Nurse anesthetists aren't the same as anesthesiologists

Sep 21, 2010 Full story: The Baltimore Sun 115

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

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Anesthesiologist

Laramie, WY

#106 Apr 20, 2013
I've read this thread with great interest. I am a Board-Certified Anesthesiologist. I am also subspecialty Board-Certified in Pain Management.

I think that the best arbiter of the debate between Anesthesiologists and the CRNAs would be the physician who began her career as a CRNA and, recognizing the depth and breadth of her ignorance, completed her education by attending medical school and then an Anesthesiology residency.

Jane C. K. Fitch, M.D. is the President-Elect of the American Society of Anesthesiologists and she serves as Professor and Chair of the Department of Anesthesiology at the University of Oklahoma in Oklahoma City.

She has stated, in no uncertain terms, that nurses who provide anesthesia care, while skilled in the technical aspects of anesthesia, lack the depth, breadth, clinical judgment, medical knowledge that one acquires in medical education and training. The education of a nurse is markedly different from that of a physician.

Nurses don't know what they don't know. Every physician whom I have met who has previously practiced as an Advanced Practice Nurse of one sort or another has clearly indicated that they didn't know very much prior to medical school and training, despite being told just how wonderful they were in their training programs. Upon retrospect, every one has remarked on their ignorance and how much they learned while completing their education.

I have worked with many CRNAs over time, both in the military and in civilian practice. I have always noted the general lack of medical knowledge that can, in many ways, affect the selection of an anesthetic technique, the conduct of the anesthetic intraoperatively, and the management of the patient in the postoperative phase.

Sorry, folks, but the fantasy that CRNAs are the equivalent of Physicians is that of a fool in his/her paradise. If you do not recognize your limits and are not able to know when to ask for help in a timely fashion, I definitely do not want you taking care of my grandchildren, my children, or anybody else for that matter.
Dr SB

Midlothian, VA

#107 Apr 21, 2013
Maybe it was the time of her training or perhaps it was the training program she attended prior to medical school, but clearly this former CRNA missed something.

CRNA's are currently trained using the same books, have the same clinical experiences, and use the same evidence-based practice modalities to take care of their patients. In the clinical setting anesthesiologist residents and nurse anesthesia residents work in the same ORs training with the same personnel throughout their entire curriculum.

How is it possible with training that is so similar that the differences Dr Fitch speaks of can be so profound? While Dr. Fitch cites her previous education as being inferior to her medical education, multiple studies provide evidence to the contrary. For decades study after study have demonstrated that CRNA practice outcomes are equivalent to physician anesthesiologist outcomes in all settings. The facts are the facts and simply ignoring the data and spouting off unsubstantiated opinions doesn't make it less true.
Anesthesiologist

Laramie, WY

#108 Apr 21, 2013
My prior comments stand. It is possible that you misconstrued what I wrote. Nursing education, although subjects such as Pharmacology, Anatomy, Physiology, etc are taught, is not provided at nearly the breadth and depth that medical education is. The two years in medical school spent in the basic sciences are much more intense than that which is provided in nursing school. The focus is directed toward that which a physician needs to become a diagnostician, a clinician and leader of the healthcare team. The phrase "drinking from a firehose" is often used for good reason. The information is provided in great density and quite rapidly and must be absorbed rapidly as well.

Further, the two clinical years in medical school provide specific experience in the core rotations of Internal Medicine, General Surgery and Surgical Subspecialties, OB/GYN, Pediatrics. The fourth year provides the student with opportunities to begin to expand knowledge and experience in directions leading to the choices made for postgraduate training. This may include "subinternships", various and sundry electives or further didactic education in public health, Biometrics and Statistics, etc.

The point, of course, is to point out that medical school is a very intense learning experience. It is specifically geared to producing physicians, where nursing school, unsurprisingly, is geared toward producing nurses. The subject matter taught there, while similar, is not offered at the depth and breadth of medical education since most nurses simply don't need all of the information that we are taught. Don't take my word for it, find a physician who started his/her career as an APN of some sort and ask to contrast and compare the respective educations.

The point is that physicians, who have completed medical school and a clinical internship of some sort (usually Internal Medicine, Pediatrics, General Surgery, or a classic rotating Internship) are already qualified as physicians who can be licensed and begin practicing medicine independently, if they so choose. That background, added to 3-5 years of Anesthesiology training, makes an Anesthesiologist.

Believing that a nurse with 2 years of technical training in anesthesia is the equivalent of a physician is delusional. If you don't believe me, ask Dr. Fitch or any of a number of other CRNAs who decided to complete their education and training what the differences are. The answers will be enlightening if you will only open your ears to hear.
Dr SB wrote:
Maybe it was the time of her training or perhaps it was the training program she attended prior to medical school, but clearly this former CRNA missed something.
CRNA's are currently trained using the same books, have the same clinical experiences, and use the same evidence-based practice modalities to take care of their patients. In the clinical setting anesthesiologist residents and nurse anesthesia residents work in the same ORs training with the same personnel throughout their entire curriculum.
How is it possible with training that is so similar that the differences Dr Fitch speaks of can be so profound? While Dr. Fitch cites her previous education as being inferior to her medical education, multiple studies provide evidence to the contrary. For decades study after study have demonstrated that CRNA practice outcomes are equivalent to physician anesthesiologist outcomes in all settings. The facts are the facts and simply ignoring the data and spouting off unsubstantiated opinions doesn't make it less true.
cassandra

Carlingford, Australia

#109 Apr 21, 2013
Wow wrote:
<quoted text>Having a physician who has trained for 12 years taking care of you while a surgeon operates is overrated, but having a nurse who has spent 2 years is a good idea?
That defies logic.
Wow, talk about arrogance. Nurses are far more experienced at hands on practical procedures than doctors. Ask any patient if they'd prefer a doctor or a nurse. Patients should at least be given the choice.
chris

Lafayette, LA

#110 Apr 21, 2013
Dr SB wrote:
Maybe it was the time of her training or perhaps it was the training program she attended prior to medical school, but clearly this former CRNA missed something.
CRNA's are currently trained using the same books, have the same clinical experiences, and use the same evidence-based practice modalities to take care of their patients. In the clinical setting anesthesiologist residents and nurse anesthesia residents work in the same ORs training with the same personnel throughout their entire curriculum.
How is it possible with training that is so similar that the differences Dr Fitch speaks of can be so profound? While Dr. Fitch cites her previous education as being inferior to her medical education, multiple studies provide evidence to the contrary. For decades study after study have demonstrated that CRNA practice outcomes are equivalent to physician anesthesiologist outcomes in all settings. The facts are the facts and simply ignoring the data and spouting off unsubstantiated opinions doesn't make it less true.
that s true, certainly one with what is referred to as inferior training could indeed be better trained, all these credentials are little of meaning as in the background lots of licenses are sold under the table and then again so much of the work in done by underlings with supposed oversight of the big licensed persons and without in reality real oversight, local district attorney recently claimed he wasn t liable for the crimes committed by underlings in his office, he thinking his only obligations were to run campaigns and collect his check while spending his time on the golf course

Since: Apr 13

Location hidden

#112 May 28, 2013
chris wrote:
<quoted text>
that s true, certainly one with what is referred to as inferior training could indeed be better trained, all these credentials are little of meaning as in the background lots of licenses are sold under the table and then again so much of the work in done by underlings with supposed oversight of the big licensed persons and without in reality real oversight, local district attorney recently claimed he wasn t liable for the crimes committed by underlings in his office, he thinking his only obligations were to run campaigns and collect his check while spending his time on the golf course
true.i agree with your statement..
factchex

Bethel Park, PA

#114 Sep 29, 2013
crna/nurse is in any way shape or form "equal" to a physician anesthesiologist? this is really stupid and dangeous...
tone

Chicago, IL

#115 Oct 3, 2013
Wow wrote:
Stanley,
In order to practice anesthesiology in the United States, you need to do residency in the U.S.
Anesthesiology is a 4 year residency. After 4 years of medical school. After 4 years of undergraduate studies. With additional fellowships in pediatrics, cardiothoracic, pain, critical care.
The best and brightest from college take one of the most difficult examinations, just to get into medical school, called the MCAT. Its all based on the individual. Just because a doctor has been trained well doesnt make him a good doctor.
To be a practicing physician in the U.S., you must pass Step 1, Step 2CK, Step 2CS, and Step 3 of
That's 12 years of training at the minimum, with many qualifying exams in between.
An anesthesiologist is a master of the full spectrum of
anesthesiology. They run the critical care units, giving
orders to the ICU nurses. They can handle all complications.
I don't understand how you can even try to argue equivalence between nurses and physicians. Anesthesiologist Assistants have the same amount of education as CRNAs, so do you think they are equivalent?

Seriously? If yrs of training equaled better caregiver then by your logic all doctors would be good doctors. Nurses are well trained as well and know a lot otherwise they would not be able to practice. To be a good caregiver requires more than training and experience, but a strong sense of adaptability.
gorillapimp

Wake Forest, NC

#116 Nov 7, 2013
ncmd.....your ignorance is astounding.....anytime you can pay one mda and 4 crnas as opposed to 4- 5mdas you save money....to say that you are better trained because you went to 12 years of school/training is ridiculous....in an emergent situation who would you rather have ??? an icu nurse with 2-4 yrs of education or a ....or podiatrist.....or dermatologist?? your years of education mean little, its your area of expertise and the education and experience you have in it that matters.....the fact that you elude to malpractice insurance and who pays for it exposes your true concerns....money. i am always responsible for my practice.....if you want to pay me for the services i provide to the extent that you are payed i will gladly pay my own malpractice insurance. the bottom line is healthcare and the attitudes about healthcare are changing....its all about cost effectiveness. the surgeon who wants the md in the room is a product of a good ole boy belief system that has been prevalent in this country for years but is changing....30 yrs ago hmos were going to be the end of healthcare in this country...and people fought them yet they are still here....with the advancement in nurse practitioners and physician assistants the aura of physicians in this country is changing.... and along with that the willingness to pay ridiculous fees for their services. read the papers look at the last 2 elections....this idea that because you went to school for x number of years so therefore you are entitled to a certain level of compensation, regardless of whether it is economically feasible are fading fast....change you must or die you will
virginia

Fresno, CA

#118 Apr 1, 2014
Wow wrote:
Stanley,
You can become a nurse anesthetist with a 2 year associate's nursing degree from a community college, online bridge-RN, 1 year working as a nurse taking orders from doctors in an ICU, and then off to a CRNA-mill for education, where one year is spent in the classroom, and the last year is in the operating room.
That doesn't inspire much confidence in someone who is taking care of you during the intense stresses of surgery.
Sorry, but I am going to choose the doctor who survived the rigors of all 12 years of medical training versus the community college-trained nurse.
No that totally wrong. To be a CRNA you have to get a 4 year degree as an RN then work 1 year in ICU and obtain 3 recommendations from nurse anesthesist, anesthesiologist, and an rn. After you enroll into a school and to the CRNA for 27 months. The first 15 months are spent in the class room and the last 7-8 months is spent working hands on with other CRNA`s
Kelley yarborough

Atlanta, GA

#119 Apr 26, 2014
CRNA are dangerous wrote:
CRNA are indeed cheaper than an anesthesiologist. Want cheap and dangerous anesthesia? Get a CRNA.
This statement is out of ignorance. It is ridiculous
The Old Professor

Cuenca, Ecuador

#120 May 10, 2014
This entire argument is based on the wrong assumptions. It is assumed that longer years of training and having passed more rigorous tests (whose to say that those who did not have to take those tests is has less knowledge) makes for a more skilled practitioner. I have met many CRNA's whose skills I would put up against any MDA. I have also met CRNA's that I wouldn't let into my vet's office. The same goes in reverse. More years of "training" (how much 'training' actually happens in the last year of an anesthesiology residency?). IMHO, its about the individual... Assuming the MD or the CRNA was trained in a high quality program with access to training in difficult and complicated cases, it comes down to individual characteristics that are not easily measured. Such things as inner drive for quality, compassion for the patient, ability to remain cool under stress, fine motor control, desire to remain on top of the latest developments in the field, a personality that inspires confidence in the operative team and foster cooperation, the ability to work quickly without a loss of quality performance... I could go on and on. Its not about he initials after one's name... its about the overall quality of the individual as an anesthesia provider. MD's are not inherently better than CRNA's, and vice-versa. This entire argument is a waste of bandwidth. The qualities that make one a "better" or "safer" anesthesia provider rest in the qualities of the individual. There wil always be MDA's, and there will always be CRNA's, and I for one would like to see a truce called. Fostering bad relations between he two is counter-productive to the goal of being an anesthesia provider-- quality patient care. The bickering I've read in this thread makes many of you seem like people I would never care to work with, nor does it inspire confidence in the argument that MDA's make better providers of patient care. Check your ego's at the door when you get to the OR, and do what's best for the patient. Or maybe we can start another argument... female anesthesia providers are better than male anesthesia providers... how's that for a topic to debate? Let it go.
Pin head

Midland, TX

#121 Jul 24, 2014
CRNA are dangerous wrote:
CRNA are indeed cheaper than an anesthesiologist. Want cheap and dangerous anesthesia? Get a CRNA.
You don't know what your talking about
Butch_MD

Nashville, AR

#122 Tuesday Sep 2
This guy is counting 4 years of undergrad as part of his anesthesia training? I see what your trying to say, but it doesn't help your argument to try to include college basics. And anesthesia residency is 2 years by the way.
Carrcar

Sparta, IL

#123 Wednesday Sep 3
There is no right or wrong answer. Just opinions.

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