The real difference is CRNAs can practice without an MDA. This difference has nothing to do with the opt-out. CRNAs have NEVER been required to be supervised by an MDA. AAs are and always will be REQUIRED to practice with an MDA. As a CRNA, I own my own anesthesia practice with 4 other CRNAs and we bill the patient's insurance for our services. AAs will never be able to be entrepreneur's in the world of anesthesia like CRNAs. Believe me it is a big difference. Go make the money you deserve and become a CRNA! AAs will always be slaves to their master MDAs. You decide which is better. Oh, and by the way, I do believe the nursing background makes a huge difference. It's called real patient experience managing sick patients in an ICU prior to anesthesia training.