aa's

Laser · Apr 17, 2004

Whether anyone likes it or not, the general public sees the MDA world as the preeminent anesthesia authority / leader in this country and this seems reasonable to me. They possess a graduate medical education in anesthesia and are by definition experts. On the other hand, ask any 100 or so people on the street what a CRNA is, or does. I know that the vast majority will not know. Fortunately for the CRNA world, demographics have been good to us throughout the years. (I say us as a wannabe CRNA). Unfortunately, no one knows who we are. This has to be dealt with if we are to equitably differentiate ourselves within the anesthesia community.

Why are MDA's pushing AA's? It's political. Everything I see and read tells me that it's about controlling the profession of anesthesia, which by the way, they have been largely successful at. There is a part of me that wants to say, ok, cool. After all, they are the MD experts. Unfortunately, the ASA doesn't think like mother Teresa. I personally have no problem working with MDA's in a collaborative relationship. The care team concept is reasonable and provides for a high quality patient care. The vast majority of surgeons and MDA's that I have worked with are great people both personally and professionally and they value the intrinsic worth of nurses. But, let's face it; the ASA political leadership has an agenda and they are very up front about it. If you have any doubts, just look at the article in the April 2004 issue of the AANA Journal, "Standards of Care and the ASA Medical Direction Statement" on page 91. Look at medicare's November 13, 2001 Federal Register: "A final rule concerning the federal Medicare and Medicaid physician supervision requirement for Certified Registered Nurse Anesthetists." This was a major victory for the ASA. Think about how much time is being spent by state CRNA Associations to try and minimize the impact on CRNA practice. Fortunately, some states have successfully opted out.

Although there are not that many AA's at this time, demographics are now helping the AA cause. I genuinely feel that they will be a force to be dealt with within the mid to distant future by virtue of the ASA pushing for them. Think about how many medical school anesthesia departments are capable of absorbing AA classes. The ASA has power, both real and perceived. The recent push for using more AA's is not happening accidentally.

From my point of view, AA's coming up in the world isn't the end of the world. It's going to take some time for their numbers to reach significant levels. The real challenge is how CRNA's differentiate themselves from MDA's /AA's in the public's mind. Heck, the general public doesn't even know what a CERTIFIED REGISTERED NURSE ANESTHETIST is. Do you think they might imagine what an ANESTHESIA ASSISTANT is? I think so. I can already hear some, not all, MDA's referring to CRNA's as there assistants.

We all know that a CRNA's scope of practice encompasses more than AA's scope of practice. AA's can not practice independently anywhere. This along with other issues needs to be differentiated. In the end the CRNA profession really needs to differentiate themselves and it has to be simple so that the public knows who we are and what we do. I believe that the future is bright for CRNA's. CRNA's have over 100 years of providing quality anesthesia care. This is powerful stuff....

Man, I can't wait to get started.

smk1, LPN · Apr 17, 2004

Question for the CRNA's here: I've always assumed the reason MDA's were pushing for AA's was to take control away from CRNA's and, essentially, make more money off of AA's by paying them less.
However, if these ads are any indication, they're paying AA's a lot of money. I'm told the $120,000 salary in D.C. is for real and, apparently, it's what they're offering both CRNA's and AA's for that position. Supposedly, this hospital is the primary proponent of AA's in the D.C. dispute.
So, the question is, if they're paying such high salaries, what's in it for them? What difference does an AA make in a situation like that, versus a CRNA if they cost the same? And why would they be fighting with the city council to keep AA's if they cost just as much?
I'm cynical by nature, and don't necessarily believe it's because they're concerned about the current shortage. Although I suppose that could also be a reason.
I tend to agree with deepz's A$A designation. This has got to be about the money. I'd just like to understand how this works for them.

Not a crna or srna but have read that some of the concerns are regarding the fact that MDA's can directly decide which cases AA's will or will not take. Because AA's practice is governed by the AMA doctors have control over their expansion. This is not the case with CRNA's because they work under their own license and are governed by the BON. This could be at least part of the problem. If CRNA's can bill for the same amount and have their own practice then that would cut a doctor out of the equation, this couldn't happen with an AA because they require a collaboration of some sort. Someone let me know if I am completely off base here !

athomas91 · Apr 17, 2004

And, for all you worriers and ruminators out there, understand this. CRNAs have been providing anesthesia in this country for decades. We are here to stay. In what capacity we will be able to practice depends on our continuing support of our national organization and political involvement to protect our practice rights at the state and national levels.

well said - it should not be a concern or worry - IF CRNA'S AND SRNA'S stay involved in the AANA and local chapters. i have found that many students do not find the time to understand the issues or even to be aware of them - which is a mistake - being involved prior to actually beginning our practice will only prepare us for our responsibilities once we pass that test!!