11 Mar A Day in the Life of an Anesthesiologist-Part Five-Anesthesiologist or Certified Registered Nurse Anesthetist. What’s the Difference?
In the business, we’re called MDAs or CRNAs. It’s easier and quicker.
This is a sensitive topic to many people in the corporate anesthesia world. When I’m asked to compare MDAs and CRNAs, I get a feeling the question really being asked is, “Who’s better?” On a national level, arrogance, power, politics and money play a role in how that question is answered. But not to me. MDAs and CRNAs are equally important. Let me explain.
I am a board-certified anesthesiologist. I spent twelve years learning to do what I do. Four years of undergraduate college, four years of medical school, and four years of residency; twelve years total. I also did a stint with the Navy during the late Vietnam War years, so by the time I started my first job as an anesthesiologist, a doctor of anesthesiology, I was thirty-six and had three kids. Most of our friends in the business world were halfway to retirement and I was just getting started. I’m not looking for sympathy. I just want people to know that I devoted a lot of years training for the career I chose.
I work with many wonderful and professional CRNAs. Nurse anesthesia training typically involves a four-year BSN degree, a year or more working as a registered nurse in an intensive hospital setting, then three-years of CRNA school. Seven years of school with at least one year of work, for a total of eight years. Both careers are very rewarding and fun, especially if you work in places like I do where everyone’s skills and opinions are respected and embraced. But that’s not always the case.
Powerful PACs and Society’s like the ASA and AANA work tirelessly at the national level to point out differences and drive wedges between our two groups. I’m sure there’s millions if not billions of dollars being haggled over in lobbyist’s offices. That sort of Pavlovian supremacy filters all the way down into the psyche of instructors and professors training future generations of CRNAs and MDAs. By the time someone graduates from one of those programs, they’ve been indoctrinated with this divisive garbage which creates barriers and imbeds students with emotional misconceptions.
I spent several years working in MDA-only practices in California where CRNAs were accused of being inferior anesthesia providers trying to take our jobs. They’d suppose, “If you had to choose between and MDA or a CRNA to do your anesthetic, you’d pick an MDA, right?”
Truthfully and with all due respect, I say, “Not automatically, no.” I base my answer upon twenty-seven of years of experience working in the MDA-CRNA care-team model in Minnesota after I moved from California. Yes, there is a distinct difference between medical school and nursing school, but by the time someone is board certified as a CRNA or MDA, believe me, they’re smart. You don’t have to be a genius to practice anesthesia, but you do need to be well-trained, attentive, diligent, analytical, unflappable, tireless, energetic, personable, and humble. If you’re not humble, you will be. Understanding the human condition and being able to predict and react perfectly to every challenging situation that presents itself during an anesthetic is impossible. Knowing when to ask for help, and trusted allies to be able to ask, is critical when an anesthetic starts spinning out of control. That’s where being a part of a unified team of doctors and nurses trained in anesthesia is so important.
In the care-team model like is used over much of the United States, I supervise up to four CRNAs at a time while they’re in the operating rooms performing the anesthetics. I’m present in the OR at the beginning, the end, and periodically during the case, as well as when the anesthetist calls me with care-concerns. I’m also busy interviewing the next patients in the pre-op area, signing out patients from the recovery room, along with a whole host of other responsibilities. I’m not, as surgeons’ joke, reclining in the doctor’s lounge drinking coffee and checking my 401K.
In the care-team model, we strive to keep egos in check and focus on providing excellent patient care. In our setting, I couldn’t do my job without CRNAs, and they couldn’t do theirs without me. I rely on them, respect them, and cherish their opinion, as they do mine. Cooperation and respect, not division and bigotry; that’s the way to provide excellent patient care in today’s world.
I am the most apolitical person you’d ever meet, but I do have a message to the national leaders of anesthesia politico; what we could accomplish as a unified body of MDAs and CRNAs, with a single vision of promoting and supporting the anesthesia providers across this great nation, would far exceed anything we do separately.
Next Monday: 99% Boredom, 1% Sheer Terror