Today’s inane image of the day:
All three jobs provide anesthesia, so what’s the difference?
While true that an anesthesiologist, CRNA [certified registered nurse anesthetist], and CAA [certified anesthesiologist assistant – generally shortened to AA, which is the designation I will use for this entry] all provide anesthesia to patients, the pathways to get to each profession and the actual practice are different. I think all three paths can definitely provide a fulfilling career and should all be considered for anyone that might have an early interest in the practice of anesthesia.
I want to note that I did not know I’d be pursuing anesthesia when I entered medical school, so I didn’t consider the CRNA/AA route. I did briefly consider PA school as a backup plan to MD/DO if I didn’t get in, but I didn’t need to go down that path. Anyway, let’s dive in.
Training
Anesthesiologist
To become an anesthesiologist, an individual must get a college degree [~4 years] and a medical degree [4 years], then complete a residency in anesthesiology [4 years]. Additional fellowship training is available for 1 additional year in order to subspecialize. This means that after high school, it takes 12 years minimum to become an anesthesiologist.
CRNA
To become a CRNA, an individual must get a nursing degree [at least a Bachelor’s in order to qualify for CRNA school], work in an ICU setting for at least a year [though I’m told generally it’s 2-3 years], then go to CRNA school [2-3 years; CRNA schools are currently in the midst of transitioning over from Master’s degree programs to doctorate programs]. This means that generally to become a CRNA, it takes ~8 years after high school.
AA
To become an AA, an individual must complete a Bachelor’s degree that fulfills standard premedical course requirements then apply to one of the 12 accredited programs. These programs are ~2 years long and are Master’s level. This means that generally to become an AA, it takes ~6 years after high school.
Cost of Training/Salary
Everyone always wonders about the $$$. But what’s also important to consider is the investment in tuition and time. I’ve mentioned in an earlier entry, becoming an MD/DO is not cheap. Basically, no degree programs are really that cheap. And there are other considerations to factor in when thinking about salaries such as how long it takes until you actually make a salary.
Let’s actually consider tuition and income potential for each role:
Anesthesiologist
Becoming an anesthesiologist requires 4 years of medical school which costs $30k-$70k/year, which most people cannot easily afford. This leads to taking on ~$120k-$300k in loans. And on top of this, the vast majority of medical students do not work during medical school because it’s basically a full-time job to try to keep up. Residents get a stipend during residency, however, usually this isn’t anywhere near enough to actually pay off a substantial amount of debt… meaning that the compounding interest on the debt continues to grow. Once residency is done, anesthesiologists can make $250k-450k/year, which definitely allows for saving and paying off of loans. But remember, by this point, you’re already into your 30s, so you’ve got some catching up to do on saving for retirement or other life things like marriage, house, kids, etc.
CRNA
Going to CRNA school isn’t cheap either. However, the advantage here is that prior to going to school, you must get ICU nursing experience… which is an actual job. With an income. And it’s a job that you could potentially pick up overtime or in the current pandemic – do travel nursing – which is extremely lucrative [I’ve asked a couple of the “travelers” what they’re pay structure looks like… and it’s comparable to my pay or sometimes more]. So, this means that prior to going to CRNA school, an RN can save enough money to pay it off. Additionally, RNs can continue to work per diem during school, which also helps offset the cost. When I looked up the cost of CRNA school, it’s also a pretty broad range of costs – I did see something like $60k-$100k+ for all 2-3 years of school. So, this isn’t cheap either. Generally, CRNAs can make $150k-$250k in salary [again, depending on the location, practice, etc].
AA
Becoming an AA is quite a different pathway than the prior two because it’s a Master’s degree program that’s ~2 years. So while you’re not making any real money when you come out of college, it’s only ~$20-$40k/year, then you’re working. There’s definitely limitations on where you can go to school as well as which practices hire AAs [I personally have not worked with an AA in my practice], however it continues to be a growing profession. Salaries can be similar to CRNAs, but I couldn’t find any hard numbers. I believe it’s generally ~$100k-$200k range.
Types of practice
Anesthesiologist
As an anesthesiologist, there are a ton of different practice options available out there. I could work in an academic center [which I already do], a community hospital, an ambulatory surgery center, an endoscopy center, or a dental office. There are ton of different types of schedule structures [hours/week worked, vacation, call, etc]. I could also work in practices where I do all of my own cases or work in a place where I work with residents and CRNAs [though one can argue there may be a bit more liability involved in this situation]. There is a ton of variety in what types of practices are available.
CRNA
In general, most CRNAs work in conjunction with anesthesiologists. There are 17 states that are designated as “opt-out,” meaning the physician oversight is not mandated in order to bill for/provide anesthetic care. I didn’t start writing this entry in order to get backlash about independent practice or scope of practice, so go away if that’s why you’re here. CRNAs also have a wide variety of practice locations and types they can participate in, but most jobs involve working with an anesthesiologist.
AA
Anesthesiologist assistants are just as the name sounds like. They practice under the oversight of an anesthesiologist in all states that they are able to practice. The setup is generally similar to how CRNAs practice, however, there are rules governing a maximum number of AAs an anesthesiologist can be working with at any given time. Practices are a bit more limited for AAs as not every state has them.
What’s the right path for you?
Knowing what I know now and acknowledging that I had a lot of financial help along my journey, I wouldn’t change my career path. That being said, it all depends on your current situation and what type of job you see yourself in. I think AA is an interesting route for someone who is considering PA school but wanted to do anesthesia. The downside really is that AAs do not have the flexibility that PAs have in switching specialties [nor do anesthesiologists/CRNAs, though because of my fellowship training, I am able to work in an ICU while CRNAs can either provide anesthesia or go back to doing bedside ICU nursing]. I think it’s important to consider the investment in time and money that each path requires in order to make an educated decision about which one to embark on. Furthermore, it’s important to look at what the job is like at the end of the road since that is what you’ll be doing for the rest of your life.