Utah surgeons against AA's - page 4

by CPhT2RNstudent

7,454 Views | 36 Comments

I found this to be very interesting. The docs on this site promote anesthesiologists and CRNA's, but is anti-AA. Many docs in Utah have been trying to get aa's here for several years. These surgeons are against it based on the... Read More


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    I am surprised to hear you are an RN in a Level 1 trauma center, several of the things you say don't reflect that experience.
    CPhT2RNstudent likes this.
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    1. There are no studies that show AA's are just as safe as CRNA or MDAs. There are only studies that show AA's that are supervised by MDAs are as safe CRNAs in the same type of practice. To accurately show if there is a difference in AA and CRNA safety you would have to compare independent AAs (which is impossible since AAs cannot work without MDA supervision) versus independent CRNAs.

    2. It doesn't matter if nurse anesthesia training is 2yrs or 10yrs the cost will still be more to educate an anesthesiologist. What most people don't realize is that medical school and residency is highly subsidized by state and federal government. Nurse anesthesia is paid by the student with very little monies coming from state or federal monies. Also, during clinicals SRNAs are not paid by in many places provide free labor to hospitals. MDAs like all physicians are paid during their residencies.
    CPhT2RNstudent likes this.
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    Wow. That was way too much to read. Whew. I would be interested in hearing how your interview went if you shared your opinion during your interview.
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    as for my interview i only answered the questions i was asked, none of which dealt with my opinion. so i thought it went well (laughing). i'm still undecided about the whole experience, nerves got the better of me during my written test and then i settled down a bit during the interview. so we’ll just have to wait and see. as always i learn something new about myself with experiences like these, and i feel more prepared for a next time if there should be one. so i’m glad to have been given the opportunity to interview, but anxiously awaiting their response.

    as for my point earlier, i just strongly feel our current physician driven healthcare system is not what’s best for america/americans. everyone should really be looking at current practices and trends in healthcare and we should be asking ourselves how safe, high quality care can be delivered to maximum number of patients efficiently and in a cost effective manner. not, how can we proliferate tiered systems of medical bureaucracy. sometime less is more… except in the case of my prior post…

    sorry for any vision loss people might have developed after reading it.
  5. 1
    Quote from jacobsz
    as for my point earlier, i just strongly feel our current physician driven healthcare system is not what’s best for america/americans. everyone should really be looking at current practices and trends in healthcare and we should be asking ourselves how safe, high quality care can be delivered to maximum number of patients efficiently and in a cost effective manner. not, how can we proliferate tiered systems of medical bureaucracy. sometime less is more… except in the case of my prior post…
    " i would first and foremost wish to make my position clear in stating that i believe the best/most qualified/competent/skilled…etc… anesthesia provider would be that of an anesthesiologist."

    i can't believe the same person posted these two statements in the same week. and someone who is applying to a crna program. i would never give an anesthetic if i felt by doing so, by patient would receive care from a less "qualified/competent/skilled…etc… anesthesia provider" because i'm a crna. why are you applying to a nurse anesthesia program if you feel you would be second best to an anesthesiologist?
    wtbcrna likes this.
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    Quote from wtbcrna
    1. There are no studies that show AA's are just as safe as CRNA or MDAs. There are only studies that show AA's that are supervised by MDAs are as safe CRNAs in the same type of practice. To accurately show if there is a difference in AA and CRNA safety you would have to compare independent AAs (which is impossible since AAs cannot work without MDA supervision) versus independent CRNAs.
    As you are well aware, tens of thousands of CRNA's, including many without a degree of any type, work in anesthesia care team settings under the supervision or direction of an anesthesiologist, just like AA's, with the exact same job description and compensation package in departments that employ both types of providers. In those departments that employ both AA's and CRNA's, the malpractice insurance rates are identical, so the malpractice carriers are very satisfied with the quality and safety of AA's. If they weren't, the rates would be higher for AA's than CRNA's. They are not. Also, remember that the truly independent CRNA is a fairly small, but incredibly vocal, minority.

    Quote from wtbcrna
    2. It doesn't matter if nurse anesthesia training is 2yrs or 10yrs the cost will still be more to educate an anesthesiologist. What most people don't realize is that medical school and residency is highly subsidized by state and federal government. Nurse anesthesia is paid by the student with very little monies coming from state or federal monies. Also, during clinicals SRNAs are not paid by in many places provide free labor to hospitals. MDAs like all physicians are paid during their residencies.
    You are correct that physician education will cost more than CRNA education because it takes longer. However, you assume that tuition pays all the cost of a CRNA education, which would of course be incorrect. Many CRNA programs are in public colleges and universities, and even in private institutions, tuition rarely if ever covers teh actual cost of the education. That's why colleges and universities have endowments. You also imply that nursing education receives no state or federal subsidies, which would also be totally incorrect.

    Medical school students pay tuition for four years, and at the end of that four years, they have a medical degree. CRNA students pay for 2-3 years depending on the program, and have a master's degree at the end of that time. That's not earth-shattering news - you pay tuition to a school to get a degree or diploma. It's only during residency that physicians are paid, but at a rate that doesn't end up being much more than minimum wage consdering the hours worked. Again, you're trying to imply something that simply isn't true, that the cost of a medical education is minimal to the individual and borne mainly by the taxpayers - nothing could be further from the truth and you know it.
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    Quote from jwk
    As you are well aware, tens of thousands of CRNA's, including many without a degree of any type, work in anesthesia care team settings under the supervision or direction of an anesthesiologist, just like AA's, with the exact same job description and compensation package in departments that employ both types of providers. In those departments that employ both AA's and CRNA's, the malpractice insurance rates are identical, so the malpractice carriers are very satisfied with the quality and safety of AA's. If they weren't, the rates would be higher for AA's than CRNA's. They are not. Also, remember that the truly independent CRNA is a fairly small, but incredibly vocal, minority.



    You are correct that physician education will cost more than CRNA education because it takes longer. However, you assume that tuition pays all the cost of a CRNA education, which would of course be incorrect. Many CRNA programs are in public colleges and universities, and even in private institutions, tuition rarely if ever covers teh actual cost of the education. That's why colleges and universities have endowments. You also imply that nursing education receives no state or federal subsidies, which would also be totally incorrect.

    Medical school students pay tuition for four years, and at the end of that four years, they have a medical degree. CRNA students pay for 2-3 years depending on the program, and have a master's degree at the end of that time. That's not earth-shattering news - you pay tuition to a school to get a degree or diploma. It's only during residency that physicians are paid, but at a rate that doesn't end up being much more than minimum wage consdering the hours worked. Again, you're trying to imply something that simply isn't true, that the cost of a medical education is minimal to the individual and borne mainly by the taxpayers - nothing could be further from the truth and you know it.
    1. I stated there are no actual studies comparing CRNAs to AAs which there isn't. You cannot compare Independent CRNAs to Independent AAs, because Independent AAs don't exist. There is no debate there. It is a simple fact. I would be surprised if malpractice rates were any different since anesthesia overall is very safe practice. What is interesting though is that no matter what the practice setting, independent or not, CRNA malpractice insurance is less than anesthesiologists. You would think that if anesthesiologists were so much better providers as some would suggest that their insurance rates would be less.

    2. The cost to train a CRNA is approximately 52,000. Which doesn't count the cost of a BSN, and is paid for almost exclusively by the CRNA. The cost to train an anesthesiologist is approximately 1,070,000. Which again doesn't count the cost of an undergraduate degree. AANA - Research
    (see bottom of page for link to the article on "Cost Effective Analysis of Anesthesia Providers") The cost of tution/fees etc. for four years on average for a medical student is 66K-133K. Those are reported figures from the AMA. Cost of Medical School - Get Prices and Information - CostHelper.com My math might not be the greatest in the world, but that leaves 900,000 dollars give or take that someone is paying for and it isn't the medical student/physician.
    ["I]The Congressional Budget Office's analysis of data from the Health Care Financing Administration indicates that for hospitals in the middle of the distribution in terms of subsidies per resident, an additional resident means that the hospital receives between $58,000 and $102,000 (in 1993 dollars) more in annual payments. About one-fourth of the teaching hospitals receive more than $102,000 annually for adding another resident, whereas about one-fourth of the hospitals receive less than $58,000 for one more."
    [/I] http://www.cbo.gov/doc.cfm?index=17&type=0&sequence=1
    There are simply no such public money backing CRNA education. The cost is almost exclusively born by the nurse anesthetist students themselves.

    3. Resident Salary and Benefits
    2010-2011 Academic Year
    PGY 1 - $45,175
    PGY 2 - $46,750
    PGY 3 - $48,350
    PGY 4 - $49,350
    Resident Salary Benefits - Graduate Medical and Dental Education

    4. Residents are mandated to work an average maximum of 80hrs week. Which if you do the math for PGY-1 is a little less than $11 dollars an hour. While it still isn't the greatest in the world, but 45-50K a year is hardly living in poverty. It also isn't half bad considering the amount of training that goes on especially in the first two years for intern/residents. It also is certainly not minimum wage as you would have some believe.


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