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Before Year 1

Undergraduate Premedical Program – Student Paying Tuition –

  • BS Degree

2 College degree (usually science/math)

  • Avg GPA: 3.75
  • Shadowing: 50-100 hrs.
  • Volunteerism
  • Extra-curriculars

3 MCAT

  • 7.5 hours
  • 97% avg score (2022)
Year 1

Medical School - MD/DO – Student Paying Tuition –

Pre-clinical

  • 1-Anatomy
  • Antimicrobials
  • Biostatistics
  • Embryology
  • Genetics
  • Histology
  • Immunology
  • Medical Ethics
  • Microbiology
  • Neuroscience
  • Nutrition
  • Pathology
  • Pathophysiology
  • Physiology

Weekly/Final Exams

Year 2

Pre-clinical

  • Abnormal Anatomy
  • Behavioral Sciences
  • Cell Biology
  • Clinical Research
  • Clinical Skills
  • Embryology
  • Epidemiology
  • Evidence Based Medicine
  • Family Medicine
  • Neuroanatomy
  • Pharmacology
  • Psychiatry
  • Radiology
  • Quality Improvement

Weekly/Final Exams

Year 3

Clinical

  • Ambulatory Care
  • Emergency Medicine
  • Family Medicine
  • Internal Medicine
  • Physical Diagnosis
  • Neurology
  • Obstetrics-Gynecology
  • Pediatrics
  • Psychiatry
  • Surgery

Clinical Scoring/NBME Subject Exam

Year 4

Electives / Sub-Internships / Core Rotations

  • Acute Pain
  • Anesthesiology
  • Cardiology
  • Chronic Pain
  • Critical Care
  • Dermatology
  • Endocrinology
  • Gastroenterology
  • Hepatology
  • Ophthalmology
  • Otolaryngology Rheumatology

Clinical Scoring/NBME Subject Exam

National Residency Application Service

National Residency Matching Program

Year 5

Fundamentals of Clinical Medicine

  • Acute Pain and Regional Techniques
  • Regional Pain
  • Cardiology
  • Critical Care
  • Emergency Medicine
  • Internal Medicine
  • Nephrology
  • Palliative Medicine
  • Pathology
  • Surgery

Anesthesia Knowledge Test - 1

Anesthesia Knowledge Test - 6

In-Training Exam

ACGME Residency – Graduate Medical Education – Paid Employees

Year 6

Fundamentals of Anesthesiology

  • Anatomy
  • Blood Products
  • Colloids
  • Pain Medicine
  • Pharmacology
  • Physiology
  • Pre-Operative Anesthesia Post-Operative Anesthesia
  • Regional Anesthesia
  • Chronic Pain

Anesthesia Knowledge Test - 24

In-Training Exam

Additional Curriculum Responsibilities Include:

  • Weekly departmental grand rounds
  • Basic and advanced resident lectures
  • Morbidity and mortality conference
  • Journal club
  • Problem-based learning discussions
Year 7

Subspecialties

  • Cardiac Anesthesia
  • Critical Care
  • Neuroanesthesia
  • OB Anesthesia
  • Pain Medicine
  • Pediatric Anesthesia
  • Practice Management
  • Risk Management
  • Thoracic Anesthesia
  • Non-hospital Anesthesia

In-Training Exam

Year 8

Subspecialties

  • Ambulatory Anesthesia
  • Cardiothoracic Anesthesia
  • Clinical Informatics
  • Research
  • Risk Stratification
  • Research
  • Unique Situations
  • Vascular Anesthesia
  • Continued work in subspecialties from previous year

In-Training Exam

Medical Licensing

  • Step 1 Exam:
    2nd year of medical school. 8-hour exam divided into seven 60-minute blocks not to exceed 280 questions.
  • Step 2 Clinical Knowledge Exam:
    3rd year of medical school. 9-hour exam divided into eight 60-minute blocks not to exceed 318 questions.
  • Step 3 Exam:
    Near completion of first year of residency. Two-day examination. Day 1: 7-hour exam divided into 6 blocks with 232 questions. Day 2: 9-hour exam divided into 6 blocks with 180 questions. Followed by 13 case simulations.
Year 9+

ACGME Fellowship – Graduate Medical Education – Paid Employees –

  • 1-2 yrs. Subspecialty Training
  • Adult Cardiac Anesthesiology
  • Critical Care Medicine
  • Health Care Administration, Leadership & Management
  • Hospice & Palliative Medicine
  • Pain Medicine
  • Pediatric Anesthesiology
  • Neurocritical Care
  • Sleep Medicine

Board Certification

  • The BASIC Exam. End of their CA-1. 4 hours / 200 questions / 4 content categories
  • The ADVANCED Exam. Post graduation. 4 hours / 200 questions / 5 content categories.
  • The APPLIED Exam. Consists of two parts: the Standard Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE).
  • Subspecialty Exams
  • Maintenance of Certification in Anesthesiology (MOCA)

Nurse Anesthetist Education (No Postgraduate Training)

Nurse Anesthetist: 5-7 yrs. of higher education. 2,000 hrs. of clinical training specific to administering anesthesia as part of a team.
Year 1

Undergraduate Nursing Program BSN or AND – Student Paying Tuition –

College degree in nursing or appropriate major (in the event of associate’s degree in nursing).

RN Licensing
NCLEX:
5 hr. computerized adaptive exam. 75-145 questions.

Year 2

Critical Care Nurse Employment – Not a Training Program

1 yr. as RN. Monitor and follow medical plan and protocols issued by attending or resident MD

Student Nurse Anesthetist Training
MS, DNP, or DNAP – Student Paying Tuition –

Year 3

MS Program:
600 clinical cases & 2000 clinical hrs.
24 months.

Doctorate Program: 650 clinical cases & 2000 clinical hours. 3 yrs.

Nurse Anesthetist Certification
NCE: 3 hr. computerized adaptive exam. 100-170 questions (including 30 random non-graded questions).

  • Profound differences exist between anesthesiologist and nurse anesthetist duration, depth, and complexity of clinical training and undergraduate/graduate coursework.
  • Medical school courses cover more material and are more intense than undergraduate college courses. US News and World Report
  • For nurse anesthesia, "There is no data that demonstrate the number of years of critical care experience improves critical thinking abilities, nore does it enhance nurse anesthesia skill acquistition or success within the program."
    Council on Accreditation of Nurse Anesthesia Educational Programs.
  • Nurse anesthetist training programs can be online at some schools.
  • No mandatory entrance exam for nurse anesthetist programs.

Differences in Education, Training and Practice between MDs, DOs, PAs, and NPs

Physician (MD)Physician (DO)Physician Assistant (PA)Nurse Practitioner (NP)
Undergraduate Education4 years – Bachelor’s Degree4 years – Bachelor’s Degree4 years – Bachelor’s Degree4 years -Bachelor of Science in Nursing (BSN)
Entrance ExamsMCATMCATPA-CAT or GREGRE
Graduate Education4 years -Medical School4 years -Medical School27 months -PA School1.5 – 3 years – Master of Science in Nursing (MSN) Program
Pre-Clinical Hours during Graduate SchoolApprox. 5,700Approx. 5,700Depends on state (32 semester hours in New York)2,300 – 3,850
Clinical Hours during Graduate SchoolApprox. 6,000Approx. 6,000
+200 hours of clinical training centered on osteopathic medicine		2,000500 – 1,500
Residency3-7 years (and1-3 years of sub-specialty training, if desired)3-7 years (and1-3 years of sub-specialty training, if desired)OptionalNone
License Requirements/RenewalUnited States Medical Licensing Examination; Renewal of license every 2-3 years,* requiring 0-150 CME credits*COMLEX and/or USMLE; Renewal of license every 1-3 years,requiring 0-150 CMEcreditsPANCE; Renewal timeline differs by State (every 3 years in New York); 100 CME credits every 2 yearsNCLEX-RN; Renewal timeline differs by State (every 3 years in New York)
Board Certifications/RenewalBoard Certification Exam in given specialty and subspecialty via ABMS**

Member Board; Recertification Exam every 7-10 years (depending on specialty)		Board Certification Exam in given specialty and subspecialty via ABMS**

Member Board; Recertification Exam every 7-10 years (depending on specialty)		PANCE to become board certified; PANRE every 10 years to recertifyCertification based on specialty; Recertification every 5 years via either 1,000 clinical hours + 75-150 CMEcredits OR re-examination
Scope of PracticeFull scope of practiceFull scope of practice + osteopathic techniquesPractice with supervision from physician; can prescribePractice with supervision from physician or independently*; can prescribe

Many thanks to Nisha Khubchandani, AMC ’23, MD/MPH Student; Loretta Ponesse, CAE & the NY Chapter of the American College of Physicians for providing this chart.

*Differs by State
**American Board of Medical Specialties

Significant differences exist between physician anesthesiologists’ and nurse anesthetists’ education training and responsibilities

PHYSICIAN ANESTHESIOLOGISTS

Medical degree (either M.D. or osteopathic) following bachelor’s degree (8 years total)

  • 1-year postdoctoral internship
  • 3-year postdoctoral residency in anesthesiology
  • Board-certified physicians may complete an additional 1 year to 2 years of subspecialty education and training in one of the recognized anesthesiology subspecialty areas after successful completion of a postdoctoral residency

Total of 12 years to 14 years after high school

Medical education and training covers:

  • Continuum of the human life cycle including health and disease, functioning of all vital systems
  • Emphasis on diagnosis and treatment, indications and contraindications
  • Comprehensive medical care
  • Preventive care
  • Acute and chronic care

12,000 hours to 16,000 hours of clinical training

Trained to provide comprehensive medical care to patients needing anesthesia, pain medicine or critical care services

NURSE ANESTHETISTS

Bachelor’s degree in nursing

  • 2-year associate RN degree, or
  • 3-year diploma RN degree in nursing after high school
  • 1 year working as a nurse in an acute care setting
  • Master’s degree from graduate school of nurse anesthesia (not required prior to 1998)

Total of an estimated 7 years after high school

Nurse anesthesia education and training covers:

  • Basics of anatomy, physiology and pharmacology
  • Principles and techniques of nurse anesthesia

Almost 2,500 hours of clinical training

Trained to administer and assist in the provision of anesthesia services

References

Altus, A. (2018, April 23). Should you do a fellowship? 5 questions to ask yourself. The DO – American Osteopathic Association.
https://thedo.osteopathic.org/2018/04/should-you-do-a-fellowship-5-questions-to-ask-yourself/

American Academy of Nurse Practitioners Certification Board. (n.d.). Recertification for ANP, FNP, and GNP…When are you due to recertify?
https://www.aanpcert.org/newsitem?id=5

American Academy of Physician Associates. (n.d.). Become a PA.
https://www.aapa.org/career-central/become-a-pa/

American Board of Medical Specialties. (n.d.). What is ABMS Board Certification?
https://www.abms.org/board-certification/

American Board of Medical Specialties. (n.d.). Why Become Board Certified?
https://www.abms.org/board-certification/board-certification-requirements/

American Osteopathic Association. (2020, May). U.S. Osteopathic Licensure Summary.
https://osteopathic.org/wp-content/uploads/2018/03/US-licensure-Summary-MAY-2020.pdf

Association of American Medical Colleges. (n.d.). The Road to Becoming a Doctor.
https://www.aamc.org/system/files/2020-11/aamc-road-to-becoming-doctor-2020.pdf

Brigham Young University. (n.d.). MD (allopathic) vs. DO (osteopathic) Medicine.
https://ppa.byu.edu/md-allopathic-vs-do-osteopathic-medicine

Brown University. (n.d.). Health Careers Advising: PA-CAT.
https://www.brown.edu/academics/college/advising/health-careers/pa-cat

Doximity. (2018, June 11). When Will Your Medical License Expire? A Complete List of State Medical License CME Requirements.
https://blog.doximity.com/articles/when-will-your-medical-license-expire-a-complete-list-of-state-medical-license-cme-requirements

Emory & Henry College. (n.d.). Physician Assistant Studies: Minimum Clinical Training Requirements.
https://www.ehc.edu/live/profiles/3000-minimum-clinical-training-requirements

Limestone University. (2021, October 31). How to Become an Osteopathic Doctor: Where Should I Start?
https://www.limestone.edu/blog/how-become-osteopathic-doctor-where-should-i-start

New York State Education Department Office of the Professions. (n.d.). Certification Requirements for Nurse Practitioner.
https://www.op.nysed.gov/professions/nurse-practitioners/certification-requirements

Nurse Journal. (2022, November 15). What Is the Role of the State Board of Nursing?
https://nursejournal.org/resources/what-is-the-role-of-the-state-board-of-nursing/

Nurse Journal. (2022, December 6). Nurse Practitioner vs. Physician Assistant: What’s the Difference?
https://nursejournal.org/resources/np-vs-physician-assistant/

PhysicianAssistantEDU. (n.d.). New York Physician Assistant Programs for Licensure.
https://www.physicianassistantedu.org/new-york/

Primary Care Coalition. (n.d.). Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners. Texas Academy of Family Physicians. https://www.tafp.org/Media/Default/Downloads/advocacy/scope-education.pdf

Rabin, R.C. (2014, July 21). Docs Slam Recertification Rules They Call A Waste Of Time. Kaiser Family Foundation.
https://khn.org/news/docs-slam-recertification-rules-they-call-a-waste-of-time/

Regis College. (n.d.). Master of Science in Nursing (MSN).
https://www.regiscollege.edu/academics/majors-and-programs/nursing-msn

Regis College. (2021, June 7). What’s the Difference Between a Nurse Practitioner and Physician Assistant
https://www.regiscollege.edu/blog/nursing/nurse-practitioner-vs-physician-assistant

St. George’s University School of Medicine. (2021, March 10). PA vs. MD: Which Medical Career Is Right for You?
https://www.sgu.edu/blog/medical/pa-versus-md/

St. George’s University School of Medicine. (2021, April 5). MD vs. DO: The Definitive Guide to Help You Decide.
https://www.sgu.edu/blog/medical/md-versus-do/

The College of New Jersey. (n.d.). Nursing Requirements.
https://graduate.tcnj.edu/application-requirements/nursing-msn/

University of Bridgeport. (2022, January 24). How Long Does it Take to Complete a BSN Program
https://www.bridgeport.edu/news/how-long-to-get-a-bsn/

University of St. Augustine for Health Sciences. (2022, September 11). Nurse Practitioner vs. Physician Assistant: Key Differences.
https://www.usa.edu/blog/np-vs-pa/

UT Health San Antonio. (n.d.). I Want to Be a Doctor! What Now?
https://uthscsa.edu/medicine/education/ume/outreach/become-doctor