CRNA this is terrible - page 2
Did you guys know that in the state of missouri the house has recently passed a bill that would allow anesthesia assistants to obtain certification. This means that CRNA's will be out of a job... Read More
Mar 4, '03Thanks for your input Tenesma. I think a large reason why many of us are interested in anesthetia is because of job security and CRNAs are in demand right now. So, it is definitely worrisome to think that AAs may threaten job security/compensation for CRNAs. However, I really am not that worried anymore now that I know what a restricted practice AAs have. Thanks for alleviating our fears about this issue.
Mar 5, '03I also went and looked at the critieria to get into an AA school...they want students who have a BS in respiratory or nursing. Then it is a 2 year program.
It dont sound like non clinical people to me.
My question would be if I wanted a Masters why would I do 2 years and get an AA degree when I could do the same 2 Yrs and get a CRNA and make twice as much?
Mar 5, '03Exactly, this is an attempt to eradicate CRNA's, (although that may take a while) who is more likely to get hired the $50,000 employee or the 120,000 employee hmmmm? Nurses everywhere should vote against this because to become a CRNA is an option to advance our career. If Doctor's cut us out of this what is next?
Mar 5, '03That article posted by Cosmid is very informative. Specifically, it points out that the cost factor would actually rise, since an AA has to have an actual MDA present to work.
My thinking on this is, the "rules" are likely to be fudged and quickly by hospitals. Somewhere, some hospital will hire 5 or 6 AA's then have just one MDA supervise...maybe even an offsite MDA. The hospital will fight it out with the regulators if and when they are caught. It's easier to apologise than to ask permission.
The MDA's are likely pushing for AA's because they would create more need for MDA's--and probably also because the insurance companies will likely pay for the MDA. One MDA supervising 5 or 6 AA's at a time; that's a lot of money. The hospital will say that the MDA was overseeing care, and thus can bill for the time.
In this scenario, the hospital makes more money; the anesthesiologist makes more money; and everyone wins except the patient and the taxpayers.
Mar 5, '03But the fact remains that there are only 2 schools with an AA program. (PAs can be certified to do anesthesia too, but I bet their numbers are relatively few). So I'm not too concerned about this in the short term. Long-term, well, NPs and PAs coexist and there are lots of them. Not that I am directly comparing CRNAs to AAs; I'm just saying that maybe there is room and a place for everyone. And again, if an MDA must be present, that doesn't help the communities without an MDA to begin with.
I admit that at first I was quick to characterize this as a doctors vs. nurses battle. The fact is, there is such a huge shortage of providers of all kinds, especially anesthesia. Maybe AAs aren't the ideal solution, but maybe it's the only marginally feasible solution for the time being despite the politics that come along with it. However, I do believe that CRNAs must now use this opportunity--as they've been doing all along--to showcase this unique profession (without getting all defensive, e.g. "we were here first", "we're just as safe as MDAs", etc.), continue to expand their research, and continue to produce a high caliber of graduates who are not only technically prepared to administer anesthesia but also have the critical thinking and academic and clinical skills and experience to back it up. Where are the doctoral-level CRNAs? I know there's a few out there--now may be the time to promote research at this level. Okay, off my soapbox now.
Mar 5, '03All of the anesthesia students who are on this bulletin board should also subscribe to email@example.com. Besides an excellent discussion on this topic, you will be able to see how CRNAs and state nurse anesthetist associations are working this issue. You need to be a student or AANA member to subscribe to old-gas, but you will have an opportunity to participate in a forum and gain respect for the wonderful people in this profession.
Mar 6, '03Yes Dianancs, you have a good point. The fact remains that if this bill passes then an AA who has is not required to have any ICU experience will provide anesthesia. Why lower the standard of care?
Mar 10, '03ASA NEWSLETTER
Volume 67 Number 3
Anesthesiologist Assistants: A New Direction for the Anesthesia Care Team Begins to Accelerate (Finally!)
David C. Mackey, M.D.
Most of us are familiar with the concept of the anesthesiologist assistant (AA), which was developed by J.S. Gravenstein, M.D., and John E. Steinhaus, M.D., nearly 40 years ago. Despite the merit of AAs as valued members of the anesthesia care team, their national impact until now has been underappreciated with fewer than 600 practicing in 16 states and only two AA schools in existence. This situation now appears to be changing with endorsement of the AA concept by the ASA leadership, consideration of AA licensure by a number of additional states and serious proposals for several additional AA schools. For this reason, the pages of this NEWSLETTER issue are dedicated to updating the ASA membership with respect to AA education, certification, licensure and practice.
Why, after approximately 30 years of dedicated practice in relative obscurity, are AAs suddenly finding themselves in the limelight? The answer is that AAs are finally being recognized for the value they provide to the anesthesia care team.
We are all acutely aware of the fact that there simply are not enough physician extenders available to fill the needs of anesthesia care team practices. This shortage, exacerbated by the extender monopoly held by nurse anesthetists, is handicapping hospital and ambulatory surgical centers across the country. Also at issue is the unceasing drive by the nurse anesthetists' lobby for independent practice. For the safety of our patients, we realize that physicians must remain in charge of all aspects of medicine, including the delivery of anesthesia care. Although most nurse anesthetists, like most anesthesiologists, have as their pre-eminent goal the provision of good clinical care for their patients, the nurse anesthetists' state and national organizations all too often appear to be fixated on the single issue of independent practice. The resultant need to constantly battle the nurses' "trade union" has been a major albatross for our profession. And for many of us, the final straw was the need for ASA to expend an enormous amount of its scarce resources in response to the recent Centers for Medicare & Medicaid Services proposal to eliminate physician supervision of nurse anesthetists in Medicare/Medicaid-supported facilities.
There is little wonder why so many anesthesiologists are finally saying, enough! Imagine what we could be doing to improve patient care if we could instead channel our resources into organizations such as the Anesthesia Patient Safety Foundation (APSF) or the Foundation for Anesthesia Education and Research (FAER). In re-examining the physician extender component of the anesthesia care team, AAs come to the forefront. AAs are educated by anesthesiologists in a medical school environment, and many of us firmly believe AAs are actually better trained than nurse anesthetists. Historically, those AAs who want to practice as anesthesiologists have gone to medical school instead of the state and national legislatures for their career advancement.
The national emergence of the AA is long overdue. It is time to work with well-trained physician extenders who want to work with us and who are committed to the anesthesia care team concept
Mar 10, '03It guess the ASA bulletin says it all. It's too bad that our national organizations can not work together.
It is of vital importance, however, that the AANA refuse to relinquish control of nurse anesthesia practice.
"Trade Union," now that is funny.