Anesthesiologist vs. CRNA

Carlos Danger

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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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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.
 

Summit

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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...
 

EpiEMS

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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.
 

Nova1300

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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
 

EpiEMS

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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.
 

VentMonkey

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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:).
 

Carlos Danger

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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.
 

EpiEMS

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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!
 

MonkeyArrow

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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.
 

VFlutter

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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.
 

EpiEMS

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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?
 

Summit

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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.
 

EpiEMS

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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.
 

Carlos Danger

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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.
 

EpiEMS

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

Summit

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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.

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

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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).

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?
 

Summit

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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.
 

EpiEMS

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

Summit

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