CRNA Threat

BabyLady, BSN, RN · Mar 2, 2011

sorry, I will clarify as I think you are confusing anesthesia tech with anesthesia assistants.
The AA involves a graduate level education and works under the supervision of a MDA. I cannot speak to the salary of the AA as I am not aware of it but check the website:
http://anesthesiaassistant.com/

....LOL...and you could be correct!!!!!

Katie5 · Mar 2, 2011

They do have the autonomy - it's called independent practice, and no, the surgeon is not liable for the CRNAs actions...the CRNA is. There are plenty of places in America where CRNAs are practicing independently and autonomously. CRNAs can practice independently in all 50 states. That's part of the beauty of the profession, one can choose what type of practice environment they want to work in - independent, supervised, medically directed, and/or ACT. Obviously there are many variations on the theme, but the choice is there.
I don't think it's unfair that an anesthesiologists makes an average of 2-3 times what a CRNA makes. Society rewards physicians for their long term commitment to education. CRNAs are reimbursed the level that society deems appropriate and based on the complexity and potential dangers of anesthesia. It's a fair wage no doubt. Go shadow an someone performing anesthesia and attempt to appreciate the the complexity and potential dangers and how that gets managed with (most of the time) multiple co-morbidities. Anesthesia looks easy because the nurses and physicians (and AA's) are really good at what they are doing, but there is not much easy about it. To add to that, anesthesia school is no "cake-walk" either...just sayin'.
I also don't think any CRNAs are out looking for any particular "prestige" and I am not sure of these "other benefits" that you mentioned. The primary concern is that nurse anesthetists want to be able to practice to their defined scope of practice without having their practice rights restricted, and there just happens to be some physicians that find that threatening.
One last thing, nurses didn't start anesthesia (can't remember who posted that, or something to that extent). Nurses were selected and trained to provide anesthesia (back in the late 1800's) because there was no money (reimbursement) in it (unless the surgeon was feeling generous) and other physicians did not care about learning a specialty that they could not get paid for. When anesthesia became eligible for reimbursement, physicians again took interest - they invented a "new" term called anesthesiology. And, yes, they did much to advance the science and technology of anesthesia that we enjoy today. Do they have more medical training - yes. Is all of it applicable to delivering anesthesia - lots of debate (on both sides about that one). There is no doubt that anesthesiologists have excellent training, knowledge, and skills which can (and are) invaluable in many circumstances, but don't underestimate the knowlege and expertise of CRNAs either. And, yes, I am aware that everyone has come across a bad CRNA, they are out there - same goes for anesthesiologists (and every other specialty, profession, field, etc.)
Bottom line - CRNAs have a defined scope of practice, and they just want to be allowed to practice within that scope how they choose - everyone else does. When another group attempts to restrict that practice, CRNAs fight back. The defense of nurse anesthesia over the past century has helped pave the way for advanced practice nursing that we see today. We stand on the shoulders of giants...please remember that.
later,
griff

Pls remember this post when anyone gripes about MAs.

allnurses Guide · Mar 2, 2011

This all has been said on here time and time again, but I will make a general statement to some of the misconceptions on this thread.

1. CRNAs aren't trying to be physicians. CRNAs have been providing independent anesthesia care for over a hundred years, if anything physicians are trying to take over a nursing speciality. All the research shows that CRNAs are just as safe and effective as anesthesiologists.

2. PAs and AAs are not even in the same category. Physician Assistants were created to provide civilian crossover training for highly trained medics after serving in Vietnam, and to expand medical care. http://www.aapa.org/about-pas/our-history It was around this same time that NPs came into existence, but nurse anesthetist had been around providing the majority of anesthetics since the late 1800's. Nurse anesthetists are the United States oldest nursing speciality.

3. AAs were created for political reasons, and that reason was to give the ASA a political tool to help control CRNA practice with an anesthetic provider who can never increase access to care or compete against anesthesiologists. There are only about 2000 practicing AAs. AAs practice in approximately 16 states under the direct supervision of an anesthesiologist. http://www.anesthesiologistassistant.net/ CRNAs on the other hand practice in every state and every US territory that I know of. CRNAs can and do increase access to care, provide the majority of anesthesia care in the US, are the sole providers in many rural hospitals, and we currently number over 42K. CRNAs and anesthesiologists practicing independently is the most cost efficient type of practice. ACT practices are just behind only all MDA practices as the most expensive. It is often necessary for all MDA practices and many ACT practices to be subsidized by the hospital that employ them because they are too expensive to be economically viable on their own.

4. Physicians are an expensive commodity that the public helps fund. Medicare (the Department of Human and Health Services) provides all or the majority of all residents salaries, and many state/federal monies supplement medical student training costs. The way the physician training is set up physician's size numbers cannot increase in size very easily. CRNAs pay for all or the vast majority of their own training, and provide nearly identical/identical anesthetic care as anesthesiologist residents during their clinical phase which costs the public nothing and saves hospitals millions of dollars a year.

CRNAs are not fighting to gain independence. We are fighting to keep something that we have always had.

Cessna172 · Mar 2, 2011

All I can say is wow, this is really what you think of PA's? You really need to research the role of a PA before you start calling us "little puppy dogs". The clinical rotations for PA's will usually be around 2000/hrs +/-, NP programs hover around 500 +/-and there is continued debate on where it should be for NP's. Then general consensus is minimum of 500hrs. PA students will have minimum 2000hrs HCE prior to entering a program, NP's require 2yrs as a RN which will average to little over 2000hrs. Most PA's applying for school will exceed the 2000hrs, my class average is around 7000 with my HCE at 35,000hrs. PA school is INTENSIVE, I studied more in the 1st 2 weeks of PA school than I did the entire time in Nursing school. To me, nursing school was a joke compared to PA school and I went to a school with a >50% attrition and 99% first pass rate on boards. Out of my class of 62 only 1 did not pass 1st time. Most every NP worked in some capacity during school, VERY few PA's worked and nobody in my class works. I currently spend 36hrs per week physically in class, 3-5 hours per day studying and 10hrs each for Sat/Sun. I will spend 35-45hrs weekly studying. In nursing school, read notes about an hour before class.
Talk to some PA's before you call them puppies, that's pretty insulting and just really shows your ignorance.

The PA's I have met are really very smart. I've likewise met some NPs that have left me in awe too. PA school probably shouldn't be compared to nursing school though, because they aren't supposed to be on the same level. Sounds like PA school is pretty tough from your description.

tokidokifantasy · Mar 2, 2011

I read the following post on a student doctor's forum:
"Agreed. CRNA's and nurses in general aren't the smartest group of people out there.
Well I hope whoever wrote this does not end up in a long term care. Nurses are the ones taking care of aging population in today's society. We have bigger roles than the doctors, so I do not think we should belittle ourselves. Just because we did not go to medical school does not make us less smart, I don't see how that correlates. Nurses are trained in their scope of practice and it's not like we can just go learn something in medical area to make us look "smarter" , i mean really, we went to Nursing school to learn about nursing, so just because the "title" is less prestigious than a MD , it does not make us dumb.

tablefor9, RN · Mar 2, 2011

all i can say is wow, this is really what you think of pa's? you really need to research the role of a pa before you start calling us "little puppy dogs". the clinical rotations for pa's will usually be around 2000/hrs +/-, np programs hover around 500 +/-and there is continued debate on where it should be for np's. then general consensus is minimum of 500hrs. pa students will have minimum 2000hrs hce prior to entering a program, np's require 2yrs as a rn which will average to little over 2000hrs.

2000 hours per year (40 hrs x 50 wks, you do the math). a 5 yr rn would thus have 10,000+ hrs real world experience. my own are well over 30,000.

most pa's applying for school will exceed the 2000hrs, my class average is around 7000 with my hce at 35,000hrs. pa school is intensive, i studied more in the 1st 2 weeks of pa school than i did the entire time in nursing school. to me, nursing school was a joke compared to pa school and i went to a school with a >50% attrition and 99% first pass rate on boards. out of my class of 62 only 1 did not pass 1st time. most every np worked in some capacity during school, very few pa's worked and nobody in my class works. i currently spend 36hrs per week physically in class, 3-5 hours per day studying and 10hrs each for sat/sun. i will spend 35-45hrs weekly studying. in nursing school, read notes about an hour before class.

graduate school is more intensive than undergraduate. that's kinda the point. as for most np students working, in my experience, most of us have to. something about mortgages and kids to feed. with all of one exception, every single pa student i've seen in the last 3 years (doing clinical with us, term after term of them) has counted on mom & dads' $$$ to live on. the exception's husband was a retired military officer, i have to assume that her unemployment was not hurting them. given the choice, i wouldn't work full time, carry a full time class load, and study 30+ hours a week. i certainly won't have much time to sleep over the next couple of years.

talk to some pa's before you call them puppies, that's pretty insulting and just really shows your ignorance.

you know, you're right. i wish we could do without the jr high neener-neener between np/pas, because neither one has the market cornered on the propensity to be a jerk. i wasn't the one that posted the puppy comment, but i can see the insult in it; don't worry, you repaid the poster in kind.

Class2011 · Mar 2, 2011

I have been informed not to place links in my posts. Kinda wondering how all these other folks seem be able to do it.
?????

That rule might just apply to competing CRNA sites

Skip219, BSN, RN · Mar 3, 2011

I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP. :uhoh3:

nomadcrna, DNP, CRNA, NP · Mar 5, 2011

Shrug, I have complete autonomy.

Ron

I'm sorry, if the CRNA wants complete autonomy, then he/she needs to go to medical school for upteen years and become an anesthesiologist.

foraneman · Mar 6, 2011

I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP.

This is not limited to rural settings. One also has to define what one means by 'complete autonomy'. If complete autonomy means providing an anesthetic from start to finish without any material involvement by any physician (material involvement meaning a physician making the ultimate decision as to what technique will be used, what medications, or physical involvement in the delivery of the anesthetic, or 'checking up' at regular intervals that the anesthetic is being delivered as they would like) OR if complete autonomy means a CRNA is no required to practice in ANY setting with an anesthesiologist available by law, then complete autonomy exists in each and every state in every anesthetizing location.

Independent CRNA practice has existed for over 100 years. Only 12 states require by law that a physician (and it can be ANY physician) 'supervise' a CRNA's practice of anesthesia. And here 'supervise' does not mean taking responsibility for or directing the anesthetic.

40 states do not have any physician "supervision" requirement for CRNAs in their nursing practice or medical practice laws or regulations. If one includes clinical "direction" requirements in addition to "supervision," 32 states do not have a physician supervision or clinical direction requirement for CRNAs. Including state hospital licensing laws or regulations, 33 states do not require physician supervision. Including state hospital licensing laws or regulations, 24 states do not require physician supervision or direction.

No state requires a CRNA be supervised or clinically directed by an anesthesiologist.

In states which do require physician supervision, the supervising physician is not required to have any training in the practice of anesthesia or additional qualifications with the exception of New Jersey and Washington D.C. (exception applies in D.C. only when a general anesthesia is given). What constitutes 'supervision' or 'direction' is generally poorly defined or not defined at all. Usually the term hangs in the air without any reference as to what it should mean and mere availability suffices. The surgeon meets the definition of 'supervision' when he does the surgery and ignores the CRNA and the anesthesia.

foraneman · Mar 6, 2011

Drs like PA and AA because they are in control of them and can bill for their actions. Whereas, the CRNA is taking some of the money out of the MDAs pocket for each case. Do you know who does most anesthesia in the rural settings? Its CRNA where MDAs don't want to work. AA can"t work on their own in away of the opt-out states. In these states the AMA hasn't bought off the politicians with their PAC. There are 40-50,000 CRNAs and about 6000 AA. Its more cost effective for a hospital to employ CRNAs because they can work independently. MDAs stand there supervising inductions and emergences: then bill for it.

There are fewer than 2000 AAs practicing and they have been around for 20 years. Not a significant threat to CRNA practice.

msn10 · Mar 8, 2011

Samirish

It is unfortunate, but it is another case of class warfare in healthcare.

RN's won't do bed baths because it is the CNA's job.

CRNA's and PA's won't help lift or toilet because it is the RN's job.

MD's won't do ... because it is someone else's job.

These young medical students took their myopic view of medicine and applied it to an entire population. They were probably referring to first year CRNA students who, to be fair, are wet behind the ears as well.

The CRNA/MD debate has been going on for some time and it is unfortunate because both disciplines have a lot to bring to the table. CRNA's have great training and MD's do as well. MD's can also bring an extra value to the OR through there post doctoral training and board certification and some have post doctoral fellowships in cardiac, peds, pain, etc.

To me it is sad to have these competitions because there are good and not so talented people in all levels of service.