TEXAS CRNA's Call to action. Stop the potential AA bill!

Specialties CRNA

Published

WHY SB 1314 AND HB 3313 ARE BAD PUBLIC POLICY

THIS IS A SCOPE OF PRACTICE FIGHT!

FACTS:

With insufficient funds for critical needs in the state, why create a licensure advisory board and licensure process for fewer than 20 people in Texas?

The Texas Medical Board (TMB) already has a backlog of over 2500 applications from badly needed physicians who cannot get licensed in Texas because TMB does not have adequate staff. The problem is so severe that TMB is receiving a supplemental appropriation to begin to address the backlog.

Anesthesiologists Assistants (AAs) do not improve access to anesthesia services because AAs can only work under the supervision of a board certified Anesthesiologist.

Anesthesiologists practice in only 70 Texas counties and one-fourth are NOT board certified.

Once licensure occurs, the next move will be to start an AA school that will drain money away from the existing anesthesiology and nurse anesthetists educational programs.

This legislation increases liability of the supervising Anesthesiologist in all cases and the health care facility if it employs an AA.

This is a pocket book issue. Anesthesiologists can make twice as much supervising 4 providers than they can actually providing care to a patient.

Passage of SB 1314 and HB 3313 WILL effect YOU!

Action Required:

Call, write, e-mail or visit your State Senator

Call, write, e-mail or visit your State Representative

Ask your friends, family and co-workers to call, write, e-mail or visit their legislators, and

Visit your legislator at the Capitol in Austin or in their district office to voice your displeasure on SB 1314 and HB 3313.

Texas must focus on accessible, affordable, high quality health care by Anesthesiologists and Certified Registered Nurse Anesthetists.

Do any CRNAs have anything other than self-protectionism to back up their claims? I guess not because I havent heard any so far.

The only thing I've heard so far is "dem aas gonna take our jobs!" spoken like a true anti-immigration right winger.

you dont have a leg to stand on. This is a self-protectionist partisan tactic that is bad for society and bad for patients. This is just as bad as the attacks MDAs have launched against CRNAs in the past.

You guys are absolutely no better than the MDAs you loathe so much.

CRNA's are getting too expensive. AA's are the next logical step to reduce anesthesia costs. Unless, the CRNA's are willing to take paycuts.

If more and more MD's, CRNA's, and AA's graduate, we will reach a saturation point. Then everybody gets screwed. It's just a question of when. 10 years or less? Before that happens though, maybe Medicare will have cut the reimbursements so much that providing anesthesia won't be so attractive anymore.

Do any CRNAs have anything other than self-protectionism to back up their claims? I guess not because I havent heard any so far.

The only thing I've heard so far is "dem aas gonna take our jobs!" spoken like a true anti-immigration right winger.

you dont have a leg to stand on. This is a self-protectionist partisan tactic that is bad for society and bad for patients. This is just as bad as the attacks MDAs have launched against CRNAs in the past.

You guys are absolutely no better than the MDAs you loathe so much.

BINGO!!! :yelclap:

Do any CRNAs have anything other than self-protectionism to back up their claims? I guess not because I havent heard any so far.

The only thing I've heard so far is "dem aas gonna take our jobs!" spoken like a true anti-immigration right winger.

you dont have a leg to stand on. This is a self-protectionist partisan tactic that is bad for society and bad for patients. This is just as bad as the attacks MDAs have launched against CRNAs in the past.

You guys are absolutely no better than the MDAs you loathe so much.

The shortages loom where MD's choose not to work. How can AA's fill these shortages when they cant work in these areas either. AA's arent any cheaper than CRNA's. In states that allow AA practice they make the same as CRNAs.

The shortages loom where MD's choose not to work. How can AA's fill these shortages when they cant work in these areas either. AA's arent any cheaper than CRNA's. In states that allow AA practice they make the same as CRNAs.

Providers should be increased at all levels to handle the shortage, CRNAs, AAs, and MDAs are all needed.

I dont want to ever hear you complain about MDAs trying to attack CRNAs again. You have lost all sympathy from me. You are just as dirty as they are.

Specializes in CRNA, ICU,ER,Cathlab, PACU.
1. My position is based on cold hard facts that are irrefutable. I have trained 3 RNs to give anesthesia over the past 10 years, and they have successfully administered propofol general anesthesia in an office setting to more than 10,000 patients without any hospital admissions of these patients, respiratory or cardiac arrests, or bad outcomes. This proves beyond a shadow of a doubt that RNs can do exactly what CRNAs would do in an office setting and with the same outcome for less than 1/3 the income of a CRNA. The patient chart includes charting similar to anesthesiologists and CRNAs use in practice.

2. CRNAs may be useful in certain settings but they are certainly not required and cannot demonstrate enhanced safety over a RN trained to administer MAC or general to a ASA 1 or 2 outpatient for short procedures.

Is your position based on the 3 RNs you trained? I am sure you have cold hard facts with three RNs you trained, I just dont agree with you that your position in irrefutable. It probably works great with a very narrow set of standards implemented by anesthesia departments. However, I am worried if more people agree with your position, it wont be you and I training the RNs/non-anesthetists, it will be the office based clinicians who may be very unprepared, untrained, and have immense secondary gain to supervise non-anesthetists in some back country office setting.

Furthermore, I am very surprised that you undermine the importance of quality and safety in such a vast subset of cases "general to ASA 1 or 2 outpatient for short procedures". I am an RN and a CRNA and I will tell you there was a very profound change in my abilities after anesthesia school. To say that a trained RN is no different than a CRNA giving general anesthesia shows either how extreme, or how misinformed you are about the depth of CRNA training.

Back to the discussion at hand, hopefully we can fill the void of providers one way or another, and not have to worry about extreme and dangerous measures to do so. If the voters want to allow AAs to fill the void, fine...its their choice, either way, it is up to all of us to educate the public to make an informed decision.

http://www.asahq.org/news/propofoluse.htm

http://www.asahq.org/publicationsAndServices/standards/37.pdf

I don't think salary parity is reality. The average AA makes 90-95K after graduation while the average CRNA in these venues makes 50% more.

The shortages loom where MD's choose not to work. How can AA's fill these shortages when they cant work in these areas either. AA's arent any cheaper than CRNA's. In states that allow AA practice they make the same as CRNAs.
Due to quirks in the CMS rules, MD's can't get the same medicare reimbursements that CRNA's can by taking advantage of Part A passthroughs.

AA's haven't claimed to be the cure-all and end-all of anesthesia providers. We can indeed be part of the solution to the overall shortage in providers. As I've said many times before, if you want to work independently in a small rural practice, go for it. Put your money where your mouth is.

Tell me - where do you work? I don't think I've ever heard what type of practice you work in. Independent? Anesthesiologists? Rural? Urban? Do tell.

Do any CRNAs have anything other than self-protectionism to back up their claims? I guess not because I havent heard any so far.

The only thing I've heard so far is "dem aas gonna take our jobs!" spoken like a true anti-immigration right winger.

you dont have a leg to stand on. This is a self-protectionist partisan tactic that is bad for society and bad for patients. This is just as bad as the attacks MDAs have launched against CRNAs in the past.

You guys are absolutely no better than the MDAs you loathe so much.

What makes you think that the CRNA profession is above the task of fighting for its interests? Are nurses special in some regard that the docs and AAs just aren't? And do you honestly think that CRNAs should just sit back and allow the AA's to expand to every part in the country and merrily co-exist with the other anesthesia providers?

Be very thankful, platon, that not all CRNAs have their heads in the clouds to believe such non-sense. They live in the real world where money and politics are real, and not some strange indecency to be shied away from. They fight for your profession and your interests while you ridicule them with your holier than thou attitude. How sad.

The shortages loom where MD's choose not to work. How can AA's fill these shortages when they cant work in these areas either. AA's arent any cheaper than CRNA's. In states that allow AA practice they make the same as CRNAs.

Very simple. We take the jobs in the cities working with the anesthesiologists, thereby freeing you guys up to take the jobs in the underserved rural areas. You don't want to work under MDA supervision anyway ... no problem - we'll do it.

1. My position is based on cold hard facts that are irrefutable. I have trained 3 RNs to give anesthesia over the past 10 years, and they have successfully administered propofol general anesthesia in an office setting to more than 10,000 patients without any hospital admissions of these patients, respiratory or cardiac arrests, or bad outcomes. This proves beyond a shadow of a doubt that RNs can do exactly what CRNAs would do in an office setting and with the same outcome for less than 1/3 the income of a CRNA. The patient chart includes charting similar to anesthesiologists and CRNAs use in practice.

2. CRNAs may be useful in certain settings but they are certainly not required and cannot demonstrate enhanced safety over a RN trained to administer MAC or general to a ASA 1 or 2 outpatient for short procedures.

I have been there, and done that, so there is simply no sophistry here. CRNAs in many situations could certainly be replaced by AAs and in most cases of outpatient office anesthesia by RNs. Then the anesthesia shortage would disappear, and CRNAs could use their skills to treat the ASA 3-5 patients that would benefit from their efforts.

If I knew who you were, I wouldn't come to you for any procedures. There is no better person to manage another person's LIFE than one that has been adequately trained and tested on the physiology of the human body. Not to mention intensive study of the pharmacodynamics and pharmacokinetics of the drugs and agents used. I can only hope you have disclosed to your patients that you have enlisted the aid of an untrained anesthesia provider to assume the reigns while you do what ever it is that you do. Its amazing that you have apparently placed a value system on which patients deserve high level anesthesia and those that could just "get by". Tell me.. is the money saved by a patient what they gamble on with their life by having untrained anesthesia providers?

So how long do you guys think these salad days will last? Being paid $140k for just a master's degree out of CRNA school can't last indefinitely. How many people were foolish to think that the dot-com bubble would last indefinitely too? Medicare will catch on and reduce reimbursements drastically in the future. Of all the specialties, I heard that anesthesiology is getting hit the hardest by the Medicare cuts in the next few years. I think that this is because anesthesiology has been regarded for a long time as a physician occupation. If the CRNA's are showing that it can be done, then they are proving that it doesn't require a physician to do it. Therefore, the reimbursements will drop to reflect a job that can be done by someone with only a master's degree. I think that the CRNA's own success will hurt them down the road.

What a bitter person. How big is the spoon that you are stirring this pot with?

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