Nurse anesthetists aren't the same as...

Nurse anesthetists aren't the same as anesthesiologists

There are 136 comments on the The Baltimore Sun story from Sep 21, 2010, titled Nurse anesthetists aren't the same as anesthesiologists. In it, The Baltimore Sun reports that:

Catherine Gilliss's primary point in her op-ed is that nurse anesthetists are a less expensive alternative to physician anesthesiologists in providing anesthesia.

Join the discussion below, or Read more at The Baltimore Sun.

stanley

Covington, KY

#66 Feb 14, 2013
Yeah several times, have done it.Why shouldn't it if the CRNA has more cardiac experience (often) then let us say a new gfrad or nMD who is doing just bread and butter (lots of them). The fact is there is no difference in outcome, I am sorry you feel differntly but thart is the way you FEEL not a FACT.
They do manage the same level of acuity and the studies are weighted for it, unless I mean you have the raw data and are really so much better at statistical analysis then the people that do it for a living?
RFA

Vancouver, Canada

#67 Feb 14, 2013
Please provide links to the studies that weight for level of acuity and state that on average CRNAs work at the same level of acuity and have the same responsibility and the same amount of knowledge and the same clinical acumen.

Also please explain to me how CRNAs are so smart and so skilled that they are able to provide the same level of care without having ever achieved the same kind of grades, attended world class universities, outperformed 90% of undergraduates, make it into medical schools, make it through 100 hour weeks in surgery, obtained clinical experience in surgery, paediatrics, psychiatry, internal medicine etc etc. outperformed medical students in most of these areas, make it into an anesthesiology residency program, write board exams, and complete fellowships? It just seems arrogant to me to believe that you are just as good without any of the training. Thats like me saying I could be an astronaut because I visited NASA for an elective and worked with a few astronauts and saw what they were doing.

I am incredibly impressed if a nurse with a few years of community college a few years experience and a 24-36 month CRNA program could gain the same skills and clinical acumen as an anesthesiologist. Call me skeptical but it just doesn't add up

I have a ton of respect for nurses and all other allied health members, we all work together to improve the quality of care for patients. What I have an issue with is the attitude that some mid-level providers have regarding being able to do what doctors can do. I find that attitude incredibly unsafe and callous. Can you imagine flight attendants thinking they could be pilots? Hygienists thinking they could be dentists or paralegals trying to be lawyers? All of these people work in teams, but there is very different levels of education, training, skills and responsibility.
BDZ

Vancouver, Canada

#68 Feb 14, 2013
Curious - if CRNAs are as brilliant as they claim why didn't they go to medical school and become doctors? Especially if the wanted to function as doctors?
-How many CRNAs out there feel like they could have gotten into medical school? If so where did you do your undergraduate degrees and what was your GPA like?(only a small part of the picture, but an important screening point).
stanley

Covington, KY

#69 Feb 14, 2013
The vast majority of edcation anesthesiologists recieve do not involve anesthesia, the majority of education you site is simply non predictive. It is as simple as that.
You do not need to an astronaut to fly a plane.

As for studiesthat would be Pine for a starter, followed by nearly evey other one.
RFA

Vancouver, Canada

#70 Feb 14, 2013
And that is exactly the difference between a tradesman and a professional.
Does an anesthesiologist need to know what the surgeon is doing? not really but it sure as heck can't hurt to know that he's spent countless hours on the other side of the sterile field (even if all he was doing was holding a retractor as a med student).
Does an anesthesiologist need to understand the anxiety that the patient coming in for a simple elective surgery? Maybe not, but I sure would want to have someone who has done a few months of psychiatry, understands the basis of said anxiety.
What about the patient who is here for resection of a tumour, sure a CRNA can keep her alive but I'd rather someone who understands a thing or two about cancer, the treatment, the prognosis, the management.
You can do the bare minimum in anything. If a pilot only has to fly from point City A to city B and can do it under visual navigation why bother teaching him or her anything about electronic navigation or how to land in any airport in the world, he'll only be landing in A or B anyways?
In your opinion can we replace any physician specialist with a tradesperson? Why not replace the orthopaedic surgeon with a technician who can only do one procedure? Its a bastardization of the profession of medicine.
stanley

Covington, KY

#71 Feb 16, 2013
Ths si the difference between knowldge and ignorence, I am aware of what is happening on the other side of the cutain, I am aware and understand patient anxiety.
The bare minimum? That would be your undertanding of my PROFESSION, not a trade. Look up the definition in websters.

I do not know what your trade is but clearly it does not encompass research.
RFA

Vancouver, Canada

#72 Feb 16, 2013
"Profession a calling requiring specialized knowledge and often long and intensive academic preparation". Classically there were only three 1.) Divinity 2.) Law 3.) Medicine.

Its not ignorance. There is an important role for nurses, OTs, PTs, Porters etc. No one role within healthcare is the end all and be all. I just find that Nurse anesthetists tend to challenge their role boundaries more than most of the other allied healthcare workers.

Again, its not that all CRNAs are like this, it just seems more common in the CRNA world than most other places. I have rarely heard of legal aids/paralegals challenging lawyers on their knowledge or hear them claiming to be the same, the same way you never hear of flight attendants challenging the roles of pilots.

Perhaps I am way off base about what I hear goes on in some US states (rural areas) but I've just heard/seen too much propaganda claiming CRNAs to be equivalent to Anesthesiologists.

Can you at least see it from the other perspective? How would you feel if you spent 13 years and $600 000 training (tuition+cost of living + expenses) and throughout this time you consistently worked your ass off to be the cream of the crop.... just to have someone go to community college work for a year or two (fully paid i may add) and then take a little 36month program and then claim to be the same as you? Can you see why this is frustrating from a doctor's point of view??

Another thing that erkkks me to no end is that everyone and their dog wants to have a doctoral degree - physics are now DPT, CRNAs are going to have one soon, nurses etc whats next a doctorate in sanitation engineering?(Aka Janitor?)
stanley

Covington, KY

#73 Feb 16, 2013
If I perform EVERY, and I mean EVERY type of case as an anesthesiologist, then I am equivilent. This is the case across the country every day. The supervision requirment has not shown to increase saftey. If I were in this situation I would reconsider the means in which I enter a profession.

In the case of pushing boundries CRNA's have always practiced autonomously, always the ones who are trying to change the status quo is the ASA.

"Profession a calling requiring specialized knowledge and often long and intensive academic preparation" 8 years that is how much time it takes to become a CRNA.

What would gall me is that I went to school did the same cases as the residents I paid for all of my education the residents got paid. So premed and med school they pay for and then they get paid in residency. Do you see that?

What irks me is that some groups seem to think they have the right to determine what the terminal degree for another profession should be. That is staggering arrogence.

The point of the discussion was quality of care and the studies. I like the way you have moved the goal post, changed the topic. This sems to happen a lot in these discussions when the absurdity and ignorence in earlier statments is revealed.

So in summation you are wrong ignorent misinformed and unable to understand any research and apper to be contented to regugitate propoganda spoon fed to you.
RFA

Vancouver, Canada

#74 Feb 16, 2013
Ok so I admit this is totally off topic - but the cost of becoming an anesthesiolgist is not even in the same ballpark as becoming a CRNA so its pretty tough for us to feel sorry for you on that one:

Essentially the cost (if you account for lost earnings (for equivalent level of education)) of becoming an anesthesiologist is 1,083,000 as compared to becoming a CRNA 161,000.

Formatting is a little off: on the left is the CRNA cost on the Right is anesthesiolgoy cost.

CRNA Anesthesiologist
Direct costs of education and clinical experience before entry into an anesthesia program BA/BS/BSN $53,696 $53,696
Medical school

$436,080
One year as acute care nurse Required, but with no direct cost

First-year residency (PGY-1)

$134,042
Total Pre-Anesthesia

$53,696 $623,818
Anesthesia graduate education (GE) Direct costs $68,465 $494,420
Student/Resident opportunity cost $291,353 $897,793
Productivity of students/residents ($251,704)($775,073)
Total Anesthesia GE (less transfer payments)

$108,113 $459,977
Total Estimated Costs

$161,809 $1,083,795
BDZ

Vancouver, Canada

#75 Feb 16, 2013
Stanley, I don't think that anyone is trying to belittle the probably exceptional work that you do.

I am sure you are a very proficient CRNA.

I think there is just some confusion about what the role boundaries are. It is surprising to me that a nurse would be able to obtain the same skills and training with 7 years of formal education that are (correct me if I am wrong) much less rigorous than the 13 years of gruelling (80 hour wks during residency and 60-80hr weeks during medical school) education that is required of anesthesiologists.

I am not trying to belittle what you do or be sarcastic, I am sincerely interested in how it is that you think that the same skills/knowledge can be obtained?

From an outsiders perspective the MD has (on average) higher quality applicants, more competitive positions, longer years training, more rigorous program, better recognized universities. Would you at least agree with that? so where does the catch up occur and how?

This may come off as rude or arrogant it is not meant to be it is a serious question and I apologize for how it may read.
stanley

Washington Court House, OH

#76 Feb 17, 2013
The problem is comparing education to outcome, pre med education is totally irrelevent, it just not does not translate to ant clinical utility, ask any physician if that calc or 2 years of bio chem helped, they probably do not remembef it. Medical school more relevant but such a broad survey that it is not suffiecent to practice anesthesia. Residecy, here is where it counts actual application of mrd school (some of it) and anesthesia. Four years of anesthesia education to three.
This is a simplification there is a continuim on both sides from poor to excellent. After school it depends on what you do, if an anesthesiologist goes to an eye center or gi clinic or supervises all of the time the clininical skills and medical education will atrophy as will a crna's
RFA

Vancouver, Canada

#77 Feb 17, 2013
I agree with you partially.

Undergraduate degrees are not clinically relevant whatsoever, but I will tell you what an undergraduate degree does.

It separates the cream from the crop. Undergraduate degrees are merely markers of an individuals ability to learn. Solid grades at a good university are an indication of the ability to learn material and problem solve.

When I finished my undergraduate degree at an Ivy league school, I had little to no clinical skills and many of my classmates had little to no real world practical skills. Despite this, many of my friends were hired at large consulting or investment banking firms with starting salaries well into 6 figures. By your reasoning this shouldn't happen and the firms might as well hire randoms from community colleges or even right out of high school?

So what undergrad and medical school does is selects the most competitive and most talented people from a general pool. If you then take these people who have continuously shown themselves to be in the top few percentile and provide them with an intensive 4 (5 in Canada) year anesthesiology training program that (at 80 hours per week) I would expect that that they have the capability to learn significantly more than picking a random group and giving them a 3 year program that is (correct me if im wrong on this but probably somewhere around 40 hrs/week)?

Now this is a bit of an exaggeration because nursing has become more competitive over the past few years and its not like the nursing pool is merely of average intelligence, they are significantly above average, but nursing schools certainly don't attract the same quality as medical schools? Is this fair to say? Again I'm talking on average.

Regardless, having a more qualified, more competitive group of people go through a significantly more intensive and longer training program, i just don't see how they can come out equal unless CRNA educators know something that medical educators do not?
stanley

Washington Court House, OH

#78 Feb 17, 2013
The problom once again with your assumption is two fold
1. Nurse anesthesia is just as competative as medical school, ghe best and most motivated wil get there if they wish
2. The training and education in anesthesia is not that much longer
As for premed it washes out people this is predictive for study or ability to retain knowldge but in no way shape or form is a predictor for clinical ability.
Case in point 30 years ago a ba in any thing got you going right? It showed you were motjvated and could learn, well try that out now, now youhave to show what you can do. The idea of a general education being predjctive for a higly specialized field has at this pkint been discarded.

Now there aresome things anesthesiologist may be better prepared to do such as run icu's due to a broader education in medicine but that requires another year of education post residency, makes little money requires more work in the hospital setting so as no suprise not done much.
Mohan

Ashburn, VA

#79 Feb 18, 2013
Anaesthetics are doctors but they r n't nurses.
stanley

Washington Court House, OH

#80 Feb 18, 2013
Anesthetics are not doctors or nurses it is an action performed such as the crna performed an anesthetic.
RFA

Vancouver, Canada

#81 Feb 18, 2013
Stanley,

We will have to agree to disagree on a few things but overall I see where you are coming from.

I am obviously bias towards a more classical education and you feel more strongly about job specific trade training.

Both have the merits.

How many CRNAs do you think wish they could be doctors? and how many doctors do you think wish they were CRNAs?

To totally change the topic (because Im interested in your opinion...)

I think that having nurse anesthesia works in the US where you have a health care industry that is market driven more than outcome driven. I think there is no denying nurse anesthesia to be cost effective.

If it were to come to Canada where the anesthesiologists have to work 60 hour + weeks to only earn on average $350 000/yr with no benefits - do you think they would get away with only paying nurse anesthetists 110k with benefits for 40 hr weeks? I just don't see it being efficient in our system for a VERY long time and and I doubt that Canadians could attract CRNAs from the states with salaries that low? As a CRNA Im curious about what you think about CRNAs coming to other countries?

It is kind of silly having an anesthesiologist here do ASA1s and ECT and other basic procedures - its not an effective use of public money, but at the same time I don't know how we could integrate a nurse anesthetist into our model.

Any thoughts/insight?
stanley

Washington Court House, OH

#82 Feb 18, 2013
We do not disagree you just do not understand the education I have, it is not "TRADE" . I learned how the various anesthetic agents worked on a celluler level, anotomy physiology, organic chemistry, hardly trace classes. The assumption that a nurse is trained in some remidial fashion is somthing you just cannot get over.
CRNA's do notwish to be doctors, why would we?
Crna,s exist in most countries in some form or another, 350000 with no benifits is an average salaryfor md's now. There are plenty of crna's working a strait 40 for 110,000 now.
The system is much more cost effective and sustainiable unlikethe demands from the md counterparts.
RFA

Vancouver, Canada

#83 Feb 18, 2013
hmm, i was under the impression that in the US CRNAs were paid much better than that >160 which is why I didn't think we would ever be able to entice them to come to Canada should we ever replace our anesthesia assistants with CRNAs.

It is becoming difficult to attract good MD anesthesiologists to British Columbia at avg of 350k because other provinces in Canada like Alberta and Ontario pay much more - not that many people on this blog probably care about the details up here in the great white north - but because major shortages in Anesthesia that is why the CRNA coming to Canada debate began up here in BC.

The demands that anesthesiolgists (at least here in BC) are not about being greedy they are about continuing to attract the best and the brightest out of medical school which is becoming difficult to do when other specialties are earning significantly more. 350k/yr affords you a pretty good lifestyle but its tough to put in the same number of years as your colleagues and then work for considerably less (the reverse is true in the US from what I understand, where anesthesia is remunerated better than most specialties).

Anyhow I've completely gone off topic - but thats why i have some interest in this CRNA/Anesthesia debate - I am supportive of integration of mid-levels into healthcare to improve efficiency I just get worked up when some try to argue for equality without enduring the same obstacles/education/competitio n/training to get there.

I do worry about the dumbing down effect in medicine in order to be cost effective but i guess the economy and policy will dictate where the future takes us. It is my hope that the incredible advancement and simplification that anesthesiology has seen over the past few decades will not penalize the profession. There is still a long ways to go and to do so the profession will need to continue to attract the very best and brightest medical minds which will only be possible with good remuneration and a positive outlook for the future.
stanley

Washington Court House, OH

#84 Feb 18, 2013
Many do earn greater then 160000, I make more but I am not a 40 hr 7 to 3 guy. I am a 24/7 kind of guy who can do any anesthetic you need, from epidural pnb, tea, geta, olv cvl placment.
TLM

Paducah, KY

#85 Feb 19, 2013
TY. :-)

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