Here's what AAs really think of CRNAs - page 19

And this comes from the PRESIDENT of the American Society of Anesthesiologist Assistants Again, assertions that AAs and CRNAs function at the same level -absolutely misleading. And, what's... Read More

  1. by   jwk
    Quote from SCSRNA
    How about this...
    I worked in an ICU in ATL for 4 years prior to starting anesthesia school. When meeting with the head MD of the Anes. Dept ( an AA-friendly Anes. dept I might add) regarding a job when I got out of school, I shyed away when he offered me a starting salary for $76,000. That's a memorable number.
    It's a free market - you can go anywhere you want. Isn't that the biggest advantage to being a CRNA?

    You'll find if you check again that salaries keep rising, as well as sign-on incentives. Many of the major hospitals in Atlanta are offering significant tuition reimbursement and sign-on bonuses.
  2. by   SCSRNA
    Quote from cnmtocrna
    In reference to my recent post under "washington DC CRNAs," I will direct everyone's attention to the blatant GREED factor underlying this post.
    This post is also misleading. The hospitals here in Atlanta tend to give student loan reimbursement - this officially counts as INCOME. Maybe the base is 76,000, this sounds low to me. I think it is more like 90,000. There is all sorts of money to be had for hours worked over a standard shift, weekend, night call. As a midwife 60 hour weeks were standard with no extra for 24 hours straight, weekends, nights.....AND I had as many patients as there happened to be - maybe 2, maybe 7. In anesthesia, you get one patient at a time, guaranteed. Hmmm, no wonder the malpractice is so much less than what a midwife has to pay. After 11 years my top income was around $106,000. $90,000 plus loan repayment and overtime is really hard to hate for a starting salary. If your tastes require more money, hooray, you're a CRNA and you can drive up North and run your own show, make tons of money - the luxury of choice is all yours.
    First of all, I'm agreeing w/ you. I thought $76,000 sounded like a low salary to me also. Your might call this greed, but don't be blind to the business aspect of the profession. When I was in the ICU, I was making about $15,000/yr less than the salary offered to me if I were start work as a CRNA at that hospital. Their was a $20,000 educational rembursment offer to me. Sure, I had to stay for 3 years, but it was offered. So now we are up to $83,000/yr. This, of course, after I borrow $90,000 and quit work for 2 1/2 years. Sound greedy? I saw from your previous posts that your husband is an OB. Some of us don't have the luxury of a supplemental 6 figure income in the house. This is gonna be more than a hobby for me.
  3. by   SCSRNA
    Quote from jwk
    It's a free market - you can go anywhere you want. Isn't that the biggest advantage to being a CRNA?

    You'll find if you check again that salaries keep rising, as well as sign-on incentives. Many of the major hospitals in Atlanta are offering significant tuition reimbursement and sign-on bonuses.
    Should have included this in my prev. post. I think that's great. Last I checked, the salaries were up @ the hospital I was at, but why should a major metropolitan area like ATL (where, if you wanted to, you could spent $5.95 on a cup of coffee) be so behind the times? I'm not insinuating that this hospital is the rule; I believe it is the exception. But it exisits. And in reference to your first sentence, that's the problem w/ tuition rembursement. You ARE stuck somewhere for 2-3 years. Their goes some of the mobility.
  4. by   jwk
    Quote from SCSRNA
    Should have included this in my prev. post. I think that's great. Last I checked, the salaries were up @ the hospital I was at, but why should a major metropolitan area like ATL (where, if you wanted to, you could spent $5.95 on a cup of coffee) be so behind the times? I'm not insinuating that this hospital is the rule; I believe it is the exception. But it exisits. And in reference to your first sentence, that's the problem w/ tuition rembursement. You ARE stuck somewhere for 2-3 years. Their goes some of the mobility.
    I can probably guess which hospital you're talking about (or narrow it down to 2 or 3). But it seems as though tuition reimbursement / signon bonuses are becoming the norm. That's one of the questions we get asked early on from the prospective employees that we interview. And as the demand for anesthetists continues to increase, so will compensation packages. Ya gotta have people to do the cases. And although staffing is sometimes extremely tight, we have never had to hire locum tenens staff.

    I'm sure Atlanta is not the highest paying area, but it also has a lower cost of living than the Northeast and West Coast, which means more net income in your pocket. I have friends that have moved to California and they brag about their salaries, but they also pay twice as much a month for half the house that I have. Their net disposable income taking into the cost of living into consideration is about the same.
  5. by   InterestedRN
    Quote from georgia_aa
    Okay - I can't stand it any longer.

    I am an AA with over 14 years of experience and currently practicing in Georgia. I have nothing but the highest regard for my CRNA colleagues and count some of them as among my closest friends. The article that you are referring to was written by Rob Wagner our association president over 1 year ago during the unsuccessful bid for licensing legislation in Florida in 2003. If you do a Google search, his is the ONLY article that you will find written by an AA attempting to set the record straight. Meanwhile you will find article after article and editorial upon editorial written by CRNA's calling us a bunch of incompetents. Now I ask you, who has been more professional and courteous through this whole thing.

    Rob's characterization of AA's functioning the same as CRNA's is exactly correct in medically directed departments. Here in Georgia, our job descriptions and salaries are exactly the same (I made over $160k last year). That's alot of money for a tech isn't it?? .

    If you would like to engage in a friendly discussion about AA's in an attempt to educate yourselves about us, I would be very happy to participate. Please understand, I am PRO - CRNA. I have no reason not to be. I work by definition under the supervision of an MDA. I can't practice alone, nor do I want to. If you want to flame me and get me thrown off the forum, be my guest. But it would behoove you to learn more about us because we will be coming soon to a state near you.
    Georgia aa,

    Thank you for your input. This is the kind of example of professionalism that needs to be set. I am interested in hearing more about your practice. Please feel free to contact me.
  6. by   SCSRNA
    Quote from jwk
    I can probably guess which hospital you're talking about (or narrow it down to 2 or 3). But it seems as though tuition reimbursement / signon bonuses are becoming the norm. That's one of the questions we get asked early on from the prospective employees that we interview. And as the demand for anesthetists continues to increase, so will compensation packages. Ya gotta have people to do the cases. And although staffing is sometimes extremely tight, we have never had to hire locum tenens staff.

    I'm sure Atlanta is not the highest paying area, but it also has a lower cost of living than the Northeast and West Coast, which means more net income in your pocket. I have friends that have moved to California and they brag about their salaries, but they also pay twice as much a month for half the house that I have. Their net disposable income taking into the cost of living into consideration is about the same.
    I see where you are commin' from. You gotta put someone at the head of the table to give the gas. Comming from the hospital I did, I met many AA's that were perfectly competent. I personally don't have any problem w/ an educated and experienced AA or CRNA putting me to sleep, but the babysitter-type, "I'm the doctor, you're the assistant" atmosphere was fostered where I came from. AA's and CRNA's were never seen performing a task w/o an MDA glaring over their shoulder. That is not an "anesthesia team." As you can see, it goes well beyond my alleged "greed" that CNMTOCRNA spoke of. The fact that you got a pretty good idea which hospital I'm talking about out of some 50 greater ATL metro hospitals says it all.

    Secondly, in comparison, ATL does have a lower cost of living than most urban areas. The bottom line is that their will be more jobs than graduates, AA, CRNA, or MDA, no matter what city you live in. Thanks for the reply JWK
  7. by   InterestedRN
    Quote from loisane
    While I can understand the need to look at issues from a personal level, using specific/individual examples, I would like to ask that we step back and take a more global look at the CRNA vs. AA comparison.

    Medicine is a profession. Physicians were the first to establish themselves as professionals in health care, and standardize their education and licensing.

    Nursing is also a profession. We are younger, but we have a well established system of educational and licensing standards.

    The practice of nurse anesthesia by CRNAs is accountable to the standards of the nursing and the governmental institutions that regulate nursing.

    Who are AAs accountable to? My understanding is that they are not professionally accountable (GeorgiaAA of course, is welcome to comment on this). Since AAs are by definition assisting the physician, it is the physician who is professionally accountable for the AAs actions. (The AA may be personally accountable, but that is a different standard from professional accountability). They are truly physicain extenders. This is congruent with organized anesthesiology's position that all anesthesia is the practice of medicine. They believe the only role for non-physician anesthesia providers is to perform delegated medicine. The physician is always accountable, at the top of the pyramid.

    So, the central issue as I see it (stay with me now)- is this a correct position? Is society best served by the physician always in charge model? Are other licensed health care providers incapable of safe, effective care without the direct supervision of a physician?

    Our culture has a strong pro-physician bias. This often leads to the (erroneous in my opinion) view that CRNAs are a "second best". Everybody wants the best of care for themselves and their families, and we have been conditioned to believe that the only way to receive that is from a physician. Everyone else is second best. There was a time, when physicians were first establishing professional standards, that this was actually true. But I believe health care has evolved past that.

    Nursing is a profession. Nurses have a legitimate role in patient care, separate from physicians. We are not physician extenders. Medicine does not control us. We have our own license, our own professional regulatory Board and our own professional standards.

    Nursing stands on its own. I don't agree with the model that requires CRNAs to always be subordinate to the anesthesiolgist. But I am not looking to replace all of them with CRNAs. What is so wrong with wanting to work side by side as equals? Those in medicine who would like to see us subserviant need to know that we aren't their hand maidens, and we aren't going back to that. Nurse anesthesia is leading the way, and the rest of nursing will follow.

    loisane crna
    Thank you Loisane, very well stated.
    Interested
  8. by   InterestedRN
    Quote from Athlein1
    Loisane, your post was excellent. Thank you for your insight. The distinction you make is clear - and also an angle that I hadn't considered.

    And DeepZ, you always inject a bit of fire into the discussion! Thanks for the explanation of reimbursement.

    Pnurse, the issue is far more complex than who is supervised and who works independently. Do a search on this board for the several recent threads.

    LBhot, I hope you clearly see that there is more difference than job outlook. But since you asked, the last time I checked www.gaswork.com, there were 1138 jobs posted for CRNAs (obviously, some may be repeats, agency, etc). There were 3 AA postings. AAs are not PAs. They can practice in a limited role in a minority of states in this country.

    Alansmith, I think we need to get you and DeepZ together for a beer at the National convention. Now THAT conversation would be a hoot!

    User69, did you really mean to say "as long as they are not students"? Are you not just starting nursing school, not even an RN yet? Who are you going to practice on? Because let me tell you, starting an IV in an orange is not the same as a screaming, kicking meth-user who just arrived in your ICU pooping blood. And "anesthesia nurse" is meant to be condescending. There are nurses in endoscopy and special procedures that call themselves "anesthesia nurses". They are not CRNAs, and "anesthesia nurse" is a non-technical, made-up name. Few people in the public can even pronounce anesthetist, let alone grasp the scope of the job description.

    Tenesma, the term anesthetist (pronounced ah-neeth-ta-test or ah-neese-tha-tist with some regional variation) is a common term for physician anesthesiologists across the British isles.

    Athomas, how about "Anesthesia Diva?"

    And seriously, Georgia_AA, I appreciate your thorough post. Your explanations were helpful and your description of the salary issue is true in the Atlanta metro area and surrounding towns, as I understand it.

    By your own admission, though, you I should point out that if you are running your cases with no involvement from your supervising MD, s/he is committing billing fraud and you are practicing beyond the scope of your license. This illustrates beautifully one of the main issues regarding AA practice. You simply cannot argue that what is designed to be a supervisory role often lapses into one of independent practice with the "supervision" being applied only to allow four rooms staffed by CRNAs or AAs to be run by one MDA, and billed accordingly. Please do not take this as a personal attack. I understand well that this is a common phenomenon that is not at all unique to your department.

    The other key issue at stake here is that the acceptance of this "anesthesia care team" model in which AAs and CRNAs function interchangeably serves as a springboard for the future restriction of CRNA scope of practice. AAs cannot rise to the current level of practice of CRNAs by virtue of their training and licensure, so the CRNA scope of practice is restricted to allow for equitable working conditions. This is not acceptable.

    And let's be honest. Physician anesthesiologists are extremely concentrated in metro/suburban areas or those with a higher quality of life. The real shortage lies in the underserved, rural areas and those with less desirable working conditions. AAs cannot practice independently, AAs must have a supervising anesthesiologist, and anesthesiologists typically do not choose to work in areas with the greatest need, therefore AAs cannot be the solution to this country's anesthesia provider shortage, contrary to the attestation of your national organizations.

    Many thanks to all for this dialogue...
    Nicely stated!
    Interested
  9. by   cnmtocrna
    Quote from SCSRNA
    First of all, I'm agreeing w/ you. I thought $76,000 sounded like a low salary to me also. Your might call this greed, but don't be blind to the business aspect of the profession. When I was in the ICU, I was making about $15,000/yr less than the salary offered to me if I were start work as a CRNA at that hospital. Their was a $20,000 educational rembursment offer to me. Sure, I had to stay for 3 years, but it was offered. So now we are up to $83,000/yr. This, of course, after I borrow $90,000 and quit work for 2 1/2 years. Sound greedy? I saw from your previous posts that your husband is an OB. Some of us don't have the luxury of a supplemental 6 figure income in the house. This is gonna be more than a hobby for me.
    You have taken my reference to greed out of context. I was refering specifically to the issues between CRNAs and AAs. In Atlanta many CRNAs feel that the AAs have depressed the salaries. I'm not going to outline the whole thing for you here, you can read it if you want to, but you may have missed my point.
  10. by   Carolina SRNA
    I think it's safe to say that this issue is interesting...seeing as I am signing on at post #244.

    A little history....

    Upon graduating with my BSN, I went directly into the SICU in Atlanta, Ga. I have always wanted to provide anesthesia. I had never heard of AAs until this move. They recovered several of my patients and seemed very professional in nature. I actually observed in the OR with an AA I met and was amazed. I went on to be trained as a CV nurse involved with balloon pumps and swan monitoring on a daily basis (who hasn't) to be more competative for anesthesia school. I also have done transplant unit nursing at Emory as well. There is an enormous degree of pathophysiological anatomy, a definite pharmacological understanding, and simply, refined acute assesment skills that a bedside RN brings to the table before anesthesia school. HOWEVER.....(those of you with experience...hold your tongue..), following my first day in the OR, my first month, sometimes even now, you would not have known me from a Walmart greeter. Yes, some prior knowledge was helpful , but fundamentaly, it's a whole new ball game. We leave the roll as nurses and take on the responsibilties as trained anesthesia providers to that of an MD-A.

    Now for Georgia AA, I commend you for stepping into the field of battle. I am very familiar with Mr Rob Wagner (previous AA President article posted). My wife performs subspecialty surgery at St. Josephs and Rob is a friend of hers. I also very much understand that AAs and CRNAs get along very well while in the anesthesia setting but bash and clash each other (as seen in about 240 other postings) when the back is turned. Now don't get me wrong, I'm not selling out...I support my profession. It just seems to me that many of the postings are very similar to the current presidential election debates....lots of talk and jabbing about laws, lack of education, lack of acute experience, bla bla bla but no real support of any certain issue. In 240+ postings, few actually settled the difference between the two professions. I hope you have not signed off. I would like to acutally speak with you privately....I most likely will be returning to Atlanta.

    Now the REAL TRUTH...it's not that AAs drive the market down in Atlanta...it's that the combination of the enormous amount of AAs there and also the CRNAs somewhat saturate the market in the metro area. Now for those of you that don't live in Atlanta, that comment did not pertain to you. I know that even as far away as <100 miles, CRNAs in Georgia are making over $200,000 with OT and call. Many of you that made postings need to really evaluate this fact. It's not that AAs are incompetant, but you better believe CRNAs will fight to maintain this ability of income power and autonomy as long as we can. If you are questioning the $$ stats, check out www.gaswork.com, and check any state. And if you haven't heard, Georgia is to open it's second AA school in Savannah at South University starting 2005. Florida is posted to open new schools (2-3??) if legislation moves through...Georgia will continue to have less competative salaries as some other regions of the country currently offer.

    For myself, I will be graduating with over $120,000 dollars in loans from undergrad and NA school. I've spoken with four major hospitals in Atlanta as of yet and the offers have ranged from $84000 to $93000 for a new grad. That does not include any stipend or sign on bonus. In fact, some places only offered a sign on bonus of $5000....very sad seeing as that's the same amount I recieved upon graduating with my BSN. In fact, one hospital is now offering $10,000 for RNs to sign on. Another fact...I worked agency most of my time in Atlanta. Each year I made over $75,000 with little effort. I DID NOT GO BACK TO SCHOOL AND GO INTO DEBT OVER 100 GRAND AS WELL AS SUFFER THE 2.5 HARDEST YEARS OF MY LIFE JUST TO RETURN FOR A COUPLE OF DOLLARS RAISE PER HOUR!!!!

    That my loyal peers lies the truth of all of the battles you have read...the almighty green daddy...HOW MUCH AM I WORTH!!!! There is no question over training, skills, (or even EF%, on pump/off pump 15 vessel is you will) or whatever guns are to be pulled out here.

    Georgia AA stated that he/she (not sure) has been working for over 14 years and is now a senior anesthetist with a base of $115 making approx $160 with lots of OT/Post Call, etc. Here in Carolina, new grads are starting out at over $145,000 in areas with populations of 100,000+ people with sign on bonuses of 20-40,000+. I know for a fact that a grad from 2003 made over $240,000 the first year out with call and post call. That's the premise for those of you who aren't yet in school or who are not familiar with the whole AA vs CRNA battle is sturring over.

    Also, in ATLANTA...not everywhere, the majority of regional blocks, spinals, epidurals, etc are not performed by AAs or CRNAs. This comes strait from an Attending MD-A at Emory University (training site for AAs)..."Yes CRNAs are trained to perform the functions of regional anesthesia and central line placement as well as our AAs but we just don't have the time to sort out the professional anesmosity between you guys, we rather do it ourselves?????"
    Nice.

    Now for those of you with revolvers loaded and ready...please be civil...or not. I just am man enough to know the truth about why I personally have an issue here. It does not involve intelligence. And please, for the sake of sanity, don't quote me on the acute care experience RNs have before school and the lack thereof AAs possess because if fact be known, many of the current SRNAs across the nation have less than one year experience...including PACU or the ED...they have never seen a swan, obtained vent management skills, or much less know anything about titrating drips, hemo monitoring etc,....and yet we all graduate together...as far as some of them are concerned, TLC is a R & B group out of Atlanta.
    And second of all, don't reply stating that I'm just wet behind the ears still or "green" d/t being an SRNA. It doesn't require a license to balance a check book.

    Come on guys...it's about the intense training and intelectual competance we learn as we go...not Physician Supervised or not....yes it hurts the pocket...but I believe it will all come out okay in the wash.
    And for you cowboys that just can't see me through...I hope your saddle rides out safely and you aren't cattle romped by some legal ramification just because you are independantly licensed and not supervised. Personnally, after observing the criminal mindset of the general public and their quick way to make a dollar by lawsuits as I have thus far, I feel I will enjoy not being the sole provider and responsibility of one's care but rather having and practicing with a "team" of providers that share some common liabilty. Although I will always have the opportunity to practice alone once graduated, it is a relief for now to have the team approach.

    And so it begins....
    Last edit by Carolina SRNA on Oct 21, '04
  11. by   makeup_nurse
    As someone is is considering becoming a CRNA, I found this thread very interesting!

    "In the 1960s, three anesthesiologists, Joachim S. Gravenstein, John E. Steinhaus, and Perry P. Volpitto, were concerned with the shortage of anesthesiologists in the country. After studying the educational pathway for anesthesiologists and nurse anesthetists (NAs), they created a new educational paradigm for a mid-level anesthesia practitioner that included a pre-med background in college. This person would perform the same job as the NA but would be readily able to go on to medical school if appropriate. This new professional, the anesthesiologist assistant, or AA, thus had the potential to alleviate the shortage of anesthesiologists."

    (http://www.asahq.org/career/aa.htm#1)

    I have an undergraduate degree in Biology from Duke (pre-med), and a MS in Molecular Biology. Why do people think a pre-med BS is much harder or "better" than a BSN?

    Right now I am looking at entering an accelerated BSN course, and I don't find it easier by any means. Different, but not easier.

    In fact, pre-med courses are great as a solid science base for medical school, but really have little practical application... The BSN seems to cover more practical applications of science. In my opinion, I think the BSN better prepares you for working in a clinical environment than a BS by many magnitudes!

    I am not on either side, it is just strange how the literature for AA programs, etc seem to emphasize that AAs "are prepared to go to med school" (paraphrasing) at a moment's notice! To me, that doesn't mean that much, as I know I certainly wasn't prepared for anything after I got my BS degree (pre-med).

    Now, the actual *training* AA receive in their program, and the *training* CRNAs receive in their program--that is what prepares both CRNAs and AAs for their jobs.
    Last edit by makeup_nurse on Oct 21, '04 : Reason: correct typos (though I probably missed a few!)
  12. by   Quickbeam
    I have found this thread fascinating. I never even heard of an AA before. I do have friends who are CRNAs and they make 3 to 4x what I make. They all have master's degrees and advanced credentialing.

    O/T: makeup nurse? I'm an accelerated program BSN graduate. PM me if you have any questions.
  13. by   Carolina SRNA
    Good observation!!!

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