Wednesday, August 4, 2010

MiM Mailbag: CRNA or MD?

Hi, I'm looking for advice from mothers in medicine. I am a biology major, in my senior year with a 3.9 gpa. I also have a 2 and 3 year old. I'm debating whether to pursue medical school or CRNA. Even though these paths are separated only by 2-3 years, I am leaning towards choosing CRNA because of having a family. I fear that the medical school and residency experience will be too great of a sacrifice of family and time. Can you offer any advice? I am worried that I will regret my decision, regardless of which one I choose. If I choose CRNA, I will regret not achieving my own personal best or ultimate fulfillment. If I choose M.D., I may regret losing countless hours with my family along the way. This of course rides on the assumption that the CRNA route, although comparable in measurement of years, will be much easier in terms of time invested (hours of study, etc.) I would really appreciate some insight from those who have chosen the M.D. route and may be familiar with that of CRNA and could make a comparison or at least shed some light on how manageable medical school and residency are with young children, and if you believe that you would do it again if you had the chance to turn back time.
Thanks you so much!

C.C.

16 comments:

  1. I am a CRNA and it's funny that 2 anesthesiologists (both men) were just talking yesterday about what they would do if they had to do it all over again. One said they would have been a dentist or a CRNA and the other said something else or a CRNA.

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  2. Hi CC,
    The time difference is much greater than you are estimating. To become an anesthesiologist, you have 4 years of medical school plus 4 years of residency, and more if you do a fellowship. A CRNA is only 2 years of training. CRNAs are paid very well--often more than primary care doctors. Also more states are allowing them to practice with less supervision, so they will be in demand.

    It really boils down to knowing yourself. If you wouldn't be happy doing anything but medicine, then you might be frustrated as a CRNA. If you would be content with a career as a midlevel provider for the sake of your family, then you will probably be very satisfied as a CRNA.

    Good luck to you!

    (FYI-I was an ICU nurse before going to medical school; clearly I fell into the former category!)

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  3. This is what I've heard as well from many people, but then again, I've also met the anesthesiologist that was once a CRNA, and have heard of others following that path as well.

    Would you say that you're happy with your level autonomy? This is the only thing I'm concerned about with going CRNA.

    A benefit of going CRNA for me would be that my husband is following this path, and we would go through school together, which would definitely offer some sync to our lives whereas my going to medical school would do the opposite.

    Thanks for your comments!

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  4. Hey, Scrubmama! Thanks for your comments. Well, I didn't provide enough information I guess ... but since I already have my biology degree behind me, it would take me 7-8 years for the M.D. path. For CRNA, I need (2 years to BSN) + (1 year ICU) + (2-3 years to CRNA) = 5-6 years. So, as little as 1 year difference, but as much as 3 if I went to a 3 year CRNA program, and did a 4 year residency+internship.

    And that 1 year difference is really what makes me anxious about choosing CRNA ... but again, I fear I'm making the assumption that a year of medical school/residency is equal to a year of CRNA school, nursing school, etc. I'm afraid that these years may be equal in length, but not necessarily so in the experience!

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  5. Hi again CC,
    I see where you're coming from in terms of comparing years. I would caution against that, though!

    2 years of BSN is 40 h/week tops, 1 year ICU is 40h/week tops (plus you get PAID plus BENEFITS), and CRNA school I would assume 40 h/week. Plus with schooling, a lot of studying can be done from home, so you have more flexibility there.

    With med school, I regularly put in about 60 hours a week, sometimes more, sometimes less. The first two years I did nothing but study; even studied in the car on the 15-minute drive to church! Residency will be 80 hours per week. So yes, more experience going the doctor route, but much more work! I can't comment on autonomy yet as I am still a med student.

    Good luck!

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  6. scrubmama, thanks for the comparison of hours input! This is really what I was looking for, I guess. I think I could be happy in a mid-level position, as long as I could find a good level of autonomy somewhere. Can I ask why you didn't go CRNA, with the experience of ICU already behind you? Are you just interested in another specialty or was there more to it?

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  7. I don't know any CRNAs but I know a number of NPs who made that choice because of work-life balance. Every single one of them finds it frustrating to navigate the hierarchical system and collaborate with (or be supervised by) docs who are less experienced and less skilled. Most of the NPs I know think the compromises were worth it, but the struggle is still there.

    Yes, it is a much more straightforward path and will make it easier to balance school and home over the next 8 years. Being a midlevel provider comes with its own set of challenges, though, and not everyone can tolerate them. I would not be able to; I have enough trouble as an MD when I have to work with colleagues who do not share my values. It's important to know what will work for you.

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  8. My sister got her P.A. in anesthesia at Emory - two years after B.S. in biology (no nursing school). She works at a Children's Hospital where she is happy with her autonomy and respect by the anesthesiologists (is close friends with some) and, yes, the salary is more lucrative than most primary care. She likes the shift work and her schedule is flexible enough to make most of her two son's ball games and school programs.

    I love what I do and have no regrets, but sometimes I get pretty jealous. Now that I am finally done with training (4 med school 6 residency plus fellowship) our lives are more similar.

    P.A.'s are not able to work in every state - you would have to look into regions and programs and that might not work for you if you have local child support you depend on. She looked into moving back to my state, and the group she interviewed with was willing to bend over backwards to bring P.A.'s to this state - but she decided not to return for other reasons.

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  9. Gizabeth - is she an AA (Anesthesiologist Assistant)? If so, I have looked into this option as well, and it is really tempting to be done with school after two more years! I would only choose CRNA over AA simply because of the option to work independently as a CRNA (though I understand this is mostly limited to rural areas.) But its so encouraging to hear that your sister is happy with her role. It would be interesting to hear if she was pre-med also, and change her course? And if so, why?

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  10. Autonomy is the key to this decision. As a CRNA, you will answer to MD's for your decisions and will be limited in what procedures you are allowed to do. In my hospital, the CRNAs are not allowed to induce anesthesia without an MD in the room. Certainly you will be alone with the patient for most of the case, but if something goes wrong, the MD will take charge.

    How important is it for you to be in control, making your own decisions? If this is very important, you should go the MD route. If you are OK with not *really* being in the driver's seat and don't mind being told what to do at times, then CRNA is a great career.

    The CRNAs I know are mostly very happy with their positions. They make a good living and clearly have a better lifestyle.

    Realize, though, that if you really want to call all the shots and be in control, you will probably be unhappy in any kind of nursing despite the better lifestyle. (Also, realize I am speaking from a surgeon's perspective.)

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  11. I agree that it all comes down to autonomy. Some my onc NPs are better than the residents by far at dignosis and management. But they know they will always be mid level. The training is also a little different so there are some situations where they are at a disadvantage. If you can tolerate that difference, it is a better lifestyle.

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  12. I am definitely a type A personality, and the control factor is a HUGE consideration! BUT. With that said, I tend to infer that the trade-off of control in the workplace is made for control of one's lifestyle. And I think it's a fair enough trade-off to make in the bigger scheme of things since I already have a family. So, I'm leaning towards CRNA. Will I have some regret? Probably. But will I be happy overall? I think so.

    And if autonomy becomes a huge issue for me that I can't live with, there are some areas where CRNA's can practice independently, and that will be an option I have as well. This being the primary reason I think CRNA is a better choice over AA, even though its a bit longer.

    So, anyway, I THINK I've made my decision. It's been a long time in the making, and I sincerely thank everyone who has taken the time to comment, I truly appreciate your insight.

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  13. She was pre-med, and tried once to get into med school, then decided to take a different route. She researched jobs and salaries and training time involved and decided P.A. (AA? I don't know about the terminology, but yes she functions in a large city in the South at a prominent pediatric hospital as an anesthesia assistant) was the way to go.

    At the time she applied to Emory, the program required the MCAT, but I think they have since dropped that requirement.

    I did get my M.D., but in many ways I think my sister is way smarter than me. And I know she is very happy with her family life -seems that growing a family, while a challenge for anyone, was a little easier for her than it was for me.

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  14. I cannot comment on med school at all, but as a nursing instructor I can say that your two years getting a BSN would require quite a bit more than 40 hours a week. It is accurate, however, than most of the time is study and prep which can be done at home.

    In addition, to take the CRNA route you first have to be able to practice AS A NURSE, which is a separate profession from medicine. Clearly the studying wouldn't bother you, but are you ready and able to think like a nurse for two years of school and a year of practice? And don't forget the matter of taking the N-CLEX before you work as a nurse. Just want you to see all angles, since you have gotten mostly MD feedback. We need all sorts of health care professionals but the courses of study and emphasis is NOT interchangeable.

    Patti, RN

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  15. Hi there,

    I'm coming a little late to this discussion but wanted to put in my two cents.

    As an RN who is considering my options for advance practice study, and who works in a teaching hospital with lots of residents in every program, this discussion interests me.

    First, if you feel that being an MD is "your highest potential" then that's what you should do. Nursing and medicine are two quite different, if complimentary, fields. You shouldn't become a CRNA if you'd rather be an MD, especially since you're young and have some time. Don't "settle" for being a nurse just because it seems as if it will take longer to be an MD.

    Also, please don't misunderstand the amount of work that goes into a BSN. Nursing curricula are difficult, and clinical work is exhausting. In addition to which, your first year as a new nurse in an ICU (if you can find a place that will hire a new grad without requiring a year of med/surg) will be stressful and difficult; I always refer to the first year after school as "the nursing intern year." You'll probably be working nights, as well. If you love the work, then it's worth it. But if you're using it only as a stepping stone, it will be difficult.

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  16. I agree with the above comment. I'm not a nurse or a doctor. Right now, I'm a research intern. My primary work for the past three years has revolved around scope of practices issues and the role that that plays in care coordination for folks with chronic health issues. Because of the specialized nature of my work I actually see kids and adults interact with medical staff.

    I want to tell you that the scope of practices for doctors and nurses are very different not only in what they are allowed to do, but in what they are trained for. Doctors often struggle thinking of options that will be the b est for patients and families because their training does not allow them to consider some practical issues that come up for patients. Particularly when it comes to compliance with PT protocols. Nurses have a leg up here in that they see a patient's life from a much broader angle. Mid level practitioners often have an advantage here because a background in nursing allows them this point of view.

    Autonomy would still be an issue. Often times however the "mid level practitioner" has unique insight because the background pulls from both medicine and nursing. If the physician recognizes this, this can put you in a unique position to contribute to care planning and things of this nature. If not you're up a crick without a paddle (so to speak).

    Before I worked in a hospital, I was a patient in one. All my experiences both personally and professionally, have given me ample time to observe. My one concern for nurses and MD'S alike is that people seeking to enter either field don't recognize the differences between them beyond the levels of education.

    These are DIFFERENT fields. You may be equally happy in both, but I assure you you won't be if you're only looking at the education component or if you think you're settling. Ask yourself questions! What relationships do you want with patients? What relationships do you want with Colleagues? If you really find yourself preferring MD, but find family concerns are still an issue. Think about Physician assistant programs. If you really have your heart set on MD career wise, it's unlikely you'll be happy in a different field. I think you'll need to change things around a bit but I know people who went to med school with young kids and they don't regret going or feel they've missed irreplaceable time. I know people who chose nursing school for the same reason you're thinking and they still feel they missed out on their kids development. That depends more on you than anything else. As a patient and a researcher I think I speak for many when I ask all MD'S and nurses (current and hopefull) to consider the CONTENT within a scope of practice before choosing a field of study. Good Luck!

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