CRNA vs MD

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BeautifulSmiles523

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I was recently grilled by a nurse when I said I was against CRNAs practicing independently. She referred me to this site


I am going to look through these studies. Has anyone of you read them before?

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What exactly are you asking? If CRNAs should practice independently? Or do "MDAs" need to still supervise the OR?
 
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I feel that CRNAs should be overseen by MDs, but I’m trying to final journal evidence to argue my point.
 
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I feel that CRNAs should be overseen by MDs, but I’m trying to final journal evidence to argue my point.
Common sense? Seriously, why do we even need to have anesthesiologists when everyone with 1-year online degree could do the same job. Bottom line: don’t argue with idiots, it is pointless.
 
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I personally think CRNAs are pretty intelligent and it's not easy to get into a good school that will get you a good job (Duke for example.) However, Anesthesiologists have a broader education and need 4-5 years training post medical school for a reason.

Most CRNA schools just require 1 year of critical care work as an RN/BSN (really BSN; most employers are wanting BSNs nowadays.) Some schools don't even need you to compete that requirement before entering their program. Some even let you work part time in crit care while in the program! Then you have 2-3 years of the doctorate program and BOOM! you're a CRNA.

I believe CRNAs play a very critical role in healthcare. They are needed everywhere (some, even CRNAs, believe the market is getting saturated though.) They're vital for patients to feel comfortable during procedures. BUT, should they practice on their own? No. And the sort-of-recent document released by AANA left a bad taste in my mouth.
 
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I was recently grilled by a nurse when I said I was against CRNAs practicing independently. She referred me to this site


I am going to look through these studies. Has anyone of you read them before?


My thoughts would be to question whether providers are working with the same populations of patients. Just like midwives have "lower complication/intervention" rates than OB's, they also deal only with the subset of healthy women with uncomplicated pregnancies who are already very unlikely to have a major problem or require intervention. Of course they would have similar or even lower complication rates when they are not managing the same populations as physicians. Same deal with CRNA. A CRNA is probably totally fine to manage someone who is 55, totally healthy and going in for cataract surgery. They'd probably have the same outcomes as any MD. Make the same patient a critically ill neaonate or an 78 year old uncontrolled diabetic with CHF going in for open heart surgery and see what the difference in outcomes are. CRNA handle the routine stuff, which is why they have good outcomes despite the lessened training. But **** can hit the fan whenever, even in healthy patient (oh yeah btw your 20 year old who needs an ACL repair is a secret drug user who conveniently didn't tell you or they didn't think you were serious when you said no eating or drinking and thought the 3 course breakfast didn't merit telling you). It's worth it to have someone with the years of training and know how on board to help with a difficult airway or whatever else crops up.
 
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I would be fine with it as long as they could pass all the boards/exams/licensing that anesthesiologist took.
 
This is pretty much the smoke and mirrors that goes into most midlevel research studies. As mentioned above, they take care of less complex things so of course outcomes are similar or better. Plus if anything goes wrong or starts going wrong, it’s often turfed to the doctor and doesn’t affect their numbers. These studies also routinely fail to adjust for when the midlevel asks questions about the care of certain patients and the doctor changes the plan. Some studies also have really stupid things they measure. I.e. I remember a few years back reading one about how NPs were treating HTN and hyperlipidemia just as well as doctors in a 6 month window of time. That’s literally a useless study. It’s the easiest thing to do AND the time period made it even more meaningless. But they claim bragging rights on crap like this even if the study is so terribly designed that it’s not proving what they claim it is. The study you posted wasn’t even randomized well and can’t prove the point it claims to prove.
 
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CRNA's are physician extenders and have a role. They should be supervised. Their claim that studies dont show any difference in outcome is weak at best. Just because you got away with shabby or generic operative care doesnt mean you did the right thing. It just means you got away with it. They didnt go to med school. Want to be an anesthesiologist? Become a doctor. I believe given the choice, a patient will choose to to have a physician at the head of the table. Will the opthalmologist run the code if someone arrests?
 
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This is pretty much the smoke and mirrors that goes into most midlevel research studies. As mentioned above, they take care of less complex things so of course outcomes are similar or better. Plus if anything goes wrong or starts going wrong, it’s often turfed to the doctor and doesn’t affect their numbers. These studies also routinely fail to adjust for when the midlevel asks questions about the care of certain patients and the doctor changes the plan. Some studies also have really stupid things they measure. I.e. I remember a few years back reading one about how NPs were treating HTN and hyperlipidemia just as well as doctors in a 6 month window of time. That’s literally a useless study. It’s the easiest thing to do AND the time period made it even more meaningless. But they claim bragging rights on crap like this even if the study is so terribly designed that it’s not proving what they claim it is. The study you posted wasn’t even randomized well and can’t prove the point it claims to prove.
Waiting for studies where NPs can give patients activated charcoal and naloxone and brag about being as effective as EM docs.
 
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CRNA's are physician extenders and have a role. They should be supervised. Their claim that studies dont show any difference in outcome is weak at best. Just because you got away with shabby or generic operative care doesnt mean you did the right thing. It just means you got away with it. They didnt go to med school. Want to be an anesthesiologist? Become a doctor. I believe given the choice, a patient will choose to to have a physician at the head of the table. Will the opthalmologist run the code if someone arrests?
In fact, many patients believe that they (patients) are observed by a doc, because a lot of DNPs introduce themselves as doctors (just omit last 2 words of their title). And many people don't really know the difference between two.
 
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because a lot of DNPs introduce themselves as doctors (just omit last 2 words of their title). And many people don't really know the difference between two.

Don't most hospitals say np's can't do this.
 
In fact, many patients believe that they (patients) are observed by a doc, because a lot of DNPs introduce themselves as doctors (just omit last 2 words of their title). And many people don't really know the difference between two.
mark my words. The NP community will slowly but surely move away from the "nursing" in their names because they realize if it's within their name, it won't get the patients to believe they are real docs, so they will move their naming to something like "Doctor of Advanced Practice"
 
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Waiting for studies where NPs can give patients activated charcoal and naloxone and brag about being as effective as EM docs.
it won’t even be that. It’ll be something like ordering the hospital mandated work up for sepsis/cva/cardiac protocol in a timely fashion. Ya know, that thing that’s literally a click in an EMR at most hospitals lol.
 
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I was recently grilled by a nurse when I said I was against CRNAs practicing independently. She referred me to this site


I am going to look through these studies. Has anyone of you read them before?

The article you're looking for doesn't and will never exist. You literally would be subjecting people to inferior care and then saying you will not help save that person from the inferior care because you want to "control" for aberrations in your "study".

I can tell you from personal experience as an Anesthesiologist that practices independently and also supervises that CRNAs run the gamut from competent to incompetent. They are good when routine care is adequate and no complications occur in the middle of the case. Technically in terms of intubating, IVs, alines, central lines they are just as good if not better than the average anesthesiologist who supervises only as they do it routinely. Use it or lose it. However, when it comes to looking at a complex patients and trying to figure out the best anesthesia to get someone through a difficult surgery they falter. Those who've been doing it a lot can recognize certain patterns and take care of patients by virtue of experience alone. However, new grads coming out of CRNA school are woefully underprepared and will need to be supervised much more closely.
 
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The article you're looking for doesn't and will never exist. You literally would be subjecting people to inferior care and then saying you will not help save that person from the inferior care because you want to "control" for aberrations in your "study".

I can tell you from personal experience as an Anesthesiologist that practices independently and also supervises that CRNAs run the gamut from competent to incompetent. They are good when routine care is adequate and no complications occur in the middle of the case. Technically in terms of intubating, IVs, alines, central lines they are just as good if not better than the average anesthesiologist who supervises only as they do it routinely. Use it or lose it. However, when it comes to looking at a complex patients and trying to figure out the best anesthesia to get someone through a difficult surgery they falter. Those who've been doing it a lot can recognize certain patterns and take care of patients by virtue of experience alone. However, new grads coming out of CRNA school are woefully underprepared and will need to be supervised much more closely.
CRNAs do central lines? Peripheral central lines I would hope.
 
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I shadowed an anesthesiologist and during a single morning shift, there were at least 2 instances I can remember where one of his CRNAs needed his help to intubate. The nice thing is they were monitoring patients during surgery and we just went from procedure to procedure and he helped the CRNAs when needed. It seems like a better deal as an anesthesiologist IMO. You are paid more and you get to have more variety. That seems like a win/win.
 
I shadowed an anesthesiologist and during a single morning shift, there were at least 2 instances I can remember where one of his CRNAs needed his help to intubate. The nice thing is they were monitoring patients during surgery and we just went from procedure to procedure and he helped the CRNAs when needed. It seems like a better deal as an anesthesiologist IMO. You are paid more and you get to have more variety. That seems like a win/win.
Yeah, it seems like it could really be ideal if the setup is correct. I was talking to an attending anesthesiologist in a busy, urban, academic center. He said he basically goes in, does the intubation, then leaves. He goes back in if the CRNA/resident needs help, and for the extubation. He might stick around to help establish vent settings or that sort of thing, but otherwise he basically gets to be there for the good part and can leave for the routine part. With numerous ORs running constantly, he said he's pretty much always busy with that workload; he's never just sitting around.
 
@BeautifulSmiles523 Genuinely curious what you were thinking about when you decided to approach a nurse with that conversation topic in mind. Considering you are a pre-dental student who is involved in topics of socialized medicine and have been involved in two past threads within the past six months about midlevels v physicians. It sounds like a very coincidental situation, very solid SDN prompt though. Finding a nurse who pushes Cochrane reviews as being an objective resource outside of the academic atmosphere is just as likely a physician who discusses their clinical practice to a pre-med with PubMed publications. These people can exist, but in all likelihood what are the chances when you consider the more plausible alternatives.
 
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Okay, the nurse is my mom, and she’s much better at debating than I am. I can’t just say “you’re stupid that’s a dumb argument”. I want to have facts so I can debate her scientifically. I just don’t think nurses have enough education to be the be all end all of care. And I know these studies are BS, but I’m trying to figure out where so I can have a better argument.
 
Yeah, it seems like it could really be ideal if the setup is correct. I was talking to an attending anesthesiologist in a busy, urban, academic center. He said he basically goes in, does the intubation, then leaves. He goes back in if the CRNA/resident needs help, and for the extubation. He might stick around to help establish vent settings or that sort of thing, but otherwise he basically gets to be there for the good part and can leave for the routine part. With numerous ORs running constantly, he said he's pretty much always busy with that workload; he's never just sitting around.
It’s not the ideal set up. Most places are 3-4:1. That’s 3-4 times the liability, 3-4 times the caseload, running around all day, running more, Preop, postop, blocks, start, wake, run some more. Help over there, block’s waiting, etc. The busier you are, the less vigilant you can be and you’re reliant on your CRNAs for everything. Chasing the dollars isn’t worth the stress. I’ll settle for the 400s, get out by 4 and never cover more than 2:1 with a lot of solo providing. Some other sucker can chase the money, or worse, get employed by a management company covering 3-4:1 24/7 for even less.
 
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Okay, the nurse is my mom, and she’s much better at debating than I am. I can’t just say “you’re stupid that’s a dumb argument”. I want to have facts so I can debate her scientifically. I just don’t think nurses have enough education to be the be all end all of care. And I know these studies are BS, but I’m trying to figure out where so I can have a better argument.

You'll be much better off for yourself and for your "debate abilities" doing some googling to read more about experimental design and review instead of looking for specific information or articles to throw at your mom. If you go out looking for specific studies to support your point, you will find them, no matter what you're trying to prove, but if you want to get a better understanding of the bigger picture of current scientific knowledge in a certain topic, you need to know the differences between different types of experimental design, how they correlate (or don't) to the argument the investigator is presenting, and where biases might be introduced.
 
Okay, the nurse is my mom, and she’s much better at debating than I am. I can’t just say “you’re stupid that’s a dumb argument”. I want to have facts so I can debate her scientifically. I just don’t think nurses have enough education to be the be all end all of care. And I know these studies are BS, but I’m trying to figure out where so I can have a better argument.
First, the study cant be done. You cant put a crna in a complicated case and say sink or swim. As I posted earlier, just because the patient survived a mediocre generic anesthetic, doesnt mean you did the right thing, it just means you got away with it. When a crna cant intubate, start an iv or God forbid , perform regional anesthesia, do they cancel the case or call the anesthesiologist? Will the crna manage a difficult airway? Do you want the opthamologist putting in a pacemaker? Want to be an anesthesiologist? go to medical school. Want to be a physician extender? Become a NP, CRNA, or PA.
 
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It’s not the ideal set up. Most places are 3-4:1. That’s 3-4 times the liability, 3-4 times the caseload, running around all day, running more, Preop, postop, blocks, start, wake, run some more. Help over there, block’s waiting, etc. The busier you are, the less vigilant you can be and you’re reliant on your CRNAs for everything. Chasing the dollars isn’t worth the stress. I’ll settle for the 400s, get out by 4 and never cover more than 2:1 with a lot of solo providing. Some other sucker can chase the money, or worse, get employed by a management company covering 3-4:1 24/7 for even less.
Excellent points.
 
Med-Surg RN here enrolled in med school. I can tell you that RNs I meet are just as intelligent and conscientious as the MDs I've met in the hospital. CRNAs may not have the MD degree but that should not be the determining factor in weather they should be allowed to practice independently. Their training, patient outcomes, and clinical abilities should instead be considered. Considering we currently have a physician shortage, independently practicing CRNAs could also have a huge role to play for us, not to mention that they offer their services at a much lower price.
 
Med-Surg RN here enrolled in med school. I can tell you that RNs I meet are just as intelligent and conscientious as the MDs I've met in the hospital. CRNAs may not have the MD degree but that should not be the determining factor in weather they should be allowed to practice independently. Their training, patient outcomes, and clinical abilities should instead be considered. Considering we currently have a physician shortage, independently practicing CRNAs could also have a huge role to play for us, not to mention that they offer their services at a much lower price.

No one is saying CRNAs and nurses are not extremely intelligent and capable providers within their scope. I trust properly supervised NPs with my health and that of my kids. The issue here is exactly the stark differences in education/training between a CRNA and a physician as it relates to clinical ability in an emergency and/or management of difficult cases. Extending the scope of practice to independent practice is a benefit to the CRNA, not the patients they will be taking care of without appropriate oversight. As you well know, the MD/DO is not a meaningless distinction.
 
Med-Surg RN here enrolled in med school. I can tell you that RNs I meet are just as intelligent and conscientious as the MDs I've met in the hospital. CRNAs may not have the MD degree but that should not be the determining factor in weather they should be allowed to practice independently. Their training, patient outcomes, and clinical abilities should instead be considered. Considering we currently have a physician shortage, independently practicing CRNAs could also have a huge role to play for us, not to mention that they offer their services at a much lower price.

No one is saying CRNAs and nurses are not extremely intelligent and capable providers within their scope. I trust properly supervised NPs with my health and that of my kids. The issue here is exactly the stark differences in education/training between a CRNA and a physician as it relates to clinical ability in an emergency and/or management of difficult cases. Extending the scope of practice to independent practice is a benefit to the CRNA, not the patients they will be taking care of without appropriate oversight. As you well know, the MD/DO is not a meaningless distinction.
I'm glad you posted this as I was about to. Intelligence is not the issue. Scope of practice and privileges should be based on education NOT, legislation. The NP pharmacology training is not equivalent to physician training. CRNAs need to be supervised. A simple case can become a complex one in a flash.They dont have the educational backround to manage difficult airways, regional anesthesia, the extremes of age, etc. Are they bright, well trained in their arena, and a great resource? Yes. Are they the same as a physician? No. Want to be an anesthesiologist,? Go to med school.
 
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Their training, patient outcomes, and clinical abilities should instead be considered.

They are though. The MD/DO degree is a direct indicator of these three attributes you list.
 
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Med-Surg RN here enrolled in med school. I can tell you that RNs I meet are just as intelligent and conscientious as the MDs I've met in the hospital. CRNAs may not have the MD degree but that should not be the determining factor in weather they should be allowed to practice independently. Their training, patient outcomes, and clinical abilities should instead be considered. Considering we currently have a physician shortage, independently practicing CRNAs could also have a huge role to play for us, not to mention that they offer their services at a much lower price.
They may be very intelligent, but they are not clinically equivalent no matter what they call themselves. As to their services being much lower price, that is false. They bill exactly the same as an anesthesiologist, unless they are being supervised by an anesthesiologist where they both bill 1/2. So the cost to you and/or your insurance is the same either way.
In fact in rural pass through hospitals, where there are usually no anesthesiologists at all, they actually bill MORE than a physician can bill. Probably one of the reasons why there are no anesthesiologists. What hospital wants to hire a physician for more money who will need a bigger subsidy from the hospital to remain there when they can hire a lower paid CRNA who generates more income to support themselves.
 
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CRNAs may not have the MD degree but that should not be the determining factor in weather they should be allowed to practice independently.

Yes, in fact, it should. If you don't have the training then you don't have the training, it doesn't matter how intelligent you are.
Considering we currently have a physician shortage, independently practicing CRNAs could also have a huge role to play for us, not to mention that they offer their services at a much lower price.

The bolded is false.
 
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