Here's what AAs really think of CRNAs - page 7

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   deepz
    Quote from lizz
    ......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......

    Money squabble, yes. But POWER also, the urge to control anesthesia nationwide as much or more than the MONEY motivates A$A to push AAs on the public.

    Folks like GeorgiaAA may be proud and boastful of making $160 K a year, but if those same folks actually understood just how exploited they are, if they grasped just how much unearned income the MDAs profit from the AAs' labors, if they knew the true dollar amounts, they'd revolt. As I say, personally, I'd rather pick cotton.

    The Atlanta MDAs are sort of like smart bankers, passing out impressive titles, like Chief Anesthetist, to their underlings instead of pay raises.

    Just MHO

    deepz
  2. by   jelrtLPN
    Quote from nilepoc
    I would like to take you up on your offer.

    During my nursing preperation to gain entry into CRNA school I worked indirectly with an AA. he seemed very competent and was a very amicable person. Unfortunately at the time I was unaware of the tensions between AAs and CRNAs. So I never sat down with this person to have a talk with him.

    My first question to you is....

    What is the difference in your practice from that of a CRNA? Do you do central axis blockade? Do you plan your own anesthetic or does the MDA suggest one and you follow it (corolary question if you decide to change the plan mid case, do you have to consult with the anesthesiologist)? The place I am currently training in, allows the CRNAs to plan and implement their own anesthetic plans (If the CRNA chooses to, they can do the entire induction themselves). CRNAs are also allowed to practice the placement of central lines, and regional anesthesia beyond central neuraxial blockade. I imagine that the scope of practice varies from institution to institution. If I remember correctly AAs lost the ability to provide central blockade in the last couple of years in Ohio.


    (This question is not particularly fair to ask, as it insinuates that you are of the opinion of the question. If you choose not to answer it, i will understand. Please do not consider it an attack, as it is just me being curious) Why does the ASA see CRNAs as a threat, yet embraces AAs (especially if AAs are comparing themselves to CRNAs to prove how valuable they are)? I guess what I am asking is what do AAs bring to the table that CRNAs do not. Or in your opinion what makes us different? Because obviously we are different. I like to say that there are anesthesiolgists that I would not let water my lawn and ohers I would seek out to give me anesthesia. Likewise with the CRNAs I know. I imagine if I knew more AAs, I could say the same thing. A title does not make for a safe provider, but it does predjudice peoples opinions of the provider.


    How long did it take for you to feel comfortable caring for patients with multi system disease? I know that the time I spent in the ICU prior to entering CRNA school really helped me attain this comfort level.

    Those questions ought to be enough to open up a discussion.

    I ask that this remain civil, and I would like to thank you for this opportunity.

    Craig
    This sounds so familiar, I'm an LPN, constantly being compared to the RN, but in the larger scheme of things, we are there for the paitent,not our egos. I do plan to go on for my RN. Not to say im an RN, but to further my education in the hopes of furthering my patients and family knowledge of thier disease process.. I will remember how i started out in this field, a nurses aid, for 10 years , then a nursing student, where im sure the term, "eat thier young came from", i've been an LPN for 10 years now, soon my RN. I will treat all health care workers i come across with respect, isn't that what it's all about anyway?
  3. by   loisane
    Quote from user69
    [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?
    no. i am making the case that is not a wise allocation of an educational system or a government's resources/dollars.

    but it is true that both physician and nursing programs receive public/federal dollars in a variety of ways. i don't know about aa programs.

    loisane crna
  4. by   Sheri257
    Quote from deepz
    Folks like GeorgiaAA may be proud and boastful of making $160 K a year, but if those same folks actually understood just how exploited they are, if they grasped just how much unearned income the MDAs profit from the AAs' labors, if they knew the true dollar amounts, they'd revolt. As I say, personally, I'd rather pick cotton.
    Oh, I agree. But this is where the CRNA argument also gets sidetracked, IMHO. Nobody really cares who gets paid what, even though you guys do, and understandly so. I'm not arguing against your point but, at the same time, this is not an issue that's going to drum up support for CRNAs. Especially since the wages for both AA's and CRNA's are still somewhat better than picking cotton.

    You guys really need to develop evidence on AA patient outcomes. That's the way to really nail this thing, IMHO. Loisane's point about education funding may be a good one, but it probably won't influence public policy nearly as much as patient endangerment.

    :spin:
    Last edit by Sheri257 on May 5, '04
  5. by   Kiwi
    Replacing existing AA programs with Nurse Anesthesia graduate programs would be key to solving some problems. Namely, there would be more RNs to help with the nursing shortage. I am going to nursing school with the sole intention of pursuing graduate studies. However, I will be doing my time as an RN until I'm accepted - this goes for many other nursing students.

    I thought about going the M.D. route, and was encouraged. It is simply not a goal of mine to have the ability to diagnose a sinus infection. By way of the four-year BSN I am working towards and after some time in the ICU, I feel I will be prepared to learn the scope of anesthesia.

    There is a saying in India, and it goes something like this:
    We all live three lives - we are first students, then become masters, then become teachers.

    I know that I will be a student for most of my life
    I genuinely appreciate those who have mastered the art of anesthesia (both CRNAs and MDAs). Never underestimate the history of anesthesia practice.
  6. by   duckboy20
    I agree that there does need to be a study regarding MDA's giving anesthetics, CRNA's solely giving anesthetics not under the direction of an MDA, CRNA's with MDA's, and MDA's with AA's. Needs to see the comparison of patient outcomes. There has already been studies done that have shown no difference between the CRNA and MDA with each one by thereself or together. Just need to look at MDA's and AA's and see what the outcomes are. Don't think that there is gonna be many people looking to fund this research but it should be done, then we can get a more accurate picture.
  7. by   gregsto
    Hello all...I am new to the board.

    After posting some comments in another CRNA forum on this subject, I was encouraged to join this discussion. I would like to give my thoughts from the perspective of someone who has worked with AA's at Grady Memorial Hospital in Atlanta Ga., a level one trauma center.

    First let me say that there were around 45 AA's and 7 CRNA's. I had been giving anesthesia for 15 years when I went there, having worked as a solo in offices and also within the team concept in large academic institutions. I worked with many fine AA's and certainly counted them as friends. The atomosphere in Atlanta city proper is that AA's and CRNA's do not do regionals, most blocks, central lines, intubate without an MDA. Within these restrictions I can say that most of the AA's were as competent as most of the CRNA's. Meaning: some of each category suck.

    The MAJOR difference that is EXTREMELY obvious to any CRNA who has worked outside of Atlanta, is the amount of restriction placed on the CRNA relevant to the amount of restrictions imposed on an AA by the very nature of their education. Their programs TEACH that they will never work independently and that they must consult an MDA for most patient care decisions. It is engrained into the AA that the MDA is the boss and that they exist only to be his extension. Since this understanding is very clear from the start of their education, there is never a question of their place in relationship to the MDA and the residents.

    I read another CRNA's thoughts and he put it best: "An AA will do nothing unless he is directed to and a CRNA will do everything unless he is directed not to." (use she if you like) Truely this can describe the practice situation I found myself in. This is not to slight AA's, this is simply the way their training is designed.

    As for patient outcomes, I am unaware of any study that can be designed to measure outcomes comparing just the CRNA to the AA since an AA will never practice independantly by law. As for the team concept, I would venture to say there is unlikely to be an adequate study done there also since the variable of the intensity of supervision would likely be scewed. (AA's receiving more, especially if an all MD/CRNA institution is included.)

    As for salaries, the AA from Atlanta might be one of my freinds who worked 60-80hrs per week, otherwise he never made $160,000. The average starting salary for a new grad, CRNA or AA, was aprox $85K when I left Atlanta 1 year ago. I made aprox $115K (yes I had a great schedule and worked elsewhere).

    There are 2 things I disliked working in an AA institution: LOW PAY, EXTREME RESTRICTION of PRACTICE. To me, these are the issues that affect CRNA's. AA's can become very proficient in technical skills, they can also develope that "sense" that comes from working with ICU patients (though they WILL NOT arrive with it when they are done with their training). That being said....if I was a 22 year old kid in Atlanta with a BS in geology and wanted to find a career...I would go to EMORY in a heartbeat, get my AA in two years and start making money. I did find it VERY difficult to adapt to teaching AA students, since I never knew what they knew and what they didn't....at least with an SRNA you know they have seen a patient with 10 different meds infusing and won't say "How do you know what to do with all that?"
  8. by   pnurseuwm
    I looked at both Emory's and the school in Ohio that teach anesthesia assistants. The students must take all pre-med classes and the MCAT before applying to the schools. What is the point in that? If I'm taking pre-med classes and have to study for, pay for, and lose sleep over the MCAT, I'm definitely applying for med school! Why would a person want to do all of this pre-med stuff just to go out and be supervised by someone that was a pre-med just like you?
    I guess to each his own. PA's take pre-med classes but they don't have to take the MCAT, do they?
    For now, I believe the positive thing we can take from this discussion is that just like there is a nursing shortage, there is also a shortage of anesthetist providers. There should be an abundance of employment opportunities for both CRNAs and AAs.
  9. by   CRNAStudent
    It is a common assumption (at least from what I have heard) that students who attend AA school are those who applied to medical school, but did not get in. I attended Case Western Reserve University in Cleveland as an undergraduate, and I know many of the people who are attending CWRU in the AA program. The minimum requirements to get into that program are:

    undergraduate GPA of 2.75
    pre-med curriculum (courses in chemistry, biology, physics, anatomy, and calculus)
    MCAT score of 20

    The website for their program is linked here: http://www.anesthesiaprogram.com .
  10. by   geecue
    Quote from NCgirl
    Since I do love to call myself a princess, I'm going for "Princess Anesthetist". Kinda has a nice ring to it!

    give me a break...
  11. by   Brenna's Dad
    Thanks for the insight Gregsto.
  12. by   alansmith52
    this a vauge discription of classes. what does "pre-med" classes mean. I always thought of "pre-med" as code for I dont' know what the hell i wanna do but i like science.
    anatomy, check
    physiology check
    micro check
    chem check
    nurtition check
    phycology check
    human developent check
    pathophysiology again check
    what is the diffrence in what we do and what they do?????
    physics?? lol.. is that it. physics.. hmmmmmmmm
  13. by   gaspassah
    i took physics, does that make me better? x's2 got a's :hatparty:

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