CRNA vs MDA
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claire the bear

Jefferson, SC

#1 Jan 6, 2008
Hello everyone! I am an O.R. nurse who frequently visits the allnurses website. There was a question by a student nurse who wanted to know the difference between the duties of a CRNA and MDA. I replied that there is a huge difference and that she should just finish school and go work in the O.R.--she would find out! I am now getting blasted by CRNAs. uh..oh!!(she does realize that the MDAs are docs) Any specific help appreciated, as they are apparently quite offended...
Claire
mda

Louisville, KY

#2 Jan 16, 2008
Well you have rattled an angry hive of bees!
I am an MD anesthesiologist, I do about 80% of my own cases and supervise about 20% of the time. The main difference is in the training. CRNA training is very focused and just like most MD they do a very good job and are quite competent. But the two are not the same. I went to 4 years of college then 4 years of med school where I trained intensively in medicine, surgery, OB, emergency medicine, cardiology etc. After that a one year internship in internal medicine with a focus on diagnosis and treatment of cardiovascular, renal, hepatic and pulmonary disease. Then 3 years of anesthesiology training specificly for OR anesthesia. The point of this is that from the begining MD training is more geared towards diagnosis and treatment and understanding the underlying pathophysiology and pharmacology, also having assisted in surgery as a student and resident one gets a more perspective. MD/CRNA teams usually work very efficiently together but I do not feel that CRNA training adequately prepares them to be completely autonomous. I can and have done emergency tracheostomies when a surgeon was unable to I don't think many CRNAs can say they are trained to do that. Having ranted on many MDs through sheer laziness do seem to allow nurses to function with minimal or no supervision. And for the record I am in no way anti CRNA.
Armygas

Frederick, MD

#3 Jan 24, 2008
I think you might be getting a narrowed view of the capabilities of a CRNA. I agree in many instances the CRNA works in an Anesthesia Care Team environment but in many cases as well CRNAs are the sole anesthetic provider in many hospitals.
sandman

United States

#4 Mar 2, 2008
Armygas wrote:
I think you might be getting a narrowed view of the capabilities of a CRNA. I agree in many instances the CRNA works in an Anesthesia Care Team environment but in many cases as well CRNAs are the sole anesthetic provider in many hospitals.
I am a CRNA and I work solo in a rural hospital. I see the usual arrogance of MD's thinking that they are the only ones who can do the job safely. History has proven them wrong. The real issue is money.
Anesthesia Doc

Pearland, TX

#6 May 29, 2008
Someone needs to correct me if I am wrong, but I believe that CRNA's that practice independently (almost always in rural settings) are technically under the medical supervision of the operating surgeon. You are unlikely to find nurses practicing independently outside rural environments, and this is considered tolerable only because there are not anesthesiologists available in those areas.

CRNA's love the term 'anesthesia provider'(just imagine someone ever using the term 'orthopedic surgery provider' or 'emergency medicine provider', it's ridiculous) because it semantically lumps them into the same category as an anesthesiologist. Please don't take this the wrong way, I have a lot of respect for the specialized education that is involved in anesthesia nursing, it's just not the same education that an anesthesiologist receives. There are overlaps, to be sure, but I've been known to draw blood from time to time, and you'd never compare my training to that of a phlebotomist.

And I agree with Sandman, the issue is money. There's a huge number of young RN's now that want to be CRNAs, not because they're interested in the science of anesthesiology, but because they've heard you can make a lot of money, and it only takes 2 years.
Mike Mac

United States

#7 Jun 15, 2008
First no, we do not need to be supervised.
You have, as many anesthesiologists do, totally misunderstood how the laws work. The only time a CRNA needs any physician of any kind is to sign the record to obtain medicare reimbursement in states which are not Opt Out states (17 of them). In opt out states CRNAs do not anyone to sign anything. If a CRNA is doing a case with other insurance or cash/pt pay there is absolutely no requirement for a physician in anyway.
What you refer to is a billing arrangement related to MEDICARE only and the proof that it isnt any sortof legal supervision is in the fact that the surgeon is no more liable for a CRNAs anesthetic than yours and it only applies to medicare. Its all terminology.
Politics abound here and im sure you are only stating what you have been taught.
I was also taught how to cric a patient. Hell, i did it as a paramedic and flight RN for 10 years.
I dont like the term provider either but it IS accurate. You and I are both "providers" of a service, in fact an identical service in every way. I prefer the terms anesthetist and anesthesiologist.
It does not only take 2 years. I lvoe how this gets totally blurred.
4 years of nursing for BSN. min 1 year critical care average is 5. then 27-36 months for CRNA school.
So, you have 4 years of medical school, your previous degree (of which i have one too) is irrelevant, 4 years residency for a total of 8 years.
I have 4 years BSN, 1 year required experience (i have 10) and 2.5 years of CRNA school. Thats a total of 7.5 years. Now that IS comparing apples to apples. Lets not distort the numbers.
Anesthesia Doc wrote:
Someone needs to correct me if I am wrong, but I believe that CRNA's that practice independently (almost always in rural settings) are technically under the medical supervision of the operating surgeon. You are unlikely to find nurses practicing independently outside rural environments, and this is considered tolerable only because there are not anesthesiologists available in those areas.
CRNA's love the term 'anesthesia provider'(just imagine someone ever using the term 'orthopedic surgery provider' or 'emergency medicine provider', it's ridiculous) because it semantically lumps them into the same category as an anesthesiologist. Please don't take this the wrong way, I have a lot of respect for the specialized education that is involved in anesthesia nursing, it's just not the same education that an anesthesiologist receives. There are overlaps, to be sure, but I've been known to draw blood from time to time, and you'd never compare my training to that of a phlebotomist.
And I agree with Sandman, the issue is money. There's a huge number of young RN's now that want to be CRNAs, not because they're interested in the science of anesthesiology, but because they've heard you can make a lot of money, and it only takes 2 years.

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Anesthesiologist

Evansville, IN

#8 Jun 28, 2008
Mike Mac wrote:
First no, we do not need to be supervised.
You have, as many anesthesiologists do, totally misunderstood how the laws work. The only time a CRNA needs any physician of any kind is to sign the record to obtain medicare reimbursement in states which are not Opt Out states (17 of them). In opt out states CRNAs do not anyone to sign anything. If a CRNA is doing a case with other insurance or cash/pt pay there is absolutely no requirement for a physician in anyway.
What you refer to is a billing arrangement related to MEDICARE only and the proof that it isnt any sortof legal supervision is in the fact that the surgeon is no more liable for a CRNAs anesthetic than yours and it only applies to medicare. Its all terminology.
Politics abound here and im sure you are only stating what you have been taught.
I was also taught how to cric a patient. Hell, i did it as a paramedic and flight RN for 10 years.
I dont like the term provider either but it IS accurate. You and I are both "providers" of a service, in fact an identical service in every way. I prefer the terms anesthetist and anesthesiologist.
It does not only take 2 years. I lvoe how this gets totally blurred.
4 years of nursing for BSN. min 1 year critical care average is 5. then 27-36 months for CRNA school.
So, you have 4 years of medical school, your previous degree (of which i have one too) is irrelevant, 4 years residency for a total of 8 years.
I have 4 years BSN, 1 year required experience (i have 10) and 2.5 years of CRNA school. Thats a total of 7.5 years. Now that IS comparing apples to apples. Lets not distort the numbers.
<quoted text>
Sure, you received a lot of training. I agree we as anesthesia providers provide a service - however, anesthesiologist are physicians. As physicians we are interested in non only providing a service but also in improving the subject of anesthesia. We are performing studies and increasing the knowledge about anesthesia. As you know - if you stop increasing you knowledge and your effort to improvement - you will become worse. Sure - "putting a patient to sleep" or placing a SpA or PDA is not the "big deal" - but we are the consultants for your patients. Therefore, we should aim for improvement in care beside working high quality every day.
Therefore, there is a clear difference between CRNAs and MDs. Unfortunately, in some places MDs behave like providers and do not behave like intellectual leaders.
JTK

Ansley, NE

#9 Jun 29, 2008
I love how CRNAs conveniently count their own undergraduate education, the "rigorous" BSN, but seem to think that all MDs played the flute or drew cartoons for four years. In reality, the undergraduate education of a pre-med student is far more science-intense than for a nursing student. My mom got her BSN at the age of 33 from a large university ONLINE, and she says it hasn't helped her to do anything but obtain a public health position.
gaz

Santa Fe Springs, CA

#10 Jun 30, 2008
Ouch...can't we all just get along!? Bottom line, there are MDAs who would blow many CRNAs outta the water with their skill and knowledge. There are CRNAs who would blow many MDAs outta the water with their skill and knowledge. The letters after your name mean ONLY one thing...whether you trained in a nursing field or medical field. It has absolutely no bearing on who is better. Some say nurses "in general" are better observers and interventionists, wheras docs "in general" are more scientific and knowledge based. Where does the"art" of anesthesia lie? Maybe somewhere in between? We live in an evidenced based society folks and there is zero data to conclude which provider is best. Just depends on the integrity and determination of the provider to better his or her practice and gain as much knowledge as possible to safely care for the patient.
gaz

Santa Fe Springs, CA

#11 Jun 30, 2008
and to know when thety are in over their head and call for help!
RN CRNA to be

Nashville, TN

#12 Jul 21, 2008
WoW...I'm not suprised..
TitsAhoy

United States

#13 Jul 22, 2008
HAHAHA! I remember one time a CRNA had a patient Trached because of "laryngospasm" but "UH-OH" it turns out she forgot to switch the ventilator on. HAHAHAHA. That was covered up by the hospital. Poor little girl now has a trach scar. Way more idiot CRNAs than MDs.
chad

AOL

#15 Aug 7, 2008
hospital here in Texas had a bad deal,where all there crna folks were taking over,so alot drs left,so hospital let go most of crna folks. the hospital was understaffed,and the Doctors were over worked,and wantd crna"s back..I respect both ends of this discussion..DRS are needed,when a crna needs help,both need to know when to ask for help..Obviously a DR has more knowledge,but crna folks work as hard,and have a wealth of knowedge to be respected..
CRNA competency

Chicago, IL

#16 Aug 20, 2008
CRNAs can be good. The ones who have been doing it for A LONG TIME are good at it based on their experience. They know the deal when a certain case gets scheduled.

However, they do miss some important things sometimes that also the surgeons, cardiologists, and internists miss. For example, chronic steroid use, didn't take it today. Did you plan on giving some steroids preoperatively or just see what surgical stress does? This is where I think it's more than just being a provider (sedate, intubate, maintain). Lot of times, people get by with stuff but that doesn't mean one day somebody as in the patient won't get screwed. And why do surgeons miss stuff? Because they don't really care too much about anything beyond the operation itself minus transplant and vascular like folks. So who catches the error in judgement?

The problem with MD anesthesiologists who graduated in the 90s and early 2000 were "lazy" FMGs for the most part. That's why FP gets a bad name too because of their resident pool. A lot of these folks don't give a hoot and don't mind abusing CRNAs or people lower on the chain. Some of these morons haven't even passed their boards yet. This low standard should not be acceptable and creates a view that then some can claim that are equals.

Let us all remember that medicine's technical tasks and non-complex things can be done by many non-docs. I was trained as a student to do lap cholecystectomies. But I was not the doc who influenced the surgical plan and postop care. A lot of NPs out there could diagnosis a COLD, so could a third year med student. That doesn't mean the med student is the NPs equivalent per se and whatever else.

Basically, I see a lot of CRNAs who do what they do and that's it. Others are strictly in it for cash and for some reason think that Congress and insurance companies will see them as MD equal providers. I see MD salaries dropping to maybe low 200s and nursing being adjusted based on that because they don't carry "separate" liability.
Jessica

Pomona, CA

#17 Aug 21, 2008
Hey everyone. My name is Jessica and I'm 21 years old. First off I want to say that i really appreciate everyone's posts. Reading them have helped me a great deal. Sorry if this is long but im driving myself nuts with this inner struggle and any response would be greatly appreciated. I am in college right now and want to become an anesthesiologist but fear that with CRNAs being in such high demand that As an MD anesthesiologist it may be harder to find an occupation. So I wonder why not just become a CRNA. I love helping people and have a very inquisitive mind.Research,and science fascinate me and I truly care about peoples well being. I have truly considered becoming a CRNA but after talking to several people MD's RN's and CRNAS and reading all these posts I realized that even though CRNAS are highly trained in their specialty they appear to receive little respect and put up with a significant amount of grief and are looked down upon. And I would not want that for myself.I distinctly remember a time when i was 17 and a relative was in the hospital and i was there with her and became friends with her Dr and told him I was considering a career in nursing and he said "If your going to do something go all the way to the top. Nurses are not treated well." that was his opinion but unfortunately it is a reality that i have finally come to. So i guess my question is. Is it worth it to go to med school and come out after 12 yrs i will be 33 or 34 and then go through hell trying to get a job because CRNA's (no disrespect intended to the crnas) are in such high demand.
thanks
bill

Mount Pleasant, SC

#18 Aug 24, 2008
I HAD a great deal of respect for the MDA before I started working with them. As far as your consulting ability, most of that is done from the lounge watching the case on monitors so you can magically walk in at emergence. The health care system can no longer afford your $500k salaries for you to walk around and watch me do the work. I dont have a problem with having someone else on the case, but dont trash my profession by saying that I am only safe if you are watching me work. If that were true, there would be MD's watching every nurse in the ICU do their job. I dont see that happening and god only knows someone needs to watch todays ICU nurses.
As far as the public wanting the holy MD, they can read through your BS and be sure that word gets around. I know several MDA's that would be better at parking cars than giving anesthesia! Just because you have MD behind your name, doesnt mean you are smart. You have to build and maintain your knowledge base just like anyone else and face it just because you made it thru school doesnt mean you are any good! Surgeons really think of the MDA as their scapegoat with the deep pocket, they dont really care about your knowledge. They are under the false impression that they cant be sued if an anesthesiologist is assigned to the case. Oh, and the reason anesthesia is given in rural america is the fact that highly qualified CRNAs are doing the job. MDA's dont want to live in BFE Kentucky where their wives dont have a MACY's to shop in. IF you guys want to DO anesthesia the sit the damn stool. The medical direction scheme is on its way out. So be careful what you wish for!
JTK

Ansley, NE

#19 Aug 24, 2008
I wholeheartedly agree with the previous poster on the ACT concept. I mean, are there that many cases in which an MDA is necessary to see the case through to a happy ending? I think that as an MDA I would get bored "supervising" all the time. I don't think that in the long run the healthcare accountants will let somebody be paid half a million to "oversee" actual work.
bill

Mount Pleasant, SC

#20 Aug 25, 2008
JTK wrote:
I wholeheartedly agree with the previous poster on the ACT concept. I mean, are there that many cases in which an MDA is necessary to see the case through to a happy ending? I think that as an MDA I would get bored "supervising" all the time. I don't think that in the long run the healthcare accountants will let somebody be paid half a million to "oversee" actual work.
I wish we could all get along. If hospitals want MDA's "available" then go to a non-medically directed model. Where I work there are usually 1 MDA to 3 CRNA's. We only have 11 OR usually. One MDA covers the PRE-OP clinic/OB for C-sections. The CRNA does the epidurals. One MDA for the surgery center down the road and the other 6 MDA's are off 3 on vacation and 3 off post call. They have a 1st,2nd, and 3rd call MDA. Pretty sweet setup for them but the hospital is too blind to see the substantial cost of this coverage. I am sorry but our MDA's do less for patients that an internal medicine doc and get paid 3 times the salary. I think we all should stop bashing each others profession and be thankful that we make the living that we do.

My other beef with our guys at least is the fact they claim to be there for the pt. Hogwash, what the pt doesnt know is how they are making fun of the pt while they are asleep-calling them dumb, fat, and other things. It is a disgrace. I am really amazed at the people who can hold the MD degree. It all goes back to the caliber of the individual and overall I am not impressed. There are good doctors out there but they are getting harder to find.
Sorry for the rant.
bill
bill

Mount Pleasant, SC

#21 Aug 25, 2008
Titsahoy:
what an as*&ole u are! All ANESTHESIA PROVIDERS are capable of making mistakes. If you actually gave anesthesia instead of walking the halls you might know that. How about that MDA that let the girl die in that surgery center a few months ago from MH? Why did he let her wait for an 90 min before beginning treatment and getting her to the hospital? CRNA's are good at what they do because we DO it everyday not just once in awhile. We need to focus on the care of the patient and not the initals after our name. It doesnt matter that you can magically tell what every neuron is doing during the case or that you can map out the entire nervous system on a piece paper. You treat the patient for the case. It is great that you have all that knowledge and I applaude you for that. I could have gone to med school but I chose my route. I accept that and expect to be paid market value for my services. Sure seems that alot of surgery residents fail out and go into anesthesia! Why is that?
Have a great day TITS
TitsAhoy wrote:
And by the way --- nobody is fooled by CRNAS. Patients ask all the time, are you an MD! I say yes. They say, thank GAWD! You know why? Because the public knows that MDs are smarter. And they are smarter. So smoke on that you CRNA money grabbers!!! hahahahah!!!
TitsAhoy!!! Always hire CRNAs with Big Tits, if you gotta have em around, then you can look down their shirts when they can't intubate and call for help!!! Ahoy there Cap'n!! Tits AHOY!!
bill

Mount Pleasant, SC

#22 Aug 25, 2008
chad wrote:
hospital here in Texas had a bad deal,where all there crna folks were taking over,so alot drs left,so hospital let go most of crna folks. the hospital was understaffed,and the Doctors were over worked,and wantd crna"s back..I respect both ends of this discussion..DRS are needed,when a crna needs help,both need to know when to ask for help..Obviously a DR has more knowledge,but crna folks work as hard,and have a wealth of knowedge to be respected..
Thanks for your positive post Chad. Where are you from? I came into this profession about 8 yrs ago because I was intrigued by anesthesia and I wanted a secure living. I still enjoy anesthesia but the politics are a bit much sometimes.

thanks again
bill

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