Page 53 - CASA Bulletin of Anesthesiology 2022; 9(2) (5)

Vol. 9, No 2, 2022

anesthesia residency was established and some alumni went on to become anesthesia department
heads, including Virginia Apgar . The American Society of Anesthesiologists (ASA) was soon
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founded in 1936 and the American board of anesthesiology (ABA) separated from the American
board of surgery to become an independent organization in 1940. Within five years, both nurses
and MDs recognized the need to create a formal society. In 2021, there are more than 50000
anesthesiologists practicing in the United States.

For many years, there has been a continued debate between CRNAs and MDs with regard to
scope of practice, independence, education and organization. Some MDs argue that CRNA are
not physicians, they did not receive qualified credential practice independently. Not like
physicians, CRNA did not go to medical school, attend a four-year intensive postgraduate
medical education in residency or take the written and oral Board exams. While some MDs may
feel threatened their career opportunities, we should realize that CRNA programs have a
comprehensive training program for nurse anesthetists. A CRNA requires a bachelor’s degree in
nursing (or an equivalent degree) is required for admission to nurse anesthesia programs. All
training programs require being at the graduate level, awarding at least a master’s degree, and
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will support doctoral education for entry into practice in near future . Anesthesiologist society
also changed certification requirements. After written and oral certificates, Anesthesiologist
mandate to participate in the Maintenance of Certification of Anesthesia program (MOCA) to
maintain up-to-date education and training.

The research determines that the United States is persistently experiencing a shortage of
anesthesia providers, both anesthesiologists and CRNAs, and these two professional groups have
been providing complementary services as part of integrated team to provide safe anesthesia for
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our patients . However, what are the differences, Anesthesiologists vs CRNA? Other than the
educational background and training requirement, title, and potential supervision required for
CRNAs, the methodology process of putting a patient under anesthesia is the same for both nurse
anesthetists and anesthesiologists.

There has been controversy in the field of anesthesia regarding whether anesthesiologists or
CRNAs provide safer and more cost effective care. The multiple evidence showed that both 30-
day mortality rate and mortality rate after complications (failure-to-rescue) were lower when
anesthesiologists directed anesthesia care . In 2014, ASA pointed out that physician
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anesthesiologists complete nearly double the education and 10 times the clinical training of
CRNA and comprehensive evidence-based review found CRNA care not equal to physician
anesthesiologist-led care. ASA also indicated the studies that a nurse anesthetist is as safe and
effective as patient-centered, physician-led anesthesia care did not include any randomized
controlled trials (RCT); not provide care to the same type of patients as physician
anesthesiologists; and a study was at “high risk” for bias because of being funded by a nursing
advocacy organization.

One study showed that anesthesiologists achieved a modestly higher mean overall score than
CRNAs (66.6% ± 11.7 [range = 41.7%–86.7%] vs 59.9% ± 10.2 [range = 38.3%–80.4%] P <
0.01) in managing acute emergencies . Some people believe, although overall scores for
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