Why don't CRNA's like AA's - page 3

i've noticed a sense of hostility on this forum towards aa's by nurse anesthetist or student nurses of anesthesia. why so hasty? i always read on this forum about the shortage of anesthesia... Read More

  1. by   jwk
    Quote from Trauma Tom
    JWK,

    I am not familiar with georgia law as it pertains to the use of AA's, however if Georgia law only allows for physicians to supervise 2 AA's or CRNA's than there is no financial benefit to using AA's unless they are willing to work for less than a CRNA. If this is a fact then you can see why CRNA's are against the use of AA's as it diminishes our earning potential? Because in markets that use AA's, MDA's will not want to employ CRNA's because of higher pay. Please check and make sure you are correct about Georgia law. I thought is was the same as federal law for medicare reimbursement?
    Georgia law allows two PA's/AA's per physician, but they may supervise/medically direct up to four anesthetists (AA's or CRNA's) at the same time, as also allowed by federal law.
  2. by   jwk
    Quote from thebigbaddog
    i don't think that you have sufficiently grasped the economics of this issue. the only thing that determines the price (salary) is supply (of providers) and demand (for the services). assuming that demand remains constant and the supply is increased the price (salary) will decrease. the amount of the salary decrease is determined by the slope and shape of the demand and supply curves.

    the supply is determined by a number of factors, but the barrier to entry into the market is probably the most important factor. what is a barrier to entry? it is something that prevents other would be suppliers of the service from competing against you. licenses, education, and experience are three of the most common and useful barriers that are used in the usa to prevent competition. if erode the barriers you will see lots of new entries into the market who are willing to provide this service, hence direct competition!

    new crna schools maybe a bigger threat to the existing salaries of crnas, but if the difficulty of achieving a crna certification, license, etc. are maintained then many of the would new competitors will not become a crna.

    there is one overriding economic principle that will affect crnas salaries, especially if it suddenly becomes easier to become a service provider, "excess profits breeds ruinous competion"! that means that the salaries of crnas climb higher more competitors will want to enter the market until there is glut of competitor and jobs will become scarce and wages will fall.

    these are basic economic that effect all professions. anyone who has a profession or a job should always be concerned about competition between service providers. i think the ama has shown that it understands these ideas, and it is willing and able to come up with ways to avoid competition. remember for the service provider competition is always bad!
    thanks for the economics lesson. although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. if there is a concern about oversupply of providers, i don't think the aana would be pushing for new schools. it wouldn't be in their own best interests.

    at least we're getting to the real meat of the matter - competition. let's stop pretending its a patient safety issue - it never has been.
  3. by   Sheri257
    Quote from jwk
    Thanks for the economics lesson. Although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. If there is a concern about oversupply of providers, I don't think the AANA would be pushing for new schools. It wouldn't be in their own best interests.

    At least we're getting to the real meat of the matter - competition. Let's stop pretending its a patient safety issue - it never has been.
    I agree, especially with the last part of your post. I've always wondered if there's actually room for everyone, since projected demand for all medical services is expected to grow substantially with the aging baby boom generation, the largest segment of the population.

    Maybe CRNA salaries won't go up as much as they would like, but certainly it's possible that salaries won't go down either, even with AA competition.

    Last edit by Sheri257 on May 20, '04
  4. by   ep71
    Quote from smkoepke
    yes techs nursing assistants, medical assistants etc... This is why I asked the question. I won't get into the whose education is more "rigorous" battle because it is a no win argument. I do agree that some AA's might feel "insulted" by having a CRNA supervise them. but then many CRNA's probably feel the same way when MDA's "supervise" them and restrict their practice though it is not required. It seems to me that this is a logical and economical step. So I ask again are there any real reasons why a CRNA can't supervise an AA? I freely admit I do not know much about this subject. enlighten me guys!
    That was one of the most ridiculous, illogical statements that I have ever read. CNA's are a part of the nursing system. What techs that aren't apart of the nursing system do nurses supervise? It would be stupid for a person with a masters to supervise another person with a masters. You can't compare doctorate supervision with master on master supervision. It's just silly.
    Last edit by ep71 on May 20, '04
  5. by   TheBigBadDog
    Quote from jwk
    Thanks for the economics lesson. Although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. If there is a concern about oversupply of providers, I don't think the AANA would be pushing for new schools. It wouldn't be in their own best interests.

    At least we're getting to the real meat of the matter - competition. Let's stop pretending its a patient safety issue - it never has been.
    My logic was not flawed, I merely excluded a discussion about the demand because it detracts from the focus of the discussion, supply of providers. But it would not affect the outcome of the analysis, even if the demand increases, if supply increases the net result would be LOWER wages. Why? Because if the supply had been held constant and the demand increased then wages would have went yet higher. So, your original idea that somehow AAs don't affect the wages of CRNAs is absolutely wrong.

    Most everything in healthcare is about money and competition, concern about patient safety issues are always secondary. Patient safety issues are the smoke screen that healthcare providers use to keep thier wages high. That's why there are licenses to perform healthcare procedures, to limit competition! Licenses are a basic barrier to entry into a labor market. Patient safety is how you justify the license, just like a plumber, real estate agent, lawyer, etc. needs a license to protect your safety

    If you really are interested in solving the shortage of healthcare providers for anesthesia provide H1-B1 visas to MDAs, and they will flood the US market with more MDAs then you could shake a stick at. How many foriegn doctors do you think would be willing to work in the US for over $300,000 per year? But the AMA has enacted laws in all 50 states as barriers to prevent this from happening, so that they can control the supply of doctors and keep thier wages artificially high!

    The AANA just need to learn from the AMA and employ the same types of tactics, or they will suffer the consequences, lower wages! CRNAs and the AANA need to determine how to limit the practice of AAs, by requiring additional training or experiences of AAs to make them comparable to AAs or preventing them from practicing all together. REMEMBER COMPETITION IS ALWAYS BAD FOR THE SELLER (service provider)! Otherwise, the CRNAs are building a sand castle on the beach, and someday a wave of AAs will come into the market place and knock down thier castle of gold!
  6. by   smk1
    Quote from ep71
    That was one of the most ridiculous, illogical statements that I have ever read. CNA's are a part of the nursing system. What techs that aren't apart of the nursing system do nurses supervise? It would be stupid for a person with a masters to supervise another person with a masters. You can't compare doctorate supervision with master on master supervision. It's just silly.

    EP71 you need to get a grip! You asked if nurses supervise anyone else, so i gave you examples where they do. by the way medical assistants are not nurses but are supervised by them in my area and yes some MA programs are associates same as some RN programs. So the analogy does fit. In any case I was not rude to you so why the personal attacks? If you can't say something nice..... In any case thanks to all those who are managing to answer questions and post new ideas in a polite manner. It really shows your professionalism.
  7. by   TheBigBadDog
    Quote from lizz
    i agree, especially with the last part of your post. i've always wondered if there's actually room for everyone, since projected demand for all medical services is expected to grow substantially with the aging baby boom generation, the largest segment of the population.

    maybe crna salaries won't go up as much as they would like, but certainly it's possible that salaries won't go down either, even with aa competition.

    the biggest problem with the current battle between the mdas, crnas, and the aas is that no one group controls the supply of service providers. generally, groups regulate the supply of providers for that service, for instance, most professional groups have large input into the requirements for training, new schools, and licenses. they will try to avoid widespread shortages, because other people outside their field will undertake means to alleviate the shortage. currently, mdas are using the excuse that there is a shortage of providers as a means to manipulate the market by changing the rules on whom can provide service and under what conditions.



    the mdas and crnas may find themselves competing to add more providers to solve the current shortage but without planning. they may over supply the market with providers since each group will be trying to add members to gain political power and control. if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".
  8. by   user69
    Quote from thebigbaddog
    the mdas and crnas may find themselves competing to add more providers to solve the current shortage but without planning. they may over supply the market with providers since each group will be trying to add members to gain political power and control. if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".
    i agree with your logic and the principals that you have put forth. i am more concerned with the ramping up of new crna schools than i am about the existing two aa schools or rumored third. as for mda flooding the market we have little control over that. but the huge expense and time to make it through the mda programs should be a hedge against them flooding the market.
  9. by   Sheri257
    Quote from thebigbaddog
    if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".
    agreed. but, the question is: will demand the remain the same?

    of course, no one can predict the marketplace. but with the aging baby boom generation, there's a good chance that demand will probably increase.

    Last edit by Sheri257 on May 20, '04
  10. by   user69
    Quote from lizz
    Agreed. But, the question is: Will demand the remain the same?

    Of course, no one can predict the marketplace. But with the aging baby boom generation, there's a good chance that demand will probably increase.

    At least increase for the next 25 years (for me)
  11. by   TheBigBadDog
    I would think some think tank would have done an economic study on it. I read on study that was done around 1995 that predicted that there would be a glut of RNs by 2002. Many of the predictions that author made never came true. The result was a bad forcast.
  12. by   Sheri257
    Quote from TheBigBadDog
    I would think some think tank would have done an economic study on it. I read on study that was done around 1995 that predicted that there would be a glut of RNs by 2002. Many of the predictions that author made never came true. The result was a bad forcast.
    In 2002, the U.S. Health Department did do projections on the general nursing shortage for the next 20 years. There are 800,000 vacancies projected nationwide, and while they didn't break it down by position, it's reasonable to assume that a fair number of CRNA vacancies would be included in that number.

    Last edit by Sheri257 on May 21, '04
  13. by   NOPAIN
    Please don't give up, I got in: :hatparty: :hatparty:

    I have been a member of this forum for a year, and through out this year I have worked very hard to gain my acceptance into CRNA School. This week I got my letter of acceptance at University of Maryland, September 2004.
    I would like to encourage those of you with this goal in mind to keep trying. I got rejected two times. Although I got sad after the rejections, this only gave me courage to try harder. I am a Hispanic nurse, and as a minority, I am proud to join such an elite group of professionals.
    I want to thank all of you on this board for your inspiration, for your opinions, for your continued advice, and for answering my questions.

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