CRNA vs. Anesthesiologist Assistant vs. Anesthesiologist

Overview of Each Role

What is an anesthesiologist assistant (AA)?

An anesthesiologist assistant is a healthcare professional with a master’s degree who works exclusively under the supervision of an anesthesiologist. Typically, anesthesiologist assistants undergo a fairly intensive two-year master’s program to work as part of an anesthesia care team. Since they can only work under the license of an anesthesiologist, they are considered “dependent practitioners.”

What is a Certified Registered Nurse Anesthetist (CRNA)?

A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice nurse with a doctoral-level degree who has passed the National Certification Examination for Nurse Anesthetists. They are able to practice as independent practitioners with a high level of autonomy in anesthesia care.

Check out George Fox University’s hybrid-online doctoral CRNA program in Oregon

What is an anesthesiologist?

An anesthesiologist is a physician who is trained in and practices anesthesia. They hold an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathy) and can both practice anesthesia and treat patients outside of anesthesia.

What does each role do?

Anesthesiologist Assistant

An AA can essentially do anything that the anesthesiologist delegates for them, as they’re working under the license of the anesthesiologist. Anesthesiologist assistants are well-trained and often perform intensive procedures, such as open-heart surgeries, under the supervision of anesthesiologists.

However, they are still dependent on the anesthesiologist, which means they cannot practice without the anesthesiologist's presence and direct supervision.

They do not design or oversee anesthesia plans, though they can practice anesthesia in various settings under the supervision of an anesthesiologist. Also, an AA cannot work under the supervision of a CRNA and is always tied to a practice or hospital where anesthesiologists are the leaders part of the anesthesia care team.

CRNA

A Certified Registered Nurse Anesthetist can work independently or side-by-side with an anesthesiologist or any other practitioner requiring anesthetic services. CRNAs often work more independently in rural areas and collaborate with a wider team in urban areas.

CRNAs and anesthesiologists both work in and outside of the operating room, monitoring vital signs before, during, and after anesthesia. Both are trained to handle any complications that may arise. They are also licensed to prescribe medications and perform procedures for chronic pain outside of ICU or emergency care settings.

Both CRNAs and anesthesiologists practice to the same standard of care, using the same body of knowledge, literature and procedural competence.

Even though becoming an anesthesiologist requires more training, it’s important to remember that the CRNA and anesthesiologist are trained in different models. The CRNA is trained in the nursing model, while the anesthesiologist is trained in a medical model.

While the medical model is a diagnosis-based model of care, the CRNA uses the more holistic nursing model to analyze care-related problems and assess appropriate treatment. Since the science required for each is the same, many of the conclusions each reaches depend on their training and experience.

Both an anesthesiologist's and a CRNA’s local scope of practice are determined by hospital privileges, which are usually set by each hospital. Under state law, anesthesiologists usually have more latitude. In other words, it matters where you practice.

For example, if I work independently as a CRNA in rural Oregon, there’s nothing I can’t do according to state law. It’s left to my professional judgment. In our state, the Oregon Nurse Practice Act says that if I have the training to do something, I've been granted privileges to do it, and it's related to an episode of care, I can do it.

On the other hand, in a more urban setting where an anesthesia care team is primarily led by anesthesiologists overseeing a team of AAs, CRNAs may be more limited in their hospital privileges.

In some states, CRNAs may require a practice agreement with an anesthesiologist or other physician.

Anesthesiologist

Anesthesiologists are independent practitioners with a medical license, so their scope of practice is the widest. They can work in hospital settings as part of an anesthesia care team and, through their license, have the ability to move into other areas of medicine.

Patient Outcomes

While many studies have compared patient outcomes, they have consistently shown no difference in patient outcomes when anesthesia is performed by a CRNA versus an anesthesiologist.

Again, it’s common for CRNAs to work more independently in rural contexts, but that is an access issue. CRNAs train to provide the same level of patient care as anesthesiologists, and outcomes tend to be consistent across both roles.

Although location often determines who a patient will have in the operating room, patients can go into surgery confident that both are well-trained to provide top-level care.

How much do professionals in these roles earn?

• Anesthesiologist Assistant: Between $160,000 and $200,000.
• CRNA: Low $200,000 range
• Anesthesiologist: Mid to high $300,000 range

Salary ranges will also depend upon the rural or urban setting and the practice context. As CRNAs and anesthesiologists are independent practitioners, there are more entrepreneurial opportunities outside of the hospital setting, such as the establishment of pain clinics and whole hospital service coverage, which can bring significant earning potential.

How do the education requirements for these jobs compare?

• Anesthesiologist Assistant: 6 years of post-secondary (after high school) education
• CRNA: 9-10 years of post-secondary education
• Anesthesiologist: 12 years of post-secondary education

To become an anesthesiologist assistant, you’ll need a bachelor’s in biology (or some other undergraduate degree with a high concentration of biology content) and a master’s degree in anesthesia studies, along with a passing grade on the National Commission for the Certification of Anesthesiologist Assistant (NCCAA) certification exam.

A CRNA currently requires a doctoral education for entry into practice (not an M.D. or D.O.) that is completed after a student completes their BSN (bachelor's in nursings), along with significant clinical hours. A CRNA is not a physician, but they are now required to hold a doctorate for entry into nurse anesthesia practice.

An anesthesiologist must graduate from medical school to practice. As such, they don’t need the same clinical experience before entering their post-secondary education. However, they do need to complete their pre-med requirements and take the MCAT to be admitted to a medical program.

Once accepted, anesthesiologists complete an internship in their first year – it's like a year long orientation into the practice of medicine for physicians. They then complete three years of anesthesia training and on completion pursue specific fellowships, such as cardiac, OB, or pediatric training.

An anesthesiologist’s typical trajectory is to attend medical school for four years, apply for an internship, and then complete three years of anesthesia residency.

Comparing these three paths, you could become an AA with six years of post-secondary (after high school) education, and a CRNA with nine to 10 years of post-secondary education (if you include ICU experience). Becoming an anesthesiologist requires roughly 12 years of post-secondary education.

Each role learns roughly the same content and requires a didactic (classroom) portion of their education, as well as a great deal of hands-on training with extensive clinical rotations.

What are the pros and cons between these professions?

Under their medical licensure and training, the anesthesiologist has more latitude in what they can do. As such, it’s easier for them to have privileges to practice outside the purview of anesthesia, including performing procedures and prescribing medication to care for patients beyond pain management, such as treating blood pressure, diabetes, etc.

Simply stated, this is the latitude a medical license allows. This is a big pro.

They also receive a more comprehensive education that includes other aspects of medicine rather than solely focusing on anesthesia.

As a CRNA in the state of Oregon, I have prescriptive authority, meaning I can prescribe medication. However, it must pertain to anesthesia or pain management for an established patient. My license is restricted to performing anesthesia. While the scope of practice for CRNAs is fairly broad, the Board of Registered Nursing still imposes limits.

While an AA can perform many of the procedures that either an anesthesiologist or a CRNA can perform, they have no autonomy outside the anesthesiologist’s supervision. By duty and license, they are required to carry out the anesthesiologist’s proposed plan. While a CRNA has a license independent of the anesthesiologist (M.D.), an AA does not.

As such, the AA does not have the decision-making power of a CRNA or an anesthesiologist. This is an important factor to consider, as it can be either a pro or a con, depending on one’s career goals.

However, when you consider the time and return on investment, those interested in anesthesia who don’t want to invest the time and money required to become a CRNA or anesthesiologist have another option. They can finish a bachelor’s degree in any field, take some leveling courses in biology, and become an AA in two years with a starting salary of up to $200,000 upon graduation.

Which path is right for you?

Three important factors to consider when choosing between these roles in anesthesia are portability, autonomy, and timing of specialization.

As a CRNA, I have much more portability in my role, whether between rural and urban settings or from state to state. While an AA is mostly constrained to working in a hospital setting, as a CRNA, I can open a pain clinic, an infusion center, or a ketamine clinic. There’s much more latitude in what I can do.

Autonomy can influence career longevity and job satisfaction. As I’ve mentioned, anesthesiologist assistants are dependent practitioners, and CRNAs have limits on their practice in certain settings, while anesthesiologists have the most autonomy.

Timing of specialization may also be a factor for you if you’re undecided. The CRNA's nursing path can largely follow a learn-as-you-go trajectory. You can start in nursing and decide whether you want to become a nurse practitioner, CRNA, midwife, psychiatric nurse practitioner and so forth. Up to the point where you start your training as a CRNA, you can continue to work and gain experience in nursing to see what fits you best.

While physicians can do this to some extent, once they begin their medical school training, they’re on a track toward a specific destination.

If you’re considering a career in any of these anesthesia specialties, find a practitioner to shadow and spend some time in their environment to see which role might be the right fit for you!