Anesthesiology Administered by MD's or CRNA's

[lealea1005]

Ummm ... even if I were a medical student, which I am not, they are allowed to ask questions in the OR. Believe it or not, surgeons and anesthesiologists both talk to medical students. Furthermore, medical students do a lot without supervision. Have you ever been in a teaching institution? They will answer to the attending physician but, most of the time the attending is only present at rounds, the residents will oversee the daily activities but, a lot of autonomy is given especially in the fourth year.

I stated low blood pressure so that everyone who was not in the medical field would understand what I was talking about. Although I would expect any health care professional to know what hypertension is, not everyone on this forum is in health care.

Notice how I said, either myself or a colleague are approached. Yes, it happens very often. Maybe a little bit of an exaggeration when I said weekly however it happens a lot.

When I made reference to sleeping at night I was talking about my intern year. I actually encountered many great nurses, and some not so great ones too. I got to know the night nurses fairly well, especially in the ICU. When I would do my midnight rounds I would ask each and everyone one of them if they could foresee needing anything for the patient in the next few hours. Most would allow me to get an hour or two of sleep, others would page me to tell me the patients coags were on point with the heparin protocol or ask for IV Tylenol. For those not in medicine, there is no such thing as IV Tylenol. There is PO (by mouth) or rectal. So, asking for IV Tylenol proves incompetence.

And yes, my respect was gained by those nurses who could actually handle some of the problems that arose at night without having to page me. Every time a patient complains of pain doesn't mean the doctor needs to be called, especially if the pain is a 2/10 and located around a surgical incision without any other complaints. Furthermore, if a nurse couldn't wait until morning rounds to ask a physician if the patient can be given clear liquids on post op day number one if they have not passed flatus then they probably deserve no respect. So, yes a lot of my respect came from those who were actually able to make minor decisions on their own.
Muscle relaxants such as vecuronium or rocuronium. One such instance was when a patient was undergoing a vaginal hysterectomy. The surgeon kept complaining that the patient was 'tight', the anesthesiologist had given a dose of vec ten minutes prior (when the surgeon complained). The patient had no twitches so, the anesthesiologist told the surgeon he wasn't going to relax the patient anymore. The surgeon was not happy and started to moan and grunt about how the anaesthesiologist didn’t know what she was doing. She replied by telling him the relaxant used has a duration of about 20 minutes, explained the patient had no twitches, what that meant, and turned up the des a little more to potentiate the vec. Instead of just bowing down to the surgeon she explained why. Where as I have seen two CRNAs give more NDMR just to shut the surgeon up.

You can find out what pressors are on your own and maybe learn something (here is a hint - phenylephrine, levophed, ephedrine). It's not much fun educating people and not getting paid for it, especially someone as educated as yourself.

Oh so sorry my grammar and spelling isn't up to par for you. I never proclaimed to be a great writer. Speaking of such wonderful writing - how exactly does one become a first and second year medical student at the same time? I find that incredible and fascinating. (“please tell where you are a first and second year MEDICAl STUDENT, I mean where you are so nurses are allowing you to sleep”)
Oh, and there are many more hospitals in Pennsylvania besides Penn State and Lebanon. How about U Penn, Temple, Jeff and Drexel to name a few. So, you can just continue to guess as to where I am.

Wish you would have put it that way the first time. I apologize for being a little defensive. Many moons ago I was one of those night nurses at a major teaching hospital (maybe even the one you're at).

[deadlock]

Actually, 3rd & 4th year med students on surgical rotations do attend the surgeries of the patients they are assigned to, and are sometimes invited to observe or participate in more "interesting" cases. They're also expected to know their patient's medical histories and the condition that brought them to surgery, inside and out, upside-down and sideways.

The question to pennmed was when med students attend surgeries AND ask questions as I asked previosly

A second year medical student "working in the OR"? And YOU would then question the CRNA about the medication administration? And this occurs where? in the OR? or perhaps your surveys are done postop? Did you question the CRNA about increasing the blood volume with fluids?

If you go back to read the whole series of questions you would understand responses.

[lealea1005]

The question to pennmed was when med students attend surgeries AND ask questions as I asked previosly


If you go back to read the whole series of questions you would understand responses.

I did...and I do...thanks.

[pennmed]

Good bye, pennmed. I cannot suffer reading any more of your silly dribble.

Awww ... can't take being wrong deadlock? Guess one of us knows what they are truly talking about, and it's not you. And I'm the one with "silly dribble"????

[deadlock]

Awww ... can't take being wrong deadlock? Guess one of us knows what they are truly talking about, and it's not you. And I'm the one with "silly dribble"????

or could it be I have more self-esteem than to try to build my ego up by boasting who I am on and what I do on a legal forum designed to help answers legal questions?

Serious problem when you are trying to present your personal conversations as surveys with statements about asking several surgeons and a 100% said this or that.
First you're a medical student (psst- med studs aren't docs- they aren't licensened to practice medicine), then a doctor... who cares what you do? YOU. THAT'S WHO. Did you want to be an atty and flunked out?

Want to try and save face by attacking me? You're a joke. Your simple mindedness and portraying to be a big shot is comical.

[deadlock]

Here, Pennemed-

This is some of your genious

A CRNA has a nursing degree and then two additional years of education. Then they are allowed to go out and practice. A doctor does 4 years of undergrad, 4 years of med school and then 4 years of residency. There is so much information that is learned, along with clinical skills during those 8 years of clinical training that cannot be acquired in 4 years of nursing training. This is a fact and even though the studies you have quoted show no statistical difference in outcome I think more studies need to be done (which is likely to happen soon).

Can't add?

4 years nursing plus 2 years CRNA equals 6. Then they take state boards before they "go out and practice".

BTW, honey after a medical student passes state boards they are then an MD and guess what that is 4 + 0= 4.

[elorei]

BTW, honey after a medical student passes state boards they are then an MD and guess what that is 4 + 0= 4.

So med students do not need to go to undergrad?

[pennmed]

Here, Pennemed-

This is some of your genious

Can't add?

4 years nursing plus 2 years CRNA equals 6. Then they take state boards before they "go out and practice".

BTW, honey after a medical student passes state boards they are then an MD and guess what that is 4 + 0= 4.

My point was that CLINICAL TRAINING is vastly different. To show how different (and show where I was getting the numbers) lets go through this exercise to explore the true difference.

Regarding a nurses training to get a BSN:"The total program is 125-126 credits. Of that total, 64 credits are in the School of Nursing and 61 credits are outside of the School of Nursing. Of the 64 credits in nursing, 23 credits are allotted to clinical practice. For each clinical practice credit, the student will be in the clinical area for a total of 45 hours per semester."

23 credits at 45 hours are 1035 hours in total clinical training during nursing school. Most of this is spread out over the last two years of the program. CRNA school is an additional two years. Of which approximately 1 ½ of those years are for clinical exposure which totals about 1300 - 3500 hours (the CRNA websites I found differed vastly). That is a total of 4535 hours of 'clinical exposure' for nursing school and CRNA school.

Approximately four years - really it would be 2 years in nursing school and then a 1 ½ in CRNA school. So, that is 3 ½ years (I gave 4 to make it simple).

A doctor becomes a MD or a DO after the four years of medical school. However, to get board certified in anesthesia you must complete an accredited residency and then pass two anesthesia board exams (after you have passed the three board exams to get a license). All five of these exams are incredibly difficult to pass. They all include anywhere from 400 - 1000 questions.

Medical students get 4 years of clinical training (most schools start 'clinical oriented teaching' right off the bat in the first year). But, for arguments sake I will say that only the last two years of medical school count towards the clinical hours. Most medical students average 60 hours per week during those two years with about four weeks off. This is variable according to the rotation, surgery may clock over 80 hours and family medicine 50 but, on average it’s 60. 60hours/week for 96 weeks = 5760 hours in total clinical training during medical school.

Then, you have to complete a residency (intern year plus three years of anesthesia). We will say on average during those four years, 70hours/week with a month off each year. 70hours/week for 192 weeks = 13440 hours.

Total clinical training time:
CRNA = 4535 hours
MD/DO = 19200 hours (MD only counting anesthesia clinical exposure = 10080 hours)

My math was not off - you just didn’t read the post correctly. If you count out clinical exposure time it is even more apparent that MDAs get a great deal more clinical experience when compared with CRNAs.

But, so you understand my math CRNA (2 years clinical training in nursing school plus 2 years in CRNA = 4 years), MDA (4 years clinical training in medical school plus 4 years in residency = 8 years). If you add a fellowship it would be 9 years. I was only referring to MDs in anesthesia since that is the topic at hand.

Or if you want to compare total training time: CRNA (4years for BSN plus 2 years - 6 years), MDA (4 years undergrad, 4 years med school and then 4 years residency = 12 years).

I do not need to inflate what I do or who I am. I do it because I have a passion for it and I am good at it. I found this topic when doing a search for a similar topic and was intrigued. I posted a response and my credentials/knowledge/intelligence were attacked (“Medical students are essentially supervised in the clinical area by nurses”, “if pennmed is a medical student, I’m the tooth fairy”, “when does a medical student attend surgery and ask questions”, “the vast majority of surgeons I know request a CRNA for their anesthesia”, “if you have a pulse ... you can get into an anesthesia residency”). Deadlock I can’t help it if you gave incorrect information and I corrected you at which time you said you can’t stand my silly dribble. That sounds more like an immature psychological defense mechanism to me.

[lawmed]

Lovely....

We all know who slept in more call rooms, gained vast experience from rejecting IV tylenol orders from idiots, who had to memorze the tricarboxylic acid cycle (oh wait...I had to do that too, along with copper kettle equations).

Now what about the original premise. Morbidity and mortality when anesthesia is delivered by a CRNA alone, Anesthesiologist alone, or via the care team model (both involved). You ask why the study regarding OB outcomes was not published in a journal that anesthesiologists read? (That was a joke right?) Because these journals are publishe BY anesthesiologists and it would never be accepted.

So......again I ask, where/what/when/who/how have you determined, based on any credible research, evidence based medicine, etc. that the anesthesia delivered by an anesthesiologist (or under the supervison/direction of one) results in a decrease in morbidity or mortality.

I will be happy to stick to facts, research and science in this debate, as anecdotes are useless and we both would have an equal number to support equally stupid contentions that CRNAs are incompetant and Anesthesiologists are lazy practitioners who went into anesthesia so the CRNAs could do all of their work.

I'm assuming the debate might then end however.

[brahms]

IGNORANT...not arrogant....although.....

Perhaps you were unaware that:

1. over 80% of the rural hospitals in America are served by CRNAs alone.
2. Over 60% of all anesthetics in the country are delivered by CRNAs.
3. CRNAs have safely been providing anesthesia for over 100 years.
4. CRNAs practice in every anesthesia specialty.
5. Uninformed, false statements lead to needlessly frightening patients, and lawsuits. Depending on the setting, the statement below could be actionable for tortuous interference, restraint of trade, libel/slander, etc.

"Next time anyone in your family undergoes surgery you should reqeust that an Anesthiology Doctor adminster the anesthesia, they are much more knowledgable and more capable of handling emergencys that might arise during surgery.
Glutamate"

There is absolutely no medical evidence, based on outcomes or morbidity, that this statement is true. What should the benefactor of your wisdom do if their local hospital has no Anesthesiologist? What if an emergency arises? Your advice, as posted, would lead a prudent person to bypass any hospital without an Anesthesiologist, despite a need for emergency surgery. Suppose that person died, whether from waiting for the Anesthesiologist they insisted on, or during their travel to the "much more knowledgable and more capable" provider, based on your guidance?

By the way, the vast majority of surgeons I know request a CRNA for their anesthesia. If you post an "opinion" in a forum like this that is without basis, and misleads others, you should be ready to be challenged. Especially if you post information regarding your criminal record and a mental illness inquiry at the same time. I mean...Jeeeeez...

I'm an ansthesiologsist and would like to make a few points.
If the argument is CRNA's are as good as anesthesiologists then do we need anesthesiologists at all? For that matter, do we need PCP if NPs or PAs are as well trained?
Why not just do away with the M.D. degree all together? Let medicine be run by advanced nursing degrees.

Is there anything wrong with this logic? It seems this is the base argument for crna's who want to practice independly.

And along come AAs (anesthesia assistants) - if they are also as good as MD/DOs and CRNA's why do we need CRNAs/MDs/DOs? And on it goes.....

The world of medicine needs structure - life needs structure - unless you're an anarchist. Perhaps nurses should be doctors and doctors nurses - fine - but lets agree on a heirarchy or nothing will get done and patients will start going to see herbalists for their care.

If you want to be the decision maker go to medical school - that's the system today. We don't need another institution producing degrees equivalent to MDs- we have plenty of medical schools.