'Here's Why Nurse Anesthetists Earn Over $150,000 A Year'

[member1000765]

I'm guessing you have advanced past your medical student status, but if you're still a med student I don't know how you can comment on a lot of this.

I know some very good nurses, I know some very terrible nurses. My mom was a good nurse, so I'm not anti-nurse. Following the bell curve, most are average and are not qualified to handle patient care without a lot of supervision, otherwise I wouldn't get called at all hours about simple tasks. The ICU nurses tend to be above the curve, but even then a lot of times they are pigeon holed into caring for a specific type of patient (be it cardiac, neuro, whatever). If you give them a patient that they aren't used to caring for (let's say you give a cardiac ICU nurse a free flap patient, which happens occasionally where I am), their knowledge based experience disintegrates, which is ok; if you haven't had exposure to that type of patient, I wouldn't expect you to be a pro at caring for them. They are difficult patients. But that's the whole point of the MD thing, is you have a much more broad exposure due to the intensive training.

And what nurses are you referring to with regards to teaching? I'm pretty sure that regular RN's aren't allowed to intubate (CRNA's can, obviously, but they've passed the basic nurse status) or place central lines at any hospital, learning how to put orders into the computer doesn't require a genius, and I don't know of any regular RN's aside from scrub techs who know how to suture. A lot more of the learning you can obtain from nurses is the actual information about your patients that you might have glanced over or not taken note of in their chart, not general medical knowledge.

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[DrOwnage]

Kaustikos, this is just slightly ironic given your signature.

If you didn't figure out third year that it's only because they're on the SAME floor all day every day...well you should have figured it out. A lot of what looks impressive in basic medicine is just a factor of having had that experience or done that thing over and over for months.

I agree. Whenever I start a new rotation, I'm lost as crap. The nurses teach me a lot, don't get me wrong. But it only takes me about 2 weeks to get up to speed with a lot of the things that they consider experience. Nursing knowledge, at least to me, seems to be static repetition. We are taught as physicians to have a more dynamic and spontaneous expertise. I feel like some nurses mistake my silence for misunderstanding, rather I'm thinking ahead of them.

 

[zeppelinpage4]

The reason there has been so much blurring between the roles of the two is that anesthesia techniques have become so safe and refined over the years that you can stick someone with less training in the room to monitor the patient and usually have no issues. Like other mid-level providers, CRNA's essentially act like overpaid residents. Let's break down what the CRNA does in the operating room: they do the pre-op paperwork immediately before surgery, some of the time will start the IV on the patient (anesthesiologists do this themselves a lot of the time, especially on children), wheel the patient to the OR, help move the patient onto the bed, set up the equipment, place electrodes on the patient, give oxygen, etc, then they call the anesthesiologist into the room. So up until the point the CRNA has done a lot of scut work essentially that the anesthesiologist has been able to avoid. Anesthesiologist is there for induction and intubation; usually they will let the CRNA intubate, if the CRNA is unable to intubate then the anesthesiologist takes over and does it. Once the patient is asleep, the anesthesiologist leaves for another room, and the CRNA starts the gas and essentially puts the patient on autopilot. Throughout the case they are doing paperwork, recording vitals etc. into their chart. They'll make slight changes to the level of anesthesia depending on how the patient is responding to the case, but otherwise they sit in their chair and chill for most of the case. As the case is ending they reverse the patient, call the anesthesiologist into the room, the patient wakes up, and it's done. It's like flying a commercial airliner - the pilot (anesthesiologist) is active for the critical parts, the takeoff (induction/intubation) and landing (reversal/extubation), and the rest of the time the plane is on autopilot. I'll probably get some angry comment from a CRNA saying "we do so much more than that!!!" but from the surgeon's perspective, that's what they do.

While most cases go smoothly, occasionally there is the one where things completely fall apart, and when the s--- is hitting the fan, you want the anesthesiologist at the bedside, not the CRNA. They are simply more experienced, have had more training, and have a better understanding of what their limitations are. If you ask the patient, "Sir, if you have a catastrophic emergency in the operating room and we are struggling to keep you from dying, who would you like at the bedside, your nurse anesthetist or anesthesiologist?" I'm pretty sure most patients will tell you they want the MD there.

As technology keeps getting better and better, it wouldn't surprise me if a computer system was eventually created that could do the job of the CRNA, monitoring the patient's level of anesthesia and vitals and adjusting levels based on some algorithm. Just like putting the plane on autopilot. I don't think it's far fetched.

Thank you! This clarifies a lot. I wanted to get a gist of how they differ and this showed it well.

First of all, you're doing a google search instead of a pubmed search to look for papers. That's mistake 1. Second of all, you're a second year, you have no idea what you're talking about. Third, CRNAs looking for independence are not the people you would ask about whether or not a CRNA can match up to a anesthesiologist.

If your life is on the line, would you trust a doctor or a crna? If you were flying in a plane, you can have the pilot get into the air and land the plane. While its on autopilot, you could have a stewardess with flight simulator training sitting there making sure everything is okay. If the plane doesn't crash, are you going to say that the stewardess is just as good as the pilot? Would you trust a stewardess when you hit some turbulence instead of a pilot?

People who can make it into an MD school and get through it successfully will be more competent and have a much greater knowledge base than someone who went to nursing school. The difference between doctors and everyone else is that doctors think. Anyone can do an H&P. They have medical assistants asking questions for the history. But can they interpret it? Can they come up with a solid differential? Can they make the right treatment plan? That's the difference

a) Yes, I PubMed is the better source, which is what I wanted. But I would expect google would have given at least some legitimate articles too. Perhaps I just didn't sift through them enough.

b) I really don't like your tone here. But yes I am a second year, and of course I don't know. Which I clearly stated in my first post and why I was asking here. I do however know not to believe someone who makes extreme claims and could have some bias behind those claims.

c) Of course I wouldn't believe opinions on this sort of thing from CRNAs looking for more independence. I posted the link just to show that there seems to be extreme opinions on both ends, just like a number of posts in this thread. And I explicitly stated, the nursing forum posts were probably heavily biased, just like some posts in this thread. How are our posts more or less valid than the ones I linked? We have bias too...this is an MD forum.
That's why I wanted to here from someone who has SEEN CRNAs and anesthesiologists working first hand, or a legitimate article backing up these claims.

d) Reading member1000765's post, definitely the anesthesiologist. But, if I didn't know any better (hence why I asked here), I probably wouldn't notice who was doing it.

e) I am certain a good number of experienced nurses could do a better job than a new doc or resident new to the clinic or field. Like an earlier post said, there are good nurses and bad nurses, just like there are good nurses and bad doctors. Our training is more broad and we are more qualified in many things, but it's not always the case.

I'm not arguing against anesthesiologists, I might end up doing it for all I know. I just wanted to know if they they really offered anything extra and how.

What?!?!
Get the hell out with that attitude. Broad assumptions like yours are why we don't make as great of progress in our training nowadays.
The amount of egotistical drivel here makes me wonder how much interaction people have with anyone outside of doctors. Doctors aren't the only ones who "think". Intelligence isn't based on your degree. I've seen doctors make bad calls. And I've seen nurses save a teams ass with their knowledge and skills.
In my training, I've found nurses to be the saving grace in learning how to work in a hospital. They know how everything works. They can teach you how to not only get to somewhere as some would think but also orders, lines, intubations, suturing, etc.
There is a lot of medicine that doesn't require an md to perform.
And **** off with that condescending remark about a differential and plan. Yes, doctors learn more. But it doesn't require an md for a nurse/pa/np in the ICU to diagnose a pulmonary embolism and the treatment all the time. Doctors are more grateful for this than you would imagine.

Or better yet - would you rather get paged at 3am because the patient has a 3.2 potassium and requires your amazing knowledge to take care of it?

+1 Thank you! I am sick of the high horse mentality. We have different skill sets with some overlap.

 

[member1000765]

Thank you! This clarifies a lot. I wanted to get a gist of how they differ and this showed it well.


a) Yes, I PubMed is the better source, which is what I wanted. But I would expect google would have given at least some legitimate articles too. Perhaps I just didn't sift through them enough.

b) I really don't like your tone here. But yes I am a second year, and of course I don't know. Which I clearly stated in my first post and why I was asking here. I do however know not to believe someone who makes extreme claims and could have some bias behind those claims.

c) Of course I wouldn't believe opinions on this sort of thing from CRNAs looking for more independence. I posted the link just to show that there seems to be extreme opinions on both ends, just like a number of posts in this thread. And I explicitly stated, the nursing forum posts were probably heavily biased, just like some posts in this thread. How are our posts more or less valid than the ones I linked? We have bias too...this is an MD forum.
That's why I wanted to here from someone who has SEEN CRNAs and anesthesiologists working first hand, or a legitimate article backing up these claims.

d) Reading member1000765's post, definitely the anesthesiologist. But, if I didn't know any better (hence why I asked here), I probably wouldn't notice who was doing it.

e) I am certain a good number of experienced nurses could do a better job than a new doc or resident new to the clinic or field. Like an earlier post said, there are good nurses and bad nurses, just like there are good nurses and bad doctors. Our training is more broad and we are more qualified in many things, but it's not always the case.

I'm not arguing against anesthesiologists, I might end up doing it for all I know. I just wanted to know if they they really offered anything extra and how.



+1 Thank you! I am sick of the high horse mentality. We have different skill sets with some overlap.

I agree that there shouldn't be a high horse mentality in that it makes you act like a douche bag, but at the same time everyone in the room should know that you are the most well-trained member of the medical staff, and if something bad happens then all liability is going to fall on YOU the MD, not the nurses or CRNA's or anyone else in the room. I've had the displeasure of being around 1 or 2 (so less than 1%) of CRNA's who think they run the show in the OR and are insubordinate to MD's, even the surgeons. One particular case was an emergent airway patient that we were performing an awake tracheostomy on. In that situation, that is our airway, not anesthesia's (otherwise anesthesia would secure the airway). We were rushing to get the patient prepped and draped and ready to make the incision, yet the CRNA kept ignoring us and slowing us down because she wanted to get all of her setup the exact way she wanted it. Eventually we just had to say no, this patient's life is in jeopardy right now, we are starting the procedure whether you like it or not. In that case it was time to hop on the high horse and push a lower-level provider out of the way, but it's a very rare occasion. And the patient got his trach and did fine.

 

[Microshaft]

why is america so fuarking random?

brb health insurance
brb PA/ NP / CRNA
brb medical degree isn't a bachelors
brb 1 mile = 5280 feet

how about u just do it like the rest of the world: free health care, doctors and nurses, bachelors degree, use metric

 

[zeppelinpage4]

First of all, you're doing a google search instead of a pubmed search to look for papers. That's mistake 1. Second of all, you're a second year, you have no idea what you're talking about. Third, CRNAs looking for independence are not the people you would ask about whether or not a CRNA can match up to a anesthesiologist.

If your life is on the line, would you trust a doctor or a crna? If you were flying in a plane, you can have the pilot get into the air and land the plane. While its on autopilot, you could have a stewardess with flight simulator training sitting there making sure everything is okay. If the plane doesn't crash, are you going to say that the stewardess is just as good as the pilot? Would you trust a stewardess when you hit some turbulence instead of a pilot?

People who can make it into an MD school and get through it successfully will be more competent and have a much greater knowledge base than someone who went to nursing school. The difference between doctors and everyone else is that doctors think. Anyone can do an H&P. They have medical assistants asking questions for the history. But can they interpret it? Can they come up with a solid differential? Can they make the right treatment plan? That's the difference

I agree that there shouldn't be a high horse mentality in that it makes you act like a douche bag, but at the same time everyone in the room should know that you are the most well-trained member of the medical staff, and if something bad happens then all liability is going to fall on YOU the MD, not the nurses or CRNA's or anyone else in the room. I've had the displeasure of being around 1 or 2 (so less than 1%) of CRNA's who think they run the show in the OR and are insubordinate to MD's, even the surgeons. One particular case was an emergent airway patient that we were performing an awake tracheostomy on. In that situation, that is our airway, not anesthesia's (otherwise anesthesia would secure the airway). We were rushing to get the patient prepped and draped and ready to make the incision, yet the CRNA kept ignoring us and slowing us down because she wanted to get all of her setup the exact way she wanted it. Eventually we just had to say no, this patient's life is in jeopardy right now, we are starting the procedure whether you like it or not. In that case it was time to hop on the high horse and push a lower-level provider out of the way, but it's a very rare occasion. And the patient got his trach and did fine.

Good points, I absolutely understand and agree with that.
The key I guess is just to be realistic about what the roles are from both nurses and doctors.

 

[malick1]

A MD has 12+ years of training to go into Anesthesia ! I Have met great nurses and horrible ones pretty 50/50, With the whole DNP things will get even more grey, but personally I much rather get my diagnosis from an MD than from a PA/NP/DNP etc is simply not the same !! and keep the nurses as nurse to give compassionate maintenance care at the bedside. perhaps there should be a Bridge program MSN to MD and PA to MD etc maybe a 3 year curriculum instead of 4, so good PA/NPs etc that want to provide better car can get the proper training.

 

[cbrons]

A MD has 12+ years of training to go into Anesthesia ! I Have met great nurses and horrible ones pretty 50/50, With the whole DNP things will get even more grey, but personally I much rather get my diagnosis from an MD than from a PA/NP/DNP etc is simply not the same !! and keep the nurses as nurse to give compassionate maintenance care at the bedside. perhaps there should be a Bridge program MSN to MD and PA to MD etc maybe a 3 year curriculum instead of 4, so good PA/NPs etc that want to provide better car can get the proper training.

MSN programs dont actually include enough medicine to warrant them being permitted to just skip over the M1 stuff.


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[malick1]

MSN programs dont actually include enough medicine to warrant them being permitted to just skip over the M1 stuff.

the M1 stuff still basic science and It could be truncated into 1 year, we already have 1.5(18months ) versions of it, and specially for NPs if they are trusted to be skilled enough to work under their own license ( unlike PAs) then they should be able to handle a 1 year accelerated preclinical program!
By the way NYU already has a 3 year MD program!

http://school.med.nyu.edu/student-resources/medical-education/md-curriculum/three-year-md-degree

 

[BurghStudent]

"It's extremely gratifying to walk up to a patient’s family after a procedure and say, 'Hey the patient did great after the anesthesia we gave' and to see the family relieved like they've had a weight taken off their shoulders," he says.

Lol, you get 'em Del Grosso

 

[PikminOC]

It is actually very relevant. They manage the patients who are on vents, they push pressors, and manage critical drips within a given order set.

In many facilities, they run the code teams.

Are they equal in experience in training and skill as an anesthesiologist, no, but many CVRU nurses are very skilled in managing critical patients and have great experience.

Wait until you complete medical school, residency and then let's have a conversation about this.

 

[chasm-e-baddoor]

the M1 stuff still basic science and It could be truncated into 1 year, we already have 1.5(18months ) versions of it, and specially for NPs if they are trusted to be skilled enough to work under their own license ( unlike PAs) then they should be able to handle a 1 year accelerated preclinical program!
By the way NYU already has a 3 year MD program!

http://school.med.nyu.edu/student-resources/medical-education/md-curriculum/three-year-md-degree

Is 1.5 years of medical school the same as 1.5 years of midlevel school?

The hallmark of medical preclinical education is not the difficulty of the content, but the sheer magnitude of information. Is comparing program lengths all there is to it. I'd wager that medical students have to learn a lot more to a deeper level of understanding regardless of program length

 

[jl lin]

While most cases go smoothly, occasionally there is the one where things completely fall apart, and when the s--- is hitting the fan, you want the anesthesiologist at the bedside, not the CRNA. They are simply more experienced, have had more training, and have a better understanding of what their limitations are. If you ask the patient, "Sir, if you have a catastrophic emergency in the operating room and we are struggling to keep you from dying, who would you like at the bedside, your nurse anesthetist or anesthesiologist?" I'm pretty sure most patients will tell you they want the MD there.

Re: my noted highlights. . .Hell Yes. And I have specifically asked for this for my children when they underwent surgery. I don't generally like to use the critical care RN card, but seriously, I am putting people on notice about exactly who will be running the show from that end of things. Some anesthesiologists seemed to have appreciated it, and perhaps some rolled their eyes when I wasn't looking. I don't care. That's my kid or family member on the table. As a RN or a family member, I have always seen my main role as one of advocacy, and that means getting the best care when the pt/family member needs it most. I am just as picky about who is doing surgery on my family member as well.

To be honest, I really don't understand how things got this far with midlevel overstep/encroachment. What's with the voice of the medical profession?
I know it's a crappy comparison, but do you think teachers would just let teacher's aids w/ Associates Degrees come in and take over for them? For better or worse, they have the NEA, and God knows I don't always agree with that organization. Still, if they can stand strong for their profession, why can't medicine?

 

[jl lin]

It is actually very relevant. They manage the patients who are on vents, they push pressors, and manage critical drips within a given order set.

In many facilities, they run the code teams.

Are they equal in experience in training and skill as an anesthesiologist, no, but many CVRU nurses are very skilled in managing critical patients and have great experience.

Yes, I know. I have done mostly those things you mentioned as an ICU RN for many years. Doesn't mean I should be running the show, especially for peds or high-risk patients. I am an open heart recovery nurse for peds and adults. I have managed but with the information given to the surgeon or ologist on the phone or in person. I know my limits. That's why I stopped working in an adult open heart recovery unit that refused to have a CT fellow or surgery resident covering the unit. You could call the surgeons directly at home. If that attending surgeon was committed to what he was doing and wasn't being a j.o., then many times, it was fine. But OMG in that unit some of the attending CT surgeons were, let's say, less than stellar as compared w/ those I had mostly worked with in other units. I can't get specific, but I could tell you it would make the hair stand up on the back of your neck. And when the place just wouldn't staff CT fellows to cover the unit, when there were really seriously problematic patients at night, well, I sweated more bullets and was so overwhelmed, b/c 1. I still need orders for pretty much anything. And 2. when the chest tube is dumping out tons of blood and the pt's beginning to crash, and there is no one to come and help me and give me the necessary orders and guidance, well, it's ethically wrong to me, and it was a liability nightmare. I mean with doc, who I think is a lawyer now, I had to get strong and say, "I can't take the pt back into the OR, open us his chest, look for bleeders, etc. I am not a surgeon. Hell, I am not a physician. I haven't been to med school or through a rigorous residency and fellowship program." Won't say anymore about situation or situations similar to that in that particular unit. Suffice it to say, I happily left there. It just wasn't safe.

There are limits in the scope of what you can do, even if you have an idea of what should be done or are a good critical thinker. There's a point when this overstepping is going to get so out of control; but hey. Everyone wants caps on liability. The hospitals should have to eat large settlements if they refuse to staff with the appropriate amount of quality physicians, instead of putting less educated and less trained personnel to handle situations they should not be handling alone.

I have been in the field long enough to tell you that s^!t happens, and it happens a lot more than people think--especially with more and more complex patients. When it does hit the fan, peeing in your pants is the least of the upset. And if I were a CRNA, I wouldn't work anywhere without good anesthesiologist there, on site. I say this having worked years in ICUs. Too much crap can go wrong too quickly.

What is the point of scope of practice for God's sake?

 

[malick1]

Is 1.5 years of medical school the same as 1.5 years of midlevel school?

The hallmark of medical preclinical education is not the difficulty of the content, but the sheer magnitude of information. Is comparing program lengths all there is to it. I'd wager that medical students have to learn a lot more to a deeper level of understanding regardless of program length

If you are and NP or CRNA you already know more than and MS2

 

[Southplains]

If you are and NP or CRNA you already know more than and MS2

Know more about what? Not phys/pathophys. Clinical management sure, cause you know, MS2's haven't started that part of the curriculum yet.

Strong post, premed.

 

[chasm-e-baddoor]

If you are and NP or CRNA you already know more than and MS2

Exactly like the above post said. You were talking about the basic science/pre-clinical curriculum. a NP or CRNA doesnt know more than an MS2 in that respect.

 

[jsmith522]

I'm guessing you have advanced past your medical student status, but if you're still a med student I don't know how you can comment on a lot of this.

I know some very good nurses, I know some very terrible nurses. My mom was a good nurse, so I'm not anti-nurse. Following the bell curve, most are average and are not qualified to handle patient care without a lot of supervision, otherwise I wouldn't get called at all hours about simple tasks. The ICU nurses tend to be above the curve, but even then a lot of times they are pigeon holed into caring for a specific type of patient (be it cardiac, neuro, whatever). If you give them a patient that they aren't used to caring for (let's say you give a cardiac ICU nurse a free flap patient, which happens occasionally where I am), their knowledge based experience disintegrates, which is ok; if you haven't had exposure to that type of patient, I wouldn't expect you to be a pro at caring for them. They are difficult patients. But that's the whole point of the MD thing, is you have a much more broad exposure due to the intensive training.

And what nurses are you referring to with regards to teaching? I'm pretty sure that regular RN's aren't allowed to intubate (CRNA's can, obviously, but they've passed the basic nurse status) or place central lines at any hospital, learning how to put orders into the computer doesn't require a genius, and I don't know of any regular RN's aside from scrub techs who know how to suture. A lot more of the learning you can obtain from nurses is the actual information about your patients that you might have glanced over or not taken note of in their chart, not general medical knowledge.

Actually I really don't want to get to involved here but at least in the system where I work there are RNs that intubate and place center all lines in the hospital. They are all the flight nurses which on average worked in the ER or ICU for at least 4-5 years before going to flights. Not unlike the paramedic in the streets. Do they miss tubes and lines yes, and do things go wrong sometimes yes; but they can do some more advanced procedures. Hell when I went to paramedic schools years ago not only were we taught but also had in our protocols the ability to do pericardiocentesis in the field. The biggest reason it was removed was the rarity of actually performing the procedure. I agree that MD/DO have way more education and foundations to build an effective treatment plan for patients. But skills are skills. I have probably intubated people in places that would give even seasoned physicians difficulty (ie in crumpled cars, deep snow pack in a blizzard, in a houses knee deep with trash and feces, or while being shot at) did I miss some, yep but again it's a practiced skill. Those patients in the field that have procedures go wrong or missed tubes and die, what percent of these would have had a successful outcome even if things were perfectly done on the field. I would venture to bet fairly low. Most people don't get themselves into the situation where they really need a central line or intubation without significant comorbidities already present.

I guess my point is that we all know nurses, docs, and others that can handle lots of things well and others that can't. But as a team we support each other which is what others have said when a CRNA has issues they get help from a doc.

The real problem here is when physicians complain about advanced practice, mid level and low level practitioners doing something that thy have classically done is that they look like a##holes to the public. The public sees physicians as part of the problem of healthcare costs not understanding that the real problem is the tort system, the huge cost of malpractice associated with the tort system, the years of accumulating debt for going to school for a an eighth of a century, and a system where everyone is trying to get their nickel from the patient. But, that is a bunch of other discussions all together. As physicians we need to do a better job of promoting our issues and not complaining about others stepping on our toes. Once the public gets behind us then we can address the other issues of job and task delegation caring for a patient.

 

[jl lin]

I think they need to be careful with reform. It is another important way to maintain serious accountability. People need to be accountable, and that means they need to be accountable and responsible for their practices or services from a financial--punitive damages or exemplary damages standpoint. Now, if the environment is setting the practitioners up for failure or less than stellar practice, that's a whole other issue, to which the institutions need to be accountable and responsible. Damages need to hurt, as much as I hate to even say that, in order to be effective deterrents to poor practice.

Also, jsmith, although it's great that paramedics and flight RNs can do various procedures in less than ideal situations, the truth I have seen after 20 years of practice is that the more someone routinely does something, generally, the better they are at it. Of course, everyone has bad days, etc. But procedural skills alone are merely one part of being a physician. The bigger parts have to do with overall knowledge, application of knowledge, critical thinking, compassion, relational skills--of course there is the admin, paperwork, and financial aspects as well--but most people that go into medicine aren't really all hot for those latter parts of being a physician. The former parts--the bigger parts-they culminate into what really makes a physician, and the individual physician's qualities in those areas differentiate between those that adequately perform in the role, versus being a truly fabulous physician. It takes sound education, clinical time and mentoring, and being held to high standards, as well as certain innate abilities to get to that place.

Being a physician goes beyond physical skill-sets. So doing certain procedures alone doesn't make the person the best practitioner in a critical moment or in very crucial moments.
Mid -level providers, or whatever you want to call them, are over-selling what they do and are inaccurate in any attempts to make their roles equivalent to well-educated/trained/certified physicians. If those folks working as mid-levels want to become physicians, let them do the legwork, get into MS, get through it, and jump through the necessary hoops that are required to be a board-certified physician in the US.

This whole issue should be settled by now; but I am thinking that it won't be until there is some kind of unionization in medicine, which has it's own inherent and malignant problems.

 

[ems2doc]

I find the notion that doctors don't have "desk work" ridiculous. It's even worse with surgeons. Everyone seems to think they spend their whole day in the OR or with patients. HAHA! Funny.

 

[Pacna]

Good points, I absolutely understand and agree with that.
The key I guess is just to be realistic about what the roles are from both nurses and doctors.

I appreciate your maturity. I actually read his condescending response to you first and thought it might be harsh but possibly appropriate. Then I read what you said and saw it was humble, honest, and curious.

It takes some kind of low self esteem to blow up on somebody who asks an honest question. People who use a position of power (usually just means +1> year in medical training than you in this context) to talk down to others reveal their true colors in doing so. Exactly the Waiter Rule in action.

More people like you in medicine = better culture.

 

[malick1]

Know more about what? Not phys/pathophys. Clinical management sure, cause you know, MS2's haven't started that part of the curriculum yet.

Strong post, premed.

Both subjects are integrated in the curriculum, and now that they will be required to get a DNP to practice, they will be Doctors, not physicians! but as much as a Doctor as and MD since lets not forget and MD is a professional Doctorate !!!!

But I guess the future will bring many changes , I know that there are dental therapist now that will do the work of a dentist without a Dr of dental medicine ( http://www.dentistry.umn.edu/programs-admissions/dental-therapy/)

Dont get me wrong I can be pretty arrogant, about who I get my care from, and up until I met an Awesome PA that give me better care than many IM PCPs, I would raise my eyebrow any time I would seek to see my PCP and get a PA instaead ( I still do for specialtist Ei: if I go to see a dermatologist ect )

But these changes will happen whether we like it or not, we can only hope that they get the proper post graduate training to provide good care !!

 

[W19]

Both subjects are integrated in the curriculum, and now that they will be required to get a DNP to practice, they will be Doctors, not physicians! but as much as a Doctor as and MD since lets not forget and MD is a professional Doctorate !!!!

But I guess the future will bring many changes , I know that there are dental therapist now that will do the work of a dentist without a Dr of dental medicine ( http://www.dentistry.umn.edu/programs-admissions/dental-therapy/)

Dont get me wrong I can be pretty arrogant, about who I get my care from, and up until I met an Awesome PA that give me better care than many IM PCPs, I would raise my eyebrow any time I would seek to see my PCP and get a PA instaead ( I still do for specialtist Ei: if I go to see a dermatologist ect )

But these changes will happen whether we like it or not, we can only hope that they get the proper post graduate training to provide good care !!

Dental therapy! Lol... Why would someone do a 3-year dental therapy master program when dental school is 4 years

 

[malick1]

Dental therapy! Lol... Why would someone do a 3-year dental therapy master program when dental school is 4 years

Initially there was a Bachelors Option, but I guess it comes down to is probably easy to do that, than apply to dental school !

 

[zeppelinpage4]

I appreciate your maturity. I actually read his condescending response to you first and thought it might be harsh but possibly appropriate. Then I read what you said and saw it was humble, honest, and curious.

It takes some kind of low self esteem to blow up on somebody who asks an honest question. People who use a position of power (usually just means +1> year in medical training than you in this context) to talk down to others reveal their true colors in doing so. Exactly the Waiter Rule in action.

More people like you in medicine = better culture.

Thank you, I really appreciate that.

 

[Successful BM]

Also...the "recent study" quoted by the article is just a literature review that quotes other studies.....studies that don't say CRNAs are safer at all since all of the CRNAs in the study were supervised by docs ( http://www.ncbi.nlm.nih.gov/pubmed/12220208)

journalists are horrible at fact checking

Journalists report facts?

 

[WhippleWhileWeWork]

Both subjects are integrated in the curriculum, and now that they will be required to get a DNP to practice, they will be Doctors, not physicians! but as much as a Doctor as and MD since lets not forget and MD is a professional Doctorate !!!!

So many words to say so little.

 

[gaspasser10]

Let's not forget about the West Virginia school that had the "distance" education CRNA program, which turned out to be DVDs. They were eventually decertified, but after turning out a number of CRNAs.

 

[oldanddone]

if more than one route leads to different designations that have very similar overlapping scopes of practice, and if they prove to have similar outcomes, but with disparate pay, then what we have is a serious failure to protect a certain pay for certain work, or a failure to protect a certain scope of practice as deserving a certain type of remuneration, and a certain level of independence.

docs have professional associations who perhaps do not take this seriously enough. a certain scope of practice that is performed proficiently should really have the same remuneration it always did. the start of nps and pas came from a perceived shortage of doctors. so give them alternate routes to an m.d., and to the proper remuneration for those proficiencies. to do otherwise is to undercut m.d.s and the scope of practice that has traditionally been called an m.d. in terms of making m.d. a managerial role with the liability, this becomes an issue and a bit of a forced shifting of practice, and also a bit of a red herring when it comes to the issue that proficiencies and what they are worth are being eroded.

edit to add: docs should not have to prove they are better...it is a doc's scope of practice that is getting discussed, and the rate for those services should be considered as already set. once the tasks get paid at the same rate, there may be less conflict between the different streams. it is economic undercutting of price that really drives a lot of that. hey, if it turns out my m.d. training doesn't need as much time/money as proven by these experiments in equivalent competency by midlevels...i'll take it! however, if it turns out there is value added in the medical education, i hope it includes learning that to be a doc also means not to be a wage labourer, to be an independent professional who should have a say in defining scope, and protecting scope, and engaging with hospitals/entities in ways that protect that self-definition.

 

[malick1]

So many words to say so little.

Same to you buddy !

 

[alpinism]

The length of training is almost irrelevant.

30 hrs/week of nursing practice and history of nursing ideas courses does not equal 60 hrs/week of medical school courses.

Also, saying an NP/CRNA knows more than an MS2 is like saying a 4 year CNA/MA knows more than a newly graduated BSN.

 

[Mad Jack]

It's articles like these, lacking any physician counterpoint, that seem to suggest there's been a wussification of physicians in recent years.

Speaking of wussy physician behavior, does anyone else's hospitals have ED docs wearing nurse-like scrubs these days? I've seen it now in 5 different hospitals, ED docs wearing these goofy dark blue scrubs with their names embroidered on them. They look like friggin triage nurses for cryin out loud. What's becoming of us?

I prefer wearing scrubs in the hospital to the white coat and such, personally. It's much more practical and vastly superior from an infection control standpoint.

Surgeons have worn scrubs for many years, it's not like doctors wearing scrubs is a new and tragic development.

 

[Mad Jack]

Wtf anesthesiologists only make $235k? I thought it was closer to $350k

More lies to further their agenda

These are likely BLS numbers, which have a high cap on reporting of something like 250k. Which is why if you look at things like Chief Executive pay, even they are shown to make under 250k.

 

[Mad Jack]

It is actually very relevant. They manage the patients who are on vents, they push pressors, and manage critical drips within a given order set.

In many facilities, they run the code teams.

Are they equal in experience in training and skill as an anesthesiologist, no, but many CVRU nurses are very skilled in managing critical patients and have great experience.

It may be relevant, but it's not training. I was a respiratory therapist at a big medical center for 5 years, which gives me extra years of experience but certainly does not qualify as training, no matter how relevant much of it has been in medical school.

 

[Psai]

The length of training is almost irrelevant.

30 hrs/week of nursing practice and history of nursing ideas courses does not equal 60 hrs/week of medical school courses.

Also, saying an NP/CRNA knows more than an MS2 is like saying a 4 year CNA/MA knows more than a newly graduated BSN.

a bachelor's in nursing is really good if you want to learn how to write papers about jean watson's theory about caring science and taking up space in the emr with unhelpful notes instead of learning how to make sure that your patient isn't lying in their own vomit for hours

 

[WhippleWhileWeWork]

The length of training is almost irrelevant.

30 hrs/week of nursing practice and history of nursing ideas courses does not equal 60 hrs/week of medical school courses.

Also, saying an NP/CRNA knows more than an MS2 is like saying a 4 year CNA/MA knows more than a newly graduated BSN.

At my school nurses have anatomy lab in the same lab as the medical students. We see what they are learning and how they are learning it. The level of depth isn't even remotely comparable. In many classes we have the same professors who when asked are very candid about the fact that the nursing students are getting a very surface level overview of only some of the topics that we are being taught. (And why wouldn't they?) The problem is, the nursing students don't know that. And they probably don't want to know it. Some of these will go on to become DNPs who will talk about their vast years of education and pepper the convo with equivalency studies, insinuating that their education was also on par with their physician colleagues.

Anatomy =/ Anatomy
Histo =/ Histo
Cell =/ Cell
etc....

 

[Kaustikos]

The "did I miss some tubes? sure, but oh well it was hard" attitude of paramedics is why there is starting to be a swing away from advanced pre-hospital care. As one leading trauma surgeon said at a conference last year, "the only skill I want a paramedic to have is a heavy right foot"

Foot in mouth for me:
A CRNA was managing our pt w/ myesthenia in the OR and we asked (curiously) "How'd you dose her?"
Response (kid you not) "Oh... I just dosed by half."
Later on in PACU - patient is still mechanically ventilated for 2 days.

 

[PL198]

the M1 stuff still basic science and It could be truncated into 1 year, we already have 1.5(18months ) versions of it, and specially for NPs if they are trusted to be skilled enough to work under their own license ( unlike PAs) then they should be able to handle a 1 year accelerated preclinical program!
By the way NYU already has a 3 year MD program!

http://school.med.nyu.edu/student-resources/medical-education/md-curriculum/three-year-md-degree

yeah and those 18 month versions are balls to the wall insane. I'm fine with covering an accelerated amount of skimmed material for nurses, just don't compare it to MD education. Look up NP scores on step 3.. End of story.

 

[PL198]

Seriously surprised at how few people understand how many fluff classes there are in nursing curriculum compared to medical curriciulum. Didn't any of you ever look at the nursing tracks in undergrad? It's like 3 to 1 in terms of actual science credits and when they take a science class, it's "chemistry for nursing" or etc. Literally not even close.

 

[Psai]

it's ridiculous to even be comparing nursing and medical education in the first place. it's not even close to the same thing without the same goals. i don't compare my education to pts or dentists or podiatrists and i don't need to compare with nurses.

 

[acceptmeplease]

Seriously surprised at how few people understand how many fluff classes there are in nursing curriculum compared to medical curriciulum. Didn't any of you ever look at the nursing tracks in undergrad? It's like 3 to 1 in terms of actual science credits and when they take a science class, it's "chemistry for nursing" or etc. Literally not even close.

While I agree that the science that undergrad nursing students take is easier, the clinical courses that I took in nursing school were much more difficult than any course I took while getting my biology degree. Even the "fluff"-sounding courses were difficult and had a more stringent grading scale.

*edit*

I realize you were comparing the graduate professional programs; NP school is a joke. Any professional graduate program that allows enough free time for the student to work another job full-time cannot be considered rigorous (or even respectable) in my opinion.

 

[KinasePro]

I prefer wearing scrubs in the hospital to the white coat and such, personally. It's much more practical and vastly superior from an infection control standpoint.

Surgeons have worn scrubs for many years, it's not like doctors wearing scrubs is a new and tragic development.

My issue isn't that they're wearing scrubs... it's that they're wearing nurse scrubs. Real doctor's wear scrubs that come out of machines at the hospital, not dickies navy blue nurse scrubs with hammer straps, cargo pockets, and personalized embroidering.

Next thing you know, they'll be wearing these:

 

[Mad Jack]

My issue isn't that they're wearing scrubs... it's that they're wearing nurse scrubs. Real doctor's wear scrubs that come out of machines at the hospital, not dickies navy blue nurse scrubs with hammer straps, cargo pockets, and personalized embroidering.

Next thing you know, they'll be wearing these:

I've only been in one hospital that had machines for the scrubs. In most units where I used to work, physicians wore certain colors of scrubs so you immediately knew where they were from, without reading whatever was stitched on them. Black, they were from the ED. Wine-colored, surgery. Gray, anesthesia. Light green, medicine. I don't get how having your name stitched on your scrubs so that patients can quickly identify that you're a physician makes you any less "manly" or whatever. And scrub cargo pockets are awesome, don't hate.

 

[ocist1121]

My issue isn't that they're wearing scrubs... it's that they're wearing nurse scrubs. Real doctor's wear scrubs that come out of machines at the hospital, not dickies navy blue nurse scrubs with hammer straps, cargo pockets, and personalized embroidering.

Next thing you know, they'll be wearing these:

You wish you looked that good in scrubs.

 

[KinasePro]

I've only been in one hospital that had machines for the scrubs. In most units where I used to work, physicians wore certain colors of scrubs so you immediately knew where they were from, without reading whatever was stitched on them. Black, they were from the ED. Wine-colored, surgery. Gray, anesthesia. Light green, medicine. I don't get how having your name stitched on your scrubs so that patients can quickly identify that you're a physician makes you any less "manly" or whatever. And scrub cargo pockets are awesome, don't hate.

What part of the country are you in? Was this an allopathic hospital? I've never seen/heard of anything like that. At the 8-9 hospitals I've worked at (number is growing with all of these aways I'm doing...) there is only one type of scrub dispensed from the machines in the hospital. It's your basic blue or sea-green scrub with the hospital name stamped on it somewhere, no frills. Any variation from this = floor nurse or tech. Docs never buy the dickies cargo scrubs because they use the hospital scrub machines. This is true in every part of the hospital except the ED apparently.

You wish you looked that good in scrubs.

This is true.

 

[Mad Jack]

What part of the country are you in? Was this an allopathic hospital? I've never seen/heard of anything like that. At the 8-9 hospitals I've worked at (number is growing with all of these aways I'm doing...) there is only one type of scrub dispensed from the machines in the hospital. It's your basic blue or sea-green scrub with the hospital name stamped on it somewhere, no frills. Any variation from this = floor nurse or tech. Docs never buy the dickies cargo scrubs because they use the hospital scrub machines. This is true in every part of the hospital except the ED apparently.



This is true.

Not only was it an allo school, it was a top 10 NIH funding allo school on the East Coast. The only department that had laundered scrubs was the OR, but they just came in a laundry bin, not a vending machine.

The only hospital with a machine around those parts was one of the smaller community hospitals. Everyone wore the same type of scrubs, every day, nurses included, but it was also color coded- respiratory was one color, nursing was another, physicians were another. Aside from that, they were the exact same scrubs.

 

[KinasePro]

Not only was it an allo school, it was a top 10 NIH funding allo school on the East Coast. The only department that had laundered scrubs was the OR, but they just came in a laundry bin, not a vending machine.

The only hospital with a machine around those parts was one of the smaller community hospitals. Everyone wore the same type of scrubs, every day, nurses included, but it was also color coded- respiratory was one color, nursing was another, physicians were another. Aside from that, they were the exact same scrubs.

Which one? Srsly curious. I've rotated in a total of 5 large level 1 trauma centers, none of which had color-coded health care teams.

 

[KnuxNole]

There are doctors that like to wear different colors, think the default one are tacky/ugly(see: the ones who wear pink/purple, or ones that match colors of their alma mater, etc.)

 

[Sirach38]

Thank you! This clarifies a lot. I wanted to get a gist of how they differ and this showed it well.


a) Yes, I PubMed is the better source, which is what I wanted. But I would expect google would have given at least some legitimate articles too. Perhaps I just didn't sift through them enough.

b) I really don't like your tone here. But yes I am a second year, and of course I don't know. Which I clearly stated in my first post and why I was asking here. I do however know not to believe someone who makes extreme claims and could have some bias behind those claims.

c) Of course I wouldn't believe opinions on this sort of thing from CRNAs looking for more independence. I posted the link just to show that there seems to be extreme opinions on both ends, just like a number of posts in this thread. And I explicitly stated, the nursing forum posts were probably heavily biased, just like some posts in this thread. How are our posts more or less valid than the ones I linked? We have bias too...this is an MD forum.
That's why I wanted to here from someone who has SEEN CRNAs and anesthesiologists working first hand, or a legitimate article backing up these claims.

d) Reading member1000765's post, definitely the anesthesiologist. But, if I didn't know any better (hence why I asked here), I probably wouldn't notice who was doing it.

e) I am certain a good number of experienced nurses could do a better job than a new doc or resident new to the clinic or field. Like an earlier post said, there are good nurses and bad nurses, just like there are good nurses and bad doctors. Our training is more broad and we are more qualified in many things, but it's not always the case.

I'm not arguing against anesthesiologists, I might end up doing it for all I know. I just wanted to know if they they really offered anything extra and how.



+1 Thank you! I am sick of the high horse mentality. We have different skill sets with some overlap.

You have absolutely no clue what you are talking about. You're a second year med student who hasn't even started rotations. Use your common sense please. It shouldn't take a study to tell you that someone with tens of thousands more hours of training in an area is better prepared to handle a situation. If your grandma/parent/children were dying during a surgery, who would you want taking care of them? Please learn to think with your head and not rely exclusively on studies and articles (especially those found by searching google instead of pubmed) for the sake of your future patients. I don't need a damn study to tell me that a residency trained CT surgeon will do a better job on my grandpa's CABG than a monkey. Even if the monkey is pushing legislature to let him/her perform unsupervised CABGs. The reason that there are not any good studies is because it would be unethical to do them. When a CRNA's patient is tanking in the OR they get bailed out by an MD and these "near misses" are never reported. It would be unethical for the MD to simply let the patient die in order to show that the CRNA care is inferior. Again, please use your brain and employ a bit of logic. Nurses are nurses for a reason and they have a very different role and training. If nurses want to do the job of doctors, there is a very simple solution! Go to medical school, residency, and become a doctor. Nobody is preventing these individuals from practicing the full spectrum of medicine because nobody but themselves and their laziness is keeping them from going to medical school. Trying to back door your way into practicing medicine through lobbying and legislature is sickening. The ones who will pay for this madness are patients and their families.

 

[malick1]

My issue isn't that they're wearing scrubs... it's that they're wearing nurse scrubs. Real doctor's wear scrubs that come out of machines at the hospital, not dickies navy blue nurse scrubs with hammer straps, cargo pockets, and personalized embroidering.

Next thing you know, they'll be wearing these:

is not every Hospital ! in fact many hospital have an Strict policy that only hospital issue scrubs must be used in th OR for safety and contamination worries, also who cares what one wears !!!