# Anesthesiologist vs. CRNA



## okayestEMT (Dec 6, 2016)

For a long time now I've been hoping to complete an Anesthesia residency after medical school (considering everything goes as planned) and I had an interesting run in with a retired nurse anesthetist two nights ago. So I'm splinting her ankle and giving her crutches and out of nowhere she tells me she worked as a CRNA for 23 years. I proceed to tell her I'm hoping to go into Anesthesia as an MD. She blows that idea off and insists that a CRNA is the same as an Anesthesiologist. Now, I recognize the bias in her opinion but what are some of your experiences going through medic school and who did you work with while in the OR?


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## NomadicMedic (Dec 6, 2016)

Oh @Remi


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## VentMonkey (Dec 6, 2016)

And/ or @Nova1300...


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## VFlutter (Dec 6, 2016)

I'll just leave this here......

https://www.amazon.com/Watchful-Care-History-Americas-Anesthetists/dp/082640510X


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## Handsome Robb (Dec 6, 2016)

Psh... AAs are better than both!  

@jwk


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## Akulahawk (Dec 6, 2016)

I was hoping nobody had laid the foundation for a full-up flame war but it seems I was wrong. There are big passions (phone wanted to put "pains" instead of "passions" so even my phone knows) around this topic so I'll just say it now: please tread lightly, be professional, and just be nice to each other.


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## Handsome Robb (Dec 7, 2016)

Ultimately at the end of the day CRNAs and AAs are mislabel practitioners whereas an Anesthesiologist is a residency trained and in certain specialties fellowship trained in anesthesia...if you look at the amount of education for an AA/CRNA vs an MDA I personally think that speaks volumes. 

With that said I think CRNAs and AAs are a valuable and integral part of the anesthesia care team. 


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## EpiEMS (Dec 7, 2016)

okayestEMT said:


> She blows that idea off and insists that a CRNA is the same as an Anesthesiologist.



If that were the case, ceteris paribus, then there wouldn't be anesthesiologists*. QED. 
 *Given that anesthesiologists are pricier to train, etc.



Handsome Robb said:


> With that said I think CRNAs and AAs are a valuable and integral part of the anesthesia care team.



This is the most important thing for us all to recognize. You've gotta have options - and from a systems perspective, it makes a heck of a lot of sense to have people of varying skill/education levels. Take a rural hospital as an example: In most states, you can have a CRNA there (call it, $150k/year), who has medical direction (I forget the specific term) from a remote anesthesiologist, so that the hospital has anesthesia services, but doesn't have to pay a (full) anesthesiologist's salary. Heck, in 15 states, a CRNA can work without anesthesiologist oversight - and boy, are they cheaper to hire than an anesthesiologist!

We have AAs and CRNAs for very much the same reason that there are PAs and NPs.


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## Carlos Danger (Dec 7, 2016)

There certainly is a lot of politics in anesthesia, and it is getting worse as the push for increased utilization of non-physician providers gets stronger. Tensions are much, much worse between CRNA's and anesthesiologists than they are between any other group of physicians and their non-physician counterparts.

The ASA puts out a lot of propaganda that is meant to scare surgeons and the general public into believing that anesthesia is not safe without a physician present; a stance which is categorically and verifiably untrue, and which almost no one in the surgical and anesthesia world actually believes. I am proud that the AANA's official stance and published responses are not nearly as hostile to the MDA's as the ASA is to CRNA's, but it is true that there are many, many individual CRNA's who feel that supervising anesthesiologists as a whole are lying parasites that do nothing but place economic drag on the healthcare system.

I stay out of the politics. I don't even go to state or national meetings because so much of what goes on there is just political, which, while necessary, just isn't my thing. In the interest of full disclosure, I do donate to the AANA-PAC, which I am comfortable doing because I believe that the AANA is very civil and fair towards the MDA lobby and that most of the AANA's political actions are simply defensive. I give respect where it is due and withhold it where it is not - regardless of the individuals post-nominals.

I won't get dragged into a debate here over whether or not CRNA's are "as good" as anesthesiologists. Instead I will post a handful of points that are either verifiable facts or at least statements that I can defend confidently. I'll reply to questions and responses, but I'll simply exit this conversation before I'll argue.

Anesthesiologists are generally better trained than CRNA's. I say generally, because I don't think that is always the case, and I think individual factors have a fair amount to do with how strong of a clinician one ends up being. CRNA training is not like NP or even PA training - it is _very_ rigorous and focused.

Where anesthesiologists have a big advantage is in the the area of sub-specialization. There are many fellowships available to physicians* that aren't available to CRNA's. Still, a fairly small percentage of anesthesiologists (~20%, I think?) are fellowship trained.

Anesthesia was a nursing specialty for decades before it became an organized physician one. That doesn't mean that physicians weren't involved in or practicing anesthesia back then - they were - but it did not become an organized profession for physicians until until long after it was a nursing one. The book that Chase linked to above is an excellent history of anesthesia in the US.

CRNA's are trained in all the same anesthetic techniques and trained to manage all the same cases and all the same types of patients that MDA's are. There is literally nothing that an anesthesiologist is trained to do that a CRNA is not trained to do. You can argue that in some specific areas MDA's tend to have better training (as I stated in my first point), but a few years out of school I think that advantage matters little. At that point, for most people their competencies are based more on what they've been doing regularly for the past few years.

CRNA's are held to the same legal standard as anesthesiologists. The anesthetic standard of care is the anesthetic standard of care, and the legal responsibilities and obligations are the same, no matter what letters are behind your name.

Virtually all of the military anesthetic care provided on the battlefield and other austere places is done by CRNA's. Anesthesiologists simply don't exist - or at least are very uncommon - in the forward surgical units. Same on deployed naval ships. Same in many government hospitals.

Only one state (NJ) requires that CRNA's be supervised by an anesthesiologist. 22 or 23 states have no oversight requirements for CRNA's at all; CRNA's are 100% independent practitioners in these states. The others require some sort of (usually very loose) collaboration with a physician, dentist, or podiatrist. In SC, for instance, a CRNA can work 100% independently as long as they have a "practice agreement" which outlines "practice guidelines" with any physician or dentist. These practice "guidelines" can simply be a letter with the statement "Will practice to the currently accepted anesthetic standard of care". It needs to be updated annually. There is zero requirement for medical direction or chart review or oversight of any kind. The doctor does not have to be available by phone. The doctor is not legally liable for the CRNA's actions. NC is similar.

Around 70% of all anesthetics delivered in the US are delivered by CRNA's. Many are supervised in some fashion; many are not.

About 50% of CRNA's practice autonomously; the other 50% work with some sort of supervision. "Supervision" can be anything from the CMS's "medical direction" which requires close supervision, to a situation where the anesthesiologist is in the building and available but has nothing to do with the cases. Even in the settings where CRNA's are supervised closely during the day, in some of these places the physicians don't do call, or only do call for certain types of cases, and after 3pm or so until 7am the next morning, CRNA's do all the cases independently. So even among CRNA's who are supervised, the ability to practice independently is often expected. The joke among CRNA's in settings like this is that they automatically become much smarter at 3pm.

The CMS's requirements to bill for medical direction do NOT require physician oversight for CRNA's. It simply says that _if a facility_ is going to bill for medical supervision of CRNA's, that certain requirements have to be met (the anesthesiologist needs to be present for induction, etc). This arrangement is beneficial to anesthesiologists because they can supervise up to 4 cases at a time being done by CRNA's, and bill for 50% of the allowable payment for each case. So instead of doing their own case where they can only bill 100% of the allowable cost, they an supervise 4 rooms and earn twice as much. The cost effectiveness of this arrangement is obviously questionable, but it is lucrative for anesthesiologists and largely explains why they fight so hard against expanding independent practice by CRNA's.

In many rural areas, anesthesiologists do not exist or at least are uncommon. Something like 80% of rural hospitals do not have anesthesiologist coverage at all. Many of those that do have anesthesiologist coverage don't have it full time. If you live in or travel through a rural area - especially in the midwest or western states - and need anesthetic care, chances are much greater that you'll receive it from an unsupervised CRNA than otherwise.

Outcomes between CRNA's and anesthesiologists have been studied many times - and no difference has been found. Many of the more respected sources of healthcare policy recommendations (The RAND Corporation, The Institute of Medicine, The National Hospital Association, etc.) have called for loosening restrictions on CRNA's.

* more as a libertarian and taxpayer than as a CRNA, I have a problem with the fact that we spend billions of dollars a year in federal funding to subsidize residencies and fellowships for physicians, but not for non-physician professionals.


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## MonkeyArrow (Dec 7, 2016)

All things considered, if you were to go under the knife in another state completely independent of where you work, and thus, don't know any of the practitioners, would you choose a CRNA or MDA? @Remi 

Personally, I would feel more than comfortable with a CRNA for the vast majority of procedures, but for things like cardiac surgery with CPB or transplants, I would prefer a MDA.


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## Carlos Danger (Dec 7, 2016)

MonkeyArrow said:


> All things considered, if you were to go under the knife in another state completely independent of where you work, and thus, don't know any of the practitioners, would you choose a CRNA or MDA? @Remi
> 
> Personally, I would feel more than comfortable with a CRNA for the vast majority of procedures, but for things like cardiac surgery with CPB or transplants, I would prefer a MDA.



Fair question. 

But I think a better question is this: If you need a CABG would you rather have your anesthesia provided by a MDA who never does hearts, or a CRNA who does them every day?

If I need a procedure done, all I care about is that the entire team is experienced with and good at whatever type of case I am having done.


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## VentMonkey (Dec 7, 2016)

Remi said:


> If I need a procedure done, all I care about is that the entire team is experienced with and good at whatever type of case I am having done.


100% concur.


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## TransportJockey (Dec 7, 2016)

Dumb question. What is an AA? 

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## Carlos Danger (Dec 7, 2016)

TransportJockey said:


> Dumb question. What is an AA?
> 
> Sent from my SM-N920P using Tapatalk



Anesthesiologist's Assistant. 

Their training programs are similar to CRNA's, but they aren't required to have any healthcare experience to get into school.

Primary functional difference between AA's and CRNA's is that AA's always have to practice under the direct supervision of an anesthesiologist.


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## TransportJockey (Dec 7, 2016)

Remi said:


> Anesthesiologist's Assistant.
> 
> Their training programs are similar to CRNA's, but they aren't required to have any healthcare experience to get into school.
> 
> Primary functional difference between AA's and CRNA's is that AA's always have to practice under the direct supervision of an anesthesiologist.


Thabk you. I thought it might be something like that,  but I wasn't entirely sure.  

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## VFlutter (Dec 7, 2016)

TransportJockey said:


> Dumb question. What is an AA?
> 
> Sent from my SM-N920P using Tapatalk



Anesthesia Assistant. Pretty much a Physician Assistant who specialized in Anesthesia. Similar to a CRNA


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## VentMonkey (Dec 7, 2016)

Remi said:


> Anesthesiologist's Assistant.
> 
> Their training programs are similar to CRNA's, but they aren't required to have any healthcare experience to get into school.
> 
> Primary functional difference between AA's and CRNA's is that AA's always have to practice under the direct supervision of an anesthesiologist.





Chase said:


> Anesthesia Assistant. Pretty much a Physician Assistant who specialized in Anesthesia. Similar to a CRNA


Given a recent turn of events on this forum, this doesn't seem like a half bad option.


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## NysEms2117 (Dec 7, 2016)

@Remi my question would be, are CRNA's usually limited to "shorter procedures" or surgeries, such as colonoscopies, where if i'm not mistaken(which i probably am) is "less work?" due to the fact it is more then likely just a bolus (Just speaking off of what little experiences I have had/seen)? Or can they do the same heart transplant/*insert big organ transplant here* that an MD can. As well as where are CRNA's often seen? Are they in hospitals as much as anesthesiologists? A quick google search said that there are roughly +- 5,000 the same amount of CRNA's as anesthesiologists.


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## Carlos Danger (Dec 7, 2016)

NysEms2117 said:


> @Remi my question would be, are CRNA's usually limited to "shorter procedures" or surgeries, such as colonoscopies, where if i'm not mistaken(which i probably am) is "less work?" due to the fact it is more then likely just a bolus (Just speaking off of what little experiences I have had/seen)? Or can they do the same heart transplant/*insert big organ transplant here* that an MD can. As well as where are CRNA's often seen? Are they in hospitals as much as anesthesiologists? A quick google search said that there are roughly +- 5,000 the same amount of CRNA's as anesthesiologists.



You will find CRNAs (and AA's) doing every type of case.

Most of the anesthesia in the US is delivered by CRNAs.


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## Handsome Robb (Dec 7, 2016)

VentMonkey said:


> Given a recent turn of events on this forum, this doesn't seem like a half bad option.



I looked and continue to look relatively seriously at AA/CRNA. due to my early life laziness both will take me about the same length since I need a BS either way, CRNA a touch longer due to having to get ICU experience. 

My biggest issue with CRNA is I don't really want to work as an ICU nurse. Biggest issue with AA is they can only practice in 17 states if I remember correctly. May be more since I last looked but if it is it's not many more. 


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## Carlos Danger (Dec 8, 2016)

Handsome Robb said:


> I looked and continue to look relatively seriously at AA/CRNA. due to my early life laziness both will take me about the same length since I need a BS either way, CRNA a touch longer due to having to get ICU experience.
> 
> My biggest issue with CRNA is I don't really want to work as an ICU nurse. Biggest issue with AA is they can only practice in 17 states if I remember correctly. May be more since I last looked but if it is it's not many more.
> 
> ...



I think AA's are up to about 22 or so states now. But in many of those states, there are very few. There are only a handful of areas where there are lots of jobs for AA's. 

If CRNA and AA would take you the same amount of time, then CRNA is the easy choice. Many more options as far as where you go to school, and many more options for where and what type of practice you work in. 

You might like ICU nursing more than you think. Especially if you get into a really good unit in a good hospital system.


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## Summit (Dec 8, 2016)

So a never-independent AA is being pushed by the MDAs as a way to build the healthcare system so the MDA is always making double-$ by managing 4 AA run cases. Sounds great for the public...


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## EpiEMS (Dec 8, 2016)

Summit said:


> So a never-independent AA is being pushed by the MDAs as a way to build the healthcare system so the MDA is always making double-$ by managing 4 AA run cases. Sounds great for the public...



You could plausibly make the same argument for PAs, but I would note that the practice model is one developed in a litigious society. No disagreement that there seems to be an issue of incentives, here.


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## Nova1300 (Dec 8, 2016)

I am probably not the right person to ask about this topic.  I chose to practice full-time critical care because I did not enjoy anesthesiology.  It was challenging and exciting in the first 3 years of residency.  But by year 4, I had moved on and was ready for a different role.  Which is how I found my way into CCM fellowship.  I have even recently transitioned to a medical ICU position, even farther removed from my previous life.  I rarely interact with surgeons, even less so with anesthesia providers.  Thus, I don't have much skin in this game anymore.  

Anesthesia takes brains and intuition.  Most of the folks who get into a CRNA program have these traits, and matured over years of practice, a well-seasoned CRNA is a machine.  I honestly believe that you could do the same with an AA, because being good at anesthesia does not really depend on your previous healthcare career.  Being good at anesthesia takes a certain mojo and charisma, intelligence, and intuition.  If you have those innate traits, you will grow to be very good at what you do, no matter the letters behind your name.  

As an outsider looking in now, I will say that I did not find it to be a professionally gratifying career.  It had its moments.  However, in the end I realized that I wanted to be a physician and for me that meant a white coat, rounds, imaging, labs, family meetings, taking a history and physical (yes, like an actual physical exam where you touch the patient), and even end of life conversations and comfort care.  

That has always been my view of the physician role.  The physician as the anesthetist became much more like a technician, and I think they lost sight of the doctoring side of the coin.    Nurse anesthetists are just as adept at performing those technical functions, hence the incredibly high degree of safety we see in modern anesthesia practice.  People are not dying because a CRNA gives an anesthetic instead of a physician.  That is nonsense.

Let me say one last thing about my overall experience climbing through this minefield we call healthcare.  I have been a basic, I have been an intermediate, I have been a paramedic. I have been a dispatcher. I have been an ER tech, I have been a pharmacy tech.  I have been a medical student, I have been a resident, and I have been a fellow.  I have been faculty in a major university hospital.  I have had a view of both the forest and the trees.  These battles rage at every level in the healthcare arena.  And rarely do they have any profound effect on the day to day care for most patients in this country.  

If you are interested in giving anesthesia because you are drawn to a profession that requires a lot of intuition, innate intelligence, patience, and good hand skills, I would consider either pathway (AA or CRNA).  You will be employed and you will make good money and work great hours.  There will come a point in your career where all of the turf wars are just nonsense because all you really want is for your patients to do well and that paycheck to be in your box every couple weeks.  If you are worried that AA will limit your career opportunities (eg. you do want autonomous practice in the future), then CRNA is probably the right choice for you.  Just know its going to be a longer road with more hoops to jump through.  The programs are quite competitive and expensive.  Then you too can be dragged into the middle of this debate that is sure to rage long after I am retired on a beach in Belize


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## EpiEMS (Dec 8, 2016)

There is an existential question lurking here...why are there physicians in anesthesia if a CRNA can do it just as well with less time/money spent on training and upkeep?
I'm curious why you all think this is the case.


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## VentMonkey (Dec 8, 2016)

EpiEMS said:


> There is an existential question lurking here...why are there physicians in anesthesia if a CRNA can do it just as well with less time/money spent on training and upkeep?
> I'm curious why you all think this is the case.


I think this can be argued with any mid-level specialists to their counterpart physicians. It is a good question and could argue for a push of less physicians required overall if their mid-levels can practice almost independently of them in their respective field; merely sparking some insightful dialogue so as to prevent this forum from further imploding overall with mindless threads.


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## Carlos Danger (Dec 8, 2016)

Excellent post @Nova1300. I agree with every word of it and I have often thought that if I were a physician, I would probably not want to do anesthesia, for the exact reasons you prefer critical care to the OR. Anesthesia is a very technical discipline and we don't really "diagnose and treat" as most physicians typically do.

@EpiEMS, I don't know. Many anesthesiologist s are excellent clinicians and I certainly think there is a place for the fellowship trained anesthetist who has developed a high degree of expertise in a narrow subset of practice and practices in a specialty center.....OR one who practices more broadly than just doing anesthesia, and for now at least, that person is a physician anesthesiologist. My boss is an anesthesiologist who did a very specialized fellowship and also spent time as both an ICU attending and as the lead anesthesiologist on a transplant team. The guy is absolutely brilliant and I would never pretend to have anywhere near the clinical knowledge he does. He's forgotten more about medicine than I've ever known. The truth is though, that for 99.9% of what we do, there is zero difference between the way we practice and the way our patients do. I think the market has started to take notice of that and while politics will continue to obstruct, we are slowly moving in the direction of more reliance on non-physicians.


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## EpiEMS (Dec 8, 2016)

Remi said:


> The truth is though, that for 99.9% of what we do, there is zero difference between the way we practice and the way our patients do. I think the market has started to take notice of that and while politics will continue to obstruct, we are slowly moving in the direction of more reliance on non-physicians.



From a systems perspective, I'm 100% ok with this, and also with the anesthesia care team model. I'd like to see some evidence on how morbidity/mortality by anesthesia provider varies by some sort of injury/illness severity metric, but I'm pretty convinced that for the typical patient requiring anesthesia (colonoscopy, cholecystectomy, etc.) it probably doesn't matter who is passing gas 

What does the role of the anesthesiologist evolve into, then, I wonder? Research/development, education, and guidance, coupled with management and some degree of clinical oversight? It'll be interesting to see what happens!


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## MonkeyArrow (Dec 8, 2016)

On the topic of mid-levels replacing their physician counterparts, I will really be looking forward to seeing how our new ED observation unit fares. It is supposed to be an 8 bed unit directly adjacent to the ED, staffed with ED nurses/staff and ED midlevels (TMK we're going to keep who we have and hire internally due to the large number of our nurses becoming NPs), with some sort of physician oversight. I'm going to be really interested in seeing how much the midlevels do, and how much they call over the physicians in this environment.


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## VFlutter (Dec 8, 2016)

On a side note for those of you who are considering the AA vs CRNA route plan on spending more than a year in the ICU. Although possible to get into some CRNA schools with 1 year, most require 2,  it is becoming exceedingly rare. Schools are only getting more competitive. So many nurses come to the ICU expecting to just float into CRNA school and have a rude awakening. 

I completely agree with Nova. And part of the reason I am leaning towards ACNP over CRNA in the future. That role appeals to me more. However the SICU and CTICU at one of my local hospitals are ran by Anesthesia Critical Care attendings and utilize CRNAs in the ICU setting which I think would be amazing.


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## EpiEMS (Dec 9, 2016)

Chase said:


> So many nurses come to the ICU expecting to just float into CRNA school and have a rude awakening.



I have to say, I'm still not entirely clear why it's OK to take a college grad, do accelerated RN + an MSN and become an ACNP or FNP or psych NP or nurse-midwife in, say 2.5 years without any full-time work experience, but not OK to have such a program for a CRNA. Doesn't really make sense to me. What do you think?


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## Summit (Dec 9, 2016)

EpiEMS said:


> I have to say, I'm still not entirely clear why it's OK to take a college grad, do accelerated RN + an MSN and become an ACNP or FNP or psych NP or nurse-midwife in, say 2.5 years without any full-time work experience, but not OK to have such a program for a CRNA. Doesn't really make sense to me. What do you think?


While those pathways do exist in theory, I don't think they are followed that often and I have heard nothing positive about the success of those who do manage such a compressed entry.


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## EpiEMS (Dec 9, 2016)

Summit said:


> While those pathways do exist in theory, I don't think they are followed that often and I have heard nothing positive about the success of those who do manage such a compressed entry.



Fair enough, I will say that at high caliber programs, it *seems* like they turn out people who can at least pass the exams, and such. Of course, I wouldn't want a substandard practitioner of any kind, my point is generally that it seems silly to require full time RN-level work experience to begin a CRNA program but not for a nurse-midwife, say.


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## Carlos Danger (Dec 9, 2016)

EpiEMS said:


> I have to say, I'm still not entirely clear why it's OK to take a college grad, do accelerated RN + an MSN and become an ACNP or FNP or psych NP or nurse-midwife in, say 2.5 years without any full-time work experience, but not OK to have such a program for a CRNA. Doesn't really make sense to me. What do you think?



To put it bluntly, I think it just takes a lot more time and practice to learn anesthesia than the other APRN specialties. Anesthesia is very hands-on and technical, and there are a lot of skills that you have to learn that you can only master through lots of hands-on experience. And that is reflected in the dramatically higher clinical hour requirements for CRNA's (2500 average) vs. NP's (about 500 or so average).  

As for background, when you start learning anesthesia it helps a lot to have a general comfort level with the hands-on care of sick patients, and a familiarity with all the technology involved (ventilators, invasive monitors, etc). That way you can jump right into the topics you are there to learn, rather than first having to get good at starting IV's, doing basic assessments, learning how vents work, etc.


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## EpiEMS (Dec 14, 2016)

Related question: Does EMS bridge more cleanly into something like an ACNP or more of a CRNA role?


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## Summit (Dec 14, 2016)

Remi said:


> NP's (about 500 or so average)



From my research 700-800 hours is the average, haven't seen any less than 600 and have seen some that are over 1400.



EpiEMS said:


> Related question: Does EMS bridge more cleanly into something like an ACNP or more of a CRNA role?



EMS doesn't bridge well into either role.

ACNP (AGACNP) tends to be more of a hospitalist/intensivist role and the board exam is through AACN (American Association of Critical Care Nurses).

CRNA is an anesthesia/intensivist  role.

Of the various APN pathways, most of EMS would best bridge into FNP with an emergency focus (or PA with emergency focus).


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## EpiEMS (Dec 14, 2016)

Summit said:


> EMS doesn't bridge well into either role.
> 
> ACNP (AGACNP) tends to be more of a hospitalist/intensivist role and the board exam is through AACN (American Association of Critical Care Nurses).
> 
> ...



Ok, I think I follow. So to work with a mixed age population (pediatric through adult, inclusive), you'd have to be an FNP, because ACNPs can't treat kids?


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## Summit (Dec 14, 2016)

EpiEMS said:


> Ok, I think I follow. So to work with a mixed age population (pediatric through adult, inclusive), you'd have to be an FNP, because ACNPs can't treat kids?



There are pediatric ACNPs too.

There are also NNPs which fill the neonatologist role. (These highly specialized APN are highly regarded, have very intensive programs, and often nearly identical scopes to their neonatologist counterparts somewhat akin to CRNA to MDA).

There is also PMHNP which is an APN role akin to a psychiatrist.


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## EpiEMS (Dec 14, 2016)

@Summit
Thanks for clarifying/explaining further. Much appreciated!


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## Summit (Dec 14, 2016)

In the strangest of strange twists, the VA will grant independent practice rights to all APNs.... EXCEPT CRNAs!


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## VFlutter (Dec 14, 2016)

Summit said:


> In the strangest of strange twists, the VA will grant independent practice rights to all APNs.... EXCEPT CRNAs!



Which is very strange given the amount of autonomy given to CRNAs in the military. On a side note you can actually go through the Army's CRNA school as a VA employee with a commitment to the VA. That is something I still consider every now and then, the education and experience of USAGPAN is extremely appealing to me.


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## EpiEMS (Dec 14, 2016)

Chase said:


> On a side note you can actually go through the Army's CRNA school as a VA employee with a commitment to the VA. That


Is that school still at Northeastern Univ.?


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## VFlutter (Dec 14, 2016)

EpiEMS said:


> Is that school still at Northeastern Univ.?



Yes it is affiliated with them but I believe all the classes are actually on base.


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## Summit (Dec 14, 2016)

Chase said:


> Which is very strange given the amount of autonomy given to CRNAs in the military. On a side note you can actually go through the Army's CRNA school as a VA employee with a commitment to the VA. That is something I still consider every now and then, the education and experience of USAGPAN is extremely appealing to me.


Not just that but they pay for your school and while in school, they pay you your full RN salary and you earn retirement and vacation. You are guaranteed a job after.


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## Carlos Danger (Dec 14, 2016)

Summit said:


> In the strangest of strange twists, the VA will grant independent practice rights to all APNs.... EXCEPT CRNAs!



And that is an EXCELLENT example of the politics of anesthesia.

CRNA's already work independently in many VA hospitals....especially after 1500. The ASA just couldn't handle having the official policy of the VA reflect the reality of what already happens. They pulled out all the stops and played every card they had to get the rule changed to exclude CRNA's.


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## NysEms2117 (Dec 20, 2016)

@Remi could you share a "normal" workweek for you? Do you work RN hours(12 hr shifts) or is it like a 9-5 type thing?


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## Carlos Danger (Dec 20, 2016)

In big hospitals, CRNA's commonly work shifts of varying lengths and times.

I work in a small hospital where there are only 3 of us. I get there in time to start the first case (which is usually a 0800, sometimes earlier), and I stay until the cases are done, which can be anywhere from noon-9pm. I probably average 40-50 hours a week. 5 days a week most weeks.


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## EpiEMS (Dec 21, 2016)

Remi said:


> I work in a small hospital where there are only 3 of us.


Do you transfer many of your critical patients? If so, do you join in on the ride?


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## Carlos Danger (Dec 21, 2016)

We occasionally transfer someone out after a case. I don't get to ride along, unfortunately.


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## Jim37F (Dec 23, 2016)

Just saw this headline, made me think of this thread:


*Advocates: Let Nurse Anesthetists Practice Across the VA*
http://www.military.com/daily-news/...et-nurse-anesthetists-practice-across-va.html


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