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
.
