Becoming an MD is not the only way to make a good living working in healthcare. Certified Registered Nurse Anesthetists overlap with the duties of anesthesiologists in many regards and may make you wonder if the lifestyle and process of becoming an MD is really what you want out of your career.
As I’ve mentioned in previous articles, when applying to medical schools you should have an awareness of other jobs in healthcare. This will further help you understand why you may want to specifically become a doctor, and also help you become more familiar with the professional environment that doctors practice in. Exploration of other healthcare fields may also lead you to a different realization of what you want out of your career. When exploring other jobs in healthcare you may find that a different pursuit may save you a lot of time, money, and stress while providing you with many of the same rewards you were hoping to find in on the other side of your residency. To demonstrate further, I’ve discussed some brief points about CRNAs, which are the advanced nursing counterparts to anesthesiologists.
Salary Differences Between Nurse Anesthetists and Anesthesiologists
While it is true that MDs typically sit at the top of the salary food chain, it should be put in the perspective of a career timeline. Rough estimates have anesthesiologists earning an average of $360,000. And that’s contingent upon successfully completing a residency in anesthesiology. While CRNAs on the other hand(specialty nurses in anesthesiology) average about $170,000, which is more than some primary care doctors. This is a fairly large salary gap, but keep in mind that an MD goes through about 9-11 years more of school/training after acquiring their bachelor’s, while a CRNA spends about 3-5 years after getting their bachelor’s. On top of this, the education for an MD is much more financially burdensome throughout those years. Being a CRNA is one of the most advanced nursing positions that can be attained, and is therefore also one of the highest paid, so don’t think of it as a representation of the entire diverse and complex nursing field.
How to Become a Nurse Anesthetist (CRNA)
According to the AANA (American Association of Nurse Anesthetists), to become a CRNA you need to be a licensed RN who completes an additional graduate education in anesthesiology and then passes a national certification exam. To first certify as an RN you must have a bachelor’s in nursing (BSN) or a bachelor’s in a related field with a master’s or abridged bachelor’s in nursing. After this, completion of the NCLEX-RN licensing exam awards the title of a registered nurse (RN). An RN must have at least a year of nursing experience, preferably in critical care, to be eligible for admission to a 2-3 year graduate program in anesthesiology before taking the national certification exam to legally practice as a CRNA. A CRNA is one of several types of advanced practice nurses (APNs). Keep in mind that the expansive field of nursing changes requirements and titling relatively frequently, making it a very dynamic yet opportunistic field.
Examining the Autonomy of CRNAs
CRNAs also have a high degree of autonomy, and there are several states where CRNAs are not required to work under the supervision of an anesthesiologist- one of those states is California. This ability to opt out of required CRNA supervision was included in a law in 2001 that allowed states to decide the autonomy of their CRNAs. Before the law, an outpatient center may have had 4 CRNAs under the supervision of 1 MD, but now in those states, the CRNAs can practice independently of physician supervision in most cases, and this has raised some concerns in the medical community. While it is true that CRNAs may be able to perform many of the same functions as anesthesiologists in most cases, the distinction may become more apparent when a critical moment of need arises. Not to mention that advancing research in anesthesiology generally comes from the MD camp. This doesn’t change the fact that for a clinic or hospital, it becomes more cost-effective to hire CRNAs over anesthesiologists, which means that it is an occupation that may only increase in demand.
Efficacy of CRNAs vs Anesthesiologists
It has been demonstrated in a study by Needleman et. al that the efficacy of CRNAs compared to Anesthesiologists in child delivery showed no significant difference in outcomes between hospitals using only anesthesiologists and those using CRNAs or a mix of CRNAs and anesthesiologists. In a more well-known study that you may have seen before, it was “verified” that there was indeed no harm found when nurse anesthetists work without physician supervision. When analyzing this study it is important to realize that it was conducted and released by the AANA (American Association of Nurse Anesthetists), so it’s much like a drug company releasing a study about how wonderful its new drug is- there should be a healthy dose of skepticism. Another thing to consider is that anesthesiologists also generally take on more high-risk patients compared to CRNAs, so it is not entirely surprising that differences in initial procedural risks could be in part responsible for unremarkable differences in outcomes between CRNAs and anesthesiologists.
What is certainly true in the end is that the field of medicine needs both anesthesiologists and CRNAs. Although both professions are still falling into balance, the presence of CRNAs allows us to complete more surgeries per year than we ever could if we relied solely upon anesthesiologists. The situation embodies some of the types of transformations that can occur in healthcare and also represent another healthcare profession that provides autonomy, direct patient care, and a competitive salary.
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