Notes from The Head of the Bed

Notes from the head of the bed

Let’s start at the beginning.  Well my beginning; as I used to say to my kids; “nothing happened in your world “til you were born.”  “Anything before that is called history and is subject to interpretation.

In the beginning you dream, are inspired, have a proclivity for, or maybe had/have a relative whose career was in the health care field.  After some suitable investigation (suitable for you) you decide you’d like to administer anesthesia for surgery.

Choices; it’s always about choices isn’t it? What career path will lead you “the head-of-the-bed” where you will be able to provide anesthesia?  Today, 2014, there are three avenues to THoTB:  become a physician who specializes in anesthesia (MDA), become a registered nurse who specializes in anesthesia (CRNA), or become an anesthesiologist assistant (AA).  What’s the difference, you ask?  That’s the age old question that patients frequently ask their anesthesia provider.  The simple and time effective answer, (remember, in the OR, time is of profound importance,) is; an anesthesiologist is an MD, a nurse anesthetist (a-nez-the-tist) is a registered nurse (CRNA,) and an anesthesiologist  assistant is person trained specifically to assist anesthesiologists and under their direct supervision.

This may seem more complicated that it really is.  Remember these two caveats when things appear complicated; it’s always about the money, and “Plus ça change, plus c'est la même chose,” (the more things change, the more they stay the same.)

Now back to the beginning, mine; the short version. In 1969, when I made the choice to go to “anesthesia school,” the requirements were: 1. you must be a registered nurse, (RN.) 2. You must have had at least one year as an operating room nurse.  The course was 18 months, and after successfully completing your program you were required to sit for a national exam and if you passed you were allowed to use the title CRNA, (Certified Registered Nurse Anesthetist.)  There was no (zero) tuition, but you did have to give a deposit of $350.00 which would be returned at graduation if you didn’t break or lose any equipment. At that time a CRNA could expect to earn twice what an OR nurse was making.  When I left the OR for anesthesia school I was earning $7,500.00 per year with call pay included. Five years later I started in the same OR at $17,000.00, call included.  Pretty good return on investment, don’t you agree?

Just so you know, back then there were few “anesthesiologists” per se.  Most MD heads of anesthesia departments, in my neck of the woods, were GPs (general practioners) who’d received some on the job training in the military during WWII.  They in-turn trained some of the OR nurses in their departments to do anesthesia and they were referred to colloquially as “Chin Holders.”

Fast forward to today.  If you choose to apply to a course of study leading to a title of CRNA, you must meet these requirements: (these requirements will change by 2016) 1. You must have a bachelor’s degree in nursing (BSN,) 2. Have at least two years experience in a critical care clinical setting.  If you are accepted, you course of study will be 30 to 36 months in length.  Most programs are now university based rather than hospital based and will cost you no less than $150,000.00 to $200,000.00 for the 3 years of study.  You will graduate with a Master’s degree in nurse anesthesia, (soon to be PHD.)  After successful completion of your program you will also have to take a national certifying exam.

Your investment to attain CRNA status today;

 4 year BSN program @ ? $40,000.00

2 years as critical care nurse.

3 year MSN anesthesia program @ $200,000.00