Here's what AAs really think of CRNAs - page 5
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
May 4, '04Quote from alansmith52There actually is a chat function, just in a separate room................oh , how i wish i could go, I think I'll be putting needles in dummies backs
ps. to bad this site doesnt have a chat function so we could have a real time chat with whos on at the time.
May 4, '04I was just sitting back watching this one from the sidelines since studying for finals is kicking my a$#, but now that beer in Seattle has been mentioned... :hatparty:
May 4, '04Quote from charles-thor:chuckle :chuckleI was just sitting back watching this one from the sidelines since studying for finals is kicking my a$#, but now that beer in Seattle has been mentioned... :hatparty:
May 4, '04Quote from athlein1I am in no way practicing beyond the scope of my license. I am performing those tasks which are fully within my practice description as accepted by the Georgia Board of Medical Examiners. I said little to no involvement. This does NOT mean that I never see my attending again. What I'm trying to point out is that I am not being told what to do step by step as has been alleged in CRNA written propaganda. I do not need to call my attending for every 5mg dose of Ephedrine. For billing purposes, the MDA must be present for induction, present for emergence and continuously available. The intent is to disallow having an anesthesiologists covering locations blocks or miles away. This also satisfies the definition of supervision. Our MDAs check on the room at regular intervals and sign the chart when they do so. All perfectly legal and normal practice. Your statement that this is an issue with AA practice is misleading since they afford the same level of supervision to the CRNAs.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.
Quote from athlein1The ONLY thing that I cannot do is practice independantly. Beyond that, I am trained and fully capable of doing anything that a CRNA can do. Honestly, I can't rise to the level of CRNA practice by virtue of my training?? Now who is insulting whom??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.Last edit by georgia_aa on May 4, '04
May 4, '04Georgia AA, what 17 states can AA's practice in? My understanding was that AA's were only in Georgia, Ohio, and now Flordia.
May 4, '04I am curious as to what education AA's must have to practice. I may have missed this info in an earlier post but don't think so. What kinds of didactics and length of clinicals must they have to provide anesthetic care that they deem is safe?
May 4, '04Quote from Brenna's DadI'm not so sure about that Tenesma. In Canada at least, which is of course based on the British medical system, an Anesthetist is a physician who practices anesthesia. .........
And so it is throughout Great Britain, Australia, New Zealand, etc, etc, all the old British Empire. Aneeesthetists, the Brits pronounce it, of course.
Anaesthetists practice all over the world. Anesthesiologist, the word, was devised in about 1937, to distinguish Dr Waters and his crowd from CRNAs. Today, nurse anesthetists, in various international descriptions, practice in over one hundred nations around the globe.
AAs, what few do exist, work in only a handful of States in one nation.
"Certified Registered Nurse Anesthetists, recognized leaders in anesthesia care, advancing patient safety and excellence in anesthesia."
May 4, '04Quote from EmeraldNYLGeorgia AA, what 17 states can AA's practice in? My understanding was that AA's were only in Georgia, Ohio, and now Flordia.
I know they work in Alabama. I have worked with them before. I thought they did a great job from the limited scope of knowledge I know. The MD comes in at the beginning and at the end, but otherwise not seen much.
May 5, '04This is a bill passed in Ohio regarding AA's and what they can do:
Ohio Legislative Service Commission
123rd Senate Bill Analysis
In an individual's practice as an anesthesiologist assistant, the bill specifies that the assistant may do any of the following:
(1) Obtain a comprehensive patient history and present the history to the supervising anesthesiologist;
(2) Pretest and calibrate anesthesia delivery systems and monitors and obtain and interpret information from the systems and monitors;
(3) Assist the supervising anesthesiologist with the implementation of medically accepted monitoring techniques;
(4) Establish basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;
(5) Administer intermittent vasoactive drugs and start and adjust vasoactive infusions;
(6) Administer anesthetic drugs, adjuvant drugs, and accessory drugs;
(7) Assist the supervising anesthesiologist with the performance of epidural and spinal anesthetic procedures;
(8) Administer blood, blood products, and supportive fluids.
In addition to the activities specified above, the supervising anesthesiologist of an anesthesiologist assistant may authorize the assistant to do the following:
(1) Participate in administrative activities and clinical teaching activities;
(2) Participate in research activities by performing the anesthesia assistance procedures the bill authorizes;
(3) Provide assistance to a cardiopulmonary resuscitation team in response to a life-threatening situation.
At all times when an anesthesiologist assistant is providing direct patient care, the assistant is required by the bill to display in an appropriate manner the title "anesthesiologist assistant" as a means of identifying the individual's authority to practice under the bill.
Under the bill, an anesthesiologist assistant may practice only under the supervision of an anesthesiologist and only in a hospital
Sounds to me like AA's must be under direct supervision of an anesthesiologist at all times, meaning an MD must be in the room at all times.
May 5, '04>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
This is bound to make a lot of eyeballs roll back in a lot of heads, but ya gota understand the history of Nurses in anesthesia and MD's in anesthesia.
I'm sure anyone knows that early anesthesia was traditionally done by Nurses.. They were more "Vigilant" (attentive) than the residents and interns , then came the surplus MD situation.
It's a matter of control. CRNA's on a day to day basis "witness" the clinical skills of Anesthesiologists, (from now on MD-A for short)
These are the guys that are supposed to be our superiors.. and in many cases, they are good.. not superior, but at least equal.. Then there historically has been the Foreign Trained MD that chose Anesthesia, because they could not speak enough English to enter private practice. Their skill level might have been good, but their other skills lacked.
For years MD-A's were looked down upon by their surgeon colleagues for some of those reasons.
And at the other extreme is the MD that is not trained in anesthesia at all, possibly taking a rotation in anesthesia for a few months, then calling themselves an Anesthesiologist. They are still out there, maybe as a GP doing anesthesia ,to a lesser degree, but still mucking about. Then there are the ones that cannot pass their boards in anesthesia, but call themselves "board Eligible" and work as MD-A's.
Now this fussin has been going on for at least 40 years that I have been passing gas and longer between CRNA's , that usually come from the tops of their classes, are somewhat over achievers, and clinically excellent, in comparison with some of the older so called MD-A's that just squeezed through med school.
The issue now is about control of anesthesia provision and competition, by the MD-A's, that by law, and standard practice have no real control over CRNA practice. CRNA's are technically supervised by a surgeon, as part of a team effort in most states, but Surgeons do not know a lot about modern anesthesia . It's about all they can do to stay on top of their own Board requirements.
So the CRNA-AA fuss stems from the CRNA / MD-A control issue. They have been unsuccessful in legislating control over CRNA's, so they have created their own Newtech Anesthesia provider.. The Anesthesia Assistant. And these folks have put down their sliderules from engineering, Botany, Chemistry , etc degrees, and come into a patient care field without any background in human science (eg Nursing background-- remember all the hoops you all had to go through, taking care of patients? Enemas till clear. talking to the family of a child that just died, Psych and OB training, etc,wrestling with the drunk in ER, and worse as part of your nursing backgrounds? )
This is not a put down of Anesthesia assistants, they have just been sucked into the CRNA MD-A turf Battle... All proposed legislation to permit Anesthesia Assistants to work has required that they be SUPERVISED by an MD-A--- talk about built in control..
there is NO requirement in ANY state that a CRNA must be supervised by an MD-A , but MD-A's would love this requirement, and control.
There is an old saying among CRNA's , that we all get smarter at 3:30, when the MD-A's go home, and we are left there by ourselves, finishing the schedule, or being on call the rest of the night, with no supervision..
The Anesthesia Programs at Emory and other places, were started as a direct attempt by MD-As to gain control over anesthesia. Note, it was not mentioned that the MD-A's actually do the cases, Lord no.. that would make it difficult to sit in the lounge and watch the stock ticker and eat donuts..
I do not really have a problem with AA's, but again I do not personally know any. They may be the greatest people in the world, I don't know. I do know, that by law, their wings are Clipped,, they may not make independent decisions , insert invasive cardiovascular lines, do regional anesthesia in most situations (another facet of "Control")
God forbid the MD-A should be stuck in the bathroom or have an MI and they had to make a clinical judgments, that is not in their armamentarium.
When I have my next surgery, I want my anesthesia done by someone that can give me an emergency enema if needed, without calling an MD-A for advice.
Oh yea, someone made the comment about the US being the only place that uses CRNA's... Untrue, and it is being experimented with in England, Australia, Canada, and many other places that have traditionally had only MD-s Doing anesthesia.. they are beginning to see the light..
Many Anesthesia Assistants are trying to pass themselves off as Physician's Assistants. The Nation Physician Assistant Assn, states in no uncertain terms, that Anesthesia Assistants are NOT the equivalent of Physicians Assistants.
You can see Emory's evaluation of the 2 on their own web site
As nurses you have seen the good and bad Physicians. And the control issues. This is what I all comes down to. Control and MONEY..
I'm done ....you can wake up now..
May 5, '04It might be me but I don't see all the hoorah about people thinking MD's being better at anesthesiology. This is in regards to a few previous posters comments. If it weren't for nurses, the art of anesthesia would not be where it is today. Look back at the late 1800's where they could not even get MD residents to perform the anesthesia because they were more interested in the actual surgery. There was also no money to be made in anesthesia at that time because the surgeons charged for anesthesia services and pocketed that money. It is not until around the 1920-1930's that MD's became more interested in anesthesia and found they could make money in it, so what better to do than to kick the "nurses" out and keep the money for themselves. CRNA's provide superior care and I would put it up against any MD.
May 5, '04Quote from georgia_aaAA's practice in 19 states? According to this ASA document, it's 10. Eleven if you now include Florida.AA's currently practice in 19 states. We just passed legislation in the biggest of them all - Florida. Florida was seen as the lynchpin in the national arena since it is historically the most difficult state to pass credentialling legislation. Other states will now follow in short order. A third program is set to open this summer.
Trust me - we are here to stay.
BTW, I checked on the situation in California, which is a pretty big state too. No AA legislation here, at least not yet. It hasn't even been introduced, or so I'm told. Just FYI.
:spin:Last edit by Sheri257 on May 5, '04