Both Certified Registered Nurse Anesthetists (CRNAs) and anesthesiologists play a key role in ensuring patient safety during surgeries and other procedures requiring anesthesia.
While each practitioner strives to keep patients comfortable and stable, these two types of providers emerge from different healthcare professions.
CRNAs are advanced practice registered nurses with specialized training in anesthesia, whereas anesthesiologists are medical doctors who have completed medical school and residency programs in anesthesiology.
By exploring how they differ in education, responsibilities, scope of practice, influence on patient outcomes, and other key areas, you can gain a greater appreciation for the high-quality anesthesia care that both CRNAs and anesthesiologists provide in the United States.
Below, we’ll compare the two roles in terms of education, duties, state law, salaries, and more.
Let’s dive in.
Education and Certification Pathways
The first point in our comparison is education and certifications because that’s also the first step in these career paths.
How to Become a Certified Registered Nurse Anesthetist (CRNA)
CRNAs build their career on a nursing foundation and then expand into advanced anesthesia training. Below is an overview of this process.
The path begins with a Bachelor of Science in Nursing (BSN) or another degree in nursing from an accredited nursing school. This undergraduate preparation covers fundamental health sciences, patient care principles, and the clinical skills essential for any registered nurse. After graduating, prospective CRNAs must pass the NCLEX-RN exam and obtain licensure as a Registered Nurse (RN).
Next, most CRNA programs require at least one year of professional experience in an intensive or critical care unit, although, in practice, incoming CRNA students average over two years of ICU experience.
This hands-on work is critical for developing monitoring skills, understanding the management of unstable patients, and gaining familiarity with critical care medicine. In fact, CRNAs are the only anesthesia providers required to have prior critical care nursing experience before starting their anesthesia training.
After fulfilling that prerequisite, the individual applies to an accredited graduate nurse anesthesia program. These programs are now doctoral-level (Doctor of Nursing Practice or Doctor of Nurse Anesthesia Practice) and typically require about 36 months of full-time study, as described by the American Medical Association (AMA).
They provide comprehensive didactic instruction in areas such as physiology, pharmacology, and anesthesia principles, coupled with extensive clinical rotations that let students administer anesthesia to patients under appropriate supervision.
By 2025, all new CRNA graduates must earn a doctoral degree—either a DNP or DNAP—a move designed to reflect the profession’s advanced scope. During these doctoral programs, nurse anesthesia students accumulate thousands of hours of clinical training and complete numerous anesthesia cases involving different medical procedures, as outlined by the American Association of Nurse Anesthesiology (AANA).
Once they finish their nurse anesthesia program, individuals must pass the National Certification Examination (NCE) through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). This successful examination grants the title of Certified Registered Nurse Anesthetist. They then seek licensure in their particular state as an Advanced Practice Registered Nurse (APRN) authorized to provide anesthesia.
CRNAs also fulfill continuing education requirements under the NBCRNA’s Continued Professional Certification (CPC) program, which runs in eight-year cycles. This ongoing recertification ensures that CRNAs remain current with patient safety standards and the latest medical practices.
How to Become an Anesthesiologist
Anesthesiologists begin their journey with an undergraduate degree, which is typically four years and includes requisite pre-med courses such as biology, chemistry, and physics.
Successful admission to medical school then follows, adding four more years of education that focus on broad medical knowledge, foundational clinical skills, and multi-specialty rotations where future anesthesiologists may first develop an interest in anesthesia care.
During these rotations, students learn patient care principles in diverse settings, from primary care to surgery.
Upon completion of medical school, graduates enter an anesthesiology residency program that usually lasts four years. One year is often devoted to general medicine or surgery (the internship), followed by three years of specialized anesthesiology training under the supervision of senior physicians.
During this time, residents gain around 12,000–16,000 hours of clinical experience by participating in thousands of anesthetics across surgical specialties. This figure far surpasses the clinical hours typical of a nursing-based curriculum, as noted by the American Society of Anesthesiologists (ASA) and further explained by the ASA’s advocacy materials.
Many anesthesiologists choose to continue their training through a one- or two-year fellowship, which refines their expertise in a particular subspecialty, such as pediatric, cardiac, obstetric, regional anesthesia, acute pain, or critical care. While optional, these fellowships enhance skill sets in managing specific patient populations or medical procedures, as noted by the AMA.
Finally, after completing residency (and fellowship, if applicable), the physician obtains a state medical license and typically pursues board certification from the American Board of Anesthesiology. This certification involves demanding written and oral exams and requires ongoing participation in continuing medical education.
How long to become an anesthesiologist?
Altogether, becoming a fully trained anesthesiologist takes at least 12 years beyond high school (4 years of undergraduate study, 4 years of medical school, and 4 years of residency).
If the physician pursues a fellowship, the total timeline stretches to 13–14 years. By that point, anesthesiologists hold MD or DO degrees and possess a broad background in medicine, specializing in anesthesia care and perioperative medicine.
What Does a CRNA Do? Role of a CRNA
CRNAs focus on the anesthesia needs of patients before, during, and after procedures, applying the advanced skills and knowledge they gained through clinical training and specialized nursing education. They conduct thorough pre-anesthetic evaluations, which involve reviewing a patient’s medical history, allergies, medications, and current health status.
Based on this assessment, CRNAs devise an anesthesia plan and coordinate with the surgical team to ensure everyone is prepared. Here’s a good visual of their duties:
During the surgical procedure, CRNAs administer the chosen anesthesia modality—whether general anesthesia, regional anesthesia such as spinal or epidural blocks, or sedation—and closely monitor the patient’s vital signs, including heart rate, blood pressure, and oxygenation.
They remain vigilant for any changes, adjusting anesthetic depth and medications as needed to keep the patient stable and comfortable. CRNAs are also responsible for airway management, which can include performing endotracheal intubation, and they oversee the patient’s emergence from anesthesia afterward.
Where Do CRNAs Work and Who Do They Report To?
In many environments, CRNAs function as part of an anesthesia team, typically led by an anesthesiologist in states or facilities that require medical supervision. However, CRNAs can also practice independently, depending on local laws and facility policies.
Beyond the operating room, some CRNAs participate in institutional protocols to enhance anesthesia safety or engage in quality improvement programs. In rural or military settings, they are often the sole anesthesia providers, taking on full responsibility for patient anesthesia management. Some also provide non-surgical pain management interventions, depending on state scope-of-practice regulations.
Regardless of the setting, CRNAs’ work emphasizes autonomy and accountability for outcomes tied to anesthesia care.
It is worth noting that some in the field refer to CRNAs as “nurse anesthesiologists,” but we use “CRNA” here for clarity. The American Association of Nurse Anesthesiology (AANA) emphasizes that CRNAs deliver a full range of anesthesia services. In many practice settings, CRNAs perform tasks equivalent to an anesthesiologist in terms of putting patients under anesthesia, monitoring them intraoperatively, and helping them recover safely.
What Does an Anesthesiologist Do? Role of an Anesthesiologist
Anesthesiologists, as fully licensed physicians, engage in comprehensive perioperative medicine. Here’s an overview of their role:
They conduct detailed preoperative evaluations, which may include specialized anesthesia clinics for high-risk patients, to review medical records, perform physical examinations, and order tests aimed at optimizing the patient’s health status before surgery.
During these evaluations, anesthesiologists consider coexisting medical conditions—such as asthma or diabetes—and create an anesthesia plan that suits the patient’s unique needs.
When delivering anesthesia during a surgical procedure, anesthesiologists may perform the process themselves or supervise CRNAs and anesthesiology residents in what is often termed the anesthesia care team. They oversee the full breadth of anesthesia methods, from general anesthesia to regional or local anesthesia, and their responsibilities include continually assessing a patient’s vital signs, addressing any hemodynamic instability or unexpected complications, and adjusting medications.
By virtue of their medical school and residency training, anesthesiologists also diagnose and treat medical issues like heart arrhythmias, hypotension, or bleeding that occur during surgery, intervening beyond strictly anesthetic management. This broader skill set enables them to handle complex emergencies and coordinate care should the patient require intensive care postoperatively.
The American Medical Association describes anesthesiologists as physicians who support vital organ functions, diagnose and treat pain, and manage critical care for patients with severe injuries or illnesses.
Many anesthesiologists extend their practice outside the operating room to manage both acute and chronic pain. Those with specialized fellowships often run pain clinics, providing interventions like nerve blocks or epidural steroid injections, and may serve as intensivists in critical care units.
Additionally, anesthesiologists frequently assume leadership roles, such as directing anesthesia departments, heading safety committees, or supervising resident physicians. Their expertise, therefore, spans all aspects of anesthesia and associated medical decision-making.
CRNA vs. Anesthesiologist: Overlapping Duties
Despite the differing educational pathways, CRNAs and anesthesiologists often perform nearly identical tasks when focusing specifically on anesthesia administration.
Both evaluate patients preoperatively, confirm a thorough medical history, and determine an appropriate anesthesia plan in collaboration with the surgical team. Both also induce and maintain anesthesia, either through intravenous medications, inhaled anesthetics, or regional blocks, and remain vigilant about the patient’s condition throughout the operation.
They continuously monitor vital signs and respond to any signs of hemodynamic instability, adjusting the anesthesia accordingly or administering additional treatments, such as fluids or vasopressors.
They also share responsibilities in transferring patients safely to the recovery area, ensuring smooth emergence from anesthesia, and addressing immediate postoperative concerns like pain control or respiratory support.
If an emergency occurs, both CRNAs and anesthesiologists possess advanced cardiac life support training and expertise in airway management, so they can initiate CPR or other life-saving interventions without delay. Indeed, the American Society of Anesthesiologists (ASA) acknowledges that nurse anesthetists and anesthesiologist assistants share identical patient care responsibilities in the anesthesia care team model, as further detailed in its statement.
Numerous large-scale studies reinforce how patient outcomes are equally favorable whether anesthesia is delivered by a CRNA alone, an anesthesiologist alone, or a CRNA supervised by an anesthesiologist.
For instance, in a study in Health Affairs examining almost 500,000 cases, researchers revealed no difference in mortality or complications among these varied provider models. Thus, in many community hospitals and outpatient centers, CRNAs may function much like anesthesiologists in day-to-day anesthesia management, with behind-the-scenes distinctions regarding who holds ultimate medical responsibility.
Anesthesiologist vs. CRNA: Autonomy in Practice
Although CRNAs and anesthesiologists frequently overlap in their duties, legal scope-of-practice definitions and autonomy levels can vary widely, especially for CRNAs.
CRNAs are credentialed as advanced practice nurses authorized to provide all facets of anesthesia care, but the degree of physician supervision they require differs depending on the state and the facility.
In some regions, CRNAs practice fully independently and make their own anesthesia decisions from start to finish. They select anesthetic techniques, prescribe necessary medications, monitor patients, and handle any adverse events themselves.
This high-level autonomy is common in rural and military settings, where CRNAs often serve as the sole anesthesia providers. CRNAs independently manage all aspects of anesthesia care, and the AANA itself notes that CRNAs practice in a wide range of settings. Here’s a good visual outlining a CRNA’s level of autonomy:
Anesthesiologists, by contrast, always have full autonomy as physicians to practice medicine, irrespective of state-specific scope-of-practice regulations. They can independently perform any anesthesia-related procedure, make medical diagnoses and treatment decisions, and supervise or direct other anesthesia personnel.
Consequently, while a CRNA’s autonomy can be restricted by state law that mandates collaboration or supervision by a physician, an anesthesiologist’s autonomy in anesthesia care is unrestricted.
That brings us to the next point:
Where Can CRNAs Practice Autonomously? State Law Variations
State laws have a major impact on how CRNAs practice. Over 20 states (22 plus Guam, according to the AANA) have “opted out” of the federal Medicare supervision rule, allowing CRNAs to practice entirely independently.
Examples include Arizona, Idaho, and California. AANA documentation outlines which states have opted out, demonstrating that solo CRNAs can manage anesthesia safely and effectively. In these opt-out jurisdictions, a solo CRNA may handle multiple operating rooms or manage anesthesia services for an entire hospital.
In other states, laws require a certain level of physician oversight. This can range from formal supervision by an anesthesiologist or surgeon to a collaborative practice model where a written agreement outlines the CRNA’s scope. Some states also require physician co-signature for certain prescriptions, though in most locations, CRNAs have prescriptive authority for anesthesia-related medications.
Meanwhile, anesthesiologist assistants (AAs), another category of anesthesia providers, must operate strictly under physician anesthesiologist supervision and are only authorized in about 17 states and Washington, DC.
As a result, patients in opt-out states might never interact with an anesthesiologist if a CRNA is available to deliver safe anesthesia independently, whereas patients in non-opt-out states are more likely to see an anesthesiologist involved in some capacity.
Nevertheless, even in states mandating some degree of physician involvement, CRNAs typically manage moment-to-moment anesthesia administration themselves. The difference lies in whether a physician is ultimately required to be on-site or readily available.
CRNA and Anesthesiologist: Collaborative vs. Independent Practice
One common U.S. model is the anesthesia care team, where one anesthesiologist oversees two to four CRNAs. This arrangement allows the physician to supervise multiple operating rooms simultaneously, stepping in for crucial segments such as induction and emergence, or to manage emergencies.
The ASA endorses physician supervision to ensure patient safety, contending that physician anesthesiologists offer deeper medical expertise.
However, many CRNAs practice independently—especially in outpatient settings or rural hospitals—collaborating primarily with the surgeon rather than under direct physician supervision.
In either the team or solo provider model, CRNAs and anesthesiologists often collaborate seamlessly, sharing insights on complex cases, exchanging ideas on pain control, or taking over cases that fall within their respective comfort zones. From a patient’s perspective, the care typically appears fluid, with attention devoted to safety and efficacy above all else.
CRNA vs. Anesthesiologist: Impact on Patient Outcomes
A key question for patients and policymakers is whether patient safety differs when anesthesia is administered by a CRNA rather than an anesthesiologist. Research consistently shows no difference in mortality or major complications across these models.
For example, in a 2010 study published in Health Affairs analyzing roughly half a million cases, investigators concluded that there was “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians,” with no significant difference in inpatient surgical mortality or complication rates. Further findings reinforced that the RTI study demonstrated safety “is equal regardless of supervision.”
Similarly, a 2018 analysis in the journal Anesthesiology found that when an anesthesiologist supervised either a CRNA or an AA, there was no difference in death rates, length of hospital stay, or costs between cases involving nurse anesthetists versus anesthesiologist assistants. Likewise, systematic reviews by the National Library of Medicine show no meaningful differences in anesthesia-related complication rates between non-physician and physician anesthetists.
Although anesthesiologists are sometimes viewed as better equipped to handle unexpected crises or extremely high-risk patients because of their broader medical training, the data have not shown measurably higher complication rates under CRNA care, even in complex scenarios.
Both CRNAs and anesthesiologists follow standardized safety guidelines, such as continuous patient monitoring, time-outs, and emergency algorithms for anesthesia-related complications.
Consequently, patient satisfaction with anesthesia care often centers more on outcomes like effective pain relief and comfort than on the credentials of the provider. Studies show that poor pain control and postoperative nausea are among the top reasons for dissatisfaction, while many patients remain unaware of the distinctions between CRNAs and anesthesiologists.
CRNA vs. Anesthesiologist: Management and Decision-Making
While outcomes are similar, CRNAs and anesthesiologists may approach clinical decision-making from slightly different perspectives.
CRNAs train within the nursing model, emphasizing the use of established protocols, patient-centered care, and timely consultation if complications fall outside their routine scope. They excel at technical anesthesia delivery and the real-time monitoring of patients throughout surgery.
In states that require physician supervision, CRNAs know they can refer complicated issues to an anesthesiologist. In independent practice, they rely on their training to manage unexpected events and may call in help from other physicians (surgeons, cardiologists, etc.) if a complication significantly exceeds anesthesia-focused problem-solving.
Anesthesiologists approach anesthesia from a physician-level background. They are prepared to diagnose and treat complex medical conditions, rapidly perform additional diagnostics, and enact broader interventions if serious medical issues arise during anesthesia.
According to the ASA’s advocacy statement, nurse anesthetists are not trained in medical decision-making, differential diagnoses, or medical interventions to the same extent as physicians. In real-time practice, an anesthesiologist might recognize a sudden drop in blood pressure as more than an anesthetic side effect, suspecting a heart rhythm problem or allergic reaction, and initiate a broader diagnostic approach.
This level of immediate physician-based decision-making can be beneficial in rare or complex emergencies, although CRNAs in team-based environments can promptly involve anesthesiologists as well.
Nevertheless, in many cases, CRNAs operate mostly autonomously, especially in stable or routine procedures. The team-based environment usually depends on mutual respect, with anesthesiologists appreciating CRNAs’ expertise in anesthesia delivery and CRNAs valuing anesthesiologists’ comprehensive medical knowledge for critical situations.
CRNA vs. Anesthesiologist: Salary Comparison
CRNAs and anesthesiologists are among the most well-compensated professionals in healthcare, reflecting the significance of their role.
How Much Do CRNAs Earn?
The U.S. Bureau of Labor Statistics (BLS) reports that nurse anesthetists have a median annual salary of around $212,650, according to Saint Mary’s University of Minnesota.
The AANA similarly cites a median pay of $212,650, and in some areas or practice settings, CRNAs may surpass $220,000. Often, new CRNAs earn in the range of $150k to $180k, while experienced CRNAs, especially in high-demand regions or rural hospitals, can exceed $200k.
Factors such as overtime, on-call shifts, and locum tenens contracts can boost these figures, as shown by AANA information and BLS data.
How Much Do Anesthesiologists Earn?
Anesthesiologists, on the other hand, often earn 1.5 to 2 times as much as CRNAs. While the BLS shows an average (mean) salary of $339,470 for anesthesiologists, other surveys suggest the total compensation can climb higher.
Medscape, for example, frequently reports that anesthesiologists earn near $405,000 annually. Starting salaries can hover near $300k for newly minted physicians, rising with experience, subspecialty expertise, and geographic considerations. Those in high-cost-of-living areas, private practice, or specialized roles like cardiac anesthesia may earn considerably more.
While anesthesiologists may earn more overall, CRNAs often have less student debt (given the shorter total training time) and enter the workforce sooner, partly narrowing lifetime earnings differences.
Trends in the CRNA Profession
The future is exceptionally bright for CRNAs, who are frequently listed among the fastest-growing healthcare occupations. The U.S. Bureau of Labor Statistics projects employment for nurse anesthetists, nurse midwives, and nurse practitioners to expand by about 38% from 2022 to 2032, a rate the BLS deems much faster than average.
This is highlighted by recent AANA market forecasts. Because the aging U.S. population is expected to need more surgeries and procedures, CRNAs will remain in high demand. Rural hospitals, in particular, depend on CRNAs for most anesthesia needs; CRNAs constitute over 80% of anesthesia providers in rural counties.
Furthermore, as more states remove supervision requirements or implement full practice authority for advanced practice registered nurses, CRNAs can more readily assume independent roles. That trend may accelerate, given the evidence that CRNA-led anesthesia care is safe and cost-effective.
The shift to doctoral-level education by 2025 could slightly lengthen CRNA training but will likely raise the profession’s standing and attract even more highly qualified applicants. Many universities already offer expanded CRNA programs, sometimes with hybrid online modules to accommodate working nurses.
CRNAs are also finding opportunities beyond the operating room, including roles in leadership, academic instruction, research, and some forms of non-surgical pain management. The AANA’s rebranding efforts to “nurse anesthesiology,” while controversial among some physician groups, reflects the profession’s growing confidence in its expertise and scope.
Trends in the Anesthesiology Field
For anesthesiologists, the job outlook is more moderate. The BLS predicts around 3% growth in anesthesiologist positions from 2022 to 2032, translating to a slight rise from about 40,000 to 41,100 jobs, according to Becker’s ASC Review.
While this growth is modest compared to CRNAs, newly graduated anesthesiologists generally still enjoy stable job prospects and high pay. Upcoming retirements among older anesthesiologists will create some openings, although many healthcare systems utilize CRNAs or AAs in team models to stretch resources.
Anesthesiologists are also diversifying their roles. More physicians in this specialty are moving into perioperative medicine, overseeing enhanced recovery after surgery (ERAS) protocols, or pursuing fellowships in pain management or critical care. These subspecialty areas require physician-level expertise and provide avenues for anesthesiologists to distinguish themselves from non-physician anesthesia providers.
Additionally, as anesthesia groups merge into larger corporate entities, anesthesiologists may see a shift toward supervisory and administrative roles, with CRNAs and AAs performing more direct anesthesia care. Nevertheless, many anesthesiologists still prefer hands-on work in complex cases, trauma, transplants, or cardiac surgery, where their medical background is invaluable.
Overall, anesthesiology remains a sought-after field among medical graduates, offering attractive compensation and relative work-life balance compared to certain surgical fields.
Although physician anesthesiologists face cost pressures that favor CRNA-heavy staffing models, they remain indispensable for high-acuity care and for advancing pain medicine, critical care, and other specialized domains.
CRNAs and Anesthesiologists Are Both Indispensable Professionals
Both groups are thoroughly prepared to manage patients through surgical procedures and beyond. When comparing outcomes, the evidence consistently indicates that anesthesia delivered by CRNAs is every bit as safe and effective as anesthesia delivered by anesthesiologists.
While physician anesthesiologists bring comprehensive medical expertise for dealing with complex or unusual problems, CRNAs offer strong clinical skills honed by critical care experience, plus cost-effectiveness and the ability to practice independently in many states.
Healthcare facilities frequently combine the two professions in a team approach to leverage each provider’s strengths.
If you’re looking to hire your next CRNA or Anesthesiologist, reach out to see how AAG/H can help.
Frequently Asked Questions
1. What can an anesthesiologist do that a CRNA cannot?
Anesthesiologists, as medical doctors, have extensive training that allows them to manage complex medical cases, perform advanced procedures, and provide comprehensive perioperative care. They can also specialize in various subspecialties within anesthesiology.
In contrast, Certified Registered Nurse Anesthetists (CRNAs) are highly skilled in administering anesthesia but typically do not have the same breadth of training to handle more intricate medical situations independently.
2. Is it better to become a nurse anesthetist or an anesthesiologist?
The decision between becoming a CRNA or an anesthesiologist depends on individual career goals, desired scope of practice, and the length of education and training one is willing to undertake.
Anesthesiologists undergo more extensive education and training, leading to a broader scope of practice and higher earning potential. CRNAs have a shorter educational path and can provide anesthesia care, often with varying degrees of independence depending on state regulations.
3. Do CRNAs or anesthesiologists make more money?
Anesthesiologists generally earn higher salaries than CRNAs. According to the U.S. Bureau of Labor Statistics, the average annual salary for anesthesiologists is significantly higher than that of CRNAs, reflecting the differences in education, training, and scope of practice.
4. Will CRNAs overtake anesthesiologists?
While the demand for anesthesia providers is growing, especially in underserved areas, CRNAs are not expected to replace anesthesiologists. Both roles are essential in the healthcare system, with anesthesiologists typically handling more complex cases and CRNAs providing critical anesthesia care, often under varying degrees of supervision depending on state laws and institutional policies.
5. Which state pays CRNAs the most?
Salaries for CRNAs vary by state, with some states offering higher average annual wages. According to recent data, states like Massachusetts, Montana, and North Carolina are among the top-paying states for CRNAs.
