PA's doing Anesthesia??

Tenesma · Dec 28, 2002

i disagree about the money issue... if this was about money, then there would be no incentive to add providers (or provider assistants) to the market as this would lead to decreased reimbursement.

correct me if i am wrong but an AA is basically a bachelor's degree followed by specialized anesthesia education over 2 years... which sounds very similar to Physician Assistants (PA). and from what i hear on the inside is that preference is given to people with nursing degrees/respiratory therapy etc... in fact in canada where they have a similar model (as they don't have the luxury of CRNAs) only nursing degrees and respiratory therapy can apply for their AA programs.

(by the way there is a huge difference between an MDA supervising CRNAs/AAs and a CRNA supervising an RN with 6-9 months of training... )

bottom line, as less and less people go to nursing school there will continue to be a larger and larger shortage of CRNAs... why not help fill the void... plus remember these AAs don't practice independently at all, the requirement for the MDA is that he/she either be in the room, the room next door or in the hallway adjacent to the room... which is a lot more stringent then the supervision many CRNAs receive.

i still don't understand what the AANA is concerned about... i could see your point if the market was shrinking and CRNAs/MDAs/AAs were all fighting for the same job.. which they aren't... for heaven's sake, salaries >120k for a CRNA is almost the norm nowadays.

Tenesma · Dec 28, 2002

i just read that article from the AMA... i don't think this has anything to do with being threatened in a financial way... i think the big issue in that article revolves around non-physicians assuming the responsibilities of physicians without going through the educational process.... ie: psychologists who want to prescribe psychotropic meds, pharmacists who want to have prescription rights, nurse practitioners who want to read x-rays, dentists doing facial surgery.... i might be naive, but i think these arguments are more for patient safety...

fence · Dec 28, 2002

Tenesma--

I have to agree with you. I do not think the issue is money. I think it is an issue in scope of practice. I think the key issues are education and patient safety. Practicing in certan areas (anesthesia) with minimal education would be very dangerous to the patient.

smiling_ru · Dec 28, 2002

I do not agree, the push for AA's is most definately about money. That and control, the advantage for MDA's is that the AA's are REQUIRED to be supervised by an ANESTHESIOLOGIST. This translates into a workhorse who can not practice without the anesthesiologist, which means an increase in work production and income for the anesthesiologist, without a perceived threat.

I wonder what your opinion would be if we brought in an anesthesia provider who was only allowed to practice under the supervision of the surgeon, with the surgeon billing for anesthesia services along with the surgery. This would fast replace MDA's and CRNA's due to the financial incentive to the surgeon. Money and control that is what it is about.

Tenesma · Dec 29, 2002

smiling ru....

"This translates into a workhorse who can not practice without the anesthesiologist, which means an increase in work production and income for the anesthesiologist, without a perceived threat. "

hmmmm... MDAs already have that "workhorse" in the form of the CRNA... thus the creation of AAs would now allow the hiring of AAs so that CRNAs could go and practice a bit more on their own and increase the independence they have been looking for...

and by the way, your last question already exists... what do you think happens when a CRNA works without MDA supervision? that's right the surgeon plays the role of supervising physician and therefore can bill if he chooses to... a lot of private practice surgeons (plastics comes to mind) do that already, they hire CRNAs and then include anesthesia as part of their services.

however this hasn't replaced MDAs.

smiling_ru · Dec 29, 2002

Yes you are right, that work horse does exist in CRNA's, the difference as I stated is the AA does not pose a threat. (why ASA feels threatened is beyond me but they are).

My point was soley to illustrate the issue, you know darn well why there are issues between CRNA's and AA's and MDA's and CRNA's. And you know the economic and power issues behind them. It is ridculous to call it anything other than what it is. I have no doubt that you are NOT so naive as to think it has to do with the number of anesthesia providers.

I did not realize that the supervising surgeon could bill for anesthesia services. If that is so it is certainly not a common thing, at any rate I was trying to give a hypothetical example of the problem from another provider perspective. Not threaten you.

Tenesma · Dec 29, 2002

smiling-ru... i understand your point of view... i am sure at the bottom of everything we do there is always the intent for power and more money, i just don't think it is that obvious in this situation...

don't worry i am not threatened... the only thing that scares me is the thought of a new miracle drug that renders complete anesthesia/amnesia/areflexia without affecting respiratory drive/protecting the airway and that has no hemodynamic compromise... then i would truly feel threatened :)

u-r-sleeepy · Dec 29, 2002

Checking back in here... ;-)

I would like to politely disagree that it is NOT about the $$$ and control. You might have been told that and are currently pursuaded to believe it, but look at the bigger picture out there.

Can you tell me why the ASA isn't screaming/running/scrambling to provide MDAs for the rural communities that are so "under-served"? Would you be so kind as to tell the class why there is NOT ONE MDA serving in the US Armed forces in active duty??? There are ONLY CRNAs providing anesthesia to our combat troops. Why is that?

Can you tell us why all the "pretty places" in California, New Mexico, Florida, etc. are dominated or outright monopolized (and many with "NO CRNAs ALLOWED!) by MDAs? Take a look at the adds in Gasworks - many of them looking for MDAs state outright "ALL MDAs - NO CRNAs!" The resort towns from skiing in Colorado to golfing and fishing along the coast are all well taken care of by MDAs, but... sadly there is an incredible shortage of MDAs to provide anesthesia care to rural America.

For the uninitiated, take a gander at the "Anesthesiologists looking for positions" at Gasworks. It is very telling. Last time I looked, it was very interesting to see the number of new or soon to be grads (from a residency program) looking for a position where they could "Supervise" CRNAs and really don't care to even do their own cases. Also, please take note of the vast number wanting to START at $400k/yr! I haven't been back to look in months - heaven forbid all the applicants have found great contracts and now the only folks left are willing to "work for food"!)

This is absolutely about $$$$$ and control. In my humble opinion, the whole "supervision" issue needs to be revisited and reworked to allow CRNAs much broader access to practice and a much more level playing field taking not just the ASA's financial goals in mind, but the health and medical welfare of the citizens of this country in mind.

I am still a firm believer in the laws of "supply and demand". When the country finally wakes up to the record of safe anesthesia provided by CRNAs and the costs associated with said service vs the costs associated with MDAs providing that SAME service, I think the pendulum will begin to swing the right way. Clearly, the ASA (and AMA!) is much better funded and politically "connected" at the moment, but sooner or later, the "truth" tends to leak out to the masses. When that avalanche starts... look out below! ;-)

Tenesma · Dec 29, 2002

1) the ASA has no motivation to provide MDA care in rural areas as there aren't major tertiary medical centers in rural areas requiring a higher level of complexity in care

2) the army has 60 active duty anesthesiologists as of 2001 (220 active duty CRNAs) - and many more reserve MDAs

3) "pretty" places have major medical centers providing tertiary level care with complicated surgeries on complicated patients (even patients from rural areas come to the pretty places for those surgeries)

4) i looked at gaswork: couldn't find anybody fitting the description of 400k for supervising CRNAs and not caring to do their own cases

5) CRNAs and MDAs don't provide the SAME service... CRNAs provide safe anesthesia and are practicing nursing, MDAs practice medicine

otherwise i agree with everything else you said :)