Here's what AAs really think of CRNAs - page 6

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   Sheri257
    I'm not really pro or con either way. To me, the real question is, has anybody been able to prove that AA's actually endanger patient safety?

    Maybe that's not possible to examine that question for a number of reasons, including the fact that there aren't many AA's to begin with. But I suspect that many of the CRNA arguments may fall on deaf ears, at least in the public arena, until somebody can prove for sure that this is a patient endangerment issue.

    Arguing that they don't have enough training, even if it is true (and I'm not saying it is BTW), probably isn't enough until it can be proven that AA cases actually result in higher death rates, etc. Otherwise, it looks like a money/power/turf struggle.

    I'm not saying that either side is right or wrong. I'm just talking about the realities of the public's perception of this kind of debate. Afterall, this may be the reason that Florida went ahead and passed AA legislation.

    Last edit by Sheri257 on May 5, '04
  2. by   Passin' Gas
    TEFRA requirements -- In supervising concurrent cases, the anesthesiologist must meet the so-called TEFRA (Tax Equity and Fiscal Responsibility Act) requirements, which are:

    Perform a pre-anesthesia examination and evaluation;
    Prescribe the anesthesia plan;
    Personally participate in the most demanding procedures in the anesthesia plan, including induction and emergence; (this requirement gets a high percentage of 'medically directed' violations)
    Ensure that any procedures in the anesthesia plan that the physician does not perform are performed by a qualified individual;
    Monitor the course of anesthesia administration at frequent intervals;
    Remain physically present and available for immediate diagnosis and treatment of emergencies; and
    Provide indicated post-anesthesia care.


    Quote Georgia-aa: As a senior anesthetist I am given free reign to manage my cases as I see fit. Very rarely does my attending dictate what the anesthetic should be. They may make a suggestion here or there like "work in a little Morphine towards the end" but I am not required to check with them about most decisions that come up during a case. New grads on the other hand (AA and CRNA) really are expected to communicate with their attendings a little more often. I commonly do extremely complicated cases from beginning to end with little to no involvement from my supervising MD. Italics added.

    How does this meet the TEFRA requirements? And is billing for medical supervision or medical direction? My understanding (admittedly, limited) is that AA MUST be medically directed. Period. CRNAs, on the other hand, may be supervised by an anesthesiologist or physician and bill directly for their own services.

    PG
    Last edit by Passin' Gas on May 5, '04
  3. by   GOCRNAS
    I have not read all the threads in detail, but know the basic discussion. I live in southwest Kansas where most hospitals are run by CRNA's. I have yet to see an AA function independently as such. I beleive there are only 2-3 anesthesiologist in that region. The rest is CRNA's
  4. by   athomas91
    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.
    see - this is what i mean by blurring the lines of distinction...just because your MDA's "afford this level of supervision to the CNRA's" doesn't mean it is neccesary for them to do - in other words - THEY MUST DO THIS FOR AA'S - THEY NEEDN'T DO IT FOR CRNA'S because we are legally allowed to function independently...i am well aware that some institutions have the MDA's present for sentinal events (intubation and extubation) but that is institution dependent - NOT LEGALLY MANDATED where CRNA's are concerned. You are misleading in your statements by equating our scope of practice when it is in fact not equal - perhaps we do many of the same skills - but your practice MUST BE supervised by law - ours may be supervised but it is NOT A MUST....there is a signifigant difference which i think the AA movement clearly tries to hide in its quest.

    perhaps i can give another example....Nursing Technicians do the almost all of the same functions a nurse can - they can place iv's, foleys, do ekgs, - and most are very adept at caring for a patient (some moreso than nurses...LOL) - however - they are not nurses and their scope of practice and what legal responsibility they carry differs much from nurses. - now i am not equating AA's to nursing techs - AA's have advanced training and advanced degrees - but...i am trying to show that just because you do some of the same functions DOES NOT mean the scope of practice is equal.
  5. by   user69
    Just a few quick points/questions.



    If AAs have been around for 30 years, has this argument been raging that entire time? Shouldn't the lobby power been used to stop AAs before they were established instead of now?



    What have the AAs or the MDAs been doing to restrict our practice? How are we more limited now than thirty years ago before AAs were introduced? From the checking I have done, it looks like CRNAs have made inroads into traditional MDA areas and not the other way around.



    If there are only 700 AAs and two schools, is there nothing more relevant that our money and lobby power should go to?



    Has an independent group ever made a decisive study of the outcomes of the CRNAs vs. AAs?





    [font='Times New Roman']I just do not understand why it is such a hot issue when it looks like almost everyone on this board has never worked with an AA. The arguments that I have read have been that AAs lower CRNA salaries, but GeorgiaAA's statement and looking on Gasworks does not appear to back this up. The second point that appears to be hot is that AAs are not properly trained to handle anesthesia, but if there was a string of dead patients behind the AAs I do not think anyone would be arguing this point.
  6. by   loisane
    Quote from user69
    If AAs have been around for 30 years, has this argument been raging that entire time?
    A few years ago the ASA announced an initiative to focus on AAs and foster their growth and membership. Some believe the timing to be related to nurse anesthesia's attempt to remove supervision requirements from Medicare regulations (that led to the individual state opt-outs that are still in progress).

    What have the AAs or the MDAs been doing to restrict our practice? How are we more limited now than thirty years ago before AAs were introduced? From the checking I have done, it looks like CRNAs have made inroads into traditional MDA areas and not the other way around.
    This is a common misconception. Read Swumpgas post for a brief history of anesthesia delivery models in this country. Or better yet, read "Watchful Care" by Bankert.

    If there are only 700 AAs and two schools, is there nothing more relevant that our money and lobby power should go to?
    One of the biggest limiting factors in any anesthesia education (MD/CRNA/AA) is the availability of clinical experiences. Any wannabe who has been following this board has learned one of the things to look for in a program is the availability of clinical experiences, and the desirability of a program where nurse anesthesia student do not compete with anesthesia residents for clinical experiences. What will happen to our education programs when you add another type of student competing for cases? Will there be enough cases for everyone? Some individual programs might by adversely affected. That is significant to the future of our profession.


    Has an independent group ever made a decisive study of the outcomes of the CRNAs vs. AAs?
    Forget about it. It isn't practical, and the results wouldn't matter anyway. I don't agree with slinging mud onto AAs over safety. I don't like it when ASA does it to us, and I won't stoop to their level.

    [font='Times New Roman']I just do not understand why it is such a hot issue when it looks like almost everyone on this board has never worked with an AA. The arguments that I have read have been that AAs lower CRNA salaries, but GeorgiaAA's statement and looking on Gasworks does not appear to back this up. The second point that appears to be hot is that AAs are not properly trained to handle anesthesia, but if there was a string of dead patients behind the AAs I do not think anyone would be arguing this point.
    I know most of you are very new to these issues. But listen to those of us that have been around awhile. There is a history here, a pattern of behavior. This is part of a bigger picture.

    loisane crna
  7. by   duckboy20
    This doesn't completely have to do with AA's, but for anyone thinking that the CRNA/MD fight is due to CRNA's, look at this thread, http://allnurses.com/forums/showthread.php?t=17140
    Hope it works, it will give you a little insight on what the MD profession thinks of us
    "lowly" CRNA's, one even calls us OR Scum. Sounds pretty professional to me.
  8. by   Peeps Mcarthur
    How interesting,

    Why the gap in education?

    AAs are basicly premeds........8 cred Genchem,8 cred Organic 8 cred Physics, 8 cred calculus, 8 cred English........a BS in premed is certainly more difficult than a BSN. Still, this doesn't change much yet.

    Isn't there a difference in clinical hours?

    Again, why the gap in training?
  9. by   Sheri257
    Quote from loisane
    I know most of you are very new to these issues. But listen to those of us that have been around awhile. There is a history here, a pattern of behavior. This is part of a bigger picture.

    loisane crna
    I have been listening. But, quite frankly, there doesn't seem to be compelling arguments coming from the CRNA side. They say AA's don't have enough training, but there's no evidence that patient outcomes are adversely affected. They say MDA's are greedy, but the same argument can be made against CRNA's. They say clinicals may be adversely affected but, once again, no one seems to know for sure.

    I agree with GeorgiaAA that the Florida decision is probably significant and, IMHO, it's a sign that CRNA's aren't doing a great job of selling this to the public. Perhaps we don't fully understand all of the details and history on this issue, but then, the Florida legislators apparently didn't either.

    And, in the end, that's what really matters since the bottom line is: CRNA's have just lost another state on this issue. Not exactly a ringing endorsement that the CRNA arguments are working, is it?

  10. by   deepz
    Quote from lizz
    ......the Florida decision is probably significant and, IMHO, it's a sign that CRNA's aren't doing a great job of selling this to the public. Perhaps we don't fully understand all of the details and history on this issue, but then, the Florida legislators apparently didn't either......

    The 'public' doesn't craft legislation, Lizz. Never underestimate the corruptibility or the ignorance of legislators. And then there's gullibility. Like the average consumer, legislators are prone to *assume* that a physician is inherently better at any medical-related task. Does not apply to anesthesia, obviously. Such unfounded presuppositions have landed many a consumer in the graveyard. Or worse. There are worse things than death.

    By allowing lesser-qualified providers like AAs in Florida, the true losers will be the patients.

    Just MHO

    deepz
  11. by   Sheri257
    Actually, I agree Deepz. I've spent a lot of time covering legislatures (in three states, BTW) as a former journalist. I certainly understand the politics, etc. But, until you have hard evidence that patients will actually lose, instead of hypotheticals, I think it's a lost argument and can easily be perceived as a money squabble more than anything else.

    I'm not saying it's right. I'm just viewing the issue from a practical standpoint. All of this stuff about what MDA's have done to CRNA's, or vice versa, probably doesn't matter much in the end. Until there's hard evidence, rather than mere predictions that this is a bad thing for the public, I don't think CRNA's will win on this one.

    Last edit by Sheri257 on May 5, '04
  12. by   loisane
    Quote from lizz
    But, until you have hard evidence that patients will actually lose, instead of hypotheticals, I think it's a lost argument and can easily be perceived as a money squabble more than anything else.
    There are other ways for patients to lose other than bad clinical outcomes. If you examine the finances, AAs are not a sound investment for our future. The money that will be spent on creation of new programs to educate providers with a more limited scope of practice than CRNAs, could be spent on our system of nurse anesthesia education that is already in place.

    And why do we need AAs in the workforce anyway? By the time a significant number of new graduates are out in practice, our present nurse anesthesia education system will have produced enough graduates to meet the manpower needs.

    These are also the kind of things responsible legislators should be looking at. But that pro-physician bias is a powerful force.

    loisane crna
  13. by   user69
    Quote from loisane
    there are other ways for patients to lose other than bad clinical outcomes. if you examine the finances, aas are not a sound investment for our future. the money that will be spent on creation of new programs to educate providers with a more limited scope of practice than crnas, could be spent on our system of nurse anesthesia education that is already in place.

    loisane crna
    [font='times new roman']are you suggesting that the money spent by the aa students (in 2001 emory's web site says that is 62k) should be taken away form the aas and used to support the crna educational system? or are you saying that there are public funds that are going to support these private programs that would be better spent to subsidies crna programs?

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