Now, in addition to CRNAs...

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I'm just a med student, but judging by this ASA article it seems like this is a good thing.

Unlike the CRNAs, the AAs are not lobbying to practice beyond their training and administer their care unsupervised. This means that someone can be in the room keeping the patient on course and charting vitals while the anesthesiologist is starting another case or responding to an emergency.

Sounds pretty good to me.
 
aa's are required to work under the supervision of the MDA I believe. These are considered a good thing by MDAs.
 
AA's are happy assisting Anesthesiologists, CRNA's just wanna take over...
 
we have no one else to thank but the old timer anesthesiologists who sold the profession to CRNAs!
 
Here's what I think: if you wanna do doctor stuff, go to doctor school!
 
Did little research on AA's...seems you need a masters in science, & take mcat ,with acceptable result, before they allow you to apply to their program- only 2, by the way: Emory, & Case Western train you to become Anesthesiologist Assistant; seems kinda cool to me: almost same requirement to get into med school, except the primary idea is to work as team, with MDA leading way in OR; CRNA's are never required to start with PreMed...they just do their nursey stuff, then decide to go into Anesthesia , granted, they do train an extra 2 yrs, but their training is from a nursing standpoint, isn't it?
 
It is a complicated issue. On the balance, I think anethesiologists will probably have to support AAs because CRNAs clearly want to compete directly with MDAs for anesthesia services. In contrast, AAs -- FOR NOW -- are committed to working with physicians. They are not trained through nursing, it is a direct entry program after high school or a college degree.

This thread may be of interest to those who missed it:
http://forums.studentdoctor.net/showthread.php?s=&threadid=63085&perpage=20&pagenumber=1

Under the law, AAs must work with MDAs, unlike CRNAs (whose scope is dependent on the state). However, as has been noted in other threads, in other "assistant" areas like ER-PA and med-PAs, the supervision is that they have to get a certain %age of their charst signed within a week!! It will be easy for them to lobby that this is a waste, that they can (and already do) decide who needs to see the MD..... and that they should bill. I doubt that this is in the best interests of the patient, as PAs, no matter how well trained, do not have the general medical training all MDs have. However, cost is king, I guess.
 
Just a small clarification, AA's are not PAs as per the original poster. completely different training and licensure. some pa's do additional training to become aa's, but the majority of aa's do not have this background.
 
Originally posted by wundabread
Unlike the CRNAs, the AAs are not lobbying to practice beyond their training and administer their care unsupervised. This means that someone can be in the room keeping the patient on course and charting vitals while the anesthesiologist is starting another case or responding to an emergency.

Sounds pretty good to me.


Please do not confuse AA's with CRNAs from the standpoint of their clinical knowledge. Why pay an MD 1/3 to sometimes 1/2 more when you can get the same job done from a CRNA?

http://www.aana.com/press/2003/052903.asp
 
Originally posted by JasonGreen
Please do not confuse AA's with CRNAs from the standpoint of their clinical knowledge. Why pay an MD 1/3 to sometimes 1/2 more when you can get the same job done from a CRNA?

http://www.aana.com/press/2003/052903.asp


CRNA's can charge insurance/patients the same amount as an MDA, so the question is why put your life in the hands of a nurse when you can have a doctor, or a nurse supervised by a doctor w/o paying a penny more.
 
Originally posted by NaeBlis
CRNA's can charge insurance/patients the same amount as an MDA, so the question is why put your life in the hands of a nurse when you can have a doctor, or a nurse supervised by a doctor w/o paying a penny more.

Based on what statistics? FYI, CRNAs do not make 300K a year and usually top off around 200K. Sure, you can charge your patient all you want, it's the insurance that sets what monetary expenses that will be paid back.
 
Originally posted by JasonGreen
Based on what statistics? FYI, CRNAs do not make 300K a year and usually top off around 200K. Sure, you can charge your patient all you want, it's the insurance that sets what monetary expenses that will be paid back.

This isn't a stat, its a just a fact, insurance sets reimbursements, and they will pay the same money for a given case, whoever the provider is, CRNA, MDA, or Supervised CRNA. The salaries are lower for CRNA's because most of them are salaried emplies of MDA groups, and that is the salary they are offered. As a side point, the salaries they make are EQUAL to MDA salaries if u account for the hours they work vs an MDA's hours. If you look at all the AANA's propaganda, they will never say that it is cheaper to have a CRNA, because they know its not. The AANA isn't really interested in making more money for themselves, they make very good money for their hours, they want power. They want to become nurses who will finally not be under the direction of doctors. Thats a dangerous thing in my opinion.

http://www.asahq.org/Newsletters/2003/04_03/ventilations04_03.html

Thats an article written by Dr. Lema, an MDA at buffalo, and it talks about the current issues with CRNA's. If you are going to read the AANA's propaganda page, you should look at the other side as well. You may argue that this article is also propaganda, but I don't think it is, It is a very well written, and balanced, and provides more facts than you will ever get from the aana website.
 
Originally posted by NaeBlis
The salaries are lower for CRNA's because most of them are salaried emplies of MDA groups, and that is the salary they are offered. As a side point, the salaries they make are EQUAL to MDA salaries if u account for the hours they work vs an MDA's hours.

Emplies? Not sure what that means...but anyway. I'll have to argue that CRNAs do not make as much as MDAs based on hours worked. 90% of the time, MDAs enter the room, sign the chart, and are back to the lounge eating donuts again. It is very rare to see an MDA sit though an entire case.
 
Originally posted by JasonGreen
Emplies? Not sure what that means...but anyway. I'll have to argue that CRNAs do not make as much as MDAs based on hours worked. 90% of the time, MDAs enter the room, sign the chart, and are back to the lounge eating donuts again. It is very rare to see an MDA sit though an entire case.

Emplies = employes

Not sure where you work, maybe the MDA hours are better there, but then their salaries are probably lower. In most places CRNA's work 4-5 shifts a week, that are usually 8-4, or 7-3. And MDA's work 7-6, and then have evening and weekend calls. As for sitting through a case, that depends on what type of patient it is. An MDA will either supervise CRNA's in 2 or 3 rooms, or will sit in on a complicated case, neuro or open heart. Even if the MDA isn't in the room he is in the vicinity and is paid because he has studied pharm and physio, and has an in depth understanding of those that can be used if a patient gets in trouble. I don't appreciate your insult, and i don't see where a surgical tech gets off insulting doc's that have spent years studying. What do you have a high school diploma? I don;t like to insult ancillary staff, but you are the equivilent of a bitter grocery room stock boy.
 
Emplies = employes
Are we making up words now?

An MDA will either supervise CRNA's in 2 or 3 rooms, or will sit in on a complicated case, neuro or open heart.
Not where I'm at. Not even on the complicated heart cases. Only CRNAs in the room.

Even if the MDA isn't in the room he is in the vicinity and is paid because he has studied pharm and physio, and has an in depth understanding of those that can be used if a patient gets in trouble.
This is funny. In the heart room, a patient can go from alive and well, to a donor in a matter of seconds. It's happened in two cases I was involved in for a four and five jump patient. So, explain to me how an MDA is going to be able to come into the room fast enough, draw meds and administer them quick enough when the aorta is blown out and the pressure is at 20? Yes, this did happen in a case once and everyone was ****ting bricks until we put them back on the pump. Same idiotic analogy that the scrub tech needs to remain sterile after a case just for the purpose of a possible laryngospasm in stage 2. What's the point of that? Is the scrub going to do the E. Trach? No, the non-sterile surgeon will do it. At any rate, some positive pressure and a little succs will do the job.

I don't appreciate your insult
If I insulted, I apologize, that wasn't my intention.

What do you have a high school diploma?
Yes, as well as two degrees, finishing up my BSN and am in the process of applying to med school. Please don't assume that just because I scrub, I'm an idiot. As soon as I'm done with nursing school, I'll be in med school.

I don;t like to insult ancillary staff, but you are the equivilent of a bitter grocery room stock boy.
This doesn't even deserve a comment. Your lack of understanding of the roles of all ancillary staff is seen quite clearly.
 
If my knowledge of ancillary staff is bad, yours of anesthesia is far worse. A complicated surgical case is not necessarily a complicated anesthestic case, and whatever "experience" you have in the OR you don't understand what anesthesia is about. If the aorta blows there is precious little that anyone short of god can do to. There are however many things that can go wrong with a patient where pushing the right drug will make the difference. These problems are less frequent now, because of the many advances in anesthesia (all made by MDA's). There huge differences in the knowledge base of nurses and docs, and if you get into med school you will learn that.

If there were enough MDA's to be in every room it would be the best situation, but there aren't. So the first job of an MDA is put the highest risk patients under direct MDA supervison, and to give the rest to MDA supervised CRNA's. Obviously if something happens and the MDA can't get there in time, there is nothing he/she can do. But there will be times when the patient is becoming unstable and the MDA can take a course of action that may improve the patients chances. AA's are not as good as CRNA's, but again there is a shortage of CRNA's like there is of MDA's, so you do what you can for who can.

You basic argument was to say that CRNA's can do all the work an MDA, so why have the MDA present. My counter argument was to say that the MDA is better trained and has a better knowledge base, and since there is no further cost to the patient or insurance company to have them there, why shouldn't they be present whenever they can be? The AANA doesn't want them because that is the only pathway for nurses to escape doc supervison w/o going to medschool. So they toss around misinformation to try to convince everyone that they don't need supervision. They've lobbied some governers over to their position, but no hospitals seem to agree with them, except where they are forced to it. In any case, you should read that article by Dr. Lema that I posted, it really does give a good view of the issues.

MDA's have more training and knowledge, even if you don't seem to appreciate that, and they don't cost a penny more to have in the OR. So tell me, do you think MDA's shouldn't be involved in anesthestic care, given all that I said? You can be honest with me, it won't hurt my feelings.
 
In any case, you should read that article by Dr. Lema that I posted, it really does give a good view of the issues.

I did read it. Some of the article seems on target such as the declining membership in AANA, and the shrinking workforce. However, he mentions AANA's "name calling and bashing" which is what the ASA does to the AANA. He will always believe that you have to be a doctor to practice quality, safe anesthesia regardless of the lack of evidence to that effect. I think his letter is just another "pep" talk to his colleagues furthering the rift between CRNAs and Anesthesiologists.
MDA's have more training and knowledge, even if you don't seem to appreciate that, and they don't cost a penny more to have in the OR.

Clinically? No, I don't believe that. I've talked to numerous Anesthesiologists that agree that certain CRNA training is just as up to speed as the training required to become an Anesthesiologist. The Anesthesiologist might have a better medical foundation, but as far as the actual job to put someone to sleep and bring them back, it's nearly identical.
So tell me, do you think MDA's shouldn't be involved in anesthestic care, given all that I said?

Oh, absolutely I do believe they should be involved. My only rife was when the post about CRNAs being far inferior to Anesthesiologists. I don't agree with that statement, nor does the actions I've seen in trauma cases reflect it. Of course, I'm just a bitter stocker boy, so what do I know?
 
Well, I guess we are at an impass. You don't agree that anesthesiologists are better skilled than CRNA's, though you were quick to point out that their background makes them very different from AA's, which i find very ironic. Sorry, but it does make you seem like a"bitter stocker boy", disparaging those more trained, while defending your turf against those with less. Perhaps when you get into medschool, you will be on my side.

As to evidence, there have been a number of studies that show MDA presence improves outcome, and at least one funded by the aana that showed the opposite, but they have all been flawed studies(poor data, and #'s in the study). In the 1980's the CDC put together a proposal for a study that would determine this once an for all, but it would have been a very expensive study, and the AIDS epidemic hit and the CDC shelved the thing.

I am certain that such a study will prove that MDA's are better than CRNA's, and that working together they are even better, but i have no way to prove it you. Once you become a doctor though you will begin to understand the difference in knowledge and skills between doc's and nurses, and perhaps see how I come to this conclusion.

I would love to meet these MDA's who think the CRNA's are as good as them. I've met nearly a hundred, and not a one ever expressed that opinion. Perhaps they just didn't want any negative comments reaching the CRNA's through you. They have to work with them everyday.

Incidentally why do you point out CRNA skill at trauma in particular? Its not really considered a very difficult aspect of the job by any providers i've met, nurse or doc. I've been in a few myself, it really just seems like simple stuff being done very quickly.

Well, good luck in getting into medschool, I think its the only way I will win you over.
 
How about this..................CRNA and AA's can do my cases if a % of their pay goes to my medical school loans?

Sounds fair , rite?

"If it looks like a anesthesiologist, and passes gas like an anesthesiologist, doesnt mean it is an anesthesiologist"

IN2BATE
 
Jason is right. There are no studies showing that MDAs are superior to CRNAs in delivery of anesthesia care.

Until those studies exist, CRNAs will continue to thrive.

Also, I have a hard time believing that CRNAs are just found in areas of MDA shortage. Go to any hospital in NYC, LA, or Chicago, where there is a high ratio of MDAs to patients and you will still find MANY CRNAs working there.

If CRNAs just worked in rural areas or slum ghettos where there were very few MDAs, then I might agree that they are largely found in the context of an MDA shortage. However, thats not the case. CRNAs are just as common in big city MDA surplus areas as they are in rural community hospital ERs where MDAs are in shortage.
 
Wow, MacGyver agrees with Jason. Oh my, if an MS1 and a surgical tech/would-be MS1 believe something, it must be true. 🙁

I guess I should start looking for a new job. Do you think you get get me a job as surgical tech Jason? I used to work in grocery store when I was in junior high.
 
Originally posted by NaeBlis
Wow, MacGyver agrees with Jason. Oh my, if an MS1 and a surgical tech/would-be MS1 believe something, it must be true. 🙁

I guess I should start looking for a new job. Do you think you get get me a job as surgical tech Jason? I used to work in grocery store when I was in junior high.

Why resort to kindergarten tactics? How about this kindergarten tactic...if you think I'm such an idiot, challenge me on any medical topic. Better yet, challange me on anything anesthetic related. I mean, if anything, I know more pertaining to the actual procedure than you do. I know a few squirts of blood across the ether screen might make you feel involved, but those aren't your elbows, elbow-deep in someones gut trying to stop a bleeding spleen.

So, funny thing happened today. I'm doing a cleft palate and I look over the ether screen and what do I see? A CRNA teaching an MD resident about anesthesia. What a waste of the residents time, huh?

And the funny thing is, how this "bitter stocker boy" is riling up an Anesthesiologist. You are an Anesthesiologist, aren't you?
 
Originally posted by JasonGreen
Why resort to kindergarten tactics? How about this kindergarten tactic...if you think I'm such an idiot, challenge me on any medical topic. Better yet, challange me on anything anesthetic related. I mean, if anything, I know more pertaining to the actual procedure than you do. I know a few squirts of blood across the ether screen might make you feel involved, but those aren't your elbows, elbow-deep in someones gut trying to stop a bleeding spleen.

So, funny thing happened today. I'm doing a cleft palate and I look over the ether screen and what do I see? A CRNA teaching an MD resident about anesthesia. What a waste of the residents time, huh?

And the funny thing is, how this "bitter stocker boy" is riling up an Anesthesiologist. You are an Anesthesiologist, aren't you?


The kindergarten tactics were more directed at good 'ol Mac then you, he likes to mouth off about stuff he know nothing about about. I had a long argument with him on this topic, and it was very frustrating, he is a master of circular logic, and ignoring any evidence that is contrary to his opinion. As for the rest of it, I am not trying so say CRNA's know nothing, or that surgical techs know nothing, but your orginal posts were to come onto a board meant for MDA's and to say that MDA's are worthless because nurses can do it all, and at the same time you wanted to point out that AA's are nothing compared to CRNA's

Did you think that wouldn't piss people off, telling them that all their education is worthless? If you say that wasn't your intention you are either a fool or a liar. Maybe you do know alot about procedures by virtue of watching them, but so does any MDA, or resident, and they know alot more as well. I've gotten alot more than a few drops of blood on me in medschool alone, we rotate through all the fields, surg, ER, medicine, and so on. Whatever you may think, it is at least as rigiorous as whatever you did in nursing school. And before any practical experience I spent 2 years leaning anatomy, pathology, pharm, microbiology, biochem, and a dozen other classes crammed into too small a span of time. I've worked with AA's and they get pretty adept at procedures too, you can learn most any procedure pretty quickly, but I recognize that they don't have as much training as nurses.

Before that I completed my bachelors in chemistry. You should open a physical chem book some day, and work on all the thermodynamics equations and quantam mechanics. I learned all that before I started any medical training, Do you want me to quiz you on any of that? I would but I doubt you've taken Calc 3. You are very quick to dismiss all this training, but even quicker to emphasize the training nurses have over AA's.

So what should I quiz you? I suppose pharmacology and physio are the most relavant here. Define minumum alveolar concentration. Explain an action potential. Tell me about the different acetylcholine receptors in nervious system. Explain how local anesthetics work to block pain and not touch. Explain why NO2 can't be used in the OR, despite its effectiveness. Explain fetal circulation. Explain how norepinephrine and epinephrine differ in the body. Tell me about all the different pumps on a nephron, and which drugs can be used on each. This is just some of the stuff MDA's learn in the first year of medical school, and we learn it in excruciating detail. Then once we have mastered it, we move on to clinical years where we learn to apply it. At that point we do get a chance to put our hands in peoples abdomens, and we do get some blood on us.

Let me know how much of this you have learned, then we can move to more complicated stuff in the in the first, and even second year of medschool, and then we can try some clinical stuff. It might intrest you know that an MDA has about 3-4 times the hours of OR experience in his residency than a CRNA does in her/his program, and then there are the many years of education before that. I suppose their is nothing keeping you from simply looking up the answers on the net, and cut and pasting them, but I hope you gain some appreciation of what goes into an MD degree, and realize there is something we gain there beyond what you can get by having blood splashed on you.
 
Oooh Ohhh! Pick me! *raises hand*

I actually have to go to work, my case starts in 45mins, but yeah, I know all those answers. And yes, I've taken (except Calc 3?...didn't know that existed) all those classes already.

Either way, I don't have time as of now to answer them. But seriously, you asked me about MAC? How easy could you start them? I'm sure you could have given me harder questions.

I have 1 CT surgeon in my family, 1 Anesthesiologist and 3 CRNAS, so usually we'll "talk shop", so I'm almost positive I've already heard the answer to most of your questions.
 
Naeblis,

I know this is hard for you to understand but I'll give it a shot


1. You dont need to understand calculus 3 to do anes

2. You dont need to understand physical chemistry/thermodynamics to do anes

3. You dont need to understand detailed biochemical intracellular pathways to do anes

4. You dont need to memorize every signal cascade to do anes


Are MDAs given broader and more in-depth total education than CRNAs? Absolutely.

Does that education translate into better patient care and a more effective on the job performance as an anesthesiologist vs CRNA? Absolutely not.

Lets look at an analogy. Suppose you have a construction engineer who has taken college level courses in statics, dynamics, engineering materials, physics, thermodynamics, etc. Suppose this contruction engineer, in addition to having all those courses, has a lot of on the job experience in house construction.

Now suppose you have a guy who has taken none of those courses but who has experience building houses.

Who is going to be more effective in building the house? According to your logic, the engineer would. But is that really the case? Doubtful. Both of them would perform well and since doing house construction does not require in-depth knowledge of gas laws, the extra education the engineer has translates very poorly into increased job performance.
 
MAC, SO IF YOU WANT TO GO INTO ANESTHESIA, THERE'S NO NEED TO GO THRU ALL YEARS & HASSEL OF GETTING INTO MED SCHOOL... JUST DO CRNA OR AA PROGRAM?
 
Originally posted by JasonGreen
Oooh Ohhh! Pick me! *raises hand*

I actually have to go to work, my case starts in 45mins, but yeah, I know all those answers. And yes, I've taken (except Calc 3?...didn't know that existed) all those classes already.

Either way, I don't have time as of now to answer them. But seriously, you asked me about MAC? How easy could you start them? I'm sure you could have given me harder questions.

I have 1 CT surgeon in my family, 1 Anesthesiologist and 3 CRNAS, so usually we'll "talk shop", so I'm almost positive I've already heard the answer to most of your questions.

Then answer 1 or 2, they are easy 1st year questions, and shouldn't take more than 5 minutes to answer, unless you need to look up the answers. I've seen the watered down version of those classes that nurses get, so recognizing the words doesn't mean u can answer those questions. In any case you miss the point, if you already know it all why are you considering med school? It seems you you already know it all. All that blood you have had splashed on you has given you much wisdom. You should lead the rest of you surgical tech's in revolt, and put all us useless doctors out of our misery.
 
Originally posted by MacGyver
Naeblis,

I know this is hard for you to understand but I'll give it a shot


1. You dont need to understand calculus 3 to do anes

2. You dont need to understand physical chemistry/thermodynamics to do anes

3. You dont need to understand detailed biochemical intracellular pathways to do anes

4. You dont need to memorize every signal cascade to do anes


Are MDAs given broader and more in-depth total education than CRNAs? Absolutely.

Does that education translate into better patient care and a more effective on the job performance as an anesthesiologist vs CRNA? Absolutely not.

Lets look at an analogy. Suppose you have a construction engineer who has taken college level courses in statics, dynamics, engineering materials, physics, thermodynamics, etc. Suppose this contruction engineer, in addition to having all those courses, has a lot of on the job experience in house construction.

Now suppose you have a guy who has taken none of those courses but who has experience building houses.

Who is going to be more effective in building the house? According to your logic, the engineer would. But is that really the case? Doubtful. Both of them would perform well and since doing house construction does not require in-depth knowledge of gas laws, the extra education the engineer has translates very poorly into increased job performance.


Your very cute when you try to use logic mac, but I won't counter with the same since I remember how good you are at ignoring it. You've shown me the light, can you help all those new MDA grads, who are starting work at about 300k in those"big city MDA surplus areas" you mentioned. I guess with your grades you'll be going into family practice, or maybe you'll be a drug rep. Maybe you can give all us useless MDA's jobs as secritaries or something, you'll be able to afford it, you'll be pulling down a good 90k. Have u done any clinical work yet btw?
 
Naeblis,

did you ever consider the possibility (GASP! 😱 ) that all the education/training that MDAs get does not translate directly into improved patient outcomes necessary for typical practice of anesthesiology?

The question here is not whether CRNAs have equal training/education of MDAs.

The question is do they have similar job performance in anesthesiology as MDAs?

If the answer to that question was "no", then surely there would be ample evidence showing that patient outcomes are WORSE under CRNAs.

The fact that there is NO such evidence should tell you something
 
a few points addressing MacGyver and JasonGreen's issues:

1) regarding the issue of no good studies showing differences in outcome between MD and CRNA - there are also no studies comparing the outcome of sleeve lobectomies by general surgeons vs thoracic surgeons. there are also no good studies showing that ORIF vs casting of a fracture affects outcome....

2) MacGyver you are either a 2nd or a 3rd year med student by now, and JasonGreen you are finishing your BSN degree with hopes of becoming a CRNA or applying for med school - until you guys are a bit further in your education and have experienced what goes on behind the ether screen, you are making assumptions based on flawed perceptions. (and being related to different professionals doesn't mean squat until you walk in their shoes)

3) job performance can not be assessed because our jobs are slightly different. it would be akin to comparing job performance of a Nurse Practitioner/PA with that of an internist - some of their skills/education/diagnoses/treatments may overlap, but do not make them identical.

4) MacGyver your logic that there is no reported evidence to show that CRNAs underperform MDs is your implication that CRNA=MD - if that were your logic why do MDs still have jobs and why the hell are they better paid. Unless you can come up w/ some dark conspiracy theory, i think this is a naive understanding of the need for anesthesia providers with different levels of training.

I hate to sound condescending - but the only way you can grasp the true differences between CRNA and MD is once you finish med school, and do an anesthesia residency... If either of you however decide that CRNA is a better route for you, then i applaud your decision and hope that you guys enjoy the wonderful field of anesthesia - because it is an amazingly gratifying job
 
As for the rest of it, I am not trying so say CRNA's know nothing, or that surgical techs know nothing, but your orginal posts were to come onto a board meant for MDA's and to say that MDA's are worthless because nurses can do it all, and at the same time you wanted to point out that AA's are nothing compared to CRNA's


No, I never said that MDAs were worthless. Obviously, the english portion of the MCAT wasn't your strong suit as you failed to comprehend simple text. Let me quote myself:
quote:
--------------------------------------------------------------------------------
So tell me, do you think MDA's shouldn't be involved in anesthestic care, given all that I said?
--------------------------------------------------------------------------------



Oh, absolutely I do believe they should be involved. My only rife was when the post about CRNAs being far inferior to Anesthesiologists. I don't agree with that statement, nor does the actions I've seen in trauma cases reflect it.

You will clearly see that above did not imply the MDAs were "worthless". I am only stating that CRNAs, 99% of the time, are just as good as MDAs for their clinical, let me say that again, CLINICAL practice.

If you say that wasn't your intention you are either a fool or a liar.


I guess we know who the fool is now.
 
Originally posted by MacGyver
Naeblis,

did you ever consider the possibility (GASP! 😱 ) that all the education/training that MDAs get does not translate directly into improved patient outcomes necessary for typical practice of anesthesiology?

The question here is not whether CRNAs have equal training/education of MDAs.

The question is do they have similar job performance in anesthesiology as MDAs?

If the answer to that question was "no", then surely there would be ample evidence showing that patient outcomes are WORSE under CRNAs.

The fact that there is NO such evidence should tell you something


BING! BING! BING! I think we have a winner!
 
If either of you however decide that CRNA is a better route for you, then i applaud your decision and hope that you guys enjoy the wonderful field of anesthesia - because it is an amazingly gratifying job


Uh, no. Despite the fact my father is an MDA, I'm going into CT surgery. Or at least that's the plan for now (and has been since 1st grade).
 
Originally posted by JasonGreen


I guess we know who the fool is now.

I certainly do. 🙄

You and Mac have way too much common.

I take back what I said about wishing you good luck in getting into medschool. In fact I hope they some how screen you out before you graduate nursing school.
 
Originally posted by NaeBlis
I certainly do. 🙄

You and Mac have way too much common.

I take back what I said about wishing you good luck in getting into medschool. In fact I hope they some how screen you out before you graduate nursing school.

Awww, don't be a bitter MDA because you had a "bitter stocker boy" made to have you look like a fool. We've got too many of those in the O.R. already.
 
Originally posted by JasonGreen
Awww, don't be a bitter MDA because you had a "bitter stocker boy" made to have you look like a fool. We've got too many of those in the O.R. already.

"made to have you look like a fool". Yes you made to have me look like a fool. I'm gonna go cry now.
 
Originally posted by JasonGreen


"NURSE! Get me a box of laps! I feel a river coming on!":laugh:

I was looking for some earlier, but couldn't find them. You must have forgotten to stock them. Were you busy getting someone a bedpan? 🙂
 
Originally posted by NaeBlis
I was looking for some earlier, but couldn't find them. You must have forgotten to stock them. Were you busy getting someone a bedpan? 🙂

Nah, I had to go find another book, pillow and a big 'ol comfy chair for my MDA for the following case.
 
It's rather funny how much this topic is repeated here...I think that if one compares a CRNA with years of experience to an MDA right out of school, you could easily make a case that the CRNA is better equipped. Anyway, a new CRNA compared to a new MDA cannot be viewed the same based on experience and knowledge. Perhaps they may function the same in routine situations, but every profession has the "routine" that would be better served with a professional who is trained in performing this task. My thoughts regarding the value of a MD vs. CRNA degree is that the honor a prestige that the medical degree holds no matter what your doing, even sitting on the couch enjoying retirement, is worth the effort. People hold an unbelievable amount of respect for physicians based on history and social views alone. It's a degree that should be held in the highest regard. People know what it is to be a physician. When I see the name tag CRNA in the hospital, I'm thinking certified nursing assistant. Anyway, who cares how much you make. The most important thing is that your satisfied with what you've done with your life, and your happy with what your doing.
 
Just wondering what cases CRNAs and AAs actually work. Around here the only place I have seen CRNAs in my admittedly limited experience is in procedure rooms, doing what I would think are relatively simple cases like sedating women for egg retrievals. In the ORs it's always MDAs or anesthesia residents. If CRNAs aren't doing anything very complicated, I would think that their outcomes would be as good as anyone, MDA or otherwise, and you wouldn't see a difference simply because everyone does well unless there's a catastrophic error made or something.

If on the other hand, they are doing trauma cases, cardiac anesthesia, and that sort of thing with the same outcome as MD-equipped anesthesiologists, that would say a lot about their abilities. That doesn't seem terribly likely to me though. Correct me if I'm wrong, but I would suspect that except in areas of desperate shortages CRNAs and AAs simply are not being given the complicated operations. I can see their value for routine operations, but it seems to me that their expertise can only go so far given their shorter training.
 
Originally posted by Smoke This
Just wondering what cases CRNAs and AAs actually work. Around here the only place I have seen CRNAs in my admittedly limited experience is in procedure rooms, doing what I would think are relatively simple cases like sedating women for egg retrievals. In the ORs it's always MDAs or anesthesia residents. If CRNAs aren't doing anything very complicated, I would think that their outcomes would be as good as anyone, MDA or otherwise, and you wouldn't see a difference simply because everyone does well unless there's a catastrophic error made or something.

If on the other hand, they are doing trauma cases, cardiac anesthesia, and that sort of thing with the same outcome as MD-equipped anesthesiologists, that would say a lot about their abilities. That doesn't seem terribly likely to me though. Correct me if I'm wrong, but I would suspect that except in areas of desperate shortages CRNAs and AAs simply are not being given the complicated operations. I can see their value for routine operations, but it seems to me that their expertise can only go so far given their shorter training.

Excellent post. I agree with you for the most part.

But keep in mind that in rural/underserved areas, CRNAs do everythign that MDAs do. They do the complex surgeries as well as the simple procedures. Now, if naeblis and others are right that patient care is being compromised by CRNAs, then shouldnt that be well apparent in teh rural areas where CRNAs are doing everything?

There are many rural areas in this country, which corresponds to a large number of CRNAs in these areas doing complex cases that only MDAs would do in the big cities. If CRNAs really are subpar compard to MDAs, then it should be readily apparent by looking at complication/mortality rates in areas where CRNAs dominate.

The fact that there is no data showing this to be the case, and the fact that rural areas still rely heavily on CRNAs to do everything is a hint that the difference between CRNA and MDA IN PATIENT CARE MEASURES is not that divergent as people on here think
 
In big cities it is as you describe smokethis. Where I did my AI's the CRNA's didn't even want to go into the heart rooms.

That patient care is compromised in these rural areas isn't noticed for 2 reason. For one, the more complicated cases are moved to the cities, and not done in the rural areas. Another is that anesthesia is 99% boredom, and 1% terror. Stuff only goes wrong a small percentage of the time. Not enough for most observers to pick up a difference, even the surgeons, since they rarely pay enough attention to the other side of the curtain. Especially observers like Mac who haven't even seen the inside of an OR.
 
Originally posted by NaeBlis
That patient care is compromised in these rural areas isn't noticed for 2 reason. For one, the more complicated cases are moved to the cities, and not done in the rural areas.

I refuse to believe that people are just looking the other way in rural areas and letting CRNAs screw up surgeries.

That point argues for letting CRNAs do all the bread and butter surgeries. Somehow I dont think you want that to happen.


Another is that anesthesia is 99% boredom, and 1% terror.

hence, 99% of the time a CRNA can replace an MDA, and only 1% of the time do you really need to have an MDA do the anesthesia.


Stuff only goes wrong a small percentage of the time.

Yet another argument for having CRNAs do all the routine stuff and reserving MDAs for only the really tricky surgeries.


Not enough for most observers to pick up a difference, even the surgeons, since they rarely pay enough attention to the other side of the curtain.

You are right, there is no observable differnence between MDA and CRNA--therefore CRNA might as well run all the "routine" surgeries
 
Just wondering what cases CRNAs and AAs actually work.
I can't tell you about AAs, as I've never even seen on in the O.R. It can become a gray area with CRNAs, however. Depending on if they are medically directed or medically supervised by MDAs depends on the scope of their practice. I've worked at hospitals where the CRNAs are the only ones on L&D call putting in all the epidurals without MDAs even in the house. In the main OR, they were responsible for induction, the length of the case and extubation (and probably some more stuff that went on in recovery that I'm not privy to).

I have, however, been in an OR where they were watched like a hawk from the MDAs. MDAs had to be in the room during induction, but not during extubation. They were not allowed to do epidurals nor administer propofol. They could, however, administer any of the narcs and reversals.

It's a trade off. If the CRNA is medically directed, the work load for the CRNA isn't all that high. However, they don't have many responsibilities (although they can be sued the same as an MDA - but probably won't because the pocketbook isn't as deep). If medically supervised, the responsibility load increases as the MDAs (may only be one - 5 depending on the size of the group) are tied up with other work (or other patients) and don't need to "direct" the CRNAs for anesthesia.

My friend works in an opt-out state where CRNAs are not directed or supervised at all by MDAs and works in an all-CRNA group. Their cases involved pretty much all the specialties....neuro, hearts, peds, gen, gyn, etc, etc...
 
Not enough for most observers to pick up a difference, even the surgeons, since they rarely pay enough attention to the other side of the curtain. Especially observers like Mac who haven't even seen the inside of an OR.

But I am. And I was on an open heart team before moving and the only ones doing the anes was CRNAs. We're talking 6-12 hour heart cases involving a lot of jumps. The CRNAs were just as ready as the MDAs to take on these cases.
 
A few points about good 'ol Macgyver:

1. He is an MS2 or at most an MS3. The most OR experience he could have had was a week.

2. He post on all the speciality forums here as an 'expert", and has done so since before he was even a medical student.

3. Among other things he believes that Chiropractors who get prescription rights will put IM, and family practice out of business. That PA's will start doing al the heart caths, and put the cardiologists out of business. That PA's will take over general surgury.

4. He would have made a good politician, he is good at twisting things you say to support his own idiodic ideas, and ignoring any evidence that might contradict his opinion. He is a master of circular logic, and when he can no longer defend his original idea, he will switch to something else and pretend he believed that all along.

He is a menace, and if you need proof, just do a search for his posts and read a few, it won't take long for you see this is all; true.
 
Originally posted by JasonGreen
But I am. And I was on an open heart team before moving and the only ones doing the anes was CRNAs. We're talking 6-12 hour heart cases involving a lot of jumps. The CRNAs were just as ready as the MDAs to take on these cases.

Look I know your in the OR alot, but you aren't an MDA or CRNA, and you havn't even completed your nursing training yet. Don't you think maybe you should wait a bit before you make judgements like that. I don't think you know enough to decide which cases are high risk, and I don't think you monitor what happens to these patients after they leave the OR. Whether they leave the OR alive or not isn't the full outcome. You said yourself that you don't monitor what goes on in the PACU, and what the MDA's might be doing out there. You have only heard of places where the CRNA's are independent, and you havn't seen what outcomes they have there.

In NYS where I have worked MDA's closely monitor all the inductions when they are supervising CRNA's, and sit in where there are complicated case. You say the groups out there 1-5 MDA's? Out here the smallest group I have seen was 9 MDA's, and 7 CRNA's, and it was in a relatively small city (Binghamton, NY)
 
Top