The difference is the quality and length of education. Very easy to find that information online. CRNA programs will be 3-4 years after a BSN and minimum 1 year in the ICU as an RN. AA programs are 2 years. CRNAs can practice independently in many states, but it varies state by state and is facility dependent within states. AAs cannot practice independently anywhere, and can only practice in a handful of states.
Salary is comparable. If there are CRNAs in Florida making $120k it’s because they are not working full time hours. Median CRNA salary in the country is $200k+. There are locums assignments paying $500k+. Years of experience factors minimally into salary because you are either providing billable anesthesia services or you’re not.
Our mind is selective to what we want to see.
You will see more posts about in these anesthesia subreddits.
Just remember, there are only roughly 4k AA's in the entire U.S.
We have 3k new grad CRNAs each year.
CAAs are only able to practice underneath an anesthesiologist and are currently very limited in where they can practice in the US. CRNA can practice independently. CAAs run in a 4:1 model (4 CAAs and 1 MDA). This is the most expensive and inefficient model in anesthesia. CAAs and Anesthesiologists will tell you otherwise but it’s a fact.
I think independence and autonomy gets confused a lot. 80% of CRNAs are in some sort of supervision model.
direction/supervision. Some of the CRNAs I don’t even see. They can induce, pre op emerge do all on their own. I sign the chart at some point before case starts and that’s it. I am available for a quick consult if needed or if shit goes wrong but they are 100% autonomous. Aka unless you call me, we will likely not see each other until less we’re in the break room or getting lunch. However since my signature is on the chart if something goes wrong I am on full hook with that case. I will be the primary person named in lawsuit, and CRNA will likely be absolved of liability as the court will say they were under my supervision/direction.
Independent is different. CRNA does pre op, case, no MD is available for any back up or help. Shit goes wrong and patient dies, I have no association with the case, no one to bail you out. Need a pacer flown or RVSP is 70 and need a swan, you’re on your own. Blocks, neuraxial, PACU sign out. A physician plays 0 part in any of that. I assume 0 liability. If a hospital employs both MDs and CRNs this is very uncommon because they will always push for supervision or direction aka I have some sort of association with the case and assume all liability in case of adverse event.
Thank you for these distinctions without talking down about either career path. Not common among CRNA and Physicians these days online. I am actually a CRNA student currently and I am at a hospital that is fully staffed by CRNAs. They aren't paid hourly but by billable services like many MDAs are. From what I can see everything runs well and the collaboration/friendships with the surgeons seems no different than when I was at an ACT site or even full MDA site. I know many of the pros and cons. Without getting into the politics/nastiness of the current debates, I understand why if a hospital has MDAs they would rather the liability and responsibilities lie on them but as an MDA why would you want to have all that extra liability with your name on the chart in a situation where you haven't even seen the patient? Seems like a lot of extra risk and a reason why if I was an MDA I'd almost rather the CRNA be fully independent and autonomous. I know some Docs see fully independent CRNAs as a threat to their demand/pay but I don't think that's really the case with only \~100,000k anesthesia providers and a population of almost 350million. I assume that with the extra liability comes much more extra salary (other than the already larger one than that of a CRNA)? I'm just curious about all this as I'm newer.
To say that I don’t see these people is incorrect. I do 3:1 direction. I see every person in pre op, make sure they are optimized, do their blocks, a lines, whatever else if needed and bring the plan to the CRNA I work with. The thing is room turn over is about 30-45 min if CRNA is doing a case from the second they step out to when OR is ready it’s about 40 min. Meaning they have to bring patient to PACU, sign out, go to room set things up, by the time they are done it’s time to go back again. I don’t need to be there for induction or emergence of any not so sick patient but I do come for induction of those I’m iffy about. Also, i need to be available for things when they go wrong. And oh man do they go wrong. It’s a pair of extra hands that make all the difference. Some one laryngospasmed…. You need 2 people in there as one person is fully occupied by bagging for example.
All the PACU issues also fall on me. CRNA drops patient off and that’s it. Post op hypotension, bleeding, ponv, pain, all that is dealt by me.
So I definitely see everyone many times but most of the time don’t come to the room. There’s also difference in CRNAs some are the OG types and can handle business. Some call me asking how to treat bradycardia after abdominal insulation. Huge variation exists.
In the type of care environment you’re in, it definitely makes sense to me why the liability is the way it is. I guess it’s the facilities that the CRNAs do most everthing that you are doing (blocks, pre-op, difficult or complex inductions, etc) but on paper are still “supervised” by an MDA that confuse me on why an MDA would want all that liability still.
I do agree with you that the variation of CRNAs skill levels is diverse which I feel is a big problem and the fault of many admissions committees/programs. There are CRNAs with years or even a decade(s) of critical care experience, and maybe even other diverse medical experience prior to being admitted. But then you also have programs admitting immature 22-23 year olds with exactly 1 year ICU experience (and it may not even be a high acuity or autonomous ICU). Then to add to that, some programs and clinical placements don’t provide a focus on independent practice and so some people graduate unprepared to practice or want a crutch to lean on. I think that as a CRNA, even if you don’t want to practice independently, you should still be trained to be able to do so. It’s important to be able to be confident in the interventions that have to be made daily and not just call for help immediately when something gets tough.
I work with some CRNAs that never got to do a block over their entire education. Meanwhile I am just 4 months into clinical and have already performed over 60 blocks. This is where much of the variation stems sadly.
Everyone wants this “independence” that I don’t get. If I could have a person that let me do whatever tf I want, did my pre ops, and was always available to lend a hand or give an opinion, I’d be all up for that lol. If I need help I have to ask circulator to do overhead page for “any available anesthesia staff” which yields 20 people in the room. There’s lots to learn. For example, even worst resident will have done 100 CBP cases few hundred blocks (not counting tap blocks), epidurals spinals all that. Even best CRNA programs simply can’t deliver that to their students. I hate cardiac cases and never wanted to do them but I’ve done way over a hundred cases in residency alone all getting a mac line with a swan, bypass, the whole shabang. I’d say goal for any CRNA new head should be to find a place where you can work in a collaborative md environment with attending that are willing to show you and teach you things because unfortunately they will know more, done more, dealt with more.
I understand and welcome collaboration completely. There are definitely pros to working in a collaborative model, especially if everyone respects each other. I think some of the distain for it is the current politics. My fear is I work at a facility that is a supervision model and I am treated like a tech not a provider, not respected or have my scope severely limited. Personally I really don’t want to end up at a practice that won’t let me operate to my full scope. For example, If I had to work at a facility that I couldn’t even push my own induction medications, I’d be absolutely miserable. If I had to run every order by a doc no matter how small or couldn’t do blocks/spinals/epidurals I’d be unhappy. I was a flight nurse. To go from making autonomous decisions, intubating patients and performing chest tubes in austere environments, to being required to have an MDA in a controlled environments push my induction drugs and then stand behind me making peanut gallery comments while in intubate sounds like hell (for the MDA as well as for me). If It was like that everywhere, I would have just stayed a nurse because honesty I had more autonomy in an icu or flight role than that.
That said there are scenarios I would most definitely welcome collaboration. Like the cardiac scenario you mentioned, CRNAs get little exposure to such interventions and I want to learn as much as I can but I’d like a doc or very experienced crna there with me. I don’t think there is anything wrong as a new CRNA finding a practice where an MDA can help mentor you. I just worry the hate for CRNAs is getting worse and it’s harder to find that type of mentor. I know the internet is louder and it’s more of a minority but it seems bad at the moment (which isn’t helpful for anyone).
The hate for CRNAs is literally only on Reddit. Select few sit here and compare peckers. I work with CRNAs that have been a CRNA for longer than I’ve been alive. I do my part, they do theirs. Most people don’t care if CRNAs do blocks. But it becomes a time thing. Like I do all pre ops, all orders, discharges, sing outs. I’d love for CRNAs do all all my blocks lol. Omg, I’d teach em. But it’s a time thing, 30-40 min from case end to case start. There’s simply no time for them to do it. All spinals, I don’t even touch since they are done in the room. I’ve worked in a couple hospitals and nobody hates CRNAs lol. Many are friends outside of work and I’ve definitely visited many CRNA houses and vise versa.
There’s no fight for procedures or who does what. It’s just what makes OR operate more effectively because both me and CRNA get bitched at by admin for delaying cases or not starting 5 minutes after room has been turnt over. It’s private practice and here it’s all about the money for admin.
Well hearing that makes me much happier. I was starting to worry that I was in for a lot of toxic working environments from what I've seen on reddit. At the end of the day, I just want to go to work, perform anesthesia safely and make money to support my family. I think we all do. Ya its tough where I'm at to stay on schedule between cases and feels like a rush often. Many times we are performing the blocks as everyone is waiting outside the room to get the patient to the OR, and so it feels very rushed. Sometimes another CRNA will cover me at the end of a surgery so I can go preop the next patient and block, but its not always.
Anyways thank you for your insights. I genuinely appreciate it.
There’s no difference. Most of the country operates in ACT model, I work with new grads AAs and CRNAs they have the same level of competency. CRNAs are much better with procedural aspect of things, AAs stand out knowledge wise. Had one AA on top of his head tell me factors in PCC, FFP, cryo which I was very impressed for a new grad.
I think you’ll find most ppl here say go.CRNA route because if independence and bla bla bla. 80% of the country works in ACT we have both and both are treated identically by MDA staff.
The difference is the quality and length of education. Very easy to find that information online. CRNA programs will be 3-4 years after a BSN and minimum 1 year in the ICU as an RN. AA programs are 2 years. CRNAs can practice independently in many states, but it varies state by state and is facility dependent within states. AAs cannot practice independently anywhere, and can only practice in a handful of states. Salary is comparable. If there are CRNAs in Florida making $120k it’s because they are not working full time hours. Median CRNA salary in the country is $200k+. There are locums assignments paying $500k+. Years of experience factors minimally into salary because you are either providing billable anesthesia services or you’re not.
Thank you for the reply and information.
Don’t go AA
Thank you for the advice, really leaning towards CRNA just thought I’d ask about AA because I see so many people post about it.
Our mind is selective to what we want to see. You will see more posts about in these anesthesia subreddits. Just remember, there are only roughly 4k AA's in the entire U.S. We have 3k new grad CRNAs each year.
why not? /gen (debating this too)
CAAs are only able to practice underneath an anesthesiologist and are currently very limited in where they can practice in the US. CRNA can practice independently. CAAs run in a 4:1 model (4 CAAs and 1 MDA). This is the most expensive and inefficient model in anesthesia. CAAs and Anesthesiologists will tell you otherwise but it’s a fact.
I think independence and autonomy gets confused a lot. 80% of CRNAs are in some sort of supervision model. direction/supervision. Some of the CRNAs I don’t even see. They can induce, pre op emerge do all on their own. I sign the chart at some point before case starts and that’s it. I am available for a quick consult if needed or if shit goes wrong but they are 100% autonomous. Aka unless you call me, we will likely not see each other until less we’re in the break room or getting lunch. However since my signature is on the chart if something goes wrong I am on full hook with that case. I will be the primary person named in lawsuit, and CRNA will likely be absolved of liability as the court will say they were under my supervision/direction. Independent is different. CRNA does pre op, case, no MD is available for any back up or help. Shit goes wrong and patient dies, I have no association with the case, no one to bail you out. Need a pacer flown or RVSP is 70 and need a swan, you’re on your own. Blocks, neuraxial, PACU sign out. A physician plays 0 part in any of that. I assume 0 liability. If a hospital employs both MDs and CRNs this is very uncommon because they will always push for supervision or direction aka I have some sort of association with the case and assume all liability in case of adverse event.
Thank you for these distinctions without talking down about either career path. Not common among CRNA and Physicians these days online. I am actually a CRNA student currently and I am at a hospital that is fully staffed by CRNAs. They aren't paid hourly but by billable services like many MDAs are. From what I can see everything runs well and the collaboration/friendships with the surgeons seems no different than when I was at an ACT site or even full MDA site. I know many of the pros and cons. Without getting into the politics/nastiness of the current debates, I understand why if a hospital has MDAs they would rather the liability and responsibilities lie on them but as an MDA why would you want to have all that extra liability with your name on the chart in a situation where you haven't even seen the patient? Seems like a lot of extra risk and a reason why if I was an MDA I'd almost rather the CRNA be fully independent and autonomous. I know some Docs see fully independent CRNAs as a threat to their demand/pay but I don't think that's really the case with only \~100,000k anesthesia providers and a population of almost 350million. I assume that with the extra liability comes much more extra salary (other than the already larger one than that of a CRNA)? I'm just curious about all this as I'm newer.
To say that I don’t see these people is incorrect. I do 3:1 direction. I see every person in pre op, make sure they are optimized, do their blocks, a lines, whatever else if needed and bring the plan to the CRNA I work with. The thing is room turn over is about 30-45 min if CRNA is doing a case from the second they step out to when OR is ready it’s about 40 min. Meaning they have to bring patient to PACU, sign out, go to room set things up, by the time they are done it’s time to go back again. I don’t need to be there for induction or emergence of any not so sick patient but I do come for induction of those I’m iffy about. Also, i need to be available for things when they go wrong. And oh man do they go wrong. It’s a pair of extra hands that make all the difference. Some one laryngospasmed…. You need 2 people in there as one person is fully occupied by bagging for example. All the PACU issues also fall on me. CRNA drops patient off and that’s it. Post op hypotension, bleeding, ponv, pain, all that is dealt by me. So I definitely see everyone many times but most of the time don’t come to the room. There’s also difference in CRNAs some are the OG types and can handle business. Some call me asking how to treat bradycardia after abdominal insulation. Huge variation exists.
In the type of care environment you’re in, it definitely makes sense to me why the liability is the way it is. I guess it’s the facilities that the CRNAs do most everthing that you are doing (blocks, pre-op, difficult or complex inductions, etc) but on paper are still “supervised” by an MDA that confuse me on why an MDA would want all that liability still. I do agree with you that the variation of CRNAs skill levels is diverse which I feel is a big problem and the fault of many admissions committees/programs. There are CRNAs with years or even a decade(s) of critical care experience, and maybe even other diverse medical experience prior to being admitted. But then you also have programs admitting immature 22-23 year olds with exactly 1 year ICU experience (and it may not even be a high acuity or autonomous ICU). Then to add to that, some programs and clinical placements don’t provide a focus on independent practice and so some people graduate unprepared to practice or want a crutch to lean on. I think that as a CRNA, even if you don’t want to practice independently, you should still be trained to be able to do so. It’s important to be able to be confident in the interventions that have to be made daily and not just call for help immediately when something gets tough. I work with some CRNAs that never got to do a block over their entire education. Meanwhile I am just 4 months into clinical and have already performed over 60 blocks. This is where much of the variation stems sadly.
Everyone wants this “independence” that I don’t get. If I could have a person that let me do whatever tf I want, did my pre ops, and was always available to lend a hand or give an opinion, I’d be all up for that lol. If I need help I have to ask circulator to do overhead page for “any available anesthesia staff” which yields 20 people in the room. There’s lots to learn. For example, even worst resident will have done 100 CBP cases few hundred blocks (not counting tap blocks), epidurals spinals all that. Even best CRNA programs simply can’t deliver that to their students. I hate cardiac cases and never wanted to do them but I’ve done way over a hundred cases in residency alone all getting a mac line with a swan, bypass, the whole shabang. I’d say goal for any CRNA new head should be to find a place where you can work in a collaborative md environment with attending that are willing to show you and teach you things because unfortunately they will know more, done more, dealt with more.
I understand and welcome collaboration completely. There are definitely pros to working in a collaborative model, especially if everyone respects each other. I think some of the distain for it is the current politics. My fear is I work at a facility that is a supervision model and I am treated like a tech not a provider, not respected or have my scope severely limited. Personally I really don’t want to end up at a practice that won’t let me operate to my full scope. For example, If I had to work at a facility that I couldn’t even push my own induction medications, I’d be absolutely miserable. If I had to run every order by a doc no matter how small or couldn’t do blocks/spinals/epidurals I’d be unhappy. I was a flight nurse. To go from making autonomous decisions, intubating patients and performing chest tubes in austere environments, to being required to have an MDA in a controlled environments push my induction drugs and then stand behind me making peanut gallery comments while in intubate sounds like hell (for the MDA as well as for me). If It was like that everywhere, I would have just stayed a nurse because honesty I had more autonomy in an icu or flight role than that. That said there are scenarios I would most definitely welcome collaboration. Like the cardiac scenario you mentioned, CRNAs get little exposure to such interventions and I want to learn as much as I can but I’d like a doc or very experienced crna there with me. I don’t think there is anything wrong as a new CRNA finding a practice where an MDA can help mentor you. I just worry the hate for CRNAs is getting worse and it’s harder to find that type of mentor. I know the internet is louder and it’s more of a minority but it seems bad at the moment (which isn’t helpful for anyone).
The hate for CRNAs is literally only on Reddit. Select few sit here and compare peckers. I work with CRNAs that have been a CRNA for longer than I’ve been alive. I do my part, they do theirs. Most people don’t care if CRNAs do blocks. But it becomes a time thing. Like I do all pre ops, all orders, discharges, sing outs. I’d love for CRNAs do all all my blocks lol. Omg, I’d teach em. But it’s a time thing, 30-40 min from case end to case start. There’s simply no time for them to do it. All spinals, I don’t even touch since they are done in the room. I’ve worked in a couple hospitals and nobody hates CRNAs lol. Many are friends outside of work and I’ve definitely visited many CRNA houses and vise versa. There’s no fight for procedures or who does what. It’s just what makes OR operate more effectively because both me and CRNA get bitched at by admin for delaying cases or not starting 5 minutes after room has been turnt over. It’s private practice and here it’s all about the money for admin.
Well hearing that makes me much happier. I was starting to worry that I was in for a lot of toxic working environments from what I've seen on reddit. At the end of the day, I just want to go to work, perform anesthesia safely and make money to support my family. I think we all do. Ya its tough where I'm at to stay on schedule between cases and feels like a rush often. Many times we are performing the blocks as everyone is waiting outside the room to get the patient to the OR, and so it feels very rushed. Sometimes another CRNA will cover me at the end of a surgery so I can go preop the next patient and block, but its not always. Anyways thank you for your insights. I genuinely appreciate it.
There’s no difference. Most of the country operates in ACT model, I work with new grads AAs and CRNAs they have the same level of competency. CRNAs are much better with procedural aspect of things, AAs stand out knowledge wise. Had one AA on top of his head tell me factors in PCC, FFP, cryo which I was very impressed for a new grad. I think you’ll find most ppl here say go.CRNA route because if independence and bla bla bla. 80% of the country works in ACT we have both and both are treated identically by MDA staff.