Many hospitals and medical practices would rather hire certified registered nurse anesthetists (CRNA) than anesthesiologists.
Others disagree and consider it necessary to have a licensed anesthesiologist—a specialized medical doctor—administer anesthesia.
This article will look into the ins and outs of both roles and focus on the value that either option could bring to your anesthesia care department.
Key Takeaways
- Benefits of hiring a CRNA: A cheaper alternative to anesthesiologists that can easily handle most everyday responsibilities.
- Benefits of hiring an anesthesiologist: Highly educated medicated professionals with strong general knowledge, broader responsibilities, and the capability of handling more sensitive cases.
- The two roles are best used in sync, with clearly defined duties and boundaries.
- At least one anesthesiologist is essential for medical practices of any size and scale, while CRNAs may be hired as a cheaper way to supplement the team.
Table of Contents
CRNA vs Anesthesiologist: Responsibilities
An anesthesiologist has a broader array of responsibilities compared to a CRNA, but in some cases, a CRNA may take over the anesthesiologist’s duties.
A CRNA is equipped and qualified for most “bread and butter” duties.
Anesthesiologist Responsibilities
Anesthesiologists are required to be board-certified medical doctors with a degree from a medical school, a four-year anesthesiology residence program, and licensed in any state where they wish to practice in.
They must also complete a MOCA certification every ten years.
This certification is simply a refresher, or maintenance, of the certification they passed before acquiring their license.
This certification will ensure that the doctor:
- Stays up to date with the newest practices
- Is still licensed and remains in good standing
- Is consistently improving in their practice
The clinical responsibilities of an anesthesiologist are to lead the anesthesia care team and oversee their work.
The four varieties of anesthesia that must be learned and practiced by an anesthesiologist include:
- General Anesthesia: Anesthesia that puts the patient into complete unconsciousness, used during major surgeries.
- Monitored Anesthesia: Can cause a variety of levels of sedation, depending on the procedure being done.
- Regional Anesthesia: A form of anesthesia used for pain management of a larger area of the body. A patient is fully conscious during this type of anesthesia.
- Local Anesthesia: Similar to regional anesthesia, but applied to a much smaller area.
Anesthesiologists often spend so much time overseeing that they don’t have many hands-on tasks in the operating room, but this completely depends on the type of practice and the cases that are at hand.
CRNA Responsibilities
A certified registered nurse anesthetist (CRNA) must be a board-certified and state-licensed graduate of a nursing school and an accredited nurse anesthesia program.
A CRNA certificate has to be refreshed every four years, and it’s required to pass the Continued Professional Certification exam every eight years.
A certified registered nurse anesthetist’s clinical responsibilities could include:
- Assessment and evaluation
- Administering of pre-anesthetic drugs
- Developing an anesthesia care plan
- Performing airway management
The American Association of Nurse Anesthetists gives a detailed description of what this position entails and what types of responsibilities a CRNA could include.
The ASA classification system considers the patient’s state and the procedure’s complexity, defining categories of anesthetic procedures according to their risk and complexity.
This chart breaks down the levels of ASA within the scope of adult anesthesia, pediatric anesthesia, and obstetric anesthesia.
Within the ASA Physical Status Classification, a CRNA’s duties fall within the ASA levels 1, 2, and sometimes 3. A licensed anesthesiologist is considered qualified to fulfill the role on all levels.
In 14 states, CRNAs require no supervision of an anesthesiologist, although this is a widely debated issue.
CRNA vs Anesthesiologist: Quality of Care
Both categories of professionals often focus on narrow specialties, so assuming responsibilities outside of their specialist training can lead to issues.
Hiring both a CRNA and an anesthesiologist thus leads to an optimal quality of care.
The biggest concern to a healthcare system is how these two medical professionals compare when it comes to the quality of patient care they offer.
Both CRNAs and anesthesiologists can qualify to work in all anesthesiology specialties.
However, CRNAs may need to undergo extra training to gain these clinical privileges. Anesthesiologists often focus on only one specialty.
The quality of care comes into question when health professionals begin to take on responsibilities outside of their abilities or are overwhelmed by too many responsibilities due to the lack of help from supporting healthcare professionals.
This is why hiring a CRNA to support your anesthesiologist can greatly improve your practice’s anesthetic quality of care.
The Debate over Clinical Experience in Education
Both professions claim to enter the workforce with more educational clinical experience than the other, but no reliable data adds up in support of either side.
Anesthesiologists claim to enter the workforce with five times more clinical experience than CRNAs.
However, The AANA claims that CRNAs log 9,369 hours between their nurse anesthesia educational program and their critical care program.
Since anesthesiologists claim to earn 12,000 hours of clinical training, these numbers don’t add up.
This contradictory data is a result of two opposing titles vying for their part in the anesthetic industry.
While CRNAs claim that the data anesthesiologists present is outdated, anesthesiologists argue that even the title “nurse anesthesiologist” should be done away with.
The Cochrane Collaboration, an evidence-based medical collaboration, completed a review of the years of varying studies already done on this topic.
Even this review, which aimed at putting a definitive answer on the subject, turned up some conflicting conclusions.
While the American Society of Anesthesiologists claims that their review proves their value as an anesthesia provider, nurses say that it only backs up their own claims.
CRNA vs. Anesthesiologist: Cost Effectiveness
Anesthesiologists have an almost double annual salary compared to CRNAs, and certain studies show that employing a CRNA without supervision offers 25% more potential revenue.
On the other hand, other data suggest that hiring an anesthesiologist reduces costs in the long run.
The most important factor in determining the cost-effectiveness of either profession is being aware of the average pay that either profession would expect to earn.
Anesthesiologist Annual Salary
According to the most recent Medscape compensation analysis for an anesthesiologist, the average annual salary is $405,000.
The Bureau of Labor Statistics provides a somewhat lower range for the salary of an anesthesiologist.
According to their data, their mean annual salary is $339,470.
Of course, the actual market value of an anesthesiologist depends on many factors.
A study published by Economics, Education, and Health Systems Research used a wide variety of formulas to measure the cost-effectiveness of hiring an anesthesiologist.
This study compiled data that showed the added cost of hiring an anesthesiologist was worth the investment.
The concluding paragraph of the publication sums the findings up succinctly.
“This study demonstrates that provider costs for physician-directed anesthesia are similar to provider costs for nonmedically directed nurse anesthesia and, when cost savings with reduced mortality are considered, physician anesthesia seems to decrease net health care costs.
Even if all model assumptions are least favorable to physicians, these cost-effectiveness analyses suggest that incremental gains in life expectancy with a physician-directed versus nonmedically directed nurse model of care can be obtained at a cost deemed reasonable by society.”
Learn more in these articles:
What Is a Fair Anesthesiologist Salary? | How Much Do Pain Management Specialists Make?
CRNA Annual Salary
The Bureau of Labor Statistics lists the mean annual salary of a CRNA as $214,200. If a CRNA works in outpatient care centers, they could earn as much as $263,960 in the United States.
While these numbers are lower than an anesthesiologist’s salary, it’s still above the average pay of a primary care doctor.
Just as the median wage would differ depending on several factors for an anesthesiologist, the same is true for a CRNA too. The factors affecting it include:
- The CRNA’s nursing experience
- The job location
- The type of healthcare system
The Lewin Group, now a part of Optum Serve, conducted a study of the cost-effectiveness of hiring a CRNA.
This study showed 25% more potential revenue for employing a CRNA without supervision.
This study was prepared for the American Association of Nurse Anesthetists, so a degree of bias is to be expected.
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Pros of Hiring an Anesthesiologist
An anesthesiologist usually has more general medical knowledge, making for a more flexible professional capable of reacting in cases of emergency.
An anesthesiologist is a trained doctor with extensive knowledge of medicine above and beyond just anesthesiology.
This makes them better suited to make executive decisions in case of an emergency.
Anesthesiologists will always carry malpractice insurance. This covers much of the potential risks of a patient or family member suing for wrongful death or injury.
An anesthesiologist’s mandatory residency (and the following optional fellowship) provides for much more hands-on anesthesiology practice than a nurse anesthetist would get.
This prepares them well for the responsibility of all anesthesia practices.
It also provides some an opportunity to sub-specialize in various areas of anesthesiology.
For example, if an obstetrician wants to hire an anesthesiology professional, they could employ a doctor who completed a fellowship in obstetric anesthesiology.
Check out our full guide to learn Why Physicians Need Malpractice Tail Coverage.
Pros of Hiring a CRNA
Hiring a CRNA is an effective budget alternative to an anesthesiologist, and practicing as a part of an anesthesiology team can help them quickly gain professional experience.
A CRNA is a viable money-saving alternative to hiring additional anesthesiologists if only one can’t cover all anesthesiology responsibilities that your practice requires.
Due to the improvements in the technology of anesthesia practices, CRNAs can complete most of what an anesthesiologist can by merely following a formula.
CRNAs are often younger than anesthesiologists when entering the field.
This gives them ample opportunity to gain valuable nursing experience early on.
Under physician supervision, CRNAs can develop into a vital part of the anesthesia team.
Their help allows for the completion of more surgeries each year, leading to an increase in profit margins for healthcare facilities.
Final Thoughts
Big inner-city hospitals may require an extensive team of anesthesiologists, anesthetic assistants, as well as CRNAs to properly function.
Smaller practices and rural areas that cannot afford these big teams can still offer safe and effective anesthetic care by employing CRNAs, overseen by only one anesthesiologist for complex cases.
In the end, it’s up to each healthcare practice to weigh the pros and cons of hiring a CRNA versus an anesthesiologist and make the best decision for their own needs.
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