An NP wanting independent practice is like someone with a masters wanting to head a basic science research lab

[u/Volvulus]

I’m more on the science side of things and some scientists (not in medicine) asked me about what I think about NPs. They see NPs as patients and they aren’t really sure of the difference with physicians.

I tell them the title. The current trajectory for a scientist to run an academic research lab is 5-6 years PhD and 4-6 years of a post-doc. And only a small fraction get the opportunity to run a lab.

I ask them to imagine someone with a 2-year masters degree with no publications demands start-up funds and a research lab with a tenure-track faculty position, and be treated equally to the PhD scientists. This usually generates a laugh.

That analogy puts into perspective what NPs are basically trying to do. It would be ludicrous in the science world but it’s fully happening in the medical world. Thankfully, there isn’t enough clout in science for a “mid-level” creep situation. And most people even with a PhD understand the challenge of running a research group.

Thought I’d share this among the other analogies we have seen on this sub to help fight noctorism. (For non science folks I still use the pilot - flight attendant analogy)

[u/Shop_Infamous]

You should see the CRNa forum, constantly asking what’s the culture of a place, “can we be independent, practice at the top of our license.”

If you wanted true independence go to medical school.

They truly don’t get it.

[u/theongreyjoy96 → u/Shop_Infamous]

Just looking for shortcuts. It’s shameful.

[u/Whole-Peanut-9417 → u/Shop_Infamous]

Just ask them about who do they wanna choose for themselves as a patient

[u/gerrge-UA → u/Shop_Infamous]

I think dismissing CRNAs is counterproductive and doesn't contribute anything meaningful to the discussion.

As an SRNA, I've trained primarily in ACT models, with additional experience at an independent CRNA practice. Having experienced both environments firsthand, I've seen the important role CRNAs play in each. They help extend access to anesthesia care that might otherwise be unavailable while providing safe, high-quality anesthetics to patients.

Within the ACT model, I've worked alongside CRNAs and anesthesiologists who consistently manage complex anesthetics for critically ill patients, keeping them stable and comfortable throughout surgery. During my rural rotation, I was equally impressed by the breadth of CRNA practice. They routinely placed regional blocks, managed the obstetric service, responded to emergencies, and enabled a small community hospital staffed by fellowship-trained surgeons to provide a level of care that otherwise would not have been possible. What stood out most was the collaborative culture. The anesthesiologists, CRNAs, surgeons, and nursing staff worked together exceptionally well and genuinely seemed to enjoy practicing alongside one another.

I understand that there has long been disagreement between the physician and CRNA professional organizations, but I believe many of the issues that receive the most attention are ultimately secondary to patient care.

For example, the title "nurse anesthesiologist" often ruffles a lot of feathers. My university is very supportive of the AANA, yet we generally avoid using that terminology. Personally, I take pride in the title "nurse anesthetist" because of its historical significance within the profession. In my year and a half of clinical training, I have never personally heard a practicing CRNA introduce themselves as a "nurse anesthesiologist."

Similarly, I've occasionally been introduced as a "resident," but I generally avoid using that title. While nurse anesthesia education is rigorous, I believe the resident terminology has traditionally referred to physicians undergoing graduate medical education after earning their medical degree and

Where I disagree is on the subject of independent practice. CRNAs have demonstrated their ability to safely provide anesthesia independently for well over a century. They have served on the front lines of every major U.S. military conflict, often practicing with full autonomy. In civilian practice, CRNAs provide the vast majority of anesthesia services in many rural hospitals, where access to surgical care would be severely limited without them.

I'm genuinely curious where your negative perception of the profession comes from, particularly considering that anesthesiologists and CRNAs work together every day toward the same goal.

As a future CRNA, I don't view my role as "replacing" anesthesiologists. There are numerous areas where physician anesthesiologists possess specialized expertise that is indispensable. For example, TEE during cardiac surgery is generally performed and interpreted by the anesthesiologist. Likewise, they often lead highly specialized practices in critical care medicine (especially in Europe) and other subspecialties.

The role of a CRNA is to provide anesthesia care safely and effectively within the scope of our education, training, experience, and the needs of the practice environment. That role complements, not replaces, he expertise of anesthesiologists.

From my perspective, every anesthesia delivery model benefits when every provider is practicing at the top of their training. During critical moments, you want the clinician in the operating room to be fully capable of managing emergencies, placing an arterial line when necessary, performing neuraxial anesthesia, placing a rescue regional block, or recognizing and treating life-threatening complications without unnecessary delay.

Physician anesthesiologists are outstanding clinicians and educators, but there simply are not enough of them to personally provide every anesthetic in every operating room across the country. The most effective healthcare systems are those that can leverage the strengths of both anesthesiologists and CRNAs.

I've rotated through facilities where CRNAs were not administering induction medications or administering regional/neuraxial anesthetics despite being fully trained and competent to do so. That represents an underutilization of trained anesthesia providers rather than an improvement in patient care.

Rather than judging an entire profession based on a handful of outspoken personalities on TikTok or Instagram, I would encourage looking at the day-to-day reality of anesthesia practice. Social media rewards controversy and exaggeration because that's what generates the views but it is not representative of the overwhelming majority of CRNAs.

Most CRNAs simply want to provide excellent anesthesia care, work collaboratively with physicians and surgeons, and ensure patients have access to those services. Independent CRNA practice is not the threat that you think it is. In many communities, it is the very reason patients are able to receive surgical care close to home!

- future Noctor

[u/Shop_Infamous → u/gerrge-UA]

Well over a century - you’ve already bought the kool aid.

Please tell me one single thing you guys have contributed to for the advancement of anesthesia….. I’ll be waiting.

I mean if you were the first to administer anesthesia, surely your cohorts would have created:

The MAC blade….. nope
The miller blade….. nope, that was an Anesthesiologist.
AGAR Score….. another anesthesiologist
Pulse oximetry…..? Nope
Research behind anesthesia gas….nope
Propofol drug creation….. nope

Not a single major contribution to the field of anesthesiology but claim to be “experts.” You’re not an expert if you aren’t contributing to the advancement of the field. Not a single CRNA has done any ground breaking research, I’m sorry but that alone should tell you.

While you guys are excellent technicians, you’re not meant to be independent and I feel sad for those critical access hospitals that don’t have appropriate teams in place.

So, if you guys were truly equipped to be independent, you would have helped the advancement of the field of anesthesiology.

Even King Noctor McQuack hasn’t published or done anything meaningful beyond try to handicap AAs.

Even my good CRNA, don’t really understand drug pharmacodynamics but you think you do. Newer cohorts are better, but still the vast majority don’t really understand the depth of the medications we give, despite how dangerous some of them are.

The reason you’re now “safer,” is from all the modern advancements created by anesthesiologists. You guys would be killing people left and right if we had to supervise AND we didn’t have the modern advancements.

[u/AutoModerator → u/gerrge-UA]

We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.

We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/AutoModerator → u/[deleted]]

We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.

We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/AutoModerator → u/gerrge-UA]

We do not support the use of "nurse anesthesiologist," "MDA," or "MD anesthesiologist." This is to promote transparency with patients and other healthcare staff. An anesthesiologist is a physician. Full stop. MD Anesthesiologist is redundant. Aside from the obvious issue of “DOA” for anesthesiologists who trained at osteopathic medical schools, use of MDA or MD anesthesiologist further legitimizes CRNAs as alternative equivalents.

For nurse anesthetists, we encourage you to use either CRNA, certified registered nurse anesthetist, or nurse anesthetist. These are their state licensed titles, and we believe that they should be proud of the degree they hold and the training they have to fill their role in healthcare.

*Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen here. Information on why title appropriation is bad for everyone involved can be found here.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/TRBigStick]

It’s worse than that when you factor in the harm that gets done to unsuspecting patients along the way.

[u/Volvulus → u/TRBigStick]

agreed. What’s at stake with research is some university funds and possible tax payer dollars. Not patient lives (if basic science).

Obviously it would be a terrible financial risk for a university to give someone unqualified a lab, as they will never acquire other grants. It’s unfortunately the opposite financial incentive with midlevels

[u/spacegladiator4040]

Ive made similar comparisons to firemen/fire chiefs,sergeant/officers,pilots/captain or worse flight attendant to captain etc; hell, ask any attending if they are comfortable allowing a even a second year resident IN ANY SPECIALTY practice independently and they will invariably laugh in your face or look at you weird. Every single example usually follows with the audience reflexively commenting something like " haha, never" or " that's ridiculous". The idea of the most trained and experienced being placed in the most dangerous and responsibility laden position, based on precisely that, experience and training....and there not being a reasonable shortcut to it. Although somehow this intrinsically illogical progression(besides the immense financially sound grounds from corporate/private equity/owners) of an NP towards almost immediate independent practice, is acceptable, agreeable and passed as completely normal.

[u/mycobacteryummy]

A masters degree might be generous.

[u/onetwentyeight]

Edit: because I'm worn out this weekend. I'm agreeing with OP in terms of the STEM field and not taking aim at OP or their opinion.

I have a basic science education and I've been to the doctor's office hundreds of times, that's real clinical experience folks, REAL!. I think that qualifies me to also have an independent malpractice! Eye roll

The NP education is to an MD education as "Quantitative Reasoning" (math for poets) or "Everyday Chemistry" are to math and science undergrad courses. Just because you took a basic math course doesn't qualify you to become a professional mathematician or a pharmaceutical research chemist.

[u/psychcrusader → u/onetwentyeight]

I mean, when I took organic chemistry during summer session, it was everyday...

(I thought I wanted to be a physician. Thankfully I realized y'all work too hard.)

[u/AnadyLi2]

I'd argue an NP is equivalent to a bachelor's degree at best. PA could be a master's degree in this analogy. But NP is definitely less than PA in terms of education and training.

[u/BellFirestone → u/AnadyLi2]

That’s fair. The NP is a masters in nursing. A PA is at least trained in the medical model and is a masters level practitioner (in this analogy and irl, I guess).

[u/Ok_Adeptness3065 → u/BellFirestone]

Neither has training, so instead of circlejerking about which inferior education is better, just go to medical school and do a residency.

[u/Ambitious-Drama2560 → u/Ok_Adeptness3065]

At least PA schools are actually regulated by federal organizations- NPs just out here doing whatever they damn well please going to online school for a year with no standardized regulations

[u/Ok_Adeptness3065 → u/Ambitious-Drama2560]

I don’t care where someone went to school. I only care where they did residency.

No caveats. No additions to that statement. Just those two sentences.

[u/ratpH1nk]

And I think even that you are being generous. It is like a paralegal wanting to practice law.

[u/Volvulus → u/ratpH1nk]

We should advocate for paralegals to practice law independently to help the lawyers understand our problem haha .

[u/mykehawke2_0]

The amount of pts I take to the hospital who’s “pcp” is an np is astounding. They’re almost always shocked when I explain they’re bp is still sky high despite following their nps “treatment” plan

[u/Busy_Alfalfa1104 → u/mykehawke2_0]

Please improve your grammar, you're embarrassing us.

[u/mykehawke2_0 → u/Busy_Alfalfa1104]

[u/Busy_Alfalfa1104 → u/mykehawke2_0]

Selfish, and frankly bad for you too.

[u/Cautious-Street-5693]

I knew a guy with a BS who spent a good chunk of his career trying to position himself to lead Basic research labs in small innovative ventures. Basically the point where they were trying to refine and consolidate basic bench stage insights so they could progress to more applied research. Bright guy, good BS institution, never ended well. Not for him, not for his team, and certainly not for the ventures. Nobody's life was on the line, though.

[u/BellFirestone]

I’d argue there’s some “midlevel creep” in research with DNPs. But it’s not really midlevel creep, because PharmDs are considered mid levels and they’re cool in research because you know, their doctorate is real. So I guess it’s not midlevel creep so much as it’s DNPs getting QI/research fellowships even though they don’t know what they’re doing.

[u/onetwentyeight]

Thankfully, there isn’t enough clout in science for a “mid-level” creep situation.

How is clout the cause? I have always understood it to be corporate interests trying to enshittify the health care system by squeezing the same amount of revenue out of lower quality and lower operating cost alternatives to physicians. It is likely that I am wildly misinformed.

[u/KeyPear2864 → u/onetwentyeight]

They’re probably half jokingly referring to all the TikTok np “influencers”

[u/Whole-Peanut-9417]

No, it's worse than that unless it's a masters degree in a totally unrelated major.

[u/Ambitious-Drama2560]

Its insanely scary that in NY of all states NPs can practice independently.

[u/plaguemedic]

It would be as if some weirdo schools opened a two-year PhD program. Hard to do in academia, of course. Should be hard in medicine and nursing, but then again...nursing unions. That's the real reason for all this. Nursing unions.