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How CRNAs and Anesthesiologist Assistants Differ

What is the difference between a Certified Registered Nurse Anesthetist (CRNA) and an Anesthesiologist Assistant (AA)?  This is a very good question and one many people are asking.  One fundamental difference is that anesthesiologist assistants must work under the medical supervision of a licensed anesthesiologist, while many times a CRNA can work under the supervision of any physician; not necessarily an anesthesiologist.  While this is one difference there are more that we will outline in this article.

There are four main differences between trained nurse anesthetists and anesthesiologist assistants.

The first difference has to do with the educational programs. While both are master’s degree programs, the prerequisites are quite different.  A CRNA must have a bachelor’s degree in nursing, a current license as a registered nurse, and 1-5 years of experience as an ICU nurse managing high acuity patients. Anesthesiologist assistant programs do not specify an undergraduate major, but they do have prerequisite courses such as: biochemistry, human anatomy with lab, human physiology, calculus, statistics, biology with lab, chemistry with lab, organic chemistry with lab, physics with lab, and English with expository writing. They highly recommend shadowing experience prior to applying.  The previous clinical experience a CRNA must have is why they have more autonomy.  They have experience in critical care dealing with patients.  They have dealt with balloon pumps, a coding patient, a post operative patient, and have worked with physicians regarding medical care plans.  This type of experience is an education within itself.

The second difference is that anesthesiologist assistants are not allowed to practice without the direct supervision of an anesthesiologist, while CRNAs may practice under the supervision of any physician or without specific supervision in certain states. AAs must have the MDA in the room with them, as the title states they are an assistant to the anesthesiologist. Nurse anesthetists have their own scope of practice.  If a CRNA is practicing under an MDA, in some states the MDA does not have to be present.  This makes CRNA’s much more effective than an AA.

The third difference is that CRNAs may practice in every state nationwide under a license, while anesthesiologist assistants may only practice in 10 states and the District of Columbia. They may work in New Mexico, but only in university hospital settings.  Louisiana has explicitly prohibited the practice of anesthesiologist assistants in that state. 

The states that have adopted medical practice act laws or board of medicine regulations explicitly authorizing AA or PA/AA practice are:
North Carolina
South Carolina
District of Columbia
(AAs work by a license, regulation, and/or certification in these states)

The fourth difference is that nurse anesthetists or CRNAs are always governed by the state’s nursing board, while AAs are always governed by the state’s medical board.

Some of the more subtle differences are the number of schools offering the two different degrees, and the pay scale for the two careers.  There are 5 schools in the United States that offer an Anesthesiologist Assistant degree while there are over 110 schools offering a CRNA degree program.  Salaries for both vary widely from state to state.  The average salary for a CRNA was $189,000; according to a 2009 study by Merritt Hawkins & Associates. The average salary for an AA is $95,000 to $120,000. 

So basically in a tertiary care center the two positions responsibilities are almost identical, but looking beyond that there are differences.

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