Anesthesia is the medicine used to relieve pain, numb a part of the body or put a patient to sleep so that health care professionals can perform medical procedures. Administering anesthesia is a challenging job that requires precision. Giving a patient too little anesthesia can result in the patient feeling extreme pain or waking up during a surgery, while giving too much of these medications could potentially be fatal.

Because it is so important to administer just the right amount of anesthesia, the health care professionals who do this work need advanced education and training. Generally, there are two types of healthcare providers whose primary job role is to administer anesthesia: nurse anesthetists and anesthesiologists.

To work in either of these careers, you need a great deal of education and clinical experience. Both of these careers are highly regulated and require professional licensing and certification. Even though nurse anesthetists and anesthesiologists perform similar work, in the sense that they both administer anesthesia, they follow different education and career paths.

nurse anesthetist vs anesthesiologist IMAGE SOURCE: Wikimedia Commons , public domain

Nurse Anesthetist vs Anesthesiologist in a Nutshell

The most basic difference between these otherwise similar careers is that a nurse anesthetist is a nurse, and an anesthesiologist is a physician. To those outside the field, this may seem like splitting hairs. However, nurses and physicians approach clinical practice from different models of care, and their education and certification requirements reflect these nuances.

Patients under the care of either a fully credentialed nurse anesthetist or an anesthesiologist can rest assured that they are in good hands. Regardless of which path a provider pursues, they undergo a lot of advanced and specialized schooling, gain supervised clinical experience and must meet high standards to acquire and maintain their professional credentials.

Both of these career options have their advantages, so it’s difficult to argue that one is superior to the other. For example, anesthesiologists earn more money than nurse anesthetists, but they also put in more time – and a greater financial investment – into their education. 

Clinical Practice in the Nursing vs. the Medical Field

The biggest difference between nurse anesthetists and anesthesiologists is simply that of a nursing background compared to a physician’s educational background. The full title for nurse anesthetists is Certified Registered Nurse Anesthetist (CRNA). CNRAs are a type of advanced practice registered nurse (APRN). Anesthesiologists are doctors who complete medical school, clinical rotations, internship and a residency.

The job duties of anesthesiologists and nurse anesthetists overlap a great deal, as these highly trained health care professionals provide many of the same services. Both work directly with surgeons and patients, administering anesthesia, monitoring the patient while under anesthesia and adjusting the medication as necessary. Much of the difference between nurse anesthetists and anesthesiologists is the difference in philosophy between the fields of nursing and medicine.

Generally speaking, the medical model of treating patients is more focused on diagnosing and treating diseases, while the nursing model puts more emphasis on patient care. Physicians are usually the leaders and primary decision-makers of health care teams and are the most accountable for patient outcomes, but nurses typically have more direct contact with the patient.

You might choose to become a nurse because you feel strongly about the nursing model of care and believe you would get the most job satisfaction from helping ease patients’ pain. On the other hand, if you’re more interested in looking at pain relief and surgery preparation as a problem to be solved than a patient’s need to be met, the doctor’s perspective of an anesthesiologist may be a better fit for you.

The differences between medical models and nursing models of healthcare exist across all specialties, but they may be less pronounced when it comes to nurse anesthetists and anesthesiologists compared to other roles in nursing and medicine. Nurse anesthetists must still know precisely how to fix a problem that occurs when a patient is under anesthesia, and anesthesiologists will still be tasked with treating patients, who are often either already in pain or nervous about an upcoming surgery, with care and compassion.

Nurses have been administering anesthesia for more than 150 years, with the CRNA credential first appearing in 1956, according to the American Association of Nurse Anesthetists .

Anesthetist vs Anesthesiologist Education and Training

A big difference between nurse anesthetists and anesthesiologists is how they prepare for their roles. Nurse anesthetists begin their careers as registered nurses (RNs), often by earning an associate’s degree in nursing (ADN) or a Bachelor of Science in Nursing (BSN) degree. They must pass the National Council Licensure Examination (NCLEX-RN) and attain their RN license.

Typically, a registered nurse needs to spend at least one year working full-time in the field of nursing before beginning an advanced nursing education program. Currently, most APRNs, including nurse anesthetists, complete a Master of Science in Nursing (MSN) degree program, according to the United States Bureau of Labor Statistics (BLS). However, that may change very soon. By the year 2025, new nurse anesthetists will be required to hold a doctoral degree, according to U.S. News & World Report , and other APRNs will be “strongly encouraged” to get one, as well. O*NET reported in 2021 that, among nurse anesthetists specifically, 56 percent held a doctoral degree. For 41 percent of nurse anesthetists, a master’s degree was their highest level of formal education. The remaining nurse anesthetists reported having a professional degree.

MSN and Doctor of Nursing Practice (DNP) degree programs for nurse anesthetists include introductory, intermediate and advanced coursework in the principles of anesthesia as well as the physics and chemistry of how anesthesia works and how it is given. To become a CNRA, you will need to administer anesthesia in a clinical setting, under the supervision of anesthesiologists and nurse anesthetists, a minimum of 600 times. Aspiring CNRAs gain thousands of hours of hands-on clinical experience as they prepare for this role.

Anesthesiologists are specialized physicians, and as such, they need a doctor’s education. This begins with a bachelor’s degree, often in a major such as biology, chemistry or pre-medical studies. Students must be accepted into medical school, which is highly competitive. Prospective medical school applicants don’t only need top grades and science prerequisites. They are often expected to have research experience, volunteer experience and experience shadowing a physician, as well.

Students also need to earn competitive scores on the Medical College Admission Test, a graduate examination used specifically for students who are bound for medical school. While aspiring nurse anesthetists may also have to take a standardized exam for admissions, they typically take the Graduate Record Examination (GRE) General Test, which is the same test used for acceptance into graduate programs in most fields.

Once aspiring doctors get into medical school, they must complete two years of classroom and laboratory studies and an additional two years of clinical rotations in a number of specialties in order to attain their Doctor of Medicine (MD) or the Doctor of Osteopathic Medicine (DO) degree, according to the BLS .

After finishing medical school, prospective anesthesiologists must complete a yearlong internship in general medical, surgical or pediatric training and three years of residency experience in clinical anesthesiology, the American Society of Anesthesiology reported. Though not required, a yearlong fellowship is valuable if you wish to work in a subspecialty of anesthesiology such as critical care medicine, cardiac anesthesiology, neuro-anesthesiology, obstetric anesthesiology, pediatric anesthesiology or pain management. Once your residency is complete, you will probably want to join the nearly 75 percent of anesthesiologists who attain certification from the American Board of Anesthesiology.

 All told, your education after high school will take at least seven years if you become a CNRA, and at least 12 years if you become an anesthesiologist. 

CRNA vs Anesthesiologist Professional Credential Requirements

CRNAs have to pass a national certification exam and get an APRN license.

Nurse anesthetists must get their registered nursing license before they even begin their Master of Science in Nursing or Doctor of Nursing Practice studies. After they complete an accredited graduate-level program, they must meet their state’s requirements for an advanced practice registered nurse license.

Detailed requirements are available from each state’s board of nursing, but most states require national certification for candidates to become licensed and use an APRN title. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the National Certification Examination (NCE). Certified registered nurse anesthetists (CRNAs) must maintain their certification through the Continued Professional Certification (CPC) Program.

Physicians like nurse anesthetists need a license to practice medicine. Besides earning their MD or DO degree from an accredited medical school and finishing the residency required for their intended specialty, new doctors need to pass a standardized national exam to get their licenses. New doctors seeking licensure must take one of two exams, depending on which medical degree they received. MD graduates have to pass the U.S. Medical Licensing Examination (USMLE) test, while earning a DO puts you on the path to taking the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).

Physicians should also consider seeking board certification, which the BLS reported is voluntary but valuable. The American Board of Anesthesiology awards board certification for this medical specialty. To become board-certified in anesthesiology, you need to pass a series of stages exams: the basic exam, advanced exam and applied exam.

Both nurses and doctors need to maintain their licenses after they first receive them. Generally, that means meeting continuing education requirements periodically. After all, new technological and biomedical engineering innovations allow medical testing and interventions to keep advancing, and practicing nurse anesthetists and anesthesiologists need to keep abreast of those advances.

Often, nurse anesthetists and other types of advanced practice registered nurses are expected to have some sort of cardiopulmonary resuscitation (CPR) or basic life support (BLS) certification as well as their professional certification, according to the BLS. 

Differences in Earning Potential and Cost of Education

Other than the philosophical differences between nursing and medical models, why would someone choose to spend 12 years studying to become an anesthesiologist rather than becoming a nurse anesthetist in seven years? For one thing, there is a considerable difference in earning potential. Both of these careers offer lucrative salaries due to the high level of responsibility and the intense educational demands.

Nurse anesthetists are among the most highly paid nurses out there, with a median wage of $183,580 as of 2020. Anesthesiologists are also the top earners among doctors – but their median salary in 2020 was $271,440 per year, the BLS reported.

Although new doctors do get paid during their residency and fellowship years, they don’t make anywhere near the salary that fully trained physicians make. In 2019, the average salary for medical residents was $61,200, according to Medscape . Even though anesthesiology is among the highest-paying medical specialties, residents in this specialty earn $61,500, which is barely more than that average salary and still several thousand dollars below the highest-paying specialties for residents. Nurse anesthetists, on the other hand, begin working in their full clinical capacity once they have finished school – including their clinicals – and gotten licensed. That means they begin earning entry-level nurse practitioner salaries much earlier than anesthesiologists begin earning a full physician’s salary, and they continue to do so during the years that anesthesiologists are finishing school, residency and fellowships.

However, there’s more to consider than just annual salaries. How much income is a prospective anesthesiologist missing out on during those five extra years of school that a nurse anesthetist doesn’t have? How much does it cost to train for a career as a nurse anesthetist or an anesthesiologist?

Ultimately, when choosing between a nurse anesthetist and an anesthesiologist career, you need to look at all of the factors, including the education and training needed for these careers, as well as earning potential.

The tuition for a DNP program typically costs tens of thousands of dollars – while the price tag for medical school may be in the hundreds of thousands of dollars. Most students will take out student loans for their advanced healthcare studies, which means they will be paying back these high tuition costs with interest. 

Additional Resources 

What Is the Difference Between a Nurse Anesthetist and a Regular Nurse?

What Is the Role of a Nurse Anesthetist?

What Kind of Certifications Does It Take to Be a Nurse Anesthetist?

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