Nurse Anesthesiology vs Physician

Hello everybody! I am a RN, BSN with this whats come to be; “thorn in my side”. I really want to be a physician, and I am weighing out all the pros and cons, and reading about all these success stories on OPM. I must admit joining this site has been motivating and inspiring. I really feel I can pull through medical shool, and whatever the road may throw at me, however; many of my nursing friends and colleagues have this “thing” about me wanting to be an MD! I can’t believe some of the thinking/rationales out there? Anyways, many nurses have this “loyalty” to nursing, but really love medicine… and so goes the advance practice nurse. People have been suggesting to me that I look into a nurse anesthesiology program. I must admit it’s tempting, but I’m really not sure thats whats going to fullfill me? Am I going to finish, get my CRNA, and still be in the same boat I am now? I need some input on what people think about this dicipline. How did some of you nurses determine what was right for you? Why MD over CRNA? Whats the physician point of view on CRNA’s? I’m confused and looking for a little direction.

Hi Jen,
I have never understood why nurses feel like there should be some “loyalty” to nursing and if you should decide to become a physician, you are somehow “disloyal” to nursing. Nursing and medicine are two completely different professions though they work in the same vicinity. If your goal in life is to administer anesthesia, then the CRNA is going to satisfy that goal. If your goal in life is to become a physician, then CRNA is not going to satisfy that goal.
Nursing and medicine have completely different goals in terms of patient managment. Even if you are administering anesthesia as a CRNA, your managment is different from that of an MD. No matter how independently you practice, you will still be limited as CRNA in terms of scope of practice. If this bothers you, then you need to look into the MD route. If it does not and you can be satisfied with your scope of practice, then CRNA will work. In some institutions (Mayo, Hopkins, UVa) your scope of practice very limited. If you are interested in anesthesia management of the extremely complicated patients in these major referral institutions, then you are going to need an MD.
In terms of options, being an MD opens up other specialties to you that are just not there as a CRNA. If you are a CRNA, you do anesthesia/pain relief and that’s about it. If you discover that you have an interest in critical care or pediatric oncology or radiology you will be very limited by being a CRNA. Sure you could work in those areas but there are some really cool stuff being done by physicians in these specialties such as bone marrow transplants, endovascular stenting etc. You might even discover after some Pathology courses, that Forensic Pathology might be something of interest to you. Again, medicine opens many options at many levels.
If you have an interest in medicine, it is certainly doable. As you well know, it is an long-term goal. Since you are out in the work-force, you may have other obligations like family, mortgage that would remain even though your earnings would be limited. If you have a family, there is a bit of sacrifice in terms of time. These are all things to consider but very managable as others in this organization have demonstrated.
Look at the time investment in becoming a CRNA versus the time investment in terms of becoming an MD. There might not be that much of a difference when you add up everything and the increased options available to an MD might be worth the extra time investment for you. Only you can decide this.
Either way, both professions MD and CRNA offer good job outlooks and are interesting work. I love what I do and I can’t really imagine doing anything else. There is nothing about my job that is not totally absorbing. I am sure that CRNAs feel exactly the same way too.
Welcome to OPM and look for Mary Riley Renard, MDs posts. She was an RN before attending medical school and now heads for an exciting year of internship and residency in Family Practice. She has even posted some of her reasons for opting not to go the route of advanced nursing practictioner. They may be of interest to you.
One thing is for sure, if your dream is to practice medicine, then you are not going to be satisfied being a CRNA. Always remember that your first “loyalty” is to yourself and your happiness. Nursing and medicine are not an “Us versus Them” situation. We all practice on the same team but we play different positions. Figure out where you want to be and go for it! Again, welcome.

Thanks Nat!
You pose some great points. I guess I needed to hear them from someone with experience and more education about the subject. I have read some of Dr. Renards posts (who has become a hero of mine), but I haven’t found ones where she talks about why she didn’t choose the path of the APRN. Every little bit of advice counts, and I thank you for responding. This site has become very valuble to me in tweeking my future plans
Thanks Again,
Jennifer RN

Jen, I’ll try to comment on this in the near future. I can definitely comment on the “loyalty” thing. In fact I can hear the thoughts starting up in my head now… but it’s too late to start a new train of thought. I PROMISE I’ll come back. If you don’t see anything from me in a day or two, bump this thread - it’ll catch my eye - and I will respond.

Short Story: RN for the past 18 years or so, Trauma, ER, Home Infusion, Hospice last 8 years. Well always wanted to be a Doc and here I go! I care about my patients but feel like something has been missing. I just have this burning desire to be in family practice. If I did that as an NP I know it wouldn’t be enough. I want to learn more and do more and as a DOC I can. I will leave nursing but nursing will always be a part of me. P.S. don’t stay in nursing because of the them and us thing. It’s not supposed to be that way. We are all part of a medical team with different parts to play.

well, my weariness of the night before is a little better but I still think I’ll probably just touch on a few points even though I could go on for pages.
Nurse vs. doctor: folks who haven’t been to nursing school don’t realize that a lot of “nursing theory” strives to define nursing practice for how it contrasts with medical practice. We heard a lot about the “medical model.” What bemused me about medical school was not once did I hear about this medical model that I’d been told about in nursing school! Regretfully nursing as a profession continues to have a bit of an inferiority complex and a chip on its shoulder. Nursing is NOT the profession for people who couldn’t hack it to get into medical school. The skill set and emotional mindset is different.
Now, I have to say that I think APRN practice is much more of a “medical model” (there’s that term again!). It’s definitely more oriented to diagnosing pathology, prescribing treatment. Traditional nursing … aaaah, I could spout the jargon about what is nursing practice but I don’t feel like going through all the words. But it’s not “junior medicine,” and it is definitely not “following the doctor’s orders.” A hospital nurse does carry out prescribed treatments, but s/he also assesses the patient’s state of well-being and works to help the patient toward better health biologically, psychologically, socially.
Anyway, nursing and medicine are different. Now, truth be told, I loved nursing - still do. I actually loved the b.s. courses like “Scholar/Educator Dimensions of Nursing Practice.” But when I started casting about for my new career, and investigated APRN programs, I found way too many of those cool theory courses and not nearly enough of the nitty-gritty that I knew i wanted to sink my teeth into. (hmmm, is that a mixed metaphor?)
It took me until mid-adult-life to realize that I had the guts to take the responsibility and make the tough decisions, not just for myself but for others. I credit some of that to motherhood - I never hesitated to tell my own kids, AND other people’s kids! what to do. But there was more to it… I just achieved a maturity that I needed to recognize before I could be comfortable assuming a job where the final, ultimate responsibility for an outcome would be mine.
OK let me quickly confess that along with recognizing that I did want the ultimate independent responsibility that comes with medical practice, I also did some practical assessment of what would be involved in pursuing an APRN career. Here is what I figured out: I’d been out of the field for a long time, so would have to take a refresher course: 6 mos - 1 year. Nurse practitioner programs want you to have usually 1-2 years of recent experience. As a new hire, that meant I’d work the crappiest shifts, all the holidays, and be the first one pulled to a different floor, for the better part of two years. In other words, I would have to spend a lot of time doing something I did NOT want to be doing. Then there’d be two years of school. Conclusion: four years of time invested, quite a bit of it in unrewarding activities, before I’d go out with my freshly-minted NP credential.
Also add in that I’ve been watching nursing since I stopped practicing in the late 80s and frankly, it’s just gotten worse and worse. Staffing levels continue to erode as patient acuity levels increase. Many nurses HATE their jobs, and I don’t blame them. Nurses are better-compensated than they used to be but ya know what, a $hitty $70K/yr job is still $hitty and unrewarding. Even if it was only for a few years, and a means to an end, the prospect of working as a floor nurse just left me cold.
So four years to an NP, seven years to an MD (and yeah, I know, three more for residency)… while the MD certainly did take longer, I am SO much happier with the result that the time trade-off seems well worth it.
Hmmmm I had a little more to say than I intended! Hopefully I have been at least marginally circumspect in my comments (well except for the bad words), and did not need to post this under my “PostCallMary” screen name!

Jen, I can’t talk to the specifics of APRN and such, but I saw the exact same mindset in the Navy. When an enlisted sailor would put in a package to become an officer, there was often some sort of wall that was created by his wanting to ‘go over to the dark side’. HOWEVER, I will say that prior-enlisted officers were the most respected once they were officers out in the fleet. Not sure how that affects the prior-nurse M.D. once he/she is out there, but . . . my .02 - I just got done with coffee number 2 and had to post.
Good Luck


It took me until mid-adult-life to realize that I had the guts to take the responsibility and make the tough decisions, not just for myself but for others. I credit some of that to motherhood - I never hesitated to tell my own kids, AND other people’s kids! what to do. But there was more to it… I just achieved a maturity that I needed to recognize before I could be comfortable assuming a job where the final, ultimate responsibility for an outcome would be mine.

I have found myself thinking the same thing!
RE: the op… I too have struggled back and forth between these 2/3 options. I have come to the conclusion that becoming an MD is truely what I aspire to and man, would it be a drag to go all the way through CRNA/ARNP and still feel this way.
The other day I had an interview for a nursing postion. The NM was aware of my career goals and chose to “push” me a little about my choice to become an MD over a NP. I find it tiresome to have to defend my particular life path to some but I try to be tactful. After all…just chosing to go for it at my age breeds lots of discussion anyway. I figure it’s just part of the package.
Good luck in this process and keep us posted.

Hey Jen! Glad to see ya finally got a chance to enjoy our little organization. Jenn is a very nice person & a strong nurse. She used to work with me @ DHMC. Were ya beginning to think I had forgotten to answer your e-mail/post? Actually, I purposely held back so that you could see how much everyone here likes to help & always strives to deliver quality advice.
Now, for my 2 cents worth…
As usual, Nat, Mary & I think a lot alike. In essence, do not let others’ expectations or anecdotes of wisdom guide your final decision - us included. Do, however, take peoples’ input & filter it through your wants & needs & allow that to assist you in your final choice. However, let the final decision be of your own making & not some engrained loyalty to a profession.
In nutshell, if you think the CRNA route will ‘scratch your itch’, then that may be the route for you. However, if you want to be a physician (MD or DO) and enjoy all of the opportunities & repsonsibilities that that entails - then CRNA will leave you wanting & unsatisfied.
This is about far more than money or prestige of title. It is about pursuing your dream & accepting nothing less than fulfilment of that dream. Besides, most folks who go to med school do not end up doing what they thought they would do after med school. Going the CRNA path would preclude you from trying on other specialties for size. Who knows, you may learn that pediatrics is your passion?
Best of luck to you Jenn. I hope you enjoy MA. If I correctly recall, you were about to get married? If you already are - best of luck to you! If not yet - best of luck to you!!!
Please keep in touch & feel free to send more questions!

I’ve kinda been holding out on this one as well.
My dad is a CRNA… when I told him that I was interested in going into medicine… he insisted that I choose anesthesia… and he and my mom still think I should go into anesthesia…
My take on CRNA…
the thing that struck me the most having just been around a BUNCH of CRNAs is that while they seem to have an extreme amount of autonomy in performing their job (monitoring, inducing, etc), they also have no authority. During procedures, in order to induce the patient, the regime of medications (not always just anesthetic, sometimes muscle relaxants among other things) must be approved by the anesthesiologist. the anesthesiologist does come in periodically to talk to the CRNA as well as check the stats on the patient. They “approve” or “disapprove” the procedures and conditions etc.
In my limited experience, the CRNA does the majority of the “work”. they sit with the patient, monitor the progress, make sure that everything is working etc. I’ve seen the MD administer some medications by IV, although the CRNA seems to administer most of them. And I’ve also witnessed the MD do the epidural. I’ve not seen a CRNA perform an epidural, but I’ve witnessed CRNAs monitor epidurals.
Take it for what it’s worth. I’ve tried to list what I’ve seen as objective.

I think you should follow your dream and go for the MD/DO.
CRNA’s do make a sh*tload of money, around here they start at $100,000 or so a year. A CRNA did my epidural when I had my last baby too and she was great, I also have a friend who is in CRNA school at Georgetown and he loves it because he IS a nurse at heart, he never wanted to be a doctor. But they also are not doctor’s and I belive, work under a doctor. As nurses they are the top of the bunch with more independence and are certainly treated better than your average nurse.
But the fact is, if you want to be a physician, going the CRNA route would not benifit you and you would not be happy.

I wanted to add one more thing about the nursing loyalty thing.
I spent 2 full time years completing my BSN pre-req’s, got accepted to OU College of Nursing and declined my acceptance (I came to the realization that nursing was not what I really wanted to do and didn’t want to take up a spot for someone who really did have the passion to be a nurse). OMG my nursing friends about threw me out the window! They started treated me weird, saying all kinds of negative things, “I hate doctors”, “You will have so much debt”, “Why do you want to do that”, “You will spend the rest of your life in school”, “you not good enough in math”, etc It really hurt my feelings that because I had made a decision for myself, they started acting this way, they made me feel (and hello I was not even a nurse but an almost nursing student-- I can’t imagine how bad it must be for working nurses!) like I had done something wrong–and Im sorry, I didn’t, I live my life for me and my family.
It really just brings up a lot of bad/sad feelings for me.
Over on the popular internet nursing site (all******.com) if you even hint around you might be interested in medicine rather than nurses they will ram you, one guy over there who had worked as a nurse for years, got accepted to medical school and he said that NONE of the nurses he worked with congratulated him or anything
I have never in my life seen this kinda of “loyalty” for any other profession and I don’t mean loyalty in a good way either…lol

I have been very lucky. Two of my friends are nurses, and I met another while training to volunteer in a hospice. I was hesitant about telling them of my plans, because I did expect to be treated as if I were going over to the other side. But all three were supportive, even the stranger, who said, "Good. we need more good doctors."
I don’t even care that she had no reason to be sure I would be a good doctor. It was great to hear. Both naysayers and supportes come from surprising quarters.

I just have to chime in here on the nurse loyalty/doctor thing.Generally, I refrain from commenting unless specifically asked. I was a pediatric ICU nurse for 7 years. I have been a pediatric nurse practitioner(PNP) for another 10 years. Now I am preparing to apply to medical school. I have friends who are nurses, PNPs, physicians. I have had a very positive experience. Everyone is supportive. Though many think I am crazy to leave my current position with nearly 20 years of experience (financial suicide). Many of my patients too are confused by it.( I work in primary care so my patients do not see any difference between what I do and what my pediatrician colleagues do everyday) The way I see it, each individual has to make the decision for him or herself. I am happy being a PNP and I believe my experience will offer significant positives to my medical school and residency experience. I certainly do not feel as though I am abandoning ship.