What do you think (if anything) MDA's will do...

  1. to protect their turf? If there's one thing I learned in my short thirty three years on this planet it is that interest groups always TEND to seek for ways to maximize THEIR interests (nothing wrong with this of course but politicians should keep this in mind when considering their input on issues). It doesn't matter if you are talking about government workers, teachers, Dr's or CRNA's. One need only to witness some of the caustic things that were put out by the AMA during the debate concerning "opt out" provisions for Medicare of direct physician supervision of CRNA's.

    Without regard to whether or not this is actually THE CASE MDA's PERCEIVE CRNA's as something of a threat. My question is what will their LONG TERM strategy be for dealing with this threat. Possibilities that I can think of might include:

    I. Working to increase the standards of education for CRNA's. Perhaps, getting CRNA schools to introduce an additional semester or two of courses like gross anatomy, and or pathophysiology. This would be an interesting approach since it would probably garner the support of many CRNA's who would benefit (at least in the short term) by the even greater shortage it would facilitate. The decrease in graduating CRNA's might encourage the common use of CRNA's to "go out of common practice" in many locales.

    II. Another route they might follow would be to seek regulation AT THE STATE LEVEL which would make it more difficult for CRNA's to effectively practice. Perhaps mandating A CERTAIN TYPE of liability insurence (not availible from CRNA associations) that would make it less viable for CRNA's to practice.

    III. Yet another tactic would be to fight the EXPANSION of existing CRNA educational facilities with a result similar to #I above in the long term.

    My question is are CRNA organizations anticipating such action and even more importantly what are they doing to fight back?
    Last edit by Roland on Aug 27, '02
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  2. 39 Comments

  3. by   lgcv
    Thus far there methods have been:
    1. State level attempts to regulate office based surgery, usually with language that requires an anesthesilogist to supervise if a CRNA is administering the anesthesia. (this is a back door route, if they can get that in it will be easier to argue that CRNA's should never work unsupervised by an anesthesiologist.)

    2. Expansion of the AA programs, I think three or four new programs are set to open, and they are working state by state to institute a practice act for AA's as they are not in every state yet. AA's are under the supervision of an anesthesiologist only therefore they appear to be the better choice from a monetary perspective for anesthesiologists.

    3. State by state efforts to stop governors from opting out of the supervision requirement. Again, this has little to do with the practice of most CRNA's but, just the implication that supervision is required in one type of practice spills over to others.

    4. Increasing the number of anesthesiology graduates

    Those are just the ones off the top of my head, I am sure there are plenty more. One of the greatest advantages CRNA's have is a VERY strong organization and PAC. The AANA is very proactive, and unlike the ANA they do not roll over to political pressure, they stand up and fight it. I think something like 97% of CRNA's are members which is a strong statement to the value of the organiztion.
  4. by   Montague
    roland you need to get that nursing degree done with and start surfin dude. i did a traveling assignment in hawaii for about a year and learned to surf. that was about 8 years ago and i'm still surfing about 30 days a year and i live in friin Alaska! nursing has been the most incredible proffession for getting time off. i'm currently a flight nurse and work 10 days a month! hang in there brotha it will all pay off.
  5. by   Roland
    ties to other nursing organization. There are approximately 4x as many nurses as Dr's. If CRNA's can tap even a fraction of that potential they should be able to be quite effective ESPCIALLY at the state level.
  6. by   lgcv
    They do have a good relationship with the ANA.
  7. by   Roland
    arguments for maintaining CRNA's as a distinct catagory of nursing? If I were a "health care decision maker" what arguments would you put forth to try and convince me to use CRNA's instead of the alternatives?

    In addition, perhaps CRNA's need to make their own contrubution to "nursing theory" to better integrate with the nursing profession! Given the "esoteric" nature of some of the nursing theories out there this shouldn't be too difficult.
  8. by   lgcv
    Go the AANA website, they will provide you with the answers you are looking for with regard to AA's. I believe most of the arguments center around autonomy and critical skills. AA's start the programs with no medical experience.

    They are not cost effective, their salary is similar. They do on the other hand ALWAYS earn a higher salary for an MDA (vs a non-supervising MDA). But, so do supervised CRNA's, the difference is that a CRNA has a choice, they can work in a team environment or work on their own. This takes CONTROL away from the MDA's, that is the reason the ASA is pushing for AA's.

    What do you think is the benefit of adding another theory?

    Why do you think that CRNA's are not integrated with the nursing profession?

    One of the first things I looked at was the representative body for CRNA's (when deciding what else to do with my life). This was because I had watched the ANA bend to pressure numerous times both at state and national levels. I really wanted to work in an area where I knew that my professional organization would back me up. not stab me in the back.

    Again the AANA is a strong organization, and while we need an alliance with the ANA and vice versa the idea that they should integrate is abhorent (to me).

    What would you see as an advantage to integration?
    Last edit by lgcv on Aug 28, '02
  9. by   Roland
    organizational integration. That is to say it would be a good thing if the ANA and CRNA's cooperated with regard to rebutting onslaughts from the AMA (and their lackeys) when they occur be they PR, legislative, or otherwise. An example of this would have been to run "counter commercials" when commercials were run by the AMA insinuating that CRNA's provide care inferior to that provided by MDA's. Another approach might be to fund high profile studies which demonstrate the safety, efficacy, and cost effectiveness of CRNA's.

    With regard to the theory statement I was alluding to the posts others here have made about the adviseability of not telling instructors while working on my BSN, about my ambition to become a CRNA (even if asked directly what area of nursing I am most interested in). In essence they have said that some (many?) nursing instructors do not consider CRNA's "real" nurses. I assume that an instructor who felt this way would defend his/her viewpoint by pointing out how CRNA's deviate from accepted nursing as outlined by whatever nursing practice theory to which they subscribe. To the extent that this attitude (that CRNA's are not "true" nurses) exists among nursing professionals in general it would be benefical to demonstrate (from a nursing theory perspective) exactly how this is in fact NOT the case. Perhaps this has already been done or perhaps it CAN be done within the framework of existing nursing theory. In any case it wouldn't convince everyone, but it would at least provide a solid rhetorical position from which to debate even those who reside in ivory towers.
    Last edit by Roland on Aug 29, '02
  10. by   Roland
    it already DOES pay off since every time I get tired or discouraged all I need do is close my eyes to see that Oahu surf calling!
  11. by   Tenesma
    As an MDA I can tell you that I am not threatened in the least by the AANA/CRNAs... I love working with CRNAs, they form a wonderful adjunct in the care of patients, and I have even learned a thing or two from some older, wiser CRNAs.

    This topic is very similar to the relationship between OB/GYNs and midwives, between family practitioners and ARNP/PAs... in the beginning there is always a fear that advanced nurses/physician's assistants are trying to assume more responsibility than they are trained for, will be "stealing" patients (in other words money) from MDs... and now the OB/GYNs/family practitioners are relieved to have ARNPs/PAs in their community... I have a feeling the same will happen down the road for the MDA/CRNA relationship... There are a lot of people in our communities who need surgeries and will need competent people providing anesthetic care - CRNA's extend those services, especially in rural settings. The person who benefits in the long run is the patient, and that is all that really should matter....

    There will always be more than enough sick/complicated/tertiary referral-quality patients to keep us MDA's busy (and employed).... So please recognize that this struggle for territory is childish, but bound to happen regardless of factual information... Now this is how and MDA feels about the struggle between the AANA and the ASA - patients come first (period...) But sometimes I feel like people latch onto this contentious issue only in order to claim equivalency in breadth of knowledge/depth of care, which I believe to be fundamentally wrong.... the training and the mindset of a CRNA and an MDA are totally different (just the same goal with similar tools)...

    - Tenesmus

    PS: at my institution (a very large, renowned hospital in Boston) the relationship between CRNAs and MDAs couldn't be better - we truly form a wonderful team and have great friendships
  12. by   Qwiigley
    Tenesmus;
    thanks for your insight. Always welcome.
  13. by   nilepoc
    So Tenesma,

    Why is it that the relationships you mention work, and the MDA CRNA ones are more tenuous? Haven't CRNA's and MDA's worked alongside each other long enough to work it out? I understand the your work place is a good one with amicable working conditions. I am glad to see that, would you say that is generally the case? Kevin says his work place is wonderful, so who is stirring the pot and making the water muddy as far as relations go between these co-existing practitioners.

    Craig
  14. by   Tenesma
    very easy craig.... there are a lot of very insecure people out there who are on a constant ego-drive.

    Here is a good example: my brother just finished chiropractic school, and throughout his education he heard over and over again that MDs think poorly of chiropractors (mainly from his chiropractic instructors who were set on pointing out the ills of allopathic medicine). He found it so hard to believe that that wasn't the case... From what I understand the same goes on within the CRNA community, namely being told that CRNAs are better because they are nurses and therefore care more, that MDAs are just out for the money... these things get perpetuated and it always comes as a surprise when it truly isn't the case... Does the ASA stir up the pot... sure it does. But the ASA is so poorly funded because only a very small percentage of insecure anesthesiologists sends in money.... My only concerns are with AANA overreacting and trying to create a setting where CRNAs can practice with the same scope that MDAs can, which in my opinion is treading on dangerous ground... Do I care if CRNAs practice independently? no... Do I care if CRNAs form groups and provide office-based anesthesia? no... Do I care if CRNA education is made out to be analogous to an MDA education? Yes Do I care if CRNAs think they can handle more complex cases than are suited for them? Yes, but that is such a rare situation (mainly because as well-educated people we all know our limitations) that i don't even really worry about it.... People will always stir pots, and you will find that those who gossip most about it are either CRNA students/AANA lobbyists/anesthesia residents/ASA lobbyists - when in fact almost everybody in academia and private practice doesn't care and works happily together.

    my 2 cents

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