md <--> crna

[inmyslumber]

Since there is so much talk about CRNA independence and ability to do the same job as anesthesiologists I am curious about the following:

Anyone know of any MD (or DO) who went back to get their nursing degree to become a CRNA?

I have known three nurses (two CRNA, one RN) who decided to go to medical school and then become anesthesiologists (MD). One told me that the "nursing approach" to learning was vastly different to the "physician approach" in that the former was more task oriented and not as medically comprehensive as the latter. Another former CRNA felt that his education as a CRNA seemed to lack medical knowledge (was too superficial for him). I don't know the motive behind the third person's decision to go to medical school.

Trying to be as objective as possible given that I never went to CRNA school.

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[illegallysmooth]

Since there is so much talk about CRNA independence and ability to do the same job as anesthesiologists I am curious about the following:

Anyone know of any MD (or DO) who went back to get their nursing degree to become a CRNA?

I have known three nurses (two CRNA, one RN) who decided to go to medical school and then become anesthesiologists (MD). One told me that the "nursing approach" to learning was vastly different to the "physician approach" in that the former was more task oriented and not as medically comprehensive as the latter. Another former CRNA felt that his education as a CRNA seemed to lack medical knowledge (was too superficial for him). I don't know the motive behind the third person's decision to go to medical school.

Trying to be as objective as possible given that I never went to CRNA school.

Why would anyone do that?

 

[kazuma]

Why would anyone do that?

Maybe someone that couldn't match into anesthesiology, especially if they had already gone to nursing school before medical school? However, I don't personally know of anyone that has done this.

 

[IN2B8R]

Since there is so much talk about CRNA independence and ability to do the same job as anesthesiologists I am curious about the following:

Anyone know of any MD (or DO) who went back to get their nursing degree to become a CRNA?

I have known three nurses (two CRNA, one RN) who decided to go to medical school and then become anesthesiologists (MD). One told me that the "nursing approach" to learning was vastly different to the "physician approach" in that the former was more task oriented and not as medically comprehensive as the latter. Another former CRNA felt that his education as a CRNA seemed to lack medical knowledge (was too superficial for him). I don't know the motive behind the third person's decision to go to medical school.

Trying to be as objective as possible given that I never went to CRNA school.

You want "objective"? Here's some objective **** for you: I personally know 4 docs who were prior CRNA's. Think any of them supervise anything? Hell no, not even ASA1 cases! These are individuals who have been on both sides of the fense.... Talk about going from MD to a CRNA, what a fuggin' joke!

 

[IN2B8R]

Since there is so much talk about CRNA independence and ability to do the same job as anesthesiologists I am curious about the following:

Anyone know of any MD (or DO) who went back to get their nursing degree to become a CRNA?

I have known three nurses (two CRNA, one RN) who decided to go to medical school and then become anesthesiologists (MD). One told me that the "nursing approach" to learning was vastly different to the "physician approach" in that the former was more task oriented and not as medically comprehensive as the latter. Another former CRNA felt that his education as a CRNA seemed to lack medical knowledge (was too superficial for him). I don't know the motive behind the third person's decision to go to medical school.

Trying to be as objective as possible given that I never went to CRNA school.

And one more thing.... Are you seriously an "attending"? 'cause I find it difficult to believe that someone is seeking objectivity about something as common sense and as clear as daylight is....

 

[inmyslumber]

The issue I am trying to understand is why CRNAs believe they have the skills to be unsupervised.

I have heard some reasons why CRNA's have chosen not to go to med school. For example, parent was a CRNA, Didn't want to spend time and money for med school, couldn't get into med school....

Perhaps Kazuma put it clearer than I did.

I personally agree with illegallysmooth I don't see why anyone would want to do go to CRNA school after med school (unless couldn't complete med school).

Perhaps someone in that case would be reluctant to post on this forum.

 

[maceo]

The issue I am trying to understand is why CRNAs believe they have the skills to be unsupervised.

Because CRNAS truly believe they know more than they actually do. They dont have and understanding nor the willingness to understand what a true medical education is. moreover, they think intubation and turning gas on and giving parlaytics is actually truly understanding the medical condition of the patient. And not having respect for this is truly dangerous.

 

[Dejavu]

You want "objective"? Here's some objective **** for you: I personally know 4 docs who were prior CRNA's. Think any of them supervise anything? Hell no, not even ASA1 cases! These are individuals who have been on both sides of the fense.... Talk about going from MD to a CRNA, what a fuggin' joke!

I'm deeply sorry, but I don't understand part of your post. The part about supervising. I don't know what you meant. And believe me, I am not trying to start something, I just didn't understand what you were getting at.

I am one of those CRNA for a decade--went back to med school/anesth residency--now attending at a well known institution in a small town in SE Minnesota--guys. I supervise many cases each day.

Anyway, I apologize for not "getting" what you meant by the supervising part of your post.

BTW, I have seen first hand that there is a difference between CRNA schooling and Med School/residency.

 

[Consigliere]

The issue I am trying to understand is why CRNAs believe they have the skills to be unsupervised.

Because CRNAS truly believe they know more than they actually do. They dont have and understanding nor the willingness to understand what a true medical education is. moreover, they think intubation and turning gas on and giving parlaytics is actually truly understanding the medical condition of the patient. And not having respect for this is truly dangerous.

Right on brother.

 

[IN2B8R]

I'm deeply sorry, but I don't understand part of your post. The part about supervising. I don't know what you meant. And believe me, I am not trying to start something, I just didn't understand what you were getting at.

I am one of those CRNA for a decade--went back to med school/anesth residency--now attending at a well known institution in a small town in SE Minnesota--guys. I supervise many cases each day.

Anyway, I apologize for not "getting" what you meant by the supervising part of your post.

BTW, I have seen first hand that there is a difference between CRNA schooling and Med School/residency.

From the feedback of those attendings: they have supervised CRNA's who have had 5 yrs or less experience and they all said that they totally felt uncomfortable with supervising any cases with these CRNA's. All of them said that they do not feel comfortable supervising ASA4 patients with any CRNA. But now that we are fortunate to have you on this forum with your prior experience, maybe you can enlighten us and tell us why four prior CRNA's who eventaully became MD's would choose to do this?! What, in your professional opinion, do they have against staffing such cases? I already have my opinion, I'd like to hear yours.

 

[SleepIsGood]

From the feedback of those attendings: they have supervised CRNA's who have had 5 yrs or less experience and they all said that they totally felt uncomfortable with supervising any cases with these CRNA's. All of them said that they do not feel comfortable supervising ASA4 patients with any CRNA. But now that we are fortunate to have you on this forum with your prior experience, maybe you can enlighten us and tell us why four prior CRNA's who eventaully became MD's would choose to do this?! What, in your professional opinion, do they have against staffing such cases? I already have my opinion, I'd like to hear yours.

I wish these MDs that you guys talk about would come out andbe more visible. It would be nice if they were featured in ads,etc that exemplify our field. They would be a vital part of a well though out and effective marketing campaign

 

[Kilosh]

I am starting my anesthesiology residency this summer and have also been a paramedic for 6 plus years. I think I can shed some light on why some CRNA's believe (incorrectly) that they are equally trained providers.

I went through a grueling paramedic program that introduced me to some common medical pathology, some pharm, and taught me alot of algorithms or what I would call "cookbook medicine." What I mean by that is that my training consisted of "if I encountered example A I was then taught to administer drug B." What was lacking from said training was the "WHY!" Why was I giving drug B, what was is mechanism, etc. As a paramedic I would call the ER physician en route to the hospital and ask for orders, and the ER doc would say "no, no, just do...." And I would say, that is f**ked up, I know what the patient needs, etc. It was not until I went to medical school that I realized how wrong I was. There was so much that I did not know and understand, so much the ER doc was taking into account that I had simply no training in and never considered.

So I think the CRNAs feel like they know what they know well, but they cant comprehend their lack of knowledge because they never went to medical school. It hard to know what your training is lacking when that is the only training you have ever had. In addition, when you are trained as "extended provider," the training you receive is in that context. You are taught by your instructors with the knowledge that if **** hits the fan someone else will come to save you. Medical school and residency training are entirely different, when you are an attending you are expected to know it all and handle it all. It two entirely different approaches to training and education.

 

[Kilosh]

I am starting my anesthesiology residency this summer and have also been a paramedic for 6 plus years. I think I can shed some light on why some CRNA's believe (incorrectly) that they are equally trained providers.

I went through a grueling paramedic program that introduced me to some common medical pathology, some pharm, and taught me alot of algorithms or what I would call "cookbook medicine." What I mean by that is that my training consisted of "if I encountered example A I was then taught to administer drug B." What was lacking from said training was the "WHY!" Why was I giving drug B, what was is mechanism, etc. As a paramedic I would call the ER physician en route to the hospital and ask for orders, and the ER doc would say "no, no, just do...." And I would say, that is f**ked up, I know what the patient needs, etc. It was not until I went to medical school that I realized how wrong I was. There was so much that I did not know and understand, so much the ER doc was taking into account that I had simply no training in and never considered.

So I think the CRNAs feel like they know what they know well, but they cant comprehend their lack of knowledge because they never went to medical school. It hard to know what your training is lacking when that is the only training you have ever had. In addition, when you are trained as "extended provider," the training you receive is in that context. You are taught by your instructors with the knowledge that if **** hits the fan someone else will come to save you. Medical school and residency training are entirely different, when you are an attending, you are expected to know it all and handle it all. It two entirely different approaches to training and education.

 

[2win]

I am starting my anesthesiology residency this summer and have also been a paramedic for 6 plus years. I think I can shed some light on why some CRNA's believe (incorrectly) that they are equally trained providers.

I went through a grueling paramedic program that introduced me to some common medical pathology, some pharm, and taught me alot of algorithms or what I would call "cookbook medicine." What I mean by that is that my training consisted of "if I encountered example A I was then taught to administer drug B." What was lacking from said training was the "WHY!" Why was I giving drug B, what was is mechanism, etc. As a paramedic I would call the ER physician en route to the hospital and ask for orders, and the ER doc would say "no, no, just do...." And I would say, that is f**ked up, I know what the patient needs, etc. It was not until I went to medical school that I realized how wrong I was. There was so much that I did not know and understand, so much the ER doc was taking into account that I had simply no training in and never considered.

So I think the CRNAs feel like they know what they know well, but they cant comprehend their lack of knowledge because they never went to medical school. It hard to know what your training is lacking when that is the only training you have ever had. In addition, when you are trained as "extended provider," the training you receive is in that context. You are taught by your instructors with the knowledge that if **** hits the fan someone else will come to save you. Medical school and residency training are entirely different, when you are an attending you are expected to know it all and handle it all. It two entirely different approaches to training and education.

I congratulate you! I bet that you gonna be a good DOCTOR.

 

[Jay K]

I am one of those CRNA for a decade--went back to med school/anesth residency--now attending at a well known institution in a small town in SE Minnesota--guys. I supervise many cases each day.

Anyway, I apologize for not "getting" what you meant by the supervising part of your post.

Although you may supervise many cases each day, I'd venture to say you probably don't supervise more than 2 rooms at one time at your institution- makes a big difference when you're splitting your time amongst 4 CRNA's, coordinating the OR, seeing preops and troubleshooting other anesthesia-related business on the floor AND don't have other academic attendings out of rooms available to help your room in case the CRNA gets into trouble. That's where it really matters how skilled, meticulous and knowledgeable your CRNA's are... I can tell you the days I have to do that... are not my favorite...

 

[Teillard]

The issue I am trying to understand is why CRNAs believe they have the skills to be unsupervised.

Because CRNAS truly believe they know more than they actually do. They dont have and understanding nor the willingness to understand what a true medical education is. moreover, they think intubation and turning gas on and giving parlaytics is actually truly understanding the medical condition of the patient. And not having respect for this is truly dangerous.

Whatever CRNA's "believe" (not sure how you know this) it is the surgeon's belief in the CRNA's abilities that matters, and believe me, your surgeon colleagues believe in the capability of CRNA's. Your beef isn't with us. You have the unenviable task of convincing thousands of surgeons that CRNA's don't have the skills to provide service to them. Not too hard at academic centers. Pretty hard in many, many areas and there seem to be more and more every year.

 

[florida]

Surgeon's would believe in hordes of trained "anesthesia" monkeys if it meant the could operate on more patients with positive wallet biopsies.(Especially if they could pay the monkey an hourly rate in an office OR).

Whatever CRNA's "believe" (not sure how you know this) it is the surgeon's belief in the CRNA's abilities that matters, and believe me, your surgeon colleagues believe in the capability of CRNA's. Your beef isn't with us. You have the unenviable task of convincing thousands of surgeons that CRNA's don't have the skills to provide service to them. Not too hard at academic centers. Pretty hard in many, many areas and there seem to be more and more every year.

 

[Sergio99]

Whatever CRNA's "believe" (not sure how you know this) it is the surgeon's belief in the CRNA's abilities that matters, and believe me, your surgeon colleagues believe in the capability of CRNA's. Your beef isn't with us. You have the unenviable task of convincing thousands of surgeons that CRNA's don't have the skills to provide service to them. Not too hard at academic centers. Pretty hard in many, many areas and there seem to be more and more every year.

This is the heart of the question, especially because the surgeons believe their wishes will be served better by someone who will offer them blind obedience and not argue with them.

Our anesthesia tech wants to become a CRNA, and I have taken up the mission to convince her that she is smart enough to go to medical school and become an anesthesiologist instead. My main argument, that I have been hammering in her head every chance I get, is the spirit of this thread: "You may one day regret having chosen CRNA as a career instead of medicine, but you will never regret having chosen medicine instead of CRNA."

Greetings

 

[Teillard]

This is the heart of the question, especially because the surgeons believe their wishes will be served better by someone who will offer them blind obedience and not argue with them.

Greetings

Again, speculative generalities aside (there aren't anesthesiologists who go along to get along?), at the end of the day, your beef isn't with CRNA's. Is this really what surgeons tell you? Anesthesia providers don't have a corner on the "safety" market. Surgeons might also have safety concerns exclusive of their outcomes, ie, as impossible as it may be to believe, they may actually care about their patients. Sure there are Surgeons that won't work with CRNAs or will only in a care team setting, but there are significant numbers who are very comfortable doing so. Those numbers aren't shrinking and it isn't because the wheels are falling off as soon as the CRNA walks in the room. As a group, I would say that surgeons have more clout with hospitals than anesthesia providers. They don't do things they don't want to do very often or for very long.

 

[maceo]

Whatever CRNA's "believe" (not sure how you know this) it is the surgeon's belief in the CRNA's abilities that matters, and believe me, your surgeon colleagues believe in the capability of CRNA's. Your beef isn't with us. You have the unenviable task of convincing thousands of surgeons that CRNA's don't have the skills to provide service to them. Not too hard at academic centers. Pretty hard in many, many areas and there seem to be more and more every year.

CRNA practice rights has nothing to do with what surgeons believe or dont believe. Like said earlier, they wouldnt care if a monkey was giving anesthesia. I guess you made your point.

 

[esperRN]

If you want to change what CRNAs do, then you'll have to change what they do in the military. And since they are almost always completely autonomous for all types of surgeries in the military with good outcomes, you'll be hard pressed to get the armed forces to change their mind.

Then there is the issue of rural areas where CRNAs practice autonomously. States with large underserved populations won't be willing to decrease the scope of CRNAs.

Consequently, urban areas will look at these practices (both military and rural) and say "well if they can do it there, why can't they do it here?"

so really what you need to do is have more anesthesiologists in the military and rural areas to the point of obviating the need for CRNAs, which will probably never happen.

 

[pgg]

If you want to change what CRNAs do, then you'll have to change what they do in the military. And since they are almost always completely autonomous for all types of surgeries in the military with good outcomes, you'll be hard pressed to get the armed forces to change their mind.

Oh, where to begin?

Military CNRAs certainly do not do the same "all types of surgeries in the military" ... first of all, 90% of military patients are young and healthy people and their families - ASA 1 and 2 patients.

Even at the larger med centers, where (fewer and fewer) older retirees are seen, you'll never see a CRNA doing a heart, or a crani, or a sick kid, or anything in the chest, or an emergent ex lap for a septic patient. Occasionally a SRNA will be in those rooms helping a resident. Furthermore, "independence" is a relative thing. At least at two of the three large Navy med centers, CRNAs aren't really independent at all - each day they are assigned to a consulting anesthesiologist, and for all ASA 3 and 4 patients, they are required to discuss the case with them. (I've never worked at the 3rd Navy med center as an anesthesiologist or resident.)

At the small Navy hospital I'm at, CRNAs are indeed independent providers of anesthesia. They cover OB without backup. They do an excellent job; they are conservative and cautious; they don't have any of the shoulder chippiness or aggressive militant attitude you do. Incidentally, I can count the number of ASA 3 patients I've seen at this little hospital in the last nine months on one hand. We refer all high risk patients out because there's no ICU. Hell, patients who have a BMI over 35 are likely to be referred out for that reason alone. We - like most small military hospitals - just don't see sick patients or do big cases. I have to moonlight at a civilian hospital out in town to do those - and guess what, the civilian CRNAs at that hospital in this opt-out state generally aren't doing the sick patients or the big cases either. Occasionally they'll get one on call and guess what, most of the time they'll call in the 2nd call anesthesiologist to help them "get it started" ... Ie, make the go/no-go decision, start the lines, do the induction.

So before you hold up the military as some glorious example of what independent CRNAs can achieve, remember
1) The military population of 100% insured 18-40 year old people in generally excellent condition is pretty hard to kill.
2) Independence generally doesn't extend to ASA 3 and 4 patients, though it's possible this may vary some at the other major med centers I've never been to.
3) The true, unequivocal independence you're speaking of relates to care delivered in an operational environment, in which ALL patients are ASA 1 and 2 active duty personnel in war zones. And this is a situation in which optimal care is a consideration secondary to military need.
4) Military CRNAs, in my experience, are a substantial cut above civilian CRNAs in terms of the quality of their training and the standards they're held to. I wish all CRNAs were as good as their military counterparts ... who still, IMO, shouldn't be fully independent.

 

[esperRN]

I'm not trying to be militant about anything. I was simply pointing out that I don't think it's about the surgeons. I think it's about where CRNAs have maximum independence, and that's what you have to change if you want to change the rest.

 

[pgg]

I'm not trying to be militant about anything. I was simply pointing out that I don't think it's about the surgeons. I think it's about where CRNAs have maximum independence, and that's what you have to change if you want to change the rest.

Just wanted to correct some misconceptions about military CRNA independence.

I agree that their role in the military appears to support (superficially) the AANA claims of suitability for independent practice elsewhere, but it only supports those claims when taken out of context.

The simple truth is that military CRNAs have a uniquely healthy patient population, are generally better trained than their civilian counterparts, are rarely (if ever) assigned the sickest patients or most complex cases, and have a supervising anesthesiologist for ASA 3/4 patients - all in an extraordinarily favorable malpractice environment. None of these facts are consistent with the AANA's manipulative, self-serving, and patient-endangering statements regarding independent practice in the civilian world.