magnet status. It is well known that flight nurses can intubate, place chest tubes, and do emergent cricothyrotomies. If the nurse is negligent it is their ass not a doctors. I would assume that a practitioner with much more education and autonomy such as the CRNA would have even more responsibility then the flight nurse or rapid response nurse.

Again I could be totally wrong on this subject.
Click to expand...
For RRT purposes, you work independently, so only you and the hospital are on the hook. For CVL placement in the ICU, it depends.

Re: medically-directed CRNAs, see my post above.

Laws are written by politician lawyers to protect malpractice lawyers, not physicians. Physicians are legal prey in this country. There is significant public ill-will against physicians. I am surprised I am not sued every time it rains and the patient gets wet on the way to my hospital.
 
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I have to say something about all that have posted to my thread... Thank you for the respectful and detailed responses. I was assuming that this would quickly turn into nothing more than bashing on each others profession. While I have read many posts on this site that are demeaning towards both CRNAs and MDs this thread has so far been very civil and professional even though difficult and controversial topics have been brought up. I hope that as a future CRNA, I can help to change the belief that we are all militant nurses who want to see MDs replaced by CRNAs. Although there are significant number of CRNAs like that out there, they only bring down our profession as a whole. Additionally, you all have proven that just because you feel strongly about your high level of education (as you should) you are still able to have a professional debate without saying CRNAs are all quacks and dangerous loose cannons (even though some might be 🙂 )
 
We all know CRNAs whom we respect, and who we'd trust with our own care (if medically-directed). But these tend to be the exception, not the rule.

In my eyes, most CRNAs' biggest defect by far is their arrogance and ego. Arrogant people are prone to making mistakes without even realizing. I personally tend to call for help sooner than most CRNAs. The difference comes from the fact that I don't wait till the patient is already in the danger zone, and I have no other choice, like some of them do. The patient comes first, not my ego.

Kudos to you for not falling into that trap... yet. We'll see after CRNA school.
 
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BLADEMDA said:
Practice Independently? Do you really think that most Physicians on the other side of the curtain will ever see you as more than an Advanced practice Nurse?
Sure, they will value working with you as long as you do what they say and they don't assume any legal responsibility for your actions. If they assume any legal responsibility for supervising you (like they can really supervise a CRNA with no knowledge of the specialty) they expect a big cut of the anesthesia fee.

The concept of CRNAs practicing independently is a smoke screen about giving 1/2 the anesthesia fee or more to the surgeon/Gi doctor or allowing a cheap-ass CEO in rural USA from having to pay for Physician anesthesia.
Click to expand...

As a surgeon, I have absolutely zero desire to be the supervising physician for a CRNA. I did not train in anesthesia and my six week rotation as an intern doesn't give me the skills to do it. I don't wan to be liable for a CRNA's work. I would refuse to operate if those conditions were going on in a hospital. And an independent CRNA without anesthesia backup? Even if I'm not delegated to be supervising physician, I wouldn't go for it. No thanks. I'd rather stand up for my patient and operate elsewhere.
 
IveGotTwins said:
I'm about to graduate from residency in a couple months. I have four boys two of who are twins and were born the summer between 1st and 2nd years of med school. It's definitely doable to have kids in med school and residency. You will have to give up some things but it's not that bad. I feel like it forced me to be an expert in time management. Very little of each day is wasted and you sleep great. Go to med school if you truly want to fully realize your intellectual potential.
Click to expand...

I applaud you for your efforts! Congratulations that was not small task. I do not know your personal situation and I am sure you encountered many of your own challenges along the way. The thing is, I am a single father with no reliable family other than a 74 year old grandmother who is in below average to average health for her age. My parents passed away when I was young. My two sisters are both younger and one is in medical school and the other is 13. My daughters mother is a basket case and that brings up a million complications. So I will be relying on my grandmother to watch my daughter meaning I have to move her to where ever I get into school as I am applying to a select set of schools. She is 74 now meaning she will be 78 when I finish CRNA. If I went to med school with the same plan she would be 83. I dont think she will be able to watch her everyday for long hours while I was in residency.

I guess to some level these may all be excuses but it just seams like a lot to undertake while even doing CRNA which is already the single hardest nursing profession by a long shot. Nevermind the fact that med school will take longer and be more strenuous. I wont be able to work for 3.5 years in CRNA school except if I am lucky I can moonlight a few PICC line placements here and there for a couple hundred bucks a pop. At least it will buy the basic necessities for my daughter. On the plus side, if I get into Mayo Clinic or Rush University they offer a small stipend while I am doing my CRNA residency. Its peanuts of course but its something.

Who knows maybe one day I will go to medical school but at this point I think the best course for me is to go to CRNA. Thank you for your words of encouragement, I wish you the absolute best of luck!
 
FFP said:
We all know CRNAs whom we respect, and who we'd trust with our own care (if medically-directed). But these tend to be the exception, not the rule.

In my eyes, most CRNAs' biggest defect by far is their arrogance and ego. Arrogant people are prone to making mistakes without even realizing. I personally tend to call for help sooner than most CRNAs. The difference comes from the fact that I don't wait till the patient is already in the danger zone, and I have no other choice, like some of them do. The patient comes first, not my ego.

Kudos to you for not falling into that trap... yet. We'll see after CRNA school.
Click to expand...

Maybe by then CRNAs will have taken over anesthesia care! ha kidding of course. For real though on that note, I don't understand why some anesthesiologists think they will be driven out of anesthesia because of CRNAs. The AMA is one of the most powerful lobby groups in the nation. If you look at the places that have sole CRNA provided anesthesia it is because the rural towns are hell holes that only people who are desperate for big bucks want to live in. Sure I could work in a place that paid me $350k a year but I would work like a dog and live in some crap hole town on the mexican boarder or some frozen waste land up north....Come to think of it Rochester MN kinda fits that description :/ Anyways for CRNAs who want to practice higher acuity cases it will have to be in places where it is either a physician directed model or at least with much collaboration between the two parties. My mentor and anesthesiologist says he is not worried about this issue and actively encourages me to go to CRNA. He tells me I should go to med school but with my child and family situation he feels CRNA is a far more logical choice.
 
BLADEMDA said:
Even the most Militant CRNAs on the internet acknowledge the fact that the vast majority of CRNAs are NOT adequately trained for Independent Practice.
This alone should be enough to understand why we oppose Independent CRNA practice.
Click to expand...

Exactly. It needs to be standardized. Post-training, you are either trained and equipped or not trained adequately and ill-equipped. When there is a gray area where you can send an ill-equipped cRNA to practice independently, patients get hurt.

There are fantastic residents out there who could go practice in a rural hospital and be just fine, but that's assinine. You can't blur lines like that.
 
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I work in a Care team model with all CRNAs, no AAs. We also have a training program so I see the CNRA making process from start to finish. Some are great team players with no desire other than to have a peaceful and uneventful day, provide excellent patient care, and go home. Which I completely respect. I think being a CRNA is one of the best if not the best job in healthcare (non MD). Also to the OP, it sounds like you have the motivation to be a good one since you have already gone above and beyond with , apparently, the advanced things that you do; like start IVs under ultrasound (vs I stuck him 5 times with a 22 with no success so lets call the resident/attending), running vasoactive medications, intubating, and putting line in during codes (!! very strange that a non MD would be doing that and I have never seen this before, usually the "rapid response nurse" is standing by the code cart with a clip board, or squeezing the ambu bag without ventilating while the NIBP is on 30 min cycles and the pulse ox is on the floor).

What I can tell you for sure tho is this: MDs and CRNAs are cut from a different cloth. They are two different kinds of people. Not to sound arrogant, just stating the facts, but MDs have been selected from the cream of the academic crop, many from ivy league universities, the great minds of their generation. WIth that comes a certain work ethic to stay late, not complain, be professional in difficult situations, be able to navigate complex social situations. That means an OR room that is set up to a T, not starting a second IV and saying "can you hang me another IV line". Or inducing an 80 year old cardiac guy and the pressure drops and saying, lets now mix up the neo drip. Things are just slightly better set up, planned, thought out, and executed (due to the mind that is doing this activity).

Rather have an old CRNA than a new Grad anesthesiologist? NOT ME! QUality and competency assessments are hard to do when you dont know what you are assessing, ie a nurse observing that the crnas and mds are essentially the same. Have a CRNA manage a patient in shock, have them transfuse 100 units in 4 hours, managing multiple pressors, putting central lines in patients with collars on, do ultrasound guided nerve bocks PROPERLY (not from watching youtube), Have them come up with a plan for difficult airway requiring fiber optic intubation, have them do TEE and interpret it for cardiac cases, or do narcotic conversions and pain consults. Have them efficiently and safely run a busy OR board. Just to name a few.

CRNAs are the machine. Anesthesiologists drive the machine. I Know each nurses plan of action for each case, and for me its a matter of seeing the patients, seeing if that plan of action is safe and optimal, and tweaking their plan for each patients unique characteristics, while dealing with the (occasional) attitude and blank stares and looks like i am a *****, but in the end not flinching and realizing patients NEED me there because this other person, while nice and competent and PROBABLY able to get by in a bread and butter situation, is not capable of things that may very well need to be done.
 
No idea how old you are, but I would expect that you will be mid 20s. I think financially you are better off going the CRNA route, as you will be around 200k in debt after med school (maybe more with the kid), make 40-50k/year during residency, and only then be able to start making money. So at the end of 8 years you are probably about 200k in debt, looking at a starting wage by that point of probably around 300k.

CRNA school can be subsidized to cost basically your cost of living. then immediately after graduation you get a job making 100-150k per year. At the end of 8 years you are up about 400-600k.

It takes a long time for the MDs to make up that gap. Probably about 5 years for most of them. As an MD, by the time you are equal financially, you are looking at being upper 30s, and you will have a much higher level of job related stress, longer work hours, higher liability for the actions of others, not to mention having gone through the grind of med school and residency with a small child. It is a clear choice to me which route is better from a practical standpoint. I dont understand those who try to talk you into going to med school.

Will your knowledge be as good?
-No.
Will you still be able to perform a valuable service for patients and think critically at work, giving yourself some measure of job satisfaction?
-Yes.
Will you have to deal with some young MD fresh out of residency telling you what to do after you have been practicing for 20 years?
-Probably, but consider it a price of the lesser work hours, lower financial burden at startup, and lesser work required to arrive at your job.
Dont be bitter about it, just laugh to yourself at how old he/she looks despite being just 30, and put in an extra giggle as you walk out the door at 3:30 sharp while he stays until who knows how late every night. Make sure you stress him out by saying you really cant stay late today because of a kids piano lesson at 4, so make sure he can get one of his partners to take over your OR for the last 5 minutes of the case. Or maybe offer to stay that extra 15 minutes, being paid time and a half, but make sure to remind him how much he owes you.

Obviously, many of us MDs end up a little bitter ourselves when we look at the far easier path that our counterparts take, the predictability of their day, their chance to just sit in a room with none of the political stresses involved in being the boss, or extra liability for the actions of others.
We feel that extra knowledge is worth something, and feel that it allows us to provide a better service on the more difficult cases and especially the unexpectedly difficult cases. Despite this, many CRNAs treat us as a necessary evil and tell the world they are just as good in all circumstances. Not all do, but it is enough to make us a bit defensive.
I'll admit there probably isnt much difference on an ASA 1/2 case for a simple surgery without complications, but there is a point where that extra knowledge may actually save a patients life.

Oh, and MDA makes us cringe because it sets us apart as non-equals to our MD counterparts. No other specialty is classified as MD-anything, there is no reason for us to. Thank you for stopping using that, it is a bit annoying to read. Of note, the more letters one puts behind their name the less respect I have for them. Just put the highest obtained degree, or if there are 2 equivalent, both of those (PhD MD)
 
to me the greatest irony of all is that the super minority of CRNAs that could be safe on their own are the ones that don't want to be on their own. They understand the value of having an anesthesiologist around.

Their knowledge and experience that keeps them safe also lets them know they shouldn't be providing independent care. Those are the greatest of all. It's the ones that are ignorant of their shortcomings that feel they are perfectly safe and competent to be independent that are scary.

So....

If you think you can be safe and independent, you are by definition not capable of it, a true catch-22.
 
RapidResponseNurse said:
If you look at the places that have sole CRNA provided anesthesia it is because the rural towns are hell holes that only people who are desperate for big bucks want to live in.
Click to expand...

No, those places exist because of rural pass-through legislation. Basically the federal government will pay 100% of whatever is necessary for that rural hospital to be staffed by CRNAs so they can't lose a penny on it. It doesn't extend to MDs. It's a federal subsidy that encourages the hospital to employ CRNAs instead of MDs. If it was financially equivalent, they'd hire the MD every time. And I've had the discussion with the CEO of several such hospitals that invited us to bid on their anesthesia contracts.

On no planet is the small rural hospital making a decision that they'd rather have a CRNA than an MD, they are simply stuck by the bottom line and they can afford to pay more money to a CRNA than an MD. If/when that legislation changes, their will be a tidal wave of change in rural hospitals anesthesia departments. That's why the AANA spends so much money lobbying against changing it.
 
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